Problem In Breast Cancer Patients Research Articles

Psychological problems in breast cancer patients should be taken seriously

With the transformation of the biopsychosocial medical model, psychological problems and related interventions for breast cancer patients have received more and more attention. Patients often have various psychological problems, in diagnosis, treatment, and even in the state of disease-free survival, such as anxiety and depression, which not only seriously reduces the quality of life, but also affects the follow-up treatment and increases the risk of recurrence and metastasis. Therefore, physicians should perform routine psychological screening and appropriate intervention for patients. In recent years, psychological intervention has gradually become an important part of comprehensive breast cancer treatment, in which cognitive behavior therapy can alleviate patients' anxiety and sleep disorders, mindfulness therapy can treat patients' anxiety, depression and fear of cancer recurrence, and psychoeducational support is mainly used to address patients' mood disorders and sexual dysfunction. Improving patients' compliance with treatment and quality of life is the main goal of psychological intervention for breast cancer patients.

Improving Self-Esteem In Breast Cancer Survivors Through A Monopoly Game Named Bermain Asik Mengenal Diri (Bersinar)

Background: Psychological problems experienced by breast cancer patients have a negative impact that can worsen their quality of life. Self-esteem is one of the psychological problems in breast cancer patients. Low self-esteem can have a negative impact on incomplete breast cancer treatment. One of the efforts to increase self-esteem is through game simulation using the monopoly named Bermain Asik Mengenal Diri (BERSINAR) (Eng: fun play to know yourself).Objective: This study aims to determine the increase in self-esteem in breast cancer patients through the Monopoly named Bermain Asik Mengenal Diri (Bersinar).Methods: The research design used pre-experimental with a one-group pretest-posttest design without a control group to measure the increase in self-esteem in breast cancer patients through the monopoly named Bermain Asik Mengenal Diri (Bersinar). The research respondents were 26 people. The sampling technique was Total Sampling. Data analysis used Marginal Homogeneity.Results: The results of the marginal homogeneity statistical test showed a p-value of 0.000  ≤ 0.05 that there is a significant difference in self-esteem before and after being given an intervention through the monopoly named Bermain Asik Mengenal Diri (BERSINAR).Conclusion: The monopoly named Bermain Asik Mengenal Diri (BERSINAR) had a positive impact on increasing self-esteem in breast cancer patients. It can be concluded that the game Monopoly Bermain Asik Mengenal Diri (BERSINAR) can improve self-esteem in breast cancer patients.

ABCB1 Regulates Immune Genes in Breast Cancer.

Resistance to standard chemotherapy is a critical problem for breast cancer patients. The ATP-binding cassette (ABC) superfamily transporters actively pump out drugs and play an important role in chemoresistance. ABCB1 (ABC subfamily B, member 1, also named as multidrug resistance protein 1, MDR1) and suppressive myeloid-derived suppressor cells (MDSCs) potentially involve in chemoresistance of breast cancer. The relationship between ABCB1 and immune genes in breast cancer has not been widely studied. Microarray and RNA sequencing data were obtained from The Cancer Genome Atlas Breast Invasive Carcinoma in Genomic Data Commons Data Portal and Gene Expression Omnibus database. A patient-derived xenograft (PDX) model of HER2+ breast cancer was established to investigate the association between ABCB1 and immune genes in breast cancer. Expression of ABCB1 increased in doxorubicin-selected MCF-7/ADR cells. High expression of ABCB1 mRNA is correlated with lymph-node metastasis and worse overall survival in patients with breast cancer. ABCB1 is positively correlated with IL6, CSF1, CSF3, and PTGS2. In the HER2+ stage IIA breast cancer PDX model, both doxorubicin and paclitaxel suppressed growth of P2 tumors. IL6, CSF1, CSF3, and PTGS2 expression were suppressed by paclitaxel but not doxorubicin. Intrasplenic MDSCs, including CD11b+Ly6G+ and CD11b+Ly6C+ cells, were more abundant than intratumor MDSCs in PDX-carrying nude mice. Clinically, the patient developed cancer recurrence after adjuvant chemotherapy with doxorubicin-based regimen and was well controlled after paclitaxel-trastuzumab combined therapy. ABCB1 was a poor predictor of HER2+ LN- breast cancer. Regulation of immune genes by ABCB1 contributed to cancer recurrence and treatment effect. The PDX model was suitable for investigation the expression of target genes and expansion of immune cells.

Psychometric Properties of Assessment Tools for Depression, Anxiety, Distress, and Psychological Problems in Breast Cancer Patients: A Systematic Review.

Various and accurate psychiatric assessments in patients with breast cancer who frequently suffer from psychological problems due to long-term survivors are warranted. This systematic review aimed to investigate the current evidence on psychometric properties of psychiatric assessment for evaluating psychological problems in breast cancer patients. This systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Four electronic databases such as Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched. This study protocol was registered on Open Science Framework. Of the 2,040 articles, 21 papers were finally included. Among them, only five studies showed the performance of psychiatric assessment tools. Among 13 assessment tools used in the selected articles, the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), or Mini-Mental Adjustment to Cancer Scale was frequently used for the evaluation of psychological problems. The DT and Psychosocial Distress Questionnaire-Breast Cancer showed acceptable performances for the prediction of depression and anxiety assessed by the HADS. This systematic review found psychiatric assessment tools with acceptable reliability and validity for breast cancer patients. However, comparative studies on reliability and validity of various scales are required to provide useful information for the selection of appropriate assessment tools based on the clinical settings and treatment stages of breast cancer. Joint research among the fields of psychiatry and breast surgery is needed for research to establish the convergent, concurrent, and predictive validity of psychiatric assessment tools in breast cancer patients.

Nursing Intervention Model to Overcome Psychosocial Problems of Breast Cancer Patients: A Literature Review

Chronic disease, such as breast cancer is a disease that requires comprehensive treatment and takes a long time. The prevalence of breast cancer patients continues to be high in number so that it will cause psychosocial problems such as social problems, anxiety, and even depression. This study aims to identify appropriate nursing interventions to address psychosocial problems in breast cancer patients. literature review was used in this study. Article searches were conducted in six journal databases, namely PubMed, JSTOR, Taylor, Willey Online, Sage, and Google Scholar. Seven articles were found that matched the inclusion of criteria. Results of this review show that social support interventions, palliative support, psychological interventions, home care, home visits, virtual reality and music therapy, relaxation techniques and motivational support, psychological therapy programs via offline and telephone, Adapted Physical Activity and Diet (APAD), Aromatherapy Plus Music Therapy can be performed on cancer patients to help reduce psychosocial problems so that the patient's quality of life will improve.

THE RELATION BETWEEN THE CYCLE OF ADMINISTRATION OF CHEMOTHERAPY TO PSYCHOSOCIAL PROBLEMS IN BREAST CANCER PATIENTS

Introduction: Breast cancer is the most common malignant neoplasm that affects women. One of the treatments for breast cancer is chemotherapy which is carried out according to a particular schedule with a specified length of therapy to increase the patient's recovery rate. In addition to the physiological effects, chemotherapy also has a psychological impact on the patient. Fulfillment of psychosocial needs is important to improve the quality of life of patients caused by changes in physical, social, cognitive, spiritual, emotional and role functions. The purpose of this study was to determine the relationship between the cycle of chemoteraphy with psychosocial problems in breast cancer patients.
 Method: This study is a quantitative correlational study using 54 breast cancer patients as samples by purposive sampling. Data collection was carried out during April 2020 to June 2020 in the chemotherapy room at Koja Hospital, North Jakarta. The Depression Anxiety Stress Scale (DASS 21) questionnaire was used to identify psychosocial problems in breast cancer patients. Statistical analysis of the Spearman rank test was carried out to analyze the relationship between chemotherapy cycles and psychosocial problems.
 Results: The results showed that there was a relationship between chemotherapy cycles and psychosocial problems (p value 0.001) although it showed a weak relationship between those two variables (r 0.257). Psychosocial problems identified included anxiety (53%), depression (9.3%), low self-esteem (16.7%) and stress (20.4%).
 Conclusion: Nurses need to provide comprehensive nursing care for patients undergoing chemotherapy including identifying problems related to physical complaints and psychosocial needs so that nursing interventions can be given comprehensively to breast cancer patients undergoing chemotherapy.

Prognostic Significance of Inflammatory Biomarkers in Patients with Breast Cancer Skeletal Metastases.

PurposeSkeletal metastases are a common problem in breast cancer patients. Identifying new prognostic factors can improve survival estimations and guide healthcare professionals in therapeutic decision-making. Our study aimed to determine the prognostic value of inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and C-reactive protein/albumin ratio (CAR) in patients with breast cancer skeletal metastases.Patients and MethodsClinical data from 212 patients with breast cancer skeletal metastases were retrospectively analyzed. The optimal cut-off values of each inflammatory biomarker were extracted from the receiver operating characteristic (ROC) curves. Patients were divided into high-value and low-value groups according to the cut-off values of NLR, LMR, and CAR. We investigated the relationship between inflammatory biomarkers and clinicopathological characteristics. The Kaplan–Meier method was used to measure progression-free survival (PFS) and overall survival (OS). The survival difference was compared by the univariate analysis. Cox multivariate regression analysis was performed to identify independent prognostic factors.ResultsThe median age of the patients was 55 years, and the median follow-up was 45 months. LMR<3.43 (P<0.0001), NLR≥2.48 (P<0.0001), and CAR≥0.34 (P=0.035) were found to be associated with worse PFS in the univariate analysis. Meanwhile, LMR<3.43 (P<0.0001), NLR≥2.48 (P<0.0001), and CAR≥0.34 (P=0.025) were linked to the poor OS. The multivariate analysis revealed that NLR≥2.48 (HR 2.044, P=0.007) and LMR<3.43 (HR 0.532, P=0.012) were independent prognostic factors for OS; LMR<3.43 (HR 0.501; P=0.006) and NLR≥2.48 (HR 1.971, P=0.011) were similarly prognosticating worse PFS. Radiotherapy to the affected bone and ER (+) was favorable for the prognosis of breast cancer skeletal metastases. The number of involved sites of bone metastases>3 was adverse for PFS.ConclusionLMR<3.43 and NLR≥2.48 were independently associated with worse prognosis of patients of breast cancer skeletal metastases.

Association between cancer-related fatigue and traditional Chinese medicine body constitution in female patients with breast cancer

BackgroundCancer-related fatigue (CRF) is a common psychosomatic problem in breast cancer patients. Traditional Chinese medicine (TCM) has been used to address symptoms in patients with CRF. Identification of the specific constitution in TCM is essential for personalized care. AimTo explore the relationship between fatigue and specific constitutions in breast cancer. Experimental procedureWe conducted a cross-sectional study in all breast cancer patients at Kaohsiung Chang Gung Memorial Hospital in Taiwan. The severity of fatigue was determined using the Brief Fatigue Inventory-Taiwanese (BFI-T) form. TCM patterns were determined using the Body Constitution Questionnaire (BCQ). The relationship between constitution and fatigue was analyzed using logistic regression. ResultsWe recruited 110 breast cancer patients with fatigue (mean age: 55 ± 11 years). The mean duration of breast cancer was 17.4 months. The major constitution among these patients with fatigue was Yang-Qi deficiency (50%). Phlegm-Stasis syndrome was correlated with a duration of breast cancer of more than 18 months (p = 0.02). Out of all participants, 42.7% (n = 47) reported clinically significant fatigue (BFI-T score ≥4). According to logistic regression, the score of Yang-Qi deficiency [odds ratio (OR): 3.5, 95% confidence interval (CI): 1.49–8.21, p < 0.01] was also associated with clinically significant fatigue. ConclusionYang-Qi deficiency is associated with clinically significant fatigue in breast cancer patients. However, the association of Phlegm-Stasis syndrome and fatigue as disease duration increases cannot be ignored. Further studies are needed to determine whether treating both constitutions integrating TCM treatment can alleviate patients’ fatigue symptoms.

Aberrant HDAC3 expression correlates with brain metastasis in breast cancer patients.

BackgroundBrain metastasis is an unsolved clinical problem in breast cancer patients due to its poor prognosis and high fatality rate. Although accumulating evidence has shown that some pan‐histone deacetylase (HDAC) inhibitors can relieve breast cancer brain metastasis, the specific HDAC protein involved in this process is unclear. Thus, identifying a specific HDAC protein closely correlated with breast cancer brain metastasis will not only improve our understanding of the functions of the HDAC family but will also help develop a novel target for precision cancer therapy.MethodsImmunohistochemical staining of HDAC1, HDAC2, and HDAC3 in 161 samples from breast invasive ductal carcinoma patients, including 63 patients with brain metastasis, was performed using the standard streptavidin‐peroxidase method. The relationships between HDAC1, HDAC2, and HDAC3 and overall survival/brain metastasis‐free survival/post‐brain metastatic survival were evaluated using Kaplan‐Meier curves and Cox regression analyses.ResultsHDAC1, HDAC2, and cytoplasmic HDAC3 all displayed typical oncogenic characteristics and were independent prognostic factors for the overall survival of breast cancer patients. Only cytoplasmic HDAC3 was an independent prognostic factor for brain metastasis‐free survival. Cytoplasmic expression of HDAC3 was further upregulated in the brain metastases compared with the matched primary tumors, while nuclear expression was downregulated. The HDAC1, HDAC2, and HDAC3 expression levels in the brain metastases were not correlated with survival post‐brain metastasis.ConclusionsOur studies first demonstrate a critical role for HDAC3 in the brain metastasis of breast cancer patients and it may serve as a promising therapeutic target for the vigorously developing field of precision medicine.Key pointsSignificant findings of the studyCytoplasmic HDAC3 is an independent prognostic factor for the overall survival and brain metastasis‐free survival of breast cancer patients.What this study addsCytoplasmic expression of HDAC3 was further upregulated in the brain metastases compared with the matched primary tumours, while nuclear expression was downregulated.

Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy

PurposeTo characterize sleep problems and to compare subjective and objective assessments in breast cancer patients starting neoadjuvant chemotherapy.MethodsSleep characteristics of 54 breast cancer patients starting neoadjuvant chemotherapy were analyzed. Subjective sleep characteristics were assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measurements with an accelerometer (ActiGraph wGT3X-BT) worn on the wrist for 7 consecutive days.ResultsAccording to the common PSQI cut-off of 8, 10 (18.87%) of the patients were poor sleepers. ActiGraph measures did not mirror this classification as values for poor, and good sleepers did not differ significantly. Overall, Bland-Altman plots illustrated higher ActiGraph values for sleep efficiency and effective sleep time and lower values for sleep latency, compared with PSQI. For total sleep time, less disagreement between both measures was observed. Actigraphy was limited in precise identification of sleep begin and sleep latency but provided supplementary information about number and minutes of awakenings during the night.ConclusionSubjective and objective measurement methods differed substantially in various parameters, with limitations in both methods. A combination of both methods might be most promising.Trial RegistrationClinicaltrials.gov: NCT02999074

Quercetin Inhibits Lef1 and Resensitizes Docetaxel-Resistant Breast Cancer Cells.

Drug resistance is a major problem for breast cancer patients. Docetaxel is an anti-mitotic agent that serves as first line of treatment in metastatic breast cancer, however it is susceptible to cellular drug resistance. Drug-resistant cells are able to spread during treatment, leading to treatment failure and eventually metastasis, which remains the main cause for cancer-associated death. In previous studies, we used single-cell technologies and identified a set of genes that exhibit increased expression in drug-resistant cells, and they are mainly regulated by Lef1. Furthermore, upregulating Lef1 in parental cells caused them to become drug resistant. Therefore, we hypothesized that inhibiting Lef1 could resensitize cells to docetaxel. Here, we confirmed that Lef1 inhibition, especially on treatment with the small molecule quercetin, decreased the expression of Lef1 and resensitized cells to docetaxel. Our results demonstrate that Lef1 inhibition also downregulated ABCG2, Vim, and Cav1 expression and equally decreased Smad-dependent TGF-β signaling pathway activation. Likewise, these two molecules worked in a synergetic manner, greatly reducing the viability of drug-resistant cells. Prior studies in phase I clinical trials have already shown that quercetin can be safely administered to patients. Therefore, the use of quercetin as an adjuvant treatment in addition to docetaxel for the treatment of breast cancer may be a promising therapeutic approach.

The role of pharmacist in handling drug-related problems in breast cancer patients at Dr. Cipto Mangunkusumo Hospital

Background: DRP (Drug-Related Problems) affects the outcome of chemotherapy treatment to cancer patients. Matters related to DRP can be prevented by a pharmacist by providing drug information to doctors or other health professionals. The objective of this study was to determine the description of DRP, type of DRP, recommendations given by pharmacists on DRPs, acceptance of the results of recommendations and analysis of factors that affect DRPs.Methods: The research method was carried out through a cross sectional study in which observational data collection was conducted concurrently. The study population was all breast cancer patients from the Division of Surgical Oncology in the period January - April 2018 as many as 228 people. The collected data consisted of dosage suitability, suitability of carrier fluid volume, patient adherence to the schedule for breast cancer patients, recommendations given by pharmacists and the results of acceptance of pharmacist recommendations.Results: Based on research findings, the incidence of DRP was 76.3%. Most problems were regarding carrier fluid volume (64.5%) and dose mismatch (30%). There was also a DRP combination of carrier fluid volume and dose of 19%. The pharmacist’s recommendation was to change the dose by 15.52%, change the carrier fluid volume by 60.92%, and change the dose and volume of the carrier fluid by 23.56%. The recommended dosage received by doctors was 13 patients (7.47%), changing the volume of carrier fluid received by doctors by 106 patients (60.92%).Conclusions: Pharmacists can prevent DRPs through providing drug information to doctors or other health professionals so that increased communication between health professionals is required.

Study on the Effects of Estradiol in Staphylococcus epidermidis Device-Related Capsule Formation.

Capsular contracture, mainly caused by Staphylococcus epidermidis (S. epidermidis) biofilm formation, is a complex problem for breast cancer patients who undergo surgical prosthetic breast reconstruction. Estradiol has been reported to be involved in the formation of bacterial biofilms. Thus, the underlying mechanism of estradiol in capsular contracture needs to be investigated. Biofilm-related gene expressions were measured by qRT-PCR after sterilizing the silicone with bacterial suspension and E2 treatment in vitro. Rat models were established with bilateral ovariectomy operations and estradiol subcutaneous injections. The effects of estradiol on capsular contracture were detected by monitoring serum estradiol levels, bacterial infection rate in organs, biofilm formation and capsular contracture in vivo; inflammatory factors in vivo were examined as well. Biofilm on the silicone implants was observed under a scanning electron microscope. Both positive regulatory genes and negative regulatory genes were increased by the high concentration of estradiol, suggesting that estradiol can promote the formation of biofilm by not only positive but also negative regulations. High estradiol levels increased bacterial infection rate in organs, biofilm formation and capsular contracture. Further, high estradiol caused a large number of inflammatory cells to infiltrate and caused serious inflammatory reactions that aggravate the immune imbalances of the host. High estradiol levels contribute to increasing capsular contracture caused by S. epidermidis biofilm formation. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

ESR1-Stabilizing Long Noncoding RNA TMPO-AS1 Promotes Hormone-Refractory Breast Cancer Progression.

Acquired endocrine therapy resistance is a significant clinical problem for breast cancer patients. In recent years, increasing attention has been paid to long noncoding RNA (lncRNA) as a critical modulator for cancer progression. Based on RNA-sequencing data of breast invasive carcinomas in The Cancer Genome Atlas database, we identified thymopoietin antisense transcript 1 (TMPO-AS1) as a functional lncRNA that significantly correlates with proliferative biomarkers. TMPO-AS1 positivity analyzed by in situ hybridization significantly correlates with poor prognosis of breast cancer patients. TMPO-AS1 expression was upregulated in endocrine therapy-resistant MCF-7 cells compared with levels in parental cells and was estrogen inducible. Gain and loss of TMPO-AS1 experiments showed that TMPO-AS1 promotes the proliferation and viability of estrogen receptor (ER)-positive breast cancer cells in vitro and in vivo Global expression analysis using a microarray demonstrated that TMPO-AS1 is closely associated with the estrogen signaling pathway. TMPO-AS1 could positively regulate estrogen receptor 1 (ESR1) mRNA expression by stabilizing ESR1 mRNA through interaction with ESR1 mRNA. Enhanced expression of ESR1 mRNA by TMPO-AS1 could play a critical role in the proliferation of ER-positive breast cancer. Our findings provide a new insight into the understanding of molecular mechanisms underlying hormone-dependent breast cancer progression and endocrine resistance.

Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection.

The purpose of this study was to investigate the factors related to early postoperative psychological conditions in breast cancer patients with axillary lymph node dissection 3months after the surgery. The subjects of this study were 200 consecutive patients who underwent axillary lymph node dissection for breast cancer at our hospital. Age, body mass index, surgical side, work, marriage, presence of children, presence of co-resident household members, resection of the pectoralis minor muscle, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion, upper limb function (Disabilities of the Arm, Shoulder and Hand; DASH), and psychological conditions were evaluated. In this study, a Distress and Impact Thermometer was used to classify patients with adjustment disorders, depression, or major depression and suicidal ideation into a group with psychological problems and the remaining patients into a group with no psychological problems. Logistic regression analysis showed that only DASH was statistically significantly associated with psychological conditions (p < 0.05). Using receiver operating characteristic curve analysis, a DASH score of 18 or greater was found to be very specific for predicting psychological conditions. The observation that somatic symptoms and disability of upper limb function are related to psychological conditions may indicate the importance of postoperative rehabilitation in breast cancer patients with axillary lymph node dissection.

Relationship of Mechanism of Coping and Psychological Problems in Breast Cancer Patients

Abstract Background Cancer patients (including Breast Cancer) are faced with health problems and chemotherapy side effects, that can cause psychological problems (anxiety and depression). Coping mechanism (CM) helps prevent psychological problems. Patients can develop adaptive or maladaptive CM. The aim of the study is to evaluate the correlation between CM and the psychological problems in breast cancer patients. Methods We conducted a cross-sectional study in General Hospital in Tangerang, from October 2018-February 2019. The samples are breast cancer patients that have undergone mastectomy and adjuvant chemotherapy. Data were collected using Cancer Coping Questionnaire (CCQ-21) and Hospital Anxiety Depression Scale. Baseline characteristics were presented using descriptive statistics. Correlation between both variables was analyzed with Somerśd using SPSS version 24.0. Result Samples are 29 breast cancer patients with a mean age of 49.93 ±11.473. 19 (65.5%) had adaptive CM, and 10 (34.5%) had maladaptive CM. Out of 19 patients with adaptive CM, 47.4% do not have anxiety, 26.3% in borderline, and 26.3% had anxiety; while, 57.9% do not have depression, 42.1% are in borderline, and none had depression. Out of 10 patients with maladaptive CM, 60% do not have anxiety, 30% in borderline, and 10% had anxiety; meanwhile, 80% do not have depression, 10% is in borderline, and 10% had depression. The correlation between CM and anxiety is r = 0.358 (p-value =0.356). The correlation between CM and depression is r =0.581 (p-value =0.340). Conclusion Most patients with adaptive and maladaptive CM had normal psychological health. Therefore, we can conclude that CM does not correlate with psychological health in breast cancer patients. There are many factors that may affect those problems. It is necessary to include other factors and more sample in order to obtain a more accurate Result.

Correlation between Cancer Pain and Psychological Health Problems in Breast Cancer Patients: A Preliminary Study

Abstract Background Cancer pain in breast cancer patients is under-diagnosed and under-treated, as it rarely happens. Cancer management can cause physical and psychological changes. The two most common problems are anxiety and depression. A few studies have shown that psychological problems are related to cancer pain, but it is not clear to what extent the pain affects them. Therefore, the aim of this study is to know the correlation between cancer pain and psychological aspect in breast cancer patients. Methods A cross-sectional study was done at our general hospital, from October 2018-February 2019. The sample is breast cancer patients that have undergone mastectomy and adjuvant chemotherapy. Brief Pain Inventory and Hospital Anxiety and Depression Scale questionnaire were used to evaluate the patients. BPI score ranges from 1, pain does not interfere with daily life, to 10, pain interferes. HADS has a total score of 21, where 0-7 is normal, 8-10 is the borderline, and 11-21 means anxiety and/or depression is present. Baseline characteristics were presented using descriptive statistics. Correlation between both variables were analysed with Spearman correlation. Results 36 breast cancer patients, with a mean age of 50.19 ± 11.089 years old, were included. Median pain on general activity, mood, walking, working, sleeping, relaxing, and interacting is 1, 2, 1, 1, 2, 1, and 1, consecutively, with a median of 1.29 (1-7.57). From 19 patients, 47.2% patients have no anxiety, 30.6% patients on borderline, and 22.2% patients have anxiety. Meanwhile, 66.7% patients have no depression, 30.6% patients on borderline, and 2.8% patients with depression. Correlation between pain and anxiety is r=0.425 (p-value=0.069), while between pain and depression is r=0.229 (p-value=0.265). Conclusion There is no correlation between cancer pain and psychological health problems. Further study with greater sample size is needed to confirm the Result.

Pengukuran Kualitas Hidup Pasien Kanker Payudara di Kota Denpasar Menggunakan Instrumen EQ-5D-5L

Breast cancer is the second most common cancer in the world and is one of the biggest causes of cancer deaths every year. Measurement of the quality of life in breast cancer patients could improve treatment and become a prognosic factor along with medical parameters for the patients. This study aims to measure the life quality of breast cancer patients and observe how it affects the life quality based on patient characteristics. The study was conducted on 93 breast cancer patients. Data were collected form patients in several breast cancer comunities in Denpasar which were carried outh within 3 months (January – March 2019). This study used a cross sectional design using a snowball sampling technique involving breast cancer patients in several cancer communities in Denpasar. The patient's life quality data was obtained using the EuroQol-5 Dimension-5 Level (EQ-5D-5L) generic instrument and conversion to health utility (utility) used the Indonesian value set. The entire data was analyzed using the independent t-test and multivariate regression. The results showed that pain/discomfort and anxiety/depression were the most dominant problem in breast cancer patients (82,7%). The utility value of breast cancer patients was 0.821±0.123 and the VAS value was 74.41±11.67. There was a significant difference in utility value based on patient characteristics of occupation (p=0.035), symptoms (p=0,003), and cancer stadium (p=0.015). Affected 20.5% of the quality of life of breast cancer patients in Denpasar city.

Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis.

We conducted a meta-analysis evaluating the effects of different exercise interventions on self-reported and objective sleep measurements during or after breast cancer treatment. Three databases were systematically searched for randomized controlled trials with any type of exercise intervention in women with breast cancer. Outcomes were self-reported or objective sleep measurements. Standardized mean differences (SMDs) were calculated using random-effects models. The meta-analysis included 22 trials with 2107 participants. Of these, 17 studies used the Pittsburgh Sleep Quality Index (PSQI), six studies included objective sleep assessments (ActiGraph). Physical exercise interventions included walking, aerobic exercise, resistance exercise or a combination of both. Mind-body exercise interventions included yoga, Tai Chi and Qigong. Most interventions were supervised. Both, physical (SMD - 0.32; 95% CI - 0.54 to - 0.10) and mind-body exercise interventions (SMD - 0.27; 95% CI - 0.44 to - 0.09), resulted in improvements of total sleep scores. Subgroup analyses revealed no clear differences between interventions conducted during versus after breast cancer treatment. Considering the PSQI subscales, exercise resulted in improvements of sleep quality (SMD - 0.28; 95% CI - 0.44 to - 0.11) and sleep disturbances (SMD - 0.26; 95% CI - 0.45 to - 0.06). Regarding the objective measurements, no significant effects were found. Physical as well as mind-body exercise can improve subjective sleep problems in breast cancer patients. In contrast, there was no effect of exercise on objective sleep measures. Future studies should clarify which type of intervention might be most effective depending on individual patients' and treatments' characteristics.

Patient-reported health problems and healthcare use after treatment for early-stage breast cancer

BackgroundA clear picture of treatment-related health problems following breast cancer treatment is useful in anticipating the informational and other needs of patients during follow-up. This study aimed to identify treatment-related health problems in breast cancer patients up to five years after diagnosis. Secondly, the use of care associated with these health problems was identified. Methods876 surgically-treated female patients diagnosed between 2012 and 2016 with early-stage breast cancer were asked to complete an online survey about their current health problems and use of care. Multivariate logistic regression analyses were applied to determine the effect of patient and treatment characteristics on health problems. Results404 patients responded (46%). The median age was 62.0 years (SD:10.9). Apart from breast surgery, patients had been treated with radiotherapy (72%), chemotherapy (49%), anti-hormonal therapy (57%), and axillary dissection (21%). Ninety-three percent experienced one or more health problems. Over 50% of respondents experienced fatigue, psychological problems, and health problems regarding the breast, and/or musculoskeletal, central nervous, and reproductive system. Treatment with chemotherapy was significantly associated (p < 0.05) with an increased risk of health problems, respectively fatigue (OR:2.00), respiratory (OR:1.81), gastrointestinal (OR:1.87), central nervous (OR:3.40), and skin problems (OR:2.62). Use of healthcare for one or more health problems was reported by 64% of respondents. DiscussionAlmost all patients experienced health problems up to five years after breast cancer diagnosis, with a range of complaints that were consistently present over time. Factors associated with the development of health problems are useful for better informing patients beforehand and targeting follow-up care.