Determinants of anxiety in patients with advanced somatic disease: differences and similarities between patients undergoing renal replacement therapies and patients suffering from cancer

Objective

Anxiety is the most frequent emotional reaction to the chronic somatic disease. However, little is known about anxiety and coping strategies in patients with end-stage renal disease (ESRD) undergoing renal replacement therapies (RRTs). The purpose of the study was to assess the intensity and determinants of anxiety in patients treated with different RRTs in comparison with end-stage breast cancer patients and healthy controls.

Methods

The study involved (1) ESRD patients undergoing different RRTs: 32 renal transplant recipients, 31 maintenance haemodialysis and 21 chronic peritoneal dialysis patients, (2) women with end-stage breast cancer (n = 25) and (3) healthy persons (n = 55). We used State–Trait Anxiety Inventory, Scale of Personal Religiousness, Mental Adjustment to Cancer Scale, Rotterdam Symptom Checklist with reference to medical history. The data thus obtained were analysed using the analysis of variance, the Tukey’s HSD post hoc test and Spearman’s rank correlation coefficient.

Results

Both ESRD and breast cancer patients revealed higher level of anxiety state and trait than healthy controls; however, there was no statistically significant difference found between both findings. There was a tendency towards higher levels of anxiety state in breast cancer patients when compared to ESRD patients undergoing the RRT treatment and for both groups non-constructive coping strategies correlated with the levels of anxiety state. With ESRD patients undergoing RRTs, the intensity of anxiety state did not depend on the mode of treatment but on the correlation between the levels of anxiety and the general quality of their life, psychological condition and social activity.

Conclusion

In patients with advanced somatic disease (ESRD and end-stage breast cancer), non-constructive strategies of coping with the disease require further evaluation and possibly psychological support.     

乳腺癌与心理社会危险因素的相关性研究

目的：探讨与乳腺癌发病有关的危险性心理社会因素。方法：对临床确诊的31例乳腺癌病人及31例正常人，进行心理行为问卷（婚姻质量问卷--ENRICH、生活事件问卷-LEs、社会支持评定量表-SSRS和特质应对方式-TCSQ）测试。结果：在乳腺癌确诊前5年内病人所经历的应激性负性生活事件（L2）明显多于对照组，其中以与家庭有关的负性生活事件（L5）及工作学习中的问题（L8）占主要位置，且病人的婚姻满意度（HS）低于对照组，在遇到应激性负性生活事件时较多地采用消极的应对方式（NC），以上差异均有统计学意义（P〈0．05）。从条件Logistic回归分析选入变量中，L5[OR=0．959，CI（0．921～0．998）]、s2[OR=0．825，CI（0．700～0．972）]和NC[OR=0．921，CI（0．847～1．002）]与乳腺癌的发病危险性关系密切。结论：病前经历较多的与家庭有关的应激性负性生活事件、面对虚激时缺乏客观社会支持及采取消极的虚对方式是女性发生乳腺癌的重要危险因素之一。     

Spectrum of Breast Cancer in Asian Women

Introduction Breast cancer is the leading cause of cancer-related deaths in Asia, and in recent years is emerging as the commonest female malignancy in the developing Asian countries, overtaking cancer of the uterine cervix. There have been no studies objectively comparing data and facts relating to breast cancer in the developed, newly developed, and developing Asian countries thus far. Material and Methods This multi-national collaborative study retrospectively compared the demographic, clinical, pathological and outcomes data in breast cancer patients managed at participating breast cancer centers in India, Malaysia and Hong Kong. Data, including those on the availability of breast screening, treatment facilities and outcomes from other major cancer centers and cancer registries of these countries and from other Asian countries were also reviewed. Results Despite an increasing trend, the incidence of breast cancer is lower, yet the cause-specific mortality is significantly higher in developing Asian countries compared with developed countries in Asia and the rest of the world. Patients are about one decade younger in developing countries than their counterparts in developed nations. The proportions of young patients (< 35 years) vary from about 10% in developed to up to 25% in developing Asian countries, which carry a poorer prognosis. In the developing countries, the majority of breast cancer patients continue to be diagnosed at a relatively late stage, and locally advanced cancers constitute over 50% of all patients managed. The stage-wise distribution of the disease is comparatively favorable in developed Asian countries. Pathology of breast cancers in young Asian women and the clinical picture are different from those of average patients managed elsewhere in the world. Owing to lack of awareness, lack of funding, lack of infrastructure, and low priority in public health schemes, breast cancer screening and early detection have not caught up in these under-privileged societies. Conclusions The inadequacies of health care infrastructures and standards, sociocultural barriers, economic realities, illiteracy, and the differences in the clinical and pathological attributes of this disease in Asian women compared with the rest of the world together result in a different spectrum of the disease. Better socioeconomic conditions, health awareness, and availability of breast cancer screening in developed Asian countries seem to be the major causes of a favorable clinical picture and outcomes in these countries.     

Prognostic influence of pregnancy before, around, and after diagnosis of breast cancer

A woman's risk of developing breast cancer is closely related to reproductive factors. Whereas the etiological importance of reproductive factors is well described, less is known about the prognostic influence of these factors. The prognostic effect of childbearing before, around, and after diagnosis is reviewed based on the literature and on studies from Danish Breast Cancer Cooperative Group, DBCG. In women with breast cancer overall number of childbirths is found to be without prognostic importance. Women with early primary childbirth seem to have an inferior prognosis compared to women who postpone childbearing. It is generally accepted that early first childbirth is associated with reduced risk of developing breast cancer. Thus, it is proposed that women who develop breast cancer despite an early first delivery represent a selected group of patients with particularly aggressive disease. Women diagnosed with breast cancer during pregnancy often present with advanced disease, but pregnancy at time of diagnosis does not seem to be an independent prognostic factor. However, women diagnosed with breast cancer in the first years after childbirth have a significantly reduced survival. It is assumed that these women, due to the physiological changes during pregnancy, experience growth induction of the tumours during the preclinical stage.In contrast, there is no evidence that pregnancy after breast cancer treatment has a negative influence on prognosis.     

Spectrum of Breast Cancer in Malaysian Women: Overview

Breast cancer is the most common cancer among Malaysian women. Nonetheless, in Malaysia there is a marked geographical difference in the incidence of breast cancer with advanced stage of presentation. The breast clinic in Kuala Lumpur Hospital diagnosed approximately 150 to 200 new cases of breast cancer a year. This number, however, represents only 12.0% to 15.0% of all breast disease seen annually in Kuala Lumpur Hospital. Between 1998 and 2001, of a total of 774 cases of newly diagnosed breast cancer in Kuala Lumpur Hospital, only 5.0% (40/774) were impalpable breast cancers. The peak age group for the three major ethnic distributions (Malay, Chinese, and Indian) ranged from 40 to 49 years. The mean tumor size at presentation was 5.4 cm (range: 1–20 cm), and the advanced stage of breast cancer is observed to be highest among the Malay ethnic group. Although it appears that the incidence of breast cancer in Malaysia is lower than in the developed countries, the difference may be attributable to the difficulty in getting accurate statistics and to underreporting of cases. Nonetheless, from the available data, it is clear that breast cancer continues to be the most common cancer among Malaysian women. The strongly negative social-cultural perception of the disease, made worse by the geographical isolation of many rural areas, accounts for the delayed diagnosis and the often advanced stage of disease at presentation. A prospective population-based study is called for to verify the demographic patterns of breast cancer, particular in Malaysia and other developing countries. The findings of such a study may have implications for future breast screening programs and for facilitating the understanding of differing risks of breast cancer among women around the world.This Breast Surgery International (BSI) article was presented at the 39th World Congress of Surgery International Surgical Week (ISW01), Brussels, Belgium, August 26–30, 2001.     

A prospective study of the relationship between breast cancer and life events,type A behaviour,social support and coping skills

Two thousand one hundred and sixty-three women completed an extensive set of psychosocial measures prior to a breast examination. These women were subsequently diagnosed as having cancer, a cyst, benign breast disease or normal breasts. It was found that the cancer group had experienced significantly more loss- or illness-related events, perceived life events generally as more stressful, used fewer and poorer coping skills and were significantly lower on type A behaviour.     

Preventive mastectomy in patients at breast cancer risk due to genetic alterations in the<Emphasis Type="Italic"> BRCA1</Emphasis> and<Emphasis Type="Italic"> BRCA2</Emphasis> gene

BACKGROUND: The availability of genetic testing for inherited mutations in the BRCA1 and BRCA2 gene provides potentially valuable information to women at high risk of breast and ovarian cancer. METHODS AND FOCUS: We review the literature on the value of prophylactic surgical strategies in patients with hereditary predisposition to develop breast cancer and discuss the surgical options available in high-risk cancer patients, decision analyses, and possible complications. RESULTS: Preventive surgical interventions to reduce cancer risk in high-risk patients are often strongly recommended. A patient's life-time risk to develop breast cancer in the presence of BRCA1 and BRCA2 mutations is 50-90%. Despite the reduction in the risk of developing breast cancer, prophylactic mastectomy often leads to significant physical and psychological sequelae.     

The importance of survivors and partners in improving breast cancer outcomes in Uganda

In limited-resource countries, cancer kills more people annually than AIDS, tuberculosis and malaria combined. Programs targeting early detection and treatment of cancer are virtually non-existent due to insufficient funding and attention given to this emerging health challenge. Breast cancer is the most common cancer in women worldwide and is also the leading cause of cancer-related death in females. In developing countries such as Uganda, breast cancer incidence is increasing and typically presents at an advanced stage of disease, for which treatment options are limited. Inadequate knowledge and understanding of the disease, social stigma, and barriers to care all contribute to a poorer prognosis. There are many challenges to reducing breast cancer incidence and mortality globally; however, there is evidence to suggest that advocacy and education, in particular through the efforts of breast cancer survivors and their partners, can play a critical role in improving overall outcomes in limited-resource countries.     

Pregnancy and Breast Cancer: when They Collide

Women of childbearing age experience an increased breast cancer risk associated with a completed pregnancy. For younger women, this increase in breast cancer risk is transient and within a decade after parturition a cross over effect results in an ultimate protective benefit. The post-partum peak of increased risk is greater in women with advanced maternal age. Further, their lifetime risk for developing breast cancer remains elevated for many years, with the cross over to protection occurring decades later or not at all. Breast cancers diagnosed during pregnancy and within a number of years post-partum are termed pregnancy-associated or PABC. Contrary to popular belief, PABC is not a rare disease and could affect up to 40,000 women in 2009. The collision between pregnancy and breast cancer puts women in a fear-invoking paradox of their own health, their pregnancy, and the outcomes for both. We propose two distinct subtypes of PABC: breast cancer diagnosed during pregnancy and breast cancer diagnosed post-partum. This distinction is important because emerging epidemiologic data highlights worsened outcomes specific to post-partum cases. We reported that post-partum breast involution may be responsible for the increased metastatic potential of post-partum PABC. Increased awareness and detection, rationally aggressive treatment, and enhanced understanding of the mechanisms are imperative steps toward improving the prognosis for PABC. If we determine the mechanisms by which involution promotes metastasis of PABC, the post-partum period can be a window of opportunity for intervention strategies.     

Mammographic Screening or Breast Cancer Awareness? Time to Ponder

Breast cancer in India is becoming the leading cause of cancer-related mortality in urban women. In developed countries, the mortality from breast cancer has decreased in the past few years attributable to better awareness of disease, screening programs, early detection and more effective treatment available. Although widely used, the screening programs running in the western countries have been a point of criticism in the recent years as they lead to increased healthcare cost and detection of otherwise benign and clinically insignificant breast lesion (both benign and malignant). Also in a developing country like ours where the awareness about breast cancer among the ladies is itself poor, whether screening is feasible and cost-effective is a matter of ongoing debate. We conducted this literature review to ascertain the importance of breast cancer awareness, breast self-examination, and clinical breast examination as effective screening tools in a resource deficient country like India.     

Long-term survival outcomes following breast cancer surgery in Western Australia

BACKGROUND: Mortality rates from breast cancer are stabilizing or falling in many developed countries including Australia, however, survival outcomes are known to vary by social, demographic and treatment related factors. The aim of the present study was to investigate how hospital, social and demographic factors were associated with survival outcomes from surgically treated breast cancer for all women living in Western Australia. METHODS: The WA Data Linkage System was used to access hospital morbidity, death and cancer information for all women diagnosed with invasive breast cancer in Western Australia 1982-2000. Relative survival and Cox proportional hazards regression analyses were used to identify social, demographic and hospital factors associated with an increased risk of dying from breast cancer or dying from any cause. RESULTS: Survival outcomes improved in all women diagnosed in more recent calendar periods. However, a significantly increased risk of dying was observed for women who underwent initial surgical treatment in regional public hospitals outside of the state capital, Perth. Consistent with other reports, women aged greater than 80 years and younger than 35 years at diagnosis also had poorer survival outcomes. Residential location, socioeconomic status and race were not associated with survival after adjusting for treatment, health and hospital related factors. CONCLUSIONS: Despite overall improvements in survival of women diagnosed with breast cancer in Western Australia, initial surgical treatment in public hospitals outside of Perth was associated with significantly poorer outcomes.     

Psychologische Interventionen in der Behandlung chronischer Rückenschmerzen

Providing the patient with a pain model based on the biopsychosocial approach is one of the most important issues in psychological intervention. Illness behaviour is influenced by pain-eliciting and pain-aggravating thoughts. Identification and modification of these thoughts is essential and aims to change cognitive evaluations, emotional processing, and pain-referred behaviour. Improved self-monitoring concerning maladaptive thoughts, feelings, and behaviour enables functional coping strategies (e.g. attention diversion and learning to enjoy things) and enhances self-efficacy expectancies. Of special importance is the establishment of an appropriate balance between stress and recreation. Intervention options include teaching relaxation techniques, problem-solving strategies, and specific skills as well as applying appropriate elements of cognitive therapy. The development of alternative cognitive and action-based strategies improves the patient’s ability to cope with internal and external stressors. All of the psychological elements are carried out in a group setting. Additionally, individual therapy is offered to treat comorbidities or to support reintegration into the patient’s job.     

Race and the Molecular Origins of Breast Cancer in Chinese Women

Although there is considerable controversy regarding the role of race in the etiology of human disease, evidence suggests that breast cancers are racially distinct diseases. Clinical features and genetic alterations are different in Chinese women with breast cancer compared with white women. These differences are significant and may influence clinical care. In this review, we summarize the literature addressing genetic heterogeneity in Chinese women with breast cancer. Data support important variations in genes involved in tumorigenic pathways of DNA repair, steroid synthesis and receptor expression, apoptosis, immunity, inflammation, cell cycle control, cancer growth and metastasis, and growth receptor signaling. These genetic differences contribute to our understanding of the molecular origins of breast cancer and may accelerate the development of personalized disease prevention strategies.     

Effectiveness of instrumental reminiscence intervention on improving coping in healthy older adults

Reminiscence is a psychological intervention that uses the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, and adjustment to present life. The main goal of this study was to investigate the effect of a reminiscence intervention programme on coping strategies. One hundred fifty healthy older adults attended the reminiscence sessions. In order to evaluate the effects of the programme and find out if its effects lasted over time, we used an experimental design with pretest, posttest, and follow‐up assessments, comparing a control group to the intervention group. Repeated‐measures analysis of variance showed significant differences in problem‐solving coping, positive reappraisal, social support seeking, and avoidance coping with the treatment group obtaining higher scores than the control group in all cases. The effects declined after 3 months, but some differences were found in the treatment group obtaining higher scores in problem‐solving coping and positive reappraisal and lower in overt emotional expression. The study suggests that reminiscence therapy contributes to mental health by enhancing coping strategies that can allow the elderly to cope successfully and overcome psychological distress.     

The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry

BACKGROUND: Women diagnosed with breast carcinoma in situ are at increased risk for developing a contralateral breast cancer. The magnitude of this risk and the relationship between this risk and age, time since diagnosis, histologic subtype, and treatment for the first breast cancer is continuing to be defined. METHODS: The risk of developing a contralateral breast cancer is examined among 4198 women diagnosed with breast carcinoma in situ and reported to the Connecticut Tumor Registry (CTR) between January 1, 1975 and March 14, 1998 using Kaplan-Meier estimation. A Cox proportional hazards model is used to assess the effect of surgical treatment, radiation therapy, age at diagnosis, race, histology, marital status, anatomic location within the breast, and time since diagnosis upon this risk. RESULTS: The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a ductal breast carcinoma in situ (DCIS) were 4.3% (95% confidence interval, 3.6-5.0%) and 6.8% (95% confidence interval, 5.5-8.2%), respectively. These risks are 3.35 times greater than those for women without a history of breast cancer but are similar to those for women diagnosed with non-metastatic invasive ductal carcinomas of the breast. The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a lobular breast carcinoma in situ (LCIS) were 11.9% (95% confidence interval, 9.5-14.3%) and 13.9% (95% confidence interval, 11.0-16.8%), respectively. CONCLUSIONS: Women diagnosed with LCIS were 2.6 (95% confidence interval, 2.0-3.4%) times more likely than women with DCIS to be diagnosed with a contralateral breast cancer within the first six months of the first breast primary. The risk of developing a contralateral breast cancer more than 6 months after the initial breast cancer was independent of surgical or radiation therapy, time since diagnosis, age at diagnosis, histology, race, marital status, or anatomic location of the cancer within the breast.     

A spectrum of coexistent tuberculosis and carcinoma in the breast and axillary lymph nodes: report of five cases

Tuberculosis (TB) and breast cancer are common diseases in developing countries. Their coexistence in the breast and axillary lymph nodes is, however, rare. It can lead to overstaging of the breast cancer. Treatment compliance may also be difficult when two major illnesses exist. Five cases of coexistent breast cancer and TB are presented with regard to presentation and outcome, with a review of the literature.     

The psychological effects of breast cancer and reconstruction: "A stroll down mammary lane"--A patient's artistic journal

One in 8 women will develop invasive breast cancer. Nationally, it is estimated that about 200,000 women in the United States are diagnosed annually, and approximately 40,000 women die from the disease each year. A diagnosis of breast cancer forces women to consider living without their gender-defining curves, reevaluate their lives, and live with a 1 in 33 possibility of their mortality. Although medical science has made advances in the treatment of breast carcinoma and breast reconstruction, it currently does not adequately address the psychological effects that this disease and its treatment have on its patients. This discussion of a patient's postmastectomy drawings and creative writing sheds some light on one woman's personal battle with breast carcinoma, from diagnosis through breast reconstruction.     

Distress, coping, and social support among rural women recently diagnosed with primary breast cancer

This study examined distress, coping, and group support among a sample of rural women who had been recently diagnosed with breast cancer. We recruited 100 women who had been diagnosed with primary breast cancer at one of two time points in their medical treatment: either within a window up to 3 months after their diagnosis of breast cancer, or within 6 months after completing medical treatment for breast cancer. Their mean age was 58.6 years (SD = 11.6), and 90% were of white/European American ethnicity. Women completed a battery of demographic and psychosocial measures prior to being randomized into a psychoeducational intervention study, and then again 3 months later at a follow-up assessment. The focus of this article is on the women's self-reported psychosocial status at baseline. Many of the women experienced considerable traumatic stress regarding their breast cancer. However, this distress was not reflected in a standard measure of mood disturbance that is frequently used in intervention research (the Profile of Mood States). The average woman considered her diagnosis of breast cancer to be among the four most stressful life events that she had ever experienced. Also, women on average reported a high level of helplessness/hopelessness in coping with their cancer. On average, women felt that they "often" (but not "very often") received instrumental assistance, emotional support, and informational support. Women varied considerably in which kind of social group provided them with the most support, with as many reporting that they found the greatest support in spiritual/church groups or within their family units as with breast or general cancer groups. These results suggest that among these rural women with breast cancer, distress with the diagnosis of breast cancer must be carefully assessed, as women who are highly distressed about their breast cancer may not report general mood disturbance. Furthermore, the kinds of groups that rural women with breast cancer experience as most supportive need to be identified so that psychosocial interventions can be matched to breast cancer patients' individual needs.     

Time trends in the outcome of elderly patients with breast cancer

Abstract:  Mortality rates for breast cancer are improving in most countries. Life expectancy is also improving, and as age is the major risk factor for the development of breast cancer, we sought to determine whether survival of elderly women with breast cancer has improved over the past 20 years in our institution. In a retrospective study using a prospectively maintained database, we identified 950 women aged ≥70 years diagnosed with breast cancer between 1980 and 2000. Overall survival of patients was compared between two different time cohorts—those diagnosed from 1980 to1990 and from 1991 to 2000—and between three age cohorts, 70–74, 75–79, and 80+ years. In all age groups, advanced stage, the need for mastectomy, and having chemotherapy were associated with a worse outcome on univariate analysis. Endocrine therapy (tamoxifen) was given to 60–70% of all age groups. After adjustment for clinical stage, we found no significant improvement in survival between the two time cohorts in any age groups. Compared with an age-matched group in the general population, these elderly breast cancer patients have a 62% increased risk of death. The results are likely to reflect lack of data to promote treatment guidelines. More clinical trials for older women are needed, if the benefits of recent advances in the management of this disease are to be extended to the over 70s. These data should, however, act as a benchmark for future audits.