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Dibble KE, Rosenberg SM, Zheng Y, Sella T, Poorvu P, Snow C, Darai S, Rene C, Mack JW, Partridge AH. Psychosocial and supportive care concerns of young women living with advanced breast cancer: baseline findings from a prospective virtual support intervention study. Support Care Cancer 2024; 32:336. [PMID: 38727753 DOI: 10.1007/s00520-024-08557-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Adolescent and young adults (AYAs) with metastatic breast cancer (MBC) experience high physical and psychosocial burdens compounded by a disrupted life trajectory. We sought to determine the psychosocial and supportive care concerns of this population to better understand and address unmet needs. METHODS AYAs diagnosed with MBC (18-39 years) participating in a prospective interventional study (Young, Empowered, and Strong) at Dana-Farber Cancer Institute completed an electronic survey following enrollment. Measures evaluated sociodemographics, health behaviors, quality of life, and symptoms, among others. We used two-sided Fisher's exact tests to determine associations between concerns (e.g., cancer progression, side effects, lifestyle, finances, fertility) and demographic variables. RESULTS Among 77 participants enrolled from 9/2020-12/2022, average age at MBC diagnosis and survey was 35.9 (range: 22-39) and 38.3 years (range: 27-46), respectively. Most were non-Hispanic white (83.8%) and 40.3% reported their diagnosis caused some financial problems. Many were concerned about fertility (27.0%), long-term treatment side effects (67.6%), exercise (61.6%), and diet (54.1%). Select concerns varied significantly by age, race/ethnicity, and education. Younger women at survey reported greater concern about familial cancer risk (p = 0.028). Women from minority racial/ethnic groups more frequently reported issues talking about their cancer to family/friends (p = 0.040) while those with more education were more frequently concerned with long-term effects of cancer on their health (p = 0.021). CONCLUSION Young women living with MBC frequently report psychosocial, health, and cancer management concerns. Tailoring supportive care and communications to address prevalent concerns including disease progression and treatment side effects may optimize wellbeing.
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Affiliation(s)
- Kate E Dibble
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoshana M Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yue Zheng
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tal Sella
- Deparment of Medical Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Philip Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Craig Snow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Sonja Darai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Christamar Rene
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Ganz PA, Bandos H, Španić T, Friedman S, Müller V, Kuemmel S, Delaloge S, Brain E, Toi M, Yamauchi H, de Dueñas EM, Armstrong A, Im SA, Song CG, Zheng H, Sarosiek T, Sharma P, Geng C, Fu P, Rhiem K, Frauchiger-Heuer H, Wimberger P, t'Kint de Roodenbeke D, Liao N, Goodwin A, Chakiba-Brugère C, Friedlander M, Lee KS, Giacchetti S, Takano T, Henao-Carrasco F, Virani S, Valdes-Albini F, Domchek SM, Bane C, McCarron EC, Mita M, Rossi G, Rastogi P, Fielding A, Gelber RD, Scheepers ED, Cameron D, Garber J, Geyer CE, Tutt AN. Patient-Reported Outcomes in OlympiA: A Phase III, Randomized, Placebo-Controlled Trial of Adjuvant Olaparib in g BRCA1/2 Mutations and High-Risk Human Epidermal Growth Factor Receptor 2-Negative Early Breast Cancer. J Clin Oncol 2024; 42:1288-1300. [PMID: 38301187 PMCID: PMC11095886 DOI: 10.1200/jco.23.01214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE The OlympiA randomized phase III trial compared 1 year of olaparib (OL) or placebo (PL) as adjuvant therapy in patients with germline BRCA1/2, high-risk human epidermal growth factor receptor 2-negative early breast cancer after completing (neo)adjuvant chemotherapy ([N]ACT), surgery, and radiotherapy. The patient-reported outcome primary hypothesis was that OL-treated patients may experience greater fatigue during treatment. METHODS Data were collected before random assignment, and at 6, 12, 18, and 24 months. The primary end point was fatigue, measured with the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary end points, assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30 item, included nausea and vomiting (NV), diarrhea, and multiple functional domains. Scores were compared between treatment groups using mixed model for repeated measures. Two-sided P values <.05 were statistically significant for the primary end point. All secondary end points were descriptive. RESULTS One thousand five hundred and thirty-eight patients (NACT: 746, ACT: 792) contributed to the analysis. Fatigue severity was statistically significantly greater for OL versus PL, but not clinically meaningfully different by prespecified criteria (≥3 points) at 6 months (diff OL v PL: NACT: -1.3 [95% CI, -2.4 to -0.2]; P = .022; ACT: -1.3 [95% CI, -2.3 to -0.2]; P = .017) and 12 months (NACT: -1.6 [95% CI, -2.8 to -0.3]; P = .017; ACT: -1.3 [95% CI, -2.4 to -0.2]; P = .025). There were no significant differences in fatigue severity between treatment groups at 18 and 24 months. NV severity was worse in patients treated with OL compared with PL at 6 months (NACT: 6.0 [95% CI, 4.1 to 8.0]; ACT: 5.3 [95% CI, 3.4 to 7.2]) and 12 months (NACT: 6.4 [95% CI, 4.4 to 8.3]; ACT: 4.5 [95% CI, 2.8 to 6.1]). During treatment, there were some clinically meaningful differences between groups for other symptoms but not for function subscales or global health status. CONCLUSION Treatment-emergent symptoms from OL were limited, generally resolving after treatment ended. OL- and PL-treated patients had similar functional scores, slowly improving during the 24 months after (N)ACT and there was no clinically meaningful persistence of fatigue severity in OL-treated patients.
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Affiliation(s)
- Patricia A. Ganz
- University of California, Los Angeles, Los Angeles, CA
- Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hanna Bandos
- NRG Oncology SDMC, The University of Pittsburgh, Pittsburgh, PA
| | - Tanja Španić
- Europa Donna—The European Breast Cancer Coalition, Milan, Italy
- Europa Donna Slovenia, Ljubljana, Slovenia
| | | | - Volkmar Müller
- Depatment of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Masakazu Toi
- Kyoto University Hospital, Kyoto, Japan
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | | | - Eduardo-M. de Dueñas
- Consorcio Hospitalario Provincial de Castellón, Castellón, Spain
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Anne Armstrong
- Department of Medical Oncology, Division of Cancer Sciences, The University of Manchester, The Christie Hospital, Manchester, United Kingdom
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chuan-gui Song
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zheng
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Cuizhi Geng
- The Fourth Hospital of Hebei Medical University, Shiijazhuang, China
| | - Peifen Fu
- Breast Surgery Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Cologne, Germany
| | | | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden—Rossendorf (HZDR), Dresden, Germany
| | | | - Ning Liao
- Guangdong People's Hospital, Guangzhou, China
| | - Annabel Goodwin
- Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of NSW and Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sylvie Giacchetti
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, Paris, France
| | - Toshimi Takano
- Breast Medical Oncology Department, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | | | | | | | - Susan M. Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA
| | | | - Edward C. McCarron
- MedStar Franklin Square Medical Center-Harry and Jeanette Weinberg Cancer Institute, Baltimore, MD
| | - Monica Mita
- Cedars Sinai Medical Center, SOCCI, Los Angeles, CA
| | | | - Priya Rastogi
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Magee Women's Hospital, Pittsburgh, PA
| | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA
- Frontier Science Foundation, Boston, MA
| | | | | | - Judy Garber
- Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Charles E. Geyer
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Andrew N.J. Tutt
- The Institute of Cancer Research London, London, United Kingdom
- Kings College London, London, United Kingdom
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Rezaei M, Keyvanloo Shahrestanaki S, Mohammadzadeh R, Aghili MS, Rajabi M, Abbasi M, Khachian A, Momen R, Khavassi M, Aghaei S. Caregiving consequences in cancer family caregivers: a narrative review of qualitative studies. Front Public Health 2024; 12:1334842. [PMID: 38584929 PMCID: PMC10997218 DOI: 10.3389/fpubh.2024.1334842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background Cancer is a significant public health issue, causing various challenges for individuals affected by it. As cancer progresses, patients often become dependent on others for support. Family caregivers and members play a crucial role in the recovery and rehabilitation of these patients. However, caregivers themselves face numerous challenges throughout the course of their family member's illness. Exploring the experiences of family caregivers can inform long-term planning and supportive interventions to address their caregiving difficulties. This study reviews previous literature on caregiving outcomes. Method This study presents a narrative review of qualitative studies, analyzing a total of 23 articles. The results were extracted and organized into subcategories. After revision by the research team, main categories were identified. These categories encompass both positive and negative outcomes of caregiving. Results The findings of this review demonstrate that caring for a family member with cancer has significant implications for caregivers. These implications include: (A) Positive outcomes of caregiving (such as achieving self-management and balance, promoting kinship intimacy, finding meaning and purpose, and experiencing spiritual growth) and (B) Negative outcomes of caregiving (including care-related physical exhaustion, disruption of personal life plans, psycho-emotional consequences, and socio-economic burden). Conclusion The results of this study highlight the challenges faced by family caregivers and emphasize the importance of addressing their needs within the healthcare system. By providing support and attention to their well-being, caregivers can enhance their resilience and adaptability in managing caregiving difficulties.
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Affiliation(s)
- Masoud Rezaei
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Sahar Keyvanloo Shahrestanaki
- Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Sadegh Aghili
- Department of Gerontological Nursing, School of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - MohammadReza Rajabi
- Department of Cardiology, School of Medicine, Shahed University, Tehran, Iran
| | - Mohammad Abbasi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Alice Khachian
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Momen
- Department of Critical Care Nursing, School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Mohammad Khavassi
- School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
| | - Simin Aghaei
- Department of Pediatrics, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Nursing, School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
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Crespi CM, Ganz PA, Partridge AH, Wolff A, Joffe H, Irwin MR, Thure K, Petersen L, Shih YCT, Bower JE. Work Productivity Among Younger Breast Cancer Survivors: The Impact of Behavioral Interventions for Depression. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:322-329. [PMID: 38135214 DOI: 10.1016/j.jval.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The Pathways to Wellness randomized controlled trial found that 2 behavioral interventions, mindfulness awareness practices and survivorship education, reduced depressive symptoms in younger breast cancer survivors (BCSs) compared with wait-list control. This secondary analysis examines whether the interventions led to reduced loss of work productivity among younger BCSs and whether such reductions were mediated by reductions in depressive symptoms. METHODS The Work Productivity and Activity Impairment scale was used to measure work productivity loss at 4 assessment time points. Correlates of productivity loss at enrollment were examined using multivariable linear regression. Differences in change over time in productivity loss between each intervention group and control were assessed using linear mixed models. Reduced depressive symptoms were tested as a mediator of reduced productivity loss. RESULTS Of 247 trial participants, 199 were employed and included in the analyses. At enrollment, higher productivity loss was associated with chemotherapy receipt (P = .003), younger age (P = .021), more severe cognitive problems (P = .002), higher musculoskeletal pain severity (P = .002), more depressive symptoms (P = .016), and higher fatigue severity (P = .033). The mindfulness intervention led to significantly less productivity loss compared with control at all 3 postintervention assessment points (all P < .05), with about 54% of the effect mediated by reduction in depressive symptoms. Survivorship education was not associated with reduced loss of productivity. CONCLUSIONS These findings suggest that addressing depressive symptoms through behavioral interventions, such as mindfulness, may mitigate impacts on work productivity in younger BCSs.
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Affiliation(s)
- Catherine M Crespi
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Antonio Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Irwin
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Katie Thure
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Ya-Chen Tina Shih
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julienne E Bower
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Jahan N, Cathcart-Rake E, Vierkant RA, Larson N, Loprinzi C, O'Sullivan CC, Faubion S, Kuhle C, Vencill JA, Couch F, Olson JE, Ruddy KJ. Sexual Dysfunction in Patients With Metastatic Breast Cancer. Clin Breast Cancer 2024; 24:72-78.e4. [PMID: 37867114 DOI: 10.1016/j.clbc.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Sexual well-being is a key determinant of quality of life. Sexual dysfunction in patients with metastatic breast cancer (MBC) is understudied. PATIENTS AND METHODS Patients were eligible for this study if they participated in the Mayo Clinic Breast Disease Registry (MCBDR), had a diagnosis of de novo MBC, and responded to a question about sexual dysfunction at the baseline MCBDR survey. Participants reported their sexual dysfunction on a scale of 0 (no dysfunction) to 10 (severe dysfunction) at baseline and then annually for 4 years. Participants answered additional sexual symptom questions in years 2 and 4. Associations between patient attributes and the presence and severity of sexual dysfunction, changes in sexual dysfunction from baseline to subsequent surveys, and associations between specific sexual symptoms and severity of sexual dysfunction were assessed. RESULTS One hundred three patients with de novo MBC answered the sexual dysfunction question at baseline. The prevalence of any sexual dysfunction (score of 1-10) was 56.3% at baseline (n = 103), 57.1 % at year 1 (n = 77), 80.4% at year 2 (n = 46), 65.8% at year 3 (n = 38), and 85% at year 4 (n = 20). Vaginal dryness was reported by approximately 49% and 39% of patients in years 2 and 4 respectively. Vaginal dryness was associated with higher severity of sexual dysfunction. CONCLUSIONS Self-reported sexual dysfunction is frequent in women with de novo MBC. Vaginal dryness is a frequently reported treatable symptom associated with higher severity of sexual dysfunction. Clinicians should assess patients with MBC for sexual dysfunction and discuss potential treatment strategies.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology and Oncology, University Alabama at Birmingham, Birmingham, AL
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nicole Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Carol Kuhle
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Zhang S, Yahaya BH, Pan Y, Liu Y, Lin J. Menstrual blood-derived endometrial stem cell, a unique and promising alternative in the stem cell-based therapy for chemotherapy-induced premature ovarian insufficiency. Stem Cell Res Ther 2023; 14:327. [PMID: 37957675 PMCID: PMC10644549 DOI: 10.1186/s13287-023-03551-w] [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: 12/16/2022] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Chemotherapy can cause ovarian dysfunction and infertility since the ovary is extremely sensitive to chemotherapeutic drugs. Apart from the indispensable role of the ovary in the overall hormonal milieu, ovarian dysfunction also affects many other organ systems and functions including sexuality, bones, the cardiovascular system, and neurocognitive function. Although conventional hormone replacement therapy can partly relieve the adverse symptoms of premature ovarian insufficiency (POI), the treatment cannot fundamentally prevent deterioration of POI. Therefore, effective treatments to improve chemotherapy-induced POI are urgently needed, especially for patients desiring fertility preservation. Recently, mesenchymal stem cell (MSC)-based therapies have resulted in promising improvements in chemotherapy-induced ovary dysfunction by enhancing the anti-apoptotic capacity of ovarian cells, preventing ovarian follicular atresia, promoting angiogenesis and improving injured ovarian structure and the pregnancy rate. These improvements are mainly attributed to MSC-derived biological factors, functional RNAs, and even mitochondria, which are directly secreted or indirectly translocated with extracellular vesicles (microvesicles and exosomes) to repair ovarian dysfunction. Additionally, as a novel source of MSCs, menstrual blood-derived endometrial stem cells (MenSCs) have exhibited promising therapeutic effects in various diseases due to their comprehensive advantages, such as periodic and non-invasive sample collection, abundant sources, regular donation and autologous transplantation. Therefore, this review summarizes the efficacy of MSCs transplantation in improving chemotherapy-induced POI and analyzes the underlying mechanism, and further discusses the benefit and existing challenges in promoting the clinical application of MenSCs in chemotherapy-induced POI.
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Affiliation(s)
- Shenghui Zhang
- Stem Cell and Biotherapy Technology Research Center, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road, Xinxiang, Henan, China
- Lung Stem Cell and Gene Therapy Group, Regenerative Medicine Cluster, Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia, Penang, Malaysia
| | - Badrul Hisham Yahaya
- Lung Stem Cell and Gene Therapy Group, Regenerative Medicine Cluster, Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia, Penang, Malaysia
| | - Ying Pan
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, , China
| | - Yanli Liu
- Stem Cell and Biotherapy Technology Research Center, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road, Xinxiang, Henan, China.
| | - Juntang Lin
- Stem Cell and Biotherapy Technology Research Center, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road, Xinxiang, Henan, China.
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Karabulut Gul S, Tepetam H, Gursel OK, Alanyali S, Oruc AF, Tugrul F, Ergen SA, Yavuz BB, Kanyilmaz G, Altinok P, Bolukbasi Y, Alomari O, Akmansu M. Investigating the levels of depression, anxiety, sexual disorders, and other influencing factors in breast cancer patients: Turkish radiation oncology integrative group study (12-05). Medicine (Baltimore) 2023; 102:e35280. [PMID: 37960771 PMCID: PMC10637556 DOI: 10.1097/md.0000000000035280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 11/15/2023] Open
Abstract
The fear of death associated with cancer and the side effects of its treatments can have a detrimental psychological impact on breast cancer patients. Early detection and support services play a crucial role in alleviating the expected symptoms of depression, anxiety, and sexual dysfunction. The objective of our study is to assess the levels of depression, anxiety, and sexual dysfunction in breast cancer patients, as well as identify the factors that influence these conditions. The study involved 329 voluntarily participating breast cancer patients who had undergone surgery and were in the follow-up stage. Data were collected from 8 different centers after obtaining ethical approval. The assessment utilized tools such as the Sociodemographic Information Form, Beck Depression and Anxiety Scale, and Arizona Sexual Experiences Scale. Data analysis was performed using SPSS 20. The study included 329 breast cancer patients in the follow-up stage post-surgery. Their average age was 52.7 years (range: 27-83). Results indicated that 33.1% experienced moderate to severe depression, 18.2% reported severe anxiety, and 82.7% scored above 11 on the sexual scale. Factors linked to higher scores were mastectomy, surgical dissatisfaction, insufficient information on sexual side effects, and comorbidities like smoking and diabetes. The study emphasizes the importance of closely monitoring anxiety, depression levels, and sexual side effects in breast cancer treatment. It underscores the need to focus not only on reducing mortality rates but also on supporting patients' psychological and sexual well-being, ultimately improving their overall quality of life.
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Affiliation(s)
- Sule Karabulut Gul
- University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Huseyin Tepetam
- University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Ozge Kandemir Gursel
- Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | | | - Ahmet Fatih Oruc
- Istanbul Oncology Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Fuzuli Tugrul
- Eskisehir City Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Sefika Arzu Ergen
- Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Gul Kanyilmaz
- Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Pelin Altinok
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Koc University Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Omar Alomari
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Muge Akmansu
- Faculty of Medicine, Gazi University, Ankara, Turkey
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Farajivafa V, Khosravi N, Rezaee N, Koosha M, Haghighat S. Effectiveness of home-based exercise in breast cancer survivors: a randomized clinical trial. BMC Sports Sci Med Rehabil 2023; 15:96. [PMID: 37550769 PMCID: PMC10405487 DOI: 10.1186/s13102-023-00710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Breast cancer patients are recommended to engage in regular exercise. In developing countries, where there is a lack of facilities to offer specialized, supervised exercise for this population, regularly exercising might be a challenge. We aimed to evaluate the effectiveness of a home-based intervention in this population. METHODS Breast cancer survivors were randomly assigned to either the home-based exercise program or the usual care group. Exercise intervention included walking, balance, and stretch exercises, along with weekly follow-up telephone calls. Quality of life (QOL) was evaluated using EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires and the predicted VO2 peak was measured using the Ebbeling submaximal treadmill test. RESULTS Eighty-nine patients were enrolled in the study. Reported minutes of exercise gradually increased from 40.7 min per week in week 1 to 116.9 min per week in week 12. This intervention improved global QOL (P = 0.001), social functioning (P = 0.04), and the predicted VO2 peak (P = 0.01). CONCLUSION This home-based exercise regime effectively increased quality of life and physical activity levels. TRIAL REGISTRY Iranian Registry of Clinical Trials identifier: IRCT20140810018746N1, prospectively registered 08/01/2018, https://en.irct.ir/trial/27959 .
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Affiliation(s)
- Vahid Farajivafa
- Department of Physical Education and Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Nasim Khosravi
- Department of Physical Education and Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Nilofar Rezaee
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
| | - Maryam Koosha
- Department of Social Welfare, Institute for Humanities and Cultural Studies, Tabatabaei University, Tehran, Iran
| | - Shahpar Haghighat
- Department of Cancer Quality of Life, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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Chang CP, Ho TF, Snyder J, Dodson M, Deshmukh V, Newman M, Date A, Henry NL, Hashibe M. Breast cancer survivorship and sexual dysfunction: a population-based cohort study. Breast Cancer Res Treat 2023; 200:103-113. [PMID: 37160510 PMCID: PMC10382144 DOI: 10.1007/s10549-023-06953-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Breast cancer is the most common non-skin cancer in women and an increasing number of people are living as breast cancer survivors. While the prognosis of breast cancer continues to improve, the rates of sexual dysfunction and the risk related to cancer treatments have not been well characterized in a population-based study. METHODS We identified a cohort of 19,709 breast cancer survivors diagnosed between 1997 and 2017 from the Utah Cancer Registry, and 93,389 cancer-free women who were matched by age and birth state from the Utah Population Database. Sexual dysfunction diagnoses were identified through ICD-9 and ICD-10 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios for risk of sexual dysfunction. RESULTS Breast cancer survivors were at higher risk of sexual dysfunction diagnosis (9.1% versus 6.9%, HR 1.60, 95% CI 1.51-1.70) compared to the general population. This risk increased 2.05-fold within 1 to 5 years after cancer diagnosis (95% CI 1.89-2.22) and 3.05-fold in individuals diagnosed with cancer at < 50 years of age (95% CI 2.65-3.51). Cancer treatments including endocrine therapy, chemotherapy and radiation therapy were associated with an increased risk of sexual dysfunction among breast cancer survivors. CONCLUSIONS Risk of sexual dysfunction in breast cancer survivors is higher than in the general population, but may be underdiagnosed in the clinical setting. Health care professionals should be encouraged to address the topic of sexual health early on in the treatment of breast cancer, and routinely screen patients for symptoms of sexual dysfunction.
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Affiliation(s)
- Chun-Pin Chang
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Tiffany F Ho
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Mark Dodson
- Intermountain Healthcare, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - N Lynn Henry
- Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
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Hayes AE, Wardell DW, Engebretson J, LoBiondo-Wood G, Allicock M. Psychosexual responses to BRCA gene mutations in women of childbearing age. J Am Assoc Nurse Pract 2023; 35:242-251. [PMID: 36947688 DOI: 10.1097/jxx.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Diagnosis of a BRCA gene mutation presents a dilemma because life-changing medical decisions must be made to prevent breast and ovarian cancer. There is minimal evidence regarding how psychosexual functioning, psychological well-being with regard to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (WCBA; 18-49 years) with a BRCA gene mutation. PURPOSE To explore, describe, and interpret the experience of women with a BRCA mutation during the treatment and decision-making process. METHODOLOGY A qualitative descriptive design was used to recruit participants online through social media postings and from national and local BRCA support groups. Participants participated in semistructured interviews exploring their experience after BRCA diagnosis. Interpretive descriptive analysis was used to identify themes. RESULTS The purposive sample comprised 18 women aged 21-49 years. Four major themes, such as body image, sexuality, femininity, and childbearing/childrearing, were identified that influenced decisions related to the diagnosis and management of a BRCA mutation. All participants voiced that concerns regarding body image and sexuality caused hesitancy in their decision to have prophylactic surgery. Women who had undergone bilateral prophylactic mastectomy were concerned about the impact of the surgery, scarring, breast disfigurement, and the lack of sensation resulting from surgical intervention. CONCLUSIONS Psychosexual concerns arise from internal and external influences that significantly affect the decision to undergo prophylactic measures. Therefore, body image, sexuality, and sexual orientation should all be addressed during the decision-making process. IMPLICATIONS Provider communication and preparation for realistic surgical outcomes can be improved to assist WCBA throughout the decision-making process and enhance psychosexual functioning.
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Affiliation(s)
- Alexis Elizabeth Hayes
- Department of Nursing, Center for Nursing Research, Education and Practice, Houston, Methodist Academic Institute, Houston, Texas
| | - Diane Wind Wardell
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Joan Engebretson
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Geri LoBiondo-Wood
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health, Dallas Campus the University of Texas Health Science Center at Houston, Texas
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11
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Avis NE, Crawford SL, Gold EB, Greendale GA. Sexual functioning among breast cancer survivors and non-cancer controls over 5 years post diagnosis: Pink SWAN. Cancer Med 2023; 12:7356-7368. [PMID: 36440508 PMCID: PMC10067058 DOI: 10.1002/cam4.5433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare sexual functioning from diagnosis to 5 years post diagnosis among breast cancer survivors (BCS) and women without cancer (controls). PATIENTS AND METHODS Analyses included 118 BCS and 1765 controls from 20 years of the longitudinal Study of Women's Health Across the Nation (SWAN), a multiracial/ethnic cohort of mid-life women assessed approximately annually from 1995 to 2015. Pink SWAN participants reported no cancer at SWAN enrollment and developed (BCS) or did not develop (controls) incident breast cancer after enrollment. Outcomes included: being sexually active or not, intercourse frequency, sexual desire, vaginal dryness, and pain with intercourse. Using longitudinal logistic regression, we compared BCS and controls on prevalence of sexual functioning outcomes with respect to years since diagnosis. In addition, we examined whether menopause transition stage, depressive symptoms, relationship satisfaction, vaginal dryness, or pain with intercourse modified the relation between breast cancer and sexual functioning outcomes. RESULTS Adjusting for partner status, both BCS and controls reported similar declines over time in being sexually active, sexual intercourse frequency, and sexual desire. Among sexually active women, more BCS than controls consistently reported vaginal dryness with significant differences between 2 and 4 years post-diagnosis, and pain with intercourse, with statistically significant differences between 0.5 years post-diagnosis to 2 years post-diagnosis. Being post-menopausal and reporting depressive symptoms were significant effect modifiers for pain with intercourse with both variables having positive and stronger associations with pain among the controls than among BCS. CONCLUSION Except for more reporting of vaginal dryness and pain with intercourse among BCS, negative changes in sexual function during mid-life were similar in those with and without breast cancer.
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Affiliation(s)
- Nancy E. Avis
- Department of Social Sciences & Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Sybil L. Crawford
- Tan Chingfen Graduate School of NursingUMass Chan Medical SchoolWorcesterMassachusettsUSA
| | - Ellen B. Gold
- Department of Public Health SciencesSchool of Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Gail A. Greendale
- David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
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Alvarez-Pardo S, Romero-Pérez EM, Camberos-Castañeda N, de Paz JA, Horta-Gim MA, González-Bernal JJ, Mielgo-Ayuso J, Simón-Vicente L, Fernández-Solana J, González-Santos J. Quality of Life in Breast Cancer Survivors in Relation to Age, Type of Surgery and Length of Time since First Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16229. [PMID: 36498299 PMCID: PMC9741017 DOI: 10.3390/ijerph192316229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 05/11/2023]
Abstract
(1) Background: Quality of life assessment is a critical aspect of breast cancer patient outcomes, as diagnosis, prognosis and treatment can have a major impact on quality of life. The aim of this study was to describe the characteristics of the sample and to verify the relationship between quality of life (QOL) in women diagnosed with breast cancer (BC) and their age, type or surgery and time since treatment; (2) Methods: a cross-sectional, descriptive study was conducted with 183 women diagnosed with BC, aged 30−80 years in Mexico. Women’s QOL was assessed using two questionnaires, The European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire (EORTC QLQ-C30) and The Breast Cancer Module (EORTC QLQ-BR23). (3) Results: the results show significant differences in several items when the variable age is taken into account, indicating that younger women have poorer social and sexual function, as well as poorer sexual enjoyment and lower expectations of the future. The type of surgery also indicates a significantly better QOL in those women who receive conservative treatment versus a mastectomy; the time elapsed since surgery does not show any significant results, except for sexual functioning and breast-related symptoms where >5 years implies better scores on the items. (4) Conclusions: in conclusion, it is important to take into account the characteristics of women with BC, particularly at the time of treatment, in order to mitigate the impact of the disease on their QOL with the help of a multidisciplinary team.
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Affiliation(s)
| | | | | | | | | | | | - Juan Mielgo-Ayuso
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
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13
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Erin R, Bayoğlu Tekin Y, Aynaci Ö, Baki Erin K, Kulaksiz D. Evaluation of the Pelvic Floor of Women with Breast Cancer Using Tamoxifen by Transperineal 3D Ultrasonography. J Obstet Gynaecol India 2022; 72:509-514. [PMID: 36506899 PMCID: PMC9732155 DOI: 10.1007/s13224-022-01669-0] [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: 11/01/2021] [Accepted: 06/25/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to investigate the anatomical changes in the pelvic floor of women with breast cancer using tamoxifen by transperineal 3D ultrasonography and their effect on the urinary incontinence and sexual dysfunction. Methods Ninety-four patients with breast cancer using TAM in the study group and ninety-five healthy women of the same age in the control group were included in this prospective cohort study. Female Sexual Function Index and Incontinence Questionnaire-Short Form scales were applied to both groups. Ultrasonographic evaluation was performed at resting and Valsalva Maneuver with a convex (3-8 MHz) probe transperineally and the levator urethra gap and levator hiatus diameter were measured after 3-dimensional imaging. Independent t-tests were performed for statistical analysis. Results The mean age and body mass index of the experimental group versus control groups were 46.3 ± 6.12 years versus 46.4 ± 5.23 years and 27.6 ± 4.34 kg/m2 versus 29.2 ± 6.45 kg/m2, respectively. LUG and LH values were found significantly higher for the experimental groups compared to control groups at 17.23 ± 2.53 mm versus 14.1 ± 2.23 mm and 21 ± 2.45 cm2 versus 18 ± 4.56 cm2, respectively. (p < 0.05). The FSFI score significantly decreased (12.49 ± 3.58 versus 20.89 ± 3.69) and the ICIQ-SF score increased (4.02 ± 0.34 versus 2.34 ± 0.45) in the experimental group in comparison to control group (p < 0.05). Conclusion This study demonstrated that the effects of TAM usage on pelvic floor can be detected by measuring the changes in the levator ani muscle using the transperineal 3D USG. With transperineal USG screening, pelvic floor changes can be early diagnosed and clinical measures can be taken before they become symptomatic.
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Affiliation(s)
- Recep Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Yeşim Bayoğlu Tekin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Özlem Aynaci
- Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey
| | - Kübra Baki Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Deniz Kulaksiz
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
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14
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Henry NL, Kim S, Hays RD, Diniz MA, Tighiouart M, Gresham G, Luu M, Cecchini RS, Yothers G, Rogatko A, Ganz PA. Toxicity Index, patient-reported outcomes, and persistence of breast cancer chemotherapy-associated side effects in NRG Oncology/NSABP B-30. NPJ Breast Cancer 2022; 8:123. [DOI: 10.1038/s41523-022-00489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/21/2022] [Indexed: 11/21/2022] Open
Abstract
AbstractAdjuvant chemotherapy improves breast cancer survival but is associated with bothersome short- and long-term toxicity. Factors associated with toxicity, especially subacute toxicity up to 2 years following chemotherapy, have not been fully elucidated. The NRG Oncology/NSABP B-30 clinical trial compared 3 different doxorubicin-, cyclophosphamide-, and docetaxel-based chemotherapy regimens given over 3–6 months. Patients with hormone receptor-positive breast cancer received subsequent adjuvant endocrine therapy. From baseline through 24 months, 2156 patients completed questionnaires serially. We used multivariable probabilistic index models to identify factors associated with acute (>0–12 months) and subacute (>12–24 months) difficulties with pain, cognition, vasomotor symptoms, and vaginal symptoms. For all symptom domains, presence of symptoms prior to chemotherapy initiation were associated with symptoms in the subacute period (all p < 0.001). In addition, different combinations of patient factors and breast cancer treatments were associated with increased likelihood of pain, vasomotor, and vaginal symptoms in the subacute period. Consideration of pre-treatment symptoms and patient factors, as well as treatments for breast cancer, can facilitate identification of groups of patients that may experience symptoms following completion of chemotherapy. This information may be important for treatment-decision-making when alternative regimens are equivalent in benefit.
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15
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Shiraishi M, Sowa Y, Tsuge I, Shiraishi A, Inafuku N, Nakayama I, Morimoto N. Risk factors associated with chronic pain after mastectomy: a prospective study with a 5-year follow-up in Japan. Breast Cancer 2022; 29:1133-1139. [PMID: 36018439 DOI: 10.1007/s12282-022-01392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic pain is a major complication following breast surgery including breast reconstruction. We previously examined prospective patient-specific and medical/surgical factors that predict chronic pain a year after breast surgery in the Japanese population. Five-year survivorship is essential for breast cancer patients. This report is a 4-year follow-up study following the previous research. METHODS A follow-up observation study was performed 5 years after breast operations. The subjects were patients who underwent breast surgery, including tissue expander/implant (TE/implant), DIEP procedures and mastectomy only. Pain at 5 years was assessed using the Japanese Version of the Short-Form McGill Pain Questionnaire (SF-MPQ-JV). A multiple linear regression model was used to examine the relationships of clinical factors with chronic pain. RESULTS Questionnaires were completed by 132 subjects. No factor related to chronic pain was significantly related to the MPQ pain ratings. Among patient characteristics, a psychotic or neurological medical history was related to significantly lower visual analog scale (p = 0.02) and present pain index (p = 0.04) scores. A history of chemotherapy and/or hormone therapy was significantly associated with the frequency of use of pain medication postoperatively (p = 0.05) and effect on the social life of the patients (p = 0.02). CONCLUSIONS A psychotic or neurological history and a history of chemotherapy and/or hormone therapy were identified as risk factors for chronic pain after breast surgery, but the type of operation was not associated with chronic pain.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan.,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan. .,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan.
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Akiko Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Naoki Inafuku
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Ichiro Nakayama
- Department of Breast Surgery, Kyoto Miniren Chuo Hospital, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Hyaluronic Acid: A Valid Therapeutic Option for Early Management of Genitourinary Syndrome of Menopause in Cancer Survivors? Healthcare (Basel) 2022; 10:healthcare10081528. [PMID: 36011183 PMCID: PMC9408661 DOI: 10.3390/healthcare10081528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a chronic condition affecting a large number of women, with a major impact on their urogenital health and sexual function. It occurs at midlife because estrogen levels decline with menopause enhancing aging-related changes of the functional anatomy of the urogenital system. Unfortunately, GSM may occur early in the lifespan of women or be exacerbated following anticancer treatments, such as chemotherapy, ionizing radiation, or surgical removal of reproductive organs. Symptoms of GSM are often under-reported by women, under-estimated and under-diagnosed by health care providers (HCPs), and subsequently under-treated, despite their profound negative impact on the quality of life. The mainstay of vaginal treatments is local estrogen therapy (LET) ensuring an effective management of moderate to severe symptomatic GSM. However, LET is generally contraindicated in women with a history of hormone receptor positive cancer, due to the fear of increased recurrence or possible interference with endocrine adjuvant therapies. Among non-hormonal treatments, hyaluronic acid-based moisturizers have shown promising clinical results both in healthy women and in cancer patients or survivors. Its strong water-binding properties provide lubricating and moisturizing effects, which contribute to maintaining a proper level of hydration and viscoelasticity in several body parts, including the urinary tract and genital tissues. Hyaluronic acid-based moisturizers are effective, safe, and well tolerated; therefore, they may represent a valid option for the early management of GSM-associated symptoms in every woman with a history of cancer who is unable or unwilling to undergo hormone-based therapies. Hence, the aim of this review was to provide an overview of GSM etiology and treatment in women with natural or iatrogenic menopause, with a focus on the use of hyaluronic acid as a prophylactic treatment in the context of an integrated management protocol for cancer patients.
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Wang Y, Li Y, Liang J, Zhang N, Yang Q. Chemotherapy-Induced Amenorrhea and Its Prognostic Significance in Premenopausal Women With Breast Cancer: An Updated Meta-Analysis. Front Oncol 2022; 12:859974. [PMID: 35463307 PMCID: PMC9022106 DOI: 10.3389/fonc.2022.859974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Chemotherapy-induced amenorrhea (CIA) is one of the most common side effects in premenopausal patients with breast cancer, and several factors may contribute to the incidence of CIA. In this meta-analysis, we aimed to summarize clinical risk factors associated with CIA incidence and to evaluate their prognostic effects in patients with breast cancer. Methods Three electronic databases (Cochrane Library, EMBASE, and MEDLINE) were systematically searched for articles published up to October 2021. The articles included clinical trials that evaluated risk factors associated with CIA and their prognostic value in treatment. For the meta-analysis, pooled odds ratio estimates (ORs) and 95% confidence intervals (CIs) were calculated using the inverse variance-weighted approach, in addition to publication bias and the chi-square test. Results A total of 68 studies involving 26,585 patients with breast cancer were included in this meta-analysis, and 16,927 patients developed CIA. From the 68 studies, 7 risk factors were included such as age group, hormone receptor (HR) status, estrogen receptor (ER) status, progesterone receptor (PR) status, tamoxifen administration, chemotherapeutic regimen, and tumor stage. Based on our results, patients with age of ≤40, HR-negative status, ER-negative status, PR-negative status, no use of tamoxifen, and use of anthracycline-based regimen (A) compared with anthracycline-taxane-based regimen (A+T) were associated with less incidence of CIA in patients with breast cancer. Moreover, CIA was associated with favorable disease-free survival (OR = 0.595, 95% CI = 0.537 to 0.658, p < 0.001) and overall survival (OR = 0.547, 95% CI = 0.454–0.660, p < 0.001) in premenopausal patients with breast cancer. Conclusion Age, HR status, ER status, PR status, tamoxifen administration, and chemotherapeutic regimen can be considered independent factors to predict the occurrence of CIA. CIA is a favorable prognostic factor in premenopausal patients with breast cancer. CIA should be a trade-off in the clinical management of premenopausal patients with breast cancer, and further large cohort studies are necessary to confirm these results.
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Affiliation(s)
- Yifei Wang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jingshu Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Nan Zhang
- Breast Cancer Center, Jinan Central Hospital, Shandong First Medical University, Jinan, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China.,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China.,Research Institute of Breast Cancer, Shandong University, Jinan, China
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Cioffi R, Fais ML, Bergamini A, Vanni VS, Pagliardini L, Papaleo E, Mangili G, Candiani M. Ovarian failure risk in post-pubertal patients with cancer: a prognostic model. Future Oncol 2022; 18:2391-2400. [PMID: 35469452 DOI: 10.2217/fon-2022-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To develop a predictive model for ovarian failure (OF) after chemotherapy in young post-pubertal women with cancer. Methods: Retrospective, monocentric cohort study including 348 patients referring to the Oncofertility Unit of San Raffaele Hospital (Milan, Italy) from August 2011 to January 2020. A predictive model was constructed by multivariate logistic regression and receiver operating characteristic analysis. Results: Data about menstrual function resumption were available for 184 patients. The best predictive model for OF was identified by the combination of age; number of chemotherapy lines; vincristine, adriamycin, ifosphamide/adriamycin, ifosphamide; capecitabine; adriamycin, bleomycine, vinblastine, doxorubicin (area under the curve= 0.906, CI 95% 0.858-0.954, p = 0.0001). Conclusions: The model predicts the probability of loss of ovarian function at cancer diagnosis and with every change of treatment.
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Affiliation(s)
- Raffaella Cioffi
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Maria Luisa Fais
- Obstetrics & Gynecology Unit, University of Cagliari, Cagliari, 09124, Italy
| | - Alice Bergamini
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Valeria Stella Vanni
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Luca Pagliardini
- Division of Genetics & Cell Biology, Reproductive Sciences Laboratory, San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Enrico Papaleo
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Giorgia Mangili
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Massimo Candiani
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
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Anderson RA, Kelsey TW, Morrison DS, Wallace WHB. Family size and duration of fertility in female cancer survivors: a population-based analysis. Fertil Steril 2022; 117:387-395. [PMID: 34933761 PMCID: PMC8865032 DOI: 10.1016/j.fertnstert.2021.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess family size and timescale for achieving pregnancy in women who remain fertile after cancer. DESIGN Population-based analysis. SETTING National databases. PATIENT(S) All women diagnosed with cancer before the age of 40 years in Scotland, 1981-2012 (n = 10,267) with no previous pregnancy; each was matched with 3 population controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The number and timing of pregnancy and live birth after cancer diagnosis, to 2018. RESULT(S) In 10,267 cancer survivors, the hazard ratio for a subsequent live birth was 0.56 (95% confidence interval, 0.53-0.58) overall. In women who achieved a subsequent pregnancy, age at live birth increased (mean ± SD, 31.2 ± 5.5 vs. 29.7 ± 6.1 in controls), and the family size was lower (2.0 ± 0.8 vs. 2.3 ± 1.1 live births). These findings were consistent across several diagnoses. The interval from diagnosis to last pregnancy was similar to that of controls (10.7 ± 6.4 vs. 10.9 ± 7.3 years) or significantly increased, for example, after breast cancer (6.2 ± 2.8 vs. 5.3 ± 3.3 years) and Hodgkin lymphoma (11.1 ± 5.1 vs. 10.1 ± 5.8 years). CONCLUSION(S) These data quantify the reduced chance of live birth after cancer. Women who subsequently conceived achieved a smaller family size than matched controls, but the period of time after cancer diagnosis across which pregnancies occurred was similar or, indeed, increased. Thus, we did not find evidence that women who were able to achieve a pregnancy after cancer had a shorter timescale over which they have pregnancies.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
| | - Tom W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | | | - W Hamish B Wallace
- Department of Hematology and Oncology, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
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20
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Garg D, Meeks HD, Johnstone E, Berga SL, Smith KR, Hotaling J, Letourneau JM. Cancer treatment is associated with a measurable decrease in live births in a large, population-based study. F S Rep 2021; 2:462-467. [PMID: 34934988 PMCID: PMC8655402 DOI: 10.1016/j.xfre.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To define the live birth rates in a large, population-based study of the most common reproductive-age cancers in women. Design Retrospective cohort study. Setting Population-based study. Patients Female cancer patients diagnosed with cancer at age 18 years old or older between 1952–2014 (n = 17,952) were compared to fertility of non-cancer controls (n = 89,436). Interventions Live births in cancer survivors were compared with those in healthy, age-matched controls. Cases and controls were matched in the ratio of 5:1 for birth year, birthplace (Utah, yes/no), and follow-up time in Utah. Main Outcome Measure Rate of at least one live birth, reported as an incidence rate ratio (IRR). Results Of all cancer survivors, 3,127 (17.4%) had at least 1 live birth after treatment in comparison to 19,405 healthy, age-matched controls (21.7%) with the same amount of time exposure for attempting pregnancy. Breast cancer was the most common cancer type (23.1% of patients in cohort). Compared with age-matched, healthy controls, IRR of live birth was 0.69 (95% confidence interval [CI], 0.67–0.70) for all cancer types, 0.25 (95% CI, 0.20–0.33) for leukemia, 0.40 (95% CI, 0.28–0.59) for gastrointestinal cancers, 0.44 (95% CI, 0.41–0.48) for breast cancer, 0.53 (95% CI, 0.47–0.59) for central nervous system cancers, and 0.57 (95% CI, 0.44–0.73) for soft tissue cancers. With all cancer types stratified by age at diagnosis, IRR for live births in cancer survivors aged >41 years at diagnosis was 0.48 (95% CI, 0.44–0.52); IRR was 0.64 (95% CI, 0.61–0.67) in the group aged 31–40 years and 0.71 (95% CI, 0.69–0.74) in the group aged 18–30 years after their cancer treatment. Conclusions Cancer and its treatment were associated with lower live birth rates when comparing women with cancer vs. age-matched, healthy controls.
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Affiliation(s)
- Deepika Garg
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Sarah L Berga
- Department of Obstetrics and Gynecology, University at Buffalo, Buffalo, New York
| | - Ken R Smith
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Jim Hotaling
- University of Utah School of Medicine, Salt Lake City, Utah
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21
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Schweizer A, Toffel K, Braizaz M. L’abord de la sexualité par les professionnel·le·s de santé en oncologie : une revue de la littérature. PSYCHOLOGIE FRANCAISE 2021. [DOI: 10.1016/j.psfr.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Moshina N, Falk RS, Botteri E, Larsen M, Akslen LA, Cairns JA, Hofvind S. Quality of life among women with symptomatic, screen-detected, and interval breast cancer, and for women without breast cancer: a retrospective cross-sectional study from Norway. Qual Life Res 2021; 31:1057-1068. [PMID: 34698976 PMCID: PMC8547129 DOI: 10.1007/s11136-021-03017-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
Purpose Breast cancers detected at screening need less aggressive treatment compared to breast cancers detected due to symptoms. The evidence on the quality of life associated with screen-detected versus symptomatic breast cancer is sparse. This study aimed to compare quality of life among Norwegian women with symptomatic, screen-detected and interval breast cancer, and women without breast cancer and investigate quality adjusted life years (QALYs) for women with breast cancer from the third to 14th year since diagnosis. Methods This retrospective cross-sectional study was focused on women aged 50 and older. A self-reported questionnaire including EQ-5D-5L was sent to 11,500 women. Multivariable median regression was used to analyze the association between quality of life score (visual analogue scale 0–100) and detection mode. Health utility values representing women’s health status were extracted from EQ-5D-5L. QALYs were estimated by summing up the health utility values for women stratified by detection mode for each year between the third and the 14th year since breast cancer diagnosis, assuming that all women would survive. Results Adjusted regression analyses showed that women with screen-detected (n = 1206), interval cancer (n = 1005) and those without breast cancer (n = 1255) reported a higher median quality of life score using women with symptomatic cancer (n = 1021) as reference; 3.7 (95%CI 2.2–5.2), 2.3 (95%CI 0.7–3.8) and 4.8 (95%CI 3.3–6.4), respectively. Women with symptomatic, screen-detected and interval cancer would experience 9.5, 9.6 and 9.5 QALYs, respectively, between the third and the 14th year since diagnosis. Conclusion Women with screen-detected or interval breast cancer reported better quality of life compared to women with symptomatic cancer. The findings add benefits of organized mammographic screening. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-03017-7.
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Affiliation(s)
- Nataliia Moshina
- Cancer Registry of Norway, Majorstuen, P.O. 5313, 0304, Oslo, Norway.
| | - Ragnhild S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Marthe Larsen
- Cancer Registry of Norway, Majorstuen, P.O. 5313, 0304, Oslo, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - John A Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Solveig Hofvind
- Cancer Registry of Norway, Majorstuen, P.O. 5313, 0304, Oslo, Norway.,Department of Health and Care Sciences, UiT The Artic University of Norway, P.O. 6050, 9037, Tromsø, Norway
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23
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Olcer ZO, Oskay U. Effects of the Better Model Based Counseling on Sexuality of Women with Breast Cancer. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:41-54. [PMID: 38595689 PMCID: PMC10903605 DOI: 10.1080/19317611.2021.1979161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/11/2021] [Accepted: 07/04/2021] [Indexed: 04/11/2024]
Abstract
Purpose Breast cancer and side effects of its treatment cause many problems such as body image, impaired quality of life, and sexual dysfunction. The aim of this experimental study is to determine the effect of BETTER Model-based counseling programme on sexual problems of female patients with breast cancer. Methods This study was conducted with experimental and control group design. The data of the study were obtained between April 2016 and March 2018. The sample group consisted of 60 women who agreed to participate in the study. Information Form, "EORTC Quality of Life Questionnaire-BR23", "Female Sexual Function Index", and "Body Cathexis Scale" were used in order to collect the data. The "Better Model"-based counseling programme was applied in four sessions a week in the experimental group. The scales were applied again one month after the last session. The women in the control group were subjected to routine hospital control after the scales were applied. The scales were applied again in this group one month later. Results After the "Better Model"-based counseling programme was applied,the women in the experimental group had higher scores from lubrication, orgasm, and pain subscales, and overall female sexual function index. Besides, the women in the experimental group had higher scores from body image subscale of functional scale of the quality of life questionnaire. Conclusions In the study, it was detected that the "Better Model"-based counseling was effective in raising and enhancing sexual health awareness and decreasing the existing sexual issues in women with breast cancer.
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Affiliation(s)
- Zeynep Ozkan Olcer
- Department of Nursing, Faculty of Health Science, Ankara Medipol University, Altındag, Ankara
| | - Umran Oskay
- Department of Women's Health and Diseases Nursing, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpasa, Şişli-İstanbul, Turkey
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24
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Moshina N, Falk RS, Hofvind S. Long-term quality of life among breast cancer survivors eligible for screening at diagnosis: a systematic review and meta-analysis. Public Health 2021; 199:65-76. [PMID: 34560477 DOI: 10.1016/j.puhe.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/07/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to explore the long-term quality of life (QoL) among breast cancer survivors eligible for mammographic screening at diagnosis and compare that to QoL among women with no history of breast cancer. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of randomised controlled trials and observational studies published between January 2000 and July 2019 was performed. Eight studies were included in the review. Six studies with QoL measurement scales (0-100) were included in the meta-analysis. We used fixed and random effects models to obtain Cohen's d with 95% confidence interval (CI). Heterogeneity among studies was evaluated by the I2 statistics. RESULTS Information about 6145 breast cancer survivors diagnosed between 1995 and 2012 and followed for >1-10 years was analysed. Four studies used SF-36/RAND-36, three studies used EORTC QLQ-C30, one study used FACT-G and one study used FACT-B. The mean score of QoL for breast cancer survivors varied from 63.0 (RAND SF-36, 0-100) to 110.5 (FACT-B, 0-123). Two studies showed better, three studies showed similar and two studies showed poorer mean scores for breast cancer survivors compared with women with no history of breast cancer. The meta-analysis showed no significant differences in QoL for breast cancer survivors compared with women with no history of breast cancer (Cohen's d = -0.07, 95% confidence interval [CI] -0.14 to 0.00 and I2 = 83.7% for the fixed effect model; Cohen's d = -0.00, 95% CI -0.18 to 0.17 and I2 = 82.4% for the random effects model). CONCLUSION QoL did not differ between breast cancer survivors eligible for mammographic screening at diagnosis and followed for >1-10 years and women with no history of breast cancer.
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Affiliation(s)
- N Moshina
- Cancer Registry of Norway, Section of Cancer Screening, P.O. 5313, Majorstuen, Oslo, 0304, Norway.
| | - R S Falk
- Oslo University Hospital, Oslo Centre for Biostatistics and Epidemiology, P.O. 4950, Nydalen, Oslo, 0424, Norway.
| | - S Hofvind
- Cancer Registry of Norway, Section of Cancer Screening, P.O. 5313, Majorstuen, Oslo, 0304, Norway; Department of Health and Care Sciences, UiT The Artic University of Norway, P.O. 6050, Tromsø, 9037, Norway.
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25
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Sella T, Snow C, Freeman H, Poorvu PD, Rosenberg SM, Partridge AH. Young, Empowered and Strong: A Web-Based Education and Supportive Care Intervention for Young Women With Breast Cancer Across the Care Continuum. JCO Clin Cancer Inform 2021; 5:933-943. [PMID: 34473546 DOI: 10.1200/cci.21.00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic. METHODS Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome-based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview. RESULTS Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms. CONCLUSION YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.
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Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Craig Snow
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Philip D Poorvu
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
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26
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Arneja J, Brooks JD. The impact of chronic comorbidities at the time of breast cancer diagnosis on quality of life, and emotional health following treatment in Canada. PLoS One 2021; 16:e0256536. [PMID: 34437611 PMCID: PMC8389459 DOI: 10.1371/journal.pone.0256536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Advances in breast cancer screening and treatment have led to an increasing number of breast cancer survivors. The objective of this study was to determine the impact of comorbidities on self-reported quality of life (QOL) and emotional health following a breast cancer diagnosis and treatment. METHODS Women with a personal history of breast cancer (N = 3,372) were identified from the cross-sectional Canadian Partnership Against Cancer (CPAC) Experiences of Cancer Patients in Transitions Survey. Multinomial (nominal) logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the relationship between burden of comorbidities and overall QOL and emotional health (very poor/poor, fair, good, very good). RESULTS Of the 3,372 participants, 57% reported at least one chronic condition at the time of breast cancer diagnosis. As the number of chronic conditions at diagnosis increased, the odds of reporting worse quality of life and emotional health following treatment also increased. Specifically, compared to women reporting very good QOL, for each additional chronic condition, women reported significantly higher odds of reporting good (OR = 1.22, 95% CI: 1.12, 1.32), fair (OR = 1.76, 95% CI: 1.58, 1.96), or poor/very poor (OR = 2.31, 95% CI: 1.86, 2.88) QOL. Similarly, for each additional comorbidity, women reported significantly higher odds of reporting good (OR = 1.17, 95% CI: 1.07, 1.28), fair (OR = 1.63, 95% CI: 1.46, 1.82), or poor/very poor (OR = 2.17, 95% CI: 1.81, 2.60) emotional health, relative to very good emotional health. CONCLUSION Breast cancer survivors coping with a high comorbidity burden experience worse overall QOL and emotional health following treatment. This highlights the importance of integrating information on comorbidities into survivorship care to improve the experience and overall outcomes of patients with complex needs.
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Affiliation(s)
- Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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27
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Mlakar I, Lin S, Aleksandraviča I, Arcimoviča K, Eglītis J, Leja M, Salgado Barreira Á, Gómez JG, Salgado M, Mata JG, Batorek D, Horvat M, Molan M, Ravnik M, Kaux JF, Bleret V, Loly C, Maquet D, Sartini E, Smrke U. Patients-centered SurvivorShIp care plan after Cancer treatments based on Big Data and Artificial Intelligence technologies (PERSIST): a multicenter study protocol to evaluate efficacy of digital tools supporting cancer survivors. BMC Med Inform Decis Mak 2021. [PMID: 34391413 DOI: 10.1186/isrctn97617326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is encouraging to see a substantial increase in individuals surviving cancer. Even more so since most of them will have a positive effect on society by returning to work. However, many cancer survivors have unmet needs, especially when it comes to improving their quality of life (QoL). Only few survivors are able to meet all of the recommendations regarding well-being and there is a body of evidence that cancer survivors' needs often remain neglected from health policy and national cancer control plans. This increases the impact of inequalities in cancer care and adds a dangerous component to it. The inequalities affect the individual survivor, their career, along with their relatives and society as a whole. The current study will evaluate the impact of the use of big data analytics and artificial intelligence on the self-efficacy of participants following intervention supported by digital tools. The secondary endpoints include evaluation of the impact of patient trajectories (from retrospective data) and patient gathered health data on prediction and improved intervention against possible secondary disease or negative outcomes (e.g. late toxicities, fatal events). METHODS/DESIGN The study is designed as a single-case experimental prospective study where each individual serves as its own control group with basal measurements obtained at the recruitment and subsequent measurements performed every 6 months during follow ups. The measurement will involve CASE-cancer, Patient Activation Measure and System Usability Scale. The study will involve 160 survivors (80 survivors of Breast Cancer and 80 survivors of Colorectal Cancer) from four countries, Belgium, Latvia, Slovenia, and Spain. The intervention will be implemented via a digital tool (mHealthApplication), collecting objective biomarkers (vital signs) and subjective biomarkers (PROs) with the support of a (embodied) conversational agent. Additionally, the Clinical Decision Support system (CDSS), including visualization of cohorts and trajectories will enable oncologists to personalize treatment for an efficient care plan and follow-up management. DISCUSSION We expect that cancer survivors will significantly increase their self-efficacy following the personalized intervention supported by the m-HealthApplication compared to control measurements at recruitment. We expect to observe improvement in healthy habits, disease self-management and self-perceived QoL. Trial registration ISRCTN97617326. https://doi.org/10.1186/ISRCTN97617326 . Original Registration Date: 26/03/2021.
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Affiliation(s)
- Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia.
| | - Simon Lin
- Data Science Department, Symptoma, Vienna, Austria.,Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ilona Aleksandraviča
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jānis Eglītis
- Riga East Clinical University Hospital, Riga, Latvia
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jesús G Gómez
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Jesús G Mata
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Matej Horvat
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Molan
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Ravnik
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | - Valérie Bleret
- Service of Sénologie, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | - Catherine Loly
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Didier Maquet
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | | | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia
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28
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Mlakar I, Lin S, Aleksandraviča I, Arcimoviča K, Eglītis J, Leja M, Salgado Barreira Á, Gómez JG, Salgado M, Mata JG, Batorek D, Horvat M, Molan M, Ravnik M, Kaux JF, Bleret V, Loly C, Maquet D, Sartini E, Smrke U. Patients-centered SurvivorShIp care plan after Cancer treatments based on Big Data and Artificial Intelligence technologies (PERSIST): a multicenter study protocol to evaluate efficacy of digital tools supporting cancer survivors. BMC Med Inform Decis Mak 2021; 21:243. [PMID: 34391413 PMCID: PMC8364016 DOI: 10.1186/s12911-021-01603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/05/2021] [Indexed: 12/09/2022] Open
Abstract
Background It is encouraging to see a substantial increase in individuals surviving cancer. Even more so since most of them will have a positive effect on society by returning to work. However, many cancer survivors have unmet needs, especially when it comes to improving their quality of life (QoL). Only few survivors are able to meet all of the recommendations regarding well-being and there is a body of evidence that cancer survivors’ needs often remain neglected from health policy and national cancer control plans. This increases the impact of inequalities in cancer care and adds a dangerous component to it. The inequalities affect the individual survivor, their career, along with their relatives and society as a whole. The current study will evaluate the impact of the use of big data analytics and artificial intelligence on the self-efficacy of participants following intervention supported by digital tools. The secondary endpoints include evaluation of the impact of patient trajectories (from retrospective data) and patient gathered health data on prediction and improved intervention against possible secondary disease or negative outcomes (e.g. late toxicities, fatal events). Methods/design The study is designed as a single-case experimental prospective study where each individual serves as its own control group with basal measurements obtained at the recruitment and subsequent measurements performed every 6 months during follow ups. The measurement will involve CASE-cancer, Patient Activation Measure and System Usability Scale. The study will involve 160 survivors (80 survivors of Breast Cancer and 80 survivors of Colorectal Cancer) from four countries, Belgium, Latvia, Slovenia, and Spain. The intervention will be implemented via a digital tool (mHealthApplication), collecting objective biomarkers (vital signs) and subjective biomarkers (PROs) with the support of a (embodied) conversational agent. Additionally, the Clinical Decision Support system (CDSS), including visualization of cohorts and trajectories will enable oncologists to personalize treatment for an efficient care plan and follow-up management. Discussion We expect that cancer survivors will significantly increase their self-efficacy following the personalized intervention supported by the m-HealthApplication compared to control measurements at recruitment. We expect to observe improvement in healthy habits, disease self-management and self-perceived QoL. Trial registration ISRCTN97617326. https://doi.org/10.1186/ISRCTN97617326. Original Registration Date: 26/03/2021.
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Affiliation(s)
- Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia.
| | - Simon Lin
- Data Science Department, Symptoma, Vienna, Austria.,Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ilona Aleksandraviča
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jānis Eglītis
- Riga East Clinical University Hospital, Riga, Latvia
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jesús G Gómez
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Jesús G Mata
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Matej Horvat
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Molan
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Ravnik
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | - Valérie Bleret
- Service of Sénologie, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | - Catherine Loly
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Didier Maquet
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | | | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia
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Martino ML, Lemmo D, Gargiulo A. A review of psychological impact of breast cancer in women below 50 years old. Health Care Women Int 2021; 42:1066-1085. [PMID: 34357855 DOI: 10.1080/07399332.2021.1901901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.
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Affiliation(s)
- Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Gargiulo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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Oei SL, Thronicke A, Kröz M, von Trott P, Schad F, Matthes H. Impact of Oncological Therapy and Viscum album L Treatment on Cancer-Related Fatigue and Internal Coherence in Nonmetastasized Breast Cancer Patients. Integr Cancer Ther 2021; 19:1534735420917211. [PMID: 32478590 PMCID: PMC7273755 DOI: 10.1177/1534735420917211] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction:Viscum album L extracts (VA) are frequently used in integrative
oncology. Aim of this study was to evaluate the impact of add-on VA applications
on various patient-reported outcome measures. Methods: A
longitudinal real-world study was conducted, using data from the Network
Oncology clinical registry. Primary, nonmetastasized breast cancer patients
treated with oncological standard therapy partly combined with VA applications
were included. Internal Coherence Cancer-related Fatigue, and EORTC QLQ-C30
questionnaires were assessed at baseline and 6, 12, and 24 months later.
Results: A total of 319 patients received standard oncological
therapy and 40% of them additionally VA applications. After 6 and 12 months for
patients treated with chemotherapy (Ctx) only a significant decline of the
thermo-coherence, and worsening of fatigue was observed. For patients receiving
VA applications but no Ctx, significant beneficial effects on thermo-coherence,
fatigue, and seven EORTC QLQ-C30 scales were observed 24 months later. Adjusted
multivariable long-term subgroup (n = 106) regression analysis
revealed that Ctx, immuno-, and endocrine therapies had a worsening of 17, 17,
and 6 point changes, respectively, for EORTC QLQ-C30 fatigue (P
= .0004), while VA applications showed an improvement of 12 point change. A
similar impact of improvement (add-on VA) and worsening (standard oncological
treatment regimens) on EORTC QLQ-C30 insomnia (P = .009) and
physical functioning (P = .005) were observed.
Conclusions: In the present real-world study, add-on VA
applications had a supportive effect on cancer-related fatigue, insomnia,
physical functioning, and thermo-coherence. Thus, VA applications might be
suited to alleviate symptom burden during anticancer therapy in breast cancer
patients.
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Affiliation(s)
| | | | - Matthias Kröz
- Research Institute Havelhöhe, Berlin, Germany.,Institute for Integrative Medicine, Witten/Herdecke, Germany
| | - Philipp von Trott
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.,Medical Clinic for Gastroenterology, CBF, Charité Universitätsmedizin Berlin, Berlin, Germany
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31
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Ooi PS, Draman N, Muhamad R, Yusoff SSM, Noor NM, Haron J, Hadi ISA. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021; 9:100351. [PMID: 34030061 PMCID: PMC8240344 DOI: 10.1016/j.esxm.2021.100351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a common complication among breast cancer patients following treatment. AIM To assess the prevalence and factors associated with FSD among breast cancer patients in Kelantan. METHODS This cross-sectional study recruited female patients, aged 18-65, who were married and sexually active with their partner, diagnosed with breast cancer, and had undergone breast surgery. Those with underlying psychiatry disorders, previous pelvic surgery, and husbands with sexual problems were excluded. The questionnaire contained demographic and clinical information, together with the Malay Version of the Breast Impact of Treatment Scale and the Malay Version of Female Sexual Distress Scale-Revised. Their sexual function was evaluated using the Malay Version of the Female Sexual Function Index-6. The data were analyzed with simple and multiple linear regressions. MAIN OUTCOME MEASURES The prevalence and associated factors for FSD in breast cancer patients. RESULTS Ninety-four eligible patients were recruited for this study. In total, 73.4% (n = 69) of the patients reported having sexual dysfunction. A family history of breast cancer (P = 0.040), duration of marriage (P = 0.046), and frequency of sexual intercourse (P = 0.002) were significant factors associated with FSD in breast cancer patients after surgery. CONCLUSION The significant associated factors shown to influence the FSD score include family history of breast cancer, duration of marriage, and frequency of sexual intercourse. About 73.4% of patients have risk of developing FSD after receiving breast cancer treatment. Siang OP, Draman N, Muhamad R, et al. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021;9:100351.
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Affiliation(s)
- Poh Siang Ooi
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Nani Draman
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia.
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Siti Suhaila Mohd Yusoff
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Juhara Haron
- Breast Cancer Awareness and Research Unit, Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
| | - Imi Sairi Ab Hadi
- Department of Surgery, Hospital Raja Perempuan Zainab II, Jalan Hospital, Kota Bharu, Kelantan, Malaysia
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32
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Efficacy and safety of ultra-low dose 0.005% estriol vaginal gel for the treatment of vulvovaginal atrophy in postmenopausal women with early breast cancer treated with nonsteroidal aromatase inhibitors: a phase II, randomized, double-blind, placebo-controlled trial. ACTA ACUST UNITED AC 2021; 27:526-534. [PMID: 32049923 PMCID: PMC7188038 DOI: 10.1097/gme.0000000000001497] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text Objective: To assess the efficacy and safety of ultra-low dose 0.005% estriol vaginal gel in women with breast cancer receiving nonsteroidal aromatase inhibitors (NSAIs) and experiencing treatment-related vulvovaginal symptoms and signs. Methods: Women with hormone receptor-positive early breast cancer receiving NSAIs were randomized to either estriol vaginal gel or placebo for 12 weeks. Vaginal maturation, vaginal pH, and total and individual scores of symptoms and signs of vulvovaginal atrophy were assessed at baseline and at weeks 3 and 12; sexual functioning was also evaluated using the Female Sexual Functioning Index (FSFI) questionnaire, as well as circulating estrogens, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Results: Sixty-one women with a mean age of 59 years were included: 50 received 0.005% estriol vaginal gel and 11 received placebo. Active treatment significantly improved maturation value and pH, vaginal dryness and global scores of symptoms and signs. Active treatment also increased the total FSFI score and all the FSFI domains, with the exception of pain. Small oscillations were observed in FSH and LH, which remained within the postmenopausal range. Estriol levels increased initially and normalized by week 12, and estradiol and estrone remained mostly undetectable throughout the study. Conclusions: Ultra-low dose 0.005% estriol vaginal gel showed efficacy in improving the symptoms and signs of vulvovaginal atrophy. These results, together with minimal oscillations in hormonal levels throughout the treatment, support the use of ultra-low dose 0.005% estriol vaginal gel as a treatment option for vulvovaginal atrophy in women with breast cancer receiving NSAIs with an indication for treatment with vaginal estrogens. Video Summary:
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33
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Jeng CJ, Hou MF, Liu HY, Wang LR, Chen JJ. Construction of an integrated sexual function questionnaire for women with breast cancer. Taiwan J Obstet Gynecol 2021; 59:534-540. [PMID: 32653125 DOI: 10.1016/j.tjog.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE With the increasing incidence of breast cancer in young women, its side effects have extended into the sexual lives of women. However, an appropriate tool to measure the sexual function is nonexistent. The aim of this study was to develop a suitable tool to measure sexual function in women with breast cancer. MATERIALS AND METHODS After conducting literature reviews regarding the sexual function characteristics of women with breast cancer, this study designed a set of integrated sexual function questionnaires, which included pertinent information and three scales. The validity of the scales was examined under the guidance of three gender studies experts and two gynecologists who are also professors. Regarding the construct validity, researchers conducted exploratory factor analysis on the measurement results of 196 women with breast cancer. RESULTS The integrated sexual function questionnaires included the following three scales: "Breasts' Role Self-Checklist," "Scales for Breasts' Role in the Foreplay," and "Female Sexual Function Scale for BCSs." The questionnaire tool consisted of the longitudinal time change, patients' and their partners' situation, information related to the recovery process, participants' perspective toward objectification of women's breasts, the role of breasts in foreplay during sexual activities, sexual desire, sexual satisfaction, sexual obstacle, and other self-evaluations. We first derived one factor from six questions in "Breasts' Role Self-Checklist" and named it as "The Importance of Breasts for Women." The other two factors were obtained from eight questions in "Scales for Breasts' Role in the Foreplay" and named as "Sexual Attraction to Breasts" and "Function of Breasts in Foreplay." In addition, three factors were derived from 16 questions in "Female Sexual Function Scale for BCSs" and named as "Sexual Desire," "Sexual Satisfaction," and "Sexual Obstacle." CONCLUSION This study determined that these integrated scales for breast cancer survivors are suitable due to their content validity, construct validity, and high internal consistency reliability, with a Cronbach's alpha of higher than 0.9 for all the three scales.
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Affiliation(s)
- Cherng-Jye Jeng
- Kaohsiung Medical University Hospital, Department of Obstetrics and Gynecology, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan; Kaohsiung Medical University, School of Medicine, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
| | - Ming-Feng Hou
- Kaohsiung Medical University Hospital, Department of Surgery, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan; Kaohsiung Medical University, Graduate Institute of Clinical Medicine, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
| | - Hsing-Yuan Liu
- Chang Gung University of Science and Technology, Department of Nursing, No. 261, Wenhua 1st Road, Guishan Dist., Taoyuan City 33303, Taiwan.
| | - Lih-Rong Wang
- National Taiwan University, Department of Social Work, No. 1, Section 4, Roosevelt Road, Taipei 106, Taiwan.
| | - Jian-Jhou Chen
- Kaohsiung Medical University, Department of Medical Sociology and Social Work, Taiwan; Kaohsiung Medical University Hospital, Department of Medical Research, Taiwan.
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34
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Mülkoğlu C, Ayhan F, Erel S. Sexual Functions and Quality of Life in Patients Developing Lymphedema After Total Mastectomy: A Pilot Study. Lymphat Res Biol 2021; 20:220-227. [PMID: 33646047 DOI: 10.1089/lrb.2020.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and without lymphedema after total mastectomy in terms of emotional state, sexual functions, and quality of life. We also investigated the factors affecting sexual functions in these patients. Methods: Married women 20-55 years of age, who presented to lymphedema polyclinic of Health Sciences University Ankara Training and Research Hospital after having undergone total mastectomy at least 1 year earlier owing to breast cancer were included. Twenty-five patients with lymphedema were assigned to the lymphedema group, and 20 without lymphedema to the control group. Hospital Anxiety and Depression Scale (HADS) was used to assess emotional state. We evaluated sexual functions of the participants by Female Sexual Function Index (FSFI) and quality of life with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QOL-C30). Results: There was no statistically significant difference in age and body mass index between the groups (p > 0.05). The mean HADS score was 13.4 ± 6.5 in lymphedema group and 13.4 ± 6.0 in control group. The groups were also similar in aspect of the HADS score (p > 0.05). FSFI and global health and physical function scores of EORTC QOL-C30 were statistically significantly lower in the lymphedema group (p < 0.05). A statistically significant correlation was found between FSFI and age and time elapsed postmenopause (p < 0.05, for both). Conclusion: We evaluated sexual functions of the patients who underwent mastectomy in this study. Although the HADS score is similar in patients with and without lymphedema, both sexual functions and quality of life are adversely affected in patients who undergo mastectomy and develop lymphedema. This study is important for investigating whether lymphedema developing after total mastectomy affects sexual functions of the patients.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
| | - Figen Ayhan
- Physical Medicine and Rehabilitation, Medicana International Hospital, Ankara, Turkey
| | - Serap Erel
- Department of General Surgery, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
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35
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Ganz PA, Bower JE, Partridge AH, Wolff AC, Thorner ED, Joffe H, Irwin MR, Petersen L, Crespi CM. Screening for Depression in Younger Breast Cancer Survivors: Outcomes From Use of the 9-item Patient Health Questionnaire. JNCI Cancer Spectr 2021; 5:pkab017. [PMID: 34164605 PMCID: PMC8216636 DOI: 10.1093/jncics/pkab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Major cancer organizations recommend depression screening in patients and survivors. The 9-item Patient Health Questionnaire (PHQ-9) is often suggested, with limited information about its use. Methods Enrollment data collected from younger breast cancer survivors participating in a behavioral intervention trial were used to examine the relationship between PHQ-9 scores (range = 0-27), patient characteristics, and responses to standardized psychosocial assessment tools. Major depressive disorder criterion was met if responses to the first 2 PHQ-9 items (range = 0-6) were 3 or greater. The sample was categorized by total PHQ-9 scores: less than 5 (minimal depressive symptoms), 5-9 (mild to moderate depressive symptoms), and 10 or greater (moderate to severe depression). PHQ-9 category associations with medical, demographic, psychosocial, and behavioral characteristics were examined using analysis of variance for continuous variables and χ2 tests for categorical variables. Results A total of 231 women met the study prescreening eligibility criterion of mild depressive symptoms and enrolled in the study. On average, they were 45.2 years old and 2.6 years since diagnosis. At enrollment, 22.1% met the screening criterion for possible major depressive disorder; among those with PHQ-9 scores of 10 or greater, 58.3% met this criterion. Anxiety, fatigue, insomnia, and intrusive thoughts about cancer were frequent and were associated with depressive symptom severity (all P < .001). In contrast, neither demographic nor cancer treatment characteristics were associated with depressive symptoms. Conclusions Depressive symptoms in this selected sample of younger breast cancer survivors were independent of demographic characteristics or cancer treatment history, suggesting that depression screening is necessary to detect uncontrolled depressive symptoms.
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Affiliation(s)
- Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Julienne E Bower
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Department of Psychology, UCLA, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa D Thorner
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Irwin
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Catherine M Crespi
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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36
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Aptecar L, Fiteni F, Jarlier M, Delaine S, Guillerme V, Jacot W, D'Hondt V. Prospective evaluation of sexual health in breast cancer women during the first year of adjuvant hormonal treatment using a cancer patient's dedicated questionnaire: A glaring gap of communication between health professionals and patients. Breast Cancer Res Treat 2021; 186:705-713. [PMID: 33452553 DOI: 10.1007/s10549-020-06062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Sexual quality of life (QoL) is affected during and after breast cancer (BC) treatment and is not specifically evaluated with the general health-related quality-of-life questionnaires EORTC QLQ-C30 or QLQ-BR23. A specific questionnaire, the EORTC SHQ-C22, including physical, psychological, and social aspects of sexuality, was recently developed to address this issue in cancer patients. METHODS A prospective bicentric study was conducted to evaluate the sexual QoL of women with BC during the first year of adjuvant hormonal treatment. RESULTS A total of 106 women completed the 3 questionnaires at baseline and 92 of them, at 12 months. At baseline, we showed low sexual satisfaction and importance given to sexual activity and a very low communication with healthcare professionals about this issue. Twelve months later, the importance given to sexuality had increased. While the communication with professionals had improved, it remained at a very low level. We were unable to identify specific clinical factors (chemotherapy, menopausal status, type of surgery or radiotherapy) that would negatively affect the global sexual well-being in BC patients. CONCLUSION The analysis of sexual QoL of BC patients during the first year of hormonal treatment with a recently developed, cancer-dedicated, standardized tool pointed out the need for deeper communication between professionals and patients regarding sexual issues to fill the current gap in care of cancer patients and help patients with adequate intervention and support.
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Affiliation(s)
- Leticia Aptecar
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | - Frederic Fiteni
- Medical Oncology Department, Centre Hospitalier Universitaire de Nimes, Nimes, France.,Institut Desbrest d'Epidemiologie et de Sante Publique, University of Montpellier, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit, Institut du Cancer de Montpellier, Montpellier, France
| | - Stephanie Delaine
- Medical Research Unit, Institut du Cancer de Montpellier, Montpellier, France
| | | | - William Jacot
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France.,Institut de Recherche en Cancerologie de Montpellier (IRCM), INSERM, University of Montpellier, Montpellier, France
| | - Veronique D'Hondt
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France. .,Institut de Recherche en Cancerologie de Montpellier (IRCM), INSERM, University of Montpellier, Montpellier, France.
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37
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Kim JHJ, Drake BL, Accortt EE, Pollin IS, Bairey Merz CN, Stanton AL. Younger Women Living with Chronic Disease: Comparative Challenges, Resiliencies, and Needs in Heart Disease and Breast Cancer. J Womens Health (Larchmt) 2021; 30:1288-1302. [PMID: 33428530 DOI: 10.1089/jwh.2020.8506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Younger women with chronic disease (<60 years of age), especially women with stereotypically "men's" heart disease (HD), are understudied. Unique difficulties may occur with HD, which is less commonly associated with women, compared with breast cancer (BC). Similarities may also exist across younger women, as chronic disease is less normative in younger people. Intersections of gender, age, and the specific disease experience require greater attention for improving women's health. This exploratory qualitative study compared younger women's experiences of HD or BC. Methods: Semistructured interviews with 20 women (n = 10 per disease) were analyzed using applied thematic analysis. Results: Amidst building careers, intimate relationships, and families, women felt thwarted by disease-related functional problems. Cognitive-behavioral coping strategies spurred resilience, including integrating the illness experience with self-identity. Barriers arose when medical professionals used representativeness heuristics (e.g., chronic disease occurs in older age). Important experiences in HD included worsened self-image from disability, negative impact of illness invisibility, and persisting isolation from lacking peer availability. Initial medical care reported by women with HD may reflect gender biases (e.g., HD missed in emergency settings and initial diagnostics). New information provided by the younger women includes limited illness-related optimism in women with HD facing age and gender stereotypes, as well as the advantages and disadvantages of peer availability in BC. Conclusions: Greater public awareness of younger women with chronic disease, alongside structural support and connection with similarly challenged peers, is suggested. As advocacy for BC awareness and action has strengthened over past decades, similar efforts are needed for younger women with HD.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Brittany L Drake
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Eynav E Accortt
- Department of Obstetrics and Gynecology and Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irene S Pollin
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences and University of California, Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
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38
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Nappi RE, Palacios S, Bruyniks N, Particco M, Panay N. The European Vulvovaginal Epidemiological Survey (EVES). Impact of history of breast cancer on prevalence, symptoms, sexual function and quality of life related to vulvovaginal atrophy. Gynecol Endocrinol 2021; 37:78-82. [PMID: 32856973 DOI: 10.1080/09513590.2020.1813273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Women with history of breast cancer (HBC) frequently suffer from vulvovaginal atrophy (VVA). European Vulvovaginal Epidemiology Survey (EVES) sub-analysis assesses the impact of HBC on VVA, sexual life and quality of life (QoL) in postmenopausal women. MATERIALS AND METHODS Women with at least one VVA symptom aged 45-75 years were included. EuroQol (EQ-5D-3L) and Day-to-Day Impact of Vaginal Aging (DIVA) questionnaires were filled to investigate QoL. VVA diagnosis was confirmed with objective gynecological examination. Comparison of postmenopausal women with and without HBC, and evaluation of treatment impact on VVA were performed. RESULTS 1985 postmenopausal women without HBC and 175 with HBC were included. VVA was confirmed in 90.4% of women without HBC and 91.4% of women with HBC. There were no differences in VVA symptoms severity or vulvovaginal discomfort between groups. However, women with HBC who had completed treatment and had surgery 11-20 years previously versus those without HBC presented significantly worse Vaginal Health Index scores, as well as a higher prevalence of VVA objective diagnosis, although their overall symptom severity score was lower. Health status and QoL comparisons were similar. CONCLUSIONS Results support a similar burden in terms of VVA prevalence and symptoms, QoL and sexual function in postmenopausal women with and without HBC.
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Affiliation(s)
- Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | | | | | | | - Nick Panay
- Queen Charlotte's & Chelsea and Westminster Hospitals, Imperial College London, London, UK
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39
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Fogh M, Højgaard A, Rotbøl CB, Jensen AB. The majority of Danish breast cancer survivors on adjuvant endocrine therapy have clinically relevant sexual dysfunction: a cross-sectional study. Acta Oncol 2021; 60:61-68. [PMID: 32869712 DOI: 10.1080/0284186x.2020.1813326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Impairments in sexual function are common among breast cancer survivors (BCSs), particularly in BCSs receiving adjuvant endocrine therapy (AET). Whether these impairments cause distress, thus qualifying for a more clinically relevant diagnosis of sexual dysfunction (SD), is inadequately described among BCSs and represents an important research gap. Hence, the primary aim of this study was to estimate the prevalence of clinically relevant SD, in this context: impairments with associated distress, and to identify factors associated with SD among BCSs on AET. Secondly, to explore the extent of distress caused by specific impairments in sexual function. MATERIALS AND METHODS In this cross-sectional study of BCSs on adjuvant treatment with endocrine therapy for at least three months, participants completed an online survey comprising standardized measures of sexual and psychosocial function. Female Sexual Function Index (FSFI) and Sexual Complaint Screener - Women (SCS-W) were used to asses clinically relevant SD. Multiple regression analyses were performed to identify factors significantly associated with SD. RESULTS In total, 333 BCSs with a mean age of 58.7 years were included in the study, of whom 227 were sexually active. Among sexually active BCSs, 134 (59%) met the criteria for having clinically relevant SD, of whom 78 (58%) perceived cancer treatment as the primary reason for their sexual problems. Factors associated with SD included vaginal dryness (adjusted OR= 2.25, 95% CI: 1.52-3.34, p < .01) and psychological well-being (adjusted OR= 1.11, 95% CI: 1.03-1.18, p < .01). Age was not related to neither prevalence of SD nor the level of distress caused by any impairment, with exception of low sexual desire. Pain in relation to intercourse was the most distressing impairment. CONCLUSION SD was highly prevalent among sexually active BCSs on AET. Sexual health is important to address independent of the woman's age.
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Affiliation(s)
- Mia Fogh
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Højgaard
- Sexological Centre, Aalborg University Hospital, Aalborg, Denmark
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Quality of life after autologous fat transfer additional to prosthetic breast reconstruction in women after breast surgery: A systematic review. Eur J Surg Oncol 2020; 47:772-777. [PMID: 33243607 DOI: 10.1016/j.ejso.2020.10.021] [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: 06/19/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequent form of cancer among women worldwide. Reconstructive surgery may improve the quality of life (QoL), after mastectomy. Various techniques are used to reconstruct the female breast; however, few is known about its specific post-surgery influence represented in patient-reported outcomes. OBJECTIVE This systematic review assesses the difference in patient-reported QoL between prosthetic reconstruction alone, and prosthetic reconstruction with additional autologous fat transfer (AFT). DATA SOURCES A literature search was performed in PubMed, Embase, Cochrane and CINAHL online databases from inception to February 11th, 2020. STUDY SELECTION Inclusion and exclusion criteria were used to assess the eligibility of the retrieved articles. The only eligible studies were cohort studies. DATA COLLECTION AND ANALYSIS Relevant data for the research question was extracted from the articles and systematically documented. Results not contributing to answering the objective were intentionally left out. No meta-analysis was realized. RESULTS This systematic review resulted in the inclusion of only six relevant studies, all cohort studies, consisting of 1437 unique patients. These studies evaluated the quality of life of patients by means of the validated BREAST-Q questionnaire. Outcomes varied for which reason no definite answer could be provided to whether additional AFT results in a higher QoL. CONCLUSIONS It is unclear whether additional AFT after prosthetic surgery leads to a higher QoL when compared to sole prosthetic reconstruction or not. Additional studies, assessing the QoL of patients who received additional AFT, are required to draw solid conclusions. LEVEL OF EVIDENCE Level III; systematic literature review of cohort studies.
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Culbertson MG, Bennett K, Kelly CM, Sharp L, Cahir C. The psychosocial determinants of quality of life in breast cancer survivors: a scoping review. BMC Cancer 2020; 20:948. [PMID: 33008323 PMCID: PMC7531081 DOI: 10.1186/s12885-020-07389-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Breast cancer care today involves state-of-the-art biomedical treatment but can fail to address the broader psychosocial and quality-of-life (QoL) issues associated with the transition to breast cancer survivorship. This scoping review examines the evidence on the influence of psychosocial determinants on QoL in breast cancer survivors. Methods Scoping review methodology was used to: (1) identify the research question(s); (2) identify relevant studies; (3) undertake study selection; (4) extract data; (5) collate, summarise and report the results. Results A total of 33 studies met the inclusion criteria. The majority of studies were conducted in the US (n = 22, 67%) and were mainly cross-sectional (n = 26, 79%). Sixteen psychosocial determinants of QoL were identified. Social support (n = 14, 42%), depression (n = 7, 21%) and future appraisal and perspective (n = 7, 21%) were the most frequently investigated determinants. Twelve different QoL measures were used. A range of different measurement tools were also used per psychosocial determinant (weighted average = 6). The 14 studies that measured the influence of social support on QoL employed 10 different measures of social support and 7 different measures of QoL. In general, across all 33 studies, a higher level of a positive influence and a lower level of a negative influence of a psychosocial determinant was associated with a better QoL e.g. higher social support and lower levels of depression were associated with a higher/better QoL. For some determinants such as spirituality and coping skills the influence on QoL varied, but these determinants were less commonly investigated. Conclusion Consensus around measures of QoL and psychological determinants would be valuable and would enable research to determine the influence of psychosocial determinants on QoL adequately. Research in other healthcare settings beyond the US is required, in order to understand the influence of organisation and follow-up clinical and supportive care on psychosocial determinants and QoL and to improve the quality of care in breast cancer survivors.
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Affiliation(s)
- Michael G Culbertson
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street, Dublin, 2, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street, Dublin, 2, Ireland
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, UK
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street, Dublin, 2, Ireland.
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Montagna E, Pagan E, Bagnardi V, Colleoni M, Cancello G, Munzone E, Dellapasqua S, Bianco N, Campennì G, Iorfida M, Mazza M, De Maio A, Veronesi P, Sangalli C, Scateni B, Pettini G, Pravettoni G, Mazzocco K, Galimberti V. Evaluation of endocrine therapy and patients preferences in early breast cancer: results of Elena study. Breast Cancer Res Treat 2020; 184:783-795. [PMID: 32929568 DOI: 10.1007/s10549-020-05900-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The development of the adjuvant therapy requires that clinicians and patients should discuss the magnitude of benefit of treatment for individual patient, estimating the pros and cons and the personal preferences. The aim of the present study was to determine the preferences of women treated with adjuvant hormonal therapy (HT) for breast cancer. METHODS The analyses were conducted into three different groups of early breast cancer patients to evaluate the survival benefit needed to make treatment worthwhile before starting HT (A), after a few months from the beginning (B) and after several years of HT (C). The questionnaires, showing hypothetical scenarios based on potential survival times and rates without HT, were used to determine the lowest gains women judged necessary to make the treatment worthwhile. RESULTS A total of 452 patients were included in the study: 149 in group A, 150 in group B and 153 in group C. In group C, 65% of patients were receiving HT with aromatase inhibitors (with or without a LHRH analogue). In the groups A, B, C 8%, 20% and 26%, respectively, received adjuvant chemotherapy. Overall, 355 women (79%) had children. The responses were quite similar between the three groups. A median gain of 10 years was judged necessary to make adjuvant HT worthwhile based on the hypothetical scenario of untreated mean survival time of 5 and 15 years. Median gain of 20% more women surviving was judged necessary to make adjuvant HT worthwhile based on an untreated 5-year survival rate expectation of 60%. Cognitive dysfunction was considered the side effect least compatible with the continuation of treatment in all three groups. CONCLUSIONS This is a large study of patient preferences on HT. Compared with other studies with similar design, the patients included in the present study required larger benefits to make adjuvant therapy worthwhile.
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Affiliation(s)
- E Montagna
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - E Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - M Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Cancello
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Munzone
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - S Dellapasqua
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - N Bianco
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Campennì
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Iorfida
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Mazza
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - A De Maio
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - P Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Sangalli
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - B Scateni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Leser C, Tan YY, Singer C, Zeillinger R, Fitzal F, Lehrner J, König D, Deutschmann C, Gschwantler-Kaulich D. Patient satisfaction after breast cancer surgery : A prospective clinical trial. Wien Klin Wochenschr 2020; 133:6-13. [PMID: 32880714 PMCID: PMC7840629 DOI: 10.1007/s00508-020-01730-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study investigated the impact of curative breast cancer surgery on patient satisfaction concerning cosmetic results and quality of life (QoL). METHODS In this study 61 participants completed questionnaires to evaluate their QoL and patient satisfaction with cosmetic results following breast cancer surgery. Cosmetic outcomes were evaluated by the breast surgeon and an independent breast specialist using the Harris scale and the breast analyzing tool (BAT). RESULTS Of the participants 71% completed all 4 follow-up visits, 38 (62%) patients received breast-conserving therapy (BCT) and 23 (38%) received a mastectomy. Surgery-associated complications arose in 2.6% of the patients who received BCT and 17.4% of patients who received a mastectomy. No significant differences in QoL between BCT patients and mastectomy patients were observed immediately after surgery, or after 6 and 12 months. Breast asymmetry, measured using the BAT score, and QoL scores were worst immediately after surgery. The surgeon rated the cosmetic results as better compared to the independent breast expert (p = 0.001). Furthermore, patients aged over 60 years old were less satisfied with the cosmetic outcome compared to younger patients at the time of discharge (p = 0.024). Patients who received a mastectomy were less satisfied when the resected volume was higher. CONCLUSION Patient satisfaction was lowest immediately after surgery but improved during the following months, despite continued breast asymmetry. For mastectomy patients, a lower resected volume led to a higher satisfaction with cosmetic results. Satisfaction is subjective and cannot be determined from the esthetic satisfaction of the surgeon or using an objective tool measuring breast asymmetry.
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Affiliation(s)
- Carmen Leser
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Yen Y Tan
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christian Singer
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Robert Zeillinger
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Ferreira AR, Di Meglio A, Pistilli B, Gbenou AS, El-Mouhebb M, Dauchy S, Charles C, Joly F, Everhard S, Lambertini M, Coutant C, Cottu P, Lerebours F, Petit T, Dalenc F, Rouanet P, Arnaud A, Martin A, Berille J, Ganz PA, Partridge AH, Delaloge S, Michiels S, Andre F, Vaz-Luis I. Differential impact of endocrine therapy and chemotherapy on quality of life of breast cancer survivors: a prospective patient-reported outcomes analysis. Ann Oncol 2020; 30:1784-1795. [PMID: 31591636 DOI: 10.1093/annonc/mdz298] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In early breast cancer (BC), there has been a trend to escalate endocrine therapy (ET) and to de-escalate chemotherapy (CT). However, the impact of ET versus CT on the quality of life (QoL) of early BC patients is unknown. Here, we characterize the independent contribution of ET and CT on patient-reported outcomes (PROs) at 2 years after diagnosis. PATIENTS AND METHODS We prospectively collected PROs in 4262 eligible patients using the European Organization for Research and Treatment of Cancer QLQ-C30/BR23 questionnaires inside CANTO trial (NCT01993498). The primary outcome was the C30 summary score (C30-SumSc) at 2 years after diagnosis. RESULTS From eligible patients, 37.2% were premenopausal and 62.8% postmenopausal; 81.9% received ET and 52.8% CT. In the overall cohort, QoL worsened by 2 years after diagnosis in multiple functions and symptoms; exceptions included emotional function and future perspective, which improved over time. ET (Pint = 0.004), but not CT (Pint = 0.924), had a persistent negative impact on the C30-SumSc. In addition, ET negatively impacted role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms and further limited emotional function and future perspective recovery. Although CT had no impact on the C30-SumSc at 2-years it was associated with deteriorated physical and cognitive function, dyspnea, financial difficulties, body image and breast symptoms. We found a differential effect of treatment by menopausal status; in premenopausal patients, CT, despite only a non-significant trend for deteriorated C30-SumSc (Pint = 0.100), was more frequently associated with QoL domains deterioration than ET, whereas in postmenopausal patients, ET was more frequently associated with QoL deterioration, namely using the C30-SumSc (Pint = 0.004). CONCLUSION(S) QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation.
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Affiliation(s)
- A R Ferreira
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - A Di Meglio
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
| | - B Pistilli
- Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
| | - A S Gbenou
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
| | - M El-Mouhebb
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
| | - S Dauchy
- Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
| | - C Charles
- Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
| | - F Joly
- Medical Oncology, Centre François Baclesse Caen, Caen
| | | | - M Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C Coutant
- Surgical Oncology, Centre Georges-François Leclerc, Dijon
| | - P Cottu
- Medical Oncology, Institut Curie, Paris
| | - F Lerebours
- Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud
| | - T Petit
- Department of Medicine, Paul Strauss Cancer Center and University of Strasbourg, Strasbourg
| | - F Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer - Oncopole, Toulouse
| | - P Rouanet
- Surgical Oncology, C.R.L.C Val d'Aurelle, Montpellier
| | - A Arnaud
- Radiotherapy Department, Clinique Sainte Catherine Avignon, Avignon
| | | | - J Berille
- Ministry of Higher Education and Research, Ministere de l'Enseignement Superieur et de la Recherche, Paris, France
| | - P A Ganz
- Medical Oncology, Ronald Reagan UCLA Medical Center, Los Angeles
| | - A H Partridge
- Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - S Delaloge
- Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
| | - S Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif; CESP, INSERM, U1018 ONCOSTAT, Université Paris-Saclay, Univ. Paris-Sud, Villejuif, France
| | - F Andre
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
| | - I Vaz-Luis
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif.
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Oei SL, Thronicke A, Matthes H, Schad F. Evaluation of the effects of integrative non-pharmacological interventions on the internal coherence and resilience of breast cancer patients. Support Care Cancer 2020; 29:1413-1421. [PMID: 32671562 DOI: 10.1007/s00520-020-05617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE In the breast cancer center at the Gemeinschaftskrankenhaus Havelhöhe (GKH), integrative strategies are implemented in the routine care of breast cancer patients. The aim of this breast cancer real-world study was to systematically evaluate changes in patients' internal coherence and resilience, associated with the use of non-pharmacological interventions (NPIs). METHODS This study included 231 primary breast cancer patients treated with standard oncological therapy and NPIs, which comprise art and movement therapies, nursing interventions, and educational components, and had answered the internal coherence scale (ICS) questionnaire at first diagnosis and 12 months later. Data were collected from the Network Oncology clinical registry of the GKH, and effects of NPIs on ICS changes were analyzed with adjusted linear multivariable regression analyses, using the software R. RESULTS Two hundred twenty breast cancer patients of all tumor stages were eligible for a total of 27 separate adjusted multivariable linear regression analyses. The NPIs elaborate consultations and life review (ECLR); nursing compresses, music therapy, and rhythmic massages were significantly associated with increases of about 2-point changes in inner resilience and coherence (p < 0.05). Furthermore, a significant association with an elevation of the thermo coherence was observed for the application of nursing compresses. CONCLUSIONS The evaluation of real-world data carried out here shows that the application of the multimodal treatment concept can lead to an enhancement of the internal coherence and resilience in breast cancer patients. To improve the care of cancer patients, this multimodal program should be further expanded into routine clinical practices. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics and Medical Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Fernández de Larrea-Baz N, Pérez-Gómez B, Guerrero-Zotano Á, Casas AM, Bermejo B, Baena-Cañada JM, Antolin S, Sánchez-Rovira P, Ramos Vázquez M, Garcia-Sáenz JÁ, Antón A, Muñoz M, de Juan A, Jara C, Chacón JI, Arcusa A, Gil-Gil M, Adrover E, Oltra A, Brunet J, González S, Bezares S, Lope V, Martín M, Pollán M. Primary breast cancer and health related quality of life in Spanish women: The EpiGEICAM case-control study. Sci Rep 2020; 10:7741. [PMID: 32385335 PMCID: PMC7211017 DOI: 10.1038/s41598-020-63637-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/02/2020] [Indexed: 01/06/2023] Open
Abstract
This study evaluates the impact of breast cancer (BC) in health related quality of life (HRQL) and in psychological distress (PD) during the initial phases of the disease and looks for contributing factors. A multicentric case-control study, EpiGEICAM, was carried out. Incident BC cases and age- and residence- matched controls were included. Clinical, epidemiological, HRQL (SF-36) and PD information (GHQ-28) was collected. We used multivariable logistic regression models to estimate OR of low HRQL and of PD in cases compared to controls, and to identify factors associated with low HRQL and with PD. Among 896 BC cases and 890 control women, cases had poorer scores than both, the reference population and the control group, in all SF-36 scales. BC women with lower education, younger, active workers, never smokers, those with comorbidities, in stage IV and with surgical treatment had lower physical HRQL; factors associated with low mental HRQL were dissatisfaction with social support, being current smoker and having children. Cases had a fivefold increased odds of PD compared to controls. Managing comorbidities and trying to promote social support, especially in younger and less educated women, could improve well-being of BC patients.
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Affiliation(s)
- Nerea Fernández de Larrea-Baz
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Ángel Guerrero-Zotano
- Medical Oncology Unit, Instituto Valenciano de Oncología, C/Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Ana María Casas
- Medical Oncology Unit, Hospital Virgen del Rocío, Avenida de Manuel Siurot s/n, 41013, Sevilla, Spain
| | - Begoña Bermejo
- Medical Oncology Unit, Hospital Clínico / INCLIVA, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - José Manuel Baena-Cañada
- Medical Oncology Unit, Hospital Universitario Puerta del Mar, Avenida Ana de Viya, 21, 11009, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz/Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Silvia Antolin
- Medical Oncology Unit, Complejo Hospitalario Universitario A Coruña, Jubias de Arriba, 84, 15006, A Coruña, Spain
| | - Pedro Sánchez-Rovira
- Medical Oncology Unit, Complejo Hospitalario de Jaén, Avenida del Ejército Español, 10, 23007, Jaén, Spain
| | - Manuel Ramos Vázquez
- Medical Oncology Unit, Centro Oncológico de Galicia, Doctor Camilo Veiras, 1, 15009, A Coruña, Spain
| | - José Ángel Garcia-Sáenz
- Medical Oncology Unit, Hospital Clínico Universitario San Carlos, Profesor Martín Lagos, S/N, 28040, Madrid, Spain
| | - Antonio Antón
- Medical Oncology Unit, Hospital Universitario Miguel Servet, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain
| | - Montserrat Muñoz
- Medical Oncology Unit, Hospital Clinic i Provincial, C/Villarroel, 170, 08036, Barcelona, Spain
- Translational Genomics and Targeted Therapeutics, Institut d'Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, Barcelona, Spain
| | - Ana de Juan
- Medical Oncology Unit, Hospital Marqués de Valdecilla, Avenida Valdecilla, 25, 39008, Santander, Spain
| | - Carlos Jara
- Medical Oncology Unit, Hospital Universitario Fundación Alcorcón-Universidad Rey Juan Carlos, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - José Ignacio Chacón
- Medical Oncology Unit, Hospital Virgen de la Salud, Avenida Barber, 30, 45004, Toledo, Spain
| | - Angels Arcusa
- Medical Oncology Unit, Consorci Sanitari de Terrassa, Carretera Torrebonica, S/N, 08227, Terrassa, Spain
| | - Miguel Gil-Gil
- Medical Oncology Unit, Instituto Catalán de Oncología, Avenida Granvia de l'Hospitalet, 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | - Encarna Adrover
- Medical Oncology Unit, Hospital General de Alicante/Complejo Hospitalario Universitario de Albacete, C/Pintor Baeza, 12, 03010, Alicante, Spain
| | - Amparo Oltra
- Medical Oncology Unit, Hospital Virgen de los Lirios, Polígono de Caramanchel, S/N, 03804, Alcoy, Alicante, Spain
| | - Joan Brunet
- Medical Oncology Unit, Instituto Catalán de Oncología, Avenida de França, S/N, 17007, Girona, Spain
| | - Sonia González
- Medical Oncology Unit, Hospital Mutua Terrassa, Plaça Dr. Robert, 5, 08221, Terrassa, Spain
| | - Susana Bezares
- GEICAM Spanish Breast Cancer Group, Avenida de los Pirineos, 7, 28703, San Sebastián de los Reyes, Madrid, Spain
| | - Virginia Lope
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Miguel Martín
- Medical Oncology Unit, Instituto de Investigación Sanitaria Gregorio Marañón, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
- Consortium for Biomedical Research in Oncology (CIBERONC-ISCIII), Madrid, Spain
| | - Marina Pollán
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
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Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors. J Cancer Surviv 2020; 14:607-613. [PMID: 32323140 DOI: 10.1007/s11764-020-00857-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study sought to evaluate the prevalence of menopausal symptoms in a population of reproductive-aged women remote from cancer therapy compared with a group of healthy similar-aged controls and with a cohort of late reproductive-aged (LR) controls. METHODS Participants were assessed for symptoms of menopause, early follicular phase hormones, and ultrasound examinations. Menopausal symptoms were analyzed in exposed participants and controls using χ2 analyses, Wilcoxon-Mann Whitney tests, and multivariable logistic regression models. RESULTS One hundred seventy cancer survivors, 135 similar-aged controls, and 71 LR controls were followed prospectively for an average of 38 months. Compared with similar-aged controls, a greater proportion of survivors reported vasomotor symptoms at some point over the study period (35% vs 19%, p < 0.01), and this proportion was similar to LR controls (44%, p = 0.22). Survivors were more likely to be bothered by vaginal dryness (27%) than similar-aged controls (16%, p = 0.02) or LR controls (14%, p = 0.02). FSH levels were 38.4% higher in those with vasomotor symptoms compared with those without symptoms (p = 0.021). CONCLUSIONS Reproductive-aged cancer survivors have a higher prevalence of vasomotor symptoms and vaginal dryness than their similar-aged peers. IMPLICATIONS FOR CANCER SURVIVORS Providers should be attuned to the high prevalence of menopausal symptoms in cancer survivors.
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Casaubon JT, Kuehn RB, Pesek SE, Raker CA, Edmonson DA, Stuckey A, Gass JS. Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy. J Am Coll Surg 2020; 230:990-998. [PMID: 32272205 DOI: 10.1016/j.jamcollsurg.2020.02.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND We demonstrated previously that lumpectomy (L) patients reported higher appearance satisfaction, appreciation of a pleasurable breast caress, and persistence of the breast during intimacy than mastectomy with reconstruction, which we used to describe breast-specific sensuality. Our current objective was to compare breast-specific sensuality between L and nipple-sparing mastectomy (NSM). DESIGN An anonymous, cross-sectional survey was distributed to breast cancer survivors between 2014 and 2016. Eligible patients underwent operation between 2000 and 2014, were adults older than 18 years, English-speaking, and at least one year into the post-operative period. Demographic characteristics, treatment details, Female Sexual Function Index metrics, and investigator-generated questions about appearance satisfaction and breast-specific sensuality were collected. RESULTS Of the 600 women who participated, 585 surveys were eligible. Surgical modality was reported as L by 406 (69.4%), mastectomy alone by 50 (8.5%), and mastectomy with reconstruction by 129 (22.1%). Nipple-preservation data were available for 47 of 129 mastectomy with reconstruction patients (36.4%), with 21 NSM and 26 non-nipple-sparing mastectomy patients. Favorable postoperative appearance satisfaction was reported by 76.2% of L and 71.4% of NSM (p = 0.039). Lumpectomy patients reported feeling more comfortable being seen undressed than NSM patients (82.4% vs 71.4%; p = 0.0003). The chest remained a part of intimacy for 65.4% of L patients vs 42.9% of NSM patients (p = 0.0009). A pleasurable breast caress was reported more frequently by L patients than NSM patients (66.2% vs 20%; p ≤ 0.0001). The breast caress was unpleasant for 40% of NSM patients, nearly 4-fold higher than L patients (11.3%; p < 0.0001). CONCLUSIONS NSM patients were significantly less satisfied with appearance, less comfortable being seen undressed, had decreased persistence of breast intimacy, and experienced a less pleasurable breast caress than L patients. Counseling patients about these findings will empower informed decision making, optimize expectations, and can enhance postoperative satisfaction.
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Affiliation(s)
- Jesse T Casaubon
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
| | - Reed B Kuehn
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Sarah E Pesek
- Breast Surgery, St Peter's Health Partners, Albany, NY
| | - Christina A Raker
- Division of Research, Women & Infants Hospital of Rhode Island, Providence, RI
| | - David A Edmonson
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Ashley Stuckey
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Jennifer S Gass
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
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49
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Reese JB, Zimmaro LA, Lepore SJ, Sorice KA, Handorf E, Daly MB, Schover LR, Kashy D, Westbrook K, Porter LS. Evaluating a couple-based intervention addressing sexual concerns for breast cancer survivors: study protocol for a randomized controlled trial. Trials 2020; 21:173. [PMID: 32051002 PMCID: PMC7014745 DOI: 10.1186/s13063-019-3975-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes. Methods This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4). Discussion Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation. Trial registration ClinicalTrials.gov, NCT03930797. Registered on 24 April 2019.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Lauren A Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, Philadelphia, PA, 19122, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Leslie R Schover
- Will2Love LLC, 1333 Old Spanish Trail, Suite G, #134, Houston, TX, 77054, USA
| | - Deborah Kashy
- Department of Psychology, Michigan State University, 316 Physics Road, Room 262, East Lansing, MI, 48824, USA
| | - Kelly Westbrook
- Department of Medicine-Oncology, Duke University Medical Center, DUMC 3459, Durham, NC, 27710, USA
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, DUMC 90399, Durham, NC, 27708, USA
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50
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Bräutigam E, Schratter-Sehn A, Kottmel A, Bitzer J, Teleky B, Ucsnik L. Do radiation oncologists talk about sexual health and dysfunction with their cancer patients? Results of the igls-vienna-sexmed-survey. Clin Transl Radiat Oncol 2020; 21:120-126. [PMID: 32090176 PMCID: PMC7025189 DOI: 10.1016/j.ctro.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/12/2020] [Accepted: 01/24/2020] [Indexed: 01/07/2023] Open
Abstract
Background and purpose The aim of this survey was to invite radiation oncologists to self-assess whether sexual health care and sexual dysfunction are an issue in daily routine. Materials and Methods At the annual congress of the Austrian Society of Radiation Oncology in 2017 doctors were asked about their care for sexual health in cancer patients by using questionnaires. No exclusion criteria were employed. Forty-one questionnaires were answered and statistically analysed so 44.5% of doctors participated. Results Only 4.9% of the participants self-assessed to routinely explore sexual health issues in 61-80% of their patients. Thirty-one point seven percent of the doctors suspected sexual problems in about half of their patients but did not raise the issue. The most common reason for not raising sexual issues by the patients was assumed by the doctors "other problems are more important" (73.2%), followed by "lack of time" (36.6%). Participants were also asked about additional medical qualifications: none of the physicians had training in sexual medicine. Conclusion The main reason for not talking about sexual problems was the impression of the participating doctors that other problems were more important for the patients. Another reason for not bringing up the topic of sexual issues by the patients was assumed by the doctors: lack of time. As doctor shortage is a problem in the observed country other kind of networks and counselling possibilities should be evaluated. An interesting finding was that survey participants show a higher awareness for male sexual problems than for female issues.
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Affiliation(s)
- E Bräutigam
- Department for Radiation-Oncology, Ordensklinikum Barmherzige Schwestern, Linz, Austria
| | - A Schratter-Sehn
- Institute for Radiation-Oncology, Kaiser Franz Josef Spital, SMZ-Süd, Vienna, Austria
| | - A Kottmel
- Private Practice for Gynecology and Sexual Medicine, Vienna, Austria
| | - J Bitzer
- Private Practice for Gynecology, Basel, Switzerland
| | - B Teleky
- Department for Visceral Surgery, Medical University Vienna, Austria
| | - L Ucsnik
- Department for Visceral Surgery, Medical University Vienna, Austria
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