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JEADV ISSN 1468-3083
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
Abstract
cosmetic care, quality of life, breast cancer Background Breast cancer is the most common cancer in women and
therefore represents a major problem in public health. Data from patients’ self- Dermatology, Notre Dame de Grâce Clinic, report questionnaires provide valuable information about the side-effects that Gosselies, 212, chaussée de Nivelles, B−6041 patients may view as having a significantly detrimental impact on their quality Gosselies, Belgium, tel. +32 71 379 654; 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 self-
perception 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.
and aesthetic point of view, alopecia is probably one of the Introduction
most difficult side-effects for patients. Moreover, disease Breast cancer is the most common cancer in women and and cancer treatments contribute to modify patients’ therefore represents an important problem in public perception of their own body, their ‘body image’.
health.1 Most patients with primary breast cancer can be Data from patients’ self-report questionnaires provide optimally treated with breast-conserving local treatments.
valuable information about the side-effects that patients The addition of systemic hormone therapy and chemo- may view as having a significantly detrimental impact on therapy reduces the risk of death by 25–50% in patients their quality of life (QOL) and yet are not always recognized as important by healthcare professionals.
These treatments are effective but are also sources of Such information is very important in enabling patients side-effects; chemotherapy is particularly a source of effects to make informed choices regarding treatment options.3 on the hair, nails and on the skin. On a psychological However, there are still surprisingly few published reports JEADV 2007, 21, 771–776 Journal compilation 2007 European Academy of Dermatology and Venereology
Impact of cosmetic care on QOL in breast cancer patients from comprehensive QOL studies comparing such The patients of the cosmetic group received individual coun- treatments and thus little is known about the relative selling to choose the wig (model, colour), to do its mainten- ance and to have refund by insurance company. Moreover, Cosmetology is a specific care offering not only face this group received, by the same investigator (dermatologist moisturizing care, moisturizing massages, corrective qualified in cosmetic care), a 2-h session including face make-up, manicure, and pedicure, but also specialized moisturizing care, body moisturizing massage with oils or hair counsels (wigs, scarf, headband) to help patients to moisturizing creams, camouflage, manicure, pedicure and take care of themselves and to correct the side-effects of make-up every month. Finally, they had an interview for anti-cancer treatment such as alopecia, paleness, dryness conclusion after the last session of radiotherapy (Table 2).
of the skin, scars, erythema, and nail dystrophy.
Data were analysed using the statistics software SPSS Unfortunately, so far there is no scientific evidence of 12. Significance was assessed using the chi-squared or the benefit of cosmetology on QOL. The aim of our study Fisher tests and was set at P < 0.05.
was to assess the impact of cosmetology and hair care on Likert scale responses were arbitrarily subdivided in QOL in breast cancer patients during the whole treatment 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, verymuch, extremely corresponding to ‘altered QOL’ group.
Materials and methods
Patients
Between January 2001 and August 2004, 27 female Patient’s characteristics
patients aged 18 years old and over were included in twocentres (Erasme University hospital and Notre Dame de In the cosmetic group we find 14 patients age 39 – 60 Grâce Clinic Gosselies). Inclusion criteria were stage II (mean 51); 2 patients had CMF chemotherapy, 12 had breast cancer treated by lumpectomy (excision of the FEC chemotherapy, and all had radiotherapy.
tumour with preservation of the breast) with positive In the control group we find 13 patients age 40 –79 axillary lymph-node dissection receiving adjuvant chemo- (mean 57), 1 had CMF chemotherapy, 12 had FEC chemo- therapy and radiotherapy. Patients were treated either by therapy, and all had radiotherapy (Table 3).
cyclophosphamide, methotrexate and fluorouracil (CMF) All patients except two developed alopecia, one in each 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 Impact of cosmetic care on QOL
obtained from the local ethics committee.
Patients were informed of the target of the study and Table 4 show the number of patients (cosmetic group and were randomized in two groups, the cosmetic group and control group) for each responses group: ‘QOL not altered’ the control group. The cosmetic group received cosmetic and ‘QOL altered’ at three different moments of the care during the chemotherapy and the radiotherapy. The control group did not received cosmetic care.
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).
Patients were administered a French validated derma- Treated patients stayed more self-confident (question no.
tologic specific quality of life questionnaire,8 the VQ- 23/P = 0.032). Cosmetic patients stayed more confident Dermato, including 28 questions about seven different on the future (question no. 24/P = 0.04).
fields of QOL: self-perception, daily life activity, mood state, We can thus notice that the treated patients keep a better social functioning, leisure/activity, treatment-induced quality of life in two explored fields, the field of the ‘self- restriction, and physical discomfort8 (Table 1).
perception of the disease “and the field of” mood state’.
All the patients had to fill in this questionnaire three times during the adjuvant treatment: before the first Discussion
chemotherapy (time 0), after the second cycle of chemo-therapy (time 1), and at the end of radiotherapy (time 2).
The quality of life becomes one useful tool in the medical All the patients had an interview before the first cure of field, not only to analyse the impact of a disease but also chemotherapy (approximately 12 days before the first cure).
JEADV 2007, 21, 771–776 Journal compilation 2007 European Academy of Dermatology and Venereology
Impact of cosmetic care on QOL in breast cancer patients Table 1 VQ-Dermato questionnaire
VQ-Dermato in English (indicative translation – not validated in English) Durant les quatre dernières semaines, votre maladie a-t-elle entraîné des During the 4 weeks, did your disease affect, restrict or Q2 – pour vous occuper de votre maison : ménage, cuisine, petits travaux Q3 – pour faire votre toilette, vous raser, vous maquiller? Q3 – your personal care (wash, ,shave, apply, make-up)? Q4 – dans le choix de vos habits; vous n’avez pas pu mettre certains vêtements Q4 – the chose of your clothes (you could not wear some of your clothes Q5 – pour vos loisirs: sport, exposition au soleil, musique, bricolage, Q5 – your recreation time: sport, sun exposure, music, do-it-yourself, Q6 – pour profiter du soleil, pour vivre dehors au soleil? Q6 – the way you enjoy the sun, you live in the sun? Q7 – pour vous concentrer: travail, lecture? Q7 – your ability to concentrate (in working, reading)? Durant les quatre dernières semaines, votre maladie vous a-t-elle gêné dans: During the 4 weeks, did your disease bother you in: Q9 – dans votre vie sociale: sorties au restaurant, au cinéma, au café, allez Q9 – your social life: going to the restaurant, bar, hairdresser or chez le coiffeur ou chez les commerçants … ? Q10 – vos relations avec vos proches: famille, amis? Q10 – your relationship with your family and friends? Q11 – votre vie affective avec votre conjoint(e), votre partenaire? Q11 – your sentimental life with your spouse or partner? Q12 – votre activité sexuelle avec votre conjoint(e), votre partenaire? Q12 – your sexual relationships with your spouse or partner? Durant les quatre dernières semaines, du fait de votre maladie, vous avez? Q14 – éprouvé le besoin de cacher votre maladie de peau: par le maquillage, Q14 – that you had to hide your skin disease? Q15 – eu les sentiments d’être dévisagé(e), rejeté(e) par les autres? Q15 – that people were staring at you or rejecting you? 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? Q23 – you were diminished, you lack self-confidence? Q24 – manqué de confiance dans l’avenir? Durant les quatre dernières semaines, jugez-vous que le (ou les) traitement(s) During the last 4 weeks, was the treatment of your disease? de votre maladie a (ont) été?Q25 – contraignant(s)? Durant les quatre dernières semaines, votre maladie a-t-elle entraîné: During the 4 weeks, did your disease cause: Q28 – des brûlures, des picotements, des tiraillements ou toute autre forme Q28 – burning, prickling, or any other type of pain? «Jamais, rarement, Parfois, Souvent, Toujours» for questions 1–8, 13–24 and ‘Never, seldom, sometimes, often and always’ for questions 1–8, 13–24 «Pas du tout , Un peu, Modérement, Beaucoup, Extrêmement / Enormement» ‘Not at all, somewhat, Moderately, very much, extremely’ for questions JEADV 2007, 21, 771–776 Journal compilation 2007 European Academy of Dermatology and Venereology
Impact of cosmetic care on QOL in breast cancer patients 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 First visit: Planning explanation + Proposal of a hair cut very short before the possible Belgian wig makers + VQ-Dermato to fill in at home 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): 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
Number of patients
Number of patients
Number of patients
CMF chemotherapy
FEC chemotherapy
radiotherapy
To date, in a surprising way, only a few publications deal for women is probably hair care because of its significant In order to study the impact of the cosmetic care on the Moreover, we insist on the fact that this study was entirely quality of life of the breast cancer patients in the course of free for patients and that the financial aspect could represent chemotherapy and radiotherapy, we developed a prospec- a brake with the cosmetic care for some patients. There- tive, multicentre, randomized, controlled study including fore, it seems important to analyse possibility of a financial 27 patients. In spite of little information about all the support by the health insurances or government. It could QOL, this study shows significant differences between also realized by cosmetic company as it is already the case the two groups of the patients but only at the end of the in France for the association ‘L’Etincelle’ devoted to the treatment; indeed at this time, patients who received quality of life of the women suffering from breast cancer.
cosmetic care remain more self-confident and are more In our study, all the cosmetic care was provided by people properly trained in ‘hospital cosmetic care’. Un- The fact that the difference is only significant at the end fortunately they are currently very few. To develop this of the treatment shows that it is interesting to follow the approach on a large scale, it seems possible to us to set up patients throughout treatment and not only during one a nurse training elaborated by people experienced in session of chemotherapy or radiotherapy.
cosmetology and oncology. Cosmetic care provided by those Although no study was carried out among breast cancer specially trained nurses stand be available in gynaecology patients, we know that self-confidence is altered in these departments treating breast cancer and in oncology patients and this might interfere with their compliance to departments and could be extended to other male and Therefore, it should be important to focus on patients’ psychological life and to develop all kind of support that Acknowledgements
can help them to stay hopeful and confident about thefuture as illustrated in our trial. We really think that This study was supported by a grant provided by Lancôme cosmetology is helpful and the most important support JEADV 2007, 21, 771–776 Journal compilation 2007 European Academy of Dermatology and Venereology
21
, 771–776 Jour
Table 4 Statistics – Fisher test
Time 0: before treatment
Time 1: during treatment
Time 2: after treatment
nal compilation 2007 European Academy of Der QOL not altered
QOL altered
QOL not altered
QOL altered
QOL not altered
QOL altered
Responses group
Number of patient
Number of patient
Number of patient
Number of patient
Number of patient
Number of patient
Patient’s group
Cosmetic
Cosmetic
P-value
Cosmetic
Cosmetic
P value
cosmetic
Cosmetic
P value

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quality of life in survivors of locally advanced breast cancer: JEADV 2007, 21, 771–776 Journal compilation 2007 European Academy of Dermatology and Venereology

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