[Promoting physical activity in women during breast cancer therapy: A mixed methods evaluation of a nursing counselling intervention]. / Bewegungsförderung bei Frauen während der Brustkrebstherapie.

Promoting physical activity in women during breast cancer therapy: A mixed methods evaluation of a nursing counselling intervention Abstract. Background: Physical activity is associated with improved quality of life in women during breast cancer treatment. However, how physical activity behaviour of patients changes in the first months after the start of the treatment and what role nursing counselling can play has not yet been sufficiently investigated. Aim: To observe differences in physical activity behaviour in women with breast cancer at the time of the initiation of the therapy and six months later, and to explore patients' and health professionals' perspective on a nursing counselling intervention on physical activity. Methods: A mixed-methods evaluation was conducted. In the quantitative part, the physical activity behaviour was assessed at two time points (t0 and t1) with the SQUASH instrument (30-2Wendel-Vos, 2003). In the qualitative part, one focus group interview was conducted with patients and health professionals separately. The quantitative data were analyzed using descriptive and inductive statistics. The qualitative data were analyzed thematically. Results: The sample (N = 47) showed a slight, but not significant increase in the extent of physical activity comparing t1 with t0. A statistically significant increase in the amount of exercise between t0 and t1 was only found in the category "work" (p = 0,002). The central theme of the women was that they felt encouraged by the nursing counselling intervention to "do something for themselves". For the health professionals, in the context of counselling it was important that they themselves were convinced of the importance of physical activity. Conclusions: The integration of physical activity into everyday life is a challenge for women with breast cancer during therapy. A counselling intervention is perceived as supportive but could have a more lasting effect through a longer-term physical activity programme.

Effect of Honey-Lime Spray as Add-On Therapy on Chemotherapy-Induced Xerostomia in Breast Cancer Patients: A Pilot Randomized Double-Blinded Controlled Trial.

INTRODUCTION: Xerostomia (dry mouth) is a common side effect among patients with cancer undergoing chemotherapy. There is no standard treatment for this symptom yet, although Persian medicine textbooks suggested some products to relieve xerostomia. We aimed to assess the efficacy of honey-lime spray in treating chemotherapy-induced xerostomia in breast cancer patients through a controlled study. METHODS: In this pilot, randomized, double-blinded clinical trial conducted in Shohadaye Tajrish Hospital, Iran, the intervention group received honey-lime spray and nystatin, while the control group used distilled water plus nystatin for 2 weeks. The six-item dry mouth form and visual analog score (VAS) were used to evaluate xerostomia extent and pain, respectively. RESULTS: The standardized value of the difference between the mean scores before and after the study was -10.21 (p < 0.001), and the effect size was estimated at 55%. Also, VAS showed a significant decrease in pain for the intervention group compared with the control group (p < 0.001). There were no serious side effects. CONCLUSION: Honey-lime spray may be a good treatment choice for xerostomia in chemotherapy-induced breast cancer patients, but robust trials with larger samples and prolonged follow-ups are highly recommended.Mundtrockenheit (Xerostomie) ist eine häufige Nebenwirkung bei Krebspatienten, die sich einer Chemotherapie unterziehen. Es gibt bisher keine Standardtherapie für dieses Symptom, doch Lehrbücher der persischen Medizin schlagen einige Mittel zur Linderung von Mundtrockenheit vor. Unser Ziel war es, die Wirksamkeit von Honig-Limetten-Spray zur Behandlung von chemotherapiebedingter Mundtrockenheit bei Patientinnen mit Brustkrebs im Rahmen einer kontrollierten Studie zu untersuchen.In dieser randomisierten, doppelt verblindeten klinischen Pilotstudie, die im Shohadaye Tajrish Hospital im Iran durchgeführt wurde, erhielt die Interventionsgruppe zwei Wochen lang Honig-Limetten-Spray und Nystatin und die Kontrollgruppe destilliertes Wasser plus Nystatin. Ein Mundtrockenheits-Fragebogen mit sechs Items wurde zur Beurteilung der Schwere der Mundtrockenheit verwendet und eine visuelle Analogskala zur Beurteilung der Schmerzen.Der standardisierte Wert der Differenz zwischen den mittleren Scores vor und nach der Studie betrug −10,21 (p < 0,01), und die geschätzte Effektstärke betrug 55%. Zudem zeigte die VAS eine signifikante Abnahme der Schmerzen in der Interventionsgruppe im Vergleich zur Kontrollgruppe (p < 0,01). Es traten keine schwerwiegenden Nebenwirkungen auf.Honig-Limetten-Spray könnte eine gute Wahl für die Behandlung von Mundtrockenheit bei Brustkrebspatientinnen unter Chemotherapie sein, doch hierzu werden belastbare Studien mit größerem Probenumfang und längerer Nachbeobachtung nachdrücklich empfohlen.

Routine practice data of three cancer entities: Comparison among cancer registry and health insurance data.

INTRODUCTION: Claims data and cancer registry data are valuable secondary data sources for addressing health service research questions. This study provides a thorough insight into the comparability of data from health insurance companies and cancer registries in Germany regarding breast, prostate, and lung cancer patients and their treatment. METHODS: For this study claims data of the InGef database and data of the Cancer Registry of Rhineland-Palatinate were used to identify patients living in Rhineland-Palatinate with an incident breast, prostate, or lung cancer diagnosis between Jan. 1, 2018 and Dec. 31, 2019. Both datasets were compared for patient and tumour characteristics as well as treatment strategy. For the descriptive analysis of tumour localisation and treatment all patients were followed up for a maximum of two years. RESULTS: A total of 1,470 incident cancer cases were identified in the InGef database and 1,694 in the Cancer Registry. Data on sex, age, and tumour localisation matched well for all cancer entities in the cohorts. Data for early UICC stages I+II varied between the cohorts for prostate cancer (84% InGef, 66% Cancer Registry) and lung cancer (29% InGef, 20% Cancer Registry). Larger deviations were found for antihormonal treatment (breast 54% vs. 44%, prostate 32% vs. 18%). Significant differences were found for surgery (breast and lung) and radiation (breast and prostate), respectively. DISCUSSION: Age at diagnosis, tumour localisation, and treatment for breast cancer was well documented in both databases. Tumour-specific deviations were observed for tumour localisations (lung cancer), UICC stage (prostate and lung cancer) and treatment options. CONCLUSION: Both databases show very good completeness across cancer entities, but at the same time have minor limitations where they could readily complement each other. Individual linkage of claims and registry data could be an important step to improve oncological studies with routine practice data and to overcome the limitations identified.

[Shared decision making in breast care centres in North Rhine-Westphalia: results of a 10-year trend analysis]. / Shared Decision Making in Brustzentren in NRW: Ergebnisse einer 10-Jahres-Trendanalyse.

BACKGROUND: Although shared decision making (SDM) has been gaining importance in German health services for some time now, the state of its implementation is still unknown. The aim of this study was to provide a valid trend analysis for SDM in breast care centres in the German federal state of North Rhine-Westphalia (NRW) for a period of 10 years. METHODS: As part of an annual patient survey in breast care centres in NRW, two subscales of the Perceived Involvement in Care Scales (PICS) were used and analysed in multi-level models. RESULTS: Data from nearly 40,000 patients could be analysed with consistently high response rates. In the observation period from 2006 to 2015 doctor facilitation and patient involvement increased on a scale from 1 to 4 of 3.1 to 3.4 and 2.6 to 2.8, respectively. CONCLUSIONS: Despite the slight increases in the 10-year observation period a stable trend cannot be assumed. However, this study might be useful as a baseline for other studies on SDM implementation.

[Signs of social inequality in information seeking and evaluation of information among young women with breast cancer - results of a cohort study]. / Hinweise auf soziale Ungleichheit im Informationsverhalten und in der Informationsbewertung junger Frauen mit Brustkrebs ­ Ergebnisse der Kohortenstudie "gemeinsam gesund werden".

OBJECTIVE: The extent to which cancer patients are well-informed can have manifold effects. The aim of this study was to explore both the sources of information that young breast cancer patients with children use and how they evaluate the information obtained. METHODS: Participants were recruited within a rehabilitation program for young mothers with non-metastatic breast cancer (the Groemitz project "gemeinsam gesund werden"). Data on information seeking, the level of information, socio-demographic data and clinical characteristics were collected using a questionnaire. RESULTS: The patients (n=827) used several additional sources of information - most frequently the internet (69.5%; n=767). The majority felt well informed about their disease and found the information provided easy to understand. A social gradient was observed in relation to media use, information evaluation and obtaining a second opinion. CONCLUSION: To young breast cancer patients, the internet is crucial for obtaining further information. The indication of a social gradient underlines the importance of addressing the information needs of patients with a lower socioeconomic status.

Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM).

BACKGROUND: Studies addressing the organizational contexts of care that may help increase the patients' ability to cope with a disease and to navigate through the health care system are still rare. Especially instruments allowing the assessment of such organizational efforts from the patients' perspective are missing. The aim of our study was to develop a survey instrument assessing organizational health literacy (HL) from the patients' perspective, i. e., health care organizations' responsiveness to patients' individual needs. METHODS: A pool of 30 items was developed by a group of experts based on a literature review. The items were developed, tested and prioritized according to their importance in 11 semi-structured interviews and cognitive think-aloud interviews with cancer patients. The resulting 16 items were rated in a standardized postal survey involving a total of N=453 colon and breast cancer patients treated in cancer centers in Germany. An exploratory factor analysis, a confirmatory factor analysis and structural equation modelling were conducted. Item properties were analyzed. RESULTS: 83.2 % of the patients were diagnosed with breast cancer, 16.8 % had a diagnosis of colon cancer. The patients' mean age was 61 (26-88), 89.4 % were female. The most common comorbidities were hypertension (34.0 %) and cardiovascular disease (11.0 %). The final prediction model included nine items measuring the degree of health literacy-sensitivity of communication. The model showed an acceptable model fit. The nine items showed corrected item-total correlations between .622 and .762 and item difficulties between 0.77 and 0.87. Cronbach's α was .912. DISCUSSION: In a comprehensive development process, the original item pool comprising several aspects of organizational HL was reduced to a one-dimensional scale. The instrument measures an important aspect of organizational HL; i.e., the degree of health literacy-sensitivity of communication (HL-COM). HL-COM was found to impact patient enablement, mediated through the support by physicians. Future research will have to test these associations in the context of other diseases or institutions.

[Ultrasound for Breast Cancer Screening: an Effective Tool in a Personalized Screening]. / L'échographie dans le dépistage du cancer du sein: un outil efficace dans un dépistage personnalisé.

Screening mammography is the only imaging modality with proved decrease in breast cancer mortality. Ultrasound has been proposed as additional tool for screening. Controversies remain about the real value of sonography in this setting. In Caucasian women with dense breast, sonography improves significantly breast cancer detection, but also increases the false positive cases, biopsies and costs. A careful selection of women who may benefit from additional screening with sonography is mandatory.

[Breast cancer screening in Austria: Key figures, age limits, screening intervals and evidence]. / Brustkrebs-Screening in Österreich: Kennzahlen, Altersgrenzen, Screening-Intervalle und Evidenzbasis.

In January 2014, the first nationwide quality-assured breast cancer screening program addressing women aged ≥ 40 years was introduced in Austria. As part of the process of developing a patient information leaflet, the Evidence Based Medicine (EBM) Review Center of the Medical University of Graz was charged with the task of assessing the potential benefits and harms of breast cancer screening from the available evidence. Based on these results, key figures were derived for mortality, false-positive and false-negative mammography results, and overdiagnosis, considering Austria-specific incidence rates for breast cancer and breast cancer mortality. Furthermore, the current evidence regarding age limits and screening interval, which were the subjects of controversial public discussions, was analyzed. A systematic search for primary and secondary literature was performed and additional evidence was screened, e. g., evaluation reports of European breast cancer screening programs. On the basis of the available evidence and of the Austrian breast cancer mortality and incidence rates, it can be assumed that - depending on the age group - 1 to 4 breast cancer deaths can be avoided per 1,000 women screened in a structured breast cancer screening program, while the overall mortality remains unchanged. On the other hand, 150 to 200 of these 1,000 women will be affected by false-positive results and 1 to 9 women by overdiagnosis due to the structured breast cancer screening. Therefore, the overall benefit-harm balance is uncertain. If women from 40 to 44 or above 70 years of age are considered, who can also participate in the Austrian screening program, even a negative benefit-harm balance seems possible. However, with the implementation of quality standards in breast cancer screening and the dissemination of a patient information leaflet, an improvement in the medical treatment situation, specifically in terms of informed decision-making, can be expected.

Grating-based darkfield imaging of human breast tissue.

Mastectomy specimens were investigated using a Talbot-Lau X-ray imaging set-up. Significant structures in the darkfield were observed, which revealed considerably higher contrast than those observed in digital mammography. Comparison with the histomorphometric image proofs that the darkfield signal correlates with a tumor region containing small calcification grains of 3 to 30µm size.