Experiences and resources of breast cancer patients in short-stay surgery

Aimed at increasing the understanding and improving the quality of nursing care for breast cancer patients in short-stay surgery, this qualitative study set out to describe the experiences and, the intra- and extra-personal coping resources these patients. The data were collected among eight breast cancer patients (n = 8). On the whole the patients described short-stay surgery as a positive experience. They felt they had been discharged at the right time. The patients thought they had coped well and received valuable emotional, informational and instrumental support from health care personnel at each phase of the illness process. The breast cancer coordinator, in particular, served as a safety net for the patients. Informational support from health care personnel was considered adequate at the illness phase, but there was evidence of some lack of information at the care phase and current phase. Lack of knowledge about follow-up treatment was a major source of fear and anxiety for the patients. Later on, family members and friends served as important extra-personal coping resources, providing emotional and instrumental support. In addition, the patients' own intra-personal coping resources were essential during all the phases.     

Assessment of quality of care in an oncology institute using information on patients' satisfaction

OBJECTIVE: To evaluate the feasibility of conducting a patient satisfaction survey in the oncology hospital setting, using a multidimensional patient satisfaction questionnaire to be completed at home. METHODS: Socio-demographic and clinical data were collected for 133 consecutive patients. Patients were asked to complete the European Organisation for Research and Treatment of Cancer QLQ-C30 (version 2.0) just before hospital discharge and the Comprehensive Assessment of Satisfaction with Care at home 2 weeks after discharge. RESULTS: Respondents (73% of patients approached) were younger, hospitalized for a shorter time and presented less appetite loss, nausea and vomiting and better physical and role functioning than non-responders. The aspects of care for which patients wanted the most improvement were associated with the provision of medical information. In multivariate analyses, longer hospital stay was associated with higher satisfaction with all aspects of medical and nursing care, most probably because patients discharged early were not assured of continuity of care and lacked information regarding self-care at home. Higher global quality of life was associated with higher satisfaction with all aspects of care, suggesting the potential contribution of patient satisfaction to the patients' well-being. CONCLUSIONS: Conducting a patient satisfaction survey in an oncology hospital setting proved feasible; however, further surveys should attempt to obtain the opinion of patients with more severe physical conditions. The assessment of the patients' satisfaction provided indications for improvement of care in a particular hospital. Although the results of this study are specific to one hospital, the methods could be reproduced in other hospital settings, but may possibly lead to other conclusions.     

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

Patients with breast cancer who require axillary clearance traditionally remain in hospital until their wound drains are removed. Early discharge has been shown to improve clinical outcomes, but there has been little assessment of the psychosocial and financial impact of early discharge on patients, carers and the health service. This study aimed to evaluate the effectiveness of a nurse-led model of early discharge from hospital. Main outcome measures were quality of life and carer burden. Secondary outcomes included patient satisfaction, arm morbidity, impact on community nurses, health service costs, surgical cancellations and in-patient nursing dependency. A total of 108 patients undergoing axillary clearance with mastectomy or wide local excision for breast cancer were randomised to nurse-led early discharge or conventional stay. Nurse-led early discharge had no adverse effects on quality of life or patient satisfaction, had little effect on carer burden, improved communication between primary and secondary care, reduced cancellations and was safely implemented in a mixed rural/urban setting. In total, 40% of eligible patients agreed to take part. Nonparticipants were significantly older, more likely to live alone and had lower emotional well being before surgery. This study provides further evidence of the benefits of early discharge from hospital following axillary clearance for breast cancer. However, if given the choice, most patients prefer to stay in hospital until their wound drains are removed.     

Women's perceptions of events impeding or facilitating the detection, investigation and treatment of breast cancer

An integrated network is currently being implemented in the province of Quebec in order to improve the cancer care continuum. In this context, formal trajectories for cancer patients through healthcare services are being established. The investigation of patients' perceptions of the healthcare continuum is essential as it allows us to identify the issue of continuity/discontinuity of health services. In addition, patients' perceptions of continuity of cancer care should be documented since they could influence the implementation of optimal trajectories through the healthcare services. An exploratory qualitative study was conducted in order to identify events, based on the perceptions of women with breast cancer, that made the patient progress more rapidly, facilitating events, or more slowly, impeding events, within the cancer care continuum. Two consecutive series of women receiving adjuvant radiation therapy in 2002 and 2003 at the University Hospital of Quebec City were recruited, for a total of 120 participants. A semi-structured interview was administered in order to identify women's perceptions regarding impeding and facilitating events during the detection, investigation and treatment periods of cancer, as well as the actors and reasons involved. Overall, 64% of women reported having at least one impeding event, while 68% reported at least one facilitating event. The periods most frequently affected by impeding or facilitating events were the investigation period, followed by the treatment period. The main stages affected by impeding or facilitating events were the scheduling of an appointment, during the investigation period, and the onset of treatment. Impeding events particularly affected the scheduling of mammography, the initial exam of the investigation for breast cancer, as well as the onset of radiation treatment. On the other hand, facilitating events mainly occurred at the time of the scheduling of medical consultations with specialists, during the investigation period, and of the onset of surgery. Finally, women generally perceived that impeding events were due to a lack in the availability of services and that facilitating events resulted from human intervention. Patients' perceptions, such as those regarding the importance of human intervention in the process of continuity of care, should be taken into account by healthcare authorities in charge of implementing cancer control programmes.     

Does routine assessment and real‐time feedback improve cancer patients’ psychosocial well‐being?

This study examined the effectiveness of giving medical oncologists immediate feedback about cancer patients' self-reported psychosocial well-being in reducing those patients' levels of anxiety, depression, perceived needs and physical symptoms. Cancer patients attending one cancer centre for their first visit were allocated to intervention (n = 42) or control (n = 38) groups. All patients completed a computerized survey assessing their psychosocial well-being while waiting to see the oncologist. Intervention patients' responses were immediately scored and summary reports were placed in each patient's file for follow-up. A total of 48 participants (25 intervention and 23 control) completed the survey four times. Intervention patients who reported a debilitating physical symptom at visit 2 were significantly less likely to report a debilitating physical symptom at visit 3 compared with control patients (OR = 2.8, P = 0.04). Reductions in levels of anxiety, depression and perceived needs among intervention patients were not significantly different to control patients. Repeated collection and immediate feedback of patient-reported health information to oncologists has potential to improve patients' symptom control, but has little impact upon emotional well-being, including those at high risk. Future research should consider providing the feedback to other health professionals and patients, and monitor the impact on the process of individual patient care.     

Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study

Background  

Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS.     

Well-being, general health and coping ability: 1-year follow-up of patients treated for colorectal and gastric cancer

The aims of this paper were to describe the patients' perceived well-being, general health, symptoms and coping ability 1 year after surgery and to compare the results with the same as recorded before and 6 weeks after surgery and with those of healthy individuals. The investigation was carried out in a surgical unit at the Karolinska Hospital in Stockholm, Sweden during 1992 and 1993. Sixty-nine patients (34 men, 35 women) with diagnoses of colorectal or gastric cancer participated in the study. Two randomly selected samples of healthy individuals were available for comparisons and were used as reference subjects. Main measurements were the Health Index (HI) and the General Health Rating Index (GHRI). The HI measured the change in well-being before and after surgery. There were few and small differences in the patients' sense of well-being 1 year after surgery compared with before. There was no significant difference between the total HI scores before and 1 year after surgery but the HI subscale scores for energy, bowel function and mobility had improved. The patients living alone rated their well-being as inferior in comparison with those who lived with relatives. Furthermore, the cancer patients perceived their well-being as inferior to that of healthy individuals. One year after surgery the patients had not returned to a state of normal health. Social and marital status apparently affected the patients' sense of well-being.     

Satisfaction with health care, psychological adjustment, and community esteem among breast cancer survivors

The present survey study examines whether satisfaction with health care predicts breast cancer patients' psychological adjustment and esteem for their communities. Forty-nine women undergoing radiation therapy for breast cancer completed measures of satisfaction with health care, psychological well-being, community esteem, depression, perceived health status, and demographics. As predicted, the results showed that breast cancer survivors' satisfaction with their health care was predictive of their psychological well-being even when controlling for relevant variables such as depression and health status. Also, breast cancer survivors' satisfaction with their health care predicted their level of community esteem. These findings are discussed in terms of their implications for the psychological adjustment of breast cancer survivors.     

The Influence of relational factors on men's adjustment to their partners' newly-diagnosed breast cancer

Steadily rising breast cancer rates in America's women are forcing more men to confront challenges of living with a partner afflicted with this disease. This study assesses teh impact of mutual emotional support as perceived by male partners on their adjustment to the diagnosis and the illness and on interactions between their perceived emotional support nd their coping methods. Seventy-one male partners of newly-diagnosed breast cancer patients completed standardized instruments that measured emotional wellbeing, illness intrusiveness, emotional support, dyadic coping styles and demographic factors. Regression analysis revealed significant associations between perceived emotional support and men's coping strategies, and between coping styles and illness intrusiveness. Also, a history of depression predisposes men to poorer adjustment and affects their coping patterns. Findings suggest that as the health care system continues to relocate burden of care to partners and families, social workers must increase their understanding of how to effectively assist patients' partners. This study emphasizes the need to work with patients and partners to develop positive coping strategies as a couple.     

Quality of life and adjuvant tamoxifen treatment in breast cancer patients

About two-thirds of all breast cancer patients are treated with adjuvant hormonal therapy. Side effects of tamoxifen and their effects on physical, emotional and social functioning have been shown to impair the quality of life. Aim of this paper was to evaluate the side effects and level of influence on the physical, emotional and social functioning caused by tamoxifen treatment. For assessment of quality of life an own questionnaire was designed. Between January 2001 and December 2003, 136 women with breast cancer and adjuvant tamoxifen therapy were included in this study. Data of side effects, physical and mental health and patients' self-evaluation identified detrimental effects on patients' quality of life. Prevalence and severity of symptoms were not influenced by length of tamoxifen treatment. Patients were damaged in their constitution in respect to previous chemotherapy and pre-existing diseases; no influence was found by age or histopathological tumour characteristics. Our survey determines that breast cancer patients experience significant influence on quality of life by the negative impact on the physical, emotional and social functioning caused by tamoxifen treatment. Explicit attention to changes in quality of life should be considered as part of the standard care for women receiving adjuvant tamoxifen treatment.     

Quality of life of women with recurrent breast cancer and their family members.

PURPOSE: Little information is available about the effects of recurrent breast cancer on the quality of life of women and their family members. The present study assessed patients' and family members' quality of life within 1 month after recurrence, and effects of multiple factors on quality-of-life scores. PATIENTS AND METHODS: Patient/family member dyads (N = 189) participated in this study. A stress-appraisal model guided selection of person factors, social/family factors, illness-related factors, appraisal factors, and quality of life, measured with psychometrically sound instruments. Quality of life was measured with both generic (Medical Outcomes Study SF-36) and cancer-specific (Functional Assessment of Cancer Therapy) scales. RESULTS: Patients reported significant impairments in physical, functional, and emotional well-being. Family members reported significant impairments in their own emotional well-being. Structural equation modeling revealed that self-efficacy, social support, and family hardiness had positive effects on quality of life, whereas symptom distress, concerns, hopelessness, and negative appraisal of illness or caregiving had detrimental effects. Study variables accounted for a sizable amount of variance in patients' and family members' physical and mental dimensions of quality of life (72% to 81%). Contrary to findings observed in studies of newly diagnosed breast cancer patients and spouses, little relationship was found between recurrent patients' and family members' quality of life. CONCLUSION: Women with recurrent breast cancer are in need of programs to assist them with the severe effects of the disease on their quality of life. Programs need to include family members to help counteract the negative effects of the recurrent disease on their mental health, and to enable them to continue as effective caregivers.     

Patient's perception of care quality during radiotherapy sessions using respiratory gating techniques: validation of a specific questionnaire

This prospective study was designed to validate a questionnaire on patients' perception of care quality during respiratory-gated radiotherapy for breast or lung cancer. Psychometric tests were performed on selected patients. Confirmatory factorial analyses and capacity to discriminate the responses were achieved to validate the best model on 297 patients. Factorial analyses identified the following three scales: (a) perception of quality, (b) global satisfaction, and (c) physical or emotional experience. The scales were able to differentiate patients' responses according to radiotherapy modalities. The questionnaire presented adequate psychometric properties. This tool could be used for the assessment from the patient's point of view.     

Predictors of patients' choices for breast-conserving therapy or mastectomy: a prospective study

A study was undertaken to describe the treatment preferences and choices of patients with breast cancer, and to identify predictors of undergoing breast-conserving therapy (BCT) or mastectomy (MT). Consecutive patients with stage I/II breast cancer were eligible. Information about predictor variables, including socio-demographics, quality of life, patients' concerns, decision style, decisional conflict and perceived preference of the surgeon was collected at baseline, before decision making and surgery. Patients received standard information (n=88) or a decision aid (n=92) as a supplement to support decision making. A total of 180 patients participated in the study. In all, 72% decided to have BCT (n=123); 28% chose MT (n=49). Multivariate analysis showed that what patients perceived to be their surgeons' preference and the patients' concerns regarding breast loss and local tumour recurrence were the strongest predictors of treatment preference. Treatment preferences in itself were highly predictive of the treatment decision. The decision aid did not influence treatment choice. The results of this study demonstrate that patients' concerns and their perceptions of the treatment preferences of the physicians are important factors in patients' decision making. Adequate information and communication are essential to base treatment decisions on realistic concerns, and the treatment preferences of patients.     

Cost of care in a randomised trial of early hospital discharge after surgery for breast cancer

The aim of this study was to determine the effect of the reduction of the length of hospital stay after surgery for breast cancer on the rate of care consumption and the cost of care. Patients with operable breast cancer were randomised to a short or long postoperative hospital stay. Data on care consumption were collected for a period of 4 months in diaries administered by patients, and socioeconomic status was evaluated by questionnaires. A cost minimisation analysis using the 'societal' perspective was performed and savings were compared with the savings of hospital charges. The use of professional home care was higher for the short stay group during the first month (7.2 versus 1.3 h, P < 0.0001). The number of out-patient consultations, the intensity of informal home care and patient's expenses did not increase after early discharge. The total cost of care was reduced by US$1320 by introducing the short stay programme (P = 0.0007), but the savings were substantially lower than the savings in hospital charges (US$2680).     

Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care.

PURPOSE: There are few data on sequelae of breast cancer treatments in older women. We evaluated posttreatment quality of life and satisfaction in a national population. PATIENTS AND METHODS: Telephone surveys were conducted with a random cross-sectional sample of 1,812 Medicare beneficiaries 67 years of age and older who were 3, 4, and 5 years posttreatment for stage I and II breast cancer. Regression models were used to estimate the adjusted risk of decrements in physical and mental health functioning by treatment. In a subset of women (n = 732), additional data were used to examine arm problems, impact of cancer, and satisfaction, controlling for baseline health, perceptions of ageism and racism, demographic and clinical factors, region, and surgery year. RESULTS: Use of axillary dissection was the only surgical treatment that affected outcomes, increasing the risk of arm problems four-fold (95% confidence interval, 1.56 to 10.51), controlling for other factors. Having arm problems, in turn, exerted a consistently negative independent effect on all outcomes (P 相似文献   

Breast cancer in older women: quality of life and psychosocial adjustment in the 15 months after diagnosis.

PURPOSE: We examined the health-related quality of life (QOL) of a cohort of older women with breast cancer after their diagnosis. PATIENTS AND METHODS: Six hundred ninety-one women aged 65 years and older were interviewed approximately 3 months after breast cancer surgery and two additional times in the following year using standardized QOL measures. Demographic factors, breast cancer treatments, and comorbid conditions were used to model ratings of health-related QOL over time. Self-perceived health and psychosocial adjustment at 15 months after surgery were modeled. RESULTS: Physical and mental health scores declined significantly in the follow-up year, independent of age. However, a cancer-specific psychosocial instrument showed significant improvement in scores. Better 3-month physical and mental health scores, as well as better emotional social support, predicted more favorable self-perceived health 15 months after surgery. Psychosocial adjustment at 15 months was significantly predicted by better mental health, emotional social support, and better self-rated interaction with health care providers assessed at 3 months. CONCLUSION: Contrary to reports from younger women with breast cancer, we observed significant declines in the physical and mental health of older women in the 15 months after breast cancer surgery, whereas scores on a cancer-specific psychosocial QOL measure improved over time, consistent with patterns in younger women. Predictive models indicate that older women with impaired physical functioning, mental health, and emotional social support after surgery have poorer self-perceived health and psychosocial adjustment 1 year later. Interventions to address the physical and emotional needs of older women with breast cancer should be developed and evaluated to determine their impact on subsequent health-related QOL.     

Associations among baseline variables,treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Provision of social support and rehabilitation for patients with physical, mental, and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1, and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression, and HRQOL at 1 month (baseline), 6 months, 1, and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the functional assessment of cancer treatment scale-general (FACT-G) and the breast cancer subscale (FACT-B). Anxiety and depression were rated using the hospital anxiety and depression scale (HADS). More than 50% of patients had local problems of “tightness”, “arm weakness.” and “arm lymphedema”, and systemic problems of “reduced energy, fatigue, and general weakness” postoperatively. The HRQOL score significantly improved 1 year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was the highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status, and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months, 1, and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery.