Decisional conflict in breast cancer patients considering immediate breast reconstruction

Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC).Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decision-making, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict).Results: Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p Conclusion: A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction.Hereditary cancer genetic

Decisional conflict in breast cancer patients considering immediate breast reconstruction

Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC). Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision

Patient-reported burden of intensified surveillance and surgery in high-risk individuals under pancreatic cancer surveillance

In high-risk individuals participating in a pancreatic cancer surveillance program, worrisome features warrant for intensified surveillance or, occasionally, surgery. Our objectives were to determine the patient-reported burden of intensified surveillance and/or surgery, and to assess post-operative quality of life and opinion of surgery. Participants in our pancreatic cancer surveillance program completed questionnaires including the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). For individuals who underwent intensified surveillance, questionnaires before, during, and ≥ 3 weeks after were analyzed. In addition, subjects who underwent intensified surveillance in the past 3 years or underwent surgery at any time, were invited for an interview, that included the Short-Form 12 (SF-12). A total of 31 high-risk individuals were studied. During the intensified surveillance period, median CWS scores were higher (14, IQR 7), as compared to before (12, IQR 9, P = 0.007) and after (11, IQR 7, P = 0.014), but eventually returned back to baseline (P = 0.823). Median HADS scores were low: 5 (IQR 6) for anxiety and 3 (IQR 5) for depression, and they were unaff

Factors associated with cancer worries in individuals participating in annual pancreatic cancer surveillance

It is important to adequately and timely identify individuals with cancer worries amongst participants in a pancreatic ductal adenocarcinoma (PDAC) surveillance program, because they could benefit from psychosocial support to decrease distress. Therefore, the aim of this study was to assess both psychosocial and clinical factors associated with cancer worries. High-risk individuals participating in PDAC-surveillance were invited to annually complete a cancer worry scale (CWS) questionnaire which was sent after counseling by the clinical geneticist (T0), after intake for participation in PDAC-surveillance (T1), and then annually after every MRI and endoscopic ultrasonography (EUS) (T2 and furth

Evaluation of information indices as indicators of environmental stress in terrestrial soils

Information indices from Ecosystem Network Analysis (ENA) can be used to quantify the development of an ecosystem in terms of its size and organization. There are two types of indices, i.e. absolute indices that describe both the size and organization of ecosystem (Total System Throughput (TST)¿system size, Ascendancy (A)¿size of organized flows and Development Capacity (C)¿upper limit for A, Overhead (L)¿size of unorganized flows) and relative indices that describe only the organization (Average Mutual Information (AMI = A:TST), Flow Diversity (H = C:TST), Relative Overhead (RL = L:TST)). It is theorized that environmental stress impair the ecosystem development and that the effect of stress can be quantified with the ENA information indices. Here we applied ENA on a case of environmental stress in a terrestrial ecosystem, i.e. soils that have endured long-term exposure to elevated copper concentration and altered pH. The absolute indices showed an unexpected pattern of response to pollution, suggesting that ecosystems in polluted soils are more active and better organized than these in unpolluted soils. The relative indices, alternatively, responded to pollution as predicted by theory, i.e. with decrease of stress (pollution level) the level of specialization increased (increase of AMI) and losses of energy, e.g. due to respiration, decreased (decrease of Overhead). The diversity and evenness of flows showed hump-backed relationship with stress. Less polluted soils appeared to be less vulnerable to external disturbances and more efficient in processing energy (higher Relative Ascendancy (RA = A:C)) than polluted soils. The relative information indices were rigid to changes in values of assumed parameters. The relative indices, opposite to absolute indices, appeared to be useful as indicators of environmental stress on the ecosystem level