scholarly journals Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom

PLoS Medicine ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. e1003504
Author(s):  
Helena Carreira ◽  
Rachael Williams ◽  
Garth Funston ◽  
Susannah Stanway ◽  
Krishnan Bhaskaran
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Cancer Diagnosis ◽  
Opioid Analgesics ◽  
Anxiety And Depression ◽  
Breast Cancer Survivorship ◽  
The United Kingdom ◽  
Health Related

Background Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health–related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer. Methods and findings We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health–related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health–related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29–1.36; p < 0.001), depression (1.35; 1.32–1.38; p < 0.001), sexual dysfunction (1.27; 1.17–1.38; p < 0.001), and sleep disorder (1.68; 1.63–1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97–1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25–1.31; p < 0.001), pain (1.22; 1.20–1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83–1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97–1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact. Conclusions In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5–10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.

scholarly journals Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life

2011 ◽  
Vol 130 (1) ◽  
pp. 243-254 ◽  
Author(s):  
Catherine M. Alfano ◽  
Kenneth L. Lichstein ◽  
Gregory S. Vander Wal ◽  
Ashley Wilder Smith ◽  
Bryce B. Reeve ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Sleep Duration ◽  
Cancer Survivorship ◽  
Health Related Quality ◽  
Breast Cancer Survivorship ◽  
Related Quality ◽  
Health Related

scholarly journals Transitioning to Breast Cancer Survivorship: Perspectives of Patients, Cancer Specialists, and Primary Care Providers

2009 ◽  
Vol 24 (S2) ◽  
pp. 459-466 ◽  
Author(s):  
Melinda Kantsiper ◽  
Erin L. McDonald ◽  
Gail Geller ◽  
Lillie Shockney ◽  
Claire Snyder ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Care Providers ◽  
Breast Cancer Survivorship ◽  
Cancer Specialists

Guideline-concordant surveillance and follow-up care among low-income patients with breast cancer: The role of primary care medical homes.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 171-171
Author(s):  
Stephanie B. Wheeler ◽  
Racquel Elizabeth Kohler ◽  
Ravi K. Goyal ◽  
Kristen Hassmiller Lich ◽  
Alexis Moore ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Low Income ◽  
Breast Cancer Survivors ◽  
Breast Cancer Survivorship ◽  
Medical Homes ◽  
Follow Up Care

171 Background: Community Care of North Carolina (CCNC) initiated an innovative medical home (MH) program in the 1990s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes, but has not been evaluated in the context of cancer care. We sought to determine whether MH enrollment was associated with guideline-concordant surveillance and follow-up care among breast cancer survivors. Methods: Using state cancer registry records matched to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007 and tracked their CCNC enrollment. Using published American Society for Clinical Oncology breast cancer survivorship guidelines to define our outcomes, we employed multivariate logistic regressions to examine correlates of receipt of surveillance mammogram and at least two physical exams within 15 months post-diagnosis. Results: In total, 840 women were included in our sample. Approximately half were enrolled in a CCNC MH during the study period, 38% were enrolled for more than 7 months post-diagnosis. Enrollment in a MH for at least 7 months post-diagnosis was strongly associated with receiving guideline-recommended surveillance mammogram (p<0.01) and at least 2 physical exams (p<0.01) within 15 months post-diagnosis. Conclusions: Results suggest that MH enrollment is associated with higher quality breast cancer survivorship care among women insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on primary care MH, more research is needed to explore how medical homes can enhance and ensure the provision of guideline-recommended care during cancer survivorship.

Risk of anxiety and depression in breast cancer survivors compared to women who have never had cancer: A population-based cohort study in the United Kingdom.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1564-1564
Author(s):  
Helena Carreira ◽  
Rachael Williams ◽  
Garth Funston ◽  
Susannah Jane Stanway ◽  
Krishnan Bhaskaran
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cohort Study ◽  
United Kingdom ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Population Based ◽  
Anxiety And Depression ◽  
The United Kingdom ◽  
History Of

1564 Background: Breast cancer survivors are the largest group of cancer survivors in the United Kingdom (UK). Having had a breast cancer diagnosis may adversely affect the patient’s mental health. We aimed to estimate the long-term risk of anxiety and depression in women with history of breast cancer compared to those who have never had cancer. Methods: We conducted a matched population-based cohort study, using data from the Clinical Practice Research Datalink (CPRD) GOLD primary care database. The exposed cohort included all adult women diagnosed with breast cancer between 1987 and 2018; the unexposed group included women with no cancer history, matched to exposed women in a 4:1 ratio on primary care practice and age. Cox regression models stratified on matched set were used to estimate hazard ratios of the association between breast cancer survivorship and anxiety and depression. Results: 59,972 women (mean 62 years; standard deviation (SD) 14.0) had history of breast cancer. The median follow-up time was 3.0 years (SD 4.4), which amounted to 256,186 person-years under observation. The comparison group included 240,387 women followed up over 3.5 years (SD 4.5) (1,163,819 person-years). The incidence of anxiety in breast cancer survivors was 0.08 (95% confidence interval (95%) 0.07-0.08) per 1000 person-years, and the incidence of depression was 70 (95%CI 68-71) per 1000 person-years. The risks of both depression and anxiety were raised in breast cancer survivors compared with controls, and this appeared to be driven by the first 3 years following diagnosis (Table). Conclusions: Breast cancer survivors in the UK had significantly higher risk anxiety and depression diagnosed in primary care for three years following diagnosis than women who never had cancer. Risk of anxiety and depression in breast cancer survivors compared to women who did not have cancer by time since diagnosis. [Table: see text]

scholarly journals Oncologists' perceived barriers to an expanded role for primary care in breast cancer survivorship care

2016 ◽  
Vol 5 (9) ◽  
pp. 2198-2204 ◽  
Author(s):  
Heather B. Neuman ◽  
Elizabeth A. Jacobs ◽  
Nicole M. Steffens ◽  
Nora Jacobson ◽  
Amye Tevaarwerk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Perceived Barriers ◽  
Survivorship Care ◽  
Breast Cancer Survivorship

scholarly journals American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

2016 ◽  
Vol 34 (6) ◽  
pp. 611-635 ◽  
Author(s):  
Carolyn D. Runowicz ◽  
Corinne R. Leach ◽  
N. Lynn Henry ◽  
Karen S. Henry ◽  
Heather T. Mackey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Clinical Oncology ◽  
Cancer Survivorship ◽  
Cancer Recurrence ◽  
American Cancer Society ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Cancer Society ◽  
American Society

The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.

Breast cancer survivorship: State of the science.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 45-45
Author(s):  
Kathy Pan ◽  
Rowan T. Chlebowski
Keyword(s):  
Breast Cancer ◽  
Cancer Survivorship ◽  
Randomized Trials ◽  
Randomized Study ◽  
Qualitative Studies ◽  
Breast Cancer Survivorship ◽  
Pilot Studies ◽  
Exploratory Stage ◽  
Health Related ◽  
State Of The Science

45 Background: Only in the past decade has breast cancer survivorship earned formal recognition as a research discipline. Complicating survivorship research is the overlap between aging and treatment sequelae (Pan et al., Breast Cancer Res Treat 2016). The ACS/ASCO 2015 Breast Cancer Survivorship Care Guideline and the jointly sponsored 2016 Cancer Survivorship Symposium afforded an opportunity to review the “state of the science.” Methods: All 236 citations from the Guideline and all 250 abstracts from the Symposium were reviewed independently by two authors and prospectively categorized as follows: randomized trial; non-randomized study with controls; study without controls; review; and guideline. Additional categories were generated during the review process. Results: The Guideline most commonly cited reviews (n = 88, 37%), followed by 51 (22%) non-randomized, non-controlled studies and 37 (16%) randomized trials, which mostly addressed interventions for therapy sequelae such as lymphedema. Symposium abstracts most commonly described non-randomized, non-controlled studies (n = 113, 45%). Among 13 randomized trials (5%), 3 had not completed accrual; sample sizes were 60-467. 42 (17%) abstracts were identified as pilot studies and 17 (7%) as qualitative studies. 65 (26%) exclusively addressed breast cancer. Abstracts mostly covered health-related or psychosocial sequelae of therapy; however, some addressed overall survival or active cancer therapy. Conclusions: Much of the survivorship literature remains in the exploratory stage, consisting of non-controlled, pilot and qualitative studies. To optimally address survivorship issues, increasing incorporation of cancer-free, age-matched control populations is needed. [Table: see text]

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