Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups

ABSTRACT

Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated.

Design: Data comes from a nationally representative sample of 2011–2014 Health Information National Trends Surveys (HINTS).

Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans’ greater cancer/health information seeking, Japanese’ higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans’ odds of cancer screening were increased. Especially, Asian Americans’ odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites.

Conclusion: This research demonstrates that health organizations, providers, and Asian American patients’ collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans.     

Cigarette smoke and the hormonal receptors status in breast cancer

This paper describes 188 cases of early breast cancer in which age, menopause status, smoking, and pathological characteristics of the tumor were investigated, as well as status and levels of estrogen and progesterone hormone receptors.Estrogen and progesterone receptor status did not seem to differ between smokers and non-smokers.The data of this study does not confirm the observation of a larger number of cases among women who smoke. However, the proportion of estrogen-receptor-negative cases is slightly higher in pre-menopause smokers and in those patients more exposed to smoke both in terms of intensity (cigarette per day) and duration (years of exposure).Corresponding author.     

Postmastectomy/postlumpectomy pain in breast cancer survivors

Few studies have focused on careful assessment of postmastectomy pain (PMP); a chronic neuropathic pain syndrome that can affect women postlumpectomy or postmastectomy for breast cancer (BC). Study aims were to determine the prevalence of PMP in an outpatient sample of breast cancer survivors (BCS), describe subjective and objective characteristics of PMP, and examine the relationship between PMP and quality of life. Breast cancer survivors (n = 134) participated in telephone interviews, and those reporting PMP (n = 36) were invited to a pain center for further evaluation and treatment. Results show PMP is a distinct, chronic, pain syndrome affecting 27% of BCS. Findings support the need for clinical trials evaluating the effectiveness of nonpharmacological or cognitive behavioral therapies in alleviating mild to moderate PMP.     

Doctor‐patient communication patterns in breast cancer adjuvant therapy discussions

Objective To identify variables within the patient‐oncologist communication pattern that impact overall patient comprehension and satisfaction within the breast cancer adjuvant therapy (AT) setting. Setting and participants Fifty patients were recruited from a number of academic and community‐based oncology practices. Fifteen oncologists participated. Main variables Three communication variables were identified: percentage of total utterances spoken by the patient, percentage of total physician utterances that were coded as affective (i.e. emotional), and total number of questions asked by the patient during the consultation. Knowledge and satisfaction were assessed by a variety of outcome measures, including knowledge items and satisfaction as measured by VASs, the satisfaction with decision scale and the decisional conflict scale. Results The level of patient knowledge about breast cancer and satisfaction with the clinical encounter showed a tendency to correlate with the variables measuring aspects of patient‐physician communication style. Patients who spoke more or asked more questions tended to be more knowledgeable whilst patients whose physicians used more affective language tended to know less but to be more satisfied with their clinical encounter. Conclusions In order to optimize patients’ degree of comprehension and satisfaction with their breast cancer adjuvant therapy, physicians need to increase their affective participation in clinical encounters whilst encouraging patients to ask questions and to actively participate in the decision‐making process.     

乳腺癌骨转移同位素与双膦酸盐治疗的对比研究

目的对比分析同位素（^89SrCl2）与双膦酸盐（帕米膦酸二钠）治疗乳腺癌骨转移的疗效。方法以108例乳腺癌骨转移患者为研究对象，其中^89SrCl2组41例，帕米膦酸二钠组36例，联合用药组31例。进行临床对比观察。结果^89SrCl2组和帕米膦酸二钠组对镇痛总有效率分别为80．5％和80．6％，对骨转移病灶总有效率分别为17．1％和8．3％，生活质量总改善率分别为48．9％和44．4％，以上两组3个指标比较差异均无统计学意义（P〉0．05）。而联合用药组镇痛总有效率为90．6％，和^89SrCl2组、帕米膦酸二钠组相比差异无统计学意义（P〉0．05），但是联合用药组对骨转移病灶有效率和生活质量总改善率分别为48．4％和74．2％，并且和^89SrCl2组、帕米膦酸二钠组比较差异有统计学意义（P〈O．05）。108例患者不良反应均较小。结论^89SrCl2和帕米膦酸二钠在治疗乳腺癌骨转移中，对镇痛及骨转移病灶和生活质量改善有同等较好的疗效。应用^89SrCl2和帕米膦酸二钠联合治疗不仅可以显著提高疗效而且不良反应无明显增加。     

新辅助内分泌治疗绝经后乳腺癌的临床疗效观察

目的 观察和探讨新辅助内分泌治疗绝经后乳腺癌的临床疗效和应用价值.方法 对56例绝经后乳腺癌患者应用新辅助内分泌治疗,疗效达CR（完全缓解）、PR（部分缓解）或SD（稳定）则继续进行治疗,直至病情出现PD（进展）或主动提出终止内分泌治疗,再给予手术治疗.结果 所有患者中CR 6例,PR 29例,总有效率（CR＋PR）为62.5%;不同受体阳性患者中,以ER、PR双阳性疗效最好,有效率为78.38%.结论 新辅助内分泌治疗用于治疗绝经后激素受体阳性的乳腺癌患者有明显疗效,副作用小,具有在临床上推广的价值.     

乳腺癌分子靶向治疗的新进展

乳腺癌的靶向治疗研究已经成为乳腺癌治疗领域研究的热点,是继手术、放疗和化疗三大传统模式之后一种全新的生物治疗模式。分子靶向治疗是针对可能导致细胞癌变的靶点,如原癌基因和抑癌基因、细胞信号转导通路、细胞因子及受体、抗肿瘤血管形成等,从分子水平逆转这种恶性生物学行为,从而抑制肿瘤细胞生长,具有特异度高、副作用小的优点。本文主要对乳腺癌分子靶向治疗药物作用的靶点及靶向治疗的最新进展做一综述。     

胸苷磷酸化酶作为乳腺癌治疗靶标的临床研究

目的：研究胸苷磷酸化酶（TP）在乳腺癌组织中的表达及其作为乳腺癌治疗靶标的可能性，同时探索TP在以5-FU为基础的化疗中化疗敏感性的预测作用。方法：采用免疫组化法，检测72例乳腺癌病例及15例良性乳腺肿瘤组织和15例正常乳腺组织中TP的表达，分析其与临床病理参数的关系。并在行含5-FU方案化疗的乳腺癌亚群中分析TP表达对预后的影响。结果：乳腺癌组织中TP表达高于正常乳腺组织和乳腺良性肿瘤组织。TP在不同年龄、病理类型、TNM分期和淋巴结转移和ER、PR和C-erbB-2中表达差异无统计学意义（P〉0．05），与高组织学分级及P53表达有关。在行含5-FU方案化疗的乳腺癌亚群中进行生存分析，TP阳性组与TP阴性组的5年总生存率差异有统计学意义（P〈0．05）。结论：TP在乳腺癌中高表达，与高组织学分级和P53表达有关。在以5-FU为基础的乳腺癌联合化疗中TP阳性组预后较TP阴性组预后为佳，因此TP在以5-FU为基础的乳腺癌联合化疗中可能起到化疗敏感性的预测作用。     

Influence of exercise activity on quality of life in long-term breast cancer survivors

Background: Behavioral and lifestyle factors may influence quality of life (QOL) outcomes in breast cancer survivors. Methods: Information on QOL (Short Form-36, SF-36), lifestyle and survivorship was collected during telephone interviews with 374 breast cancer patients, diagnosed between 1983 and 1988 at ages 40 years or younger and interviewed, on average 13.2 years following diagnosis. These women previously participated in a case-control study soon after their diagnoses, providing information on breast cancer risk factors including exercise activity. We examined the impact of changes in exercise activity (comparing pre- to post-diagnosis levels) on the SF-36 mental and physical health summary scales using regression analyses. Results: A positive change in exercise activity was associated with a higher score on the SF-36 physical health summary scale at follow-up (p= 0.005). Change in exercise activity was not associated with the SF-36 mental health summary scale score. Patients who increased their activity levels did not differ from those who did not in terms of medical or demographic characteristics. Conclusion: This study provides one of the longest follow-up periods of breast cancer survivors to date among studies that focus on QOL and is unique in its focus on women diagnosed at a young age. Our results confirm high levels of functioning and well-being among long-term survivors and indicate that women whose exercise activity increased following diagnosis score higher on the SF-36 physical health summary scale. These findings suggest a potential role for exercise activity in maintaining well-being after a cancer diagnosis.     

Factors influencing quality of life in breast cancer survivors

Longitudinal data from 195 breast cancer survivors were used to identify factors affecting the level and rate of change in quality of life after completion of treatment. Women were interviewed up to four times at approximately yearly intervals using Kaplan and Bush's Quality of Well Being instrument (QWB). Random coefficient regression analysis was used to model QWB as a function of time since diagnosis and personal characteristics. QWB scores decreased over time and the rate of decline increased with age (p = 0.032). This was similar to declines in women with benign breast biopsies, but overall QWB levels were lower in women with breast cancer. Having a spouse tended to slow the rate of decline in breast cancer survivors (p = 0.004). The presence of comorbidity was associated with significantly lower QWB levels (p = 0.037) but did not affect the rate of change over time. Education, family history of breast cancer, cancer stage and treatment modalities were not significantly related to QWB levels or rates of change. Breast cancer survivors experience a reduction in quality of life that persists for years after treatment and is similar in magnitude to that associated with other health problems.     

乳腺癌易感基因1在散发性乳腺癌中的表达及其临床意义

目的 研究乳腺癌易感基因1(BRCA1)在散发性乳腺癌中的表达与各病理学指标之间的相关性.方法 应用SABC免疫组化染色法对30例乳腺纤维腺瘤和42例乳腺癌患者的病变组织中BRCA1的表达进行检测,并与腋窝淋巴结转移、肿瘤大小、组织学类型和组织学分级进行相关分析.结果 BRCA1在乳腺纤维腺瘤中的阳性表达率为85.7%(36/42),在乳腺癌中的阳性表达率为52.4%(22/42),乳腺癌中腋窝有淋巴结转移的BRCA1阳性表达率明显低于无淋巴结转移的BRCA1阳性表达率(P<0.05),BRCA1在乳腺癌中的阳性表达率随着组织学分级的升高有逐渐下降趋势,其中Ⅰ级和Ⅲ级、Ⅱ级和Ⅲ级比较差异有统计学意义(P<0.05),Ⅰ级与Ⅱ级比较差异无统计学意义(P>0.05),BRCA1的表达与肿瘤的组织学类型、肿块大小无关(P值均>0.05).结论 BRCA1在乳腺癌的发生、发展过程中有重要的作用,它有可能成为临床对乳腺癌治疗和判断预后的一个生物学指标.     

第三代芳香化酶抑制剂在绝经后乳腺癌新辅助内分泌治疗中的应用

乳腺癌新辅助内分泌治疗是指对非转移性的乳腺癌患者在应用局部治疗前进行的系统性的内分泌治疗.研究证实,第三代芳香化酶抑制剂（Aromatase inhibitors,AIs）应用于绝经后乳腺癌患者的新辅助内分泌治疗效果显著优于他莫西芬（Tamoxifen,TAM）,并且能够明显提高局部进展期乳腺癌（Locally advanced breast cancer,LABC）的手术切除率,改善巨大肿瘤和不可手术切除乳腺癌的外科治疗效果.     

Wellbeing and nutrition-related side effects in children undergoing chemotherapy

Objective: To describe wellbeing and nutrition‐related side effects in a group of paediatric oncology patients undergoing chemotherapy, and to examine associations with nutritional status, disease and treatment‐related factors. Methods: Cross‐sectional survey of patients attending the Sydney (n = 41) or John Hunter Children’s Hospitals (n = 13). Wellbeing was assessed using the Multi‐attribute Health Status Classification Scheme (MHSCS) and the Play Performance Scale (PPS). Disease and treatment details were obtained through patient and parent interviews and audit of medical records. Nutritional status was assessed using anthropometric and biochemical measurements. Results: Twenty‐four per cent and 33% scored maximum points on the MHSCS and PPS, respectively. Advanced stage of solid tumour or lymphoma was associated with worse MHSCS scores, P = 0.008. Longer time on treatment correlated negatively with PPS scores (r = ?0.35; P = 0.030). The most frequent side effects were nausea, decreased appetite, vomiting and changes in taste. While 67% experienced five or more side effects concurrently, the number increased with length of time on treatment (r = 0.38; P = 0.006). Of the 23 patients experiencing five or more side effects, only two had been seen by a dietitian in the previous two months. Conclusion: Nutrition‐related side effects are common in children undergoing chemotherapy, with the number of side effects not decreasing over time. While wellbeing scores were generally satisfactory, those with advanced stage of solid tumour or lymphoma, or with longer time on treatment, reported lower scores. We recommend that all paediatric oncology patients are referred for dietetic review, even those in the later stages of treatment, in order to optimise nutritional status and wellbeing.     

Health status and health resource use among long-term survivors of breast,colorectal and prostate cancer

Introduction

The growing number of long-term cancer survivors poses a new challenge to health care systems. In Spain, follow-up is usually carried out in oncology services, but knowledge of cancer survivors’ health care needs in this context is limited. The purpose of this study was to ascertain the health status of long-term survivors of breast, prostate, and colorectal cancer and to characterize their use of health care services.

Methods

Retrospective multicenter cohort study. We collected data from patients’ clinical histories and through telephone interviews, using a specially designed questionnaire that included the SF-36v2 Quality of Life and Nottingham Health Profile scales.

Results

The questionnaire was completed by 51.2% (n= 583) of the potential sample. No significant differences were observed between 5-year and 10-year survivors. Overall, more than 80% of respondents were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer-related morbidity was low and of little complexity. For the most part, participants reported using primary care services for care of chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow-up was centralized at the hospital.

Conclusions

Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain.     

Health, healing and recovery: therapeutic landscapes and the everyday lives of breast cancer survivors

Drawing on the theory of therapeutic landscapes, this paper examines the importance of place for shaping health and healing among breast cancer survivors. Semi-structured in-depth interviews were conducted with 14 women in the Greater Toronto Area at various stages of breast cancer recovery to examine where and how they access and create landscapes of healing. The interviews revealed the importance of everyday and extraordinary therapeutic landscapes that are created in bodies and homes, as well as the broader community and nature. Those landscapes with which women interact on an everyday basis appear to be most important for physical and psychological healing. In addition, the research suggests a strong interplay between emotions and place such that emotional geographies, which appear to be embedded within places of healing, play an important role in shaping and maintaining therapeutic landscapes. Further research is needed to understand the place of emotions in creating therapeutic landscapes, particularly for those populations most in need of healing.     

Hormone replacement therapy in breast cancer patients and survivors

Menopause is arguably the most important phase of a woman's social, physiologic, and personal life. Approximately 1.3 million women reach this age in the United States annually. In the past decade, numerous studies have correlated breast cancer and the use of ERT (estrogen replacement therapy) or HRT (hormone replacement therapy) in menopausal women. Whether this is an actual increase in the creation of new cancers or a result of a diagnostic or other bias has yet to be determined. Even more uncertainty surrounds the use of hormones once breast cancer is diagnosed. Previously, once a woman was diagnosed with an estrogen-dependent tumor, ERT and HRT were simply forbidden. As discussed herein, that is no longer the case.     

Personal accounts of exercise and quality of life from the perspective of breast cancer survivors

Objectives The purpose of the study was to examine breast cancer survivors’ perceptions of exercise and their quality of life (QoL). Methods About 289 breast cancer survivors completed a survey addressing exercise attitudes, behaviour and perceived QoL. In addition, the breast cancer survivors completed two open-ended questions designed to explore perceptions of exercise and QoL throughout their cancer experience. Inductive and deductive content analyses were used to analyse responses. Results About 19 first-order themes were identified, which were clustered into five second-order themes that included; Exercise behaviour, Lifestyle, Limitations and barriers, Growth and priorities, and Personal beliefs and values. The findings identified a framework of multifaceted views held by breast cancer survivors in relation to their QoL and outlook on their disease. Conclusions Given that cancer survivors are faced with a number of treatment related morbidities 2 years post-diagnosis, there is a need for health professionals to carefully address a cancer survivor’s exercise needs in an attempt to help improve their future QoL.     

乳腺癌浸润相关因素分析及其在保乳手术中的应用

目的 探讨乳腺癌保乳手术距肿瘤边缘最佳的切除范围及肿瘤浸润相关因素。方法 对100例乳腺癌患者行肿瘤切除的标本分别距肿瘤边缘0．5、1．0、1．5、2．0cm处进行病理学检查，并对乳腺癌浸润与肿瘤大小、年龄、腋窝淋巴结及肿瘤分期等临床相关性进行分析。结果 100例标本中，分别于0．5、1．0、1．5、2．0cm处发现癌细胞浸润36、26、15、0例，肿瘤浸润距离与肿瘤大小呈正相关，与年龄呈负相关，与肿瘤分期（I、Ⅱ期）无明显相关性。0．5cm浸润距离的腋窝淋巴结阳性率较高，大于1．0cm的浸润距离与腋窝淋巴结状态无相关性。结论 乳腺癌行保乳手术的切除范围至少应为距离肉眼可见肿瘤边缘2．0cm的癌旁组织织。     

成都市社区女性乳腺癌认知及乳腺自检行为调查分析

目的 调查了解成都市社区女性乳腺癌相关知识知晓情况及乳腺自检行为现状,分析影响乳腺自检行为的因素,为制定和实施提高女性乳腺癌相关知识水平和促进乳腺检查行为的措施提供参考依据。方法 采用两阶段随机抽样方法,抽取成都市社区1 541名年满15岁且未诊断乳腺癌的女性进行问卷调查。使用方法包括描述性分析、χ2检验、非条件二分类logistic回归分析。结果 调查女性乳腺癌知识的总知晓率为29.3%(10 848/36 984),做过乳腺自检的女性仅占25.5%(393/1 541)。乳腺自检行为受到年龄（45～59岁OR=2.436,95%CI:1.343～4.419;≥60岁OR=2.327,95%CI:1.181～4.582）、文化程度（高中/技校/中专OR=3.169,95%CI:1.777～5.653;大专OR=2.842,95%CI:1.526～5.293;本科及以上OR=3.752,95%CI:2.009～7.007）、获取乳腺癌知识的主动性（OR=3.905,95%CI:2.483～6.141）及乳腺癌认知水平（OR=1.186,95%CI:1.148～1.225）的影响。结论 ...