BrCa Survivors Research Articles

Abstract B129: The association of Covid-19 pandemic restrictions with patient-reported outcomes and lifestyle behaviors among breast cancer survivors: Evidence from a cohort of Black and Hispanic breast cancer survivors in New Jersey

Abstract Purpose: The onset of COVID-19 pandemic restrictions in the US since March 2020 has worsened the disproportionate burden of physical and mental health challenges faced by vulnerable Black and Hispanic breast cancer (BrCa) patients. BrCa survivors experienced delays in their cancer treatments and limited access to supportive care, which may lead to further physical, and psychosocial challenges during an already difficult time. This study aimed to evaluate the association of the COVID-19 pandemic restrictions with patient-reported outcomes (PROs) (i.e. health-related quality of life (HRQoL), sleep, perceived stress, coping and financial toxicity), and lifestyle behaviors (i.e. obesity, smoking, and alcohol) among Black and Hispanic BrCa survivors participating in the Women’s Circle of Health Follow-Up 1 (WCHSFU1) and the New Jersey Breast Cancer Survivors Study (NJBCS), two ongoing population-based studies in New Jersey. Methods: The NJBCS followed similar methods to those in the WCHSFU1. We included a total of 447 Black (npre=364 and npost=83) and 182 Hispanic (npre=102 and npost=80) BrCa survivors who completed a home interview ~24 months post-diagnosis, from 2017 to 2023. The COVID-19 pandemic era was defined as pre- (recruited prior to March 2020) and post-(recruited after March 2020) pandemic. To assess the association of the pandemic with PROs and lifestyle behaviors we employed multivariable adjusted Poisson regression models with robust standard errors to estimate prevalence ratios with 95%CI. Results: Compared to the pre-pandemic group, Black survivors in the post-pandemic group were more likely to be educated, to have higher income, and to be foreign-born, while Hispanic women were significantly more likely to have private insurance and higher HRQoL, physical and emotional well-being mean scores (p<0.05 for all). Adjusted Poisson models indicated that Hispanic women in the post-pandemic group had 1.53 times higher prevalence of low resilience (vs high resilience) (PR:1.53 95% CI: 1.15-2.04), compared to the pre-pandemic group. Whereas Black women in the post-pandemic group reported a higher prevalence of clinically significant sleep disturbance and efficiency (PR: 1.43 95% CI: 1.23-1.68 and PR:1.50 95% CI: 1.30 – 1.73, respectively), compared to the pre-pandemic group. Both Hispanic and Black women in the post-pandemic group showed significantly less perceived stress and a lower prevalence of alcohol consumption. Conclusion: We found heterogeneity in the prevalence of PROs and lifestyle behaviors by pandemic era among Black and Hispanic survivors. Notably, we also noticed differences in demographic characteristics of women participating after the onset of the pandemic, which highlights the importance of considering the impact of the pandemic in all aspects of research, including the interpretation of findings. Continuing research to untangle important factors contributing to racial and ethnic differences in patient characteristics, PROs and lifestyle behaviors post-pandemic in cancer survivorship is warranted. Citation Format: Carola T. Sanchez-Diaz, Nur Zeinomar, Hari S. Iyer, Marley Perlstein, Chi-Chen Hong, Bo Qin, Elisa V. Bandera. The association of Covid-19 pandemic restrictions with patient-reported outcomes and lifestyle behaviors among breast cancer survivors: Evidence from a cohort of Black and Hispanic breast cancer survivors in New Jersey [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B129.

Abstract B072: Reproducibility of plasma metabolome over 1 year in a population-based study of Black breast cancer survivors

Abstract Background: African American/Black women have higher rates of breast cancer (BrCa) mortality and morbidity than White women. The metabolomics approach using blood samples from epidemiological studies has the potential to elucidate pathways or uncover biomarkers for adverse BrCa outcomes. Therefore, understanding the within-person reproducibility of the blood metabolome of BrCa survivors and factors that influence metabolite levels over time is crucial. However, the stability of blood metabolome among Black BrCa survivors is unknown. Objective: This study aimed to estimate the within-person reproducibility of metabolites over 1 year via global untargeted metabolomic profiling of plasma samples collected in the Women’s Circle of Health Follow-Up Study (WCHFS), a population-based longitudinal study of Black BrCa survivors in New Jersey. The study also aims to identify factors associated with reproducibility. Methods: We estimated the metabolite reproducibility among 61 Black women with BrCa diagnosed between 2012 and 2017 in WCHFS. Plasma samples were collected once for each participant at ~2 and 3 years post-diagnosis, respectively, and analyzed at Metabolon via ultrahigh performance liquid chromatography-tandem mass spectrometry. Using a mixed-effects model, we calculated the intraclass correlation coefficients (ICC) for each metabolite by dividing the between-person variance by the total variance (i.e., within- and between-person variances). ICCs were compared by age, obesity status, estrogen receptor (ER) status, and seasons, fasting status and time interval between two visits when blood samples were collected. Statistical significance was determined using the Wilcoxon test. Results: Of the 857 named metabolites identified after excluding those undetectable in ≥80% of samples or with a coefficient of variance≥0.25, the median ICC was 0.58 (interquartile range [IQR]: 0.44-0.70). 16.6% had high within-person reproducibility (ICC≥0.75), spanning across all metabolite classes, while 65.6% had an ICC within 0.4-0.75, and the remaining 17.9% had an ICC<0.4. Significant differences in ICCs were noted by participants’ age (median ICC [IQR; same below]: 0.56 [0.40 - 0.68] for younger women, i.e. ≤ 55.6 years vs. 0.61 [0.44 - 0.73] for older women), obesity status (0.55 [0.40 - 0.68] for non-obese vs. 0.62 [0.46 - 0.75] for obese), and ER status (0.56 [0.41 - 0.68] for ER+ vs. 0.62 [0.45 - 0.79] for ER-). The reproducibility also differed by fasting status (0.63 [0.45 - 0.77] for fasting vs. 0.53 [0.39 - 0.67] for non-fasting), but not the seasons or time interval between blood collections. Conclusion: The within-person reproducibility of plasma metabolites over 1 year among Black breast cancer survivors was generally reasonable, suggesting a single-time-point measurement could be useful in evaluating associations between metabolites and BrCa outcomes. However, the reproducibility varied across metabolites and was influenced by participant characteristics and certain sample collection conditions, which need consideration in future analysis or design. Citation Format: Bo Qin, Madhir Vyas, Steven C. Moore, Xiaoyang Su, Eileen White, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Reproducibility of plasma metabolome over 1 year in a population-based study of Black breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B072.

Lived Experiences of Women Who are Long-Term Breast Cancer Survivors in Lagos State, Nigeria

Introduction: Breast cancer (BrCa) survivors have increased globally with the continued improvement in cancer management. Despite this, there are significant issues experienced by these women during BrCa treatment. It is therefore important to explore the unique experiences of women who are long-term BrCa survivors.
 Objective: This study aimed to explore the lived experiences of 22 women who are long-term BrCa survivors in Lagos State, Nigeria.
 Methodology: A phenomenological approach was used to carry out one-on-one unstructured interviews with the participants, who were selected purposively using a snowball sampling technique. The interviews were analysed using Nvivo 14 to identify themes and subthemes.
 Result: The participants were 5 years or more, post-treatment for BrCa, with an average age of 43 years at the time of diagnosis. Four themes emerged: (i) In the very beginning, (ii) Going through difficult times, (iii) Becoming a survivor, and (iv) Living as a survivor. Sixteen subthemes were also identified. The participants had a self-identification pattern as survivors, and an interpretation of their experiences which were influenced by a cascade of factors including spirituality, family support, financial burden, counselling and emotional support which differs from one participant to the other.
 Conclusion: The study highlights the unique experiences of long-term BrCa survivors and the challenges they face on their journey to survivorship. Early diagnosis, inner strength, family support, faith, and quality treatment were identified as important factors in fighting cancer and reaching survivorship. The findings have implications for nurses and other healthcare providers, who should acknowledge the distinct experiences of these women to provide appropriate support and care.

Lived Experience of Breast Cancer Survivors: A Phenomenological Study

Introduction: Breast cancer (BrCa) is the most common cancer in women worldwide. The population who survive breast cancer is increasing; even so, they usually have to go through many problems in their life. Except for the diseased part, numerous socio-cultural factors may pose challenges for the survivors. Hence, the aim of this study was to explore the experiences of cancer survivors. Methods: A phenomenological qualitative design reseach was performed with eight BrCa survivors in Kaski district of Nepal. Data were collected through semi-structured in-depth interviews and analyzed using Colaizzi’s descriptive phenomenological method. Results: Two major themes were extracted from the in-depth interviews. One was the reaction to the diagnosis and another was fear of disease. Most participants lacked awareness of their cancer diagnosis, and nearly all of them experienced fear that persisted until death. They faced a multitude of physical issues throughout the treatment phase and subsequent years, including headaches, loss of appetite, anemia, gastritis, body pain, and swollen extremities. Additionally, they grappled with psychological challenges such as anxiety and depression, rendering them more susceptible. Financially, due to the exorbitant costs of treatment, they had to resort to borrowing money from others, with the burden primarily falling upon their families Conclusion: Most of the participants had fear regarding illness, treatments, recurrence, and death. Patients were worried about the cost of care. Therefore, it is imperative for family members and healthcare professionals to recognize the experiences of breast cancer survivors in order to optimize patient health during critical stages.

Chemotherapy-induced peripheral neuropathy onset is associated with early risk of depression and anxiety in breast cancer survivors.

The objective was to assess for an association between chemotherapy-induced peripheral neuropathy (CIPN) onset and development of depression and anxiety in breast cancer (BrCa) survivors. A retrospective observational cohort was used and identified from Optum's De-identified Clinformatics® Data Mart Database years 2012-2015. Three groups of women were derived based on BrCa and CIPN status: BrCa+/CIPN+ (n = 244), BrCa+/CIPN- (n = 8870), and BrCa-/CIPN- (n = 1,125,711). The ratio of the prevalence ratios (RPR) determined if the change in risk of depression and anxiety from the 12-month preindex period to postindex period I (0-6months) and II (7-12 months) was different for BrCa+/CIPN+ compared to BrCa+/CIPN- and BrCa-/CIPN-. The adjusted RPR for depression was significantly elevated for BrCa+/CIPN+ compared to BrCa+/CIPN- and BrCa-/CIPN- for postindex periods I (RPR = 1.35 [1.10,1.65] and 1.33 [1.08,1.63], respectively) and II (RPR = 1.53 [1.21,1.94] and 1.50 [1.17,1.93], respectively). The RPR for anxiety was significantly elevated for BrCa+/CIPN+ compared to BrCa+/CIPN- and BrCa-/CIPN- for postindex periods I (RPR = 1.37 [1.12,1.67] and 1.31 [1.06,1.61], respectively) and II (RPR = 1.41 [1.13,1.76] and 1.28 [1.02,1.62], respectively). Among BrCa survivors, CIPN onset is associated with a subsequent increased 12-month risk of depression and anxiety. Depression and anxiety screening should be considered in BrCa+/CIPN+ survivors, particularly given their known impact on fall risk. The observed association between CIPN and an increased risk of depression and anxiety should be further studied in prospective studies.

Chemotherapy-induced peripheral neuropathy increases nontraumatic fracture risk in breast cancer survivors.

ABSTRACTChemotherapy is a common treatment for breast cancer (BrCa) and can cause chemotherapy‐induced peripheral neuropathy (CIPN). CIPN contributes to falls, and is thus a potential risk factor for nontraumatic fractures (NTFx); yet, the effect of CIPN on NTFx risk has not been examined for BrCa survivors. We therefore investigated the association between CIPN and NTFx in BrCa survivors. Data were extracted from Optum's Deidentified Clinformatics® Data Mart Database years 2010–2015 in this retrospective cohort study. Among women, three groups were derived based on BrCa and CIPN status: BrCa+/CIPN+ (primary group of interest), BrCa+/CIPN− (first comparison group), and BrCa−/CIPN− (second comparison group). After propensity score matching the comparison groups to BrCa+/CIPN+ at a ratio of 1:11 (BrCa:control) for demographics, osteoporosis, glucocorticoid medication, comorbidities, and cancer‐related variables for BrCa+/CIPN−, 1‐year incidence rate (IR) of NTFx was determined for each group. The incident rate ratio (IRR) determined if the IR for NTFx was different for BrCa+/CIPN+ compared to BrCa+/CIPN− and BrCa−/CIPN−. Cox proportional hazards regression models estimated the hazard ratios (HRs) after adjusting for covariates that were unable to be matched for. The crude IR (95% confidence interval [CI]) of NTFx was 4.54 (2.32–6.77) for BrCa+/CIPN+ (n = 359), 2.53 (2.03–3.04) for BrCa+/CIPN− (n = 3949), and 1.76 (1.35–2.18) for BrCa−/CIPN− (n = 3949). The crude IRR of NTFx was significantly elevated for BrCa+/CIPN+ as compared to BrCa+/CIPN− (IRR = 1.80; 95% CI, 1.06–3.05) and BrCa−/CIPN− (IRR = 2.58; 95% CI, 1.50–4.44). The elevated rate of NTFx for BrCa+/CIPN+ remained unchanged after adjusting for aromatase inhibitors compared to BrCa+/CIPN− (HR = 1.79; 95% CI, 1.06–3.04). Female BrCa survivors have an increased 1‐year IR of NTFx after the onset of CIPN, suggesting that CIPN is an additive burden on NTFx risk among BrCa survivors. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Racial disparities in setting of care in women with breast cancer in South Carolina.

e18146 Background: African American (AA) women with breast cancer (BrCa) suffer a 40% higher mortality burden than White women despite having about equal incidence nationally and lower incidence in South Carolina. Our aim was to describe inpatient and emergency department visits by race and geographic location among BrCa survivors. Methods: We analyzed data from a study (1R15CA179355-01A1; Adams, PI) that combined administrative claims data from South Carolina’s Medicaid Program and a state-based, private-payor health plan to matching BrCA cases from the SC Central Cancer Registry. Race was determined by patient self-report. Geographic location was assigned using designations from the Rural-Urban Commuting Area Codes (RUCA). We used descriptive statistics to characterize the study sample and Chi-square test of independence to compare the descriptive statistics by race and rural/urban continuum. Results: The sample (N = 2723) was 33.6% AA, 91.8% non-Hispanic, primarily married 48.8%, and ranged in age from 14 to 64 years. Most women in the sample lived in an urban area (74.9 %). Most women had Stage I (16.9%), IIA (13.9%), or IIB (7.5%) disease. Women were primarily treated in an outpatient setting; 1.3% (n = 36) were seen in an emergency room and 1.2% (n = 34) were hospitalized. When comparing women living in a rural versus urban area, there were significant differences in TNM stage of disease (by pathology), marital status, race, and setting of care (all p’s ≤ 0.001). When comparing women by race, there were significant differences in age, ethnicity, marital status, stage of disease, and setting of care (all p’s ≤ 0.001). Conclusions: Women with BrCA in SC continue to experience disparities with regard to stage of disease at diagnosis and setting of care. Future research should focus on specific predictors of hospitalization and the relationship of rurality and race with setting of care.

Examining peer support and survivorship for African American women with breast cancer.

More than 3.5 million female breast cancer (BrCa) survivors live in the United States, and the number continues to grow. Health status and quality of life among survivors are variable, and African American (AA) survivors suffer disproportionately from BrCa morbidity and mortality. Emerging evidence suggests that peer support is an effective strategy to promote positive survivorship outcomes for AA BrCa survivors. This study aimed to explore the role of peer support in the BrCa experiences of AA survivors. Working collaboratively with The Breakfast Club, Inc. (BCI), a community-based BrCa peer support organization, we conducted a quasiexperiment to compare the BrCa experiences of AA survivors. We conducted in-depth interviews with two survivor groups (N=12 per group), categorized according to receiving peer support during their BrCa experiences. Survivors who received peer support reported greater access to and utilization of alternative support sources, more capacity to process BrCa-related stress, and improved quality of life and adjustment to life as BrCa survivors compared with those who did not receive peer support. Peer relationships provide consistent, quality social support. Consistent peer support helps survivors cope with the continued stress of BrCa, with implications for psychosocial health and quality of life. Findings expand our current understanding of peer support and may enable public health and clinical practitioners to better recognize and intervene with those for whom additional support services are needed.

Sexual life after breast cancer

Younger breast cancer (BR CA) survivors face a unique set of treatment-related issues that have enormous impact on quality of life and psychological well-being. In particular, young BR CA survivors are at increased risk for experiencing a range of distressing treatment-related sexual sequalae including negative changes in body image, sexual function and relationship intimacy. Developmental and relationship factors often play a role in exacerbating these challenges. Unfortunately, these issues are not routinely addressed for many young survivors. Clinicians report feeling unprepared to discuss and manage these problems and there is often a lack of concrete resources to offer women who are struggling. Cultural barriers may also contribute to lack of attention to these issues. It is imperative that clinicians who treat young BR CA survivors become aware of common problems regarding self-image and sexual dysfunction and increase their competence to complete a basic inquiry. This may be accomplished with a simply checklist approach. There is a growing number of evidence-based intervention strategies for addressing treatment related sexual dysfunction after BR CA. Beyond having the prevalence of treatment-related sexual side effects be acknowledged, young women need to know that treatment-related sexual problems can be effectively addressed. Samples of a checklist and resource sheet for young women will be overviewed and cultural considerations will be noted. As the large majority of young breast cancer patients are now becoming long-term survivors, it is essential for clinicians to learn how to inquire about and address treatment-related late effects including distressing changes in sexual dysfunction.

Applying pre-participation exercise screening to breast cancer survivors: a cross-sectional study.

Clinical guidelines recommend that breast cancer (BrCa) survivors be prescribed exercise. However, clinicians often do not prescribe exercise citing the presence of multiple health issues found among cancer survivors. No study has examined the proportion of BrCa survivors that can be prescribed a community/home-based unsupervised exercise program safely and independently, without further medical investigations or supervision. Participants included BrCa survivors who received treatment at a university healthcare system between 2009 and 2014. We applied previously identified published guidelines for health conditions that may impede BrCa survivors from completing a community/home-based exercise program. Logistic regression models were used to quantify the magnitude of the association between demographic and clinical characteristics and the ability to perform community/home-based exercise. Among 667 BrCa survivors, 65 to 75% was classified as able to complete community/home-based exercise as recommended by the clinical guidelines. Older age, black race, treatment with chemotherapy, and treatment with radiation were associated with the potential need for further medical evaluation prior to starting exercise. A large proportion of BrCa survivors can be prescribed community/home-based exercise program safely and independently, without further medical investigations or supervision. Future research will be needed to determine how to identify the subset of BrCa survivors that may benefit from medical evaluation prior to starting exercise in a manner that does not interrupt clinical oncology workflow. Approximately 35% of BrCa survivors may benefit from medical evaluation prior to starting community/home-based exercise.

Patient-reported factors associated with adherence to adjuvant endocrine therapy after breast cancer: an integrative review

Adjuvant endocrine therapy (AET) significantly reduces recurrence and mortality in women with breast cancer (BrCa). Despite the efficacy of AET in improving BrCa outcomes, up to 50% of women do not adhere to prescribed AET regimens. While numerous demographic and clinical predictors influence adherence and persistence, few studies have identified the patient-reported factors that influence AET adherence and persistence. The aim was to examine the patient-reported personal, social, and structural factors influencing BrCa survivors' adherence and persistence with AET. An integrative review was undertaken wherein PubMed, Medline, CINAHL, Embase, and PsycINFO databases were searched using keyword descriptors and database subject headings. Inclusion criteria included quantitative or qualitative peer-reviewed studies written in English that assessed AET adherence and/or persistence through objective measurement or self-report and included patient-reported factors found to influence adherence and/or persistence. The data extracted from eligible studies were entered into a matrix, and systematically compared and iteratively analyzed using relational autonomy as an organizing theoretical framework. A total of 43 manuscripts (9 qualitative and 34 quantitative) were reviewed. Several personal, social, and structural factors were identified that influenced AET adherence and persistence, including side effects, necessity beliefs, self-efficacy, the patient-healthcare provider relationship, social support, and continuity of follow-up care. An increasing number of studies have focused on identifying the patient-reported factors that influence AET adherence and persistence. This review highlights important personal, social, and structural factors that act as facilitators and barriers in adhering to and persisting with long-term AET. Acknowledging and addressing these factors is key to providing women with the care needed to improve suboptimal adherence and persistence.

Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer.

PurposeFor breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors’ CT and general information and decision-making needs related to menopausal symptoms.MethodsThe needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data.ResultsMenopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management.ConclusionsHigh quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment.

Abstract B27: Overweight/obesity and physical activity rates in an ethnically diverse sample of breast cancer survivors

Abstract Background: High body mass index (BMI) is linked to poorer survival after breast cancer diagnosis. Physical activity (PA) could moderate this association. Objectives/Hypothesis: Prevalence of high BMI (overweight/obesity) and level of PA were evaluated in a statewide sample of women within 18 months of breast cancer diagnosis. Methods: In an ongoing study, 73 women (35 EA and 38 AA) were identified through the SC Central Cancer Registry, and were interviewed to obtain their self-reported body weight, height, PA and other data. Results: Age: Age ranged from 26 to 90 years (mean 61 years, SD 13.0), with AAs 2.1 years younger than EAs (p=0.49). Education: 62% had more than a high school (HS) diploma (58% of AAs and 66% of EAs, p=0.49). BMI: 77% were overweight/obese; 42% of AAs and 31% of EAs were overweight, 45% of AAs and 34% of EAs were obese (p=0.03). PA: 23% reported no PA (29% of AAs and 17% of EAs, p=0.23). Only 38% met CDC PA guidelines of at least 150 min/week of moderate PA (29% of AAs and 47% of EAs; p=0.11). PA and BMI: PA <90 min/week was associated with 4-fold higher risk of overweight/ obesity (p=0.023). No significant associations were seen by race. PA and Education: No significant association was observed between >HS education and meeting PA guidelines (p=0.15), or between >HS education and greater PA per week (p=0.57). Education and BMI: No significant association was seen (p=0.77). Conclusions: Prevalence of overweight/obesity was high, especially among AAs. Future Recommendations: It is imperative to identify strategies to reduce obesity/overweight in BRCA survivors. Citation Format: Joan E. Cunningham, Colleen E. Bauza, Erika T. Brown, Alberg J. Anthony, Emily Kistner-Griffin, Ida J. Spruill, Debbie C. Bryant, Nestor F. Esnaola, Melanie S. Jefferson, Keith Whitfield, Rita M. Kramer, Susan Bolick, Deborah Hurley, Catishia Mosley, Tonya R. Hazelton, Vivian J. Bea, Dana R. Burshell, Kendrea D. Knight, Marvella E. Ford. Overweight/obesity and physical activity rates in an ethnically diverse sample of breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B27.

Breast cancer survivorship care: A continuity of care model of delivery.

116 Background: With more than 2.9 million BrCa survivors in the US, it is imperative to determine how best to deliver post-treatment survivorship care. National accreditation standards are pushing survivorship care plans, while evidence supporting specific methods of delivery and outcomes are lacking. The University of Kansas Breast Cancer Survivorship Center opened in 2007 as a continuity of care, post-treatment survivorship clinic. We report prospective findings from a group of BrCa survivors from 2007-2013. Methods: Four hundred twenty-four BrCa survivors consented to an IRB approved, longitudinal survivorship registry. Baseline variables on demographics, disease history, summary of cancer treatment, late effects, medications and health status were collected. Follow-up data collection included disease status or new primary cancer, patient’s health status and late/long-term effects. Comparisons from baseline to subsequent visits provided information on changes in key variables over time. Results: Participants were ~57 years old, primarily Caucasian, attended at least some college, made >$40K per year, and 49% were premenopausal at diagnosis. Forty-five women reported having another malignancy and 10 were diagnosed with either a recurrence or a second primary breast cancer while followed in the survivorship center. Significant self-reported symptoms included menopausal symptoms: hot flashes (n=164), vaginal dryness (n=211) and a lack of sexual activity (195). 95% were seen for >1 post-baseline visit. Menopausal symptom interventions, lifestyle recommendations (weight loss and increasing physical activity), referrals to specialists (77% referred for colonoscopy completed colon ca screening; 92% referred attending cardio-oncology screening visit; 100% referred completed a bone mineral density analysis), and lymphedema education and management increased significantly. Conclusions: Multidisciplinary care facilitated through a continuity of care survivorship clinic improves compliance with recommended follow-up and cancer screening, however additional research on the cost and impact of delivering survivorship care is needed to evaluate sustainability and long-term patient outcomes.

Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema

To profile the prescription for and adherence to breast cancer-related lymphedema (BCRL) self-care modalities among breast cancer (BrCa) survivors with BCRL in a 12-month randomized weightlifting trial. We developed a questionnaire that assessed prescription for and adherence to 10 BCRL self-care modalities that included physical therapy exercise, pneumatic compression pump, medication, lymphedema bandaging, arm elevation, self-administered lymphatic drainage, therapist-administered lymphatic drainage, compression garments, skin care, and taping. We measured prescription for and adherence to BCRL self-care modalities at baseline, 3, 6, and 12 months. Longitudinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (95 % CI) associated with prescription for and adherence to BCRL modalities over time. This study included 141 BrCa survivors with BCRL. Women were prescribed an average of 3.6 ± 2.1 BCRL self-care modalities during the study. The prescription for therapist-administered lymphatic drainage (OR = 0.92, 95 % CI 0.88-0.96), pneumatic compression pump use (OR = 0.94, 95 % CI 0.89-0.98), and bandaging (OR = 0.96, 95 % CI 0.93-0.99) decreased over 12 months of follow-up. No other prescribed BCRL self-care modalities changed during the study. Over 12 months, the average adherence to all BCRL self-care modalities varied with 13, 24, 32, and 31 % of women reporting <25, 25-49, 50-74, and ≥75 % adherence, respectively. Over 12 months, there was a noticeable change from high to low adherence in self-administered lymphatic drainage, such that there was a 15 % increased likelihood of adherence <25 % compared to ≥75 % (OR = 1.15 (95 % CI 1.05-1.26); p = 0.002). The adherence patterns of all other modalities did not change over follow-up. Our findings suggest the prescription for BCRL self-care modalities is variable. The average adherence to BCRL self-care was non-optimal. Future research is necessary to prepare BrCa survivors with the knowledge, skills, abilities, and resources necessary to care for this lifelong condition.

Diet quality of rural breast cancer survivors as measured by the Healthy Eating Index‐2005

Rural women are at increased risk for obesity compared to urban women. Obesity is a risk factor for breast cancer recurrence, but little is known about diet quality of breast cancer (BrCa) survivors in rural America. The objective of this study was to determine diet quality of rural BrCa survivors using the Healthy Eating Index‐ 2005 (HEI). Baseline data were obtained from a 2 year weight management trial for rural BrCa survivors in the Midwest. Participants (n=128; age 57.8 ± 7.8 years, BMI = 34.4 ± 4.3 kg/m2) underwent two baseline 24‐hour multiple‐pass dietary recalls (one weekday, one weekend). The recalls were entered into NDSR software and HEI scores were determined. Possible HEI scores range from 0–100, with higher scores indicating better diet quality. Mean HEI score was 56 ± 11, similar to the national average for adult women of 59 ± 4. Fruit and vegetable intake was 1.2 ± 1.1 and 2.9 ± 1.6 servings per day, respectively. Macronutrient profiles were 36 ± 7% fat, 45.8 ± 7.6% carbohydrate, and 16.9 ± 4.1% protein. Age was significantly correlated with total HEI score (p≤0.05). Specifically, older women had higher fruit (p≤0.01) intake, and lower sodium (p≤0.05) and saturated fat (p≤0.05) intake. Total HEI score did not differ across degree of rurality. Rural BrCa survivors are not meeting diet quality recommendations, and younger survivors may be in greater need of diet quality education than older survivors. Support of research by NIH R01 CA155014

Abstract P2-11-17: Pilot Study to Evaluate a Home-based Exercise and Weight Loss Intervention on Cardiopulmonary Fitness and Markers of Breast Cancer Risk in Postmenopausal Breast Cancer Survivors

Abstract Background: BrCa survivors have an estimated 4-fold increase in risk for developing cardiovascular disease compared to women never treated for breast cancer and a nearly 3-fold increase in breast cancer mortality in women with an exercise capacity (VO2max) less than 28mL kg−1 min−1. Cardiac events are the second most common cause of death in long-term breast cancer (BrCa) survivors. Purpose: We conducted a study to investigate the effects of standard exercise or structured exercise on targeted cardiovascular outcomes during a home-based diet and exercise intervention for breast cancer survivors. Method: Cross-sectional within- and between-group design. A total of 19 breast cancer survivors, average age of 52.6+/−9.3, were enrolled in the study. A convenient sample was enrolled into two exercise groups receiving either: standard (150 minutes per week of usual care (exercise without instruction) cardiovascular exercise + resistance training) or structured (150 minutes per week of gradual increased intensity cardiovascular exercise + resistance training) exercise instruction along with a group based behavioral weight loss intervention. All participants underwent baseline and 17 week assessments including maximal exercise testing (VO2max and minutes on the treadmill), measurements of body composition (weight, BMI, % body fat), and assessment of quality of life. Results: We report on the 16 participants who completed the baseline and 17 week assessments (9 = Standard Exercise Group; 7 = Structured Exercise Group). The structured exercise group exhibited significantly greater improvements in measures of cardiorespiratory fitness: VO2max (p = 0.05) and duration on treadmill (p = 0.02). No significant differences were noted for all other cardiorespiratory fitness testing outcomes. Significant improvements from baseline to 17 weeks were seen across both groups for all measures of body composition. Lean body mass did not significantly change from baseline to 17 weeks in both groups. There were no significant between group differences for change in body composition. Conclusion: In this study, both standard exercise and structured exercise improved CR fitness measured by VO2max, but the structured exercise group experienced significantly greater improvements. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-17.

Abstract P2-11-15: Development of a web-based survey tool to assess change in breast cancer (BrCa) survivor knowledge after receipt of cancer treatment summary and survivorship care plan (SCP).

Abstract Intro: The Institute of Medicine advocates survivorship care plans (SCPs) as tools to improve coordination of care by improving survivor knowledge of follow-up recommendations and future risks. No evidence exists to demonstrate that SCPs impact survivor knowledge of diagnosis, treatment, or future/chronic side effects. Furthermore, there is a lack of information on existing surveys and their ability to assess survivor knowledge regarding these issues, without change over time. The purpose of this research is to report on the development of a survey assessing knowledge of diagnosis, treatment, and side effects in BrCa survivors. Methods: Using existing literature, two oncologists created 24 questions addressing knowledge of diagnosis, treatment, and side effects. Content experts including breast oncology providers (representing multiple subspecialties), Survey Research Shared Service (SRSS) and patient advocates reviewed and revised the questions. Next, potential questions were administered in a group setting to BrCa survivors to evaluate clarity of instructions and survey wording. The Breast Cancer Knowledge (BreaCK) survey was further revised based on survivor feedback. For pilot testing, BrCa survivors were recruited from clinic to test BreaCK survey content and clarity. Survey 1 was administered in clinic online. SRSS conducted verbal assessments regarding content after Survey 1. Four weeks later, survivors received Survey 2 via email and answered online. Correct answers were abstracted from the medical record. Results: Nine subjects completed both surveys. Qualitatively, little intra-subject variation was seen between surveys. Subjects did not feel that the survey was burdensome or intrusive. No subject was able to correctly answer all questions. Final survey adjustments were made based on subject feedback and common incorrect answers encountered when grading the surveys. Specifically, subjects had difficulty understanding “endocrine or hormone therapy.” Furthermore, subjects reported guessing in response to some questions – additional answer categories were added, including “I don't know.” Conclusion: Survivor knowledge did not change significantly between surveys. This suggests survivor knowledge was not impacted by the survey over the four-week interval. The revised BreaCK survey may be a useful tool for assessing survivor knowledge of diagnosis, treatment and side effects. A larger cohort of BrCa survivors is being recruited, starting Summer 2012, and will be evaluated using the survey. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-15.

Post diagnosis weight gain and the role of exercise in breast cancer survivors.

9007 Background: Obesity is linked to poor breast cancer (Br Ca) outcomes including higher risk of recurrence and death. No study has examined if post-diagnosis weight (wt) gain modifies the effect of exercise interventions on body composition. We examined wt change from diagnosis (diag) to enrollment (enroll) into a 6-mo randomized trial of exercise v. usual care to explore if post-diagnosis wt gain modified the effect of exercise on body wt, body fat, lean body mass (LBM) and bone mineral density (BMD) in breast cancer survivors. Methods: 75 inactive Br Ca survivors were recruited and randomized to exercise (n = 37) or usual care (UC) (n = 38). At baseline, women completed a questionnaire assessing self-report wt at diag and at the time of enroll into the study (~3 yr). The exercise group participated in 150 min/wk of supervised exercise. The UC group maintained their physical activity level. Body composition was assessed at enroll and 6-mo via dual-energy X-ray absorptiometry (DXA) by one radiologist blinded to intervention group. Results: Wt and DXA data were available for 68 / 75 participants. On average, women gained 3.3±8.2 kg from diag to enroll, with 53% gaining wt (mean = 8.9 ± 6.8 kg) and 47% maintaining or losing wt (mean change = -2.9 ±3.9 kg). The majority of wt gain occurred among women who were non-obese at diag (BMI &lt; 30), with 60% of non-obese women gaining wt (mean = 8.0 ± 6.8 kg) compared with 38% of obese women gaining wt (mean = 12.2 ± 6.4 kg). Those randomized to exercise lost body fat including women who gained wt since diag (mean % fat loss for exercisers (-0.92 ± 0.31) vs. UC (0.36 ±0.30), p = .0063) and women who did not gain wt since diag (mean % fat loss for exercisers (-0.65 ± 0.39) vs. UC (0.45±0.47), p = .08) even after adjusting for obesity status at diag. Similar improvements in LBM and BMD were observed with exercise in women who did or did not gain wt since diag. Conclusions: Wt gain in Br Ca survivors is common, the majority of weight gain in this study occurred among women who were not obese at diag. Exercise led to body fat loss and other favorable body composition changes among both non-obese and obese women. Exercise and other wt management programs should be offered to all Br Ca survivors regardless of BMI at diagnosis as a strategy towards prevention of wt gain.

Abstract B4: Impact of obesity on the effectiveness of aromatase inhibitors (AIs): Can breast cancer survivors on AIs lose weight compared to non-AI users?

Abstract Background and Objectives: Weight at diagnosis and weight gain after diagnosis are associated with increased risk of breast cancer (BrCa) recurrence and mortality. In addition, post-menopausal obese breast cancer survivors on anti-hormonal therapy were 40% more likely to develop a local recurrence and 46% more likely to develop a distant recurrence compared to their normal weight counterparts. This evaluation was conducted to examine if a diet/exercise/behavioral weight loss intervention for overweight breast cancer survivors: 1) would impact BrCa risk biomarkers and 2) would the response differ by aromatase inhibitor (AI) status. Methods: 84 BrCa survivors with a BMI 25-45 kg/m,2 ≥3 months from chemotherapy were recruited, and 52 agreed to participate. 6 (11%) participants did not complete the intervention. The 6-month intervention included: 225 minutes/week of aerobic exercise, resistance training, 1200-1500 calorie/day diet, and weekly group behavioral meetings. Pre and postintervention assessments included: anthropometrics (weight, BMI), body composition (DEXA % body fat), and serum biomarkers (estradiol, testosterone, SHBG, IGF-1/IGFBP3, insulin, leptin, adiponectin, glucose, CRP, cholesterol). Results are shown for 52 women (median age 52 ± 8 years) who initiated the program and 45 (87%) who completed the 6-month intervention. Results: Women were approximately 4.25 years from diagnosis, their median weight at diagnosis was 84.1 kg (±15.8), and BMI was 31.3 kg/m2 (±5.6). Median pre-intervention weight was 91.8 kg (±13.4) and participants lost an average of 10.6 kg (±6.0)* or 13.3% (±28.8)* of their starting weight after the 6-month intervention. BMI decreased from 32.6 kg/m2 (±4.7) to 28.2 kg/m2 (±4.7)* and total percent body fat decreased by 5.6% (±4.5)*. Favorable changes in serum biomarkers of BrCa risk were observed for insulin*, leptin*, adiponectin*, and estradiol*. When comparing AI users to nonusers the significant favorable change in estradiol was not seen for those on AI's. There was a significant difference in decrease in % body fat* between AI users and nonusers. No other differences were significant. (*p-values &amp;lt;0.05) Conclusions: Overall, results suggest a 6-month diet/exercise/behavioral weight loss intervention in overweight post-menopausal BrCa survivors results in a significant decrease in weight and change in serum biomarkers of BrCa risk in both current AI users and nonusers, however, due to the small sample size significant between group difference were not seen. Larger studies evaluating the effects of weight and weight loss based on exposure to antihormonal therapy are needed. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B4.