Differences in quality of life between American and Chinese breast cancer survivors

This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.OBJECTIVE: It has been speculated that cancer survivors in Asia may have lower quality of life (QOL) compared with their Western counterparts. However, no studies have made international comparisons in QOL using a comprehensive measure. This study aimed to compare Chinese breast cancer survivors' QOL with US counterparts and examine if demographic and medical factors were associated with QOL across groups. METHOD: The sample consisted of 159 breast cancer patients (97 Chinese and 62 American) who completed the Functional Assessment for Cancer Therapy Breast Cancer (FACT-B) scale before the start of radiotherapy in Shanghai, China and Houston, USA. RESULTS: Higher income was associated with higher QOL total scores in both Chinese and American cancer patients, but QOL was not significantly associated with other factors including age, education, disease stage, mastectomy, and chemotherapy. Consistent with hypotheses, compared to their US counterparts, Chinese breast cancer survivors reported lower QOL and all four subdimensions including functional well-being (FWB), physical well-being (PWB), emotional well-being (EWB), and social well-being (SWB); they also reported more breast cancer-specific concerns (BCS). Differences were also clinically significant for Functional Assessment for Cancer Therapy General (FACT-G) scale total scores and the FWB subscale. After controlling for demographic and medical covariates, these differences remained except for the SWB and BCS. Furthermore, Chinese breast cancer survivors receiving chemotherapy reported significantly lower FACT-G scores than those who did not, but this difference did not emerge among US breast cancer survivors. DISCUSSION: Chinese breast cancer survivors reported poorer QOL on multiple domains compared to US women. Findings indicate that better strategies are needed to help improve the QOL of Chinese breast cancer survivors, especially those who underwent chemotherapy.Support was provided in part by the US National Cancer Institute (NCI) grants CA108084 and CA121503 (principal investigator, Lorenzo Cohen) and the American Cancer Society MRSGT-10-011-01-CPPB (principal investigator, Qian Lu). Partial support for Lorenzo Cohen was provided by the Richard E. Haynes Distinguished Professorship in Clinical Cancer Prevention. Jennifer McQuade is supported by an institutional T32 training grant and an ASCO Young Investigator Award

Psychopharmacology in Oncology and Palliative Care: General Issues

At least 25–30 % of patients with cancer and even a higher percentage of those in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, including severe adjustment disorders, sleep disorders, and delirium. A number of studies in psychooncology have accumulated over the last 35 years on the use of psychotropic drugs as a pillar in the treatment of psychiatric disorders. Major advances in research have also shown the efficacy of psychotropic drugs as adjuvant treatment of cancer-related symptoms, such as pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. The knowledge about pharmacokinetics and pharmacodynamics, clinical use, safety, side effects, and efficacy of drugs in cancer care is essential. The aims of this chapter are to consider the need for an integrated psychological and psychopharmacological intervention, as the concept of psychopharmoncology specifies, favoring the vision of an integrated and multidimensional approach in oncology, and palliative care services as well as in community-based cancer centers