Mary Jo Nissen

Quality of life after breast carcinoma surgery: a comparison of three surgical procedures.

Because breast‐conserving surgery (BCS), mastectomy alone, and mastectomy with reconstruction are equally effective for the treatment of early stage breast carcinoma, womens choice among them often focuses on quality‐of‐life (QOL) issues. Information regarding QOL after these surgical treatments could help women with this decision.

Case-Control Study to Evaluate Predictors of Lymphedema After Breast Cancer Surgery

PURPOSE/OBJECTIVES To identify risk factors for lymphedema after breast cancer surgery. DESIGN Multisite case-control study. SETTING Lymphedema clinics in the upper midwestern region of the United States. SAMPLE 94 patients with lymphedema and 94 controls without lymphedema, matched on type of axillary surgery and surgery date. METHODS The Measure of Arm Symptom Survey, a patient-completed tool, assessed potential risk factors for lymphedema. Severity of lymphedema was measured by arm circumference, and disease and treatment factors were collected via chart review. MAIN RESEARCH VARIABLES Risk factors for lymphedema after breast cancer surgery. FINDINGS On univariate analysis, patients with lymphedema were more likely than controls to be overweight (body mass index >or= 25) (p = 0.009). They also were more likely to have had axillary radiation (p = 0.011), mastectomy (p = 0.008), chemotherapy (p = 0.033), more positive nodes (p = 0.009), fluid aspirations after surgery (p = 0.005), and active cancer status (p = 0.008). Strength training (p = 0.014) and air travel (p = 0.0005) were associated with less lymphedema occurrence. On multivariate analysis, the only factor significantly associated with lymphedema was being overweight (p = 0.022). CONCLUSIONS Being overweight is an important modifiable risk factor for lymphedema. Axillary radiation, more extensive surgery, chemotherapy, and active cancer status also were predictive of lymphedema. IMPLICATIONS FOR NURSING This study provides evidence that excess weight contributes to lymphedema; strength training and airline travel did not contribute to lymphedema.

Quality of life after postmastectomy breast reconstruction

PURPOSE/OBJECTIVES To explore womens expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction. DESIGN Qualitative focus group study. SETTING Integrated healthcare system in a midwestern suburban community. SAMPLE 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer. METHODS An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization. FINDINGS Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence. CONCLUSIONS Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence. IMPLICATIONS FOR PRACTICE Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

Surgical recommendation for early‐stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early‐stage breast carcinoma who underwent SLND without concomitant ALND.

Changes in Weight and Body Composition in Women Receiving Chemotherapy for Breast Cancer

PURPOSE This study aimed to identify predictors of changes in weight and body composition among women receiving chemotherapy for breast cancer. PATIENTS AND METHODS Data were from 49 women age 40-54 receiving chemotherapy for breast cancer. Weight, height, and body composition measurements from dual-energy x-ray absorptiometry (DEXA) scanning were completed at baseline (within 1 month of beginning chemotherapy) and 12 months. Caloric intake was assessed from food diaries at baseline, 6 and 12 months, and physical activity was measured by questionnaire at baseline, 3, 6, 9, and 12 months. RESULTS Baseline body mass index (BMI) was inversely associated with gains in weight (P = .01) and fat mass in torso (P = .006). Women of normal weight gained an average of 4.3 pounds and increased fat mass in torso and arms. Overweight women lost 3.0 pounds, and obese women lost 4.1 pounds, and neither group increased body fat. Decreased physical activity was associated with weight gain (P = .047). Additional predictors of increased fat mass in torso were younger age (P = .023) and treatment with tamoxifen (P = .015). Predictors of loss of bone mineral content included older age (P = .004) and treatment with aromatase inhibitor (P = .024), whereas treatment with bisphosphonate prevented bone loss (P < .0001). CONCLUSION Women receiving chemotherapy for breast cancer who are of normal weight at the time of breast cancer diagnosis are more likely to gain weight and body fat during the following year than overweight or obese women.

Physical Activity in Women Receiving Chemotherapy for Breast Cancer: Adherence to a Walking Intervention

PURPOSE/OBJECTIVES To describe and predict adherence to a physical activity protocol for patients with breast cancer receiving chemotherapy. DESIGN Longitudinal, observational study. SETTING Cancer center in the upper Midwestern region of the United States. SAMPLE 36 patients with breast cancer aged 40-55 years who were receiving adjuvant treatment. METHODS A longitudinal study was conducted within a randomized clinical trial comparing the effects of physical activity versus bisphosphonates on bone mineral density. Participants randomized to physical activity were advised to walk 10,000 steps per day and received initial physical therapy consultation and ongoing motivational interviewing. Multilevel modeling was used to identify variables that predict adherence. MAIN RESEARCH VARIABLES Adherence to the 10,000-step protocol was estimated with total steps and mean steps per day. FINDINGS Thirty-six women were enrolled in the physical activity group; 29 provided step data. The mean total steps per participant for the first six weeks was 280,571 (SD = 111,992), which is 67% of the prescribed steps. Excluding days when no steps were recorded, the mean steps per day for the initial six-week period was 7,363 (SD = 2,421), a 74% adherence rate. A significant linear increase occurred in steps per day after chemotherapy in a treatment cycle (p < 0.0001). Baseline inactivity predicted adherence. CONCLUSIONS Adherence to the walking program was compromised during chemotherapy but improved after chemotherapy completion. IMPLICATIONS FOR NURSING Knowing that chemotherapy predicts adherence to a walking protocol is useful for selecting the type, timing, and intensity of physical activity interventions.

Breast and colorectal cancer survivors’ knowledge about their diagnosis and treatment

IntroductionAspects of a personal cancer history can have implications for future decisions regarding screening, diagnosis, and treatment. Clinicians must sometimes rely on patients’ self-report of their medical history. This study assessed knowledge of details of cancer diagnosis and treatment among breast and colorectal cancer survivors.MethodsWritten surveys were completed by 480 breast cancer survivors and 366 colorectal cancer survivors diagnosed between 1999 and 2008 at a large cancer center in the Minneapolis, MN, area (81% response rate). Responses were compared with cancer registry and medical records.ResultsForty percent of breast cancer survivors and 65% of colorectal cancer survivors were unable to identify their stage of disease. Seven percent of breast cancer survivors and 21% of colorectal cancer survivors in whom regional nodes were examined did not know whether they had positive nodes. Accuracy of knowledge of estrogen and progesterone status among breast cancer survivors was 58% and 39%, respectively. Of breast cancer survivors treated with doxorubicin, 43% correctly identified it as a drug they had received. Their accuracy of identification of receipt of tamoxifen or specific aromatase inhibitors was >90%. Of colorectal cancer survivors treated with oxaliplatin, 52% correctly identified it as a drug they had received. Accuracy on many items decreased with patient age.ConclusionsThis study identifies several gaps in adult cancer survivors’ knowledge of details of their diagnosis and treatment that have implications for follow-up care.Implications for cancer survivorsProvision of written treatment summaries to cancer survivors could help them obtain appropriate patient-centered long-term follow-up care.

Identification of tools to measure changes in musculoskeletal symptoms and physical functioning in women with breast cancer receiving aromatase inhibitors.

PURPOSE/OBJECTIVES To estimate and compare responsiveness of standardized self-reported measures of musculoskeletal symptoms (MSSs) and physical functioning (PF) during treatment with aromatase inhibitors (AIs). DESIGN Prospective, longitudinal study. SETTING Park Nicollet Institute and North Memorial Cancer Center, both in Minneapolis, MN. SAMPLE 122 postmenopausal women with hormone receptor-positive breast cancer. METHODS MSSs and PF were assessed before starting AIs and at one, three, and six months using six self-reported MSSs measures and two PF tests. MAIN RESEARCH VARIABLES MSSs and PF changes from baseline to six months. FINDINGS Using the Breast Cancer Prevention Trial-Musculoskeletal Symptom (BCPT-MS) subscale, 54% of participants reported MSSs by six months. Scores from the BCPT-MS subscale and the physical function subscales of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) were most responsive to changes over six months. CONCLUSIONS BCPT-MS, AUSCAN, and WOMAC were the most responsive instruments for measuring AI-associated MSSs. IMPLICATIONS FOR NURSING Assessment and management of MSSs are important aspects of oncology care because MSSs can affect functional ability and AI adherence. KNOWLEDGE TRANSLATION The three measures with the greatest sensitivity were the BCPT-MS, AUSCAN, and WOMAC questionnaires. These measures will be useful when conducting research on change in MSSs associated with AI treatment in women with breast cancer.

Cancer rehabilitation: outcome evaluation of a strengthening and conditioning program.

Background: Cancer treatments can lead to detriments in patients’ health and declines in quality of life (QOL). Cancer rehabilitation programs may improve functional status, symptom control, and QOL. Objective: The objective of this study was to determine if an outpatient, physical therapy–supervised Cancer Rehabilitation Strengthening and Conditioning (CRSC) program improved patients’ conditioning level, functional status, QOL, and symptoms. Methods: This was a prospective study of oncology patients participating in CRSC program. Measurements included conditioning level (6-minute walk test [SMWT], metabolic equivalent level, grip strength), functional status (Physical Component Summary of Short Form 36), QOL (Mental Component Summary of Short Form 36), and symptoms (M. D. Anderson Symptom Inventory). Paired t tests were conducted to determine significant changes between pre- and post-CRSC program measures, and regression methods identified predictors of change from baseline. Results: One hundred fifteen patients with cancer were enrolled in the study; 75 patients completed pre- and post-CRSC program measures. Significant improvements were noted in SMWT by 186.4 ft, SMWT speed by 0.35 mph, treadmill time (3.5 minutes longer), metabolic equivalent level (by 0.87 units), QOL, symptom severity, symptom interference with daily life, fatigue, shortness of breath, and sadness. Conclusions: In a pretest-posttest design, significant improvements were noted in conditioning level, functional status, QOL, and symptoms. Greater improvements were noted in participants who were most deconditioned at baseline. Implications for Practice: Further research should be conducted to provide additional support for CRSC programs. Cancer rehabilitation strengthening and condition programs may benefit patients across the continuum of care, including deconditioned patients.

Evaluating a risk-based model for mammographic screening of women in their forties

A risk‐based model was developed for recommendations for mammography screening of women in their 40s. We determined retrospectively the proportion of women already diagnosed in their 40s with breast cancer (BC) who would have been recommended for mammography screening by this model.