RESUMEN
Objectives To investigate the attitudes of breast cancer patients who accepted or declined participation in a randomized trial with hormone replacement therapy that might increase their risk of recurrence (the Stockholm trial). Methods A total of 115 patients free from breast cancer recurrence were interviewed; 57 were participants and 58 were non-participants in the Stockholm trial. Patients answered five questionnaires regarding information needs (two), attitudes to participation in trials (two) and patient role in treatment decisions (one). Results Participants in the Stockholm trial had a lower risk of breast cancer recurrence (measured by node-positive disease and tumor size) and were older than non-participants. Their information needs were the same. Participants in the trial were more prepared to accept uncertainty, to have an altruistic attitude, to accept risks including an increased risk of recurrence of breast cancer, if their quality of life or general health was improved. Most patients preferred a collaborative role in relation to their physician but participants often wanted more influence than they had in treatment decisions. Conclusion A patient's decision to accept or decline participation in the Stockholm trial was influenced by her objective risk of breast cancer recurrence and reflected her attitude to risk, uncertainty and preference to be active in treatment decisions.
Asunto(s)
Actitud Frente a la Salud , Neoplasias de la Mama , Terapia de Reemplazo de Estrógeno/psicología , Recurrencia Local de Neoplasia , Prioridad del Paciente , Posmenopausia , Anciano , Neoplasias de la Mama/terapia , Terapia de Reemplazo de Estrógeno/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/inducido químicamente , Investigación , Factores de Riesgo , Encuestas y Cuestionarios , SueciaRESUMEN
PURPOSE: To study the sexual effects of the 2-year adjuvant goserelin (Zoladex [Zeneca AB, Södertälje, Sweden]) alone, tamoxifen alone, and Zoladex and tamoxifen in combination (ZT) versus no adjuvant endocrine therapy among premenopausal breast cancer patients with or without chemotherapy in a controlled clinical trial (a European multicenter trial: Zoladex in Premenopausal Breast Cancer Patients). PATIENTS AND METHODS: This prospective study examined several aspects of sexuality through the use of self-administered questionnaires, which were completed by patients at seven points of assessment for 3 years after randomization. RESULTS: Patients treated with chemotherapy had a higher level of sexual dysfunction than did patients who received no systemic treatment. The addition of endocrine treatment did not alter this result. In contrast, among patients who did not receive chemotherapy, Zoladex and ZT produced a significantly higher level of dysfunction from 1 to 2 years after inclusion, as compared with those who received no endocrine treatment. Tamoxifen alone did not produce side effects. After termination of endocrine treatment, sexual dysfunction began to diminish. Those with chemotherapy had high and frequently increasing levels of dysfunction even after 2 to 3 years of independent of endocrine treatment. Zoladex had a negative effect on sexual fear, which was reduced by the addition of tamoxifen. CONCLUSION: Zoladex increased sexual dysfunction during treatment among patients without chemotherapy, but the disturbances of sexual functioning were reversible. The use of adjuvant chemotherapy was associated with continued sexual problems, even at 3 years after randomization.
Asunto(s)
Antineoplásicos Hormonales/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Goserelina/efectos adversos , Disfunciones Sexuales Fisiológicas/inducido químicamente , Tamoxifeno/farmacología , Adulto , Antineoplásicos Hormonales/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/psicología , Cisplatino/administración & dosificación , Quimioterapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Goserelina/administración & dosificación , Humanos , Metotrexato/administración & dosificación , Persona de Mediana Edad , Satisfacción del Paciente , Premenopausia , Tamoxifeno/administración & dosificaciónRESUMEN
Patient participation in treatment decisions presupposes well-informed patients. The purpose of this study was to determine Swedish breast cancer patients' information needs and their preferences for participation in treatment decisions. Patients (n = 201) were interviewed on nine categories of information and five patient roles, using paired comparisons. Patients gave priority to facts about disease and treatment (chances of cure, stage of disease, treatment options). A collaborative role in treatment decisions was preferred by 87% of the patients. Most patients (56%) preferred a passive form of collaboration: I prefer that my doctor makes the final decision about my treatment but seriously considers my opinion. Younger and better educated patients tended to prefer a more active role. Many patients wanted to be more active (20%) and some more passive (8%) than they actually were. Patients gave priority to disease-specific information, but this reflected needs other than taking control of treatment decisions.
Asunto(s)
Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Educación del Paciente como Asunto , Participación del Paciente , Adulto , Factores de Edad , Anciano , Toma de Decisiones , Femenino , Humanos , Servicios de Información , Persona de Mediana Edad , Relaciones Médico-Paciente , SueciaRESUMEN
The EORTC QLQ-C30 Health-Related Quality of Life (HRQOL) questionnaire was completed by 3069/3919 (78%) of a random sample of the Swedish population aged 18-79 years. The aims of the study were to provide normative data on the questionnaire and to investigate differences in HRQOL with respect to age, gender, sociodemographic characteristics and reported chronic health problems. Women had lower scores than men on all but one of the EORTC QLQ-C30 subscales and reported more chronic health problems. The oldest respondents (70-79 years) had a greater degree of impaired HRQOL than the other age groups, with one exception, 'Emotional functioning', in which they scored higher. Unemployed respondents reported poorer HRQOL than employed respondents. Higher income was associated with a more positive assessment of HRQOL. The results of the study present reference values for EORTC QLQ-C30 Version 3 questionnaire and clarify the influence of factors which should be taken into account when planning studies of HRQOL.
Asunto(s)
Estado de Salud , Calidad de Vida , Encuestas y Cuestionarios , Adolescente , Adulto , Factores de Edad , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Factores Sexuales , DesempleoRESUMEN
PURPOSE: To examine HRQoL measured by EORTC QLQ-C30 with respect to an increasing number of self-reported chronic health problems in the general Swedish population and to study the association between HRQoL, chronic health problems and age, gender, income, marital status and employment status. METHOD: A postal survey among a large random sample of 4000 adults aged 18-79 years. The study material contained EORTC QLQ-C30 core questionnaire supplemented by a sociodemographic questionnaire including questions about 13 chronic health problems of which four categories, 'No', 'Few', 'Some' or 'A lot of chronic health problems were constructed. RESULTS: Multiple chronic health problems were significantly associated with reduced HRQoL. The increased number of chronic health problems was also associated with age. When the number of chronic health problems was accounted for, the influence of age diminished. Low income and unemployment were associated with greater decline in HRQoL with respect to increasing number of problems among the respondents in working age. CONCLUSION: The impact of increased number of chronic health problems had varying consequences in different age groups. Moreover, sociodemographic and economic factors showed to interact differently with chronic health problems and HRQoL in various age groups. It appears from our results that an assessment and a careful consideration of these factors will be valuable in order to facilitate the interpretation of the effects of cancer and treatment on long-term HRQoL of cancer patients.
Asunto(s)
Enfermedad Crónica/epidemiología , Calidad de Vida , Factores Socioeconómicos , Adolescente , Adulto , Factores de Edad , Anciano , Enfermedad Crónica/clasificación , Enfermedad Crónica/psicología , Empleo/estadística & datos numéricos , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Estado Civil/estadística & datos numéricos , Persona de Mediana Edad , Distribución Aleatoria , Sistema de Registros , Muestreo , Encuestas y Cuestionarios , Sobrevivientes/psicología , Suecia/epidemiologíaRESUMEN
The aim in this study was to gain a deeper understanding of the interaction between women who have been treated for breast cancer and their children. The focus was on how they deal with being a mother at the same time attending to their own needs. The main strategies of the grounded theory method were used to conceptualize the interactive process involved. Nine women, with children aged 4 to 23, living at home at the time of diagnosis, were interviewed. By the process of constant comparative analysis, the main theme that seemed to capture how the lives of these women had changed was transforming the exhausting-to-energizing process in being a good parent in the face of cancer. This theme is related to Meleis's concept of health-illness transition. The findings here indicate the need for family counseling, with special attention paid to the single parent with cancer.
Asunto(s)
Neoplasias de la Mama/psicología , Salud de la Familia , Fatiga/psicología , Responsabilidad Parental , Adulto , Neoplasias de la Mama/complicaciones , Niño , Fatiga/etiología , Femenino , Humanos , Persona de Mediana Edad , Investigación Metodológica en EnfermeríaRESUMEN
After primary surgery, 149 premenopausal breast cancer patients, with node-negative disease, were randomized to one of four treatment groups: goserelin, tamoxifen, goserelin plus tamoxifen or to a systematically untreated control group. The aim was to assess the effects of adjuvant endocrine therapy in terms of physical symptoms and perception of anxiety and depressive symptoms. Assessments were made before randomization, at 3-4 months and at 12 months. Treatment with goserelin resulted in early and more intense menopausal symptoms, while the effects of tamoxifen were slower and milder. The side effects with goserelin appeared to be alleviated by concurrent tamoxifen except for vasomotor symptoms (hot flashes, sweating, feeling warm). No significant group differences were found for anxiety and depressive symptoms. In conclusion, chemical castration with goserelin was associated with the highest level of physical symptoms. The group treated with tamoxifen alone showed the lowest levels of symptoms among the treatment groups, except for vaginal discharge and irregular bleedings.
Asunto(s)
Antineoplásicos Hormonales/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/fisiopatología , Goserelina/efectos adversos , Premenopausia/efectos de los fármacos , Tamoxifeno/efectos adversos , Adulto , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ansiedad/inducido químicamente , Ansiedad/etiología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Quimioterapia Adyuvante , Depresión/inducido químicamente , Depresión/etiología , Femenino , Goserelina/administración & dosificación , Goserelina/uso terapéutico , Humanos , Memoria/efectos de los fármacos , Persona de Mediana Edad , Premenopausia/fisiología , Tamoxifeno/administración & dosificación , Tamoxifeno/uso terapéutico , Vagina/efectos de los fármacos , Vagina/fisiopatología , Sistema Vasomotor/efectos de los fármacos , Sistema Vasomotor/fisiopatologíaAsunto(s)
Predicción , Neoplasias/terapia , Cuidados Paliativos/tendencias , Apoyo Social , Humanos , Neoplasias/psicología , Noruega , SueciaRESUMEN
In parallel with a randomized study of the 'starting again' rehabilitation program for cancer patients, a group of 73 non-participants were monitored (another 20 patients declined monitoring). In comparison with participants (intervention + control), gender, diagnosis, and 10 out of 18 dependent measures differed significantly at baseline. The non-participants group included more men, mostly with cancer of the prostate and irrespective of gender, they showed lower problem levels than participants throughout. Thus, the wish to participate seems to be an indicator of the need for assistance in the rehabilitation process. Social validation of effects was performed by comparing the non-participants with the intervention group. The rationale for this comparison is that non-participants presumably felt so well that they were in no need of rehabilitation. Effects on three variables were socially validated: patients' appraisal of having received sufficient information, physical strength and fighting spirit. No negative effects on outcome variables resulting from being randomized to the control condition (resentful demoralization) were detected when non-participants were compared with controls over one year. Further analysis showed that although a few patients in the control group may have experienced resentful demoralization, this did not significantly affect the outcome variables.
Asunto(s)
Adaptación Psicológica , Neoplasias/rehabilitación , Psicoterapia de Grupo , Rol del Enfermo , Negativa del Paciente al Tratamiento/psicología , Adulto , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Determinación de la Personalidad , Solución de Problemas , Ajuste SocialRESUMEN
BACKGROUND: The incidence of and mortality from melanoma are increasing and no effective treatment for disseminated disease exists. Studies of factors influencing participation in prevention and early detection of melanoma are therefore warranted. In the present study, participants in public melanoma screening were compared with a sample of the Swedish population with respect to concern for nevi, perceived risk for melanoma, knowledge about melanoma, and sources of information. Gender differences were studied. METHOD: Consecutive participants in public melanoma screening (Participants) received questionnaires at registration for skin examination; 235 (96%) responded. Questionnaires were distributed by mail to a random sample of the Swedish population (Public); 1,070 (63%) responded. RESULTS: Participants were more concerned about nevi, and a higher proportion had previously consulted physicians for suspected lesions compared with the Public. Participants were better informed in terms of the number of sources of information and knowledge of melanoma and risk factors. There were no differences regarding perceived risk and there was a mixed picture concerning knowledge of sun effects and sun protection. Gender differences were found for perceived susceptibility to, knowledge of, and number of sources of information about melanoma, favoring women. CONCLUSION: The preventive aspects of screening as well as the good prognosis of melanoma detected early should be stressed in invitations to skin cancer screening. New approaches for reaching men are warranted.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Melanoma/etiología , Melanoma/prevención & control , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/prevención & control , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Medios de Comunicación de Masas , Tamizaje Masivo , Persona de Mediana Edad , Nevo/complicaciones , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios , SueciaRESUMEN
A longitudinal quality of life (QOL) study was performed on patients with advanced melanoma during chemotherapy. The purpose was to describe QOL in this palliative context and to compare the clinical outcome variables and patients' self-assessed QOL. QOL was assessed by the EORTC core questionnaire technique (QLQ-C36), a study-specific melanoma (MM module and the Hospital Anxiety and Depression (HAD) scale. The questionnaires displayed good psychometric qualities and the technique proved to be applicable in this longitudinal study of severely ill patients. Only six patients, out of 95 in total, complied with the full one-year study. Drop-outs occurred early in the course of treatment, most of them due to progressive disease or death. Pretreatment, patients reported a low level of dysfunction and symptom burden but 9 weeks later they exhibited significant deterioration in all QOL measurements, with the exception of pain and emotional functioning. The mean duration of response was short and there was considerable observed treatment-related toxicity. However, no correlation was found between physician-rated clinical outcome variables and QOL measurements, except for neuropathy. Our results are in accordance with earlier data on the supplementary value of QOL measurements to define endpoints in clinical trials.
Asunto(s)
Antineoplásicos/efectos adversos , Melanoma/tratamiento farmacológico , Melanoma/psicología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
In a randomised prospective study, a brief structured rehabilitation programme, 'Starting Again', was evaluated over a follow-up year. 98 patients were assigned to the programme, and 101 to the control condition. The 11, 2-h sessions emphasised physical training, information and coping skills. Patients in the programme improved significantly more than the controls with respect to appraisal of having received sufficient information, physical training, physical strength and fighting spirit. Results indicate improvement with respect to the three areas focused on in the 'Starting Again' programme: physical training, information and coping skills training.
Asunto(s)
Adaptación Psicológica , Terapia por Ejercicio , Neoplasias/rehabilitación , Educación del Paciente como Asunto , Imagen Corporal , Empleo , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Neoplasias/psicología , Aptitud Física , Relaciones Profesional-Paciente , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Ausencia por EnfermedadRESUMEN
An information programme for patients with cutaneous malignant melanoma, Stage 1, aiming at increasing satisfaction with information, was carried out at the Department of Oncology (Radiumhemmet). The programme consisted of a group meeting and a brochure. A total of 231 consecutive patients were included, and 149 (65%) reported interest in participation and were randomized to the Information group (n = 77) or to the Control group. A total of 67 patients (29%) were not interested (the NI-group). To evaluate the programme, the patients in the three groups completed questionnaires regarding satisfaction with information, knowledge of melanoma and psychological and psychosomatic variables before randomization and at the first visit for follow-up at Radiumhemmet. After the information programme, the Information group was significantly more satisfied with information, had a higher level of knowledge and a lower proportion requested further information as compared with the Control group. No differences were found on the psychological and psychosomatic variables.
Asunto(s)
Melanoma/psicología , Educación del Paciente como Asunto/métodos , Satisfacción del Paciente/estadística & datos numéricos , Neoplasias Cutáneas/psicología , Análisis de Varianza , Evaluación Educacional , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Folletos , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios , Suecia , Materiales de EnseñanzaRESUMEN
Eighty-nine patients with generalized malignant melanoma, 63% men and median age 53 years, were included in a longitudinal quality of life (QOL) study before the start of chemotherapy. QOL was assessed by the EORTC core questionnaire technique (QLQ-C36), a study-specific melanoma (MM) module and the Hospital Anxiety and Depression (HAD) scale. The questionnaires displayed good psychometric qualities and were able to document the florid symptomatology of disseminated melanoma. They were well accepted by the patients. Before treatment the patients reported a relatively low symptom burden, good physical and social functioning, moderate psychological distress and a high overall QOL rating during the past week. Fatigue and pain were the most frequent symptoms reported. The QOL measurement differentiated between subgroups of patients differing in performance status and the tumour burden. We conclude that the EORTC questionnaire technique is feasible and clinically relevant in generalized malignant melanoma patients.
Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Melanoma/psicología , Calidad de Vida , Encuestas y Cuestionarios/normas , Actividades Cotidianas , Adulto , Anciano , Ansiedad/psicología , Depresión/psicología , Estudios de Factibilidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Melanoma/complicaciones , Melanoma/fisiopatología , Salud Mental , Persona de Mediana Edad , Psicometría , Reproducibilidad de los ResultadosAsunto(s)
Eutanasia Pasiva , Cuidados Paliativos , Cuidado Terminal/métodos , Femenino , Humanos , Masculino , SueciaRESUMEN
Correlation between anxiety parameters and oestrogen receptor levels (ER) were investigated in 89 patients with primary breast cancer. Patients were divided into two groups, ER poor (< 0.05 fmol/microgram DNA) and ER rich (> 0.05 fmol/microgram DNA). No differences were found between anxiety levels, determined by a modified Hospital Anxiety and Depression (HAD) scale, in the two groups. This report does not support the findings from other studies, claiming an association between psychological parameters and oestrogen receptor status, which is believed to be a prognostic predictor.
Asunto(s)
Ansiedad/fisiopatología , Biomarcadores de Tumor/análisis , Neoplasias de la Mama/psicología , Proteínas de Neoplasias/análisis , Receptores de Estrógenos/análisis , Adulto , Neoplasias de la Mama/química , Neoplasias de la Mama/patología , Femenino , Humanos , Menopausia/fisiología , Persona de Mediana EdadRESUMEN
Participants in public screening for malignant melanoma (n = 190) completed a questionnaire containing items regarding cognitive and emotional responses to skin examination on two occasions, before screening and 7 months later. The results suggest subjective susceptibility to melanoma in participants in public screening, especially in women. No increase in psychosomatic problems, anxiety or depressive symptoms or signs of "false security" were seen as an effect of the screening, neither in the total sample nor in those who at the screening were recommended further medical procedures.
Asunto(s)
Tamizaje Masivo/psicología , Melanoma/psicología , Neoplasias Cutáneas/psicología , Anciano , Ansiedad/etiología , Actitud Frente a la Salud , Depresión/etiología , Susceptibilidad a Enfermedades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores de TiempoRESUMEN
The effects of a seven-week (11 two-hour sessions) group post-treatment rehabilitation program ('Starting again') for cancer patients were assessed. The program emphasised physical training, information, and training of coping skills. Thirty participants were matched to thirty patients, not wanting to participate (comparison group) and compared in a longitudinal study: before and after the program, and three, six and twelve months after program completion. Program participants had a significantly heavier burden of physical and psychological symptoms at entry than did patients who chose not to participate. More participants reported change of their life-style and habits after the cancer diagnosis than did the comparison group. In comparison with non-participants, participants were more satisfied with information during the entire follow-up, improved more from pre- to post measurement with respect to physical strength and increased their physical training and social activities more.