Undergoing Radiotherapy For Breast Cancer Research Articles

Autonomic function measurements for evaluating fatigue and quality of life in patients with breast cancer undergoing radiation therapy: a prospective longitudinal study

BackgroundFatigue during radiation therapy in women with breast cancer can decrease quality of life (QOL), yet it is often underestimated and needs to be evaluated objectively. This longitudinal study aimed to evaluate fatigue and QOL of women with breast cancer undergoing radiotherapy with a simple autonomic function measurement.MethodsWomen with breast cancer who underwent postoperative radiotherapy in eight cancer care hospitals in Chubu and Kinki regions in Japan were recruited between October 2021 and June 2022. The women underwent a self-administered questionnaire that included the Cancer Fatigue Scale (CFS) and the Short Form-8 Health Survey (SF-8) and an autonomic nervous function measurement using a simple, non-invasive device before (T0, baseline), mid (T1), and at the end (T2) of treatment.ResultsThe 57 women showed similar trends, with CFS scores and log LF/HF ratio being the highest at T0 and significantly decreasing at T1 (both p < 0.05). The log LF/HF trends differed between those with high and low baseline log LF/HF values. Women with mental component summary (MCS) score improvement (T0 to T2) had the highest log LF/HF ratio at T0 and had significantly lower log LF/HF values at T1 and T2 than at T0 (p < 0.01 and p < 0.05, respectively). The change of (⊿) MCS from T0 to T1 was negatively correlated with ⊿log LF/HF from T0 to T1 (r = − 0.36, p < 0.01).ConclusionsMeasurement of autonomic nerve function with a simple device is useful for objective fatigue assessment during radiotherapy. Psychological support is important as improvement in mental health helps improve autonomic nerve function and, in turn, fatigue.

A Phase II, Randomized, Double Blind, Placebo Controlled Study of the Safety and Efficacy of a Caffeine-Based Antifibrosis Cream in Patients with Breast Cancer Undergoing Radiation Therapy

Radiation induced fibrosis (RIF) is a common long term adverse event in patients undergoing post-mastectomy radiation therapy (PMRT) which can cause capsular contracture, implant loss, and reconstruction complications in women with implant-based breast reconstruction. At a molecular level, adenosine is a driver of RIF. Preclinical data have shown that pharmacologic blockade of the adenosine A2A Receptor (A2AR) in mice as well as an A2AR knockout mouse model prevented skin fibrosis associated with radiation injury. Caffeine is an A2AR antagonist which has been shown to block the development of hepatic fibrosis in liver disease patients. We present a phase II placebo controlled clinical trial to evaluate whether a caffeine-based cream can prevent RIF and thus reduce the rates of reconstructive complications in patients with tissue expander-based reconstruction requiring PMRT. Women ≥ 18 years old with breast carcinoma stage 0-III status post mastectomy with tissue expander-based reconstruction who require PMRT to the chest wall +/- the regional nodes are being enrolled. The target accrual is 60 patients. Boost field to the chest wall, scar and/or nodal region is allowed. Patients with inflammatory breast cancer or those requiring skin bolus are excluded. Prior to starting radiation, patients will be randomized to placebo vs. caffeine cream and they will be instructed to apply the cream twice a day starting on the first day of radiation treatment and continuing daily for the duration of radiation until the removal of tissue expanders. The primary study endpoint is reconstructive complications requiring rehospitalization or reoperation by 2 years post radiation including reconstructive failure with or without reconstruction. A safety endpoint of grade ≥ 2 acute radiation dermatitis will also serve as a co-primary endpoint. Secondary endpoints are wound infection/cellulitis, hematoma, seroma, threatened exposure, wound dehiscence, implant leakage, rupture, and or deflation, and capsular contracture that do not meet criteria for the primary endpoint. Clinician rated cosmesis, local recurrence, regional recurrence, distant metastasis and survival up to 4 years are additional secondary endpoints. Exploratory endpoint includes the use of shear wave elastography (SWE) as a potential tool to quantitatively measure post irradiation fibrosis. Correlative aims include assessing epidermal thickness and fat layer thickness from tissue obtained at time of implant exchange for association with the development of fibrosis. The primary efficacy endpoint will be estimated using Kaplan Meier methods from date of randomization. Treatment comparisons will be based on a 2-sided log rank chi-square test and the hazard ratio will be estimated with 95% confidence intervals. The study started accruing in 12/2019 and is estimated to end by 04/2024. As of January 2023, 67% (40/60 patients) of the planned patients have been enrolled. To be determined. To be determined.

An Investigation of the Effect of Virtual Reality on Alleviating Anxiety in Patients With Breast Cancer Undergoing Radiation Therapy: A Randomized Controlled Trial

The aim of this study was to evaluate the anxiety-reducing effects of virtual reality (VR) on patients with breast cancer undergoing adjuvant radiation therapy (RT). This randomized controlled trial was conducted among patients with breast cancer receiving RT at a single institution. Of 196 enrolled and randomized patients, 97 were assigned to a VR explanation group (intervention) and 99 were assigned to the standard-of-care group (control). Anxiety levels were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) as the primary endpoint and the State-Trait Anxiety Inventory (STAI) and Linear Analogue Scale Assessment (LASA) as secondary endpoints. Knowledge of the RT procedure, patient satisfaction, and time spent for counseling were also assessed. Intervention significantly reduced patient anxiety immediately, not only on the primary endpoint, APAIS, but also on the STAI and LASA anxiety scales. Specifically, in the intervention group, there were immediate reductions of 26.0%, 16.1%, and 55.8% for APAIS, STAI, and LASA, respectively, whereas in the control group, the respective reductions were 8.1%, 8.5%, and 13.7%. Among the 3 anxiety scales, long-term anxiety reduction was observed only when anxiety was measured by LASA. Subgroup analyses showed that the effect on anxiety did not differ based on the physician, baseline anxiety level, use of hormone therapy, or health literacy. The intervention also significantly improved knowledge of the RT procedure (81.9/100 vs 76.8/100; P=.006) and patient satisfaction with the explanation manner (6.56 vs 5.72; P < .001) compared with the control group. Immersive VR applied to the current procedure reduces anxiety during RT planning for patients with breast cancer. Further research is necessary to investigate the long-term effects of VR on anxiety.

Gated radiation therapy for patients with breast cancer to reduce the dose to the lung and heart: A comparative cross-sectional study

ABSTRACT JOURNAL/crsat/04.03/02201859-202306020-00005/figure1/v/2023-08-03T140821Z/r/image-tiff Background: Deep inspiratory breath hold (DIBH) is an established technique to treat left breast cancer with fewer side-effects to the surrounding organs at risk (OARs). However, studies assessing DIBH in resource-poor settings, especially in a government setup, are scarce. Objectives: Our primary objective was to assess and compare the dosimetric changes in the DIBH technique compared to the free breathing technique among patients with left-sided breast cancer undergoing radiation therapy. Materials and Methods: This was a comparative cross-sectional study conducted in the Department of Radiation Oncology, Kidwai Memorial Institute of Oncology (Bengaluru, India), over a period of 24 months. A total of 65 patients were treated with the three-dimensional conformal radiation therapy (3D-CRT) technique either using DIBH or free breathing as per the standard protocol. The dosimetric comparisons for the surrounding OARs, in terms of mean percentage volume receiving 15 Gy (V15Gy) and 20 Gy (V20Gy) in the left lung, V25Gy, V30Gy, V5Gy in the heart the mean dose in Gy received by 25% (V25%) and 40% (V40%) of the heart, V10% and V30% of the left anterior descending artery (LAD) and mean values of Dmean dose (Gy) received by the left lung, heart, and LAD artery were compared between both the techniques. Results: Among 65 patients, 25 (38.4%) were treated by the free breathing technique and 40 (61.6%) by DIBH. Various dosimetric parameters that were significantly lower in the DIBH compared to free breathing techniques included the mean percentage volume of left lung receiving 20 Gy (V20 Gy) (29.5% vs. 23.5%), heart receiving 25 Gy (V25Gy) (6.7% vs. 2.9%) and 30 Gy (12.8% vs. 2.0%), mean values of Dmean received by the heart (7.8 Gy vs. 4.5 Gy) and LAD artery (31.3 Gy vs. 16.9 Gy), mean dose received by 10% volume of LAD (V10%) (36.3 Gy vs. 29.0 Gy) and 30% of LAD artery (V30%) (34.3 Gy vs. 22.2 Gy) (P &lt; 0.001). Conclusion: DIBH significantly decreases the radiation dose delivered to the heart, left lung, and LAD artery. Thus, in patients with left-sided breast cancer, DIBH leads to a lower radiation dose to the OARs, leading to potentially less side-effects.

Patient-reported outcomes for patients with breast cancer undergoing radiotherapy: A single-center registry experience.

BackgroundWe present Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) for patients undergoing adjuvant radiotherapy for breast cancer with curative intent. We describe the frequency and severity of PRO-CTCAE and analyze them with respect to dose fractionation.MethodsPatients were included in this study if they were treated with curative intent for breast cancer and enrolled on a prospective registry. Patients must have completed at least one baseline and one post-radiation survey that addressed PRO-CTCAE. For univariate and multivariate analysis, categorical variables were analyzed by Fisher’s exact test and continuous variables by Wilcoxon rank sum test. PRO-CTCAE items graded ≥2 and ≥3 were analyzed between patients who received hypofractionation (HF) versus standard conventional fractionation (CF) therapy by the Chi-square test.ResultsThree hundred thirty-one patients met inclusion criteria. Pathologic tumor stage was T1–T2 in 309 (94%) patients. Eighty-seven (29%) patients were node positive. Two hundred forty-seven patients (75%) experienced any PRO-CTCAE grade ≥2, and 92 (28%) patients experienced any PRO-CTCAE grade ≥3. CF was found to be associated with an increased risk of grade ≥3 skin toxicity, swallowing, and nausea (all p < 0.01). HF (OR 0.48, p < 0.01) was significant in the multivariate model for decreased risk of any occurrence of PRO-CTCAE ≥3.ConclusionsOur study reports one of the first clinical experiences utilizing multiple PRO-CTCAE items for patients with breast cancer undergoing radiation therapy with curative intent. Compared with CF, HF was associated with a significant decrease in any PRO-CTCAE ≥3 after multivariate analysis.

A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study.

BackgroundMobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care.ObjectiveThe aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy.MethodsThe evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material.ResultsAfter the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%.ConclusionsThe mobile app titled “AMOR Mama” was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use.

Comparative analysis of dose distribution to critical organs in radiation therapy of left breast cancer with respiratory synchronization

Relevance: Breast cancer is one of the most common oncological diseases. Today, it leads among female cancers. Patients with left breast cancer undergoing radiation therapy have a considerable risk of developing cardiovascular diseases caused by ionizing radiation. Various methods are introduced to reduce the radiation load to critical organs to ensure compliance with the main radiation therapy principle. One of these methods is radiation therapy with synchronized breathing, including deep inspiration breath-hold (DIBH). DIBH can significantly reduce the dose load to the heart and the left lung.&#x0D; The study aimed to compare the radiation load to the heart and the left lung during radiation therapy for left breast cancer with free breathing and respiratory synchronization.&#x0D; Results: During radiation therapy with synchronized breathing, the average radiation load to the heart is 1.7 times lower and to the left lung – 1.26 times lower compared to radiation therapy with free breathing.&#x0D; Conclusion: The study results confirm that respiratory synchronization in radiation therapy for left breast cancer reduces the dose to the heart and the left lung.

Evaluation of Sleep Disturbance and Mood Status of Breast Cancer Patients Undergoing Radiotherapy

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths among women. Radiation therapy plays a significant role in the treatment of patients with breast cancer as it reduces the relative risk of recurrence. Sleep and mood disorder have been widely reported in female patients during the treatment. The purpose of this research is to evaluate patients’ mood and its relation to their sleep quality during radiation therapy. The analysis was carried out on 100 female patients with breast cancer undergoing radiation therapy, and the control group consisted of 100 women attending medical imaging in Tehran. Participants’ mood situation was evaluated by POMS questionnaire, and their sleep status was checked through standard questionnaires specified for analyzing sleepiness, sleep quality and insomnia severity. Study results demonstrated higher overall score for mood in breast cancer patients in comparison with woman without cancer, which means worse mood status among them. (The mean score of the mood was 51.4 ± 29.25 and 39.52 ± 42.31 for cancer patients and healthy women, respectively). Furthermore, there was a significant correlation between some mood subcategories such as vigor, fatigue with sleeping quality and insomnia severity. Also, the “independent T" test result showed a significant difference in the sleep quality of the two groups (p = 0.008). Low mood status and sleep disorders are common problems in women with breast cancer, and paying attention to their mental health as well as routine cancer treatments may significantly improve patients’ quality of life and their mood and sleep quality.

Rapid Adaptation of Breast Radiation Therapy Use During the Coronavirus Disease 2019 Pandemic at a Large Academic Cancer Center in Canada

PurposeMitigation strategies to balance the risk of coronavirus disease 2019 (COVID-19) infection against oncologic risk in patients with breast cancer undergoing radiation therapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiation therapy by oncologic risk and omission or deferral of radiation therapy for lower risk cases. Timely adoption of these measures reduces COVID-19 risk to both patients and health care workers and preserves resources. Herein, we present our early response and adaptation of breast radiation therapy utilization during the COVID-19 pandemic at a large academic cancer center in Canada. Methods and MaterialsA state of emergency was announced in Ontario on March 17, 2020, owing to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast radiation therapy starts, type of breast radiation therapy, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019. ResultsAfter the declaration of emergency in Ontario, there was a decrease of 39% in radiation therapy starts in 2020 compared with 2019 (79 vs 129, P < .001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared with 2019 (46% vs 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiation therapy were aged >50 years in 2020, 66% (78 of 118) versus 83% (132 of 160) in 2019, P = .0027. ConclusionsA significant reduction in breast radiation therapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiation therapy to patients associated with higher oncologic risk requiring RNI. A quick response to a health care crisis is critical and is of particular importance for higher volume cancer sites where the potential effect on resources is greater.

Delays in Care for Non-English Speaking Patients with Breast Cancer Undergoing Radiation Therapy

Language discrepancies create barriers to healthcare that may impact a patient’s course of care including delays in diagnosis, biopsy, resection, and radiation treatment. The aim of this study was to determine if non-English speakers (NES) experience treatment delays within their path to radiation treatment compared to English-speaking patients. NES patients diagnosed with breast cancer and treated with radiation between 2016 and 2017 (n=67) were matched with English-speaking patients based on sex, age, cancer stage, and chemotherapy (neoadjuvant or adjuvant). A total of 27 NES were matched to 40 English speakers; 13 NES were matched to 2 English-speakers and 14 NES were matched to one English speaker. Conditional logistic regression on matched data was used to compare time between diagnostic mammogram and biopsy, resection, Radiation Oncology consult, and start of radiation treatment. We also evaluated the time from resection to Radiation Oncology consult, resection to start of radiation treatment, and Radiation Oncology consult to start of radiation treatment. The time from diagnostic mammogram to diagnostic biopsy was significantly longer for NES compared to English-speaking patients (p= 0.0322), with an average difference of 25 days and an odds ratio of 1.043, 95%CI [1.003, 1.102]. A one-week increase in time to biopsy increased the odds of a patient being NES by 34% (p=0.0322). Although not statistically significant, similar time delay trends were observed between NES and English-speaking patients for time from diagnostic mammogram to resection (p=0.0703), diagnostic mammogram to Radiation Oncology Consult (p=0.0702), and diagnostic mammogram to start of radiation treatment (p=0.0848). We did not observe a difference in time from resection to new visit (p=0.2197) or resection to start of treatment (p=.2004). Independent of sex, age, race/ethnicity, and receipt of chemotherapy, language predicted delays in care for patients undergoing treatment for breast cancer. The most pronounced delay in care for NES was the time from diagnostic mammogram to diagnostic biopsy. However, notable trends were observed as NES patients progressed to resection, Radiation Oncology consult, and the start of radiation treatment. Additional analyses are underway for a larger matched cohort to build on these findings. These results provide preliminary data to help guide future interventions for improving healthcare delivery for Non-English speaking patients.

Radiation Dermatitis: A Prevention Protocol for Patients With Breast Cancer.

Patients with breast cancer undergoing radiation therapy can experience dermatologic adverse events. Oncology nurses can advocate for radiation dermatitis (RD) prophylaxis to minimize dermatologic adverse events. This quality improvement project was conducted to evaluate the effect of implementing an RD prevention protocol. The objectives of this study were to (a) improve clinicians' knowledge of screening, assessment, and prevention of RD in patients with breast cancer and (b) decrease the incidence of RD by 10% at a tertiary care cancer center. Center-wide standards of care were created and implemented. A retrospective chart analysis was performed before and after protocol implementation. An education session was used to analyze protocol effectiveness. Surveys completed by nurses (N = 11) before and after the education session demonstrated a significant increase in overall confidence in assessing RD. Statistically significant increases were noted in using topical steroids for prophylaxis.

Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction.

BackgroundThe use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction.MethodsImmediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes.ResultsThere was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P<0.01). There was no significant difference in the short- and long-term aesthetic results between the groups.ConclusionsWhen performing immediate autologous breast reconstruction, 14% volume overcorrection is recommended for patients in whom adjuvant radiation therapy is anticipated to improve aesthetic outcomes.

Randomized Clinical Trial of a Progressive Exercise Program for Young Women With Breast Cancer Undergoing Radiation Therapy

Randomized Clinical Trial of a Progressive Exercise Program for Young Women With Breast Cancer Undergoing Radiation Therapy

Factors influencing fatigue in breast cancer patients undergoing breast irradiation.

96 Background: We are conducting an exploratory, prospective study to investigate factors associated with radiation-induced fatigue in women with early breast cancer undergoing radiation therapy (RT) for breast conservation. Our hypothesis is that fatigue associated with adjuvant RT is related to tissue damage by apoptosis and inflammation, and to baseline psychological profiles. Methods: All subjects were assessed immediately before RT (T1), mid-point of RT (T2), end of RT (T3), 6 months (T4) and 1 year (T5) after completing RT. Clinical evaluations of skin toxicity, laboratory measures, fatigue, distress, depression, anxiety, sleep, energy and pain were assessed using validated measures. Results: Thirty-one subjects (target 50) have been enrolled to date; 23 have completed T3 and are presented here. 35% had a history of depression and 17% are currently depressed; 22% had past and current anxiety. BCTOS breast pain, tenderness and sensitivity increased during RT and were consistent with functional pain scores. No clinically relevant changes in energy or distress were seen. Despite a notable prevalence of depression and anxiety at baseline, there were no relevant changes in depression or anxiety. Most IL-1β, IL-4, IL-6 and IL-10 levels were undetectable. 39% of subjects showed increases in fatigue and were 14 years younger than non-fatigued subjects. Fatigued subjects had more frequent past (44%) and current (33%) depression than non-fatigued subjects (29% and 7%, respectively), and woke up tired more frequently (44% versus 0%). Current depression, but not fatigue, was associated with decreased a.m. cortisol levels during RT. 56% of fatigued subjects had an RTOG Acute Skin Toxicity score &gt; 1 and 78% had BCTOS breast-specific pain subscales scores ≥ 3 during RT vs. 21% and 14% of non-fatigued subjects, respectively. Serum caspase-1 (inflammation) and caspase-3 (apoptosis), hs-CRP and TNF-α were increased but not associated with fatigue. Conclusions: Our preliminary findings suggest that radiation-associated fatigue is complex and, as hypothesized, is dependent on a patient’s psychological profile in the setting of skin toxicity and insomnia. If this data holds at study completion, it may guide clinical interventions.

Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer.

This study examined the effects of yoga on quality of life (QOL) and psychosocial outcomes in women with breast cancer undergoing radiotherapy. Sixty-one women were randomly assigned to either a yoga or a wait-list group. Yoga classes were taught biweekly during the 6 weeks of radiotherapy. Participants completed measures of QOL, fatigue, benefit finding (finding meaning in the cancer experience), intrusive thoughts, sleep disturbances, depressive symptoms, and anxiety before radiotherapy and then again 1 week, 1 month, and 3 months after the end of radiotherapy. General linear model analyses revealed that compared to the control group, the yoga group reported significantly better general health perception (p = .005) and physical functioning scores (p = .04) 1 week postradiotherapy; higher levels of intrusive thoughts 1 month postradiotherapy (p = .01); and greater benefit finding 3 months postradiotherapy (p = .01). There were no other group differences in other QOL subscales for fatigue, depression, or sleep scores. Exploratory analyses indicated that intrusive thoughts 1 month after radiotherapy were significantly positively correlated with benefit finding 3 months after radiotherapy (r = .36, p = .011). Our results indicated that the yoga program was associated with statistically and clinically significant improvements in aspects of QOL.

Abstract OT2-1-01: A personalized approach to understanding the development of radiation-induced fatigue

Abstract Background Fatigue, a common complication of radiation therapy, can impact patients’ quality of life and ability to engage in their cancer treatments. The pathogenesis of radiation-induced fatigue is unclear. This lack of clear understanding has hindered the development of treatment strategies to overcome this morbidity. The purpose of our exploratory, non-randomized, prospective study is to investigate the factors associated with development of radiation-induced fatigue in women with early breast cancer. Our study is based on the hypotheses that adjuvant radiation therapy given to women with breast cancer for local disease control causes tissue damage by apoptosis and inflammation. This leads to increased levels of inflammatory cytokines and biomarkers of apoptosis. This inflammatory cascade differentially induces fatigue in patients depending on their baseline psychological profile. Trial design Existing patient flow in the radiation oncology division will be utilized to screen eligible subjects. All subjects will assessed at five different time points, beginning immediately before radiation therapy through 1 year after completion of therapy. Detailed clinical evaluation of skin toxicity (RTOG acute toxicity criteria) and laboratory parameters assessing anemia, cardiac and hepatic toxicity will be performed. Comprehensive psychological assessment will be done using questionnaires for fatigue, distress, depression, sleep, quality of life and pain. Buccal mucosa swabs will be obtained for genetic analysis in future studies. Selection criteria Inclusion: Women with breast cancer undergoing radiation therapy for breast conservation Exclusion: Prior non-breast malignancy with active treatment (radiation or chemotherapy) within 1 year of enrolment on the study Specific aims 1. To measure the severity of radiation-induced tissue damage 2. To measure circulating markers of apoptosis (caspase 3 p17) and inflammation 3. To establish a baseline psychological profile for each subject prior to start of radiation and determine temporal changes during the course of radiation therapy. 4. To determine the correlation between goals 1, 2 and 3. 5. To propose interventions for reducing radiation-induced fatigue which will be evaluated in a future study. Statistical methods The association between fatigue and severity of tissue toxicity (Yes vs. No) will be assessed using chi-square tests (eg, row mean score test). ANOVA will be used to compare mean visual analogue scales (VAS) and psychological questionnaire scores across the levels of the tissue toxicity scale. Mean log cytokine levels will be compared across levels of the dermatitis scale using ANOVA. The association between cytokines and fatigue will be assessed using correlation (eg, VAS) and two-group t-tests (eg, Yes vs. No) depending on which fatigue outcome is used. Two statistical models will be used to assess fatigue and its relationship to dermatitis, cytokine level, and their interactive effects using logistic regression (for dichotomous) and OLS regression (for VAS) approaches. Present accrual: 0; Study initiation planned for July 1, 2013 Target accrual : 100. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-1-01.

Predictors of Initial Levels and Trajectories of Depressive Symptoms in Women With Breast Cancer Undergoing Radiation Therapy

Women with breast cancer undergoing radiation therapy (RT) are at increased risk for depressive symptoms. However, only 4 studies specifically evaluated changes in and predictors of depressive symptoms in these patients. This study evaluated changes in depressive symptoms from the initiation of and through 6 months following RT and investigated whether specific demographic, clinical, symptom, and psychological adjustment characteristics predicted initial levels and trajectories of depressive symptoms. A total of 184 women with breast cancer completed the Center for Epidemiologic Studies-Depression Scale that evaluated depressive symptoms prior to and approximately 1, 2, 3, and 6 months after the initiation of RT. Hierarchical linear modeling was used for these analyses. Approximately one-fourth of patients had clinically meaningful levels of depressive symptoms prior to RT, but the trajectory of depressive symptoms improved over time. Women with less education, children living at home, a higher level of sleep disturbance, worry about disease outcome, less meaning in life, and less support from family and friends had higher levels of depressive symptoms prior to RT. Some women with breast cancer experience depressive symptoms prior to, during, and after RT, and specific demographic, clinical, symptom, and psychological adjustment characteristics identified women at higher risk for depressive symptoms. Nurses could use knowledge of the predictors to identify patients at risk for depressive symptoms and to educate patients about how depressive symptoms may change during and following RT for breast cancer.

Effects of Nia Exercise in Women Receiving Radiation Therapy for Breast Cancer

To compare a 12-week nontraditional exercise Nia program practiced at home to usual care on fatigue, quality of life (QOL), aerobic capacity, and shoulder flexibility in women with breast cancer undergoing radiation therapy. Randomized clinical trial. Large community-based hospital in the midwestern United States. 41 women with stage I, II, or III breast cancer starting radiation therapy. 22 women were randomized to the Nia group and 19 to the usual care group. Those in the Nia group were instructed to practice Nia 20-60 minutes three times per week for 12 weeks. Those in the usual care group were instructed to continue normal activities. Fatigue, QOL, aerobic capacity, and shoulder flexibility. Controlling for baseline scores, change over time between groups was significantly different for the women who practiced Nia at least 13 times during the 12-week period; those in the Nia intervention reported significantly less fatigue between weeks 6 and 12, as compared to control group (p = 0.05). No statistical differences in QOL, aerobic capacity, or shoulder flexibility were found, but trends favoring Nia were identified. For women undergoing radiation therapy for breast cancer, Nia can help relieve fatigue. Additional research in arm and shoulder mobility and preservation also may be beneficial. Oncology nurses are in a unique position to offer suggestions to help manage fatigue, and Nia could be considered as part of a cancer survivorship program. Exercise is beneficial for women with breast cancer, and interest is growing in nontraditional exercise options. Nia can benefit women with breast cancer undergoing radiation therapy.

Spiritual well-being and quality of life in Iranian women with breast cancer undergoing radiation therapy

Psychological distress and morbidity are common consequences of diagnosis and treatment of breast cancer and associated with poor quality of life (QOL). Spiritual well-being is an important aspect of QOL, but little is known about the spiritual well-being and its relationship with QOL in patients of different cultures such as Iranian Muslim patients. The aim of this study was to investigate the association of QOL and spirituality among patients with breast cancer undergoing radiation therapy. This was a cross-sectional study which was conducted in the Breast Cancer Research Center of St. S. Al-Shohada Hospital, Isfahan, Iran. Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12). The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and its supplementary breast cancer questionnaire (QLQ-BR23) were used to assess the quality of life of patients. Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. In all, 68 patients fulfilled the study's inclusion criteria and were interviewed. The mean global QOL was 41.42 (SD = 18.02), and the mean spiritual well-being was 28.41 (SD = 6.95). There was a significant positive correlation between general QOL and total spiritual well-being scores. Also, spiritual well-being, social functioning, pain, and arm symptoms were significant predictors of global QOL. The results of this study provide evidence that breast cancer survivors in Iran experience a poor quality of life across a broad spectrum of health domains, particularly social, emotional, and spiritual, indicating that psychosocial-spiritual support should be considered in caring for patients with breast cancer.

Changes Over Time in Occurrence, Severity, and Distress of Common Symptoms During and After Radiation Therapy for Breast Cancer

ContextLittle is known about changes over time in multiple dimensions of the symptom experience in patients with breast cancer undergoing radiation therapy (RT). ObjectivesThis study evaluated for changes in and predictors of occurrence, severity, and distress of six common symptoms (lack of energy, worrying, difficulty sleeping, feeling drowsy, sweats, and pain) during RT for breast cancer. MethodsPatients (n = 188) completed the Memorial Symptom Assessment Scale before, during, and after the completion of RT, over a six-month period. Changes in symptom occurrence were evaluated using multilevel logistic regression analysis. Changes in severity and distress scores were evaluated using multilevel proportional odds ordinal logistic regression. The impact of five demographic and clinical characteristics (age, functional status, comorbidities, axillary lymph node dissection, and previous chemotherapy) was evaluated in these analyses. ResultsThe trajectories for occurrence, severity, and distress for the six symptoms followed similar patterns. For three of the six symptoms (lack of energy, feeling drowsy, and worrying), all three dimensions changed over time. For the other three symptoms (difficulty sleeping, sweats, and pain), no changes over time occurred for any of the symptom dimensions. The overall effect of the five covariates was to increase symptom burden across all three dimensions. ConclusionFindings from this study provide a more complete picture of the symptom experience of women who undergo RT for breast cancer. These findings can be used to identify patients at higher risk for more severe symptoms before, during, and after RT.