The Satisfaction with Life Domains Scale for Breast Cancer (SLDS-BC)

Despite improved overall survival rates, the diagnosis of breast cancer continues to generate fear and turmoil in the lives of many women. All phases related to diagnosis, treatment, and recovery create challenges and problems that patients and survivors must face. Clearly, at the time of diagnosis and during the first phases of treatment, patients experience uncertainty, confusion, and distress. Quality of life (QOL) can be negatively affected by inadequate information, complex decisions, and adverse events related to cancer therapies. As treatment continues, concerns related to physical functioning, body image, mood, sexuality, family, and vocational pursuits quickly emerge. Adjuvant treatments generate additional physiological assaults that further affect body image, sexuality, and family. As women move beyond treatment, the role of patient shifts to that of survivor, with a need for continued focus on overall QOL issues. Throughout this continuum, QOL is a critical factor that must be evaluated and monitored. The Satisfaction with Life Domains Scale for Breast Cancer (SLDS-BC) is a reliable and valid scale that presents a critical opportunity to assess QOL throughout the various phases of patient care. A principal component factor analysis with a varimax rotation identified the following five QOL factors, explaining 70.8% of the variance: social functioning, physical functioning, internal locus of control, spirituality, and communication with medical providers. Cronbach's alpha for the entire scale was 0.93. Test-retest produced r's for each factor ranging from 0.45 to 0.91, with an overall r = 0.70. Concurrent and divergent validity were assessed through the Functional Assessment of Cancer Therapies for Breast Cancer (FACT-B) and the Brief Symptom Inventory (BSI). Significant negative correlations (p < 0.01) were found between the SLDS-BC and the FACT-B as well as the BSI. These results indicated strong concurrent and divergent validity. The SLDS-BC clearly offers a user-friendly format that can briefly and rapidly assess QOL across the breast cancer continuum of care.     

Quality-of-Life Measurement in Women with Breast Cancer

Abstract: The health-related quality of life (QOL) of breast cancer patients has been the focus of study for many years. However, it is only recently that the quality-of-life construct has been precisely defined and measured with validated, reliable instruments. The measurement of health-related quality of life and the application of this data in clinical practice has been facilitated by the publication of several QOL instruments widely used in clinical trials. Knowledge of available instruments and a growing database on quality of life following treatment for breast cancer allows clinicians and patients to better collaborate to improve patient functioning following treatment. The task for practitioners is to translate current QOL data into useful information for patients.     

Lymphedema: Knowledge, Treatment, and Impact Among Breast Cancer Survivors

Abstract: Lymphedema is an understudied consequence of surgery for breast cancer. It is estimated that as many as 60% of breast cancer survivors report symptoms of lymphedema. Few studies have examined the impact of lymphedema on the lives of women with breast cancer. The goal of this pilot study was to identify knowledge about, treatment received for, and the effect of lymphedema among a group of breast cancer survivors and physicians. Forty women with lymphedema and 10 physicians who treat breast cancer patients participated. Overall, women knew little to nothing about lymphedema before they developed it. After diagnosis, the primary source of information about lymphedema was a doctor or physical therapist. The majority of women received compressive garment therapy (75%), 46.9% received mechanical compressive therapy, 26% received bandaging, and 22% received physical therapy. More than half (55%) reported that clothing and appearance were affected by their condition and 48% reported that routine daily activities were impaired. Hot weather (58%) and regular arm use (40%) were reported to exacerbate the swelling. Most physicians reported that they did not routinely counsel women or provide written information on lymphedema prevention to their patients, and the extent to which women's daily living was affected by the condition was not always recognized. These findings have implications for interventions aimed at educating women and providers about lymphedema.     

Considerations for Comprehensive Assessment of Genetic Predisposition in Familial Breast Cancer

About 10–15% of breast cancer cases are family related, classified as familial breast cancer. The disease was first reported in 1866 and determined to be an autosomal dominant genetic disease in 1971. Germline mutations in BRCA1 were discovered and deemed as the first genetic predisposition for the disease in 1994. By now, genetic predispositions for about 40% of familial breast cancer families have been identified. New molecular genetic approaches currently under development should accelerate the process to identify the full spectrum of genetic predispositions for the disease, thereby enabling a better understanding of the genetic basis of the disease and therein providing benefit to high‐risk patients.     

Polymorphism of Metastasis Suppressor Genes MKK4 and NME1 in Kashmiri Patients with Breast Cancer

Genetic polymorphisms in metastatic suppressor genes like MKK4 and NME1 are not well studied in breast cancer. Hence, we analyzed the relationship between MKK4 and NME1 polymorphisms and breast cancer risk in Kashmir, India. The different genotypes of NME1 and MKK4 genes were analyzed by polymerase chain reaction and restriction fragment length polymorphism in 130 breast cancer cases and 200 age‐ and sex‐matched controls. Conditional logistic regression models were used to assess the association of various genotypes with breast cancer. In this study, we found an inverse association between MKK4 promoter polymorphism and breast cancer risk. As compared to TT (wild) genotype, individuals with TG (heterozygous) (OR = 0.32; 95% CI = (0.17–0.58) and GG (mutant) (OR = 0.13; CI = 0.04–0.40) genotypes showed decreased risk of breast cancer. When participants were classified on the basis of lymph node involvement, a strong association between NME1 heterozygous genotype (OR = 3.82; CI = (1.54–9.44) and breast cancer was found.     

乳癌患者配偶的生存质量与压力的相关性研究

目的 探讨乳癌患者配偶的生存质量、压力以及两者间的关系,为临床护理工作提供重要参考依据.方法 应用世界卫生组织生存质量测定简表(WHOQOL-BREF)和压力症状自评量表对114名乳癌患者配偶的生存质量和压力水平进行测评,并以92名健康者为对照组.结果 乳癌患者配偶生存质量各领域的得分均显著低于对照组(均P＜0.01),总压力水平为1.5±0.4,属轻度;乳癌患者配偶生存质量各领域的得分与其压力水平呈显著负相关(P＜0.01).结论 乳癌患者配偶的生存质量较一般人群差,其生存质量与其压力水平密切相关.     

乳腺癌根治术后保留乳房对患者心理与生活质量的影响

目的:观察乳腺癌根治术后保留乳房方案对患者心理及其生活质量的影响.方法:选取笔者医院92例乳腺癌患者,按照手术方式分为改良根治术组(n=38,予以改良根治术)与保留乳房组(n=54,予以改良根治术后保留乳房治疗),比较两组手术前后腺癌生命质量量表(FACT-B)评分、汉密尔顿焦虑(HAMA)与抑郁(HAMD)评分、社会...     

乳腺癌患者性功能障碍相关因素分析

目的 :探讨乳腺癌患者性功能障碍的相关因素 ,以利于开展乳腺癌患者性功能障碍的防治工作以及提高患者生活质量。　方法 :以统一自制的性功能状况问卷 ,对门诊 6 5例康复期的乳腺癌患者问卷调查治疗前后的性功能状况。　结果 :患者年龄和认知因素与患者性功能障碍患病率显著相关。 4 5～ 5 5岁组和 5 6～ 6 5岁组性功能障碍患病率分别为 6 6 .7%、73.9% ,与小于 4 5岁组 (33.3% )相比 ,有显著统计学差异 (P <0 .0 1) ;认为性生活不是生活重要内容者性功能障碍患病率为 70 .3% ,与认为性生活是生活重要内容者 (4 7.6 % )相比 ,有统计学差异 (P <0 .0 5 ) ;在调查因素中 ,肿瘤分期、治疗方式、阴道干燥、性欲降低、性交痛及认知因素与患者新发性功能障碍的发生显著相关 (P <0 .0 5 )。　结论 :乳腺癌患者治疗后 ,性功能障碍的发生与肿瘤分期、治疗方式、认知因素及阴道干燥等显著相关 ;提示为防治乳腺癌患者性功能障碍 ,从事肿瘤专业的医务人员在治疗过程中应与患者交流关于性功能障碍的问题 ,并进行全面评价 ,指导患者解决这些问题的方法。     

MR Imaging Findings in Molecular Subtypes of Breast Cancer According to BIRADS System

To evaluate magnetic resonance imaging (MRI) findings, according to Breast Imaging‐Reporting and Data System (BI‐RADS), and to relate them with molecular subtypes of breast cancer. The MRI findings were reviewed retrospectively in 201 women diagnosed of invasive breast cancer confirmed by surgery and were compared with the molecular subtypes. Following the BI‐RADS, MRI findings included disease type, size, enhancement, morphology and contrast kinetics. In mass‐like lesion types were studied shape, margin and enhancement, and in nonmass‐like lesion types, distribution modifiers and internal enhancement. Chi‐squared analysis showed significant association (p < 0.01) between molecular subtypes and lesion type on MRI and histologic grade. Shape, margin and mass enhancement (p < 0.05) also showed significant association among molecular subtypes. Triple negative were more frequently unifocal and mass‐like lesion, high histologic grade, round shape, smooth margin, and rim enhancement. Luminal‐A were more frequently low grade, mass‐like lesion, irregular shape and spiculated or irregular margin. Luminal‐B were more frequently moderate‐low grade, mass‐like lesion, nonirregular shape and spiculated margin. HER‐2‐enriched were more frequently moderate grade, nonmass‐like lesion and multicentric lesions were more present than in other subtypes. There are significantly different MRI features, according to BI‐RADS, between the molecular subtypes breast cancer.     

A Comparison of Criteria to Identify Inflammatory Breast Cancer Cases from Medical Records and the Surveillance,Epidemiology and End Results Data base, 2007–2009

Inflammatory breast cancer (IBC) is a relatively rare and extremely aggressive form of breast cancer that is diagnosed clinically. Standardization of clinical diagnoses is challenging, both nationally and internationally; moreover, IBC coding definitions used by registries have changed over time. This study aimed to compare diagnostic factors of IBC reported in a U.S. Surveillance, Epidemiology, and End Results (SEER) registry to clinical criteria found in the medical records of all invasive breast cancer cases at a single institution. We conducted a medical record review of all female invasive breast cancers (n = 915) seen at an NCI‐designated comprehensive cancer center in Detroit from 2007 to 2009. IBC cases were identified based on the presence of the main clinical characteristics of the disease (erythema, edema, peau d'orange). We compared the proportion of IBC out of all breast cancers, using these clinical criteria and the standard SEER IBC codes. In the reviewed cases, the clinical criteria identified significantly more IBC cases (n = 74, 8.1%) than the standard IBC SEER definition (n = 19, 2.1%; p < 0.0001). No IBC cases were identified in the cancer center records using the SEER pathologic coding, which requires the diagnosis of inflammatory carcinoma on the pathology report, a notation that is rarely made. Emphasis must be placed on the documentation of clinical and pathologic characteristics of IBC in the medical record, so that analysis of putative IBC subtypes will be possible. Our results indicate the need for a consensus on the definition of IBC to be utilized in future research.     

Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical,Psychological, and Social Sequelae

Women with metastatic breast cancer face a wide range of medical, practical, and emotional challenges that impact their quality of life. Research to date, however, has not focused on the quality‐of‐life concerns of metastatic breast cancer patients with significant distress. The present study examined a range of concerns among distressed metastatic breast cancer patients, including physical and emotional distress, social functioning, and existential issues. Forty‐four distressed women with metastatic breast cancer wrote their deepest thoughts and feelings regarding their illness. These essays were thematically analyzed for effects of the illness on quality of life. Three themes were identified in patients' essays. First, metastatic breast cancer and its treatment may result in a number of quality‐of‐life concerns, including physical symptom burden, emotional distress, body image disturbance, and disrupted daily activities. Second, social constraints on disclosure of cancer‐related concerns may exacerbate patients' distress. Third, many women experience a heightened awareness of life's brevity and search for meaning in their cancer experience. Results highlight a range of quality‐of‐life concerns following a metastatic breast cancer diagnosis and suggest that addressing social constraints on cancer‐related disclosure and the search for meaning may improve patients' psychological adjustment.     

Surviving Triple Trouble: Synchronous Breast and Cervical Cancer,HIV Infection and Myocardial Infarction

Breast and cervical cancer are the two most common cancers in female. However, owing to the contrasting risk factors, synchronous breast and cervical cancer has very rarely been reported. However, noncommunicable disease like cardiovascular disease and different infections has tended to make situations complicated because of complex interaction. In recent years, such cases are being seen frequently and their management is challenging. We report such a case of synchronous breast and cervical cancer complicated by HIV infection and myocardial infarction. This highlights the importance of a wide spectrum of clinical knowledge and skill and interdisciplinary coordination.     

MR Imaging Features of Triple‐Negative Breast Cancers

Triple‐negative (TN) breast cancers, which are associated with a more aggressive clinical course and poorer prognosis, often present with benign imaging features on mammography and ultrasound. The purpose of this study was to compare the magnetic resonance imaging features of TN breast cancers with estrogen (ER) and progesterone (PR) positive, human epidermal growth factor receptor (HER2) negative cancers. Retrospective review identified 140 patients with TN breast cancer who underwent a preoperative breast MRI between 2003 and 2008. Comparison was made to 181 patients with ER+/PR+/HER2? cancer. Breast MRIs were independently reviewed by two radiologists blinded to the pathology. Discrepancies were resolved by a third radiologist. TN cancers presented with a larger tumor size (p = 0.002), higher histologic grade (<0.001), and were more likely to be unifocal (p = 0.018) compared with ER+/PR+/HER2? tumors. MRI features associated with TN tumors included mass enhancement (p = 0.026), areas of intratumoral high T2 signal intensity (p < 0.001), lobulated shape (p < 0.001), rim enhancement (p < 0.001), and smooth margins (p = 0.005). Among the TN tumors with marked necrosis, 26% showed a large central acellular zone of necrosis.     

乳癌患者社会支持与生活质量的相关性研究

目的了解社会支持与乳癌患者生活质量的关系，据其结果提出护理对策，以提高患者生活质量。方法对80例乳癌患者进行生活质量和社会支持问卷调查，分析其相关性。结果乳癌患者情感状况、功能状况、附加关注得分较低，可获得的社会支持较高；社会支持与其生活质量呈显著正相关（P〈0．05，P〈0．01）。结论社会支持与乳癌患者的生活质量密切相关，护理过程中重视社会支持系统可以改善护理效果，提高乳癌患者的生活质量。     

Clinical Outcomes and Cost‐effectiveness of Primary Prophylaxis of Febrile Neutropenia During Adjuvant Docetaxel and Cyclophosphamide Chemotherapy for Breast Cancer

Docetaxel and cyclophosphamide (TC) is a widely used breast cancer adjuvant regimen. We sought to compare the rates of febrile neutropenia (FN) between patients receiving no primary prophylaxis (PP) and those receiving PP with either granulocyte‐colony stimulating factor (G‐CSF) or antibiotics. We also analyzed cost‐effectiveness of TC with and without either G‐CSF or antibiotics. Charts were reviewed of all 340 patients who received adjuvant TC between January 2008 and December 2012 at two major cancer centers. Rates of FN in the three groups – no PP, PP with G‐CSF and PP with antibiotics were compared. A Markov model was constructed comparing cost‐effectiveness of PP with G‐CSF, PP with antibiotics, and secondary prophylaxis (SP) with G‐CSF after an episode of FN in a previous cycle. Costs were based on actual resource utilization and supplemented by the published literature, adjusted to 2012 Canadian dollars. Of the 73 (21%) patients who did not receive any PP, 23 (32%) of patients developed FN. Of the 192 (57%) patients receiving PP with G‐CSF alone, only two (1%; p < 0.0001) developed FN; and of the 53 (16%) receiving PP with antibiotics alone, six (11%; p < 0.01) developed FN. From a cost‐standpoint, PP with G‐CSF was less cost‐effective than PP with antibiotics. The rate of FN with TC chemotherapy exceeds 30%, and American Society of Clinical Oncology guidelines recommend PP with G‐CSF in this situation. PP with antibiotics is more cost‐effective, and is a reasonable option in resource‐limited settings or for patients who decline or do not tolerate G‐CSF.     

Quality of Life Across the Continuum of Breast Cancer Care

This article examines the quality of life concerns for women across the continuum of breast cancer care-from screening and high-risk status through palliative care. The psychosocial and quality of life concerns of women regarding breast cancer have been extensively studied, with much information available about these issues. Better awareness of these issues will facilitate the optimum care of women as they face screening, diagnosis, and treatment of this disease.     

Relation between Hypofractionated Radiotherapy,Toxicity and Outcome in Early Breast Cancer

To compare adjuvant conventional radiotherapy (C‐RT) to hypofractionated schedule (HF‐RT) in early breast cancer. Between May 2012 and September 2015, 120 patients were included in the analysis. All patients underwent conservative surgery and adjuvant RT. RT was delivered in C‐RT (50 Gy; 2 Gy/fr) or HF‐RT (42.5 Gy; 2.66 Gy/fr), followed by a tumor bed boost (10 Gy; 2 Gy/fr). RT‐induced toxicity was recorded and compared between groups. Toxicity results were graded according to the Common Terminology Criteria for Adverse Events guidelines. A multivariate analysis was performed of the factors associated with acute toxicity onset. Mild acute skin toxicity was observed in 71.7% of patients. No grade 4 toxicity was observed. From the multivariate analysis, Breast volume and RT fractionation significantly affected acute radiation‐related toxicity. No increase in late toxic effects has been reported between C‐RT and HF‐RT schedules. Overall, the 2‐year disease free survival was 94.4%. HF‐RT represents a valid adjuvant treatment option in early breast cancer patients, without negative impact on acute and late radiation sequelae, as well as tumor control.     

Case Report of a Synchronous Nipple Adenoma and Breast Carcinoma with Current Multi‐modality Radiologic Imaging

This case report presents the first reported molecular breast imaging appearance of a nipple adenoma coexisting with an ipsilateral breast malignancy. Conventional multi‐modality radiologic imaging, including mammography, ultrasonography, and magnetic resonance imaging are also shown, and a brief review of the literature is provided.     

心理行为干预对乳癌病人心理反应及生活质量的影响

目的探讨心理行为干预对乳癌病人心理及其生活质量的影响.方法按随机和匹配原则将40例乳癌病人分为干预组和对照组,各20例.对照组接受常规治疗与护理,干预组在此基础上进行为期4周的心理行为干预.应用综合生活质量问卷与心理反应评定标准,评估病人干预前后的生活质量.结果干预组病人除自杀倾向外,其它心理反应显著轻于对照组(P＜0.05,P＜0.01);病人的生活质量在躯体、心理、社会功能、症状维度等方面显著高于对照组(P＜0.05,P＜0.01).结论开展有针对性的心理行为干预,可降低乳癌病人负性心理,提高乳癌病人生活质量.