Young Adult German Breast Cancer Patients Participating in a Three-Week Inpatient Mother-Child Rehab Program Have High Needs for Supportive Care.

A known cut-off problem hampers the interpretation of quality of life (QOL) scores. The purpose of this study was to apply a novel approach for the EORTC QLQ-C30 instrument to identify the proportion of breast cancer (BC) patients in need of supportive care. Changes in QOL during the COVID-19 pandemic were evaluated, as well as changes over time (after treatment termination and up to 4 years later). Data were obtained from a cohort study on young adult BC patients with minor children participating in a mother-child rehab program. Cross-sectional QOL data were collected from 2015 to 2021 (baseline). Follow-up data were available for up to 4 years after diagnosis for a subgroup. The baseline cohort included 853 women (mean age 35 years). More than 50% had a need for supportive care. In the subgroup with follow-up, this proportion remained at a high level up to several years after diagnosis. During the COVID-19 pandemic, changes regarding the proportion with this need were not as high as expected-with the exception of changes on the QLQ-C30 scale 'role functioning' (+15%). Even several years after diagnosis, every second BC patient with minor children had a need for supportive care, which is much higher than previously found. Healthcare staff should be aware of this potential need and should address this issue.

Conditional Disease-Free and Overall Survival of 1,858 Young Women with Non-Metastatic Breast Cancer and with Participation in a Post-Therapeutic Rehab Programme according to Clinical Subtypes.

BACKGROUND: Breast cancer in young women is associated with unfavourable tumour biology and is the main cause of death in this group. Conditional survival analysis estimates survival rates under the pre-condition of already having survived a certain time. OBJECTIVES: To describe conditional disease-free and overall survival of female breast cancer patients according to clinical subtypes and age. METHODS: This study analyses information from 1,858 breast cancer patients aged between 21 and 54 years, who were taking part in a post-therapeutic rehab programme (time between diagnosis and rehab start: maximum 24, median 11 months). Mean follow-up time was 3.6 years. We describe biological, clinical and pathological features in regard to different age groups (<40 and ≥40 years) and report conditional 5-year survival rates for overall and disease-free survival, and Cox proportional hazard models. RESULTS: Very young and young patients differed in regard to hormone receptor negativity, tumour grade, lymphovascular invasion, and molecular subtypes. Young women bore triple-negative and HER2-like disease more frequently. Conditional 5-year overall survival did not differ substantially between women <40 and 40-54 years of age (95 vs. 96%). It was highest for women with cancer of the luminal A subtype (98%) and lowest for the triple-negative subtype (91%). Lymphangiosis was a significant predictor of death. Results for disease-free survival were comparable. CONCLUSIONS: Conditional 5-year overall survival after non-metastatic breast cancer was as high as 95.5%, and disease-free survival was 85.2%. When controlling for time between diagnosis and rehab start, molecular subtypes influenced overall and disease-free survival prospects. When additionally controlling for clinical characteristics, this effect only remained stable for disease-free survival.

Psychosocial and family-centered support among breast cancer patients with dependent children.

OBJECTIVE: To evaluate the psychosocial situation of breast cancer (BC) patients with dependent children, with regard to who used family-centered psychosocial support (PS) services, reasons against using it, as well as existing, unmet needs, and current PS need. METHODS: Data were collected via survey and patient files during an inpatient rehabilitation program for mothers with BC, who were accompanied by a child <12 years. Descriptive statistics and tests for statistical significance were used. RESULTS: Out of the total of 561 patients, 23.0% had used family-centered PS services before. Common reasons against it were enough support, no anticipated need and organizational issues. Patients stated a high number of unmet needs. The most urgent ones related to their children. About 59.3% of mothers stated a current PS need (PSN) and 33.3% a need for their children. Little social support and a worse maternal HRQOL, but not time since diagnosis, were related to a higher PSN in mothers and children (bivariate association). CONCLUSION: Among BC patients with dependent children, clinicians need to take the whole family and their support needs into account. They should know about the existing organizational barriers, which need to be overcome with the help of tailored offers. Patients with low HRQOL, little social support and single-mothers (with regard to children's PSN) need special attention as these can be indicators of high PSN.

Use of Complementary and Alternative Medicine among Young Patients with Breast Cancer.

BACKGROUND: Complementary and alternative medicine (CAM) has received increasing attention in Western countries and is especially common among breast cancer (BC) patients. So far, its effectiveness has not been well studied, which is in part due to the contextuality of CAM along with a lack of information of why patients use it. OBJECTIVES: Young BC patients constitute a special patient group regarding clinical characteristics, QOL, and their role in society. Since little is known about their CAM use, this study aimed at exploring it as well as their reasons for CAM use. METHODS: Data on CAM and sociodemographics were collected via questionnaire in the context of a rehabilitation program for young mothers with BC. Initial BC diagnoses were between 2009 and 2014 (recruitment period 2012-2015). Clinical characteristics were derived from the patient files. Descriptive statistics were used to describe frequencies and statistically significant differences were tested. RESULTS: Among the 827 patients, with an average age of 39.6 years, 62.5% had used CAM with regard to their cancer. CAM use was significantly higher in women with higher educational level, higher employment status, and statutory health insurance, respectively. The average monthly expenses on CAM were EUR 50. Every 5th woman used CAM without her physician's knowledge. The types most often used were dietary supplements with vitamins or minerals. The most frequent reasons for CAM use were to strengthen the immune system, support conventional medicine, and combat side effects. CONCLUSIONS: CAM plays an important role for young BC patients with regard to prevalence and monthly expenses, and was used for a wide range of reasons. Certain subgroups with more frequent CAM use could be identified. Physicians should therefore proactively talk about CAM with their young BC patients, so that patients do not need to rely on information sources on CAM outside the medical system.

Early-Onset Breast Cancer: Effect of Diagnosis and Therapy on Fertility Concerns, Endocrine System, and Sexuality of Young Mothers in Germany.

BACKGROUND: The purpose of this study was to analyze the effect of breast cancer therapy on fertility concerns and sexuality of young mothers with breast cancer in Germany. METHODS: During a mother-child rehabilitation program, 1,191 young mothers with locoregional primary breast cancer, treated between 2006 and 2014, were recruited. Data included sociodemographic data, TNM stage, tumor biology, therapies, and patient-reported outcomes such as sexuality and fertility concerns. RESULTS: The mean age at diagnosis was 40 years. Approximately a quarter of the patients stated that family planning had not been completed at the time of diagnosis. Nearly half of all patients had been informed as to how treatment could affect fertility, but counseling at a specialized fertility center was offered to only 13%. Of all patients, 4% took a consultation and 2% underwent fertility preservation procedures. CONCLUSION: Our study indicates that only a minority of patients is referred to fertility centers although family planning is incomplete at the time of diagnosis in about 25% of young women with breast cancer. Thus, these patients should not only be informed about the effects of treatment on fertility and sexuality, but should be referred to a fertility center.

[Signs of social inequality in information seeking and evaluation of information among young women with breast cancer - results of a cohort study]. / Hinweise auf soziale Ungleichheit im Informationsverhalten und in der Informationsbewertung junger Frauen mit Brustkrebs ­ Ergebnisse der Kohortenstudie "gemeinsam gesund werden".

OBJECTIVE: The extent to which cancer patients are well-informed can have manifold effects. The aim of this study was to explore both the sources of information that young breast cancer patients with children use and how they evaluate the information obtained. METHODS: Participants were recruited within a rehabilitation program for young mothers with non-metastatic breast cancer (the Groemitz project "gemeinsam gesund werden"). Data on information seeking, the level of information, socio-demographic data and clinical characteristics were collected using a questionnaire. RESULTS: The patients (n=827) used several additional sources of information - most frequently the internet (69.5%; n=767). The majority felt well informed about their disease and found the information provided easy to understand. A social gradient was observed in relation to media use, information evaluation and obtaining a second opinion. CONCLUSION: To young breast cancer patients, the internet is crucial for obtaining further information. The indication of a social gradient underlines the importance of addressing the information needs of patients with a lower socioeconomic status.

Guideline conformity treatment in young women with early-onset breast cancer in Germany.

BACKGROUND: The purpose of the study was to characterize the treatment of young mothers with breast cancer in Germany and to investigate whether it followed applicable guidelines. METHOD: Retrospective data obtained between 2002 and 2011 for 1,053 mothers with children of < 12 years of age with adjuvantly treated loco-regional primary breast cancer were analyzed. Collected data included sociodemographic data, TNM stage, biology of tumor and therapies. Actually received therapies were compared to those suggested in guideline treatment plans. RESULTS: The mean age of the patients was 39 years. 97% of the women with node positivity received an axillary dissection. Overall, 90% of the patients received chemotherapy with a guideline adherence range of 87-99% depending on clinical parameters. For radiation therapy, guideline adherence was high (range 82-100%). 95% of the patients with a hormone receptor-positive tumor received endocrine therapy; in 94%, tamoxifen therapy was performed in compliance with guidelines, whereas gonadotropin-releasing hormone (GnRH) agonist therapy complied with the guidelines in 52% of the cases. CONCLUSION: Guideline adherence in young mothers with breast cancer in Germany was high (with the exception of GnRH therapy), as comorbidity or the ambiguity of the therapeutic success does not need to be considered as much in this young, otherwise usually healthy, cohort compared to an age-heterogeneous group.

Blood loss after caesarean section: depending on the management of oxytocin application?

PURPOSE: Oxytocin donation in caesarean section is used to reduce postpartum blood loss. Cardiovascular side effects such as tachycardia, hypotension and decreased cardiac output are known and seem to depend on the way of application, whereas the blood loss is said to be similar. We aimed to examine that extent of haemorrhage in our own patients. METHOD: In July 2011, the perioperative oxytocin management was changed and the postpartum was oxytocin bolus abolished. Retrospectively, we reviewed the pre- and postpartum haemoglobin in all women who had undergone caesarean section in the year 2011 at the University Hospital of Schleswig-Holstein, Campus Luebeck. RESULTS: We found a significantly higher blood loss in those patients who were treated without oxytocin bolus but only with oxytocin infusion (-10.5 vs. -9 g/dl). CONCLUSION: We recommend to do further studies to clarify the advantage and contraindications of using oxytocin boluses and until to use the oxytocin bolus again in healthy patients but to avoid it in patients with cardiovascular risk.