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- Browall, Maria, 1963, et al.
(författare)
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The impact of age on Health-Related Quality of Life (HRQoL) and symptoms among postmenopausal women with breast cancer receiving adjuvant chemotherapy.
- 2008
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Ingår i: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 47:2, s. 207-15
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Elderly women with breast cancer are often not given adjuvant chemotherapy (CT). One reason for this is that older women are believed to have more problems in tolerating side-effects of CT. The purpose of this study was to analyze the impact of age on health related quality of life (HRQoL) and symptoms in postmenopausal women with breast cancer undergoing adjuvant CT. PATIENTS AND METHODS: Eighty consecutive postmenopausal patients planned for CT were invited. Seventy-five agreed to participate (age 55-77 years). The patients completed two cancer-specific HRQoL questionnaires, The European Organisation for Research and Treatment of cancer (EORTC) EORTC-QLQ-C30, the EORTC-QLQ-BR23, and the Hospital Anxiety and Depression Scale (HADS) before, during, and 4 months after completion of treatment. The design was descriptional and longitudinal. Correlations were examined between age and change in HRQoL variables. RESULTS: No significant correlations were found between age and any of the assessed HRQoL domains or symptom scales, except for dyspnoea and sexual functioning. Age was inversely correlated to change in dyspnoea from baseline through follow-up, whereas older women perceived their sexual functioning significantly lower at baseline. CONCLUSION: The results indicate that among postmenopausal patients in the age range 55-77 years consecutively selected for adjuvant CT age was not a predictor of decreased HRQoL. This supports the argument that age should not be used in isolation in decisions about adjuvant CT for breast cancer in elderly women.
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| 2. |
- Browall, Maria, et al.
(författare)
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Daily assessment of stressful events and coping among post-menopausal women with breast cancer treated with adjuvant chemotherapy : Original article
- 2009
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Ingår i: European Journal of Cancer Care. - : John Wiley & Sons. - 0961-5423 .- 1365-2354. ; 18:5, s. 507-516
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (≥55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: 'nausea and vomiting', 'fatigue', 'other symptoms', 'isolation and alienation', 'fear of the unknown' and 'being controlled by the treatment'. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. 'Nausea/vomiting' was the most frequently observed stressful event (21.6%). 'Isolation and alienation' and 'fear of the unknown' were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy.
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| 3. |
- Browall, Maria, 1963
(författare)
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Experience of adjuvant treatment among postmenopausal women with breast cancer - Health-Related Quality of Life, symptom experience, stressful events and coping strategies.
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden, breast cancer is today the most common type of cancer among women. Of the approximately 7,059 women who developed the disease in Sweden during 2006, about 73% were postmenopausal and aged 55 or older at time of diagnosis, and about 33% were aged 70 or older. Survival time for women with breast cancer has been extended due primarily to the development of new adjuvant treatments; however, these treatments may produce a wide variety of troublesome symptoms. There are limited descriptions in the literature of how Health-Related Quality of Life (HRQoL) is affected by adjuvant treatments in elderly populations. Nevertheless, it is common that in clinical practice these women are offered less aggressive treatment due to fears that the side effects may be greater for them.This thesis explores the experience of adjuvant chemotherapy (CT) and/or radiotherapy (RT) among postmenopausal women with breast cancer. More specifically, the thesis aims to examine how HRQoL develops over time, what factors predict overall HRQoL after treatment and if age is associated with HRQoL. A further aim was to describe stressful events experienced by these women and how they manage these stressful events or situations. The participants were recruited from three centres in Sweden (Gothenburg, Stockholm and Skövde). In the first study, 150 women scheduled to receive adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75) were included. In the second study, 20 women with breast cancer were interviewed regarding their experiences during CT. The third and fourth studies included the same 75 women scheduled to receive adjuvant CT from the first study. Both inductive and deductive research methods were used. Data from the qualitative studies (II and IV) were analysed with content analyses (qualitative and quantitative). Data collected with quantitative methods were analysed using mainly non-parametric methods (Paper I and III). No significant relationship was found between age and any of the HRQoL domains, except dyspnoea and sexual functioning. Thirty percent of the diaries recorded no stressful events during adjuvant CT. Stressful events experienced during CT were more related to physical problems than to psychosocial problems. CT and RT affected many aspects of the women?s HRQoL negatively. RT was associated with more localized problems, whereas CT was associated with systemic symptoms. Nausea/vomiting was one of the most stressful events reported by women undergoing CT, increased significantly during and after treatment and was also the most anticipated side effect of CT. Fatigue and depression increased over time and remained high at time of follow-up. Baseline predictors for overall QoL after CT were emotional functioning and pain, whereas overall QoL after RT was predicted by baseline emotional and physical functioning, lower tumour stage and less breast symptoms. Social support from family, friends and health care professionals was important for these women. The women employed many different coping strategies for each stressful event. Acceptance, relaxation and distraction were the most commonly used strategies. In conclusion, CT and RT variously and seriously affect aspects of HRQoL in postmenopausal women. This indicates that the situation of these women cannot be understood as simply a function of chronological age, but as an individual process where the biological age is important. Patient care may be improved by focusing more attention on specific symptoms, notably fatigue, nausea/vomiting, and depression, and also on social and emotional functioning. Interventional studies are needed that specifically target identified pre-treatment predictors of later impaired QoL to determine if it is possible to prevent declines in QoL in these women. The deeper understanding of the coping strategies used by women to handle stressful events is also an important knowledge and a possible way for health care professionals to support in clinical practice.
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| 4. |
- Browall, Maria, et al.
(författare)
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Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women
- 2008
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 12:3, s. 180-189
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present study was twofold: first, to describe changes of Health-Related Quality of Life (HRQoL) during the adjuvant treatment among postmenopausal women with breast cancer; second, in the same population to identify the best predictors of Overall Quality of Life (QoL) after treatment, from perceived functioning, symptoms, emotional distress and clinical/demographic variables measured at baseline. The study group was 150 women (>= 55 years of age) scheduled for adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75). They were examined before (baseline), during and after completing the treatment. Data about QoL, perceived functioning, symptoms and emotional distress were collected with the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, BR23 and Hospital Anxiety and Depression Scale (HADS) questionnaires. The general finding was that the adjuvant treatments were associated with decrease in overall QoL, physical and role functioning, anxiety and body image, as well as with increase in fatigue, dyspnoea, pain, nausea/vomiting, constipation and systemic therapy side effects measured over time. For women receiving CT, better emotional functioning and less pain at baseline predicted better overall QoL at the end of the treatment. For women receiving RT, better physical and emotional functioning, less breast symptoms and lower tumour stage at baseline predicted better overall QoL at the end of the treatment.
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