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Browsing by Author "Newton, Erin"
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Item Adherence Barriers to Breast Cancer Treatment: Fragmentation of Care, Mood Disorders, and Substance Use Disorder(2021-03) Wells, Lindsey; Brown, Lucy; Heitz, Adaline; Newton, ErinCase: The patient is a premenopausal, recently divorced 40-year-old female with a history of alcohol use disorder, anxiety, and depression. She presented with a 3-month history of a palpable right sided breast mass and was found to have Stage IIB/IIIA ER+ PR+ invasive ductal carcinoma of her right breast. She successfully completed preoperative therapy followed by a right mastectomy. She subsequently had a relapse in her alcohol use disorder and since then has had inconsistent and incomplete radiation treatment. Her substance use led to the loss of her job, custody of her children, and social support. Conclusions: We identified four primary barriers to adherence to cancer treatment: fragmentation of care, major depressive disorder, generalized anxiety disorder, and substance use disorder. As a result of these mental health and systemic communication challenges, her treatment was discontinued and her care team lost her in follow-up. Clinical Significance: As many as 28% of breast cancer patients do not complete their recommended treatment, which increases risk for recurrent breast cancers. Discontinuation of and non-adherence to therapy for breast cancers are associated with increased mortality. Among breast cancer patients who have difficulty adhering to chemotherapy treatment, a common barrier is fragmentation of care. Studies have also indicated that anxiety and depression may play explanatory roles in non-adherence to breast cancer treatment. Prevalence of depression is as high as 24% among breast cancer patients. Furthermore, rates of co-occurrence of substance use disorders in cancer patients can reach up to 35%. Substance use disorders, including alcoholism, have been associated with increased rates of non-adherence and discontinuation of hormonal treatment in individuals with ER+ breast cancer diagnoses. Interventions addressing the occurrence of mental illness and fragmented cancer care are important steps in increasing adherence among these patients.Item Factors underlying metastatic breast cancer patients' perceptions of symptom importance: a qualitative analysis(Wiley, 2018-01) Mosher, Catherine E.; Daily, Susan; Tometich, Danielle; Matthias, Marianne S.; Outcalt, Samantha D.; Hirsh, Adam; Johns, Shelley A.; Rand, Kevin; Schneider, Bryan; Mina, Lida; Storniolo, Anna Maria; Newton, Erin; Miller, Kathy; Psychology, School of ScienceThe symptom literature in cancer has primarily examined symptom severity, frequency and distress. Assessing cancer patients' perceptions of symptom importance-how important it is for them to see improvement in a symptom following an intervention-and factors influencing these judgments would also inform patient-centred care, but this analysis has not been undertaken. This qualitative study aimed to identify factors underlying perceptions of symptom importance among 25 symptomatic metastatic breast cancer (MBC) patients. Participants were recruited from a cancer centre in the Midwestern USA. Semi-structured interviews focused on patients' rationale for considering common symptoms (i.e., anxiety, sadness, sleep problems, pain or fatigue) to be important. Thematic analyses revealed five interrelated factors underlying MBC patients' perceptions of symptom importance: activity restriction, concentration difficulties, exacerbation of other physical symptoms, symptom-related long-term health concerns and negative impact on their relationships with others. Patients most frequently stated that a physical or psychological symptom was important because of the resulting activity restriction. Additionally, some patients considered pain to be important because it signalled potential long-term health concerns, such as worsening metastatic disease. Findings suggest that clinicians should take into account MBC patients' perceptions of symptom importance and factors underlying these judgments when making shared treatment decisions.Item Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility(Wiley, 2017-11) Mosher, Catherine E.; Tometich, Danielle B.; Hirsh, Adam; Rand, Kevin L.; Johns, Shelley A.; Matthias, Marianne S.; Outcalt, Samantha D.; Bricker, Jonathan; Schneider, Bryan; Mina, Lida; Storniolo, Anna Maria; Newton, Erin; Miller, Kathy; Psychology, School of ScienceOBJECTIVE: This study examined symptom-based subgroups of metastatic breast cancer (MBC) patients and the extent to which they differed across key constructs of acceptance and commitment therapy (ACT). METHODS: Eighty women with MBC completed self-report surveys assessing 10 common symptoms and several ACT variables (ie, activity engagement, psychological inflexibility, value obstruction, and value progress) during a single time point. RESULTS: A cluster analysis yielded 3 patient subgroups: low symptoms, low-moderate symptoms, and moderate-high symptoms. Relative to the subgroup with low symptoms, the other subgroups reported less activity engagement. In addition, compared with patients with low symptoms, the subgroup with moderate-high symptoms reported greater psychological inflexibility (ie, avoidance of unwanted internal experiences) and greater difficulty living consistently with their values. CONCLUSIONS: Women with MBC show heterogeneity in their symptom profiles, and those with higher symptom burden are more likely to disengage from valued activities and avoid unwanted experiences (eg, thoughts, feelings, and bodily sensations). Findings are largely consistent with the ACT model and provide strong justification for testing ACT to address symptom interference in MBC patients.Item Treatment of Metastatic Her2Neu+ Breast Cancer with Oligoprogressive Disease(2024-03-22) Pelton, Sarah; Ayub, Jinan; Kenyon, Taylor; Ramchandani, Muskaan; Newton, ErinBackground Information: In treating metastatic Her2Neu+ breast cancer, trastuzumab-based chemotherapy regimens typically result in fairly durable tumor control. Historically, when there was any disease progression, the systemic therapy was changed, but it has recently been recognized that “oligoprogressive disease” (when only a limited number of metastatic sites progress) might be approached differently. This heterogeneous response to treatment is due to variation in tumor cell phenotypes, which confer drug resistance. Oligoprogressive disease is often treated with local therapy, such as stereotactic body radiotherapy (SBRT), or resection, and determination of optimal treatment regimens remains a challenge. Case Description: We report a case of a 37-year-old, premenopausal female with locally advanced, Her2Neu+ right breast cancer with de novo metastases to the liver and bone. First line systemic therapy was well-tolerated and resulted in disease control. Unfortunately, she had symptomatic progression in her primary breast tumor, which was treated with mastectomy while continuing the same systemic therapy. Later, she developed a painful, right infraclavicular metastasis; surgical resection was ultimately declined due to local edema and the tumor’s proximity to significant neurovasculature. She elected to receive palliative radiation therapy for pain control via SBRT, and her systemic therapy remained unchanged. Currently, she shows no signs of progression and continues to have excellent tolerance of her systemic therapy. Clinical Significance: Oligoprogression is a clinically significant concept for numerous cancers, but the best methods of control have not been elucidated. This case contributes to the limited knowledge base as an example of treating Her2Neu+ breast cancer-associated oligoprogressive disease with local therapy. Conclusion: The treatment approach in this case helps to define best practices for treatment of Her2Neu+ breast cancer-associated oligoprogressive disease.