Mediator Roles of Social Support and Hope in the Relationship Between Body Image Distress and Resilience in Breast Cancer Patients Undergoing Treatment: A Modeling Analysis.

Breast cancer and its treatment are particularly distressing for patients because of their potential impacts on body image. The most difficult phase of cancer treatment is usually the first year after a diagnosis. Cancer patients with strong resilience have the positive attitude, internal strength and external resources needed to cope with the disease and its treatment. This cross-sectional study investigated the mediator roles of hope and social support in the association between body image distress and resilience. A structured questionnaire was used to collect data for a convenience sample of 141 breast cancer patients undergoing treatment in southern Taiwan. Structural equation modeling was used for data analysis. The results showed that the final model had a good fit to the data and accounted for 51% of the total variance in resilience. The model of multiple parallel mediators of resilience revealed that hope and social support had mediator roles in the effect of body image distress on resilience. Hope had an important partial mediating role in the association between body image distress and resilience. Social support also had a partial mediating role in the relationship between body image distress and resilience. Social support did not directly affect resilience and indirectly affected resilience through hope. Psychosocial interventions aimed at reducing the impact of body image distress and increasing resilience in breast cancer patients should focus on cultivating hope and increasing social support, particularly support from family members and health professionals.

Emotional distress and quality of life during folinic acid, fluorouracil, and oxaliplatin in colorectal cancer patients with and without chemotherapy-induced peripheral neuropathy: A cross-sectional study.

When the 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy regimen is used to treat colorectal cancer (CRC), chemotherapy-induced peripheral neuropathy (CIPN) caused by oxaliplatin can substantially affect quality of life (QOL) in the CRC patients. This study compared emotional distress and QOL during FOLFOX in CRC patients with and without CIPN symptoms.This cross-sectional, descriptive, and comparative study recruited 68 CRC patients receiving FOLFOX at a local teaching hospital and at a medical center in southern Taiwan. Self-reported structured questionnaires (oxaliplatin-associated neuropathy questionnaire, profile of mood states short form, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30, version 3.0) were used for 1-time data collection. The Chi-square test, Fisher exact test, and Mann-Whitney U test were used to analyze data, and a P-value < .05 was considered statistically significant.The CIPN group had 45 (66.2%) patients, and the non-CIPN group had 23 (33.8%) patients. The 5 most common symptoms were coldness-related burning sensation or discomfort in the upper limbs, numbness in the upper limbs, tingling in the upper limbs, impairment of vision, and discomfort in the throat. The CIPN group had more females (P = .013), a more advanced stage of CRC (P = .04) and a higher chemotherapy dosage (P = .006). The 2 groups did not significantly differ in anxiety (P = .065) or depression (P = .135). Compared to the non-CIPN group, the CIPN group had significantly lower functioning (P = .001) and global health status (P < .001) and significantly more symptoms (P < .001).The CIPN group had significantly lower QOL compared to the non-CIPN group. However, the CIPN group did not have lower emotional distress compared to the non-CIPN group. The results of this study demonstrate the need for in-service courses specifically designed to train health professionals in assessing and managing CIPN symptoms to improve QOL in CRC patients receiving FOLFOX.

Symptom Cluster Trajectories During Chemotherapy in Breast Cancer Outpatients.

CONTEXT: Breast cancer patients often experience multiple symptoms and substantial discomfort. Some symptoms may occur simultaneously and throughout the duration of chemotherapy treatment. OBJECTIVES: The aim of this study was to investigate symptom severity and symptom cluster trajectories during chemotherapy in outpatients with breast cancer in Taiwan. METHODS: This prospective, longitudinal, repeated measures study administered a standardized questionnaire (M. D. Anderson Symptom Inventory Taiwan version) to 103 breast cancer patients during each day of the third 21-day cycle of chemotherapy. Latent class growth analysis was performed to examine symptom cluster trajectories. RESULTS: Three symptom clusters were identified within the first 14 days of the 21-day chemotherapy cycle: the neurocognition cluster (pain, shortness of breath, vomiting, memory problems, and numbness/tingling) with a trajectory of Y = 2.09 - 0.11 (days), the emotion-nausea cluster (nausea, disturbed sleep, distress/upset, drowsiness, and sadness) with a trajectory ofY = 3.57 - 0.20 (days), and the fatigue-anorexia cluster (fatigue, lack of appetite, and dry mouth) with a trajectory of Y = 4.22 - 0.21 (days). The "fatigue-anorexia cluster" and "emotion-nausea cluster" peaked at moderate levels on chemotherapy days 3-5, and then gradually decreased to mild levels within the first 14 days of the 21-day chemotherapy cycle. CONCLUSION: Distinct symptom clusters were observed during the third cycle of chemotherapy. Systematic and ongoing evaluation of symptom cluster trajectories during cancer treatment is essential. Healthcare providers can use these findings to enhance communication with their breast cancer patients and to prioritize symptoms that require attention and intervention.

Prophylactic Treatment with Adlay Bran Extract Reduces the Risk of Severe Acute Radiation Dermatitis: A Prospective, Randomized, Double-Blind Study.

Acute radiation dermatitis is a frequent adverse effect in patients with breast cancer undergoing radiotherapy, but there are only a small number of studies providing evidence-based interventions for this clinical condition. Adlay is a cereal crop that has been previously shown to have anti-inflammatory and antioxidant properties. In this study, we seek to evaluate the effectiveness of oral prophylactic treatment with adlay bran extract in reducing the risk of severe acute radiation dermatitis. A total of 110 patients with breast cancer undergoing radiotherapy were analyzed. Using a prospective, randomized, double-blind design, 73 patients received oral treatment with adlay bran extract and 37 patients received olive oil (placebo). Treatment was started at the beginning of radiation therapy and continued until the termination of radiation treatment. Our results showed that the occurrence of severe acute radiation dermatitis (RTOG grade 2 or higher) was significantly lower in patients treated with oral adlay bran extract compared to placebo (45.2% versus 75.7%, adjusted odds ratio 0.24). No serious adverse effects from adlay bran treatment were noted. In conclusion, prophylactic oral treatment with adlay bran extract reduces the risk of severe acute radiation dermatitis and may have potential use in patients with breast cancer undergoing radiotherapy.

Breast cancer quality of care in Taiwan in relation to hospital volume: a population-based cohort study.

AIM: To evaluate, compare and improve quality of care for patients with breast cancer at the institution and population level requires a standard set of core measures. We performed a population-based cohort study to examine the association between hospital volume and breast cancer core measures compliance in Taiwan. METHODS: Data were obtained from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. All women with a diagnosis of breast cancer between 2007 and 2011 were selected. Hospitals were divided into quartiles of hospital volume based on the total number of breast cancer surgery performed from 2007 to 2011. The core measure set that evaluates the quality of care for breast cancer included one preoperation and nine treatment-related indicators. RESULTS: Our final study population included 38 943 patients from 74 hospitals. An increase in hospital volume was associated with better core measures compliance as indicated by higher adherence rates. As compared with the lower quartiles (quartiles 1/2/3) of hospital volume, quartile 4 (high volume) showed significantly higher adherence rate in two indicators measured ("percentage of breast cancer patients whose diagnoses were histologically and cytologically confirmed before surgery" and "percentage of stage 1 and 2 patients with sentinel node sampling performed," P = 0.011 and 0.016, respectively). An increasing trend in compliance for "percentage of stage 1 patients who underwent breast conserving surgery" was observed in high-volume but not low-volume hospitals (P < 0.001). CONCLUSION: This institution and population-based study showed a certain degree of variation to core measures compliance among hospitals. In some aspects of pre- and postoperative care, high-volume hospitals demonstrated higher and more improved quality as supported by increased adherence rates. Further research is needed to determine whether better core measures compliance would result in better outcomes.

Exercise behaviors in breast cancer survivors in Taiwan.

BACKGROUND: Although exercise is a recommended rehabilitation intervention for many breast cancer survivors, exercise activity after cancer treatment is rarely reported in this patient group in Taiwan. OBJECTIVE: The objectives of this study were to analyze trends in exercise activity in breast cancer survivors in Taiwan. INTERVENTIONS/METHODS: This prospective, longitudinal study with repeated-measures design used standardized instruments to measure trends in exercise activity but performed no treatments or interventions. RESULTS: Of the 196 breast cancer survivors who participated in this study, 39% regularly engaged in light-to-moderate intensity exercise for approximately 15 minutes per day throughout the 6-month period of the study. Of these, 40% indicated that their exercise stage had increased, and only 13% indicated that their exercise stage had decreased. The most common exercise activities were walking, hiking, calisthenics, folk dancing, chi kung and tai chi. Although most women reported that exercise made them feel better both physically and emotionally, most said that they exercised mainly for health maintenance reasons. CONCLUSIONS: Frequency, duration, and intensity of exercise significantly increased during the 6-month study but did not reach the recommended levels. Most women believed that physical activity enhanced their recovery from cancer treatment. IMPLICATIONS FOR PRACTICE: When planning patient education interventions for breast cancer survivors, healthcare professionals should consider not only the role of exercise in breast cancer recovery, but also trends in exercise behavior among breast cancer survivors. The findings of this study contribute to the literature on exercise trends in breast cancer survivors.

Quality of life, depression, and stress in breast cancer women outpatients receiving active therapy in Taiwan.

The aims of the present study were to compare the quality of life (QoL), depression and stress between patients with malignant breast cancer and those with benign breast tumors. The present study also examined the factors related to QoL among the patients who were receiving active treatment for breast cancer. Among the 97 patients participating in the study, 73 patients were diagnosed as having malignant breast cancer (malignant group) and 24 as having benign tumors (benign group). All the participants completed the World Health Organization Questionnaire on Quality of Life to determine their QoL. The level of depression, stress, and demographic characteristics were also collected. Quality of life, depression and stress were compared between the malignant and benign groups, and the factors related to QoL were also examined. It was found that the malignant group had poorer physical and psychological QoL and higher life stress. Depression was significantly associated with QoL for both the malignant and benign groups, and the stress from health problem was the most significant predictors for QoL among the malignant group. The breast cancer patients suffered more severe psychological difficulty under active treatment than did the benign group patients. This will have great impact on their QoL, as in Western society. Depression and stress need to be recognized and aggressive psychological and/or medical intervention needs to be carried out in order to diminish the impact on QoL.