Lena-Marie Petersson

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 (< 1; 1 to 2; > 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 implications.

Differential Effects of Cancer Rehabilitation Depending on Diagnosis and Patients' Cognitive Coping Style

Objective The major aim was to explore the extent to which the Miller Behavioral Style Scale (MBSS) can be used to differentiate cancer patients who are likely to benefit from rehabilitation efforts with a strong information component from those who are not. Methods Newly diagnosed patients with breast, gastrointestinal, or prostate cancer (N = 442) were included in a randomized, prospective study of the effects (on anxiety, depression, intrusion, avoidance) of rehabilitation approximately 4 months after diagnosis as compared with control patients. Patients were classified as “monitors” or “blunters” on the basis of the MBSS (368 patients, 83%, completed the MBSS). Results The expected interaction at postintervention between coping style and experimental condition (ie, rehabilitation or control) was found only for avoidance among breast and prostate cancer patients. Assignment to the rehabilitation or control condition was of no importance for outcome among blunters. Among monitors, the response pattern differed between breast and prostate cancer patients. Prostate cancer monitors seemed to benefit from rehabilitation on all outcome measures, whereas intrusion and avoidance were reduced among breast cancer patients in the control condition. This interaction of diagnosis with condition (rehabilitation or control) among monitors is suggested to be due to demands for diagnosis-specific information during diagnostic work, in the period just after diagnosis, and before treatment decision. Conclusions Only the monitor concept seems useful for predicting response to cancer rehabilitation with a strong information component. However, whether rehabilitation is of benefit depends also on other factors.

Work situation and sickness absence in the initial period after breast cancer surgery

Abstract Background. Breast cancer is the most common cancer diagnosis in women, many of whom are of working age, and the five-year survival rate in Sweden is approaching 90%. Accordingly, aspects of working life and sickness absence are of increasing importance for breast cancer survivors and may have a long-term impact on health and quality of life of these women. The aim was to elucidate the work situation and sickness absence during the initial period after breast cancer surgery and to explore factors associated with sickness absence. Material and methods. This is a cross-sectional questionnaire study 4–6 weeks after breast cancer surgery of women aged 20–63 years, and living in Stockholm. A consecutive sample of 933 women were invited and 756 (81%) accepted to participate. Logistic regression analyses were computed to estimate crude and adjusted odds ratios for associations between sick leave and other variables. Results. Most women (86%) were employed (including self-employed) at diagnosis, and 91% of those worked ≥75% of full-time. At time of survey, 56% were on sick leave, the majority for full-time. Low self-rated health, poorer health than before diagnosis, having a strenuous work posture, and younger age were associated with sick leave during the initial period after breast cancer surgery in both univariate and multivariate analyses. Discussion. The results of this study is not fully consistent compared to previous studies in this field, often performed in later phases after breast cancer surgery or after other cancer diagnoses. Therefore our results indicate that knowledge is needed during all phases of the breast cancer trajectory to determine factors of importance regarding sick leave and their impact throughout the disease trajectory.

Women's reflections and actions regarding working after breast cancer surgery – a focus group study

To better understand processes affecting return to work (RTW) after breast cancer, more knowledge from the perspective of sickness absentees is warranted. Still, research based on womens own reasoning and actions in RTW is very scarce. This study aims to elucidate how women with breast cancer reflect and act on work‐related issues.

Physical activity following a breast cancer diagnosis: Implications for self-rated health and cancer-related symptoms

PURPOSE Studies have consistently shown an association between physical activity and increased health and well-being after a cancer diagnosis. Nevertheless, large proportions of breast cancer survivors do not meet recommended levels of physical activity. The aim of this study was to describe physical activity levels during the first two years after being diagnosed with breast cancer, and to explore the predictive ability of physical inactivity on longer-term self-rated health, physical symptoms, and psychological distress. METHOD Study participants were women recently having had a first breast cancer surgery at one of the three main hospitals in Stockholm between 2007 and 2009. A total of 726 women were included and responded to six questionnaire assessments during the 24 months following diagnosis. RESULTS Less than one third of the participants were sufficiently physically active at baseline. Physical activity decreased after surgery, increased at 8 month follow-up, and subsequently decreased slightly during the subsequent follow-up period. Physical inactivity was related to reduced health, increased symptoms such as pain, depression, and anxiety. CONCLUSION This study provides additional support for the beneficial consequences of being physically active after a breast cancer diagnosis and highlights a potential target for intervention. This study provides additional support showing that being physically active even at a very low level seems to result in health benefits. Physical activity should be encouraged among patients treated for breast cancer.

Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence

As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work‐related problems caused by treatments. Most previous studies have focused on individual and disease‐related factors, whereas few have focused on work‐related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery.

Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: Patterns of transiency and severity of the distress response

BACKGROUND Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress. AIM To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery. METHODS Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemars test, and logistic regression. RESULTS There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness. DISCUSSION The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.

Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship

Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

Arm morbidity and sick leave among working women shortly after breast cancer surgery.

BACKGROUND There is limited knowledge about the impact of arm morbidity on sick leave in the immediate period after breast cancer surgery. PURPOSE To determine if arm morbidity was associated with sick leave shortly after breast cancer surgery and to investigate the association between arm morbidity and sick leave, adjusted for treatment, work characteristics, co-morbidity, time since surgery, and sociodemographic factors. SAMPLE AND METHODS Included were 511 women who within 12 weeks had had breast cancer surgery, were aged 20-63 years, had no distant metastasis, pre-surgical chemotherapy, or previous breast cancer, and worked ≥75% before breast cancer diagnosis. Percentages and odds ratios (OR) for being on sick leave were calculated, using multivariable analyses. RESULTS Of the women, 10% reported arm morbidity, 43% had had a total axillary clearance, and 60% were on sick leave. In multivariable analysis, those with planned chemotherapy had the highest OR (4.69; 95% CI 2.97-7.41) for being on sick leave. Nevertheless, those reporting arm morbidity had the second highest OR (2.71; 1.23-5.97) which was higher than if having strenuous work postures (2.49; 1.50-4.15) or having had an axillary clearance (1.64; 1.04-2.60). CONCLUSION Arm morbidity is an important factor for whether being on sick leave or not shortly after breast cancer surgery, even more important than type of axillary surgery or work situation. However, planned chemotherapy had the greatest impact for being on sick leave already shortly after breast cancer surgery.

Sickness absence in relation to breast and arm symptoms shortly after breast cancer surgery

PURPOSE To determine whether and, to what extent, breast and arm symptoms are associated with sick leave (SL) shortly after breast cancer (BC) surgery, and to investigate the associations of these symptoms and different surgical procedures with SL, adjusting for age and work posture. Women (n = 511), aged 26-63 years, who worked ≥ 75% before a BC diagnosis, were included within 12 weeks of surgery. RESULTS 31% reported breast symptoms and 22% arm symptoms; and, of these, 47% reported both. Having strenuous work postures increased the OR for being on SL most (OR 2.60), followed by breast symptoms (OR 2.40), more extensive axillary (OR 2.24) or breast surgery (OR 2.13), and arm symptoms (OR 2.06). CONCLUSIONS Breast and arm symptoms are as strongly associated with being on SL as types of breast and/or axillary surgery. Early self-reported symptoms are important to consider in guidelines for SL and rehabilitation after BC surgery.