Group Of Breast Cancer Survivors Research Articles

Abstract PO2-12-03: Home-based Resistance Exercise Improves Fatigue and Functional Strength in Female Breast Cancer Survivors Post Chemotherapy

Abstract Introduction: Chemotherapy is associated with an increase in fatigue and loss of strength in female breast cancer (BCa) survivors. Strength training has been found to reverse these effects, however, the COVID pandemic added a complexity to clinic-based exercise intervention. The purpose of this study is to determine if a home-based resistance exercise program can attenuate these debilitating effects in a cohort of breast cancer survivors that have recently completed chemotherapy. Methods: Ten BCa survivors who completed chemotherapy within the previous 6 months were recruited to participate in a 12-week home-based resistance exercise proof of concept study. Exercise was performed 3 times per week, supervised via Zoom. Participants completed 2-3 sets of upper body and lower body exercises to volitional fatigue. Self-reported fatigue was measured using the respective subscale from the EORTC QLQ-C30. Strength was measured using hand grip dynamometry and isometric leg strength. Physical function was measured using the 6-minute walk test. Assessments were completed at baseline and end of study. As a comparison, age matched controls (AMCs) were recruited to complete cross-sectional analysis of each of these variables. A one-way analysis variance was done with Tukey’s post hoc test. Significance was set at p< 0.05. Results: BCa survivors were 46.4 ± 12.5 years old with a BMI of 28.11 ± 5.25. AMCs were 50.3 ±13.3 years old with a BMI of 30.8 ± 5.8. There was no significant difference in patient characteristics. A significant difference in self-reported fatigue was found between groups (F=18.52; p< 0.0001). Post hoc analysis found significant difference in fatigue between BCa survivors at baseline (48 ± 23) and the age matched controls (p< 0.0001). Exercise was able to significantly reduce fatigue in BCa survivors (21 ± 15; p=0.003) to levels not significantly different to AMCs (3.3 ± 7.5). A significant difference was also observed between groups for right-hand grip strength (F= 4.923; p=0.015) and left-hand grip strength (F=8.685, p=0.001). Post hoc analysis found a significant increase in right hand grip strength in the BCa survivor group following the intervention (p=0.012). Left hand grip strength was found to be significantly lower at baseline than AMCs (p=0.048). Left hand grip strength was significantly increased in BCa survivors at end of study (p< 0.001). Finally, a significant difference was observed between groups for isometric leg strength (F= 3.699; p=0.038). Post hoc analysis found a significant difference in leg strength in the BCa survivor group following intervention (pre: 105.9 ± 50.6 N-M; post: 158.4 ± 13.2 N-M; p=0.030) which was 16.5% higher than AMCs (127.4 ± 36.5 N-M). No significant difference was found in 6-minute walk distance. However, there was a 21% increase in the distance walked for BCa survivors after interventions (pre: 441.2 ± 66.5m; post: 501.4 ± 123m), identical to distances walked by AMCs (501.4 ± 90.8m). Conclusion: The results of our study suggest that a virtually supervised resistance exercise program can attenuate the negative effects of chemotherapy in BCa survivors to levels similar to their peers that never had breast cancer. Further research using powered sample sizes is needed to validate these results. Citation Format: Taylor Moncrief, Crisann Moon, Angela Gonzalez, Allison Stepanenko, Tiffany Cortes, Darpan Patel. Home-based Resistance Exercise Improves Fatigue and Functional Strength in Female Breast Cancer Survivors Post Chemotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-03.

Abstract 48: Identifying Temporal Patterns in Healthcare Service-Use Trajectories of Long-Term Breast Cancer Survivors

Abstract Purpose: Advances in the population screening programs and treatment efficacy, as well as, the rapidly aging global population, have led to a gradual increase of the number of long-term breast cancer survivors (BCS) in the past years. With the estimation for their survival rate to continue rising, it has become evident by the clinical and scientific community that BCS should be efficiently monitored in order to obtain a better understanding of their needs and subsequently, improve their medical care, further increase their survivorship and optimize the associated healthcare costs. Methods: A novel data-mining methodology is proposed for the temporal analysis of healthcare service-use trajectories of long-term BCS. Specifically, an unsupervised clustering technique, based on Dynamic Time Warping, is applied on the extracted trajectories of a large longitudinal cohort (SURBCAN) of BCS and non-breast cancer (BC) women, with data on their contacts to all healthcare services. Introducing the time dimension permits the identification of complex time-dependent patterns (clusters) of the services that these women have used throughout the course of a five-year monitoring period. A comparison of the identified time patterns and the respective patient characteristics is also performed between the BCS (case) and non-BC (control) group. Results: More than two hundred clusters representing temporal patterns of healthcare service use, were extracted for both the case and control group. It was found that the BCS group made a more complex and intense use of certain healthcare services, such as, radiology, outpatient care and hospital admission, than the control group. Furthermore, the corresponding mortality rates were significantly higher and a larger number of comorbidities (varying between different clusters) were registered at the beginning of the monitoring period in BCS. Additional patient characteristics and time information for certain paths of the extracted service-use network were reported and analyzed. Conclusion: A flexible data-mining methodology was applied on a longitudinal cohort of long-term BCS for the identification of temporal patterns of healthcare service use, in an attempt to gain more insight into their needs, better predict their evolution, and subsequently, improve their received attention and eventually optimize the associated healthcare costs. Citation Format: Alexia Giannoula, Mercè Comas, José Martín Solorzano Gonzalez, Ferrán Sanz, Xavier Castells, Maria Sala. Identifying Temporal Patterns in Healthcare Service-Use Trajectories of Long-Term Breast Cancer Survivors [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 48.

The Key Role of Emotional Repair and Emotional Clarity on Depression among Breast Cancer Survivors.

Breast cancer is the malignancy with the highest incidence in women worldwide. The empirical evidence is inconsistent with the prevalence of depression among breast cancer survivors (BCS), pointing to emotional competencies as protective factors against affective disorders. However, the mechanisms through which these competencies favor a more adaptive emotional state are unknown. Therefore, this study aims to explore the relationship between the experience of having survived the disease and depression levels in a group of BCS, and the mediating role of Perceived Emotional Intelligence (PEI) in this relation. This was a cross-sectional study with 237 women divided into two groups: 56 BCS and 181 healthy controls who completed the Trait Meta-Mood Scale 24 (TMMS-24) and the Hospital Anxiety and Depression Scale (HADS). Results showed that Survivorship and PEI explained and predicted 37.8% of the variance of depression, corresponding the 11.7% to the direct and/or the indirect effect of the PEI dimensions (Emotional Attention, Emotional Clarity, and Emotional Repair). In conclusion, interventions aimed at promoting an adequate PEI in this population—and in the Psycho-oncology field, in general—with a particular focus on the development of Emotional Clarity and Repair need to be implemented. Limitations and future research lines are discussed.

Comparison of Anthropometric Equations and Dual X-ray Absorptiometry to Determine Body Composition in Active Breast Cancer Survivors

Objective The purpose of this study was to 1) compare the body composition values of an active group of breast cancer survivors (BCS) determined by dual X-ray absorptiometry (DXA) and anthropometry, and 2) compare the bone mineral density of the upper thoracic region to assess the effect of tumor burden on bone health. Design and Methods Forty (n=40) breast cancer survivors from a local competitive Dragon Boat Team were measured as part of team assessments. ANOVA with Dunn’s post-hoc testing was used to compare results of DXA, body density, and body composition estimated from anthropometry. Bland-Altman testing and correlational analysis were calculated. Results Percentage of fat measure by DXA was significantly higher than values used to estimate body fat from skinfold measures or from body density equations (DXA 41.1±6.0% vs. 3-site skinfolds 28.8±4.9%, 4-site skinfolds, 22.1±4.1%, skinfold and body density, 31.8±9.4%, respectively, p<0.05). Post-hoc testing revealed that all values were significantly different and the strongest correlation with DXA was skinfolds at three sites was r=0.81. Regional (upper thoracic) bone mineral density was not significantly different based on tumor side diagnosis (breast cancer diagnosis side versus healthy, 0.971±0.198 vs. 0.988±0.190 gm*cc-1). Anthropometry and bilateral bone mineral density characteristics are presented to serve as a comparative sample of BCS for future studies. Conclusion As body composition is an important factor in long-term cancer survivorship, we found the use of skinfold measures inadequate to accurately determine percentage of fat in this group of active female BCS. As a result, recommendations aimed at achieving an ideal body composition based solely on anthropometry would have grossly underestimated fat mass, which may lead to overall clinically poorer outcomes.

Work productivity loss in breast cancer survivors and its effects on quality of life.

Return to work is an important process for many breast cancer survivors (BCSs) that acts as a positive step towards their reintegration into society. This study examined whether work productivity loss due to presenteeism could predict the quality of life (QOL) of employed BCSs. This study used a cross-sectional design. Seventy-five BCSs and seventy-five participants in the Non-Cancer Comparison (NCC) group were surveyed. The main outcome measures were productivity loss (as measured by the Work Limitations questionnaire) and quality of life (as measure by the European Organization for Research and Treatment Quality of Life questionnaire C30). Other measures included psychological distress (as measured by the Hospital Anxiety and Depression Scale) and cognitive limitation at work (as measured by the Cognitive Symptom Checklist). The BCS group had a lower summary score, a lower global health related score and greater work limitation in all domains than the NCC group. The productivity loss due to presenteeism of the BCS group was 8%. The multiple regression model shows that work productivity loss and level of job stress were the significant predictors of quality of life in the BCS group. These findings raise questions about the effects of level of job stress and work productivity loss on the QOL of BCSs. Longitudinal studies are needed to map these relationships.

Abstract PD12-08: Young, empowered & strong (YES): A web-based education and supportive care intervention for young women with breast cancer across the care continuum

Abstract Background: Young women diagnosed with breast cancer have unique physical and psycho-social needs that are often unaddressed. Patient-centered models of care, including eHealth strategies, can help empower young women to self-manage symptoms and psychosocial concerns, as well as support informational needs throughout the cancer care trajectory. Methods: YES (Young, Empowered and Strong) is an interactive web-based portal designed with patient-reported outcome questionnaires (PROs) that trigger delivery of young breast cancer patient-specific education and symptom management materials. Personal journal and messaging components are also available. We piloted the YES portal among young women (<45 years) with newly diagnosed early breast cancer (EBC), breast cancer survivors (BC-S) and women living with metastatic breast cancer (MBC), for whom PROs were deployed weekly (EBC, MBC) or every 4 weeks (BC-S) over 12-weeks. At study completion, the use, feasibility and acceptability of the YES portal was assessed via a survey and a structured interview. Results: Thirty women were enrolled between April and June 2019: 10 EBC, 10 BC-S and 10 MBC. Mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years respectively and 13% (4/30) were non-white. Nearly all participants were receiving treatment (96%, 27/28) including 54% (15/28), endocrine therapy and 43% (12/28), chemotherapy. Overall, 61% (180/296) of PROs deployed were completed, with completion rates highest for EBC patients (EBC: 70%, BC-S: 63%, MBC: 52%). Of 37 PROs domains, the most frequently triggered were sexual health (EBC: 90%, BC-S: 90%, MBC: 90%), anxiety (EBC: 80%, BC-S: 90%, MBC: 90%) and fatigue (EBC: 90%, BC-S: 80%, MBC: 90%). Physical domains and young breast cancer specific domains commonly addressed in clinic (i.e., fertility, genetic testing) were less frequently triggered. The post-pilot survey was answered by 15 participants: 8/15 reported the information shared through YES was helpful, 6/14 felt the portal helped monitor side effects and 8/14 felt the portal helped manage side-effects. Nineteen women completed post-pilot interviews: most women with EBC and MBC said the portal increased symptom awareness and complemented information communicated by providers; the BC-S group more frequently commented that features of the YES portal focusing on symptom monitoring/management would have been more useful when they were earlier in their care (newly diagnosed or undergoing more active treatment). Conclusions: YES, a novel eHealth intervention designed to support young women with breast cancer, is feasible and acceptable to young women across the breast cancer care continuum. The nearly universal triggering of information and support for sexual and mental health suggests sub-optimal management of these issues in the clinical setting and the potential role for self-management through an eHealth platform for this population. Future efforts will aim to evaluate whether provision of information through the YES portal reduces symptom burden and unaddressed needs and concerns in young women with breast cancer. Citation Format: Tal Sella, Craig Snow, Hannah Freeman, Phillip D Poorvu, Shoshana M Rosenberg, Ann H Partridge. Young, empowered & strong (YES): A web-based education and supportive care intervention for young women with breast cancer across the care continuum [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-08.

Comparison of Quality of Life in Breast Cancer Survivors with Lymphoma Survivors

Objectives: To compare the Quality of Life of Breast Cancer Survivors and Lymphoma Survivors post treatment.
 Methodology: A cross sectional study was performed in the departments of General Surgery and Oncology at Pakistan Institute of Medical Sciences Islamabad from 1st June to 31st December 2019. Patients who had received treatment for breast cancer and Lymphoma were included using non probability consecutive sampling technique. A standardized questionnaire (QOL-CSV) to assess quality of life in cancer survivors was filled in by the researchers after interviewing the patients and their responses were recorded with the demographic and clinical characteristics of each patient. The data was entered in SPSS version 20 and co-relations were obtained.
 Results: A total number of 50 lymphoma survivors (LS) and 166 breast cancer survivors (BCS) participated. Physical parameters revealed a better mean score of 75.86 ±10.53 for LS group than for BCS group (63.45 ±9.64). Psychological well being score was similar with a mean of 42.18 ±8.06 for LS and 43.04 ±7.04 for BCS group. Distress was dealt better by LS than BCS (50% scoring 41-50 in LS versus 46.6% scoring 31-40 in BCS). Fear of recurrence and spread was higher amongst BCS group (≤10 score in 46.4% participants). LS group performed worse in social factors (mean value of 26.88 ±6.67). Spiritual well being was markedly better in BCS (mean value 47.15 ±6.27).
 Conclusion: Considerable negative impact on physical, psychological and social well being of carcinoma survivors is noted, especially after mastectomy.
 Key words: Carcinoma, Lymphoma, Breast cancer

Posttraumatic growth in breast cancer survivors: Are depressive symptoms really negative predictors?

Breast cancer (BC) diagnosis is a potentially traumatic event, the related challenges of which can trigger positive or negative reactions. Posttraumatic growth (PTG) is defined as a positive psychological change experienced as a result of the struggle. The present study aimed to shed light on the relationship between the evolution of depressive symptoms over time and PTG in a group of BC survivors. Depressive symptoms at the time of diagnosis (T0) and 2 years later (T1) were evaluated to investigate their potential impact on the level of PTG at T1. A total of 147 BC patients were recruited and divided into 4 groups according to the changes in depressive symptoms they experienced over time (patients who were never depressed, no longer depressed, still depressed, and depressed now). A One-way analysis of variance was run to compare the levels of PTG for the four groups. The One-way analysis of variance showed that PTG score was significantly different among groups with different levels of depressive symptoms (p = .008). Post hoc comparisons indicated that the PTG score was statistically significantly higher in the no longer depressed group compared with the still depressed and depressed now groups. The current results suggest that high levels of depressive symptoms, displayed at the time of cancer diagnosis, can be considered catalysts for PTG at follow-up, on condition that women experience elevated depressive symptoms only in the first period of the disease. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise in survivors of breast cancer.

Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28-week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS.

Cognitive challenges while at work and work output in breast cancer survivors employed in a rapidly evolving economy.

To determine whether work output was related to cognitive limitations while at work in occupationally active breast cancer survivors (BCS) employed in a rapidly developing economy. Measures of demographics, job type, job stress, general distress (anxiety, depression), fatigue, work-related cognitive limitations, and work output were obtained using self-report measures in a cross-sectional study in both BCS and controls (n = 267/group). Groups had similar educational backgrounds, job types, and levels of job stress. The BCS group was a median of 3.2years post-primary treatment, slightly older, more likely to be divorced, have children, and was more likely working part-time. The BCS group reported higher levels of fatigue, general distress, and lower levels of work output (p < .05). A multivariate regression adjusting for group differences indicated that cognitive symptoms at work were related to lower levels of quantity, quality, and timeliness of completed work in the BCS group (adj. R2 = .57, unstandardized coefficient = 1.062, 95% CI = .436 to 1.689). When reported in the context of work, cognitive limitations were associated with lower levels of reported work output exclusively in the BCS group. This study provides further evidence that cognitive limitations reported in the context of work in a developing country is similar to that of BCS working in more developed economies and is specific to BCS and not healthy workers with similar job types and job stress. Solutions to this problem may be applicable across countries.

Development of the Cancer Survivor Profile-Breast Cancer (CSPro-BC) app: patient and nurse perspectives on a new navigation tool.

Despite advancements in care, cancer survivors continue to report unmet needs following active cancer treatment. The Cancer Survivor Profile-Breast Cancer (CSPro-BC) application (app) was developed to help address these needs, using breast cancer survivors (BCS) as a pilot group. This paper describes the app development, BCS and nurse perceptions of the app, and changes made based on this feedback. The CSPro-BC app was developed for use on an iPad and includes (1) administration of a 15-20-min survey assessing 18 needs, (2) generation of a profile of needs, relative to a reference group of BCS (median 2years post-treatment), and (3) provision of problem-specific online resources. Perceptions of the app were evaluated using both quantitative and qualitative approaches. Feedback was elicited from nurse navigators and BCS. BCS were recruited until the point of saturation. BCS (N = 11) were middle-aged and a median of 2.4months post active treatment. Structured questionnaires indicated the following: survey covered meaningful problem areas, profile display was clear, and nurse's involvement was helpful. Follow-up interviews (2weeks later) revealed that BCS shared their profile with others, but most BCS did not use the resources and those who did thought there were too many. Nurses (N = 3) said the app increased appointment time, but prompted them to discuss areas often not covered in typical BCS follow-up. Feedback by end users directly informed revision of the app. The CSPro-BC app has been optimized based on BCS feedback.

Correspondence between Subjective and Objective Cognitive Functioning Following Chemotherapy for Breast Cancer

This study examined subjective and objective cognitive functioning in 26 female breast cancer survivors (BCS) who received chemotherapy treatment that finished .5 to 5 years prior to testing and compared their results to 25 demographically matched women with no history of cancer. Participants were assessed on prospective memory (PM) tasks; neuropsychological tests of processing speed, attentional flexibility with greater cognitive load, executive function, and verbal memory; self-report measures of cognitive dysfunction and PM failures; and distress. The BCS group showed significantly slower speed of processing and reduced attentional flexibility, and reported significantly more cognitive complaints and PM failures than the control group on five of six self-report measures. The groups did not differ on other PM or neuropsychological measures or on a measure of distress. Subjective cognition correlated with some neuropsychological tests and with a virtual reality PM task. Objective cognitive impairments were associated with reduced quality of life in the BCS group. The results provide some evidence of both self-reported impairment and objective cognitive dysfunction following chemotherapy treatment.

Cognitive Limitations at Work Among Employed Breast Cancer Survivors in China.

This study aimed to determine whether levels of distress (anxiety and depression) and cognitive symptoms at work are related to work productivity and quality of life (QOL) in Chinese breast cancer survivors (BCS), compared to a group of Chinese women without cancer but with different musculoskeletal pain related to work. This study used a cross-sectional study design. Working BCS were recruited in a tumor hospital's outpatient department, and women with no history of cancer (noncancer comparison [NCC] group) were recruited from a rehabilitation center. A total of 412 participants were included. Multiple regression analyses indicated that higher anxiety was associated with work limitations (B = .005, p = .014) and QOL (B = 2.417, p = .004) in the BCS group only. Cognitive limitations at work were associated with work limitations (B = .002, p = .001) and QOL (B = 1.022, p = .003) in the BCS group only. Depressive symptoms (B = .028, p = .017) were significantly associated with work limitations in the NCC group. Breast cancer survivors reported higher levels of cognitive limitations at work and anxiety, lower levels of work productivity, and QOL. When remaining at work is a viable option for the cancer survivor with cognitive limitations at work, the rehabilitation nurse should consider approaches to best accommodate the specific cognitive limitations and work tasks, as well as help the patient manage associated anxiety when present.

Diet quality of Australian breast cancer survivors: a cross‐sectional analysis from the Australian Longitudinal Study on Women's Health

Evidence supports strong associations between healthful eating patterns and maintaining a healthy weight with favourable health outcomes for breast cancer survivors (BCS). The present study aimed to evaluate the diet quality of Australian BCS and to determine whether diet quality differed between BCS and age-matched healthy controls (HC) or by geographical location. This cross-sectional study included 281 BCS and 4069 HC from the Australian Longitudinal Study on Women's Health mid-aged cohort completing Survey 3 in 2001. Data from the Dietary Questionnaire for Epidemiological Studies food frequency questionnaire were used to calculate the Australian Recommended Food Score (ARFS), a validated summary estimate of diet quality based on adherence to the Australian dietary guidelines. The mean (SD) ARFS of the BCS group was 33.2(9.4) out of a maximum of 74. Mean (SD) total ARFS and component scores of BCS did not differ from the HC group [32.9(8.7)] and no differences were found in ARFS between urban and rural BCS. This is the first study dedicated exclusively to describing the diet quality of Australian BCS. Although no difference was found when comparisons were made with a HC group, there is considerable room for improvement in the diet quality of Australian BCS. Given research suggesting higher risk of chronic conditions such as obesity amongst BCS, and the recognition of optimising diet quality as a key factor in health promotion for all population groups, data from the present study suggest the need for research targeting the feasibility and impact of improving diet quality of Australian BCS.

Bupropion for Control of Hot Flashes in Breast Cancer Survivors: A Prospective, Double-Blind, Randomized, Crossover, Pilot Phase II Trial

ContextHot flashes (HFs) and sexual dysfunction often affect breast cancer (BC) survivors and compromise their quality of life. Bupropion is an antidepressive medication used for smoking cessation and also has been previously studied for the treatment of sexual dysfunction. ObjectivesWe aimed to evaluate bupropion's efficacy in controlling HFs in BC survivors. MethodsThis was a randomized, double-blind, crossover, placebo-controlled pilot study that enrolled 55 BC survivors who reported more than seven HFs per week. Subjects were randomized to receive either bupropion 150mg twice daily for four weeks followed by one week of washout and four more weeks of placebo twice daily or vice versa. The primary end point was average daily HF activity (number of HFs and a score combining number and severity) reported while on bupropion or on placebo. Secondary end points were sexual dysfunction, depression, and quality of life evaluated with the Arizona Sexual Experience Scale, Beck Depression Inventory, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, respectively. ResultsBupropion reduced HFs by 1.26 per day and the HF score by 6.31%, whereas placebo reduced HFs by 2.11 per day (P>0.05) and the HF score by 30.47% (P>0.05). There were no statistically significant differences between bupropion and placebo in the Arizona Sexual Experience Scale, Beck Depression Inventory, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. At the end of the study, 47% of the patients preferred bupropion, whereas 53% preferred placebo. There were no statistically significant differences in side effects between the study groups. ConclusionCompared with placebo, bupropion did not control HFs in this group of BC survivors.

Measures of Cognitive Function and Work in Occupationally Active Breast Cancer Survivors

This study investigated performance-based and patient-reported cognitive limitations on work output. Working breast cancer survivors (BCS) (n = 122) and a non-cancer comparison group (NCCG; n = 113) completed measures of cognitive function, fatigue, distress, job stress, and work output. Distress, fatigue, and job stress were higher in the BCS group who were on average 3-years post-treatment. Patient-reported cognitive limitations at work were related to work output in BCS (memory beta = 0.29; executive function beta = 0.26) only. Changes in work output were more responsive to changes in job stress and fatigue in the BCS group. Reports of cognitive problems at work should be carefully followed up.

Health behaviors in breast cancer survivors experiencing bone loss

To describe the baseline healthy lifestyle behaviors (dietary, calcium, vitamin D, caffeine and alcohol intake, smoking history, and physical activity) of postmenopausal breast cancer survivors (BCS); and to identify any relationship of healthy lifestyle behaviors with bone mineral density (BMD) at the forearm, total hip and spine, L1-L4. Self-reported responses to a demographic and health status questionnaire, to a 3-day Diet Record, and to the 7-Day Physical Activity Questionnaire-Adapted provided data for the lifestyle behaviors. Baseline BMD (g/cm(2)) was determined with dual-energy x-ray absorptiometry (DEXA). Height, weight, and body mass index (BMI) were also measured in each of the 249 postmenopausal BCS. There was an imbalance between consumed kilocalories and expenditure of energy. The majority of BCS were overweight or obese. They consumed less fruit and vegetable servings than recommended by the new 2005 U.S. Department of Agriculture's dietary guidelines, less dairy products, below average recommended grains and fiber, less protein and carbohydrate intake, and a slightly higher fat gram intake. Approximately, 43% did not take any supplemental calcium, with 46% taking less than 1000 mg a day. Likewise, 52.59% consumed less than 400 IU of vitamin D with both supplemental and dietary intake. This group of BCS consumed below accepted levels of caffeine and alcohol. Only 18 BCS continued to smoke. This group spent an average of 10.36 h in light (sedentary) activities on a daily basis. There were significant negative relationships with bone mass (g/cm(2)) at the total hip and daily intake of caffeine/mg and daily grams of alcohol. Weight and BMI both demonstrated a significant relationship with bone mass (g/cm(2)) at the total hip, spine L1-L4, and the forearm. The healthcare provider must incorporate appropriate teaching strategies, intensive counseling, and coaching, along with a support mechanism, to enable BCS to understand the importance of a healthy diet, calcium, and vitamin D supplement, and a regular strength/weight program that will be integrated into their daily lifestyle. Early DEXA screens should be part of the protocol with BCS, and there is a particular need for forearm DEXA screens to be included in the treatment protocol for BCS.