Knowledge About Genomic Recurrence Risk Testing Among Breast Cancer Survivors

Genomic expression profiling of tumors is used to individualize early-stage breast cancer treatment. However, very little is known about patients’ understanding of and desired information about these tests, such as Oncotype DX. We addressed these issues via a survey mailed to 130 early-stage breast cancer patients who received an Oncotype DX test result. The survey assessed understanding (14 items), information desired about genomic expression profiling tests, and if and where they sought information about Oncotype DX. Sixty-four surveys were returned. Overall, 54% of the knowledge items were answered correctly. Patients wanted education about genomic tests in many areas. Overall, 62% sought information about the test, primarily from the Internet (48%) and doctor or health care provider (31%). In sum, patients’ misunderstanding of genomic tests abound, necessitating better educational efforts on behalf of health care systems to meet their needs for varied information through different communication channels.     

Exploring the Relationship Between Fear of Cancer Recurrence and Sleep Quality in Cancer Survivors

Fear of cancer recurrence (FCR) and sleep disturbance are identified as top psychosocial concerns in cancer survivorship, yet few studies have explored the association between these two factors. Using data from a study of 67 cancer survivors, hierarchical logistic regression models examined the relationships between socio-demographic characteristics, FCR, and sleep disturbance. More than half of survivors reported poor sleep quality; those with some college education and those with higher levels of FCR were at greater risk for poor sleep. These findings provide formative data for oncology social workers to implement interventions that target FCR as a strategy for improving sleep.     

Triggers and Coping Strategies for Fear of Cancer Recurrence in Cancer Survivors: A Qualitative Study

Background: Fear of cancer recurrence (FCR) has been demonstrated to be one of the most frequently reported unmet psychological needs among cancer survivors. The aim of this study was to explore and describe the potential triggers and coping strategies for FCR in Chinese cancer survivors. Methods: The study process was conducted using an interpretive phenomenological research method, and Chinese cancer survivors were interviewed face-to-face in a semi-structured interview, using purposive sampling combined with a maximum variance sampling strategy, and the interviews were transcribed, organized, and analyzed by applying Giorgi analysis with the help of NVivo11 software. Results: A total of 10 participants, 4 males and 6 females, were interviewed. Three themes emerged in terms of potential triggers for FCR: (1) intrusive thoughts; (2) disease symptoms; and (3) awaiting medical examination. Two themes regarding positive coping and avoidance coping emerged with regard to coping strategies adopted by cancer survivors when experiencing FCR. Under these 2 themes were 5 sub-themes: (1) seeking medical support; (2) self-health management; (3) spiritual coping; (4) unaccompanied toleration; and (5) attention shifting. Conclusion: FCR as the most common psychological problem for cancer survivors, and it should be given more attention. Early identification and precise intervention for potential triggers of FCR may prevent the emergence and development of FCR. The guidance toward and cultivation of positive coping strategies when cancer survivors experience FCR could be an important direction in future nursing education.     

Biopsychosocial Predictors of Psychological Functioning Among African American Breast Cancer Survivors

This study examined the relationships of biological and psychosocial predictors as contributing factors to the psychological functioning among breast cancer survivors. A sample of (N = 155) African American breast cancer survivors were recruited from California. A general linear model was utilized to examine the relationships. Biological and psychosocial risk factors were significant predictors for anxiety and depression. These predictors can be viewed as contributing factors to the psychological well-being of this cohort. Anxiety and depression are often under-recognized and subsequently undertreated in survivors. Understanding the predictors of depression and anxiety is necessary for incorporating a multidisciplinary approach to address this problem.     

Exploring Coping Strategies Among Young Asian American Women Breast Cancer Survivors

In recent years, breast cancer rates among young Asian American women have been increasing. Despite increases in breast cancer among young Asian American women, little is known about how this population copes throughout diagnosis, treatment, and survivorship. This study was a qualitative exploration of how young Asian American women cope with breast cancer diagnosis, treatment, and survivorship. In-depth interviews with 22 young (under the age of 50) Asian American women diagnosed with early stage breast cancer were conducted. Through qualitative data analysis, three major themes emerged including moving from managing the emotions of others to expressing emotional vulnerability, moving from work and productivity to work-life balance, and moving beyond the family and reaching out to breast cancer survivors. At diagnosis, participants worked to maintain normalcy including caring for others and working during treatment. Once treatment was over, women worked to find ways to use their experience as a transformative one and also to develop more positive coping skills including expressing emotional vulnerability and reaching out to others. Further studies are needed to create and test culturally tailored supportive interventions that enhance positive coping tools among young Asian American women diagnosed by breast cancer.     

Quality of Life of Breast Cancer Survivors After a Recurrence: A Follow-Up Study

Previous studies on breast cancer recurrence provide a mixed picture of the quality of life of women following a recurrence. To clarify the picture, the present study addresses some previous methodological concerns by offering a multidimensional assessment with follow-up, a matched comparison group of disease-free survivors, and a closer look at the nature of recurrence (local versus metastatic). Fifty-Four of 817 women who participated in an earlier study experienced a recurrence at follow-up, and are compared to a matched sample of 54 women who remained disease-free. Analyses indicate that women who had a recurrence report significantly poorer functioning on various health-related quality of life (HRQOL) domains compared to women who remained disease-free. However, the differences appear to be largely due to the poorer HRQOL of women with metastatic disease. Although women who had a recurrence report good mood, low stress, and good quality of interpersonal relationships, they report significantly higher cancer-specific stress compared to disease-free women at follow-up. Women who had a recurrence also report experiencing both more meaning and vulnerability as a result of breast cancer than disease-free women, but report similar levels of spirituality and benefit-finding at follow-up as disease-free women. These results suggest that although women report relatively good psychosocial adjustment following a recurrence, cancer-specific domains of quality of life are most likely to be negatively affected. These results may be useful in identifying individuals with breast cancer recurrences who are most in need of psychosocial services.     

Evaluating Survivorship Experiences and Needs Among Rural African American Breast Cancer Survivors

Disparities in cancer survivorship exist among specific populations of breast cancer survivors, specifically rural African American breast cancer survivors (AA-BCS). While effective survivorship interventions are available to address and improve quality of life, interventions must be culturally tailored for relevance to survivors. Here, we report the results of our formative research using focus groups and in-depth interview to better understand unique rural AA-BCS survivorship experiences and needs in the Alabama Black Belt. Surveys were used to gather sociodemographic and cancer treatment data. Fifteen rural AA-BCS shared their experiences and concerns about keeping their cancer a secret, lack of knowledge about survivorship, lingering symptoms, religion and spirituality, cancer surveillance, and general lack of survivorship education and support. Rural AA-BCS were unwilling to share their cancer diagnosis, preferring to keep it a secret to protect family and friends. Quality-of-life issues like lymphedema body image and sexuality were not well understood. They viewed spirituality and religion as essential in coping and accepting cancer. Participants also discussed the importance of and barriers to maintaining health through regular check-ups. They needed social support from family and friends and health care providers. Overall, rural AA-BCS expressed their need for knowledge about survivorship self-management by providing a vivid picture of the realities of cancer survival based on shared concerns for survivorship support and education within the context of culture.     

Healthy Lifestyle Changes During the Period Before and After Cancer Diagnosis Among Breast Cancer Survivors

Aims: The purpose of the present study was to investigate healthy lifestyle changes during the period beforeand after breast cancer diagnosis in Taiwan. Materials and Method: Lifestyle changes during the period beforeand after cancer diagnosis were assessed by convenience sampling with a structured questionnaire for breastcancer survivors. Results: A total of 235 breast cancer survivors completed the healthy lifestyle scale. The meanvalues before and after breast cancer diagnosis of the participants were 3.27 and 3.73. The final five dimensionsfor the period before breast cancer diagnosis were: had not experienced stress; had exercised; had maintainedsleep quality; had maintained body weight; and had maintained relationships. The final five dimensions for theperiod after breast cancer diagnosis were: sleep quality; had not experienced stress; relationship; had exercised;and had maintained body weight. A paired-t test was applied to examine the differences before and after cancerdiagnosis, revealing that the total average scores of the participants on the healthy lifestyle scale clearly differedstatistically (t= -17.20, p<0.01); and the nine dimensions before and after testing also demonstrate a markedstatistical difference (p<0.01). Conclusions: These findings are helpful in understanding the healthy lifestylechanges during the period before and after cancer diagnosis among breast cancer survivors. It is expected thatthese results can offer references of self-care for this group of patients.     

Health Management of Breast Cancer Survivors

Breast cancer is defined as a chronic disease.Increasing amounts of attention have been paid to the health management of breast cancer survivors. An important issue is how to find the most appropriate method of follow-up in order to detect long-term complications of treatment, local recurrence and distant metastasis and to administer appropriate treatment to the survivors with recurrence in a timely fashion. Different oncology organizations have published guidelines for following up breast cancer survivors. However, there are few articles on this issue in China. Using the published follow-up guidelines,we analyzed their main limitations and discussed the content,follow-up interval and economic benefits of following up breast cancer survivors in an effort to provide suggestions to physicians.Based on a large number of clinical trials, we discussed the role of physical examination, mammography, liver echograph, chest radiography, bone scan and so on. We evaluated the effects of the above factors on detection of distant disease, survival time,improvement in quality of life and time to diagnosis of recurrence.The results of follow-up carried out by oncologists and primary health care physicians were compared. We also analyzed the correlation factors for the cost of such follow-up. It appears that follow-up for breast cancer survivors can be carried out effectively by trained primary health care physicians. If anything unusual arises, the patients should be transferred to specialists.     

乳腺癌长期生存者的健康管理

乳腺癌作为一种慢性疾病.长期生存者其健康管理问题越采越值得关注,这方面的一个重要问题是如何以最合适的方式进行随访.以保证患者在初步治愈后能及时发现远期并发症及可能出现的复发转移并予以及时治疗.目前不同肿瘤组织出台的随访指南不尽相同.国内这方面的资料更少.本文结合国际权威肿瘤机构的随访指南,分析其中存在的主要问题,探讨乳腺癌患者随访的内答、间隔和经济学效益,以期为乳腺癌患者随访的临床处理提供一定的方向.根据大量临床试验,阐述了常规体检、乳腺钼靶摄片、胸片、B超、骨扫描等检查在监测肿瘤的复发转移、延长患者的生存期和提高患者的生活质量方面的作用;比较了由初级保健医师和肿瘤专科医师进行随访工作的效果;分析了影响随访费用的因素.最后认为随访可由经过训练的初级保健医师进行,主要的随访内容为病史回顾、体检、乳腺钼靶摄片,其它的相关检查可以在发现异常时交给专科医生进行.     

Relationship Between Exercise During Treatment and Current Quality of Life Among Survivors of Breast Cancer

Abstract

This retrospective study examined the relationship between exercise during cancer treatment and current quality of life among 167 survivors of breast cancer. The women had been diagnosed within the previous two years and had completed adjuvant therapy. Each participant completed a mailed, self-administered questionnaire that assessed her exercise behavior at three points (prediagnosis, active treatment, and posttreatment); her current physical, functional, emotional, and social quality of life; and her overall satisfaction with life. The results indicated that (1) levels of exercise declined from prediagnosis to active treatment and then increased from active treatment to posttreatment, (2) exercise during active treatment was associated with a higher quality of life and with overall satisfaction with life, and (3) maintenance of exercise across the three time periods was the optimal pattern for enhanced quality of life and overall satisfaction with life. The authors concluded that cancer treatment has a negative impact on exercise levels but that the women who maintained their exercise behavior during and after treatment reported a higher quality of life one to two years later.     

Alterations in Self-Perceptions Among Adolescent Cancer Survivors

Psychosocial adjustment in adolescent cancer survivors has been documented to be quite variable. Factors mediating adjustment need to be identified. The current study is an exploration of the impact that cancer diagnosis and treatment has on adolescent's self-perceptions and the role this has in mediating adjustment in this group. Fijiy-eight adolescent survivors of hematologic malignancies were interviewed about alterations in self-perceptions related to their cancer experience and completed a cancer-specific social problem-solving task. Initial findings suggest that cancer universally alters the way adolescent survivors view themselves, but that the alteration can be both positive or negative depending on the meaning ascribed to it.     

复发性乳腺癌预后分析

根据４０２例乳腺癌术后复发患者的临床回顾性分析的资料，探讨影响乳腺癌术后复发转移的预后因素及其改善疗效的途径。分析结果表明，６０％的乳腺癌复发患者在复发后２年内死亡。乳腺癌复发患者复发后的２年生存率与患者的年龄、月经状况、雌激素受体与孕酮受体状况、手术方式、预防或治疗性去势无关，与首发部位、原发肿瘤分期、肿瘤大小、手术时淋巴结转移数、复发后治疗情况及无复发间期长短有关。文章指出重视手术操作，合理安排术后治疗及加强术后患者的随诊，力求改善疗效。     

The Symptom Burden in Breast Cancer Survivors

Breast cancer survivors continue to experience an array of physical, psychological and cognitive symptoms following the completion of their treatment. However, there is a lack of understanding of symptom burden during an extended and long-term survivorship. The present review attempts to provide an overview of conceptual and contextual understanding of symptom burden that women with breast cancer may experience following treatment completion. We will focus on six commonly reported symptoms or symptom clusters in post-treatment breast cancer survivors, including menopausal symptoms, lymphoedema, fatigue, depression, sleep disturbance and cognitive dysfunction. To identify and manage the symptom burden effectively, further investigation is required into individual symptoms and their relationship to others.     

Studies of Cancer Among the Japanese A-Bomb Survivors

Studies of cancer among the Japanese survivors of the A-bombs dropped on Nagasaki and Hiroshima are the major source of information on radiation carcinogenesis in humans. They have already made important contributions to the estimation of the risk of radiation-induced cancer and to our understanding of key factors influencing risk, especially tissue sensitivity, age at exposure, and the temporal distribution of radiogenic cancers. The size of the exposed population still surviving virtually guarantees the continued productivity of the research conducted in Hiroshima and Nagasaki. It should not be supposed, however, that these studies will ever provide all the information needed for radiation protection standards or risk estimation. The experience of the A-bomb survivors simply does not include all important aspects of radiation exposure for which information is needed. Moreover, despite the size of the sample remaining under study, it is most unlikely that direct, empirical estimates can be made that will remove the necessity for dependence upon mathematical models to derive estimates of risk in the low-dose region.