Cognitive emotional and social aspects in breast cancer

[eng] BACKGROUND: Breast cancer is one of the most prevalent diseases in women. Prevention and treatments have lowered mortality; nevertheless, the impact of diagnosis and treatment continue to affect ali aspects of patients' lives (physical, emotional, cognitive, social, and spiritual). The presence of psychological distress, anxiety and depression are still very prevalent. Cancer treatment often involves surgery, radiotherapy, chemotherapy, or hormonal therapy, treatment options that must be assessed and decided, and where patients have a relevant role. Shared decision-making (SDM) regarding adjuvant systemic therapy is based on both properly conveying information about the prognosis of the disease and the benefits and risks of adjuvant treatment, as well as the patient's ability to understand this information. AIMS: This research has two objectives: 1) Describe breast cancer patient's experiences throughout all the stages of their disease with a journey model, and 2) Examine doctor-patient coincidence with respect to the estimation of relapse with/without adjuvant chemotherapy and regarding the risk of treatment toxicity. METHODS: To meet the first objective, a qualitative study was designed. Twenty-one women with breast cancer or survivors were recruited at 9 large hospitals in Spain and intentional sampling methods were applied. Data were collected using a semi-structured interview that was elaborated with the help of medical oncologists, nur ses, and psycho-oncologists. Data were processed by adopting a thematic analysis approach. To attain the second objective, cross-sectional, multicenter study was conduct ed. lt involved 281 breast cancer patients and 23 oncologists employed at 11 Spanish hospitals. Prognosis (risk of recurrence with and without chemotherapy and risk of severe toxicity with chemotherapy) and SDM questionnaires were completed by oncologists and breast cancer patients. These lastones also filled out the 18-item Brief Symptom lnventory scale (BSl-18). RESULTS: The diagnosis and treatment of breast cancer entails a radical change in patients' day-to-day that linger in the mid-term. Seven stages have been defined that correspond to the different medical processes: diagnosis/unmasking stage, surgery/cleaning out, chemotherapy/loss of identity, radiotherapy/transition to normality, follow-up care/the "new" day-to-day, relapse/starting over, and metastatic/time-limited chronic breast cancer. The most relevant aspects of each of the states are highlighted, as are the various cross-sectional aspects that manifest throughout the patient's journey. The results of the second objective indicate that oncologists' prediction of risk of relapse without and with chemotherapy (30.4 and 13.3%) and risk of severe toxicity (9.8%) were more optimistic than those of breast cancer patients (78.6, 29.6, and 61.0%, respectively). The greater the severity, the higher the risk of relapse according to the oncologists (p = 0.001); not so far the patients. Older physicians and more experienced ones predicted lower risk of relapse with and without chemotherapy and less severe toxicity than younger doctors and those with less experience (p < 0.001). Oncologists' SDM and their prediction of risk of relapsing with chemotherapy correlated negatively with patients' SDM and their prediction of risk of severe toxicity (p < 0.01). There is a positive correlation between psychological distress (BSl-18) and the estimated risk of recurrence with chemotherapy in breast cancer patients (p < 0.001). These results stress the importance of improving doctor-patient communication in SDM. CONCLUSIONS: An in-depth understanding of breast cancer patients' experiences favor patient-centered care , which facilitates a better adjustment of the healthcare professional as well as the detection of risk situations, helping to identify the key moments when more precise information and support should be offered. Similarly, preparing women for the process they have to face and for the sequelae of treatments would contribute to reduce their uncertainty and concern, and improve their quality-of-life. In breast cancer patients undergoing treatment with curative intent, enhancing doctor-patient communication to coincide more the respect to risk of relapse and toxicity would raise expectations of cure, decrease treatment-related anxiety, and achieve a more realistic estimate of the risk of relapse and toxicity.[spa] ANTECEDENTES: El cáncer de mama es una de las enfermedades más prevalentes en la mujer. La prevención y los tratamientos han reducido la mortalidad; sin embargo, el impacto del diagnóstico y el tratamiento continúa afectando todos los aspectos de la vida de los pacientes (físico, emocional, cognitivo, social y espiritual). La presencia de angustia psicológica, ansiedad y depresión sigue siendo muy frecuente. El tratamiento del cáncer a menudo implica cirugía, radioterapia, quimioterapia u hormonoterapia, opciones de tratamiento que deben evaluarse y decidirse, y donde los pacientes tienen un papel relevante. La toma de decisiones compartida (TDC) con respecto a la terapia sistémica adyuvante se basa en la transmisión adecuada de información sobre el pronóstico de la enfermedad, los beneficios y los riesgos del tratamiento adyuvante, así como en la capacidad del paciente para comprender esta información. OBJETIVOS: Esta investigación tiene dos objetivos: 1) Describir las experiencias de las pacientes con cáncer de mama a lo largo de todas las etapas de su enfermedad con un "patient journey", y 2) Examinar la coincidencia médico-paciente con respecto a la estimación de la recaída con / sin quimioterapia adyuvante y con respecto al riesgo de toxicidad del tratamiento. MÉTODOS: Para cumplir con el primer objetivo se diseñó un estudio cualitativo. Se reclutaron 21 mujeres con cáncer de mama o supervivientes en 9 grandes hospitales de España y se aplicaron métodos de muestreo intencional. Los datos se recolectaron mediante una entrevista semiestructurada que se elaboró con la ayuda de médicos oncólogos, enfermeras y psicooncólogos. Los datos se procesaron adoptando un enfoque de análisis temático. Para alcanzar el segundo objetivo, se realizó un estudio transversal y multicéntrico. En él participaron 281 pacientes con cáncer de mama y 23 oncólogos de 11 hospitales españoles. Los oncólogos y los pacientes con cáncer de mama completaron los cuestionarios de pronóstico (riesgo de recurrencia con y sin quimioterapia y riesgo de toxicidad grave con quimioterapia) y los cuestionarios de TDC. Estos últimos también cumplimentaron la escala de Inventario Breve de Síntomas de 18 ítems (BSl- 18). RESULTADOS: El diagnóstico y tratamiento del cáncer de mama conlleva un cambio radical en el día a día de las pacientes que perdura a medio plazo. Se han definido siete etapas que corresponden a los diferentes procesos médicos: etapa de diagnóstico/ desenmascaramiento, cirugía/ "limpieza", quimioterapia / pérdida de identidad, radioterapia / transición a la normalidad, atención de seguimiento / el "nuevo" día a día, recaída / comienzo de nuevo, y cáncer de mama crónico metastásico / limitado en el tiempo. Se destacan los aspectos más relevantes de cada uno de los estados, así como los diversos aspectos transversales que se manifiestan a lo largo del recorrido del paciente. Los resultados del segundo objetivo indican que la predicción de los oncólogos del riesgo de recaída sin y con quimioterapia (30,4 y 13,3%) y el riesgo de toxicidad grave (9,8%) fueron más optimistas que las de las pacientes con cáncer de mama (78,6, 29,6 y 61,0 %, respectivamente). A mayor gravedad, mayor riesgo de recaída según los oncólogos (p = 0,001); no así para los pacientes. Los médicos de mayor edad y los más experimentados predijeron un menor riesgo de recaída con y sin quimioterapia y una toxicidad menos grave que los médicos más jóvenes y aquellos con menor experiencia (p <0,001). La TDC de los oncólogos y su predicción del riesgo de recaída con la quimioterapia se correlacionaron negativamente con la TDC de los pacientes y su predicción del riesgo de toxicidad grave (p <0,01). Existe una correlación positiva entre la angustia psicológica (BSl-18) y el riesgo estimado de recurrencia con quimioterapia en pacientes con cáncer de mama (p <0,001). Estos resultados subrayan la importancia de mejorar la comunicación médico-paciente en la TDC. CONCLUSIONES: Un conocimiento profundo de las vivencias de los pacientes de cáncer de mama favorece la atención centrada en el paciente, lo que facilita un mejor ajuste del profesional de la salud, así como la detección de situaciones de riesgo, ayudando a identificar los momentos clave en los que se debe ofrecer información y apoyo más preciso. Asimismo, preparar a las mujeres para el proceso que deben afrontar y las secuelas de los tratamientos contribuiría a reducir su incertidumbre e inquietud y mejorar su calidad de vida. En pacientes con cáncer de mama que se someten a un tratamiento con intención curativa, mejorar la comunicación médico-paciente para que se ajuste más al riesgo de recaída y al de toxicidad aumentaría las expectativas de curación, disminuiría la ansiedad relacionada con el tratamiento y lograría una estimación más realista del riesgo de recaída y toxicidad

Estimation of Risk of Recurrence and Toxicity Among Oncologists and Patients With Resected Breast Cancer: A Quantitative Study

Shared decision-making regarding adjuvant systemic therapy in breast cancer is based on both properly conveying information about the prognosis of the disease and the benefits and risks of adjuvant treatment, as well as the patient's ability to understand this information. This work proposed to analyze oncologists' and patients' perceptions of the risk of recurrence with and without chemotherapy and toxicity, and the factors influencing said impressions. This was a prospective, crosssectional, multicenter study that involved 281 breast cancer patients and 23 oncologists. Prognosis (risk of recurrence with and without chemotherapy and risk of severe toxicity with chemotherapy) and shared decision making (SDM) questionnaires were completed by all participants; breast cancer patients also filled out the 18 item Brief Symptom Inventory (BSI-18). Oncologists' prediction of risk of relapse without and with chemotherapy (30.4 and 13.3%) and risk of severe toxicity (9.8%) were more optimistic than those of breast cancer patients (78.6, 29.6, and 61%, respectively). The greater the severity, the higher the risk of relapse according to the oncologists (p = 0.001); not so for the patients. Older physicians and more experienced ones predicted lower risk of relapse with and without chemotherapy and less severe toxicity than younger doctors and those with less experience (p < 0.001). Oncologists' SDM and their prediction of risk of relapsing with chemotherapy correlated negatively with patients' SDM and their prediction of risk of severe toxicity (p < 0.01). There is a positive correlation between psychological distress (BSI-18) and prognosis of risk of recurrence with chemotherapy in breast cancer patients (p < 0.001). These results stress the importance of improving doctor-patient communication in SDM. In breast cancer patients undergoing treatment with curative intent, expectations of being cured would increase and treatment-related anxiety would decrease by enhancing doctor-patient communication to coincide more with respect to risk of relapse and toxicity, thereby enhancing patients' quality of life

A Digital Cancer Ecosystem to Deliver Health and Psychosocial Education as Preventive Intervention

Health education and psychosocial interventions prevent emotional distress, and the latter has been shown to have an impact on survival. In turn, digital health education interventions may help promote equity by reaching a higher number of cancer patients, both because they avoid journeys to the hospital, by and having a better efficiency. A total of 234 women recently diagnosed with breast cancer in a comprehensive cancer center used the digital ecosystem ICOnnecta't from March 2019 to March 2021. ICOnnecta't consists of four care levels, provided to patients according to their level of distress. The second level of this intervention consists of an educational campus, which was analyzed to track users' interests and their information-seeking behavior. Overall, 99 out of 234 women (42.3%) used the educational campus. There were no significant differences in sociodemographic and clinical variables between the campus users and non-users. Among users, the median number of resources utilized per user was four (interquartile range: 2-9). Emotional and medical resources were the contents most frequently viewed and the audiovisual format the most consulted (p < 0.01). Resources were used mainly within the first three months from enrolment. Users who were guided to visit the virtual campus were more active than spontaneous users. Offering an early holistic health educational platform inside a digital cancer ecosystem, with health professionals involved, can reach more patients, promoting equity in the access of cancer information and prevention, from the very beginning of the disease

Optimism and Social Support as Contributing Factors to Spirituality in Cancer Patients

Background/objective: The impact a cancer diagnosis and its treatment are affected by psychosocial factors and how these factors interrelate among themselves. The objective of this study was to analyze the relationship between optimism and social support in spiritual wellbeing in cancer patients initiating chemotherapy. Methods: A cross-sectional, multi-center (15 sites), prospective study was conducted with 912 cancer patients who had undergone curative surgery for a stage I-III cancer and were to receive adjuvant chemotherapy. They completed the Functional Assessment of Chronic Illness-Spiritual Well-being Scale (FACIT-Sp), Life Orientation Test-Revised (LOT-R), and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Significant differences on spirituality scales (meaning/peace and faith) were detected depending on age (≤ 65 vs > 65), sex, marital status, employment, and cancer treatment. Married or partnered participants had significantly higher meaning/peace scores compared to their non-partnered counterparts (p = 0.001). Women, > 65 years, unemployed, and patients treated with chemotherapy and radiotherapy had significantly higher faith scores versus men, ≤ 65 years, employed, and subjects only receiving adjuvant chemotherapy (all p < 0.030). Multivariate analyses indicated that meaning/peace and faith correlated positively with optimism and social support. Conclusion: During oncological treatment, the positive effects of optimism and social support exhibit a positive correlation with spiritual coping. A brief assessment evaluation of these factors can aid in identifying at risk for a worse adaptation to the disease

Ascertaining breast cancer patient experiences through a journey map: A qualitative study protocol

This study seeks to describe breast cancer patients' experience over the course of the various stages of illness by means of a journey model. This is a qualitative descriptive study. Individual, semi-structured interviews will be administered to women with breast cancer and breast cancer survivors. Patients will be recruited from nine large hospitals in Spain and intentional sampling will be used. Data will be collected by means of a semi-structured interview that was elaborated with the help of medical oncologists, nurses, and psycho-oncologists. Data will be processed adopting a thematic analysis approach. The outcomes of this study will afford new insights into breast cancer patients' experiences,providing guidance to improve the care given to these individuals. This protocol aims to describe the journey of patients with breast cancer through the healthcare system to establish baseline data that will serve as the basis for the development and implementation of a patient-centered, evidence-based clinical pathway