Reshaping Breast Cancer Survivorship Through Expanding the Indications for the Omission of Radiation

Objective Breast cancer is one of the most common malignant tumors in women.The number of women diagnosed with breast cancer each year is also increasing.It is also the leading cause of cancer deaths in women, accounting for 14-23% of cancer deaths.However, with the development of medical technology, the survival rate of breast cancer patients is improving.In general, the treatment of breast cancer mainly includes surgical treatment, adjuvant chemotherapy and radiotherapy，But these treatments can do a lot of damage to breast cancer patients.These injuries can limit some of the physical activity of breast cancer patients, and can be accompanied by significant psychological damage，Therefore, the quality of life of breast survivors is largely destroyed.Physical exercise is one of the important ways to improve the overall health of the human body.It also plays an important role in increasing people's mood and quality of life.So whether physical exercise has a positive impact on improving the quality of life of breast cancer survivors or there is some doubt.Therefore, the main purpose of this study is to explore the impact of physical exercise on the quality of life of breast cancer survivors, and then to prove the impact of supervised exercise and individual exercise on the quality of life of breast cancer survivors.
 Methods Data bases searched were MEDLINE, EMBASE, CINAHL, PubMed.Keywords were“breast cancer and quality of life” in combination with “exercise”or “physical activity”.At the same time, the references of the included articles were reviewed to obtain more relevant studies.In terms of the criteria for inclusion and exclusion of literature, the paper was initially screened to determine whether the title and abstract of the paper were consistent with the research topic.The criteria for inclusion are ①the subjects were breast cancer survivors,②the type of intervention was physical exercise,③the measured result is quality of life,④the type of experiment is randomized controlled trial.The exclusion criteria of the article are ①the subject's occupation was athlete，②quality of life is not measured on a formal scale，③article type is review or abstract.
 Results A total of 14 articles are included in our review.Quality of life was measured using scale tools in all included studies, of which two scales were used in all included articles.The two scales used can reflect the real life quality of the subjects, of which FACT-G is a mass life quality scale and FACT-B is a life quality scale designed specifically for breast cancer patients. Both scales are globally recognized by the public.In our review, we found that exercise significantly improved the quality of life of breast cancer survivors, particularly aerobic exercise.In the studies included in our study, except Nanette et al. used aerobic exercise combined with resistance strength training as the intervention method in their study, all the other studies used aerobic exercise as the intervention method for the subjects.Among the 14 included studies, 10 indicated that physical exercise significantly increased the quality of life of breast cancer survivors, and 4 found that compared with the control group, the quality of life of breast cancer survivors did not have significant changes, but there was a trend of improving the quality of life.At the same time, our review found that monitoring breast cancer survivors improved quality of life.In two of the studies we included, subjects were divided into individual exercise groups and supervised exercise groups.In their study, Anne et al. divided the recruited research samples into the supervision intervention group and the routine control group. Among them, the supervision intervention group received physical exercise 5 times a week for 12 weeks, and the quality of life of breast cancer survivors was significantly improved.In the study of Cadmus et al., the subjects recruited were divided into individual exercise group, supervised exercise group and routine control group, and the exercise group performed physical exercise with the same load and frequency. The result was that there was no physical activity in the home individual exercise group or the routine control group that improved the quality of life for breast cancer survivors.However, in the supervised exercise group, breast cancer survivors' scores for FACT-B and SF-36 (a measure reflecting quality of life) were significantly improved.
 Conclusions Exercise can improve the quality of life for breast cancer survivors, especially aerobic exercise. Supervised exercise intervention for breast cancer survivors can better improve their quality of life and alleviate social and psychological problems than individual exercise.The supervised aerobic exercise can be integrated into the life of breast cancer survivors so as to better promote the recovery of breast cancer survivors.

Background: Epidemiologic studies in the West have found that lifestyle factors, including maintaining normal body weight, being physically active and eating a healthy diet are individually associated with better quality of life (QOL) among breast cancer survivors. Limited data is available on lifestyle modifications in association with quality of life of breast cancer survivors in Asian region. The objectives of this study were to [1] determine the lifestyle changes among Chinese breast cancer survivors at diagnosis and 18-month post diagnosis; and [2] to assess the association of lifestyle changes with QOL. Methods: In this prospective cohort study, 1300 Chinese breast cancer patients were assessed at breast cancer diagnosis (baseline; reflecting pre-diagnosis) and at 18-month post-diagnosis. During each assessment, individual patient's lifestyle within the previous 12 months were recorded and included exercise, diet, and body mass index (BMI) data; each patient also underwent self-administered QOL assessment. Assessment of lifestyle modifications were based on World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendation adherence scores (range: 0-6).QOL was evaluated by European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire C-30 (EORTC-QLQ-C30). Paired t-test was performed to compare the overall recommendation adherence score before and after diagnosis.To investigate the association between recommendation adherence score and HRQoL, generalized linear models were used to compare the least-square means by tertiles of adherence score (T1, T2, and T3) and continuous adherence score. In the multivariate models, adjustment were made for age, stage of cancer, education level, marital status, comorbidities, smoking status, current hormonal therapy and energy intake. Results: The mean recommendation adherence score significantly increased from baseline of 3.2 (SD=1.1) to 3.9 (SD=1.1, p<0.001) at 18-month follow-up. Overall, increasing adherence to WCRF/AICR guideline was associated with higher scores of global health status (P=0.01), physical functioning (P<0.001) and role functioning (P=0.03), and lower scores of fatigue (P=0.001), nausea and vomiting (P=0.003), pain (P<0.001), dyspnea (P=0.006), loss of appetite (P=0.001) and diarrhea (P<0.001). Conclusions: Positive lifestyle changes were made among Chinese breast cancer survivors after cancer diagnosis. Increased adherence to WCRF/AICR recommendations after cancer diagnosis improves QOL, suggesting that Chinese breast cancer survivors should follow the WCRF/AICR guideline for cancer prevention. Acknowledgments: This study is funded by the World Cancer Research Fund International (Grant Number WCRF 2010/249and WCRF 2014/1197) and Madam Diana Hon Fun Kong Donation for Cancer Research. Citation Format: Lei Y-Y, Lee IC-K, Cheung KL, Lee R, He Y, Yeo W. Quality of life of Chinese breast cancer survivors in association with lifestyle changes before and after cancer diagnosis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-04.

To assess fatigue and quality of life in disease-free breast cancer survivors in relation to a sample of age-matched women with no cancer history and to explore the relationship between fatigue and quality of life. A cross-sectional study was conducted in a sample of 202 consecutive disease-free Brazilian breast cancer survivors, all of whom had completed treatment, treated at 2 large hospitals. The patients were compared to age-matched women with no cancer history attending a primary health care center. The Piper Fatigue Scale-Revised and the World Health Organization Quality of Life Instrument (WHOQOL-BREF) were used to measure the fatigue and quality of life, respectively. Socio-demographic and clinical variables were also obtained. The χ2 test, generalized linear model, and Spearman correlation coefficient were used for statistical purposes. The adopted level of significance was 5%. Breast cancer survivors experienced significantly greater total and subscale fatigue scores than comparison group (all p-values<0.05). In addition, survivors reported a poorer quality of life in physical (p=0.002), psychological (p=0.03), and social relationships (p=0.03) domains than comparison group. No difference was found for the environmental domain (p=0.08) for both groups. For survivors of breast cancer and for comparison group, the total and subscale fatigue scores were related to lower quality of life (all p-values<0.01). The findings of this study highlight the importance of assessing fatigue and quality of life in breast cancer survivors.

Purpose Few studies have reported postdiagnosis differences in distress and quality of life (QOL) for breast cancer (BC) survivors. Here we investigated the differences in distress and QOL for BC survivors in Korea, during follow-up. Methods Completed questionnaires were collected from 179 BC survivors in 2013. Functional Assessment of Cancer Therapy-Breast was administered to measure the distress and Distress Thermometer and Problem List was administered to measure the QOL. Results The mean QOL score was 96.69 (standard deviation, ±20.33). Seventy-nine patients (44.1%) with distress-test scores >4 were assigned to the severe distress group. The patient group with higher family income had high QOL score (p=0.008). In addition, QOL scores were significantly higher in patients who lived longer after diagnosis (p=0.016). Patients at high TNM stage had low QOL scores (p=0.006). Furthermore, older patients tended to have high distress scores (p=0.028). Based on duration of the postdiagnosis period, we divided the patients into two groups. Seventy patients had a postdiagnosis period <2 years; 109 patients, postdiagnosis period ≥2 years. Distress score of the under-2-year group (4.26±2.73) was significantly higher (p=0.044) than that of the longer-than-2-year group (3.47±2.42). Conclusion BC survivors showed improvement in physical well-being, emotional well-being, and functional well-being domain of QOL over time. However, social well-being and BC subscale score were only slightly improved over time. It is possible that cancer patients’ supporting programs are focused on the recently diagnosed patients or those currently undergoing treatment. Therefore, more support should be made available to long-term BC survivors. Keywords: Breast; Neoplasms; Psychological stress; Quality of life; Survivors

Background. Breast cancer fatigue (BCF) is a complex and multidimensional condition characterized by a persistent sense of physical and/or mental stiffness, resulting in a substantial impairment of health-related quality of life in breast cancer patients and survivors. Several therapeutic approaches have been proposed for BCF. Among them, supervised exercise therapy is a valuable non-pharmacologic option. However, the optimal exercise scheme (i.e. type, combination, frequency, intensity, and duration) remains controversial. Here, we sought to evaluate the effects of a specific therapeutic exercise protocol on BCF and muscle performance. Methods. This is a still-recruiting pilot prospective cohort study including women with a diagnosis of BCF up to two months after breast surgery. Exclusion criteria: Hb &amp;lt;9 g/dl, platelets &amp;lt;150,000/mm3, and brain and/or bone metastases. Intervention: all participants were subjected to a physical exercise rehabilitative protocol consisting of 10 minutes of warm-up, 40 minutes of aerobic exercise (e.g. walking, cycling, rowing) and strength training (e.g. light weightlifting), and 10 minutes of cool-down. Each session was repeated 2 times/week with &amp;gt;2 days of rest for 4 weeks, under the supervision of an experienced physical therapist. Primary outcome evaluation: brief fatigue inventory (BFI). Secondary outcomes: the European organization for research and treatment of cancer quality of life questionnaire (EORTC QLQ-C30); hand grip strength test (HGS); short physical performance battery (SPPB); 10 meter walking test (10MWT); 6 minute walking test (6MWT). All outcomes were assessed at baseline (T0), after 1 month (T1), and after 3 months (T2). Results. Of the 102 patients assessed, 48 did not meet the inclusion and exclusion criteria and 18 refused to sign the informed consent. Finally, 36 BC women (mean age: 55.17 ±7.76 years; body mass index: 25.15 ±5.52 kg/m2) were enrolled. BFI showed a statistically significant reduction both at T1 (5.4 ±1.6 vs 4.2 ±1.7; p=0.004) and T2 (5.4 ±1.6 vs 4.4 ±1.6; p=0.004). Furthermore, we found significant differences at T1 in terms of HGS (20.1 ± 5.8 vs 22.5 ± 5.2: p&amp;lt;0.001), SPPB (9.3 ± 2.0 vs 11.3 ± 1.2; p&amp;lt;0.001), 10MWT (1.5 ± 0.3 vs 1.8 ± 0.3; p&amp;lt;0.001), 6MWT (464.5 ± 62.9 vs 554.1 ± 71.6; p&amp;lt;0.001), EORTC QLQ-C30 Functional score (69.2 ± 14.9 vs 76.9 ± 15.7; p&amp;lt;0.001), EORTC QLQ-C30 Symptoms score (29.2 ± 14.9 vs 21.2 ± 16.0: p&amp;lt;0.001), and EORTC QLQ-C30 Global Health score (40.7 ± 12.5 vs 67.6 ± 14.8; p&amp;lt;0.001). At 2 months (T2), all the outcome measures significantly differ from the baseline (p&amp;lt;0.05), including FFM (43.2±6.4 vs 45.5±6.6; p&amp;lt;0.001) and FM (24.0±10.6 vs 21.7±10.0; p&amp;lt;0.001), as showed by Table 3. Moreover, the GPE score measured at T1 was 2.20 considering patients’ perspective and 2.40 considering physical therapists’ perspective.Conclusions. The physical exercise rehabilitation protocol proposed herein might be a feasible, safe, reliable and effective intervention in reducing BCF and improving muscle mass, function, and health-related quality of life in breast cancer survivors. Further studies are needed to define the role of physical rehabilitation in the multidisciplinary management of BCF. Citation Format: Marco Invernizzi, Alessandro de Sire, Elham Sajjadi, Konstantinos Venetis, Alessandra Gennari, Nicola Fusco. Exercise therapy to reduce breast cancer fatigue: Results from the EXPECT study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-36.

Breast cancer fatigue (BCF) is a complex and multidimensional condition characterized by a persistent sense of physical and/or mental stiffness, resulting in a substantial impairment of health-related quality of life in breast cancer survivors. Aim of this prospective cohort study was to evaluate the feasibility and the effectiveness of a 4-week rehabilitation protocol on BCF, muscle mass, strength, physical performance, and quality of life in breast cancer (BC) survivors. We recruited adult BC women with a diagnosis of BCF, according to the International Classification of Diseases 10 criteria, referred to the Outpatient Service for Oncological Rehabilitation of a University Hospital. All participants performed a specific physical exercise rehabilitative protocol consisting of 60-min sessions repeated 2 times/week for 4 weeks. All outcomes were evaluated at the baseline (T0), at the end of the 4-week rehabilitation treatment (T1), and at 2 months follow up (T2). The primary outcome measure was the Brief Fatigue Inventory (BFI); secondary outcomes included: Fat-Free Mass and Fat Mass, assessed by Bioelectrical Impedance Analysis (BIA); Hand Grip Strength Test (HGS); Short Physical Performance Battery (SPPB); 10-meter walking test (10 MWT); 6-min walking test (6 MWT); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ–C30). Thirty-six women (mean age: 55.17 ± 7.76 years) were enrolled in the study. Significant reduction of BCF was observed both after the 4-week rehabilitation treatment (T1) (BFI: 5.4 ± 1.6 vs. 4.2 ± 1.7; p = 0.004) and at the follow-up visit (T2) (BFI: 5.4 ± 1.6 vs. 4.4 ± 1.6; p = 0.004). Moreover, significant differences (p < 0.001) HGS, SPPB, 10 MWT, 6 MWT, and EORTC QLQ-C30 were found at T1, while at T2 all the outcome measures were significantly different (p < 0.05) from the baseline. The rehabilitation protocol seemed to be feasible, safe, and effective in reducing BCF, improving muscle mass and function, and improving HRQoL in a cohort of BC survivors. The results of this study could improve awareness of this underestimated disease, suggesting the definition of a specific therapeutic exercise protocol to reduce BCF.

PurposeThis study focused on developing and testing a comprehensive model that explores the social determinants of health influencing the quality of life of young breast cancer survivors, particularly highlighting the impact of treatment regret.MethodsThis descriptive-analytical study with a cross-sectional design was conducted on 462 young female breast cancer survivors referred to the Yazd Radiation Therapy Center. Data were collected using a demographic questionnaire, the standard decision regret scale, the perceived social support scale, the reproductive concern inventory, and the quality-of-life questionnaire for breast cancer survivors. Then, using path analysis test, the relationship between social determinants of health and quality of life in breast cancer survivors was examined. Data were analyzed by SPSS-26 and LISREL-8 software.ResultsAccording to the results of path analysis, among the structural determinants of health examined, socioeconomic status (β=0.279) had the most positive effect on the quality of life. Also, among the intermediate determinants, treatment regret (β=−0.26) and fertility concerns (β=−0.36) had the most direct and negative effect on the quality of life of breast cancer survivors. The fertility concerns had the most indirect and negative effect on the quality of life of young female survivors with the mediation of treatment regret (β=−0.039). The results also indicated an acceptable goodness of fit for the model.ConclusionSocioeconomic status had the strongest influence on the quality of life of young breast cancer survivors, partly through social support. Fertility concerns also affected quality of life directly and indirectly via treatment regret. Addressing fertility-related distress should be a key component of supportive care. Although fertility preservation options such as egg or embryo freezing exist in Iran, limited access and awareness highlight the need for early fertility counseling and integrated psychosocial support to improve survivors’ well-being.Implications for Cancer SurvivorsTo improve their quality of life, it is essential to implement strategies such as creating support groups in treatment centers, offering counseling on fertility options, and providing regular follow-up programs for their physical and mental health.

Background: The aim was to explore the association between coping strategies (CSs) and health-related quality of life (HRQoL) in breast cancer (BC) survivors and to analyze the role of relevant sociodemographic and clinical variables. Methods: A cross-sectional study involving 305 women under follow-up for surgically treated BC in Spain. CSs were measured using the Brief Coping Orientation to Problems Experienced Scale and the HRQoL with the Short-Form Health Survey (SF-12). Results: The mean age at BC diagnosis for participants was 57.4 years, with 60.3% of diagnoses at the local stage. Most frequent complementary treatments were radiotherapy (53.4%) and chemotherapy (33.1%). Adaptative CS scores were positively associated both with higher physical HRQoL (adjusted regression coefficient: 2.19; 95% confidence interval: 0.11; 4.27, p-value: 0.039) and mental HRQoL scores (coef.: 2.65: 95%CI: 0.25; 5.04, p-value: 0.030). Maladaptive CS scores were inversely associated with mental HRQoL scores (coef.: -3.92; 95%CI: -6.62; -1.22, p-value: 0.005). The effects were stronger among women with a favorable BC prognosis. Conclusions: Adaptive CSs positively affected the physical and mental HRQoL, while maladaptive CSs negatively affected the mental HRQoL. Therefore, psychosocial interventions that promote adaptive CSs and avoid maladaptive ones could improve the well-being of women with a favorable BC prognosis.

Background With the advancement of early cancer diagnosis and treatment modalities, the number of cancer survivors has grown totaling 38 million worldwide with 13.7 million cancer survivors in the United States (US) as of 2012. More than 2.5 million of these are breast cancer survivors, making up 18% of the survivorship population in the US and 1.5 million worldwide. Breast cancer survivors need ongoing health care during survivorship. In 2006, The Institute of Medicine (IOM) recommended that all cancer survivors, along with their health care providers, be given a survivorship care plan on completion of active treatment that incorporates cancer treatment, potential consequences, specific follow-up and preventative health maintenance information. This plan also provides information regarding employment, health insurance, and psychosocial support in the community. A survivorship care plan (SCP), when individualized and utilized effectively, may maximize health outcomes and positively impact the quality of life of breast cancer survivors. Objective To examine and synthesize the best available evidence regarding the impact of an individualized care plan on the quality of life of adult female breast cancer survivors. Inclusion criteria Types of participants This review considered studies that included adult female breast cancer survivors, 18 years of age and older. Types of interventions This review considered individualized survivorship care plans as the additional intervention provided to adult female breast cancer survivors receiving the standard or routine care. Types of outcomes The outcomes examined are quality of life as it relates to physical, psychosocial and sexual health as measured by validated and reliable tools. Types of studies This review considered randomized controlled studies, and then other research designs such as non-randomized control trials, quasi-experimental, cohort case control, and cross sectional studies. Search strategy The search strategy aimed to find both published and unpublished studies in the English language from 1980 to present. The databases searched were CINAHL, PubMed, Embase, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL), Academic Search Premier, Health Source: Nursing/Academic Edition, ProQuest, Sage, and Salem Health. A search of the gray literature and electronic hand searching of relevant journals was also performed. Methodological quality The studies selected for retrieval were critically appraised by two independent reviewers using the Joanna Briggs Institute’s standardized critical appraisal instruments. Data collection Data was extracted from studies included in this review using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MASTARI). Data synthesis Studies were found to have significant heterogeneity between populations, interventions and outcomes. The findings are presented in narrative format as statistical meta-analysis was not possible. Results One randomized control trial (RCT) and one study, consisting of two small RCTs and one pre-experimental study, were included. The single RCT found no statistically significant differences or clinically important differences between the groups that received the intervention (SCP) and the control group (no SCP) based on the outcome variables of cancer-related distress, any of the secondary outcomes, or quality of life. More of the intervention group than the control group identified the primary care provider as being primarily responsible for follow-up by a difference of 9.6% (98.7% more than 89.1%), with a 95% confidence interval (CI) 3.9 to 15.9; p = .005. All patients showed a non-clinically important improvement in the impact of event scale (IES) scores and its subscales over time. In the second study, older breast cancer survivors aged 65 and over were recruited for three pilot studies (two small randomized clinical trials and one pre-experimental study) conducted in the US. In all three pilot studies, the breast cancer survivors’ symptoms of distress significantly decreased and symptom management behaviors positively increased in the intervention group. In the third pilot study there was also a statistically significant decrease in negative mood symptoms. There was no statistically significant change in specific quality of life measures in all three pilot studies. Based on participants’ very positive ratings and feedback, the intervention was assessed as feasible and acceptable. Conclusions There is a paucity of evidence on the effectiveness of survivorship care plans. In the two studies selected for inclusion, the first one found no significant difference or change in measured patient outcomes. The second suggests that it is important to understand the older breast cancer survivor beliefs about symptoms and how these beliefs motivate the symptom management behaviors. Such knowledge could lead to better assessment and symptom management interventions when caring for older cancer survivors.

Background Breast cancer (BC) is the most diagnosed cancer in women, contributing to 24.6% of malignancies in females and responsible for 15% of all cancer-related deaths among women worldwide.[1] Over the last 20 years, BC survival rates have significantly improved.[1] However, this survivorship is often marked by fatigue, poor quality of life (QoL), reduced functional capacity along with treatment-related adverse effects.[2] The implementation of a model similar to cardiac rehabilitation (CR) program as a preventive strategy may provide a potential solution to improve functional capacity, quality of life and reduce cardiovascular disease (CVD) risk in cancer survivors.[3] Objective to investigate the effect of 12-week completed cardiac rehabilitation program on quality of life (using FACT-B questionnaire) and 6-minute walk test in breast cancer survivors. Patients and Methods In this 2-arm parallel prospective, randomized, controlled clinical trial, sixty breast cancer survivors 3 months to 1 year after completion of chemotherapy were recruited at Ain Shams University hospitals and divided into two groups Study group (n = 30); participated in 12-week CR program and Control group (n = 30) did not participate in CR program but still received the usual cancer care. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, Behavior and psychosocial management, Sexual activity education Smoking cessation. Functional capacity was assessed before and after study period by sixminute walk test (6MWT) and exercise test (using modified Bruce protocol). All patients were personally interviewed for assessment of quality of life before and after study period using (FACT-B) questionnaire. In addition patients underwent echocardiography assessment before and after study period. Result Sixty female breast cancer survivors were enrolled. Nine patients dropped from CR program, some due to social commitments (n = 2), others due to long distance issues (n = 2), and the remaining were not interested in continuing the program (n = 5). There were no significant differences between the two groups regarding age, baseline BMI, hemoglobin (Hb) levels, medical history, chemotherapy protocol, and radiation. When comparing two groups, the study group showed significant increase in age-predicted 6MWD (p = 0.02), ET (p &amp;lt; 0.001), METs (p &amp;lt; 0.001), QoL score (p &amp;lt; 0.001), along with significant decrease in SBP (p &amp;lt; 0.001), HR (p &amp;lt; 0.001), RPP (p &amp;lt; 0.001). Conclusion The results of this study demonstrated that completed cardiac rehabilitation program improves functional capacity and quality of life in breast cancer survivors. Recommendation We recommend that multicomponent supervised cardiac rehabilitation program should be incorporated within the usual care of breast cancer survivor

To examine the effectiveness of a psychoeducational intervention on quality of life (QOL) in breast cancer survivors in post-treatment survivorship. A randomized controlled trial. An academic center collaborating with a regional cancer center in the southeastern United States. 256 breast cancer survivors. Women were randomly assigned to the experimental or wait control group. The Breast Cancer Education Intervention (BCEI) study was delivered in three face-to-face sessions and five monthly follow-up sessions (three by telephone and two in person). The control group received four monthly attention control telephone calls and the BCEI at month 6. Data were collected at baseline, three and six months after the BCEI for the experimental group, and one month after the BCEI (at month 7) for the wait control group. Primary endpoints were overall QOL and physical, psychological, social, and spiritual well-being. No differences in QOL were reported at baseline between groups. The experimental group reported improved QOL at three months, whereas the wait control group reported a significant decline in QOL. The experimental group reported continued maintenance of QOL at six months. Although the wait control group reported improved QOL at six months, significant differences continued to exist between the groups. The BCEI was an effective intervention in improving QOL during the first year of breast cancer survivorship. Treatment effects were durable over time. Post-treatment survivorship has not been empirically studied to a large degree. The BCEI is one of the few interventions demonstrating effectiveness among survivors after primary treatment, suggesting that oncology nurses may be uniquely positioned to provide safe passage using education and support.

Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data

Age-specific detriments to quality of life among breast cancer patients one year after diagnosis

Breast cancer is the most commonly diagnosed cancer in women; it is also the second-leading cause of death from cancer. Persistent pain after breast cancer surgery is a serious clinical problem that negatively impacts the health-related quality of life of breast cancer survivors. Although persistent post-surgical pain following breast cancer surgery has long been under-reported; however, it is less explored in Pakistan's geographical background. The study aimed to examine the persistent post-surgical pain after breast cancer surgery and its relationship to health-related quality of life among Pakistani women. A descriptive correlational research design was employed in this study. The Brief Pain Inventory Short Form (BPI-SF) was used to assess the persistent post-surgical pain. The Functional Assessment of Cancer Therapy-Breast (FACT-B) was used to measure the health-related quality of life. Data were collected between February and May 2019 from Pakistani women who have undergone breast cancer surgery for at least three months and attended follow-up visits at two tertiary care hospitals in Pakistan. A Spearman's correlation coefficient was used for data analysis. The study included 91 Pakistani women. The participants were all females, with an average age of 45.6 years (SD = 6.53). The majority received radical mastectomy (n = 84, 92.3%) with adjuvant therapy (n = 91, 100%). The prevalence of breast surgery-related persistent pain was 100%, with 63 (69.2%) rating the pain as moderate to severe and reported neuropathic pain. The data analysis revealed a statistically significant negative correlation between BPI-SF items and FACT-B dimensions (r = -.43, p < 0.01). The participants appeared to show the highest score of the FACT-B in the social/family well-being (M = 16.58, SD = 3.44). The lowest score of the FACT-B was physical well-being (M = 6.98, SD = 6.38). Persistent post-surgical pain has a negative impact on the health-related quality of life of Pakistani women breast cancer survivors, particularly on their physical well-being. Therefore, follow-up care of breast cancer survivors after treatment completion requires proper persistent pain-relief treatments and interventions to control pain and maintain health-related quality of life in oncology and research in this sphere. This basic knowledge from this study will enlighten the nurses and health care professionals to pay more attention to pain management and regular evaluation of persistent post-surgical pain after breast cancer surgery in order to improve their health-related quality of life.

Determinants in the quality of life of breast cancer survivors