Psychosocial outcomes following surgery in women with unilateral, nonhereditary breast cancer.

570 Background: Rates of bilateral mastectomy continue to rise in average-risk women with unilateral breast cancer. We aim to characterize psychosocial predictors of surgical procedure and how psychosocial outcomes change over time after surgery for breast cancer. Methods: A prospective cohort of women with unilateral, nonhereditary breast cancer were recruited at University Health Network in Toronto, Canada between 2014-2017. Women completed validated psychosocial questionnaires (BREAST-Q) pre-operatively, and 6 and 12 months after surgery. Outcomes were assessed between three surgical groups (unilateral lumpectomy, unilateral mastectomy, bilateral mastectomy). Predictors of surgical procedure were identified using a multinomial logistic regression model. Change in psychosocial scores over time according to procedure was assessed using linear mixed models. All models control for age, stage, reconstruction and treatment. P values < .05 were considered statistically significant. Results: 506 women underwent surgery as follows: 216 unilateral lumpectomy (43%), 181 unilateral mastectomy (36%) and 109 bilateral mastectomy (22%). In the multinomial regression model, younger age (p < .01), and lower chest physical (p = .03) and sexual well-being (p = .02) predicted having bilateral mastectomy over unilateral lumpectomy while younger age (p < .01) and lower disease stage (p = .02) predicted bilateral mastectomy over unilateral mastectomy. The mixed model demonstrates that breast satisfaction follows a non-linear pattern of change over time, with 6- but not 12-month scores being significantly different from baseline (p = .015). Procedure predicts baseline satisfaction (p = .016), with bilateral mastectomy having worse satisfaction than unilateral lumpectomy. Procedure also predicts change in satisfaction, with unilateral and bilateral mastectomy having lower scores across time than lumpectomy. While a significant improvement in psychological well-being is detected by 12 months (p = .02), those with unilateral and bilateral mastectomy have worse psychological well-being over time compared to lumpectomy. Women having mastectomy start with worse physical well-being than those in the lumpectomy group, but their physical well-being does not decline as much as the lumpectomy group over time (p < .01). Conclusions: Definitive surgical procedure affects the trajectory of psychosocial functioning over time. This emerging data may be used to further facilitate surgical decision-making in women considering contralateral prophylactic mastectomy.

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Impact of patient, tumour and treatment factors on psychosocial outcomes in invasive breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.568 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 568-568

Author(s):

David W Lim ◽

Helene Retrouvey ◽

Isabel Kerrebijn ◽

Kate Butler ◽

Anne C. O'Neill ◽

...

Keyword(s):

Breast Cancer ◽

Surgical Procedure ◽

Psychosocial Outcomes ◽

Well Being ◽

Stage I ◽

Bilateral Mastectomy ◽

Pathologic Stage ◽

Modifiable Factors ◽

The Impact ◽

Over Time

568 Background: In breast cancer, clinicians aim to improve survival while patients value quality of life. We aim to delineate the impact of patient, tumour and treatment factors on psychosocial outcomes after treatment. Methods: A prospective cohort of women with unilateral stage I-III breast cancer were recruited at University Health Network in Toronto, Canada between 2014-2017. Validated questionnaires (BREAST-Q, Impact of Event, Hospital Anxiety & Depression Scales) were completed pre-operatively, and 6 and 12 months after surgery. Change in psychosocial scores over time by surgical procedure was assessed using linear mixed models, controlling for age, pathologic stage, hormone (HR) and HER2 receptor, and treatments. Predictors of psychosocial outcomes at 12 months were assessed using multivariable linear regression models. P values <.05 were significant. Results: 413 women underwent unilateral lumpectomy (48%), unilateral mastectomy (36%) and bilateral mastectomy (16%). Pathologic stage were: 18 ypT0/Tis (4%), 201 stage I (49%), 136 stage II (33%) and 58 stage III (14%). Receptor profiles were as follows: 277 HR+/HER2- (68%), 59 HR+/HER2+ (14%), 31 HR-/HER2+ (8%) and 39 HR-/HER2- (10%). Over time, women having unilateral lumpectomy had the highest scores of breast satisfaction ( P<.01), psychosocial ( P<.01) and sexual ( P<.01) well-being, with no difference between unilateral versus bilateral mastectomy groups. Age was inversely related with distress ( P <.01), psychosocial ( P <.01) and physical ( P =.001) well-being. Radiotherapy was associated with worse breast satisfaction (-8.1, P<.01), psychosocial (-6.9, P<.01) and physical (-5.8, P<.01) well-being, while chemotherapy was associated with worse sexual well-being (-5.5, P=.04). Endocrine therapy was associated with worse distress (6.7, P <.01), physical (-5.2, P <.01) and sexual (-6.4, P =.03) well-being. Women with a pathologic complete response had less anxiety compared to stage I (-2.0, P=.03). Women with triple-negative disease had worse breast satisfaction (-8.0, P=.03), distress (8.0, P =.01), anxiety (2.4, P <.01) and psychosocial (-7.5, P =.047) well-being than HR+/HER2- disease. In our regression model at 12 months, surgical procedure was a significant predictor of breast satisfaction ( P <.01), psychosocial ( P<.01), physical ( P<.01) and sexual ( P<.01) well-being. HER2 positivity predicted worse satisfaction ( P=.045), psychosocial ( P =.047), physical ( P =.02) and sexual ( P =.01) well-being. Income level ( P=.01) predicted breast satisfaction and physical well-being. Ethnicity (P <.01) and education level (P =.04) predicted distress scores. Conclusions: Psychosocial functioning after breast cancer is influenced by an interplay between patient, tumour and treatment factors. Delineating these influences identifies potentially modifiable factors with de-escalation therapy and enhancing psychosocial support.

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Decision regret following treatment for localized breast cancer: Is regret stable over time?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.19 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 19-19

Author(s):

Kathryn Anne Martinez ◽

Ken Resnicow ◽

Sarah T. Hawley

Keyword(s):

Breast Cancer ◽

Los Angeles ◽

Breast Conserving Surgery ◽

Invasive Disease ◽

Bilateral Mastectomy ◽

Decision Regret ◽

Disease Trajectory ◽

Item Responses ◽

Unilateral Mastectomy ◽

Over Time

19 Background: While studies suggest most women have little regret with their breast cancer treatment decisions, few (or no) studies have evaluated whether regret changes over time. Methods: Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan, or Los Angeles County Surveillance Epidemiology and End Results (SEER) registry completed surveys at 9 months post diagnosis (time 1) and again approximately 4 years later (time 2). A decision regret scale (Brehaut, 2003) consisting of 5 items was completed at both time points. Item responses were summed to create a regret score at both 9 months and 4 years (scales of 5 to 25 points, with 25 being most regret). We used multivariable linear regression to examine change in regret from 9 months to 4 years. Independent variables included surgery type (breast conserving surgery, unilateral mastectomy, bilateral mastectomy), presence of invasive disease (yes/no), and recurrence status (yes/no) at follow-up. We included an interaction between surgery type and recurrence status. The model controlled for demographic and clinical factors. Results: The sample included 1,497 women. Mean decision regret at 9 months was 9.5 points and 10.1 points at 4 years (range 5-25) (NS). Two-thirds (64%) of respondents had breast conserving surgery, 26% had unilateral mastectomy, and 9% had bilateral mastectomy. We found no impact of surgery type on change in regret in the overall sample. However, among the, 86 (6%) women who recurred, those who underwent unilateral mastectomy reported significant reduction in decision regret over time relative to recurrent women who had breast conserving surgery (d= -6.76, p=0.024). Average change in regret among non-recurrent women was 0.52 points and was 2.7 points for women who recurred. Conclusions: Decision regret in breast cancer is generally stable over time, yet changes in regret appear to be associated with disease trajectory and treatment received. Our results suggest that more extensive treatment is associated with a reduction in regret only when women experience a recurrence. Understanding patients’ assessment of their decisions related to treatment may be useful for informing future decision making processes.

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Changes in Media Credibility when a Predicted Disaster Doesn't Happen

Journalism & Mass Communication Quarterly ◽

10.1177/107769909707400409 ◽

1997 ◽

Vol 74 (4) ◽

pp. 797-813 ◽

Cited By ~ 15

Author(s):

Ann M. Major ◽

L. Erwin Atwood

Keyword(s):

Real Time ◽

Earthquake Prediction ◽

News Media ◽

Well Being ◽

The Body ◽

Adaptation Theory ◽

Change Over Time ◽

Public Response ◽

Media Credibility ◽

Over Time

This study examines public response to and perceived believability of information disseminated in the news media about a real-time earthquake prediction, and extends the body of media credibility research by examining these responses within the context of Taylor's (1983) cognitive adaptation theory. The theory focuses on people's illusions of well-being that under certain circumstances of threat can lead to adaptive behaviors and provides insights into why some people increased their assessments of message credibility while others lowered their evaluations; still others made no change over time in their assessments of message believability.

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What are the unmet supportive care needs among Hong Kong Chinese women with advanced breast cancer? : do they change over time?

10.5353/th_b4852181 ◽

2012 ◽

Author(s):

Ho-yee, Angel Au

Keyword(s):

Breast Cancer ◽

Hong Kong ◽

Supportive Care ◽

Advanced Breast Cancer ◽

Chinese Women ◽

Supportive Care Needs ◽

Hong Kong Chinese ◽

Care Needs ◽

Change Over Time ◽

Over Time

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Symptom Clusters Change Over Time in Women Receiving Adjuvant Chemotherapy for Breast Cancer

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2016.12.332 ◽

2017 ◽

Vol 53 (5) ◽

pp. 880-886 ◽

Cited By ~ 13

Author(s):

Randa M. Albusoul ◽

Ann M. Berger ◽

Caryl L. Gay ◽

Susan L. Janson ◽

Kathryn A. Lee

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Symptom Clusters ◽

Change Over Time ◽

Over Time

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Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution

The American Surgeon ◽

10.1177/000313481608200316 ◽

2016 ◽

Vol 82 (3) ◽

pp. 227-235 ◽

Cited By ~ 5

Author(s):

Katherine A. Rodby ◽

Emilie Robinson ◽

Kirstie K. Danielson ◽

Karina P. Quinn ◽

Anuja K. Antony

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Academic Institution ◽

Bilateral Mastectomy ◽

Autologous Reconstruction ◽

Age Related ◽

Younger Age ◽

Age Dependent ◽

Statistical Trends ◽

Oncologic Treatment

Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts <40 and ≥40 as well cohorts by decade (20s, 30s, 40s, 50s, and 60s). Statistical trends were reported as odds of risk per year of increasing age using logistic regression; linear regression, χ2, and Fischer's exact were used to compare <40 and ≥40 and split cohorts for comparison. Comorbidities, tumor staging, oncologic treatment including chemotherapy and radiation, disease characteristics and genetics, and mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends ( P < 0.005). Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications ( P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.

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Promoting Adolescent Girls’ Well-Being in Pakistan: a Mixed-Methods Study of Change Over Time, Feasibility, and Acceptability, of the COMPASS Program

Prevention Science ◽

10.1007/s11121-018-0890-9 ◽

2018 ◽

Vol 19 (8) ◽

pp. 1030-1042 ◽

Cited By ~ 2

Author(s):

Khudejha Asghar ◽

Yana Mayevskaya ◽

Marni Sommer ◽

Ayesha Razzaque ◽

Betsy Laird ◽

...

Keyword(s):

Mixed Methods ◽

Adolescent Girls ◽

Well Being ◽

Mixed Methods Study ◽

Change Over Time ◽

Over Time

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Minimally Important Differences for Interpreting EORTC QLQ-C30 Scores in Patients With Advanced Breast Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz037 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 9

Author(s):

Jammbe Z Musoro ◽

Corneel Coens ◽

Frederic Fiteni ◽

Pogoda Katarzyna ◽

Fatima Cardoso ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Weighted Average ◽

Advanced Breast ◽

Life Questionnaire ◽

Change Over Time ◽

Eortc Qlq C30 ◽

Group Change ◽

Eortc Qlq ◽

Over Time

Abstract Background We aimed to estimate the minimally important difference (MID) for interpreting group-level change over time, both within a group and between groups, for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) scores in patients with advanced breast cancer. Methods Data were derived from two published EORTC trials. Clinical anchors (eg, performance status [PS]) were selected using correlation strength and clinical plausibility of their association with a particular QLQ-C30 scale. Three change status groups were formed: deteriorated by one anchor category, improved by one anchor category, and no change. Patients with greater anchor changes were excluded. The mean change method was used to estimate MIDs for within-group change, and linear regression was used to estimate MIDs for between-group differences in change over time. For a given QLQ-C30 scale, MID estimates from multiple anchors were triangulated to a single value via a correlation-based weighted average. Results MIDs varied by QLQ-C30 scale, direction (improvement vs deterioration), and anchor. MIDs for within-group change ranged from 5 to 14 points (improvement) and −14 to −4 points (deterioration), and MIDs for between-group change over time ranged from 4 to 11 points and from −18 to −4 points. Correlation-weighted MIDs for most QLQ-C30 scales ranged from 4 to 10 points in absolute values. Conclusions Our findings aid interpretation of changes in EORTC QLQ-C30 scores over time, both within and between groups, and for performing more accurate sample size calculations for clinical trials in advanced breast cancer.

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Utility of Two PANSS 5-Factor Models for Assessing Psychosocial Outcomes in Clinical Programs for Persons with Schizophrenia

Schizophrenia Research and Treatment ◽

10.1155/2013/705631 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Jeanette M. Jerrell ◽

Stephanie Hrisko

Keyword(s):

Medication Adherence ◽

Psychosocial Functioning ◽

Goodness Of Fit ◽

Negative Symptoms ◽

Controlled Trial ◽

Psychosocial Outcomes ◽

Factor Models ◽

Regression Equations ◽

Change Over Time ◽

Over Time

Using symptom factors derived from two models of the Positive and Negative Syndrome Scale (PANSS) as covariates, change over time in consumer psychosocial functioning, medication adherence/compliance, and treatment satisfaction outcomes are compared based on a randomized, controlled trial assessing the effectiveness of antipsychotic medications for 108 individuals diagnosed with schizophrenia. Random effects regression analysis was used to determine the relative performance of these two 5-factor models as covariates in estimating change over time and the goodness of fit of the regression equations for each outcome. Self-reported psychosocial functioning was significantly associated with the relief of positive and negative syndromes, whereas patient satisfaction was more closely and significantly associated with control of excited/activation symptoms. Interviewer-rated psychosocial functioning was significantly associated with relief of positive and negative symptoms, as well as excited/activation and disoriented/autistic preoccupation symptoms. The VDG 5-factor model of the PANSS represents the best “goodness of fit” model for assessing symptom-related change associated with improved psychosocial outcomes and functional recovery. Five-factor models of the syndromes of schizophrenia, as assessed using the PANSS, are differentially valuable in determining the predictors of psychosocial and satisfaction changes over time, but not of improved medication adherence/compliance.

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