A preliminary study into women’s experiences of undergoing reconstructive surgery after breast cancer

Breast cancer is the most common type of cancer among women. In Sweden, about 40% of women diagnosed with breast cancer undergo a mastectomy; breast reconstruction (BR) may be an option for these women. However, the experience of undergoing reconstructive surgery appears to be only very scarcely researched, despite its importance in clinical nursing.AimThe purpose of this study was to explore women’s experiences of undergoing breast reconstructive surgery after mastectomy due to breast cancer.MethodsSix women participated in narrative interviews about their experiences of reconstructive surgery, and the interview data were analysed using thematic narrative analysis.ResultsAll six women were unprepared for the strenuous experience of undergoing a BR. They described the process as difficult and painful, entailing several operations and an unexpectedly long recovery period. They were also unprepared for how arduous it would be, both physically and emotionally. However, getting a BR had been important to all the women. The BR process was captured in four themes: (1) uninformed care; (2) arduous experiences; (3) body alterations; and (4) moving on.ConclusionsObtaining adequate information and being involved in the decision-making process along the pathway of a BR could help the women to prepare physically and emotionally for the strenuous experiences related to reconstructive surgery.     

Work-aged stroke survivors’ psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study

Background

Studies point to the lack of psychosocial support and rehabilitation services that are adjusted to the work-aged stroke survivors’ specific needs in order to promote psychosocial well-being. The aim of the study was to illuminate the psychosocial challenges work-aged participants (i.e. aged 18–67 years) thematised during and after participating a dialogue-based psychosocial intervention during the first year following a stroke.

Methods

The study was a feasibility study guided by the UK Medical Research Council Framework for developing and evaluating complex interventions. Qualitative data from in-depth interviews with fourteen stroke-survivors aged 33–66 years, researcher field notes and log notes written during the intervention were analysed applying a hermeneutic-phenomenological approach.

Results

The stroke and its consequences had a substantial impact on family and work life. Their experiences were summarised in the two themes The threat of becoming marginalised in family life and The threat of becoming marginalised in work life.

Conclusion

Life as a work-aged stroke survivor was experienced as challenging and created a threat of becoming marginalised in family and work life. The study highlights the need to understand the specific psychosocial challenges and needs facing work-aged stroke survivors’ in order to promote their psychosocial well-being. More research is needed concerning specific life-span challenges amongst work-aged stroke survivors in order to further develop appropriate interventions that helps address this issue.

     

Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis

Purpose  

The aim of this study was to document the psychological well-being of a group of women with invasive breast cancer (BC) on an average of nearly 2 years after their diagnosis.     

Stress response symptoms in adolescents during the first year after a parent’s cancer diagnosis

Purpose  

This work aims to prospectively study stress response symptoms (SRS) in adolescents during the first year after a parent’s cancer diagnosis and factors associated with SRS. Additionally, SRS in these adolescents were compared to SRS in adolescents whose parents were diagnosed 1–5 years (reference group) previously.     

Lymphedema: experience of a cohort of women with breast cancer followed for 4 years after diagnosis in Victoria, Australia

Purpose

The aim of this work was to study the incidence and prevalence of self-reported lymphedema in breast cancer survivors between 2 and 4 years following diagnosis, the factors associated with the development of lymphedema and the impact of lymphedema on psychological well-being.

Methods

We assessed self-reported lymphedema in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study, a questionnaire-based study of 1,683 women newly diagnosed with their first episode of invasive breast cancer in Victoria, Australia. Psychological well-being was assessed using the Psychological General Well-being Index.

Results

Two years after diagnosis, nearly 20 % of women reported lymphedema and this proportion remained above 18 % 2 years later. However, self-reported lymphedema was a dynamic phenomenon, with the condition resolving in some women and others reporting onset for the first time up to 4 years from diagnosis. Lymphedema 2 years from diagnosis was positively associated with the number of nodes removed at initial surgery, although this variable only explained a small proportion of the likelihood of reporting lymphedema. The presence of lymphedema was associated with lower psychological general well-being.

Conclusions

Lymphedema after breast cancer treatment frequently has a dynamic pattern and may emerge as an issue for women several years after their initial treatment. It is associated with a lower level of general well-being.     

Progress in study on lymphedema of arm after surgery of breast cancer

Lymphedemaofaffectedarmisaseverecomplicationaftersurgeryofbreastcancer．Qualityoflifeandrehabilitationofpa－tientssufferedfrombreastcancerreceivemoreandmoreattentionwithincreaseofincidenceanddecreaseofmortality，longationofsurvivaltime．Lymphedemaofarmnotonlyaffectsestheticsbutproducepain，dysfunction，deprivationofworkability，andseriouspsychologicalissues．Inthecurrentpaper，wereviewedprogressinstudyonriskfactorsassociatedwithsurgery，evaluation，preventionandmanagementoflymphedemainarm．１E…     

Measuring cognitive complaints in breast cancer survivors: psychometric properties of the patient’s assessment of own functioning inventory

Purpose

Cognitive complaints are a concern for breast cancer survivors. Among various published measures for cognitive complaints, the Patient’s Assessment of Own Functioning Inventory (PAOFI) is one of the few assessing a spectrum of cognitive abilities, including those most commonly reported by breast cancer survivors. This study aimed to examine the psychometric properties of the PAOFI in breast cancer survivors.

Methods

An exploratory factor analysis was conducted with a sample of breast cancer survivors (n?=?189) who had completed all primary cancer treatments. Construct validity was examined by correlating factor scores with valid measures of cognitive complaints, fatigue, and quality of life. Reliability was measured by internal consistency of the items in each factor within this sample, a separate sample of breast cancer survivors with high persistent cognitive complaints (n?=?72), and healthy controls (n?=?63). Factor scores were compared across the three samples.

Results

A five-factor structure similar to the PAOFI standardization study was found, with factors related to executive functioning (accounting for most of the variance), two aspects of memory functioning, language, and motor/sensory-perceptual abilities. Factor scores highly correlated with measures of cognitive complaints, fatigue, and quality of life. Executive functioning and memory-related factors achieved adequate reliability across samples. Scores were significantly different across the three samples as expected.

Conclusions

The PAOFI is a reliable and valid tool for measuring cognitive complaints in breast cancer survivors.

     

Psychologists’ views of inter-disciplinary psychosocial communication within the cancer care team

Background

Little is known about how psychologists working in cancer care centres communicate clinical information to other members of the multidisciplinary team or what information is communicated.

Purpose

This study surveyed Australian cancer care psychologists regarding their communication practices and their views on barriers to and facilitators of effective inter-disciplinary communication.

Methods

Psychologists were invited to complete an online survey containing purpose-designed items that addressed study aims.

Results

Forty-four psychologists completed the survey. Psychologists’ most common method of recording initial consultations was in patient medical records, with 69 % of respondents recording notes in either most of the time or all of the time. Twenty-two percent of psychologists said they did not regularly feedback the results of an initial assessment to a referrer and more than 40 % used verbal and e-mail communication to do so.

Conclusions

This study provides data that will assist in the development of guidelines for inter-professional communication between psychologists and other members of the cancer care team.     

Sonographic diagnosis of Fournier’s gangrene: a rare surgical emergency

Early diagnosis of life-threatening Fournier’s gangrene, a rare surgical emergency, is essential. Detection of gas within the swollen scrotal skin by ultrasonography (US) is of great help in patients with equivocal physical examination findings.     

The assessment of Shin’s method for the prediction of creatinine kinase-MB elevation after percutaneous coronary intervention: an intravascular ultrasound study

Cardiac enzyme release is common after percutaneous coronary intervention (PCI). At present there is no established relationship between the quantity of necrotic core and dense calcium, as assessed by Shin’s method using intravascular ultrasound virtual histology (VH-IVUS), and post-PCI creatinine kinase-MB (CK-MB) elevation. A total of 112 consecutive patients with unstable angina and a normal pre-PCI CK-MB level were imaged using VH-IVUS. Patients were divided into 2 groups according to the presence (CK-MB group, n = 22) or absence (non CK-MB group, n = 90) of a post-PCI CK-MB elevation >1.0 the upper limit of normal (3.6 ng/ml). Using Shin’s method contours were drawn around the IVUS catheter (instead of the lumen), and the vessel. Mean area and volume of necrotic core and dense calcium were significantly greater in CK-MB group than in non CK-MB group (1.7 ± 0.9 mm² vs. 0.9 ± 0.6 mm², P < 0.001; 17.2 ± 8.8 mm³ vs. 8.8 ± 5.8 mm³, P < 0.001, and 0.9 ± 0.6 mm² vs. 0.4 ± 0.4 mm², P = 0.001; 9.1 ± 5.8 mm³ vs. 3.9 ± 3.7 mm³, P < 0.001, respectively). Percent necrotic core and dense calcium areas calculated by external elastic membrane (EEM) area were significantly greater in CK-MB group than in non CK-MB group (11.9 ± 5.1 vs. 6.6 ± 4.0%, P < 0.001 and 6.5 ± 4.0 vs. 3.0 ± 2.9%, P < 0.001, respectively). In the multivariate analysis, dense calcium volume and percent necrotic core to EEM at the most diseased segment were the only independent predictors of post-PCI CK-MB elevation (odds ratio: 1.22; 95% confidence interval: 1.09–1.37, P < 0.001 and odds ratio: 1.26; 95% confidence interval: 1.12–1.43, P < 0.001). Lesions with a greater amount of dense calcium volume and percent necrotic core to EEM, which can be easily identified and quantified on VH-IVUS analyzed using Shin’s method, are responsible for post-PCI CK-MB elevation. With a rapid analyzing time, Shin’s method may increase the identification of high risk lesions likely to induce a post-procedural myocardial injury in the catheterization laboratory facilitating on-line clinical decision making.     

Social support and depressive mood 1?year after diagnosis of breast cancer compared with the general female population: a prospective cohort study

Background  

Social support may influence the impact of stressful life events on breast cancer patients’ psychological state. However, the precise status of depressive mood in breast cancer during the first year after diagnosis is not yet known.     

The adolescent’s experience of cancer: An integrative literature review

AimThis integrative review appraises the literature that explores the experiences of the adolescent diagnosed with cancer.BackgroundThe cancer experience has an impact on the way the adolescent lives their life, their future hopes dreams and fears, their health and wellbeing. Healthcare professionals require an understanding of what the adolescent experiences after a diagnosis of cancer and during the treatment experience to be able to provide optimal age appropriate care.MethodsThe review was conducted following Whittemore and Knafl’s (2005) framework. A comprehensive search using the following four databases, CINAHL, MEDLINE, PyschINFO, Embase was undertaken for the period of 2005–2016. Google scholar, healthcare policies and guidelines reference lists were also searched. Screening and appraisal of 911 articles resulted in 22 articles being included in this review.FindingsThree themes were identified: ‘Losing what I know - this is what makes me different’, ‘Communication and information sharing - the need to know’, and ‘The importance of friends, peers and relationships’.ConclusionThis review reports that healthcare providers should be aware of the changing self-perceptions the adolescent experiences throughout the cancer journey. Accessing this information will enable healthcare providers to determine more appropriate care when these adolescents are feeling most vulnerable. The review identified there is limited information about the experience of the younger adolescent (11–15 years) with cancer. Future research may benefit from focusing on the stage of development of the adolescent with cancer.     

Can regional analgesia reduce the risk of recurrence after breast cancer?: Methodology of a multicenter randomized trial

Surgery is the primary and most effective treatment of breast cancer, but minimal residual disease is probably unavoidable. Whether residual disease results in clinical metastases depends on numerous factors, including anti-tumor cell mediated immunity and angiogenic and growth signals in sites of residual disease. At least three perioperative factors adversely affect these: 1) the neuroendocrine stress response to surgery, 2) volatile anesthetics, and 3) opioids. Animal studies indicate that regional anesthesia and optimum postoperative analgesia independently reduce the metastatic burden in animals inoculated with breast adenocarcinoma cells following surgery. Retrospective studies in humans also suggest that regional analgesia may reduce recurrence risk after cancer surgery. We will test the hypothesis that local or metastatic recurrence after breast cancer surgery is lower in patients randomized to paravertebral or high-thoracic epidural analgesia combined with sedation or light anesthesia than in patients given intraoperative volatile anesthesia and postoperative opioid analgesia. In a Phase III, multi-center trial, Stage 1-3 patients having mastectomies for cancer will be randomly assigned to thoracic epidural or paravertebral anesthesia/analgesia, or to sevoflurane anesthesia and morphine analgesia. The primary outcome will be cancer recurrence. Enrolling 1100 patients over 5 years will provide 85% power for detecting a 30% treatment effect at an alpha of 0.05. We plan four equally spaced interim analyses, each evaluating efficacy and futility. Confirming our hypothesis will indicate that a small modification to anesthetic management, one that can be implemented with little risk or cost, will reduce the risk of cancer recurrence - a complication that is often ultimately lethal.