1
|
Sarang B, Bhandarkar P, Parsekar SS, Patil P, Venghateri JB, Ghoshal R, Veetil DK, Shah P, Gadgil A, Roy N. Concerns and coping mechanisms of breast cancer survivor women from Asia: a scoping review. Support Care Cancer 2023; 31:528. [PMID: 37597043 PMCID: PMC10439845 DOI: 10.1007/s00520-023-07996-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: 03/23/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by the patient's cultural beliefs and social systems. This scoping review aims to summarise concerns and coping mechanisms of women with breast cancer in Asia and understand gaps in the existing literature. METHODS We performed a scoping review using the population-concept-context strategy. A systematic search of MEDLINE (PubMed, Web of Science), CINAHL, SCOPUS, and Embase was conducted for studies conducted in Asia on women diagnosed with breast cancer, identifying their concerns and coping mechanisms, published between January 2011 and January 2021. Data from included studies were reported using frequencies and percentages. RESULTS We included 163 studies, of which most (81%) were conducted in hospital settings. Emotional and psychological concerns were reported in 80% of studies, followed by physical appearance and body-image concerns in 46%. Social support (59%), emotion-based coping (46%), spirituality, and problem-based coping (37%) were the major coping systems documented. CONCLUSION The mapped literature documented that anxiety, depression, and fear of cancer recurrence dominated women's emotional concerns. Women coped with the help of social support, positive reappraisal, and faith in God and religion. Sensitization of caregivers, including healthcare professionals and family members, to context-specific concerns and inquiry into the patients' available support systems is essential in strengthening breast cancer women's recovery and coping.
Collapse
Affiliation(s)
- Bhakti Sarang
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- Department of Surgery, Terna Medical College & Hospital, New Mumbai, India
| | - Prashant Bhandarkar
- Department of Statistics, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, BARC Hospital, Mumbai, India
- Tata Institute of Social Sciences, Mumbai, India
| | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Priti Patil
- Department of Statistics, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, BARC Hospital, Mumbai, India
| | | | - Rakhi Ghoshal
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- CARE India, Patna, Bihar, India
| | - Deepa Kizhakke Veetil
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- Department of Surgery, Manipal Hospital, Delhi, India
| | - Priyansh Shah
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Anita Gadgil
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India.
- Research Affiliate, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
2
|
Pakistani healthcare professionals' perceptions of communication with patients and their relatives about hereditary breast cancer: a qualitative study in a LMIC. J Community Genet 2023:10.1007/s12687-023-00639-x. [PMID: 36821042 DOI: 10.1007/s12687-023-00639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
Pakistan has the highest incidence and mortality rates of breast cancer in Asia, with high numbers of patients diagnosed at a young age suggesting the possibility of an inherited cancer syndrome. Communication of hereditary breast cancer (HBC) risk information with patients could enable earlier detection of the condition in relatives and reduce mortality rates. This study aimed to explore perceptions of healthcare professionals (HCPs) in Pakistan about communication with patients and their relatives about HBC. Semi-structured qualitative interviews were conducted with eighteen HCPs during March to May 2020 in Lahore. Thematic analysis shows the HCPs were generally supportive of informing patients themselves about HBC, but believed it was the patients' role to inform their relatives. HCPs also highlighted important barriers to communication with patients about HBC, including (i) patients' low socioeconomic status and educational attainment; (ii) high prevalence of the social stigma of breast cancer; and (iii) lack of health resources and facilities to provide genetic testing for HBC. In conclusion, HCPs would value the development of interventions to support communication between HCPs and patients. They also highlighted the need for interventions to support intrafamilial communication about HBC. Much research and political support are needed to address patient, social, and systemic-level barriers to facilitate communication about HBC.
Collapse
|
3
|
Rehman S, Nagarajan JS, Ghafoor B, Qureshi MH, Shahrukh S. Invasive Lobular Carcinoma in Premenopausal Woman: A Delayed Diagnosis Due to Socio-Cultural Factors Prevalent in Pakistan. Cureus 2022; 14:e24766. [PMID: 35677012 PMCID: PMC9167430 DOI: 10.7759/cureus.24766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
A 41-year-old premenopausal woman presented to the outpatient department with a diagnosis of invasive lobular carcinoma. She noticed a lump a year back but did not seek medical attention due to many socio-cultural factors prevalent in Pakistan that prevent her from seeking medical attention earlier. She came in for a check-up after increasing in size of the lump. The bilateral mammogram showed large areas of asymmetrical density in the left upper quadrant. It was followed by an ultrasound-guided biopsy which confirmed the diagnosis of invasive lobular carcinoma. Due to stage 3, it was recommended to have CT and an MRI of the breast to assess the extent of the disease. Tissue immunohistochemistry was also requested, which came back as ER-positive, PR-positive, and HER2/neu negative. MRI of the breast revealed a 4.2 x 3.3cm heterogeneously enhancing asymmetric mass-like enhancement area within the left breast outer quadrant with an adjacent spiculated nodular lesion measuring 2.2 cm. CT chest/abdomen/pelvis with contrast showed left breast with minimal parenchymal asymmetry and a small 9 mm node seen in the left axilla. There was no evidence of metastasis. The patient was started on neoadjuvant therapy to minimize systemic disease, followed by mastectomy. This case highlights socio-cultural factors prevalent in Pakistan that lead to delays in the diagnosis and treatment of invasive lobular carcinoma. The outcome had been better if the patient sought medical attention sooner at an earlier stage. We also propose strategies to raise awareness in Pakistan for the timely diagnosis and treatment of breast cancer.
Collapse
|
4
|
Rizvi F, Shaukat L, Azhar A, Jafri A, Aslam U, Imran-ul-Haq H. Preclinical meritorious anticancer effects of Metformin against breast cancer: An In vivo trial. J Taibah Univ Med Sci 2021; 16:504-512. [PMID: 34408607 PMCID: PMC8348326 DOI: 10.1016/j.jtumed.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This research aims to evaluate the preclinical meritorious and anticancer effects of Metformin in a Xenograft model of breast cancer. METHODS This interventional trial was conducted during a defined period of 5 months (August 2016 January 2017). We used a Xenograft model of nude BALB/c mice. A sample size of 50 mice, allocated into two groups and designated as Group A and Group B for Metformin and negative control groups, respectively. The anticancer activity of Metformin has been evaluated by comparing the tumour volume, tumour weight, tumour regression ratio, percentage regression, and survival rate. RESULTS Compared with the control group, Metformin can significantly reduce the progression of tumour in the Xenograft model of breast cancer induced by MCF-7. This is reflected by significant differences in tumour volume at the final follow-up (p = <0.001). Our findings are further supported by a significant reduction of the tumour growth rate (p = <0.001) and tumour weight (p = <0.001) in the Metformin group than in the control group. Similarly, the total survival rate and tumour regression are more significantly correlated in the Metformin group. CONCLUSION This study demonstrates that Metformin can significantly reduce the tumour growth and can increase the survival rate in a Xenograft model of breast cancer.
Collapse
Affiliation(s)
- Fatima Rizvi
- Dow International Medical College (DUHS), Department of Pharmacology, Karachi, Pakistan
| | - Lubna Shaukat
- DUHS, Department of Oral and Maxillofacial Surgery, Karachi, Pakistan
| | - Arfa Azhar
- AKUH, Department of Biological and Biomedical Sciences, Karachi, Pakistan
| | - Alia Jafri
- Department of Biochemistry Institute, JSMU, Karachi, Pakistan
| | | | | |
Collapse
|
5
|
Saeed S, Asim M, Sohail MM. Fears and barriers: problems in breast cancer diagnosis and treatment in Pakistan. BMC WOMENS HEALTH 2021; 21:151. [PMID: 33853583 PMCID: PMC8045297 DOI: 10.1186/s12905-021-01293-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
Background Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment. Methods In this process 45 women (age = 18–50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan. Results An inductive approach was used to analyze the data which resulted in the emergence of eight subthemes under the umbrella of three major themes that delineate individual, socio-cultural and structural barriers to seek screening and treatment of breast cancer in Punjab. Individual barriers included lack of awareness, hesitance in accepting social support, and spiritual healing. The identified socio-cultural factors included feminine sensitivity, stigmatization, and aversion to male doctors. Lack of financial resources and apathetic medical services were structural barriers that hinder screening and treatment. Conclusions These barriers can be addressed through raising awareness and community mobilization about breast-self exam and treatment. The healthcare system should also pay attention to socio-psychological and cultural factors impeding women's access to available health facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01293-6.
Collapse
Affiliation(s)
- Sidra Saeed
- Department of Sociology and Social Research, University of Trento, Trento, Italy
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Malik Muhammad Sohail
- Department of Sociology, Institute of Arts and Sciences, Government College University Faisalabad, Chiniot Campus, Chiniot, Pakistan
| |
Collapse
|
6
|
Malik R, Vera N, Dayal C, Choudhari A, Mudaliar J, Noovao Hill A, Kubuabola I, Gunnarsson R. Factors associated with breast cancer awareness and breast self-examination in Fiji and Kashmir India - a cross-sectional study. BMC Cancer 2020; 20:1078. [PMID: 33167928 PMCID: PMC7654031 DOI: 10.1186/s12885-020-07583-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low-income countries breast cancer awareness (BCA) is essential to reduce the proportion of advanced stage presentations of breast cancer. There is a lack of studies using multivariable techniques to explore factors related to BCA in low-income countries. The objective of this study was to identify to what extent women in Fiji and Kashmir, India have BCA and practice breast self-examination (BSE) as well as factors associated with BCA and BSE. METHODS A survey of women aged ≥18 years was conducted in Fiji and Kashmir, India to assess BCA and rates of BSE. Comparison between Fiji and Kashmir was done using student's t-test for continuous data and chi-square for binary data. Factors associated with BCA and BSE were analysed using a multivariable logistic regression for Fiji and Kashmir separately. RESULTS Data were collected from 399 and 1982 women in Kashmir and Fiji, respectively. Of 1968 women in Fiji 57% were deemed to have an acceptable BCA compared to only 7.3% of 395 women in Kashmir. Having some education was associated with having BCA with an odds ratio of 4.7 (1.7-13) in Fiji and 10 (1.7-59) in Kashmir. Of 1976 women in Fiji 40% had tertiary education while 40% of 392 women in Kashmir had no education at all. The marital status was similar in both samples (n = 1973 and 395) with 68-69% being married and 21-26% being single. The lack of female doctors or nurses with whom to discuss issues, was perceived as a problem in both countries. CONCLUSIONS The key finding is an association between having any level of education and BCA. This correlation was much stronger than for a family history of breast cancer and BCA. Hence, general education to illiterate women may reduce the proportion of women in low-income countries presenting with advanced-stage breast cancer.
Collapse
Affiliation(s)
- Rukaiya Malik
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Numa Vera
- School of Health Sciences, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Chandra Dayal
- School of Nursing, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Abhay Choudhari
- School of Medical Sciences, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Jyotishna Mudaliar
- Northern Division Scabies Control Project, Labasa Fiji by the Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Amanda Noovao Hill
- School of Medical Sciences, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Ilisapeci Kubuabola
- Pacific Research Center for Prevention of Obesity and Non-Communicable Diseases, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Ronny Gunnarsson
- Primary Health Care, School of Public Health, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg, Boras, Sweden.
| |
Collapse
|
7
|
Hameed Khaliq I, Mahmood HZ, Sarfraz MD, Masood Gondal K, Zaman S. Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer. Breast 2019; 46:40-47. [PMID: 31075671 DOI: 10.1016/j.breast.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31-128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.
Collapse
Affiliation(s)
- Imran Hameed Khaliq
- Department of Public Health, University of Health Sciences Lahore, Pakistan.
| | - Hafiz Zahid Mahmood
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Pakistan
| | | | - Khalid Masood Gondal
- Vice Chancellor, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences Lahore, Pakistan
| |
Collapse
|
8
|
Silva RMD, Pinheiro CPO, Bezerra IC, Caldas JMP, Brasil CCP. Mastectomy and the Meaning Attributed by Patients to Delay in Early Diagnosis of Breast Cancer. Asian Pac J Cancer Prev 2018; 19:2083-2088. [PMID: 30139205 PMCID: PMC6171414 DOI: 10.22034/apjcp.2018.19.8.2083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Breast cancer is a major public health problem and its early detection (ED) can reduce the number of breast mutilations, morbidity and mortality rates, health costs and negative health outcomes. Given that, this study aimed to assess the meaning attributed by mastectomized women to delay in early detection of their breast cancers. Methods: Qualitative research was conducted with 26 mastectomized women who participated in semi-structured interviews about the meaning of delay in early detection of breast cancer in a reference oncology outpatient clinic in the city of Fortaleza, Ceará, Northeastern Brazil from December 2015 to January 2016. Information was analyzed on the basis of symbolic interactionism. Results: After noticing breast changes, women start to ponder about them and experience this moment according to interpretive particularities. Fear of disease, multiple roles in modern society, denial of breast changes, lack of information on the issue, and lack of professionals to encourage their involvement in health care, favor delay in the search for care and therefore in the early detection of breast cancer, which is a determinant of therapeutic success. Conclusion: Women receive limited information and professional support for breast health. Delay in early diagnosis occurred in all the women who participated in the study.
Collapse
|
9
|
Iqbal J, Abbasi BA, Batool R, Mahmood T, Ali B, Khalil AT, Kanwal S, Shah SA, Ahmad R. Potential phytocompounds for developing breast cancer therapeutics: Nature’s healing touch. Eur J Pharmacol 2018. [DOI: 10.1016/j.ejphar.2018.03.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
10
|
Naqvi AA, Zehra F, Ahmad R, Ahmad N. Developing a Research Instrument to Document Awareness, Knowledge, and Attitudes Regarding Breast Cancer and Early Detection Techniques for Pakistani Women: The Breast Cancer Inventory (BCI). Diseases 2016; 4:diseases4040037. [PMID: 28933416 PMCID: PMC5456323 DOI: 10.3390/diseases4040037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/23/2022] Open
Abstract
There is a general hesitation in participation among Pakistani women when it comes to giving their responses in surveys related to breast cancer which may be due to the associated stigma and conservatism in society. We felt that no research instrument was able to extract information from the respondents to the extent it was needed for the successful execution of our study. The need to develop a research instrument tailored for Pakistani women was based upon the fact that most Pakistani women come from a conservative background and sometimes view this topic as provocative and believe discussing publicly about it as inappropriate. Existing research instruments exhibited a number of weaknesses during literature review. Therefore, using them may not be able to extract information concretely. A research instrument was, thus, developed exclusively. It was coined as, “breast cancer inventory (BCI)” by a panel of experts for executing a study aimed at documenting awareness, knowledge, and attitudes of Pakistani women regarding breast cancer and early detection techniques. The study is still in the data collection phase. The statistical analysis involved the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s test for sampling adequacy. In addition, reliability analysis and exploratory factor analysis (EFA) were, also employed. This concept paper focuses on the development, piloting and validation of the BCI. It is the first research instrument which has high acceptability among Pakistani women and is able to extract adequate information from the respondents without causing embarrassment or unease.
Collapse
Affiliation(s)
- Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, University of Dammam, Dammam 31441, Saudi Arabia.
| | - Fatima Zehra
- Department of Social Sciences, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology SZABIST, Clifton, Karachi 75600, Pakistan.
| | - Rizwan Ahmad
- Natural Products and Alternative Medicines, College of Clinical Pharmacy, University of Dammam, Dammam 31441, Saudi Arabia.
| | - Niyaz Ahmad
- Department of Pharmaceutics, College of Clinical Pharmacy, University of Dammam, Dammam 31441, Saudi Arabia.
| |
Collapse
|