'I wouldn't have been interested in just sitting round a table talking about cancer'; exploring the experiences of women with breast cancer in a group exercise trial

There is evidence that physical activity improves the psychological and physical health of patients with cancer. However, relatively little attention has been paid to understanding their experiences of exercise. This focus group study explored the experiences of women undergoing treatment for breast cancer who had taken part in a supervised group exercise trial. We found that setting up classes solely for women with breast cancer, led by an expert instructor, helped to reduce gender-related barriers to physical activity, such as difficulties in prioritizing exercise over caring roles and worries about changed appearance. For example, some women challenged traditional expectations of femininity by removing their wigs in the classes in order to exercise in comfort. Respondents valued exercising with women in the 'same boat' because of the empathy and acceptance they received and the opportunities to exchange information and form friendships. However, the action-orientated format of the group was preferred to a talk-based format such as a support group; some respondents felt that the 'last thing' they wished to do was to talk about cancer. Our findings therefore challenge stereotypes about women invariably preferring to cope with cancer through emotional disclosure.     

Survivor Dragon Boating: A Vehicle to Reclaim and Enhance Life After Treatment for Breast Cancer

The authors investigated the psychosocial impact of dragon boat participation on women who have been treated for breast cancer. Open-ended qualitative interviews were completed by 10 new members recruited from two breast cancer survivor dragon boat teams. Our findings indicate that the women's experience of survivor dragon boating surpassed their expectations and offered them hope and increased strength and the ability to regain control of their lives. Key themes emerging from the in-depth interviews that encapsulate the experiences of women in their first season of dragon boating follow: awakening of the self, common bond, regaining control, being uplifted, and transcending the fear of death. The interview data support the emerging hypothesis that dragon boating is a vehicle for improving women's wellness and post-treatment qualityof life.     

Survivor dragon boating: a vehicle to reclaim and enhance life after treatment for breast cancer

The authors investigated the psychosocial impact of dragon boat participation on women who have been treated for breast cancer. Open-ended qualitative interviews were completed by 10 new members recruited from two breast cancer survivor dragon boat teams. Our findings indicate that the women's experience of survivor dragon boating surpassed their expectations and offered them hope and increased strength and the ability to regain control of their lives. Key themes emerging from the in-depth interviews that encapsulate the experiences of women in their first season of dragon boating follow: awakening of the self, common bond, regaining control, being uplifted, and transcending the fear of death. The interview data support the emerging hypothesis that dragon boating is a vehicle for improving women's wellness and post-treatment quality of life.     

The effect of physical activity on breast cancer risk: A cohort study of 30,548 women

Background: In epidemiological studies abundant physical activity has been related to decreased breast cancer risk, though the results have been inconsistent. The purpose of this paper was to study the association of physical activity at leisure and commuting to work and incidence of breast cancer. Methods: The study cohort consisted of 30,548 female participants of the Finnish adult health behaviour survey, based on annual random samples of Finns aged 15–64, collected in 1978–1993. By the end of 1995, 332 breast cancer cases had been diagnosed in the cohort. Relative risks of breast cancer were adjusted for age at survey, body mass index (BMI), education, length of follow-up, parity and age at first birth using Poisson regression models. Results: Compared to women exercising less than once a week, the adjusted relative risk of breast cancer for women exercising once a week was 0.80 (95% confidence interval (CI): 0.58–1.10), for women exercising 2–3 times per week 0.92 (95% CI: 0.78–1.22) and for women exercising daily 1.01 (95% CI: 0.72–1.42). Women who reported commuting, walking or bicycling to work 30 min or more daily had slightly lower adjusted risk of breast cancer (RR: 0.87, 95% CI: 0.62–1.24) than women working at home, being unemployed or driving a car to working place. Conclusion: Although a small protective effect of regular physical activity for breast cancer incidence was found in physical activity when commuting to work, the role of the physical activity in breast cancer prevention is still an open question.     

The perceived influence of an exercise class intervention on the process and outcomes of post-traumatic growth

Post-traumatic growth (PTG) is the phenomenon of positive change through the experience of trauma and has been linked recently to the participation in group based therapies. The aim of this study was the explorative documentation of the experience of PTG among breast cancer patients and the role, if any, that a group based physical activity intervention had in the attainment of growth. Ten female breast cancer survivors, from an already existing study, participated in an individual, open-ended interview. Employing interpretive phenomenological analysis (IPA), interviews were transcribed verbatim and analysed for themes that reflected the women's experience of growing from adversity. The women attributed much of their process and outcomes of PTG to the experience of participating in an exercise intervention programme during rehabilitation. The programme's success in facilitating PTG could be viewed as superior in some ways to other group based therapies in offering the women a safe environment, positive support system, opportunity to transfer new skills and heightened health awareness/behaviours. Future research should acknowledge and conduct further investigations into the role of physical activity interventions as facilitators of the PTG process.     

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

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

Effect of a national population-based breast cancer screening policy on participation in mammography and stage at breast cancer diagnosis in Taiwan

In Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study examined whether the CAQIP program increased participation in mammography and achieved more early stage diagnosis of breast cancer. We utilised a natural experiment to compare outcomes of interest in women aged 50–69 years with their first mammography date in two different phases, 2005–2009 and 2010–2014. Propensity score matching was used to match comparable cohorts in each phase. In total, 468,259 matched participants in phases 1 and 2 were analyzed. Patient-level logistic regressions were used and adjusted for patient risk factors. Compared with phase 1, our findings indicated women in phase 2 were more likely to have repeat mammography participation (OR, 1.33; 95 % CI, 1.32–1.34), and be diagnosed with early stage breast cancer (OR, 1.15 times; 95 % CI, 1.05–1.26). Women living in rural areas were less likely to repeatedly participate mammography (OR, 0.86; 95 % CI, 0.85–0.86) and experience early diagnosis (OR, 0.90, 95 % CI, 0.81–0.99). Women at low socioeconomic status were less likely to experience early diagnosis, and those with reproductive and hormonal risk factors were less likely to repeatedly participate mammography. Our findings provide evidence of potential benefits of health policy intervention to improve accessibility on participation in mammography and early stage diagnosis of breast cancer.     

Population-based mammographic screening: Does Informed choice‘ require any less than full disclosure to individuals of benefits,harms, limitations and consequences?

Mammographic screening is a public health intervention with benefits, harms and consequences. Assuming technical excellence and at least 70% participation, mammographic screening of women aged 50 years or over will reduce breast cancer mortality by 24%. Before the introduction of mammographic screening in Australia, the mortality rate from breast cancer for women in the target age group was 69.0 per 100,000. On the basis of this relative risk reduction, breast cancer mortality would be reduced to 46 per 100,000. However, for every breast cancer death averted, 10 additional cases of breast cancer will be diagnosed. As it is unknowable who will benefit from mammographic screening, it is unethical to claim that any given individual has been 'saved' through participation, especially in the absence of evidence that all-cause mortality will change. As women misunderstand their risks of breast cancer and the benefits and limitations of mammographic screening, public education is needed. As an individual's choice about screening is affected by the way benefits are framed, our public messages must be carefully scrutinised. It is impossible otherwise to assert that women are making an 'informed choice'. The decision of women who decline to participate must be respected. Public health expertise is crucial to ensure the rhetoric of 'informed choice' in cancer screening is realised.     

Discourses of normality and difference: responses to diagnosis and treatment of gynaecological cancer of Australian women

By comparison to other cancers such as breast and lung cancer, women in Australia are relatively infrequently diagnosed with gynaecological cancers. Apart from cervical cancer, public health information on gynaecological cancer is limited, as are published stories from gynaecological cancer survivors in women's magazines. Our qualitative study investigated how women with gynaecological cancers develop an identity in relation to their illness, and examined the extent of, and reasons for, a sense of perceived difference. The study was conducted between 2001 and 2003 and included in-depth interviews with 52 women aged 27-80 years diagnosed with gynaecological cancer within the past 5 years. Our analysis illustrates how women draw on a wider cancer discourse to make sense of their own illness, which gave them a sense of commonality. However, some women, predominantly those who were diagnosed with cancer of the vulva or vagina, or who underwent particular uncommon or unfamiliar treatments such as brachytherapy, had difficulties situating their illness within the wider cancer discourse. This had implications for women when accessing social support.     

Correlates of leisure-time physical activity in an elderly population in Singapore.

OBJECTIVES: This study assessed correlates of leisure-time physical activity among the elderly in Singapore. METHODS: A cross-sectional household survey was conducted in 1998 with 2494 subjects 60 years and older. RESULTS: Regular leisure-time physical activity was practiced by 47.0% of men and 38.5% of women. It was significantly correlated with family support, proportion of family members exercising, awareness of benefits of exercise, and healthy dietary habits. Other significant but negative correlates were smoking and barriers to exercise, such as lack of time and poor health. CONCLUSIONS: Exercise programs for the elderly should aim at helping them overcome barriers to exercise, informing them of the benefits of exercise, and involving their families.     

Addressing the Silence in the Noise: How Abortion Support Talklines Meet Some Women's Needs for Non-Political Discussion of Their Experiences

Little progress has been made toward increasing physical activity in women. This study aimed to determine if an 8-month theory-based book club intervention (Women Bound to Be Active) was effective in increasing: (a) self-worth, (b) benefits relative to barriers to physical activity, and (c) physical activity in women (n = 51). Findings suggested a book club was effective for improving: self-worth, the benefits relative to barriers to physical activity, and possibly participation in physical activity. This is an innovative model to help women become more active and learn skills that may enable them to be active on their own long after a physical activity program has ended.     

‘Worse than HIV’ or ‘not as serious as other diseases’? Conceptualization of cervical cancer among newly screened women in Zambia

Invasive cervical cancer is the second most common cancer among women worldwide, with approximately 85% of the disease burden occurring in developing countries. To date, there have been few systematic efforts to document African women's conceptualization of cervical cancer after participation in a visual inspection with acetic acid (VIA)-based "see and treat" cervical cancer prevention program. In this study, conducted between September, 2009-July, 2010, focus groups and in-depth interviews were conducted with 60 women who had recently undergone cervical cancer screening at a government-operated primary health care clinic in Lusaka, Zambia. Interviewers elicited participants' causal representations of cervical cancer, associated physical signs and symptoms, perceived physical and psychological effects, and social norms regarding the disease. The lay model of illness causation portrayed by participants after recent exposure to program promotion messages departed in several ways from causal models described in other parts of the world. However, causal conceptualizations included both lay and biomedical elements, suggesting a possible shift from a purely traditional causal model to one that incorporates both traditional concepts and recently promoted biomedical concepts. Most, but not all, women still equated cervical cancer with death, and perceived it to be a highly stigmatized disease in Zambia because of its anatomic location, dire natural course, connections to socially-condemned behaviors, and association with HIV/AIDS. No substantive differences of disease conceptualization existed according to HIV serostatus, though HIV positive women acknowledged that their immune status makes them more aware of their health and more likely to seek medical attention. Further attention should be dedicated to the processes by which women incorporate new knowledge into their representations of cervical cancer.     

Exercise therapy in women who have had breast cancer: design of the Sheffield women's exercise and well-being project

Recovering from cancer treatment can be a difficult experience, both physically and psychologically. This paper describes a randomized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer. To facilitate behaviour change, exercise counselling is also included as an integral component in the exercise therapy intervention. Participants are randomized to one of three groups: exercise therapy, body conditioning (placebo control) or a normal care control group. The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks. Outcome measures include quality of life, physical self-perceptions, depression, satisfaction with life, exercise behaviour, aerobic capacity and percentage body fat. All outcomes are assessed at baseline, 4 weeks during the intervention and at the end of the 8-week intervention. Follow-up assessments of outcomes take place at 3 and 6 months post-intervention. As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life, it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment.     

What advice are oncologists and surgeons in the United Kingdom giving to breast cancer patients about physical activity?

Evidence has shown that physical activity may attenuate the negative physical, psychological and functional effects of treatment in women diagnosed with breast cancer. Physical activity levels also decline substantially during and after completion of treatment for cancer, highlighting the importance of strategies to promote participation in regular physical activity in this population. Oncologists and surgeons may serve as an influential source of motivation to be physically activity in cancer patients, by conveying the importance of a healthy lifestyle. The primary purpose of the present study was to investigate whether oncologists and surgeons routinely discuss physical activity with their breast cancer patients and to investigate the nature of any information/advice provided during consultations. A secondary aim was to examine whether physically active oncologists and surgeons were more likely to provide advice about physical activity to patients, than inactive oncologists and surgeons. A brief postal questionnaire was sent to 710 consultant breast cancer oncologists and surgeons throughout the UK and 102 responded (response rate = 14.4%). Of responders, most (55.9%) did not routinely discuss physical activity with their patients. Amongst oncologists/surgeons (clinicians) who did offer advice, most focussed on discussing the benefits of physical activity for physical and functional health gains and for facilitating weight control and maintenance. A number of clinicians indicated they advised patients that physical activity may decrease risk of recurrence and improve survival, despite the lack of evidence from RCTs to support this suggestion. There was no significant association between the physical activity status of oncologists/surgeons and the likelihood that they discussed physical activity with patients. Educational strategies aimed at encouraging clinicians to promote physical activity in consultations need to be targeted widely amongst the cancer clinician community.     

Opinion and Participation in the Regional Early Breast Cancer Detection Program in 2007 on the part of family physicians from a health district in the Autonomous Community of Madrid, Spain

BACKGROUND: Mammogram screening is the most effective method for the early detection of breast cancer. The objective of this study is to evaluate the degree of knowledge, the opinion and the participation in the early breast cancer detection program on the part of the family physicians of the Autonomous Community of Madrid. METHODS: The population studied was comprised of family physicians from Madrid Health District Seven. An anonymous, self-administered questionnaire comprised of 30 questions grouped into physicians characteristics and opinion concerning the early breast cancer detection programs. RESULTS: A total of 46% of the physicians replied. A total of 94% of the physicians believed that it is their duty to inform their patients concerning preventive activities, including breast cancer screening, and 95% believed their advice to be useful for convincing women to have a mammogram. A total of 72% believed information to be lacking on this program. During the time when mammograms are being taken at their centres, 24% of the physicians surveyed always or almost always ask the women if they have any doubts or would like further information, 43% having set up appointments for them and 95% advising them to have a mammogram taken. CONCLUSIONS: The family physicians have a good opinion of the early breast cancer detection program and feel their advice to be effective for improving the participation in the program. They report lack of information and inform women about the program to only a small degree.     

Experiences of women with breast cancer: exchanging social support over the CHESS computer network

Using an existential-phenomenological approach, this paper describes how women with breast cancer experience the giving and receiving of social support in a computer-mediated context. Women viewed their experiences with the computer-mediated support group as an additional and unique source of support in facing their illness. Anonymity within the support group fostered equalized participation and allowed women to communicate in ways that would have been more difficult in a face-to-face context. The asynchronous communication was a frustration to some participants, but some indicated that the format allowed for more thoughtful interaction. Motivations for seeking social support appeared to be a dynamic process, with a consistent progression from a position of receiving support to that of giving support. The primary benefits women received from participation in the group were communicating with other people who shared similar problems and helping others, which allowed them to change their focus from a preoccupation with their own sickness to thinking of others. Consistent with past research is the finding that women in this study expressed that social support is a multidimensional phenomenon and that their computer-mediated support group provided abundant emotional support, encouragement, and informational support. Excerpts from the phenomenological interviews are used to review and highlight key theoretical concepts from the research literatures on computer-mediated communication, social support, and the psychosocial needs of women with breast cancer.     

Reattendance of women for breast cancer screening programs. A review

BACKGROUND: In France, breast cancer is the most frequently occurring cancer and the leading cause of cancer deaths in women. Breast cancer screening has been shown to reduce breast cancer mortality by 30% provided attendance rate is 70% and re-screening interval is two to three years. Maintaining a high rate of reattendance is also important. The decline with time of completion rates of re-screening will lessen the benefits of a breast cancer screening program. METHODS: A review of published studies examining factors associated with attendance and reattendance to breast cancer screening. RESULTS: Positive views about initial screening are determining factors in reattendance: mammography should not be painful and embarrassing, appointments should be punctual and clinic staff courteous and supportive. Psychological factors influencing attendance also influence reattendance as does intention to participate, a major predictor of repeat participation and as do perceived susceptibility of breast cancer, perceived benefits of mammography, absence of emotional barriers. These factors can be modified by experience of previous screening. Other predicting factors of attendance continue to influence reattendance: practice of other preventive health behaviors, outside support from physicians, knowledge of breast cancer and screening. CONCLUSION: A better understanding of factors influencing attendance is necessary to increase the impact of breast cancer screening. Field studies are necessary to support the elaboration of publicity campaigns aimed at increasing participation.