Perceptions of a Breast Cancer Survivorship Intervention: Pearls of Wisdom from Young African American Women.

PURPOSE: African American (AA) women ages 20-44 develop breast cancer at higher rates compared with Caucasian women. These young survivors (<45 years) also have disparate quality of life (QOL). Little is known about survivorship information needs of young AA survivors. The purpose of this study was to explore young AA survivors' perceptions of an existing QOL intervention for breast cancer survivors, identifying information needs to address using a targeted intervention. METHODS: Two semistructured interviews were conducted with each of 15 young AA survivors who had completed breast cancer treatment. This article focuses on the second interview in which young AA survivors reviewed intervention materials and described their perceptions of the intervention. Content analysis was used to identify themes, which were validated by participants. RESULTS: Participants (n: 15; mean age at study entry: 35 years) reported that the existing evidence-based intervention discussed relevant but general survivorship information. They suggested adapting the information for young AA survivors: addition of content geared toward finances, how to better communicate to manage dating and relationships, how to engage in healthful activities, and how to find local resources for any stage of survivorship. Furthermore, they suggested multiple modes of information delivery and inclusion of diverse imagery. CONCLUSION: Engaging young AA survivors yielded pearls of wisdom, highlighting the general nature of an existing intervention and suggesting adaptations to meet young AA survivors' information needs. Applying such pearls can be a powerful method to target survivorship interventions for this disparate group of cancer survivors.

Evaluating Survivorship Experiences and Needs Among Rural African American Breast Cancer Survivors.

Disparities in cancer survivorship exist among specific populations of breast cancer survivors, specifically rural African American breast cancer survivors (AA-BCS). While effective survivorship interventions are available to address and improve quality of life, interventions must be culturally tailored for relevance to survivors. Here, we report the results of our formative research using focus groups and in-depth interview to better understand unique rural AA-BCS survivorship experiences and needs in the Alabama Black Belt. Surveys were used to gather sociodemographic and cancer treatment data. Fifteen rural AA-BCS shared their experiences and concerns about keeping their cancer a secret, lack of knowledge about survivorship, lingering symptoms, religion and spirituality, cancer surveillance, and general lack of survivorship education and support. Rural AA-BCS were unwilling to share their cancer diagnosis, preferring to keep it a secret to protect family and friends. Quality-of-life issues like lymphedema body image and sexuality were not well understood. They viewed spirituality and religion as essential in coping and accepting cancer. Participants also discussed the importance of and barriers to maintaining health through regular check-ups. They needed social support from family and friends and health care providers. Overall, rural AA-BCS expressed their need for knowledge about survivorship self-management by providing a vivid picture of the realities of cancer survival based on shared concerns for survivorship support and education within the context of culture.

Interventions for Cognitive Deficits in Breast Cancer Survivors Treated With Chemotherapy.

BACKGROUND: Cognitive deficits are distressing adverse effects of chemotherapy that have a negative effect on quality of life in breast cancer survivors (BCSs). Cognitive deficits in cancer survivors are a top research and clinical practice priority. OBJECTIVE: The aims of this study were to describe cognitive deficits that occur after chemotherapy, describe deficits in BCSs treated with chemotherapy within a framework of cognitive reserve and neuroplasticity, and discuss cognitive interventions (ie, cognitive training interventions, compensatory strategies with cognitive training interventions, pharmacological interventions, and complementary and integrative medicine interventions). METHODS: PubMed search yielded 21 intervention studies of cognitive deficits in BCSs. RESULTS: Cognitive training interventions and compensatory strategies with cognitive training resulted in improvement of cognitive deficits. Methylphenidate did not result in cognitive improvement. Modafinil showed improvement in attention. Some complementary and integrative medicine interventions are promising. CONCLUSIONS: Cognitive training has been most beneficial. Effectiveness of pharmacologic and complementary and integrative medicine interventions has not yet been established. IMPLICATIONS FOR PRACTICE: While limited evidence is available to guide clinical management of cognitive deficits in BCSs, validating patients' symptom experience and evaluating co-occurring symptom clusters such as fatigue, sleep, and depression, are suggested.

Cognitive Deficits in Breast Cancer Survivors After Chemotherapy and Hormonal Therapy.

Adjuvant treatments, specifically chemotherapy and hormonal therapy, have dramatically increased breast cancer survival, resulting in increased attention to the residual effects of treatment. Breast cancer survivors (BCS) frequently report that cognitive deficits are a particular source of distress, interfering with many aspects of quality of life. The literature on neuropsychological performance measures in BCS supports the reality of subtle cognitive deficits after both chemotherapy and hormonal therapy. This premise is supported by recent imaging studies, which reveal anatomical changes after chemotherapy as well as changes in patterns of neural activation while performing cognitive tasks. This review suggests that, even when performance on neuropsychological performance measures is within normal limits, BCS may be using increased cognitive resources in the face of reduced cognitive reserve. Potential interventions for cognitive deficits after adjuvant therapy include prescriptions for healthy living, pharmacotherapy, complementary therapy, and cognitive remediation therapy directed toward specific cognitive deficits or a combination of several strategies.

Attention and memory deficits in breast cancer survivors: implications for nursing practice and research.

Breast cancer survivors (BCSs) commonly report deficits in attention and memory, cognitive functions crucial for daily optimal functioning. Perceived deficits are reported before, during, and after adjuvant therapy and affect quality of life throughout survivorship. Deficits of attention and memory are particularly disruptive for BCSs working or attending school who report that subtle impairment diminishes their confidence and their performance at all levels of occupation. Chemotherapy and endocrine therapy contribute to attention and memory deficits, but research findings have not fully established the extent or timing of that influence. Fortunately, potential interventions for attention and memory deficits in BCSs are promising. These include cognitive remediation therapies aimed at training for specific areas of deficit, cognitive behavioral therapies aimed at developing compensatory strategies for areas of deficit, complementary therapies, and pharmacologic therapies.

Dealing with the financial burden of cancer: perspectives of older breast cancer survivors.

PURPOSE: Financial burden among cancer survivors is often overlooked in survivorship care planning. Cancer survivors with limited incomes may be particularly affected. Yet, little data are available to address financial issues among them. Eliciting the survivors' perspectives on how to deal with this financial burden is a first crucial step to identifying the means to provide this supportive care. METHODS: In this pilot study, three nominal group technique (NGT) sessions were conducted with a convenience sample of 23 older breast cancer survivors (age 52 to 83) recruited from a county safety net hospital and a Comprehensive Cancer Center. One single NGT question was posed in these sessions, namely "What could help women deal with the financial burden that cancer brings to them and their families?" Survivors responded in an iterative fashion and then ranked the most relevant responses. RESULTS: The most relevant responses addressed the (1) need for affordable insurance; (2) need to have prompt information on treatment costs patients will face, insurance coverage, and agencies or programs that provide needed products and services; and (3) need to access social workers, navigators, support groups, or others knowledgeable about available resources. Survivors also suggested that physicians become aware of cancer costs and financial issues faced by patients and consider costs in their treatment plans. CONCLUSIONS: Older survivors face financial challenges for which there are few available resources. They suggested several avenues to address cancer-related financial issues that may be considered in developing supportive interventions.

Quality of life in older women with early-stage breast cancer in the first year of survivorship.

PURPOSE/OBJECTIVES: To describe quality-of-life (QOL) changes in older women with early-stage breast cancer in the first year of survivorship and report on the effectiveness of a psychoeducational intervention on survivors' QOL. DESIGN: Secondary analysis, descriptive, repeated measure. SETTING: An academic setting in the southeastern United States. SAMPLE: 50 early-stage breast cancer survivors, aged 65 years and older. METHODS: Data were drawn from the Breast Cancer Education Intervention (BCEI) research study. Data for a six-month time period within the survivors' first year were available for an experimental group participating in a psychoeducational intervention and a control group. MAIN RESEARCH VARIABLES: Overall QOL and physical, psychological, social, and spiritual well-being subscales. FINDINGS: Older women reported positive overall QOL within the first year of survivorship, but overall QOL declined slightly over time. Physical and psychological well-being declined over time. Social well-being initially improved over time, but then declined. Spiritual well-being initially declined over time, then improved. Survivors had a downward trend in overall QOL during the study time period; however, experimental group participants had a smaller decline in QOL compared to control group participants. CONCLUSIONS: QOL in older breast cancer survivors within the first year is positive. However, overall QOL declines over time. The BCEI attenuated decline of QOL in the experimental group compared to the control group. IMPLICATIONS FOR NURSING: Few studies focus on older breast cancer survivors. This descriptive study is one of the first to describe changes in QOL and report the effect of interventions for older breast cancer survivors. Oncology nurses are in a position to recognize QOL issues and help older women maintain QOL in the first year of survivorship after treatment.