Distress in partners of high-risk women undergoing breast cancer surveillance

BackgroundPartners are an importance source of support for women at risk for hereditary breast cancer. The impact of regular breast cancer surveillance in at-risk women on psychological distress in the partners of these women is unknown. This study aimed to (1) examine the levels and courses of psychological distress of partners and high-risk women around breast cancer surveillance appointments at the clinic, (2) to explore the relationship between partners’ and women's distress, and (3) to identify factors that were associated with distress in partners.MethodsPartners of 77 high-risk women adhering to breast cancer surveillance, and participating in a psychological follow-up study, completed questionnaires measuring psychological distress 2 months before (T0), on the day of (T1) and 1 to 4 weeks after (T2) two consecutive biannual appointments for the women at the clinic.ResultsPartners’ breast cancer-specific distress was positively related to the women's cancer-specific distress prior to breast cancer surveillance. Fatherhood and affective risk perception were positively associated with distress in partners.ConclusionsOur findings indicate that the psychological distress associated with stressful waiting for the breast cancer surveillance appointment, and – after the appointment – for the results, is an interpersonal experience, which is shared within the couple. These findings underscore the importance of involving partners in the clinical interventions for high-risk women. Clinicians should address the affective risk perception of partners, i.e. how they experience the increased breast cancer risk of the woman.     

Older Breast Cancer Survivors: Factors Associated with Self‐reported Symptoms of Persistent Lymphedema Over 7 years of Follow‐up

Abstract: Lymphedema of the arm is a common complication of breast cancer with symptoms that can persist over long periods of time. For older women (over 50% of breast cancer cases) it means living with the potential for long‐term complications of persistent lymphedema in conjunction with the common diseases and disabilities of aging over survivorship. We identified women ≥65 years diagnosed with primary stage I–IIIA breast cancer. Data were collected over 7 years of follow‐up from consenting patients’ medical records and telephone interviews. Data collected included self‐reported symptoms of persistent lymphedema, breast cancer characteristics, and selected sociodemographic and health‐related characteristics. The overall prevalence of symptoms of persistent lymphedema was 36% over 7 years of follow‐up. Having stage II or III (OR = 1.77, 95% CI: 1.07–2.93) breast cancer and having a BMI >30 (OR = 3.04, 95% CI: 1.69–5.45) were statistically significantly predictive of symptoms of persistent lymphedema. Women ≥80 years were less likely to report symptoms of persistent lymphedema when compared to younger women (OR = 0.44, 95% CI: 0.18–0.95). Women with symptoms of persistent lymphedema consistently reported worse general mental health and physical function. Symptoms of persistent lymphedema were common in this population of older breast cancer survivors and had a noticeable effect on both physical function and general mental health. Our findings provide evidence of the impact of symptoms of persistent lymphedema on the quality of survivorship of older women. Clinical and research efforts focused on risk factors for symptoms of persistent lymphedema in older breast cancer survivors may lead to preventative and therapeutic measures that help maintain their health and well‐being over increasing periods of survivorship.     

Aromatase Inhibitor Associated Musculoskeletal Symptoms are associated with Reduced Physical Activity among Breast Cancer Survivors

Physical activity (PA) has numerous health benefits for breast cancer survivors. Recent data suggest that some breast cancer survivors treated with aromatase inhibitors may experience aromatase inhibitor associated musculoskeletal symptoms. It is unknown whether aromatase inhibitor associated musculoskeletal symptoms are associated with reduced PA and what other risk factors are associated with such PA reductions. We conducted a cross‐sectional study at a large university‐based breast cancer clinic among breast cancer survivors prescribed an aromatase inhibitor. At routine follow‐up, we surveyed participants about aromatase inhibitor associated musculoskeletal symptoms, as well as pre‐aromatase inhibitor, and current, PA levels. Among 300 participants, 90 (30%) reported a reduction of PA since the initiation of aromatase inhibitor therapy. Those with aromatase inhibitor associated musculoskeletal symptoms were more likely to report decreased PA (62% versus 38%, p = 0.001) compared with those without aromatase inhibitor associated musculoskeletal symptoms. In multivariate analyses, aromatase inhibitor associated musculoskeletal symptoms (odds ratio [OR] = 2.29 [95% confidence interval [CI]: 1.36–3.86]), and body mass index (OR = 1.06 [95% CI: 1.02–1.12]) were associated with reductions in PA. In subgroup analysis among breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms, self‐reported lower extremity joint pain (OR = 1.23 [95% CI: 1.00–1.50]) and impaired lower extremity physical function (OR = 1.07 [95% CI: 1.01–1.14]) were associated with reductions in PA. Breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms were more likely to report reductions in PA since initiating aromatase inhibitor therapy compared with those without aromatase inhibitor associated musculoskeletal symptoms. Our findings suggest that tailored interventions targeting lower extremity functional limitations are needed to enable breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms to participate in PA.     

Is low cortisol release an indicator of positive health?

Compared to the knowledge of physiological processes associated with stress, ill‐health, and disease, the understanding of physiological processes associated with positive psychological functioning is lagging behind. The present study aimed to examine the relationships between psychological well‐being and physiological indicators, including blood pressure, catecholamines, and cortisol. Initial questionnaires concerning demographic information, work characteristics (decision authority, job demands, and skill discretion), physical symptoms, nicotine use, and Ryff's Psychological Well‐Being scales (RPWB) which cover self‐acceptance, environmental mastery, positive relations with others, personal growth, purpose in life and autonomy, were completed by a group of highly educated white‐collar workers. Subsequent assessments of blood pressure, urinary catecholamines, and salivary cortisol were performed during two separate workdays. Analyses of data from 12 women and 11 men revealed that individuals with high psychological well‐being had significantly lower total cortisol output than individuals with low psychological well‐being (p < 0.01), while no significant differences emerged for blood pressure and catecholamines. Further, individuals with high psychological well‐being had significantly lower levels of general (p < 0.01) as well as musculoskeletal symptoms (p < 0.01). In conclusion, the findings suggest a link between positive psychological functioning and lowered cortisol release. Copyright © 2002 John Wiley & Sons, Ltd.     

The effects of Pythagorean Self-Awareness Intervention on breast cancer patients undergoing adjuvant therapy: A pilot randomized controlled trial

IntroductionBreast cancer patients undergo extended treatments that affect their psychological state and quality of life. There is a lack of studies examining the effects of holistic stress management interventions (that combine stress perception, cognitive and lifestyle interventions) on mental health and biological indices (e.g. cortisol concentrations) of breast cancer patients.Materials and methodsThis pilot randomized controlled trial provided the first assessment of the effects of a novel, cognitive-based intervention, the Pythagorean Self-Awareness Intervention (PSAI), on psychological symptoms, quality of life, sleep quality and lifestyle as well as on stress-related biological measures of breast cancer patients undergoing adjuvant therapy. Standardized questionnaires were administered at baseline and 8-weeksafter the intervention to evaluate quality of life, stress, depression, and anxiety (primary outcomes). Sleep quality, lifestyle and hair cortisol concentrations were also assessed (secondary outcomes).ResultsForty-five breast cancer patients undergoing adjuvant therapy were randomly assigned to the PSAI group (n = 25) or the control group (n = 20).Women in the PSAI group reported significant improvements post-intervention in total Quality of Life, specific aspects of Quality of Life [Physical well-being, Social well-being, Emotional well-being, Functional well-being, Breast cancer concerns] as well as Perceived stress, depression, anxiety and stress. Improvements in secondary outcomes included increase in sleep quality, empowerment for healthy lifestyle and reduction of hair cortisol concentrations.ConclusionsThe PSAI was beneficial as complementary therapy in the women studied. Larger randomized controlled trials with longer follow-up are needed to ascertain these findings.     

The Effects of Type of Surgery and Time on Psychological Adjustment in Women After Breast Cancer Treatment

Background: The aim of the present study was to examine whether type of surgery, age, and time since surgery influenced psychological distress and quality of life (QOL) in women treated for breast cancer.Methods: We surveyed 183 women who had undergone surgery for breast cancer. Psychological distress was measured with the Mental Health Inventory and QOL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.Results: After controlling for stage of disease, radiation treatment, and age, there was a statistically significant interaction between type of surgery and time since surgery for the Mental Health Inventory total score, and a marginal interaction between type of surgery and time since surgery for the Global health status/QOL score. Women who had breast conservation surgery experienced significantly greater levels of psychological distress and marginally worse QOL from 40 months after surgery onward than did women who received a mastectomy.Conclusions: The effects of different surgical treatments for breast cancer on psychological distress and QOL become apparent only after a period of several years. Women, therefore, need counseling on the potentially positive and negative psychological implications of different surgical treatments for breast cancer.     

Machine-learned identification of psychological subgroups with relation to pain interference in patients after breast cancer treatments

BackgroundPersistent pain in breast cancer survivors is common. Psychological and sleep-related factors modulate perception, interpretation and coping with pain and may contribute to the clinical phenotype. The present analysis pursued the hypothesis that breast cancer survivors form subgroups, based on psychological and sleep-related parameters that are relevant to the impact of pain on the patients’ life.MethodsWe analysed 337 women treated for breast cancer, in whom psychological and sleep-related parameters as well as parameters related to pain intensity and interference had been acquired. Data were analysed by using supervised and unsupervised machine-learning techniques (i) to detect patient subgroups based on the pattern of psychological or sleep-related parameters, (ii) to interpret the detected cluster structure and (iii) to relate this data structure to pain interference and impact on life.ResultsArtificial intelligence-based detection of data structure, implemented as self-organizing neuronal maps, identified two different clusters of patients. A smaller cluster (11.5% of the patients) had comparatively lower resilience, more depressive symptoms and lower extraversion than the other patients. In these patients, life-satisfaction, mood, and life in general were comparatively more impeded by persistent pain.ConclusionsThe results support the initial hypothesis that psychological and sleep-related parameter patterns are meaningful for subgrouping patients with respect to how persistent pain after breast cancer treatments interferes with their life. This indicates that management of pain should address more complex features than just pain intensity. Artificial intelligence is a useful tool in the identification of subgroups of patients based on psychological factors.     

Development in self-reported arm-lymphedema in Danish women treated for early-stage breast cancer in 2005 and 2006 – A nationwide follow-up study

The main purpose of this nationwide follow-up study was to examine the development of self-reported lymphedema in the population of women with early-stage breast cancer in Denmark. In 2008 and 2012 two identical questionnaires were sent to the women aged 18–70 years treated for unilateral primary breast cancer in 2005 and 2006. 2293 women (87%) reported on lymphedema in 2008 and 2012. Overall 37% reported lymphedema in 2008 while 31% reported lymphedema in 2012 and severity of symptoms decreased. 50% of women treated with SLNB and reporting lymphedema in 2008 did not report symptoms by 2012 in contrast to 30% treated with ALND. However, 19% of women treated with ALND and not reporting lymphedema in 2008 had developed lymphedema by 2012. In conclusion lymphedema remains a frequent problem, years after treatment for breast cancer, though, number of women reporting lymphedema and overall severity of symptoms decreased.     

Multiple somatic symptoms in employees participating in a randomized controlled trial associated with sickness absence because of nonspecific low back pain

Background contextThe prevalence of multiple somatic symptoms is high in primary and hospital outpatient populations. Multiple somatic symptoms may be present in patients sick-listed because of low back pain (LBP) and may be associated with increased risk of not returning to work (RTW).PurposeTo explore whether multiple somatic symptoms in a subset of patients with nonspecific LBP was associated with RTW, sickness absence (SA), or other social benefits.Study designThe study was a cohort study based on a randomized clinical trial with a prospective 2-year follow-up period. Patients were referred from general practices to the Spine Center, Regional Hospital Silkeborg, Denmark.Patient samplePatients were 285 sick-listed employees (4–12 weeks), with nonspecific LBP as their prime reason for SA. Exclusion criteria were unemployment, radiculopathy, LBP surgery within the past year, previous lumbar fusion, suspected cauda equina syndrome, progressive paresis or other serious back disease, pregnancy, known substance abuse, or primary psychiatric diagnosis.Outcome measuresSelf-reported health was assessed by the LBP rating scale and questions about pain and health in general. Disabilities were measured by the Roland Morris Questionnaire, the Short Form-36, and the Fear-Avoidance Beliefs Questionnaire. Work-related questions comprised expectations about RTW and risk of losing job because of SA. The Common Mental Disorder Questionnaire (subscale SCL-SOM) was used to assess multiple somatic symptoms (12 items). We categorized multiple somatic symptoms into four groups based on the SCL-SOM sum score: <6, 6 to 12, 13 to 18 and >18. Status of SA (>2 weeks) and RTW were gathered from a national database (DREAM).MethodsThe patients (N=285) were randomized into either multidisciplinary or brief intervention at the Spine Center (2004–2008). Both interventions comprised clinical examination and advice by a physiotherapist and a rheumatologist. Data were collected from questionnaires at baseline (inclusion) and 1 year after inclusion. Data on SA benefits were gathered from the DREAM database that contains data on all social transfer payments (such as sick leave benefits and other disability benefits) registered on a weekly basis.ResultsAll health factors, female gender, and poor work ability were significantly associated with a higher level of multiple somatic symptoms. The percentage of persons with SA increased significantly with the symptom score after 1 year, and the duration of SA remained significantly longer after 2 years of follow-up between the multiple somatic symptoms groups. The percentages with RTW after 1 and 2 years were negatively associated with a higher level of multiple somatic symptoms at baseline. We found no difference between the intervention groups.ConclusionsA higher level of multiple somatic symptoms was significantly associated with poor health and work ability at baseline and with longer duration of SA and unsuccessful RTW through a 2-year follow-up period.     

Traumatic stress symptoms among women with recently diagnosed primary breast cancer

This study examined the concurrent and longitudinal relationships between traumatic stress symptoms and demographic, medical, and psychosocial variables among women recently diagnosed with primary breast cancer. Participants were 117 women drawn from a parent study for women recently diagnosed with primary breast cancer. At baseline, the Impact of Event Scale (IES) total score was related to intensity of postsurgical treatment and lower emotional self-efficacy. At the 6-month follow-up, the IES total score was significantly related to younger age, to the increased impact of the illness on life, and to the baseline IES total score assessment. These results suggest that it is important to intervene for traumatic stress symptoms soon after the diagnosis of breast cancer. Furthermore, these results suggest women at greatest risk are those who are younger, who receive postsurgical cancer treatment, who are low in emotional self-efficacy and whose lives are most affected by having cancer.     

Tamoxifen related side effects and their impact on breast cancer incidence: A retrospective analysis of the randomised IBIS-I trial

BackgroundStudies in the adjuvant setting have shown that endocrine therapy related side effects predict breast cancer recurrence risk. Here, we assess the relationship between early reported side effects and incidence of breast cancer in women randomised to tamoxifen for cancer prevention in the International Breast Intervention Study (IBIS)–I trial.MethodsWomen randomised to tamoxifen in the IBIS-I trial and for whom side effect status was known at the 6-month follow-up visit were included in this analysis. Side effects included in this analysis were hot flushes, vaginal discharge, and vaginal dryness. The primary endpoint was all breast cancer and secondary endpoint was oestrogen receptor (ER) positive breast cancer. Cox proportional hazard models were used to investigate breast cancer incidence in the tamoxifen group with and without side effects reported within 6 months of randomisation.ResultsWomen randomised to tamoxifen and reporting hot flushes at the 6-month follow-up visit had a non-statistically significant increase in breast cancer compared to those without hot flushes (HR = 1.26 (0.98–1.62), P = 0.08). A significant higher breast cancer risk was observed for postmenopausal women who reported hot flushes at the 6-month follow-up visit compared to those without hot flushes (HR = 1.59 (1.12–2.26), P = 0.01). A higher risk was observed for ER-positive breast cancer in postmenopausal women (HR = 1.81 (1.19–2.74), P = 0.01). No significant associations between gynaecological side effects and breast cancer occurrence was observed.ConclusionsOverall, no association between side effects reported at 6 months and subsequent breast cancer occurrence was observed. Some side effects might be useful markers for breast cancer occurrence in postmenopausal women.     

Reliability and validity of the body image after breast cancer questionnaire

The purpose of this study was to determine the reliability and validity of the Body Image After Breast Cancer Questionnaire (BIBCQ) in a series of outpatients with breast cancer. One hundred sixty-four breast cancer patients attending outpatient clinics completed questionnaires at baseline. The patients' BIBCQ scores were compared with their scores on related psychological measures including depression, self-esteem, quality of life, and sexual functioning. Scores on the BIBCQ for women after mastectomy and breast conservation were compared. Select items of the BIBCQ were compared between women with and without breast cancer. Patients received a second questionnaire after a 2 week interval to assess test-retest reliability. Good reliability was found for the six scales (ranging from 0.77 to 0.87). The BIBCQ correlated with similar measures as predicted, but not with a measure of social desirability. The BIBCQ distinguished between women treated with lumpectomy and mastectomy, and between women with breast cancer and a control group, supporting the validity of the BIBCQ. The BIBCQ provides a reliable and valid assessment of the long-term impact of breast cancer on body image. It is suitable for use in research focusing on this issue.     

Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care

PurposeVarious long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses.MethodsThis was a cross-sectional, population-based study of 350 breast cancer survivors treated with chemo- and/or radiotherapy ≥5 years (median 10) after diagnosis and 350 women without cancer matched by age and primary care physician. All women completed a questionnaire enquiring about symptoms, underwent echocardiography to assess the left ventricle ejection fraction, and completed the Hospital Anxiety and Depression Scale. Cardiovascular diseases were diagnosed from primary care records. In a multivariable logistic regression analysis, symptoms were adjusted for the long-term effects and compared between cohorts and within the survivor group.ResultsConcentration difficulties, forgetfulness, dizziness, and nocturia were more frequent among breast cancer survivors compared with controls, but differences could not be explained by cardiac dysfunction, cardiovascular diseases, depression, or anxiety. Intermittent claudication and appetite loss were more frequent among breast cancer survivors than controls and associated with cardiac dysfunction, depression, and anxiety. Breast cancer survivors treated with chemotherapy with/without radiotherapy were at significantly higher odds of forgetfulness and nocturia, but significantly lower odds of dizziness, compared with breast cancer survivors treated with radiotherapy alone.ConclusionsIntermittent claudication and appetite loss are common among breast cancer survivors and are associated with cardiac dysfunction and mood disorders. Other symptoms varied by whether the patient underwent chemotherapy with/without radiotherapy (forgetfulness and nocturia) radiotherapy alone (dizziness).     

Follow-up after treatment for breast cancer in young women

The majority (80%) of breast cancers are diagnosed in women over the age of 50; only 5% will be in their 20s and 30s. These women have specific needs that include genetic counselling, psychological support, advice with regard to fertility and pregnancy issues and information on coping with treatment-related morbidity. The primary purpose of follow-up is often regarded as the early detection of recurrence as well as the detection of second primary tumours. Rather than concentrating solely on detecting cancer recurrence, clinicians need to be more susceptive to symptoms related to treatment morbidity and to the information needs of their patients. This paper outlines the specific issues listed above that need to be addressed in follow-up clinics and highlights interventions that may help improve the value of follow-up appointments and quality of life for young women with breast cancer.     

Psychological profile of women seeking breast reconstruction and quality of life assessment after surgery

Summary Even though the number of women seeking reconstruction after mastectomy has risen during the last decade from 10% to 30%, this percentage remains low. Research suggests that quality of life improves after breast reconstruction. This raises the question as to why reconstructive surgery is not performed more often. Could it be that only those patients asking for reconstructive surgery experience an improved quality of life? And how can this group be characterized? In this study, the psychological profile of women seeking breast reconstruction was evaluated and, compared to that for women who do not have the wish for breast reconstruction. In addition, quality of life was related to the psychological profile in both groups. Sixty-seven patients who had undergone a breast reconstruction over a 10-year period were included in the study. Psychological evaluation consisted of three standardized self-administered questionnaires: the Eysencks Personality Questionnaire, the Profile of Mood States and the Self Consciousness Scale. Quality of life was assessed using the Nottingham Health Profile (I and II) and the EQ-5D. A matched group of 155 women who had undergone a mastectomy without reconstruction were used as a control group. The psychological profile of the two groups was found to be significantly different. Women in the reconstruction group were more extravert, more self-conscious and also sexually more self-conscious (all: P<0.05) in comparison to the patients in the non-reconstruction group. In addition, women in the reconstruction group were (socially) more active, more talkative, more animated, sought contact easier, put themselves forward more often and took the initiative more often. In the quality of life surveys, only marginal differences were found between the groups. The quality of life was not found to be significantly different in the two groups of patients. However, there is a significant difference in the psychological profile of the women. This explains why on the one hand the percentage of breast reconstruction is relatively low, while on the other hand it has been shown that quality of life improves after breast reconstruction.     

New onset vasomotor symptoms but not musculoskeletal symptoms associate with clinical outcomes on extended adjuvant letrozole – Analyses from NCIC CTG MA.17

PurposeNew onset symptoms on adjuvant aromatase inhibitors for hormone receptor positive early breast cancer may associate with clinical outcomes. We performed this exploratory analysis of the association of new onset musculoskeletal (MSK) and vasomotor (VM) symptoms with clinical outcomes in the NCIC CTG MA.17 trial 5 years of extended adjuvant endocrine therapy with letrozole after tamoxifen.MethodsSymptoms were collected at baseline, 1, 6, and every 12 months on study. Multivariate Cox Models adjusting for age, nodal status, duration of tamoxifen and prior chemotherapy were used to compare disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) based on data collected before, and after, the unblinding between women with VM or MSK symptoms and those without.ResultsData post-unblinding showed new VM symptoms on extended letrozole significantly improved DFS and DDFS when occurring 1 month (DFS HR 0.52, 95% CI, 0.28–0.96; p = 0.04; DDFS HR 0.49, 95% CI, 0.24–0.99; p = 0.046) and 6 months (DFS HR 0.43, 95% CI, 0.24–0.78; p = 0.006; DDFS HR 0.44, 95% CI, 0.22–0.85; p = 0.02) after treatment initiation. Those with new VM symptoms at 12 months also had a significantly better DFS (HR 0.47, 95% CI 0.26, 0.84; P = 0.01) and a trend in improved DDFS. Only a trend to improved OS was found for those with VM symptoms 6 month after treatment. No significant improvement was found for those with new MSK symptoms at any time point or for any endpoint.ConclusionsNew onset VM symptoms with extended letrozole may be useful in predicting treatment benefit.     

The age at natural menopause and the frequency of climacteric symptoms in Chinese women

IntroductionNaturalmenopauseisconsistentlydefinedasthelastmenstrualperiod.Itisobservedretrospectivelyas12consecutivemonthsofa-menorrheawithuterusandatleastoneovaryintactandwithoutanidentifiablecausefora-menorrheaL1j.Itwasconservativelyestimatedthattherewereabout113.4miIlionwomenatagesof45andaboveinChinaby199OL2j.Ear-lynaturalmenopauseisapotentialbiologicmarkerofhealthandaging.TheageatmenopauseinindividualsmaybeobtainedbyperiodicaIlyaskingwomenaboutthepresenceofmenstrualcyclesL'j.oritmaybed…     

Determinants of anxiety in patients with advanced somatic disease: differences and similarities between patients undergoing renal replacement therapies and patients suffering from cancer

Objective

Anxiety is the most frequent emotional reaction to the chronic somatic disease. However, little is known about anxiety and coping strategies in patients with end-stage renal disease (ESRD) undergoing renal replacement therapies (RRTs). The purpose of the study was to assess the intensity and determinants of anxiety in patients treated with different RRTs in comparison with end-stage breast cancer patients and healthy controls.

Methods

The study involved (1) ESRD patients undergoing different RRTs: 32 renal transplant recipients, 31 maintenance haemodialysis and 21 chronic peritoneal dialysis patients, (2) women with end-stage breast cancer (n = 25) and (3) healthy persons (n = 55). We used State–Trait Anxiety Inventory, Scale of Personal Religiousness, Mental Adjustment to Cancer Scale, Rotterdam Symptom Checklist with reference to medical history. The data thus obtained were analysed using the analysis of variance, the Tukey’s HSD post hoc test and Spearman’s rank correlation coefficient.

Results

Both ESRD and breast cancer patients revealed higher level of anxiety state and trait than healthy controls; however, there was no statistically significant difference found between both findings. There was a tendency towards higher levels of anxiety state in breast cancer patients when compared to ESRD patients undergoing the RRT treatment and for both groups non-constructive coping strategies correlated with the levels of anxiety state. With ESRD patients undergoing RRTs, the intensity of anxiety state did not depend on the mode of treatment but on the correlation between the levels of anxiety and the general quality of their life, psychological condition and social activity.

Conclusion

In patients with advanced somatic disease (ESRD and end-stage breast cancer), non-constructive strategies of coping with the disease require further evaluation and possibly psychological support.     

The impact of bowel cancer awareness week

Objectives To assess knowledge of Bowel Cancer Awareness Week (BCAW) amongst patients attending their general practice surgery and to identify whether BCAW could increase knowledge of colorectal cancer symptoms. Method Questionnaire study with ethics committee approval. Patients attending non‐emergency clinics in a single general practice during the week following BCAW were given a questionnaire. Respondents were asked for knowledge of colorectal cancer symptoms, sources of this information and awareness of BCAW compared to similar knowledge of breast cancer. Results Seventy‐seven patients responded (96% response rate, median age 42, 40% male). Eighty‐five percent could name a breast cancer symptom compared to only 44% who could name a colorectal cancer symptom (McNemar's χ², P < 0.0001). Respondents identified more sources of information for breast than colorectal cancer. Only 21% had heard of BCAW and none could name any symbol for bowel cancer awareness whereas 69% were aware of Breast Cancer Awareness Month and 28% could name its symbol (McNemar's χ², P < 0.0001). Multivariate analysis demonstrated that patients who were aware of BCAW were 4.6 times more likely to have knowledge of colorectal cancer symptoms (95% CI 1.25–17.1). Conclusions Despite their similar incidence, knowledge of colorectal cancer is much less than breast cancer. In part this may be due to the greater publicity given to breast cancer. BCAW can increase knowledge of colorectal cancer symptoms but currently, too few people are aware of it.