WINSTON-SALEM, N.C. -- As the number of long-term survivors of cancer continues to grow, the medical community is becoming more concerned about issues of survivorship and quality of life and a new study will examine these issues.
"Breast cancer survivors face issues related to spiritual, physical, economic and psychosocial issues," said Electra D. Paskett, Ph.D., associate professor of public health sciences (epidemiology) at the Wake Forest University School of Medicine. "These issues have not been well-studied in terms of incidence, duration and impact on overall health-related quality of life as a survivor."
She added, "Issues of survivorship are especially important in breast cancer due to the increased use of mammography and the increasing number of younger women being diagnosed."
Paskett is the principal investigator of the new two-year study, paid for with a $276,332 grant from the National Institute on Aging.
"These women 'survive' the immediate crisis involving the diagnosis and treatment and enter into a new chronic phase of survivorship that involves lifelong utilization of medical resources, psychological effects, changes in social relationships and economic impacts," Paskett said.
The study will examine the prevalence of reproductive problems, early menopause, osteoporosis, the effect of the chemotherapy on the heart, post-surgery pain, fatigue, and weight gain.
For instance, more than half the women treated with chemotherapy following surgery will have chemically induced menopause. But estrogen replacement therapy, which ordinarily provides women with relief from menopausal symptoms, is controversial in women with a history of breast cancer, Paskett said.
Osteoporosis is another potential problem. Following chemotherapy-induced ovarian failure, some studies have found significant decreases in bone mineral density -- an indication that osteoporosis is occurring. But sizable surverys of the prevalence and effect of osteoporosis in breast cancer survivors do not exist. Tamoxifen, which is used to decrease the risk of breast cancer recurrence, may also help prevent loss of bone density. So might estrogen replacement therapy.
The investigators will look at the benefits of "lumpectomy" -- removal of only the lump and surrounding tiessue (instead of the whole breast) -- or reconstructive surgery to reduce the permanent scarring and disfiguring of the breast.
They will explore the economic consequences of breast cancer. Paskett noted that some previous studies have suggested that women who had had breast cancer have difficulties in making enough money to meet their needs, that health insurance was often difficult to obtain, and that some women reported difficulties at work.
Psychological issues include anxiety over the future, loneliness, depression, anger, guilt, fear about recurrence and body image changes. Often these are accompanied by marital and relationship stress, isolation and changes in social support.
Based on the findings, the investigators will develop and pilot test a telephone-based counseling intervention for long-term breast cancer survivors.
They will randomly select 400 disease-free breast cancer survivors who are 8-13 years post diagnosis and who have participated in a particular clinical trial of the Cancer and Leukemia Group B, a major national cancer clinical trials cooperative group composed of 200 institutions from both academic medical centers and community hospitals.
The women in this group have had combination therapy using cyclophosphamide, Adriamycin and 5-fluorouracil. Paskett said about half the women were premenopausal at the time of diagnosis.
The results of the project will be used to find ways of reducing the physical, psychosocial, spiritual and economic consequences of the diagnosis and treatment of breast cancer on those women who become long-term survivors.
Contact: Robert Conn, Jim Steele or Mark Wright at (336) 716-4587