Impact of cosmetic care on quality of life in breast cancer
Transcription
Impact of cosmetic care on quality of life in breast cancer
JEADV ISSN 1468-3083 ORIGINAL ARTICLE Blackwell Publishing Ltd Impact of cosmetic care on quality of life in breast cancer patients during chemotherapy and radiotherapy: an initial randomized controlled study G Titeca,*†§ F Poot,†§ D Cassart,‡ B Defays,† D Pirard,†§ M Comas,† P Vereecken,†¶†† V Verschaevec, P Simon,† M Heenen† † ‡ § ¶ Erasme University Hospital, Free University of Brussels, Belgium Institut de Statistique et de Recherche Opérationnelle and European Centre for Advanced Resaerch in Economics and Statistics, Brussels, Belgium Notre Dame de Grâce Clinic, Gosselies, Belgium Bordet Institute, Brussels, Belgium, †† CHU, Brugmann, Brussels, Belgium Keywords cosmetic care, quality of life, breast cancer *Corresponding author, Department of Dermatology, Notre Dame de Grâce Clinic, Gosselies, 212, chaussée de Nivelles, B−6041 Gosselies, Belgium, tel. +32 71 379 654; fax +32 71 379 623; E-mail: [email protected] Received: 24 October 2005, accepted 13 July 2006 DOI: 10.1111/j.1468-3083.2006.02080.x Abstract Background Breast cancer is the most common cancer in women and therefore represents a major problem in public health. Data from patients’ selfreport questionnaires provide valuable information about the side-effects that patients may view as having a significantly detrimental impact on their quality of life (QOL) and yet are not always recognized as important by healthcare professionals. Cosmetology is a specific care for patients and there is actually no scientific evidence regarding effects on QOL for women with breast cancer. Objective The purpose of this study is to assess the impact of cosmetic care on QOL in breast cancer patients during chemotherapy and radiotherapy. Methods We developed a prospective, multicentre, randomized, controlled study including 27 patients. All the patients had to fill in a French-validated dermatologic specific quality-of-life questionnaire to compare the QOL of the two groups, the cosmetic group and the control group, at three different times of the adjuvant treatment. Results The results show a statistically significant difference between the cosmetic group and the control group in two areas of QOL: mood state and selfperception of the disease. Conclusion This study emphasizes the interest of cosmetic care in breast cancer patients. However, further larger trials are needed to confirm this study. Introduction Breast cancer is the most common cancer in women and therefore represents an important problem in public health.1 Most patients with primary breast cancer can be optimally treated with breast-conserving local treatments. The addition of systemic hormone therapy and chemotherapy reduces the risk of death by 25–50% in patients with invasive carcinoma.2 These treatments are effective but are also sources of side-effects; chemotherapy is particularly a source of effects on the hair, nails and on the skin. On a psychological and aesthetic point of view, alopecia is probably one of the most difficult side-effects for patients. Moreover, disease and cancer treatments contribute to modify patients’ perception of their own body, their ‘body image’. Data from patients’ self-report questionnaires provide valuable information about the side-effects that patients may view as having a significantly detrimental impact on their quality of life (QOL) and yet are not always recognized as important by healthcare professionals. Such information is very important in enabling patients to make informed choices regarding treatment options.3 However, there are still surprisingly few published reports © 2007 The Authors JEADV 2007, 21, 771–776 Journal compilation © 2007 European Academy of Dermatology and Venereology 771 Impact of cosmetic care on QOL in breast cancer patients from comprehensive QOL studies comparing such treatments and thus little is known about the relative impacts of each of these on QOL.4–7 Cosmetology is a specific care offering not only face moisturizing care, moisturizing massages, corrective make-up, manicure, and pedicure, but also specialized hair counsels (wigs, scarf, headband) to help patients to take care of themselves and to correct the side-effects of anti-cancer treatment such as alopecia, paleness, dryness of the skin, scars, erythema, and nail dystrophy. Unfortunately, so far there is no scientific evidence of the benefit of cosmetology on QOL. The aim of our study was to assess the impact of cosmetology and hair care on QOL in breast cancer patients during the whole treatment (chemotherapy and radiotherapy). Materials and methods The patients of the cosmetic group received individual counselling to choose the wig (model, colour), to do its maintenance and to have refund by insurance company. Moreover, this group received, by the same investigator (dermatologist qualified in cosmetic care), a 2-h session including face moisturizing care, body moisturizing massage with oils or moisturizing creams, camouflage, manicure, pedicure and make-up every month. Finally, they had an interview for conclusion after the last session of radiotherapy (Table 2). Data were analysed using the statistics software SPSS 12. Significance was assessed using the chi-squared or Fisher tests and was set at P < 0.05. Likert scale responses were arbitrarily subdivided in two groups: never, seldom, not at all, somewhat, I don’t know, not concerned corresponding to ‘not altered QOL’ group, and sometimes, often, always, moderately, very much, extremely corresponding to ‘altered QOL’ group. Results Patients Between January 2001 and August 2004, 27 female patients aged 18 years old and over were included in two centres (Erasme University hospital and Notre Dame de Grâce Clinic Gosselies). Inclusion criteria were stage II breast cancer treated by lumpectomy (excision of the tumour with preservation of the breast) with positive axillary lymph-node dissection receiving adjuvant chemotherapy and radiotherapy. Patients were treated either by cyclophosphamide, methotrexate and fluorouracil (CMF) or fluorouracil, epirubicin and cyclophosphamide (FEC) administrated at intervals of 3 or 4 weeks for 4 months (CMF) to 6 months (FEC). Approval for study was first obtained from the local ethics committee. Patients were informed of the target of the study and were randomized in two groups, the cosmetic group and the control group. The cosmetic group received cosmetic care during the chemotherapy and the radiotherapy. The control group did not received cosmetic care. Methods Patients were administered a French validated dermatologic specific quality of life questionnaire,8 the VQDermato, including 28 questions about seven different fields of QOL: self-perception, daily life activity, mood state, social functioning, leisure/activity, treatment-induced restriction, and physical discomfort8 (Table 1). All the patients had to fill in this questionnaire three times during the adjuvant treatment: before the first chemotherapy (time 0), after the second cycle of chemotherapy (time 1), and at the end of radiotherapy (time 2). All the patients had an interview before the first cure of chemotherapy (approximately 12 days before the first cure). 772 Titeca et al. Patient’s characteristics In the cosmetic group we find 14 patients age 39–60 (mean 51); 2 patients had CMF chemotherapy, 12 had FEC chemotherapy, and all had radiotherapy. In the control group we find 13 patients age 40–79 (mean 57), 1 had CMF chemotherapy, 12 had FEC chemotherapy, and all had radiotherapy (Table 3). All patients except two developed alopecia, one in each group. Impact of cosmetic care on QOL Table 4 show the number of patients (cosmetic group and control group) for each responses group: ‘QOL not altered’ and ‘QOL altered’ at three different moments of the treatment (times 0, 1 and 2). Three questions showed a difference between the two groups of patients but only after all the treatment (time 2). Cosmetic patients were less discouraged than patients receiving any cosmetic care (question no. 17/P = 0.032). Treated patients stayed more self-confident (question no. 23/P = 0.032). Cosmetic patients stayed more confident on the future (question no. 24/P = 0.04). We can thus notice that the treated patients keep a better quality of life in two explored fields, the field of the ‘selfperception of the disease “and the field of” mood state’. Discussion The quality of life becomes one useful tool in the medical field, not only to analyse the impact of a disease but also to evaluate impact of treatments. © 2007 The Authors JEADV 2007, 21, 771–776 Journal compilation © 2007 European Academy of Dermatology and Venereology Titeca et al. Impact of cosmetic care on QOL in breast cancer patients Table 1 VQ-Dermato questionnaire VQ-Dermato in French (validated version) VQ-Dermato in English (indicative translation – not validated in English) Durant les quatre dernières semaines, votre maladie a-t-elle entraîné des difficultés: Q1 – pour marcher? Q2 – pour vous occuper de votre maison : ménage, cuisine, petits travaux d’entretien? Q3 – pour faire votre toilette, vous raser, vous maquiller? Q4 – dans le choix de vos habits; vous n’avez pas pu mettre certains vêtements ou ceux que vous souhaitiez? Q5 – pour vos loisirs: sport, exposition au soleil, musique, bricolage, jardinage? Q6 – pour profiter du soleil, pour vivre dehors au soleil? Q7 – pour vous concentrer: travail, lecture? Q8 – pour dormir? During the 4 weeks, did your disease affect, restrict or interfere with: Q1 – the way you walk or move? Q2 – your housework? Q3 – your personal care (wash, ,shave, apply, make-up)? Q4 – the chose of your clothes (you could not wear some of your clothes you wished)? Q5 – your recreation time: sport, sun exposure, music, do-it-yourself, gardening? Q6 – the way you enjoy the sun, you live in the sun? Q7 – your ability to concentrate (in working, reading)? Q8 – sleeping? Durant les quatre dernières semaines, votre maladie vous a-t-elle gêné dans: Q9 – dans votre vie sociale: sorties au restaurant, au cinéma, au café, allez chez le coiffeur ou chez les commerçants … ? Q10 – vos relations avec vos proches: famille, amis? Q11 – votre vie affective avec votre conjoint(e), votre partenaire? Q12 – votre activité sexuelle avec votre conjoint(e), votre partenaire? During the 4 weeks, did your disease bother you in: Q9 – your social life: going to the restaurant, bar, hairdresser or shopping … ? Q10 – your relationship with your family and friends? Q11 – your sentimental life with your spouse or partner? Q12 – your sexual relationships with your spouse or partner? Durant les quatre dernières semaines, du fait de votre maladie, vous avez? Q13 – ressenti de la fatigue? Q14 – éprouvé le besoin de cacher votre maladie de peau: par le maquillage, les vêtements? Q15 – eu les sentiments d’être dévisagé(e), rejeté(e) par les autres? Q16 – été stressé(e), énervé(e)? Q17 – été découragé(e)? Q18 – été angoissé(e)? Q19 – été agressif, irritable? Q20 – eu le sentiment d ‘être différent des autres? Q21 – eu le sentiment d’être sale, repoussant? Q22 – eu le sentiment d’être seule, isolé(e)? Q23 – eu le sentiment d’être diminué(e), de manquer de confiance en vous? Q24 – manqué de confiance dans l’avenir? During the 4 last weeks, did you feel: Q13 – tired? Q14 – that you had to hide your skin disease? Durant les quatre dernières semaines, jugez-vous que le (ou les) traitement(s) de votre maladie a (ont) été? Q25 – contraignant(s)? Q26 – désagréable(s)? During the last 4 weeks, was the treatment of your disease? Q15 – that people were staring at you or rejecting you? Q16 – stressed, irritable? Q17 – discouraged? Q18 – anxious? Q19 – aggressive, irritable? Q20 – different from the others? Q21 – dirty, repulsive? Q22 – alone, isolated)? Q23 – you were diminished, you lack self-confidence? Q24 – no confidence for the future? Q25 – restricting? Q26 – uncomfortable? Durant les quatre dernières semaines, votre maladie a-t-elle entraîné: Q27 – des démangeaisons? Q28 – des brûlures, des picotements, des tiraillements ou toute autre forme de douleur? During the 4 weeks, did your disease cause: Q27 – itching? Q28 – burning, prickling, or any other type of pain? Five Likert scale responses: «Jamais, rarement, Parfois, Souvent, Toujours» for questions 1–8, 13–24 and 27, 28 «Pas du tout , Un peu, Modérement, Beaucoup, Extrêmement / Enormement» for questions 9–12 and 25, 26 + Non concerné, Ne sait pas Five Likert scale responses: ‘Never, seldom, sometimes, often and always’ for questions 1–8, 13–24 and 27, 28 ‘Not at all, somewhat, Moderately, very much, extremely’ for questions 9–12 and 25, 26 + Not concerned, I don’t know © 2007 The Authors JEADV 2007, 21, 771–776 Journal compilation © 2007 European Academy of Dermatology and Venereology 773 Impact of cosmetic care on QOL in breast cancer patients Titeca et al. Table 2 Programme of the meetings Control group Cosmetic group 12 days after the 1st cure of chemotherapy (1st time): Meeting 12 days before the 1st cure of chemotherapy (1st time): Meeting Planning explanation + delivery of the list of the advised Belgian wig makers + VQ-Dermato to fill in at home First visit: Planning explanation + Proposal of a hair cut very short before the possible loss of the hair + choice of capillary prosthesis + delivery of VQ-Dermato to fill in at home 12 days after the second cure (2nd time): 12 days after the second cure (2nd time): Meeting VQ-Dermato to fill in at home. Sent by post mail Planning for Cosmetic Care and first séance of cosmetic care + VQ-Dermato to fill in at home. Specific cosmetic care programme established for each patient with the dermatologist After the last radiotherapy (3rd time): After the last radiotherapy (3rd time): Meeting VQ-Dermato to be fill-in at home. Sent by post mail Conclusions + VQ-Dermato to fill in at home Table 3 Patient’s characteristics Mean age (years) Number of patients CMF chemotherapy Number of patients FEC chemotherapy Number of patients radiotherapy Cosmetic group 14 patients 51 (39 to 60) 2 12 14 Control group 13 patients 57 (40 to 79) 1 12 13 To date, in a surprising way, only a few publications deal with the topic of QOL. In order to study the impact of the cosmetic care on the quality of life of the breast cancer patients in the course of chemotherapy and radiotherapy, we developed a prospective, multicentre, randomized, controlled study including 27 patients. In spite of little information about all the QOL, this study shows significant differences between the two groups of the patients but only at the end of the treatment; indeed at this time, patients who received cosmetic care remain more self-confident and are more optimistic. The fact that the difference is only significant at the end of the treatment shows that it is interesting to follow the patients throughout treatment and not only during one session of chemotherapy or radiotherapy. Although no study was carried out among breast cancer patients, we know that self-confidence is altered in these patients and this might interfere with their compliance to treatments.9,10 Therefore, it should be important to focus on patients’ psychological life and to develop all kind of support that can help them to stay hopeful and confident about the future as illustrated in our trial. We really think that cosmetology is helpful and the most important support 774 for women is probably hair care because of its significant impact on the ‘body image’. Moreover, we insist on the fact that this study was entirely free for patients and that the financial aspect could represent a brake with the cosmetic care for some patients. Therefore, it seems important to analyse possibility of a financial support by the health insurances or government. It could also realized by cosmetic company as it is already the case in France for the association ‘L’Etincelle’ devoted to the quality of life of the women suffering from breast cancer. In our study, all the cosmetic care was provided by people properly trained in ‘hospital cosmetic care’. Unfortunately they are currently very few. To develop this approach on a large scale, it seems possible to us to set up a nurse training elaborated by people experienced in cosmetology and oncology. Cosmetic care provided by those specially trained nurses stand be available in gynaecology departments treating breast cancer and in oncology departments and could be extended to other male and female cancers patients as well. Acknowledgements This study was supported by a grant provided by Lancôme Belgium. © 2007 The Authors JEADV 2007, 21, 771–776 Journal compilation © 2007 European Academy of Dermatology and Venereology Titeca et al. Time 0: before treatment Time 1: during treatment Time 2: after treatment Responses group QOL not altered Number of patient QOL altered Number of patient QOL not altered Number of patient QOL altered Number of patient QOL not altered Number of patient QOL altered Number of patient Patient’s group Control Cosmetic Control Cosmetic P-value Control Cosmetic Control Cosmetic P value control cosmetic Control Cosmetic P value Question 1 Question 2 Question 3 Question 4 Question 5 Question 6 Question 7 Question 8 Question 9 Question 10 Question 11 Question 12 Question 13 Question 14 Question 15 Question 16 Question 17 Question 18 Question 19 Question 20 Question 21 Question 22 Question 23 Question 24 Question 25 Question 26 Question 27 Question 28 12 11 13 13 10 12 10 5 12 13 13 13 3 12 12 7 8 7 11 11 12 11 10 10 9 7 10 7 12 9 13 13 9 10 9 7 11 12 12 11 6 13 14 10 11 9 12 12 14 14 12 13 9 11 14 10 1 2 0 0 3 1 3 8 1 0 0 0 9 0 0 5 4 5 1 1 0 1 2 2 3 5 2 5 1 4 0 0 4 3 4 6 2 1 1 2 8 1 0 4 3 5 2 2 0 0 2 1 5 3 0 4 0.760 0.322 / / 0.500 0.297 0.500 0.348 0.500 0.500 0.500 0.240 0.296 0.538 / 0.387 0.404 0.536 0.560 0.560 / 0.463 0.641 0.440 0.437 0.246 0.203 0.387 8 6 8 8 7 6 8 5 8 9 9 9 4 7 8 3 5 4 8 6 11 8 6 6 9 8 9 8 12 9 12 12 9 10 9 8 10 12 12 8 5 11 11 8 10 7 9 9 8 11 8 8 8 8 11 10 1 3 1 1 2 3 1 4 1 0 0 0 5 2 1 6 4 5 1 3 1 1 3 3 0 1 0 1 0 3 0 0 3 2 3 4 2 0 0 4 7 1 1 4 2 5 3 3 1 1 4 4 4 4 1 2 0.429 0.523 0.429 0.429 0.647 0.353 0.414 0.472 0.612 / / 0.083 0.623 0.388 0.686 0.142 0.183 0.425 0.414 0.523 0.686 0.686 0.681 0.681 0.083 0.258 0.571 0.612 8 8 10 9 8 9 6 8 9 9 10 9 2 11 10 6 5 5 7 9 10 9 5 4 8 10 8 8 11 9 10 9 9 8 8 7 9 10 11 8 4 11 11 7 10 8 9 9 10 10 10 9 8 10 11 7 3 3 1 2 3 2 5 3 2 2 1 2 9 0 0 5 6 6 4 2 1 2 6 7 3 1 3 3 0 2 1 2 2 3 3 4 2 1 0 3 7 0 1 4 1 3 2 2 1 1 1 2 3 1 0 4 0.107 0.500 0.762 0.707 0.500 0.500 0.330 0.500 0.707 0.500 0.500 0.500 0.318 / 0.500 0.500 0.032 0.193 0.318 0.707 0.762 0.500 0.032 0.040 0.682 0.762 0.107 0.500 775 Impact of cosmetic care on QOL in breast cancer patients © 2007 The Authors JEADV 2007, 21, 771–776 Journal compilation © 2007 European Academy of Dermatology and Venereology Table 4 Statistics – Fisher test Impact of cosmetic care on QOL in breast cancer patients Titeca et al. 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