The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

Social Support and Breast Cancer Recurrence: Is there any Association?



Leyli Hosseini1, Mehdi Dehghani2, Sedigheh Tahmasebi3, Majid Akrami3, Nasrin Shokrpour4, Ramin Ravangard5, 6, *
1 School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Hematology and Medical Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
3 Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4 English Department, School of Paramedical Sciences, Shiraz, Iran
5 Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
6 Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background:

Breast cancer is the most prominent cause of women's mortality due to cancer and is one of the most serious and commonly diagnosed cancers among Iranian women. Also, social support plays a vital role in breast cancer patients' lives and their diagnosis and treatment processes. This study aimed to determine the associations between social support status and the recurrence of breast cancer in women breast cancer referred to the Breast Diseases Research Center in Motahari Clinic in Shiraz, Iran in 2018.

Methods:

This was an applied and descriptive-analytic study on women with breast cancer referred to the Breast Diseases Research Center in Motahari Clinic in Shiraz, Iran in 2018. A sample of 221 patients in two groups of 117 non-recurrence patients and 44 patients with recurrence and metastasis were selected randomly. A localized standard questionnaire was used to collect the required data. The collected data were analyzed using SPSS 24.0.

Results:

Based on the results, there were significant differences between the two studied groups of patients with and without recurrence in terms of the means of social support and all of its dimensions (P-value<0.05); the means of social support and all of its dimensions in the group of patients without recurrence were higher than those in those with recurrence. Also, 88.6% of patients in the group without recurrence received high social support, while in the group of patients with recurrence, only 11.4% of them received high social support.

Conclusion:

The results showed that the breast cancer patients studied without recurrence had higher social support. Therefore, to improve the studied patients' health, we recommend providing the patients with a safe and secure environment, giving accurate and complete responses to the patients' questions, providing continuous psychological counseling, etc.

Keywords: Breast Cancer, Cancer, Recurrence, Social Support, Psychological counseling, Association.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 30
Last Page: 35
Publisher Id: TOPHJ-13-30
DOI: 10.2174/1874944502013010030

Article History:

Received Date: 19/10/2019
Revision Received Date: 02/01/2020
Acceptance Date: 08/01/2020
Electronic publication date: 18/02/2020
Collection year: 2020

© 2020 Hosseini et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Tel: 00987132340774;
E-mail: ra_ravangard@yahoo.com






1. INTRODUCTION

In recent decades, there are significant advances in the field of health and medical sciences, and the pattern of diseases has become different compared to the past due to the identification of the biological causes of diseases, access to health facilities, and transition from acute and infectious diseases to chronic ones [1Keyvanara M, Hosseini SM, Emami P. Study of the relationship between socioeconomic status and controlling diabetes among patients admitted to specialized clinic of Dr. Gharazi hospital in Isfahan-2011. J Educ Health Promot 2012; 1(28): 28-31.
[PMID: 23555131]
].

“Cancer” refers to a group of diseases with a variety of about 100 different types [2Hamid N, Ahmadian A, Akbari Shaye Y. Effectiveness of cognitive behavior therapy based on religious believes on hope and quality of life in the patients suffering breast cancer. Hormozgan Med J 2012; 16(3): 213-21.], which puts considerable pressure on both individuals and society [3Liao XZ, Shi JF, Liu JS, et al. Health economic evaluation working group, Cancer Screening Program in Urban China (CanSPUC). Medical and non-medical expenditure for breast cancer diagnosis and treatment in China: A multicenter cross-sectional study. Asia Pac J Clin Oncol 2018; 14(3): 167-78.
[http://dx.doi.org/10.1111/ajco.12703] [PMID: 28670694]
]. According to the results of a study, there were about 17.5 million cases of cancer worldwide in 2015 which caused more than 8.7 million deaths, as the second leading cause of death in the world after cardiovascular diseases. In the mentioned study, breast cancer, with 2.4 million new cases, had the highest rate of cancer among women in the world [4Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol 2017; 3(4): 524-48.
[http://dx.doi.org/10.1001/jamaoncol.2016.5688] [PMID: 27918777]
]. In 2018, breast cancer alone accounted for 30% of total new diagnoses of cancers in the United States and was the most common type of cancer in American women [5Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1): 7-30.
[http://dx.doi.org/10.3322/caac.21442] [PMID: 29313949]
]. Overall, it can be said that this disease is the most common cancer and also the most prominent cause of cancer deaths among women at the global level [4Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol 2017; 3(4): 524-48.
[http://dx.doi.org/10.1001/jamaoncol.2016.5688] [PMID: 27918777]
].

Breast cancer has also been one of the most commonly diagnosed cancers among Iranian women in the past few decades and has been prevalent in recent years [6Fazeli N, Feizi A. Social construction of breast cancer case study: Women with breast cancer in tabriz. Q J Women’s Stud Sociol Psychol 2012; 10(2): 51-84.]. According to the results of a study, breast cancer in Iran (between 2005 and 2015) has had the second-highest cancer incidence and mortality rate [4Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol 2017; 3(4): 524-48.
[http://dx.doi.org/10.1001/jamaoncol.2016.5688] [PMID: 27918777]
].

Breast cancer is the result of an uncontrollable and malignant growth of the epithelial cells of the lobules (which are the milk-producing glands), ducts (which are the passages that drain milk from the lobules to the nipple), and the stromal tissues (which include the fatty and fibrous connective tissues of the breast). Although it mainly affects women, in rare cases, men can get breast cancer as well [2Hamid N, Ahmadian A, Akbari Shaye Y. Effectiveness of cognitive behavior therapy based on religious believes on hope and quality of life in the patients suffering breast cancer. Hormozgan Med J 2012; 16(3): 213-21., 7 The american cancer society. Breast Cancer Facts & Figures 2017-2018. Atlanta, Georgia: The American Cancer Society; 2018 [updated 2018; cited 2017.12.24]; Available from: https://www.cancer.org/cancer/breast-cancer.html].

In medicine, the disease relapse is used to evaluate the outcome of the treatment. In general, in cancers, the disease can return as a recurrence in the same organ or as metastasis in another organ [8Lamont EB, Herndon JE II, Weeks JC, et al. Cancer and Leukemia Group B. Measuring disease-free survival and cancer relapse using Medicare claims from CALGB breast cancer trial participants (companion to 9344). J Natl Cancer Inst 2006; 98(18): 1335-8.
[http://dx.doi.org/10.1093/jnci/djj363] [PMID: 16985253]
]. Based on the results of a study, more than 50% of breast cancer recurrence occurs in women after 5 years of their initial diagnosis [9 Security and exchange commission. Novartis AG. Compelling disease-free survival results in breast cancer trial prompt independent researchers to offer patients the opportunity to switch to Femara®, as reported in N Engl J Med Washington, D.C; 2003 [updated 2003; cited 2018.2.16]; Available from: https://www.sec.gov/Archives/edgar/data/1114448/000104746903035888/a2121806z6-k.htm#toc_bq2013_1]. Studies have shown that surgery and postoperative therapies reduce the risk of recurrence and significantly increase disease-free survival [10Gohari MR, Moghadami fard Z, Abolghasemi J, et al. Prognostic factors of metastases in breast cancer patients using the recurrent Andersen-Gill model. Koomesh 2013; 14(4): 483-9.].

On the other hand, some researchers in their studies have demonstrated the positive effects of social support on the patients' general health [11Bener A, Alsulaiman R, Doodson L, Agathangelou T. Depression, hopelessness and social support among breast cancer patients: In highly endogamous population. Asian Pac J Cancer Prev 2017; 18(7): 1889-96.
[PMID: 28749617]
], so that having a high level of social support has been associated with patients' good health behaviors and better health outcomes [12Jensen LF, Pedersen AF, Andersen B, Vedsted P. Social support and non-participation in breast cancer screening: A danish cohort study. J Public Health (Oxf) 2016; 38(2): 335-42.
[http://dx.doi.org/10.1093/pubmed/fdv051] [PMID: 25922368]
]. In women with breast cancer, also social support plays a vital role in their lives, diagnosis and treatment processes, and is also an important component in providing them with good care. Therefore, although providing appropriate medical treatments for breast cancer patients is necessary, social support can increase the effectiveness of treatments because it helps women to have positive attitudes towards their health condition and cope with their illness [13Dumrongpanapakorn P, Liamputtong P. Social support and coping means: The lived experiences of Northeastern Thai women with breast cancer. Health Promot Int 2017; 32(5): 768-77.
[http://dx.doi.org/10.1093/heapro/dav023] [PMID: 25876908]
, 14Spatuzzi R, Vespa A, Lorenzi P, et al. Evaluation of social support, quality of life, and body image in women with breast cancer. Breast Care (Basel) 2016; 11(1): 28-32.
[http://dx.doi.org/10.1159/000443493] [PMID: 27051393]
].

Considering the fact that researchers conducting the present study did not find any research in this field in Iran studying and comparing the social support status among two groups of breast cancer patients with and without recurrence, this study aimed to determine the associations between social support status and the recurrence of breast cancer in women referred to the Breast Diseases Research Center in the Motahari Clinic in Shiraz, Iran in 2018.

2. METHODS

This was an applied, cross-sectional and descriptive-analytic study conducted on women with breast cancer referred to the Breast Diseases Research Center in the Motahari Clinic in Shiraz, Iran in 2018. The studied patients in the present study were only in stages I, II and III.

These patients were divided into two groups of those with and without recurrence. The first group included patients who had a relapse and/or metastasis in the first 10 years after the diagnosis, and the second group consisted of those who did not have any relapse up to 10 years after the diagnosis. Therefore, in the present study, the recurrence time for patients with relapse was considered in the first 10 years of the onset and diagnosis of the disease.

According to the results of the pilot study on the studied patients conducted prior to the present study and based on the following formula [15Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research 3rd ed. 2017.
[http://dx.doi.org/10.1201/9781315183084]
], assuming α=0.05, β=0.1, Without Recurrence=1.32, , Without Recurrence=1.26, Without Recurrence=3.5, Without Recurrence=3.1 as as well as according to the results of a previous study [16Abdollahi A, Zadeh HS, Akbari M, Tahmasbi S, Talei A, Hassanzadeh J. Investigation of prognostic factors and survival without recurrence in patients with breast cancer. Adv Biomed Res 2017; 6(1): 42-50.
[http://dx.doi.org/10.4103/2277-9175.204595] [PMID: 28503497]
] reporting that the average number of patients without recurrence was about four times to that of those with recurrence [16Abdollahi A, Zadeh HS, Akbari M, Tahmasbi S, Talei A, Hassanzadeh J. Investigation of prognostic factors and survival without recurrence in patients with breast cancer. Adv Biomed Res 2017; 6(1): 42-50.
[http://dx.doi.org/10.4103/2277-9175.204595] [PMID: 28503497]
], and considering the probability of 10% patient dropout, the sample size was determined as 175 patients in the group of patients without recurrence and 44 in those with recurrence. The determined samples were selected randomly in each group of patients with and without recurrence referred to the Breast Diseases Research Center, using the simple random sampling method through the use of the random numbers table.

The required data were collected using the Persian and localized version of the Social Support Measurement Questionnaire used by Denewer and colleagues in their study (2011) [17Denewer A, Farouk O, Mostafa W, Elshamy K. Social support and hope among egyptian women with breast cancer after mastectomy. Breast Cancer (Auckl) 2011; 5(1): 93-103.
[http://dx.doi.org/10.4137/BCBCR.S6655] [PMID: 21695094]
]. This questionnaire was first translated from English into Persian and then back-translated; its reliability was confirmed (α=0.79) and its validity was also approved by getting the experts' opinions. The questionnaire consisted of two parts. The first part included items related to the studied patients' demographic data, and the second part included 33 items to assess the social support dimensions, including psychological support (9 items), material support (8 items), medical support (8 items), and family and friends' support (8 items). A five-point Likert scale was used to measure the social support dimensions, 1 referring to “strongly disagree” and 5 to “strongly agree”. Also, the inverse items were scored reversely. In general, the mean of social support higher than 4 was considered as high social support, between 3 and 4 as medium social support, and lower than 3 was considered as low social support.

The collected data were analyzed through SPSS 24.0 software using some statistical tests, including Shapiro-Wilk, Chi-Square, Fisher’s exact test, Independent-Samples T-Test and One-Way ANOVA tests, as well as the Pearson Correlation coefficient. A P-value<0.05 was considered statistically significant.

3. ETHICS

All patients participating in the present study gave their written informed consent. This study was approved by the Ethics Committee of Shiraz University of Medical Sciences (Code: IR.SUMS.REC. 1397.316).

4. RESULT

The demographic and clinical characteristics of the studied patients are shown in Table 1. As displayed in Table 1, there was no significant difference between demographic and clinical characteristics of the studied patients in the two groups of patients with and without recurrence (P-value>0.05). Also, the mean age of patients without recurrence and those with recurrence was, 51.16±10.01 and 54.59±13.14, respectively, indicating no significant difference between them (P-value=0.112).

Moreover, the results of the Shapiro-Wilk test showed that social support and its dimensions were normal (P>0.05). The results showed that there were no significant associations between the social support and its dimensions and the demographic and clinical characteristics of the studied patients in each group of patients with and without recurrence (P>0.05).

Based on the results, the highest and lowest means of social support dimensions in the group of patients without recurrence were related to the family and friends' support (3.96±0.53) and the material support (3.69±0.61), respectively; also, in those with recurrence, the minimum and maximum dimensions were related to the psychological support (3.69±0.36) and material support (3.42±0.61) (Table 2). Also, as shown in Table 2, there were significant differences between the two studied groups in terms of the means of social support and all of its dimensions (P-value<0.05), so that the means of social support and all of its dimensions in the group of patients without recurrence were higher than those with recurrence.

On the other hand, Table 3 shows that 88.6% of patients without recurrence received high social support, while in the group with recurrence, only 11.4% of patients received high social support. On the contrary, 71.4% of patients in the group with recurrence, compared with 28.6% of those without recurrence, received low social support.


Table 1
Demographic and clinical characteristics of the studied patients with and without recurrence.


5. DISCUSSION

The social support and its dimensions, especially psychological and family and friends' support, are very important for coping with the diseases, particularly breast cancer [18Koosha M, Haghighat S, Karampoor R, Shekarbeygi A, Bahrami A, Tafazzoli-Harandi H, et al. Evaluation of socio-economic status and its impact on coping behavior of patients with breast cancer. Iran J Breast Dis 2017; 9(4): 15-25.]. Studies have also shown that social and economic inequalities have an impact on the risk of recurrence in breast cancer patients and the opportunity for getting future proper care [19Di Salvo F, Caranci N, Spadea T, et al. Socioeconomic Inequalities and Oncological Outcomes Italian Working Group. Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. Oncotarget 2017; 8(40): 68402-14.
[http://dx.doi.org/10.18632/oncotarget.19447] [PMID: 28978126]
]. Furthermore, according to the results of a study (2017) conducted in Italy in 2003-2005, among the factors affecting the mental health and quality of life of breast cancer patients, social support plays a major role [20Johansson I, Berterö C. Social support and self-esteem in patients afflicted with cancer in the reproductive organs, including breasts. Aust-Asia J Cancer 2003; 2(2): 116-23.].

Table 2
The means of social support and its dimensions among the studied patients with and without recurrence


Table 3
The level of social support among the studied patients with and without recurrence


In the present study, women with breast cancer were divided into two groups without and with recurrence and/or metastases. This study aimed to determine the association between social support and recurrence of breast cancer in patients referred to the Breast Diseases Research Center in the Motahari Clinic in Shiraz, Iran in 2018. The results of the present study showed that patients with more social support had less recurrence. In other words, the means of social support and its dimensions, including psychological, instrumental, medical and family and friends' support, in women who had recurrence or metastases on average in the first 10 years after the first course of treatment were at a lower level. The results also showed that the number of non-recurrence patients at the high social support level (means higher than 4) (88.6%) and women with recurrence at the low level of social support (less than 3) (71.4%) was high. The results of the study by Orsini and colleagues in France (2016) [21Orsini M, Trétarre B, Daurès JP, Bessaoud F. Individual socioeconomic status and breast cancer diagnostic stages: A French case-control study. Eur J Public Health 2016; 26(3): 445-50.
[http://dx.doi.org/10.1093/eurpub/ckv233] [PMID: 26823441]
], by Jalali-Farahani et al. in Iran (2018) [22Jalali-Farahani S, Amiri P, Karimi M, Vahedi-Notash G, Amirshekari G, Azizi F. Perceived social support and health-related quality of life (HRQoL) in Tehranian adults: Tehran lipid and glucose study. Health Qual Life Outcomes 2018; 16(1): 90-8.
[http://dx.doi.org/10.1186/s12955-018-0914-y] [PMID: 29747652]
], by Denewer and colleagues in Egypt (2016) [17Denewer A, Farouk O, Mostafa W, Elshamy K. Social support and hope among egyptian women with breast cancer after mastectomy. Breast Cancer (Auckl) 2011; 5(1): 93-103.
[http://dx.doi.org/10.4137/BCBCR.S6655] [PMID: 21695094]
], by Yang et al. in China (2017) [23Yang L, Song WP, Chen ZL, et al. Correlation between social support and quality of life in patients with breast cancer at different periods of treatment. Zhonghua Zhong Liu Za Zhi 2017; 39(3): 202-6.
[PMID: 28316220]
], by Suwankhong and Liamputtong in Thailand (2016) [24Suwankhong D, Liamputtong P. Social support and women living with breast cancer in the south of thailand. J Nurs Scholarsh 2016; 48(1): 39-47.
[http://dx.doi.org/10.1111/jnu.12179] [PMID: 26580861]
], by Zhang and colleagues in China (2017) [25Zhang H, Zhao Q, Cao P, Ren G. Resilience and quality of life: Exploring the mediator role of social support in patients with breast cancer. Med Sci Monit 2017; 23: 5969-79.
[http://dx.doi.org/10.12659/MSM.907730] [PMID: 29248937]
], by Gage-Bouchard in the United States (2017) [26Gage-Bouchard EA. Social support, flexible resources, and health care navigation. Soc Sci Med 2017; 190: 111-8.
[http://dx.doi.org/10.1016/j.socscimed.2017.08.015] [PMID: 28858696]
], by Thompson and colleagues in the United States (2017) [27Thompson T, Pérez M, Kreuter M, Margenthaler J, Colditz G, Jeffe DB. Perceived social support in african american breast cancer patients: Predictors and effects. Soc Sci Med 2017; 192: 134-42.
[http://dx.doi.org/10.1016/j.socscimed.2017.09.035] [PMID: 28965004]
], by Faller et al. (2016) in Germany [28Faller H, Weis J, Koch U, et al. Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. J Psychosom Res 2016; 81: 24-30.
[http://dx.doi.org/10.1016/j.jpsychores.2015.12.004] [PMID: 26800635]
], by Kauffmann et al. in the United States (2016) [29Kauffmann R, Bitz C, Clark K, Loscalzo M, Kruper L, Vito C. Addressing psychosocial needs of partners of breast cancer patients: A pilot program using social workers to improve communication and psychosocial support. Support Care Cancer 2016; 24(1): 61-5.
[http://dx.doi.org/10.1007/s00520-015-2721-x] [PMID: 25917451]
], and by Hulbert-Williams et al. study (2018) [30Hulbert-Williams NJ, Beatty L, Dhillon HM. Psychological support for patients with cancer: Evidence review and suggestions for future directions. Curr Opin Support Palliat Care 2018; 12(3): 276-92.
[http://dx.doi.org/10.1097/SPC.0000000000000360] [PMID: 30074924]
]showed that social support and its dimensions had positive effects on patients' health, hope, quality of life, coping behavior, and body image, that are consistent with those of the present study.

The present study, like other studies, has several limitations, including the use of a cross-sectional design, collecting the required data using a single method (i.e. questionnaire), and the use of patients' self-report data. Also, the results of the present study are related to the studied clinic and their generalization to the entire country should be careful and conservative.

To the best of our knowledge, this study has been conducted in Iran for the first time and health policymakers and managers, as well as families of patients with breast cancer, can benefit from its results.

CONCLUSION

According to the results of the present study, social support has a significant association with the absence of recurrence in breast cancer patients. Therefore, specialists, authorities and families should take the importance of social support and its dimensions in the improvement of patients' health into consideration. Families should provide the patient with a safe and secure environment and help him/her to perform his/her activities and tasks and accompany the patient when visiting the health centers. Specialists also have to take into account cancer patients' distress and consider that their patience, support and accurate and complete responses to the patients' questions will be a major contribution to coping with diseases and their compliance with the professional advice. Moreover, because one of the patients' concerns is the costs of treatment, which, in some cases, even caused poverty, the authorities and policymakers should take the necessary measures to create financial and insurance funds to financially support such patients and establish centers to provide the patients and their families' access to cheap medicines. Furthermore, these patients, especially in the early stages, need continuous psychological counseling. By providing these services and facilities, effective steps can be taken to reduce the patients' depression and anxiety, and their fear of lack of timely and appropriate access to the necessary treatments and medicines due to lack of financial support.

AUTHORS’ CONTRIBUTIONS

RR, MD and LH conceived, designed, analyzed, and interpreted the data; LH, ST and MA performed data collection. NSh, RR and LH wrote the first draft and finalized it. All authors read and approved the final manuscript.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The present study was approved by the Ethics Committee of Shiraz University of Medical Sciences, Iran (Code: IR.SUMS.REC. 1397.316).

HUMAN AND ANIMAL RIGHTS

No animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION

Informed consent was obtained from all patients participating in the study.

AVAILABILITY OF DATA AND MATERIALS

The data that support the findings of this study are with the corresponding author, [R.R], and can be made available on reasonable request.

FUNDING

This study was a research project supported financially by Iran, Shiraz University of Medical Sciences with the contract number 97-01-68-16935.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest, financial, or otherwise.

ACKNOWLEDGEMENTS

The researchers would like to thank the studied patients for their kind cooperation with the researchers in collecting and analyzing data.

REFERENCE

[1] Keyvanara M, Hosseini SM, Emami P. Study of the relationship between socioeconomic status and controlling diabetes among patients admitted to specialized clinic of Dr. Gharazi hospital in Isfahan-2011. J Educ Health Promot 2012; 1(28): 28-31.
[PMID: 23555131]
[2] Hamid N, Ahmadian A, Akbari Shaye Y. Effectiveness of cognitive behavior therapy based on religious believes on hope and quality of life in the patients suffering breast cancer. Hormozgan Med J 2012; 16(3): 213-21.
[3] Liao XZ, Shi JF, Liu JS, et al. Health economic evaluation working group, Cancer Screening Program in Urban China (CanSPUC). Medical and non-medical expenditure for breast cancer diagnosis and treatment in China: A multicenter cross-sectional study. Asia Pac J Clin Oncol 2018; 14(3): 167-78.
[http://dx.doi.org/10.1111/ajco.12703] [PMID: 28670694]
[4] Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol 2017; 3(4): 524-48.
[http://dx.doi.org/10.1001/jamaoncol.2016.5688] [PMID: 27918777]
[5] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68(1): 7-30.
[http://dx.doi.org/10.3322/caac.21442] [PMID: 29313949]
[6] Fazeli N, Feizi A. Social construction of breast cancer case study: Women with breast cancer in tabriz. Q J Women’s Stud Sociol Psychol 2012; 10(2): 51-84.
[7] The american cancer society. Breast Cancer Facts & Figures 2017-2018. Atlanta, Georgia: The American Cancer Society; 2018 [updated 2018; cited 2017.12.24]; Available from: https://www.cancer.org/cancer/breast-cancer.html
[8] Lamont EB, Herndon JE II, Weeks JC, et al. Cancer and Leukemia Group B. Measuring disease-free survival and cancer relapse using Medicare claims from CALGB breast cancer trial participants (companion to 9344). J Natl Cancer Inst 2006; 98(18): 1335-8.
[http://dx.doi.org/10.1093/jnci/djj363] [PMID: 16985253]
[9] Security and exchange commission. Novartis AG. Compelling disease-free survival results in breast cancer trial prompt independent researchers to offer patients the opportunity to switch to Femara®, as reported in N Engl J Med Washington, D.C; 2003 [updated 2003; cited 2018.2.16]; Available from: https://www.sec.gov/Archives/edgar/data/1114448/000104746903035888/a2121806z6-k.htm#toc_bq2013_1
[10] Gohari MR, Moghadami fard Z, Abolghasemi J, et al. Prognostic factors of metastases in breast cancer patients using the recurrent Andersen-Gill model. Koomesh 2013; 14(4): 483-9.
[11] Bener A, Alsulaiman R, Doodson L, Agathangelou T. Depression, hopelessness and social support among breast cancer patients: In highly endogamous population. Asian Pac J Cancer Prev 2017; 18(7): 1889-96.
[PMID: 28749617]
[12] Jensen LF, Pedersen AF, Andersen B, Vedsted P. Social support and non-participation in breast cancer screening: A danish cohort study. J Public Health (Oxf) 2016; 38(2): 335-42.
[http://dx.doi.org/10.1093/pubmed/fdv051] [PMID: 25922368]
[13] Dumrongpanapakorn P, Liamputtong P. Social support and coping means: The lived experiences of Northeastern Thai women with breast cancer. Health Promot Int 2017; 32(5): 768-77.
[http://dx.doi.org/10.1093/heapro/dav023] [PMID: 25876908]
[14] Spatuzzi R, Vespa A, Lorenzi P, et al. Evaluation of social support, quality of life, and body image in women with breast cancer. Breast Care (Basel) 2016; 11(1): 28-32.
[http://dx.doi.org/10.1159/000443493] [PMID: 27051393]
[15] Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research 3rd ed. 2017.
[http://dx.doi.org/10.1201/9781315183084]
[16] Abdollahi A, Zadeh HS, Akbari M, Tahmasbi S, Talei A, Hassanzadeh J. Investigation of prognostic factors and survival without recurrence in patients with breast cancer. Adv Biomed Res 2017; 6(1): 42-50.
[http://dx.doi.org/10.4103/2277-9175.204595] [PMID: 28503497]
[17] Denewer A, Farouk O, Mostafa W, Elshamy K. Social support and hope among egyptian women with breast cancer after mastectomy. Breast Cancer (Auckl) 2011; 5(1): 93-103.
[http://dx.doi.org/10.4137/BCBCR.S6655] [PMID: 21695094]
[18] Koosha M, Haghighat S, Karampoor R, Shekarbeygi A, Bahrami A, Tafazzoli-Harandi H, et al. Evaluation of socio-economic status and its impact on coping behavior of patients with breast cancer. Iran J Breast Dis 2017; 9(4): 15-25.
[19] Di Salvo F, Caranci N, Spadea T, et al. Socioeconomic Inequalities and Oncological Outcomes Italian Working Group. Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. Oncotarget 2017; 8(40): 68402-14.
[http://dx.doi.org/10.18632/oncotarget.19447] [PMID: 28978126]
[20] Johansson I, Berterö C. Social support and self-esteem in patients afflicted with cancer in the reproductive organs, including breasts. Aust-Asia J Cancer 2003; 2(2): 116-23.
[21] Orsini M, Trétarre B, Daurès JP, Bessaoud F. Individual socioeconomic status and breast cancer diagnostic stages: A French case-control study. Eur J Public Health 2016; 26(3): 445-50.
[http://dx.doi.org/10.1093/eurpub/ckv233] [PMID: 26823441]
[22] Jalali-Farahani S, Amiri P, Karimi M, Vahedi-Notash G, Amirshekari G, Azizi F. Perceived social support and health-related quality of life (HRQoL) in Tehranian adults: Tehran lipid and glucose study. Health Qual Life Outcomes 2018; 16(1): 90-8.
[http://dx.doi.org/10.1186/s12955-018-0914-y] [PMID: 29747652]
[23] Yang L, Song WP, Chen ZL, et al. Correlation between social support and quality of life in patients with breast cancer at different periods of treatment. Zhonghua Zhong Liu Za Zhi 2017; 39(3): 202-6.
[PMID: 28316220]
[24] Suwankhong D, Liamputtong P. Social support and women living with breast cancer in the south of thailand. J Nurs Scholarsh 2016; 48(1): 39-47.
[http://dx.doi.org/10.1111/jnu.12179] [PMID: 26580861]
[25] Zhang H, Zhao Q, Cao P, Ren G. Resilience and quality of life: Exploring the mediator role of social support in patients with breast cancer. Med Sci Monit 2017; 23: 5969-79.
[http://dx.doi.org/10.12659/MSM.907730] [PMID: 29248937]
[26] Gage-Bouchard EA. Social support, flexible resources, and health care navigation. Soc Sci Med 2017; 190: 111-8.
[http://dx.doi.org/10.1016/j.socscimed.2017.08.015] [PMID: 28858696]
[27] Thompson T, Pérez M, Kreuter M, Margenthaler J, Colditz G, Jeffe DB. Perceived social support in african american breast cancer patients: Predictors and effects. Soc Sci Med 2017; 192: 134-42.
[http://dx.doi.org/10.1016/j.socscimed.2017.09.035] [PMID: 28965004]
[28] Faller H, Weis J, Koch U, et al. Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. J Psychosom Res 2016; 81: 24-30.
[http://dx.doi.org/10.1016/j.jpsychores.2015.12.004] [PMID: 26800635]
[29] Kauffmann R, Bitz C, Clark K, Loscalzo M, Kruper L, Vito C. Addressing psychosocial needs of partners of breast cancer patients: A pilot program using social workers to improve communication and psychosocial support. Support Care Cancer 2016; 24(1): 61-5.
[http://dx.doi.org/10.1007/s00520-015-2721-x] [PMID: 25917451]
[30] Hulbert-Williams NJ, Beatty L, Dhillon HM. Psychological support for patients with cancer: Evidence review and suggestions for future directions. Curr Opin Support Palliat Care 2018; 12(3): 276-92.
[http://dx.doi.org/10.1097/SPC.0000000000000360] [PMID: 30074924]
Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open