Breast Cancer Survivor Experience Of Rehabilitation Services In South Africa: Towards A Cancer Survivorship Plan

Purpose Integrated rehabilitation health care pathway are implemented to meet both physical and clinical needs of breast cancer survivors as they transition from treatment to survivorship. The aim of this study was to assess the current South African upper limb rehabilitation service, provision, and perspectives of these from the health professionals and the end users breast cancer survivor with upper limb disorder. Methods A sequential mixed-methods design informed this study. Service provision was evaluated via an online survey questionnaire completed by health practitioners working in public and private breast cancer units. Focus groups were conducted with both public health practitioners providing the services and breast cancer survivors accessing the services. Results This study has revealed a dearth of rehabilitation services for breast cancer survivors in the public health sector of South Africa. Data reveal an overstretched, understaffed and poorly trained public health sector, unable to deliver adequate upper limb services to breast cancer survivors. Focus group data suggests that this is due to financial austerity rather than poor recognition of the need. Poor patient education is driving poor upper limb outcomes and barriers to exercise behaviour. Conclusion The current South African upper limb rehabilitation services does not cater for the unmet needs of a breast cancer survivor leading to poor health outcomes.

Case Report: Dynamic Interdependencies Between Complementary and Alternative Medicine (CAM) Practice, Urinary Interleukin-6 Levels, and Fatigue in a Breast Cancer Survivor

Background: This study investigated the influence of complementary and alternative medicine (CAM) techniques (i.e., Jin Shin Jyutsu, music, physiotherapy, Tai Chi, and energy healing) on urinary interleukin-6 (IL-6) levels and fatigue in a 49-year-old breast cancer survivor suffering from cancer-related fatigue and depression. Data were sampled under conditions of “life as it is lived.”Methods: For 28 days, a female breast cancer survivor collected her full urine output in 12-h intervals from about 8 a.m. to 8 p.m. and from about 8 p.m. to 8 a.m. These urine samples were used to determine urinary IL-6 levels through ELISA and creatinine concentrations via HPLC. In 12-h intervals (every morning and evening), the patient completed the DIARI, which included fatigue measurement and notes on incidents and activities such as CAM practice. In addition, the patient was interviewed weekly to identify meaningful everyday incidents. In this context, CAM practice was also discussed. Time series analysis consisted of ARIMA modeling and cross-correlational analyses (p < 0.05).Results: When each CAM technique was considered separately in time series analysis, CAM was consistently associated with increases in urinary IL-6 release and decreases in fatigue. Furthermore, when all CAM techniques experienced as positive were included in one time series, a biphasic urinary IL-6 response pattern was found in which CAM practice was first preceded by decreases in IL-6 by 12–0 h and then followed by increases in IL-6 after 108–120 h. Finally, cross-correlations between IL-6 and fatigue showed that increases in IL-6 were followed by decreases in fatigue intensity after 48–60 h and, conversely, that decreases in fatigue intensity were followed by decreases in IL-6 after 24–36 h and 48–60 h.Conclusion: IL-6 increases and fatigue decreases highlight potential health-promoting effects of CAM practice. Moreover, a cyclic IL-6 pattern in response to all CAM activities experienced as positive underscores that CAM was meaningful to the patient. Additionally, a negative feedback circuit between IL-6 and fatigue intensity was detected. Taken together, this study confirms the necessity of integrating subjective meaning and dynamic complexity into biopsychosocial research in order to understand human functioning under real-life conditions.

Including Partners in Discussions of Sexual Side Effects from Breast Cancer: A Qualitative Study of Survivors, Partners, and Providers

Clinical guidelines are mixed regarding the inclusion of intimate partners in discussions between oncology providers and survivors about cancer-related sexual concerns. Therefore, this qualitative study assessed breast cancer survivor, partner, and provider perspectives on this issue. All three groups expressed value in incorporating partners in discussions about cancer-related sexual concerns, while also emphasizing the importance of allowing survivors to decide whether to do so.

The Use of Breast Cancer Survivor Patients as Part of Patient-Centred Education in the Training of Breast Cancer Care Nurses

INTRODUCTION: Breast cancer is the most common cancer worldwide. Patients diagnosed with breast cancer face many psychological and social distress that might affect their quality of life and indirectly might affect the disease outcome. Patient-centred education has been found to have a positive influence on the quality of management and anxiety reduction. A one-day workshop involving breast cancer survivor patients was designed as a preliminary step to improve the quality of care provided by oncology nurses in University Kebangsaan Malaysia Medical Centre (UKMMC). The objectives of the workshop were to train the nurses in providing patient-centred education using breast cancer survivor patients and to implement the breast cancer Malaysian Clinical Practice Guidelines (CPG) recommendation. MATERIALS AND METHODS: One-day workshop was designed to meet specific learning outcomes. The patient education program was introduced with special emphasis on a patientcentred approach through the involvement of breast cancer survivor patients. Twenty-one staff nurses and two breast cancer survivor patients have participated in this workshop. The workshop was conducted by a breast cancer surgeon, oncologist, dietitian, family physician, and medical educators. RESULT: Overall, all participants found the workshop was very useful, particularly with the involvement of breast cancer survivor patients. Sixty – two percent of the participants agreed that the objectives of the workshop were met and 76 % of them found the workshop relevant to their work. CONCLUSION: The involvement of breast cancer survivor patients in this workshop was a valuable learning experience that enhanced the patient-centred approach in medical education.