Factors related to depressive symptoms among long-term survivors of cervical cancer

In this article we describe depressive symptoms among survivors of cervical cancer. Study participants were previously diagnosed and treated with cervical cancer 5 to 25 years prior to the completion of a telephone survey. Through a population-based survey of women identified via a state tumor registry in southern New England, the investigators learned that depressive symptoms are prevalent among a subgroup of long-term survivors long after diagnosis and treatment. The at-risk participants included those who were at a lower economic status and whose marital status and ability to work had changed, and who continued to experience pain and diarrhea caused by radiotherapy. Findings from this study warrant additional research with this potentially vulnerable group of women.     

Frequent search for sense by long-term breast cancer survivors associated with reduced HRQOL

This study examined breast cancer survivors' reports of continuing efforts to make sense of their breast cancer experience and associations of such efforts with post-traumatic stress symptomology (PTSS) and long-term health related quality of life (HRQOL). A cross-sectional survey was conducted with 636 women in 2002-2003 two, five and ten years after their diagnosis of breast cancer. Only a minority of women with breast cancer reported frequently searching for sense in their cancer experience, or wondering "why did this happen to me?" two or more years after diagnosis. Controlling for key demographic and disease variables, greater involvement in search two, five and ten years post-diagnosis was associated with higher levels of PTSS (R2 = 0.26; p < 0.001) and with reduced HRQOL as measured using the SF-36 scale (p < 0.01 for all scales). It appears that continued efforts to search for sense in the cancer experience two or more years after cancer diagnosis are associated with PTSS and lower levels of HRQOL in long-term survivors of breast cancer.     

Factors associated with return to work of breast cancer survivors: a systematic review

Background

The breast cancer survival rate is the highest among all types of cancers, and survivors returning to work after completing treatment is extremely important in regards to economy and rehabilitation. The aim of this systematic review study is to identify the prevalence of breast cancer survivors who return to work (RTW) and the factors associated to RTW.

Methods

A computer based literature search was carried out. "PubMed, Cochrane Library, Embase, Web of Science, and Science Direct" databases were searched systematically. Our search strategy identified a total of 12,116 papers of which 26 studies met the inclusion criteria and quality assessment. These were original papers published between January 2003 and January 2013.

Results

The trends in RTW differ among countries for the breast cancer survivors. The time to RTW after successful cancer treatment also varies among the countries and by ethnicity. The prevalence of the RTW varies from 43% to 93% within one year of diagnosis. The prevalence of the RTW for the Netherland is the lowest in the world (43%). The United States survivors showed the highest RTW (93%) within 12 months of the diagnosis. Numerous barriers and facilitators were identified as factors that affect RTW. For instance, socio-demographic factors such as education and ethnicity; treatment oriented factors such as chemotherapy; work related factors such as heavy physical work; disease related factors such as poor health condition and fatigue; and psychological factors such as depression and emotional distress, act as barriers of RTW. In contrast, social, family, employer support, and financial independency emerge as key facilitators in enabling breast cancer survivors to return and continue work.

Conclusion

Minimising these identified barriers and strengthening these facilitators could further improve the work condition and increase the percentage of RTW among the breast cancer survivors.

     

Technology use and its association with health and depressive symptoms in older cancer survivors

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.

     

Skin carotenoids are inversely associated with adiposity in breast cancer survivors

Carotenoids are antioxidants which may mitigate some of the adverse effects of obesity, a condition associated with poor outcomes in breast cancer patients. We hypothesized that baseline skin carotenoids would be inversely associated with adiposity in breast cancer survivors and would increase with weight loss. Skin carotenoid score (SCS) was assessed by resonance Raman spectroscopy in breast cancer survivors (body mass index ≥25 kg/m²) enrolled in a 6-month randomized controlled weight loss trial (n = 47). Measurements included total body fat using dual-energy X-ray absorptiometry, height, weight, waist and hip circumference, dietary intake, and serum biomarkers. Associations between SCS, adiposity measures, and serum biomarkers were assessed at baseline, as was the change in SCS from baseline to 6 months, in the intervention and usual care groups. At baseline, SCS was inversely correlated with all adiposity measures (P ≤ .05). In multivariate analyses, baseline percent body fat had the strongest association with baseline SCS (partial R²= 0.20). Baseline SCS was significantly inversely associated with log C-reactive protein levels (regression coefficient β ± SE: −0.051± 0.019; P = .011) and log leptin (β ± SE: −0.019± 0.009; P = .046), but the associations were no longer significant after adjustment for adiposity. Over the 6-month study, the intervention group had a 17.6% increase in SCS compared to a 1.5% decrease in the usual care group (P = .28). In our study of overweight and obese breast cancer survivors, dual-energy X-ray absorptiometry–measured body fat explained a large portion of the variation in skin carotenoids at baseline, suggesting a stronger association than that previously seen in studies using less accurate measures of adiposity.     

Factors influencing quality of life in breast cancer survivors

Longitudinal data from 195 breast cancer survivors were used to identify factors affecting the level and rate of change in quality of life after completion of treatment. Women were interviewed up to four times at approximately yearly intervals using Kaplan and Bush's Quality of Well Being instrument (QWB). Random coefficient regression analysis was used to model QWB as a function of time since diagnosis and personal characteristics. QWB scores decreased over time and the rate of decline increased with age (p = 0.032). This was similar to declines in women with benign breast biopsies, but overall QWB levels were lower in women with breast cancer. Having a spouse tended to slow the rate of decline in breast cancer survivors (p = 0.004). The presence of comorbidity was associated with significantly lower QWB levels (p = 0.037) but did not affect the rate of change over time. Education, family history of breast cancer, cancer stage and treatment modalities were not significantly related to QWB levels or rates of change. Breast cancer survivors experience a reduction in quality of life that persists for years after treatment and is similar in magnitude to that associated with other health problems.     

Profiles of depressive symptoms and the association with anxiety and quality of life in breast cancer survivors: a latent profile analysis

Quality of Life Research - The aim of this study was to examine profiles of depressive symptoms and the association with anxiety and quality of life (QOL) in breast cancer survivors. A...     

Communication with breast cancer survivors

Breast cancer survivors must manage chronic side effects of original treatment. To manage these symptoms, communication must include both biomedical and contextual lifestyle factors. Sixty breast cancer survivors and 6 providers were recruited to test a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship. Visits were audio-taped, then coded using the Measure of Patient-Centered Communication (Brown, Stewart, & Ryan, 2001). Consultations were found to be 52% patient-centered. Chi-square Automatic Interaction Detection (CHAID) analysis showed that survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication. Survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.     

Determinants of quality of life among long-term breast cancer survivors

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.

     

Factors associated with the onset of an episode of depressive symptoms in the general population

OBJECTIVES: To determined the association between spinal pain, headache, health, demographic and socio-economic characteristics, and development of depressive symptomatology. METHODS: A population-based, random sample of adults was surveyed and followed at 6 and 12 months. Individuals at risk of depression at baseline are the subjects of this article (n=845). We used Cox proportional hazards models to measure the time-varying effects of demographic, socio-economic, and health status; comorbid medical conditions; spinal pain; and headaches on the development of depression. RESULTS: After adjusting for baseline depressive symptoms and factors associated with nonresponse to follow-up, we found that spinal pain severity, younger age, marital status (separated/divorced/widowed), self-perceived poor health status, and comorbid neurologic and gastro-intestinal disease were associated with onset of a new episode of depression. CONCLUSIONS: Important predictors of depressive symptomatology include demographic characteristics, health problems, and pain problems.     

Factors associated with repeat adherence to breast cancer screening

This study identified barriers and facilitators of repeat participation in mammography and breast physical examination among women ages 50 years and over. Telephone interviews were conducted with 910 women in this age group. Forty percent of respondents had never had a mammogram. Only 38% had had one in the past 12 months. Of women who had a prior mammogram, 43% had had only one. Only 60% of women had had a breast exam in the past 12 months. A physician recommendation was the single best predictor of adherence to mammography. However, only 60% of women reported that their physicians had ever recommended mammography. Several other barriers to mammography were revealed, including anxiety, embarrassment, and concerns about cost and radiation. Both a family history of breast cancer and heightened perceived vulnerability to breast cancer were associated positively with repeat mammography participation; anxiety about screening reduced the likelihood of this outcome. These findings suggest that physicians can play a powerful role in motivating women to participate in initial and subsequent breast cancer screening. Reassurance may reduce women's anxiety and embarrassment and increase utilization further.     

A correlated frailty model with long-term survivors for estimating the heritability of breast cancer

The aim of this study is to investigate the role of genetics and environment in susceptibility to breast cancer (frailty). An interdisciplinary approach was adopted, combining a correlated frailty-mixture model with genetic equations, allowing for decomposition of the frailty variance into genetic and environmental components. In addition, the possibility that a fraction of the population under study is 'immune' to the disease is evaluated, and changes in heritability estimates introducing a fraction of non-susceptible individuals are determined. The methodology is applied to breast cancer data from the Swedish Twin Registry, including information about all female monozygotic and dizygotic twin pairs born in Sweden between 1886 and 1967. The inferential problem is solved in a Bayesian framework and the numerical work is carried out using Markov chain Monte Carlo (MCMC) methods.     

Influence of exercise activity on quality of life in long-term breast cancer survivors

Background: Behavioral and lifestyle factors may influence quality of life (QOL) outcomes in breast cancer survivors. Methods: Information on QOL (Short Form-36, SF-36), lifestyle and survivorship was collected during telephone interviews with 374 breast cancer patients, diagnosed between 1983 and 1988 at ages 40 years or younger and interviewed, on average 13.2 years following diagnosis. These women previously participated in a case-control study soon after their diagnoses, providing information on breast cancer risk factors including exercise activity. We examined the impact of changes in exercise activity (comparing pre- to post-diagnosis levels) on the SF-36 mental and physical health summary scales using regression analyses. Results: A positive change in exercise activity was associated with a higher score on the SF-36 physical health summary scale at follow-up (p= 0.005). Change in exercise activity was not associated with the SF-36 mental health summary scale score. Patients who increased their activity levels did not differ from those who did not in terms of medical or demographic characteristics. Conclusion: This study provides one of the longest follow-up periods of breast cancer survivors to date among studies that focus on QOL and is unique in its focus on women diagnosed at a young age. Our results confirm high levels of functioning and well-being among long-term survivors and indicate that women whose exercise activity increased following diagnosis score higher on the SF-36 physical health summary scale. These findings suggest a potential role for exercise activity in maintaining well-being after a cancer diagnosis.     

A systematic review of quality of life instruments in long-term breast cancer survivors

Background  

Breast cancer is the most common cancer in women, representing 16% of all female cancers. According to the American Cancer Society, long-term cancer survival is defined as more than five years of survivorship since diagnosis, with approximately 2.5 million breast cancer survivors (BCS) in 2006. The long-term effects from breast cancer and its treatment have been shown to have positive and negative effects on both recovery and survivors' quality of life (QoL). The purpose of the study was to identify QoL instruments that have been validated in long-term BCS and to review the studies that have used the QoL instruments in this population.     

Prevalence of self-reported depressive symptoms in young adolescents.

To investigate the significance and measurement of depressive symptoms in young adolescents, 624 junior high school students were asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) during home interviews. In 384 usable symptom scales, item-scale correlations (most were above .50), inter-item correlations, coefficient alpha (.85), and patterns of reported symptoms were reasonable. Persistent symptoms were reported more often by Blacks, especially Black males. Prevalence of persistent symptoms in Whites was quite close to reported figures for adults, ranging from 1 per cent to 15 per cent in adolescent males and 2 per cent to 13 per cent in adolescent females. Adolescents reported persistent vegetative symptoms less often and psychosocial symptoms more often. Reports of symptoms without regard to duration were much more frequent in the adolescents, ranging from 18 per cent to 76 per cent in White males, 34 per cent to 76 per cent in White and Black females, and 41 per cent to 85 per cent in Black males. The results support the feasibility of using a self-report symptom scale to measure depressive symptoms in young adolescents. Transient symptoms reported by adolescents probably reflect their stage of development, but persistent symptoms are likely to have social psychiatric importance.     

Prevalence of depressive symptoms in adolescents and young adults

The objective of this work is to estimate the prevalence of depressive symptoms in three groups of adolescents and young adults (aged 16-25) from the city of San Sebastian. For that purpose 188, 189 and 160 young unemployed, students and workers, respectively, were selected by the method of quota. As screening instrument, an Spanish version of the CES-D (Center for Epidemiologic Studies-Depression) scale was used. Using the standard criterion of total score of the scale equal to or higher than 16, irrespective of the length of symptoms, a prevalence of 44.68% in unemployed and of 41.79% in students, opposite to 29.37% in workers (p less than 0.01 and p less than 0.05, respectively) was obtained. Taking into account the criterion of total score equal to or higher than 16, starting from symptoms that last three days at least, the rates were 18.08% in unemployed and 14.81% in students, opposite to 9.37% in workers (p less than 0.05 and "not significant", respectively). Stratifying by sex, it was observed that the differences among groups were at the expense of the female sex. These results suggest that a situation of unemployment seems to act as a depression-inducing factor, more important among female adolescents and young than among male adolescents and young.