BackgroundThe research objective was to investigate social and cultural factors affecting breast cancer survivors’ experiences in Lebanese.MethodsA snowball sampling of 20 breast cancer survivors participated in the study. Semi-structured open-ended interviews were used to collect data.ResultsThe results showed that family support and religious beliefs were the primary supporting sources for breast cancer survivors. On the other hand, their body image and children were the major concerns. Thus, family and religious beliefs were (...) needed to overcome breast cancer’s daily burden.ConclusionWomen with breast cancer perceived their cancer experience through their social roles, reflecting a concern for image and role preservation. (shrink)

Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors with persistent postsurgical pain over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture (...) outcomes were vertical spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open, eyes open relaxed and eyes closed. Assessments were made before and after the Qigong training. The association between categorical variables was measured by Cramer’s V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs. (shrink)

ObjectivesQuality of life has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two.MethodsA sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction, (...) which measures participants' satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls.ResultsCompared with the general population sample, the patients were less satisfied with their health and more satisfied with all other QoL domains. The subjective importance of health was lower in the patients' sample. Satisfaction with health and importance of health were slightly positively correlated. The effect of QoL domain importance on general QoL was small, and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible.ConclusionIn addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers' attention. (shrink)

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused (...) solely on survivors of breast cancer at least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

ObjectiveTo examine the relations between social support, illness uncertainty, and fear of cancer recurrence.MethodsUsing data from a convenience sample of 231 breast cancer survivors in China to perform structural equation modeling with bootstrapping estimation. Participants were recruited from a general hospital in Shenyang, China. Participants completed the Perceived Social Support Scale, Mishel Uncertainty in Illness Scale, and Fear of Cancer Recurrence Inventory- Shorter Form.ResultsThe majority of breast cancer survivors have FCR. FCR was (...) significantly negatively associated with social support, and was significantly positively associated with IU. Moreover, IU was found to mediate the relationship between social support and FCR.ConclusionThe findings support the final model. Good social support can directly mitigate FCR, while illness uncertainty can play a mediation role between social support and FCR. Further studies should be conducted to explore effective interventions for social support and IU to ultimately mitigate FCR in cancer survivors. (shrink)

BackgroundPrevious findings indicated that breast cancer patients often have dysfunction in empathy and other cognitive functions during or after chemotherapy. However, the manifestations and possible neuro-electrophysiological mechanisms of pain empathy impairment in breast cancer patients after chemotherapy were still unknown.ObjectiveThe current study aimed to investigate the potential correlations between pain empathy impairment and event-related potentials in breast cancer patients undergoing chemotherapy.MethodsTwenty-two breast cancer patients were evaluated on a neuropsychological test and pain empathy (...) paradigm before and after chemotherapy, containing the Chinese version of the Interpersonal Reactivity Index, while recording ERP data.ResultsThe empathic concern scores were lower and personal distress scores were higher on IRI-C task compared with those before chemotherapy. Meanwhile, the accuracy rates were lower than those before chemotherapy for both pain and laterality tasks on the pain empathy paradigm. However, the response time was no significant differences before and after chemotherapy. Further, the amplitude of the N1 component was significantly increased, and the amplitude of the P2 component was significantly decreased in the subsequent ERP study. A linear mixed effect model was used to analyze the correlation, the average amplitude of N1 and P2 were positively correlated with the accuracy rates in laterality tasks.ConclusionThe results indicated that pain empathy impairment was performed in chemotherapeutic breast cancer patients, which was possibly correlated to the changes of N1 and P2 components in ERP. These findings provide neuro-electrophysiological information about chemo-brain in breast cancer patients. (shrink)

Cancer is a chronic disease that causes the most deaths in the world, being a public health problem nowadays. Even though breast cancer affects the daily lives of patients, many women become resilient after the disease, decreasing the impact of the diagnosis. Based on a positive psychology approach, the concept of co-vitality arises understood as a set of socio-emotional competencies that enhance psychological adaptation. In this sense, emotional intelligence is one of the main protective factors associated with (...) resilience. However, it is not always as beneficial as it seems, and can lead to collateral effects on psychological adjustment. Given this controversy, this study aims to find the specific processes through which the dimensions of Perceived Emotional Intelligence can act as a risk or protective factor in the development of resilience. The total sample was 167 women, 46.7% were breast cancer survivors, and 53.3% were healthy controls. The selection of women with breast cancer carries out randomly, recruited through the Oncology Units. The sample completed measures of resilience and PEI, through Resilience Scale and TMMS-24. The results showed that breast cancer survivors showed higher age and greater levels of resilience and mood repair than healthy women. The mediation analysis revealed that breast cancer survival and PEI predicted 28% of the variance of resilience. The direct effects showed that emotional clarity and mood repair increased resilience levels. Although breast cancer did not predict resilience directly, it does through mood repair by an indirect process. Besides, the analysis showed that emotional attention played a role in vulnerability, decreasing mood repair, and resilience. These research support theories that point to a possible dark side of PEI, thus, a great level of emotional attention makes dark the positive effect of mood repair and personal growth if a clear perception of emotions does not complement it. These results provide empirical support concerning the need to work complementary each dimension of PEI to avoid unwanted effects on intrapersonal adjustment. (shrink)

The experience of breast cancer and related treatments has notable effects on women's mental health. Among them, the subjective perception of the body or body image is altered. Such alterations deserve to be properly treated because they augment the risk for depression and mood disorders, and impair intimate relationships. A number of studies revealed that focused psychological interventions are effective in reducing BI issues related to breast cancer. However, findings are inconsistent regarding the dimension of such (...) effects. This meta-analysis synthesizes and quantifies the efficacy of psychological interventions for BI in breast cancer patients and survivors. Additionally, since sexual functioning emerged as a relevant aspect in the BI distortions, we explored the efficacy of psychological interventions on sexual functioning related to BI in breast cancer patients and survivors. The literature search for relevant contributions was carried out in March 2020 through the following electronic databases: Scopus, PsycINFO, and ProQUEST. Only articles available in English and that featured psychological interventions for body image in breast cancer patients or survivors with controls were included. Seven articles with 17 dependent effect sizes were selected for this meta-analysis. Variables were grouped into: Body Image and Sexual Functioning Related to the Body Image in breast cancer patients and survivors. The three-level meta-analysis showed a statistically significant effect for Body Image [g = 0.50; 95% CI ; p < 0.05] but no significant results for Sexual Functioning Related to Body Image [g = 0.33; 95% CI ; p = 0.19]. These results suggest that psychological interventions are effective in reducing body image issues but not in reducing sexual functioning issues related to body image in breast cancer patients and survivors. Future review efforts may include gray literature and qualitative studies to better understand body image and sexual functioning issues in breast cancer patients. Also, high-quality studies are needed to inform future meta-analyses. (shrink)

Objective:Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, (...) worry, and uncertainty in the breast cancer survivorship literature to improve research and practice.Inclusion Criteria:We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs.Methods and Analysis:The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings.Findings:After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty.Conclusion:While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted. (shrink)

In line with some recent studies that emphasize the importance of embodied meanings in social interaction and face-to-face communication, this study recognizes the significance of the body in human meaning-making processes and contributes to the emerging studies that explore the relation of the body, self, and social interaction. Unlike studies that analyze the body as a symbol or text disconnected from the actual body (i.e., a representation), this study does not separate appearance from the body. Rather, this research explores embodied (...) appearance and shows how a nonconforming appearance might highlight the body's presence in interaction, making it a focal point of attention in contrast to the taken-for-grantedness of our bodies in everyday life. I examine the reported experiences of some breast cancer survivors to find the implications of changes in physical appearance due to radiation, chemotherapy, or surgery, for survivors and their interactions with others. (shrink)

ObjectivesThis pilot study sought to develop and evaluate a novel online group-based intervention to help breast cancer survivors make healthy lifestyle changes intended to yield not only beneficial physical outcomes but also greater behavioral, and psychosocial well-being.MethodsAn exploratory single-arm, mixed-method triangulation design was employed to evaluate the feasibility and preliminary effectiveness of the HLM-ABC intervention for overweight BCSs. Fourteen women participated in the 10-week intervention and completed quantitative measures of the above-mentioned outcomes at baseline, post-treatment, 6-month, and (...) 12-month follow-up time points. Qualitative data were obtained post-treatment via semi-structured interviews and a treatment satisfaction questionnaire.ResultsParticipants lost an average of 2.83% of their baseline weight by 1-year follow-up, equal to a small effect size. Despite achieving only modest weight loss, participants achieved meaningful gains in the form of increased physical activity, discovery of gratifying movement, more intuitive eating habits, greater bodily and emotional awareness, and positive shifts in beliefs about being able to make healthy choices regarding food and physical activity. Furthermore, they demonstrated a slight improvement in body image and described feeling more self-compassionate, empowered, and acknowledging of variables beyond control that can present barriers to change.ConclusionAfter completing a 10-week online program, participants achieved meaningful and lasting changes on a number of healthful indicators, even when this did not correspond with a significant reduction in weight. Findings highlight the complex, multifaceted nature of “health” and lend support for promotion of healthier lifestyle following cancer treatment that encompasses not only physical weight, but also behavior, psychosocial well-being, and circumstances such as life-preserving hormonal treatments. (shrink)

In this paper, I explore the meaning of bodily integrity in disfiguring breast cancer. Bodily integrity is a normative principle precisely because it does not simply refer to actual physical or functional intactness. It rather indicates what should be regarded and respected as inviolable in vulnerable and damageable bodies. I will argue that this normative inviolability or wholeness can be based upon a person's embodied experience of wholeness. This phenomenological stance differs from the liberal view that identifies respect (...) for integrity with respect for autonomy (resulting in an invalidation of bodily integrity's proper normative meaning), as well as from the view that bodily integrity is based upon ideologies of wholeness (which runs the risk of being disadvantageous to women). I propose that bodily integrity involves a process of identification between the experience of one's body as “Leib” and the experience of one's body as “Körper.” If identification fails or is not possible, one's integrity is threatened. This idea of bodily integrity can support breast cancer patients and survivors in making decisions about possible corrective interventions. To implement this idea in oncology care, empirical-phenomenological research needs to establish how breast cancer patients express their embodied self-experiences. (shrink)

IntroductionYounger age at diagnosis is a risk factor for poor health-related quality of life in long-term breast cancer survivors. However, few studies have specifically addressed HRQOL in young adults with breast cancer, nor have early changes in HRQOL been fully characterized.MethodsEligible female patients with breast cancer were identified through our local cancer center. To establish HRQOL, patients completed the Functional Assessment of Cancer Therapy-Breast around diagnosis and 12 months later. Sociodemographic (...) factors, genetic susceptibility to cancer, tumor- and treatment-related factors, and comorbidities were abstracted from medical records and the local oncology registry. Mixed-effects models were used to identify changes in FACT-B scores during the first year of treatment and to determine whether any demographic/treatment-related factors modulated changes in scores.ResultsHealth-related quality of life in young patients with breast cancer was within normal limits at baseline, with a FACT-B overall well-being score of 108.5. Participants reported slight improvements over a 12-month period: FACT-B overall well-being scores increased 6.6 points, functional well-being improved 3.0 points, emotional well-being improved 1.9 points, and physical well-being improved 1.5 points, on average. Participants with anxiety/depression at baseline reported greater improvements in FACT-B overall well-being and functional well-being than participants who did not have anxiety/depression at baseline. Marital status, reconstructive surgery, and baseline clinical staging were also significantly associated with changes in aspects of HRQOL, although their impact on change was relatively minimal.ConclusionYoung women with breast cancer do not report HRQOL concerns during the first year of treatment. Improvements in HRQOL during the first year of treatment may be attributable to a sense of relief that the cancer is being treated, which, in the short run, may outweigh the negative late effects of treatment. (shrink)

As a university professor, an environmentalist, and a world-traveller, Sue Hendler was thriving. Then she was diagnosed with metastatic breast cancer. She had to give up her job, make hard decisions about medical treatment, and drastically shorten her vision of the future. As her cancer spread, she ironically acquired a new identity as a cancer "survivor." Compelled to find meaning in her "new normal" of life with a fatal disease, she decided to write for a wider (...) audience. In Dying in Public: Living with Metastatic Breast Cancer, Hendler talks about her experiences of undergoing surgery, taking steroids, receiving chemotherapy, and enrolling in a clinical drug trial. As her condition worsens she remains committed to living fully. She struggles with writing a bucket list, discusses her "legacy," and talks about her feelings of anger and the importance of love. She also describes how she lived, towards the end, with the support of the members of her "Care Team," a group of over thirty friends, family, and health care workers who enabled her to remain at home until the day before her death. This honest, witty, and unsentimental depiction of "dying in public" is a profound tribute to a life well lived. (shrink)

BackgroundDepression is common psychiatric morbidity in breast cancer survivors, seriously affecting patients’ quality of life and mental health. A growing body of research has investigated depression in breast cancer. However, no visual bibliometric analysis was conducted in this field. This study aimed to visualize the literature to identify hotspots and frontiers in research on breast cancer and depression.MethodsThe publications related to depression in breast cancer were retrieved in the Web of Science (...) Core Collection between 1 January 2002 and 17 March 2022. VOSviewer was used to identify co-occurrences and collaborations among countries, institutions, and keywords. CiteSpace was used to detect keyword bursts.ResultsA total of 7,350 articles and reviews related to depression in breast cancer were identified. From 2002 to 2022, the United States and the People’s Republic of China were the most productive countries in this field. The University of California, Los Angeles, and the University of Toronto were the most productive institutions in this field. The Journal of Psycho-oncology, followed by Supportive Care in Cancer and the Journal of Clinical Oncology, had the most publications on depression in breast cancer. Of the top 10 journals, seven were from the United States, two were from England, and one was from Germany. Five research hotspots of depression in breast cancer were identified by co-word analysis. Research on post-traumatic growth, spiritual interventions, cognitive-behavioral therapy, physical activity, and symptom cluster management of depression in breast cancer was relatively mature in the core hotspots. Burst detection of keywords on depression in breast cancer showed the latest hotspots, such as mental health, cancer survivor mortality, and activity.ConclusionThe research on depression in breast cancer is growing. Attention should be paid to the latest hotspots, such as mental health, cancer survivor, mortality, exercise, and physical activity. (shrink)

BackgroundWomen survivors of breast cancer treatments face significant challenges around initiation or maintenance of physical activity as they transit to recovery. Embracing their needs and preferences is important to increase adherence. This study aimed to explore the perspectives of Portuguese women survivors of breast cancer regarding regular performance of PA and individual choices and strategies that should be considered in designing effective interventions.MethodsThe individual semi-structured interviews were analyzed through thematic analysis, following an inductive process, (...) seeking to identify the barriers, facilitators, and particular influencing circumstances associated with regular PA.ResultsFour themes and several contextual, emotional, physical, and social factors were identified as determinants of regular PA. Guilt, women’s duties, and altruism to help close relatives were identified as emotional and cultural factors that are less-found in the existing literature. PA showed influence both from health professionals’ counseling and from knowledge and beliefs held by these women.ConclusionWhile confirming the already-known impact of breast cancer diagnosis and treatments on PA, which redefine participants’ availability to be active, the findings highlight beliefs and specific emotional factors that should be considered when planning culturally sensitive interventions. (shrink)

An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and (...) were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature. (shrink)

In researching the biomedically-engineered drug Neulasta (filgrastim), a breast cancer patient becomes aware of the extent to which knowledge about the development and marketing of drugs influences her decisions with regard to treatment. Time spent on understanding the commercial interests of insurers and pharmaceutical companies initially thwarts but ultimately aids the healing process. This first-person narrative calls for physicians to recognize that the alignment of commercial interests transgresses the patient’s humanity.

Background: An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. Methods: We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included (...) articles, and were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. Results: Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. Conclusions: The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature. (shrink)

This study investigates the prevalence of ‘Seeking God's Help’, its relation to time since diagnosis, and its association with Life Satisfaction for all cancer types. This study also investigates Disease-Specific Quality of Life for patients with breast, prostate, and colorectal cancers. Data were obtained from the third wave of the Nord-Trøndelag Health Study of Norway, with 2,086 cancer patients identified by the Cancer Registry of Norway and 6,258 cancer-free controls. Our results indicate a higher prevalence (...) of ‘Seeking God's Help’ after a shorter time since diagnosis among men. No association was observed in multivariate analyses between ‘Seeking God's Help’ and ‘Life Satisfaction’ or ‘Disease-Specific QoL’ in long-term cancer survivors. Longitudinal investigations are needed to elucidate the relationship between the ‘Seeking God's Help’ variable and Life Satisfaction and Disease-Specific QoL among cancer patients in a Norwegian context. (shrink)

This study investigates the prevalence of ‘Seeking God’s Help’, its relation to time since diagnosis, and its association with Life Satisfaction for all cancer types. This study also investigates Disease-Specific Quality of Life for patients with breast, prostate, and colorectal cancers. Data were obtained from the third wave of the Nord-Trøndelag Health Study of Norway , with 2,086 cancer patients identified by the Cancer Registry of Norway and 6,258 cancer-free controls. Our results indicate a higher (...) prevalence of ‘Seeking God’s Help’ after a shorter time since diagnosis among men. No association was observed in multivariate analyses between ‘Seeking God’s Help’ and ‘Life Satisfaction’ or ‘Disease-Specific QoL’ in long-term cancer survivors. Longitudinal investigations are needed to elucidate the relationship between the ‘Seeking God’s Help’ variable and Life Satisfaction and Disease-Specific QoL among cancer patients in a Norwegian context. (shrink)

ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded (...) couple-based intervention to address the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: A highly flexible intervention that can be tailored to couples’ specific RSH concerns; Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship. (shrink)

The Knowledge Based System for Diagnosing Breast Cancer is used to assist medical students to improve their education on diagnosis and counseling the process of analyzing the biopsy image of the microscope, determining the type of tumor and the treatment method for each case and identifying the disease related questions. According to the Ministry of Health in its annual report in Gaza, between 2009 and 2014 there are 7069 cases of breast cancer, and in 2014 there (...) are 1502 cases of breast cancer . We are now in the age of visual information where 65% of the populations are visual learners; the Knowledge Based System is the easiest way to ensure students remember the information in the long term, using visual and textual information. The Knowledge Based System has an easy-to-use interface to help students diagnose the disease and enhance their information about the disease; the system can be used on smart phones. This Knowledge Based System can be divided into three main parts: The first part is specific questions for the patient, to help student to know questions type. The second part is the process of analyzing the biopsy sample image, to see if the biopsy image is intact or infected. The last part is the video shows ways to treat breast cancer in the form of animation. (shrink)

Plasminogen activator inhibitor‐1 (PAI‐1) is a physiological inhibitor of urokinase (uPA), a serine protease known to promote cell migration and invasion. Intuitively, increased levels of PAI‐1 should be beneficial in downregulating uPA activity, particularly in cancer. By contrast, in vivo, increased levels of PAI‐1 are associated with a poor prognosis in breast cancer. This phenomenon is termed the “PAI‐1 paradox”. Many factors are responsible for the upregulation of PAI‐1 in the tumor microenvironment. We hypothesize that there is (...) a breast cancer predisposition to a more aggressive stage when PAI‐1 is upregulated as a consequence of Metabolic Syndrome (MetS). MetS exerts a detrimental effect on the breast tumor microenvironment that supports cancer invasion. People with MetS have an increased risk of coronary heart disease, stroke, peripheral vascular disease and hyperinsulinemia. Recently, MetS has also been identified as a risk factor for breast cancer. We hypothesize the existence of the “PAI‐1 cycle”. Sustained by MetS, adipocytokines alter PAI‐1 expression to promote angiogenesis, tumor‐cell migration and procoagulant microparticle formation from endothelial cells, which generates thrombin and further propagates PAI‐1 synthesis. All of these factors culminate in a chemotherapy‐resistant breast tumor microenvironment. The PAI‐1 cycle may partly explain the PAI‐1 paradox. In this hypothesis paper, we will discuss further how MetS upregulates PAI‐1 and how an increased level of PAI‐1 can be linked to a poor prognosis. BioEssays 29:1029–1038, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

The purpose of this study was to compare breast cancer patients' perceived partici pation in their own care with nurses' perceptions of such participation. Both groups reported that patients are able and willing to take part in their own care more actively than allowed under the present health care system. Nurses also reported that they do provide patients with opportunities for participation.

PurposeThis study aims to develop and validate a stigma scale for Chinese patients with breast cancer.MethodsPatients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale’s content validity was assessed by a Delphi (...) study and feedback from patients with breast cancer ; exploratory factor analysis was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale ; internal consistency Cronbach’s α, split-half reliability, and test–retest reliability were used to identify the reliability of the scale.ResultsThe final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale. Exploratory factor analysis revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach’s α for the total scale was 0.86, and each subscale was 0.75–0.882. The test–retest reliability with intra-class correlation coefficients of the total scale was 0.947, and split-half reliability with intra-class correlation coefficients of the total scale was 0.911. The content validity index was 0.73–1.0.ConclusionThe newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China. (shrink)

Perhaps no other medical advocacy movement has been as successful as breast cancer advocacy in increasing awareness and funds. Recent decades have seen a division between a “green” environmental advocacy aimed at prevention and a “pink” advocacy focused on fund-raising for a cure. The movement has largely failed to address the implications of corporate control over genetic testing, as reflected by the involvement of only one breast cancer organization in the lawsuit against Myriad Genetics Laboratory, which (...) held patents on the BRCA 1/2 genes. This article argues that the reason for this failure is an unwillingness to challenge the role that corporations play in advocacy. (shrink)

This paper illustrates a role that bioethics should play in developing and criticizing protocols for breast cancer genetic screening. It demonstrates how a critical bioethics, using approaches and reflecting concerns of contemporary philosophy of science and science studies, may critically interrogate the normative and conceptual schemes within which ethical considerations about such screening protocols are framed. By exploring various factors that influence the development of such protocols, including politics, cultural norms, and conceptions of disease, this paper and the (...) critical bioethics' approach it endorses illuminate and critically assess some of the competing worldviews informing protocol development. One of the frequently neglected worldviews in traditional bioethics' treatment of protocols concerning breast care is constituted by women's own views of their breasts and breast cancer, both within the technologically-oriented social practice of American medicine and in light of the social construction of their breasted experience in American society. This paper attempts to redress and critically assess this neglect on the part of traditional bioethics. Finally, in contrast to traditional bioethics, critical bioethics critically interrogates its own normative and conceptual commitments. In this final capacity, a critical bioethics' approach makes a valuable contribution to the evolution of bioethics. (shrink)

Twitter integrates with streaming data technologies and machine learning to add new value to healthcare. This paper presented a real-time system to predict breast cancer based on streaming patient’s health data from Twitter. The proposed system consists of two major components: developing an offline building model and an online prediction pipeline. For the first component, we made a correlation between the features to determine the correlation between features and reduce the number of features from the Breast (...) class='Hi'>Cancer Wisconsin Diagnostic dataset. Two feature selection algorithms are recursive feature elimination and univariate feature selection algorithms which are applied to features after correlation to select the essential features. Four decision trees, logistic regression, support vector machine, and random forest classifier have been used on features after correlation and feature selection. Also, hyperparameter tuning and cross-validation have been applied with machine learning to optimize models and enhance accuracy. Apache Spark, Apache Kafka, and Twitter Streaming API are used to develop the second component. The best model with the highest accuracy obtained from the first component predicts breast cancer in real time from tweets’ streaming. The results showed that the best model is the random forest classifier which achieved the best accuracy. (shrink)

Every year medical researchers make contact with a large number of cancer survivors with the aim of evaluating cancer treatment. For this reason we decided to investigate how Swedish cancer survivors perceived their participation in research studies focusing on the long-term consequences of being a survivor of gynaecological or urinary bladder cancer. Data were collected by means of two study-specific postal questionnaires, both consisting of questions covering physical symptoms, well-being and the experience of being (...) a cancer survivor. Both questionnaires also included questions evaluating the participants’ experience of being research subjects. The questionnaires were developed in close co-operation with cancer survivors. The study population consisted of 1068 cancer survivors. Of these, 95% (n=1003) reported that they thought the study was valuable and 54% (n=559) that they had been positively affected by participating. Four per cent (n=39) expressed that they had been negatively affected by their participation in the study. The vast majority of the cancer survivors thought that participating in their particular study was valuable. (shrink)

An ex-voto (from the Latin for ‘from the vow’) is an image made to express the patron's gratitude for divine assistance in the face of personal difficulty. Here, we describe a late 18th century Mexican painting that shows Doña Josefa Peres Maldonado undergoing a mastectomy, and, as an ex-voto, expresses her thanks for divine aid in having survived the operation. As such, the painting manifests Doña Josefa's response to her disease, drawing on both medical and religious sources of support. This (...) brief report analyses the unusual double dedication of the ex-voto, the elaborate home altar it depicts and the surgical technique it demonstrates. (shrink)

Breast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50–74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has (...) drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening. (shrink)

The three claims put forward by Dr. Roger Poisson to rationalize his enrollment of ineligible subjects in clinical trials do not justify research fraud. None the less, certain lessons for the conduct of clinical research can be learned from the affair: experimental therapies should be made available to technically ineligible subjects when no effective therapy exists for their disease; further research must investigate the possible benefits of clinical-trial participation; broadly based, pragmatic trials must be regarded as the ideal model; and (...) each eligibility criterion in a clinical-trial protocol should be justified. (shrink)

Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying non-harmful cancers is called (...) overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women’s vulnerability and undermines women’s agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability. (shrink)

Rationale Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines.Aims and objectives To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines.Methods Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment (...) of breast cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression.Results The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P < 0.001) and from 31.1% to 52.2% across these periods for stage II (P < 0.001). Adjuvant radiotherapy also became more common (P < 0.001), with 20.6% of patients receiving this treatment in 1977–1990 compared with 60.7% in 1997–2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P < 0.001), from 19.6% in 1977–1990 to 36.9% in 1997–2003, and the proportion having hormone therapy also increased (P < 0.001), from 34.3% to 59.4% between these periods.Conclusions Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based. (shrink)

BackgroundTo limit selective and incomplete publication of the results of clinical trials, registries including ClinicalTrials.gov were introduced. The ClinicalTrials.gov registry added a results database in 2008 to enable researchers to post the results of their trials as stipulated by the Food and Drug Administration Amendment Act of 2007. This study aimed to determine the direction and magnitude of any change in publication proportions of registered breast cancer trials that occurred since the inception of the ClinicalTrials.gov results database.MethodsA cross-sectional (...) study design was employed using ClinicalTrials.gov, a publicly available registry/results database as the primary data source. Registry contents under the subcategories ‘Breast Neoplasms’ and ‘Breast Neoplasms, Male’ were downloaded on 1 August 2015. A literature search for included trials was afterwards conducted using MEDLINE and DISCOVER databases to determine publication status of the registered breast cancer trials.ResultsNearly half (168/340) of the listed trials had been published, with a median time to publication of 24 months (Q1 = 14 months, Q3 = 42 months). Only 86 trials were published within 24 months of completion. There was no significant increase in publication proportions of trials that were completed before the introduction of the results database compared to those completed after (OR = 1.00, 95 % CI =.61 to 1.63; adjusted OR = 0.84, 95 % CI =.51 to 1.39). Characteristics associated with publication included trial type (observational versus interventional adjusted OR =.28, 95 % CI =.10 to.74) and completion/termination status (terminated versus completed adjusted OR =.22, 95 % CI =.09 to.51).ConclusionsLess than a half of breast cancer trials registered in ClinicalTrials.gov are published in peer-reviewed journals. (shrink)