Women Undergoing Treatment For Breast Cancer Research Articles

Impact of breast reconstruction on quality of life in women undergoing mastectomy for breast cancer: a systematic review and meta-analysis using the Breast-Q questionnaire

Introduction: Post-mastectomy breast reconstruction is crucial in breast cancer treatment; however, its impact on women’s quality of life (QOL) remains inadequately understood. The BREAST-Q questionnaire is used for assessing QOL related to breast surgery. Therefore, this study aimed to determine whether there are differences in QOL between women undergoing mastectomy with and without breast reconstruction using the BREAST-Q questionnaire. Methods: We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in PROSPERO. Articles in English, Portuguese, or Spanish were included, and studies on prophylactic mastectomy or breast-conserving surgery, duplicate studies, duplicate data, articles without original data (reviews, editorials, case reports, technical reports) and those without breast reconstruction were excluded. A comprehensive search was conducted across nine scientific databases. The defined search strategy was related to the terms standardized by the MeSH/PubMed controlled vocabularies, including Medical Subject Headings (MeSH), Embase subject headings (Emtree), and their synonyms. Statistical heterogeneity was assessed using the chi-squared and inconsistency tests. Statistical analyses were performed using the R software. A meta-analysis was performed for each BREAST-Q domain when data from multiple studies were available. Results: Of 1266 studies identified, three with 611 participants were included in the meta-analysis. Of these participants, 248 underwent mastectomy without reconstruction and 363 underwent post-mastectomy breast reconstruction. The meta-analysis revealed significantly higher scores in the domains “satisfaction with the breast,” “physical well-being of the chest,” “psychosocial well-being,” and “physical well-being” in women who underwent breast reconstruction compared with those who did not. Conclusion: This study demonstrates a positive association between breast reconstruction and enhanced QOL in women undergoing breast cancer treatment and mastectomy. Patient-reported outcome measures using questionnaires, such as Breast-Q, can elucidate satisfaction levels with the reconstruction, which will likely improve continuously with advances in modern plastic surgery.

Assessing the factors associated with body image perception and quality of life of Palestinian women undergoing breast cancer treatment: a cross-sectional study

BackgroundWorldwide, breast cancer has replaced lung cancer and has become the most commonly diagnosed malignancy. Breast cancer poses a significant burden on the health and quality of life of women and can lead to substantial physical burdens and significant psychological problems, including distress, anxiety, depression, and sexuality-related issues, including negative body image. This study was conducted to assess how women diagnosed with, treated, and/or receiving treatment for breast cancer perceived their body image.MethodsA cross-sectional study design was used to assess body image perceptions among Palestinian women diagnosed with breast cancer. The study was conducted in four different hospitals located in the West Bank of Palestine where women with breast cancer received their treatments or visited for follow-up care in the period between November 2023 and March 2024. An interviewer-administered questionnaire was used to collect the data. Body perception was assessed using the body image self-rating questionnaire for breast cancer (BISQ-BC).ResultsIn this study, 376 women with breast cancer completed the interviewer-administered questionnaire (response rate = 75.2%. The mean age of the women was 44.0 ± 5.3 years. Of the women, 74.7% agreed or strongly agreed that they cared about their body image. On the other hand, 43.1% of the women were not satisfied with their body image and 58.8% did not think that their body image was attractive. Multiple linear regression showed that younger age, employment status, living in cities, marital status, educational level, presence of comorbidities, and longer time passes since diagnosis with breast cancer were associated with the different aspects of body image perception and behavior.ConclusionThe findings of this study indicated that Palestinian women with breast cancer were concerned about their body image. The findings also indicated that breast cancer and its treatment posed a significant burden on the physical and psychosocial well-being of the affected women and impacted the different dimensions of their lives, including their perceptions of their body image. Patients with significant physical and body image changes might benefit from reconstructive surgeries, psychosocial support, cognitive behavioral therapy, and nutritional, and physical activity interventions.

Auricular Therapy to Control Pain in Women With Breast Cancer: Protocol for Systematic Review and Meta-Analysis.

The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433. DERR1-10.2196/55792.

Perception Of Benefits, Barriers, And Self-efficacy Towards Physical Activity Among Women Undergoing Breast Cancer Treatment In Puerto Rico

Perception Of Benefits, Barriers, And Self-efficacy Towards Physical Activity Among Women Undergoing Breast Cancer Treatment In Puerto Rico

Men in Marital Relationships with Women Undergoing Breast Cancer Treatment: A Qualitative Study

Objective Sexual health is an essential part of overall health and well-being. Breast cancer affects the marital relationships and sexual activity of patients and their sexual partners. The present qualitative study was conducted to discover the experiences of women undergoing breast cancer treatment and their husbands regarding marital relationships after breast cancer. Methods Semi-structured interviews were conducted with the 37 women undergoing breast cancer, their husbands, and healthcare providers. Recorded interviews were transcribed and analyzed using a qualitative content analysis approach. Results Four categories of ‘Utilization of couple-based approach,’ ‘Consequences of relationship breakdown,’ and ‘A need for the spouse’s support and compassion’ were revealed. Conclusion The present study showed that the husbands of women undergoing breast cancer treatment played a dual role in marital relationships. It seems that using couple-based approaches, such as mental and sexual health counseling, should be considered by healthcare providers.

Effect of Conservative Rehabilitation Interventions on Health-Related Quality of Life in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Systematic Review.

Breast cancer-related lymphedema (BCRL) of the upper limb is a very common condition in women undergoing breast cancer treatment; it can cause considerable alterations in the daily life of patients and a decrease in their health-related quality of life (HRQoL). Currently, there are many conservative therapies that try to palliate the symptoms, but the results are still controversial and there are still no globally accepted treatments. The purpose of this article is to determine the effect, according to the current available evidence, on HRQoL of different conservative interventions in the rehabilitation of BCRL in the upper limb in women. Eighteen articles that compared the effects of standard treatments, such as manual lymphatic drainage-based decongestive therapy or compression measures, and other newer treatments, including new technologies and other types of treatment programs, were reviewed. According to the results of this review, the most recommended modality for the improvement of HRQoL would be a complex decongestive technique without manual lymphatic drainage. Although there are clinical trials that have demonstrated the effectiveness of various treatments, the results of the positive effects on HRQoL remain highly controversial. There is a need to continue to develop studies to help guide therapeutic decisions that can promote HRQoL in women affected by upper limb BCRL.

Body Image and Breast Cancer: A Systematic Review

This systematic review aimed to synthesize the existing literature on body image dissatisfaction among women undergoing breast cancer treatment, its prevalence, associated factors, and potential interventions. A comprehensive search was conducted in multiple electronic databases up to April 2023. This systematic review identified 194 articles initially, with 168 unique articles remaining after removing duplicates. After screening titles and abstracts, 107 articles were excluded based on eligibility criteria, leaving 61 articles for further evaluation. Finally, 14 studies were included in the qualitative synthesis after excluding 47 articles. A total of 14 studies met the inclusion criteria, involving 1,031 female breast cancer survivors undergoing active treatment or follow-up care. The studies utilized cross-sectional, cohort, qualitative, and interventional designs. Body image dissatisfaction was measured using validated scales, and statistical analyses included bivariate and multivariate approaches. The studies included female breast cancer survivors aged 18 to 75 years, who had undergone breast cancer treatment and were either undergoing active treatment or in follow-up care. Participants were excluded if they were male, non-breast cancer populations, had not received any form of breast cancer treatment, or were diagnosed with metastatic breast cancer. Studies not published in English were also excluded from this systematic review. The prevalence of body image dissatisfaction ranged from 56.8% to 92%. Significant associations were found with receiving multi-professional follow-up and returning to employment after treatment. Factors such as surgical procedures, chemotherapy, time since treatment completion, dispositional gratitude, and coping strategies influenced body image perceptions. The review highlights the impact of body image dissatisfaction on various aspects of quality of life and calls for the implementation of interventions to improve the well-being of breast cancer survivors. Future research should focus on culturally tailored approaches to address this concern effectively.

Women’s Experiences of Managing Fatigue During Breast Cancer Treatment: Strategies from Patients in a Low-Resource Setting

Cancer-related fatigue can lead to a reduced health-related quality of life among patients with cancer. We explored the experiences of fatigue among women undergoing breast cancer treatment at a public hospital in South Africa. We recruited 12 participants using purposive sampling. In-depth, semi-structured interviews were conducted by registered clinical psychologists. The interviews were audio recorded and transcribed. A thematic analysis of the data produced three themes, namely, fatigue is tiredness, the pervasive impact of fatigue and fatigue management strategies. These strategies included rest, pacing, physical activity, energy drinks, instrumental support and cognitive strategies such as distraction and self-talk. Our recommendation is that healthcare providers need to prioritise communication about fatigue and provide appropriate management strategies.

Effects of the Anchor System on Postural Balance of Women Undergoing Breast Cancer Treatment: A Clinical, Randomized, Controlled, and Crossover Trial

ObjectiveInvestigate the effects of multisensory training with and without the anchor system on breast cancer survivors’ postural balance and self-efficacy of falls. DesignClinical randomized, controlled, and crossover trial. SettingTeaching, Research, and Assistance Center in Mastectomized Rehabilitation. ParticipantsEighty breast cancer survivors homogeneously distributed in the groups of adults and elderly affected, or not, by lymphedema. InterventionsParticipants were randomized to multisensory training with and without the anchor system involving 3 sessions per week for 12 weeks. After the 4-week washout period, the remaining therapeutic intervention was applied. Main Outcome MeasuresThe primary outcome was semi-static and dynamic balance as evaluated by baropodometry and Mini Balance Evaluation Systems Test, and the secondary outcome was self-efficacy of the fall episode as assessed by Falls Efficacy Scale - International in the pre-, post-immediate, and 4-week follow-up period. ResultsBoth therapeutic interventions caused positive and significant effects on postural balance and self-efficacy of falls in the immediate period. The multisensory training with the anchor system induced significant functional retention in the short term, related to the clinical effect of small to moderate variation. ConclusionsMultisensory training with the anchor system is convenient for postural balance and self-efficacy for falls, regardless of age and upper limb volume, for breast cancer survivors.

Effects of social support and self-efficacy on eHealth literacy in Korean women undergoing breast cancer treatment: A secondary analysis

ObjectivePatients with breast cancer need to seek out and understand relevant health information to make informed decisions about long-term and complicated illnesses. With the increased use of interventions using online health information, research on eHealth literacy should be expanded. However, existing studies on the factors affecting eHealth literacy in patients with breast cancer are currently lacking. This study, therefore, conducts a secondary analysis of a previous study that surveyed the quality of life of patients with breast cancer. The primary study found a significant correlation between eHealth literacy, social support, and self-efficacy. In this secondary analysis study, we specifically examine eHealth literacy among patients with breast cancer undergoing treatment, and how patient demographic characteristics, breast cancer-specific self-efficacy, and social support contribute to their eHealth literacy. MethodsA total of 143 women receiving outpatient treatment or were hospitalized for breast cancer at a cancer hospital in South Korea participated in the study from January to November 2022. The eHealth Literacy Scale (eHEALS), Multidimensional Social Support Scale, and Breast Cancer Survivors Scale were utilized in the analysis. The data were analyzed using a multiple regression analysis. ResultsFull-time employment (β ​= ​0.19, P ​= ​0.006), a monthly family income of over 4 million won (3600 USD) (β ​= ​0.14, P ​= ​0.042), completing a high school education (β ​= ​0.52, P ​< ​0.001), completing college level or higher education (β ​= ​0.54, P ​< ​0.001), age (β ​= ​−0.23, P ​= ​0.003), and social support (β ​= ​0.21, P ​= ​0.002) were predictors of eHealth literacy, explaining 40.2% of the total variance (F ​= ​14.63, P ​< ​0.001). ConclusionsSocial support was identified as a new factor influencing eHealth literacy among patients with breast cancer undergoing treatment. Therefore, nursing interventions to strengthen social support should be developed to improve eHealth literacy.

Psychological Factors Associated With Mental Adjustment to Breast Cancer: A Hospital-Based Observational Study

This study examined mental adjustment to breast cancer, that is, coping strategies. Participants were 130 women undergoing breast cancer treatment in two medical settings in Accra, Ghana. They completed questionnaires assessing mental adjustment to cancer, psychological distress (anxiety and depression), negative religious coping, body change stress, and illness perceptions. Data were analyzed using hierarchical linear regression. Results showed that patients who reported higher depression were more likely to engage in anxious preoccupation (worry and thinking about breast cancer). Higher depression was associated with a greater sense of helplessness/hopelessness. Moreover, patients higher in negative religious coping were more likely to experience a greater sense of helplessness/hopelessness. Illness perception facets of personal control and emotional response were positively associated with fatalism and anxious preoccupation, respectively. The results suggest that screening breast cancer patients for psychological morbidity could help identify patients with increased risks for maladaptive adjustment to the disease.

Abstract P4-07-31: A whole food, plant-based (WFPB) dietary intervention to improve cardiometabolic and cancer-related outcomes in women with breast cancer

Abstract Background: With dramatically rising obesity rates in the US, obesity at breast cancer diagnosis is common; further compounding the problem is that breast cancer treatment often results in additional weight gain. Among women undergoing breast cancer treatment, both obesity at diagnosis and post-diagnosis weight gain are associated with increased all-cause mortality and increased breast cancer mortality. We tested a WFPB dietary intervention in metastatic breast cancer patients to improve cardiometabolic and cancer-related outcomes, as it has been shown to reduce weight and improves cardiometabolic health in overweight and obese individuals. Methods: Women with stage 4 breast cancer receiving treatment were randomized 2:1 into 2 arms: 1) a WFPB diet (N=21) or 2) usual diet (N=11) for 8 weeks with assessments at baseline, 4, and 8 weeks. Our WFPB diet consisted of an ad libitum whole food, plant-based diet; 3 meals/day were provided to WFPB subjects, which included fruits, vegetables, whole grains, nuts and seeds, and excluded meat, dairy, eggs, and added oils/solid fats. WFPB subjects received weekly education regarding diet. Subjects in the usual care group were asked to continue their usual diet for the next 8 weeks. Outcomes include cardiometabolic risk factors, related sex hormones, and cancer progression markers. Effects of the WFPB diet on the outcomes were assessed by comparing marginal means by arm estimated at 8 weeks from the analysis of covariance model controlling for the baseline value. Results: Of the 32 subjects randomized, 30 subjects (20 WFPB and 10 usual care) completed all 3 assessments. Reductions in weight, BMI, total cholesterol, and LDL cholesterol were statistically significant as well as clinically meaningful, both within the WFPB group and between the groups. In the WFPB group, subjects lost a mean of 6.2% of their body weight versus 0.7% body weight loss in the control group (p&amp;lt; 0.01). LDL cholesterol was reduced by a mean of 20.0% in the WFPB subjects versus a 10.6% increase in control subjects (p&amp;lt; 0.01). Reductions in insulin and HOMA-IR, a measure of insulin sensitivity, were statistically significant within the WFPB group and trended towards significance between the groups. Sex hormone binding globulin (SHBG) levels increased significantly both within the WFPB group and between groups. There was a significant decrease in both IGF-1 and free testosterone within the WFPB group from baseline to week 8. Conclusions: Our WFPB intervention resulted in improvements in several cardiometabolic and hormonal markers. The intentional weight loss, which was clinically large given the duration of the trial, was accompanied by reduced cholesterol, insulin resistance, free testosterone, and IGF-1. Given the moderate to large effect sizes noted, further study is warranted to evaluate the sustainability of benefits over time and to assess their potential impact on cancer-related outcomes. Table 1: Cardiometabolic and Cancer-Related Outcomes Citation Format: Erin Campbell, Thomas Campbell, Eva Culakova, Nellie Wixom, Joseph Guido, Lisa Blanchard, James Fetten, Michelle Janelsins, Karen Mustian, Luke Peppone. A whole food, plant-based (WFPB) dietary intervention to improve cardiometabolic and cancer-related outcomes in women with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-31.

Effectiveness of online sexual education based on the extended PLISSIT model on sexual function and sexual satisfaction in women undergoing breast cancer treatment.

Despite therapeutic interventions having increased the survival rate of women with breast cancer, sexual dysfunction occurs in cancer survivors due to treatment. The aim of this study is to determine the effect of online sexual education, based on the Ex-PLISSIT model on sexual function and satisfaction, on women undergoing breast cancer treatment. The present study was a quasi-experimental and interventional control study. It was conducted with a pretest-posttest design between April and July 2022 in Isfahan, Iran. The participants were divided into an intervention (n = 40) and a control group (n = 40). The intervention group received sexual education based on the Ex-PLISSIT model that consisted of four levels of intervention, namely, permission (P), limited information (LI), specific suggestions (SS), and intensive therapy (IT), presented in four sessions. The Female Sexual Function Index (FSFI) and Larson's Sexual Satisfaction Questionnaire were used to measure the sexual function and sexual satisfaction of the participants. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. P values below 0.05 were considered statistically significant. The results showed that the mean of sexual satisfaction and function scores in the intervention group significantly increased after intervention. Moreover, the results showed a statistically significant difference in the mean of sexual satisfaction scores between the intervention and control groups after intervention (P = 0.020). Although there was a difference between the mean of sexual function scores in the intervention and control groups after the intervention, the t-test showed no statistically significant difference (P = 0.176). According to the results of the study, sexual education based on the Ex-PLISSIT model could effectively enhance sexual satisfaction of women undergoing breast cancer treatment. It seems that this model can help health care providers evaluate the sexual needs of the patients and provide appropriate suggestions in order to decrease sexual problems.

Recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil

Objective: To present the updated recommendations of the Brazilian College of Radiology and Imaging Diagnosis, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Methods: Between January 2012 and July 2022, searches for scientific evidence published in MEDLINE, Embase, Cochrane Library, EBSCO, CINAHL and LILACS were carried out. The recommendations were based on this evidence, with the consensus of a committee of experts from the three institutions. Recommendations: The annual mammography screening is recommended for normal-risk patients aged between 40 and 74 years. For women aged more than 75 years, it is reserved for those whose life expectancy is longer than seven years. Women whose risk is higher than normal, such as those with dense breasts, personal history of atypical lobular hyperplasia, classic in situ lobular carcinoma, atypical ductal hyperplasia, women undergoing breast cancer treatment or thoracic irradiation before the age of 30, or those with genetic mutation or strong family history, benefit from complementary screening, being considered in an individual manner. Tomosynthesis is an evolution of mammography and should be considered in screening whenever accessible and available.

A silence full of words: sociocultural beliefs behind the sexual health of Iranian women undergoing breast cancer treatment, a qualitative study.

Therapeutic interventions lead to impaired sexual health in women undergoing breast cancer treatment. There are some problem such as vaginal dryness, decreased libido, decreased sexual satisfaction, and decreased frequency of sexual intercourse among breast cancer survivors. This study was conducted to discover the sexual experiences of women undergoing breast cancer treatment. A total of 39 semi-structured interviews were held with the women undergoing breast cancer treatment, husbands, and health care providers. Recorded interviews were transcribed and analyzed using qualitative content analysis. Three categories of cultural and gender taboos, adherence to subjective norms, and hidden values in sexuality were revealed. The cultural and gender taboos category consisted of subcategories of learned sexual shame, fear of judgment, sexual schemas, and gender stereotypes. The adherence to subjective norms category consisted of subcategories of sexual socialization, being labeled as a disabled woman and the priority of being alive to sexuality. The hidden values in sexuality category consist of subcategories of Task-based sexuality, Tamkin, and Sexuality prevents infidelity. Socio-cultural beliefs affect the sexual health of women undergoing breast cancer treatment, so paying attention to this issue can improve the quality of sexual health services.

DIFICULDADES ENFRENTADAS POR MULHERES COM CÂNCER DE MAMA: DO DIAGNÓSTICO AO TRATAMENTO

The aim of this study is to describe the difficulties encountered by women diagnosed with breast cancer. It is an integrative bibliographic review of the exploratory type. For this purpose, a search for publications on the VHL website, in the LILACS, Scielo and Pubmed databases was performed, by crossing the Health Sciences Descriptors (DeCS) interconnected by the Boolean operator AND, in the period from September to October 2020. The review was presented in a synoptic table, where discussions about the relevant literature on the subject were possible. It was found that there are several difficulties faced by patients who have breast cancer, ranging from taking the exams to trying to complete the diagnosis, including treatment, access to health services, professionals, personal, family and social suffering. In this sense, it can be concluded that the knowledge of the feelings experienced by women undergoing breast cancer treatment significantly helps in the actions to be implemented by health professionals, as well as serving as a foundation or improvement of public policies. Keywords: Breast neoplasm. Cancer. Diagnosis. Treatment.

Vulnerabilities in workplace features for essential workers with breast cancer: Implications for the COVID-19 pandemic.

The coronavirus pandemic has highlighted the health and financial vulnerabilities of essential workers, especially among women. The purpose of this study is to understand the workplace environment of essential workers. We used data from a prospective cohort study of disparities in employment outcomes among women undergoing breast cancer treatment between 2010-2018 in New York City. We characterized participants as essential or non-essential based on self-reported occupation/industry and New York State executive orders issued during the pandemic. We compared job benefits and perceptions of workplace environment between groups. There were 563 participants: 341 essential and 222 non-essential workers. Essential workers less frequently reported access to disability pay through work [n(%): 148 (58) versus 130 (73), p < 0.01]. Essential workers in unions had greater availability of sick leave and disability pay than non-unionized essential workers (86% versus 53%, p < 0.01, and 76% versus 46%, p < 0.01, respectively). Health insurance differed by essential worker status (p < 0.01): essential workers more frequently had public insurance (29% versus 18%). Surprisingly, in multivariable analyses controlling for age, race/ethnicity, income, education, chemotherapy receipt, and comfort with English, essential workers were less likely to say their employer had treated them unfairly (p < 0.01). However, minorities were less likely to say their employer was accommodating (p = 0.03) and more likely to say their employer had treated them unfairly (p < 0.01) than Non-Latina Whites. We identified vulnerabilities in workplace protections, particularly among essential workers not in unions. Minority women more often had negative perceptions of their work environment, possibly reflecting employer bias.

P60. PATIENT FACTORS THAT AFFECT PRE-OPERATIVE PATIENT REPORTED OUTCOMES IN WOMEN UNDERGOING BREAST CANCER SURGERY

PURPOSE: Understanding the impact of patient, disease, and treatment factors on pre-operative patient reported outcomes (PROs) is important to guide surgical decision-making with breast cancer. METHODS: This prospective cohort study evaluates PROs in women undergoing breast cancer treatment at a metropolitan health care system. New cases undergo tumor board discussion and same-day consultations with various specialties. Women choose to complete pre- and post-operative Breast-Q© Breast Conserving Surgery(BCS), Mastectomy(M), or Reconstruction(R) modules and demographic surveys. Individual associations to pre-operative Breast-Q survey scores were assessed using linear regression models (one for each Breast-Q survey type). Variables significant for at least one survey were included in multiple linear regression models. RESULTS: 375 women completed the pre-operative surveys (BCS=244, M=39, BR=92). Procedure choice, laterality, race, marital status, employment, prior breast cancer, neoadjuvant chemotherapy, or history of radiation or chemotherapy did not impact PROs. Breast satisfaction decreased with higher BMI (est=-0.367, p=0.045) and stage 2 disease (est=-11.011 (vs. stage 0), p=0.008). Lower psychosocial score was associated with younger age (est=0.271, p=0.002), higher BMI (est=-0.367, p=0.014), and income <35k (est=0.172 (vs. 35k+), p=0.016). Similarly, lower physical well-being of the chest was associated with younger age (est=0.207, p=0.011), higher BMI (est=-0.285, p=0.039), and income <35k (est=0.218 (vs. 35k+, p=0.039). Sexual well-being decreased with higher BMI (est=-0.545, p=0.004) and income <35k (est=0.135 (vs. 35k+), p=0.016). CONCLUSION: While factors such as age, BMI, and stage of disease are difficult to change prior to surgery, patients with lower income may need special interventions to assist them through the treatment process.

Called Back: My Reply to Cancer, My Return to Life

In 2009, Mary Cappello published a memoir that bravely, and intimately, focused on her cancer diagnosis, treatment, and “cure.” This prize-winning book has now been rereleased with an afterword by the author. The text is timely, given our national and world focus on health, disease, death, and immortality, sparked by the COVID-19 pandemic.Susan Sontag and Elaine Scarry laid out the theoretical underpinnings for Cappello in the late 1970s and 1980s, and physician/writers have long animated American readers, particularly Abraham Verghese and Oliver Sacks. Cappello's book is neither theoretical nor “medical”: she is a forceful writer of nonfiction; she is an extraordinarily insightful reader of literature; she is deeply in love with her partner—she is in love with everything, especially the life that took on renewed meaning after her cancer diagnosis.So this is really a book about love. And gratitude. The author reminds us constantly of her privileged position on the battlefield of cancer—as a professional woman with health insurance, a woman with a supportive family and many friends; and she dedicates the book to the ordinary people who helped her heal: the acupuncturist, the hairdresser, the massage therapist, the physical therapist, all of whom gently guided her recovery. The literature in the text is introduced with skill and calm and without fanfare or pretension. There is a heavy reliance on Proust—the patient brought Swann's Way with her into the operating theater—and reports how, right before surgery, “My anesthesiologist recited lines from Proust that were his favorite” (43).The book is crisp in organization and completely unsentimental. Four sections map the cancer voyage in chronological order. Cappello directs the reader from “Diagnosis” to “Surgery,” “Chemotherapy,” and “Radiation.” Each segment of her specific (but not uncommon in terms of treatment protocol) cancer journey is written as a separate chapter. The final section, the coda, is entitled “Called Back: The Voyage Out,” and the author recounts a simple, moving story of the day she's essentially “released’ from treatment following a clear 2008 mammogram. “You live your life,” instructs Cappello's surgeon, “and leave the monitoring to me” (207). Everyone deserves this level of humane care and attention from a health-care professional.Called Back should find again a wide readership—in this new, updated edition—among women undergoing breast cancer treatment. But anyone facing the uncertainty of a scary diagnosis, multiple surgeries, and treatment with toxic chemicals and radiation will benefit from Cappello's clear-eyed nonfiction narrative. Physicians—to gain added perspective on the fear, courage, and resilience of their patients—might spend some time with this book, which should be required reading for medical students.As of late April 2022, we close in on one million reported deaths in the United States from COVID-19, and it's safe to say that the entire nation has been transfixed and, to some degree, transformed by a deadly pandemic that waxes and wanes. The virus has forced us to rethink, totally, the society we live in. “We read and write,” asserts Cappello, “to interrupt the daily tale we tell ourselves” (125). Her generosity, her truthfulness, and the love that pours from her pages helps all readers imagine and construct a better tale—a more hopeful tale—even in times of great uncertainty.

Sexual health promotion interventional program for women undergoing breast cancer treatment: Protocol for a mix-methods study.

BACKGROUND:Women undergoing breast cancer treatment, especially those of reproductive age, experience sexual health challenges. The aim of this study is to design an interventional program for promoting the sexual health of women undergoing breast cancer treatment.MATERIALS AND METHODS:This is a mixed qualitative-quantitative exploratory study consisting of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will be selected using purposive sampling method and the data will be collected through semi-structured interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase, the initial version of the program will be designed based on the results of qualitative study and review of literature, the appropriate strategies are prioritized by the members of the panel of experts, and then, the final interventional program is prepared. In the fourth phase, the designed interventional program will be conducted as a quasi-experimental study in two groups of intervention and control and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be selected based on the results of the previous phases and the opinion of the expert panel.CONCLUSIONS:The results of this study are expected to contribute to the design of an interventional program based on the needs of women undergoing breast cancer treatment and promote health and meet the sexual health needs of breast cancer patients.