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1.
JAMA ; 327(1): 41-49, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982119

RESUMO

Importance: Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective: To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants: A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions: Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures: The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results: All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance: Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration: ClinicalTrials.gov Identifier: NCT02941614.


Assuntos
Neoplasias da Mama/psicologia , Serviços de Saúde Comunitária , Depressão/diagnóstico , Programas de Rastreamento , Encaminhamento e Consulta/estatística & dados numéricos , Feminino , Humanos , Masculino , Oncologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto , Inquéritos e Questionários
2.
JAMA Netw Open ; 4(12): e2139670, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34962562

RESUMO

Importance: The high risk for breast and ovarian cancers conferred by being a carrier of BRCA1 or BRCA2 germline variant can negatively impact physical and psychological well-being. Novel nonpharmacological interventions on well-being in women with BRCA variants have rarely been reported. Objective: To determine the effect of a 12-week inquiry-based stress reduction (IBSR) program on psychological well-being, sleep quality, psychosocial variables, and attitudes toward risk-reducing surgical procedures among women in Israel who carried BRCA variants. Design, Setting, and Participants: This randomized clinical trial had a 12-week intervention period and a 12-week follow-up period. It was conducted between April 1, 2017, and July 31, 2020. Participants were recruited from the Meirav Breast Center at the Sheba Medical Center, Israel, and the intervention was conducted in Tel Aviv, Israel. The cohort included women with BRCA variants. Data were analyzed from August 1 to December 1, 2020. Interventions: Women were randomly assigned to the 12-week IBSR program or standard care. The IBSR technique is based on the skills of mindfulness, inquiry, and cognitive reframing. The intervention included standardized, weekly group meetings conducted throughout 12 weeks. Standard care included semi-annual breast examinations and breast magnetic resonance imaging (alternating), a gynecological examination, a transvaginal ultrasonographic examination, and CA-125 serum determination. Differences between the groups were tested using mixed-effects models in an intent to treat analysis. Main Outcomes and Measures: The primary outcome was psychological well-being, including 6 parameters: autonomy, personal growth, positive relationships, control of the environment, goals in life, and self-acceptance. Secondary outcomes included sleep quality, attitudes toward risk-reducing surgical procedures, and psychosocial variables. Questionnaires were administered at baseline (T1), at completion of the 12-week intervention (T2), and 12 weeks after completion of the intervention (T3). Results: Overall, 100 women (mean [SD] age, 41.37 [11.06] years) completed the study, with 50 randomized to the intervention group and 50 randomized to the control group. Mean (SD) time from variant discovery was 4.7 (3.3) years. There were no differences between the intervention and control groups in baseline mean (SD) scores of psychological well-being parameters (autonomy: 55.20 [11.12] vs 56.77 [9.90]; environmental control: 56.30 [11.98 vs 58.51 [11.41]; positive relationships: 63.10 [15.91] vs 68.10 [9.86]; goals in life: 60.00 [14.12] vs 64.82 [10.57]; self-acceptance: 55.02 [16.62] vs 60.32 [13.50]) except personal growth (63.70 [14.66] vs 68.85 [8.07]). The IBSR group, compared with the control group, experienced better mean (SD) scores on all psychological well-being parameters at T2 (autonomy: 63.64 [8.35] vs 54.73 [10.41]; environmental control: 63.95 [10.05] vs 57.45 [11.43]; personal growth: 73.00 [8.34] vs 65.76 [10.95]; positive relationships 71.17 [9.99] vs 65.06 [12.58]; goals in life: 67.57 [8.88] vs 61.18 [12.87]; self-acceptance: 66.93 [11.15] vs 58.09 [15.55]) and at T3 (autonomy: 62.68 [9.05] vs 56.12 [10.64]; environmental control: 64.55 [10.28] vs 59.35 [12.98]; personal growth: 72.00 [8.06] vs 67.15 [11.82]; positive relationships: 71.24 [9.78] vs 66.92 [12.37]; goals in life: 68.33 [8.54] vs 62.92 [13.24]; self-acceptance: 66.84 [11.35] vs 58.97 [17.03]). Individuals in the IBSR group also experienced statistically significant improvements in sleep quality (mean [SD]: T1, 7.35 [3.97]; T3, 4.63 [3.21], P < .001), whereas the control group experienced no statistically significant difference. Women in the intervention group had a more favorable consideration of risk-reducing oophorectomy, from 7 women (14%) who refused to consider oophorectomy at T1 to 1 woman (2%) who refused to consider it at T3 (P = .04), and similar change in consideration of mastectomy: from 23 women (46%) who refused to consider mastectomy at T1 to 13 women (29%) who refused to consider it at T3 (P < .001). Conclusions and Relevance: This randomized clinical trial found that IBSR improved psychological well-being and led to a more favorable view on risk-reducing surgical procedures for at least 6 months among women in Israel who carried BRCA variants. These results suggest that IBSR may be implemented as a self-practice tool to enhance the well-being of individuals who carry BRCA variants and support them in their decision-making processes. Trial Registration: ClinicalTrials.gov Identifier: NCT03162276.


Assuntos
Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Reestruturação Cognitiva , Atenção Plena , Mastectomia Profilática , Adulto , Neoplasias da Mama/genética , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Israel , Comportamento de Redução do Risco , Inquéritos e Questionários
3.
Sci Rep ; 11(1): 24501, 2021 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-34969949

RESUMO

During the COVID-19 pandemic, breast and ovarian cancer survivors experienced more anxiety and depression than before the pandemic. Studies have not investigated the similarities of this trend among BRCA1/2-positive women who are considered high risk for these cancers. The current study examines the impact of COVID-19 experiences on anxiety and depression in a sample of BRCA1/2-positive women in the U.S. 211 BRCA1/2-positive women from medically underserved backgrounds completed an online survey. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for associations between COVID-19 experiences and self-reported anxiety and depression stratified by demographic factors. Overall, women who reported COVID-19 stigma or discrimination (aOR, 5.14, 95% CI [1.55, 17.0]) experienced significantly more depressive symptoms than women who did not report this experience. Racial/ethnic minority women caring for someone at home during COVID-19 were 3.70 times more likely (95% CI [1.01, 13.5]) to report high anxiety while non-Hispanic white women were less likely (aOR, 0.34, 95% CI [0.09, 1.30], p interaction = 0.011). To date, this is the first study to analyze anxiety and depression considering several COVID-19 predictors among BRCA1/2-positive women. Our findings can be used to inform future research and advise COVID-19-related mental health resources specific to these women.


Assuntos
Neoplasias da Mama , COVID-19 , Pandemias , Ansiedade , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , COVID-19/epidemiologia , COVID-19/psicologia , Estudos Transversais , Depressão , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Estados Unidos/epidemiologia
4.
Pan Afr Med J ; 40: 38, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34795819

RESUMO

Breast cancer is the most common neoplastic disease in women. Several treatment strategies are used: chemotherapy, radiotherapy, surgery and hormone therapy. Each of these treatments may affect sexual health of patients in the short or long term. The purpose of our study is to assess the quality of sexual life in women after breast cancer treatment. We made a quantitative descriptive estimate of 100 sexual active patients followed up for non-metastatic breast cancer, met during their consultations with a gynaecologist at the Farhat Hached hospital in Sousse. Data collection was carried out using an information sheet and two validated scales: RSS (relation Ship and sexual) and BESAA (Body EsteemScale for adolescents and Adults) to assess the quality of sexual life and body image. The average age of patients was 53.8 years. About half of patients (48%) had impaired sexuality due to the disease. The frequency of intercourse, sexual desire and the ability to reach orgasm were decreased in 65. 45, and 54 patients, respectively. The overall score for the three body image dimensions was 49.4. Women aged between 35 and 39 years were significantly more afraid of sexual intercourse (p=0.002) and less of sexual frequency (p=0.004). Adequate and enhanced training focused on the management of women with cancer and their sexual problems and multidisciplinary approach can improve women's psychological status.


Assuntos
Neoplasias da Mama/terapia , Qualidade de Vida , Comportamento Sexual/psicologia , Saúde Sexual/estatística & dados numéricos , Adulto , Imagem Corporal/psicologia , Neoplasias da Mama/psicologia , Coito/psicologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Orgasmo , Comportamento Sexual/estatística & dados numéricos , Sexualidade/psicologia , Inquéritos e Questionários
5.
BMJ ; 375: e066542, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34759002

RESUMO

OBJECTIVE: To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery. DESIGN: Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation. SETTING: 17 UK National Health Service cancer centres. PARTICIPANTS: 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196). INTERVENTIONS: Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months. MAIN OUTCOME MEASURES: Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective. RESULTS: Between 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale -0.68, -1.23 to -0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) -2.02, -3.11 to -0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average -£387 (€457; $533) (95% confidence interval -£2491 to £1718; 2015 pricing) and was cost effective compared with usual care. CONCLUSIONS: The PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications. TRIAL REGISTRATION: ISRCTN Registry ISRCTN35358984.


Assuntos
Terapia Comportamental/métodos , Neoplasias da Mama/reabilitação , Terapia por Exercício/métodos , Mastectomia/reabilitação , Modalidades de Fisioterapia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/economia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Análise Custo-Benefício , Avaliação da Deficiência , Terapia por Exercício/economia , Feminino , Humanos , Mastectomia/economia , Pessoa de Meia-Idade , Qualidade de Vida , Medicina Estatal , Resultado do Tratamento , Reino Unido
6.
Anticancer Res ; 41(10): 5045-5052, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593453

RESUMO

BACKGROUND/AIM: To examine the association between sense of coherence (SOC) and health-related quality of life (HRQoL) in early breast cancer patients. PATIENTS AND METHODS: The study population included 406 disease-free breast cancer survivors who participated in 3-year and 5-year follow-ups of a randomized exercise intervention. SOC was assessed using the short version of the Orientation to life questionnaire (SOC-13) in the 3-year follow-up. HRQoL was self-reported using the EORTC QLQC30 questionnaire in both 3-year and 5-year follow-ups. The association between SOC and HRQoL was analyzed using the Spearman's rank correlation coefficient. RESULTS: SOC had a strong positive correlation with global HRQoL in both 3-year (rs=0.57, p<0.01) and 5-year (rs=0.51, p<0.01) follow-ups. CONCLUSION: This study provides evidence of SOC's predictive value for HRQoL in early breast cancer patients. SOC might be used for identifying patients who will profit most from psychosocial support and intervention during the rehabilitation period.


Assuntos
Adaptação Psicológica , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Qualidade de Vida , Senso de Coerência/fisiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Inquéritos e Questionários , Taxa de Sobrevida
7.
Maturitas ; 152: 32-47, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34674806

RESUMO

Two behavioral change-based strategies for promoting adherence to physical activity (PA) suggested to have the greatest potential are the pedometer and Motivational Interviewing (MI). However, there are no comparisons between these two strategies identifying which one is more effective for improving PA adherence. This systematic review and meta-analysis aimed to determine which PA motivation strategy is more effective for promoting adherence to self-directed PA in female breast cancer survivors. Studies implementing self-directed PA which used a step tracker and/or MI for motivation in female breast cancer survivors were identified from the following databases at two timepoints, September 2019 and June 2020: CENTRAL, PubMed, CINAHL, PsycINFO, and Sportdiscuss. Sixteen randomized controlled trials (RCTs) were selected for data extraction, whereas ten RCTs were included in meta-analysis. Meta-analysis was performed on pooled data to estimate the standardized mean differences in PA duration and step count, and 95% confidence intervals. The number of participants meeting PA recommendations was also analyzed. Subgroup analysis was performed for three motivational strategies (pedometer combined with counselling, with print material or with motivational interviewing). Meta-analysis showed that pedometer combined with another intervention has a small effect on step count (p = 0.03) and a moderate effect on duration of moderate-vigorous physical activity (MVPA) (p = <0.0001) compared to controls. Additionally, motivational strategies increase the number of participants who meet a PA goal (p = 0.005). The findings of this review endorse the use of a step tracker combined with counselling, print material or MI based on behavioral change theory. This approach provided the most consistent positive effect on adherence to self-directed PA among breast cancer survivors. Future studies should evaluate differences between measures of adherence to self-directed PA, to identify the best motivation strategy for improving patient adherence and health outcomes. Systematic review registration: PROSPERO Registration number CRD42020148542.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Exercício Físico/psicologia , Monitores de Aptidão Física , Entrevista Motivacional , Cooperação do Paciente/psicologia , Acelerometria , Neoplasias da Mama/reabilitação , Feminino , Humanos , Motivação , Cooperação do Paciente/estatística & dados numéricos , Dispositivos Eletrônicos Vestíveis
9.
BMC Cancer ; 21(1): 1065, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587936

RESUMO

PURPOSE: The incidence of depression and anxiety is higher in patients with breast cancer than in the general population. We evaluated the degree of depression and anxiety and investigated the changes in patients with breast cancer during the treatment period and short-term follow-up period. METHODS: Overall, 137 patients with breast cancer were evaluated using the Patient Health Questionnaire 9-item depression scale (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). The scales were developed as a web-based electronic patient-reported outcome measure, and serial results were assessed before the operation, after the operation, in the post-treatment period, and in the 6-month follow-up period after surgery. RESULTS: The degree of depression and anxiety increased during treatment and decreased at 6-month follow-up, even if there were no statistical differences among the four periods (PHQ-9: p = 0.128; GAD-7: p = 0.786). However, daily fatigue (PHQ-9 Q4) and insomnia (PHQ-9 Q3) were the most serious problems encountered during treatment and at 6-month follow-up, respectively. In the GAD-7, worrying too much (Q3) consistently showed the highest scores during the treatment and follow-up periods. Of the patients, 7 (5.11%) and 11 (8.03%) patients had a worsened state of depression and anxiety, respectively, after treatment compared with before treatment. CONCLUSION: Most factors associated with depression and anxiety improved after treatment. However, factors such as insomnia and worrying too much still disturbed patients with breast cancer, even at 6-month follow-up. Therefore, serial assessment of depression and anxiety is necessary for such patients.


Assuntos
Ansiedade/diagnóstico , Neoplasias da Mama/psicologia , Depressão/diagnóstico , Registros Eletrônicos de Saúde , Medidas de Resultados Relatados pelo Paciente , Índice de Massa Corporal , Neoplasias da Mama/cirurgia , Fadiga/diagnóstico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Inquéritos e Questionários , Fatores de Tempo
11.
BMC Cancer ; 21(1): 1018, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511112

RESUMO

BACKGROUND: An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM). METHODS: This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients. RESULTS: A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors. First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected. CONCLUSIONS: Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status.


Assuntos
Neoplasias da Mama/etnologia , Neoplasias dos Genitais Femininos/etnologia , Motivação , Determinação de Necessidades de Cuidados de Saúde , Preferência do Paciente/etnologia , Relações Médico-Paciente , Migrantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/psicologia , Comunicação , Assistência à Saúde Culturalmente Competente/etnologia , Feminino , Neoplasias dos Genitais Femininos/psicologia , Alemanha , Letramento em Saúde , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etnologia , Cooperação do Paciente , Preferência do Paciente/estatística & dados numéricos , Satisfação do Paciente/etnologia , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Inquéritos e Questionários , Migrantes/estatística & dados numéricos , Traduções , Adulto Jovem
12.
BMC Cancer ; 21(1): 1042, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544362

RESUMO

BACKGROUND: The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) instrument is commonly used worldwide by professionals of oncology, but the scale has not, up to date, been validated in Arabic and Moroccan context, and there is an absence of data in the Moroccan population. This study aims to validate the Mini-MAC, translated and adapted to the Arabic language and Moroccan culture, in women with breast cancer. METHODS: Data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 158). Then, this structure was confirmed in the validation sample (N = 203) using confirmatory factor analysis (CFA). RESULTS: Confirmatory factor analysis confirmed Watson's original structure underlying the Mini-MAC items: Helpless/Hopeless, Anxious Preoccupation, Fighting Spirit, Cognitive Avoidance, and Fatalism. Absolute, incremental, and parsimonious fit indices showed a highly significant level of acceptance confirming a good performance of the measurement model. The instrument showed sufficient reliability and convergent validity demonstrated by acceptable values of composite reliability (CR =0.93-0.97), and average variance extracted (AVE = 0.66-0.93), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio of correlations values were lesser than 0.85, indicating acceptable discriminant validity. CONCLUSIONS: reliability; and both convergent and discriminant validity tests indicated that the Arabic version of the Mini-MAC had a good performance and may serve as a valid tool measuring psychological responses to cancer diagnosis and treatment.


Assuntos
Adaptação Psicológica , Neoplasias da Mama/psicologia , Emoções , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Aprendizagem da Esquiva , Análise Fatorial , Feminino , Humanos , Idioma , Pessoa de Meia-Idade , Marrocos , Pessimismo , Testes Psicológicos , Psicometria , Reprodutibilidade dos Testes , Resiliência Psicológica , Fatores Socioeconômicos , Traduções
13.
Psico USF ; 26(3): 417-428, Jul.-Sept. 2021. tab
Artigo em Português | LILACS-Express | LILACS, Index Psicologia - Periódicos | ID: biblio-1351334

RESUMO

Crescimento pós-traumático (CPT) refere-se à mudança positiva em algum aspecto da experiência humana como resultado do enfrentamento de adversidades. Investigou-se a relação entre CPT, estilos de enfrentamento e centralidade de evento. Participaram do estudo 65 mulheres que concluíram os tratamentos recomendados para o câncer de mama. Tratou-se de uma pesquisa quantitativa cujos instrumentos foram respondidos on-line. Identificou-se correlações altas entre CPT e centralidade de evento e moderadas entre CPT e os estilos de enfrentamento: estratégia focada no problema, busca de suporte social e práticas religiosas. A centralidade de evento e as estratégias focadas no problema mostraram-se melhores preditoras de CPT. Os resultados sugerem que quanto maior a adversidade percebida, maior a possibilidade de crescimento, sendo as estratégias de enfrentamento focadas no problema um componente importante para a sua ocorrência. Este estudo apontou a possibilidade de crescimento pessoal relacionado ao enfrentamento do CA de mama e indicou estratégias relevantes para desenvolvê-lo. (AU)


Posttraumatic growth (PTG) refers to a positive change in some aspect of the human experience as a result of coping with adversity. This study investigated the relationship between PTG, coping styles, and event centrality, using a cross-sectional research design. The sample consisted of 65 women who had completed the recommended treatments for breast cancer (BC) and answered an online survey. High correlations were identified between PTG and event centrality, and moderate correlations between PTG and the coping styles 'problem-focused strategy', 'social support seeking', and 'religious practices'. Event centrality and problem-focused coping strategies were the best predictors of PTG. The results suggest that the greater the perceived adversity, the greater the possibility of growth, and that problem-focused coping strategies are important for the occurrence of growth in the context of BC. This study pointed to the possibility of personal growth from coping with BC and indicated effective strategies to develop it. (AU)


El crecimiento postraumático (CPT) se refiere al cambio positivo en algún aspecto de la experiencia humana como resultado del enfrentamiento de adversidades. Se investigó la relación entre CPT, estilos de enfrentamiento y centralidad de eventos. Participaron del estudio 65 mujeres que completaron los tratamientos recomendados para el cáncer de mama. Se trató de una investigación cuantitativa respondida on-line. Se identificaron altas correlaciones entre CPT y centralidad de eventos; y moderadas entre CPT y los estilos de enfrentamiento: estrategia centrada en el problema, búsqueda de apoyo social y prácticas religiosas. La centralidad de eventos y las estrategias centradas en el problema demostraron mejores predictores del CPT. Los resultados sugieren que cuanto mayor es la adversidad percibida, mayor es la posibilidad de crecimiento, siendo las estrategias de afrontamientos centradas en el problema un componente importante para su ocurrencia. Este estudio señaló la posibilidad de crecimiento personal frente a la lucha contra el cáncer de mama. (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Mama/psicologia , Adaptação Psicológica , Crescimento Psicológico Pós-Traumático , Assistência Religiosa , Apoio Social , Estudos Transversais , Inquéritos e Questionários , Análise de Regressão
14.
PLoS One ; 16(8): e0249809, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34351924

RESUMO

We aimed to examine rates of breast and cervical cancer screening in women with immune-mediated inflammatory diseases (IMID), including inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus a matched cohort with IMID; and examine the association of psychiatric comorbidity with screening in these populations. We conducted a retrospective cohort study in Manitoba, Canada using administrative data. We identified women with IBD, MS and RA, and controls without these IMID matched on age and region. Annually, we identified individuals with any active mood/anxiety disorder. Using physician claims, we determined the proportion of each cohort who had cervical cancer screening within three-year intervals, and mammography screening within two-year intervals. We modeled the difference in the proportion of the IMID and matched cohorts who underwent mammography; and pap tests using log-binomial regression with generalized estimating equations, adjusting for sociodemographics, comorbidity and immune therapy use. We tested for additive interactions between cohort and mood/anxiety disorder status. During 2006-2016, we identified 17,230 women with IMID (4,623 with IBD, 3,399 with MS, and 9,458 with RA) and 85,349 matched controls. Having an IMID was associated with lower (-1%) use of mammography; however, this reflected a mixture of more mammography in the IBD cohort (+2.9%) and less mammography in the MS (-4.8 to -5.2%) and RA (-1.5%) cohorts. Within the IBD, MS and RA cohorts, having an active mood/anxiety disorder was associated with more mammography use than having an inactive mood/anxiety disorder. The MS and RA cohorts were less likely to undergo Pap testing than their matched cohorts. In the absence of an active mood/anxiety disorder, the IBD cohort was more likely to undergo Pap testing than its matched cohort; the opposite was true when an active mood/anxiety disorder was present. Among women with an IMID, mood/anxiety disorder influence participation in cancer screening.


Assuntos
Transtornos de Ansiedade/complicações , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/psicologia , Transtornos do Humor/complicações , Neoplasias do Colo do Útero/diagnóstico , Adulto , Transtornos de Ansiedade/psicologia , Artrite Reumatoide/complicações , Artrite Reumatoide/psicologia , Neoplasias da Mama/psicologia , Estudos de Casos e Controles , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/psicologia , Manitoba , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Estudos Retrospectivos , Neoplasias do Colo do Útero/psicologia
15.
Curr Opin Oncol ; 33(6): 553-573, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34456250

RESUMO

PURPOSE OF REVIEW: A comprehensive approach to survivorship care for women with early-stage, hormone-receptor positive breast cancer should systematically include the proactive assessment and adequate management of endocrine therapy-associated symptoms, in order to assure optimal balance between preserving quality of life (QOL) and maximizing treatment adherence. We reviewed the recent literature focused on lifestyle factors, including physical activity, diet and nutrition, weight management, smoke, and alcohol behavior, and their link with symptomatology and QOL among women receiving adjuvant endocrine therapy. RECENT FINDINGS: Recent studies confirm the safety, feasibility, and effectiveness of lifestyle interventions in mitigating several common endocrine therapy-related effects, including musculoskeletal pain, fatigue, and insomnia, and in improving physical and emotional wellbeing as well as overall health-related QOL among women with early-stage breast cancer. SUMMARY: Healthy lifestyle behaviors have the potential to modulate the downstream impact of endocrine therapy and improve QOL among women with early-stage breast cancer. Considerations for real-world clinical care implementation emerged, including a need to evaluate the long-term uptake of healthy behaviors and facilitate the postintervention maintenance of an improved lifestyle. Some facilitators to health promotion in breast cancer survivors were also suggested, such as individualized and one-to-one supervised programs, and digital solutions providing real-time feedback, building on personalized, direct patient engagement.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/terapia , Estilo de Vida , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Quimioterapia Adjuvante , Dieta , Exercício Físico , Feminino , Humanos , Estadiamento de Neoplasias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Holist Nurs Pract ; 35(5): 281-289, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34407026

RESUMO

The aim of this study was to explore the psychological outcomes of a mindfulness-based Internet-streamed yoga video in breast cancer survivors. A one-group, repeated-measures, purposive sample using a directed qualitative descriptive and convergent mixed-methods approach was used. Participants were recruited from breast oncology practices across 2 settings in the northeastern United States in April 2019. Education about the video was provided, and the link to the video was sent to participants. Demographic information, Knowing Participation in Change Short Form (KPCSF), Short Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and the Generalized Anxiety Distress Scale (GAD-7) were obtained at baseline and at 2 and 4 weeks. A semistructured interview was conducted at 4 weeks. Thirty-five women (mean age = 56 years) participated. A one-group, repeated-measures analysis of variance indicated statistically significant changes occurred in all measures between week 0 and week 4: decreased GAD (t = -2.97, P = .004), improved WEMWBS (t = 2.52, P = .008), and increased KPC (t = 2.99, P = .004). Qualitative findings suggest the overall experience of the video was positive and the women would recommend its use to others. Improvements in all psychological measures were achieved with video use. Findings indicate an improvement in psychological measures and support the theory of Knowing Participation in Change. This work further contributes to accessible, flexible interventions available through the Internet and/or mobile applications aimed at improving breast cancer survivorship.


Assuntos
Neoplasias da Mama/terapia , Atenção Plena/normas , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Ioga/psicologia , Adulto , Idoso , Ansiedade/psicologia , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Depressão/psicologia , Feminino , Humanos , Internet , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Atenção Plena/métodos , Atenção Plena/estatística & dados numéricos , New England , Avaliação de Resultados em Cuidados de Saúde/métodos , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Inquéritos e Questionários , Resultado do Tratamento
17.
Health Qual Life Outcomes ; 19(1): 178, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34253195

RESUMO

BACKGROUND: Women with breast cancer are prone to have mental stress and be stimulated by the fear of progression (FOP), then giving rise to a lower quality of life (QOL). The study aimed to examine the relationships between FOP, social support and QOL, and further explore whether social support mediates the association between FOP and QOL among Chinese patients with breast cancer. METHODS: The cross-sectional study was conducted from October 2019 to May 2020 at Anshan Cancer Hospital in Liaoning, China. 244 female breast cancer patients completed questionnaires including the Functional Assessment of Cancer Therapy for Breast (FACT-B), Multi-Dimensional Scale of Perceived Social Support (MSPSS), and Fear of Progression (FOP). Hierarchical multiple regression analysis was performed to assess the associations between FOP, social support and QOL. Asymptotic and resampling strategies were used to explore the mediating role of social support. RESULTS: The mean QOL score was 90.6 ± 17.0 among the patients with breast cancer. FOP was negatively correlated with QOL, while social support was positively related to QOL. Social support partly mediated the association between FOP and QOL, and the proportion of the mediating effect accounted for by social support was 25%. CONCLUSIONS: Chinese breast cancer patients expressed low QOL. Social support could mediate the association between FOP and QOL. Medical staffs and cancer caregivers should alleviate patients' FOP to improve their QOL by facilitating social support.


Assuntos
Neoplasias da Mama/psicologia , Medo/psicologia , Qualidade de Vida/psicologia , Apoio Social , Estresse Psicológico/psicologia , Adulto , Neoplasias da Mama/terapia , China , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários
18.
Future Oncol ; 17(25): 3373-3381, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34291649

RESUMO

Aim: To assess the anxiety levels of breast cancer patients during the COVID-19 pandemic. Materials & methods: A total of 298 patients completed the State-Trait Anxiety Inventory (STAI-S and STAI-T) and the Visual Analogue Scale for Anxiety (VAS) and VAS for Anxiety in COVID-19 (VAS-CoV). Results: 144 patients were in the high anxiety category for STAI-S, and 202 patients were in the high anxiety category for STAI-T. STAI-T score was significantly high in the metastatic group (p = 0.017). VAS-CoV score in the hormonotherapy group was significantly higher than in the no-treatment group (p = 0.023). There was a positive correlation between VAS-CoV and VAS levels (r = 0.708, p < 0.001), VAS-CoV and STAI-S and STAI-T scores (r = 0.402, p < 0.001; r = 0.185, p = 0.001, respectively), and a negative correlation between education years and STAI-T scores (r = -0.172, p = 0.003). Conclusion: The COVID-19 pandemic is related to high anxiety levels in breast cancer patients.


Assuntos
Ansiedade/epidemiologia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , COVID-19/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/terapia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , COVID-19/virologia , Comorbidade , Estudos Transversais , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade , Vigilância em Saúde Pública , SARS-CoV-2 , Fatores Socioeconômicos , Turquia/epidemiologia
19.
BMC Cancer ; 21(1): 872, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330229

RESUMO

BACKGROUND: Despite the progress in assessment and treatment of breast cancer, being diagnosed with it or receiving chemotherapy treatment is still conceived as a traumatic experience. Women develop negative thoughts about life and death with detrimental effects on their daily physical functioning/activities, emotional state and overall quality of life. The aim of our study was to evaluate the level of anxiety and depression among breast cancer patients receiving chemotherapy and explore the correlation between these psychological disorders, clinical, sociodemographic and genetic factors. METHODS: A cross-sectional study was conducted among breast cancer patients undergoing intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France hospital (November 2017-June 2019; Ethical approval number: CEHDF1016). All patients gave their written informed consent and completed several validated scales, including the Hospital Anxiety and Depression scale (HADS) for the assessment of anxiety and depression. Sleep quality, insomnia, cognitive function, fatigue and pain were also evaluated. Genotyping for certain gene polymorphisms (CLOCK, PER2, CRY2, OPRM1, ABCB1, COMT, DRD2) was performed using the Lightcycler® (Roche). RESULTS: A total of 112 women was included. The prevalence of depression was 43.4%, and 56.2% of the patients reported anxiety (based on the HADS classification). Multivariable analysis showed that higher cognitive scores and taking fosaprepitant were significantly associated with lower depression and anxiety scores. Moreover, being married compared to single was also associated with lower depression scores, whereas higher PSQI scores (worse sleep quality) and having the PER2 AA variant genotype compared to GG were significantly associated with higher depression scores. Finally, reporting a more severe insomnia and having the COMT Met/Met genotype were significantly associated with a higher anxiety score. CONCLUSIONS: Our study demonstrated a strong relationship between depression scores and cognitive impairment, sleep quality, marital status, fosaprepitant intake, and PER2 polymorphism, while anxiety scores were correlated to cognitive impairment, insomnia severity, fosaprepitant intake, and COMT polymorphism. The association with PER polymorphism was not previously reported. Identification of genetic and clinical risk factors for anxiety and depression would help clinicians implement an individualized management therapy aiming at preventing and alleviating the burden of these symptoms in breast cancer patients, hence improving their overall quality of life.


Assuntos
Ansiedade/epidemiologia , Ansiedade/etiologia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Depressão/epidemiologia , Depressão/etiologia , Suscetibilidade a Doenças , Adulto , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Estudos Transversais , Feminino , Predisposição Genética para Doença , Humanos , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Medição de Risco
20.
Health Qual Life Outcomes ; 19(1): 179, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247645

RESUMO

BACKGROUND: Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS: This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS: Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION: This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Fadiga/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Neoplasias da Mama/complicações , Estudos Transversais , Análise Fatorial , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , República da Coreia
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