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      Early-Onset Breast Cancer: Effect of Diagnosis and Therapy on Fertility Concerns, Endocrine System, and Sexuality of Young Mothers in Germany

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          Background: The purpose of this study was to analyze the effect of breast cancer therapy on fertility concerns and sexuality of young mothers with breast cancer in Germany. Methods: During a mother-child rehabilitation program, 1,191 young mothers with locoregional primary breast cancer, treated between 2006 and 2014, were recruited. Data included sociodemographic data, TNM stage, tumor biology, therapies, and patient-reported outcomes such as sexuality and fertility concerns. Results: The mean age at diagnosis was 40 years. Approximately a quarter of the patients stated that family planning had not been completed at the time of diagnosis. Nearly half of all patients had been informed as to how treatment could affect fertility, but counseling at a specialized fertility center was offered to only 13%. Of all patients, 4% took a consultation and 2% underwent fertility preservation procedures. Conclusion: Our study indicates that only a minority of patients is referred to fertility centers although family planning is incomplete at the time of diagnosis in about 25% of young women with breast cancer. Thus, these patients should not only be informed about the effects of treatment on fertility and sexuality, but should be referred to a fertility center.

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          Most cited references 17

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          Life after breast cancer: understanding women's health-related quality of life and sexual functioning.

          To describe the health-related quality of life (HRQL), partner relationships, sexual functioning, and body image concerns of breast cancer survivors (BCS) in relation to age, menopausal status, and type of cancer treatment. A cross-sectional sample of BCS in two large metropolitan areas was invited to participate in a survey study that included the following standardized measures: the RAND 36-Item Health Survey; the Centers for Epidemiologic Studies-Depression Scale (CES-D); the Dyadic Adjustment Scale (DAS); the Breast Cancer Prevention Trial (BCPT) Symptom Checklist; the Watts Sexual Functioning Questionnaire (WSFQ); and subscales from the Cancer Rehabilitation Evaluation System (CARES). Eight hundred sixty-four BCS completed the survey. RAND Health Survey scores were as good or better than those of healthy, age-matched women, and the frequency of depression was similar to general population samples. Marital/partner adjustment was similar to normal healthy samples, and sexual functioning mirrored that of healthy, age-matched postmenopausal women. However, these BCS reported higher rates of physical symptoms (eg, joint pains, headaches, and hot flashes) than healthy women. Sexual dysfunction occurred more frequently in women who had received chemotherapy (all ages), and in younger women who were no longer menstruating. In women > or = 50 years, tamoxifen therapy was unrelated to sexual functioning. BCS report more frequent physical and menopausal symptoms than healthy women, yet report HRQL and sexual functioning comparable to that of healthy, age-matched women. Nevertheless, some survivors still experience poorer functioning, and clinicians should inquire about common symptoms to provide symptomatic management or counseling for these women.
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            Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study.

            There are many conflicting results in the literature comparing quality of life following breast-conserving therapy (BCT) and mastectomy. This study compared long-term quality of life between breast cancer patients treated by BCT or mastectomy in three age groups. Patients (n = 990) completed a quality of life survey, including the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), at regular intervals over 5 years. In the cross-sectional data, mastectomy patients had significantly (p or =70 years of age reported higher body image and lifestyle scores when treated with BCT. The repeated measures analysis indicated that four functioning scores, half the symptom scores, future health, and global quality of life improved significantly (p < 0.01) over time. All these variables increased significantly for BCT patients and those 50 to 69 years of age. Body image, sexual functioning, and lifestyle disruption scores did not improve over time. BCT should be encouraged in all age groups. Coping with appearance change should be addressed in patient interventions.
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              Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study.

              Breast-conserving therapy (BCT) was developed to improve quality of life (QOL) in early stage breast cancer patients. Except for differences in body image, literature comparing the psychosocial sequelae of BCT with mastectomy is ambiguous and shows a lack of substantial benefits. However, knowledge regarding long term effects of treatment on QOL in breast cancer is very limited as most of the pertinent studies have been performed in the early post-operative period. Therefore we compared QOL in women with breast cancer undergoing BCT versus women undergoing mastectomy over a 5-year period following primary surgery. QOL was assessed at 1, 3, and 5 years after diagnosis in a population based cohort of 315 women with early stage breast cancer (UICC stage I-II) from Saarland (Germany) using the EORTC QLQ-C30 questionnaire and the breast cancer specific module BR23. Breast-conserving therapy was performed in 226 women (72%). After control for potential confounding, women with BCT reported better physical and role functioning, were sexually more active and more satisfied with their body image already at 1 year after diagnosis (all P values < 0.05). Differences in overall QOL and social functioning were gradually increasing over time and became statistically significant only at 5 years. Whereas some, very specific benefits of BCT, such as a better body image, are already visible very timely after completion of therapy, benefits in broader measures such as psychosocial well-being and overall quality of life gradually increase over time and become fully apparent only in the long run.

                Author and article information

                Breast Care
                S. Karger AG
                March 2019
                05 September 2018
                : 14
                : 1
                : 23-29
                a Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; b Department of Urology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; c Insitute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany; d Authority for Health and Consumer Protection, Hamburg Cancer Registry, Hamburg, Germany; e Department of Obstetrics and Gynecology, Ernst von Bergmann Clinic, Potsdam, Germany
                Author notes
                *Dr. med. Telja Pursche, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany, Telja.Pursche@uksh.de
                488795 PMC6465684 Breast Care 2019;14:23-29
                © 2018 S. Karger GmbH, Freiburg

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                Page count
                Figures: 1, Tables: 3, References: 27, Pages: 7
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/488795
                Research Article


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