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1.
Gynecol Oncol ; 163(2): 371-377, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34456057

RESUMO

OBJECTIVE: Risk-reducing surgery is advised to BRCA1/2 pathogenic variant (PV) carriers around the age of 40 years to reduce ovarian cancer risk. In the TUBA-study, a multicenter preference study (NCT02321228), BRCA1/2-PV carriers are offered a choice: the standard strategy of risk-reducing salpingo-oophorectomy or the novel strategy of risk-reducing salpingectomy with delayed oophorectomy. We evaluated feasibility and effectiveness of a patient decision aid for this choice. METHODS: Premenopausal BRCA1/2-PV carriers were counselled for risk-reducing surgical options in the TUBA-study; the first cohort was counselled without and the second cohort with decision aid. Evaluation was performed using digital questionnaires for participating women and their healthcare professionals. Outcome measures included actual choice, feasibility (usage and experiences) and effectiveness (knowledge, cancer worry, decisional conflict, decisional regret and self-estimated influence on decision). RESULTS: 283 women were counselled without and 282 women with decision aid. The novel strategy was chosen less frequently in women without compared with women with decision aid (67% vs 78%, p = 0.004). The decision aid was graded with an 8 out of 10 by both women and professionals, and 78% of the women would recommend this decision aid to others. Users of the decision aid reported increased knowledge about the options and increased insight in personal values. Knowledge on cancer risk, decisional conflict, decisional regret and cancer worry were similar in both cohorts. CONCLUSIONS: The use of the patient decision aid for risk-reducing surgery is feasible, effective and highly appreciated among BRCA1/2-PV carriers facing the decision between salpingo-oophorectomy or salpingectomy with delayed oophorectomy.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Predisposição Genética para Doença , Neoplasias Ovarianas/prevenção & controle , Procedimentos Cirúrgicos Profiláticos/estatística & dados numéricos , Adulto , Proteína BRCA1/genética , Proteína BRCA2/genética , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Heterozigoto , Humanos , Pessoa de Meia-Idade , Mutação , Neoplasias Ovarianas/genética , Ovariectomia/psicologia , Ovariectomia/estatística & dados numéricos , Preferência do Paciente , Procedimentos Cirúrgicos Profiláticos/psicologia , Estudos Prospectivos , Salpingectomia/psicologia , Salpingectomia/estatística & dados numéricos , Salpingo-Ooforectomia/psicologia , Salpingo-Ooforectomia/estatística & dados numéricos
2.
Fam Cancer ; 20(2): 157-169, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32754788

RESUMO

Hereditary diffuse gastric cancer (HDGC) is an inherited cancer syndrome associated with high lifetime risk of diffuse-type gastric cancer. Current guidelines recommend individuals with HDGC undergo prophylactic total gastrectomy (PTG) to eliminate this risk. However, PTG is associated with significant lifestyle changes, post-surgical recovery, and symptom burden. This study examined factors related to decision-making about PTG in three groups of individuals who: (1) underwent PTG immediately after receiving genetic testing results; (2) delayed PTG by ≥ 1 year or; (3) declined PTG. Participants were recruited from a familial gastric cancer registry at a tertiary care hospital. Patients with CDH1 pathogenic or likely pathogenic variants who contemplated and/or underwent PTG were eligible. 24 individuals contemplated PTG: 9 had immediate surgery (within a year), 8 delayed surgery, and 7 declined surgery. Data on PTG barriers and facilitators were obtained on all participants using quantitative surveys (n = 7), qualitative interviews (n = 8) or both methods (n = 9). PTG barriers included age, positive beliefs about screening, close relatives with negative PTG experiences, fertility-related concerns, and life stress. Facilitators included social support, trust in healthcare providers, understanding risk, negative beliefs about screening, family-related factors, positive or abnormal screening results, and positive attitude toward PTG. This study highlights factors related to the PTG decision-making process among individuals with HDGC from three distinct groups. Future research should explore educational interventions aimed at addressing surgery-related concerns and the limitations of screening, and might also consider incorporating close relatives as informational supports.


Assuntos
Antígenos CD/genética , Caderinas/genética , Tomada de Decisões , Gastrectomia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Profiláticos/estatística & dados numéricos , Neoplasias Gástricas/prevenção & controle , Adulto , Fatores Etários , Atitude , Estudos Transversais , Família , Feminino , Gastrectomia/psicologia , Testes Genéticos , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Procedimentos Cirúrgicos Profiláticos/psicologia , Pesquisa Qualitativa , Apoio Social , Neoplasias Gástricas/genética , Fatores de Tempo , Confiança/psicologia , Adulto Jovem
3.
Menopause ; 27(2): 156-161, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31644510

RESUMO

OBJECTIVE: BRCA mutation carriers are advised to undergo bilateral salpingo-oophorectomy to prevent ovarian cancer. The abrupt hormonal withdrawal associated with early surgical menopause has been shown to increase the risk of depression and anxiety among women in the general population. The impact in women with a BRCA1 or BRCA2 mutation is not known. METHODS: We undertook a matched prospective study of BRCA mutation carriers to evaluate the impact of oophorectomy on self-reported initiation of antidepressant use. We identified women with no personal history of cancer or depression and prospectively evaluated the frequency of self-reported medication use after surgery. Each exposed participant (oophorectomy) was randomly matched to a control participant (no oophorectomy) according to year of birth (within 3 years), BRCA mutation type (BRCA1 or BRCA2), and country of residence (Canada, United States, Poland). A total of 506 matched sets were included. We estimated the odds ratio (OR) and 95% confidence intervals (CIs) of antidepressant use (ever/never) following preventive oophorectomy in the entire study population and stratified by age at oophorectomy and by use of hormone therapy. RESULTS: Oophorectomy was not associated with more frequent antidepressant use among BRCA mutation carriers (OR = 0.46; 95% CI 0.22-0.96). We observed reductions in the odds of antidepressant medication use among women who underwent oophorectomy before the age of 50 years (OR = 0.33; 95% CI 0.14-0.78) and among those who initiated hormone therapy use after oophorectomy (OR = 0.35; 95% CI 0.14-0.90). Findings were similar when the analysis was based on self-reported depression (rather than antidepressant use). CONCLUSIONS: Although based on a small number of women, these findings suggest that oophorectomy does not increase psychological distress among women at an elevated risk of ovarian cancer.


Assuntos
Antidepressivos/uso terapêutico , Depressão/epidemiologia , Predisposição Genética para Doença/psicologia , Procedimentos Cirúrgicos Profiláticos/psicologia , Salpingo-Ooforectomia/psicologia , Adulto , Proteína BRCA1/genética , Proteína BRCA2/genética , Canadá/epidemiologia , Depressão/tratamento farmacológico , Depressão/etiologia , Feminino , Predisposição Genética para Doença/genética , Humanos , Pessoa de Meia-Idade , Mutação , Razão de Chances , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/prevenção & controle , Polônia/epidemiologia , Estudos Prospectivos , Estados Unidos/epidemiologia
4.
Fam Cancer ; 18(4): 429-438, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31273560

RESUMO

Germline CDH1 mutation carriers are at risk for early-onset diffuse gastric cancer (DGC) and female carriers have an additional risk of lobular breast cancer. The reported literature GC risk of 70% has led to the recommendation for germline mutation carriers to undergo prophylactic total gastrectomy (PTG). The objective of this research was to examine post-surgical clinical outcomes and to identify which of the domains/symptoms from the European Organisation for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30) were determinants of overall quality of life (QOL) in individuals undergoing PTG. Participants were recruited through multiple sources. Postsurgical clinical outcomes were obtained from hospital records. Participants completed validated questionnaires measuring generic and condition specific QOL (PROMIS, EORTC and SF 36v.II) at a single point in time. The mean QOL in this cohort was 70.6 (SD = 25.6), which is better than reference values from the general populations in USA and Canada Role and social function plus the symptoms anxiety, pain, taste, dyspnea and diarrhea were significant predictor variables for QOL (p < 0.05). Although this study reveals good overall QOL for individuals after PTG, attention should be given to managing symptoms as part of long term care to further enhance QOL. The function/symptom scores were associated with worse overall health and global health status and thus may mark a real need for more attentive post-surgical care.


Assuntos
Gastrectomia/psicologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Profiláticos/psicologia , Neoplasias Gástricas/prevenção & controle , Ansiedade/etiologia , Peso Corporal , Depressão/etiologia , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/psicologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Procedimentos Cirúrgicos Profiláticos/efeitos adversos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
5.
J Gynecol Oncol ; 30(1): e2, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30479086

RESUMO

OBJECTIVE: To explore current practice and influencing factors on adoption of the opportunistic salpingectomy (OS), particularly regarding the decision making, to eventually enhance the development and implementation of clear guidelines. METHODS: This nationwide cross-sectional survey study was conducted in all hospitals in the Netherlands. An anonymous online survey was sent to gynecologists with special interest in gynecological oncology, gynecological endoscopy or urogynecology and all Dutch gynecology trainees. The survey mainly focused on current practice regarding OS and identification of influencing factors on the level of innovation, organization, healthcare professional and individual patient. RESULTS: The response rate was 348 out of 597 gynecologists (58.3%) and 142 out of 340 trainees (41.8%). Current practice of discussing and performing the OS varied widely, with ovarian cancer (OC) risk reduction as most important supportive factor on innovation level. Supportive factors on the level of organization and healthcare provider were; working in a non-training hospital, knowledge of current literature and extensive work experience (in years and annual number of hysterectomies). On individual patient level, a vaginal approach of hysterectomy, negative family history for OC and the presence of firm adhesions were suppressive factors for the OS. CONCLUSION: In this study we evaluated the current practice regarding the opportunistic salpingectomy in the Netherlands and identified influencing factors on different levels to raise awareness and attribute to development of a targeted implementation strategy, on both national and international level.


Assuntos
Carcinoma Epitelial do Ovário/prevenção & controle , Tomada de Decisão Clínica , Neoplasias Ovarianas/prevenção & controle , Procedimentos Cirúrgicos Profiláticos/psicologia , Salpingectomia/psicologia , Estudos Transversais , Feminino , Ginecologia/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Histerectomia Vaginal/estatística & dados numéricos , Países Baixos , Ovário/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Medição de Risco , Inquéritos e Questionários
6.
J Minim Invasive Gynecol ; 26(2): 253-265, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30240898

RESUMO

Carriers of genetic mutations that predispose to cancer syndromes are often faced with complex decisions. For women with hereditary breast and ovarian cancer in particular, the decision to undergo risk-reducing mastectomy or bilateral salpingo-oophorectomy is burdensome from a physical and psychological perspective. Although risk-reducing surgery is the most effective preventative measure in reducing a genetic mutation carrier's risk of breast or ovarian cancer, the success of these procedures requires a multidisciplinary approach that centers on careful counseling regarding the risks and benefits of risk-reducing surgery. The physical and psychological distress associated with risk-reducing surgery often makes a combined surgical approach attractive to some patients. In this review, we present the evidence surrounding the comprehensive surgical care of women with hereditary breast and ovarian cancer syndromes and evaluate the perioperative factors that influence surgical management.


Assuntos
Síndrome Hereditária de Câncer de Mama e Ovário/prevenção & controle , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Profiláticos , Salpingo-Ooforectomia , Feminino , Síndrome Hereditária de Câncer de Mama e Ovário/psicologia , Humanos , Assistência Perioperatória/psicologia , Mastectomia Profilática/métodos , Mastectomia Profilática/psicologia , Procedimentos Cirúrgicos Profiláticos/métodos , Procedimentos Cirúrgicos Profiláticos/psicologia , Salpingo-Ooforectomia/métodos , Salpingo-Ooforectomia/psicologia
8.
Heart ; 104(6): 480-486, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28780581

RESUMO

OBJECTIVE: The study is an early phase of development of a decision support framework for people with Marfan syndrome who are anticipating prophylactic aortic root surgery. Implications of the timing and the nature of the operation chosen were previously elicited in focus groups. In this step, we explored the range of relative values placed by individuals on the implications of decisions made about surgery. METHODS: Following the principles of the Ottawa Decision Support Framework, eight questions in the general form 'How important is it to you …' were framed by a panel. Marfan people, families and specialist doctors answered online. Quantitative and qualitative analyses were performed. RESULTS: Worldwide, 142 responses were received including 25 specialist doctors. Respondents were 55% female and 46% had previous aortic root surgery. Overall, active lifestyle was more important to males (p=0.03). Patients placed more importance than doctors on not deferring surgery (p=0.04) and on avoidance of anticoagulation in the interests of childbearing (p=0.009). Qualitative analysis showed differing but cogently reasoned values that were sometimes polarised, and mainly driven by the wish to maintain a good quality of life and active lifestyle. CONCLUSIONS: Given the cogency of these viewpoints, people anticipating root replacement surgery should have ample opportunity to express them and to have them acknowledged ahead of a consultation when they can then be fully explored in a mutually informed forum. If they differ from local medical practice, they can then be discussed in the process of reaching shared and individualised decisions.


Assuntos
Valva Aórtica/cirurgia , Síndrome de Marfan , Participação do Paciente , Procedimentos Cirúrgicos Profiláticos/psicologia , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Tomada de Decisões , Feminino , Humanos , Masculino , Síndrome de Marfan/psicologia , Síndrome de Marfan/cirurgia , Participação do Paciente/métodos , Participação do Paciente/psicologia , Pesquisa Qualitativa , Tempo para o Tratamento
9.
Clin Obstet Gynecol ; 60(4): 758-770, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28957952

RESUMO

Lack of success in ovarian cancer control through screening or advances in treatment in the general population has prompted exploration in new avenues of prevention. "Opportunistic" salpingectomy describes a surgical procedure or risk-reducing intent in women at low-risk/general population risk for developing ovarian cancer who are undergoing pelvic/abdominal surgery for other indications. This chapter reviews the uptake, safety, and anticipated impact of this prevention initiative.


Assuntos
Carcinoma/prevenção & controle , Neoplasias Ovarianas/prevenção & controle , Procedimentos Cirúrgicos Profiláticos/métodos , Salpingectomia/métodos , Adulto , Carcinoma/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Profiláticos/psicologia , Fatores de Risco , Comportamento de Redução do Risco , Salpingectomia/psicologia
10.
Int J Gynecol Cancer ; 26(7): 1338-44, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27465883

RESUMO

OBJECTIVE: To determine how frequently gynecologic oncologists discuss sexuality with women considering risk-reducing salpingo-oophorectomy. Secondary objectives were to assess the availability of resources, and the barriers to discussing sexuality. METHODS: Members of the Australian Society of Gynaecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncology were invited to complete an online survey. Questions addressed frequency of, and barriers to, discussing sexuality, and availability of resources related to sexual issues. RESULTS: Three hundred eighty-eight physicians in 43 countries responded from 4,006 email invitations (9.7%). Ninety-one percent reported discussing sexuality preoperatively, and 61% discuss it with every patient. Factors associated with higher rates of discussion were female sex (P = 0.020), higher level of training (P = 0.003), time in practice (P = 0.003), and consulting more risk-reducing salpingo-oophorectomy patients per month (P = 0.006). Commonly discussed issues were vasomotor menopausal symptoms (91%) and vaginal dryness (85%). Eighty-eight percent of respondents believed that sexuality should be discussed preoperatively, and most felt that it is their responsibility (82%). Fear of causing distress was the most common barrier to discussing sexuality (49%). Twenty-four percent felt that they did not have adequate training to discuss sexual function. CONCLUSIONS: Although most respondents believed that discussing sexuality should occur preoperatively, only 61% discuss this with every patient. Resources specifically relating to sexuality are limited. The most common barrier to discussing sexuality was fear of causing distress. Nearly one quarter of gynecologic oncologists felt inadequately trained to discuss sexual function.


Assuntos
Comunicação , Ginecologia/estatística & dados numéricos , Procedimentos Cirúrgicos Profiláticos/psicologia , Salpingo-Ooforectomia/psicologia , Sexualidade/psicologia , Feminino , Humanos , Masculino
11.
Maturitas ; 85: 42-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26857878

RESUMO

OBJECTIVES: Investigate the effects of pre-operative menopausal status and HRT use on sexual outcomes following risk-reducing salpingo-oophorectomy (RRSO). STUDY DESIGN: Cross-sectional study of 119 women who underwent RRSO between 2009 and 2014. MAIN OUTCOME MEASURES: Data was collected via a questionnaire and serum test for testosterone and free androgen index (FAI). The questionnaire comprised demographic data and validated measures of sexual function, sexual distress, relationship satisfaction, body image, psychological stress, menopause quality of life and general quality of life. RESULTS: Rates of sexual issues were similar despite menopause status at operation. Women who were pre-menopausal at operation (mean age=44 years ± 5) had significantly higher rates of sexual distress (p=0.020), dissatisfaction with sex life (p=0.011) and bothersome sexual menopause symptoms (p=0.04) than women who were post-menopausal (mean age=55 years ± 7). Pre-menopausal women reported higher psychological distress from surgery (p=0.005) and poorer emotional (p=0.052) wellbeing. HRT use reduced the rates of dyspareunia (p=0.027) and the severity of sexual menopausal symptoms (p=0.030). Androgen levels were not significantly associated with desire or arousal scores. CONCLUSIONS: Regardless of menopausal status at operation, women experienced the same sexual issues at equivalent rates. However, pre-menopausal women reported higher sexual distress and dissatisfaction with sex life. Pre-menopausal women also had greater psychological distress and poorer emotional function.


Assuntos
Terapia de Reposição Hormonal , Menopausa , Neoplasias Ovarianas/prevenção & controle , Ovariectomia , Procedimentos Cirúrgicos Profiláticos/efeitos adversos , Salpingectomia , Sexualidade/psicologia , Adulto , Idoso , Imagem Corporal/psicologia , Estudos Transversais , Dispareunia/etiologia , Emoções , Feminino , Humanos , Relações Interpessoais , Pessoa de Meia-Idade , Ovariectomia/psicologia , Pós-Menopausa/sangue , Pré-Menopausa/sangue , Período Pré-Operatório , Procedimentos Cirúrgicos Profiláticos/psicologia , Qualidade de Vida , Salpingectomia/psicologia , Disfunções Sexuais Psicogênicas/etiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários , Testosterona/sangue
12.
BMC Nephrol ; 17: 11, 2016 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-26785745

RESUMO

BACKGROUND: Treatment of end stage renal disease has an impact on patients' physical and psychological health, including quality of life (QoL). Nowadays, it is known that reducing the dialysis period has many advantages regarding QoL and medical outcomes. Although preemptive transplantation is the preferred strategy to prevent patients undergoing dialysis, its psychological impact is unknown. Moreover, transplantation can be experienced in a completely different manner among patients who were on dialysis and those who still had a functioning kidney at the time of surgery. Longitudinal data are often collected to allow analyzing the evolution of patients' QoL over time using questionnaires. Such data are often difficult to interpret due to the patients' changing standards, values, or conceptualization of what the questionnaire is intended to measure (e.g. QoL). This phenomenon is referred to as response shift and is often linked to the way the patients might adapt or cope with their disease experience. Whether response shift is experienced in a different way among patients who were on dialysis and those who still had a functioning kidney at time of surgery is unknown and will be studied in the PreKit-QoL study (trial registration number: NCT02154815). Understanding the psychological impact of pre-emptive transplantation is an important issue since it can be associated with long-term patient and graft survival. METHODS/DESIGN: Adult patients with a pre-emptive transplantation (n = 130) will be prospectively included along with a control group of patients with a pre-transplant dialysis period < 36 months (n = 260). Only first and single kidney transplantation will be considered. Endpoints include: comparison of change between groups in QoL, anxiety and depressive disorders, perceived stress, taking into account response shift. These criteria will be evaluated every 6 months prior to surgery, at hospital discharge, at three and six months, one and two years after transplantation. DISCUSSION: The PreKit-QoL study assesses and compares the evolution of QoL and other psychological criteria in preemptive and dialyzed patients taking patients' adaptation into account through response shift analyses. Our study might help to conceive specific, adapted educational programs and psychological support to prevent a possible premature loss of the kidney as a consequence of non-compliance in patients that may be insufficiently prepared for transplantation. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02154815 , registered on May 28, 2014.


Assuntos
Adaptação Psicológica , Transplante de Rim/psicologia , Procedimentos Cirúrgicos Profiláticos/psicologia , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Insuficiência Renal Crônica/cirurgia , Adulto , Humanos , Falência Renal Crônica/prevenção & controle , Falência Renal Crônica/terapia , Estudos Prospectivos , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Digestion ; 92(4): 220-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26488160

RESUMO

BACKGROUND/AIMS: This study investigated the safety of endoscopic variceal ligation (EVL) under conscious sedation with midazolam and sequential flumazenil after procedure in these patients. METHODS: A total of 279 patients who underwent secondary prophylactic EVL at our institution between April 2012 and June 2014, were enrolled. Conscious sedation was achieved using intravenous midazolam, and flumazenil was routinely used as an antidote immediately after EVL. Patients with sleep (n = 165) and non-sleep (n = 55) endoscopy were matched using propensity score analysis (3:1). Frequencies of overt hepatic encephalopathy (HEP) and patient' satisfactions with EVL were compared between the 2 groups. RESULTS: Of the 279 patients, 155 (55.6%) were of Child-Turcotte-Pugh (CTP) class, B or C, and 224 (80.3%) patients underwent sleep endoscopy. After propensity score analysis, overt HEP was observed in 1 (0.4%) of the 165 patients in the sedated group, but not found in any in the non-sedated group. Patient' satisfaction with EVL was better in the sedated group (p < 0.001). Twenty-nine (65.9%) of the 44 patients with CTP class C underwent sleep endoscopy, and only one (3.4%) experienced overt HEP. CONCLUSIONS: Prophylactic EVL under conscious sedation using midazolam and flumazenil is probably safe in cirrhotic patients without experience of HEP, even in those of CTP class C.


Assuntos
Antídotos/administração & dosagem , Sedação Consciente , Esofagoscopia/métodos , Flumazenil/administração & dosagem , Hipnóticos e Sedativos , Midazolam , Procedimentos Cirúrgicos Profiláticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Varizes Esofágicas e Gástricas/cirurgia , Esofagoscopia/psicologia , Feminino , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Ligadura , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Procedimentos Cirúrgicos Profiláticos/psicologia
14.
Ann Surg Oncol ; 22(12): 3809-15, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25930247

RESUMO

BACKGROUND: Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM. METHODS: As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I-III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS). RESULTS: Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS. CONCLUSIONS: Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.


Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/cirurgia , Tomada de Decisões , Mastectomia Segmentar , Participação do Paciente , Procedimentos Cirúrgicos Profiláticos/psicologia , Adolescente , Adulto , Ansiedade/etiologia , Índice de Massa Corporal , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Aconselhamento Diretivo , Medo , Feminino , Genes BRCA1 , Genes BRCA2 , Testes Genéticos , Humanos , Metástase Linfática , Mutação , Estadiamento de Neoplasias , Paridade , Receptor ErbB-2/análise , Recidiva , Carga Tumoral , Adulto Jovem
15.
Ann Surg Oncol ; 22(2): 383-91, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25190120

RESUMO

PURPOSE: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for unilateral early-stage breast cancer (ESBC) have been increasing since 2003. Recent studies suggest that this increase may be due to women choosing UM and CPM because of fear. We conducted an in-depth qualitative study to identify those factors influencing a woman's choice for more extensive surgery. METHODS: Semi-structured interviews were conducted with breast cancer patients to examine the experiences, decision making, and choice of UM ± CPM for the treatment of ESBC. Purposive sampling identified suitable candidates for breast-conserving therapy (BCT) who underwent UM ± CPM. Interviews were guided by grounded theory methodology, and constant comparative analysis identified key concepts and themes. RESULTS: Data saturation was achieved after 29 interviews. 'Taking control of cancer' was the dominant theme. Fear of breast cancer was expressed at diagnosis and remained throughout decision making. Personal experiences of family or friends 'living with cancer' were the most influential source of information during the decision-making process. Fear translated into an overestimated risk of recurrence, contralateral breast cancer (CBC), and death. Despite surgeons discussing equivalent survival with BCT, UM ± CPM patients believed that by choosing UM ± CPM they would eliminate recurrence, CBC and live longer. By choosing more extensive surgery, women were actively trying to control cancer outcomes as more surgery was believed to offer greater survival. CONCLUSIONS: Women seek UM and CPM to take control of cancer and manage their fear. It is important for surgeons to understand how personal experiences shape women's choice for UM ± CPM to facilitate informed decision making.


Assuntos
Neoplasias da Mama/cirurgia , Comportamento de Escolha , Mastectomia , Procedimentos Cirúrgicos Profiláticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Imagem Corporal , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/psicologia , Feminino , Humanos , Mastectomia/psicologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/psicologia , Procedimentos Cirúrgicos Profiláticos/psicologia
16.
Fam Cancer ; 14(1): 51-60, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25342222

RESUMO

Women with Lynch syndrome (LS) have a significantly increased lifetime risk of endometrial cancer (40-60 %) and ovarian cancer (7-12 %). Currently there is little evidence to support the efficacy of screening for the early detection of these cancers. Another option is risk-reducing hysterectomy and/or bilateral salpingo-oophorectomy (BSO). Research on the impact of BSO in premenopausal women with a non-LS associated family history cancer has generally shown that women have a high level of satisfaction about their decision to undergo surgery. However, debilitating menopausal symptoms and sexual dysfunction are common post-surgical problems. We used a mixed methods study to explore the impact of risk-reducing gynaecological surgery in women with LS: 24 women were invited to take part; 15 (62.5 %) completed validated questionnaires and 12 (50 %) participated in semi-structured interviews. Our results suggest that risk reducing surgery does not lead to significant psychological distress and the women tend not to think or worry much about developing cancer. However, they tend to be distressed about the physical and somatic symptoms associated with menopause; their social well-being is somewhat affected, but sexual difficulties are minimal. The women reported being overwhelmingly satisfied with their decision to have surgery and with the quality of information they received prior to the operation. However, they felt underprepared for menopausal symptoms and received conflicting advice about whether or not to use HRT. Recommendations from the study include that professionals discuss the menopause, its side effects and HRT in detail prior to surgery.


Assuntos
Neoplasias do Endométrio/prevenção & controle , Histerectomia/psicologia , Neoplasias Ovarianas/prevenção & controle , Ovariectomia/psicologia , Procedimentos Cirúrgicos Profiláticos/psicologia , Salpingectomia/psicologia , Adulto , Neoplasias do Endométrio/genética , Estudos de Avaliação como Assunto , Feminino , Predisposição Genética para Doença , Humanos , Histerectomia/efeitos adversos , Entrevistas como Assunto , Síndrome de Lynch II/complicações , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Ovariectomia/efeitos adversos , Satisfação do Paciente , Pré-Menopausa , Procedimentos Cirúrgicos Profiláticos/efeitos adversos , Salpingectomia/efeitos adversos , Inquéritos e Questionários
17.
Am J Clin Oncol ; 38(2): 179-83, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23648435

RESUMO

PURPOSE: Studies demonstrate an increasing rate of contralateral prophylactic mastectomy (CPM). The purpose of this study is to evaluate decision making and factors influencing women's long-term satisfaction with CPM. Descriptive analysis is used to analyze the results of our designed questionnaire approved by our Institutional Review Board. METHODS: We searched our institutional cancer registry for patients diagnosed with breast cancer between 2000 and 2010. The studied time frame is of significance as this study is the first to measure response rate in questions examining patient satisfaction for >1 year after undergoing CPM. The questionnaire was mailed to all consented participants to examine factors contributing to the choice of CPM and postoperative satisfaction. RESULTS: Of the 206 women included in the study, 147 were aged up to 50 years. Majority of women who underwent CPM in this cohort was with a bachelor's degree or higher, married or partnered women, and women earning >$60,000/y. Almost all women were "happy with overall surgery" and would recommend CPM to other patients. Psychological factors, such as fear of recurrence, were more commonly associated with the decision for CPM in patients with invasive carcinoma. Opinions of partners, relatives, friends, and physicians further contributed to the decision to undergo surgery. The availability of reconstruction was also an influential factor in the overall decision. CONCLUSIONS: The majority of our study participants experienced long-term satisfaction with the surgical procedure of CPM. From our analysis, we can confidently say that fear of cancer recurrence and the opinions of others, among other factors, were influencing contributors toward the decision of undergoing CPM.


Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/cirurgia , Mastectomia/psicologia , Procedimentos Cirúrgicos Profiláticos/psicologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Tomada de Decisões , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
18.
Psychooncology ; 24(1): 33-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24839250

RESUMO

OBJECTIVE: Genetic testing for breast and ovarian cancer susceptibility is now part of routine clinical practice. Although rates of risk-reducing surgery following genetic testing have been increasing, little is known about attitudes toward risk-reducing surgery in women prior to genetic counseling and testing. This study examines correlates of patient intentions to undergo risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO). METHODS: Participants were 696 women, ages 21-85, who sought breast cancer gene 1 and 2 (BRCA1/2) genetic counseling and had at least a 10% risk of carrying a mutation. The sample included women who were affected with breast or ovarian cancer and unaffected women with a known familial BRCA1/2 mutation. Participants completed a precounseling telephone questionnaire. RESULTS: Prior to receiving genetic counseling, 23.3% of participants were considering RRM and 42.5% were considering RRO. Variables that were independently associated with RRM intentions were cancer-specific distress (OR = 1.14, 95% CI = 1.03-1.26), perceived risk of breast cancer (OR = 1.16, 95% CI = 1.05-1.28), education (OR = 1.76, 95% CI = 1.03-2.99), and age (OR = 0.96, 95% CI = 0.95-0.98). Predictors of RRO intentions were perceived risk for ovarian cancer (OR = 1.25, 95% CI = 1.14-1.37), perceived risk of carrying a BRCA1/2 mutation (OR = 1.74, 95% CI = 1.15-2.62), marital status (OR = 1.92, 95% CI = 1.34-2.76), and age (OR = 1.02, 95% CI = 1.00-1.03). CONCLUSIONS: Because precounseling intentions predict subsequent risk-reducing surgery decisions, this study identified patient factors associated with surgical intentions. These factors reinforce the critical role for pretest genetic counseling in communicating accurate risk estimates and management options, and addressing psychosocial concerns, to facilitate informed decision making regarding RRM and RRO.


Assuntos
Neoplasias da Mama/prevenção & controle , Genes BRCA1 , Genes BRCA2 , Aconselhamento Genético/psicologia , Intenção , Neoplasias Ovarianas/prevenção & controle , Procedimentos Cirúrgicos Profiláticos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Neoplasias da Mama/genética , Neoplasias da Mama/psicologia , Feminino , Predisposição Genética para Doença/psicologia , Humanos , Mastectomia/psicologia , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/psicologia , Ovariectomia/psicologia , Encaminhamento e Consulta , Adulto Jovem
19.
Fam Cancer ; 14(1): 105-15, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25283514

RESUMO

This study prospectively investigated long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret 3 years post-surgery. Outcomes were compared to age- and risk-matched controls. Participants (N = 233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM + RRSO (30 controls). Women who underwent RRM and those who underwent RRM + RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.


Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias Ovarianas/prevenção & controle , Procedimentos Cirúrgicos Profiláticos/psicologia , Adulto , Idoso , Neoplasias da Mama/genética , Feminino , Predisposição Genética para Doença , Humanos , Mastectomia/efeitos adversos , Mastectomia/psicologia , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Ovariectomia/efeitos adversos , Ovariectomia/psicologia , Procedimentos Cirúrgicos Profiláticos/efeitos adversos , Salpingectomia/efeitos adversos , Salpingectomia/psicologia , Tempo
20.
Bull Cancer ; 101(11): 1001-8, 2014 Nov.
Artigo em Francês | MEDLINE | ID: mdl-25418592

RESUMO

Genetic tests in families with a mutation related to breast and ovarian cancers (BRCA1/2) are now offered to the persons before completion of their reproductive project. The aim of this qualitative study was to descriptively explore how the issues of reproduction are faced in women belonging to these families, and how the possible use of prenatal diagnostic (PND) and preimplantation genetic diagnosis (PGD) would be faced in a theoretical context. We conducted in-depth interviews, face to face, according to the so-called Grounded Theory approach. Twenty women with a BRCA genetic mutation participated in the study (age range: 31-57 years); 12 have had a breast and/or ovarian cancer. The knowledge of having the mutation did not modify the parental project; however prophylactic anexectomy was likely to alter it in some women. If the majority of women were in favor of PGD (n = 14), medical termination of pregnancy was a constraint towards the position in relation to PND. Besides ethical and moral arguments, the women's attitudes were constructed differently according to their own personal or familial experience of the disease. The women's perceptions of the cancer severity, risk and cure were organized according to this experience.


Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/psicologia , Genes BRCA1 , Genes BRCA2 , Mutação , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/psicologia , Aborto Legal , Adulto , Neoplasias da Mama/terapia , Tomada de Decisões , Características da Família , Feminino , Teoria Fundamentada , Humanos , Pessoa de Meia-Idade , Princípios Morais , Neoplasias Ovarianas/terapia , Filosofia , Cuidado Pré-Concepcional , Gravidez , Procedimentos Cirúrgicos Profiláticos/psicologia , Pesquisa Qualitativa , Fatores de Risco
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