Group Rehabilitation for Cancer Patients: : Effects, Patient Satisfaction, Utilisation and Prediction of Rehabilitation Need

The aims are to investigate cancer patients' perceived satisfaction with a Group Rehabilitation (GR) intervention, to evaluate its effects, and to explore the extent to which the patient's coping style (monitoring, blunting) modulates the effects of the GR. An additional aim is to investigate to what extent some aspects of health-related quality of life (HRQOL) [Physical Functioning (PF), Emotional Functioning (EF) and Global Quality of Life (QoL)] one year after diagnosis can be predicted on the basis of medical, socio-demographic and psychological data collected att diagnosis. Patients (n=481) newly diagnosed with breast, gastrointestinal or prostate cancer, were randomly assigned (Support-Care-Rehabilitation project) to one of four alternatives: 1. “Individual Support” (IS) starting at diagnosis; 2. “Group Rehabilitation” (GR) starting approximately four months later; 3. A combination of IS and GR; or 4. Standard Care (SC). All patients were monitored for two years. The GR comprised eight weekly sessions and one booster session after two months. The 2.5 hour meetings dealt with information about cancer, treatment, nutrition, cognitive behavioural therapy (CBT), light physical training and relaxation. Patients rated the physical and informative components as somewhat more beneficial than the CBT component. Meeting others was also rated as beneficial. However, there were limited effects on quality of life and anxiety. The monitoring concept was useful for distinguishing a subgroup of cancer patients (prostate cancer monitors) who benefited from the GR programme. Regression analyses demonstrated that the presence of advanced disease at diagnosis predicted a reduced physical function one year later. Having one or more comorbid conditions predicted lower PF and QoL, EF was predicted only by lower mental well-being and being classified as a case on the basis of the HADS. Indications for offering rehabilitative programs to cancer patients are critically discussed

Symptom prevalence, intensity, and distress in patients with inoperable lung cancer in relation to time of death

Purpose To examine symptom prevalence, intensity, and association with distress in patients with inoperable lung cancer (LC), using time to death as point of reference. Patients and Methods A consecutive sample of 400 patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 plus a 13-item LC-specific scale and the Thurstone Scale of Symptom Distress-Lung Cancer at six time points during the first year after diagnosis. Patients were divided into subgroups, using data from the time point closest to death ( 2 to 3; > 3 to 6; > 6 to 12; and > 12 months before death) for analysis. Results More than 50% of patients in all subgroups reported problems related to physical, role, and emotional functioning; fatigue; dyspnea; and cough. In general, functional levels were lower and symptoms higher in subgroups closer to death. Notably, clinically relevant differences were also found in role and social functioning and appetite loss between the two groups furthest from death. A consistent pattern was found among the six subgroups, with breathing, pain, and fatigue rated as the symptoms most associated with distress. Conclusion High prevalence of symptoms was found in all subgroups, with higher intensity in subgroups closer to death, indicating a need for prophylactic and proactive symptom management. Less concordance was found among symptom prevalence, intensity, and association with distress in subgroups further from death. Future studies should investigate longitudinal associations between symptoms with low intensity and high distress, and examine their clinical implication

Sexual dysfunction and reproductive concerns in young women with breast cancer : Type, prevalence, and predictors of problems

OBJECTIVE: A dearth of studies focusing on young women (<40 years) with breast cancer have hampered the understanding of the type, prevalence, and predictors of sexual dysfunction and reproductive concerns in this population. METHODS: Data were collected from 181 women (response rate = 60%) diagnosed with breast cancer approximately 2 years previously (age 21-39) using the Swedish National Quality Registry for Breast Cancer and a survey including standardized measures of sexual dysfunction, reproductive concerns, body image, and health-related quality of life. Multivariable logistic binary regression analyses were used to identify predictors of sexual dysfunction and reproductive concerns. RESULTS: Sexual dysfunction in at least one domain was reported by 68% of the women, and a high level of reproductive concerns in at least one dimension was reported by 58%. Model results showed that current endocrine treatment was a significant predictor of dysfunction related to lubrication (OR 3.8, 95% CI 1.2-12.1) and vaginal discomfort (OR 8.7, 95% CI 1.5-51.5). Negative body image was related to satisfaction with sex life (OR 1.1, 95% CI 1.0-1.2). A high level of reproductive concerns was predicted by a wish for (additional) children in the future (OR 3.4, 95% CI 1.1-10.2) and by previous chemotherapy (OR 2.5, 95% CI 1.1-5.9). CONCLUSIONS: Sexual dysfunction and reproductive concerns are common in young women with breast cancer. Current endocrine treatment, previous chemotherapy, a negative body image, and a wish for children in the future predict higher level of problems

Life satisfaction of women of working age shortly after breast cancer surgery

PURPOSE: To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery. METHODS: This cross-sectional study included 605 women, aged 20-63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression. RESULTS: Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables-having children, being in work, having emotional and informational social support, and having good physical and emotional functioning-were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning. CONCLUSIONS: One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning