Sources of meaning in cancer patients – influences on global meaning,anxiety and depression in a longitudinal study

Although existential needs are highly prevalent in patients with cancer, specific sources of meaning have been little explored. We investigated whether specific sources of meaning predict global meaning and psychological distress. N = 258 patients with breast (45%), lung (39%) and gynaecological cancer (16%) completed a battery of validated questionnaires at T1. Six months later (T2), n = 183 (78%) patients participated again. The primary outcomes – sources of meaning, global meaning and psychosocial distress – were measured with the Sources of Meaning Profile‐Revised (SOMP‐R), Life Attitude Profile‐Revised (LAP‐R) and modules for depression and anxiety of the Patient Health Questionnaire (PHQ‐9, GAD‐7). Most important sources of meaning were ‘engaging in personal relationships’, ‘preserving human values and ideals’ and ‘feeling financially secure’. Stepwise multivariate regression analyses controlling for demographic and medical factors revealed that ‘engaging in personal relationships’, ‘preservation of culture and tradition’ and ‘interest in social and/or political causes’ predicted lower depression. ‘Leaving a legacy for the next generation’ and ‘feeling financially secure’ predicted both higher depression and anxiety. The findings highlight the relevance of sources of meaning for the psychological well‐being of cancer patients and point towards specific sources of meaning that should be focused in psychosocial interventions.     

Erythrocyte membrane fatty acids and breast cancer risk: a prospective analysis in the nurses' health study II

The roles of specific fatty acids in breast cancer etiology are unclear, particularly among premenopausal women. We examined 34 individual fatty acids, measured in blood erythrocytes collected between 1996 and 1999, and breast cancer risk in a nested case‐control study of primarily premenopausal women in the Nurses' Health Study II. Breast cancer cases diagnosed after blood collection and before June 2010 (n = 794) were matched to controls and conditional logistic regression was used to estimate OR's (95% CI's) for associations of fatty acids with breast cancer; unconditional logistic regression was used for stratified analyses. Fatty acids were not significantly associated with breast cancer risk overall; however, heterogeneity by body mass index (BMI) was observed. Among overweight/obese women (BMI ≥ 25), several odd‐chain saturated (SFA, e.g. 17:0, OR_Q4vsQ1(95% CI) =1.85 (1.18 – 2.88), p_trend=0.006 p_int<0.001), trans (TFA, e.g. 18:1, OR_Q4vsQ1(95% CI) =2.33 (1.45 – 3.77), p_trend<0.001, p_int=0.007) and dairy‐derived fatty acids (SFA 15:0 + 17:0 + TFA 16:1n‐7t; OR_Q4vsQ1(95% CI) =1.83(1.16 – 2.89), p_trend=0.005, p_int<0.001) were positively associated, and n‐3 polyunsaturated fatty acids (n‐3 PUFA, e.g. alpha‐linolenic acid; OR_Q4vsQ1(95% CI) =0.57 (0.36 – 0.89), p_trend=0.017, p_int=0.03) were inversely associated with breast cancer. Total SFA were inversely associated with breast cancer among women with BMI < 25 (OR_Q4vsQ1(95% CI) =0.68 (0.46 – 0.98), p_trend=0.05, p_int=0.01). Thus, while specific fatty acids were not associated with breast cancer overall, our findings suggest positive associations of several SFA, TFA and dairy‐derived fatty acids and inverse associations of n‐3 PUFA with breast cancer among overweight/obese women. Given these fatty acids are influenced by diet, and therefore are potentially modifiable, further investigation of these associations among overweight/obese women is warranted.     

Association of breast cancer risk loci with breast cancer survival

The survival of breast cancer patients is largely influenced by tumor characteristics, such as TNM stage, tumor grade and hormone receptor status. However, there is growing evidence that inherited genetic variation might affect the disease prognosis and response to treatment. Several lines of evidence suggest that alleles influencing breast cancer risk might also be associated with breast cancer survival. We examined the associations between 35 breast cancer susceptibility loci and the disease over‐all survival (OS) in 10,255 breast cancer patients from the National Cancer Institute Breast and Prostate Cancer Cohort Consortium (BPC3) of which 1,379 died, including 754 of breast cancer. We also conducted a meta‐analysis of almost 35,000 patients and 5,000 deaths, combining results from BPC3 and the Breast Cancer Association Consortium (BCAC) and performed in silico analyses of SNPs with significant associations. In BPC3, the C allele of LSP1‐rs3817198 was significantly associated with improved OS (HR_per‐allele=0.70; 95% CI: 0.58–0.85; p_trend = 2.84 × 10^?4; HR_{heterozygotes} = 0.71; 95% CI: 0.55–0.92; HR_homozygotes = 0.48; 95% CI: 0.31–0.76; p_2DF = 1.45 × 10^?3). In silico, the C allele of LSP1‐rs3817198 was predicted to increase expression of the tumor suppressor cyclin‐dependent kinase inhibitor 1C (CDKN1C). In the meta‐analysis, TNRC9‐rs3803662 was significantly associated with increased death hazard (HR_META =1.09; 95% CI: 1.04–1.15; p_trend = 6.6 × 10^?4; HR_{heterozygotes} = 0.96 95% CI: 0.90–1.03; HR_homozygotes = 1.21; 95% CI: 1.09–1.35; p_2DF=1.25 × 10^?4). In conclusion, we show that there is little overlap between the breast cancer risk single nucleotide polymorphisms (SNPs) identified so far and the SNPs associated with breast cancer prognosis, with the possible exceptions of LSP1‐rs3817198 and TNRC9‐rs3803662.     

Depression,anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients

MEHNERT A., LEHMANN C., GRAEFEN M., HULAND H. & KOCH U. (2010) European Journal of Cancer Care 19 , 736–745
Depression, anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients The aim of this study is to identify anxiety, depression and post‐traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health‐related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow‐up care for an average of 27 months after surgery using standardised self‐report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist – Civilian Version, Illness‐Specific Social Support Scale, Short‐Form Health Survey). Seventy‐six per cent of patients evaluated their disease as ‘not’ or a ‘little threatening’. The cancer diagnosis and uncertainty were most frequently reported as ‘distressing’, while medical treatment and doctor–patient interaction were most frequently evaluated as ‘most helpful’. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age‐adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co‐morbidity (P < 0.001). Lack of positive support, detrimental interactions, threat of cancer, disease stage and age significantly predicted mental health (P < 0.001), whereas the impact of social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening.     

Prognostic evaluation of VEGFA genotypes and haplotypes in a cohort of Brazilian women with non metastatic breast cancer

Vascular Endothelial Growth Factor (VEGF) mediates angiogenesis, which is crucial for tumor development and progression. The present study aimed to evaluate the impact of VEGFA gene polymorphisms rs699947, rs833061, rs1570360, rs2010963 and rs3025039 on breast cancer features and prognosis. A cohort of Brazilian women (N = 1038) with unilateral non-metastatic breast cancer was evaluated. The association between VEGFA polymorphisms and histopathological features or pathological complete response (pCR) to neoadjuvant chemotherapy was evaluated by the Chi-square test, with calculation of the respective odds ratio (OR) and 95% confidence intervals (95% CI). The impact of individual categories on disease-free survival was evaluated using Kaplan-Meier curves and multivariate Cox proportional hazards regression models for calculation of adjusted hazard ratios (HR_adjusted). Variant genotypes of rs699947 (CA + AA) were significantly associated with high-grade (G2 + G3) tumors (OR = 1.82; 95% CI = 1.15 – 2.89), and with shorter disease-free survival among patients treated with neoadjuvant chemotherapy followed by mastectomy (HR_adjusted = 1.82; 95% CI = 1.16 – 2.86). Variant genotypes of rs833061 (TC + CC) were significantly associated with high-grade (G2 + G3) tumors (OR = 1.79; 95% CI = 1.12 – 2.84) and with positive lymph node status (OR = 1.34; 95% CI = 1.01 – 1.77), but showed no independent effect on disease-free survival. Variant haplotypes (*2 to *5) appear to favor pCR (OR = 7.1; 95% CI = 1.7 – 30.1). VEGFA genotyping may add to prognostic evaluation of breast cancer, with rs699947 being the most likely to contribute.     

早期乳腺癌保乳术后瘤床同步加量短疗程放疗临床观察

目的 探讨早期乳腺癌保乳术后瘤床同步加量短疗程放疗疗效、不良反应以及美容效果。方法 2008—2010年本院收治早期乳腺癌保乳术后患者 306例,其中 160例行常规分割放疗(常规组),两野切线全乳照射,后续瘤床电子线推量,总疗程 46~48 d;146例行短疗程放疗(短程组),两野切线全乳照射,同步瘤床电子线推量,总疗程 30~32 d。Kaplan-Meier法计算生存率和局部复发率并Logrank检验差异,χ²检验两组资料可比性、不良反应及美容效果。结果 中位随访时间26个月,随访率为100%。两组1、2、3年生存率均为100%,均无局部复发(χ²=0.00,P=1.000)。常规组与短程组1、2级急性皮肤反应发生率分别为46.9%与45.1%(χ²=0.73,P=0.695)、16.3%与13.7%(χ²=0.73,P=0.695),1级皮肤及皮下组织晚期反应发生率分别为16.9%与17.1%(χ²=0.00,P=0.954);1级中性粒细胞减少发生率分别为11.9%与13.7%(χ²=0.23,P=0.633);美容优良率分别为66.2%与65.5%(χ²=0.01,P=0.927)。结论 保乳术后全乳放疗同步瘤床加量的短疗程方案与常规放疗的疗效相似,美容效果相当且未加重皮肤反应,但还需进一步研究。     

Unique associations of eudaimonic and hedonic wellbeing with psychosocial adjustment in breast cancer survivors

Abstract

Purpose: Eudaimonic wellbeing (e.g., meaning, purpose in life) and hedonic wellbeing (e.g., happiness, life satisfaction) are related but conceptually distinct facets of wellbeing. Eudaimonic wellbeing is highly underexplored in cancer research despite its relevance to important existential concerns faced by cancer survivors. Therefore, this study examined the unique associations of eudaimonic and hedonic wellbeing with adjustment in breast cancer survivors.

Methods: Women diagnosed with early-stage breast cancer within two years (N?=?64) were recruited through the UCLA Tumor Registry and completed self-report questionnaires (Mental Health Continuum – Short Form Scale, Posttraumatic Growth Inventory, Social Provisions Scale, Quality of Life in Adult Cancer Survivors Scale, Center for Epidemiological Studies – Depression Scale, Pittsburgh Sleep Quality Index, Fatigue Symptom Inventory, Perceived Stress Scale).

Findings: Controlling for their shared variance and covariates, eudaimonic wellbeing was uniquely associated with greater posttraumatic growth (β?=?0.42, p?=?.026, R²?=?.07), more reliable social support (β?=?0.50, p?=?.010, R²?=?.09), and marginally lower fear of recurrence (β?=?–0.40, p?=?.063, R²?=?.06) while hedonic wellbeing was uniquely associated with lower sleep disturbance (β?=?–0.56, p?=?.004, R²?=?.12), fatigue (β?=?–0.53, p?=?.003, R²?=?.11), and depressive symptoms (β?=?–0.59, p?<?.001, R²?=?.14).

Conclusions: Findings suggest eudaimonic wellbeing may confer quality of life benefits beyond symptom reduction in breast cancer survivors, while hedonic wellbeing is primarily associated with fewer behavioral symptoms.     

Cancer‐related trauma,stigma and growth: the ‘lived’ experience of head and neck cancer

Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme – Distress, Stigma and Psychological Growth – encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on ‘self’. Acceptance allowed a new sense of identity that recognised cancer‐related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer‐related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic ‘self’ for psychological growth. Implications are discussed.     

Development of the Psycho-social Discomfort Scale (PsDS): investigation of psychometric properties among Japanese breast cancer survivors

Objective: To develop a new scale to assess psycho‐social discomfort in breast cancer (BC) survivors in Japanese society and to investigate its psychometric properties. Method: A total of 248 Japanese BC survivors completed both the Psycho‐social Discomfort Scale (PsDS) and WHO Quality of Life BREF Japanese version (WHO QoL‐Jp). A principal component factor analysis (with promax rotation) was performed, and internal consistency was examined using Cronbach's alpha. Divergent and convergent validities and criterion validity were examined using the Spearman's R. Results: The factor analysis extracted three factors: ‘internalised stigma (IS)’, ‘social disclosure of BC (SD)’, and ‘psychological resources to live with BC (PR)’. The factors were moderately correlated. The scale had good internal consistency (alpha = 0.80). All sub‐scales were inversely correlated with all the domains in the WHO QoL‐Jp (r = ?0.09 to ?0.47). BC stage was significantly correlated with the SD sub‐scale, and type of surgery was significantly correlated with the IS sub‐scale. Conclusions: The PsDS has 25 items. It measures psycho‐social discomfort that Japanese BC survivors experienced or were experiencing in their community. It has a simple factor structure, relatively good internal consistency, and a satisfactory divergent validity. Copyright © 2010 John Wiley & Sons, Ltd.     

Locoregional recurrence of pT3N0M0 breast cancer after mastectomy is not higher than that of pT1‐2N0M0: An analysis for radiotherapy

The purpose of this study was to investigate the value of post‐operative radiotherapy in the treatment of pT3N0M0 breast cancer after mastectomy. We analyzed the clinical data of 1390 patients with pT1‐3N0M0 breast cancer who were admitted and treated from 1998 to 2007 at the Sun Yat‐sen University Cancer Center. All patients underwent mastectomy and did not receive radiotherapy. The locoregional recurrence‐free survival, distant metastasis‐free survival and overall survival of different T stages of breast cancer were compared. The median follow‐up duration was 72 months. The 10‐year locoregional recurrence‐free survival patients with pT1N0, pT2N0 and pT3N0 breast cancers were 95.3, 91.9 and 93.6%, respectively (χ² = 2.550, P = 0.279). The 10‐year distant metastasis‐free survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 88.1%, 81.0% and 78.4%, respectively (χ² = 8.254, P = 0.016). The 10‐year overall survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 91.9%, 83.5% and 73.0%, respectively (χ² = 12.403, P = 0.002). Univariate analyses failed to identify any prognostic factors for locoregional recurrence in pT3N0 patients. Multivariate analysis showed that the T stage had no effect on locoregional recurrence. The locoregional recurrence rate in patients with pT3N0M0 breast cancer who underwent mastectomy and did not receive postoperative radiotherapy was not higher than that in patients with pT1‐2N0M0 breast cancer who received the same treatment, suggesting that routine adjuvant post‐operative radiotherapy should not be recommended in this patient population.     

分子分型对1~3个腋窝淋巴结转移早期乳腺癌患者局部或区域复发风险的预测价值

目的 研究1~3个腋窝淋巴结转移早期(病理N₁期)乳腺癌分子分型与术后局部或区域复发(LR)间关系,探讨改进个体化辅助放疗指征。方法 回顾分析1998—2009年本院手术的 547例病理T_1~2N₁M₀期乳腺癌根治术后未行放疗患者。根据免疫组织化学、荧光原位杂交检测结果分为Luminal A、Luminal B、HER-2过表达和三阴型,比较LR复发率(LRR)及LR生存率(LRFS),并结合临床病理特征对其LR风险进行分组分析。Kaplan-Meier法计算LRR、LRFS并Logrank法检验和单因素预后分析,多因素预后分析采用Cox模型。结果 Luminal A、Luminal B、HER-2过表达和三阴型分别占30.0%、48.6%、9.3%和12.1%。随访率97.1%,随访时间满5、10年者分别为334、127例。单因素分析显示HER-2过表达型、三阴型LR风险比Luminal A型高,5年LRR分别为19.0%、14.9%与5.3%(χ²=4.28、5.02,P=0.026、0.015),LRFS分别为73.5%、80.6%与91.1%(χ²=7.27、4.77,P=0.005、0.021)。多因素分析显示HER-2过表达型、三阴型、年龄≤35岁、pT₂期病变是LRR及LRFS的不良预后因素(χ²=2.29、2.08、18.22、6.86,P=0.020、0.016、0.001、0.005及 χ²=1.90、1.41、8.58、3.94,P=0.006、0.025、0.002、0.039)。有以上0、1和≥2个危险因素者 10年LRR分别为4.3%、14.1%和31.9%(χ²=28.03,P=0.000)。结论 分子分型有助于个体化区别1~3个腋窝淋巴结转移病理N₁早期乳腺癌患者间LR风险,具有多个危险因素者应接受术后放疗。     

Onset and relapse of psychiatric disorders following early breast cancer: a case–control study

Objective: Our objective is to evaluate the mental status of primary early breast cancer survivors according to DSM‐IV criteria, distinguishing new psychiatric diagnosis, which started after the cancer diagnosis from relapse. Methods: A comparative study of 144 breast cancer survivors and 125 women without previous history of cancer was carried out. Neuropsychiatric symptomatology was assessed retrospectively using standardized psychiatric examinations (Mini International Neuropsychiatric Interview, Watson's Post‐Traumatic Stress Disorder Inventory) over three successive periods, ‘before cancer’ (from childhood to 3 years before the interview), ‘around the cancer event’ (the last 3 years including the time of diagnosis and treatment), and ‘currently’ (the last 2 weeks). Results: Increased rates of anxiety and mood disorders were observed following a diagnosis of breast cancer compared with controls (generalized anxiety disorder (GAD) and major depressive disorder (MDD); 10.4 vs 1.6% and 19.4 vs 8.8%, respectively). The cancer disease promoted the development of dysthymia (n=4 new cases/6 two‐year prevalent cases) and PTSD (7/7) and the re‐emergence of MDD (n=21 relapses/28 three‐year prevalent cases) and GAD (10/15). No improvement in serious mood disorders such as MDD (16.0 vs 7.2%) and dysthymia (4.2 vs 0%) was reported at the time of interview, more than 1.75 years (median time) after the cancer surgery, the prevalence being 2–4 times greater in breast cancer survivors than in controls. Conclusion: Despite significant advances in treatment, a diagnosis of breast cancer is highly associated with various forms of psychopathology, regardless of psychiatric history, with symptoms persisting after treatment. These results may assist clinicians in planning mental healthcare for women with breast cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

改良食管癌UICC第七版分期预测术前放疗预后价值分析

目的 评价食管癌术前放疗后病理T、N分期以及国际抗癌联盟(UICC) TNM分期是否能准确预测预后。方法 回顾分析1980—2007年本院接受术前放疗并有详细临床、病理、放疗和手术记录的 311例食管鳞状细胞癌患者资料。Kaplan-Meier法生存分析并Logrank检验和单因素分析。结果 随访率96.5%,随访时间满5、10年者分别为89、43例。全组单因素分析发现放疗后原发部位有无肿瘤残存(T-pCR,χ²=11.53,P=0.001)和淋巴结转移个数(0、1~3、≥4个,χ²=42.13,P=0.000)是影响预后因素。UICC第7版分期可用于区分上述患者预后。而根据转移淋巴结数改良第7版N分期为N₀(0个)、N₁(1~3个)、N₂(≥4个)期并结合残存癌T分期,则ypⅠ期(T_1~2N₀M₀期)与ypⅡ期(T_0-3N₁M₀期+T₃N₀M₀期)、ypⅡ期与ypⅢ期(T₄N_0~1M₀期或T_0-3N₂M₀期)间预后差异均有统计学意义(χ²=11.15、23.39,P=0.001、0.000)。结论 食管鳞状细胞癌术前放疗后病理的T分期和阳性淋巴结个数是影响预后因素。UICC 第7版分期能较准确评价预后,改良第7版N分期后与T分期结合更方便、准确预测预后。     

A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer

Purpose. To assess how women with ductal carcinoma in situ (DCIS) perceive their risks of recurrence, dying from breast cancer, and psychological distress compared to women with early stage invasive breast cancer (EIBC). Patients and methods. Eligible patients included those with DCIS or EIBC (T1 or T2, N0) referred to one cancer center between November 1998 and June 1999. Participants completed a self-administered survey regarding their views of their risks of developing recurrent cancer, of dying of breast cancer and the presence of psychological symptoms of distress. Responses were scored and compared between the two groups. Results. In total, 495 patients were screened, 240 found ineligible, 228 patients who agreed to participate. No significant difference between the two groups was observed in perceptions of risk related to the likelihood of developing local recurrence (DCIS: 53%, EIBC 45%, P = 0.14), distant recurrence (DCIS: 36%; EIBC: 39%, P = 0.35) or dying of breast cancer (DCIS: 27%, EIBC 27%, P = 0.5). Both groups expressed similar levels of psychological distress (anxiety, DCIS: 56%, EIBC 54%, P = 0.38; depression, DCIS: 41%, EIBC, 48%, P = 0.17). Conclusions. Despite the excellent prognosis, women with DCIS express serious concerns and report similar psychological morbidity as women with invasive cancer.     

Progestin‐only and combined oral contraceptives and receptor‐defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study

Receptor‐defined subtypes of breast cancer represent distinct cancer types and have differences in risk factors. Whether the two main hormonal forms of oral contraceptives (OCs); i.e. progestin‐only (POC) and combined oral contraceptives (COC), are differentially associated with these subtypes are not well known. The aim of our study was to assess the effect of POC and COC use on hormone receptor‐defined breast cancer risk in premenopausal women in a prospective population‐based cohort – The Norwegian Women and Cancer Study (NOWAC). Information on OC use was collected from 74,862 premenopausal women at baseline. Updated information was applied when follow‐up information became available. Multiple imputation was performed to handle missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for breast cancer. 1,245 incident invasive breast cancer cases occurred. POC use ≥5 years was associated with ER+ (HR = 1.59, 95% CI 1.09– 2.32, p_trend = 0.03) and ER+/PR+ cancer (HR = 1.63, 95% CI 1.07–2.48, p_trend = 0.05), and was not associated with ER? (p_{heterogeneity} = 0.36) or ER?/PR? (p_{heterogeneity} = 0.49) cancer. COC use was associated with ER? and ER?/PR? cancer, but did not increase risk of ER+ and ER+/PR+ cancer. Current COC use gave different estimates for ER/PR‐defined subtypes (p_{heterogeneity} = 0.04). This is the first study to show significant associations between POC use and hormone receptor‐positive breast cancer. The lack of power to distinguish effects of POC use on subtype development calls for the need of larger studies to confirm our finding.     

Determining circulating endothelial cells using CellSearch system during preoperative systemic chemotherapy in breast cancer patients

Background

Circulating endothelial cells (CECs) have been studied as a biomarker for tumour progression and monitoring therapeutic effects. The CellSearch system is a semi-automated system that allows standardised analysis of CECs. This study assessed the clinical implications of CECs determined by the CellSearch system in breast cancer patients.

Methods

Seventy-six consecutive breast cancer patients (53 operable and 23 metastatic or recurrent) were enrolled for the study. Thirty-five patients with operable breast cancer received preoperative chemotherapy with a regimen based on anthracycline and/or taxane. CECs are defined as CD146⁺CD105⁺CD45⁻DAPI⁺ cells in the system. CD34 expression was examined using the additional channel in the system.

Results

A majority (4539 of 5183 cells, 88%) of CECs from patients with operable breast cancer were CD34-positive. Triple-negative cancers showed higher baseline CEC and CD34⁺CEC counts than the other types (P = 0.0387 and 0.0377, respectively). Low baseline CEC and CD34⁺CEC counts, and a low CD34 positive rate were associated with pathological complete response (pCR) of preoperative chemotherapy in patients with primary breast cancer (P = 0.046, 0.027 and 0.01, respectively). In multivariate analyses, the CD34 positive rate was significant for pCR (P = 0.021). During preoperative chemotherapy, CEC and CD34⁺CEC counts before each cycle of chemotherapy increased with taxane-based regimens (P = 0.0018 and 0.0008, respectively) but not with anthracycline-based regimens.

Conclusions

Baseline CEC, in particular CD34⁺CEC, counts and the CD34 positive rate might be useful for the prediction of treatment response of preoperative chemotherapy in patients with operable breast cancer.     

Traumatic distress symptoms in early breast cancer I: Acute response to diagnosis

In this study, the concept of ‘acute traumatic stress response’ was applied to breast cancer diagnosis. A total of 106 patients were studied before surgery, by means of a psychiatric interview and questionnaires (Impact of Event Scale, General Health Questionnaire and Clinical Global Impression Scale). The traumatic stress response was related to age, marital status, occurrence of breast cancer in first-degree relatives, previous physical and psychological health parameters, social support and life events during the last year. Of the patients, 44% reported a high level of intrusive symptoms (mean score 17.2) and 29% of avoidance symptoms (mean score 15.0). Younger age and being married were positively correlated with intrusive symptomology while patients with a first-degree relative with breast cancer had less intrusive distress. Previous physical and psychiatric health parameters showed no association to acute traumatic stress symptoms except for those who had experienced ‘a serious illness/accident/hospitalisation last year’ who had some more avoidant symptomology. Multiple regression showed a statistically significant effect for age only on intrusive symptoms when other factors were controlled for in this analysis.     

A simple system for grading the response of breast cancer to neoadjuvant chemotherapy

BackgroundThe response of primary breast cancer to chemotherapy is usually expressed either as a pathological complete remission (pCR) or as ‘no pCR’. A more quantitative measure is called for.Patients and methodsThe ‘neoadjuvant response index’ (NRI) was calculated by adding a breast response score (a number from a five-point scale) to an axillary response score (a number from a three-point scale) and dividing this by the score that would have been obtained in case of a pCR in both breast and axilla. Consequently, the NRI is a number between 0 (representing no response) and 1 (a pCR of both breast and axilla).ResultsThe NRI was calculated in 267 patients who had received neoadjuvant chemotherapy. The average NRI was 0.48 (median 0.40). Forty-one patients (15%) had an NRI of 0; 55 patients (21%) had an NRI of 1 (pCR). ‘Highly endocrine responsive’ tumors responded substantially less than ‘incompletely endocrine responsive’ ones. In triple negatives, an NRI of >0.70 was associated with a better recurrence-free survival than a lower NRI.ConclusionsThe NRI proposed here may be useful to better reflect the efficacy of neoadjuvant systemic regimens than the binary pCR–‘no pCR’ system.     

Adolescent's stress responses and psychological functioning when a parent has early breast cancer

Objective: To identify factors associated with psychological functioning in adolescent children of early‐stage breast cancer patients. Method: Adolescents' self‐reported psychological functioning using the Child Behaviour Checklist (YSR), Mental Health subscale of the Child Health Questionnaire (CHQ‐MH) and Child Impact of Events (C‐IES) scale. The Family Assessment Device (FAD) and the Family Environment Scale (FES cohesion subscale) assessed family functioning. Maternal depression was assessed on the Beck Depression Inventory (BDI) and quality of life using the SF8. Using a cross‐sectional within‐groups design, assessments were obtained for 56 adolescents of 11–17 years. Results: High rates of stress were found (C‐IES) in 33% males and 45% females. Thirty percent of adolescents reported psychological problems (YSR) (28% males and 32% females) when compared with published norms. Poor family functioning was linked with YSR internalising and externalising problems; poor family cohesion with higher externalising and total YSR psychological problems. Maternal depression was linked with adolescent‐reported internalising problems. Conclusions: When mothers have breast cancer, a substantial minority of their adolescent children have psychological and stress response‐related problems linked with poor family functioning. These results argue in favour of a family‐oriented approach to psychological support of breast cancer patients. Copyright © 2008 John Wiley & Sons, Ltd.     

The transition from breast cancer 'patient' to 'survivor'

Background: While much is now known about breast cancer survivors' long‐term health, quality of life, and psychological state, relatively little is known about the period immediately following completion of treatment, when women transition out of the role of breast cancer ‘patient’ to life as ‘survivor’. Objective: To explore women's fears regarding risk of cancer recurrence, sense of loss of medical monitoring, and social support from health‐care providers and other patients, and the strategies they use to cope with these issues. Method: Focus group interviews were conducted with women who had completed adjuvant chemotherapy or radiation for new stage I or II breast cancer in the prior 12 months. Interviews were audio‐taped, transcribed, and analyzed using a constant comparative analysis approach. Results: Of 216 women identified as eligible, over half (155) were reached by telephone and invited to participate. Of those invited, 47 (30%) agreed. Findings suggest that while women acknowledge positive life changes as a result of the cancer experience, emotional and physical stresses are prevalent following the completion of treatment. Conclusion: The period of time when women who have been treated for breast cancer transition to life without treatment presents numerous emotional and physical challenges. By illuminating patients' experience during this transition period, this study provides insights into the development of interventions to support women after treatment. Copyright © 2008 John Wiley & Sons, Ltd.