Breast Cancer-specific Quality Of Life Research Articles

Quality of Life in CAM and Non-CAM Users among Breast Cancer Patients during Chemotherapy in Malaysia.

BackgroundComplementary and alternative medicine (CAM) use has become increasingly popular among patients with cancer. The purposes of this study were to compare the QOL in CAM users and non-CAM users and to determine whether CAM use influences QOL among breast cancer patients during chemotherapy.MethodologyA cross-sectional survey was conducted at two outpatient chemotherapy centers. A total of 546 patients completed the questionnaires on CAM use. QOL was evaluated based on the European Organization for Research and Treatment of Cancer (EORTC) core quality of life (QLQ-C30) and breast cancer-specific quality of life (QLQ-BR23) questionnaires.ResultsA total of 70.7% of patients were identified as CAM users. There was no significant difference in global health status scores and in all five subscales of the QLQ C30 functional scales between CAM users and non-CAM users. On the QLQ-C30 symptom scales, CAM users (44.96±3.89) had significantly (p = 0.01) higher mean scores for financial difficulties than non-CAM users (36.29±4.81). On the QLQ-BR23 functional scales, CAM users reported significantly higher mean scores for sexual enjoyment (6.01±12.84 vs. 4.64±12.76, p = 0.04) than non-CAM users. On the QLQ-BR23 symptom scales, CAM users reported higher systemic therapy side effects (41.34±2.01 vs. 37.22±2.48, p = 0.04) and breast symptoms (15.76±2.13 vs. 11.08±2.62, p = 0.02) than non-CAM users. Multivariate logistic regression analysis indicated that the use of CAM modality was not significantly associated with higher global health status scores (p = 0.71).ConclusionWhile the findings indicated that there was no significant difference between users and non-users of CAM in terms of QOL, CAM may be used by health professionals as a surrogate to monitor patients with higher systemic therapy side effects and breast symptoms. Furthermore, given that CAM users reported higher financial burdens (which may have contributed to increased distress), patients should be encouraged to discuss the potential benefits and/or disadvantages of using CAM with their healthcare providers.

Abstract B12: Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program

Abstract For Latina women, breast cancer is the leading cancer and we expect this trend to continue as the US Hispanic population expands. Latinas generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to timely, high-quality treatment. Despite these challenges observed among Latina breast cancer survivors (BCS), there is very limited knowledge of survivorship-related issues and priorities among Latinas, specifically the effectiveness of using patient navigators (PN) to link Latina BCS with unmet psychosocial needs to appropriate psychosocial services, screening, risk reduction services and treatment follow-up. Methods: The Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio is conducting “Staying Healthy,” a two-year, two-arm randomized controlled trial (75 planned in each arm) of patient navigation among Latina BCS (Susan G. Komen for the Cure Grant #SAB-08-00005). The study compares Enhanced PN (PN+) to Usual PN over time. PN+ subjects receive tailored educational materials and regular personalized assistance including phone calls, meetings, and coordination of targeted care. Usual PN comparison subjects receive navigation upon request for specific needs. All navigation is conducted by trained paraprofessionals from the target community. Participants are Latina BCS age 18 and older who have completed primary treatment at least 3 months prior to study entry, have no metastatic disease, lack cancer or co-morbidity screening and have no ongoing neo-adjuvant therapy. Study outcomes include general and breast cancer-specific quality of life (QOL: Functional Assessment of Cancer Therapy-General, FACT-G, and breast cancer-specific, FACT-B), and compliance with health care recommendations and screening practices. The study includes overall descriptive statistics and hierarchical linear regression of QOL scores at baseline on self-efficacy (SE), communication (Perceived Efficacy in Patient-Physician Interactions, PEPPI), needs (Supportive Care Needs Survey, SCNS), levels of distress (adapted Cognitive Somatic Anxiety Questionnaire, CSAQ), and worry interference (WI), controlling by acculturation (Short Acculturation Scale for Hispanics, SASH), age, and time (months) since primary treatment. Results: We have conducted the baseline analyses of 120 enrolled Latina BCS who average 3.6 years post-diagnosis (SD=2.8 years) and 3.2 years post-primary treatment (SD=2.6 years). About 57% of participants reported having Medicare or Medicaid healthcare coverage. Participants were an average age of 57.3 (SD=9.5 years), 38% Spanish monolingual, 58% US born, 47% married or in an equivalent relationship, and 87% parents. More than three-fifths of the sample (61%) reported an annual household income below $25,000. Consistent with prior work with Latina BCS, our sample reported similar general health-related (M=82, SD=16.8) and breast cancer-specific (M=107, SD=21.4) QOL as measured by the FACT-G and FACT-B scales, respectively. Lower levels of distress (adapted CSAQ) were significantly associated with higher scores of both general QOL (β = -1.3, 95% CI -1.7, -0.9, for FACT-G) and disease-specific QOL (β = -1.9, 95% CI -2.3, -1.4, for FACT-B) after controlling by age, time since primary treatment, and acculturation score. Conclusion: These results show that among Latina BCS, levels of distress and QOL (general and breast cancer-specific) are inversely associated regardless of age, time since primary treatment, and degree of acculturation. Interventions to address unmet psychological needs may be one effective approach for ameliorating distress and enhancing QOL in this vulnerable population. Citation Format: Edgar Munoz, Alfredo A. Santillan-Gomez, Amanda Sintes-Yallen, Kipling Gallion, Amelie G. Ramirez. Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B12.

Abstract P1-09-12: Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial

Abstract Regular physical activity and healthy body composition are important predictors of good outcomes for breast cancer survivors, especially in overweight/obese individuals. However, individualized exercise and healthy eating programs have not focused on lifestyle changes and outcomes among women recovering from triple-negative breast cancer. Our purpose was to examine the associations between baseline levels of inflammatory cytokines and obesity-related adipokines after weight loss, diet and physical activity intervention in survivors of triple-negative breast cancer. We enrolled overweight/obese survivors (average time since diagnosis, 4 years) and randomly assigned them to a 12-week supervised exercise and low-fat diet (n=18) or a usual care group (n=10). The program consisted of supervised exercise 3 times/week, as well as 2 unsupervised sessions per week. The goal of our Get Fit for the Fight® program was to complete 150 min/week of moderate-intensity aerobic exercise. Participants completed a 3-day diet record during baseline testing and the dietitian recommended ways to cut calories from these typical eating patterns. The goal of caloric restriction was to decrease dietary fat in order for the participant to consume 200 kcal/week less. Assessments included aerobic fitness, body composition, and self-reported physical activity, mood and quality of life. Blood cytokines and obesity-related adipokines were also analyzed before and after the intervention period. The intervention group lost an average of 2% body fat compared with the control group (p<0.01). Significant (p<0.05) decreases were seen in the intervention group for body weight, BMI, and all skinfold measures except mid-axillary. Self-reported physical activity and breast-cancer specific quality of life also improved significantly in the intervention group from baseline to 12 weeks, indicating a shift from inactivity toward increasing time spent in moderate physical activity, primarily during weekends. No significant associations were observed between the intervention group and serum levels of inflammatory cytokines. However, BMI was significantly correlated (p<0.05) with serum leptin/adiponectin ratios, an indicator of insulin resistance. These findings indicate that a pragmatic lifestyle intervention with physical activity and healthy eating were consistent with improvements in body composition, functional capacity and quality of life for triple-negative breast cancer survivors. The intervention also evoked favorable changes in blood leptin/adiponectin ratios which are linked to reductions in central adiposity and improved insulin sensitivity. Citation Format: Linda Vona-Davis, Jame Abraham, Daniel Bonner, Diana Gilleland, Gerald Hobbs, Sobha Kurian, Mary Anne Yanosik, Anne Swisher. Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-12.

EORTC QLQ-BR23 and FACT-B for the assessment of quality of life in patients with breast cancer: a literature review.

This study aims to compare the development, characteristics and validity of two widely used tools in the breast cancer population, the EORTC QLQ-BR23 and the FACT-B. A literature search was conducted using Ovid MEDLINE, OLDMEDLINE, Embase, Embase Classic and the Cochrane Central Register of Controlled Trials to identify relevant studies. Both tools were found to be reliable and valid. The QLQ-BR23 focuses on physical function, whereas the FACT-B emphasizes emotional well-being. Scoring, item format, organization and response options differ between questionnaires. Overall, both questionnaires are effective in assessing breast cancer-specific quality of life. Clear similarities and differences between the two tools exist. Decision-making between the questionnaires should be based on the purpose and design of the study.

Water versus land-based multimodal exercise program effects on body composition in breast cancer survivors: a controlled clinical trial

Our aim was to compare the effects of land versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors. Ninety-eight breast cancer survivors were assigned to three groups: control, land exercise, and water exercise. Both exercise groups participated in an 8-week multimodal program. Adiposity was measured by anthropometry (body mass index, waist circumference) and bioelectrical impedance (body fat and muscle lean body mass). Incidence of clinically significant secondary lymphedema was also assessed. Finally, specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23. Using ANCOVA, significant group × time interactions for body fat percentage (F = 3.376; P = 0.011) and lean body mass (F = 3.566; P = 0.008) were found. Breast cancer survivors in the land exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise (P < 0.001) and control (P = 0.002) groups. The ANCOVA revealed a significant group × time interaction for waist circumference (F = 4.553; P = 0.002): breast cancer survivors in the control group showed a greater waist circumference when compared to water (P = 0.003) and land (P < 0.001) exercise groups. A significant group × time interaction was also found for breast symptoms (F = 9.048; P < 0.001): participants in the water exercise group experienced a greater decrease of breast symptoms than those in the land exercise (P < 0.01) and control (P < 0.05) groups. Land exercise produced a greater decrease in body fat and an increase in lean body mass, whereas water exercise was better for improving breast symptoms.

Quality-of-Life Measurement in Randomized Clinical Trials in Breast Cancer: An Updated Systematic Review (2001–2009)

Quality-of-life (QOL) measurement is often incorporated into randomized clinical trials in breast cancer. The objectives of this systematic review were to assess the incremental effect of QOL measurement in addition to traditional endpoints (such as disease-free survival or toxic effects) on clinical decision making and to describe the extent of QOL reporting in randomized clinical trials of breast cancer. We conducted a search of MEDLINE for English-language articles published between May-June 2001 and October 2009 that reported: 1) a randomized clinical trial of breast cancer treatment (excluding prevention trials), including surgery, chemotherapy, hormone therapy, symptom control, follow-up, and psychosocial intervention; 2) the use of a patient self-report measure that examined general QOL, cancer-specific or breast cancer-specific QOL or psychosocial variables; and 3) documentation of QOL outcomes. All selected trials were evaluated by two reviewers, and data were extracted using a standardized form for each variable. Data are presented in descriptive table formats. A total of 190 randomized clinical trials were included in this review. The two most commonly used questionnaires were the European Organization for Research and Treatment of Cancer QOL Questionnaire and the Functional Assessment of Cancer Therapy/Functional Assessment of Chronic Illness Therapy. More than 80% of the included trials reported the name(s) of the instrument(s), trial and QOL sample sizes, the timing of QOL assessment, and the statistical method. Statistical power for QOL was reported in 19.4% of the biomedical intervention trials and in 29.9% of the nonbiomedical intervention trials. The percentage of trials in which QOL findings influenced clinical decision making increased from 15.2% in the previous review to 30.1% in this updated review for trials of biomedical interventions but decreased from 95.0% to 63.2% for trials of nonbiomedical interventions. Discordance between reviewers ranged from 1.1% for description of the statistical method (yes vs no) to 19.9% for the sample size for QOL. Reporting of QOL methodology could be improved.

Kwan’s arm problem scale: psychometric examination in a sample of stage II breast cancer survivors

Arm/shoulder problems and lymphedema are common in patients treated for breast cancer. The Kwan's arm problem scale (KAPS) is a 13 items self-rating form developed for examination of such problems. Since no such testing has been done, we wanted to examine the psychometric properties of the KAPS. At a median of 47 months (range 32-87 months) post-surgery, 256 stage II breast cancer survivors filled in the KAPS. Findings from physical examination of arm/shoulder function, assessment of lymphedema, and established measures of quality of life (QOL), mental distress and fatigue were used to study convergent and discriminant validity. Factor structure and internal consistency were tested in split-half samples. The total KAPS as well as its two subscales showed high internal consistency (alpha > or = 0.92). A two factor solution explained 70% of the variance in the total KAPS score. Convergent validity was shown as the total KAPS score explained 32.5% of the variance in abduction of the ipsilateral shoulder. Discriminant validity was shown as the total KAPS score explained only 6.7% of the variance in abduction of the contralateral shoulder. Concurrent validity was confirmed since the total KAPS explained 54.8% of the variance in arm symptom subscale of breast cancer-specific QOL. Area under the curve was 0.80 for problems of using the arm at a cut-off of the total KAPS score of 21.5. The results show that the KAPS has good psychometric properties supported by high reliability and considerable convergent and discriminant validity.

Quality of life assessment in women with breast cancer: benefits, acceptability and utilization

In 2006, breast cancer was the third leading cause of death in American women; however, more women survive breast cancer than any other type of cancer. As the disease progresses, it is important to know how one's health-related quality of life (QOL) is affected for those who receive treatment, those who survive, and those who remain disease-free. The purpose of this study was to summarize the benefits, challenges, and barriers of QOL measurement for female breast cancer patients. A PubMed literature search was conducted using the terms "quality of life" and "breast cancer." The search was then refined with terms related to QOL assessment instruments. The research team reviewed over 100 of the 2,090 articles identified.From the results, a detailed outline of QOL instruments is presented, and the effectiveness of QOL instruments is discussed. In the current literature review, both generic and breast cancer specific QOL instruments, examining computerized and paper-and-pencil versions, are explained as well as the advantages, acceptability, and problems of these assessments. Potential barriers to implementation are also discussed. The implementation of QOL assessment tools in breast cancer clinical practice is discussed, with evidence detailing how such tools would benefit patients.