Abstract
A recent study indicated that sometimes, facing a highly stressful situation – such as being diagnosed with breast cancer and going through the treatment process – can lead to the reconsideration of one's life goals and past experiences and result in more positive attitude towards life.
Suzanne Danhauer and colleagues at the Wake Forest Baptist Medical Center (NC, USA) reported the results of a longitudinal study on 653 women recently diagnosed with breast cancer who were followed for 2 years, in the journal Psychooncology. The participants in the study completed surveys about their post-traumatic growth (PTG) within 8 months of diagnosis and 6, 12 and 18 months later. Danhauer mentioned to the journal Breast Cancer Management: “The novelty of this study was that it examined PTG over multiple time points, following cancer diagnosis, during cancer treatment and following treatment.” The authors used the PTG Inventory to analyze the data.
Danhauer summarized the results of the study, saying: “In this study, we found that PTG scores increased over time and most of the increase happened in the months following breast cancer diagnosis. Higher PTG was associated with some other interesting factors, such as greater level of ‘illness intrusiveness’ at baseline (how much having cancer ‘intrudes’ on a variety of areas of one's life) and increases in social support and more active coping strategies. The developers of the PTG concept suggest that PTG develops following processing of a ‘seismic’ event in one's life. Cancer diagnosis is a pretty ‘seismic’ event for many (although not all) people. So, having breast cancer really ‘intrude’ upon one's life while having supportive people and reasonable coping to handle all of the stress can work together to facilitate positive changes in one's life (in the paper, we defined the subscales of the measure and the types of positive changes that one might experience). Increases in social support can help women to process what they are dealing with and feel supported in contrast to feeling like they cannot talk about their cancer or their concerns with people close to them.”
Danhauer added: “Interestingly, we didn't find that PTG was related to how optimistic women were. So, it wasn't just the ‘glass half full’ respondents who reported that they experienced PTG.” The authors stressed that the experience of PTG does not occur in all people and it should not be expected to happen; however, they were surprised by “how common it is to talk about why one's life has improved in a variety of ways following cancer.”
When considering the possible implications of the results of their study, Danhauer concluded that “Emphasizing to oncologists and other healthcare providers that being open to hearing about what their patients are experiencing, including distress and (perhaps unexpected) positive outcomes, can be beneficial.”
– Written by Marco De Ambrogi
Source: Danhauer SC, Case LD, Tedeschi R et al. Predictors of posttraumatic growth in women with breast cancer. Psychooncology doi:10.1002/pon.3298 (2013) (Epub ahead of print).
“Emphasizing to oncologists and other healthcare providers that being open to hearing about what their patients are experiencing … can be beneficial.”
Study finds that hospitalized pregnant women are more likely to suffer from venous thromboembolism
Researchers based at the University of Nottingham (Nottingham, UK) and Guy's and St Thomas Foundation Trust (London, UK) have found that pregnant women admitted to hospital for reasons other than delivery have an increased risk of venous thromboembolism (VTE). The authors of the study, published in the British Medical Journal, explained how, to their knowledge, “this is the first study to assess the impact of antepartum hospitalization on the incidence of VTE during pregnancy.”
VTE is reported to affect approximately one to two pregnancies in every 1000 women, and in developed countries, it is one of the leading causes of maternal mortality. The researchers aimed to assess the risk of first VTE onset in pregnant women who were hospitalized, and compare those with rates of VTE in women who were not admitted to hospital. The team studied primary and secondary care records of 206,785 women aged 15–44 years, who had one or more pregnancies from 1997 to 2010. These women had no prior history of VTE. To assess risk, the absolute rate of VTE was compared with the rates that were observed during a follow-up period not associated with hospitalization. A Poisson regression model was used to estimate incidence rate ratios.
“…women hospitalized during pregnancy “should receive careful consideration” in terms of deciding who should receive thromboprophylaxis.”
The research team found that women who were hospitalized during pregnancy were associated with an excess risk of 16.6 cases per 1000 person-years when compared with time outside hospital (17.5-fold increase in risk). They also found an increased risk of 5.8 cases per 1000 person-years in the 28 days after discharge, with VTE events most likely to occur in the third trimester of pregnancy and in women aged 35 years and over.
The results of the study also demonstrated that women who were hospitalized for less than 3 days, when compared with time outside hospital, had an increased risk of 4.6 cases per 1000 person-years. By contrast, women hospitalized for 3 days or more had an increased risk of 14.1 cases per 1000 person-years. The research team had observed that the results were similar when taking other factors associated with VTE into consideration.
The results of this first-of-a-kind study allow the researchers to suggest that women hospitalized during pregnancy “should receive careful consideration” in terms of deciding who should receive thromboprophylaxis.
– Written by Simi Thankaraj
Sources: Abdul Sultan A, West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England. BMJ 347, f6099 (2013); Study finds high clot risk for women admitted to hospital during pregnancy: http://company.bmj.com/content/study-finds-high-clot-risk-women-admitted-hospital-during-pregnancy
UK expert warns that the fight against breast cancer is not a done deal
Hilary Thomas, Trustee of the charity Breakthrough Breast Cancer (London, UK), has tackled critics of cancer awareness campaigns and labeled public awareness as having “an incredibly important role to play in tackling the disease.”
In an article published by Oncology Central, an online portal for medical professionals, Thomas proposes the key challenge for advancing breast cancer research, prevention and treatment is confronting the fallacy that enough work has already been done. With 12,000 women in the UK losing their lives to the disease each year, Thomas believes that through awareness campaigns “we can continue to make a difference.”
Following a successful breast cancer awareness month in October, Thomas has outlined the three ways in which awareness campaigns contribute to the fight against the disease. The first is getting health promotion initiatives, such as Breakthrough Breast Cancer's TLC (touch, look, check), message into the public consciousness. The second is emphasizing the importance of risk factors. With an estimated 40% of breast cancers being preventable through lifestyle changes, drawing attention to alcohol intake and activity level are key messages that awareness campaigns put forward. The third strand is by raising money to fund research into new therapies for the disease.
Professor Thomas hits back at the criticism of the ‘pink fog’ – the perceived saturation of products and messages from breast cancer organizations and instead speaks of the risk of believing the “myth that breast cancer is a done deal.” Through both funding and awareness, she hopes we will move more quickly towards no longer losing 1000 UK women each month to breast cancer.
Thomas has both professional and personal experience of the disease. Thomas worked as a clinical oncologist at Hammersmith Hospital (London, UK) and Royal Surrey County Hospital (Surrey, UK) and from 2001 led the implementation of the National Health Service Cancer Plan over four National Health Service Trusts for a population of 1.2 million people, before becoming the Medical Director of the Royal Surrey County National Health Service Trust in 2004.
In 2006, however, Thomas developed breast cancer herself and underwent surgery followed by chemotherapy and radiotherapy. Thomas described this as a life-changing event that also put the patient experience at center stage. Following completion of her treatment, she chose to move in a different direction and after 2 years as Group Medical Director of Care UK, she joined KPMG (UK) in 2009 and is a partner in their health advisory business. Thomas has also been a Trustee of Breakthrough Breast Cancer since 2007.
Thomas explains that the field is making good progress and that through developments in awareness and treatments, more women are surviving breast cancer than ever before. However, there is still much more to be done. “Increasing the public's awareness of the gaps in our fight against the disease, and informing them how their voices, and their money, can help fill these gaps, is where breast cancer awareness initiatives are at their strongest. And it is through them that we can continue to make a difference.”
– Written by Tess O'Neil
Source: Oncology Central. What role does breast cancer awareness amongst the public have to play in improving prevention of disease and outcomes for patients?: https://oncology-central.com/content/article/what-role-does-breast-cancer-awareness-amongst-the-public-have-to-play-in-improving
Test for placental protein could help predict pre-eclampsia risk
Research published in a recent issue of Circulation explores how testing for PlGF in pregnant women can help differentiate women with pre-eclampsia from those with high blood pressure alone. In pregnant women suffering from hypertensive disorders, death and disability for them and their newborns are potential outcomes. The diagnosis of pre-eclampsia by using blood pressure and proteinuria is of limited use as they detect the features of the disease rather than predicting its onset. PlGF is a known angiogenic factor, and a secondary marker of associated placental dysfunction in pre-eclampsia, with low plasma concentrations in the disease.
The UK-based multicenter study involved 625 patients, of which 61% developed pre-eclampsia. The research team studied the diagnostic accuracy of low plasma PlGF concentration (>5th centile for gestation, Alere Triage® assay; Alere™, MA, USA) in women presenting with suspected pre-eclampsia between 20 and 35 weeks gestation (and up to 41 weeks gestation as a secondary analysis). Confirmed pre-eclampsia in the women led to delivery.
The study demonstrated that if the concentration of PIGF was below 100 pg/ml at less than 35 weeks of pregnancy, the baby was more likely to be delivered within 14 days. In a normal pregnancy, where the mother was not experiencing pre-eclampsia, the concentration of PIGF is reported to be between 100 and 3000 pg/ml.
Speaking of future studies, Lucy Chappell, a senior clinical lecturer from King's College London (London, UK) explains, “I would propose that further assessment of PlGF should be undertaken to measure the impact of changing diagnostic and treatment decisions on the health of mother and baby.”
– Written by Simi Thankaraj
Sources: Chappell LC, Duckworth S, Seed PT et al. Diagnostic accuracy of placental growth factor in women with suspected pre-eclampsia: a prospective multicenter study. Circulation 128(19), 2121–2131 (2013); World first pre-eclampsia test could save hundreds of babies: www.kcl.ac.uk/newsevents/news/newsrecords/2013/10-October/World-first-pre-eclampsia-test-could-save-hundreds-of-babies.aspx
Women with pregnancy-related liver disease could have a three-times higher stillbirth risk
Research funded by Sands (London, UK), a stillbirth and neonatal death charity, and managed by Wellbeing of Women (London, UK, has shown that intrahepatic cholestasis of pregnancy (ICP) could be one of the factors that causes stillbirth in women. ICP is a pregnancy-specific liver disease that is defined by maternal pruritus as well as raised serum levels of bile acids. This study, published by Hepatology and so far reported to be the largest of its kind, has demonstrated that the risk of stillbirth is increased by three-times in women suffering from severe ICP (from 0.5 to 1.5%).
The study was undertaken at the Institute of Reproductive and Developmental Biology, Imperial College London (UK) and the Women's Health Academic Centre, King's College London (UK), and was led by Catherine Williamson (Imperial College London) and Victoria Geenes (King's College London). The study aimed to determine the effect of ICP on perinatal outcome, and was the first study to demonstrate an increased association with stillbirth. The mechanism behind high risk lies behind the increase of bile acids produced by the mother. The results of the study could lead to changes in current management guidelines in pregnant mothers suffering from ICP. A pregnant woman is classified with having severe ICP when bile acids levels are ≥40 mmol/l and it is prevalent in approximately one in 1000 pregnancies. Using data collected by the UK Obstetric Surveillance System, Williamson studied the data of 713 women who were suffering from severe ICP and compared them to a low-risk control group.
In smaller case studies, severe ICP was demonstrated to be associated with deleterious outcomes for the baby; including fetal distress, low Apgar scores on delivery and stillbirth, as well as preterm labor. The study further confirmed the risks and has demonstrated that increased risk is associated with the higher prevalence of bile acids in the mother's blood. In stillbirth cases, peak bile acid levels were demonstrated to be higher. The results of the study demonstrated that women experiencing severe ICP and a singleton pregnancy (n = 669) had increased risks of preterm delivery (164 out of 664 [25%] vs 144 out of 2200 [6.5%]; adjusted odds ratio: 5.39; 95% CI: 4.17–6.98), neonatal unit admission (80 out of 654 [12%] vs 123 out of 2192 [5.6%]; adjusted odds ratio: 2.68; 95% CI: 1.97–3.65) and stillbirth (ten out of 664 [1.5%] vs 11 out of 2205 [0.5%]; adjusted odds ratio: 2.58, 95% CI: 1.03–6.49) when compared with a control group. The study also showed that seven out of ten stillbirths in ICP cases were associated with coexisting pregnancy complications.
From the study, the researchers concluded that bile acid levels should be utilized as a method to monitor ICP as they could provide crucial information regarding the wellbeing of the baby.
Jenny Chambers, the founder of ICP Support, hopes it “will enable the refinement of the current Royal College of Obstetricians and Gynaecologists guidelines, which may help to protect future unborn ICP babies.”
– Written by Simi Thankaraj
Sources: Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case–control study. Hepatology doi:0.1002/hep.26617 (2013) (Epub ahead of print); Sands-funded research shows stillbirth risk is three times higher in women with pregnancy-related liver disease: www.uk-sands.org/news/research/2013-11-11/sands-funded-research-shows-stillbirth-risk-three-times-higher-women
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