Effect of age and race on quality of life in young breast cancer survivors.

BACKGROUND: Given their early age at diagnosis, young breast cancer survivors (YBCSs) face issues that differ widely from their older counterparts. PATIENTS AND METHODS: We mailed a survey to 2209 patients who were ≤ 45 years at the time of breast cancer (BC) diagnosis. Each survey was composed of the Quality of Life in Adult Cancer Survivors instrument, Menopause Symptom Scale, and questions aimed at obtaining pertinent background information. RESULTS: One thousand ninety patients completed the survey. Mean age at time of diagnosis was 39.5 years; median years from diagnosis was 6.6 years. Distress related to vaginal dryness (P = .0002) and pain from intercourse (P = .0014) was significantly higher in patients who were < 5 years from diagnosis compared with those > 10 years from diagnosis. In the area of financial problems, black women had greater distress than did white women (P = .0010). Compared with white women, Hispanic women had worse family distress scores (P = .0028) and summary cancer-specific scores (P = .0076). Patients > 10 years from diagnosis had less sexual interest (P = .003) than did women who were closer to diagnosis. Women ≥ 40 years at diagnosis had significantly lower sexual interest (P = .0016) than did women < 40 years. Stage and neoadjuvant chemotherapy did not have a significant effect on quality of life (QOL). CONCLUSION: Even in comparison to stage and neoadjuvant chemotherapy, race, age at diagnosis, and time from diagnosis have significant long-term effects on QOL after treatment for BC.

Sword of Damocles cutting through the life stages of women with ovarian cancer.

PURPOSE/OBJECTIVES: To identify the most prevalent worries and fears of women diagnosed with ovarian cancer. RESEARCH APPROACH: Online survey design was used to elicit qualitative data. Examination of worry was a single question extracted from a broader investigation. SETTING: A "virtual interview" enabled women from 12 countries and 44 states to participate in this study. PARTICIPANTS: 360 English-speaking women aged 19-82 years with a diagnosis of ovarian cancer. Ninety-one percent of the women were partnered, were Caucasian, and had received at least some college education. The sample was equally stratified on income, geographic location (rural versus urban), and distance to healthcare services. METHODOLOGIC APPROACH: A descriptive survey was used to investigate "worry" among women with ovarian cancer. Colaizzi's qualitative method was used to analyze the narrative responses. MAIN RESEARCH VARIABLES: Worries and fears of women with ovarian cancer stratified by age and development stage. FINDINGS: Consistent with previously published studies, worry about recurrence and fear of death were expressed by most women, regardless of age, ethnicity, or stage of life. Other worries expressed by study participants varied by age and development and were found to correlate with the last three stages of life as described in Erikson's Theory of Psychosocial Development. CONCLUSIONS: Age and development stage are key determinants of the needs and concerns of women with ovarian cancer. INTERPRETATION: Age and development stage should be considered when developing an individualized plan of care. Because recurrence is common among this population, the fear of death exists regardless of age and should be explored by nurses, particularly during periods of remission.

Caring for the caregiver.

PURPOSE/OBJECTIVES: To describe the quality of life (QOL) and well-being of caregivers of patients receiving outpatient chemotherapy for leukemia and to identify strategies to promote the best possible QOL and well-being for the caregivers. DESIGN: Descriptive, cross-sectional study. SETTING: Ambulatory treatment center of a major comprehensive cancer center in the southern United States. SAMPLE: Convenience sample of 194 caregivers of patients receiving chemotherapy for leukemia. METHODS: Participants completed the Caregiver Quality-of-Life-Cancer Scale, the Caregiver Well-Being Scale, and the Learning Needs Questionnaire developed by the authors. Descriptive statistics were used to summarize the demographic characteristics of the caregivers, and exploratory factor analysis was performed to identify meaningful factors. MAIN RESEARCH VARIABLES: QOL, well-being, and learning needs. FINDINGS: Caregivers identified burden as their most important concern for QOL. Key factors identified with caregivers' well-being were expression of feelings and household maintenance. Caregivers identified giving medications and managing the side effects as crucial to learning needs. Communication, positive attitudes, support, and education were important in promoting QOL for the caregivers. CONCLUSIONS: Caregiving for a patient receiving chemotherapy for leukemia influences the QOL and well-being of the caregiver. IMPLICATIONS FOR NURSING: This study highlights the need for better nurse-caregiver communication and education, particularly in the areas of symptom management and medication administration. Additional research should focus on factors that affect caregivers' QOL, their educational needs, and improved interventions for delivering new information or reinforcing old information.

Proliferative changes in the bronchial epithelium of former smokers treated with retinoids.

BACKGROUND: Retinoids have shown antiproliferative and chemopreventive activity. We analyzed data from a randomized, placebo-controlled chemoprevention trial to determine whether a 3-month treatment with either 9-cis-retinoic acid (RA) or 13-cis-RA and alpha-tocopherol reduced Ki-67, a proliferation biomarker, in the bronchial epithelium. METHODS: Former smokers (n = 225) were randomly assigned to receive 3 months of daily oral 9-cis-RA (100 mg), 13-cis-RA (1 mg/kg) and alpha-tocopherol (1200 IU), or placebo. Bronchoscopic biopsy specimens obtained before and after treatment were immunohistochemically assessed for changes in the Ki-67 proliferative index (i.e., percentage of cells with Ki-67-positive nuclear staining) in the basal and parabasal layers of the bronchial epithelium. Per-subject and per-biopsy site analyses were conducted. Multicovariable analyses, including a mixed-effects model and a generalized estimating equations model, were used to investigate the treatment effect (Ki-67 labeling index and percentage of bronchial epithelial biopsy sites with a Ki-67 index > or = 5%) with adjustment for multiple covariates, such as smoking history and metaplasia. Coefficient estimates and 95% confidence intervals (CIs) were obtained from the models. All statistical tests were two-sided. RESULTS: In per-subject analyses, Ki-67 labeling in the basal layer was not changed by any treatment; the percentage of subjects with a high Ki-67 labeling in the parabasal layer dropped statistically significantly after treatment with 13-cis-RA and alpha-tocopherol treatment (P = .04) compared with placebo, but the drop was not statistically significant after 9-cis-RA treatment (P = .17). A similar effect was observed in the parabasal layer in a per-site analysis; the percentage of sites with high Ki-67 labeling dropped statistically significantly after 9-cis-RA treatment (coefficient estimate = -0.72, 95% CI = -1.24 to -0.20; P = .007) compared with placebo, and after 13-cis-RA and alpha-tocopherol treatment (coefficient estimate = -0.66, 95% CI = -1.15 to -0.17; P = .008). CONCLUSIONS: In per-subject analyses, treatment with 13-cis-RA and alpha-tocopherol, compared with placebo, was statistically significantly associated with reduced bronchial epithelial cell proliferation; treatment with 9-cis-RA was not. In per-site analyses, statistically significant associations were obtained with both treatments.