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1.
Background
Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients.Methods
In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10?weeks, and after 40?weeks. Logistic regression analysis was applied to estimate the association of RTW at 40?weeks following discharge with sociodemographic and disease-related characteristics (n =?577).Results
The sociodemographic variables “entrance certificate at a university of applied science” compared to “university entrance certificate” (OR?=?3.1, 95%-CI?=?1.2–8.1), age group “55–59?years” compared to “18–44?years” (OR?=?3.2, 95%-CI?=?1.2–8.4) and “having children” (OR?=?2.8, 95%-CI?=?1.2–6.2) as well as the disease-related variables “rehabilitation” (OR?=?0.5, 95%-CI?=?0.3–0.9), self-rated health “good” and “excellent” compared to “bad” (OR?=?2.7, 95%-CI?=?1.4–5.5; OR?=?11.6, 95%-CI?=?4.2–31.8) and the UICC-classification “stage II” and “stage III/IV” in comparison to “stage 0/I” (OR?=?0.5, 95%-CI?=?0.3–0.8; OR?=?0.2, 95%-CI?=?0.1–0.5) significantly affect RTW among breast cancer patients (Nagelkerke’s Pseudo-R2 =?0.275).Conclusions
The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses.Trial registration
Database Health Services Research, VfD_PIAT_12_001630, registered 01.03.20122.
Mechelle D. Claridy Benjamin Ansa Francesca Damus Ernest Alema-Mensah Selina A. Smith 《Quality of life research》2018,27(8):2067-2075
Purpose
The purpose of this study was to compare differences in health-related quality of life (HRQOL) between African-American female breast cancer survivors, African-American female survivors of other cancers, and African-American women with no history of cancer.Methods
Using data from the 2010 National Health Interview Survey (NHIS), the HRQOL of African-American women aged 35 years or older was compared by cancer status. Physical and mental health items from the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale were used to assess differences in HRQOL.Results
For summary physical and mental health measures, no significant differences were found between breast cancer survivors and women with no history of cancer; survivors of other cancers reported poorer physical and mental health than did women with no history of cancer. Similar differences were found at the item level. When we examined the two African-American female cancer survivor groups, we found that cancer survivors whose cancer was being treated reported substantially poorer physical health and mental health than did those whose cancer was not being treated. Survivors who had private insurance and were cancer free reported better physical and mental health than did those who did not have private insurance and those who were not cancer free. Breast cancer survivors reported slightly better physical and mental health than did survivors of other cancers.Conclusions
Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of African-American female survivors of cancer.3.
Purpose
Social support does not always lead to health benefits; the outcomes depend on the match between the need and the provision of social support. Culture shapes individuals’ preference of social support types (e.g., supportive communication, social companionship, and tangible support). The present study examined how the association between social support and well-being may vary as a function of acculturation among minority cancer survivors.Methods
One hundred and twenty-three Chinese American breast cancer survivors were invited to complete a questionnaire package.Results
Findings showed that acculturation moderated the association of social support subtypes with psychological and physical well-being. Higher emotional/information support was associated with better quality of life and less physical symptoms among highly acculturated cancer survivors but more physical symptoms among those who were less acculturated. Tangible support was associated with more physical symptoms among highly acculturated cancer survivors but less physical symptoms among those who are less acculturated. Positive social interaction was associated with better quality of life and less physical symptoms among less acculturated cancer survivors but not associated with quality of life or physical symptoms among their highly acculturated counterparts.Conclusion
The findings pointed to the significance of acculturation in breast cancer experience among minority women, especially its interplay with social support transactions.4.
Roelen CA Koopmans PC de Graaf JH Balak F Groothoff JW 《International archives of occupational and environmental health》2009,82(4):543-546
Purpose
Most women are diagnosed with breast cancer when they are of working age. How long are breast cancer patients absent? How many of them return to work?Methods
ArboNed Occupational Health Services documents sickness absence data of 1 million workers of whom 40% were women. Between 2001 and 2005, 2,259 women had 2,361 episodes of sickness absence due to breast cancer. These absence episodes were followed for 2 years using Kaplan–Meier analysis.Results
The mean ± standard error of mean duration of absence due to breast cancer was 349 ± 5 days. Thirty-seven percent of absences lasted longer than one year and 12% of absences lasted longer than 2 years particularly in women aged 25–34 years.Conclusions
The mean duration of sickness absence due to breast cancer was nearly a year, but most women returned to work. The results of the study can be used as a reference for return to work of women following breast cancer.5.
6.
Sarah A. Marshall Christopher C. Yang Qing Ping Mengnan Zhao Nancy E. Avis Edward H. Ip 《Quality of life research》2016,25(3):547-557
Purpose
User-generated content on social media sites, such as health-related online forums, offers researchers a tantalizing amount of information, but concerns regarding scientific application of such data remain. This paper compares and contrasts symptom cluster patterns derived from messages on a breast cancer forum with those from a symptom checklist completed by breast cancer survivors participating in a research study.Methods
Over 50,000 messages generated by 12,991 users of the breast cancer forum on MedHelp.org were transformed into a standard form and examined for the co-occurrence of 25 symptoms. The k-medoid clustering method was used to determine appropriate placement of symptoms within clusters. Findings were compared with a similar analysis of a symptom checklist administered to 653 breast cancer survivors participating in a research study.Results
The following clusters were identified using forum data: menopausal/psychological, pain/fatigue, gastrointestinal, and miscellaneous. Study data generated the clusters: menopausal, pain, fatigue/sleep/gastrointestinal, psychological, and increased weight/appetite. Although the clusters are somewhat different, many symptoms that clustered together in the social media analysis remained together in the analysis of the study participants. Density of connections between symptoms, as reflected by rates of co-occurrence and similarity, was higher in the study data.Conclusions
The copious amount of data generated by social media outlets can augment findings from traditional data sources. When different sources of information are combined, areas of overlap and discrepancy can be detected, perhaps giving researchers a more accurate picture of reality. However, data derived from social media must be used carefully and with understanding of its limitations.7.
Purpose
After cancer treatment, it is desirable to maintain or regain a high quality of life (QoL) and the ability to accomplish everyday tasks well. Therefore, we substantiated the scarce knowledge regarding long-term QoL after breast cancer, burdensome problems, and unmet needs for more support.Methods
Disease-free breast cancer survivors (n?=?190) who had participated in two randomized controlled exercise trials during primary treatment were followed up to 5 years post-diagnosis. QoL-related functions and symptoms (EORTC QLQ-C30/-BR23), health problems, and support needs were assessed. EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany.Results
QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references, but largely improved over time. Yet, cognitive function and sleep were still significantly impaired at 5-year follow-up. Other common long-term problems included sexual issues (45% of survivors), hot flashes (38%), pain (34%), fatigue (24%), and polyneuropathy (21%). Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders (43%), physical performance (39%), sleep problems (38%), arthralgia (37%), cognitive problems (36%), weight problems (32%), and fatigue (31%).Conclusions
While QoL in disease-free breast cancer survivors 5 years post-diagnosis was largely comparable to the general population on average, still many survivors suffered from adverse effects. There appears to be a need for ongoing screening and support regarding fatigue, sleep problems, cognitive problems, arthralgia/pain, menopausal/sexual symptoms, physical performance, and weight problems during and several years following breast cancer therapy.8.
Christina L. Rush Margaret Darling Maria Gloria Elliott Ivis Febus-Sampayo Charlene Kuo Juliana Muñoz Ysabel Duron Migdalia Torres Claudia Campos Galván Florencia Gonzalez Larisa Caicedo Anna Nápoles Roxanne E. Jensen Emily Anderson Kristi D. Graves 《Quality of life research》2015,24(5):1107-1118
Introduction
Few studies have evaluated interventions to improve quality of life (QOL) for Latina breast cancer survivors and caregivers. Following best practices in community-based participatory research (CBPR), we established a multi-level partnership among Latina survivors, caregivers, community-based organizations (CBOs), clinicians, and researchers to evaluate a survivor–caregiver QOL intervention.Methods
A CBO in the mid-Atlantic region, Nueva Vida, developed a patient–caregiver program called Cuidando a mis Cuidadores (Caring for My Caregivers), to improve outcomes important to Latina cancer survivors and their families. Together with an academic partner, Nueva Vida and three CBOs established a multi-level team of researchers, clinicians, Latina cancer survivors, and caregivers to conduct a national randomized trial to compare the patient–caregiver program to usual care.Results
Incorporating team feedback and programmatic considerations, we adapted the prior patient–caregiver program into an 8-session patient- and caregiver-centered intervention that includes skill-building workshops such as managing stress, communication, self-care, social well-being, and impact of cancer on sexual intimacy. We will measure QOL domains with the patient-reported outcomes measurement information system, dyadic communication between the survivor and caregiver, and survivors’ adherence to recommended cancer care. To integrate the intervention within each CBO, we conducted interactive training on the protection of human subjects, qualitative interviewing, and intervention delivery.Conclusion
The development and engagement process for our QOL intervention study is innovative because it is both informed by and directly impacts underserved Latina survivors and caregivers. The CBPR-based process demonstrates successful multi-level patient engagement through collaboration among researchers, clinicians, community partners, survivors, and caregivers.9.
Background
This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice.Methods
A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location.Results
Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas.Conclusion
Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.10.
11.
Wai-on Chu Pegdwende Olivia Dialla Patrick Roignot Marie-Christine Bone-Lepinoy Marie-Laure Poillot Charles Coutant Patrick Arveux Tienhan Sandrine Dabakuyo-Yonli 《Quality of life research》2016,25(8):1981-1990
Purpose
To identify the impact of clinical and socio-economic determinants on quality of life (QoL) among breast cancer (BC) survivors 5 years after diagnosis.Methods
A cross-sectional survey was conducted in women diagnosed in 2007 for primary invasive non-metastatic BC and identified through the Côte d’Or BC registry. QoL was assessed with the Medical Outcomes Study 12-item Short Form Health Survey (SF-12), the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30) and the breast cancer (EORTC-QLQ-BR23) questionnaires. Social support was assessed with Sarason’s social support questionnaire, and deprivation was assessed by the EPICES questionnaire. Clinical variables were collected through the registry database. Determinants of QoL were identified using multivariable mixed model analysis for each SF-12 dimension. A sensitivity analysis was conducted with multiple imputations on missing data.Results
Overall, 188 patients on 319 patients (59 %) invited to participate to the survey completed the questionnaires. Five years after breast cancer diagnosis, the disease stages at diagnosis, as well as the treatment received, were not determinants of QoL. Only the age at diagnosis and comorbidities were found to be determinants of QoL.Conclusions
Five years after BC diagnosis, disease severity and the treatment received did not affect QoL.12.
Mariann Olsson Marie Nilsson Kerstin Fugl-Meyer Lena-Marie Petersson Agneta Wennman-Larsen Linnea Kjeldgård Kristina Alexanderson 《Quality of life research》2017,26(3):673-684
Purpose
To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery.Methods
This cross-sectional study included 605 women, aged 20–63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression.Results
Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables—having children, being in work, having emotional and informational social support, and having good physical and emotional functioning—were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning.Conclusions
One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning.13.
Purpose
Acknowledging the expanding influence of technology in the promotion of health and wellness, this study assessed the role of information and communication technology (ICT) use in the lives of older cancer survivors.Methods
A community sample of cancer survivors aged 65 and older (N?=?1411) was extracted from a 2011 U.S. National Health and Aging Trends Study dataset. Weighted multiple regression and multinomial logistic regression analyses were performed to explore the relationships between survey respondents’ ICT use and their self-rated health status and depressive symptoms.Results
The majority of respondents reported rarely or never engaging in ICT use. Greater use of communication technology such as emailing or texting was associated with decreased risk for severe depressive symptoms and higher self-rated health status. Information technology use was not associated with depressive symptoms and self-rated health status.Conclusions
Investigation into reasons behind older cancer survivors’ apparent low rates of engagement with ICT is warranted, particularly the examination of access as a potential barrier. Findings indicated that frequent use of communication technology was positively linked with mental and physical wellness. The nature of the relationships between communication technology use and physical and mental health merits further research, helping to determine whether community-based educational efforts to improve technology access and skills may benefit the growing population of older cancer survivors.14.
V. D’Egidio C. Sestili M. Mancino I. Sciarra R. Cocchiara I. Backhaus A. Mannocci Alessandro De Luca Federico Frusone Massimo Monti G. La Torre RETURN TO BREAST Collaborative group 《Quality of life research》2017,26(10):2573-2592
Background
Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life.Objective
To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients.Methods
A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included.Results
Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation.Conclusion
A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients.15.
C. van den Broeke T. de Burghgraeve M. Ummels N. Gescher L. Deckx V. Tjan-Heijnen F. Buntinx Marjan van den Akker 《The journal of nutrition, health & aging》2018,22(2):191-198
Objectives
In older adults, nutritional health is essential for good quality of life and living independently at home. Especially in cancer patients, malnutrition is common and known to complicate treatment. This study aims to evaluate the nutritional status and its associated factors in community-dwelling older adults with and without cancer.Design
This is an observational study.Setting
This study focuses on older community-dwelling people.Participants
This study included older people with and without cancer (≥70 years). Cancer patients included patients with a new diagnosis of breast, lung, prostate, or colorectal cancer.Measurements
Data collection included measures of nutritional status, quality of life, depression, fatigue, distress and functional status. We used multivariate logistic regression analysis to assess the association between personal characteristics and malnutrition.Results
Data were available for 657 people; 383 people without cancer and 274 with a cancer diagnosis. Overall, malnutrition was detected in 245 (37.5%) people; in cancer patients this was 66.1%. Multivariate analysis showed that having cancer (OR 14.4, 95% CI: 8.01 - 23.3), being male (OR 2.38, 95% CI: 1.49–3.70), having depression (OR 13.5, 95% CI: 6.02-30.0), distress (OR 2.60, 95% CI: 1.55–4.37) and impaired instrumental activities of daily living (IADL) (OR 2.63, 95% CI: 1.63–4.24) were associated with a higher risk of malnutrition.Conclusion
The prevalence of malnutrition in community-dwelling older people is high, particularly in patients with cancer. Benchmarking and routine screening of older patients may be helpful strategies to increase awareness of (risk of) malnutrition among professionals.16.
Background
A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP.Objective
Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old.Methods
Based on an administrative database of 50,752 women aged 50–74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use).Results
Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41–2.35 %)], but the effect was not significantly different following the implementation of the contract.Conclusion
The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.17.
18.
Peter?Haubjerg?Asdahl Rohit?Priyadarshi?Ojha Jeanette?Falck?Winther Anna?S?llfors?Holmqvist Sofie?de?Fine Licht Thorgerdur?Gudmundsdottir Laura?Madanat-Harjuoja Laufey?Tryggvadottir Klaus?Kaae?Andersen Henrik?Hasle 《European journal of epidemiology》2017,32(12):1089-1096
Introduction
Given considerable focus on health outcomes among childhood cancer survivors, we aimed to explore whether survivor bias is apparent during long-term follow-up of childhood cancer survivors.Methods
We identified all 1-year survivors of cancer diagnosed before 20 years of age in Denmark, Finland, Iceland, and Sweden. From the general population, we randomly sampled a comparison cohort. Study individuals were followed for hospitalizations for diseases of the gastroenterological tract, endocrine system, cardiovascular system, or urinary tract from the start of the cancer registries to 2010. We estimated cumulative incidence with death as competing risk and used threshold regression to compare the hazards of the diseases of interest at ages 20, 40, 60, and 75 years.Results
Our study included 27,007 one-year survivors of childhood cancer and 165,620 individuals from the general population. The cumulative incidence of all four outcomes was higher for childhood cancer survivors during early adulthood, but for three outcomes, the cumulative incidence was higher for the general population after age 55 years. The hazard ratios (HRs) decreased for all outcomes with increasing age, and for two of the outcomes, the hazards were higher for the general population at older ages (endocrine diseases: age-specific HRs = 3.0, 1.4, 1.0, 0.87; Cardiovascular diseases: age-specific HRs = 4.1, 1.4, 0.97, 0.84).Conclusions
Our findings provide empirical evidence that survivor bias attenuates measures of association when comparing survivors with the general population. The design and analysis of studies among childhood cancer survivors, particularly as this population attains older ages, should account for survivor bias to avoid misinterpreting estimates of disease burden.19.
Daniel M. A. McCartney Declan G. Byrne Marie M. Cantwell Michael J. Turner 《Zeitschrift fur Gesundheitswissenschaften》2017,25(2):197-213
Aim
This observational ecological study aims to compare Ireland’s age-specific cancer incidence rates (ASRs) with equivalent European and global data and to highlight possible dietary, nutritional and lifestyle contributors to cancer in Ireland.Subjects and methods
Using the International Agency for Research on Cancer’s (IARC) GLOBOCAN database, Irish ASRs for all-site cancer and for “lifestyle-related” cancers such as those of the colo-rectum, oesophagus, breast, lung and prostate were compared with European and global incidence data. Irish dietary and nutrient intake data were reviewed and evaluated in the context of these cancer incidence data and in relation to the established dietary, nutritional, lifestyle and anthropometric predictors of increased cancer risk previously articulated in the literature.Results
Incidence rates of colorectal, oesophageal, breast, lung, prostate and all-site cancer are higher in Ireland than in most other countries. National nutrition surveys in Ireland indicate that dietary, nutritional, lifestyle and anthropometric risk factors for cancer occur with high frequency in the Irish population. For example, low fruit and vegetable consumption, high red and processed meat intake, low fish intake, low dairy consumption, high saturated fat intake, low folate and vitamin D intakes, and excessive alcohol consumption are all common amongst Irish adults.Conclusions
Our data suggest that unfavourable diet and nutrient intakes prevail in Ireland and that these may contribute to Ireland’s excess cancer burden. These risk factors should be targeted by interventions seeking to sustainably redress Ireland’s high cancer incidence. Such initiatives may provide a template for intervention in other high-risk countries.20.