Experiences Of Breast Cancer Patients Research Articles

Exercise despite pain--breast cancer patient experiences of muscle and joint pain during adjuvant chemotherapy and concurrent participation in an exercise intervention.

Chemotherapy-related pain is a well-known side effect in cancer patient receiving chemotherapy. However, limited knowledge exists describing whether exercise exacerbates existing pain. Aim of the research was to explore muscle and joint pain experienced by women with breast cancer receiving adjuvant chemotherapy with epirubicin and cyclophosphamide followed by docetaxel and factor support and concurrently participating in an exercise intervention. The study used individual semi-structured interviews (pre- and post-intervention). Fifteen women were interviewed. The multimodal group intervention comprised supervised training: high-intensity cardiovascular, heavy resistance and relaxation, massage and body-awareness (9 h weekly, 6 weeks). The analysis revealed five categories: Abrupt pain - a predominant side effect, cogitated pain management, the adapted training, non-immediate exacerbation of pain and summarised into the essence of chemotherapy related muscle and joint pain in exercise breast cancer patients; exercise despite pain. Findings indicate that the patients' perception of sudden onset of chemotherapy-related muscle and joint pain was not aggravated by training. Pain intensity peaked between 2 and 9 days after chemotherapy and is described to be stabbing pain with a feeling of restlessness in the body. The patients demonstrated a high adherence rate to the exercise intervention caused by their own willpower and camaraderie of the group.

Factors Affecting Symptom Experiences of Breast Cancer Patients: Based on the Theory of Unpleasant Symptoms

【Purpose: The purpose of this study was to identify the factors affecting symptom experiences of breast cancer patients. Methods: A cross-sectional descriptive study was conducted with based on the Unpleasant symptom Theory. Sixty breast cancer patients were recruited. We measured their symptom experiences, physiologic factors (immune system function and specific perceived symptoms), psychological factors (depression and anxiety), and situational factors (family support). After obtaining permission from the IRB, data were collected from self-report questionnaires and electronic medical records from a single cancer center. Descriptive statistics, t-test, one-way ANOVA, correlations and multiple regressions were used to analyze the data. Results: The most frequent and severe symptoms were fatigue ( $4.47{\pm }2.99$ ), numbness or tingling ( $3.67{\pm}3.08$ ) and sadness ( $3.45{\pm}3.64$ ). Symptom experiences were significantly positively correlated with psychological factors (r=.603, p】

Abstract P6-08-08: Adjuvant breast cancer therapy: Correlation of treatment data with patient reported outcomes in a German breast cancer centre

Abstract Objectives: Clinical diagnosis and treatment data lack a subjective perspective of the affected patients. Patient reported outcomes on the other hand often provide only basic information of the medical background. In this analysis we matched treatment data from clinical files and subjective experiences of breast cancer patients. Methods: Identification of breast cancer patients who had their primary surgery between 2006 and 2010 at a breast cancer centre followed by systemic adjuvant treatment. Relevant medical data were transferred from clinical files into a database and patients were asked to fill in a standardized paper pencil interview. Statistical analyses were conducted using SPSS 19. Results: 1044 unselected female patients who suffered from invasive breast cancer were contacted, 740 responded (return rate 70.9%) and 734 questionnaires could be analyzed. Non-responders showed no systematic differences in diagnosis or treatment. Median age at the time of the interview was 65 (30-91) for responders and 66 (33-96) for non-responders respectively (p = .412). Further analyses were conducted for the 734 responders only. Distribution according to UICC criteria at initial diagnosis was as follows: stage I 46%, stage II 42%, stage III 12%. 78% received breast-preserving surgery, 22% mastectomy. 3% received neo-adjuvant chemotherapy, 85% radiotherapy and 85% anti-hormonal therapy. 49% received adjuvant chemotherapy with taxane containing regimens in 60%. 91% were “satisfied” or “very satisfied” with the surgical result, in which patients with breast-preserving surgery were more satisfied than patients after mastectomy. 66% indicated a complete freedom of pain, 65% reported no limitations of arm or shoulder function. In both cases the results improved with increasing age. In frequency of antihormonal therapy a correspondence of 91% between data from medical records and subjectively reported treatment could be observed. Psychological distress, cognitive limitations and physical consequences were rated on a scale from 1 - “not at all” to 4 - “very much”. The highest average values were found for the items sleep disturbances (2.3) and exhaustion (2.3), the lowest for depression (1.7). Patients up to 60 years suffered more from the psychological consequences than older patients. 44% were in employment before the disease, 66% of them could return to their workplace. The return to work was as easier the younger the patients were. For 75% their partnership did not change, 12% experienced deterioration, 12% improvement. No effect of surgery or systemic treatment could be found here. Before the illness 9% consulted a psychiatrist / psychotherapist, after the illness 19%. Before the diagnosis of breast cancer 14% received antipsychotic drugs, after the disease 26%. In both cases is the increase in frequency stronger for younger patients and for patients who had received chemotherapy. Multivariate analyses will be presented. Conclusions: Adjuvant breast cancer therapy leads to long lasting impairment of physical, psychological, social and job-related functioning in a significant number of patients. Depending on age, surgery and systemic treatment patients are affected differently. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-08.

Incidence, consequences and treatment of bone metastases in breast cancer patients—Experience from a single cancer centre

BackgroundThere is a paucity of literature about the benefits of bone-targeted agents for breast cancer patients with bone metastases treated in the non-trial setting. We explored the incidence, consequences, and treatment of bone metastases at a single cancer centre. MethodsElectronic records of metastatic breast cancer patients were reviewed and pertinent information was extracted. ResultsOf 264 metastatic breast cancer patients, 195 (73%) developed bone metastases. Of these patients, 176 were eligible for analysis. Median age at bone metastases diagnosis was 56.9 years (IQR 48–67) and initial presentation of bone metastases included asymptomatic radiological findings (58%), bone pain (40%), or a SRE (12.5%). Most patients (88%) received a bone-targeted agent, starting a median of 1.5 months (IQR 0.8–3.30) after bone metastasis diagnosis. 62% of patients had ≥1 SRE. The median time from bone metastasis diagnosis to first SRE was 1.8 months (IQR 0.20–8.43 months). Median number of SREs per patient was 1.5 (IQR 0–3). Overall, 26.8% of all SREs were clinically asymptomatic. Within the entire cohort, 51% required opioids and 20% were hospitalized due to either an SRE or bone pain. ConclusionsDespite extensive use of bone-targeted agents, the incidence of SREs remains high. Nearly half of SREs occur prior to starting a bone-targeted agent. Use of opioids and hospitalizations secondary to bone metastases remain common. More effective treatment options are clearly needed.

Disentangling breast cancer patients' perceptions and experiences with regard to endocrine therapy: Nature and relevance for non-adherence

Background & study aimsAdjuvant endocrine therapy effectively prevents recurrence and progression of estrogen-receptor positive breast cancer. However, studies reveal substantial non-adherence. The objective was therefore to identify the nature of the experiences and beliefs of women treated with endocrine therapy in an attempt to find potential determinants of non-adherence. MethodOnline Focus Groups (OFGs) and individual interviews were conducted with 37 women who were treated with endocrine therapy. Sixty-three statements derived from the OFGs and 11 belief items from the Beliefs about Medicines Questionnaire (BMQ) were used in a Q-sorting task conducted with 14 of the women. The quantitative Q-sorting data were statistically analyzed with Hierarchical Cluster Analysis. ResultsA six cluster solution was revealed that included the clusters ‘information’, ‘efficacy’, ‘tenacity’, ‘coping’, ‘side effects’ and ‘usage’. Women's own experiences and perceptions were not clearly delineated from the beliefs measured with the BMQ. However, women judged their own experiences and perceptions with regard to endocrine therapy as more relevant for adherence than the BMQ beliefs. ConclusionIn order to understand and to improve women's adherence to endocrine therapy, women's own perceptions and experiences about endocrine therapy should be targeted in addition to common beliefs that apply to a wide range of medicines.

Exploring the use of the survivorship consult in providing survivorship care

Advances in breast cancer treatment have increased survival and contributed to longer periods of survivorship as reported by the Committee CCSsS (Canadian Cancer Statistics) (2011) and Hewitt et al. (2005), increasing the relevance of survivorship care. Survivorship care includes encouraging survivors to acquire the knowledge, skills and confidence to manage their life, as well as engaging survivors through post-diagnosis disease self-management and self-care strategies. The Survivorship Consult (SC) was designed to help survivors reflect on their needs, establish goals and create an action plan. Twenty-six breast cancer survivors who participated in the SC at Princess Margaret Cancer Centre took part in semi-structured interviews to assess the survivor experience and effectiveness of the SC. Data from these interviews were coded, and themes were identified using a modified grounded theory approach. Themes that emerged regarding the experience and effectiveness of the SC included (1) the supportive experience of collaborative dialogue with supportive care clinicians (i.e. nurses, social workers, occupational therapists, etc.), (2) the development of personalized goals that motivated individuals to implement recommendations, (3) an enhanced understanding of their health condition, team and options, (4) an improved ability to identify needs and (5) an increased sense of confidence to manage issues related to care. The assessment of the SC improved the experience of breast cancer patients by providing a supportive environment where they could feel cared about, by increasing understanding of their condition and its treatment, by improving communication with the care team and by motivating patients to manage care issues. Further research is needed on survivors who conduct the SC before the treatment phase of their cancer trajectory.

Uptake and experiences of breast cancer patients referred for fertility preservation.

86 Background: The 2006 ASCO guidelines suggest women of childbearing age receive counseling and referrals regarding the impact of treatment on fertility. Less is known about the use and uptake of FP in these women. The objective of this study was to evaluate the experience of patients referred for FP from a multidisciplinary breast cancer program. Methods: After IRB approval, patients diagnosed with a primary breast cancer between January 1, 2006 and June 30, 2011 and referred for FP counseling were identified via queries of institutional databases. Clinicopathologic, treatment, and outcome data were collected. Patients who received a consultation with a reproductive endocrinologist (REI) and did not pursue FP were selected for further contact via telephone survey. Results: Twenty-two patients had a consultation with REI; 10 were nulliparous. Fifteen of these saw an REI prior to any treatment. Thirteen (59%) had embryo or oocyte preservation. The majority (9) underwent consultation with both surgical and medical oncology prior to REI. Nine of the 13 had surgery prior to FP. Of the remaining 9, 7 (78%) responded to a telephone survey. Six (86%) recalled counseling at the initial visit or prior to chemotherapy. Barriers to FP included: cost (3), perceived delay in chemotherapy (2), being overwhelmed by cancer diagnosis (2), uncertainty of FP effects on cancer (1), and ethical concerns (1). Conclusions: Patients counseled by multiple oncology providers in a multidisciplinary setting prior to REI consultation were more likely to pursue FP. Those who did not cited a number of factors in their decision. Consultation with multiple oncology specialists may enhance decision-making regarding FP. [Table: see text]

Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services

PurposeThe aim of this paper was to briefly describe how the experience-based co-design (EBCD) approach was used to identify and implement improvements in the experiences of breast and lung cancer patients before (1) comparing the issues identified as shaping patient experiences in the different tumour groups and (2) exploring participants' reflections on the value and key characteristics of this approach to improving patient experiences.MethodsFieldwork involved 36 filmed narrative patient interviews, 219 h of ethnographic observation, 63 staff interviews and a facilitated co-design change process involving patient and staff interviewees over a 12-month period. Four of the staff and five patients were interviewed about their views on the value of the approach and its key characteristics. The project setting was a large, inner-city cancer centre in England.ResultsPatients from both tumour groups generally identified similar issues (or 'touchpoints') that shaped their experience of care, although breast cancer patients identified a need for better information about side effects of treatment and end of treatment whereas lung cancer patients expressed a need for more information post-surgery. Although the issues were broadly similar, the particular improvement priorities patients and staff chose to work on together were tumour specific. Interviewees highlighted four characteristics of the EBCD approach as being key to its successful implementation: patient involvement, patient responsibility and empowerment, a sense of community, and a close connection between their experiences and the subsequent improvement priorities.ConclusionEBCD positions patients as active partners with staff in quality improvement. Breast and lung cancer patients identified similar touchpoints in their experiences, but these were translated into different improvement priorities for each tumour type. This is an important consideration when developing patient-centred cancer services across different tumour types.

Experiences from having breast cancer and being part of a support group. Notes written in diaries by women during radiotherapy

The purpose of this study was to examine the experiences of breast cancer patients participating in a support group. This study explores 28 stories of women with breast cancer as expressed through written diaries. Diaries were written during a 5-week period in parallel with radiotherapy and participation in a support group in a hospital. Answers to six open-ended evaluative questions concerning the support group were included in the majority of the written diaries. A qualitative content analysis was used to identify themes. Three themes were constructed during the analysis: "positive group development." "Inhibited group development." and "the individual living with the disease." Hopes and fears for the future in regards to illness and getting better, the value of family and friends, and feelings related to daily life with breast cancer such as fatigue and changes in body image were also expressed in the diaries. The findings suggest that the women with breast cancer found it valuable to be able to share experiences with other women in a similar situation in the context of a support group. Being part of such a group provided a space and an opportunity for reflection.

P5-17-07: HER2+ Metastatic Breast Cancer Patient Experiences on Treatment in the Biologic Era: Findings from a Community Web-Based Survey.

Abstract Background: HER2−directed biologic therapy is part of recommended treatment for women with HER2+ metastatic breast cancer (MBC). However, little is known regarding the quality of life (QoL) experience and symptom burden in these women outside of clinical trials. Methods: This one-time, web-based survey was conducted with 6 independent U.S. breast cancer support groups. Respondents were required to be female, aged 18+ with HER2+ MBC, and to have received active treatment in the past month outside of a clinical trial. Data were collected on demographic, clinical, employment, QoL (Rotterdam Symptom Checklist and EQ-5D), and other measures. Survey responses were stratified by active treatment (biologic alone, biologic in combination with other therapy, no biologic) and number of months since diagnosis of MBC. Results: Of 337 possible respondents, 185 women with HER2+ MBC completed the survey. The majority were aged 45–59 years (53.5%), white (94.6%), living with a spouse or partner (74.6%), and had at least some college education (93.5%). Most (64.9%) reported bone as a site of metastasis, followed by liver (36.2%), lung (31.9%), and brain (21.6%). During the prior month, 60 respondents (32.4%) had received biologic therapy only (trastuzumab, lapatinib and/or bevacizumab), 93 (50.3%) received biologic with another treatment, 21 (11.4%) received no biologic and 11 (5.9%) did not report a specific active treatment. Demographic and clinical characteristics were similar across therapy groups, with some geographic variation. Overall, the tumor receptor status was ER+/PR+ for 43.2% of respondents. Mean months since MBC diagnosis ranged from 46 among those taking a biologic with another treatment to 60 for those taking biologics only. Average Rotterdam subscale scores indicate that psychological symptoms caused the greatest impairment (mean= 67.8 of 100, where 100 is best), followed by physical symptoms (74.1) and activity limitations (87.3). There were no clinically meaningful (≥8 point) differences across biologic groups, with the greatest difference between the biologic with other therapy (73.5) and biologic-only (80.8) groups for “overall evaluation of life.” The average EQ-5D utility index score was 0.8 (1.0 is perfect health), with minimal variation across therapy groups. Most respondents reported no problems with mobility (62-77%) or self-care (≥90% across groups). However, pain/discomfort and anxiety/depression were problematic for more than 50% of all respondents, and were most commonly reported among the biologic plus other treatment group (61.3% and 51.6% respectively, P<.05 for differences in usual activity problems). Rotterdam and EQ-5D dimension scores indicated less impairment with more time since MBC diagnosis, particularly for EQ-5D mobility, self-care, usual activities, and pain/discomfort. Pain and mobility scores for those diagnosed 72+ months ago were significantly better than for those diagnosed 0–17 months ago (both P<.05). Conclusions: This community survey of women with HER2+ MBC provides valuable insight into treatment, quality of life and symptom burden. Pain and psychological issues continue to be challenges for this population. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-17-07.

4186 POSTER The Experiences of Breast Cancer Patients With the Care of the Breast Care Nurse

4186 POSTER The Experiences of Breast Cancer Patients With the Care of the Breast Care Nurse

The lived experience of breast cancer patients and couple distress

A major trend in research has focused on identification of couple characteristics and dynamics against the backdrop of life-threatening or chronic illness. Awareness of these factors may lead to identification of couples at high risk for severe relationship distress. The researchers obtained an emic perspective of the impact of a breast cancer diagnosis on womens' couple relationships and the response by healthcare providers to such psychosocial issues. This was a phenomenological study of the lived experience of breast cancer patients using a purposive sample of seven women in individual psychotherapy with a history of breast cancer and a focus group of five women from a breast cancer support group. Data analysis was conducted following Colaizzi's framework with five emergent themes identified. Interrater reliability was achieved with data analysis by two other researchers. Results confirmed that breast cancer may have a profound impact on the couple relationship from diagnosis through survivorship. Relationships with healthcare providers disclosed significant disparities in identification and response to couple distress. Healthcare providers need to be sensitive to the "silent suffering" that exists for some breast cancer patients and incorporate consistent methods to identify and respond to couple distress.

Comparison of patient-reported symptoms and health behaviors to clinician documentation among patients with breast cancer in follow-up care.

9133 Background: Breast cancer (BC) patients (pts) experience symptoms from disease and treatment. While detection of recurrence is fundamental to follow up care, symptom management is equally important. UCSF has implemented a secure online health questionnaire enabling BC pts to update their health history and symptoms. A report summarizing this information is placed in the chart for clinician review prior to visits. Methods: We randomly selected a sample of stage I-III BC pts (n=41) who completed the questionnaire prior to a medical oncology visit and who consented to have data used for research. We conducted a chart review calculating the number of symptoms reported in the questionnaire, the clinic note only, and both questionnaire and clinic note, excluding chronic symptoms addressed previously. We used a paired t-test to compare the number of symptoms reported in the questionnaire compared to those documented by the clinician. We used a regression plot to determine whether the fraction of symptoms agreed upon by the pt questionnaire and provider clinic note affected symptom management. We also compared self-reported data on exercise and alcohol consumption to documentation of these lifestyle factors in clinic notes. Results: Pts reported significantly more symptoms using the online questionnaire (mean=4, range 0-13) than were documented by the provider in clinic notes (mean=2.8, range 0-9; p=0.028 for the difference). A regression plot comparing the percentage of symptoms agreed upon by the pt and provider and the percentage of symptoms addressed yields a slope of 0.50 (95% CI 0.22 to 0.78, p=0.001). Information on exercise behavior and alcohol consumption was completed in 100% of the online questionnaires, but was documented in only 12/41 (29%) and 27/41 (66%) of charts reviewed. In 6/27 (22%) charts where alcohol consumption was documented, there was discordance between pt and clinician reporting. Conclusions: The integration of the online health questionnaire into clinical practice facilitates symptom and lifestyle factor reporting, may increase the percentage of symptoms addressed, and may identify research targets for improved symptom management.

Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer.

Background:Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients’ consultation and decision-making experiences with specialist clinicians.Methods:Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units.Results:Low mastectomy rate unit patients’ consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients’ perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT.Conclusion:Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making.

Comparing breast and lung cancer patients’ experiences at a UK Cancer Centre: implications for improving care and moves towards a person centered model of clinical practice

Patient surveys are increasingly used to obtain feedback about experiences of care to guide changes in the way services are delivered. We compared the experiences of breast and lung cancer patients at diagnosis, in-patient and outpatient care at a Cancer Centre using a locally adapted version of the Picker Institute Cancer Patient Experience Survey. 65% of breast (82/127) and 65% of lung (75/116) cancer patients responded. Both groups reported good experiences at diagnosis, good support from clinical nurse specialists, and had very positive overall views. Breast patients had slightly poorer experiences of hospital stays while lung patients less often received clinical nurse specialist support and information about other support. Both groups reported that written information was not always provided. 84% (132/157) consented to data on the clinical severity of their condition being used to investigate whether this influenced experiences. This study showed that supportive care policies are being implemented at diagnosis and patients value clinical nurse specialist care. Sufficiently large comparative surveys can identify specific areas of performance for services to focus upon in order to improve quality of care. Patients facing poor prognoses can complete surveys and future studies might explore whether disease stage is associated with differing experiences.

The role of patient–provider communication for black women making decisions about breast cancer treatment

Recent reports suggest that Black breast cancer patients receive adjuvant therapies less often than their White counterparts; however, few studies have examined the self-reported experiences of Black breast cancer patients making treatment decisions. This study examined cultural beliefs and healthcare factors that impacted Black women's treatment decisions. In-depth interviews were conducted with 49 Black women with early stage breast cancer (stages 0-III). Participants resided in Washington, DC (n = 13), and Philadelphia, Pennsylvania (n = 36). Women's ages ranged from 26 to 85 (m = 53.9). All interviews were transcribed verbatim and then entered into a qualitative software program. Three coders independently read and coded transcripts using this software. The data did not reveal common cultural themes that influenced women's treatment decisions. Spiritual beliefs were important to all participants and did seem to help them cope with and reframe their illness experiences. The patient-provider relationship was the most notable factor that influenced treatment decisions. While most women reported that they were satisfied with their provider relationships, their narratives revealed that many lacked knowledge about their diagnoses and treatment regimens. Those patients who demonstrated a better understanding of their disease and treatments also seemed to adhere to recommendations for adjuvant therapy. Poor communication may impact treatment decision-making and, ultimately, outcomes. Important next steps will include quantifying Black women's patient-provider interactions and examining how these factors influence adherence behaviors. Ensuring that patients understand their diagnosis and treatment options will also be important for clinical practice.

Cultural interrelationships and the lived experience of Pakistani breast cancer patients

Aim There is a paucity of British and international literature on the psychological, sociological and cultural correlates of breast health in ethnic minority women. Methods This two centre qualitative study was part of a larger study that aimed to examine the influence of culture on the lived experience of Pakistani Muslim breast cancer patients. Thirty six patients attending hospital out-patient breast cancer clinics in Lahore, Pakistan and London, UK were recruited to the study. Women were predominantly married, 20–76 years of age with an average of three children. Semi-structured interviews were undertaken. Interview data were analysed using thematic analysis. Results Five themes emerged: Discovery and reaction to the disease; disclosure to family; developing emotions; emerging reality; long term uncertainty. Conclusions Data infer that irrespective of city of residence, the cultural attributes of women, breast health awareness and reactions to the diagnosis and treatment are similar. To raise awareness, more focused health education interventions are needed.

Medical oncologists and quality of life of women treated for breast cancer.

6051 Background: Quality of life (QOL) of breast cancer patients receiving chemotherapy varies widely. More information is needed as to how the organization of care influences the experience of breast cancer patients. We examined the extent to which medical oncologists (oncs) influence breast cancer patient QOL near the time of chemotherapy. Methods: 3133 women with nonmetastatic breast cancer diagnosed from 6/05-2/07 in Detroit and Los Angeles were identified through SEER registries and surveyed after diagnosis (n = 2268, response rate 72.4%). For women who received systemic chemotherapy (n = 1,116), treating oncs were identified and surveyed (n = 207, RR 65%). Patient survey, SEER and onc data were then merged (480 patients and 145 oncs). The 5 subscales of the FACT-B – social well being (SWB), functional (FWB), physical (PWB), emotional (EWB), and breast cancer specific (BCS) - were dependent variables. Independent variables included patients factors (demographics, stage, surgery type, chemotherapy status (completed vs. ongoing), comorbidities) and onc factors (practice size, use of support personnel, university affiliation, weekly patient care hours, breast cancer case volume, frequency of visits during chemotherapy, and education/support resources). We compared the mean FACT-B scores across oncs. For each FACT-B subscale, we used random effects models to evaluate the variation at the onc level, sequentially controlling for patient and onc factors. Results: The mean (SD) FACT-B score for the sample was 95.1 (1.0) (best possible score = 144), with a range across 145 oncs between 44 and 135. The variation in FACT-B scores explained by onc characteristics was modest (7.9%). Similar effects were found for SWB (9.3%), FWB (8.2%), and BCS (7.2%). The variation explained by oncs for EWB (6.6%) and PWB (3.2%) was weaker. No specific onc variables were significantly associated with the FACT-B or subscales. Conclusions: There is modest variation in QOL among breast cancer patients receiving chemotherapy that is attributable to oncs. Oncs contribute most to SWB and FWB. Further understanding of the mechanisms by which oncology practices improve patient QOL is warranted. No significant financial relationships to disclose.

Changes in breast cancer patients after psychosocial intervention as indicated in drawings

The present study attempts to understand the experience of breast cancer patients who had participated in an Eastern-based body-mind-spirit (BMS) psychosocial intervention program by observing changes in the images made by the patients. Pre- and post-intervention drawings on the theme of 'my cancer' were collected from 67 primary breast cancer patients. Two creative art therapists compared the drawings according to the structural and formal art elements (body), the symbols used (mind), and the emotions and feelings presented in the drawings (spirit). Numbers of pre- and post-intervention drawings, showing the presence of each element in these three dimensions, were also counted and compared. There were several changes noted between pre- and post-intervention drawings. The use of color, space, and multiplicity increased from 12 to 17%. Images of breasts decreased from 13 to 0%. Representations of cancer decreased from 15 to 7%. There was a slight increase in symbolic representations of natural, landscapes, and social support in post-drawings (3-6%). The portrayal of negative emotions was greatly reduced from 52 to 3%, while positive emotions increased from 28 to 93% in post-drawings. The comparison of pre- and post-intervention drawings revealed changes in subject matter and accompanying emotions. Overall, there was a trend in changes toward a more peaceful and hopeful attitude. Through the use of realistic and symbolic images, participants depicted a range of emotions. Limitations and recommendations for using art-making, as an assessment tool and intervention, are addressed.

Paget Disease of a Nipple Graft Following Completion of a Breast Reconstruction With a Nipple-Sharing Technique

Surgical treatment of breast cancer can have a profound impact on patients both physically and psychologically. Postmastectomy breast reconstruction can significantly decrease the psychologic distress that a breast cancer patient experiences. Whereas breast mound reconstruction was initially thought to be sufficient, surgeons and patients have recognized the importance of nipple-areolar reconstruction. The following is a case report of a patient who developed Paget disease of a left nipple graft after left mastectomy and reconstruction with a TRAM flap and nipple sharing from the right breast. This case report provides a unique 14-year retrospective review of a clinical course and to our knowledge is the first reported case in the English literature of Paget disease developing in a nipple reconstructed from the contralateral nipple using the nipple-sharing technique.