Conflicts women with breast cancer face with: A qualitative study

Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care

(1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. (2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centred care of pregnant cancer patients. (3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy-namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and biolaw) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)-and informed by a systematic review of clinical practice guidelines. (4) Results: Five foundational discussion themes, summarising the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. (5) Conclusion: The proposed framework was further operationalised into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centred guidance.

The lived experiences of pregnancy planning after breast cancer in women of childbearing age: A phenomenological study

Objective

This phenomenological study aimed to explore the lived experiences of planning for pregnancy after breast cancer in women of childbearing age.

Methods

The study comprised 15 women with breast cancer who were considering pregnancy and childbirth. Individual in-depth interviews were conducted between November 2022 and March 2023, and the verbatim transcripts were analyzed using Colaizzi's phenomenological method.

Results

Four theme clusters emerged: (1) deepening desires amidst hardships, (2) endless worries about an uncertain future, (3) unveiling the meaning of having a child, and (4) perpetual deliberations regarding unresolved dilemmas. Over time, the participants' longing for children intensified, despite the contradiction of their reduced fertility. They expressed concerns about the potential risks and challenges of pregnancy in breast cancer patients, but they attributed value to having a child as a means to restoring their health, reclaiming their ordinary lives, and providing motivation for a healthier future. The participants found making decisions regarding pregnancy to be difficult and were often influenced by others.

Conclusions

This study underscores the unique challenges faced by women with breast cancer who are making fertility-related decisions. The findings contribute to a better understanding of these challenges and offer valuable insights for the development of decision aids that support shared decision-making for pregnancy after breast cancer.

Psychological and reproductive decision-making experiences of young women after breast cancer diagnosis: a qualitative study

BACKGROUND

Breast cancer has the highest incidence rate among malignant tumors in China, with a trend of affecting younger women. The treatment has short- and long-term adverse effects such as damage to the ovaries, which may result in infertility. Such consequences then increase patients' concerns over future reproduction. At present, nor do medical staffs continuously assess their overall well-being, or ensure that they have the knowledge necessary to manage their reproductive concerns. This qualitative study aimed to explore psychological and reproductive decision-making experiences of young women who had experienced childbirth after their diagnosis.

METHODS

The phenomenological research, as a kind of qualitative study, was conducted on 12 young women who experienced childbirth after breast cancer diagnosis. Data collection was from September 2021 to January 2022 and content analysis method was used to analyze the data.

RESULTS

Five main themes were identified: (1) desire for childbearing from individual, familial, and social aspects after the diagnosis of breast cancer; (2) emotional experiences through pregnancy till raising children; (3) support needs from professionals, family, and peer; (4) self and doctors' influencing factors on reproductive decision-making; and (5) satisfaction with the outcome of reproductive decision-making.

CONCLUSIONS

The desire for childbearing of young women should be considered during the reproductive decision-making process. A multidisciplinary team is suggested to be set up to provide professional support. During the reproductive process, professional and peer support should be strengthened to improve decision-making abilities, alleviate negative emotional experience, and smoothen the process of reproductive experience for young patients.

Contributions of a Rehabilitation Nursing Program in the Self-Care of Women Undergoing Breast Surgery

BACKGROUND

Although surgical treatments for breast cancer have exhibited advanced interventions, axillary lymph node dissection can limit functionality and compromise women's self-care. This study aims to assess the effectiveness of a rehabilitation nursing program in improving self-care performance in women undergoing breast surgery with axillary lymph node dissection.

METHODS

This quantitative, quasi-experimental study involved 48 women recruited from a main hospital between 2018 and 2019. The participants completed a three-month rehabilitation program at home. The evaluation instrument used was the DASH questionnaire. This study was not registered.

RESULTS

The functionality of the upper limb ipsilateral to the surgery improved significantly (p < 0.001) after the implementation of the program, influencing the participants' capacity for self-care, including washing/drying their hair, washing their back, and wearing a shirt. The average DASH total score increased from 54.4 to 8.1 after the program.

CONCLUSIONS

The rehabilitation nursing program positively influenced the participants' self-care ability. Incorporating rehabilitation nursing programs into breast cancer treatment can improve self-care performance and the overall quality of patients' lives. This study was not registered.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

How do I deal with breast cancer: a qualitative inquiry into the coping strategies of Iranian women survivors

Background

Breast cancer is the most frequent cancer in Iran. Understanding the coping strategies employed by cancer survivors can provide valuable information for designing interventions to help them adapt to the problems produced by cancer and its treatment. This study aimed to explore the coping strategies of BC survivors in Iran.

Methods

This qualitative study was conducted in Mashhad, Northeast Iran, between April and December 2021. Fourteen BC survivors were selected through purposive sampling. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA 12 software was used for data organization. Components of trustworthiness, including credibility, dependability, confirmability, and transferability, were considered.

Results

The main categories that emerged from the participants' data analysis were “behavioral coping strategies” and “emotional coping strategies.” Behavioral coping strategies included efforts to adopt healthy nutrition, attempts to improve a healthy lifestyle, maintenance of everyday activities, use of specialized cancer support consultation services, and seeking to increase health literacy about BC. The emotional coping strategies consisted of denial as a temporary escape route, positive thinking and focusing on the positive aspects of life, reinforcement of spirituality, and seeking the support of relatives.

Conclusion

Our findings provide an in-depth understanding of Iranian women’s strategies for coping with BC. A trained team of oncologists, psychiatrists, mental health professionals, and reproductive health specialists needs to contribute significantly to improving the coping ability of patients with cancer, which could lead to enhanced health promotion and a higher quality of life.

Cancer-Related Stigmatization, Quality of Life, and Fear of Death Among Newly Diagnosed Cancer Patients

The purpose of the study is to investigate the gender differences among newly diagnosed cancer patients from the cultural perspective of Pakistan. The data comprised two equal groups: men (50%) and women (50%). Most participants were 31-45 years old, and the duration of the cancer diagnosis was less than 6 months (74.6%). The data was collected on the following scales: the discrimination and stigma scale, the internalized stigma scale, the WHO-quality of life scale, and the fear of death scale. Data was analyzed using SPSS v.25; descriptive statistics, an independent sample t-test, and simple linear regression were applied to the data. The results revealed that men and women are both experiencing cancer-related stigmatization in Pakistan. However, women face a higher level of stigmatization, lower quality of life, and higher fear of death than men. Furthermore, the regression analysis result confirms that the cancer-related stigma faced by the diagnosed patients decreases the patient's quality of life and induces the fear of death.

Decision regret regarding treatments among women with early-stage breast cancer: a systematic review protocol

INTRODUCTION

Women with early-stage breast cancer (EBC) are commonly required to make treatment decisions. Decision regret regarding treatments is an adverse outcome that negatively affects women's psychological well-being and quality of life. A systematic review will be conducted to synthesise evidence about decision regret among women regarding treatments for EBC. The study will focus on levels of decision regret, what is regretted, and the factors associated with decision regret.

METHODS AND ANALYSIS

A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Electronic databases, including CINAHL Complete, Embase, PubMed, Medline and Web of Science, will be searched for relevant articles published from 2000 to 2021. The reference lists of eligible studies will also be manually searched. All types of quantitative, qualitative and mixed-methods studies that report on decision regret regarding treatments among women with EBC will be included. The primary outcome of this review will be women's levels of decision regret regarding breast cancer treatments. The secondary outcomes will include the content of their regrets, and the factors contributing to decision regret. The methodological quality of the studies will be assessed using the Joanna Briggs Institute appraisal tools. Meta-analysis and thematic synthesis approaches will be used to synthesise quantitative and qualitative data, respectively. A convergent parallel approach will be used to integrate quantitative and qualitative findings.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review. The findings of this work will be disseminated at international conferences and peer-reviewed journals. The findings of this systematic review will inform the development of decision interventions to improve the decision outcomes of breast cancer treatments.

PROSPERO REGISTRATION NUMBER

CRD42021260041.

The effect of PLISSIT based counseling model on sexual function, quality of life, and sexual distress in women surviving breast cancer: a single-group pretest-posttest trial

BACKGROUND

Diagnosis and treatment of breast cancer potentially leads to sexual dysfunction and sexual distress in women and negatively affects their quality of life (QoL). This study aimed at determining the effect of PLISSIT based counseling on sexual function, sexual distress, and QoL in women surviving breast cancer.

METHODS

In this pre-test, post-test, single-group semi-experimental study, 65 women surviving breast cancer who were referred to the selected centers were included in the study via the available sampling method. Data gathering tools included a researcher-made demographic questionnaire, female sexual function index, beck depression inventory-II, State-Trait Anxiety Inventory, World Health Organization QoL-Brief, and Female Sexual Distress Scale-Revised. The counseling program (7 sessions 60 min each) was designed based on the PLISSIT model. The sexual function, sexual distress, and QoL were evaluated before, and 2 and 4 weeks after the intervention. To compare the mean scores of variables before and after the intervention, repeated-measured ANOVA was used.

RESULTS

The findings showed that PLISSIT based counseling significantly reduced sexual distress and increased the scores of QoL and all its domains, as well as sexual function and all its domains in women surviving breast cancer (p < 0.05). There was no significant difference in the mean scores of variables 2 and 4 weeks after the intervention.

CONCLUSIONS

It seems that PLISSIT based counseling reduces sexual dysfunction and sexual distress and improves the QoL of women surviving breast cancer. So, it is recommended that these counseling programs be integrated into the health care program of this group of women.

TRIAL REGISTRATION

TCTR202103170010, 17 March 2021, Retrospectively registered, at https://www.thaiclinicaltrials.org/ .

Factors Associated with Unplanned Pregnancy Among Cancer Survivors

Background: Approximately half of all pregnancies in the United States are unintended. However, women who are diagnosed with cancer in their reproductive years may be a unique population. This study examines the prevalence of and identifies factors associated with unplanned pregnancy among cancer survivors. Methods: Female cancer survivors aged 22-45 years, diagnosed between ages 20-35 years and at least 2 years postdiagnosis, and women with no history of cancer were interviewed about their reproductive histories, including pregnancy intention. Using a random matching process, comparison women were assigned an artificial age at cancer diagnosis equal to that of her cancer survivor match. An adjusted Cox model was fit examining time to unintended pregnancy after cancer for each of 1,000 matches. Cox proportional hazards models were also fit to assess associations between participant characteristics and unplanned pregnancy after cancer among survivors. Results: Cancer survivors (n = 1,282) and comparison women (n = 1,073) reported a similar likelihood of having an unplanned pregnancy in models adjusted for race, income, history of sexually-transmitted infection, and history of unplanned pregnancy before diagnosis (adjusted hazard ratio [aHR] 1.06, 95% simulation interval 0.85-1.36). After adjusting for confounders, unplanned pregnancy among survivors was associated with age <30 years at diagnosis (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.32-2.44), black race (HR: 1.55, 95% CI: 1.13-2.12; referent: white), receiving fertility counseling (aHR: 1.41, 95% CI: 1.04-1.92), and having at least one child before diagnosis (aHR: 1.44, 95% CI: 1.05-1.97). Conclusion: Cancer survivors and comparison women had similar likelihood of unplanned pregnancy. Rates of unplanned pregnancy after cancer were not higher for cancer survivors compared with comparison women, but 46.4% of survivors with a postcancer pregnancy reported an unplanned pregnancy. Cancer patients may benefit from patient-centered guidelines and counseling before cancer treatment that covers both risks of infertility and risks of unplanned pregnancy.

Concept d'adaptation chez les conjoints de femmes iraniennes atteintes du cancer du sein: étude qualitative basée sur une approche phénoménologique

Introduction

Le cancer du sein provoque une crise multidimensionnelle qui ébranle non seulement la patiente, mais aussi le conjoint et les autres membres de sa famille. Il convient donc d'étudier l'adaptation à ce phénomène, qui constitue l'une des principales difficultés pour les proches. En comprenant mieux comment les conjoints de femmes atteintes d'un cancer du sein font face à cette crise, ces derniers pourraient mieux prendre soin de leurs épouses et améliorer leur qualité de vie.

But de l’étude

L'étude visait à explorer le concept d'adaptation à partir d'expériences vécues par les conjoints de femmes souffrant d'un cancer du sein.

Méthodologie

Cette étude qualitative a été réalisée en 2019 selon une approche phénoménologique dans les villes de Hamadan et Rasht, en Iran. Le groupe de participants comptait 20 conjoints de femmes atteintes du cancer du sein, recrutés grâce à une méthode d'échantillonnage par choix raisonné. Les données ont été recueillies au moyen d'entretiens non structurés en personne; elles ont été analysées à l'aide de la méthode phénoménologique en six étapes de van Manen.

Résultats

Les expériences vécues par les participants ont montré que le phénomène d'adaptation des conjoints au cancer du sein de leur femme se décline en cinq thèmes: souffrance émotionnelle, fardeau des soins, maintien de la cohésion familial, incertitude de l'avenir et sentiment de perte du concept de soi. La compréhension du concept d'adaptation chez les conjoints de femmes atteintes du cancer du sein dans les stratégies de santé peut aider les femmes à bien s'adapter, tout en aidant les professionnels à adopter des mesures efficaces dans le domaine des soins médicaux, pour les patientes et leurs conjoints.

The concept of coping in male spouses of Iranian women with breast cancer: A qualitative study using a phenomenological approach

Introduction

Breast cancer is a multidimensional crisis that affects not just the patient, but the spouse and other family members. Coping with this phenomenon, as one of the important challenges for the families and spouses, requires investigation. Understanding more about how spouses of women with breast cancer cope with this crisis could lead to better performance of spouses in front of their wives and raise their wives' quality of life.

Purpose

The study was conducted to explore the concept of coping based on the lived experiences of spouses of women with breast cancer.

Methods

This qualitative study was conducted with a phenomenological approach in Hamedan and Rasht cities in Iran in 2019. Participants included 20 spouses of women with breast cancer selected by a purposive sampling method. Data were collected through unstructured face-to-face interviews and analyzed using van Manen's six-stage phenomenological method.

Results

The lived experiences of participants showed that the phenomenon of coping in spouses of women with breast cancer included five themes: Emotional pain, Shouldering the burden of care, Striving for family life cohesion, Future in ambiguity, and Sense of loss of self concept. Understanding the concept of coping in the spouses of women with breast cancer in health strategies can help wives achieve effective adaptation and also help professionals take effective measures in the field of medical care for patients and their spouses.

Surgery decision conflict and its related factors among newly diagnosed early breast cancer patients in China: A cross-sectional study

Aim

The aim of this study was to explore surgery decision conflict and its related factors among newly diagnosed early breast cancer patients in China.

Design

A cross‐sectional survey study was conducted.

Methods

A total of 262 patients confronted with surgery decision‐making were enrolled. The related factors were assessed with a demographic questionnaire, the Chinese version of the Decision Conflict Scale (DCS‐C‐16) and the Patient Participation Competence Scale (PPCS).

Results

Patients had a high level of decision conflict that was negatively correlated with the PPCS score. Age, marital status, living environment, education level, family income, cancer stage and the PPCS score were independent factors influencing decision conflict. Marital status, education level, cancer stage and participation competence were significant predictors of decision conflict. Patients who had higher participation competence were married, were well educated and had a lower cancer stage were likely to experience lower decision conflict.

Information Needs of Breast Cancer Patients Attending Care at Tikur Anbessa Specialized Hospital: A Descriptive Study

PURPOSE

The purpose of this study was to assess the information needs of women with breast cancer attending care at a major hospital in Ethiopia. It also aimed at describing the association of information needs with sociodemographic and clinical variables, preferred sources of information, and time to have it.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted on 375 women with breast cancer at Tikur Anbessa Specialized Hospital. Data were collected by interview and Toronto information needs questionnaire for breast cancer which contains 52 items categorized under five domains was pretested, adopted, and used to address the information needs of patients. One way ANOVA was done to get an association of sociodemographic and clinical variables with information needs. All statistical analysis was performed using STATA (Version 14), and statistical significance was set at P ≤ 0.05.

RESULTS

The total mean score for overall information needs among breast cancer patients was 238.7 (22.5) with a range scale of 156-260. Among the five subscales information on disease and information on treatment were the most highly needed areas with a mean percentage of 94.8 and 93.7, respectively; and 254 (67%) of them preferred the information to come from health professionals. Diagnosing as stage IV (p=0.0005) and urban residence (0.02) was associated with less and high information needs, respectively.

CONCLUSION

The information needs of breast cancer patients were high. Determining what the patient's needs are an important aspect of providing health care especially in cancer care. The healthcare system should include a way of information provision system for breast cancer patients based on their needs.

Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study

BACKGROUND

Young women diagnosed with breast cancer face challenges that interfere with their entire life with psychological and physical effects.

METHOD

We employed a qualitative exploratory descriptive design, and recruited twelve participants through purposive and snowball sampling methods to conduct 12 face to face individual interviews. A reputable review board in Ghana; Noguchi Memorial Institute for Medical Research, gave ethical clearance for data collection. Data were transcribed verbatim and analysed using thematic content analysis.

RESULTS

Three themes emerged from the data; physical effects of breast cancer, effects of treatment on body image, and emotional effects of breast cancer diagnosis and treatment. The negative effects of treatment incapacitated most of the women and limited their activities of daily living. Some experienced severe bodily weakness and stayed indoors for days. Most participants felt they looked unattractive because they have had a mastectomy done, and used pieces of rags and handkerchiefs as breast prostheses. Those who had hair loss through chemotherapy used different kinds of wigs to cover their baldness. Almost all the participants cried, felt depressed, and became emotionally unstable when they were told their diagnosis. Some denied their diagnoses and displaced their anger on healthcare personnel. A few of them felt they had brought disgrace to their families because breast cancer is perceived, a disgraceful disease.

CONCLUSION

Young women diagnosed with breast cancer require psychological interventions and physical support from healthcare personnel and their families.

Identification of Hub Genes Using Co-Expression Network Analysis in Breast Cancer as a Tool to Predict Different Stages

Background

Breast cancer has a high mortality rate and is the most common cancer of women worldwide. Our gene co-expression network analysis identified the genes closely related to the pathological stage of breast cancer.

Material/Methods

We performed weighted gene co-expression network analysis (WGCNA) from the Gene Expression Omnibus (GEO) database, and performed pathway enrichment analysis on genes from significant modules.

Results

A non-metastatic sample (374) of breast cancer from GSE102484 was used to construct the gene co-expression network. All 49 hub genes have been shown to be upregulated, and 19 of the 49 hub genes are significantly upregulated in breast cancer tissue. The roles of the genes CASC5, CKAP2L, FAM83D, KIF18B, KIF23, SKA1, GINS1, CDCA5, and MCM6 in breast cancer are unclear, so in order to better reveal the staging of breast cancer markers, it is necessary to study those hub genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated that 49 hub genes were enriched to sister chromatid cohesion, spindle midzone, microtubule motor activity, cell cycle, and something else. Additionally, there is an independent data set – GSE20685 – for module preservation analysis, survival analysis, and gene validation.

Conclusions

This study identified 49 hub genes that were associated with pathologic stage of breast cancer, 19 of which were significantly upregulated in breast cancer. Risk stratification, therapeutic decision making, and prognosis predication might be improved by our study results. This study provides new insights into biomarkers of breast cancer, which might influence the future direction of breast cancer research.