Management of genitourinary syndrome of menopause in breast cancer survivors:An update

There is increasing attention about managing the adverse effects of adjuvant therapy(Chemotherapy and anti-estrogen treatment)for breast cancer survivors(BCSs).Vulvovaginal atrophy(VVA),caused by decreased levels of circulating estrogen to urogenital receptors,is commonly experienced by this patients.Women receiving antiestrogen therapy,specifically aromatase inhibitors,often suffer from vaginal dryness,itching,irritation,dyspareunia,and dysuria,collectively known as genitourinary syndrome of menopause(GSM),that it can in turn lead to pain,discomfort,impairment of sexual function and negatively impact on multiple domains of quality of life(QoL).The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly.The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures,introitus,and vaginal mucosa.Systemic estrogen treatment is contraindicated in BCSs.In these patients,GSM may be prevented,reduced and managed in most cases but this requires early recognition and appropriate treatment,but it is normally undertreated by oncologists because of fear of cancer recurrence,specifically when considering treatment with vaginal estrogen therapy(VET)because of unknown levels of systemic absorption of estradiol.Lifestyle modifications and nonhormonal treatments(vaginal moisturizers,lubricants,and gels)are the first-line treatment for GSM both in healthy women as BCSs,but when these are not effective for symptom relief,other options can be considered,such as VET,ospemifene,local androgens,intravaginal dehydroepiandrosterone(prasterone),or laser therapy(erbium or CO2 Laser).The present data suggest that these therapies are effective for VVA in BCSs;however,safety remains controversial and a there is a major concern with all of these treatments.We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research.We include recommendations for an approach to the management of GSM in women at high risk for breast cancer,women with estrogen-receptor positive breast cancers,women with triplenegative breast cancers,and women with metastatic disease.

The relationship between psychological distress with salivary <i>α</i>-amylase and stress related symptoms among breast cancer survivors

Background and Aims: This study examined the stress levels, the stressors and biomarker such as Alpha (α)-Amylase enzyme which is secreted under distress conditions. The aim was to determine the relationship between these three variables. Methods: The study respondents were made up of cancer outpatients from 3 hospitals namely the Hospital Kuala Lumpur, Seberang Jaya and Johor Baru, Pantai Ipoh and Putrajaya. The Personal Stress Inventory (PSI) questionnaire was used to identify stressors, while the Hospital Anxiety and Depression Scale (HADS) were used to determine the psychological distress levels. The Salimentary Oral Swab (SOS) Technique was used to collect the saliva and then the Salivary α-Amylase Assay Kit was used to analyse for α amylase. Results: The majority of respondents were stressed due to their sensitive emotion and nervousness in their daily lives (68.7%), they had poor memory and short attention spans of carrying out job tasks (67.3%) as well as they were emotionally depressed (65.3%). Their poor memory and short attention span (p = 0.037), heavy work load and poor task delivery (p = 0.008) were predictors for distress using HADS. The salivary α-amylase concentration was significantly related to the stress levels (p = 0.002). Conclusion: Breast cancer respondents with musculoskeletal system related symptoms, with heavy work load and poor task delivery, as well as had poor memory and short attention span were at higher risk of experiencing psychological distress. The salivary α-amylase which had significant relationships with psychological distress was therefore, a potential biological indicator for distress, while the musculoskeletal system related symptoms from the PSI questionnaire were predictors for distress.

The Relationship between Workplace Stressors and Job Strain with Psychological Distress among Employed Malaysian Breast Cancer Survivors

Evidence showed occupational factors may contribute distress to breast cancer survivors, however, very few studies focused on the occupational factors and job strain among breast cancer survivors. This study examined the relationship between job strain and workplace stressors with psychological distress among employed breast cancer survivors after the completion of their medical treatment. Study subject were outpatients of 2 hospitals and members of 4 breast cancer support groups. They were requested to fill up the Job Content Questionnaires (JCQ), the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) were filled up by the selected respondents. On simple logistic regression, psychological job demand and job strain were significantly associated with anxiety, distress on HADS-T and DT at (p < 0.001). While, psychological job demand (p < 0.001), social support (p = 0.047) and job strain (p < 0.001) were significantly associated with depression. Results showed survivors with high job strain has 4.74 time the odds of having anxiety (p < 0.001). Survivors with high psychological job demand have 8.08 time the odds of getting depression (p < 0.001). On the other hand, social support served as a protective factor of depression, (p = 0.041). Survivors with high psychological job demand were 4.4 time the odds of having distress (HADS-T) (p = 0.012). As a conclusion, survivors who experienced high psychological job demand, low social support and high job strain were reported with anxiety, depression or psychological distress.

Health Management of Breast Cancer Survivors

Breast cancer is defined as a chronic disease.Increasing amounts of attention have been paid to the healthmanagement of breast cancer survivors. An important issue ishow to find the most appropriate method of follow-up in orderto detect long-term complications of treatment, local recurrenceand distant metastasis and to administer appropriate treatmentto the survivors with recurrence in a timely fashion. Differentoncology organizations have published guidelines for followingup breast cancer survivors. However, there are few articles onthis issue in China. Using the published follow-up guidelines,we analyzed their main limitations and discussed the content,follow-up interval and economic benefits of following up breastcancer survivors in an effort to provide suggestions to physicians.Based on a large number of clinical trials, we discussed the roleof physical examination, mammography, liver echograph, chestradiography, bone scan and so on. We evaluated the effects ofthe above factors on detection of distant disease, survival time,improvement in quality of life and time to diagnosis of recurrence.The results of follow-up carried out by oncologists and primaryhealth care physicians were compared. We also analyzed thecorrelation factors for the cost of such follow-up. It appears thatfollow-up for breast cancer survivors can be carried out effectivelyby trained primary health care physicians. If anything unusualarises, the patients should be transferred to specialists.

A review of home-based physical activity interventions for breast cancer survivors

As breast cancer relative survival continues to increase, many breast cancer patients face many issues, including recurrence of cancer and cancer-related side effects that impact several aspects of their quality of life. With breast cancer patients living longer, there is more of a concern for negative breast cancer outcomes. Although physical activity is an affordable and relatively convenient way to improve breast cancer outcomes, only about one-third of breast cancer survivors engage in the recommended level of physical activity. This article reviews articles published to date to examine whether home-based physical activity interventions are effective in improving physical activity and other outcomes among breast cancer survivors who have completed primary therapy for the disease. The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1980 through February 28, 2019 were identified. A total of 360 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 20 studies that met the eligibility criteria. Three of the studies were pre-/post-test trials and 17 were randomized controlled trials. Home-based exercise programs are effective in improving physical activity among breast cancer survivors who have completed primary therapy for the disease. Home-based exercise programs such as walking programs offer a convenient and affordable option for women who wish to increase their physical activity and maintain a healthy lifestyle.

Breast Cancer Survivor’s Views on Duration of Follow Up

Background: Breast cancer is one of the commonest cancers in women in the UK and western countries [1]. Follow ups after breast cancer diagnosis is usual practice, but there is no agreed consensus among breast care providers on frequency or duration of follow up after diagnosis and adjuvant treatment. The aim of this study is to find out women’s views on the period of the clinical follow up after breast cancer diagnosis. Method: This was a surveillance study in Greenock and Glasgow in the UK (Between September 2009 and December 2010). The study group comprised of 446 Women, 246 with the history of breast cancer diagnosed 1 - 10 years, (median 4.2 years) were asked to complete a questionnaire about their views of preferred duration of follow up while they were waiting for the annual review at a breast clinic, the same questionnaire was completed by 200 women with no history of breast cancer. Results: Between September 2009 and December 2010, 246 patients were included in the study. 40% of patients were within the first three years of follow up, 27% between the 4th and 6th year and 33% were in follow-up for more than 6 years. 63% of cancer survivors think that, 10 years of follow up is necessary for reassurance, detection and treatment of any new, recurrent or spread of their breast cancer. 14% and 22% of women with a history of breast cancer preferred 3 and 5 years review by trained Radiologist/GP respectively. Women without a history of breast cancer were different in their thoughts about follow up after breast cancer: 10%, 25%, and 30% chosen 10, 5 and 3 years, 35% preferred don’t know the answer. Conclusion: Follow up programs for breast cancer survivors need to be organized, evidence based, flexible and patient tailored. Patients’ views should be taken into account when considering provision of follow-up care for breast cancer patients.

The Role of Work in Breast Cancer Patients

Background: Since the survival rates of cancer have increased considerably, the long-term side effects of cancer and cancer-related treatments may impact survivors’ capability to regain normal lives. The aim of this study was to evaluate the effects of the breast cancer on the job satisfaction and the quality of life. Methods: We enrolled 130 women divided into four groups: 1) 40 breast cancer survivors (aged 39 - 50);2) 44 women diagnosed with breast cancer (aged 35 - 49);3) 46 women in good health status (aged 37 - 48). Job satisfaction was measured with the Warr-Cook-Wall (WCW) Job satisfaction scale that measures overall job satisfaction and satisfaction with nine aspects of work. Results: Compared to healthy subjects, breast cancer survivors reported a poorer number of hours of work (p < 0.05) and a significant amount of variety in job (p < 0.01), opportunity to use abilities (p < 0.001), income (p < 0.01). Compared to patients with breast cancer at diagnosis, breast cancer survivors reported a significant amount of variety in job (p < 0.05), opportunity to use abilities (p < 0.05), amount of responsibility (p < 0.05), income (p < 0.05). In our study, the comparison between breast cancer survivors, breast cancer at diagnosis, and healthy subjects does not differ significantly in overall job satisfaction. Conclusions: Understanding the job problems associated with cancer can provide relevant information regarding potential treatment and psychological support in breast cancer survivors.

Promestriene Affects <i>GREB</i>1 Expression in Estrogen Sensitive Breast Cancer Cells

Promestriene (3-propyl ethyl, 17B-methyl estradiol) is a synthetic estrogen analogue with reported minimal systemic absorption which has been suggested for topical treatment of vaginal atrophy. Promestriene’s ability to stimulate proliferation and estrogen responsive gene expression was analyzed in estrogen receptor (ER+) positive breast cancer cell lines MCF-7, T-47D, and BT-474 using CFSE flow cytometric analysis, and quantitative RT-PCR analysis of GREB1 RNA expression, an estrogen responsive gene involved in estrogen receptor alpha expression. In estrogen replete conditions, Promestriene did not stimulate proliferation even at high concentrations (100,000 pg/ml). However, anti-estradiol depletion allowed low dose Promestriene (2 - 10 pg/ml) to stimulate GREB1 expression in all three cell lines at levels equal to that induced by estradiol (BT-474) or significantly higher than estradiol (MCF7 and T-47D). These findings suggest that Promestriene has the potential to support estrogen like cell signaling, a possible contraindication for use in treatment of vaginal atrophy associated with breast cancer aromatase inhibitor therapy.

Chinese Medicine Approach in Clinical Practice for Breast Cancer Survivors

A Chinese medicine （CM） approach, designed based on the clinical experiences of the West Los Angeles Center for Traditional Chinese Medicine, is a practical path for assessing and treating breast cancer survivors. The approach consists of balancing the body with deciphering the cause of the patient＇s chief complaints by assessing and recognizing the six physiological dysfunctions that include gastrointestinal problems, sleeps problems, emotional imbalance, low body energy, menstrual change and pain. Multifaceted interventions are used for eliminating various CM pathologies based on identifying the basic CM patterns （syndromes） differentiation. Watching to assess the above two situations dynamically is used for outcome evaluation and predicting prognosis. Therefore this approach is called BMW. It can serve as a reference for CM clinical practice and integrative clinical care. It also can be used to simplify the clinical interpretation of CM and provide an easier way for CM doctors to communicate with Western medical doctors and patients. Additionally, it can be used as a guide for patients to assess their own symptoms for self-monitoring and self-care.

乳腺癌幸存者睡眠障碍非药物预防及管理最佳证据总结

目的筛选、提取并归纳乳腺癌幸存者睡眠障碍非药物预防及管理的相关最佳证据,为乳腺癌幸存者进行睡眠管理提供相关实践依据。方法采用PIPOST模式构建循证问题。根据循证检索资源的“6S”模型,使用计算机对PubMed、BMJ Best Practice、JBI循证卫生保健中心、NICE、Web of Science、美国临床肿瘤学会(ASCO)、中国知网、万方等数据库进行文献检索,检索内容包括临床指南、专家共识、系统评价、随机对照试验、临床决策以及证据总结等。结果共计纳入文献13篇,其中包含临床指南2篇,专家共识2篇,系统评价3篇,随机对照试验6篇。最终从睡眠障碍筛查与评估、体育活动建议、正念训练治疗、认知行为干预、中医治疗以及睡眠卫生健康教育等6个维度总结了27条最佳证据。结论本研究总结的27条最佳证据能为乳腺癌幸存者进行睡眠管理提供实践依据,将证据与临床实际相结合有助于制定系统化、全面化、个体化的睡眠管理方案。

太极拳与广场舞运动对乳腺癌术后患者负性情绪、癌因性疲乏和生活质量影响的比较研究

探究广场舞和太极拳运动对中老年乳腺癌患者术后负性情绪、癌因性疲乏和生活质量的影响。选取某医学院第一附属医院、第二附属医院甲乳外科和肿瘤科2021年1月—2022年1月收治的符合纳入标准的143名乳腺癌术后患者,随机分为对照组(48人),广场舞干预组(50人),太极拳干预组(45人)。采用焦虑·抑郁自评量表、癌因疲乏量表、生活质量量表对3组患者进行测评分析。得到以下结果:①术后3组患者均有焦虑、抑郁的负性情绪。太极拳组和广场舞组明显优于对照组(p<0.05);太极拳组和广场舞组之间无明显差异(p>0.05)。②在癌因性疲乏各个领域维度上,太极拳和广场舞运动干预明显优于传统康复锻炼组(p<0.05),但在情感疲乏维度,广场舞干预组和对照组没有明显差异(p>0.05);太极拳运动组和广场舞运动组相比无明显差异。③3个月时,除社会领域和环境领域3组无明显差异外,其他数据指标均有明显差异;6个月后,广场舞和太极拳运动组均优于对照组(p<0.05),太极拳组得分优于广场舞组,但差异不明显。结论为:①太极拳或广场舞运动干预均能改善乳腺癌患者术后焦虑抑郁情况,减轻患者疲乏程度、提高患者生活质量,且康复效果明显优于传统术后康复锻炼。太极拳运动在改善乳腺癌患者负性情绪和癌因疲乏方面与广场舞运动相比没有明显差异,但在生活质量改善方面略优于广场舞组。②太极拳和广场舞运动强度合适,康复效果较好,且两者均具有广泛的群众基础,为乳腺癌患者回归社会提供很好的锻炼和交流平台,值得进一步推广。

乳腺癌幸存者未满足需求的研究进展

乳腺癌幸存者存在多方面的未满足需求,给其心理健康和生活质量等带来不良影响。文章对乳腺癌幸存者未满足需求的现状、测评工具、影响因素和干预策略等进行了综述,以期为制定针对性的干预措施提供参考。

健康教练技术在超重乳腺癌幸存者管理中应用的研究进展

对健康教练技术的研究进展以及其对超重乳腺癌幸存者管理的启示进行综述,阐述了健康教练技术的概念、基本步骤、优势特征以及实施干预模式(包括实施人员、干预方式、效果评价3个方面)。思考对我国超重乳腺癌幸存者管理的影响与启示,并展望我国健康教练技术的应用前景,以求更好地应用于临床,为癌症病人带来福祉。

乳腺癌幸存者症状负担的研究进展

对乳腺癌幸存者症状负担概念、测评工具、症状负担现状及影响因素等方面进行综述,以期为我国医务人员对乳腺癌幸存者的症状负担进行针对性评估及管理提供参考。

亚洲及亚裔乳腺癌生存者重返工作现状及其影响因素的范围综述

目的对亚洲及亚裔乳腺癌生存者(breast cancer survivors,BCSs)重返工作相关研究进行范围综述,分析研究现状及影响因素,为未来职业康复提供理论支持。方法采用范围综述法,系统检索并筛选PubMed、Embase、中国知网、万方等中英文数据库,检索时限为2012年1月1日至2023年3月1日,并采用主题分析法对文献数据进行归类和分析。结果最终纳入16篇文献,总结出6个影响BCSs重返工作状态的主题,分别是:社会人口学、工作、疾病-治疗、心理、社会支持、生活行为方式。结论相较于西方国家,亚洲及亚裔BCSs重返工作现况不容乐观,整体水平较低。未来可进一步探索影响BCSs重返工作状态的争议因素,并开发和开展基于该群体文化敏感性的测量工具和职业康复干预研究,以改善BCSs重返工作状态,实现其全面康复。

基于卡诺模型的社区乳腺癌患者健康服务需求分析

目的为乳腺癌患者提供满意的医疗服务,可有效减轻患者的负担和医疗资源压力。本研究的目的是利用卡诺模型探讨社区乳腺癌患者的健康服务需求。方法2023年1月—3月对某三级肿瘤医院出院的乳腺癌患者进行横断面调查。患者填写了基于卡诺模型自行设计的健康服务需求调查问卷,同时也提供了社会人口学信息。调查问卷中包括30项健康服务内容,基于卡诺模型对这些项目的属性进行分类和优先级排序。结果共回收有效问卷296份。对30项医疗服务的需求属性进行评价的结果显示,30项服务中有1项被归类为“必备型属性”(身体形象管理),13项被归类为“期望型属性”(侧重于医疗保障支持、健康管理和健康咨询),3项被归类为“魅力型属性”(侧重于沟通需求和远程保健服务),11项被归类为“无差异型属性”(主要集中在社会心理服务领域)。结论社区乳腺癌患者对不同健康服务项目的需求程度不同。医务工作者应根据患者需求确定有效的健康服务策略,优先提供必备型和期望型属性的服务,努力提供魅力型属性服务,以提高社区乳腺癌患者的生活质量。

乳腺癌长期幸存者生活质量的影响因素分析

目的通过分析乳腺癌长期幸存者生活质量状况,探讨影响乳腺癌长期幸存者生活质量的相关因素。以期为乳腺癌长期幸存者生活质量的提高,提供参考依据。方法结合美国癌症协会对癌症长期幸存者的定义,乳腺癌长期幸存者为自诊断以来,生存期≥5年的乳腺癌个体。以山西医科大学第一医院2017年1~12月诊断为乳腺癌的202例乳腺癌患者为研究对象。采用欧洲癌症研究与治疗组织生活质量核心调查表(EORTC QLQ-C30)对202例乳腺癌长期幸存者进行调查,调查时间2023年1~4月。通过SPSS 26.0软件对数据结果进行分析。结果202例乳腺癌长期幸存者的整体生活质量得分为65.88分;EORTC QLQ-C30功能量表中,认知功能得分最低;症状量表中,经济困难得分最高。多重线性回归分析显示乳腺癌长期幸存者的生活质量与体重指数、居住地、居住方式、工作状态、家庭月收入、付费方式、费用影响、临床分期以及手术方式呈显著相关。结论乳腺癌患者5年存活率较高,生活质量高低对评价乳腺癌患者预后尤为重要。可通过控制患者体重指数,改善居住环境,重视早期诊治,选择合适的治疗方案,调整工作状态,提高其工作的可持续性,以改善乳腺癌患者的长期生活质量。

乳腺癌幸存者久坐行为研究进展

对乳腺癌幸存者久坐行为的现状、影响因素及干预措施进行综述,以期为我国开展乳腺癌相关研究提供参考。

乳腺癌幸存者重返工作岗位的相关研究进展

对国内外乳腺癌病人重返工作岗位的影响因素、干预性研究现状以及相关模型的建立进行综述,旨在为开展乳腺癌幸存者重返工作岗位制订有效可行的干预措施提供参考。

社会关系质量在乳腺癌幸存者病耻感与社交回避及苦恼间的中介效应

目的探讨乳腺癌幸存者社会关系质量在病耻感与社交回避及苦恼间的中介效应。方法采用便利抽样法,选取于2019年5—9月在山东第一医科大学附属肿瘤医院、山东中医药大学附属医院乳腺外科门诊及病房复诊的228例乳腺癌幸存者作为研究对象,采用一般情况调查表、社会影响量表、社会关系质量量表和社交回避及苦恼量表对其进行调查,采用结构方程模型检验社会关系质量在病耻感与社交回避及苦恼间的中介效应。结果乳腺癌幸存者病耻感、社会关系质量、社交回避及苦恼总分分别为(56.63±9.68)分、(50.53±6.08)分、(9.39±6.63)分;社会关系质量与病耻感、社交回避及苦恼总分均呈负相关(r=-0.463,-0.552;P<0.01),病耻感与社交回避及苦恼总分呈正相关(r=0.532,P<0.01);结构方程模型结果显示,病耻感对社交回避及苦恼有直接(正向)效应(β=0.421,P<0.01),社会关系质量对社交回避及苦恼有直接(负向)效应(β=-0.404,P<0.01),社会关系质量在病耻感与社交回避及苦恼之间起部分中介效应(β=0.211,P<0.01)。结论乳腺癌幸存者社交回避及苦恼处于中等水平,社会关系质量在病耻感与社交回避及苦恼间起部分中介效应。建议在改善乳腺癌幸存者社交状况的干预工作中应重视社会关系质量的影响,以增强该人群的社会关系质量为依托,减轻病耻感,促进其社会交往。