乳腺癌病人生活质量及其影响因素现况调查

目的：了解乳腺癌病人的生活质量水平及其影响因素。方法：采用横断面研究设计,对上海3家综合性医院325例治疗期间的乳腺癌病人进行问卷调查。自行设计的一般资料问卷,欧洲癌症治疗研究组织针对肿瘤病人制定的生活质量核心问卷（EORTCQLQ-C30）及乳腺癌的特异性量表（EORTC-BR23）。结果：乳腺癌病人整体生活质量得分为（61.30±18.56）分,与EORTC提供的乳腺癌参考值比较无统计学差异（P〉0.05）,但国内、外病人在不同的生活质量子量表比较中仍存在一定差异。不同月收入组（P=0.030）和不同年龄组的乳腺癌病人间生活质量存在差异（P=0.038）;不同治疗方案组病人在躯体功能（P〈0.001）、社会功能（P=0.019）及恶心、呕吐、气促、经济困难、体形、系统治疗不良反应、手臂症状、脱发引起的烦恼这些症状比较上,差异有统计学意义;改良根治术与保乳术病人在体形得分上有显著差异（P〈0.001）。结论：乳腺癌病人的生活质量处于中等水平,影响其生活质量的主要因素有经济收入、年龄、治疗方案及具体的手术方式等。     

影响乳腺癌病人生命质量因素调查分析

采用乳腺癌生命质量调查表对84例乳腺癌病人进行测定,并对其影响因素进行分析.结果:病人的收入、年龄、职业、文化、医疗费用等因素明显影响生命质量.据此,提出定期开展普查工作,加强防癌知识宣传,教会高危人群自我检查的方法等乳腺癌防治措施.     

乳腺癌骨转移病人危险因素及预后因素分析

目的 分析乳腺癌骨转移病人的危险因素及预后因素。方法 收集2013～2015年美国监测、流行病学和最终结果(SEER)数据库中晚期乳腺癌病人,分析骨转移的相关危险因素,采用多因素Cox回归分析影响骨转移病人预后的独立危险因素。结果 单因素分析结果显示,在晚期乳腺癌病人中,骨转移与病人性别、年龄、种族、组织分级、病理类型、N分期、肝转移、肺转移、ER状态、PR状态及HER-2状态有关(P 0. 05);多因素分析结果显示,骨转移与病人的年龄、性别、组织分级、病理类型、N分期、ER状态、PR状态及HER-2状态有关。晚期乳腺癌病人中骨转移病人的总体生存率较高;多因素Cox回归模型显示,病人发病年龄大、黑人、组织分级高、T分期高、没有进行手术及化疗、伴有脑转移、伴有肺转移、伴有肝转移、ER阴性、PR阴性及HER-2阴性均是影响骨转移病人生存的独立危险因素。结论 在晚期乳腺癌病人中,骨转移较非骨转移病人预后好。发病年龄大、黑人、组织分级高、T分期高、伴有脑转移、伴有肺转移、伴有肝转移、ER阴性、PR阴性及HER-2阴性均是其预后差的独立危险因素。     

151例乳腺癌患者骨丢失及药物防治现况调查

目的调查乳腺癌患者骨健康状况及药物防治现况。方法对151例女性乳腺癌患者进行回顾性研究,记录患者年龄、体质量指数、骨密度和药物干预情况的信息,所有数据用Excel表格进行处理。结果 151例女性乳腺癌患者中,骨质疏松发生率为22.52%(34/151),唑来膦酸联合钙剂和维生素D制剂构成骨质疏松药物治疗方案;骨量减少发生率为30.46%(46/151),其中符合相关指南推荐的合并2个危险因素的中危患者,药物治疗方案为口服钙剂和维生素D制剂,未使用唑来膦酸。结论临床应综合骨密度、FRAX评分及患者个体情况,加强对乳腺癌患者骨折风险评估及防治。     

中青年乳腺癌患者手术方式决策困境及影响因素研究

目的 了解中青年乳腺癌患者手术方式决策困境现状及其影响因素,为针对性干预提供参考。 方法 对198例住院拟行手术治疗的中青年乳腺癌患者,采用一般资料调查表、中文版决策困境量表和领悟社会支持量表进行问卷调查。结果 患者决策困境总分（43.59±15.68）分,多元逐步回归分析结果显示,领悟社会支持量表中的家庭支持和其他支持、家庭人均月收入、年龄、文化程度和对疾病知识了解程度是患者决策困境的主要影响因素（调整R2=0.783,P＜0.05,P<0.01）。结论 中青年乳腺癌患者手术方式决策困境程度较严重,宜从患者家庭及工作关系入手提高其社会支持水平,应特别重视年轻、文化程度较低、疾病知识不足等患者针对性决策信息的提供,从而降低决策困境。     

年轻乳腺癌患者病耻感及影响因素研究

目的了解年轻乳腺癌患者病耻感现状及其影响因素,为制定针对性干预措施提供参考。方法采用Link病耻感系列量表、自尊量表、社会支持评定量表调查304例术后年轻乳腺癌患者。结果患者病耻感量表贬低-歧视感知(3.83±0.31)、误解(2.87±0.39)、保密(2.81±0.43)、退缩(2.71±0.36)、教育(2.93±0.36)、挑战(3.09±0.43)和分离(2.73±0.42)维度得分显著高于量表中点(均P0.05)。年龄大、已婚、受教育程度高、家庭收入高、自尊和社会支持水平高是病耻感的保护性因素,而术后时间长、乳房全切除是病耻感的危险因素(均P0.05)。结论年轻乳腺癌患者存在一定程度的病耻感,年龄、受教育程度、家庭人均月收入及自尊水平越高者、已婚者病耻感越低,而术后时间长及乳房全切除者病耻感越高。     

乳腺癌患者信息需求研究进展

阐述信息支持对提高乳腺癌患者自我护理及促进其身心康复的作用;分析了乳腺癌患者信息需求的影响因素,主要包括文化程度、经济收入、自护知识、年龄等,描述乳腺癌患者信息需求的满足现状,提出了乳腺癌患者信息需求存在的不足和对策。     

乳腺癌患者自我同情状况及影响因素分析

目的 了解乳腺癌患者自我同情现状,分析其影响因素,为医护人员采取针对性措施提高乳腺癌患者自我同情水平提供参考。方法 运用方便抽样方法选取在山东省4所三级甲等医院乳腺科病房及门诊的265例乳腺癌患者为研究对象,使用一般资料调查表、自我同情量表、亲密关系经历量表简版、领悟社会支持量表进行调查。结果 乳腺癌患者自我同情总得分为(79.33±12.40)分;自我同情总分与依恋焦虑、依恋回避得分呈负相关,而与社会支持总分及各维度得分呈正相关(均P<0.05)。多重线性逐步回归分析结果显示,年龄、文化程度、病理分期、依恋焦虑、社会支持是自我同情的预测因素(均P<0.05),共同解释变异量的50.8%。结论 乳腺癌患者自我同情处于一般水平。医护人员应对乳腺癌患者实施针对性干预,以提高其自我同情水平,增强患者的积极心理力量。     

乳腺癌患者信息需求研究进展

阐述信息支持对提高乳腺癌患者自我护理及促进其身心康复的作用;分析了乳腺癌患者信息需求的影响因素,主要包括文化程度、经济收入、自护知识、年龄等,描述乳腺癌患者信息需求的满足现状,提出了乳腺癌患者信息需求存在的不足和对策。     

乳腺癌患者性生活满意度及其影响因素调查

目的了解乳腺癌改良根治术患者术后性生活的满意程度及影响因素,为提高患者性生活满意度提供依据。方法采用自行设计的乳腺癌改良根治术术后患者身体形象及性生活调研问卷对217例乳腺癌改良根治术后患者进行调查。结果 11个性满意度调查条目中,6个条目选择从未或偶尔的患者超过60.0%,最高条目为93.5%的患者从不或偶尔主动提出性活动;年龄、学历及身体形象中对胸部或乳房、发型、性器官、身体耐力、精力、患肢手臂力量的感觉影响患者的性生活满意度(P<0.05,P<0.01)。结论乳腺癌改良根治术后患者性生活满意度较差,需针对年龄较大、学历较低的患者加强干预,同时需要开展普及外形康复和术后性生活的知识来帮助其纠正错误观念,建立健康的性生活。     

“三阴”乳腺癌新辅助化疗前后BCSG1基因状况研究

目的 探讨乳腺癌特异基因（BCSG1）在“三阴”性乳腺癌新辅助化疗疗效评估中的价值。方法采用免疫组化S．P法和荧光定量PCR方法检测32例“三阴”性乳腺癌患者新辅助化疗（CEF方案）前后乳腺癌组织BCSG1的表达,比较化疗前后肿瘤体积的变化情况,分析新辅助化疗前后BCSG1蛋白表达与肿瘤形态学变化的关系。结果23例乳腺癌患者新辅助化疗后肿瘤体积均有明显缩小,病灶缓解率（CR＋PR）为84．4％;新辅助化疗后BCSG1mRNA表达水平亦明显低于化疗前（P〈O．05）,BCSG1蛋白高表达率低于新辅助化疗前（P〈0．01）。结论BCSG1分子和蛋白水平在“三阴”性乳腺癌新辅助化疗后均明显降低,与新辅助化疗后疗效呈负相关（r=-0．584,P〈0．01）,提示BCSG1可作为“三阴”乳腺癌新辅助化疗疗效的预测因子。     

The incidence of symptomatic thromboembolism in patients receiving adjuvant anthracycline-based chemotherapy for early stage breast cancer

Thromboembolism is a well recognised complication of systemic chemotherapy and cancer. Its incidence is frequently not reported in clinical trials of adjuvant chemotherapy for early stage breast cancer. Our own experience suggested that thromboembolic complications were common and we undertook a retrospective review of consecutive patients receiving adjuvant chemotherapy to determine the incidence and morbidity/mortality of this complication.A total of 280 consecutive patients were identified who had received adjuvant ECMF chemotherapy between January 2001 and February 2007. Thromboembolic events occurred in 21 patients (7.5%). Events were distributed across chemotherapy cycles, but were more common during CMF chemotherapy (18 cases vs 3 cases). Patients over the age of 60 years appeared to be at particular risk of thromboembolism with an event rate of 27% (15/56 patients). Thromboembolic events were associated with dose delays and cessation of chemotherapy in some patients. With a median follow up of 28 months there is no significant difference in the incidence of breast cancer recurrence (16.7% vs 14.3%, p = 0.9) or overall survival (89.5% vs 89.9%, p = 0.8) between patients who experienced a thromboembolic event during adjuvant chemotherapy and those who did not. Based on the incidence of thromboembolism in our unselected patient population we believe that further prospective studies are indicated seeking to identify those patients at increased risk of this important complication who might benefit from thromboprophylaxis.     

Standards for follow-up care of patients with breast cancer

In the United States alone, over 200,000 women are diagnosed with invasive breast cancer each year, and another 50,000 are diagnosed with ductal carcinoma in situ. The vast majority of these women will survive for five or more years, and the majority will never experience a recurrence of their disease. Follow-up care is focused on the early identification of new primary cancer and locoregional recurrences. There is no clear evidence that early identification of distant metastases will lead to an extension in survival, and for this reason routine imaging studies such as CT and PET scans are not recommended. Comprehensive care for breast cancer survivors should also address late complications of treatment and ongoing psychosocial problems that may have arisen as a result of a breast diagnosis and treatment. Although subspecialists often provide follow-up care for breast cancer survivors, randomized trials have demonstrated that generalists can provide such care. As the number of breast cancer survivors continues to increase, guidelines and programs to provide comprehensive, compassionate, and cost-effective follow-up care will become ever more important.     

Multidetector-row computed tomography for the preoperative evaluation of axillary nodal status in patients with breast cancer

Purpose We evaluated the effectiveness of multidetector-row computed tomography (MD-CT) for detecting axillary lymph nodal status (ALNS) in patients with breast cancer. Methods We reviewed 42 patients with breast cancer. A metastatic lymph node on MD-CT was defined as oval or round, with more than 5 mm on the short axis. We evaluated ALNS preoperatively by both palpation and MD-CT findings and performed sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection (ALND). Results For establishing the ALNS, MD-CT showed a sensitivity of 76.9%, a specificity of 96.6%, and an accuracy of 90.5%. On the basis of the MD-CT findings, misdiagnosis was made in 4 of the 42 patients, only one of which was false positive. On the other hand, one patient with a histologically negative sentinel lymph node (SLN) result had metastasis only in a non-SLN. Preoperative MD-CT showed a positive node in this patient. Conclusions Multidetector-row computed tomography assists in identifying women who require ALND without SLNB, with sufficient positive predictive value. Falsenegative detection by SLNB could be avoided with careful interpretation of the axillary lymph nodes shown by MD-CT.     

Immediate breast reconstruction with expander in pregnant breast cancer patients

BackgroundBreast reconstruction after mastectomy is currently considered an essential component in managing breast cancer patients, particularly those diagnosed at a young age. However, no studies have been published on the feasibility of immediate breast reconstruction in patients diagnosed and operated during the course of gestation.MethodWe retrospectively identified all breast cancer patients who were subjected to mastectomy and immediate breast reconstruction during pregnancy at the European Institute of Oncology between 2002 and 2012. Patient demographics, gestational age at surgery, tumor stage, adjuvant treatment, details of the surgical procedures, surgical outcomes and fetal outcomes were analyzed.ResultsA total of 78 patients with breast cancer diagnosed during pregnancy were subjected to a surgical procedure during the course of gestation. Twenty-two patients had mastectomy; of whom 13 were subjected to immediate breast reconstruction. Twelve out of 13 patients had a two-stage procedure with tissue expander insertion. Median gestational age at surgery was 16 weeks. No major surgical complications were encountered. Only one patient elected to have an abortion, otherwise, no spontaneous abortions or pregnancy complications were reported. Median gestational age at delivery was 35 weeks (range: 32–40 weeks). No major congenital malformations were reported. At a median follow-up of 32 months, all patients are alive with no long-term surgical complications.ConclusionsThis is the first study of immediate breast reconstruction in pregnant breast cancer patients. Tissue expander insertion appears to ensure a short operative time, and does not seem to be associated with considerable morbidity to the patient or the fetus. Hence, it could be considered in the multidisciplinary management of women diagnosed with breast cancer during pregnancy.     

Clinicopathologic characteristics and prognosis of young patients with breast cancer

Background

The aim was to describe the clinicopathological features and prognosis of young patients with breast cancer.

Patients and Methods

We reviewed the records of 1478 consecutive patients aged ≤50 years with first diagnosis of invasive breast cancer referred to surgery from January 1999 to March 2005. A total of 174 patients were aged <35 years (group I) and 1304 were aged 35-50 years (group II).

Results

Compared with patients of group II, patients of group I had a higher percentage of tumors classified as estrogen receptors (ER) negative, progesterone receptors (PR) negative, with a Ki-67 labeling index ≥20% of the cells. The 5-year survival of group I was 78.3% as compared with 84.2% for group II (P = 0.006).

Conclusion

Compared with patients aged between 35 and 50 years, patients aged <35 years have a greater chance of having an endocrine-unresponsive tumor and a significantly poor prognosis.     

Private insurance is the strongest predictor of women receiving breast conservation surgery for breast cancer

Background

It is widely accepted that mastectomy and breast-conserving surgery (BCS) with irradiation yield similar results, yet many women continue to receive mastectomy. This study evaluates factors contributing to surgical decision-making in breast cancer. Registry data were obtained on all patients treated at the Southwest Cancer Treatment and Research Center (SWCTRC) between 2002 and 2006. Patient demographics, including age and race, and insurance type, tumor characteristics, surgical procedure performed, lymph node status, stage, adjuvant therapy, and outcome were analyzed against mastectomy versus BCS using bivariate and multivariate analysis.

Results

There was a higher proportion of uninsured patients in the mastectomy cohort, which also included more patients with later stage disease, larger tumor size, and a higher number of lymph node metastases. The only independent predictors of BCS were fewer lymph node metastases and having insurance. Patients with private insurance were almost 4 times more likely to receive BCS (odds ratio 3.90, 95% confidence interval 1.20-12.67).

Conclusions

Insurance status is an important predictor determining whether a patient receives BCS or mastectomy for breast cancer.     

Follow-up of patients with localized breast cancer and first indicators of advanced breast cancer recurrence: A retrospective study

We conducted a retrospective study to assess the follow-up of patients with localized breast cancer and the first indicators of advanced breast cancer recurrence.All patients with advanced breast cancer recurrence treated between January 2010 and June 2016 in our institution were registered. Among these patients, 303 patients initially treated for early breast cancer with curative intent were identified.After initial curative treatment, follow-up involved the oncologist, the general practitioner and the gynecologist in 68.0%, 48.9% and 19.1% of cases, respectively. The median DFI was 4 years for luminal A, 3.8 years for luminal B, 3.7 years for HER2-positive and 1.5 years for TNBC (p = 0.07). Breast cancer tumor marker was prescribed for 164 patients (54.1%). No difference in terms of follow-up was observed according to the molecular subtype. Symptoms were the primary indicator of relapse for 143 patients (47.2%). Breast cancer recurrence was discovered by CA 15.3 elevation in 57 patients (18.8%) and by CAE elevation in 3 patients (1%). The rate of relapse diagnosed by elevation of CA 15.3 or CAE was not statistically associated with the molecular subtype (p = 0.65). Luminal A cases showed a significantly higher rate of bone metastases (p = 0.0003). TNBC cases showed a significantly higher rate of local recurrence (p = 0.002) and a borderline statistical significant higher rate of lung/pleural metastases (p = 0.07).Follow-up recommendations could be adapted in clinical practice according to the molecular subtype. General practitioners should be more involved by the specialists in breast cancer follow-up.     

Clinical characteristics of breast cancer patients with mental disorders

BackgroundSevere mental disorders are thought to affect the diagnosis and treatment of breast cancer because of their lower awareness and understanding of the disease and their reduced ability to cooperate with medical staff. We analyzed the clinical features of patients with breast cancer and pre-existing mental disorders such as schizophrenia, dementia, and intellectual disability. Patients and methods: We reviewed the records of 46 patients who were diagnosed with schizophrenia, dementia, or intellectual disability, before being diagnosed with breast cancer. Three patients had more than 2 mental disorders. All patients underwent curative surgical treatment between September 1992 and January 2015. Patients' clinicopathological information was compared with a control group of 727 breast-cancer patients without mental disorders seen during the same period.ResultsPatients with mental disorders were less likely to be aware of their own breast cancer; the lesions were often found by other people such as family, care staff, and medical staff. Breast cancer patients with mental disorders had significantly more advanced T factors and overall stage at the time of surgery than their counterparts without mental illness, more patients underwent total mastectomy, and fewer patients underwent postoperative adjuvant chemotherapy and radiation. Biological markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expression were not significantly different between groups. Disease-free survival and overall survival were not significantly different between groups.ConclusionPatients with mental disorders receive less postoperative adjuvant chemotherapy; however, their outcomes were not worse than those of patients without mental disorders.