Mental health and quality of life in patients with premenstrual exacerbation: a cross-sectional study in Japan.

BACKGROUND: In the classification of premenstrual disorders (PMDs), premenstrual exacerbation (PME) is listed as one of the variants of PMDs, along with core PMD. However, the incidence of PME and its impact on mental health and quality of life have not been investigated. Therefore, we investigated the proportion of PME among women seeking treatment for premenstrual symptoms in Japan and compared the levels of anxiety, depression and quality of life between women with PME and those with core PMD. METHODS: Women who presented to the Department of Obstetrics and Gynaecology of a single institute for treatment of premenstrual symptoms and were diagnosed with PMDs using patient diaries were included in the study. Based on the diagnosis, patients were divided into two groups (core PMD and PME) and their responses to a questionnaire on mental health and quality of life at the first visit were analysed. RESULTS: A total of 32 women were diagnosed with PMDs (22 with core PMD and 10 with PME). All underlying medical conditions in women with PME were psychiatric disorders. There were no significant differences in various factors between the two groups. In terms of mental health, the PME group had higher levels of anxiety and depression than the core PMD group. Regarding quality of life, the PME group had lower scores than the core PMD group in all domains except physical and social functioning. CONCLUSIONS: Patients seeking treatment for premenstrual symptoms included many PME. Women with PME were more anxious and depressed than those with core PMD, and their quality of life was low in both physical and psychological domains. Patients with PME should be diagnosed and treated more appropriately.

Premenstrual exacerbation of underlying medical conditions is one of the variants of premenstrual disorders. This study aimed to assess the proportion of premenstrual exacerbation among patients attending a gynaecological clinic for premenstrual symptoms and to evaluate their mental health and quality of life. Women diagnosed with premenstrual disorder were divided into the core premenstrual disorder group and the premenstrual exacerbation group. We compared the mental health and quality of life scores calculated from the questionnaire between the two groups. Among the patients diagnosed with premenstrual disorders, about one-third were patients with premenstrual exacerbation. The premenstrual exacerbation group were more anxious and depressed than the core premenstrual disorder group, and had lower quality of life scores in almost all domains. The results underscore the importance that health care providers should always consider the possibility of premenstrual exacerbation when managing patients with premenstrual symptoms and provide appropriate care for these patients.

Symptoms and QOL in breast cancer patients receiving hormone therapy in Japan.

BACKGROUND: The aim was to clarify subjective symptoms and quality of life (QOL) in breast cancer patients receiving hormone therapy. METHODS: After obtaining approval from the research ethics committee, an observational study using a self-administered questionnaire was conducted at outpatient clinical oncology offices in 3 facilities that targeted breast cancer patients under the age of 50 who had been undergoing hormone therapy for less than 1 year. The study examined elements such as the breast cancer patients' basic information, symptoms, pain in daily life, QOL, and depression/anxiety. RESULTS: There were 214 valid responses. The respondents had an average age of 43.6. Of them, 100% were also treated with Tamoxifen and 30% with LH-RH agonist. There were 75% who were cognizant of side effects. Difficult symptoms that occurred with high frequency were stiff shoulders/back pain, decreased physical strength, hot flashes, and sweating. Over half the respondents were uncertain as to whether the subjective symptoms were side effects. They lost confidence in their physical strength and felt distressed over weight gain. There were 51 with a HADS anxiety score of 8 or higher, and 46 who scored 8 points or higher for depression. CONCLUSION: Breast cancer patients undergoing hormone therapy experience a variety of pains, and some also have serious psychological symptoms. Reassessing support systems to examine screening and self-care support is an issue going forward.

Developing a checksheet for breast cancer patients receiving endocrine therapy-examining reliability and validity.

BACKGROUND: The aim was to develop a checksheet that comprehends the daily lives of breast cancer patients receiving endocrine therapy, and examine its reliability and validity. METHODS: An anonymous, cross-sectional questionnaire was given to breast cancer patients under the age of 50 who had been receiving endocrine therapy for less than 1 year at outpatient clinical oncology offices in three facilities. Reliability was examined using Cronbach's alpha and test-retest reliability. Content validity, face validity, concurrent validity, convergent validity/discriminant validity, and factor analysis were used to examine validity. The study was carried out with approval from the research ethics committee. RESULTS: The checksheet was composed of three sections: subjective symptoms, discomforts in daily life while undergoing treatment, and coping with stress. Content validity was assessed as being mostly appropriate, and items identified as needing revision were corrected. Factor analysis led to four factors and 22 items for subjective symptoms, five factors and 18 items for daily life while undergoing treatment, and six factors and 24 items for coping with stress. Results indicated a high degree of correlation for concurrent validity, a moderate degree of correlation for convergent validity, and a low degree of correlation for discriminant validity. CONCLUSION: This study verified that the checksheet in its initial development as a scale has high reliability and validity.

Japanese translation and linguistic validation of the US National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

BACKGROUND: The US National Cancer Institute (NCI) has developed the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) to capture patients' self-reported symptomatic adverse events in cancer clinical trials. The aim of this study was to develop and linguistically validate a Japanese translation of PRO-CTCAE. Forward- and back-translations were produced, and an independent review was performed by the Japan Clinical Oncology Group (JCOG) Executive Committee and the US NCI. We then conducted cognitive interviews with 21 patients undergoing cancer treatment. Participants were asked to complete the PRO-CTCAE and were interviewed using semi-structured scripts and predetermined probes to investigate whether any items were difficult to understand or answer. The interviews were recorded and transcribed, and a thematic analysis was performed. The data were split into two categories: 1) remarks on the items and 2) remarks on the questionnaire in general. RESULTS: Twenty-one cancer patients undergoing chemotherapy or hormone therapy were interviewed at the University of Tokyo Hospital and the Kansai Medical University Hirakata Hospital during 2011 and 2012. Thirty-three PRO-CTCAE items were evaluated as "difficult to understand," and 65 items were evaluated as "difficult to answer" by at least one respondent. However, on further investigation, only 24 remarks were categorized as "comprehension difficulties" or "clarity" issues. Most of these remarks concerned patients' difficulties with rating their experience of individual symptomatic events. CONCLUSIONS: The study provides preliminary evidence supporting the linguistic validity of the Japanese version of PRO-CTCAE. Further cognitive interviewing is warranted for PRO-CTCAE items relating to sexuality and anxiety and for response options on severity attribute items.

Effectiveness of a stress management program to enhance perimenopausal women's ability to cope with stress.

AIM: To evaluate the effectiveness of a stress management program to enhance the ability to cope with stress in perimenopausal women. METHODS: In this quasi-experimental design, a stress management program was provided to an experimental group (n = 55), while a control group (n = 42) was given an informational pamphlet. The stress management program included a short lecture, group discussion, and hands-on training in 2 h sessions once a week for 3 weeks. Participants were recruited through a public announcement. Data were collected before and after the intervention, and 1 month following the intervention. The ability to cope with stress was the primary outcome, while psychological well-being and relief of symptoms were the secondary outcomes. The primary purpose of this program is to enhance the ability to cope with stress. Therefore, the aspects of knowledge, coping flexibility, and manageability were measured in the resultant ability to cope with stress. RESULTS: Compared to the control group, knowledge in the experimental group improved positively as the primary outcome (P < 0.01). Changes in coping flexibility were demonstrated within the experimental group (P < 0.05). A comparison between groups for the secondary outcome of psychological well-being showed that personal growth (P < 0.05) and happiness (P < 0.01) significantly improved in the experimental group. In addition, the secondary outcome of relief of symptoms indicated not improved. CONCLUSION: Results suggest that the stress management program has the potential to boost perimenopausal women's ability to cope with stress and improve their psychological well-being.

Guided self-help for prevention of depression and anxiety in women with breast cancer.

Depression and anxiety are prevalent in women with breast cancer. We developed a self-help kit as a self-learning package of necessary preparatory information (basic knowledge on chemotherapy, side effects, and problem-solving skills). We provided an oncology nurse-guided self-help kit with a cognitive behavioral therapy approach to 46 women with breast cancer in the intervention group and usual care to 36 in the control group in outpatient chemotherapy settings. The oncology nurse monitored and facilitated the patient's progress using the diary during the patient's chemotherapy. We also provided professional-led support group programs. Depression, anxiety, and quality of life were measured at baseline, 1 week, 3 months, and 6 months. The chi-square test and t were used to examine differences between the two groups, and repeated measures analysis of variance was used to test the effects of the intervention on the measures over time. All depression and anxiety scores were improved in both the intervention and control groups, but there were no significant differences between the two groups. Further studies are needed to evaluate the effectiveness of an oncology nurse-guided self-help approach for cancer patients.

Information sharing and case conference among the multidisciplinary team improve patients' perceptions of care.

BACKGROUND: As the advent of genomic technology accelerates personalized medicine and complex care, multidisciplinary care is essential for management of breast cancer. OBJECTIVES: To assess whether healthcare delivery systems are related to patients' perceptions of care in breast cancer treatment institutions. METHODS: We conducted a cross-sectional nationwide study of breast cancer treatment institutions approved by the Japanese Breast Cancer Society in Japan. From 128 of the 457 institutions, 1,206 patients were included in the analysis. Each patient completed a questionnaire regarding perceptions of care that consisted of a multidisciplinary care subscale and a patient-centered care subscale. RESULTS: Multiple regression analysis revealed that the multidisciplinary care subscale was significantly related to implementation of patient-based medical record system that was paper-based (p<0.05). The results of the secondary analysis showed a significant relationship between the interdepartmental medical record system and the patient's perception of multidisciplinary care (p<0.05) and patient-centered care (p<0.05). When a multidisciplinary case conference took place regularly or multidisciplinary viewpoints were incorporated into the conference records, the conference had a significantly higher correlation with both subscales (p<0.001). CONCLUSIONS: Integrated patient-based information and regular multidisciplinary case conferences that include records of viewpoints from different professionals improve patients' perceptions of comprehensive breast cancer care.