Returning to work after breast cancer: A systematic review of reviews.

BACKGROUND: Due to improvements in breast cancer diagnosis and treatment, the healthcare system faces a growing number of cancer survivors. Breast cancer survivors experience many difficulties when returning to work, including discrimination at work and lack of support by employers and colleagues. OBJECTIVE: To point out the knowledge in literature up to date about return to work (RTW) after breast cancer, the factors influencing it and the interventions to facilitate it. METHODS: A literature search was conducted in January 2017 using the databases Medline (PubMed) and Scopus. Studies were included if they analyzed the problem of RTW in women treated for breast cancer. RESULTS: Twenty-six articles met the inclusion criteria. The studies were divided into four themes: factors facilitating or impeding RTW; interventions to enhance RTW; lived experiences of RTW; economic aspects related to cancer survivors and RTW. CONCLUSIONS: The heterogeneity of the interventions suggests the need for a better definition of the concept of RTW. To compare interventions, studies should use a rigorous approach and better outcome measures should be identified to evaluate RTW.

"GiochiAMO": a school-based smoking and alcohol prevention program for children - a pilot randomized field trial. Part 2.

BACKGROUND: Young people who begin to smoke at an early age are at a higher risk of becoming occasional or regular smokers and establishing a premature dependence. It is fundamental to act as soon as possible, from very early childhood, to prevent harmful behaviors for health such as smoking and drinking alcohol. Young people must be encouraged to adopt healthy lifestyles. OBJECTIVES: The aim of the study is two-fold. First, increasing the knowledge about the negative health effects of cigarette smoking and alcohol consumption among children aged 9-10 years; and second, to introduce and reinforce life skills in order to learn how to tackle social influences that encourage children to smoke and to drink alcohol. METHODS: A pilot randomized field trial was conducted in May-June 2017. Four primary school classes in Rome were randomized to either the intervention or the control group. Both groups participated in an oral presentation about the risks and consequences of smoking and alcohol consumption, and the concept of life skills. The intervention group participated in two gaming sessions, each lasting 1.5 hours. Children were involved in six games aiming to deliver and reinforce knowledge about the target themes of the study. A 21 multi-response questions questionnaire was handed out to both groups at the beginning and at the end of the study. Eleven questions were about smoking; five questions about alcohol; five questions about life skills. Each question item included one correct answer. For each domain, a score was computed (total; smoking; alcohol; life skills). RESULTS: 67 children participated in the study (34 in the intervention and 33 in the control group). Univariate analyses showed significant differences among the intervention group before and after the intervention for total score (p<0.001), smoke score (p<0.001), and life skills score (p=0.003). No significant differences among the intervention group before and after the intervention were reported for alcohol score (p=0.076). Regarding the control group univariate analysis showed significant differences in total score (p=0,001) and life skills score (p=0.005). Multivariate analysis revealed that enrollment in the intervention was the only variable that had a significant positive influence on smoking knowledge score (beta=1.070, p=0.05). CONCLUSION: This pilot study shows that the intervention was effective among the intervention group for all the scores: total score, smoke score and life skills score, but ineffective for alcohol. Overall, the combination of a presentation and games was effective in increasing life skills knowledge.

Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review.

BACKGROUND: Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life. OBJECTIVE: To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients. METHODS: A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included. RESULTS: Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation. CONCLUSION: A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients.