Sample Of Breast Cancer Survivors Research Articles

Perceptions of positive meaning and vulnerability following breast cancer: Predictors and outcomes among long-term breast cancer survivors

Survival rates for women with early-stage breast cancer have increased significantly in recent years. However, little is known about the long-term impact of the cancer experience on women's psychological functioning. Theoretical and descriptive accounts suggest that cancer may evoke both perceptions of vulnerability and positive meaning, with potentially different effects on mental health. This study was designed to evaluate the prevalence and stability of these perceptions in a large sample of breast cancer survivors, to identify their antecedents, and to determine their impact on long-term adjustment. Breast cancer survivors (N = 763) were assessed longitudinally at 1 to 5 years and 5 to 10 years postdiagnosis. Participants completed surveys assessing perceptions of positive meaning and vulnerability and standard measures of psychological adjustment and quality of life. The majority of women reported positive changes in outlook and priorities as well as feelings of vulnerability at both assessment points. Consistent with hypotheses, results showed that perceptions of positive meaning and vulnerability were positively correlated and were both associated with factors that increased the disruptiveness of the cancer experience. Vulnerability was strongly associated with negative affect, whereas meaning was associated with positive affect in cross-sectional and longitudinal analyses. Results suggest that a cancer diagnosis may lead to enduring feelings of vulnerability as well as positive changes in meaning; however, these perceptions have very different mental health correlates.

Assessing task ?burden? of daily activities requiring upper body function among women following breast cancer treatment

To determine which individual or groups of "upper-body" daily tasks are considered most burdensome to women following breast cancer treatment, and to assess whether certain patient or treatment characteristics influence task burden. A convenience sample of breast cancer survivors (n =619) completed a self-administered questionnaire regarding 48 daily tasks requiring upper-body function. Women were asked to rate how frequent and physically demanding each task was using a five-point Likert scale, and the product of task frequency and physical demand determined overall task burden. Tasks were ranked to identify the most burdensome individual tasks, while a factor analysis was performed to define independent constructs (groupings) among the tasks. Multiple linear regression models were fitted to consider the independent influences on task groups of various participant characteristics. Factor analysis identified seven distinct task groups and the individual tasks considered most burdensome fell in five of these groups, specifically whole body, flexibility, carrying/upper-body strength, hand and weighted flexion tasks. Having lymphoedema or poor fitness was associated with upper-body disability involving all seven task groups, whereas other patient and treatment characteristics were related only to certain types of activities. Breast cancer survivors report difficulty with a range of upper-body tasks, particularly if they also have lymphoedema or poor fitness. Using all or some of the tasks within the reported constructs in a questionnaire format, or the functional requirements of the most burdensome tasks to develop more objective and quantitative measures, would provide a solid base for the measurement of upper-body function in women with breast cancer.

Health-related quality of life in a multiethnic sample of breast cancer survivors.

Little is known about the experiences of women from varying ethnic groups following treatment for breast cancer. This study provides a comprehensive description of health-related quality of life (HRQL) and identifies problem areas and predictive factors for a multiethnic sample. Six hundred twenty-one breast cancer survivors from 2 major cities participated within 5 years of their diagnosis. Participants were African Americans, Latinas, Asian Americans, and Whites. Patients filled out questionnaire packets comprising standardized instruments related to HRQL, psychological adjustment, cancer-related treatment, and demographic variables. Data were analysed using 2 methods: (a) observation of findings prior to controlling for demographic and treatment variables and (b) observation of findings after controlling for variables confounded with ethnicity. Findings indicate that most women experienced good HRQL. Group differences revealed that African Americans found more meaning in life as a result of having breast cancer, and Latinas reported more physical symptoms. Age predicted aspects of HRQL for African Americans and Whites. This study comprehensively assessed HRQL following breast cancer for ethnic minority women. Most breast cancer survivors in this study reported levels of HRQL comparable to established norms. However, some quality of life impediments surfaced in particular groups. Researchers should not assume that predictive models of breast cancer HRQL are the same across ethnic groups.

Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study

BackgroundQuality of life after cancer treatment becomes more important as the number of long-term survivors increases. This study aimed to investigate complaints of fatigue after treatment for breast cancer. Patients and methodsThe study patients were 150 women who had finished curative treatment for breast cancer by a mean of 29 months before commencement of this study. Measurements included computerised questionnaires and a daily Self-Observation List. ResultsThirty-eight per cent of the sample were severely fatigued, compared with 11% in a matched sample of women without a history of cancer. No association was found between fatigue and former treatment. The ‘severely fatigued disease-free breast cancer patient’ scored more ‘problematic’ on psychological well-being, functional impairment, sleep disturbance, physical activity, social support, neuropsychological and social functioning compared with the ‘non-severely fatigued disease-free breast cancer patient’. Furthermore, the severely fatigued patients had a lower sense of control with respect to their fatigue complaints and stronger breast cancer- and psychologically-related attributions with regard to the causes of fatigue compared with the non-severely fatigued patients. Regression analyses indicated that sleep disturbance, physical activity and causal attributions contributed significantly to the subjective experience of fatigue. ConclusionsSevere fatigue is a problem for almost 40% of the sample of breast cancer survivors. Severe fatigue is related to physical, psychological, social, cognitive and behavioural factors.

The Hot Flash Related Daily Interference Scale: A Tool for Assessing the Impact of Hot Flashes on Quality of Life Following Breast Cancer

To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.

Physician sex and other factors associated with type of breast cancer surgery in older women.

Physician-related factors as well as patient characteristics may explain why women aged 65 years or older with early-stage breast cancer undergo lumpectomy less often than younger women, despite National Institutes of Health recommendations favoring lumpectomy over mastectomy. A descriptive and analytical retrospective computer-assisted telephone survey. A population-based random sample of breast cancer survivors in Colorado, identified from the Colorado Central Cancer Registry. Women aged 65 to 84 years when diagnosed as having stage I or II breast cancer, treated 1 to 6 years previously with mastectomy or lumpectomy, and without recurrence or second primary cancers. Among women contacted, 58% participated. Results of 198 interviews are reported. Survey questions included patient decision-making participation and physician recommendations, sources and amount of treatment information provided by physicians, physician characteristics, and patient surgery preferences and demographic characteristics. A multivariate logistic regression model identified factors independently associated with lumpectomy. Lumpectomy was strongly associated with higher patient education, female physician sex, patient age 75 years or older, and amount of physician-provided information. The number of physician-provided information sources was associated with surgery explanations, and female physicians provided more sources of information. A physician decision or recommendation for surgery type was reported by 61% of women, of whom 93% underwent the recommended procedure. A subset of patients (13%) reported deferring the surgery decision to someone else. These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy, and that physicians may influence breast cancer patients' decisions about surgery type.

Making effective use of tumor registries for cancer survivorship research.

The growing number of cancer survivors has created an increased need for survivorship research; however, the identification and recruitment of cancer survivors present some challenges. This report describes how two hospital cancer registries were used to recruit a large sample of breast cancer survivors (BCS) for a study examining the late reproductive effects of breast cancer treatments. Limitations and opportunities associated with this type of recruitment strategy are described, and the overall success of recruitment using this approach is presented. Tumor registries from a comprehensive cancer center and a community hospital were used to identify BCS who met the study screening criteria. Invitations and response forms were mailed to all potentially eligible women, and those who did not respond by mail also were contacted by telephone. Women who indicated interest and met the study requirements were asked to give written consent, were enrolled in the study, and were sent a self-report questionnaire. Seventy percent of the eligible women (n = 733 women) responded to the mailing. Seventy-seven percent of the 512 respondents indicated a willingness to participate and were sent a questionnaire. Of these, 78% (n = 368 women) completed questionnaires. BCS recruited from the cancer center registry were more likely than those from the community hospital registry to respond to the invitation form (P = 0.033) and were more likely to return a completed questionnaire (P = 0.001). However, the community hospital provided access to a more ethnically diverse sample of survivors. The two participating cancer registries were an excellent source for identifying a large sample of long-term BCS, and the different types of registries provided greater sample size and diversity. Although there are some limitations to this approach, including nonresponse of a significant number of BCS, tumor registries represent an important resource for the rapid identification of cancer survivors for research studies. Findings from this study suggest several enhancements for future studies that may increase the yield from registry recruitment.

Involvement in decision-making and breast cancer survivor quality of life

Advances in treatment for breast cancer have improved women's chances of surviving this disease, while giving patients more treatment options than in the past. This study examined the influence of patient involvement in decision-making on survivor quality of life. A prevalence sample of breast cancer survivors were interviewed about their involvement in decision-making about their cancer treatment and follow-up care. A series of multivariate regression analyses were then conducted to examine how involvement in decision-making about cancer treatment and follow-up care contributed to survivor quality of life. Analyses revealed involvement in decision-making about the use of testing for recurrent disease (TFR) as part of follow-up care is associated with improved quality of life in several domains (p < 0.05). This association of improved quality of life with involvement in decision-making about follow-up TFR was independent of associations of quality of life with surgical treatment received, involvement in decision-making about surgical treatment, frequency of TFR, use of mammography, age, income, education, and years since diagnosis. This suggests that efforts to increase patient involvement in decision-making about follow-up care may improve quality of life for breast cancer survivors.

Predictors of sexual health in women after a breast cancer diagnosis.

To identify variables that might be predictive of sexual health (interest, dysfunction, and satisfaction) in a large sample of breast cancer survivors, with a validation conducted in a second, independent sample. On the basis of a conceptual framework of sexual health in breast cancer survivors, we performed multivariable regression analyses to estimate sexual interest, dysfunction, and satisfaction in both samples. Additional analyses were performed using stepwise regression and recursive partitioning to explore in each sample the relative contributions of the independent variables toward predicting the outcome measures. The models for sexual interest accounted for at least 33% of the variance, and the significant predictors common to the two samples were having a new partner since the diagnosis of breast cancer, mental health score, and body image score. For sexual dysfunction, the models in the two samples explained at least 33% of the variance, and the common significant predictors were vaginal dryness, past chemotherapy use, and having a new partner since diagnosis. The sexual satisfaction models explained at least 27% of the variance, with the common significant predictors being the quality of the partnered relationship and sexual problems in the partner. Among the predictors of sexual health, several are mutable (vaginal dryness, emotional well-being, body image, the quality of the partnered relationship, and sexual problems in the partner), and these should be considered for future interventions to address the sexual health and well-being of breast cancer survivors.

Postmastectomy/Postlumpectomy Pain in Breast Cancer Survivors

Few studies have focused on careful assessment of postmastectomy pain (PMP); a chronic neuropathic pain syndrome that can affect women postlumpectomy or postmastectomy for breast cancer (BC). Study aims were to determine the prevalence of PMP in an outpatient sample of breast cancer survivors (BCS), describe subjective and objective characteristics of PMP, and examine the relationship between PMP and quality of life. Breast cancer survivors ( n = 134) participated in telephone interviews, and those reporting PMP ( n = 36) were invited to a pain center for further evaluation and treatment. Results show PMP is a distinct, chronic, pain syndrome affecting 27% of BCS. Findings support the need for clinical trials evaluating the effectiveness of nonpharmacological or cognitive behavioral therapies in alleviating mild to moderate PMP.