Background Research recommends the development and evaluation of interventions to support women with breast cancer in returning to, or managing, work. Despite this, there has historically been a paucity of rehabilitation interventions to support women with breast cancer to maintain or return to their work role. The aim of this systematic review was to examine key characteristics of rehabilitation interventions, and their effectiveness on work outcomes for women with breast cancer, compared to usual care. Methods A systematic review was conducted of controlled studies of rehabilitation interventions with work outcomes for women with breast cancer. Six databases were systematically searched: EMBASE, Web of Science, MEDLINE (OVID), CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Results are presented either as pooled odds ratio (OR) or pooled effect size (hedges g) between groups, with 95% confidence intervals (CI). Narrative synthesis was conducted on intervention outcomes not suitable for meta-analysis. Results Five thousand, five hundred and thirty-five studies were identified. Nine out of 28 abstracts met inclusion criteria. Heterogeneity of interventions and outcomes precluded meta-analysis for most outcomes. Of the interventions included in meta-analysis, no significant differences compared to usual care were found for sick leave (2 studies (12 months); OR 1.11 (95% CI: 0.66 to 1.87), number of sick days taken (2 studies (six months); difference in effect: -0.08, (95% CI: -0.48 to 0.38) or working hours (2 studies (12 months); 0.19, (95% CI: -0.20 to 0.64). Only one study, with a multidisciplinary intervention, showed a significant difference for work outcomes when compared to usual care. Work-specific content featured in three interventions only, none of which provided conclusive evidence for improvement in work outcomes. Enhanced physical and psychological sequalae, and quality of life was observed in some studies. Conclusion There remains a lack of effective and methodologically rigorous rehabilitation intervention studies for breast cancer survivors. The development and evaluation of effective rehabilitation interventions to support return to work is warranted.
Background The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether the impact varied by social determinants of health (SDH). Methods Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models. Results A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P < .001) and lower QoL (β = −12.01, SE = 3.37, P < .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction < .05). Conclusions There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.
BACKGROUND: Breast cancer is the most common invasive cancer in females worldwide. While work is important for well-being, 84% of women in Ireland temporarily or permanently cease working up to six months post-breast cancer diagnosis. Under Irish law, there is a right to reasonable work accommodations, however paid sick leave is not state-mandated. Legislation internationally varies across nations. OBJECTIVE: The aim of this study was to explore the experiences of women who have had breast cancer returning to, and/or remaining in work, in the context of employment legislation. METHODS: Fifteen women with breast cancer, fifteen healthcare professionals, and nine employers nationwide participated in a qualitative-descriptive design, using semi-structured interviews. Interviews were audio-recorded, transcribed, and data analysed using thematic analysis. RESULTS: Thirty-nine participants were recruited. A prominent theme from interviews was that most women with breast cancer and healthcare professional cohorts were not aware of employment rights in the context of cancer diagnoses. This is in contrast to employers. Experiences of sick leave and pay entitlements varied amongst women with breast cancer with financial pressure and expediated the return to work evident for some participants. Most women did not report any discrimination on returning to the workplace, although there were examples of indirect discrimination where unfair expectations were being placed on women by colleagues. CONCLUSIONS: Education and awareness on employment rights and entitlements during and after cancer treatment is warranted. This could be incorporated into work-focused interventions to support those living with and beyond cancer to transition back into the workplace.
Background Deformation imaging represents a method of measuring myocardial function, including global longitudinal strain (GLS), peak atrial longitudinal strain (PALS) and radial strain. This study aimed to assess subclinical improvements in left ventricular function in patients undergoing transcatheter aortic valve implantation (TAVI) by comparing GLS, PALS and radial strain pre and post procedure. Methods We conducted a single site prospective observational study of 25 patients undergoing TAVI, comparing baseline and post-TAVI echocardiograms. Individual participants were assessed for differences in GLS, PALS and radial strain in addition to changes in left ventricular ejection fraction (LVEF) (%). Results Our results revealed a significant improvement in GLS (mean change pre-post of 2.14% [95% CI 1.08, 3.20] p = 0.0003) with no significant change in LVEF (0.96% [95% CI − 2.30, 4.22], p = 0.55). There was a statistically significant improvement in radial strain pre and post TAVI (mean 9.68% [95% CI 3.10, 16.25] p = 0.0058). There was positive trend towards improvements in PALS pre and post TAVI (mean change of 2.30% [95% CI − 0.19, 4.80] p = 0.068). Conclusion In patients undergoing TAVI, measuring GLS and radial strain provided statistically significant information regarding subclinical improvements in LV function, which may have prognostic implications. The incorporation of deformation imaging in addition to standard echocardiographic measurements may have an important role in guiding future management in patients undergoing TAVI and assessing response.
COVID-19 has heightened social inequalities, particularly for those with non-communicable diseases (NCDs), such as cancer, and health services for NCDs have been significantly disrupted. Breast cancer (BC) is the most common cancer for women in Ireland, and the impact of the pandemic on BC care needs to be established. The purpose of this study is to explore the health care experience of women with BC during the pandemic and to investigate whether these experiences vary based on social determinants of health (SDH). The study included semi-structured qualitative interviews with 37 women who had previously participated in a related quantitative study. Individuals were selected through stratified purposive sampling to ensure data was available on information-rich cases based on SDH. Interviews were conducted in early 2021 and thematic analysis was conducted using NVivo software. Three major themes, with additional subthemes, emerged from analysis: breast cancer services; breast cancer support and communication; and mental well-being. There were differences in women’s experiences within the themes that were dependent upon the SDH, including socio-economic status (SES), region, and time since diagnosis. For example, most women experienced disrupted BC services throughout the pandemic, but disruptions were more severe for women of lower SES. Table 1 provides quotation examples as evidence for these different experiences. The pandemic has impacted women with BC considerably, but the impact differed by social inequalities and time of diagnosis. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice. Table 1. General experiences and variation of experience based on SDH for women receiving BC services during COVID-19 Diagnostic/screening services Active treatment services Post-treatment services General experiences “I felt a lump… so I went to my own GP. She saw me and she faxed a letter straight into [cancer centre]. Within a week, I was in [cancer centre] having seen the doctors and then followed on with biopsies and mammograms.” “Well, it was a stressful period of time because I felt it was growing. And I couldn''t do anything about it. And the hospitals weren''t really taking patients… But eventually I got called again into the… clinic. I had my operation there.” “…the safety net of going in and being told this is all normal, you’re okay. And yeah, that’s gone, even though I know I can pick up the phone if I want to. But it’s not the same.” Experience based on SDH “What happened was… I got an appointment sent out for October. And I phoned them and they said to me look, there’s probably other women that met the criteria, that needed the mammogram before me.” (low SES) “I’d wait for three months or such time until COVID was over… before he would do anything. And I, at that time, I just said “no, I can’t wait that long, that’s too long.” (low SES) “I haven''t had an MRI in about a year and I meant to be getting them every six months. So then when I did, [the lump] just showed up.” (low SES) Citation Format: Charlotte L. Myers, Catherine Waldron, Kathleen Bennett, Caitriona Cahir. COVID-19 and breast cancer care in Ireland: A qualitative study to explore the perspective of breast cancer patients on their health and health care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5276.
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