Sailing toward healing. A combined group intervention to improve well-being in breast cancer survivors: a brief report study

Objectives. To compare the shoulder mobility, muscular strength, and quality of life (QOL) among breast cancer survivors with and without Tai Chi (TC) Qigong training to those of healthy individuals and to explore the associations between shoulder impairments and QOL in breast cancer survivors with regular TC Qigong training. Methods. Eleven breast cancer survivors with regular TC Qigong training, 12 sedentary breast cancer survivors, and 16 healthy participants completed the study. Shoulder mobility and rotator muscle strength were assessed by goniometry and isokinetic dynamometer, respectively. QOL was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire. Results. Goniometric measurements of the active range of motion in the flexion, abduction, and hand-behind-the-back directions were similar among the three groups. The TC Qigong-trained breast cancer survivors had significantly higher isokinetic peak torques of the shoulder rotator muscles (at 180°/s) than untrained survivors, and their isokinetic shoulder muscular strength reached the level of healthy individuals. Greater shoulder muscular strength was significantly associated with better functional wellbeing in breast cancer survivors with TC Qigong training. However, no significant between-group difference was found in FACT-B total scores. Conclusions. TC Qigong training might improve shoulder muscular strength and functional wellbeing 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

Exercise is an effective non-pharmacological approach for alleviating treatment-related adverse effects and enhancing physical fitness in breast cancer survivors. A Kinect-based mixed reality device (KMR), with real-time feedback and user data collection, is an innovative exercise intervention for breast cancer survivors. This study aimed to investigate the effect of KMR exercise program on quality of life (QOL) and physical function in breast cancer survivors. Seventy-seven participants were randomly assigned to either the KMR exercise group or home stretching group with an 8-week intervention. Physical function (shoulder range of motion, body composition, aerobic capacity, and hand grip strength) was evaluated before and after the intervention period. Participants completed questionnaires such as the Disabilities of the Arm, Shoulder, and Hand (DASH), Functional Assessment of Cancer Therapy-Breast, and International Physical Activity Questionnaire (IPAQ) to assess upper extremity disabilities, QOL, and physical activity levels. Significant group-by-time interaction was found for flexion of the operated arm (154.3±12.5 to 165.8±11.2), and the non-operated arm (158.2±13.8 to 166.5±12.2), abduction of the non-operated arm (154.8±31.6 to 161.1±28.1), and adduction of the operated arm (46.5±9.1 to 52.6±7.2). Significant improvements were also observed in DASH (46.8±9.1 to 40.8±9.3) and IPAQ (1,136.3±612.8 to 1,287±664.1). The KMR exercise program effectively improved the physical function, alleviated edema, reduced upper extremity disability, and enhanced the QOL in breast cancer survivors. Coupled with significant group-by-time interactions for various outcomes, the results emphasize the potential benefits of incorporating the KMR exercise program to improve the QOL in breast cancer survivors.

To determine the effects of breast cancer-specific print materials and step pedometers on physical activity (PA) and quality of life (QoL) in breast cancer survivors. Breast cancer survivors (N = 377) were randomly assigned to receive one of the following: a standard public health recommendation for PA, previously developed breast cancer-specific PA print materials, a step pedometer, or a combination of breast cancer-specific print materials and step pedometers. The primary outcome was self-reported moderate/vigorous PA minutes per week. Secondary outcomes were QoL (Functional Assessment of Cancer Therapy-Breast), fatigue, self-reported brisk walking, and objective step counts. Assessments were conducted at baseline and postintervention (12 weeks). Attrition was 10.3% (39 of 377). On the basis of linear mixed-model analyses, PA increased by 30 minutes/week in the standard recommendation group compared with 70 minutes/week in the print material group (mean difference, 39 minutes/week; 95% CI = -10 to 89; d = 0.25; P = .117), 89 minutes/week in the pedometer group (mean difference, 59 minutes/week; 95% CI, 11 to 108; d = 0.38; P = .017), and 87 minutes/week in the combined group (mean difference, 57 minutes/week; 95% CI, 8 to 106; d = 0.37; P = .022). For brisk walking minutes/week, all three intervention groups reported significantly greater increases than the standard recommendation group. The combined group also reported significantly improved QoL (mean difference, 5.8; 95% CI, 2.0 to 9.6; d = 0.33; P = .003) and reduced fatigue (mean difference, 2.3; 95% CI, 0.0 to 4.7; d = 0.25; P = .052) compared with the standard recommendation group. Breast cancer-specific PA print materials and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors. A combined approach appears to be optimal. ClinicalTrials.gov Identifier NCT00221221

The survival rate of breast cancer survivors (BCSs) is > 90%. Particular issues are upper arm dysfunction caused by surgery and treatments. Physical activity has been recommended to improve shoulder function and quality of life (QoL) in BCSs. However, rehabilitation programs tend not to be continuous. To explore the effectiveness of therapeutic inflatable ball self-exercise for improving shoulder function and QoL in breast cancer survivors (BCSs) following breast cancer surgery. Seventy-two BCSs were allocated to two groups, conventional self-exercise (CSE; n = 34; age, 48.9 ± 7.2years) and therapeutic inflatable ball self-exercise (IBE; n = 38; age, 47.7 ± 8.9years); 22 in the CSE and 23 in the IBE group completed the interventions. Both groups performed intervention for 12weeks, three times per week and 15min a day at least. Measurement was performed three times for shoulder range of motion (ROM), handgrip strength, Shoulder Pain and Disability Index (SPADI), and Functional Assessment of Cancer Therapy-Breast (FACT-B). Flexion and extension ofshoulder ROM showed significant differences between the two groups at 12weeks. Flexion and extension of shoulder ROM showed significant differences for t1-t2 (p = 0.02) and t0-t1 (p = 0.04). Abduction showed a significant difference for t0-t1 (p = 0.03), t1-t2 (p = 0.02), and t0-t2 (p = 0.01). CSE (7 points) and IBE (20 points) satisfied the MDC in FACT-B total score. The MDC of the SPADI total score was 13 points in the CSE group and 9 points in the IBE group. IBE would be more appropriate to start the rehabilitation for BCSs and CSE would be effective after the pain has improved.

Background:Quality of life (QOL) has become an important indicator for evaluating patients’ symptoms and their overall satisfaction with life. Thus, examining QOL is essential for fully understanding the life satisfaction of breast cancer survivors (BCS). However, selecting the appropriate instrument for QOL measurement is challenging, and few studies have compared disease-specific and generic QOL measures and how they reflect the impact of cancer-related symptoms on QOL in BCS. We examined QOL in BCS using both disease-specific and generic instruments and compared their representation of the QOL impacts of anxiety, depression, sleep, fatigability, and posttraumatic growth.Methods:This study involved analysis of follow-up data for an exercise intervention called the BLESS (Better Life after cancer, Energy, Strength, and Support) program, which included 40 BCS treated at 1 medical center in South Korea. Their QOL was assessed using both the Functional Assessment of Cancer Therapy-Breast (FACT-B) and Quality of Life Index (QLI).Results:Both FACT-B and QLI total scores revealed that Korean BCS had low levels of QOL. Furthermore, both FACT-B and QLI total scores were significantly related to anxiety, depression, sleep, fatigability, and posttraumatic growth in the participants. Notably, multivariate regression analysis of FACT-B and QLI total scores showed different predictors for QOL: with the FACT-B, depression was the only significant predictor, while with the QLI, posttraumatic growth was the only significant predictor.Conclusion:The selection of a given QOL instrument may affect the overall findings and interpretation of the impacts of related symptoms. The FACT-B should be considered for studies of symptoms such as depression, while the QLI is more appropriate for examining overall QOL and posttraumatic growth.

Breast cancer survivors are known to develop upper torso pain and stiffness including shoulder elevation and ipsilateral inclination of the trunk within a short period of time as a result of cancer adjuvant therapies correlating with the type and side of surgery. Hence, the study. Twenty-two breast cancer survivors at a tertiary care hospital, Belgaum, Karnataka, have participated in this pre-post experimental study which included myofascial release (MFR), stretching, and strengthening for four sessions per week for 3weeks that is, a total of 12 sessions. The participants were assessed at baseline and post-intervention using photogrammetry for Posture and shoulder range of motion (ROM), flexicurve for spinal curvatures, digital inclinometer for cervical ROM, manual muscle testing and hand dynamometer for strength of the upper back, shoulder muscles and hand grip, Shoulder Pain and Disability Index (SPADI) for shoulder impairment and Functional Assessment of Cancer Therapy-Breast (FACT-B) for quality of life. The outcomes were analyzed with a p-value set at ≤0.05. The results of the study demonstrated a substantial improvement in the posture alignment (p=0.001), shoulder and cervical ROM (p=0.001), upper back and shoulder muscle and hand grip strength (p=0.001), SPADI (p=0.001), and FACT-B (p=0.001) values. The upper torso malalignment and muscular imbalance is seen in patients who has undergone surgeries involving the chest wall and early physiotherapy intervention can benefit the patients overall physical performance and quality of life. Hence, MFR, stretching and strengthening has shown to be beneficial in improving upper torso malalignment in breast cancer survivors. The suggested techniques can be applied at a larger scale which can involve patients with head and neck cancer since the areas of intervention are identical. CTRI (Clinical Trial Registry- India) Registration No.: CTRI/2021/01/030453.

Impaired quality of life (QOL) is commonly experienced by breast cancer survivors (BCS) due to direct effects of cancer or associated treatments. BCS are more predisposed to compromised QOL components in the physical, emotional, social, and cognitive well being domains than the general population. QOL may be affected by cardiorespiratory fitness (CRF); CRF refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. Higher levels of CRF, measured by maximal oxygen uptake (VO2max), are associated with higher QOL in healthy and diabetic populations, as improved CRF presumably eases activities of daily living and subsequently improves QOL. Limited research has examined the association between CRF and QOL in BCS. Purpose: The purpose of this study was to investigate the association between CRF, measured by estimated VO2max values (relative to body weight), and QOL, assessed by the FACT-B questionnaire, in BCS. Methods: Eligible participants (n = 45) were sedentary women diagnosed with stage I-III breast cancer, and who completed cancer-related treatments within 6 months prior to study enrollment in a larger ongoing exercise intervention trial. Baseline data were collected prior to initiating the exercise intervention. CRF was determined by estimated VO2max value (mL/kg/min) derived from the Single Stage Submaximal Treadmill Test, a 4-minute treadmill walking test where the treadmill speed is self-selected by the participant. Heart rate was obtained upon completion of the test and used to generate an estimated VO2max value using a validated equation. QOL was determined by the FACT-B questionnaire, a validated breast cancer specific questionnaire measuring four dimensions of QOL; physical well-being, social/family well-being, emotional well-being, and functional well-being. Each QOL dimension score was summed to yield an overall QOL score. The FACT-B questionnaire is scored out of a total 144 points from 0 (low QOL) to 144 (high QOL). A Spearman ranked-difference correlation test was used to determine the association between CRF and QOL. Independent t-tests were used to compare mean CRF and QOL between premenopausal and postmenopausal BCS. Results: Among BCS, mean estimated VO2max values were 29.13 ± 6.37 mL/kg/min, classified as average (45th percentile) according to the American College of Sports Medicine. Mean VO2max values for premenopausal BCS (n=24) was 31.01 ± 7.52 mL/kg/min and 27.22 ± 3.79 mL/kg/min for postmenopausal BCS (n=21); however these differences by menopausal status were not statistically significant (p&amp;gt;0.05). Mean FACT-B scores for BCS was 99.79 ± 21.02 (69th percentile). FACT-B mean scores for premenopausal BCS were 97.22 ± 21.23 (67th percentile) and 102.41 ± 21.75 (71st percentile) for postmenopausal BCS; however these differences by menopausal status were not statistically significant (p&amp;gt;0.05). Overall, there was a weak positive correlation between CRF and QOL (rs = 0.27, p&amp;lt;0.05). When stratified by menopausal status, we found a moderate positive correlation between CRF and QOL (rs = 0.48, p&amp;lt;0.05) in postmenopausal BCS. However, in premenopausal BCS, there was a weak non-significant correlation between CRF and QOL (rs = 0.36, p&amp;gt;0.05). Conclusion: In summary, QOL and CRF were weakly related, which differs from the stronger association between CRF and QOL in healthy and diabetic populations. However, this association between CRF and QOL was stronger in postmenopausal BCS, thus it may be valuable to further investigate the effect of menopausal status on CRF and QOL. Both CRF and QOL values were average and above average, respectively, in our sample which may explain the weak-moderate association between CRF and QOL. Nonetheless, due to the possible association between CRF and QOL, it may be necessary to consider investigating this association in a larger sample of BCS. Citation Format: Christina M. Dieli-Conwright, Breanna Orozco, Joanne Mortimer, Debu Tripathy, Darcy Spicer, Leslie Bernstein. Association between cardiorespiratory fitness and quality of life in breast cancer survivors. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B09.

Given the 3.1 million breast cancer survivors in America, quality of life (QoL) is a vital issue. Bio-psychosocial milieu of survivorship is increasingly important. This study assesses the impact of Bio-psychosocial Intervention (BPSI) on the QoL of breast cancer survivors utilizing Functional Assessment of Cancer Therapy - Breast (FACT-B) instrument. A prospective randomized trial was designed; intervention arm included a 4-hour BPSI coping skills class; control arm received standard of cancer and follow-up care (SOC). Women diagnosed within 2 years of study initiation were eligible. Sample size was based on 8-point difference in FACT-B score, 90% power, 5% type I error, and 20% attrition. FACT-B questionnaire was administered to all patients at baseline and at 6-month intervals. SAS 9.3 software was used to analyze data using Chi-square test for categorical and Wilcoxon rank sum for ordinal data; linear mixed modeling was used for longitudinal analysis. One-hundred and three of 120 (86%) patients were available for analysis. Forty-seven patients were in BSPI arm, and 56 received SOC. For BPSI arm versus SOC arm, the median (interquartile) age (60 [52.68] versus 58 [52.68] years, p = 0.9135), cancer-stage (0:1:2:3 = 11%:41%:35%:13% versus 18%:46%:22%:15%, p = 0.4645), and biology (ER+:triple negative:HER2+ = 74%:9%:16% versus 72%:7%:20%, p = 0.8454), respectively, was similar. Median (25th to 75th centile) FACT-B scores in BPSI versus SOC arms at baseline were 109 (95.121) versus 112 (95, 122) (p = 0.6125); mean (SE) change since baseline at 6, 12, 18, and 24 months was: 7.42 (2.22) versus 7.04 (1.97) (p = 0.8862); 17.0 (2.64) versus -6.09 (2.37) (p < 0.0001); 16.03 (2.53) versus 3.58 (2.29) (p = 0.0004), and 15.48 (1.89) versus 16.4 (1.71) (p = 0.7966), respectively. The inter-group differences remained after adjusting for confounding variables at baseline. The p-value for interaction among groups over 2 years remained <0.0001 except for breast cancer specific concerns. BPSI coping skills class significantly improved the QoL of breast cancer survivors by 1 year post-intervention time point; this difference narrowed at 18 months and disappeared at 24 months.

Cancer patients who have undergone treatment often experience negative changes in physical and psychological function; all of which may influence quality of life (QoL). Understanding the degree of impact of various physiological and psychological parameters on a cancer survivor's QoL is of fundamental importance when designing individualized rehabilitation programs. PURPOSE: To investigate how select physiological and psychological parameters may influence QoL in a group of breast cancer survivors prior to enrollment in a combined exercise and recreation therapy rehabilitation program. METHODS: Seventy-nine women diagnosed with stages I-III breast cancer who had completed major treatment within 6 months underwent physiological and psychological testing upon enrollment in the rehabilitation program. Physical and psychological parameters included Aerobic Fitness (VO2max) using the Modified Bruce submaximal treadmill protocol, Percent Body Fat (%BF) via skinfolds, Total Physical Activity (MET-minutes per week) using the International Physical Activity Questionnaire (IPAQ) short form, Fatigue using the Revised Piper Fatigue Scale, and Depression using the Center for Epidemiological Studies Depression Scale (CES-D), NIMH. QoL was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B). The associations between VO2max, %BF, Total Physical Activity, Fatigue, Depression, and QoL were examined using Pearson correlations and multiple linear regression models. RESULTS: Fatigue was negatively associated with QoL (r = -0.702; p < 0.0005) as was Depression (r = -0.654; p < 0.0005). When examining multiple linear regression models characterizing the effects of all select physiological and psychological parameters on QoL, only Fatigue and Depression significantly affected QoL (r2=0.638; unstandardized Beta weights = -4.496 and -0.852 respectively; p < 0.0005). CONCLUSIONS: Fatigue and Depression appear to have the most influence on QoL in breast cancer survivors who have recently completed major cancer treatment. Therefore, rehabilitation programs aimed at improving overall QoL in this cancer population should encompass both physical and psychological improvement strategies. Supported by the Lineberger Comprehensive Cancer Center UCRF

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

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.

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.

Background: The 37-item Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument has been validated and widely used in the literature to assess quality of life (QOL) among women with breast cancer. However, validation of the Korean version was conducted among breast cancer patients in Korea, and most studies in the United States have examined multiethnic samples with typically small numbers of Korean Americans (KA). This study examined the psychometric properties of FACT-B and its five subscales (physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer subscale (BCS)) in a sample of KA breast cancer survivors. Methods: Data for this study are from a seven week randomized control trial aiming to increase QOL and reduce perceived stress among KA breast cancer survivors. Participants completed the FACT-B instrument at baseline, end of the program, and 7-weeks post intervention. In this study, baseline assessments of FACT-B were examined from 61 KA women in the Washington, D.C. metropolitan area with stages 0 to IV breast cancer. Participants' ages ranged from 30 to 83 (mean=56.7; SD=10.2). Principal component analysis (PCA) was conducted to examine FACT-B and its subscales. The factor correlation matrix was examined to determine the appropriate rotation method. Internal reliability was assessed using Cronbach's alpha. Results: Varimax rotation was employed given that factor correlations were mostly less than 0.32, which suggests that the variance between factors do not greatly overlap. The internal reliability of FACT-B in this sample was found to be good (α=.88). Moreover, the internal reliabilities were also good for PWB, SWB, and FWB (α=.85 to .89), but lower for EWB and BCS (α=.69 and α=.67 respectively). In general, these findings are consistent with the literature on White (α=.64-.91), African American (α=.77-.92), and Latina women (α=.72-.91) with breast cancer. Some variations were found between our study on KA women and other literature on breast cancer patients in China, Japan, and Korea. The internal reliability for EWB was lower in KA women (α=.69) as compared to Chinese women (α=.84), Japanese women (α=.74), and women in Korea (α=.79). However, our reliability is the same as that found in the initial FACT-B validation study by Brady et al. (1997) (α=.69). For other subscales, the internal reliabilities were similar or lower than in our sample. The initial PCA with varimax rotation retained 11 factors with eigenvalues above 1. However, 4 factors had only one or two items with factor loadings of at least |0.4|. Thus, 5 factors were specified based on the established number of subscales in the literature. The only item with a factor loading less than .4 was a question that asked how bothered participants were by hair loss. The low loading may be a result of few participants experiencing hair loss at the time of the survey. Interestingly, an item asking participants about how much they worry about dying had a negative loading even after reverse coding (ℓ=-.48), meaning those who worry more tend to have better QOL. One reason may be that concerns regarding death motivate some individuals to reassess priorities and better allocate their time on things that are more valued and enjoyable. Conclusions: Our findings were consistent with those from previous studies examining White, African American, and Latina women with breast cancer. In addition, FACT-B and its subscales had similar or higher internal reliabilities in our sample of KA women with breast cancer as compared to breast cancer patients in China, Japan, and Korea, with the exception of EWB. Overall, FACT-B was found to be reliable in our sample of KA breast cancer survivors providing additional support for its use in this population. Citation Format: Mary Y. Jung, Min Q. Wang, Sunmin Lee. Examining the psychometric properties of the Functional Assessment of Cancer Therapy-Breast (FACT-B) among Korean American breast cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B23.