No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Comparing Fatigue, Loneliness, Daytime Sleepiness, and Stress in Younger and Older Breast Cancer Survivors: A Cross-Sectional Analysis
Abstract
Background: Breast cancer treatment can negatively affect psychosocial outcomes for breast cancer survivors (BCS), but these outcomes present differently for younger and older survivors.
Objectives: The objective of this study was to compare psychosocial outcomes between younger and older BCS and identify predictors of loneliness in younger BCS.
Methods: This cross-sectional descriptive study of 90 BCS evaluated data on sociodemographic and clinical characteristics and self-reported measures of psychosocial outcomes (fatigue, depressive symptoms, anxiety, loneliness, daytime sleepiness, and stress). Participants were dichotomized into two groups by age (aged less than 50 years and aged 50 years or older). Descriptive statistics, bivariate correlations, and multiple regression were also examined.
Findings: Younger BCS reported greater fatigue, loneliness, daytime sleepiness, and stress than older BCS. No between-group differences were found in depressive symptoms or anxiety. Having children and less time since chemotherapy completion were significant predictors of less loneliness in younger BCS.
... Patient-related factors: Findings about the relationship between age and social isolation were inconsistent. Some studies confirmed that younger patients experienced greater feelings of isolation [55,61,67,70], while others certified that older patients had a greater score for subjective social isolation [57]. Similarly, studies regarding the relationship between gender and social isolation were inconclusive, with some findings showing that male patients felt more lonely [53] and others suggesting that female patients were more prone to subjective or objective social isolation [54,56,68,70,73]. ...
... Family-related factors: The findings from three studies indicated a negative association between the level of household income and the degree of subjective social isolation [10,63,73], suggesting that the higher the level of family income, the lower the degree of subjective social isolation. In a cross-sectional survey of 90 breast cancer patients, Choi and Henneghan indicated that not having children may be a risk factor for increased levels of loneliness in patients [55]. The other study conducted on 100 older adults with cancer, showed that patients who lived alone had significantly higher loneliness scores than the others [73]. ...
... Two studies on breast cancer [67] and colorectal cancer [56], respectively, both indicated that postoperative time was negatively related to subjective or objective social isolation. However, the results of three studies on the relationship between time since the last treatment and the feelings of isolation were controversial [55,63,65]. In addition, results from two studies indicated that informed patients had greater feelings of isolation than ignorant patients [54,68]. ...
(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients’ social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.
... Common symptoms of late-stage cancer include fatigue, pain and weakness, nausea and vomiting, poor appetite and malnutrition, oral symptoms, constipation, diarrhea, depression, and anxiety (E. Choi & Henneghan, 2022). Among them, fatigue and weakness are quite subjective symptoms that more than 50% to 89% of cancer patients complain of, and often do not improve with enough rest (Rau et al., 2020;Shah et al., 2022). ...
... Several studies (E. Choi & Henneghan, 2022;Ebede et al., 2017;M. K. Jang et al., 2021;Marker et al., 2022;Rau et al., 2020) including intervention studies, on chronic fatigue experienced by cancer patients, explored fatigue-related factors and relief, but it continues to be a major nursing problem and the identified interventions had different goals and mechanisms. ...
... Some previous studies (E. Choi & Henneghan, 2022;Miaskowski et al., 2021;Rau et al., 2020;Stulz et al., 2020) have also indicated that cancer patients often experience anxiety, depression, fear, and stress, as well as social unemployment, decreased interpersonal relationships, and sexual problems, the grouping for this item needs further consideration in the future. Among the items on the FACIT-Fatigue Scale (W. ...
Cancer fatigue (CF) is a major issue facing cancer patients that can negatively impact their quality of life. This study describes the development and validation of the Cancer Fatigue (CF) scale for the assessment of fatigue in cancer patients. A total of 202 cancer patients at university hospitals in South Korea were recruited and completed the questionnaires. Descriptive analysis was performed to determine the participants’ socio-demographic characteristics; the construct validity was examined using exploratory factor analysis; internal consistency reliability of the scale was estimated for the meaningful total scale and factors; and confirmatory factor analysis was performed to confirm the repetitive reproducibility of the factors. Findings indicated that the CF scale had good psychometric properties. 67.89% of the variance was explained by four subfactors: socio-cognitive (six items), physical (five items), psycho-affective (three items), and social-relationship networks (two items). The Cronbach’s alpha of the 16-item CF scale was 0.89 for the total scale, and the range of Cronbach’s alpha for subfactors was .75 to .89, indicating that it is valid and reliable. The 16-item CF scale is a feasible and time-efficient tool for assessing the fatigue of cancer patients in the clinical setting. Healthcare providers may use this measurement tool to explore cancer patients’ fatigue and routinely track the effect of a customized intervention on CF. This study also informs healthcare providers in other countries about the fatigue characteristics of Korean cancer patients.
... The underlying reason for this stability is that during the treatment period, breast cancer patients may encounter difficulties in engaging in social activities as they previously did, owing to the decline in their physical condition and immunity. This physical constraint diminishes their interaction with the external world, thereby augmenting their sense of isolation [46]. Furthermore, surgical interventions, chemotherapy, and other treatments may lead to image-related issues such as breast amputation, alopecia, and skin discoloration, which can evoke disturbances in the patients' self-image [47]. ...
Purpose
Loneliness is a prevalent affective issue among patients with breast cancer, with its developmental trajectory being a contentious subject. Therefore, the aim of this study was to explore trends in loneliness in patients with breast cancer and identify predictors of different trajectory categories.
Methods
Using convenience sampling, 176 patients planning to undergo breast cancer surgery in a university hospital in Shaanxi Province, China, were followed up six times over 12 months following surgery, and data from 144 patients were analyzed. The data were analyzed using a mixed growth model (GMM) and logistic regression.
Results
Two latent classes of loneliness trajectory were identified among patients with breast cancer, namely “persistent high loneliness” and “persistent low loneliness.” Patients who with education level of junior secondary and less (OR = 13.59, P = 0.002), had a melancholic temperament (OR = 12.07, P = 0.002) were more likely to be categorized in the “persistent high loneliness group”, whereas the better family functioning (OR = 0.60, P < 0.001) and choleric temperament (OR = 0.16, P = 0.025) of the patients were more likely to be categorized in the “persistent low loneliness group”.
Conclusion
Patients with breast cancer exhibit diverse trajectories of loneliness, with educational level, temperament type, and family functioning being predictive of these trajectories. Therefore, it is crucial to promptly identify populations at risk in a clinical setting and devise intervention strategies, grounded in identified trajectory characteristics and influencing factors, to enhance patient outcomes.
... Breast cancer is a common malignant tumor among young women. With the promotion of early screening for breast cancer and the improvement of breast cancer diagnosis and treatment techniques, the survival rate of breast cancer patients for more than 5 years has significantly increased, and it has become the norm for patients to enter the rehabilitation period after clinical treatment [1,2]. Post-traumatic growth is the positive change that occurs in an individual during the process of experiencing a traumatic event [3]. ...
To explore the mechanism of the effect of expressive writing on the post-traumatic growth of breast cancer patients, and to provide evidence for the rehabilitation of cancer patients. A qualitative interview study was done among 15 young convalescent breast cancer patients who participated in expressive writing intervention in a tertiary A hospital in Guangdong Province, The interview focused on the psychological experience of post-traumatic growth in the process of expressive writing, while content analysis focuses on the content of expressive writing. The interview materials were sorted and analyzed using the Colaizzi 7-step analysis method, and the themes were organized. Results showed that Five themes were extracted from the psychological experience of the post-traumatic growth, including the personality change, the relationship change, the life change, the meaning of illness, the gratitude and dedication. The text content of breast cancer patients' expressive writing includes five dimensions: fact description, emotional expression, self affirmation, cognitive reappraisal, and meaning discovery. There were obvious post-traumatic growth in convalescent young breast cancer patients, while experiencing the negative events and negative psychology of illness. The potential therapeutic mechanism of expressive writing in breast cancer survivors includes five factors: fact description, emotional expression, self affirmation, cognitive reappraisal, and meaning discovery.
... Patients with breast cancer face multifaceted challenges in cancer diagnosis and treatment that cause physical and psychosocial distress, such as anxiety, fear of recurrence, post-traumatic stress disorder, cognitive dysfunction, sexuality, body image, social isolation, and loneliness [1,2]. Especially, young patients with breast cancer report many problems related to social functions and role functions during treatment, as they often play multiple roles as mothers, spouses, friends, and workers [3,4]. ...
Purpose:
We evaluated the association between changes in social support after cancer treatment and recurrence-free survival (RFS) in such patients using a prospective cohort study.
Materials and methods:
Data were obtained from a prospective cohort study (NCT03131089) conducted at Samsung Medical Center (2013-2021). The primary outcome measure was RFS. Social support was measured using the Social and Family Well-Being (SFWB) domain of the Functional Assessment of Cancer Therapy-General. We calculated the changes in SFWB scores before and during treatment and the hazard ratio (HR) for RFS by comparing such changes.
Results:
The mean (SD) age of the patients was 35 (3.9) years, and 71.5% and 64.8% of the patients were married and had children, respectively. The mean (SD) SFWB score at baseline was 20.5 (5.0) out of 26. After cancer treatment, 35.9%, 10.3%, and 53.8% of the participants had increasing, unchanged, and decreasing SFWB scores, respectively. The decreasing SFWB score group had a higher risk of mortality or recurrence than the increasing group. Risk factors for the decreasing score were the presence of children during diagnosis.
Conclusion:
In this cohort, changes in social support after treatment were associated with RFS in young patients with breast cancer. Health professionals should develop family interventions to help them receive proper social support.
Background
The objectives of the study were to assess the quality of life (QOL) among women with breast cancer and associate the QOL with selected background variables.
Methods
A cross-sectional descriptive study was adopted for the study. Data collection was done in oncology units of tertiary care centers. The sample type includes woman with breast cancer at stage I or II or IIIa as per TNM classification. A purposive sampling technique was followed with a total sample size of 60. The tool used was the Quality of Life (QOL) questionnaire - Breast Cancer Version by National Medical Center & Beckman Research institute.
Results
The QOL among study participants revealed that 42 (70%) had average QOL and 18 (30%) had poor QOL. The QOL was examined in various domains such as physical wellbeing, where the mean score was 38.47, the psychological wellbeing mean score was 60.58, social wellbeing mean was 38.10 and spiritual wellbeing mean was 38.58. There was an association between residence and occupation with QOL at p<0.05. Further there was an association between the clinical variable such as period and stages of cancer at p<0.05 and type of treatment at p<0.01.
Conclusions
Breast cancer diagnosis has an undeniable effect on women at work, home and can have rapid consequences for other members in the family. Evaluation of QOL and associated factors would help the health care professionals especially nurses to organize health promotion activities and counselling sessions in varied health care settings to overcome challenges and improve Quality of Life.
Purpose:
To examine the psychosocial adjustment of young to middle-aged women who were newly diagnosed with breast cancer and to determine the comprehensive risk factors contributing to psychosocial adjustment.
Methods:
This study was carried out on 358 young to middle-aged women who recently received a breast cancer diagnosis in two hospitals in Guangzhou, China. Participants reported data about sociodemographic characteristics, disease and treatment information, coping modes, social support, self-efficacy, and psychosocial adjustment. To analyze the data, the researchers utilized independent t-tests, one-way analysis of variance, and multiple linear regression.
Results:
The results showed that the participants exhibited a moderate level of psychosocial maladjustment, with a mean score of 42.44 ± 15.38. Additionally, 30.4% of the participants were classified as having severe psychosocial maladjustment. The study identified the coping mode of acceptance-resignation (β = 0.367, P < 0.001), mode of avoidance (β = -0.248, P = 0.001), social support (β = -0.239, P < 0.001), self-efficacy (β = -0.199, P = 0.001) as factors that impacted the level of psychosocial adjustment.
Conclusions:
Psychosocial adjustment among young to middle-aged women who were newly diagnosed with breast cancer is affected by self-efficacy, social support, and coping modes. Healthcare professionals should pay attention to psychosocial adjustment in young to middle-aged women with breast cancer at the time of diagnosis, and could formulate effective interventions to improve their psychosocial adjustment by increasing self-efficacy, promoting social support, and encouraging effective coping.
Background: The objectives of the study were to assess the quality of life (QOL) among women with breast cancer and associate the QOL with selected background variables. Methods : A cross-sectional descriptive study was adopted for the study. Data collection was done in oncology units of tertiary care centers. The sample type includes woman with breast cancer at stage I or II or IIIa as per TNM classification. A purposive sampling technique was followed with a total sample size of 60. The tool used was the Quality of Life (QOL) questionnaire - Breast Cancer Version by National Medical Center & Beckman Research institute. Results : The QOL among study participants revealed that 42 (70%) had average QOL and 18 (30%) had poor QOL. The QOL was examined in various domains such as physical wellbeing, where the mean score was 38.47, the psychological wellbeing mean score was 60.58, social wellbeing mean was 38.10 and spiritual wellbeing mean was 38.58. There was an association between residence and occupation with QOL at p<0.05. Further there was an association between the clinical variable such as period and stages of cancer at p<0.05 and type of treatment at p<0.01. Conclusions : Breast cancer diagnosis has an undeniable effect on women at work, home and can have rapid consequences for other members in the family. Evaluation of QOL and associated factors would help the health care professionals especially nurses to organize health promotion activities and counselling sessions in varied health care settings to overcome challenges and improve Quality of Life.
Purpose
Immigrant young adults of cancer survivors face unique challenges but their unmet needs were not well understood. The purpose of this study was to identify the challenges and strengths of immigrant young adult Chinese American breast cancer survivors.
Method
Descriptive phenomenology using a qualitative research approach was employed in this study. Expressive writing was used to explore the experience of 15 young adult Chinese American immigrant breast cancer survivors. Thematic analysis was conducted to gain an understanding of the lived experiences of young adult Chinese American breast cancer survivors.
Results
On average, participants had been diagnosed at 37 years (ranging from 32 to 39) and living in the USA for 12 years. Participants' writings revealed their challenges during and after treatment (major theme), including difficulty accepting having cancer at a young age, financial difficulties, self-blame, inadequate family support, uncertainty about their futures, and worries about their children and infertility (sub-themes). Participants’ strengths and coping strategies (major theme) included physical recovery and positive self-perception, family as motivation for survival, and support from family and friends (sub-themes). Post-traumatic growth (major theme) included shifting life priorities and enjoying life and self-transcendence (i.e., forgiving and helping others) (sub-themes).
Conclusions
The overarching topic found across the major themes in the young adult Chinese American breast cancer survivors’ essays was the importance of interpersonal relationships, especially with family and children. Healthcare providers should respond with culturally appropriate support, referrals, and resources based on these findings.
Introduction:
In palliative care, the prevention and relief of fatigue are regarded as crucial goals in patients with cancer.
Methods:
A systematic review was carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Searches were conducted in Medline (through PubMed), Web of Science, Open Gray, Scielo, Cochrane, CINAHL and EMBASE. All instruments found in each study were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development and Evaluation approach.
Results:
A total of 5598 articles were identified in the different databases. In total, 57 studies describing 19 instruments were included in this study. The main properties evaluated were internal consistency, cross-cultural validity, hypotheses testing and responsiveness. All studies were evaluated with the Strobe scale with a score greater than 6 points.
Conclusions:
According to the quality methodological results, Edmonton Symptom Assessment System, Problems and Needs in Palliative Care Questionnaire, European Organisation for Research and Treatment of Cancer Quality of Life 15-item Questionnaire for Palliative Care and Palliative Care Quality of Life Instrument are the recommended instruments used for assessing cancer-related fatigue in palliative care. PROPESRO registration number: CRD42020206783.
Objective:
To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial.
Methods:
Survivors (aged 35-68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors.
Results:
The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference -0.017, 95% CI: -0.031 to -0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference -0.019, 95% CI: -0.031 to -0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up.
Conclusions:
HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.
Objective:
Breast Cancer Survivors (BCSs) experience negative effects on their physical and mental health, including sleep disorders, after the completion of treatment and over the whole spectrum of survival. The aim of this study was to investigate the levels of posttreatment anxiety, depression, and sleep disorders exhibited by women who have survived breast cancer.
Methods:
A descriptive, cross-sectional study was conducted with a population of 170 BCSs, who were monitored as outpatients by two surgical departments of a central Athens hospital for between one and five-5 years after completing their therapy. The data were collected between November 2019 and March 2020 and included demographic and clinical characteristics, as well as the Athens Insomnia Scale to measure sleep disorders and the Hospital Anxiety and Depression Scale to assess the incidence of mental disorders.
Results:
The majority of the patients were aged 61-70 years (41.4%), married (56.9%), with two children (56.3%), and graduates of higher education (41.8%). Of the total population, 53.5% had sleep disorders, 29.4% anxiety, and 18.2% depression. Insomnia had a moderately positive correlation with both anxiety and depression (r = 0.598, P < 0.001 and r = 0.584, P < 0.001, respectively), while a strongly positive correlation was found between depression and anxiety (r = 0.683, P < 0.001). Sleep disorders were associated with factors such as profession (P < 0.001), income (P = 0.01), the number of minor children (P = 0.021), and the number of pathological problems (P = 0.003); anxiety was related to the number of minor children (P = 0.008) and the use of drug therapy to treat mental disorders (P = 0.038); while for depression, the relevant factors were the duration of treatment (P = 0.029), the number of minor children (P < 0.001), the use of medication for treatment of mental disorders (P = 0.008), and sleep disorders (P = 0.003).
Conclusions:
Women who have survived breast cancer in Greece show a high rate of anxiety and depression related to the disease, as well as sleep problems that are partly associated with their psychological status, but are also affected by parameters such as income, type of profession, and the presence of minor children in the household.
We introduce a simple new approach to variable selection in linear regression, with a particular focus on quantifying uncertainty in which variables should be selected. The approach is based on a new model—the ‘sum of single effects’ model, called ‘SuSiE’—which comes from writing the sparse vector of regression coefficients as a sum of ‘single‐effect’ vectors, each with one non‐zero element. We also introduce a corresponding new fitting procedure—iterative Bayesian stepwise selection (IBSS)—which is a Bayesian analogue of stepwise selection methods. IBSS shares the computational simplicity and speed of traditional stepwise methods but, instead of selecting a single variable at each step, IBSS computes a distribution on variables that captures uncertainty in which variable to select. We provide a formal justification of this intuitive algorithm by showing that it optimizes a variational approximation to the posterior distribution under SuSiE. Further, this approximate posterior distribution naturally yields convenient novel summaries of uncertainty in variable selection, providing a credible set of variables for each selection. Our methods are particularly well suited to settings where variables are highly correlated and detectable effects are sparse, both of which are characteristics of genetic fine mapping applications. We demonstrate through numerical experiments that our methods outperform existing methods for this task, and we illustrate their application to fine mapping genetic variants influencing alternative splicing in human cell lines. We also discuss the potential and challenges for applying these methods to generic variable‐selection problems.
In recent decades, the living conditions of young breast cancer (BC) survivors have garnered increasing attention. This population-based study aimed to identify the clinical, social and economic determinants of Health-Related Quality of Life (HRQoL), and to describe other living conditions of young long-term BC survivors. Women with non-metastatic BC diagnosed between 2006 and 2015, aged 45 years and younger at the time of diagnosis, were identified through the Breast and Gynecologic Cancer Registry of the Côte d’Or, France. Participants completed self-report questionnaires including standardized measures of HRQoL, anxiety, depression, social deprivation, social support and sexuality. Fertility and professional reintegration issues were also assessed. The determinants of HRQoL were identified using mixed regression model. In total, 218 BC survivors participated in the survey. The main determinants of poor HRQoL were anxiety, depression, comorbidities, social deprivation and menopausal status. Among 72% of women who did not receive information about fertility preservation, 38% of them would have liked to have been informed. Finally, 39% of survivors reported a negative impact of BC on their professional activity. This study showed that BC stage or treatments did not have an impact on HRQOL of young long-term BC survivors. Fertility, sexuality and professional reintegration remained the main concerns for survivors. Specific interventions in these population should focus on these issues.
Background:
Debate still exists regarding physical and cognitive factors associated with Body Mass Index (BMI) in the elderly population. This study aimed to determine the association between BMI and comorbidity, Quality of Life (QOL), and cognitive function in the elderly population.
Methods:
This cross-sectional study was conducted from October 2017 to January 2018. The participants included 246 old people who referred to Imam Reza elderly clinic, Shiraz, Iran. The data were collected using Leipad Quality of Life Questionnaire and Mini-Mental State Examination (MMSE). Indeed, weight and height were measured to assess the BMI. The data were entered into SPSS, version 21, and analyzed using ANOVA, Chi-square test, Pearson correlation coefficient, and multiple regression analysis.
Results:
This study showed that 104 (47%) of the participants were overweight and obese. The mean±SD score of QOL was 46.14±12.01. Additionally, 93 (37.8%) of the participants had cognitive impairment. The results showed a significant difference among normal weight, overweight, and obese groups regarding the mean scores of QOL (P<0.001) and cognitive function (P<0.001). Moreover, 29% of the changes in BMI was explained by QOL, cognitive function, and having hypertension and cancer. Among these variables, the associations between BMI and QOL (r=-0.52, P<0.001) and cognitive function (r=-0.28, P<0.001) were significant.
Conclusion:
The results showed that half of the old people suffered from overweight and obesity. Moreover, roughly one-third had cognitive impairment. In addition, BMI was associated with QOL and cognitive function in the elderly. Therefore, healthcare workers might use these findings to design prevention and treatment programs targeting the elderly population.
Objectives:
To identify subgroups of Latina breast cancer survivors with unique trajectories of depression and anxiety and examine predictors associated with these subgroups.
Sample & setting:
Secondary analysis of Latina breast cancer survivors (N = 293) from three psychosocial intervention studies.
Methods & variables:
Depression and anxiety were assessed at intake and at weeks 8 and 16. Group-based growth mixture modeling was used to identify subgroups who followed distinct trajectories of depression and anxiety. Multinomial logistic regression models were used to identify predictors of trajectory-based subgroup membership.
Results:
Three trajectories emerged for depression.
Implications for nursing:
Latina women treated for breast cancer are at an elevated risk for depression and anxiety and follow distinct trajectories of these symptoms. Psychosocial interventions are needed to manage these symptoms, particularly for subgroups in which depression and anxiety persist or worsen.
Purpose:
Το explore the relationship between mental health (depression, anxiety, and stress), loneliness, and illness perception with health-related quality of life (HRQoL) in young breast cancer patients, within a year after mastectomy, and to investigate the role of breast reconstruction.
Methods:
Eighty-one women with stage II breast cancer-35 with breast reconstruction and 46 without breast reconstruction-completed the Missoula-VITAS Quality of Life Index-15, the Depression Anxiety Stress Scale 21, the UCLA Loneliness Scale, the Brief Illness Perception Questionnaire, and a questionnaire with demographic and medical information. Statistical analysis was performed using IBM SPSS Statistics version 20.
Results:
Breast reconstruction was a significant predictor of total HRQoL and its domains. Women with breast reconstruction had better HRQoL, significantly better mental health, less stress and anxiety levels but experienced more physical discomfort and perceived higher level of physical distress compared to the ones without breast reconstruction. On the contrary, patients without breast reconstruction had higher level of loneliness, which was found to be correlated with poor HRQoL and higher levels of anxiety. Negative illness perceptions were associated with poor HRQoL for both groups.
Conclusions:
Breast reconstruction is not a panacea for patients in improving HRQoL.
Cancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified. This study examined whether cancer-related loneliness (i.e., feeling socially disconnected related to having cancer) mediated the relationships between social constraints and symptoms (i.e., pain interference, fatigue, sleep disturbance, and cognitive complaints) in patients with various cancers (N = 182). Patients (51% female, mean age = 59) were recruited from the Indiana Cancer Registry and completed questionnaires assessing social constraints, cancer-related loneliness, and symptoms. Structural equation modeling was used to evaluate the hypothesized relationships among variables. The model demonstrated good fit. Consistent with our hypothesis, cancer-related loneliness mediated the relationships between social constraints and each symptom. Findings suggest that addressing cancer-related loneliness in symptom management interventions may mitigate the negative impact of social constraints on outcomes.
Purpose:
Loneliness is a known risk factor for poor mental and physical health outcomes and quality of life in the general population, and preliminary research suggests that loneliness is linked to poorer health outcomes in cancer patients as well. Various aspects of the cancer experience contribute to patients feeling alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Cancer-specific tools are needed to assess key constructs of this theory. In the current study, we developed and tested measures of (1) loneliness attributed to cancer (i.e., cancer-related loneliness) and (2) negative social expectations related to cancer.
Methods:
First, we developed the items for the measures based on theory, prior research, and expert feedback. Next, we assessed the measures' psychometric properties (i.e., internal consistency and construct validity) in a diverse sample of cancer patients.
Results:
The final products included a 7-item unidimensional Cancer Loneliness Scale and a 5-item unidimensional Cancer-related Negative Social Expectations Scale. Evidence of excellent reliability and validity was found for both measures.
Conclusions:
The resulting measures have both clinical and research utility.
Among individuals coping with cancer, emotional approach coping—expressing and processing emotions following negative events—has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.
Social environment is a well-recognized determinant in health and wellbeing. Among breast cancer patients, inadequate social support is associated with a substantial increase in cancer-related mortality. A common explanation is that socially isolated individuals fare worse due to reduced instrumental support (i.e., assistance meeting the demands of treatment). However, the ability to replicate the detrimental effects of social isolation on mammary tumor growth in rodents strongly suggests an alternative explanation; i.e., socially isolated individuals have a physiological milieu that promotes tumor growth. This review summarizes the clinical and basic science literature supporting social influences on breast cancer, and provides a conceptual physiological framework for these effects. We propose that social environment contributes to the vast individual differences in prognosis among breast cancer survivors because social environment is capable of altering basic physiological processes, which in turn can modulate tumor growth. Appreciation of the role of social environment in breast cancer progression could promote the identification of patients at increased risk for poor outcomes. In addition, characterization of the underlying physiological mechanisms could lead to targeted disruption of detrimental pathways that promote tumor progression in socially isolated individuals, or exploitation of protective pathways activated through social engagement as novel therapeutic complements to contemporary treatments.
The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
In this article I evaluated the psychometric properties of the UCLA Loneliness Scale (Version 3). Using data from prior studies of college students, nurses, teachers, and the elderly, analyses of the reliability, validity, and factor structure of this new version of the UCLA Loneliness Scale were conducted. Results indicated that the measure was highly reliable, both in terms of internal consistency (coefficient alpha ranging from .89 to .94) and test-retest reliability over a 1-year period (r = .73). Convergent validity for the scale was indicated by significant correlations with other measures of loneliness. Construct validity was supported by significant relations with measures of the adequacy of the individual's interpersonal relationships, and by correlations between loneliness and measures of health and well-being. Confirmatory factor analyses indicated that a model incorporating a global bipolar loneliness factor along with two method factor reflecting direction of item wording provided a very good fit to the data across samples. Implications of these results for future measurement research on loneliness are discussed.
Purpose:
To conduct a detailed content analysis of the theme "I'm still Mom" as described by young women living with advanced breast cancer.
Participants & setting:
12 young adult women living with advanced breast cancer were recruited from across the United States.
Methodologic approach:
van Manen's hermeneutic phenomenologic method was used to analyze qualitative data from interviews and establish subthemes.
Findings:
Women were a mean age of 36 years and had at least one child. The following three subthemes emerged from the overarching theme of I'm still Mom.
Implications for nursing:
This study provides a foundation for additional research that can inform family-centered education and interventions to help align the parenting priorities of this cohort of women, as well as optimize their quality of life.
Background:
Young women with breast cancer (YWBC) are more likely to have aggressive disease, carry mutations for hereditary cancer genes, and experience higher mortality. They also may face reduced fertility because of the toxicity of chemotherapy.
Objectives:
This article aims to present a review of YWBC treatments, sequelae of treatment, and psychosocial challenges.
Methods:
The authors performed a review of guideline-supported treatment options, patient resources, and nursing implications.
Findings:
Because of high-risk cancers and a lack of specific treatment guidelines, healthcare providers may consider aggressive treatments for younger patients. However, studies indicate that the foundation for treatment decisions for YWBC are best based on disease stage and National Comprehensive Cancer Network guidelines.
OBJECTIVES:
To identify symptom clusters in breast cancer survivors and to determine sociodemographic and clinical characteristics influencing symptom cluster membership.
SAMPLE & SETTING:
The authors performed a cross-sectional secondary analysis of data obtained from a community-based cancer registry-linked survey with 1,500 breast cancer survivors 6-13 months following a breast cancer diagnosis.
METHODS & VARIABLES:
Symptom clusters were identified using latent class profile analysis of four patient-reported symptoms (pain, fatigue, sleep disturbance, and depression) with custom PROMIS® short forms.
RESULTS:
Four distinct classes were identified.
IMPLICATIONS FOR NURSING:
Common symptom clusters may lead to better prevention and treatment strategies that target a group of symptoms. Results also suggest that certain factors place patients at high risk for symptom burden, which can guide tailored interventions.
KEYWORDS:
breast cancer; survivors; symptom burden; symptom clusters
Background:
Delay in diagnosis may be a contributing factor to the observed correlation between young age and advanced disease. We examined time to cancer diagnosis in young women presenting to surgeons with breast-related complaints.
Materials and Methods:
This population-based cohort study included all women aged 18-44 presenting to a surgeon with breast-related complaints between 2005 and 2015 in a large health care plan (n = 157,264). Data included demographics, diagnosis codes, and workup. Cancer diagnosis was ascertained from the national cancer registry. Time to breast imaging and biopsy was compared between the different age groups. Logistic regression analysis was used to determine the association between age and delay to biopsy while adjusting for possible confounders.
Results:
During the 1st year after the visit, 45,434 (29%) women had breast imaging; 5,766 (3.7%) women had a breast biopsy; and 676 (0.43%) were diagnosed with breast cancer. Overall, time to first breast imaging and biopsy did not differ significantly between the age groups. But nonspecific visit codes (other than breast mass) were associated with delays to imaging and biopsy. Among, women diagnosed with breast cancer, age under 40 years (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.9), being postpartum (OR: 2.6, 95% CI: 1.1-5.9), and a nonspecific visit code (OR: 8.3, 95% CI: 4.9-14.2) were associated with delay.
Conclusions:
Symptomatic women with lower a-priori likelihood of malignancy (younger age, postpartum, or nonspecific visit code) are at significantly greater risk of delayed diagnosis of cancer. Physicians should be aware of the diagnostic challenge in young women presenting with nonspecific symptoms.
Background:
Chemotherapy leads to various symptoms and psychological distress, which contribute to a significant decrease in the quality of life of the patients.
Objectives:
The aim of this study was to identify changes and interrelationships in the fatigue-depression-anxiety symptom cluster and quality of life during the cancer care trajectory in women with breast cancer.
Methods:
Fifty women participated in the study and completed questionnaires at 3 different times: prechemotherapy, postchemotherapy, and 6 months after the completion of chemotherapy. The assessment tools were the Functional Assessment of Cancer Therapy-Fatigue Scale, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Breast Cancer version 4 Scale. Data were analyzed using descriptive and repeated-measures analysis of variance statistics.
Results:
A significant increase in fatigue (F = 41.95, P < .001) and psychological distress (F = 26.55, P < .001) from prechemotherapy to postchemotherapy was noted. Improvement was observed 6 months after the completion of chemotherapy. A positive or negative change in fatigue was associated with the same in psychological distress. Quality of life (F = 65.22, P < .001) also showed similar change patterns as observed with fatigue and psychological distress. Fatigue had a greater impact on quality of life at postchemotherapy, but psychological distress had a greater impact at prechemotherapy and at the 6-month follow-up.
Conclusion:
These results suggest that chemotherapy is highly associated with the fatigue-depression-anxiety symptom cluster and quality of life in women with breast cancer.
Implications for practice:
Nursing intervention is needed to relieve the intensity of the fatigue-depression-anxiety symptom cluster and thus improve the quality of life of patients undergoing chemotherapy from before treatment to follow-up.
Background: With a nearly 89% 5-year survival rate for women with early-stage breast cancer, symptoms are a priority. Healthy lifestyle behaviors may be temporally associated with symptoms; however, evidence is lacking.
Objective: This research examined temporal relationships among healthy lifestyle behaviors and symptoms in women diagnosed with breast cancer receiving chemotherapy.
Methods: This research was part of a study (R01NR012667) approved by the institutional review board. Women (n = 76) providing written informed consent participated in this longitudinal study examining health-promoting lifestyle behaviors and symptoms (fatigue, anxiety, depression, and pain). Participants completed well-validated self-report questionnaires primarily at a clinic visit. Statistical methods included descriptive statistics, linear mixed-effects models, and pairwise comparisons using SAS 9.4; α was set at .05.
Results: Lowest healthy lifestyle behavior scores for physical activity and highest scores for spiritual growth were reported. Significant changes in physical activity and stress management were noted. Fatigued patients had lower physical activity and nutrition scores than did patients without fatigue. Patients with anxiety had lower spiritual growth and interpersonal relation scores than did patients without anxiety. Relationships demonstrated temporal differences.
Conclusions: Breast cancer survivors did not routinely engage in healthy lifestyle behaviors. Significant temporal changes in healthy lifestyle behaviors and symptoms and significant associations among healthy lifestyle behaviors, symptoms, and demographic and clinical factors were noted in this study.
Implications for Practice: Knowing the temporal relationships among these variables provides insight that could be useful for nurses so they can encourage healthy lifestyle behaviors to mitigate symptoms throughout the cancer trajectory.
Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.
Background:
empirical evidence suggests that anxiety and depression in cancer patients is underdiagnosed and subsequently this patient population receives little or no support or intervention to address their psychosocial needs. It is often difficult to distinguish between normal emotional distress experienced following a cancer diagnosis and anxiety and depression, which can have a significant impact on coping mechanisms and subsequent outcomes.
Aim:
a qualitative study using the Hospital Anxiety and Depression Scale (HADS) was undertaken in the National Centre for Cancer Care and Research in Qatar. The driver for change was to provide evidence of the need for an assessment to be incorporated into the nursing admission process as a means of early detection and onward referral for more formal interventions if required. The sample size was 57.
Findings:
the evidence from the outcome data supported the hypothesis that anxiety and depression were present in a significant number of the sample group. This would support the proposal of early screening and onward referral. A number of patients surveyed expressed moderate to severe depression, which may impact negatively on outcomes.
Conclusion:
screening for anxiety and depression in adult cancer patients should form part of an early nursing assessment to identify those who may benefit from more structured interventions. HADS is a useful screening tool; however, further research is required on validating tools used to screen for anxiety and depression in cancer and chronic disease in different cultures to ensure validity and reliability of outcome data.
Objectives:
To examine the nature of the symptom cluster of emotional distress, fatigue, and cognitive difficulties in young and older breast cancer survivors (BCS); To assess the mediating role of subjective stress and coping strategies (emotional control and meaning-focused coping) in the association between age and symptom cluster.
Materials and methods:
Participants were 170 BCS, stages I-III, 1-12 months post-chemotherapy, filled-out the Fatigue, Emotional Control, Meaning-focused Coping, Emotional Distress and the Cognitive Difficulties Questionnaires. Statistical analyses included tests for difference between-groups Pearson correlations and Structural Equation Modeling for the assessment of the study model.
Results:
Older BCS (aged 60-82) reported lower levels of emotional distress (M = 0.87, SD = 0.87), fatigue (M = 3.85, SD = 2.38), and cognitive difficulties (M = 1.17, SD = 1.07) compared to the younger BCS (aged 24-59) (emotional distress M = 1.17, SD = 0.85, fatigue M = 5.02, SD = 2.32, and cognitive difficulties M = 1.66, SD = 1.23, p < .01-,05). The older survivors reported lower levels of subjective stress and used more emotional control strategies compared to the younger BCS. The empirical model had good fit indices (χ2 = 27.60, p = 0.20, χ2/df = 1.26; CFI = 0.98; TLI = 0.98; NFI = 0.95; RMSEA = 0.04 (90% CI = 0.00, 10) and showed that subjective stress, but not coping strategies, mediated the effect of age on symptom cluster severity.
Conclusions:
Lower levels of subjective stress, but not coping strategies, mediated the association of age with the symptom cluster of emotional distress, fatigue and cognitive difficulties. Further research is needed to explore differences in subjective stress by age.
Objective
Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy.
Methods
Women 21 to 65 years old with a history of non‐metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated.
Results
90 women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = ‐0.37 to ‐0.49, Ps<.00049), but not objective cognitive performance of verbal fluency, memory or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance.
Conclusions
Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research.
Purpose:
There is a paucity of information regarding health related quality of life (HRQoL) of young adults (YAs) with cancer and caregivers. Therefore, we characterize YA and caregiver perspectives on the impact of cancer and its treatment on HRQoL.
Methods:
We conducted descriptive qualitative in-depth, semi-structured interviews with YAs receiving cancer care at an academic health center in Albuquerque, New Mexico (USA) and primary informal caregivers. The interviews, conducted from September through December 2015, focused on perspectives on the impact of the disease and its treatment in terms of physical and emotional effects, coping, and strategies to enhance HRQoL. We used an iterative thematic analysis approach to identify emergent themes and create a coding structure.
Results:
We reached thematic saturation after interviewing 8 YAs and 8 caregivers. YAs and caregivers discussed cancer triggered challenges such as anxiety, depression, isolation, fear, and financial hardships. YAs and caregivers coped by maintaining positive perspectives, relying on friends and family, and prayer. Caregivers discussed how expectations for and experiences of a "good day" changed depending on their loved ones' stage of cancer treatment. YAs navigated challenges by focusing on activities and thoughts that provided meaning to their lives. YAs and caregivers suggested strategies to enhance HRQoL through patient/provider communication, support services, and decision making tools as potential mechanisms for grounding patient-centered interventions to improve cancer care.
Conclusions:
Implications include the development and evaluation of informational and behavioral interventions tailored and targeted to address the pragmatic needs of YAs undergoing cancer treatment and informal caregivers.
Social relationships are adaptive and crucial for survival. This review presents existing evidence that our social connections to others have powerful influences on health and longevity and that lacking social connection qualifies as a risk factor for premature mortality. A systems perspective is presented as a framework by which to move social connection into the realm of public health. Individuals, and health-relevant biological processes, exist within larger social contexts including the family, neighborhood and community, and society and culture. Applying the social ecological model, this review highlights the interrelationships of individuals within groups in terms of understanding both the causal mechanisms by which social connection influences physical health and the ways in which this influence can inform potential intervention strategies. A systems approach also helps identify gaps in our current understanding that may guide future research. Expected final online publication date for the Annual Review of Psychology Volume 69 is January 4, 2018. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Purpose
We aimed to examine the level of psychological distress, fatigue, and health-related quality of life (HRQOL) and identify HRQOL predictors in men with prostate cancer receiving androgen deprivation therapy (ADT).
Methods
Using a cross-sectional design, we recruited 161 men with prostate cancer receiving ADT (mean age, 73 years) at two university-based hospitals in South Korea. Participants completed a self-reported questionnaire. Measures included the Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) subscale, and the Functional Assessment of Cancer Therapy-Prostate (FACT-P).
Results
The mean scores were 3.3 (SD = 2.8) for anxiety with a prevalence of 8.9%, 5.7 (SD = 3.8) for depression with a prevalence of 25.5%, and 30.3 (SD = 7.4) for fatigue with a prevalence of 15.6%. The five FACT-P subscale means were 23.9 (SD = 4.3) for physical well-being, 15.4 (SD = 6.4) for social well-being, 18.5 (SD = 4.3) for emotional well-being, 17.3 (SD = 5.6) for functional well-being, and 30.3 (SD = 7.4) for the prostate cancer-specific subscale. Multiple linear regression analysis revealed that depression, which was inversely associated with all FACT-P subscales, was the strongest predictor of worse HRQOL. Fatigue and comorbid conditions were also associated with the HRQOL of multiple domains.
Conclusion
This study suggests that intervention aimed at improving HRQOL of men receiving ADT should include depression, fatigue, and comorbidity management.
Background:
Fear of recurrence (FOR) is a primary concern for both cancer survivors and their caregivers, yet little is known about what care-related factors exacerbate this worry.
Objectives:
This study aimed to establish the role of care-related stressors-as distinct from survivor characteristics-in predicting FOR in head and neck cancer caregivers.
Methods:
HNC survivor-caregiver dyads took part in a mailed survey. Survivors provided information on health and quality of life (using the Functional Assessment of Cancer Therapy Questionnaire). Caregivers provided sociodemographic information, impact of caring on their time and finances, as well as their level of social support (Oslo Support Scale), loneliness (3-point loneliness scale), and completed the Worry of Cancer Scale (to measure FOR).
Results:
Data from 180 dyads were available for analysis. Multiple regression analysis was used to examine the role of caregiver stressors, social support, and loneliness while controlling for caregiver and survivor characteristics. The model explained 28% of the variance in Worry of Cancer scores (FOR). Caregivers who reported more loneliness, spent more time caring, and had greater financial stress from caring had higher scores on Worry of Cancer (FOR). Female caregivers, those caring for younger survivors, and those with survivors who had undergone less extensive forms of surgery also reported higher FOR.
Discussion:
A combination of factors place caregivers at greater risk of cancer-related worry, paving the way for designing interventions aimed at reducing FOR in caregivers of patients with head and neck cancers.
Background:
African American (AA) women are more likely to be given a diagnosis of breast cancer at an early age, experience morbidity after treatment, and exhibit disparities in survivorship. Although psychosocial well-being is largely studied among breast cancer survivors, data are sparse regarding young AA survivors.
Objective:
This integrative review examined psychosocial concerns in survivorship among young AA survivors using a quality-of-life framework.
Methods:
PubMed, CINHAL, EMBASE, PsychINFO, and Scopus were searched for articles exploring psychosocial well-being in young AA survivors.
Results:
The search yielded 237 articles that were retrieved and reviewed for relevance. Of these, 16 articles were selected based on inclusion/exclusion criteria. Data were evaluated and synthesized based on the quality-of-life model. Selected articles omitted the study of several psychological subconstructs and identified existing psychosocial concerns that require mitigation.
Conclusions:
The review revealed key areas of psychosocial concerns among young AA survivors including ongoing anxiety/depression, cognitive changes, and relationships. Identified gaps include paucity of research with young AA survivors and their residual psychosocial concerns.
Implications for practice:
Review findings indicate a need to increase survivorship research on young AA survivors. Researchers, clinicians, and young AA survivors must partner in efforts to understand psychosocial concerns and translate findings into clinical practice (ie, use of psychosocial distress tools, distress de-escalation protocols, and individualized survivorship care plans) toward reduction of quality-of-life health disparities among young AA survivors.
Background:
Chemotherapy (CT) is an important adjuvant treatment that has been widely used for breast cancer (BC) patients. However, no research has focused on trends in emotions and quality of life (QOL) during intermittent periods between CT sessions that are critical for recovery.
Objective:
The aim of this study was to investigate longitudinal trends in anxiety, depression, and QOL during the different intermittent periods between adjuvant CT for BC.
Methods:
A longitudinal study design was adopted. Eighty-eight women undergoing CT for BC were selected using a purposive sampling method, and they completed the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5 points. A repeated-measures analysis-of-variance model was used to compare anxiety, depression, and QOL at different time points.
Results:
The results showed a significant difference in SAS (F = 187.78, P < .00), SDS (F = 263.07, P < .00), and FACT-B (F = 140.82, P < .00) scores at the 5 time points. The SAS and SDS scores were highest at T3, whereas the FACT-B score was lowest at T3.
Conclusions:
The BC patients had psychological distress during intermittent periods between adjuvant CT, as evidenced by anxiety and depression, which were highest in the third cycle. Meanwhile, QOL was lowest at the third CT cycle and highest at the first CT cycle.
Implications for practice:
Clinical staff should focus on critical time periods during CT, particularly during the third cycle, and provide additional support to patients to ensure that CT is delivered in an optimal fashion.
Objective:
To summarize the psychosocial experience of women with breast cancer from a lifespan perspective by examining the findings of qualitative studies.
Methods:
A meta-aggregate review of 24 qualitative studies was undertaken. To be included, studies must include women with a breast cancer diagnosis and focus on younger or older women (as defined by the study), or compare a psychosocial issue across the lifespan. Eight databases were searched systematically.
Results:
Study participants ranged in age from 26 to 91 years. Sixteen studies focused on younger women, six focused on older women, and two included women across the lifespan. A total of 155 findings were extracted from the studies and were aggregated into 11 categories. These were synthesized into four synthesized findings: (a) dealing with cancer, (b) the importance of caring, (c) the aftermath of cancer, and (d) fertility and infertility.
Conclusions:
Further research is required to explore these findings, and to examine the needs of older women in particular. Delineating the similarities and differences in the needs of women across the lifespan will inform the development of psychosocial interventions for all women with breast cancer.
Purpose:
Evaluation of the effect of supportive expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors.
Methods:
A randomized control trial including breast cancer patients who had completed chemotherapy and randomly allocated into two groups: intervention (n = 41) and control (n = 40). The intervention consisted of twelve weekly 90-min sessions for groups of six to eight breast cancer survivors. Data were obtained pre-to -post the intervention and at 8-week follow-up. The data were analyzed using a repeated-measures analysis of variance (ANOVA).
Results:
The findings revealed a significant reduction in loneliness scores (F = 69.85, p < 0.001), promotion in total hope (F = 20.8, p < 0.05) and enhancement in quality of life from pre- to post-intervention, and then over the 8-week follow-up period in the intervention group, while scores of control participants did not show this pattern during the study. The strongest effects were found for global quality of life (effect size) = 0.59), for future perspectives (effect size = 0.51), emotional functioning (effect size = 0.35) and social functioning (effect size = 0.31).
Conclusion:
The intervention was effective on loneliness, hope and quality of life in the intervention group. The intervention needs further evaluation in a larger study and with other cancer types. Copyright © 2016 John Wiley & Sons, Ltd.
Objectives:
Researchers have suggested that older adults express less negative emotions. Yet, emotional expression patterns in older and younger breast cancer survivors, have barely been examined. This study aimed to explore types and intensity of negative and positive emotional expression related to the breast cancer experience by younger and older Arab breast cancer survivors.
Design:
Participants were 20 younger (aged 32-50) and 20 older (aged 51-75) Muslim and Christian Arab breast cancer survivors (stages I-III), currently free of disease. Data were gathered through in-depth semi-structured interviews. Mixed methods analyses were conducted, including: (1) frequency analysis of participants' emotional expressions; (2) content analysis of emotional expressions, categorized according to negative and positive emotions.
Results:
Three emotional expression modalities were revealed: (1) Succinct versus comprehensive accounts; (2) expression of emotions versus avoidance of emotions; (3) patterns of expression of positive emotions and a sense of personal growth. Younger women provided more detailed accounts about their illness experiences than older women. Older women's accounts were succinct, action-focused, and included more emotion-avoiding expressions than younger women.
Conclusions:
Understanding the relationships between emotional expression, emotional experience, and cancer survivors' quality of life, specifically of those from traditional communities, is necessary for developing effective psycho-social interventions.
Little is known about the prevalence of combined anxiety and depressive symptoms (CADS) in breast cancer patients. Purpose was to evaluate for differences in demographic and clinical characteristics and quality of life (QOL) prior to breast cancer surgery among women classified into one of four distinct anxiety and/or depressive symptom groups.
A total of 335 patients completed measures of anxiety and depressive symptoms and QOL prior to and for 6 months following breast cancer surgery. Growth Mixture Modelling (GMM) was used to identify subgroups of women with distinct trajectories of anxiety and depressive symptoms. These results were used to create four distinct anxiety and/or depressive symptom groups. Differences in demographic, clinical, and symptom characteristics, among these groups were evaluated using analyses of variance and Chi square analyses.
A total of 44.5% of patients were categorized with CADS. Women with CADS were younger, non-white, had lower performance status, received neoadjuvant or adjuvant chemotherapy, had greater difficulty dealing with their disease and treatment, and reported less support from others to meet their needs. These women had lower physical, psychological, social well-being, and total QOL scores. Higher levels of anxiety with or without subsyndromal depressive symptoms were associated with increased fears of recurrence, hopelessness, uncertainty, loss of control, and a decrease in life satisfaction.
Findings suggest that CADS occurs in a high percentage of women following breast cancer surgery and results in a poorer QOL. Assessments of anxiety and depressive symptoms are warranted prior to surgery for breast cancer.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Purpose Fertility preservation is an important issue for premenopausal cancer patients; however, not all patients receive counseling about chemotherapy-induced infertility and potential mitigation strategies. We aimed to identify characteristics of premenopausal breast cancer patients less likely to receive fertility counseling. We also investigated patient recall of chart-documented fertility discussions and patient attitudes toward fertility preservation. Methods The study was approved by our institution’s Institutional Review Board. All female patients with invasive primary breast cancer of any type, aged 40 or younger at the time of diagnosis, who were diagnosed during or up to 5 years prior to the study period were eligible. The study was conducted between February 2012 and October 2013. Enrolled patients completed an anonymous survey, and their medical charts were subsequently reviewed to identify provider documentation of fertility discussions, referral to fertility specialists, or implementation of fertility preservation. Patient comments regarding their fertility were solicited and examined thematically. Results Forty-nine patients consented to participate. Fertility discussions were documented by providers in 55 % of patients. Patients aged over 35 and multiparous patients were significantly less likely than their counterparts (p Conclusions Despite increasing awareness, fertility is not universally discussed with premenopausal breast cancer patients at the time of diagnosis; older and multiparous patients are at particular risk of not receiving fertility counseling. Even when such discussions are documented, only about half of patients recall the conversation. Patient-reported barriers to fertility preservation include lack of education combined with the stress of diagnosis, financial costs, and perceived treatment toxicities.
Details of the technique of hormonal replacement therapy at the menopause and afterwards are described. Estrogen deficiency indicated by symptoms including hot flashes sweats emotional instability and lassitude and confirmed by a vaginal smear taken at midcycle which shows poor cornification requires replacement therapy with natural conjugated estrogens (which have few side effects). The cycle of 4 or 5 weeks consists of daily estrogen administered alone for 14 or 21 days respectively in doses of .625 1.25 or 2.5 mg followed by 7 days of the same plus progesterone (2.5 mg of norethisterone acetate) followed by 7 days of nothing or .625 mg of estrogen in order to permit withdrawal bleeding. A satisfactory level of estrogen and progesterone can be maintained after menopause with continuous therapy for as long as 10 years.
This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.