Use of complementary and alternative therapy by women in the first 2 years after diagnosis and treatment of invasive breast cancer.

OBJECTIVE: Our aim was to document patterns of consultation with alternative practitioners, use of complementary and alternative medicine (CAM) commonly used to alleviate menopausal symptoms, and lifestyle changes made by women in the first 2 years after their diagnosis with invasive breast cancer. METHODS: A total of 1,588 women in the MBF Foundation Health and Wellbeing After Breast Cancer Study completed both the enrollment questionnaire and the first follow-up questionnaire (FQ1), on average, 41 and 92 weeks after diagnosis, respectively. The Menopause Quality of Life Questionnaire and the Psychological General Wellbeing Index were included in the FQ1. Logistic regression analysis was used to examine characteristics associated with consulting a CAM practitioner or using CAMs. RESULTS: At the time of completion of the FQ1, 16.4% of women had consulted a CAM practitioner and 10.6% reported using at least one CAM commonly used to alleviate menopausal symptoms. Women who consulted a CAM practitioner and women who were using at least one CAM at the time of completion of the FQ1 were, on average, younger and more educated and had a higher Menopause Quality of Life Questionnaire score than did women who did not. Of the women, 33.6% reported having made a dietary change, and the most common lifestyle change was an increase in physical activity, which was reported by 29.0% of women. CONCLUSIONS: The frequency of use of CAMs in common usage for menopausal symptoms by women with breast cancer was lower than anticipated, increased with time from diagnosis, and is associated with more severe menopausal symptoms.

Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis.

PURPOSE: The aim of this study was to document the psychological well-being of a group of women with invasive breast cancer (BC) on an average of nearly 2 years after their diagnosis. METHODS: Participants were women in the Medical Benefits Fund Australia Limited Foundation Health and Wellbeing after Breast Cancer Study, a cohort study of 1,684 women recruited within 12 months of their diagnosis with invasive BC, who completed their first annual follow-up questionnaire. Psychological well-being was measured using the Psychological General Well Being Index questionnaire (PGWB) in women with BC. RESULTS: The PGWB questionnaire was completed by 1,589 women on an average of 92 weeks after their BC diagnosis, of whom 46 had evidence of active disease. PGWB total scores for all age groups of the BC cohort were lower than community-based norms (p < 0.001 for age groups > or =70, 60-<70, 50-60; p = 0.002 for age group 40-<50 and p = 0.05 for age group <40). PGWB total scores for the BC cohort were positively associated with age (p < 0.001) and living with others (p < 0.01) and inversely associated with active disease (p < 0.001) and education beyond secondary school (p = 0.03). For the domain of anxiety, there was no statistically significant association with living with others but an inverse association with education beyond school. CONCLUSION: A higher level of education may be associated with increased anxiety and lower well-being. Social support is particularly important for women with BC who are known to live alone.

The relationship between hormone therapy use at the time of diagnosis of breast cancer and tumor characteristics.

Exposure to postmenopausal hormone therapy (HT) may affect the stage, histological type, and hormone receptor (HR) status of invasive breast cancer at the time of diagnosis. One thousand six hundred eighty-four women with newly diagnosed first invasive breast cancer were recruited to the "MBF Foundation Health and Wellbeing after Breast Cancer Study." Women using systemic HT estrogen (E) or E combined with progesterone (P) at the time of diagnosis of breast cancer were compared with those not using HT. Breast cancer tumor data were obtained from the Victorian Cancer Registry. Regression analysis was used to determine the associations between HT use or not at the time of diagnosis and tumor histology (ductal vs lobular), stage (I vs II, III, IV), HR status (ER+ or PR+ or both vs ER- or PR-). Of 1,377 women included in the analysis, 226 (16%) were using HT at the time of diagnosis. Of HT users, 20.4% had lobular breast cancer, 50% were stage I, and 85.8% had HR-positive tumors. Of non-users, 13.6% had lobular breast cancer, 48.2% were stage I, and 82.4% had HR-positive tumors. Use of systemic HT was associated with increased odds of having lobular compared with ductal breast cancer (OR = 1.75, 95% CI = 1.14-2.69, p = 0.01). There were no associations between HT use and either breast cancer stage or HR status. Women using systemic HT at the time of diagnosis were more likely to have lobular rather than ductal breast cancer compared with women not on HT.

The relationship between knowledge of family history and cancer characteristics at diagnosis in women newly-diagnosed with invasive breast cancer.

AIM: To document the prevalence of family history of breast cancer (BC) amongst women newly-diagnosed with invasive BC and to explore the relationship between family history and cancer size and stage. METHODS: A cross-sectional analysis was conducted on baseline questionnaire data from a cohort study of 1,684 women diagnosed with invasive BC within the previous 12 months and recruited between 2004 and 2006 in Victoria, Australia. RESULTS: Women with affected first degree relative(s) were more likely to have a smaller BC (odds ratio for

Lack of knowledge of hormone receptor status and use of endocrine therapy in invasive breast cancer.

OBJECTIVE: The aim of this study was to investigate the level of understanding in women with newly diagnosed invasive breast cancer of the key clinical features of their disease that are important determinants in treatment decision making. METHODS: The 1684 women aged between 26 and 88 years at diagnosis enrolled in a 5-year cohort study were asked by questionnaire about their estrogen receptor (ER) and progesterone receptor (PR) status and about their past or current treatment with adjuvant endocrine therapy. Information was linked with their ER and PR status determined from the histopathology report. Logistic regression analysis was used to explore the relationship between age and education status and the likelihood of being able to correctly report hormone receptor status, as well as the relationship between the likelihood of receiving adjuvant endocrine therapy and knowledge of hormone receptor status in women who were ER or PR positive. RESULTS: Not being able to correctly report hormone receptor status was associated with being older and having a lower level of education. Of women who were ER positive or PR positive or both and were at least 40 weeks from diagnosis, having received some form of endocrine therapy was significantly associated with self-identification as being ER or PR positive (OR=1.82, 95% CI 1.24-2.68, p=0.002), even when age was taken into account. CONCLUSIONS: That self-knowledge of hormone receptor status was independently associated with likelihood of receiving endocrine therapy suggests that the methods of helping women understand the nature of their breast cancer are worthy of review.

Assessing sexual function in well women: validity and reliability of the Monash Women's Health Program Female Sexual Satisfaction Questionnaire.

INTRODUCTION: A validated questionnaire to assess the nature and quality of the recent female sexual experience and that can be employed to evaluate acute therapeutic effects does not exist. AIM: To validate an instrument with which researchers can evaluate the nature and quality of the female sexual experience within 24 hours of a sexual event. METHODS: A cross-sectional questionnaire study in 349 sexually active community-based women, aged 20-65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. MAIN OUTCOME MEASURES: Scores from the Monash Women's Health Program Female Sexual Satisfaction Questionnaire (MFSSQ), completed within 24 hours of sexual activity, on two occasions. RESULTS: Participants were 349 women who were sexually active at least once per fortnight, but not necessarily partnered. Almost equal groups of self-identified satisfied, dissatisfied, premenopausal, and postmenopausal women participated. Three hundred forty-five women (99%) completed one MFSSQ, and 326 women (94%) completed two separate questionnaires, each within 24 hours of a sexual event. Missing responses were few, good inter-item correlation was seen, and excellent reliability was demonstrated for most items, based on test-retest data. The questionnaire was able to discriminate well between sexually satisfied and dissatisfied women. CONCLUSIONS: The MFSSQ is a 12-item questionnaire specifically designed to assess the quality and nature of a recent sexual experience. It is easy and quick to administer, is reliable and valid, and has the potential to be used to assess the efficacy of acute interventions in the area of female sexual dysfunction.

Use of a cancer registry is preferable to a direct-to-community approach for recruitment to a cohort study of wellbeing in women newly diagnosed with invasive breast cancer.

BACKGROUND: Breast cancer (BC) mortality is declining such that the number of survivors of BC in the community is increasing. BC survivors report a range of sequelae from their cancer and its management beyond the period of their immediate treatment. Previous studies to document these have generally been small, clinic-based or commenced years after diagnosis. We have recruited a large cohort of women newly diagnosed with invasive BC from the community who will be followed for five years in order to systematically document the physical, psychological and socio-economic consequences of BC and its treatment. The aim of this manuscript is to describe the issues encountered in the recruitment of this community-based study population. METHODS: Women residing in the southern Australian state of Victoria newly diagnosed with invasive BC were recruited to this cohort study using two approaches: directly from the community using an advertising campaign and contemporaneously using an invitation to participate from the Victorian Cancer Registry (VCR). RESULTS: Over the two and half year recruitment period, 2135 women were recruited and agreed to receive the enrollment questionnaire (EQ). Of these, 1684 women were eligible and completed an EQ, with the majority of participants having been recruited through the VCR (n = 1321). Only 16% of women contacted by the VCR actively refused participation following a letter of invitation and phone follow-up. The age distribution and tumour characteristics of participants are consistent with state-wide data and their residential postcodes include 400 of a possible 699. Recruitment through a direct community awareness program aimed at women with newly diagnosed invasive BC was difficult, labour-intensive and expensive. Barriers to the recruitment process were identified. CONCLUSION: Most of the women in this study were recruited through a state-based cancer registry. Limitations to recruitment occurred because we required questionnaires to be completed within 12 months of diagnosis in a setting where there is several months delay in notification of new cases to the Registry. Characteristics of the cohort suggest that it is generally representative of women in the state of Victoria newly diagnosed with BC.