Long-Term Survival of Women with Breast Cancer. Overview Supportive Care Needs Assessment Instruments.

INTRODUCTION: Worldwide, breast cancer is the fifth leading cause of cancer death (after lung, stomach, liver and colon cancer), while among women it is first on the list. The incidence of breast cancer has made a dramatic increase since 1970 which is partly interpreted by the modern western life standards. The expected risk of breast cancer throughout a lifespan of an average is 1 in 11 women. The five-year survival rates for breast cancer are at 80% if it has not spread, and only at 40% for the metastatic type of cancer.The concept of survival comes from the US, where there is an active promotion of self-help difficulties coping strategies. Surviving from cancer may be a mixed experience. Survivors of cancer often say they are still running a full and meaningful life after experiencing a threatening disease. Others may find it difficult to handle the feeling that they have no right to be alive, which is probably related to the guilt of survival after the war. Although the survival potential for some is a satisfactory fee, others may be looking for improvement, change, or to adapt their life and struggle with the late effects of cancer after stopping the treatment.In recent years it has been observed that survival of women with breast cancer has increased significantly because of current antineoplastic therapeutic interventions. The definition of support needs derives from the one of supportive care considering that there is no theoretical framework or specific definition at the moment. "Supportive care is defined as the care which helps the individual and his/her family to deal with the experience of cancer and cover their bodily, emotional, psychological, social, mental and practical needs, as well as their need of information. It includes the period before the final diagnosis, during the diagnosis and the treatments or during the ongoing disease with recurrences and the survivors of the disease." PURPOSE: The purpose of this review is to describe the tools used in research to measure and evaluate supportive care needs during long-term survival of women with breast cancer. METHOD: An electronic search of articles was held in the PubMed database for the period from 2005 up to 2015. The terms used in the search were "breast cancer", "quality of life", "long-term survivorship" and "supportive care needs". The entry criteria of the articles were to be breast cancer diagnosis, written in English, quantitative methodology and include patients with at least a five-year survival. The sorting of articles were based on the inclusion and exclusion criteria according to the MOOSE Checklist systematic review. With the criteria set out, the articles incurred are a total of 249 from which 47 were excluded according to their title, 28 as they were articles of other types of cancer, 61 had direct objective the description of drugs, treatments and their cost, 5 did not study supportive care needs, 49 did not have direct research questions, 4 did not relate to the period of 10 years, and 6 were not associated with a five-year survival. From a total of 249 articles 43 met the inclusion criteria and 23 were finally included. These 23 articles were studied thoroughly by two independent researchers in order to record the analytical tools used by individual researchers to measure the supportive care needs. RESULTS: There were several different methodological approaches identified, particularly in the way of recruiting and determining the patient research sample and complete questionnaires. Altogether 82 different tools were used to measure the support needs. Supportive care needs are divided into organic, psychological, socio-economic and spirituality. The commonly studied supportive care needs are related to mobility/functionality (39.8%), psychological well-being (37.3%), mainly depression, sexuality (14.5%), fatigue (7.2%) and spirituality (4.8%) of the surviving women. Some tools were discovered that studied bodily needs (47.6%), psychological needs (36.6%), a combination of the two (3.7%), socioeconomic needs (8.5%) and mental needs (1.2%). Tools such as Center for Epidemiologic Studies-Depression Scale (17.4%), Physical Component Scale (13%) and Beck Depression Inventory (13%) are included in the most commonly used ones. CONCLUSIONS: The supportive care needs of breast cancer women during long-term survivorship are slightly explored, comparing to antineoplasmatic treatment period supportive care needs. This is probably due to the subjective nature of the concept examined. Approximately every scientific team worked on the study of supportive care needs on two or three different dimensions. More frequently examined are Physical and Psychological Care Needs. Gap is observed in exploring the social/economical and spiritual supportive care needs of women with breast cancer survivors as well as practical needs.

Responses to SARS-CoV-2 Vaccination in Patients with Cancer (ReCOVer Study): A Prospective Cohort Study of the Hellenic Cooperative Oncology Group.

Data on the effectiveness and safety of approved SARS-CoV-2 vaccines in cancer patients are limited. This observational, prospective cohort study investigated the humoral immune response to SARS-CoV-2 vaccination in 232 cancer patients from 12 HeCOG-affiliated oncology departments compared to 100 healthcare volunteers without known active cancer. The seropositivity rate was measured 2-4 weeks after two vaccine doses, by evaluating neutralising antibodies against the SARS-CoV-2 spike protein using a commercially available immunoassay. Seropositivity was defined as ≥33.8 Binding-Antibody-Units (BAU)/mL. A total of 189 patients and 99 controls were eligible for this analysis. Among patients, 171 (90.5%) were seropositive after two vaccine doses, compared to 98% of controls (p = 0.015). Most seronegative patients were males (66.7%), >70-years-old (55.5%), with comorbidities (61.1%), and on active treatment (88.9%). The median antibody titers among patients were significantly lower than those of the controls (523 vs. 2050 BAU/mL; p < 0.001). The rate of protective titers was 54.5% in patients vs. 97% in controls (p < 0.001). Seropositivity rates and IgG titers in controls did not differ for any studied factor. In cancer patients, higher antibody titers were observed in never-smokers (p = 0.006), women (p = 0.022), <50-year-olds (p = 0.004), PS 0 (p = 0.029), and in breast or ovarian vs. other cancers. Adverse events were comparable to registration trials. In this cohort study, although the seropositivity rate after two vaccine doses in cancer patients seemed satisfactory, their antibody titers were significantly lower than in controls. Monitoring of responses and further elucidation of the clinical factors that affect immunity could guide adaptations of vaccine strategies for vulnerable subgroups.