Psychosocial impact of newly diagnosed advanced breast cancer

The purpose of this study was to delineate the key emotional concerns of women newly diagnosed with recurrent or metastatic breast cancer. Sixty-six women diagnosed with metastatic breast cancer within the previous 6 months, receiving treatment at the Medical Oncology Departments of two metropolitan teaching hospitals, completed measures of HADS, IES, CARES-SF and Memorial Symptom Assessment Scale, and participated in a semi-structured interview. There were high levels of psychological morbidity, 56.7% of women younger than 55 years qualifying as "cases" on the HADS, compared with 34.5% of women aged over 55 years. The total HADS score was significantly correlated with the Global and Physical Subscales of the MSAS and CARES. Women younger than 55 years had significantly higher levels of intrusive and avoidant symptoms than women over 55 years. Women also reported high numbers of physical symptoms. Key themes which emerged during the interviews were: difficulties in communicating with doctors, perceived delay in diagnosis, the emotional impact, concerns about the family, feelings about why the cancer developed, other life stress and trauma, and use of non-prescribed treatments.     

血小板计数在判断初诊乳腺癌患者预后中的意义

目的:研究血小板计数在判断初诊乳腺癌患者预后中的意义。方法:回顾性分析68例乳腺癌患者初诊时的血小板计数及其他临床信息,采用SPSS 16.0对血小板计数与其他临床资料之间的相关性进行分析。结果:68例乳腺癌患者中,Ⅰ期10例、Ⅱ期22例、Ⅲ期18例、Ⅳ18例,淋巴结转移33例、远处转移18例。3年生存率39.71%,5年生存率19.11%,单因素分析、t检验及相关性分析表明血小板计数与生存之间存在相关性（r=-0.597,P＜0.01）;血小板计数与临床分期、淋巴结转移及远处转移之间均有相关性（P＜0.01）。雌激素受体（estrogen receptor,ER）状态以及发病年龄与患者的生存时间之间无统计学差异（P＞0.05）。结论:初诊乳腺癌患者血小板的增高与其生存时间之间呈负相关性,血小板计数的增高对初诊患者不良预后有预测作用。     

Circulating tumor cells in newly diagnosed inflammatory breast cancer

Introduction

Circulating tumor cells (CTCs) are an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer. Inflammatory breast cancer (IBC) is one of the most aggressive forms of breast cancer. The prognostic value of a CTC count in newly diagnosed IBC has not been established. The aim of this study was to assess the prognostic value of a baseline CTC count in patients with newly diagnosed IBC.

Methods

This retrospective study included 147 patients with newly diagnosed IBC (77 with locally advanced and 70 with metastatic IBC) treated with neoadjuvant therapy or first-line chemotherapy during the period from January 2004 through December 2012 at The University of Texas MD Anderson Cancer Center. CTCs were detected and enumerated by using the CellSearch system before patients were started with chemotherapy.

Results

The proportion of patients with ≥1 CTC was lower among patients with stage III than among patients with metastatic IBC (54.5% versus 84.3%; P = 0.0002); the proportion of patients with ≥5 CTCs was also lower for stage III than for metastatic IBC (19.5% versus 47.1%; P = 0.0004). Patients with fewer than five CTCs had significantly better progression-free survival (PFS) (hazard ratio (HR) = 0.60; P = 0.02) and overall survival (HR = 0.59; P = 0.03) than patients with five or more CTCs. Among patients with stage III IBC, there was a nonsignificant difference in PFS (HR = 0.66; 95% confidence interval (CI), 0.31 to 1.39; P = 0.29) and OS (HR = 0.54; 95% CI, 0.24 to 1.26; P = 0.48) in patients with no CTCs compared with patients with one or more CTCs. In multivariate analysis, CTC was prognostic for PFS and OS independent of clinical stage.

Conclusions

CTCs can be detected in a large proportion of patients with newly diagnosed IBC and are a strong predictor of worse prognosis in patients with newly diagnosed IBC.     

The effects of journaling for women with newly diagnosed breast cancer

Forty-three women newly diagnosed with breast cancer participated in this study, which examined the role of expressive journal writing characteristics on mood over the course of a 12-week support group. Writing was analyzed using the linguistic inquiry and word count program. Writing characteristics that were examined included: average word count, number of journal entries, positive and negative emotion words, the ratio of positive to negative words, and the use of cognitive mechanism words (i.e. insight and causal words). Regression analyses revealed that increased levels of anxiety and depression, post-intervention, were predicted by the prevalence of negative emotion in writing. Unique variance in mood (anxiety and depression) was accounted for by expression of negative emotion (7 and 6%, respectively). These relationships were significant (p<0.05) and remained significant even after accounting for pre-intervention levels of distress, and for the quantity and frequency of writing. These findings suggest the need for additional research into the naturalistic application of journaling so that appropriate recommendations for writing (e.g. focus, timing, amount) can be offered to patients who might choose to utilize this approach for coping with the stresses of cancer diagnosis and treatment.     

Determinants of newly diagnosed comorbidities among breast cancer survivors

Purpose

Comorbid conditions have become increasingly relevant for breast cancer care given the large numbers of long-term survivors. Our aim was to identify potential determinants associated with the development of comorbidities after breast cancer.

Methods

Self-reported comorbidities and lifestyle were assessed at recruitment and after a median follow up of 69.4 months from diagnosis in a population-based cohort of breast cancer cases aged 50 to 74 years at diagnosis (MARIEplus study). Tumor and therapy data were extracted from medical records. Determinants potentially associated with incident diagnoses of hypertension, cardiovascular diseases (CVD), and osteoporosis were assessed using multivariable Cox proportional hazard regression models.

Results

Follow-up interview was completed by 2,542 women (76.4 % of eligible patients). A diagnosis of hypertension was significantly associated with age, higher education (hazard ratio (HR) 0.54, CI 0.37–0.79), baseline body mass index (BMI; ≥30 kg/m²; HR, 1.90; CI, 1.24–2.90), and trastuzumab medication (HR, 2.16; CI, 1.09–4.33). An increased risk for CVD was associated with age, BMI, and intake of aromatase inhibitors (AI; HR, 1.42; CI, 1.09–1.84). Risk of osteoporosis was also positively associated with AI treatment (HR, 2.15; CI, 1.64–2.82) but inversely associated with a higher BMI (≥30 kg/m²; HR, 0.50; CI, 0.31–0.79).

Conclusion

In breast cancer survivors, treatment with AI constituted a risk factor for incident CVD and osteoporosis. Besides known risk factors, patients who were treated with trastuzumab may have an increased risk for hypertension.

Implications for cancer survivors

Reducing overweight and regular sport/cycling activities may help to prevent CVD after breast cancer. Patients should be monitored for risk factors and advised on possible cardiac side effects of AI and trastuzumab.     

Comparison of lesbian and heterosexual women's response to newly diagnosed breast cancer

In a study comparing lesbian and heterosexual women's response to newly diagnosed breast cancer, we compared data from 29 lesbians with 246 heterosexual women with breast cancer. Our hypotheses were that lesbian breast cancer patients would report higher scores of mood disturbance; suffer fewer problems with body image and sexual activity; show more expressiveness and cohesiveness and less conflict with their partners; would find social support from their partners and friends; and would have a poorer perception of the medical care system than heterosexual women. Our predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care. There were no differences in mood, sexual activity or relational issues. Not predicted were differences in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.     

Accuracy of self-reported tobacco use in newly diagnosed cancer patients

Purpose

Accurate identification of tobacco use is critical to implement evidence-based cessation treatments in cancer patients. The purpose of this study is to evaluate the accuracy of self-reported tobacco use in newly diagnosed cancer patients.

Methods

Tobacco use questionnaires and blood samples were collected from 233 newly diagnosed cancer patients (77 lung, 77 breast, and 79 prostate cancer). Blood was analyzed for cotinine levels using a commercially available enzyme-linked immunosorbent assay. Patients with cotinine measurements exceeding 10 ng/mL were categorized as current smokers. Smoking status based upon cotinine levels was contrasted with self-report in current smokers, recent quitters (1 or less year since quit), non-recent quitters (>1 year since quit), and never smokers. Multivariate analyses were used to identify potential predictors of discordance between self-reported and biochemically confirmed smoking.

Results

Cotinine confirmed 100 % accuracy in self-reporting of current and never smokers. Discordance in cotinine and smoking status was observed in 26 patients (15.0 %) reporting former tobacco use. Discordance in self-reported smoking was 12 times higher in recent (35.4 %) as compared with non-recent quitters (2.8 %). Combining disease site, pack-year history, and employment status predicted misrepresentation of tobacco use in 82.4 % of recent quitters.

Conclusions

Self-reported tobacco use may not accurately assess smoking status in newly diagnosed cancer patients. Patients who claim to have recently stopped smoking within the year prior to a cancer diagnosis and lung cancer patients may have a higher propensity to misrepresent tobacco use and may benefit from biochemical confirmation.     

The multimorbidity profile of South African women newly diagnosed with breast cancer

Multimorbidity in women with breast cancer may delay presentation, affect treatment decisions and outcomes. We described the multimorbidity profile of women with breast cancer, its determinants, associations with stage at diagnosis and treatments received. We collected self-reported data on five chronic conditions (hypertension, diabetes, cerebrovascular diseases, asthma/chronic obstructive pulmonary disease, tuberculosis), determined obesity using body mass index (BMI) and tested HIV status, in women newly diagnosed with breast cancer between January 2016 and April 2018 in five public hospitals in South Africa. We identified determinants of ≥2 of the seven above-mentioned conditions (defined as multimorbidity), multimorbidity itself with stage at diagnosis (advanced [III–IV] vs. early [0–II]) and multimorbidity with treatment modalities received. Among 2,281 women, 1,001 (44%) presented with multimorbidity. Obesity (52.8%), hypertension (41.3%), HIV (22.0%) and diabetes (13.7%) were the chronic conditions that occurred most frequently. Multimorbidity was more common with older age (OR = 1.02; 95% CI 1.01–1.03) and higher household socioeconomic status (HSES) (OR = 1.06; 95% CI 1.00–1.13). Multimorbidity was not associated with advanced-stage breast cancer at diagnosis, but for self-reported hypertension there was less likelihood of being diagnosed with advanced-stage disease in the adjusted model (OR 0.80; 95% CI 0.64–0.98). Multimorbidity was associated with first treatment received in those with early-stage disease, p = 0.003. The prevalence of multimorbidity is high among patients with breast cancer. Our findings suggest that multimorbidity had a significant impact on treatment received in those with early-stage disease. There is need to understand the impact of multimorbidity on breast cancer outcomes.     

Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer

Women treated for breast cancer have shown cognitive deficits with reduced capacity to focus and concentrate or to direct attention. This study examined the relationship between cognitive function prior to any treatment for breast cancer and individual factors including age, education, menopausal status, chronic health problems, and distress. Women newly diagnosed with breast cancer (N=184), ages 27-86 years, were assessed with standardized attention tests, self-reports of effectiveness in cognitive functioning, and measures of distress at about 18 days before surgery. Measured performance on the cognitive tests was not significantly correlated to self-reports of effectiveness in cognitive functioning. Age, education, presence of a chronic health problem, and menopausal status, but not distress, were associated with performance on the cognitive tests. Only age and education, however, were significant (p<0.001) predictors of overall performance on the cognitive tests, when controlling covariates. In contrast, symptom and mood distress significantly (p<0.001) predicted perceptions of effectiveness in cognitive functioning. Thus, different factors were associated with measured performance versus self-reports of cognitive functioning. Individual factors that predispose to lowered effectiveness in cognitive functioning prior to treatment in women newly diagnosed with breast cancer are discussed.     

The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer

We investigated the association between the risk of locoregional recurrence (LRR) and biological subtypes defined by hormonal receptors (HR) and HER-2 status in women with invasive breast cancer (BC). A total of 618 newly diagnosed BC patients were identified from a cancer registry within a single institution with standardized methods of tumor assessment for estrogen receptor (ER), progesterone receptor (PR), and HER-2. Patients were stratified based on surgical treatment, breast-conserving therapy (BCT) versus modified radical mastectomy (MRM), as well as biological subtypes: HR+/HER-2− (ER-positive or PR-positive, HER-2-negative), HR+/HER-2+ (ER-positive or PR-positive, HER-2-positive), HR−/HER-2+ (ER-negative and PR-negative, HER-2-positive) and TN (ER-negative, PR-negative and HER-2-negative). The association between clinicopathological factors, biological subtype and LRR was evaluated with univariate and multivariate Cox analysis. With a median follow-up of 4.8 years, the rate of LRR was 7.5%. On multivariate analysis, TN, tumor size ≥2 cm and lymph node (LN) positivity were associated with increased risk of LRR (P = 0.023, P = 0.048, and P = 0.0034, respectively). In BCT group, HR−/HER-2+ and LN positivity were associated with increased risk of LRR (HR 11.13; 95% CI 2.78–44.53; P = 0.0007 and HR 5.40; 95% CI 1.67–17.43; P = 0.0048, respectively). In MRM group, TN subtype and LN positivity were associated with increased risk of LRR (HR 4.72; 95% CI 1.53–14.52; P = 0.0069 and HR 3.23; 95% CI 1.44–7.29; P = 0.0047, respectively). Compared to HR+/HER-2−, HR−/HER-2+ treated by BCT and TN treated by MRM showed a significant decrease of 5-year LRR free survival (P = 0.0002 and P = 0.002, respectively). Tumor profiling using ER, PR, and HER-2 biomarkers is a promising tool to identify patients at high risk of LRR based on surgical treatment. Our findings suggest a different follow-up and locoregional treatment for patients with HR−/HER-2+ and TN subtypes.     

初诊Ⅳ期乳腺癌的局部治疗研究进展

转移性乳腺癌(Metastatic breast cancer,MBC)是一种难以治愈性疾病,得益于全身治疗的发展和普及,患者整体预后已得到显著改善。而初诊Ⅳ期乳腺癌(De novo stage IV breast cancer)原发灶、转移灶的手术切除能否在系统治疗的基础上带来生存获益,目前存在较大争议,需要结合病人具体情况给予个体化诊治。现就初诊Ⅳ期乳腺癌外科治疗领域的热点问题进行综述。     

Sexual quality of life in women with newly diagnosed breast cancer

Sexual quality of life (QOL) is a significant concern for breast cancer survivors. This study investigated sexual quality of life in a sample of 191 newly diagnosed breast cancer patients. Sixty percent of the sample indicated disruption in their sexual quality of life. Sexual QOL during treatment was significantly more disrupted among women who received chemotherapy, were younger, had higher stage of disease, reported more depressive symptoms near time of diagnosis, and underwent a total mastectomy. Hierarchical linear regression was used to model sexual QOL and feelings of sexual attractiveness. Worse physical quality of life, chemotherapy, and depressive symptoms near time of diagnosis were associated with worse sexual QOL during treatment. An interaction between chemotherapy status and type of surgery, for feelings of sexual attractiveness, suggested that chemotherapy affected sexual attractiveness only among women who underwent a lumpectomy. These results add to growing evidence that sexual QOL is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.     

Depression experienced by young women newly diagnosed with breast cancer

Breast cancer is the most common type of cancer among women. While almost a quarter of women diagnosed with breast cancer are 50 or younger, few studies are focused on them. Compared to older women, young women have more difficulty adjusting to the breast cancer diagnosis, report more symptoms of distress and a lower quality of life. This study examined depressive symptoms among an ethnically diverse sample of 331 young women, newly diagnosed with breast cancer. The focus was to determine the relative importance of biological, psychological and social variables as correlates of their level of depression. A hierarchical multiple regression analysis indicated that a model combining these variables is more highly correlated with depressive symptoms than using biological, psychological or social variables separately. Single measures including bodily pain, self-esteem, level of emotional support and age had independent effects in the combined regression model. Early intervention may prevent these biopsychosocial symptoms progressing to major depression and, thus, enhance the quality of life.     

Increased prevalence of prior breast cancer in women with newly diagnosed diabetes

SummaryObjective There is growing evidence of a link between type 2 diabetes and breast cancer, possibly through insulin resistance and/or hyperinsulinemia. Because insulin levels are at their highest prior to the development of diabetes, breast cancer risk may be even greater during the pre-diabetes period.Research design and methods In this cross-sectional study, women aged 55–79 years living in Ontario, Canada, with newly diagnosed diabetes from 1994 to 2002 were identified from a validated, population-based database (N = 82,390). Prior history of breast cancer in this group was recorded from 1964 until their diabetes diagnosis from a linkable cancer registry, and was compared to a similarly aged comparison group without diabetes (N = 411,950).Results Prior breast cancers were identified in 3.7% of women with diabetes and in 3.1% women without diabetes (odds ratio, OR 1.22, 95% confidence interval, CI 1.17–1.27, p < 0.0001). The mean time from breast cancer diagnosis to diabetes diagnosis was 7.9 years. The likelihood of a breast cancer history remained significantly higher in women with diabetes after adjustment for age, income and physician visits (OR 1.13, 95% CI 1.09–1.18, p < 0.0001).Conclusions These results suggest that breast cancer risk may be increased in the pre-diabetes phase and may have implications for screening and prevention strategies. Further studies are required to better characterize the processes that link insulin resistance, diabetes and breast cancer.     

A population-based study of the effectiveness of breast conservation for newly diagnosed breast cancer

PURPOSE: Our objective was to evaluate the effectiveness of breast conservation for newly diagnosed breast cancer. Effectiveness was operationalized as two outcomes within 5 years of the diagnosis of breast cancer: the probability of mastectomy-free survival (either death or mastectomy count as event, whichever comes first), and the probability of mastectomy conditional on survival (mastectomy counts as event, observations censored at death). METHODS AND MATERIALS: We linked records of 46,687 new cases of breast cancer from 1982 to 1991 in the Ontario Cancer Registry to records of surgery from 1982 to 1995, radiotherapy (RT) from 1982 to 1992, and median household income from the 1986 census. We labeled breast surgery within 4 months and postoperative RT within 12 months of diagnosis as treatment for newly diagnosed breast cancer. Surgery was categorized as mastectomy, lumpectomy plus RT, lumpectomy alone, or no surgical procedure. Among cases that did not undergo mastectomy within 4 months of diagnosis, we labeled mastectomy subsequent to 4 months after diagnosis as treatment failure. We performed life-table analysis and Cox proportional hazards regression, to describe the probability of mastectomy conditional on survival and the probability of mastectomy-free survival. RESULTS: A total of 16,279 cases underwent lumpectomy as the maximum procedure on the breast within 4 months of diagnosis, and 49.7% of these received postoperative RT. Compared to the provincial mean, regions with higher rates of lumpectomy plus RT have higher probability of mastectomy-free survival and lower probability of mastectomy conditional upon survival 5 years after diagnosis of breast cancer. CONCLUSIONS: These findings are consistent with a hypothesis that breast conservation is effective in the overall breast cancer population of Ontario within the first 5 years after diagnosis.     

Predicting general and cancer-related distress in women with newly diagnosed breast cancer

Background

Psychological distress can impact medical outcomes such as recovery from surgery and experience of side effects during treatment. Identifying the factors that explain variability in distress would guide future interventions aimed at decreasing distress. Two factors that have been implicated in distress are illness perceptions and coping, and are part of the Self-Regulatory Model of Illness Behaviour (SRM). The model suggests that coping mediates the relationship between illness perceptions and distress. Despite this; very little research has assessed this relationship with cancer-related distress, and none have examined women with screen-detected breast cancer. This study is the first to examine the relative contribution of illness perceptions and coping on general and cancer-related distress in women with screen-detected breast cancer.

Methods

Women recently diagnosed with breast cancer (N?=?94) who had yet to receive treatment completed measures of illness perceptions (Revised Illness Perception Questionnaire), cancer-specific coping (Mental Adjustment to Cancer Scale), general anxiety and depression (Hospital Anxiety and Depression scale), and cancer-related distress.

Results

Hierarchical regression analyses revealed that medical variables, illness perceptions and coping predicted 50% of the variance in depression, 42% in general anxiety, and 40% in cancer-related distress. Believing in more emotional causes to breast cancer (β?=?.22, p?=?.021), more illness identity (β?=?.25, p?=?.004), greater anxious preoccupation (β?=?.23, p?=?.030), and less fighting spirit (β?=??.31, p?=?.001) predicted greater depression. Greater illness coherence predicted less cancer-related distress (β?=??.20, p?=?.043). Greater anxious preoccupation also led to greater general anxiety (β?=?.44, p?<?.001) and cancer-related distress (β?=?.37, p?=?.001). Mediation analyses revealed that holding greater beliefs in a chronic timeline, more severe consequences, greater illness identity and less illness coherence increases cancer-specific distress (ps?<?.001) only if women were also more anxiously preoccupied with their diagnosis.

Conclusions

Screening women for anxious preoccupation may help identify women with screen-detected breast cancer at risk of experiencing high levels of cancer-related distress; whilst illness perceptions and coping could be targeted for use in future interventions to reduce distress.

     

Factors influencing changes in employment among women with newly diagnosed breast cancer

BACKGROUND:

Although studies have demonstrated that women are less likely to work after they are diagnosed with breast cancer, the influence of cancer treatments on employment is less clear. The authors of this report assessed whether chemotherapy or radiation therapy was associated with a disruption in employment during the year after a breast cancer diagnosis.

METHODS:

Using a database of health insurance claims that covered 5.6 million US residents, 3233 women aged ≤63 years were identified who were working full time or part time when they were diagnosed with breast cancer between 1998 and 2002. All changes in employment during the year after a breast cancer diagnosis were identified. Using a Cox proportional hazards model that incorporated time‐varying treatment variables, the authors evaluated the impact of chemotherapy and radiation therapy on the likelihood of experiencing an employment disruption.

RESULTS:

Although most women (93%) continued to work, chemotherapy recipients were more likely than nonrecipients to go on long‐term disability, stop working, or retire (hazards ratio, 1.8; P < .01). Women aged ≥54 years were more likely to experience a change in employment than women aged ≤44 years (P < .01). Radiation therapy did not influence employment (P = .22).

CONCLUSIONS:

In this population of employed, insured women, chemotherapy had a negative impact on employment. This finding may aid treatment decision making and could foster the development of interventions that support a patient's ability to continue working after treatment. It also reinforces the need to assess the impact of treatments, especially new treatments, on patient‐centered outcomes such as employment. Cancer 2009. © 2009 American Cancer Society.