We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors.
To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks.
Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group.
Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = -0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks.
Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.
This 2-year follow-up study explores aspects of body image after mastectomy due to breast cancer.
This population-based study included 76 women living in northern Sweden who, during November 2006 to October 2007, underwent mastectomy due to breast cancer. The women completed a questionnaire entitled "Life After Mastectomy (LAM)" 10 months after the mastectomy and again 2 years later. We used SPSS version 18.0 for data processing and analysis.
The findings indicate that few significant changes in body image had taken place during the 2-year interval between the first and second completion of the questionnaire. An exception was a significant decrease in feelings of sexual attractiveness and comfort during sexual intimacy. At follow-up, 21% of the women had undergone breast reconstruction (BR). They were significantly younger than the women who had not had BR (53 vs. 63 years). Besides being younger, no other significant differences could be found between those women who had undergone BR and those who had not. The fact that the decrease in sexual attractiveness and feelings of comfort during sexual intimacy also applied to the subgroup of women who had had BR may therefore be surprising. A better understanding of issues related to breast cancer treatment and sexual function is vital.
It is important for health care professionals to be aware of problems related to sexual intimacy and to be prepared not just to provide information about these, but also to reflect on expectations vs. reality together with the women.
OBJECTIVE: The aim of this study was to assess cognitive function, quality of life, and psychological distress after surgery for early breast cancer but before initiation of adjuvant treatment. MATERIAL AND METHODS: We performed a population-based study in the county of North Jutland, Denmark, including 124 women aged less than 60 years who had surgery for early breast cancer from 2004 - 2006. They were compared with an aged-matched group of 224 women without previous cancer selected randomly from the same population. The cognitive function of patients and controls was tested using a revised battery from the ISPOCD study. Data were collected on quality of life (EORTC QLQ-C30) and psychological distress (POMS). RESULT: The neuropsychological tests did not reveal significant differences between patients and controls. Compared to the control group, breast cancer patients had a significantly 3 - 4 fold increased risk of experiencing cognitive impairment. Quality of life and psychological distress were also significantly poorer among patients. CONCLUSION: This study demonstrated that women diagnosed with breast cancer experience a significant deterioration of their perceived cognitive functioning, quality of life and of psychological well being.
Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Ontario, Toronto, Canada, M4N 3M5. firstname.lastname@example.org
Complementary and alternative medicines (CAMS) are frequently used by patients with breast cancer and their use may be related to the presence of psychosocial distress. The objective of this study is to assess the presence of anxiety and depression in breast cancer patients who use CAM and assess how they perceive their risks of recurrence and dying from breast cancer compared to non-users.
Breast cancer patients attending ambulatory clinics at a single cancer center were approached by their oncologist. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM, views of their risks of developing recurrent cancer, and of dying of breast cancer. The presence of anxiety and depression was scored using the Hospital Anxiety and Depression Scale (HADS). Responses were scored and compared between CAM users and non-users.
A total of 251 patients completed the survey. CAM usage was reported by 43% of patients. Individuals who used CAM were younger [53.1 versus 63.0 year (p
The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories.
A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12 months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories.
The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13 % had a high stable trajectory, 38 % an intermediate decreasing trajectory, and 49 % a low trajectory. Similar trajectories were found for partners (11, 22, and 67 %, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated.
A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories.
In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.
A focus group research study was conducted at a Canadian community hospital breast clinic to determine information needs of women who had experienced surgical breast biopsy procedures with benign results. Nine breast clinic patients who had benign breast biopsy results provided the researcher with findings related to this experience. The patients determined what they believed were the nine most important information needs during the diagnostic phase of a breast lump evaluation. These information needs emerged from the types of benign breast disease, the meaning of risk associated with benign breast disease developing into breast cancer, and the tests required to diagnose and treat benign breast disease. Perioperative nurses can use this information to plan and assess the care provided to women undergoing breast biopsy procedures.
A diagnosis of breast cancer is a key turning point in a woman's life that may lead to her experiencing severe and persistent distress and potentially presaging a psychiatric disorder, such as major depression. In Denmark an increased standardization of care and a short hospital stay policy minimize the time of medical and nursing surveillance. Consequently, there is the potential risk that distress goes unnoticed, and therefore, untreated. Therefore, the purpose of this study was to explore the experience of distress in Danish women taking part in surgical continuity of care for breast cancer.
A phenomenological-hermeneutic approach inspired by the French philosopher Paul Ricoeur was conducted to explore the experience of distress in relation to surgical treatment and care for breast cancer. Semi-structured interviews were conducted with 12 women who recently had surgery for breast cancer at six departments of breast surgery in Denmark from May 2013 to November 2013.
The understanding of the experience of distress in the period of surgical continuity of care for breast cancer is augmented and improved through a discussion related to four identified themes: A time of anxiety, loss of identities, being treated as a person and being part of a system, drawing on theory and other research findings.
Distress experienced by women in the period following diagnosis arises from multiple sources. Support and care must be based on the woman's individual experience of distress.
Patients with breast cancer experience unmet informational and psychosocial needs at the end of treatment. A brief psychoeducational intervention delivered at this transition may help to address some of the challenges these women face. The purpose of this study was to test the effectiveness of a single-session group psychoeducational intervention (GBOT group) compared with standard print material (usual care).
In this randomized controlled trial, 442 patients with breast cancer who were completing their adjuvant radiotherapy were recruited and randomized to receive either usual care, which includes standard print material (CRL group n = 226) or usual care and the GBOT group intervention (INT group n = 216). Participants completed measures at baseline and again at 3 and 6 months post-intervention.
The INT group showed significant improvement in their knowledge regarding the re-entry transition period (d = 0.31) and in their feelings of preparedness for re-entry (d = 0.37). There were no differences between the groups over time on health-related distress or mood.
Results support the effectiveness of providing a single-session group psychoeducational intervention as a first-step approach to supportive care for women at the end of breast cancer treatment.
A retrospective, descriptive study to determine the information needs of women who underwent a breast biopsy with a benign outcome and to ascertain the levels of uncertainty and anxiety they experienced was conducted in two community health care sites in Winnipeg, Manitoba. A sample of 70 women completed a four-part survey after learning the benign breast biopsy diagnosis. The survey consisted of an Information Needs Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, State-Trait Anxiety Inventory, and a Demographic Questionnaire. Before the study, nine information needs were identified in a focus group composed of women (n = 9) who had a benign breast biopsy. The nine information needs were arranged in 36 pairs in the Information Needs Questionnaire. Profiles of information needs were developed through Statistical Analysis Systems analysis using Thurstone's Law of Comparative Judgement--Case V. The most important information need of women who underwent a benign breast biopsy was knowing when they would learn the diagnosis. The next four information needs were categorized as information about the risks of developing breast cancer. Information about follow-up and diagnostic tests were less important than information about the threat of breast cancer. Women experienced heightened uncertainty and anxiety levels related to the benign breast biopsy experience. Profiles of information needs were developed for women experiencing various levels of uncertainty and anxiety, women of different age groups, and women who experienced with a loved one with breast cancer.
The BEST study, a multicenter randomized trial of group psychosocial support in metastatic breast cancer, had several unusual features that may have influenced recruitment, notably the group nature of the intervention and the need for close collaboration between medical and psychosocial investigators. The recruitment process was examined in light of these features. Establishment of study centers was facilitated by involvement of experienced medical investigators who had successfully collaborated in previous research projects. Systematic evaluation of potential subjects or direct recruitment by psychosocial investigators optimized recruitment; however, the group nature of the intervention prolonged recruitment. Overall, 652 women were approached and 237 (43.3% of those medically eligible) randomized. Using population-based estimates, 24.3% of women with metastatic breast cancer were assessed for the study and 8.7% randomized. A randomization ratio of 2:1 was required to form and maintain groups. Competing clinical trials were the greatest barrier to recruitment. Five lessons were learned during recruitment for this trial: (1) multicenter randomized trials of psychosocial interventions are feasible, even in very ill patients, (2) the use of a group intervention effectively increased the required sample size by 50%, (3) similarity of randomization rates suggests that generalizability of study results will probably be comparable to that of other randomized cancer trials, (4) multidisciplinary collaborations and involvement of experienced researchers facilitated enrollment, and (5) most challenges encountered in recruitment were similar to those seen in all clinical trials.