Breast cancer stage, social class and the impact of screening

Two studies were carried out to examine socio-economic factors in breast cancer: a random sample of all new cases in Edinburgh in 1979 was reviewed, and the control population of the Edinburgh randomized trial of breast screening was used to determine stage and survival in relation to social class. Small area statistics from census data were used as measures of social class, the method being now well accepted. More than one-third of women still present with obviously advanced or metastatic breast cancer, but both studies showed this has no association with socio-economic status. Late stage at presentation is a serious problem, and although mass screening is likely to cause an improvement in those who are screened, it cannot in those who do not attend for screening. As attendance is related to social class, less affluent women are less likely to benefit and will continue to be diagnosed with advanced disease.     

Breast cancer: Epidemiology,risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally,epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer.This review discusses genetic, hormonal, behavioral, envi...     

Short-term impact of cancer prevention and screening activities on quality of life.

PURPOSE:There are few data on the short-term effects of participating in cancer prevention activities, undergoing genetic risk assessment, or having routine screening. The objective of this article is to systematically review existing research on short-term effects of prevention, genetic counseling and testing, and screening activities on quality of life. METHODS:We conducted a MEDLINE search for original research studies that were published between January 1, 1985, and December 31, 2002, and conducted in North America or Western Europe. Data were abstracted and summarized using a standardized format. RESULTS: We reviewed 210 publications. Most studies focused on psychological states (anxiety, depression), symptoms, or general health status. One hundred thirty-one studies used 51 previously validated noncancer instruments. Many researchers (12.6%) also added cancer-specific measures, such as perceived cancer risk or symptom indices. Only one study measured satisfaction or quality of provider-client communication. While one report examined lost workdays, no other economic consequences of short-term outcomes were evaluated. Among seven studies that assessed short-term outcomes preferences, only four specifically used time trade-off or linear rating scale methods. No study used standard gamble or willingness-to-pay methods. The overwhelming majority of research indicated that short-term effects were transient. Only two studies linked short-term effects to long-term cancer-related health behaviors such as repeat screening. CONCLUSION: There is considerable heterogeneity in short-term outcome measurement. Clinicians need to be aware of potential for short-term, transient adverse effects. The impact of short-term experiences should to be linked to long-term health status and use of services.     

The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998–1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by €4040 in women, and by €4100 in men. Of these, €660 in women, and €890 in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately €4000. However, because of the favourable CER''s, including unrelated healthcare costs will in general have limited policy implications.     

Psychosocial factors in lung cancer: quality of life, economic impact, and survivorship implications

Lung cancer is the leading cause of cancer mortality in men and women. Lung cancer accounts for approximately 30% of all cancer deaths in the United States. In addition, it is the most often diagnosed cancer in men, and the second most often diagnosed cancer in women. Five-year survival rates in lung cancer remain very low, around 15%. Approximately 45% of patients present with stage III disease. The majority of these patients are considered non-resectable, leading to the poor survival statistics seen in this disease. Unfortunately, survival rates have not improved in the past 30 years despite much research in diagnostics and therapeutics. Patients with advanced disease often experience multiple symptoms, including fatigue, pain, dyspnea, cough, hemoptysis, and anorexia. This paper will review the enormous toll that lung cancer takes on society, as well as individuals and families affected. In addition, we will examine psychosocial factors pertinent to lung cancer. Specifically, the article briefly discusses treatment approaches to lung cancer, as they relate to quality of life (QOL). QOL as a construct within lung cancer is then reviewed. Comment is made on the evaluation and prognostic importance of QOL. Next, economic and survivorship aspects of lung cancer are discussed. Finally, a summary of relevant psychosocial interventions for patients diagnosed with lung cancer is given.     

Breast cancer surgery from the viewpoint of quality of life

Recently, cancer therapy has been evaluated not only for the therapeutic results themselves but also in the quality of life of the treated patients. The first category of such efforts in breast cancer surgery is the introduction of conservative surgery, that is, muscle preserving operation, partial mastectomy, subcutaneous mastectomy and so on. The second approach is breast reconstruction after mastectomy, which has been improved with the progress in plastic surgery. Recent problems in the above respects in Japan are discussed.     

Health-related quality of life and cost-effectiveness studies in the European randomised study of screening for prostate cancer and the US Prostate,Lung, Colon and Ovary trial

Decisions on policies for screening for prostate cancer require that information upon health-related quality of life (HRQL) and cost-effectiveness (CE) be available, as the lead time for some of the cases detected by screening will be very long and detriments in quality of life could have a major impact on the subjects remaining life-span. A framework within which both HRQL and cost-effectiveness of prostate cancer screening can be assessed is presented. Studies of both are ongoing in the European Randomised Study of screening for prostate cancer and the US Prostate, Lung, Colon and Ovary trial. Preliminary information confirms that it is important to study screened subjects and controls, and not to assume that inferences derived from study of prostate cancer outside screening trials can be extrapolated to the trials. However, it will require prolonged study to enable the overall effects on quality of life, and on cost-effectiveness to be determined. Such studies are ongoing for the two trials.     

Breast cancer survivors: Psychosocial concerns and quality of life

Purpose To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatment.Methods A sample of 139 breast cancer survivors who had been interviewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in person. The mailed questionnaire included standardized instruments to assess quality of life (QL), rehabilitation needs, and psychological distress. Additional survey questions were developed to examine post-surgical recovery, employment and insurance problems. social support, and existential concerns. The in-person interviews expanded on these questions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surgery.Results The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardized QL instruments during the first year after surgery, nor did they differ from the full study sample of 227 women. The scores on the Profile of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previous assessments at 1 year after initial treatment. The scores on the Cancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning between the 1 year and 3 year evaluations. For the 2 year sample only Sexual Functioning showed a deterioration between the 1 and 2 year evaluations. Using the RAND 36-Item Health Survey 1.0, the breast cancer survivors were compared with patients from the Medical Outcomes Study. The breast cancer survivors demonstrated higher levels of functioning in many dimensions (role functioning, social functioning, pain, and general health) than the patients with chronic medical conditions. In spite of relatively good physical and emotional functioning on this generic measure of health status and quality of life, these breast cancer survivors reported a number of important and severe rehabilitation problems that persisted beyond one year after primary treatment. Especially frequent were problems associated with physical and recreational activities, body image, sexual interest, sexual function, and problems with dating for those who were single.Conclusions Breast cancer survivors appear to attain maximum recovery from the physical and psychological trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Nevertheless, breast cancer survivors rate their QL more favorably than outpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.     

Hereditary breast cancer growth rates and its impact on screening policy

Imaging is often performed yearly for the surveillance of BRCA1/2 mutation carriers and women at high familial breast cancer risk. Growth of cancers in carriers may be faster as these tumours are predominantly high grade. Quantitative data on tumour growth rates in these 2 groups are lacking. Here, we have examined 80 high-risk women under surveillance for tumour size at diagnosis and preceding examinations at mammography and/or MRI. Tumour volume doubling time (DT) was assessed in 30 cancers in BRCA1/2 mutation carriers and 25 non-carriers. Impact of age and menopausal status were also evaluated. Mean DT of all invasive cancers was shorter in carriers (45 days CI: 26-73) than non-carriers (84 days CI: 58-131) (P = 0.048). Mean age at diagnosis was lower in carriers (40 years) than non-carriers (45 years) (P = 0.007). At multivariable analysis only age (P = 0.03), not risk-group (P = 0.26) nor menopause (P = 0.58) correlated significantly with DT. The mean growth rate slowed down to half in each successive 10 years-older group. In conclusion, age at detection indicated the growth rates of hereditary and familial breast cancers. It is recommended that the screening frequency should be adjusted according to a woman's age and a high-sensitive biannual test may be appropriate before the age of 40 years.     

Anticipatory nausea among ambulatory cancer patients undergoing chemotherapy: prevalence, associated factors, and impact on quality of life

The purposes of this study were to investigate the prevalence of anticipatory nausea (AN), its associated factors, and its impact on quality of life (QOL) among ambulatory cancer patients receiving chemotherapy. Patients were randomly selected to participate in this study, and were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short-form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe AN. The presence of AN was significantly associated with most domains of the investigated patients' outcome, including psychological distress and perceived needs, with the exception of the health system and information domain of patients' needs, and the physical functioning domain of QOL. Anticipatory nausea was also associated with QOL even after adjustments for age, sex, performance status, and psychological distress. The prevalence of AN in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including QOL, AN should not be neglected in current clinical oncology practice. (Cancer Sci 2010; 101: 2596-2660).     

肺癌患者睡眠与生活质量影响因素的回归分析

目的:了解肺癌患者的睡眠质量和生活质量的现状,探讨睡眠质量与生活质量及相关因素的关系.方法:以Karnofsky功能状态量表(KPS)、匹兹堡睡眠质量指数(PSQI)、欧洲癌症研究与治疗组织生活质量核心量表和肺癌特异性量表(EORTC QLQ-C30和LC13)评估我院98例肺癌患者的躯体功能状态、睡眠质量和生活质量,并选择其中的初诊患者,在治疗结束后1个月进行再评估.结果:78.6％的患者能维持正常生活或工作,45.9％的患者存在睡眠障碍.多元逐步回归分析结果显示,婚姻状况和KPS评分是肺癌患者睡眠质量的主要影响因素(P＜0.05),KPS评分和睡眠质量是肺癌患者生活质量的主要影响因素,P＜0.05.结论:肺癌患者存在不同程度的睡眠障碍.躯体功能仍是影响肺癌患者生活质量的主要因素.     

Breast cancer survivors of different sexual orientations: which factors explain survivors' quality of life and adjustment?

BackgroundLittle is known about differences by sexual orientation in explanatory factors of breast cancer survivors' quality of life, anxiety, and depression.Patients and methodsSurvivors were recruited from a cancer registry and additional survivors recruited through convenience methods. Data were collected via telephone survey from all 438 survivors, who were disease free and diagnosed with non-metastatic breast cancer an average of 5 years earlier. To explain quality of life, anxiety, and depression, we focused on sexual orientation as the primary independent factors, in addition, considering demographic, psychosocial, clinical, and functional factors as correlates.ResultsSexual orientation had indirect associations with each of the outcomes, through disease-related and demographic factors as well as psychosocial and coping resources. The various explanatory models explain between 36% and 50% of the variance in outcomes and identified areas of strengths and vulnerabilities in sexual minority compared with heterosexual survivors.ConclusionsThis study's findings of strengths among specific subgroups of sexual minority compared with heterosexual survivors require further explorations to identify the reasons for this finding. Most of the identified vulnerabilities among sexual minority compared with heterosexual survivors of breast cancer are amenable to change by interventions.     

Quality-adjusted life years in cancer: pros,cons, and alternatives

WOODWARD R.M., MENZIN J. & NEUMANN P.J. (2013) European Journal of Cancer Care 22 , 12–19 Quality-adjusted life years in cancer: pros, cons, and alternatives High and rising cancer treatment costs have forced a discussion about the use of cost-effectiveness analyses and other approaches to assess the value of cancer care. Oncologists have traditionally resisted using economic considerations in day-to-day medical considerations, though unavoidably their decisions have important resource implications, and increasingly economic realities are impacting their actions. In this paper, we summarise the use of the quality-adjusted life years to assess the value of cancer care and suggest potential ways to improve upon value measurement in cancer coverage and reimbursement decisions.