Quality of life among younger women with breast cancer: Study from a tertiary cancer institute in south India

The impact of age on physical functioning after treatment for breast cancer, as measured by patient-reported outcome measures: A systematic review

PURPOSE

This systematic review aims to explore the impact of age on physical functioning post-treatment for early-stage, locally advanced, or locally recurrent breast cancer, as measured by patient-reported outcome measures (PROMs), identify PROMs used and variations in physical functioning terms/labels.

METHODS

MEDLINE, EmBase, PsycINFO, CINAHL and AMED were searched, along with relevant key journals and reference lists. Risk of bias (quality) assessment was conducted using a Critical Appraisal Skills Programme checklist. Data was synthesised through tables and narrative.

RESULTS

28,207 titles were extracted from electronic databases, resulting in 44 studies with age sub-groups, and 120 without age sub-groups. Of those with findings on the impact of age, there was variability in the way findings were reported and 21 % found that age did not have a significant impact. However, 66 % of the studies found that with older age, physical functioning declined post-treatment. Comorbidities were associated with physical functioning declines. However, findings from sub-groups (breast cancer stage, treatment type and time post-treatment) lacked concordance. Twenty-eight types of PROM were used: the EORTC QLQ-C30 was most common (50.6 %), followed by the SF-36 (32.3 %). There were 145 terms/labels for physical functioning: 'physical functioning/function' was used most often (82.3 %).

CONCLUSIONS

Findings point towards an older age and comorbidities being associated with more physical functioning declines. However, it was not possible to determine if stage, treatment type and time since treatment had any influence. More consistent use of the terminology 'physical functioning/function' would aid future comparisons of study results.

Quality of Life Outcomes and Determining Factors in Breast Cancer Patients Reporting to a Tertiary Care Centre in the Sub-Himalayan Region of India

PURPOSE

Breast cancer is the most common malignancy among women worldwide. This study was conducted to determine the quality of life (QOL) outcomes among breast cancer patients in the sub-Himalayan region and, secondly, to identify factors affecting them.

METHOD

The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and BR-45 questionnaires in English and Hindi translations were used. The BR-45 Hindi translation was obtained using the forward-backward translation method. To check internal consistency and validity, Cronbach's alpha was employed. EORTC scoring manuals were used to score the questionnaires. The analysis of variance test was used to determine the impact of different treatment and sociodemographic factors on QOL domains.

RESULTS

The English and Hindi translations had Cronbach's alpha values of 0.949 and 0.950, respectively, suggesting that the data gathered were reliable. The mean score for global health status was 64.4 ± 29.7, the functional scale (FS) of QLQ_C30 was 76.9 ± 21.5, the FS of BR45 was 64.6 ± 24.1, the symptom scale (SS) of QLQ_C30 was 20.3 ± 19.2, and the SS of BR45 was 22.5 ± 19.1. Factors adversely affecting global health status included younger age, pre/perimenopausal status, and ongoing chemotherapy. Functional scales were significantly affected by marital status and earlier stages of the disease. Symptom scales were adversely affected by ongoing chemotherapy, an earlier stage of the disease, and a duration of treatment of less than six months.

CONCLUSION

Tailoring treatment to reduce radiotherapy, surgery, and systemic therapy-related side effects may improve QOL. Counselling and social support groups may help patients cope with the burden of family and societal roles.

Global quality of life in breast cancer: systematic review and meta-analysis

BACKGROUND

Breast cancer (BC) is the most common cancer among women worldwide. We conducted a systematic review and meta-analysis to cover the existing research gap and contribute to existing knowledge to provide both researchers and clinicians with a better profile on the topic and consequently help improve the quality of life (QoL) of patients with BC.

METHODS

A comprehensive review of original articles published in English from January 2000 to October 2021 from databases including Embase, Scopus, PubMed and Web of Science was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

Based on the meta-regression which examined a total of 9012 patients with BC, the QoL score calculated by EORTC QLQ-C30 was 64.72 (95% CI 59.24 to 70.20), while the score obtained from FACT-B was 84.39 (95% CI 64.24 to 104.54) and the scores from QLQ-BR23 and SF-36 were 66.33 (95% CI 62.76 to 69.90) and 57.23 (95% CI 47.65 to 66.82), respectively. A meta-analysis affirmed a significant direct relationship between the QoL score of patients with BC and their age (p=0.03). The results also revealed that the QoL scores of patients who had completed treatment were higher than those who were currently under treatment.

CONCLUSION

The present systematic review identified several factors that affect the QoL of women with BC worldwide and provided several implications for developing policy interventions to effectively improve the QoL of women with BC. In this way, clinicians can sufficiently give advice to their patients with the purpose of improving their QoL. PROSPERO registration number CRD42022309791.

Investigation of the relationship between perceived social support and body image in women with breast cancer

Background

Patients with breast cancer have more body image disorders than healthy individuals. The present study aimed to determine the relationship between perceived social support and body image in women with breast cancer. This descriptive-analytical study was performed on 192 women with breast cancer undergoing mastectomy or tumor resection with breast preservation referred to Golestan Hospital in Ahvaz from February 2016 to May 2017. Data collection tools included Demographic Information, Perceived Social Support, and Multidimensional Body-Self Relationship Questionnaires (MBSRQ). Data analysis was performed using SPSS 22 and Pearson correlation coefficient and multivariate linear regression. A p value less than 0.05 was considered significant.

Results

The Pearson correlation test showed a positive and significant relationship between perceived social support from family, friends, and leading people and body image in mastectomy (r 0.81) and tumor resection groups with breast preservation (r 0.78) (p < 0.001).

Conclusion

The results showed a direct relationship between perceived social support and body image in women with breast cancer. Accordingly, by educating patients and their families and medical staff about the importance of perceived social support, it is possible to help improve the dimensions of social support in these patients and improve the body image of these patients.

Health-related quality of life in breast cancer patients in Asia: A meta-analysis and systematic review

Objectives

The primary purposes of this meta-analysis and systematic review were to evaluate the health-related quality of life (HRQoL) of Asian breast cancer (BC) patients to understand their holistic HRQoL level and provide medical and nursing recommendations to improve and preserve their quality of life.

Methods

A comprehensive literature search was conducted to find cross-sectional studies published in Chinese and English concerning HRQoL in BC patients from the inceptions of databases to 14 March 2022. The databases consulted were PubMed, Web of Science, Embase, Cochrane, PsyclNFO, CINAHL, and CNKI. Literature screening, data extraction, risk bias assessment, and data synthesis were independently carried out by two researchers. The Endnote X9 and Stata 15.0 software programs were used during the meta-analysis process.

Results

Out of the 8,563 studies identified, 23 cross-sectional studies involving 3,839 Asian BC patients were included in this meta-analysis. Two tools, namely, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and Quality of Life Questionnaire Breast Cancer module 23 (EORTC QLQ-BR23)—were used to evaluate the HRQoL of BC patients in Asia. The pooled mean of the global health status of Asian BC patients was 58.34 (95% confidence interval [CI]: 53.66–63.02). According to functional subscales of EORTC QLQ-C30 and EORTC QLQ-BR23, Asian BC patients suffered from the worst emotional functioning (pooled mean=66.38; 95% CI: 59.66–73.11) and sexual enjoyment (pooled mean=49.31; 95% CI: 31.97–63.36). In addition, fatigue (pooled mean=42.17; 95% CI: 34.46–49.88) and being upset by hair loss (pooled mean=48.38; 95% CI: 36.64–60.12) were the most obvious symptoms that Asian BC patients experienced according to the meta-analysis results of the EORTC QLQ-C30 and EORTC QLQ-BR23 symptom subscales.

Conclusion

Asian BC patients experience a relatively low HRQoL due to the prominent decline in their body functions, as well as the unpleasant experiences caused by their symptoms. It is suggested that timely, appropriate, and targeted intervention should be provided in relation to the physical, psychological, and social aspects of Asian BC patients’ lives to enhance their ability to function, relieve them of adverse symptoms, and improve their overall HRQoL.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022321165.

Quality of life and its sociodemographic determinants in breast cancer patients

BACKGROUND

Breast cancer is the most common cancer in women worldwide. As the outcome of any cancer treatment is not only dependent on disease-free interval but also on the quality of life (QOL) of the survivor. Hence, this study was conducted to evaluate QOL of breast cancer patients and sociodemographic factors affecting QOL of patients.

SUBJECTS AND METHODS

A cross-sectional study was conducted among 50 breast cancer patients and 50 controls, which fulfilled the selection criteria. The sociodemographic profile and QOL using the World Health Organization QOL-BREF were analyzed using the descriptive statistical methods.

RESULTS

All the QOL indicators were statistically significantly (P = 0.0001) lower among breast cancer patients. QOL indicators were statistically significantly (P < 0.01) lower in young age. Not much difference was observed according to religion and these were significantly (P < 0.05) higher among the homemakers. There was no significant difference in all the QOL indicators according to the marital status of the cases. However, these were significantly (P < 0.05) higher among rural cases compared with urban one. The QOL indicators were statistically significantly (P < 0.05) higher among the cases living in joint families than nuclear. No difference was observed among different socioeconomic status.

CONCLUSION

QOL was significantly lower among the breast cancer patients. Age, occupational status, type of family, and locality were the significant factors that affect the QOL of breast cancer patients. Hence, psychological and social support can play an important role in improving QOL of cancer patient.

Patient-centered Outcomes in Breast Cancer: Description of EQ-5D-5L and EORTC-QLQ-BR23 Measurements in Real-world Data and Their Association With Survival

AIMS

In recent years, major improvements in breast cancer treatments have led to a significant increase in survival. Despite that, this population's quality of life (QoL) information is lacking, especially real-world data.

MATERIALS AND METHODS

This was a prospective, multicentre, observational study of female breast cancer patients, without prior systemic treatment, treated between 2012 and 2019 in private health care in Brazil. QoL was assessed by two questionnaires, the EQ-5D-5L and the EORTC-QLQ-BR23. Additional data were retrospectively collected.

RESULTS

The study comprised 1372 patients, most with early-stage disease (80.2% stages 0-II). At a median follow-up of 25.6 months, the estimated 3-year overall survival was 93.6%. Patients with locally advanced and metastatic breast cancer had the lowest visual analogue scale scores and the highest symptom burden in all dimensions of EQ-5D-5L, but with the most significant improvement after treatment. With the EORTC-QLQ-BR23 questionnaire, patients undergoing lumpectomy had a better perception of body image. Axillary dissection led to greater arm symptoms after 12 months, radiotherapy enhanced breast symptoms and patients treated with chemotherapy had significant worsening in the effects of systemic therapy compared with endocrine or HER2 therapy. Staging and immunohistochemical subtype correlated with survival and with several QoL parameters, but overall survival was not independently affected by patient-reported outcomes in this cohort.

CONCLUSION

Our results show that early diagnosis and access to treatments with fewer side-effects, such as endocrine or targeted therapy, and less aggressive surgeries are the best strategies to achieve a better QoL for breast cancer patients.

Quality of Life Post Breast Cancer Surgery: Comparison of Breast Conservation Surgery versus Modified Radical Mastectomy in a Developing Country

Introduction  Breast cancer survivors are the largest group of female cancer survivors. Oncologic breast surgery can have a profound impact on a woman's body image and sense of self that can significantly affect their quality of life (QOL). The paucity of data about the effect of type of surgery on QOL of Indian breast cancer survivors has led to this study. Materials and Methods  This prospective study included consecutive female early breast cancer patients who underwent primary surgery, that is, breast conservation surgery (BCS) or modified radical mastectomy (MRM) from January 1, 2015 to December 31, 2015. The primary objective was the comparison of QOL using European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and EORTC QLQ-BR 23 between the two groups at 6 months and 1 year postsurgery with the baseline. Results  One hundred and thirty-eight patients were included of which 62 underwent BCS and 76 underwent MRM. BCS patients fared better with respect to physical functioning, dyspnea, fatigue, appetite loss, and body image at 6 months ( p  < 0.05) as compared with MRM. At 1 year postsurgery, BCS patients fared better with respect to physical functioning, role functioning, global health status, body image, sexual enjoyment, and dyspnea, while MRM patients fared better in emotional functioning and future prospectives ( p  < 0.05). Conclusion  Patients undergoing BCS have a better QOL with respect to various functional and symptom scales at 6 months and 1 year. However, patients undergoing MRM perform better in terms of future perspective and emotional functioning at 1 year.

Quality of Life in Patients with Breast Cancer following Breast Conservation Surgery: A Systematic Review and Meta-Analysis

To evaluate the health-related quality-of-life (QOL) outcomes in surgical breast cancer survivors who received breast conservation therapy (BCT) compared to mastectomy, we utilized a systematic review to conduct observational studies of QOL in patients with breast cancer following breast conservation therapy from their inception until October 2021. The PubMed, the Cochrane Library, and the Web of Science databases were systematically searched to retrieve the observational studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were applied as an effect estimate and calculated using Stata 15 software. Nine studies comprising 2301 patients were included. The results showed that no significant differences compared to mastectomy were detected for global health status (P=0.971 and P=0.613), physical function (P=0.099), emotional function (P=0.096), cognitive function (P=0.377), social function (P=0.602), sexual functioning (P=0.072), and sexual enjoyment (P=0.142), while role function (P=0.036), body image (P=0.000), and future perspective (P=0.012) showed a significant difference for BCT when compared to mastectomy. When compared to breast reconstruction (BR), the BCT group was inferior at physical function (P=0.002) and cognitive function (P=0.040) but superior at body image (P=0.001). When used the Functional Assessment of Cancer Therapy (FACT) tool, BCT has better results in physical function (P=0.000), emotional function (P=0.000), and social function (P=0.000) than mastectomy. QOL outcomes after BCT were better than mastectomy in body image, future perspective, and role function. BCT may be an acceptable option in the study setting for breast cancer patients who pursue high QOL.

The impact of mastectomy on body image and sexuality in women with breast cancer: a systematic review

Objective: The study aims to evaluate the impact of mastectomy on body image and sexuality of women with breast cancer, as well as to provide a general understanding of their quality of life. Method: This review followed the PRISMA guidelines. The expression “Mastectomy AND (sexuality OR “body image”)” was searched in Lilacs, Scielo, Pubmed and Scopus databases. Articles published in English, Portuguese and Spanish between 2010 and 2020 were selected. The text analysis was carried out by peers. Results: 69.3% (43) of the studies presented mastectomy as a technique that worsens body image, sexual functioning and quality of life of women. Less radical procedures, such as breast-conserving surgery, showed lower impact on these indicators. Breast reconstruction is an alternative to mitigate breast surgery impacts. Conclusion: Mastectomy caused the major impacts on body image, sexual functioning and quality of life. These implications need to be considered during therapeutic choice.

Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital

BACKGROUND

Cancer is the second most common cause of deaths worldwide. Likewise, in India, it is a major health problem, and disease burden is escalating every year. Cancer chemotherapy produces unfavorable effects on the well-being of an individual. Since the past few years, quality of life (QoL) is considered as the main goal of cancer treatment in the survival of a patient.

AIM

This current study aimed to assess the QoL and factors affecting it in adult cancer patients undergoing chemotherapy treatment.

METHODS AND RESULTS

An analytical, cross-sectional study was conducted to achieve the objectives, employing the consecutive sampling method. A total of 120 adult (>19 years) patients were recruited from daycare chemotherapy unit of a tertiary care hospital. The data were collected using patient record form and Functional Assessment of Cancer Therapy-General (FACT-G), a quality of life (QoL) questionnaire. The overall mean score of quality of life (QoL) was 61.933 ± 5.85502. The domains of functional well-being and emotional well-being were most negatively affected after cancer chemotherapy. Education (illiteracy) and occupation (unemployment) were negatively associated with overall quality of life (QoL) of cancer patients on chemotherapy. Adverse drug reactions due to cancer chemotherapy negatively affect the quality of life (QoL) of cancer patients. Education (illiteracy) affects social well-being domain of cancer patients. Working in the government/private sector has a positive impact on functional well-being domain of quality of life (QoL).

CONCLUSION

The study findings suggest an overall low quality of life (QoL) among adult cancer patients undergoing chemotherapy at our setup. It has been identified as a stressful therapy, also affecting both psychological and physical well-being. Poor infrastructure, illiteracy, poverty, and lack of proper treatment facilities at most centres often lead to poor survival outcomes and hence focus has always been on achieving quantity of life rather than quality of life (QoL). This is further complicated due to nonavailability of validated tools in local vernacular, apathy of the treating physicians in the context of QoL aspects and social and cultural factors that are unique to this society. Psycho-oncology needs to become an integral entity of comprehensive cancer care.

Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis

BACKGROUND

Breast cancer is becoming the most common cancer among women of Indian origin. However, little is known about the psychological impact of the disease and its treatment among this population.

AIM

To improve understanding of psychological symptoms among Indian women with breast cancer.

DESIGN

This is a systematic literature review and critical interpretive synthesis. Medical Subject Headings(MeSH) terms and keywords for breast cancer, psychological symptoms and treatment were used to search databases from inception to 7 May 2019. The reference lists of the included articles were examined. Search results were screened against the inclusion criteria, data were extracted, and quality was appraised by two independent researchers with recourse to a third. Narrative (quantitative) and thematic qualitative syntheses were applied, followed by critical interpretive synthesis.

DATA SOURCES

ProQuest, MEDLINE, Ovid EMBASE, EBSCO, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

RESULTS

18 of 763 studies from India or Canada were included (13 quantitative, 5 qualitative). Critical interpretive synthesis found psychological concerns similar to 'Western' women, but were framed by the common culture of Indian women in either country. Family structure, religion and community appear to protect against and cause distress in relation to the expected core role of being a wife and a mother and the male dominance in decision making. Stigma was amplified by poor knowledge about the nature of cancer. Migrant Indian women had additional problems due to language barriers.

CONCLUSIONS

Indian women with breast cancer living in India and Canada experience psychological morbidities which profoundly affect their role in their family and the wider community. Culturally congruent care, including accessible communication and information, may help prevent and alleviate distressing symptoms whether in India or in a migrant community.

Female Breast Cancer Patients, Mastectomy-Related Quality of Life: Experience from Ethiopia

Background

Mastectomy is the most common form of treatment for a developing-nation woman diagnosed with breast cancer. This can have huge effect on a women's quality of life.

Objective

To assess mastectomy-related quality of life in female breast cancer patients.

Materials and Methods

A facility-based cross-sectional descriptive study was conducted from February 1^st to July 30^th, 2018. A pretested structured data collection format was used to interview patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Breast Cancer-Specific (EORTC QLQ-BR23) were used to evaluate quality of life, functional capacity, and symptom scales. Data was analyzed with SPSS version 23.

Results

The mean age of the 86 patients was 43.2 years (SD ± 11.4) and ranged from 25 to 70 years. 54.7% (47) of patient's mastectomy was done on the right side. Based on EORTC QLQ-C30 global health status/QOL scale, the mean score was 48.3. On the evaluation of EORTC QLQ-BR23, future perspective about their health was low with a mean of 40.3 and their sexual functioning and enjoyment were significantly affected with mean scores of 85.3 and 71.2, respectively. Symptom scales were low with mean from 19.1 to 24.5. Majority (49, 57%) of respondents do not want to have breast reconstruction after mastectomy.

Conclusion

Our breast cancer patients who underwent mastectomy performed poor in terms of quality of life as compared to international findings which demands attention in incorporating psychosocial aspects in the treatment plan.

Social networks and quality of life among female breast cancer patients at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia 2019

Background

Breast cancer is a major life-threatening global public health problem. It is the most common form of cancer in females in many developing countries including Ethiopia. Social networks could change the course of cancer and can influence the quality of life among breast cancer patients. Therefore, the purpose of this study was to assess social networks and quality of life among female breast cancer patients attending in Tikur Anbassa Specialized Hospital, Addis Ababa, Ethiopia 2019.

Methods

An institutional-based cross-sectional study was conducted in Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia from March 1 to April 30/2019. A total of 214 female breast cancer patients were included Binary and multiple logistic regression was used to show the association of social networks and quality of life.

Result

A total of 214 females with breast cancer were recruited with a mean age of 41.85. Participants who had children (AOR = 5, 95%CL: 1.3,21 COR = 6), and other relatives (AOR = 6, 95%CI: 1.2,30, COR = 7), were more likely to have good social networks. Participants who were not married (AOR = 0.02, 95%CI: 0.03, 0.28), had no parents living (AOR = 0.1, 95%CI: 0.02, 0.4), no close friends (AOR = 0.06, 95%CI: 0.01, 0.4), and no neighbors (AOR = 0.09, 95%CI: 0.03, 0.5) had poor social networks.

Conclusion

The quality of life was relatively low and social support were found to be poor in women with breast cancer. Health-care providers in oncology departments need to focus on addressing the side effects of therapy and social networks which may help to improve the quality of life of females with breast cancer.

Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India

PURPOSE

Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India.

METHODS

We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed.

RESULTS

We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores.

CONCLUSION

QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

Health-related quality of life and its predictors among patients with breast cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background

Breast cancer is the second most prevalent malignancy in Ethiopia and severely affects patients’ health-related quality of life (HRQOL). We aimed to assess HRQoL, factors influencing HRQoL, and utilities among breast cancer patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A hospital-based cross-sectional study was conducted in Tikur Anbessa Specialized Hospital from December 2017 to February, 2018. A total of 404 breast cancer patients were interviewed using the validated Amharic version of the European Organization for Research and Treatment of Cancer module (EORTC QLQ-C30), EORTC QLQ-BR23, and Euro Quality of Life Group’s 5-Domain Questionnaires 5 Levels (EQ-5D-5 L) instruments. Mean scores and mean differences of EORTC- QLQ-C30 and EORTC- QLQ-BR23 were calculated. One-way ANOVA test was employed to determine the significance of mean differences among dependent and independent variables while stepwise multivariate logistic regression was used to identify factors associated with the global quality of life (GQOL). Coefficients and level specific utility values obtained from a hybrid regression model for the Ethiopian population were used to compute utility values of each health state. Data was analyzed using SPSS version 23.

Results

The mean age of patients was 43.94 ± 11.72 years. The mean score for GQoL and visual analog scale was 59.32 ± 22.94 and 69.94 ± 20.36, respectively while the mean utility score was 0.8 ± 0.25. Predictors of GQoL were stage of cancer (AOR = 7.94; 95% CI: 1.83–34.54), cognitive functioning (AOR = 2.38; 95% CI: 1.32–4.31), pain (AOR = 7.99; 95% CI: 4.62–13.83), financial difficulties (AOR = 2.60; 95% CI: 1.56–4.35), and future perspective (AOR = 2.08; 95% CI: 1.24–3.49).

Conclusions

The overall GQoL of breast cancer patients was moderate. Targeted approaches to improve patients’ HRQoL should consider stage of cancer, cognitive functioning, pain, financial status and worries about the patient’s future health. This study also provides estimates of EQ-5D utility scores that can be used in economic evaluations.

Quality of life and associated factors among patients with breast cancer under chemotherapy at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

Background

Breast cancer is the most common cancer affecting women in Ethiopia with increasing burden, and chemotherapy treatment produces a detrimental effect on individual wellbeing. Since last few years quality of life has been the primary goal of cancer treatment, yet little research has been conducted on quality of life of breast cancer patients under chemotherapy.

Objective

To determine the quality of life and associated factors among patients with breast cancer under chemotherapy at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

Methods

Institution based cross-sectional study was conducted on 404 patients with breast cancer, who took at least one cycle of chemotherapy treatment using face to face interview at oncology unit of Tikur Anbessa specialized hospital day care center from February to April 2018. The validated Amharic version of European organization for research and treatment of cancer core 30 (EORTC QLQ-C30) and quality of life questionnaire specific to breast (QLQ-BR23) was used to measure health related quality of life. Both descriptive and inferential statistics were used. For the purpose of interpretation quality of life score was dichotomized in to two using the calculated mean score, which is 53 as a cutoff point, then, bi-variable and multivariable logistic regression was used to describe association between dependent and independent variables. Hence, patients who score above 53 for quality of life were considered to have good quality of life.

Result

Of the total sample, overall response rate was 99.77%. The average quality of life score of patients with breast cancer under chemotherapy treatment was 52.98 (SD = 25.61). Majority of patients had scored poor in emotional functioning, sexual functioning, and financial difficulties. Educational status of college and above, being divorced, higher household income, higher scores of physical and social functioning were associated with significantly improved (better) quality of life. Lower scores of fatigue, insomnia, financial difficulties and systemic therapy side effects all were associated with better scores of quality of life of breast cancer patients. Whereas, patients receiving < = 2 cycles of chemotherapy had significantly lower scores of quality of life.

Conclusion and recommendation

Quality of life of breast cancer patients under chemotherapy treatment is poor in comparison with the reference data and international findings. Therefore, quality of life assessment should be incorporated in patient’s treatment protocol. And financial aids may significantly improve the quality of life of breast cancer patients under chemotherapy treatment.

Health-related quality of life in Asian patients with breast cancer: a systematic review

OBJECTIVE

To summarise the evidence on determinants of health-related quality of life (HRQL) in Asian patients with breast cancer.

DESIGN

Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO (CRD42015032468).

METHODS

According to the PRISMA guidelines, databases of MEDLINE (PubMed), Embase and PsycINFO were systematically searched using the following terms and synonyms: breast cancer, quality of life and Asia. Articles reporting on HRQL using EORTC-QLQ-C30, EORTC-QLQ-BR23, FACT-G and FACT-B questionnaires in Asian patients with breast cancer were eligible for inclusion. The methodological quality of each article was assessed using the quality assessment scale for cross-sectional studies or the Newcastle-Ottawa Quality Assessment Scale for cohort studies.

RESULTS

Fifty-seven articles were selected for this qualitative synthesis, of which 43 (75%) were cross-sectional and 14 (25%) were longitudinal studies. Over 75 different determinants of HRQL were studied with either the EORTC or FACT questionnaires. Patients with comorbidities, treated with chemotherapy, with less social support and with more unmet needs have poorer HRQL. HRQL improves over time. Discordant results in studies were found in the association of age, marital status, household income, type of surgery, radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being.

CONCLUSIONS

In Asia, patients with breast cancer, in particular those with other comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQL. Appropriate social support and meeting the needs of patients may improve patients' HRQL.

Health Related Quality of Life of Cancer Patients in Ethiopia

Background

Neoplasm, AKA cancer (Ca), is associated with major morbidity and mortality.

Aim

Measurement of health related quality of life (HRQoL) of Ca patients is uncommon in Ethiopia. The present study determined the HRQoL and its determinants among people living with Ca in north Ethiopia.

Methods

A prospective hospital based study was conducted from 1 January 2017 to 30 August 2017 on Ca patients attending cancer treatment center of University of Gondar Teaching Hospital. The European Organization for Research and Treatment of Cancer Questionnaire version 3 was utilized to collect the data. The rate of QoL was presented using means with standard deviation (±SD). Binary logistic regression was employed to determine factors associated with HRQoL.

Result

The present study is based on the findings from 150 subjects. The rate of QoL was 52.7 (20.1) (mean ± SD). The highest functional status was emotional functioning 61 (25.5). Patients with no disease metastasis, 92.1 (5.1), had high QoL as compared to metastasis, 22.1 (18.9) (p = 0.03). Patients with affected physical functioning have a 20% reduction in QoL and Adjusted Odds Ratio (AOR) of 0.794 [0.299-891]. Patients with low satisfaction level with the provided care, 0.82 [0.76-0.93], and those with unmet needs, 0.85 [0.80-0.95], experienced reduced level of HRQoL.

Conclusion

Health related quality of life of cancer patients was found to be low in Ethiopia. Patients with limited rate of disease metastasis had improved HRQoL. Further, the unmet needs of Ca patients and the level of satisfaction with the overall care were found to influence the extent of HRQoL. Therefore, early detection of neoplasm to arrest metastasis is warranted in order to achieve better QoL. In addition, addressing the unmet needs of these patients and ensuring higher satisfaction rate are recommended to maintain adequate HRQoL.

Reference Data for Standardized Quality of Life Questionnaires in Indian Patients with Brain Metastases from Non-small Cell Lung Cancer: Results from a Prospective Study

INTRODUCTION

Reference data for European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires do not include studies from the Indian subcontinent. The objective of the current study was to establish a reference dataset for Indian patients of non-small cell lung cancer (NSCLC) presenting with brain metastases (BM).

MATERIAL AND METHODS

One hundred forty patients with NSCLC with BM treated between 2012-2015 were registered in a prospective cohort study (CTRI/2013/01/003299). The baseline quality of life was evaluated using the EORTC general quality of life questionnaire QLQ-C30 and lung cancer specific module LC13. Minimum important difference (MID) scores for individual domains of the EORTC QLQ-C30 and LC13 questionnaires were derived (MID = 0.2 x standard deviation) from the reference data for patients with recurrent/metastatic lung cancers. In addition, a systematic review was conducted to identify studies reporting baseline quality of life scores for recurrent/metastatic NSCLC.

RESULTS

Scores of several functional as well as symptom scales in the current NSCLC population differed by more than the MID from the baseline mean scores in the reference EORTC population as well as that reported from other studies. Differences in mean score from the EORTC reference data ranged from 6.2 and 9.4 points for the role functioning and cognitive functioning domains. In the symptom scales, the largest differences were observed for the financial difficulties (23.9) scores for the QLQ-C30 and peripheral neuropathy (21.7) for LC13 questionnaires.

CONCLUSION

The current study demonstrates that baseline reference scores need to be established for patients from the Indian subcontinent. The findings from the current study have important implications for studies employing quality of life (QOL) assessment in the Indian NSCLC patient population.

Desarrollo investigativo en salud sexual de mujeres con cáncer de mama: una revisión integrativa

<p>Objetivo: Caracterizar la producción científica relacionada con la salud sexual en mujeres con cáncer de mama.Metodología: Revisión integrativa. Se realizó una búsqueda en las bases de datos Scopus, Medline, LILACS y SciELO, así comobúsquedas secundarias en revistas científicas. Se encontraron 85artículos organizados y caracterizados por año, idioma y continente; edad promedio y tipos de tratamiento; metodología, perspectiva, enfoque, diseño, perspectiva disciplinar y tendenciatemática.Resultados: La temática reportó mayor producción de conocimiento en los últimos 10 años. La tendencia de investigación se orienta hacia tres categorías: Salud sexual y cáncer de mama; Salud sexual en la mujer y tratamientosdel cáncer de mama; y Salud sexual y relaciones de pareja.Conclusiones: La salud sexual en mujeres con cáncer de mamaes un aspecto importante en la calidad de vida, que continuamente se ve alterada como resultado de la enfermedad y los efectos adversos de los tratamientos. Esta condición no sólo aqueja a la persona enferma, sino también a su pareja, por lo que se requiere del desarrollo de líneas de acción que permitan dar una atención integral a las mujeres con esta enfermedad.</p>

Experiences of Breast Cancer Survivors with Oncology Settings in Urban India: Qualitative Findings

The experience of diagnosis and treatment of cancer leads to significant changes within an individual. In the course of survivorship trajectory, very often cancer survivors are left with the sense, improvements could be done to enhance the quality of cancer care. This article focuses on experiences of breast cancer survivors with oncology setting in urban India. Data was collected from 15 women in South and East India using in-depth interview method. Qualitative interview data was analysed using descriptive phenomenology method. Areas of importance that emerged broadly included informational and emotional categories. Findings reveal quality of cancer care in India can be improved through developing an orientation towards patient-centred style rather than doctor/disease centred approach which has major influence on physical and mental health outcomes. This would require further research and increased emphasis on training of medical as well as paramedical professionals.

Profile of mood states and quality of life of Chinese postmastectomy women in Hong Kong: Integrating variable- and person-centered approaches

Understanding the mood state and its relationship with quality of life (QOL) of mastectomy recipients can serve as baseline within which a sound rehabilitation program can be developed. This study therefore was conducted to facilitate a better understanding of participants' postmastectomy mood states, identify their potential predictors, identify clusters of mood profiles, and clarify between-cluster differences in terms of QOL. Hong Kong mastectomy patients completed the Profile of Mood States and Ferrans and Powers Quality of Life Index. We extended the complementary strengths of the application of both variable- and person-centered approaches to clarify relationships and to identify profiles of mood states in relation to QOL in a sample of 200 women who had undergone a mastectomy in Hong Kong. Simultaneous regression identified age and educational attainment as predictors of mood states, and cluster analysis identified three distinct mood profiles that are able to explain differences in various measures of QOL after mastectomy. Implications for future research and practice are discussed.

Impact of Surgery Type on Quality of Life in Breast Cancer Patients

OBJECTIVE

Breast cancer can lead to alterations in quality of life of the patients. The aim of this study is to evaluate the changes in quality of life of the female patients who had undergone surgical treatment for breast cancer.

MATERIALS AND METHODS

A total of 250 female patients (breast-preserving surgery (BPS), n=27, 11%; modified radical mastectomy (MRM), n=194, 77%, and simple mastectomy (SM), n=29; 11%) aged between 28-55 years (47.4±6.4 yrs) were included in the study. Patient information, demographic characteristics, income, and treatment modalities applied were recorded. Validated Turkish versions of EORTC QLQ-C30, and EORTC-BR23 questionnaires were used for all patients.

RESULTS

Breast-preserving surgery has a more favorable impact on general well-being, physical role, cognitive, psychological, and social functions, and symptom scale scores. When the identical parameters were taken into consideration, relatively favorable outcomes of BPS on the patients were observed relative to mastectomized patients. Besides, though not statistically significant, BPS has more patient-friendly effects on sexual function and sexual satisfaction in comparison with mastectomy. Patients with advanced stage disease and elder patients had more unfavorable health related quality of life (HRQoL) scores than younger patients, and those in their early stages of breast cancer.

CONCLUSION

Quality of life of BPS patients is less adversely affected relative to mastectomized patients. In the decision-making process, quality of life should be taken into consideration.

Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS

ALND is part of primary management of breast cancer. In spite of complications it causes, its use in prognostication and planning adjuvant treatment in carcinoma breast is unquestioned. Prospective study was conducted on 100 patients of EBC [clinical stage I&II]. 50 underwent MRM, 50 WLE&AC. Patients were asked to rate on likert scale various symptoms on follow up. Multivariate regression analysis was carried out between pain, numbness, limitation of shoulder or arm motion, arm swelling, infection and age, BSA, clinical status of axilla, no. of LNs removed, no. of positive LNs, co-morbidities, chemotherapy, radiotherapy, hormone therapy, type of surgery. 60% patients reported one or more symptoms. Numbness, pain were reported by 39% each, arm swelling by 25%, limitation of arm movement by 16%, infection by 11%. Symptoms were mild in majority. On regression analyses numbness was associated with EBRT, co-morbidity, type of operation (p value- <0.01, <0.01, <0.05), pain had no significant association, swelling with EBRT, no. of LNs positive for metastases, co-morbidity, type of operation (p value- <0.01, <0.05, <0.05, <0.01), limitation of arm motion with no. of positive LNs (p value < 0.01), infection with no. of positive LNs, co-morbidity (p value <0.05, <0.05). There was no statistically significant difference in reporting of symptoms by patients in two groups. ALND caused morbidity in majority of patients but few reported severe symptoms and interference with daily activities.