The Lived Experience of Australian Women Living with Breast Cancer: A Meta-Synthesis

Background: Breast cancer is the second most common cancer among Australian women. In 2019, an estimated 19,000 women in Australia were diagnosed with breast cancer, with around 3,058 women dying from the disease in the same year. Although many qualitative studies published in Australia exist which examine breast cancer from various perspectives, only limited literature is available which addresses Australian women’s lived experience of breast cancer from diagnosis, treatment and beyond. Method: Meta-synthesis of qualitative studies. Participants who took part in either semi-structured interviews or surveys with open-ended questions were included. A thematic synthesis analysis approach was used. Results: Five themes and 13 sub themes emerged from the data analysis which illustrated the lived experience of Australian women diagnosed with breast cancer. Emotional burden and women’s response towards their breast cancer diagnosis were key themes. Experience of decision- making , social distress, symptoms beyond changes in their body, fertility considerations and their role as mothers were some of the challenges during their treatment. Women coped and adjusted with these challenges through the support of their family, and healthcare providers. Women developed greater empowerment by making their life choices after treatment. Life choices such as getting into a new relationship was challenging for single women. Conclusion: Although most women were emotionally supported following their diagnosis, there are still areas where women could be better supported such as when having to break the news of their breast cancer diagnosis to their children, provision of ongoing emotional support for caregivers of women with breast cancer, providing constant emotional and informational support at the point of diagnosis and during their treatment, tailoring treatments according to different stages of pregnancy, and discussion of fertility treatments in timely manner by healthcare professionals.     

Psychosocial impact of newly diagnosed advanced breast cancer

The purpose of this study was to delineate the key emotional concerns of women newly diagnosed with recurrent or metastatic breast cancer. Sixty-six women diagnosed with metastatic breast cancer within the previous 6 months, receiving treatment at the Medical Oncology Departments of two metropolitan teaching hospitals, completed measures of HADS, IES, CARES-SF and Memorial Symptom Assessment Scale, and participated in a semi-structured interview. There were high levels of psychological morbidity, 56.7% of women younger than 55 years qualifying as "cases" on the HADS, compared with 34.5% of women aged over 55 years. The total HADS score was significantly correlated with the Global and Physical Subscales of the MSAS and CARES. Women younger than 55 years had significantly higher levels of intrusive and avoidant symptoms than women over 55 years. Women also reported high numbers of physical symptoms. Key themes which emerged during the interviews were: difficulties in communicating with doctors, perceived delay in diagnosis, the emotional impact, concerns about the family, feelings about why the cancer developed, other life stress and trauma, and use of non-prescribed treatments.     

Elevated CA 15.3 in Newly Diagnosed Breast Cancer: A Retrospective Study

PurposeTo examine the relationship between baseline elevated CA 15.3 (>30 kU/L) and the prevalence of primary or secondary metastatic disease in breast cancer.MethodsWe performed a retrospective, single-center cohort study on patients with newly diagnosed breast cancer and baseline CA 15.3> 30 kU/L, diagnosed between 2000-2015. Information on tumor characteristics, pre-treatment CA 15.3, staging results, treatment approach, disease recurrence and death were collected from individual medical files. For every tumor subtype, the optimal cut-off value of CA 15.3 for determining primary metastatic disease is determined.ResultsEight hundred ninety-four patients with baseline CA15.3 > 30 kU/L were included of which 38% were diagnosed with primary metastatic disease while 15% subsequently developed secondary metastatic disease, with a median follow-up of 74 months. LuminalHER2 tumors had the highest proportion of primary metastatic disease (48%), Triple Negative tumors had the highest proportion of secondary metastatic disease (24%) (p=0.008). A higher CA 15.3 value corresponds to higher risk of both primary and secondary metastatic disease (p<0.001). For the determination of primary metastatic disease, optimal cut-off values for CA 15.3 range between 44 kU/L (Triple Negative) and 59 kU/L (Luminal B).ConclusionIn patients with newly diagnosed breast cancer and baseline elevated CA 15.3>30 kU/L, 38% presents with primary metastatic disease and 15% develops secondary metastatic disease, with a median follow-up of 74 months. Our results can help clinicians to identify patients at risk of primary or secondary metastatic disease via information on tumor subtype and baseline CA 15.3.     

Health-related quality of life in male breast cancer patients

The objective of this study is to investigate health-related quality of life (HRQoL) in male breast cancer patients. Data of 20,673 patients diagnosed with primary breast cancer (male: n = 84) who completed a questionnaire after discharge from hospital were analysed. HRQoL (SF-36), age, sex, education, native language, insurance status, and partnership status were measured. Cancer staging, treatment (partial mastectomy vs. radical mastectomy), and cancer site were indicated by the clinicians. The HRQoL scores of male breast cancer patients were compared with reference populations. Differences in HRQoL scores between men and women were compared using t tests and regression analysis. Compared to female breast cancer patients, male patients scored significantly higher on seven of eight subscales (physical functioning, role functioning-physical and emotional, bodily pain, vitality, social functioning, and mental health) in the regression analysis. Compared to the reference populations (general male population, men aged 61-70, and the cancer-affected population), male breast cancer patients scored lower on SF-36 subscales on average, with major differences in emotional and physical role functioning. The results suggest that male breast cancer patients may need early interventions that specifically target role functioning, which is severely impaired compared to the male reference population. Future research needs to assess HRQoL with cancer-specific questionnaires and longitudinal designs also focussing on male patients in breast centres.     

Problem-solving style and adaptation in breast cancer survivors: a prospective analysis

Introduction  Emotional care of the breast cancer patient is not well understood; this lack of understanding results in both a high cost to the patient, as well as the health care system. This study examined the role of problem-solving style as a predictor of emotional distress, adjustment to breast cancer, and physical function immediately post-surgery and 12 months later. Methods  The sample consisted of 121 women diagnosed with breast cancer and undergoing surgery as a primary treatment. The survivors completed a measure of problem-solving style and three outcome measures immediately post-surgery, as well as at 1 year later. There was a 95.6% retention rate at 1 year. Results  Multiple hierarchical regressions revealed, after controlling for patient demographics and stage of cancer, that problem-solving style (particularly personal control) was associated with emotional distress, adjustment to chronic illness, and physical function immediately following surgical intervention. In addition, a more positive problem-solving style was associated with less emotional distress, but not a better adaptation to a chronic illness or physical functioning 12 months later; the Personal Control again was the best single predictor of the emotional distress, adding 10% of the variance in predicting this outcome. Conclusions  The utility of post-surgery assessment may help identify those in need for problem-solving training to improve these outcomes at 1 year. Future studies need to determine the impact of interventions tailored to levels of problem-solving styles in cancer survivors over time. Implications for Cancer Survivors  Understanding the role of problem solving style in breast cancer survivors deserves attention as it is associated with emotional distress immediately and one year after medical intervention. Problem-solving style should be evaluated early, and interventions established for those most at risk for emotional distress.     

Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer

PURPOSE/OBJECTIVES: To evaluate quality of life (QOL) and cost outcomes of advanced practice nurses' (APNs') interventions with women diagnosed with breast cancer. DESIGN: Randomized clinical trial. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 210 women with newly diagnosed breast cancer with an age range of 30-85 years. METHODS: The control group (n = 104) received standard medical care. The intervention group (n = 106) received standard care plus APN interventions based on Brooten's cost-quality model and the Oncology Nursing Society's standards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years. Information about costs (charges and reimbursement) was collected through billing systems. MAIN RESEARCH VARIABLES: Uncertainty, mood states, well-being, charges, and reimbursement. FINDINGS: Uncertainty decreased significantly more from baseline in the intervention versus control group at one, three, and six months after diagnosis (p = 0.001, 0.026, and 0.011, respectively), with the strongest effect on subscales of complexity, inconsistency, and unpredictability. Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being. No significant cost differences were found. CONCLUSIONS: APN interventions improved some QOL indicators but did not raise or lower costs. IMPLICATIONS FOR NURSING PRACTICE: The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes. More research is necessary to define cost-effective interventions.     

Use of the metastatic breast cancer progression (MBC-P) questionnaire to assess the value of progression-free survival for women with metastatic breast cancer

While overall survival (OS) has historically been the primary endpoint for clinical trials in oncology, progression-free survival (PFS) has gained acceptance as a valuable surrogate endpoint. However, there are no known published reports about the value of PFS from the patient’s perspective. We developed a questionnaire that included items regarding quality of life (QoL) and the importance of different treatment outcomes and presented hypothetical scenarios for which respondents were asked to indicate their preferences concerning treatments as they relate to PFS. 282 women with metastatic breast cancer (MBC), ranging in age from 21 to 80 years completed an online version of this questionnaire. The majority of women (66 %) had been diagnosed with MBC within the previous 3 years and 56 % had been told their MBC had progressed. When asked to rank five treatment characteristics from most important to least important, respondents ranked “extending PFS” as the second most important treatment outcome after OS. When presented with a hypothetical scenario of two women receiving different treatments, respondents preferred the treatment that resulted in longer PFS (16 vs. 12 months), even when OS and side effects were assumed to be equal. Specifically, when asked to consider which woman within the hypothetical scenario had better QoL, physical functioning, and emotional well-being, respondents more often chose the woman who experienced longer PFS (QoL: 40 vs. 6 %; physical functioning: 32 vs. 8 %; emotional well-being: 58 vs. 6 %) compared to the woman within the hypothetical scenario who had a shorter time of progression. Respondents rated their own QoL highest after being told their MBC was responding to treatment (mean score 76.6) versus after the initial diagnosis of breast cancer and MBC (68.5 and 60.3). These findings suggest that extending PFS is an important treatment outcome and, from a patient perspective, improves overall QoL, physical functioning, and emotional well-being.     

Exploring Coping Strategies Among Young Asian American Women Breast Cancer Survivors

In recent years, breast cancer rates among young Asian American women have been increasing. Despite increases in breast cancer among young Asian American women, little is known about how this population copes throughout diagnosis, treatment, and survivorship. This study was a qualitative exploration of how young Asian American women cope with breast cancer diagnosis, treatment, and survivorship. In-depth interviews with 22 young (under the age of 50) Asian American women diagnosed with early stage breast cancer were conducted. Through qualitative data analysis, three major themes emerged including moving from managing the emotions of others to expressing emotional vulnerability, moving from work and productivity to work-life balance, and moving beyond the family and reaching out to breast cancer survivors. At diagnosis, participants worked to maintain normalcy including caring for others and working during treatment. Once treatment was over, women worked to find ways to use their experience as a transformative one and also to develop more positive coping skills including expressing emotional vulnerability and reaching out to others. Further studies are needed to create and test culturally tailored supportive interventions that enhance positive coping tools among young Asian American women diagnosed by breast cancer.     

Bone integrity and bone metastases in breast cancer

Individuals with a history of early-stage breast cancer may be at increased risk of osteoporosis related to adjuvant therapy, and those with metastatic breast cancer may experience skeletal-related complications from the cancer affecting the bone. Maintaining bone strength is critical in the care of both early- and late-stage breast cancer patients because fractures are associated with morbidity and mortality. This article reviews the maintenance of bone integrity in women with breast cancer.     

Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy

Background. Previous reports suggest that problems in sexual functioning may be common among long-term (>5 years) breast cancer survivors. To investigate this issue further, we examined the characteristics and correlates of sexual functioning in women diagnosed with breast cancer at least 5 years previously and treated with adjuvant chemotherapy and in an age-matched comparison group of women with no history of cancer. Patients and methods. Participants were 58 women initially diagnosed with breast cancer at an average of 7.65 years previously and 61 women with no history of cancer. All participants completed standardized self-report measures of sexual functioning, marital functioning, depression, fatigue, and menopausal symptoms. Results. Compared with women with no history of cancer, long-term breast cancer survivors reported worse sexual functioning (P 0.01), characterized by greater lack of sexual interest, inability to relax and enjoy sex, difficulty becoming aroused, and difficulty achieving an orgasm. Additional analyses indicated that severity of vaginal dryness was significantly (P 0.05) related to poorer sexual functioning among long-term breast cancer survivors and mediated the relationship between group membership (breast cancer survivor v.s. noncancer comparison subject) and sexual functioning. Conclusions. These findings confirm and extend previous reports of impaired sexual functioning among long-term breast cancer survivors. Results further suggest that relief of vaginal dryness should be an essential component of efforts to improve sexual functioning among long-term breast cancer survivors.     

基质金属蛋白酶-2和纤维粘连蛋白mRNA表达与乳腺癌转移相关性的探讨

目的:探讨基质金属蛋白酶-2(MMP-2)和纤维粘连蛋白(Fibronectin,FN)mRNA表达量与乳腺癌转移的关系.方法:采用荧光定量RT-PCR方法检测30例乳腺原发癌和配对淋巴结转移癌的MMP-2和FN mRNA表达量,分析MMP-2和FN mRNA表达量与乳腺癌转移的关系.结果:30例淋巴结转移癌的MMP-2和FN mRNA表达量低于原发癌,组间比较差异有显著性(P＜0.05).MMP-2和FN mRNA表达量呈线性分布,但线性回归和双变量线性相关分析表明两个基因的mRNA表达量无相关性(P＜0.05).结论:MMP-2和FN mRNA表达量在转移癌较原发癌下调.     

Breast cancer and problems with medical interactions: relationships with traumatic stress, emotional self-efficacy, and social support

This investigation examined relationships between breast cancer patients' psychosocial characteristics (impact of the illness, traumatic stress symptoms, emotional self-efficacy, and social support) and problems they perceived in their medical interactions and their satisfaction with their physicians. Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer. The findings reported here are from a cross-sectional analysis of baseline data gathered prior to randomization. Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress (p < 0.01), less emotional self-efficacy for cancer (p < 0.05), less satisfaction with informational support from family, friends, and spouse, and a tendency to perceive those sources of support as more aversive (p < 0.05). Women who were less satisfied with emotional support from their family, friends and spouse were less likely to feel satisfied with their physicians (p < 0.05). These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians.     

Does psychological adjustment of melanoma survivors differs between genders?

Objective: Survival rates of cancer have significantly increased. However, cancer survivors face physical, psychological and social difficulties, while adjusting to post‐illness status. We examined between‐gender differences in the psychological adjustment (mental well‐being, distress and subjective level of functioning), the putative origin of those differences, and the roles of cognitive appraisal, hardiness and attachment style in the psychological adjustment of melanoma survivors. Methods: Our sample included 300 malignant melanoma survivors (182 women and 118 men). Most were diagnosed in stages IA and IB of the disease, and had no evidence of disease for 5 years or more. Participants completed self‐report questionnaires regarding personal data, adjustment measured by sense of well‐being, distress and subjective functioning, cognitive appraisal (primary and secondary) and personal resources (hardiness and attachment style). Results: Between‐gender differences were revealed in psychological adjustment and in various components of cognitive appraisal and attachment styles. Women revealed more distress, less secondary cognitive appraisal and were more secure in attachment styles. Men showed higher secondary appraisal and were more dismissing‐avoidant in attachment. No between‐group differences were found in mental well‐being, subjective functioning, and primary cognitive appraisal or in the global measure of hardiness. Conclusions: We present social processes that seem to account for gender differences in behavior and response to stress, and psychological explanations for these findings. This study contributes to the field of psycho‐oncology by identifying factors that promote adjustment among melanoma survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Family communication and mental health after breast cancer

In the context of a traumatic event, such as a breast cancer diagnosis, talking with others about the event can facilitate emotional adjustment and meaning-finding. Among women with a history of breast cancer, open communication is likely to be of particular importance in the family setting, as the family is frequently a primary source of support. The goal of this cross-sectional survey study was to determine the association between open family communication about cancer and breast cancer survivors' mental health. Responses from 230 women at various stages post-treatment suggest that the majority of women are able to talk openly with their family about breast cancer. Multivariate regression analysis further indicates that open family communication is independently associated with better mental health outcomes. Given that many women live long after a breast cancer diagnosis, maintaining mental health functioning is an important long-term goal. Efforts to enhance productive communication between patients and their family members may help women cope with and overcome the challenges of breast cancer survivorship.     

乳腺癌原发灶和转移灶激素受体与HER2表达差异及其影响因素

目的 乳腺癌的治疗已经进入分子分型时代,雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人类表皮生长因子受体-2(human epidermal growth factor receptor 2,HER2)的表达对指导制订乳腺癌治疗方案及评价患者预后等尤为重要.许多研究证实,部分乳腺癌患者原发灶及转移灶激素受体与HER2表达存在差异,影响术后辅助及解救治疗方案的制订,进而影响患者的治疗效果及预后.本研究探讨乳腺癌原发灶与腋窝及远处转移灶之间激素受体与HER2表达的差异及其临床意义,同时分析了造成差异的影响因素.方法 以乳腺癌、激素受体(ER和PR)、HER2、原发灶和转移灶为关键词,检索PubMed、CNKI数据库和万方数据库1995-01-2016-10的相关文献.共505篇文章被检索到.纳入标准:原发灶与腋窝转移灶激素受体及HER2表达差异情况,原发灶与远处转移灶激素受体及HER2表达差异情况,原发灶与转移灶激素受体及HER2表达差异情况的临床意义.根据纳入标准最终纳入分析38篇文献.结果 在部分乳腺癌患者中,原发灶与腋窝转移灶及远处转移灶激素受体及HER2表达情况存在差异,多数文献报道,乳腺癌原发灶与转移灶ER表达状况变化(阳性转阴性或阴性转阳性)比例约为20％,PR约为20％,HER2约为15％.“肿瘤异质性、抗肿瘤治疗和检测方法”等是影响其表达差异的影响因素.结论 推荐对于存在局部及远处转移的乳腺癌患者,同时检测并综合原发灶及转移灶的激素受体及HER2表达情况制订治疗方案.     

Incidence of second primary breast cancer among women with a first primary in Manitoba, Canada

Second primary breast cancer is of importance because of the increasing incidence of first primary breast cancer and improved survival. There is lack of information on the disease in Canada. We studied 14,220 women with a first primary breast cancer (invasive only) diagnosed during the period from 1970 to 1997, in Manitoba, Canada. A breast cancer was considered to be a second primary if it was an invasive lesion diagnosed at least six months after the diagnosis of an initial primary breast cancer. The incidence rate of second primary breast cancer was approximately six per 1,000 person-years, and the cumulative incidence during the 28-year study period was 14.3%. Average age at diagnosis of first primary breast cancer had increased significantly since 1970. The incidence was higher in 1975–1979, and there was no significant difference among other study periods after adjustment for the age at diagnosis of first primary breast cancer. Standardized incidence ratios showed no significant difference among six age groups after adjusting for calendar year. However, women with a first primary breast cancer had an increased risk of developing a second primary breast cancer compared with the risk of developing a first primary breast cancer among the general female population. The SIR was markedly greater among women who had a first primary breast cancer before the age of 40 years, and decreased significantly with increasing age at diagnosis of first primary breast cancer. The data provide epidemiological information on second primary breast cancer risk for the general female population in Manitoba, Canada.     

Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer.

PURPOSE: To assess whether detriments in quality of life (QOL) among women with breast cancer persist over years. PATIENTS AND METHODS: QOL was assessed in a population-based cohort of 314 women with breast cancer from Saarland (Germany) 1 and 3 years after diagnosis and compared internally and with reference data from the general population. RESULTS: Three years after diagnosis, deficits in QOL were still apparent for role, emotional, cognitive, and social functioning and for the symptoms of insomnia, fatigue, dyspnea, and financial difficulties. Differences between breast cancer patients and women from the general population were predominantly found in younger ages. Compared with the QOL scores measured 1 year after diagnosis, only minor functional changes were observed, but recurrence of breast cancer during the follow-up interval had a deleterious effect on QOL. CONCLUSION: Deficits in role, emotional, cognitive, and social functioning persist over years in women with breast cancer and predominantly affect younger patients.     

A comprehensive review of sexual health concerns after cancer treatment and the biopsychosocial treatment options available to female patients

The repercussions of cancer diagnosis and treatment profoundly impact the sexual wellbeing of women prior to, during, and following cancer treatment. Sexual health concerns are often under‐addressed within clinical and research settings, and information tends to be limited to women with breast or gynecological cancers. In this narrative literature review, the authors critically evaluate research published between 1990 and 2016, pertaining to sexual health concerns of women diagnosed with cancer, of any type or stage, and to the psychosocial and biomedical interventions that currently exist for the treatment of sexual health‐related side‐effects (e.g. vaginal dryness, dyspareunia and vulvo‐vaginal atrophy). The findings of 109 published articles are discussed and summarised according to four central themes: how cancer affects female sexual wellbeing; physical impacts of cancer diagnosis and treatment; emotional impacts of cancer diagnosis and treatment; and interventions for sexual dysfunction. Suggestions to enhance research and clinical practice in relation to the sexual health concerns of women following cancer treatments are also presented. Concerns pertaining to women's sexual health are diverse, multiple, and pervade all types and stages of cancer. Several evidence‐based psychosocial and biomedical interventions exist to help women manage physical and psychosocial ramifications of cancer diagnosis and treatment.