Self-management Needs of Breast Cancer Survivors After Treatment: Results From a Focus Group Interview.

BACKGROUND: Recognition of the importance of self-management (SM) for breast cancer survivors (BCSs) is increasing, but evidence from investigations of their needs focusing on SM is limited. OBJECTIVES: The aim of this study was to explore the SM needs of BCSs who had completed treatment. METHODS: Using a qualitative study design, we interviewed a focus group of 20 BCSs who underwent cancer therapy (mean time since diagnosis 3.4 years) at a university hospital in South Korea. Data were analyzed via conventional content analysis. RESULTS: The focus group interviews revealed 10 subthemes that we organized into 5 themes about the posttreatment SM needs of BCSs: (1) symptom management needs, (2) emotional management needs, (3) information acquisition needs, (4) need for a relationship with healthcare providers, and (5) adaptation needs. Specifically, participants needed to acquire SM skills to relieve symptoms (eg, peripheral neuropathy, insomnia), deal with emotional problems (eg, fear of recurrence, anxiety, depression), and adapt to changes due to cancer treatment (eg, body image, lifestyle, and role changes). In particular, participants expressed a substantial need for a constructive relationship with healthcare providers who, by respecting and communicating with them, would help empower them. Participants placed a high value on building self-confidence for successful SM. CONCLUSIONS: Our findings can contribute to the development of breast cancer survivorship care plans by emphasizing posttreatment SM. IMPLICATIONS FOR PRACTICE: Future SM support intervention for BCSs after treatment should focus on training SM skills, enhancing the survivor-provider relationship, and building survivor self-confidence.

Changes in Bone Mineral Density in Women With Breast Cancer: A Prospective Cohort Study.

BACKGROUND: Cancer treatment-induced bone loss is an important long-term effect among breast cancer survivors. Little is known, however, about the pattern of bone loss and the factors associated with it. OBJECTIVE: The aim of this study was to examine annual bone health changes and factors associated with bone loss for 3 years after diagnosis among women with breast cancer. METHODS: Ninety-nine newly diagnosed women with breast cancer (mean age, 51.1 years) were enrolled in a prospective longitudinal study. Bone mineral density (BMD) was measured with dual-energy x-ray absorptiometry at baseline and yearly for 3 years. RESULTS: During the 3-year follow-up, the proportion of women who had osteopenia or osteoporosis increased from 33.3% to 62.5%. The BMD of the participants significantly decreased 6.8% in the lumbar spine, 4.6% in the femur neck, and 3.5% in the total hip, with bone loss the greatest in the first year. In multiple linear regression analysis, chemotherapy was significantly associated with bone loss at all sites, and premenopausal status at diagnosis was significantly related to bone loss at the lumbar spine. We found no significant relationship between health behavior status and BMD change at any site. CONCLUSION: Women newly diagnosed with breast cancer can lose up to 6.8% of BMD during a 3-year follow-up. Chemotherapy and premenopausal status are important risk factors for bone loss. IMPLICATIONS FOR PRACTICE: Identification of premenopausal women at diagnosis and monitoring BMD before and after chemotherapy are key for promoting bone health in women with breast cancer.

Psychometric Evaluation of a Korean Version of the Cancer Survivors' Self-efficacy Scale.

BACKGROUND: Self-efficacy has become the target outcome of many self-management interventions for cancer survivors. However, no measurement is available that can be used to measure cancer-specific self-efficacy in Korea. OBJECTIVE: The aim of this study was to cross-culturally evaluate the reliability and validity of a Korean version of the Cancer Survivors' Self-Efficacy Scale (CSSES-K). METHODS: We translated the original version of the CSSES (11 items) and created a Korean version. We then conducted a validation study with 204 cancer survivors who had completed their primary treatment. We conducted psychometric evaluation using item analysis, factorial construct validity (exploratory factor analysis and confirmative factor analysis), hypothesis testing construct validity, and internal consistency reliability (Cronbach's α). RESULTS: Exploratory factor analysis revealed 2 subscales for which model fitting was appropriate-"self-efficacy for managing health problems" (5 items) and "self-efficacy for seeking help and support" (5 items). Hypothesis testing construct validity was confirmed showing significant moderate correlations between the CSSES-K and general self-efficacy (r = 0.511, P < .001), anxiety (r = -0.596, P < .001), depression (r = -0.554, P < .001), and health-related quality of life (r = 0.586, P < .001). The internal consistency of the CSSES-K of total scale and subscales was high (Cronbach's α = .86-.92). CONCLUSIONS: The results supported that the CSSES-K was valid and reliable in measuring self-efficacy among Korean cancer survivors after cancer treatment. IMPLICATIONS FOR PRACTICE: Our findings suggest that the CSSES-K can be effectively used for measuring self-efficacy in Korean cancer survivors.

The Effect on Bone Outcomes of Adding Exercise to Supplements for Osteopenic Breast Cancer Survivors: A Pilot Randomized Controlled Trial.

BACKGROUND: Cancer treatment-induced bone loss is an important long-term effect in breast cancer survivors, but evidence regarding lifestyle interventions for preventing cancer treatment-induced bone loss is lacking. OBJECTIVE: The aim of this study was to investigate the feasibility, safety, and effects of a 6-month combined home-based exercise and calcium and vitamin D supplements (EX + SUPP) intervention compared with calcium and vitamin D supplements alone (SUPP) on bone health of osteopenic breast cancer survivors. METHODS: In this pilot randomized controlled trial, we enrolled 43 women with breast cancer who were diagnosed as osteopenic through bone mineral density screening. Women were randomly assigned to the EX + SUPP group (n = 23) or the SUPP group (n = 20). RESULTS: The rates of participant retention (90.7%) and of counseling calls delivered to the EX + SUPP group (90.3%) were high. The average exercise adherence rate was 69.5% for weight-bearing exercise and 48.5% for resistance exercise. The EX + SUPP group reported no injuries or adverse events. Despite positive findings of adherence and safety, no significant group differences were observed for bone mineral density, bone turnover marker, or physical performance. CONCLUSIONS: A home-based exercise program for bone health among osteopenic breast cancer survivors is feasible and safe. There was no significant additive effect of exercise on bone outcomes under the conditions studied, however, suggesting the need for a larger trial. IMPLICATIONS FOR PRACTICE: Effective exercise intervention may require more intensive components such as higher loading forces and longer duration for improving bone health among this population.

[Effects of a tilting training program on lower extremities function, depression, and self-efficacy among stroke inpatients].

PURPOSE: The purpose of this study was to identify effects of a tilting training program on lower extremities function, depression, and self-efficacy among stroke inpatients. METHOD: The subjects were 60 stroke patients hospitalized in an oriental medical hospital; 31 in the experimental group and 29 in the control group. A nonequivalent control group pretest-posttest design was used. The tilting training program consisted of 3 sessions and was implemented for 30 minutes daily during 3 weeks. Data was collected from Feb to July 2003, and analyzed by percentage, Fisher's exact probability, chi2-test, and t-test using the SPSS/Win 10.0 computerized program. RESULT: After treatment with the tilting training program, the experimental group was significantly increased in the mean score for function of lower extremities (t=2.72, p=.009) compared to the control group, especially for keeping standing balance (t=2.78, p=.007) and standing by oneself (t=3.32, p=.002). However, in the mean scores of depression and self-efficacy, there were no significant differences between the two groups. CONCLUSION: The tilting training program was effective for increasing the function of lower extremities and to improve walking ability earlier among stroke inpatients. Therefore, the tilting training program is applicable to increase the balance level in standing and walking ability at the early rehabilitation stage for stroke patients.