| 1. |
- Kenne Sarenmalm, Elisabeth, 1956, et al.
(författare)
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Changes in health-related quality of life may predict recurrent breast cancer.
- 2009
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1532-2122 .- 1462-3889. ; 13:5, s. 323-329
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patient-reported outcomes incorporated in cancer clinical trials, are increasingly hypothesized to be predictors of disease-free survival. Previous research supports health-related quality of life (HRQoL) as an independent predictor of survival in patients with advanced or metastatic breast cancer. In contrast, recent studies provide evidence that baseline HRQoL scores are not associated with increased risk of relapse or survival in women with early-stage breast cancer. One plausible assumption might be that baseline HRQoL scores are limited as predictors of a recurrence of breast cancer several years after the initial diagnosis. In this explorative study, we examined whether changes in HRQoL over time may predict breast cancer recurrence. As a supplement, we investigated whether baseline HRQoL predicted recurrence. METHODS: The study sample consisted of 141 participants in the International Breast Cancer Study Group adjuvant Trial 12-93 and Trial 14-93, from the Western region of Sweden. HRQoL was assessed, during a 5-year follow up. Poisson regression analysis was used to estimate the hazard function of recurrence depending on time since primary diagnosis and on HRQoL variables. RESULTS: According to the Poisson multivariable regression analysis changes in physical well-being (beta=0.00439, p-value=0.0470), and nausea/vomiting (beta=-0.00612, p-value=0.0136) significantly predicted recurrence. Baseline HRQoL outcomes were not predictors of recurrence. CONCLUSIONS: Changes of HRQoL during adjuvant therapy may be associated with recurrence. This explorative finding needs prospective investigation.
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| 2. |
- Kenne Sarenmalm, Elisabeth, 1956, et al.
(författare)
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Coping with recurrent breast cancer: predictors of distressing symptoms and health-related quality of life.
- 2007
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Ingår i: Journal of pain and symptom management. - : Elsevier BV. - 0885-3924 .- 1873-6513. ; 34:1, s. 24-39
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about how postmenopausal women with recurrent breast cancer cope with distressing symptoms and which factors predict health-related quality of life (HRQOL). In the present study, 56 consecutively enrolled patients completed questionnaires measuring symptom occurrence, coping capacity, coping efforts, and HRQOL at the time of recurrence. Results from this study illustrate that women with recurrent breast cancer suffer from multiple, concurrent, and interrelated symptoms of illness, anxiety, depression, and fatigue. Highly prevalent symptoms are lack of energy, difficulty sleeping, pain, worrying, problems with sexual interest, feeling sad, and dry mouth. The most frequently occurring symptom is problem with sexual interest, and the most severe symptom is worrying. The most distressing symptom experienced is pain. The majority of the women report 10-23 symptoms. Women who experience multiple symptoms also report higher levels of symptom distress. The experience of distressing symptoms is predicted by coping capacity, and the coping efforts experienced predict HRQOL. Patients with lower coping capacity report higher prevalence of symptoms, experience higher levels of distress, and experience worse perceived health, which in turn may decrease their HRQOL. To help women manage recurrent breast cancer, it is important to use multidimensional measurement to identify, evaluate, and treat distressing symptoms, and not assess single symptoms only. Care must be based upon the awareness of critical factors that exacerbate vulnerability to distress, as well as the ability to adapt to a recurrent breast cancer disease.
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| 3. |
- Kenne Sarenmalm, Elisabeth, 1956, et al.
(författare)
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Experience and predictors of symptoms, distress and health-related quality of life over time in postmenopausal women with recurrent breast cancer.
- 2008
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 17:5, s. 497-505
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to explore the symptom experience and predictors of distress and quality of life over time in women with recurrent breast cancer. Fifty-six women completed questionnaires at the diagnosis of recurrence, 1 month, 3 and 6 months after recurrence. A majority of women reported multiple, concurrent and distressing symptoms such as lack of energy, difficulty sleeping, pain, worry and problems with sexual interest or activity during the recurrent breast cancer trajectory. The highest level of symptom burden and distress and decreased quality of life was reported 3 months after recurrence. Although distress declined and quality of life improved over time, patients reported persistent symptoms. Of the patients at increased risk of vulnerability to distress were women who experienced multiple and concurrent symptoms. Other risk factors were co-morbidity, prehistory of anxiety and depression and progressive or terminal disease. Fatigue, pain and depression explained 68-72% of the variance in distress. Distress explained 44-46% of the variance in quality of life. These findings suggest that symptoms are important contributors to the distress experience, and that distress has a severe impact on quality of life. The care of women with recurrent breast cancer must be based upon the awareness of critical factors that exacerbate the vulnerability to distress throughout the disease trajectory.
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| 4. |
- Kenne Sarenmalm, Elisabeth, 1956, et al.
(författare)
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Making Sense of Living Under the Shadow of Death: Adjusting to a Recurrent Breast Cancer Illness
- 2009
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Ingår i: QUALITATIVE HEALTH RESEARCH. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 19:8, s. 1116-1130
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Tidskriftsartikel (refereegranskat)abstract
- Women with recurrent breast cancer face many difficulties and challenges, from clinical symptoms of disease progression and treatment to a range of emotional responses. Guided by grounded theory methodology, we explored the main concerns of women with recurrent breast cancer, and how they were dealing with their situations. Data were collected from 40 in-depth interviews with 20 women diagnosed with recurrent breast cancer. The core category illustrated the process of “making sense of living under the shadow of death,” and was based on the women's experiences of adjusting to living with a persistent life-threatening illness. Confronting a recurrence of breast cancer was a life-altering event. Moving through a difficult and challenging time, women eased their distress by letting go of losses and reassessing important values. Through a personal transition women transcended living with a life-threatening illness. These findings emphasize the importance of recognizing existential distress in clinical practice.
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| 5. |
- Kenne Sarenmalm, Elisabeth, 1956
(författare)
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When Breast Cancer Returns. Women's experiences of Health, Illness and Adjustment During the Breast Cancer Trajectory
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although a recurrence of breast cancer is associated with significant distress, affecting health-related quality of life (HRQOL), little is known about women?s experience during the recurrent breast cancer trajectory. The primary aim of this thesis was to explore women?s experiences of health, illness and adjustment to a recurrence of breast cancer. Both deductive and inductive methods were used. The first aim was to explore whether HRQOL factors predicted recurrence. The second aim was to explore distress, symptoms and HRQOL, over time in women with recurrent breast cancer. The third aim was to explore what major concerns these women experienced and how they deal with their situations living with recurrent breast cancer. The four papers included in this thesis are based on selected quantitative data (Papers I?III) and qualitative data (Paper IV). Exploratory findings suggest that changes in physical well-being and nausea/vomiting may predict recurrence. Women with recurrent breast cancer experience multiple, concurrent, and persistent symptoms. Nearly ninety percent of the patients reported fatigue at the time of recurrence. Women with a strong sense of coherence reported a lower prevalence of symptoms and experienced lower levels of distress and better perceived adjustment to their illness, as well as perceived a better health and quality of life. Distress had a major impact on HRQOL. Over time, women adjusted to the many implications of a life-threatening illness through personal transition. By making sense of living with a threat to their lives, the women adjusted to their recurrence. The findings highlight the major existential impact of a recurrence. Promoting health is possible, even in severe illness and in unchangeable and almost unbearable situations. Opportunities to manage adversity remain. Women may transcend their illness by finding new meaning through discovering or re-discovering significant values in life, and creating wellness by being in the present moment.
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