9046 Background: Reducing diagnostic delays may improve treatment outcomes in BC. We investigated in various countries patient-related factors influencing time to seeking medical advice for signs of BC. Methods: A total of 4,816 female BC patients from 10 countries were surveyed using a uniform questionnaire translated into local languages. Time between first patient-detected signs of BC and AMV was measured using categorized time scales. Out of 14 original items on a multiple scale measuring BC-related attitudes and behaviors, 5 factors were extracted and used for further analysis: distrust in medical system and success of therapy, disregard of signs, fear of BC, practicing regular breast self-examination and support from friends and family. Results: In the subset of 2,870 patients with self-detected BC who provided complete answers to relevant variables, the mean time to AMV varied in particular countries from 3.4 to 6.2 weeks (grand mean of 4.7 weeks), with 39% of cases with a delay of >4 weeks. Overall, patient attributes that significantly influenced time to AMV were: distrust (p<1E-36), disregard (p=1.26E-30), fear (p=2.65E-16), self-examination (p=1.31E-21), place of living (p=3.5E-3) and education (p=2.73E-3). Multilevel analysis indicated that significant differences among particular countries were only due to slopes of distrust and disregard included in general regression model. The model enhanced with the two abovementioned random effects provided significant improvement in predicting time to AMV. Re-estimation of the model based solely on data from individual countries produced 10 significant equations with varied coefficients for distrust and disregard (see table). Conclusions: Patient-related factors contribute considerably to delay in the diagnosis of BC. Differences between particular countries call for country-specific approaches. [Table: see text]

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Введение. Психологическая помощь, являясь сутью психологической реабилитации в онкологии, основывается на работе с переживаниями больных, вызванными заболеванием раком. Специфичность переживаний пациентов определяется локализацией опухоли и тем, какое значение придает пациент больной части тела. Гинекологический рак затрагивает важные для женщины сферы, связанные с женственностью, материнством, влияющие на ее сексуальную жизнь и на семейные отношения. Цель-психологическое исследование переживаний онкогинекологических больных, специфику которых необходимо учитывать в процессе психологической реабилитации. Материал и методы. Обследована 41 больная в возрасте от 19 до 45 лет с онкогинекологическими заболеваниями на различных этапах лечения. Данные клинико-психологической беседы дополнялись результатами психодиагностических тестов-ТОБОЛ, Гиссенский опросник соматических жалоб, EQRTCQLQ-C30. Результаты исследования. Для онкогинекологических пациенток не характерен длительный период отрицания злокачественного характера заболевания. На фоне эргопатического реагирования на заболевание в структуре отношения к болезни у больных на этапе «до операции» доминировал тревожный компонент, у больных «после операции»-дисфорический компонент. Выявлена высокая интенсивность жалоб пациенток по поводу здоровья, в том числе неспецифических, свидетельствующих о психосоматической составляющей страдания больной. Качество жизни больных взаимосвязано с их представлением о видах лечения, их опасности. Показано, что заболевание раком является психологическим кризисом не только для самой онкогинекологической пациентки, но и для других членов ее семьи, особенно ее мужа. Выводы. Психологическая помощь онкогинекологическим больным в процессе психологической реабилитации должна основываться на учете их глубинных переживаний, которые определяются самоотношением женщин и принятием себя и которые могут больными не осознаваться, но влиять на их отношение к болезни и лечению и, тем самым, определять их качество жизни. Психологическая помощь, направленная на выстраивание новых взаимоотношений, адекватных ситуации заболевания, необходима всей семье больной.

Materials and methods. The effect of melatonin (MLT) and metformin (MTF) on the efficacy of neoadjuvant hormone therapy with toremifene was investigated in 54 patients with estrogen receptor-positive, locally advanced breast cancer (ER + BC). The average age of women was 67 years. The patients had no diabetes mellitus. The first group of patients (n = 19) received toremifene 120 mg per day, the second group (n = 16) - toremifene in combination with MLT 3 mg orally every night, the third group (n = 19) - toremifene in combination with MTF 850 mg twice daily. Randomization was performed - 1: 1: 1. The duration of therapy in all study groups was 4 months. After the end of treatment, all patients were undergone surgery. Further adjuvant treatment depended on the results of the postoperative pathomorphological conclusion. The primary endpoint was a decrease in the Ki-67% level (a surrogate marker for the effectiveness of hormone therapy), the secondary endpoints were the objective response, a pathological response in the tumor and lymph nodes, and the quality of life. Results. In all patients (n = 54), the frequency of decrease Ki-67 level and the frequency of objective response were 57% and 50%, respectively. At the same time, the incidence of Ki-67% level decrease in the «toremifene» group was 42%, in the «toremifene+MLT» group - 56%, in the «toremifene+MTF» group - 74%. Multifactor analysis showed that the addition of MTF to toremifene increases the chances of reducing Ki-67 compared with control 4.2 times (RR 4.23 [95% CI 1,04417,139], p = 0.043). It is important that only in the patients of the «toremifene+MTF» group a significant correlation was found between the Ki-67 index decrease in the tumor and the BMI value above the norm (p = 0.015). A complete pathomorphological response in the tumor and lymph nodes was not achieved in any patient. The objective response in the study groups was 31.6%, 86.7% and 47.3%, respectively. The addition of MLT to hormone therapy with toremifene significantly increased the frequency of the objective response from 31.6% to 86.7% (x2 = 10.32, p = 0.001). The inclusion into neoadjuvant hormone therapy with toremifene of MLT or MTF did not reduce the quality of life of patients, while in 50% of patients in the «toremifene+MLT» group there was an improvement in sleep.