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Sherman K.A.,Macquarie University | Sherman K.A.,Westmead Breast Cancer Institute | Koelmeyer L.,Westmead Breast Cancer Institute
Psycho-Oncology | Year: 2013

Background The effective management of lymphedema risk following breast cancer surgery and treatment requires enactment of simple behavioural strategies, including regularly checking for early lymphedema symptoms. Adopting a broad self-regulatory perspective, our aim for this study was to identify psychological factors associated with adherence to these risk management strategies. Methods Women (N = 98) recently diagnosed with breast cancer and scheduled for breast and lymph node surgery completed questionnaires prior to surgery and at 3 months post-surgery. Variables assessed included demographics, cognitive belief variables in relation to lymphedema and its management (perceived negative consequences, perceived lymphedema controllability, self-efficacy, perceived personal risk, perceived self-regulatory ability to manage risk-related distress), lymphedema knowledge, trait anxiety and adherence to lymphedema risk management recommendations. Results Greater adherence was associated bivariately with greater beliefs in lymphedema controllability, self-efficacy, perceived consequences and perceived self-regulatory ability. Linear regression analyses revealed that only greater beliefs in the controllability of lymphedema and self-regulatory ability, as well as greater knowledge, were predictive of greater adherence to risk management strategies. Conclusions This study highlights the importance of underlying beliefs as determinants of whether a woman who is informed and knowledgeable about lymphedema risk and its management will undertake the recommended risk management actions. Along with raising awareness of lymphedema and its risk management, health professionals should promote positive beliefs among women regarding the controllability of lymphedema through early-detection/early- treatment approaches. In addition, educational approaches should aim to enhance a woman's beliefs in her ability to adhere to these risk management recommendations over time. Copyright © 2012 John Wiley & Sons, Ltd.

Bilinski K.,Westmead Breast Cancer Institute | Boyages J.,Macquarie University
Breast Cancer Research and Treatment | Year: 2013

The objective of this study is to examine the association between vitamin D status and risk of breast cancer in an Australian population of women. The study design is observational case-control study, performed at Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia. 214 women newly diagnosed with breast cancer were matched to 852 controls, and their blood samples were tested at the same laboratory between August 2008 and July 2010. Circulating 25-hydroxyvitamin D (25(OH)D) concentration, was defined as sufficient (≥75 nmol/L), insufficient (50-74 nmol/L), deficient (25-49 nmol/L) or severely deficient (<25 nmol/L). The difference in median 25(OH)D concentration between cases and controls was reported, and the Mann-Whitney U test was used to determine the significance of the difference. Odds ratios and 95 % confidence intervals for the risk of breast cancer were estimated by Cox regression. Median plasma 25(OH)D was significantly lower in cases versus controls overall (53.0 vs 62.0 nmol/L, P < 0.001) and during summer (53.0 vs 68.0 nmol/L, P < 0.001) and winter (54.5 vs 63.0 nmol/L, P < 0.001). Median 25(OH)D was also lower in cases when stratified by BMI (<30, ≥30) and age group (<50, ≥50 years) compared to matched controls, although the difference failed to reach statistical significance. In a Cox regression model, plasma 25(OH)D was inversely associated with the odds ratio of breast cancer. Compared to subjects with sufficient 25(OH)D concentration, the odds ratios of breast cancer were 2.3 (95 % CI 1.3-4.3), 2.5 (95 % CI 1.6-3.9) and 2.5 (95 % CI 1.6-3.8) for subjects categorised as severely deficient, deficient or insufficient vitamin D status, respectively. The results of this observational case-control study indicate that a 25(OH)D concentration below 75 nmol/L at diagnosis was associated with a significantly higher risk of breast cancer. These results support previous research which has shown that lower 25(OH)D concentrations are associated with increased risk of breast cancer. © 2012 Springer Science+Business Media New York.

Bartula I.,Macquarie University | Sherman K.A.,Macquarie University | Sherman K.A.,Westmead Breast Cancer Institute
Breast Cancer Research and Treatment | Year: 2013

Breast cancer patients are at increased risk of sexual dysfunction. Despite this, both patients and practitioners are reluctant to initiate a conversation about sexuality. A sexual dysfunction screening tool would be helpful in clinical practice and research, however, no scale has yet been identified as a "gold standard" for this purpose. The present review aimed at evaluating the scales used in breast cancer research in respect to their psychometric properties and the extent to which they measure the DSM-5/ICD-10 aspects of sexual dysfunction. A comprehensive search of the literature was conducted for the period 1992-2013, yielding 129 studies using 30 different scales measuring sexual functioning, that were evaluated in the present review. Three scales (Arizona Sexual Experience Scale, Female Sexual Functioning Index, and Sexual Problems Scale) were identified as most closely meeting criteria for acceptable psychometric properties and incorporation of the DSM-5/ICD-10 areas of sexual dysfunction. Clinical implications for implementation of these measures are discussed as well as directions for further research. © 2013 Springer Science+Business Media New York.

Bilinski K.,Westmead Breast Cancer Institute | Bilinski K.,University of Sydney | Boyages S.,University of Sydney
BMJ Open | Year: 2013

Objective: To comprehensively examine pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) testing in each state of Australia to determine the cost impact and value and to add evidence to enable the development of vitamin D testing guidelines. Design: Longitudinal analysis of all 25(OH)D pathology tests in Australia. Setting: Primary and Tertiary Care. Measurements: The frequency of 25(OH)D testing between 1 April 2006 and 30 October 2010 coded for each individual by provider, state and month between 2006 and 2010. Rate of tests per 100 000 individuals and benefit for 25(OH)D, full blood count (FBC) and bone densitometry by state and quarter between 2000 and 2010. Results: 4.5 million tests were performed between 1 April 2006 and 30 October 2010. 42.9% of individuals had more than one test with some individuals having up to 79 tests in that period. Of these tests, 80% were ordered by general practitioners and 20% by specialists. The rate of 25(OH)D testing increased 94-fold from 2000 to 2010. Rate varied by state whereby the most southern state represented the highest increase and northern state the lowest increase. In contrast, the rate of a universal pathology test such as FBC remained relatively stable increasing 2.5-fold. Of concern, a 0.5-fold (50%) increase in bone densitometry was seen. Conclusions: The marked variation in the frequency of testing for vitamin D deficiency indicates that large sums of potentially unnecessary funds are being expended. The rate of 25(OH)D testing increased exponentially at an unsustainable rate. Consequences of such findings are widespread in terms of cost and effectiveness. Further research is required to determine the drivers and cost benefit of such expenditure. Our data indicate that adoption of specific guidelines may improve efficiency and effectiveness of 25(OH)D testing. Copyright © 2013 BMJ Publishing Group. All rights reserved.

Bartula I.,Macquarie University | Sherman K.A.,Macquarie University | Sherman K.A.,Westmead Breast Cancer Institute
Breast Cancer Research and Treatment | Year: 2015

Sexual dysfunction following breast cancer treatment is common and screening for this is recommended. This study determined the reliability, validity, and acceptability of a breast cancer-specific adaptation of the Female Sexual Function Index, the FSFI-BC. This new measure addresses limitations in the FSFI when assessing sexual dysfunction of women with breast cancer regarding applicability to non-sexually active women, measuring distress and changes after cancer. Female breast cancer survivors (n = 596; 429 sexually active, 166 non-sexually active) completed an online survey including demographic/medical information, the FSFI-BC, and scales measuring sexual functioning, fatigue, body image, physical and mental health, and relationship adjustment (Time 1). Three weeks later, 326 women (245 sexually active; 81 non-sexually active) completed the Time 2 survey including the FSFI-BC, and questions regarding its acceptability and perceived change in sexual functioning. Reliability, construct validity, and acceptability were examined using standard scale validation techniques. Exploratory factor analysis delineated seven factors: Changes after cancer, desire/arousal, lubrication, orgasm, pain, satisfaction, and distress, accounting for 79.98 % (sexually active) and 77.19 % (non-active) variance in responses. Acceptable internal consistencies (non-active: α = 0.71–0.96; sexually active: α = 0.89–0.96) and test–retest reliabilities (non-active: r = 0.63–0.86; sexually active: r = 0.71–0.88) were evident. Inter-scale correlations provided evidence for convergent and divergent validities of the FSFI-BC. Both sexually active and non-active women provided positive feedback about the FSFI-BC. The optional partner questions demonstrated clinical utility. With desirable psychometric properties and acceptability to participants, the FSFI-BC is suitable for screening for sexual dysfunction in women with breast cancer. © 2015, Springer Science+Business Media New York.

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