Who are the breast cancer survivors in Malaysia?

Introduction: Worldwide, breast cancer is the commonest cause of cancer death in women. However, thesurvival rate varies across regions at averages of 73%and 57% in the developed and developing countries,respectively. Objective: This study aimed to determine the survival rate of breast cancer among the women ofMalaysia and characteristics of the survivors. Method: A retrospective cohort study was conducted on secondarydata obtained from the Breast Cancer Registry and medical records of breast cancer patients admitted toHospital Kuala Lumpur from 2005 to 2009. Survival data were validated with National Birth and Death Registry.Statistical analysis applied logistic regression, the Cox proportional hazard model, the Kaplan-Meier methodand log rank test. Results: A total of 868 women were diagnosed with breast cancer between January 2005 andDecember 2009, comprising 58%, 25% and 17% Malays, Chinese and Indians, respectively. The overall survivalrate was 43.5% (CI 0.573-0.597), with Chinese, Indians and Malays having 5 year survival rates of 48.2% (CI0.444-0.520), 47.2% (CI 0.432-0.512) and 39.7% (CI 0.373-0.421), respectively (p<0.05). The survival rate waslower as the stages increased, with the late stages were mostly seen among the Malays (46%), followed by Chinese(36%) and Indians (34%). Size of tumor>3.0cm; lymph node involvement, ERPR, and HER 2 status, delayedpresentation and involvement of both breasts were among other factors that were associated with poor survival.Conclusions: The overall survival rate of Malaysian women with breast cancer was lower than the westernfigures with Malays having the lowest because they presented at late stage, after a long duration of symptoms,had larger tumor size, and had more lymph nodes affected. There is an urgent need to conduct studies on whythere is delay in diagnosis and treatment of breast cancer women in Malaysia.     

Who benefits?: distress, adjustment and benefit-finding among breast cancer survivors

The current study explored distress and adjustment over time and a woman's ability to find benefit in her experience of breast cancer. Over 700 women were initially assessed at a pre-diagnostic visit to a breast clinic. Of those who were originally diagnosed, 39 women participated in all four study assessments, completed over a two-and-one-half-year period following diagnosis. Compared to non-benefit-finders, women who reported finding benefits in their breast cancer experienced high levels of distress pre-diagnostically, which significantly declined over time. Results of the current study suggest that a woman's distress prior to receiving her diagnosis of breast cancer may be related to her ability to find benefit during later stages of her illness.     

Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this

Purpose

The purpose of this study is to investigate how women, during the 2 years following breast cancer surgery, rate importance of work and vocational satisfaction, and baseline factors associated with rating over time.

Methods

A prospective cohort study of 692 women aged 20–63 included about 4 weeks after a first breast cancer surgery. Register data on treatment and data from six repeated questionnaires during a 2-year follow-up (at baseline, 4, 8, 12, 18, 24 months) were used in two-way mixed repeated analysis of variance and mixed repeated measures analysis of covariance.

Results

The women rated importance of work (m?=?3.74; sd 0.88) (maximum 5) and vocational satisfaction (m?=?4.30; sd 1.38) (maximum 6) high during the 2 years. Women with planned chemotherapy rated lower vocational satisfaction and especially so at 4 months after inclusion (F 1, 498?=?8.20; p?=?0.004). Higher age, better physical, and mental/social work ability at baseline influenced rating of vocational satisfaction. Supportive colleagues was an important covariate that significantly affected ratings of importance of work as well as vocational satisfaction, i.e., women with better support rated on average higher on these outcomes. The effect of chemotherapy disappeared after including the abovementioned baseline covariates.

Conclusions

Women diagnosed with breast cancer in the following 2 years rate importance of work and vocational satisfaction high, which are associated to lower work ability and social support.

Implications for cancer survivors

Work is a very important aspect in life also after a cancer diagnosis, which has to be acknowledged when discussing treatment and rehabilitation plans with women with breast cancer. Furthermore, workplace support needs to be assessed as this is an influential factor.

     

Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact?

A better understanding of the role of psychosocial resources and factors associated with participating in patient support groups appears to be important for the development and implementation of cancer survivorship care plans. We therefore investigated the frequency of participation in and satisfaction with patient support groups after completion of a rehabilitation programme and aimed to examine differences in demographic, medical and psychosocial characteristics between group participants and non‐participants. We further aimed to identify predictors of participation in patient support groups. A total of 1281 eligible patients (75.5% participation rate) were recruited on average 11 months post diagnosis and assessed at the beginning (t₁), at the end (t₂) and 12 months after rehabilitation (t₃). Study participants completed self‐report measures assessing support‐group participation and satisfaction, psychosocial distress (anxiety, fear of cancer recurrence, depression), social support, coping, quality of life, pain and treatment‐related characteristics. Sixty‐seven patients (7.6%) participated in a patient self‐help group. Being unemployed, undergoing an increased number of overall treatments, and a higher active emotion‐oriented coping style significantly predicted self‐help group participation; the predictive power of the multivariate logistic regression model was rather weak (Nagelkerke's R² = 0.07). Our data provide evidence that self‐help group participation in cancer patients may be largely related to other factors than medical or psychosocial distress.     

What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert-endorsed risk factors

Purpose

The aim of this paper was to review published research that analyzed causal attributions for breast cancer among women previously diagnosed with breast cancer. These attributions were compared with risk factors identified by published scientific evidence in order to determine the level of agreement between cancer survivors’ attributions and expert opinion.

Methods

A comprehensive search for articles, published between 1982 and 2012, reporting studies on causal attributions for breast cancer among patients and survivors was undertaken. Of 5,135 potentially relevant articles, 22 studies met the inclusion criteria. Two additional articles were sourced from reference lists of included studies.

Results

Results indicated a consistent belief among survivors that their own breast cancer could be attributed to family history, environmental factors, stress, fate, or chance. Lifestyle factors were less frequently identified, despite expert health information highlighting the importance of these factors in controlling and modifying cancer risk. This review demonstrated that misperceptions about the contribution of modifiable lifestyle factors to the risk of breast cancer have remained largely unchanged over the past 30 years.

Conclusions

The findings of this review indicate that beliefs about the causes of breast cancer among affected women are not always consistent with the judgement of experts. Breast cancer survivors did not regularly identify causal factors supported by expert consensus such as age, physical inactivity, breast density, alcohol consumption, and reproductive history. Further research examining psychological predictors of attributions and the impact of cancer prevention messages on adjustment and well-being of cancer survivors is warranted.     

Adolescent cancer survivors�� smoking intentions are associated with aggression, attention, and smoking history

Introduction  

The present study examines behavioral and psychosocial factors associated with smoking intentions and experimentation among adolescent survivors of pediatric cancer.     

The relationship between psychosocial factors in the patient–oncologist relationship and quality of care: A study of breast cancer patients

This study examined the relationship between psychosocial factors in the patient–oncologist relationship and aspects of care among women with breast cancer. Breast cancer patients (N = 118) completed a questionnaire about their relationship with their oncologist, their treatment, and their health. While trust was related to several positive outcomes, physician supportiveness was most strongly related to satisfaction with care, and health care access was most strongly associated with general health. The results suggest that the addition of supportiveness and healthcare access to trust provide a more complete picture of patients' health outcomes.     

Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?

Introduction Risk of axillary lymph node metastasis, the most important predictor of disease-free and overall survival in breast cancer patients, is estimated primarily from histologic features of the primary cancer including tumor size, histologic type and grade, and hormone receptor expression. Based upon a clinical impression, and research showing that palpable cancers are more likely to be node positive, we hypothesized that primary breast cancers more proximal to the skin of the breast are more likely to be positive for axillary lymph node metastasis.Methods This is a retrospective medical record review of 209 women with stage T1 or T2 (≤5.0 cm) invasive breast cancer who received dedicated breast ultrasound at a single mammography clinic in Columbia, South Carolina, between 1997 and 2002.Results None of the 26 cancers more than 14 mm from the skin had metastasized to axillary lymph nodes. In logistic regression modeling only tumor size, histologic grade and tumor proximity to the skin (as a categorical variable) were significantly associated with odds of axillary metastasis. Among cancers within 14 mm of the skin, proximity was not an independent predictor.Conclusions Stage T1 and T2 breast cancers located less proximally to the skin may be less likely to spread to the axillary lymph nodes. We observed what appears to be a threshold at approximately 14 mm from the skin (based upon this group of patients): none of 26 cancers below this level had spread to axillary nodes. Further research is needed to confirm these provocative findings.     

Who are the cancer survivors? A nationwide study in Denmark, 1943–2010

Background:

No nationwide studies on social position and prevalence of comorbidity among cancer survivors exist.

Methods:

We performed a nationwide prevalence study defining persons diagnosed with cancer 1943–2010 and alive on the census date 1 January 2011 as cancer survivors. Comorbidity was compared by social position with the non-cancer population.

Results:

Cancer survivors composed 4% of the Danish population. Somatic comorbidity was more likely among survivors (OR 1.59, 95% CI 1.57–1.60) and associated with higher age, male sex, short education, and living alone among survivors.

Conclusions:

Among cancer survivors, comorbidity is common and highly associated with social position.     

Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates

Purpose

African-American breast cancer survivors (AABCS) suffer the greatest from cancer recurrence, morbidity, and mortality in part due to the lack of cancer follow-up care and surveillance. To improve survival and survivorship, the Institute of Medicine advises that cancer survivors be provided a survivorship care plan (SCP). The current study investigated AABCS’ understanding of SCP and gathered preliminary feedback on infusing cultural and socioecological responsiveness.

Methods

The study embraced a community-based participatory research framework. Three facilitated, structured, consensus meetings were conducted with AABCS (N?=?25) and advocates (N?=?3) to provide information towards identifying the content domains of an SCP that are culturally responsive to AABCS.

Results

AABCS recommended inclusion of patient-centered information on the purpose and use of the SCP. They raised concerns that higher mortality in AABCS may be due to greater comorbidities and inadequate surveillance and follow-up care. Participants recommended that the SCP document all comorbidities and medications, regardless of relationship to cancer; referrals for cancer-related providers; and culturally informed health advisories.

Conclusion

Study findings indicate that the available SCP template lacked adequate content on health history, comorbidity, health promotion, and functioning. These factors constitute the underlying clinical, psychosocial, and behavioral risks for poor disease outcomes that may be exacerbated in AABCS.

Implications for Cancer Survivors

SCPs are intended to educate and activate patients to join their oncology care team as informed partners. However, the emerging science and implementation of SCPs seem void of patient input. Our investigation suggests a practical approach for survivor engagement in the SCP discourse to increase their cultural responsiveness and patient-centeredness.     

Is mode of breast cancer detection associated with cancer treatment in the United States?

BACKGROUND: The prognosis for women who have breast cancer detected by mammography is more favorable than that for women who have breast cancer detected by other methods, even after controlling for tumor characteristics. In the current study, the authors explored whether detection by mammography was associated with greater use of guideline-consistent breast cancer treatment among patients with recently diagnosed breast cancer in the United States. METHODS: The authors evaluated the association between mode of breast cancer detection (mammography vs other) and use of guideline-consistent treatment in 1006 women aged > or =40 years who were diagnosed in 2000. These patients were sampled from the Surveillance, Epidemiology, and End Results Program as part of the Patterns of Care studies. The analyses controlled for the potential confounders of clinical, demographic, and health system characteristics in multivariate logistic regression models. RESULTS: Breast cancer patients who were diagnosed by mammography were more likely to be aged > or =55 years, to have lower stage disease, and to be treated in larger hospitals than patients who were diagnosed by other methods (P < .05). Women whose breast cancer was diagnosed by a method other than mammography were more likely to receive guideline-consistent treatment than women who were diagnosed by mammography in unadjusted (odds ratio, 1.39; 95% confidence interval, 1.07-1.80) and multivariate analyses (odds ratio, 1.43; 95% confidence interval, 1.05-1.95). CONCLUSIONS: The current results indicated that women who had breast cancer detected by methods other than mammography were slightly more likely to receive guideline-consistent therapy than women who had breast cancer detected by mammography. Future research exploring mode of detection, guideline-consistent treatment, and survival among patients with recently diagnosed breast cancer may inform understanding of factors associated with breast cancer prognosis.     

High fat and alcohol intakes are risk factors of postmenopausal breast cancer: a prospective study from the Malmö diet and cancer cohort

Associations between intakes of relative fat, total alcohol and alcoholic beverages and risk of breast cancer were examined in a subsample of 11726 postmenopausal women from the MDC cohort. The MDC conducted baseline examinations from 1991 to 1996; the end of follow-up was 31 December 2001. Data were obtained by an interview-based diet history method, a structured questionnaire, anthropometric measurements and national and regional cancer registries. During 89602 person-years of follow-up, 342 incident cases were documented. Cox regression analysis examined breast cancer risks adjusted for potential confounders. Two energy-adjustment approaches (i.e., adjusting for total energy vs. adjusting for nonalcohol energy) were used. High total alcohol intake was associated with a nonsignificantly elevated risk. High wine intake was associated with a significantly elevated breast cancer risk (relative risk = 2.12, 95% CI 1.24-3.60). There were significant trends of increased breast cancer risk across quintiles of relative fat intake. Mutual adjustment did not affect risk estimates for total alcohol or relative fat intakes. The specific energy-adjustment approach did not influence associations differentially.     

Immune approaches to the treatment of breast cancer,around the corner?

Immunotherapy for the treatment of breast cancer can be categorized as either (a) specific stimulation of the immune system by active immunization, with cancer vaccines, or (b) passive immunization, such as tumor-specific antibodies (including immune modulators) or adoptive cell therapy that inhibit the function of, or directly kill, tumor cells. We will present the current information and the future perspectives of immunotherapy in patients with breast cancer, including the prognostic role of tumor infiltrating lymphocytes, immune signatures, targeted therapies modulating the immune system, and tumor antigen cancer vaccines. Active immunotherapy in breast cancer and its implementation into clinical trials have been largely a frustrating experience in the last decades. The concept that the immune system regulates cancer development is experiencing a new era of interest. It is clear that the cancer immunosurveillance process indeed exists and potentially acts as an extrinsic tumor suppressor. Also, the immune system can facilitate tumor progression by sculpting the immunogenic phenotype of tumors as they develop. Cancer immunoediting represents a refinement of the cancer immunosurveillance hypothesis and resumes the complex interaction between tumor and immune system into three phases: elimination, equilibrium, and escape. Major topics in the field of immunology deserve a response: what do we know about tumor immunogenicity, and how might we therapeutically improve tumor immunogenicity? How can we modulate response of the immune system? Is there any gene signature predictive of response to immune modulators? The success of future immunotherapy strategies will depend on the identification of additional immunogenic antigens that can serve as the best tumor-rejection targets. Therapeutic success will depend on developing the best antigen delivery systems and on the elucidation of the entire network of immune signaling pathways that regulate immune responses in the tumor microenvironment.