Barriers to Early Diagnosis and Treatment among Breast Cancer Survivors: Qualitative Study in Tertiary Care Hospital, North Karnataka

Introduction: Around the World, Breast cancer has become one of the common cancers among women. Prevalence and mortality of Breast cancer in India are 18 lakh & 12.7 per lakh cases respectively. One of the important reasons behind late presentation & high death rate is the lack of breast cancer awareness. Objectives: To assess the barriers in diagnosis and treatment among breast cancer patients and to explore the perception about cancer prevention among them. Methods: A qualitative study was done among women with confirmed breast cancer who were admitted to KIMS, Hubballi, and Cancer hospital, Navanagar in April 2019. Data collection was done by the In-depth interview method and analyzed as per qualitative study protocol standards. Results: The data was collected among 14 participants. Themes were generated accordingly. The findings showed lack of awareness, myths, financial constraints, negligence were the major barriers to the early presentation of breast cancer. Conclusion: This study showed barriers such as lack of awareness, negligence, fear, financial constraints, myths and misconceptions, social stigma, lack of family support. Measures taken to reduce mortality by early diagnosis and treatment.

Health-Related Quality of Life among Long Term and Short Term Breast Cancer Survivors

@#Introduction: The number of breast cancer survivors in developing Asian countries is still lacking compared to Western countries. Health-related quality of life (HRQoL) of cancer patients is one of the significant predictors of survival. Hence, this study was conducted to determine HRQoL status among breast cancer survivors of different diagnosis duration in East Coast of Peninsular Malaysia. Methods: Cross-sectional data were collected for 128 breast cancer survivors, aged 37 to 72 years who were recruited by using purposive sampling method at two main government hospitals in Kelantan (n=67) and Terengganu (n=61). The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) which had been translated into the Malay language were used to measure HRQoL. Independent t-test was used to compare HRQoL status among short term (≤5 years duration since diagnosis) and long term (>5 years duration since diagnosis) breast cancer survivors. Results: Overall, our breast cancer survivors reported good HRQoL, with high scores for global health status, functional status and low symptoms scores. Long term breast cancer survivors had better social functioning compared to short term survivors (p=.038). Nevertheless, there was no significant difference found for other HRQoL status between short and long term breast cancer survivors. Conclusion: Breast cancer survivors in East Coast of Peninsular Malaysia generally experienced good HRQoL. The relatively similar HRQoL status between long-term and short-term survivors indicated a constant HRQoL profile among survivors throughout their survivorship.

Psychosocial Health of Disease-Free Breast Cancer Survivors Compared with Matched Non-cancer Controls / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The present study investigated the psychosocial health of disease-free breast cancer survivors who receive health examinations compared to matched non-cancer controls in a community setting. MATERIALS AND METHODS: We used baseline data from the Health Examinee cohort, which is composed of subjects participating in health. The disease-free breast cancer survivors were defined as those who were ≥ 2 years from initial diagnosis of breast cancer who had completed treatment. Females without a history of cancer were randomly selected at 1:4 ratio by 5-year age groups, education, and household income as a comparison group. We analyzed results from the Psychosocial Well-being Index-Short Form (PWI-SF) as a psychosocial health measurement. RESULTS: A total of 347 survivors of breast cancer and 1,388 matched controls were included. Total scores on the PWI-SF were lower in breast cancer survivors than matched non-cancer controls (p=0.006), suggesting a lower level of psychosocial stress in breast cancer survivors. In comparison to the control group, prevalence of drinking, smoking and obesity were lower, while exercising for ≥ 150 min/wk was higher in breast cancer survivors (p < 0.05). These findings suggest that breast cancer survivors have better health behaviors than their noncancer controls. After adjusting for other sociodemographic variables, breast cancer survivors were 36% less likely to be included in the stress group (odds ratio, 0.64; 95% confidence interval, 0.42 to 0.98). CONCLUSION: The disease-free breast cancer survivors resuming daily life demonstrated better psychosocial health status compared to matched non-cancer controls.

Reliability and validity of Chinese version of ambivalence over emotional expression questionnaire:testing in breast cancer survivors / 中华行为医学与脑科学杂志

Objective To examine the validity and reliability of the Chinese version of ambivalence over emotional expression questionnaire(AEQ) in breast cancer survivors.Methods A total of 323 breast cancer survivors were divided into 2 parts:sample 1 contains 122 breast cancer survivors for item and exploratory factor analysis,while sample 2 contains 201 breast cancer survivors for further confirmatory factor analysis,criterion validity,and internal consistency reliability.Results One-factor construct was determined and the results of confirmatory factor analysis showed that one-factor construct AEQ had a good construct validity (x2/df=1.01,CFI=0.99,TLI=0.99,NFI=0.86,IFI=0.99,RMSEA=0.02).The AEQ score was correlated with TAS-20 (r=0.28,P＜0.01).Cronbach α coefficient,Spearman-Brown split coefficient and the test-retest reliability of AEQ were 0.86,0.80 and 0.79,respectively.Conclusion The AEQ is a reliable tool to assess the ambivalence over emotional expression in Chinese breast cancer survivors.

Dietary Changes After Breast Cancer Diagnosis: Associations with Physical Activity, Anthropometry, and Health-related Quality of life Among Korean Breast Cancer Survivors / 대한지역사회영양학회지

OBJECTIVES: We aimed to examine levels of physical activity, anthropometric features, and health-related quality of life (HRQoL) among Korean breast cancer survivors who reported changes in their diet after diagnosis. METHODS: A total of 380 women who had been diagnosed with stage I to III breast cancer and had breast cancer surgery at least six months before the interview were included. Participants provided information on dietary change after diagnosis, post-diagnostic diet, physical activity, anthropometric measures, and HRQoL through face-to-face interview. We assessed HRQoL levels of breast cancer survivors using a validated Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Breast Cancer Module (BR23). We used the logistic regression and generalized linear models to identify the associations of dietary changes in relation with physical activity, anthropometry, and HRQoL. RESULTS: The majority of participants (72.6%) reported that they have changed their diet to a healthier diet after diagnosis. Breast cancer survivors who reported to have change to a healthy diet had higher intakes of vegetables and fruits and lower intakes of red and processed meats, and refined grains than those who did not. Also, survivors with a healthy change in their diet were more likely to engage in physical activity (top vs. bottom tertile: odds ratio [OR], 1.85; 95% confidence interval [95% CI], 1.02-3.36) and have lower body mass index (BMI) (OR, 0.90; 95% CI, 0.82-0.98 for one kg/m² increment in BMI) compared to those who did not. We found that a healthy change in diet was associated with higher scores of physical functioning (p=0.02) and lower scores of constipation (p=0.04) and diarrhea (p=0.006) compared to those who did not. CONCLUSIONS: Healthy changes in diet after breast cancer diagnosis may be associated with lower levels of BMI, and higher levels of physical activity and HRQoL.

Effect of Sexual Function Improvement Program for Breast Cancer Survivors on Sexual Distress, Sexual Satisfaction and Marital Intimacy

PURPOSE: This study was conducted to examine effects of a sexual function improvement program on sexual distress, sexual satisfaction and marital intimacy among breast cancer survivors. METHODS: With quasi-experimental design, a total of 54 women after breast surgery were assigned into experimental group (n=28) and control group (n=26) after recruited via convenience sampling. They were endocrine surgery outpatients in university hospital at Chonnam province. Experimental group received a sexual function improvement program 5 sessions over 5 weeks. Sexual distress, sexual satisfaction, and marital intimacy were examined with self-report structured questionaries. Data were analyzed using ?2 test, Fisher's exact, independent t-test, and analysis of covariance with SPSS 17.0/window program. RESULTS: Women who participated in the sexual function improvement program had lower sexual distress (F=27.29, p<.001), higher sexual satisfaction (t=3.09, p=.003) higher marital intimacy (F=17.51, p<.001) than the women who did not participate. CONCLUSION: Results suggest that a sexual function improvement program can be effective strategy to improve sexual distress, sexual satisfaction and marital intimacy. Therefore, this program can be regarded as useful nursing intervention program for breast cancer survivors.

The Association between the Adherence to Dietary Guidelines for Breast Cancer Survivors and Health-related Quality of Life among Korean Breast Cancer Survivors / 대한지역사회영양학회지

OBJECTIVES: We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors. METHODS: A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model. RESULTS: Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05). CONCLUSIONS: Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.

Yoga, fatigue, and regular physical activity among Japanese breast cancer survivors / 体力科学

Research highlights the importance of maintaining pre-diagnosis physical activity levels for breast cancer survivors post-treatment. However, many survivors have difficulty engaging in physical activity due to cancer-related fatigue. The aim of this study was to explore how participation in a 12-week yoga intervention impacted fatigue and physical activity. 20 individuals with breast cancer diagnosis participated in a 12-week yoga intervention. The yoga intervention included modified hatha yoga postures and consisted of 10 min. of warm-up, 45 min. of yoga postures, 10 min. of breath work, and 10 min. of supine resting pose <I>(savasana)</I>, for a total of 75 min. Assessments were administered at 3 time points: pre (T1), post (T2) yoga intervention and at a 12-week follow-up (T3). Measures included self-reported fatigue (Cancer Fatigue Scale) and physical activity (accelerometer step counts). One-way ANOVA were used to examine how fatigue scores and steps counts were changed over the course of the intervention. Total fatigue score (FS) and daily step (DS) counts at each time point were T1 (FS=21.6±8.9, DS=7709±2036), T2 (FS=14.0±8.3, DS=8429±2722), and T3 (FS=16.8±6.9, DS=8406±3389). Significant improvements in physical fatigue T1 (p<0.05, η² = 0.14) and cognitive fatigue (p<0.01, η² = 0.11) were seen at T1-T2. No significant changes were seen in psychological fatigue. 12 participants (65%) had high fatigue levels at T1, which decreased to 5 participants (27.8%) at T2. 12 participants (66.7%) increased daily steps at T2 and 8 participants (44.4%) continued to increase at T3. There were negative correlations between fatigue scores and step counts at all time points (r=-0.45~-0.55). Participation in a 12-week yoga program was associated with improved cancer-related fatigue.

Exercise training improves mean arterial pressure in breast cancer survivors / O exercício físico melhora a pressão arterial média em sobreviventes de câncer de mama / El ejercicio físico mejora la presión arterial media en los sobrevivientes de cáncer de mama

Currently, many breast cancer survivors worldwide live with treatment-related side effects, including cardiovascular health problems. This study examined effects of a 5-month exercise intervention on non-invasive markers of cardiovascular health in breast cancer survivors. Relationships between these markers and commonly used markers of overall health were also explored. Fifty-two survivors completed the exercise training at a rehabilitation center at the University of North Carolina at Chapel Hill between 2008-2011. A combined aerobic and resistance exercise intervention (3 times/week for 1h) at intensities progressing from low (40%) to moderate (65-70% of VO2max) for aerobic and 8-12 repetitions max for the resistance exercise were implemented. Significant reduction in mean arterial pressure (MAP) was observed from baseline to final assessment. A significant correlation was found between MAP and Body Mass Index (BMI). In conclusion, 5-months combined aerobic and resistance exercise intervention positively improved MAP which was, in part, attributed to changes in BMI...

"O exercício físico melhora a pressão arterial média em sobreviventes de câncer de mama."Atualmente, muitos sobreviventes de câncer de mama em todo o mundo vivem com os efeitos secundários relacionados com o tratamento, incluindo problemas de saúde cardiovascular. Este estudo examinou os efeitos de uma intervenção de exercício de 5 meses com marcadores não-invasivos de saúde cardiovascular em sobreviventes de câncer de mama. As relações entre esses marcadores e os marcadores mais utilizados de saúde em geral também foram exploradas. Cinquenta e duas sobreviventes completaram o treinamento em um centro de reabilitação da Universidade da Carolina do Norte em Chapel Hill entre 2008-2011. Foram implementadas intervenção combinando exercício aeróbio e resistido (3 vezes / semana durante 1h) em intensidades progredindo de baixo (40%) a moderada (65-70% do VO2max) para exercícios aeróbios, e 8-12 repetições máxima para o exercício de resistência. Redução significativa da pressão arterial média (PAM) foi observada a partir da linha de base para avaliação final. Foi encontrada uma correlação significativa entre o MAPA e Índice de Massa Corporal (IMC). Em conclusão, 5 meses de intervenção com exercícios combinados de resistência e aeróbio melhorou positivamente o MAP, que foi, em parte, atribuída a mudanças no IMC...

"El ejercicio físico mejora la presión arterial media en los sobrevivientes de cáncer de mama."Actualmente, muchos de los sobrevivientes de cáncer de mama en todo el mundo viven con los efectos secundarios relacionados con el tratamiento, incluyendo problemas de salud cardiovascular. Este estudio examinó los efectos de una intervención de ejercicio durante cinco meses con marcadores no invasivos de la salud cardiovascular en sobrevivientes de cáncer de seno. También se exploraron las relaciones entre estos marcadores y los marcadores más utilizados de la salud general. Cincuenta y dos sobrevivientes completaron la formación en un centro de rehabilitación en la Universidad de Carolina del Norte en Chapel Hill de 2008 a 2011. Intervención se implementara la combinación de ejercicio aeróbico y de resistencia (3 veces / semana durante 1 h) a intensidades que van de la baja (40%) o moderada (65-70% VO2max) para el ejercicio aeróbico, y 8-12 repeticiones máximas para el ejercicio de resistencia. Se observó una reducción significativa de la presión arterial media (MAP) desde el inicio hasta la evaluación final. Se encontró una correlación significativa entre el MAPA y el Índice de Masa Corporal (IMC). En conclusión, a cinco meses de intervención con ejercicio aeróbico y de resistencia combinado mejoraron positivamente el MAP, que se atribuye en parte a los cambios en el IMC...

Lifestyle Practices and Its Influence on Quality Of Life among Breast Cancer Survivors

Breast cancer is ranked number one from the ten most frequent cancers in female, Peninsular Malaysia. Various studies provide negative evidence on malignancies and one of the end results is impaired quality of life (QOL). Studies show lifestyle approaches are key factors in enhancing the QOL among cancer survivors. The purpose of this study is to describe the lifestyle practices (LP) among breast cancer survivors (BCS) which consist of dietary intake, exercise habits, and stress management and to determine whether these practices have influence on the QOL among Malaysian BCS. This study adopts a cross-sectional study design using a self-administered questionnaire. A total of 280 BCS from public and private hospitals throughout Peninsular Malaysia had participated. The questionnaire covers QOL and LP items which consist of dietary intake (consumption of high-fat food, high-fibre food, fruits and vegetables), exercise habits, and stress management. Descriptive statistics and one-way ANOVA were used to determine the relationship between LP and QOL. Mean age of the study sample was at 41 (SD=7.37). Majority of them were Malay (74%), 53% were diagnosed with breast cancer between 1 to 2 years whereas 54% were presented with stage 2 at diagnosis. There was a statistically significant difference (p< 0.05) in the overall quality of life score for the three LP groups (Better, No change, Worse). Malaysians’ BCS reported an improvement in LP and the enhancement in LP may result to better QOL outcomes.

Work Engagement among Breast Cancer Survivors: Are They Less Engaged in Their Work?

This study investigates work engagement of employed breast cancer survivors in comparison to unmatched control samples of healthy working women without cancer and any other chronic diseases from the general population. A case-control study design using unmatched controls was adopted in this study. The case comprised of 80 female breast cancer survivors who have returned to full-time employment selected using purposive sampling technique. Meanwhile, controls were 88 healthy female working women in full time paid employment, selected using quota sampling. Questionnaire covering socio-demographic characteristics and self-rated work engagement measured using Utrecht Work Engagement Scale (UWES) was distributed to the cancer survivors through face-to-face meeting during their hospital visits. For the healthy controls the questionnaires were distributed using drop-and-collect method through the human resource personnel of the participating organization. The results revealed, after controlling for age, marital status, ethnic group and tenure with organization, no significant differences in the overall work engagement was found between the breast cancer survivors [mean (SD) = 4.66 (0.92)] and the healthy controls [mean (SD) = 4.75 (0.85)]; F(1, 163) =1.70. In comparison to the work engagement domains, only the Vigor domain was found to be significantly lower for the survivors, survivors [F (1, 163) =14.94; p<.001] compared to healthy controls. However, the effect size was small (2= 0.004). No significant difference was found in the mean absorption and dedication domain scores. The findings suggest, except for vigor domain, work engagement of breast cancer survivors who have returned to work do not differ from individuals without cancer.​

The Influencing Factors on Quality of Life among Breast Cancer Survivors / 종양간호학회지

PURPOSE: This study was aimed to identify the influencing factors on the quality of life among breast cancer survivors. METHODS: The subjects were 159 female patients who visited out-patient department (OPD) after the mass removal surgery for breast cancer and had completed adjuvant treatments such as chemotherapy, radiation therapy at a university hospital and a general hospital. Data collection was conducted using the Ferrell QOL scale, the Mishel uncertainty scale, the Fitts & Osgoods body image scale revised by Jeon & Kim. the Rosenberg self-esteem scale, and the Kang family support scale. RESULTS: The level of QOL in the participants was in the middle. There were a significant correlation between QOL, uncertainty, self-esteem, and family support. There were significant differences in QOL with the perceived health condition and the best support person. In a regression analysis, the most powerful predictor of QOL was body image (21.7%). Altogether uncertainty and perceived health condition explained 28.6% of the variance of QOL of the participants. CONCLUSION: Body image, uncertainty, and perceived health condition were important predictors of QOL. These results demonstrated the need for developing interventions to improve QOL of breast cancer survivors.

Sexual Function of Breast Cancer Survivors and Healthy Women : A Comparative Study / 종양간호학회지

PURPOSE: The purpose of this study was to analyse the level of sexual function among breast cancer survivors as compared with that among healthy women. METHOD: A total of 208 women participated in this study: 103 breast cancer survivors attending self-help group and 105 community-residing healthy women in G city. A self-reported questionnaire with the Female Sexual Function Index (FSFI) was used to obtain data. Data were analyzed using the SPSS Win 14.0 K+ for descriptive statistics, t-test, and two-way ANOVA. RESULTS: The sexual function score of breast cancer survivors was significantly lower than that of healthy women, respectively 14.9+/-9.9 and 20.6+/-11.1 (p<0.001). The sexual function of recurrent breast cancer survivors was significantly lower than that of women without recurrence. However, there were no significant differences in the sexual function score according to the cancer stage, period since diagnosis, and types of cancer treatment modality. CONCLUSION: The findings indicate the importance of sex-related counseling and educational programs to improve the quality of life of breast cancer survivors.