Breast Cancer-specific Quality Of Life Research Articles

Nurse-Led Individualized Follow-Up Versus Regular Physician-Led Visits After Early Breast Cancer (MyHealth): A Phase III Randomized, Controlled Trial.

Follow-up after breast cancer with regular visits has failed to detect recurrences, be cost-effective, and address patient needs. MyHealth is a phase III randomized controlled trial (ClinicalTrials.gov identifier: NCT02949167). Patients, who recently completed primary treatment for stage I-II breast cancer, were randomly assigned in variable block sizes and stratified by age and human epidermal growth factor receptor 2 status to intervention or control follow-up. The nurse-led intervention comprised three to five individual self-management sessions, regular reporting of symptoms, and navigation to health care services. The control follow-up comprised regular outpatient visits with the physician. The primary outcome was breast cancer-specific quality of life (QoL) measured by the Trial Outcome Index-Physical/Functional/Breast summary score of the Functional Assessment of Cancer Therapy-Breast 2 years after random assignment. Secondary outcomes were fear of recurrence, anxiety, depression, and health care utilization. Analyses were intention-to-treat and P values were two-sided with 95% confidence level set at 0.005 because of multiple comparisons. Among 1,101 eligible patients, 875 were invited and 503 were randomly assigned to control (n = 252) or intervention (n = 251) follow-up. At 2 years, patients in the intervention group reported a significantly and clinically relevant higher QoL (mean, 75.69 [standard deviation [SD], 12.27]) than patients in the control group (71.26 [SD, 14.08]), with a mean difference of 5.05 (95% CI, 3.30 to 6.79; P < .001). The intervention group reported significantly less fear of recurrence, anxiety, and depression; they had fewer physician consultations but more nurse contacts and an unchanged diagnostic imaging pattern. The effect on all outcomes was stable through a 3-year follow-up. The MyHealth study suggested a new strategy for follow-up after early breast cancer as it provided significant improvements in QoL.

Breast Cancer: How Hippotherapy Bridges the Gap between Healing and Recovery-A Randomized Controlled Clinical Trial.

Breast cancer is the most diagnosed women's cancer, and has a high survival rate. Despite great progress in detection and treatment, life reconstruction requires comprehensive cross-sectoral approaches between different disciplines and deeper consideration of the patient's challenges. Hippotherapy is an emerging specialized rehabilitation approach, performed by accredited health professionals and equine specialists, on specially trained horses via their movement, activating major paths for physical, mental, psychic and social reinforcement, and is synergistic to rehabilitative and supportive care. We conducted a randomized open, prospective, two-armed, controlled trial on the effectiveness of hippotherapy versus conventional supportive care on adult women with a diagnosis of breast cancer, after the period of primary treatment (surgery, chemotherapy, radiotherapy). The 6-month program included, in the treated group, an initial 1-week daily hippotherapy session, followed by three short 2-day sessions with an interval of 2 months between each, where the patients received conventional supportive care. The control group received 6 months of conventional supportive care. The primary end point was quality of life. Cognitive performances, fatigue, anxiety, depression, and body image were the secondary end points. Measurements were done through self-reported questionnaires. We observed statistical differences in the evolution of the measured parameters over time between the two groups. The hippotherapy group showed a much faster, favorable and continuous improvement until the end of the program for each function assessed. The most striking improvements were observed in global quality of life, and fatigue, while breast cancer-specific quality of life, cognitive performance, anxiety and depression and body image showed a less marked but still statistically significant difference at the final post-treatment evaluation. We demonstrate the therapeutic relevance of hippotherapy, a one-health approach, as a key initial stage after cancer diagnosis and treatment to foster recovery. Furthermore, hippotherapy has a strong impact on cancer treatments' efficiency and reconstruction of patient's life and ecosystem. This work reveals a layer of complexity that needs to be broadly considered. ClincalTrials.gov NCT04350398 accessed on 1 January 2022. Registered 17 April 2020, retrospectively registered; French Clinical Trials in Cancer Register RECF3818. Registered 18 March 2019, retrospectively registered.

Acupuncture for hot flashes in hormone receptor-positive breast cancer, a pooled analysis of individual patient data from parallel randomized trials.

12124 Background: Hot flashes are a common side effect of endocrine therapy in breast cancer patients (pts). In a coordinated multinational study, we evaluated the impact of acupuncture on hot flashes and related symptoms in hormone receptor-positive breast cancer pts undergoing adjuvant endocrine therapy in the USA, China, and South Korea. Methods: Parallel randomized trials were conducted at three sites: Dana-Farber Cancer Institute, USA; Jiangsu Hospital of Traditional Chinese Medicine, China; and Daegu Catholic University Medical Center, Republic of Korea, using the same inclusion/exclusion criteria, randomization, and measures. Breast cancer pts receiving adjuvant endocrine therapy and having ≥14 hot flashes per week were randomized equally to acupuncture (A) or usual care (UC); randomization was stratified by number of hot flashes per day (2-6 or 7+). Pts in arm A received a standardized acupuncture protocol twice per week for 10 weeks; pts in the UC arm received usual care. Symptoms were assessed at baseline and week 10. The primary endpoint was change in the Endocrine Symptom Subscale (ESS) of the Functional Assessment of Cancer Therapy-Endocrine Systems (FACT-ES). Secondary endpoints included changes in the FACT-Breast (FACT-B) and Daily Hot Flash Score (DHFS), a measure incorporating hot flash frequency and severity. Target enrollment was 160 pts (USA 80, China 40, Korea 40) providing 84% power to detect a clinically meaningful change in the ESS. Analyses were intention-to-treat. A pooled analysis of individual patient data was performed using linear models adjusted for site and baseline number of hot flashes. Results: Between Jan. 2019 and June 2021, 158 female pts with stage 0-III breast cancer were randomized from the USA (n=78), China (n=40), and South Korea (n=40). Median age was 48 years (range: 25 to 73). At baseline, pts reported similar numbers of hot flashes between study arms (6.2± 4.3 vs. 6.5± 3.8 per day). At week 10, pts in arm A reported statistically significant improvements in ESS score, FACT-B total score and DHFS compared with the UC arm (Table). The reduction in the DHFS from baseline in arm A was 53%. There were no serious adverse events. Conclusions: Acupuncture led to statistically and clinically meaningful improvements in hot flashes, endocrine symptoms, and breast cancer-specific quality of life in women undergoing adjuvant hormonal therapy for breast cancer in the USA, China and South Korea. Clinical trial information: NCT00797732, ChiCTR2100045888, KCT0003618. [Table: see text]

Discontinuation of adjuvant endocrine therapy and impact on quality of life and functional status in older patients with breast cancer

PurposeSide effects are the main reason for discontinuation of adjuvant endocrine therapy in older adults. The aim of this study was to examine geriatric predictors of treatment discontinuation of adjuvant endocrine therapy within the first 2 years after initiation, and to study the association between early discontinuation and functional status and quality of life (QoL).MethodsPatients aged ≥ 70 years with stage I–III breast cancer who received adjuvant endocrine therapy were included. The primary endpoint was discontinuation of endocrine therapy within 2 years. Risk factors for discontinuation were assessed using univariate logistic regression models. Linear mixed models were used to assess QoL and functional status over time.ResultsOverall, 258 patients were included, of whom 36% discontinued therapy within 2 years after initiation. No geriatric predictive factors for treatment discontinuation were found. Tumour stage was inversely associated with early discontinuation. Patients who discontinued had a worse breast cancer-specific QoL (b = − 4.37; 95% CI − 7.96 to − 0.78; p = 0.017) over the first 2 years, in particular on the future perspective subscale (b = − 11.10; 95% CI − 18.80 to − 3.40; p = 0.005), which did not recover after discontinuation. Treatment discontinuation was not associated with functional improvement.ConclusionA large proportion of older patients discontinue adjuvant endocrine treatment within 2 years after initiation, but geriatric characteristics are not predictive of early discontinuation of treatment. Discontinuation of adjuvant endocrine therapy did not positively affect QoL and functional status, which implies that the observed poorer QoL in this group is probably not caused by adverse effects of endocrine therapy.

Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer.

Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer.

Practice and Outcome of Exercise Intervention on Breast Cancer-Specific Quality of Life of Breast Cancer Survivors in Nigeria

Background: Lifestyle modification like exercise is an essential rehabilitation measure that improves the quality of life (QoL) of women with breast cancer and helps in preventing cancer related complications. This study assessed the practice and outcome of exercise interventions on breast cancer-specific quality of life of survivors in Delta State, Nigeria. Methods: Experimental design was applied with intervention (47) and control (47) groups. This design involved a pre-test, an intervention, and a post-test. Exercise intervention (aerobic, resistance and flexibility exercises, including warm-up with Swiss ball and dance, climbing of stairs, treadmill, stationary exercise bicycle, shoulder, and arm exercises) was administered to the intervention group for twelve weeks. The assessment of breast cancer survivors' specific quality of life in the two groups was done with the English version of The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire (QLQ- EORTC-BR23) before and after the exercise intervention. Results: The overall pre and post-intervention breast cancer-specific functional quality of life was 65.4±22.7 (intervention group); 71.3±23.4 (control group) and 75.05 ±10.4 (intervention group); 58.65±12.9 (control group) while the pre and post breast cancer-specific symptoms QoL was 22.2±6.2 (intervention group); 24.1±9.6 (control group) and 11.8±13.0 (intervention group); 30.9±21.2 (control group), respectively. All the women in the intervention group practiced exercise only at mild/moderate intensity and no notable side effects were observed during the practice by many of them (n=39). Significant differences existed in the overall post-intervention breast cancer-specific functional and symptoms QoL between the two groups (p&lt;0.001) and no significant differences were observed among most of the specific QoL scales in relation to age, duration of diagnosis, and stage of the cancer diagnosis. Conclusion: Exercise remains beneficial to women with breast cancer and has proven to be one of the necessary means to improve their overall well-being. Therefore, healthcare providers that manage these patients in different hospitals should always counsel and support them to initiate the recommended exercises for cancer survivors to enhance their survival.

Cognitive-Behavioral Therapy and Hypnosis Intervention on Anxiety, Depression, and Quality of Life in Patients with Breast Cancer Undergoing Chemotherapy: A Clinical Trial

Background: Women with breast cancer undergo painful and distressing treatment procedures. Hypnotherapy and cognitive-behavioral therapy (CBT) could be considered as an effective therapy. Method: In this clinical trial, 50 women aged 25 to 65 were assigned to three groups (CBT, hypnosis, and control groups). Eight one-hour treatment sessions were run for each of the hypnosis and CBT groups. We utilized The European Organization for Research and Treatment of Breast Cancer-specific Quality of Life (QoL), The European Organization for Research and Treatment of Cancer QoL questionnaires, and The Hospital Anxiety and Depression Scale for the evaluation of the QoL, anxiety, and depression at the beginning and end of the treatment, as well as six months post-treatment. Results: The improvements in the stress, depression, and qoL amongst the three groups were significant, although these improvements in CBT group were more than those in hypnosis group, and in hypnosis and CBT groups were not significant. Physical functioning, body image, sexual functioning, arm symptoms, breast symptoms, future perspective, pain, digestive problems, and functional scale significantly changed in CBT and hypnosis groups (p <0.05). Memory and social functioning; however, did not change in the groups and across the three groups. In addition, sleeping disorders and emotional malfunctioning were recovered only in the hypnosis group, which was statistically significant. Conclusion: We found hypnosis exclusively effective on reducing certain problems of breast cancer patients, such as sleeping disorders and emotional malfunctioning; therefore, it is suggested as an efficient solution for these patients’ problems.

Autologous breast fibrofatty flaps for immediate breast reconstruction after excision of small cancer mass (&lt;50 mm) improves surgical and aesthetical outcomes and patients’ quality of life

Background: Evaluation of surgical feasibility, aesthetic outcomes and 6-m postoperative (PO) effect of immediate breast reconstruction (IBR) using autologous fibrofatty flaps after localized small breast mass excision.Methods: Total 29 women had duct carcinoma of &lt;50 mm in diameter with N1-3 regional lymphadenopathy were studied. Through diamond-shape incision, breast gland was removed with 1 cm circumferential free safety margin, then the medial and lateral fibrofatty flaps were undermined and approximated for IBR. Breast measurements; the nipple-to-suprasternal notch distance and the nipple-to-nipple distance were determined preoperatively and 6-m PO. Quality of life (QoL) evaluation was performed preoperatively and 6-m PO using the short-form-36 (SF-36), the multidimensional body self-relations questionnaire appearance assessment and the European organization for research and treatment of cancer breast cancer-specific QoL questionnaire scores in breast cancer. Results: Mean operative time was 94.5±15.4 min; mean intraoperative blood loss was 170.1±34.9 ml and 25 patients had returned home on the same operative day. Two patients had PO wound seroma and one patient had wound hematoma, but were resolved spontaneously. PO breast measurements showed non-significant differences in comparison to preoperative measurements of the same breast, and to measurements of the contralateral breast. PO evaluation of QoL showed significantly improved PO scoring in line with improved body image and future perspectives, and sexual scores in comparison to preoperative scorings. Conclusions: The applied procedure of localized excision of BC mass of&lt;50 mm with IBR using the breast remnant fibrofatty flaps provided acceptable surgical and esthetical outcomes and allowed improvement of patients’ QoL.

Patient-reported outcomes in survivors of breast cancer one, three, and five years post-diagnosis: a cancer registry-based feasibility study.

The burden of treatment toxicities in breast cancer requires longitudinal assessment of patient-centered outcomes. The current study aimed to assess the feasibility of collecting general and breast cancer-specific quality of life (QoL), ongoing symptoms and unmet needs, in patients identified from a population-based cancer registry, and to assess the contribution of demographic, disease, and care-related factors. Eligible patients were identified from the Victorian Cancer Registry (Victoria, Australia) using the ICD-10 code C50, diagnosed during 2013, 2011, and 2009. Data included age, area of residence, cancer diagnosis, date of diagnosis, treatment modality, and staging. Patients completed a number of validated tools including the EQ-5D-5L and FACT-B, symptom items, and unmet needs. Of 1006 eligible patients, the overall response rate was 45.6%. Survivors 1year post-diagnosis had significantly greater problems with pain or discomfort (59.2%) and with anxiety or depression (51.3%) compared with survivors 5years post-diagnosis (45.1% with pain or discomfort, p < 0.05, and 32.7% with anxiety or depression, p < 0.01). For the 5years group, pain or discomfort and anxiety or depression were significantly higher than for the general population (32.2% and 21.6%, respectively). Improved quality of life was found in those who did not receive chemotherapy (coefficient = 0.2269, p = 0.0409) and those who did not have a longstanding health condition (coefficient = 0.6342, p < 0.001). Poorer quality of life was associated with those who were not certain what was happening with their breast cancer (coefficient = - 0.3674, p = 0.0094) and those whose cancer had not been treated, had been treated but was still present, or had returned after treatment (coefficient = - 0.5314, p = 0.0136). Across the total cohort, women were bothered by changes in weight (21.3%) and concerned about the effects of stress on their cancer (19.6%). Fear of cancer recurrence was commonly reported and did not diminish over time (60.7%, 52.2%, and 56.9% at 1, 3, and 5years, respectively). Collecting patient-reported outcomes from a population-based sample of breast cancer survivors was feasible. Physical symptoms and psychosocial issues are common and are persistent. Use of chemotherapy was the only treatment modality that significantly impacted on QoL.

Young Women With Breast Cancer in Mexico: Results of the Pilot Phase of the Joven & Fuerte Prospective Cohort.

PURPOSEThe pilot-phase report of the Joven & Fuerte prospective cohort broadly characterizes and assesses the needs of Mexican young women with breast cancer (YWBC).PATIENTS AND METHODSWomen age ≤ 40 years with nonmetastatic primary breast cancer were consecutively accrued from 2 hospitals. Data were collected at the first/baseline oncology visit and 2 years later using a sociodemographic survey, European Organisation for Research and Treatment of Cancer Quality-of-Life (QOL) Questionnaire Core 30 (QLQ-C30) and Breast Cancer–Specific QOL Questionnaire (QLQ-BR23), Hospital Anxiety and Depression Scale (HADS), Female Sexual Functioning Index (FSFI), Sexual Satisfaction Inventory, and patients’ medical records. Pearson χ2 and 2-sided t tests were used for statistical analysis. An unadjusted P value < .05 was considered significant.RESULTSNinety patients were included, all with government health care coverage. Most had low monthly household incomes (98%) and at least a high school education (59%). There was a considerable prevalence of unpartnered patients (36%) and unmet parity (25%). Patients’ most common initial symptom was a palpable mass (84%), and they were most frequently diagnosed with stage III disease (48%), with 51% having had a physician visit ≤ 3 months since detection but 39% receiving diagnosis > 12 months later. At baseline, 66% of patients were overweight/obese, and this proportion had significantly increased by 2 years (P < .001). Compared with baseline, global QLQ-C30 had improved significantly by 2 years (P = .004), as had HADS-Anxiety (P < .001). However, both at baseline and at 2 years, nearly half of patients exhibited FSFI sexual dysfunction.CONCLUSIONThese preliminary findings demonstrate that YWBC in Mexico have particular sociodemographic and clinicopathologic characteristics, reinforcing the necessity to further describe and explore the needs of these young patients, because they may better represent the understudied and economically vulnerable population of YWBC in limited-resource settings.

Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors

IntroductionsFor young premenopausal breast cancer patients, adjuvant chemotherapy may cause menstrual disruptions and premature menopause, which may in turn impair their quality of life (QoL). In this study among young breast cancer survivors who have undergone adjuvant chemotherapy, the objectives were to assess post-treatment menopausal symptoms and their associated factors, and to correlate these symptoms with breast cancer-specific QoL.MethodsThe study population included premenopausal young Chinese women with early-stage breast cancer who had undergone adjuvant chemotherapy between 3 and 10 years prior to enrolling into this study. At study entry, patients’ characteristics and clinical features were collected; each patient had detail menstrual history collected and each filled in MENQOL and FACT-B + 4 questionnaires.ResultsTwo hundred eighty eligible patients were recruited. For adjuvant chemotherapy, 92% received anthracyclines and 28% received taxanes; 76% received adjuvant tamoxifen. At a median of 5.0 years from initial cancer diagnosis, 49 and 11% had become post- and peri-menopausal respectively. MENQOL at study entry revealed that physical domain score was worse in overweight/obese patients (mean scores for underweight/normal vs overweight/obese: 2.65 vs 2.97, p = 0.0162). Vasomotor domain score was worse in those who received taxanes or tamoxifen (taxane vs non-taxane: 2.91 vs. 2.35, p = 0.0140; tamoxifen vs no tamoxifen: 2.75 vs. 2.34, p = 0.0479). Sexual domain score was worse among those who had become peri/post-menopausal (peri/postmenopausal vs premenopausal: 2.82 vs. 2.29, p = 0.0229). On the other hand, patients who utilized traditional Chinese medicine had significantly worse scores for vasomotor, psychosocial and physical domains. Further, there was a significant association between MENQOL scores and FACT-B + 4 scores; less severe symptoms in the MENQOL domains were associated with better QoL scores in FACT-B + 4 physical, functional, psychosocial and emotional well-being, Breast Cancer Subscale, Arm Subscale and FACT-B total score.ConclusionAmong premenopausal breast cancer women who had undergone adjuvant chemotherapy, those who had received taxanes or tamoxifen, were overweight/obese and utilized traditional Chinese medicine had more severe menopausal symptoms. Patients who experienced worse menopausal symptoms were found to have worse breast cancer-specific QoL. Interventional studies with an aim to alleviate menopausal symptoms are warranted to assess if overall QoL of these patients could be improved.Trial registrationNot applicable.

Usefulness of Kinect sensor-based reachable workspace system for assessing upper extremity dysfunction in breast cancer patients.

Recently, the utility of the Kinect sensor-based reachable workspace analysis system for measuring upper extremity outcomes of neuromuscular and musculoskeletal diseases has been demonstrated. Here, we investigated its usefulness for assessing upper extremity dysfunction in breast cancer patients. Twenty unilateral breast cancer patients were enrolled. Upper extremity active range of motion was captured by the Kinect sensor, and reachable workspace relative surface areas (RSAs) were obtained. The QuickDASH was completed to assess upper extremity disability. General and breast cancer-specific quality of life (QOL) were assessed by the EORTC QLQ-C30 and EORTC QLQ-BR23. The total RSA ratio of the affected and unaffected sides ranges from 0.64 to 1.11. Total RSA was significantly reduced on the affected versus unaffected side (0.659 ± 0.105 vs. 0.762 ± 0.065; p = 0.001). Quadrant 1 and 3 RSAs were significantly reduced (0.135 ± 0.039 vs. 0.183 ± 0.040, p < 0.001; 0.172 ± 0.058 vs. 0.217 ± 0.031, p = 0.006). Total RSA of the affected side was strongly correlated with the numeric pain rating scale during movement (r = - 0.812, p < 0.001) and moderately with the QuickDASH (r = - 0.494, p = 0.027). Further, quadrant 3 RSA was correlated with EORTC QLQ-C30 role functioning (r = 0.576, p = 0.008) and EORTC QLQ-BR23 arm symptoms (r = - 0.588, p = 0.006) scales. The Kinect sensor-based reachable workspace analysis system was effectively applied to assess upper extremity dysfunction in breast cancer patients. This system could potentially serve as a quick and simple outcome measure that provides quantitative data for breast cancer patients.

Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors

ContextSymptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied. ObjectivesThe objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time. MethodsWomen with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer–specific QOL) by group, controlling for covariates. ResultsNearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer–specific QOL at all time points (all P < 0.05). ConclusionNearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.

Home-based multidimensional survivorship programmes for breast cancer survivors.

Home-based multidimensional survivorship programmes for breast cancer survivors.

How does adjuvant chemotherapy affect menopausal symptoms, sexual function, and quality of life after breast cancer?

The aim of the study was to determine the association between adjuvant chemotherapy for breast cancer and menopausal symptoms, sexual function, and quality of life. Participants attended a menopause clinic with a dedicated service for cancer survivors at a large tertiary women's hospital. Information about breast cancer treatments including adjuvant chemotherapy was collected from medical records. Menopausal symptoms were recorded with the Greene Climacteric Scale and Functional Assessment of Cancer Therapy, Breast Cancer, and Endocrine Symptom Subscales. Sexual symptoms were recorded using Fallowfield's Sexual Activity Questionnaire. Quality of life was measured with Functional Assessment of Cancer Therapy scales. The severity of vasomotor, psychological, or sexual symptoms (apart from pain) did not differ between those who had received adjuvant chemotherapy (n = 339) and other breast cancer survivors (n = 465). After adjustment for current age, time since menopause, and current use of antiestrogen endocrine therapy, the risk of "severe pain" with sexual intercourse was twice as common after chemotherapy (31.6% vs 20.0%, odds ratio [OR] 2.18, 95% CI 1.25-3.79). Those treated with chemotherapy were more likely to report "severe problems" with physical well-being (OR 1.92, 95% CI 1.12-3.28) and lower breast cancer-specific quality of life (OR 1.89 95% CI 1.13-3.18), but did not differ in other quality of life measures. In this large study of breast cancer patients presenting to a specialty menopause clinic, previous chemotherapy was not associated with current vasomotor or psychological symptoms. Severe pain with intercourse was significantly more common in those treated with adjuvant chemotherapy.

Breast cancer specific quality of life in HR+/HER2- advanced/metastatic breast cancer patients in a real-world setting.

554Background: To assess patient reported breast cancer (BC) specific quality of life (QOL) in HR+/HER2- advanced or metastatic BC (ABC/MBC). Methods: Patients (N=2,352) were recruited into a cross-sectional survey from centers in 5 major EU countries and the US. BC specific QOL was reported by a subset of patients (n=739) using the Functional Assessment of Cancer Therapy Breast (FACT-B) tool, which includes the FACT General (FACT-G) (4 subscales assessing physical [PWB], social [SWB], emotional [EWB], and functional [FWB] wellbeing) and the BC specific subscale (BCS). Results are reported for the overall cohort, by therapy and sites of metastases. Significance was assessed using Mann-Whitney U and Kruskal-Wallis tests. Results: Patients’ mean (SD) age was 65.2 (10.6). Most patients (82.7%, n=611) had MBC, of which 31.9% had bone only metastases, 39.6% visceral only, 18.0% had bone + visceral, and 10.5% had other metastasis sites. Most patients received either endocrine or chemotherapy (46.3% and 48.6%), ...

Abstract C22: Study protocol: A randomized controlled trial of patient navigation to reduce cancer health disparities in Latina breast cancer survivors

Abstract Background: Breast cancer is the leading cancer among women of Hispanic origin. It is expected to continue to be the leading cancer as the US Hispanic population grows towards 31% of all US citizens by 2060. Hispanic women (Latinas) experience significant disparities in breast cancer services resulting in lower breast cancer survival rates than the general population after accounting for differences in age, cancer stage and other factors. Root- causes of disparities are multifactorial, including diagnostic and treatment delays, language, social, and financial barriers, and poor communication between patients and health care providers. Patient navigation (PN) is a potential intervention to address cancer disparities. We conducted “Staying Healthy,” a two-year, two-arm randomized controlled trial testing the effectiveness of a PN intervention to increase Latinas' access to cancer screening, diagnosis and care. Methods/Design: Staying Healthy is a Susan G. Komen for the Cure-sponsored randomized controlled trial (RCT) of PN targeting Latina breast cancer survivors (BCS). The goal is to develop a model of PN that will eliminate cancer care disparities in Latinas by addressing barriers to cancer care and promoting patient self-efficacy. The intervention uses trained navigators from the target community. Participants are randomly assigned to receive either usual PN services or intervention (PN+) services. In addition to usual participant-initiated PN services, PN+ participants receive tailored educational materials, regular personalized assistance including phone calls, meetings, and coordination of targeted care. Dependent measures include compliance with health care recommendations, screening practices and general and breast cancer-specific quality of life (QOL). Results: Baseline analyses have been performed on 120 enrolled participants. Results indicate 57% had Medicare or Medicaid insurance coverage; they average 57.3±9.5 years of age; 38% are Spanish monolingual, 58% US born, 47% are married or living together and 87% are parents. Additionally, more than three-fifths (61%) report an annual income below $25,000. They are 3.6±2.8 years post-diagnosis and 3.2±2.6 years post-primary treatment. Finally, study participants report general health-related (Functional Assessment of Cancer Therapy-General, FACT-G: 82±16.8) and breast cancer-specific QOL (FACT-B: 107±21.4). Lower levels of distress are significantly correlated with higher QOL measures after controlling for the effects of age, time since primary treatment, and acculturation. Discussion: Results show that levels of distress and QOL are inversely associated independently of other factors such as age, time since primary treatment and degree of acculturation. Interventions to reduce cancer health disparities may be an effective approach for patient navigation. Citation Format: Amelie G. Ramirez, Edgar Muñoz, Erika L. Stoerkel, Amanda Sintes-Yallen, Alan E.C. Holden. Study protocol: A randomized controlled trial of patient navigation to reduce cancer health disparities in Latina breast cancer survivors. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C22.

Discrimination and quality of life among breast cancer survivors.

250 Background: We examined the role of race/ethnicity, education, and medical discrimination on global and breast cancer-specific (BCS) quality of life (QoL). Methods: Telephone interviews were administered to 536 Asian, Black, Hispanic and White women identified through the Greater Bay Area Cancer Registry who were aged 20+ when diagnosed with a first invasive primary breast cancer between 2006 and 2009. Women reported perceptions of discriminatory experiences while receiving breast cancer care. QoL was assessed with a single item asking about global QoL over the past 4 weeks ( “excellent” vs “less than excellent”) and a summary score for the 6-item breast cancer subscale of the FACT-B (higher scores indicated more concerns (or worse QoL)). Race/ethnicity and education were combined into an 8-category variable (4 race/ethnic groups x 2 education groups). Psychometric analyses was used to create a summed medical discrimination score using 7 items that comprised a single factor, and split into tertiles to indicate no, low, and moderate/high levels of discrimination. Main effects for race/ethnicity x education and medical discrimination were identified using logistic and linear regression models. Adjusted analyses controlled for age, marital status, health insurance, stage, histology, and tumor size. Results: In adjusted analyses, disparities across combined race/ethnicity x education groups were observed for global QoL (Wald χ2(7) = 23.32, p &lt; 0.01) but not for BCS QoL (F= 0.78, p= 0.60). Black and Asian women reported lower global QoL than college-educated White women. Medical discrimination was related to global (Wald χ2(2) = 6.98, p= 0.03) and BCS QoL (F= 6.14, p&lt; 0.01). Women reporting moderate/high levels of medical discrimination had significantly lower odds of excellent QoL (OR= 0.416, p&lt; 0.01) and more breast cancer concerns (β= 1.19, t= 3.50, p&lt; 0.001) than women reporting no discrimination. Conclusions: Medical discrimination was associated with lower global and BCS QoL. More research is needed to identify specific factors at the individual, provider, and organizational levels that contribute to perceptions of medical discrimination so that they can be addressed and QoL can be improved for breast cancer patients.

Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection.

The aim of this study was to evaluate the effects of physical therapy (PT) combined with manual lymphatic drainage (MLD) on shoulder function, pain, lymphedema, visible cords, and quality of life (QOL) in breast cancer patients with axillary web syndrome (AWS). In this prospective, randomized trial, 41 breast cancer patients with visible and palpable cords on the arm and axilla and a numeric rating scale (NRS) pain score of >3 were randomly assigned to PT (3 times/week for 4 weeks; n = 20) and PT combined with MLD (5 times/week for 4 weeks; PTMLD; n = 21) groups. MLD was performed by a physical therapist and the patients themselves during week 1 and weeks 2-4, respectively. Arm volume, shoulder function (muscular strength; active range of motion; and disabilities of the arm, shoulder, and hand [DASH]); QOL (European Organization for Research and Treatment of Cancer Core and Breast Cancer-Specific QOL questionnaires), and pain (NRS) were assessed at baseline and after 4 weeks of treatment. QOL including functional and symptom aspects, shoulder flexor strength, DASH, and NRS scores were significantly improved in both groups after the 4-week intervention (P < 0.05). NRS score and arm volume were significantly lower in the PTMLD group than in the PT group (P < 0.05). Lymphedema was observed in the PT (n = 6), but not PTMLD, group (P < 0.05). PT improves shoulder function, pain, and QOL in breast cancer patients with AWS and combined with MLD decreases arm lymphedema.

Quality of Life in CAM and Non-CAM Users among Breast Cancer Patients during Chemotherapy in Malaysia.

BackgroundComplementary and alternative medicine (CAM) use has become increasingly popular among patients with cancer. The purposes of this study were to compare the QOL in CAM users and non-CAM users and to determine whether CAM use influences QOL among breast cancer patients during chemotherapy.MethodologyA cross-sectional survey was conducted at two outpatient chemotherapy centers. A total of 546 patients completed the questionnaires on CAM use. QOL was evaluated based on the European Organization for Research and Treatment of Cancer (EORTC) core quality of life (QLQ-C30) and breast cancer-specific quality of life (QLQ-BR23) questionnaires.ResultsA total of 70.7% of patients were identified as CAM users. There was no significant difference in global health status scores and in all five subscales of the QLQ C30 functional scales between CAM users and non-CAM users. On the QLQ-C30 symptom scales, CAM users (44.96±3.89) had significantly (p = 0.01) higher mean scores for financial difficulties than non-CAM users (36.29±4.81). On the QLQ-BR23 functional scales, CAM users reported significantly higher mean scores for sexual enjoyment (6.01±12.84 vs. 4.64±12.76, p = 0.04) than non-CAM users. On the QLQ-BR23 symptom scales, CAM users reported higher systemic therapy side effects (41.34±2.01 vs. 37.22±2.48, p = 0.04) and breast symptoms (15.76±2.13 vs. 11.08±2.62, p = 0.02) than non-CAM users. Multivariate logistic regression analysis indicated that the use of CAM modality was not significantly associated with higher global health status scores (p = 0.71).ConclusionWhile the findings indicated that there was no significant difference between users and non-users of CAM in terms of QOL, CAM may be used by health professionals as a surrogate to monitor patients with higher systemic therapy side effects and breast symptoms. Furthermore, given that CAM users reported higher financial burdens (which may have contributed to increased distress), patients should be encouraged to discuss the potential benefits and/or disadvantages of using CAM with their healthcare providers.