Body image disturbance and surgical decision making in egyptian post menopausal 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.

A scoping review of measures used to assess body image in women with breast cancer

OBJECTIVE

The emergence of body image studies in the oncology setting has led to the use of numerous measures to assess different dimensions of body image. The present study is a scoping review of the literature on body image in women with breast cancer to describe: measures used to assess body image in women with breast cancer, dimensions the measures used tap into, and gaps and issues needing attention going forward.

METHODS

Three databases were searched for peer-reviewed original studies that had: (1) full-texts available in English; (2) focused on women with breast cancer; and (3) assessed body image.

RESULTS

The search yielded 3,729 peer-reviewed articles; after screening, 562 articles met inclusion criteria. Of the 88 measures used, 28 were used in more than two studies and analyzed herein. The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire constituted the most frequently used measure. Most measures used focused on the affective dimension of body image (n = 24/28, 85.7%), followed by the cognitive (n = 20/28, 71.4%), behavioral (n = 13/28, 46.4%), and perceptual dimensions (n = 13/28, 46.4%).

CONCLUSIONS

This review provides a current summary of measures used to assess body image in women with breast cancer. Although some further development and refinement of body image measures could benefit the field, depending on the questions researchers or clinicians seek to answer, there are many available for use. Future research should use these measures to assess the effectiveness of interventions aimed at improving body image in women with breast cancer across the lifespan.

The Impact of Delaying Breast Reconstruction on Patient Expectations and Health-Related Quality of Life: An Analysis Using the BREAST-Q

Purpose

An understanding of patient expectations predicts better health outcomes following breast reconstruction. No study to date has examined how patient expectations for breast reconstruction and preoperative health-related quality of life vary with time since breast cancer diagnosis.

Methods

Women consulting for breast reconstruction to a single surgeon's practice over a 13-month period were enrolled in this cross-sectional study. Patients were asked to prospectively complete the BREAST-Q expectations and preoperative reconstruction modules. A retrospective chart review was then performed on eligible patients, and patient demographics, cancer-related factors, and comorbidities were collected. BREAST-Q scores were transformed using the equivalent Rasch method. Multivariate linear regression models were constructed to assess the association between BREAST-Q scores and time since cancer diagnosis.

Results

Sixty-five patients met inclusion criteria for analysis and are characterized by a mean age of 53 ± 11 (34-79) years and a mean body mass index of 28 ± 6 (19-49). Most patients were treated by mastectomy (58%) or lumpectomy (23%). At the time of retrospective chart review, 29 (43%) patients had undergone reconstruction, most of which were delayed (59%). The mean latency from cancer diagnosis to reconstruction was 685 ± 867 days (range: 28-3322 days). Latency from cancer diagnosis to reconstruction was associated with a greater expectation of pain (β = 0.5; standard error [SE] = 0.005; 95% confidence interval [CI]: 0.003-0.027; P < .05), and a slower expectation for recovery (β = -0.5; SE = 0.004; 95% CI: -0.021 to -0.001; P < .05) after breast reconstruction. Latency from cancer diagnosis to reconstruction was associated with an increase in preoperative psychosocial well-being (β = 0.578; SE 0.009; 95% CI: 0.002-0.046; P < .05).

Conclusion

Delaying breast reconstruction may negatively impact patient expectations of postoperative pain and recovery. Educational interventions aimed at understanding and managing patient expectations in the preoperative period may improve health-related quality of life and patient-related outcomes following initial breast cancer surgery.

Challenges, Coping Strategies, and Social Support among Breast Cancer Patients in Ghana

Background. Despite the high incidence and mortality rate of breast cancer (BC) in Ghana, little attention has been given to the issue of how adult women cope with having BC. The aim of this study was to explore the challenges, coping strategies, and support systems among women diagnosed with BC in Ghana. Methods. A descriptive cross-sectional study was conducted from February to August 2017 at the Komfo Anokye Teaching Hospital (KATH), Ghana. A systematic random sampling technique was used to select 202 women with a confirmed diagnosis of BC. Coping strategies of women with BC were assessed using the Brief-COPE. The associations between sociodemographic characteristics, social network/support, and coping strategies were assessed using linear regression models. Results. The most and least adopted active coping strategies were religious coping and humors, respectively. Self-distraction and substance use were the most and least adopted avoidant coping strategies, respectively. Spouses and children offered the most support to women with BC; having support from 5 or more sources was associated with higher mean active coping (beta [β] 1.14; 95% CI 0.66 to 1.62) and avoidant coping (β 1.46; 95% CI 0.98 to 1.94), as compared with having <2 sources of social support. Conclusion. This study demonstrates that women diagnosed with BC in Ghana adopt varied coping strategies to deal with these challenges. The forms of coping strategies adopted by women diagnosed with BC are influenced by the extent of social support received. Psychosocial counseling and support should be an integral part of BC management. Exploring and including social networks could play an important role in the management of BC in Ghana.

Body Image Disturbance Improvement After Operative Correction of Adolescent Idiopathic Scoliosis

HYPOTHESIS

Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) is a sensitive outcomes instrument to evaluate improvements in body image-related psychosocial effects with surgical correction.

DESIGN

Prospective observational study.

INTRODUCTION

The BIDQ-S was previously validated (convergent validity, internal consistency) as a tool to assess body image-related distress and psychosocial impairment in adolescent idiopathic scoliosis (AIS). This study was conducted to evaluate responsiveness to change in the BIDQ-S associated with surgical treatment of AIS two years postoperatively to complete the validation of this questionnaire.

METHODS

Seventy-five consecutive operative AIS patients were enrolled and completed BIDQ-S and Scoliosis Research Society-22 (SRS-22) at preoperative and two-year postoperative visits. Demographic and radiographic data were collected. Preoperative and two-year postoperative BIDQ-S (1 = best, 5 = worst) and SRS-22 scores (1 = worst, 5 = best) were compared using paired t test. Correlations between BIDQ-S and SRS-22 scores were evaluated by linear regression.

RESULTS

Eighty-four percent of the subjects were females, with average age at surgery of 14.4 ± 1.6 years. The mean follow-up was 2.26 years (range 2.0-4.5). The major Cobb was corrected from 50.0° ± 7.2° to 14.2° ± 5.8° (Δ = 71.3% ± 12.1%; p < .0001). There was a significant improvement in BIDQ-S scores after surgery (1.64 ± 0.51 to 1.21 ± 0.38, p < .0001). BIDQ-S improvements were correlated with change in SRS self-image (p = .0055), activity (p = .0057), mental (p = .0018), and overall mean (p = .0007) domains. Preoperative, two-year postoperative, and Δ BIDQ-S score were not associated with major Cobb magnitude, truncal rotation, or Lenke curve type. Patients who reached SRS-22r minimal clinically important difference (MCID) in activity and self-image domains had worse preoperative BIDQ scores than those who did not reach MCID (activity 1.91 vs. 1.54 [1 = best, 5 = worst], p = .0099; self-image 2.08 vs. 1.51, p < .0001). Greater improvement in BIDQ-S was noted in patients who reached MCID in SRS-22 self-image than those who did not (Δ = 0.77 vs. 0.38, p = .0052).

CONCLUSION

BIDQ-S is responsive to surgical correction of AIS. The BIDQ-S is a valuable clinical outcome tool to assess the psychosocial effects of scoliosis in adolescents augmenting existing outcome instruments.

Factors Influencing Body Image in Women with Breast Cancer: A Comprehensive Literature Review

Context

Many psycho-socioeconomic and other types factors associated with cancer, the treatment process, and changes in patients’ physical appearance and sexual function influence the body image of women with breast cancer. The purpose of this study was to determine which factors influence the body image of women with breast cancer.

Data Collection

A narrative literature review was conducted. Electronic databases, including Google Scholar, SID, Magiran, IranDoc, Barekat, Web of Science, Science Direct, Cochrane Library, ProQuest, Scopus, and PubMed, including Medline, were searched to retrieve articles published from 1993 to 2016 using the keywords breast cancer, treatment, body image, and related factors. The quality of selected studies was appraised using a checklist adapted from Samadaee-Gelehkolaee (2016).

Results

Of 690 articles retrieved in the search, 190 articles were selected for full text appraisal. Finally, 44 articles were selected for data analysis. The results were classified under three headings: bio-psycho-socioeconomic factors, factors associated with the disease and treatment processes, and physical appearance and sexual function.

Conclusions

The findings of this review showed that many factors can influence the body image of women suffering from breast cancer. These factors were predictors of patients’ inter-personal and intra-personal relationships with their partners and others who influenced various other aspects of their lives, possibly leading to many life’s issues. These factors must be identified and considered to make the most appropriate decisions for patients. The strength of this study lies in the exploration of factors influencing the body image of women with breast cancer which earlier studies did not consider. Moreover, the authors believe that this research has addressed nearly all the factors that are real concerns in the body image of women with breast cancer.

Patients' Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey

INTRODUCTION

Pulmonary nodules are detected in more than 1 million Americans each year. Prior qualitative work suggests that the detection of incidental pulmonary nodules can be burdensome for patients, but whether these findings generalize to a broader sample of patients is unknown. We categorized patients' knowledge, beliefs, and distress associated with detection and evaluation of a pulmonary nodule, as well as their impressions of clinician communication.

METHODS

We administered a cross-sectional survey to adults with an incidental pulmonary nodule who were recruited from a rural medical center, an urban safety net hospital, and a Veterans Affairs hospital.

RESULTS

Of the 490 individuals mailed surveys, 244 (50%) responded. Median nodule size was 7 mm, mean patient age was 67 years, 29% of respondents were female, and 86% were white. A quarter of the respondents (26%) reported clinically significant distress related to their nodule, our primary outcome, as measured by the Impact of Event Scale. Patients reported multiple concerns, including uncertainty about the nodule's cause (78%), the possibility of cancer (73%), and the possible need for surgery (64%). Only 25% of patients accurately estimated their lung cancer risk (within 15% of their actual risk); overall, there was no correlation between perceived and actual risk (r = -0.007, p = 0.93). The 23% of patients who did receive information on cancer risk from their provider were more likely to find this information reassuring (16%) than scary (7%).

CONCLUSION

A quarter of patients with incidental pulmonary nodules experienced clinically significant distress. Knowledge about cancer risk and evaluation was poor. Clinician communication may help bridge knowledge gaps and alleviate distress in some patients.

Body image investment in breast cancer patients undergoing reconstruction: taking a closer look at the Appearance Schemas Inventory-Revised

Breast cancer and its treatment can significantly affect a woman's body image. As such, it would be useful to understand the importance or value these patients place on their appearance. We evaluated the factor structure of the Appearance Schemas Inventory-Revised (ASI-R), a measure of body image investment, with a sample of 356 breast cancer patients undergoing mastectomy and breast reconstruction. Using confirmatory and exploratory factor analyses, we found that a three-factor model demonstrated an improvement in fit over the original two-factor structure of the ASI-R. These factors were named Appearance Self-Evaluation, Appearance Power/Control, and Appearance Standards and Behavior. The three aforementioned factors demonstrated acceptable internal consistency reliabilities. Our findings have implications for the use of the ASI-R in an oncology setting, specifically for breast cancer patients undergoing reconstruction.

Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire--Scoliosis Version

BACKGROUND

Appearance concerns in individuals with adolescent idiopathic scoliosis can result in impairment in daily functioning, or body image disturbance. The Body Image Disturbance Questionnaire (BIDQ) is a self-reported, seven-question instrument that measures body image disturbance in general populations; no studies have specifically examined body image disturbance in those with adolescent idiopathic scoliosis. This study aimed to validate a modified version of the BIDQ in a population with adolescent idiopathic scoliosis and to establish discriminant validity by comparing responses of operatively and nonoperatively treated patients with those of normal controls.

METHODS

In the first phase, a multicenter study of forty-nine patients (mean age, fourteen years; thirty-seven female) with adolescent idiopathic scoliosis was performed to validate the BIDQ-Scoliosis version (BIDQ-S). Participants completed the BIDQ-S, Scoliosis Research Society (SRS)-22, Children's Depression Index (CDI), and Body Esteem Scale for Adolescents and Adults (BESAA) questionnaires. Descriptive statistics and Pearson correlation coefficients were calculated. In the second phase, ninety-eight patients with adolescent idiopathic scoliosis (mean age, 15.7 years; seventy-five female) matched by age and sex with ninety-eight healthy adolescents were enrolled into a single-center study to evaluate the discriminant validity of the BIDQ-S. Subjects completed the BIDQ-S and a demographic form before treatment. Independent-sample t tests and Pearson correlation coefficients were calculated.

RESULTS

The BIDQ-S was internally consistent (Cronbach alpha = 0.82), and corrected item total correlations ranged from 0.47 to 0.67. The BIDQ-S was significantly correlated with each domain of the SRS-22 and the total score (r = -0.50 to -0.72, p ≤ 0.001), with the CDI (r = 0.31, p = 0.03), and with the BESAA (r = 0.60, p < 0.001). BIDQ-S scores differed significantly between patients (1.50) and controls (1.06, p < 0.005), establishing discriminant validity.

CONCLUSIONS

The BIDQ-S is an internally consistent outcomes instrument that correlated with the SRS-22, CDI, and BESAA outcomes instruments in a scoliosis population. The scores of the patients with scoliosis indicated greater back-related body image disturbance compared with healthy controls. To our knowledge, this user-friendly instrument is the first to examine body image disturbance in adolescent idiopathic scoliosis, and it provides a comprehensive evaluation of how scoliosis-related appearance concerns impact psychosocial and daily functioning.

Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement

Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments.

Psychiatric morbidity among Egyptian breast cancer patients and their partners and its impact on surgical decision-making

INTRODUCTION

Psychiatric morbidities, especially cases of anxiety and depression, are prevalent among breast cancer patients and their partners.

PATIENTS AND METHODS

Fifty-four early diagnosed breast cancer patients and their partners were compared with 50 healthy couples to assess psychiatric morbidity and the impact of various factors upon patients' surgical choice.

RESULTS

It was found that 18.5%, 22.2%, and 3.7% of husbands had generalized anxiety disorder, major depressive disorder, and panic disorder, respectively. It was also found that 38.8%, 29.6%, and 9.2% of the patients had major depressive disorder, generalized anxiety disorder, and panic disorder, respectively. Depression and anxiety scores were high in both partners in love-based, well-adjusted marriages, within the middle socioeconomic class, and among educated couples. Among the well-known factors related to surgical treatment choice (age, parity, tumor size, pathology, grade, lymph node status), only age and psychological morbidity (in the patients and their partners) had a significant impact on treatment choice.

CONCLUSION

Patients of middle socioeconomic class, the well educated, and those in love-based marriages had a higher likelihood of suffering different types of psychological morbidities and were more likely to choose breast conservation or reconstruction than mastectomy.

[Research on body image in oncology: a methodological synthesis]

Cancer and its treatments induce important physical transformations, which could be source of psychological and social difficulties. Since about 15 years, interest for cancer and treatments consequences on body image had grown in oncology. Nevertheless studying body image remains complex because of conceptual and methodological limits. This article aims at a clarification about the methods employed in the field of cancer to assess body image, in order to make accessible reference marks about adapted instruments for every person who would like to study this theme.

Effects of cognitive behavioral counseling on body Image following mastectomy

BACKGROUND

Breast cancer is the most common cancer in women. Surgical treatment of breast cancer may cause body image alterations. The purpose of the current study was to examine the effects of cognitive behavioral counseling on body image among Iranian women with primary breast cancer.

METHODS

In this quasi-experimental designed study, 72 patients diagnosed as breast cancer and surgically treated were enrolled in Isfahan, Iran. The patients were entered the study by convenience sampling method and were randomly divided in two groups of intervention (n = 32) and control (n = 40). The intervention group received consultation based on Ellis rational emotive behavior therapy (REBT) method for 6 sessions during 3 weeks. The control group did not receive any consultation Paired t-test was used to compare the changes in groups and independent t-test was conducted to compare two groups. The average values represented as mean ± standard deviation.

RESULTS

Before the study, the body image score was not significantly different between the intervention (16 97 ± 5 44) and control (15 95 ± 4 66) groups (t = 0 86, P = 0 395). The body image score was significantly lower in the interven-tion group (9 03 ± 6 11) compared to control group (17 18 ± 5 27) after the intervention (t = -6 07, P < 0 001).

CONCLUSIONS

Since a woman's body image influences her breast cancer treatment decision, oncology professionals need to recognize the value of a woman's favorite about appearance and body image. This study emphasizes the importance of offering consultation in breast cancer patients.

Breast cancer treatment and sexual dysfunction: Moroccan women's perception

Background

This exploratory prospective study evaluated women's responses to questions that asked them to describe how their body image and sexual functioning had changed since their breast cancer diagnosis to treatment.

Methods

A questionnaire concerning body image scale and various sexual problems experienced after diagnosis and treatment was anonymously completed by 120 women in the outpatient clinic of our hospital's Division of medical Oncology. To be eligible, subjects had to be sexually active and had histology proven breast cancer. They also had to have received treatment for breast cancer.

Results

100% of participants have never spoken with their doctor about this subject. 84% of the participants continued sexual activity after treatment, but there was an increase in the incidence of sexual functioning problems which resulted in a slight reduction in the quality of their sex lives. 65% of the women experienced dyspareunia followed by lubrication difficulties (54%) and the absence or reduction of sexual desire (48% and 64%, respectively) while, 37% had lack of satisfaction (37%). Female orgasmic disorder and brief intercourse and arousal were reported respectively by 40% and 38% of the subjects. The sexual dysfunctions were absent before diagnosis and management of breast cancer in 91.5% subjects and of these 100% subjects complained of a deterioration of the symptomatology after the various treatments. 90% of the dysfunctions were observed after chemotherapy, 9% after surgery and 3% after radiotherapy; none of the subjects indicated the onset of dysfunctions to have been associated with hormonotherapy. 100% expressed not having received sufficient information about how the disease and treatment (including surgery) might affect their sexual life.

Conclusion

Breast cancer and its treatment may result in significant difficulties with sexual functioning and sexual life. Addressing these problems is essential to improve the quality of life of Moroccan women with breast cancer.

Comparison of Arab breast cancer survivors and healthy controls for spousal relationship, body image, and emotional distress

BACKGROUND

Cultural perceptions and norms affect individuals' psychological reactions to cancer and quality of life, but very few studies have assessed reactions to breast cancer in specific cultural groups. Such assessments are especially rare for Arab women with breast cancer.

AIMS

To assess the effect of spousal support, sharing household tasks, and body image in relation to emotional distress in Arab breast cancer survivors compared with matched healthy controls.

METHOD

Fifty-six Israeli Arab breast cancer survivors (stages I-III), and 66 age- and education-matched women answered Brief Symptoms Inventory-18, Perceived Body Image, Perceived Spousal Support and Division of Household Labor scale questionnaires.

RESULTS

Breast cancer patients experienced higher psychological distress, especially anxiety and somatization. They reported receiving more support from their spouses and higher sharing of household tasks than did matched healthy controls, but were not different regarding body image. Twenty-eight percent of the variance of psychological distress was explained, with group, perceived support, and group × body image interaction. Thus, higher psychological distress was more likely to occur in participants receiving lower support and in breast cancer survivors with lower body image.

CONCLUSIONS

The study described the effects of breast cancer on Arab women compared to healthy women. It highlights the need for culture-sensitive care for Arab breast cancer patients, as well as other patients from minority groups residing in other Western countries.