Receiving Radiation Therapy For Breast Cancer Research Articles

Newly Diagnosed Mental Health Disorders in Patients With Breast Cancer Receiving Radiation Therapy

ObjectivesPatients with a mental health disorder (MHD) have higher age-adjusted mortality compared to the general population. Few reports investigate factors contributing to MHD among breast cancer patients receiving radiotherapy. Here, we report the incidence of acquired MHD after the diagnosis of breast cancer and treatment with radiotherapy. MethodsUtilizing a single-institution, prospectively maintained database, we analyzed patients with breast cancer treated with radiotherapy between 2012 and 2017. We cross-referenced these patients with newly acquired ICD-10 MHD codes within 3 years post-breast cancer diagnosis. The study included baseline NCCN distress tool scores and area deprivation index (ADI). Univariate (UVA) and multivariable (MVA) Cox regression analyses were conducted to evaluate factors impacting new MHD onset. ResultsOf the 967 included patients, 318 (33%) developed an MHD after their breast cancer diagnosis, which were predominately anxiety (45.1%) and depression (20.1%) related, with a median (IQR) time to diagnosis of 30 (24–33) months. UVA showed lymph node-positive disease, receipt of chemotherapy, receipt of a mastectomy, high comorbidity index, divorced status, retired status, and fourth-quartile ADI as significant predictors. On MVA, only receipt of chemotherapy (HR=1.70, p=0.014) and divorced status (HR=2.04, p=0.009) remained significant. Fourth-quartile ADI, retired status, and high comorbidity index showed trends towards significance (HR=1.78, p=0.065; HR=1.46, p=0.094; HR=1.41, p=0.059, respectively). On MVA examining the effects of the radiotherapy type on MHD, whole breast with regional nodal irradiation (WBI+RNI) (HR=2.31, p=0.015) and post-mastectomy radiotherapy (PMRT) (HR=1.88, p=0.024) were both strong predictors of MHD development. Additionally, an NCCN distress tool score of >3 was also predictive of MHD onset. ConclusionIn this cohort, one in three patients with localized breast cancer developed a new MHD, predominantly related to anxiety and depression. MHD risk was higher among divorced patients, those receiving chemotherapy, and patients receiving PMRT or WBI+RNI. These findings highlight the importance of future studies and targeted interventions to support this vulnerable population.

Depression and Anxiety Among English- and Spanish-Speaking Patients With Breast Cancer Receiving Radiation Therapy

An estimated 30% and 40% of patients with breast cancer experience depression and anxiety, respectively. However, distress experienced by patients with breast cancer receiving radiation therapy may vary among patients and vary at different time points. This study sought to describe the changes in levels of depression and anxiety experienced by English- and Spanish-speaking patients throughout a course of radiation therapy for breast cancer, along with the effect of different variables to better understand potential gaps. Eligibility criteria included English- and Spanish-speaking females, aged 18 or older, undergoing radiation therapy treatment for breast cancer at 2 institutions. Pre- and posttreatment surveys were completed before and after delivery of radiation therapy. Sociodemographic characteristics collected included race, ethnicity, marital status, education level, longest residency location, religion, housing, and food insecurity. The survey ended with the standardized PHQ-4 questionnaire to assess anxiety and depression. Results were analyzed using the analysis of covariance procedure. A total of 160 participants completed pre- and posttreatment surveys, with an initial response rate of 100% (169 patients), though 9 were lost to follow-up. Most of the participants were nonwhite (50%), primarily married (42.5%), and had a high school or associate's level education (46.9%). The total baseline distress mean (BDM) was 2.96 and the final distress mean was 2.78. English-speaking patients comprised 82.5% (n=132) of the sample and had a BDM of 2.91 with an adjusted change mean decrease of 0.45. Spanish-speaking patients comprised 17.5% (n=28) of the sample, with a baseline distress mean of 3.21 and an adjusted change mean increase of 1.03 (P=.002). Housing (P=.017) and food insecurity (P=.0002) also showed increasing distress with increased insecurity at baseline. Patients who speak Spanish, identify as Hispanic, or are experiencing food and housing insecurity are at an increased risk for depression and anxiety, and could benefit from more support during their course of radiation therapy to minimize distress.

Newly Diagnosed Mental Health Disorders in Patients with Breast Cancer Receiving Radiation Therapy

Patients with a mental health disorder (MHD) have higher age-adjusted mortality compared to the general population. There are few reports investigating the factors that contribute to newly diagnosed MHD following the diagnosis and treatment of breast cancer. Here, we report the incidence of acquired MHD after the diagnosis and treatment of breast cancer in patients who received radiation therapy. A database query of a single institution, prospectively maintained database identified patients diagnosed with breast cancer who received whole or partial breast irradiation (WB/PBI) or post-mastectomy radiotherapy (PMRT). A second query of the patients' electronic medical record cross-referenced those patients with ICD-10 mental health diagnosis codes (F1-F99) that were newly acquired following the diagnosis of breast cancer. Univariable and multivariable analyses were performed, analyzing the effect of multiple factors on new mental health diagnoses. Odds ratios (OR) were calculated with a linear regression model, examining demographic characteristics, cancer stage, surgery type, receipt of chemotherapy or hormone therapy, insurance type, and substance use. We identified 1129 patients, aged 26 - 92 years at the time of breast cancer diagnosis, who were treated at our institution between 2012 and 2017. 136 patients had a pre-existing MHD and were excluded from the analysis. 714 (74%) received WB/PBI, and 254 (26%) received PMRT with a median follow up of 63 months. 318 patients (33%) were diagnosed with MHD following breast cancer diagnosis. Median time to diagnosis of MHD was 30 months following the initial breast biopsy. On univariable (UVA) and multivariable analysis (MVA), N+ disease (UVA OR = 1.70, p<0.001), mastectomy (UVA OR = 1.55, p<0.01), receipt of chemotherapy (MVA OR = 1.77, p<0.0001), divorced relationship status (MVA OR = 2.38, p = 0.007), and retired employment status (MVA OR = 1.93, p<0.0001) conferred an increased risk of developing MHD. The primary new MHD identified following completion of radiation therapy included anxiety related disorders (44.4%), depression related disorders (19.4%), tobacco use disorder (12.9%), and dementia related disorders (6.2%). One in three patients treated with radiation therapy developed a new MHD following the diagnosis of breast cancer in this cohort. The majority of acquired MHD in this study were depression and anxiety related disorders. Patients who received chemotherapy, were divorced, or were retired were at a higher risk of developing MHD following breast cancer diagnosis. Further prospective studies are needed to identify potential interventions that would benefit this at-risk population.

Assessing Depression and Anxiety Levels in English and Spanish-Speaking Patients throughout a Course of Radiation Therapy

An estimated 32.2% and 41.9% of breast cancer patients experience depression and anxiety, respectively. However, distress experienced by patients with breast cancer receiving radiation therapy may vary at different time points and differ in comparison to other patients with breast cancer, potentially due to differences in the understanding of radiotherapy and variability in the severity of side effects. This study sought to describe the changes in levels of depression and anxiety experienced by English and Spanish-speaking patients throughout a course of radiation therapy for breast cancer, along with the impact of different variables on these levels of distress to better understand and quantify potential gaps. Eligibility criteria included English and Spanish-speaking females, ages 18 or older, undergoing radiation therapy treatment for breast cancer at two institutions, including a safety-net hospital. Pre- and post-treatment surveys were completed before and after delivery of radiation therapy. Sociodemographic characteristics collected included: race, ethnicity, marital status, education level, longest residency location, housing, and food security. The survey ended with the standardized PHQ-4 questionnaire, which uses a maximum total score of 12 to assess anxiety and depression. Results were analyzed using the Analysis of Covariance procedure. A total of 160 participants completed pre- and post-treatment surveys. Half of the participants were non-white (50%), primarily married (42.5%), and had a high school or associate's level education (46.9%). The total baseline distress mean (BDM) was 2.96 (Standard deviation, SD = 3.11), and the final distress mean (FDM) was 2.78 (SD = 3.78). English-speaking patients comprised 82.5% (n = 132) of the sample and had a BDM of 2.91 with an adjusted change mean (ACM) decrease of 0.45. Spanish-speaking patients comprised 17.5% (n = 28) of the sample, with a BDM of 3.21 and an ACM increase of 1.03 (P = 0.002). Housing (P = 0.021) and food insecurity (P = 0.002) also showed increasing distress with increased insecurity at baseline. Our study shows that Spanish-speaking patients present with higher levels of distress than their English-speaking counterparts and their distress increased throughout treatment as opposed to English speakers. Other factors, such as housing and food insecurity, are also significantly associated with increased distress. As the number of Spanish speakers in the US continues to increase, it will be important to continue assessing potential differences in cancer care. In addition, understanding the distress changes throughout radiation treatment could help inform future interventions that address these disparities.

Abstract P6-05-37: Comparing Changes in Depression and Anxiety Levels of Breast Cancer Patients throughout a Course of Radiation Therapy

Abstract An estimated 32.2% and 41.9% of breast cancer patients experience depression and anxiety, respectively. However, due to differences in the understanding of radiotherapy and variability in the severity of side effects, responses of patients with breast cancer receiving radiation therapy may vary at different time points and differ in comparison to other patients with breast cancer. This study sought to describe the changes in levels of depression and anxiety experienced by English and Spanish-speaking patients throughout a course of radiation therapy for breast cancer along with the impact of different variables on these levels to better understand and quantify potential gaps. Eligibility criteria included English and Spanish-speaking females, ages 18 or older, undergoing radiation therapy treatment for breast cancer at Boston Medical Center. Pre- and post-treatment surveys were completed before and after delivery of radiation therapy. Survey included sociodemographic questions along with the standardized PHQ-4 questionnaire, which uses a maximum total score of 12, to assess anxiety and depression. Results were analyzed using a least means square procedure. A total of 60 participants completed pre- and post- treatment surveys. Total baseline distress mean (BDM) was 3.32 (SD= 3.55) and final distress mean (FDM) was 3.22 (SD= 3.78). English-speaking patients comprised 70% (n=42) of the sample and had a BDM of 3.40 with an adjusted change mean (ACM) decrease of 0.48. Spanish-speaking patients comprised 30% (n=18) of the sample, with a BDM of 3.11 and an ACM increase of 0.79, differences in ACM trended toward significance with a p-value of 0.083. Sociodemographic characteristics included: race, ethnicity, marital status, education level and longest residency. Additional variables surrounding social determinants of health included housing and food insecurity, which showed statistically significant increasing distress with increased insecurity at baseline. While our study showed a higher BDM among English-speaking patients in comparison to Spanish-speaking patients, results showed that Spanish-speakers’ distress increased throughout treatment as opposed to English-speakers. Most of our patient population was English-speaking, though approximately one third Spanish-speaking and our participants were also primarily Black, non-Hispanic, never married, had a high school or associate level education, and had their longest residence in the US. Although the majority did not report housing or food insecurity, both had increasing DM with increased insecurity, with statistically significant results. As the number of Spanish-speakers in the US continues to increase, it will be important to continue assessing potential differences in cancer care. In addition, an understanding of the changes of distress throughout radiation treatment could help inform future interventions that address these disparities. Baseline distress values and adjusted change in overall score by sociodemographic factors Citation Format: Corina Beiner, Jenny Zhao, Muhammad Mustafa, Ariel Hirsch. Comparing Changes in Depression and Anxiety Levels of Breast Cancer Patients throughout a Course of Radiation Therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-37.

Quality of Life Assessment in Patients with Breast Cancer Receiving Radiation Therapy: A Prospective Study

<h3>Purpose/Objective(s)</h3> Quality of life (QOL) is important for cancer patients while it is frequently neglected in clinical patient care as well as cancer research. The purpose of this study is to exam the changes of QOL status and the associated factors during the course of radiation therapy in patients with breast cancer. <h3>Materials/Methods</h3> Invasive breast cancer patients, aged 18-year-old and above requiring adjuvant radiation therapy were eligible. A self-addressed promise questionnaire according to NCI "promise" were used to assess the QOL. The Questionnaires were completed one day prior to and at the end of radiation. Patient, tumor and prior treatment factors were collected during the first visit of the treatment. The primary endpoint was QOL which included physical function, activities, anxiety, depression, fatigue, sleep disturbance and pain. Data are presented as mean ± SD unless otherwise specified. The computer adaptive testing algorithm present in these three PROMIS domains standardized T scores according to a reference population, providing a mean score of 50 and a standard deviation of 10. Statistical significance of QOL between pre-radiation and end-radiation were tested using paired t test. The factors affecting changes of QOL were analyzed by correlation of spearman for continuous variables, and the analysis of variance for categorical variables. P less than 0.05 was considered to be significant. <h3>Results</h3> Between July 2019 and June 2021, a total of 321 breast cancer patients enrolled this study. The mean age was 45 years old. 88.5% patients received hypofractionated radiation with 72.9% patients at stage II-III. All of them signed written consent forms and completed the QOL prospectively. There was no significant difference in the scores of fatigue, sleep disturbance, physical function, activities and pain between pre-radiation and end-radiation. After radiation, anxiety and depression were improved instead. T score of anxiety pre-radiation and end-radiation was 47.68 ± 8.64 and 44.96 ± 7.48 respectively (p = 0.023). The improvement of anxiety was significantly correlated with RT fractions, RT dose and integral dose of the total body (p values < 0.05), but not RT techniques, RT fields, mean lung dose, age, tumor subtypes, surgical approaches, stage and prior chemotherapy. T score of depression pre-radiation and end-radiation was 44.05 ± 5.86 and 42.65 ± 4.74 respectively (p = 0.041). The improvement of depression was significantly correlated with integral dose of the total body and anti-HER2 target therapy (p values < 0.05). <h3>Conclusion</h3> Most QOL measures were not significantly changed after radiation while anxiety and depression improved in patients with breast cancer. Future study with larger cohort shall be investigated to validate these finding. This is part of a prospective study of treatment toxicity, quality of life and biomarker in cancer patients (GCOG0001/NCT05061342).

Financial Toxicity in Women With Breast Cancer Receiving Radiation Therapy: Final Results of a Prospective Observational Study

PurposeWe sought to quantify financial toxicity (FT) present in a prospective cohort of women with breast cancer (BC) receiving radiation therapy (RT), identify predictors of FT, correlate FT with health-related quality of life (QoL), and determine whether duration of RT is associated with FT. Methods and MaterialsConsecutive patients with stage I-III BC completed Functional Assessment of Cancer Therapy-G7 (FACT-G7), a tailored FT questionnaire, and Comprehensive Score for Financial Toxicity (COST) scoring within 1 month of RT completion. Lower scores on FACT-G7 (range, 0-28) and COST (range, 0-44) indicate worse QoL and FT. Group comparisons were performed with a 2-sample t test and χ2 tests for continuous and categorical variables, respectively. Pearson correlation was used to associate COST with FACT-G7. Linear and multiple regression were used to evaluate predictors of COST. ResultsOne hundred eight enrolled patients were eligible for analysis with completed COST scores, including 56, 42, and 10 patients treated with long-, intermediate-, and short-course RT. Mean COST score was 28.6 and mean FACT-G7 was 18.4. Among patients treated with intermediate- and long-course RT (n = 98), marital status (higher COST associated with married status relative to other), medication cost (higher COST for no significant medication costs relative to significant medication costs), employment type (lower COST associated with disabled status or unemployed, higher COST with retired status relative to working), and surgery type (higher COST for lumpectomy relative to mastectomy) were significantly associated with COST score by multivariable analysis (all P values < .05). RT length group was not associated with COST (P = .79). COST and FACT-G7 were strongly correlated for the overall cohort (P < .0001). ConclusionsIn this prospective study of women with BC receiving RT, distinct factors including surgery type were significantly associated with FT. FT was strongly correlated with health-related QoL. Increased characterization of the relationship between FT and health-related QoL for women with BC receiving RT and defining clinical predictors of FT may help guide future studies investigating optimal targeted interventions for patients with BC at high risk for FT.

Financial Toxicity (FT) in Patients (pts) with Breast Cancer (BC) Receiving Radiation Therapy (RT): A Prospective Observational Study

Cancer pts often face FT due to direct medical expenses and indirect expenses like lost income due to disability or missed work time. The incidence and severity of FT in pts receiving RT for BC is unknown. We aimed to describe the incidence of FT and the distribution of the COST score, a measure of FT validated in cancer pts. We also aimed to associate COST with the length of RT (long course, 25-35 fractions vs. short/intermediate (S/I) course, 1-24 fractions), disease burden, treatment and demographic factors, and the FACT-G7 quality of life score. We hypothesized that pts receiving long course RT vs. S/I would have greater FT. After signing informed consent, pts with stage 0-III BC completed a FT questionnaire, COST and FACT-G7 within one month of completion of RT. Group comparisons were performed with two-sample t-test for continuous variables and Chi-square for categorical. Pearson correlation was used to associate COST with FACT-G7. Linear and multiple regression were used to evaluate explanatory variables as predictors of COST. Between 12/2018-1/2019, 88 pts were eligible and 65 (35 long, 30 S/I) consented. Participants were well matched with non-participants with respect to stage, demographic and treatment factors; however, participants were less likely to be underserved (p = 0.04) or to have Medicaid (p = 0.02). Mean COST and FACT-G7 scores were 28.3 (95% CI 25.8-30.7) and 18.8 (95% CI 17.5-20.2), respectively. Due to RT, 26% (n = 17) reported they were unable to work during RT, 14% (n = 9) missed ≥10 work days, 17% (n = 11) lost wages, 20% (n = 13) had high transportation costs, 9% (n = 6) had high medication costs, and 19% (n = 12) had a caregiver that lost time or wages from work. Pts in long and S/I RT groups were well matched for income, education level, insurance, underserved status, dependent children, marital and employment status, but dissimilar with respect to stage, age, surgery and RT type, chemotherapy use, nodal RT and time since BC diagnosis (all p<0.001). There was significant correlation between COST and FACT-G7 score for all pts (correlation coefficient 0.62, p<0.001), long course RT (0.60, p<0.001) and S/I (0.65, p<0.001). In a multivariable regression model for COST, marital status (married vs. unmarried, p = 0.010), high medication costs (no vs. yes, p = 0.025), surgery type (lumpectomy vs. mastectomy, p = 0.008) and time since BC diagnosis (p = 0.015) retained significance, but RT duration did not (p = 0.340). After adjusting for FACT-G7 in multivariable regression, FACT-G7 (p<0.001) and surgery type (p = 0.003) retained significance, with marital status (p = 0.058) having borderline significance. Among study participants, indirect expenses due to RT were common. RT duration does not appear to predict FT, but pts who are unmarried, have mastectomy, and a longer course of BC treatment are at highest risk of FT during RT. Clinicians should recognize FT as an important determinant of quality of life in women receiving RT for BC.

Breast Cancer Survivors' Unmet Needs After Completion of Radiation Therapy Treatment.

To identify the unmet needs of breast cancer survivors after radiation therapy. Patients who received radiation therapy for unilateral breast cancer with six months or longer of follow-up and exhibited no disease progression were eligible for selection to a study conducted at an outpatient radiation therapy academic practice in the southeastern United States. A qualitative descriptive study was undertaken using semistructured interviews, framed by the five domains of the Survivor Unmet Needs Survey and analyzed using an iterative inductive and deductive process. Of the 24 invited patients, 17 agreed to the interview (including one male patient). Themes emerged from the emotional, relationships, and information needs domains. Healthcare providers should perform a comprehensive needs assessment for patients with breast cancer receiving radiation therapy. Self-management assessment instruments may address patients' confidence in managing all phases of radiation therapy side effects.

Symptom clusters in patients with breast cancer receiving radiation therapy.

Symptoms experienced by breast cancer patients often cluster together in groups known as "symptom clusters". The aim was to determine the symptom clusters in women with non-metastatic breast cancer treated by radiation therapy (RT). Edmonton Symptom Assessment Scale (ESAS) scores were taken from breast cancer patients receiving RT before, at completion of RT, and after RT. Exploratory factor analysis (EFA), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items at all three time points. This study included 1224 patients. The PCA and EFA identified the same two symptom clusters before the start of RT: 1) pain, tiredness, nausea, drowsiness, appetite, and dyspnea; 2) depression, anxiety, and wellbeing. The HCA further split the symptoms into three clusters. Wellbeing, depression, and anxiety consistently clustered together. Among the ESAS scores collected at the end of and after RT, each statistical method identified different symptom clusters. For the symptom clusters experienced at the end of RT, the following symptoms were always in the same cluster: wellbeing, depression, and anxiety; nausea and appetite; drowsiness and dyspnea. Following RT, depression and anxiety consistently clustered together, with nausea and appetite in a second cluster. Among the symptom clusters derived before, at the end of RT, and after RT, the following symptoms consistently presented together: depression and anxiety, nausea and appetite, pain and tiredness, and drowsiness, dyspnea, and tiredness. Understanding symptom clusters in this population can improve management of symptoms.

Evaluation of the Brachial Plexus With Shear Wave Elastography After Radiotherapy for Breast Cancer.

The aim of this study was to analyze the elasticity characteristics of the brachial plexus by shear wave elastography (SWE) in patients receiving radiation therapy (RT) for breast cancer and to compare them with their contralateral brachial plexus to evaluate whether elasticity properties can be used as supporting findings for the early diagnosis of brachial plexus involvement in patients receiving RT. A prospective analysis with electromyography and SWE was performed on 23 brachial plexuses of patients receiving RT for breast cancer and their contralateral brachial plexuses. An electromyographic device was used for nerve conduction studies. Evaluations were done by the same investigator, and superficial electrodes were used in the recordings. A quantitative analysis of the brachial plexus with SWE was performed, with values in kilopascals on a color scale ranging from 0 (red, soft) to 150 (dark blue, hard) kPa. Mean SWE values ± SD were 51.0 ± 14.0 kPa for the ipsilateral brachial plexuses of patients receiving RT and 18.0 ± 4.2 kPa for the contralateral brachial plexuses. Statistically significant differences were observed between the groups in the analysis of SWE values (P < .001). No significant correlation was found between the nerve conduction parameters and elastographic values (P > .05). Shear wave elastography showed that the brachial plexuses of patients receiving RT were stiffer than the unaffected brachial plexuses. Brachial plexus stiffening may be associated with fibrotic processes.

Comparison of Treatments for Breast Cancer Arising After Radiation Treatment for Hodgkin Lymphoma

Breast cancer in patients that received radiation therapy (RT) for Hodgkin lymphoma (HL) have traditionally been treated with mastectomy. Prior irradiation is a contraindication for patients to receive breast conserving therapy. However, retrospective studies have found that lumpectomy followed by breast irradiation is an acceptable treatment option for breast cancers that arise after RT for HL. This study compares treatment modalities for breast cancers arising from previously irradiated HL patients, specifically the addition of RT. Data was extracted from the Surveillance, Epidemiology and End Results (SEER) from the years 1983 and 2009. All patients previously treated with RT for HL who subsequently developed breast cancer and received surgical treatment were included. Patients were grouped by breast cancer treatment received, as well as by RT utilization. Patients were staged using AJCC 7th edition criteria. Univariate analysis was then made to compare treatment groups. There were 413 female patients with a history of RT for HL breast cancer identified, who had breast cancer surgery with or without radiation therapy. Of these patients, 406 patients were fully staged. Sixty-eight patients received a bilateral mastectomy, 247 received a mastectomy, and 91 received a lumpectomy. A total of 66 patients received RT. RT was given to 1 patient completing a bilateral mastectomy, 19 patients completing a mastectomy, and 46 patients completing a lumpectomy. On univariate analysis, the addition of radiation therapy did not significantly impact CSS or OS (smallest p = 0.70). When treatment categories were analyzed as a whole, there were no statistically significant differences between treatment groups (greatest p = 0.14). Patients that received RT for Hodgkin lymphoma and subsequently develop breast cancer are typically treated with mastectomy. Using the SEER database, there were no statistically significant differences between surgical treatment modalities (bilateral mastectomy, mastectomy and lumpectomy) with or without RT.

Polarity Therapy for Cancer-Related Fatigue in Patients With Breast Cancer Receiving Radiation Therapy: A Randomized Controlled Pilot Study

Cancer-related fatigue (CRF) is the most frequently reported side effect of cancer and its treatment. In previous research, Polarity Therapy (PT), an energy therapy, was shown to reduce CRF in patients receiving radiation. This study reports on a small randomized clinical trial designed to collect preliminary data on the efficacy of PT compared with an active control (massage) and passive control (standard care) for CRF among cancer patients receiving radiation therapy. Forty-five women undergoing radiation therapy for breast cancer were randomized to 1 of 3 weekly treatment conditions. Patients received standard clinical care, 3 modified massages, or 3 PT treatments. CRF and health-related quality of life (HRQL) were assessed during baseline and the 3 intervention weeks. TResults show CRF ratings were reduced after PT. The effect sizes for PT versus modified massage and versus standard care were small when using the primary measure of CRF (Brief Fatigue Inventory) and large when using the secondary measure of CRF (Daily CRF Diaries).The effect size was medium when assessing the benefit of PT on maintaining HRQL compared with standard care with very little difference between the PT and modified massage conditions. Patients' feedback showed that both the modified massage and PT treatments were deemed useful by radiation patients. The present pilot randomized clinical trial supports previous experimental research showing that PT, a noninvasive and gentle energy therapy, may be effective in controlling CRF. Further confirmatory studies as well as investigations of the possible mechanisms of PT are warranted.

Radiation-induced effects on gene expression: An in vivo study on breast cancer

Background and Purpose Breast cancer is diagnosed worldwide in approximately one million women annually and radiation therapy is an integral part of treatment. The purpose of this study was to investigate the molecular basis underlying response to radiotherapy in breast cancer tissue. Material and Methods Tumour biopsies were sampled before radiation and after 10 treatments (of 2 Gray (Gy) each) from 19 patients with breast cancer receiving radiation therapy. Gene expression microarray analyses were performed to identify in vivo radiation-responsive genes in tumours from patients diagnosed with breast cancer. The mutation status of the TP53 gene was determined by using direct sequencing. Results and conclusion Several genes involved in cell cycle regulation and DNA repair were found to be significantly induced by radiation treatment. Mutations were found in the TP53 gene in 39% of the tumours and the gene expression profiles observed seemed to be influenced by the TP53 mutation status.

Perceived symptoms and quality of life in women with breast cancer receiving radiation therapy

The purpose of this study was to describe symptoms, side-effects and quality of life (QoL) of women with breast cancer during and following treatment with radiation therapy. The sample consisted of 134 women with breast cancer. Symptoms were measured using a modified version of the Oncology Treatment Toxicity Tool (OTTAT) and QoL was measured using the Cancer Rehabilitation Evaluation System-short form (CARES-sf). The results showed an increase in experienced symptoms and their severity as the treatment progressed. QoL was perceived as poorest at baseline before treatment had started. During the treatment, QoL scores leveled out and an improvement could be seen after completion of treatment.The study findings provide directions and suggestions for assessment and management of perceived symptoms for women receiving radiation therapy for breast cancer from the second week and up to 2 weeks after completion of therapy is the critical time-period for targeting interventions for experienced symptoms and side-effects from radiation therapy.

Fatigue in women with breast cancer receiving radiation therapy.

Fatigue is a common complaint of individuals receiving treatment for cancer. There is a dearth of rigorous research investigating the clinical course and prognosis of fatigue over the course of radiation therapy. Seventy six patients with breast cancer receiving external radiation therapy were followed longitudinally from the onset of treatment to 6 months post-treatment. Fatigue significantly increased over the course of treatment, was highest at the last week of treatment, and returned to pretreatment levels by 3 months after treatment. Fatigue was not influenced by the patient's age, stage of disease, time since surgery, weight, and length of time since diagnosis. Fatigue was significantly related to symptom distress, psychologic distress, and self-reported fatigue relief strategies. The most frequently reported self-relief strategies were "sit" and "sleep." Fatigue had a negative impact on the patient's quality of life. Impairment in quality of life was evident by the end of treatment, with improvement by 3 and 6 months after treatment. The second week through to the last week of radiation therapy are critical times to target interventions for the management of fatigue. The amelioration of concomitant symptoms is a supportive approach that might be helpful. Self-help strategies focusing on the cessation of activity and increasing rest were reported as successful by patients.