Associations between adjuvant endocrine therapy and onset of physical and emotional concerns among breast cancer survivors

Background

Breast cancer survivors often receive long-term adjuvant endocrine therapy (AET) to reduce recurrence risk. Adherence to AET is suboptimal, which may be due to the experience of symptoms and/or concerns. Few studies have comprehensively assessed self-reported concerns between those who currently, previously or have never received AET. The study objective is to describe self-reported physical and emotional concerns of breast cancer survivors who are current, prior, or never-recipients of AET.

Methods

Secondary analysis was performed on a subset of survey data collected in the 2010 LIVESTRONG Survey. Breast cancer survivors (n?=?1,013, mean 5.4 years post-diagnosis) reported on 14 physical and eight emotional concerns that began after diagnosis and were experienced within 6 months of participation in the survey. Bivariate analyses examined the prevalence of each concern by AET status. The relationships between AET and burden of physical or emotional concerns were modeled with logistic regression.

Results

More than 50 % of the participants reported currently experiencing cognitive issues, fatigue, fear of recurrence, emotional distress, and identity/grief issues. Thyroid dysfunction and stigma concerns were more common among participants with prior AET (p?<?0.01), while fear of recurrence, emotional distress, and concern about appearance were more common among those currently receiving AET (p?<?0.01). Fatigue, sexual dysfunction, and pain were more common among prior and current AET recipients (p?<?0.01). In adjusted models, receipt of AET was associated with a higher number of physical, but not emotional concerns. A higher number of concerns was associated with younger age, having children, receipt of chemotherapy, longer duration of cancer treatment, and shorter time since diagnosis (p?<?0.01).

Conclusions

Breast cancer survivors who received AET were at risk of developing a variety of physical and emotional concerns, many of which persisted after treatment. These findings suggest the importance of developing individualized, supportive resources for breast cancer survivors.     

乳腺癌患者内分泌治疗相关症状及非药物干预的研究进展

乳腺癌已经成为威胁女性健康的常见恶性肿瘤,其发病率和病死率较高.内分泌治疗能有效减少乳腺癌的复发率和病死率,但也给患者带来严重的症状负担.该文对乳腺癌患者内分泌治疗相关的特异性症状及非药物干预方法进行综述,以期为临床护理实践和相关研究提供参考.     

乳腺癌患者内分泌治疗相关症状的调查研究

目的 调查乳腺癌患者内分泌治疗相关症状的发生情况,并探讨其影响因素。方法 采用方便抽样方法,应用一般情况调查表、乳腺癌内分泌治疗知识和态度问卷、乳腺癌患者生命质量测定-内分泌症状量表,于2019年11月—2020年4月在上海市2所三级甲等医院及1所抗癌康复俱乐部的患者随访平台对正在接受内分泌治疗的乳腺癌患者进行在线调查。结果 共回收有效问卷613份,患者内分泌症状量表评分总分为（18.99±11.43）分,其中容易烦躁或易怒、情绪波动、对性生活失去兴趣、潮热、关节痛、性交疼痛或不适是发生率和严重程度较高的症状。多元线性回归结果显示,年龄、自费、内分泌治疗药物种类、既往手术、既往化疗、内分泌治疗态度是症状发生的独立影响因素（P<0.05）,可解释总变异的19.1%。结论 乳腺癌患者内分泌治疗相关症状的发生率高,症状负担重,年龄小、自费、使用选择性雌激素受体调节剂、既往手术、既往化疗、内分泌治疗态度差的患者症状负担更重。     

乳腺癌患者术后淋巴水肿与其相关症状的关系研究

目的 调查乳腺癌患者术后不同程度淋巴水肿发生状况及其相关症状情况,分析两者之间的关系。 方法 采用便利抽样及目的抽样方法,选择乳腺癌行腋窝淋巴结清扫术后患者 224 例, 采用肢体周径测量法判断淋巴水肿严重程度, 采用乳腺癌淋巴水肿症状体验指数（ Breast Cancer and Lymphedema Symptom Experience Index , BCLE鄄SEI ）评估患者淋巴水肿相关症状体验。 结果 224 例患者中,无水肿 94 例（ 42.0% ）,轻度水肿 46 例（ 20.5% ）,重度水肿 84 例（ 37.5% ）。 轻度淋巴水肿患者的症状个数、症状严重程度及症状困扰总分高于无淋巴水肿患者（ P=0.007 ）;重度淋巴水肿患者的症状个数、症状严重程度及症状困扰总分高于轻度淋巴水肿患者（ P=0.017 ）。 轻度水肿患者的上肢肿胀、患肢沉重、患肢疲乏、患肢紧绷、患肢僵硬、手臂受限、 肘部受限、 手腕受限的发生率高于无水肿患者。 结论 淋巴水肿早期就出现相应症状,且症状体验随着水肿加重而越发严重。 关注患肢肿胀、患肢沉重等淋巴液积聚症状,可早 期发现淋巴水肿并给予早期干预,阻止或延缓水肿程度的进展。     

Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors

Purpose

This study aimed to compare the symptoms, unmet needs, and QoL reported by women at 6 months to <2 years and 2 to 5 years following surgery and adjuvant treatment for breast cancer. It also evaluated the relationships among symptoms, unmet needs, and QoL using structural equation modeling.

Methods

In this study, 113 and 137 survivors following breast cancer treatment 6 months to <2 years and 2 to 5 years, respectively, completed the Memorial Symptom Assessment Scale, the Supportive Care Needs Survey-34, and the Medical Outcomes Study 12-item Short Form Health Survey version 2.0 during their medical follow-up.

Results

The mean numbers of symptoms and unmet needs were 5.43 and 3.0, respectively, for survivors at <2 years, and 5.24 and 2.42, respectively, for survivors at 2 to 5 years following treatment. The most common reported symptoms were related primarily to physical domains. No significant differences were found between the two survivor groups on the MSAS scores. Survivors at <2 years reported significantly higher scores in Psychological and Health Care System/Information needs (p?<?0.01), and lower composite scores in physical and mental QoL (p?<?0.05) than those at 2 to 5 years post-treatment. Significant direct and indirect effects were found of symptom burden through unmet needs on survivors’ physical and mental QoL after adjustment for survival time, and the models showed a good fit.

Conclusions

Results suggest that breast cancer survivors continue to endure many symptoms independent of the survivorship period. The unmet needs mediate the relationship between symptom burden and survivors’ QoL.

     

Association between race and physical functioning limitations among breast cancer survivors

Purpose

The goal of this study was to examine differences in physical functioning limitations among African-American and white breast cancer survivors.

Methods

Data were analyzed from 115 African-American and 712 white breast cancer survivors who responded to a hospital registry-based survey. Physical functioning limitations were assessed using a series of eight questions in which individuals were asked about their ability to perform a physical task such as walking a quarter of a mile. A four-category summary score, representing overall severity of limitation, was created using participant responses to the eight questions. Ordinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (CI) for the association between race and physical functioning limitation adjusted for potential confounders.

Results

In the unadjusted model, the African-American breast cancer survivors were more than twice as likely to have a greater degree of physical functioning limitation compared to their white counterparts (OR 2.31; 95 % CI 1.59, 3.38). After adjustment for covariates, including body mass index (BMI), the race OR was attenuated and no longer statistically significant (OR 1.44; 95 % CI 0.92, 2.27).

Conclusions

Findings from this study showed that African-American breast cancer survivors were more likely to have worse physical functioning limitations than their white counterparts; however, much of this disparity was due to racial differences in other variables such as BMI. Future research should focus on effective interventions targeting modifiable risk factors of physical functioning limitations among breast cancer survivors with the goal of improving quality of life.     

Postoperative adjuvant therapy for premenopausal patients with breast cancer

The age peak of breast cancer morbidity is younger in Japan in comparison with that in Western countries. This results in a higher incidence of premenopausal patients in Japan. There are specific concerns on the postoperative adjuvant therapy for premenopausal patients, such as its influences on pregnancy, delivery and lactation, and acute and chronic adverse events related to earlier ovarian dysfunction. International guidelines such as the recommendations by the St. Gallen consensus conference provide clinicians with useful information on the risk assessment for recurrence and treatment selection of postoperative adjuvant therapy. Recommendations on postoperative adjuvant therapy for premenopausal breast cancer patients are presented according to the guidelines and evidence established by clinical trials. On-going clinical trials to resolve unanswered questions on the adjuvant therapy are also reviewed. Finally, future perspectives on the adjuvant therapy are discussed.     

应对方式、家庭亲密度适应性与乳腺癌患者自尊的关系

目的 探讨乳腺癌术后化疗患者应对方式、家庭亲密度适应性与自尊的关系.方法 采用Rosenberg自尊量表、医学应对问卷、家庭亲密度适应性量表,对300例乳腺癌术后化疗患者进行横断面调查.结果 乳腺癌患者的自尊与面对应对方式呈正相关(r=0.16,P＜0.05),与屈服应对方式呈负相关(r＝-0.16,P＜0.05).乳腺癌患者家庭实际亲密度、实际适应性与自尊均呈正相关(P＜0.05);亲密度不满意程度、适应性不满意程度与自尊均呈负相关(P＜0.05).结论 护理人员可引导乳腺癌患者采取积极的应对方式并发挥其家庭功能,以提高患者的自尊水平.     

Self-transformation as a factor in the self-esteem and well-being of breast cancer survivors

Diagnosis with a life-threatening illness can lead to many changes in one's self. These changes, called self-transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self-transformation among breast cancer survivors, (ii) examine factors associated with self-transformation in breast cancer survivors, and (iii) examine the relationships between self-transformation and self-esteem and well-being in breast cancer survivors and age-matched comparison women without cancer. Cancer survivors (n = 60) participated in structured interviews and both survivors and comparison women (n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self-esteem and well-being in comparison with (i) survivors grouped as feeling stuck and (ii) age-matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self-esteem and well-being than the other groups of survivors and lower well-being in comparison with healthy women of the same age. Findings provide support for the concept of self-transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self-transformation may be a factor in the self-esteem and well-being of breast cancer survivors.