Dysfunction In Breast Cancer Survivors Research Articles

Assessment of sexual function in postmenopausal breast cancer survivors.

Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors. The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC. This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70years of age, with amenorrhea for ≥12months and sexually active. They were compared with 178 women without BC, matched (±2years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's t test, chi-square test, and logistic regression (odds ratio [OR]). Evaluation of sexual function in postmenopausal women treated for BC. Postmenopausal BC survivors showed poorer sexual function in the desire domain (P = .002). No significant differences were observed between groups in the other FSFI domains and total score (P >.05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) (P = .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; P = .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; P = .002). Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction. The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners. Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.

Endothelial dysfunction in breast cancer survivors on aromatase inhibitors: changes over time

BackgroundBreast cancer is estimated to comprise about 290,560 new cases in 2022. Aromatase inhibitors (AIs) are recommended as adjuvant treatment for estrogen-receptor positive (ER+) breast carcinoma in postmenopausal women, which includes approximately two-thirds of all women with breast cancer. AIs inhibit the peripheral conversion of androgens to estrogen by deactivation of the aromatase enzyme, leading to a reduction in serum estrogen level in postmenopausal women with ER+ breast carcinoma. Estrogen is known for its cardiovascular (CV) protective properties through a variety of mechanisms including vasodilation of blood vessels and inhibition of vascular injury resulting in the prevention of atherosclerosis. In clinical trials and prospective cohorts, the long-term use of AIs can increase the risk for hypertension and hyperlipidemia. Studies demonstrate mixed results as to the impact of AIs on actual CV events and overall survival.MethodsA single arm longitudinal study of 14 postmenopausal women with ER+ breast cancer prescribed adjuvant AIs at the University of Minnesota (UMN). Subjects with a history of known tobacco use, hypertension, hyperlipidemia, and diabetes were excluded to eliminate potential confounding factors. Participants underwent routine labs, blood pressure assessments, and vascular testing at baseline (prior to starting AIs) and at six months. Vascular assessment was performed using the EndoPAT 2000 and HDI/PulseWave CR-2000 Cardiovascular Profiling System and pulse contour analysis on two occasions as previously described. Vascular measurements were conducted by one trained vascular technician. Assessments were performed in triplicate, and the mean indices were used for analyses. All subjects were on an AI at the follow-up visit. The protocol was approved by the UMN Institutional Review Board and all participants were provided written informed consent. Baseline and follow-up characteristics were compared using Wilcoxon signed-rank tests. Analyses were performed using R version 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria).ResultsAfter six months of AI treatment, EndoPAT® ratio declined to a median 1.12 (Q1: 0.85, Q3: 1.86; p = 0.045; Figure 1) and median estradiol levels decreased to 2 pg/mL (Q1: 2, Q3: 3; p=0.052). There was no evidence of association between change in EndoPAT® and change in estradiol level (p = 0.91). There were no statistically significant changes in small or large arterial elasticity.ConclusionsWe hypothesize that long-term use of AI can lead to persistent endothelial dysfunction, and further investigation is necessary. In our study, patients were on AI for approximately 5-10 years. As a result, we do not have data on whether these changes, such as EndoPAT® ratio and the elasticity of small and large arterial, are reversible with discontinuation of AI. These findings set the stage for a larger study to more conclusively determine the association between AI exposure and cardiovascular outcomes. Further studies should evaluate for multivariate associations withmodifiable risk factors for CV disease.

A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors.

Sexual difficulties and vaginal pain are common following treatment for breast cancer. The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. Breast cancer survivors (n= 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. Assessments were repeated at posttreatment and 6 months after the completion of the group. There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. We used a randomized methodology. Future studies should seek to diversify participants. These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.

Sexual function index adaptation for breast cancer patients (FSFI-BC)- translation and psychometric properties of Persian version

BackgroundEffective interventions to improve sexual dysfunction in breast cancer survivors need screening of these dysfunctions with a suitable instrument. The aim of present study was translation and identifying psychometric properties of Female Sexual Function Index – Adapted for Breast Cancer (FSFI-BC) which has been specifically developed for breast cancer survivors.MethodThis methodological study was performed between February 2017 and October 2018. 200 breast cancer survivors in stage 1 or 2 who were selected through convenience sampling method, completed the questionnaire. Reliability was assessed by Cronbach’s alfa and test re-test analysis and construct validity was performed through confirmatory (CFA) and exploratory factor analysis( EFA).ResultsSix factors were extracted in exploratory factor analysis (EFA). These factors explained 74.6% of the total variance in in NSA group and 0.821 in SA group. Reliability evaluation indicated high internal consistency and good test re-test reliability. Cronbach’s alpha coefficient in all areas of the tool was above 0.7 (the lowest and the highest measures were 0.885 and 0.945, respectively), which is a good indicator for reliability of an instrument. Confirmatory factor analysis showed an acceptable fitness for seven factors of FSFI-BC questionnaire (Normed Fit Index or NFI = 0.9 for both groups, Comparative of Fit Index or CFI = 0.93 and 0.92, χ 2/df = 1.68 and 1.71 for SA(Sexually Active) and NSA(No Sexually Active) individuals, respectively) .ConclusionStudy findings suggest that Persian version of FSFI-BC is a suitable instrument for sexual dysfunction screening in breast cancer survivors.

Care for breast cancer survivors in Asian countries: A review of sexual dysfunction.

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

An online home-based exercise program improves autonomic dysfunction in breast cancer survivors.

Introduction: Exercise interventions for breast cancer survivors have proved their potential to improve clinical, physical, and psychosocial outcomes. However, limited studies have explored exercise effects on autonomic dysfunction and the measurement of exercise tolerance and progression through daily heart rate variability (HRV). Purpose: To analyze the effects of a 16-wk exercise intervention on the autonomic modulation of breast cancer survivors, as well as to examine the evolution of daily measured HRV and its interaction with exercise sessions in this population. Methods: A total of 29 patients who had undergone chemotherapy and radiotherapy were randomly assigned to the exercise group or to the control group. The exercise intervention was delivered remotely through online meetings and consisted of supervised training resistance and cardiovascular exercise 3 times per week. During the intervention all patients measured their HRV daily obtaining the napierian logarithm of the root mean square of successive differences between normal heartbeats (lnrMSSD) and the napierian logarithm of the standard deviation of the interbeat interval of normal sinus beats (lnSDNN) values at four moments: day 0 (the morning of the training sessions), 24, 48, and 72h after exercise. Results: The results revealed a significant interaction between group and months during the intervention period for lnrMSSD and lnSDNN (p < 0.001). Additionally, there were significant differences in lnSDNN recovery time between months (p < 0.05), while differences in lnrMSSD become apparent only 24h after exercise (p = 0.019). The control group experienced a significant decrease in both variables monthly (p < 0.05) while exercise group experienced a significant increment (p < 0.05). Conclusion: HRV is daily affected by exercise training sessions in cancer patients. Although results strongly support the role of exercise as a post-chemotherapy and radiotherapy rehabilitation strategy for breast cancer survivors to improve autonomic imbalance, further research is necessary to validate these initial findings.

Assessing Upper Limb Function in Breast Cancer Survivors Using Wearable Sensors and Machine Learning in a Free-Living Environment.

(1) Background: Being able to objectively assess upper limb (UL) dysfunction in breast cancer survivors (BCS) is an emerging issue. This study aims to determine the accuracy of a pre-trained lab-based machine learning model (MLM) to distinguish functional from non-functional arm movements in a home situation in BCS. (2) Methods: Participants performed four daily life activities while wearing two wrist accelerometers and being video recorded. To define UL functioning, video data were annotated and accelerometer data were analyzed using a counts threshold method and an MLM. Prediction accuracy, recall, sensitivity, f1-score, 'total minutes functional activity' and 'percentage functionally active' were considered. (3) Results: Despite a good MLM accuracy (0.77-0.90), recall, and specificity, the f1-score was poor. An overestimation of the 'total minutes functional activity' and 'percentage functionally active' was found by the MLM. Between the video-annotated data and the functional activity determined by the MLM, the mean differences were 0.14% and 0.10% for the left and right side, respectively. For the video-annotated data versus the counts threshold method, the mean differences were 0.27% and 0.24%, respectively. (4) Conclusions: An MLM is a better alternative than the counts threshold method for distinguishing functional from non-functional arm movements. However, the abovementioned wrist accelerometer-based assessment methods overestimate UL functional activity.

Detecting microstructural alterations of cerebral white matter associated with breast cancer and chemotherapy revealed by generalized q-sampling MRI.

Previous studies have discussed the impact of chemotherapy on the brain microstructure. There is no evidence of the impact regarding cancer-related psychiatric comorbidity on cancer survivors. We aimed to evaluate the impact of both chemotherapy and mental health problem on brain microstructural alterations and consequent cognitive dysfunction in breast cancer survivors. In this cross-sectional study conducted in a tertiary center, data from 125 female breast cancer survivors who had not received chemotherapy (BB = 65; 49.86 ± 8.23 years) and had received chemotherapy (BA = 60; 49.82 ± 7.89 years) as well as from 71 age-matched healthy controls (47.18 ± 8.08 years) was collected. Chemotherapeutic agents used were docetaxel and epirubicin. We used neuropsychological testing and questionnaire to evaluate psychiatric comorbidity, cognitive dysfunction as well as generalized sampling imaging (GQI) and graph theoretical analysis (GTA) to detect microstructural alterations in the brain. Cross-comparison between groups revealed that neurotoxicity caused by chemotherapy and cancer-related psychiatric comorbidity may affect the corpus callosum and middle frontal gyrus. In addition, GQI indices were correlated with the testing scores of cognitive function, quality of life, anxiety, and depression. Furthermore, weaker connections between brain regions and lower segregated ability were found in the post-treatment group. This study suggests that chemotherapy and cancer-related mental health problem both play an important role in the development of white matter alterations and cognitive dysfunction.

(512) Towards Scalable Future Interventions for Breast Cancer Survivors: Effects of a Brief Mindfulness Exercise on Genital and Subjective Sexual Arousal

Abstract Introduction Breast Cancer (BC) with a lifetime prevalence of 12.0%, is the most common cancer in women. Out of all BC cases, 70% are hormone receptor positive, requiring anti-hormonal therapy and, in some patients, supplementary chemotherapy. The condition itself, as well as respective BC treatment, often comes with physical impairments (i.e., diminished lubrication, vaginal atrophy), as well as psychological stressors (i.e., sexual self- and body-esteem, performance anxiety) that result in sexual problems in 73.4% of BC survivors (BCS). Sexual problems are frequently accompanied by sexual distress and impaired quality of life. Overall, limited attention is given to sexual health in oncology and treatment options are scarce. Currently, hardly any therapies target the interplay of physical and psychological symptoms to improve sexual distress and overall quality of life of BCS. Recently, meta-analyses have shown the efficacy of mindfulness-based cognitive behavioral therapy for women with sexual dysfunctions (i.e., experiencing sexual problems and simultaneous sexual distress) including BCS. However, the access to health care providers offering such treatments is limited. Psychophysiology studies have identified specific mindfulness exercises, which can lead to an increase of subjective and genital sexual arousal in non-clinical samples after a single brief session. These findings serve as an underpinning for the promising effects of including mindfulness tasks in future therapeutic interventions and scalable digital health applications in order to improve the access to evidence-based treatments for BCS with sexual dysfunctions. Objectives The aim of the present study is to test the effect of a brief audio-based mindfulness exercise on genital and subjective sexual arousal, and their concordance in BCS currently undergoing endocrine therapy. Methods For this study, 60 women (20 healthy controls, 40 premenopausal BCS currently undergoing anti-hormonal therapy) are recruited to participate in a psychophysiology lab study. Participants are randomly assigned to three experimental conditions: 1) neutral audio, 2) body scan mindfulness exercise, 3) mindfulness exercise with focus on genitals, followed by self-stimulation with a vacuum stimulation device (Womanizer Premium, WOW Tech™ GmbH) in all three groups. Genital arousal and subjective sexual arousal (SSA) serve as outcome variables. As a measure of genital arousal, the vaginal pulse amplitude (VPA) is continuously recorded using vaginal photoplethysmography (BIOPAC®). SSA is repeatedly measured on a scale from 0 (not aroused) to 10 (extremely aroused). Demographic data, hormone levels, heart rate variability, sexual self-esteem, sexual function, and sexual distress are assessed as control variables. Results In order to analyze the repeated measures data nested within individuals, intra- (SSA, VPA) and inter-individual (BCS, healthy controls) differences are appraised using hierarchical linear modelling (HLM). Separate 2-level mixed effect models are constructed for each outcome variable (subjective arousal, genital arousal). In order to measure the agreement of genital and subjective arousal (i.e., concordance) within-subject correlations between subjective and genital arousal are calculated. Conclusion If effective, a single brief evidence-based mindfulness exercise could serve as a directive for future clinical trials and potentially constitute an accessible treatment approach for sexual dysfunction in BCS. Disclosure Yes - WOW Tech™ GmbH

Breast cancer survivorship and sexual dysfunction: a population-based cohort study.

Breast cancer is the most common non-skin cancer in women and an increasing number of people are living as breast cancer survivors. While the prognosis of breast cancer continues to improve, the rates of sexual dysfunction and the risk related to cancer treatments have not been well characterized in a population-based study. We identified a cohort of 19,709 breast cancer survivors diagnosed between 1997 and 2017 from the Utah Cancer Registry, and 93,389 cancer-free women who were matched by age and birth state from the Utah Population Database. Sexual dysfunction diagnoses were identified through ICD-9 and ICD-10 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios for risk of sexual dysfunction. Breast cancer survivors were at higher risk of sexual dysfunction diagnosis (9.1% versus 6.9%, HR 1.60, 95% CI 1.51-1.70) compared to the general population. This risk increased 2.05-fold within 1 to 5years after cancer diagnosis (95% CI 1.89-2.22) and 3.05-fold in individuals diagnosed with cancer at < 50years of age (95% CI 2.65-3.51). Cancer treatments including endocrine therapy, chemotherapy and radiation therapy were associated with an increased risk of sexual dysfunction among breast cancer survivors. Risk of sexual dysfunction in breast cancer survivors is higher than in the general population, but may be underdiagnosed in the clinical setting. Health care professionals should be encouraged to address the topic of sexual health early on in the treatment of breast cancer, and routinely screen patients for symptoms of sexual dysfunction.

Psychological measures of stress and biomarkers of inflammation, aging, and endothelial dysfunction in breast cancer survivors on aromatase inhibitors

The use of aromatase inhibitors (AIs) is associated with higher rates of cardiovascular events and lower endothelial function in breast cancer survivors. Psychosocial stress is associated with higher levels of inflammatory and aging markers, and lower endothelial function in otherwise healthy subjects. These associations among breast cancer survivors on AIs are not well defined. A cross-sectional study of 30 breast cancer survivors on AIs was performed to assess the associations between self-reported scores of psychosocial measures of depression, anxiety, and stress assessed by validated questionnaires with markers of inflammation (CRP; IL-6; IL-18), aging (p16INK4a), and endothelial function (ICAM-1, EndoPAT ratio). Significant positive correlations were observed between psychosocial measures and inflammatory markers including CRP, IL-6, and ICAM-1. However, no psychosocial scores were related to endothelial function or gene expression of the aging biomarker p16INK4a. Overall, survivors had endothelial dysfunction with reduced EndoPAT ratios. Psychosocial stress is associated with greater inflammation in breast cancer survivors on AIs, corroborating previous studies in cancer-free populations. The lack of association between psychosocial stress and either endothelial function or aging biomarkers could be due to the already low endothelial function and accelerated aging in our cohort of breast cancer survivors on AIs, though our small sample size limits conclusions. Further work in a larger and more diverse cohort of patients is needed to further understand the relationships among inflammation, aging and endothelial function in breast cancer survivors.

Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors.

Little is known about the neural basis of subjective cancer-related cognitive changes. The purpose of this study was to explore salience network connectivity in relation to subjective executive and memory dysfunction in breast cancer survivors compared to controls. A retrospective cross-sectional analysis of neuroimaging, subjective cognitive, clinical, and demographic data in chemotherapy-treated primary breast cancer survivors compared to frequency matched controls was used. Functional connectivity within salience network hubs (anterior cingulate, bilateral insula) was determined using resting state functional MRI. Mann-Whitney U tests were used to evaluate group differences and Spearman's rho correlations were examined among the behavioral measures and salience network connectivity. We included 65 breast cancer survivors and 71 controls. Survivors demonstrated greater subjective executive dysfunction and memory complaints (p < .001) and lower salience network connectivity (p < .05) than controls. Executive functioning correlated with bilateral insula and left anterior cingulate connectivity (rho > - 0.29, p < .05). Distress did not correlate with salience network connectivity. These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes. Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.

Episodic Memory and Recollection Network Disruptions Following Chemotherapy Treatment in Breast Cancer Survivors: A Review of Neuroimaging Findings.

Simple SummaryMemory disturbances are amongst the most common and disruptive symptoms of chemotherapy-related cognitive impairment. Chemotherapy treatments commonly cause neurotoxicity within the hippocampus, creating a vulnerability to memory impairment. Most clinical assessments of long-term memory in breast cancer survivors assess basic verbal and visual memory processing, and do not capture the complexities of everyday event memories, including episodic and autobiographical memory. This review focuses on structural and functional neuroimaging studies identifying disruptions in the hippocampus and recollection network, and related episodic memory impairments in chemotherapy-treated breast cancer survivors. We argue for the need to better characterize memory dysfunction following chemotherapy treatments. Given the importance of episodic and autobiographical memory to a person’s personal history and quality of life, an under-appreciation of how this memory domain is impacted by standard cancer treatments potentially diminishes the negative experiences of breast cancer survivors, and neglects cognitive problems that could benefit from intervention strategies.Long-term memory disturbances are amongst the most common and disruptive cognitive symptoms experienced by breast cancer survivors following chemotherapy. To date, most clinical assessments of long-term memory dysfunction in breast cancer survivors have utilized basic verbal and visual memory tasks that do not capture the complexities of everyday event memories. Complex event memories, including episodic memory and autobiographical memory, critically rely on hippocampal processing for encoding and retrieval. Systemic chemotherapy treatments used in breast cancer commonly cause neurotoxicity within the hippocampus, thereby creating a vulnerability to memory impairment. We review structural and functional neuroimaging studies that have identified disruptions in the recollection network and related episodic memory impairments in chemotherapy-treated breast cancer survivors, and argue for the need to better characterize hippocampally mediated memory dysfunction following chemotherapy treatments. Given the importance of autobiographical memory for a person’s sense of identity, ability to plan for the future, and general functioning, under-appreciation of how this type of memory is impacted by cancer treatment can lead to overlooking or minimizing the negative experiences of breast cancer survivors, and neglecting a cognitive domain that may benefit from intervention strategies.

Cancer treatment-related cardiac dysfunction in breast cancer survivors: A retrospective descriptive study using electronic health records from a Korean tertiary hospital.

The population overlap of breast cancer and cardiovascular diseases (CVDs) has increased due to early breast cancer detection and treatment and aging population trends. Moreover, breast cancer patients are at an increased risk for CVDs consequent to cancer treatments. We aimed to understand the characteristics of breast cancer patients with pre-existing CVDs and of those diagnosed with CVDs after receiving chemotherapy, and cancer treatment-related cardiac dysfunction's occurrence among Korean breast cancer patients with CVDs. This retrospective descriptive study, which collected clinical data from electronic health records from a Korean tertiary hospital, included 1200 female breast cancer patients with CVDs, aged 15-75 years. A total of 45.7% had pre-existing CVDs, and 91.6% were classified as very high-risk for cardiotoxicity in the pre-existing CVDs group. Among the 1200 breast cancer patients with CVDs, only 439 patients had left ventricular ejection fraction (LVEF) data during their cancer treatment, and 121 received baseline assessment for LVEF. Of the 439 patients with LVEF data, 134 patients have been classified into cancer treatment-related cardiac dysfunction (CTRCD), and the median period from cancer diagnosis to CTRCD occurrence was 26.5 months. Despite the high cardiotoxicity risk of breast cancer patients with pre-existing CVDs, baseline studies of the risk assessment before chemotherapy were insufficient to support the prevention and early detection of cardiotoxicity. Therefore, it is paramount to consider how nurses focus on risk stratification before chemotherapy and support the regular monitoring of breast cancer survivors' cardiac functioning, to maintain optimal health status.

Kynurenine Metabolism as a Mechanism to Improve Fatigue and Physical Function in Postmenopausal Breast Cancer Survivors Following Resistance Training.

This pilot examines whether resistance training (RT) can induce changes in kynurenine (KYN) metabolism, which may contribute to improved physical function in breast cancer survivors (BCSs). Thirty-six BCSs (63.2 ± 1.1 years) underwent assessments of physical function and visual analog scale (100 cm) fatigue and quality of life before and after 12 weeks of RT (N = 22) or non-exercise control (CBCT©: Cognitively Based Compassion Training, N = 10). Blood was collected before and after interventions for assessment of KYN, kynurenic acid (KYNA), and peroxisome proliferator-activated receptor γ co-activator 1α (PGC-1α). At baseline, the women were moderately fatigued (mean score: 46 cm) and at risk of poor functional mobility. A group*time interaction was observed for all measures of strength with improvements (~25–35%) following RT (p’s < 0.01), but not CBCT. Time effects were observed for fatigue (−36%) and quality of life (5%) (p’s < 0.01), where both groups improved in a similar manner. A group*time interaction was observed for KYN (p = 0.02) and PGC-1α (p < 0.05), with KYN decreasing and PGC-1α increasing following RT and the opposite following CBCT. These changes resulted in KYN/KYNA decreasing 34% post-RT, but increasing 21% following CBCT. These data support RT as a therapeutic intervention to counteract the long-term side effect of fatigue and physical dysfunction in BCSs. Additionally, the results suggest that this effect may be mediated through the activation of PGC-1α leading to alterations in KYN metabolism.

Physical Activity and Cardiac Function in Long-Term Breast Cancer Survivors: A Cross-Sectional Study

BackgroundHigher levels of physical activity are associated with a lower risk of cardiovascular disease in the general population. Whether the same holds for women who underwent treatment for breast cancer is unclear. ObjectivesThe aim of this study was to evaluate the association between physical activity in a typical week in the past 12 months and cardiac dysfunction in breast cancer survivors. MethodsWe used data from a cohort of breast cancer survivors who were treated at ages 40 to 50 years (N = 559). The association between physical activity and global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF) was evaluated using both linear and modified Poisson regression analyses adjusted for relevant confounders. ResultsIn total, 559 breast cancer survivors were included, with median age of 55.5 years and a median time since treatment of 10.2 years. GLS was less favorable in inactive survivors (−17.1%) than in moderately inactive (−18.4%), moderately active (−18.2%), and active survivors (−18.5%), with an adjusted significant difference for active versus inactive survivors (β = −1.31; 95% CI: −2.55 to −0.06)). Moderately active (n = 57/130) and active survivors (n = 87/124) had significantly lower risks of abnormal GLS (defined as >−18%) compared with inactive survivors (n = 17/26) (RR: 0.65 [95% CI: 0.45-0.94] and RR: 0.61 [95% CI: 0.43-0.87], respectively). LVEF, in normal ranges in all activity categories, was not associated with physical activity. ConclusionsIn long-term breast cancer survivors, higher physical activity levels were associated with improved GLS but not LVEF, with the relatively largest benefit for doing any activity versus none. This finding suggests that increasing physical activity may contribute to cardiovascular health benefits, especially in inactive survivors.

Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Abstract Introduction: Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice. Objective: To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors. Methods: Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%. Conclusion: We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.

Analysis of Spinal Dysfunction in Breast Cancer Survivors with Lymphedema.

Background:To study and analyse the spinal dysfunction in breast cancer survivors with lymphedema. Methods:This study was carried out by analysing total 116 breast cancer survivor women, who were having lymphedema. Out of 116 subjects, 39 undergone radical mastectomy (RM), 39 undergone modified radical mastectomy (MRM) and 38 undergone breast conserving surgery (BCS). Thesesubjects were assessed for spinal function bytaking range of motionusing goniometer, lymphedema measurement usinginch tape, spinal stability test and functional rating index. Results:The spinal range of motion wassignificantly reduced in patients suffering from lymphedema in breast cancer survivors. The strength and endurance were significantly reduced in abdominals, extensors and lateral muscles of spine. There wasmarked effect seen on quality of life of patients assessed by using functional rating index due to spinal dysfunction in lymphedema patients. Conclusion:This study showed that there is statistically significant spinal dysfunction caused due to lymphedema in breast cancer survivors.

146P Impact of breast cancer treatment on sexual health in pre-menopausal women

With increasing awareness and provision of better treatment modalities, younger women with breast cancer have increased survival. However, due to long term treatment related side effects, they experience an overall decline in sexual health. The study aimed to analyze the incidence of sexual dysfunction in breast cancer survivors and the impact of various treatment modalities on female sexuality. All non-metastatic pre-menopausal women diagnosed with breast cancer or undergoing therapy for breast cancer were enrolled in the study between January to December 2020; and were assessed by Female Sexual Function Index questionnaire (FSFI) before starting therapy, immediately (4 weeks) after completion of therapy and at 3 months follow up. Comparison of FSFI scores between patients who underwent mastectomy versus breast conservation surgery (BCS) and patients on hormonal therapy versus non-hormonal therapy on follow up was done. A total of 150 patients were included in the study. Seventy percent patients underwent mastectomy (n=104) and the rest underwent BCS (n=46). Based on the cut off of 26.55, 82.6% (124) patients had persisting sexual dysfunction at 3 months post treatment. The median scores of BCS group was significantly better than mastectomy group at 3 months (22.85 +/- 2.19 versus 21.75 +/- 2.09, p= 0.002). When individual domains were compared between the two groups at 3 months, arousal, lubrication, orgasm and pain showed more reduction in patients undergoing MRM as compared to BCS, however the differences were not statistically significant. Median FSFI scores were comparable in patients receiving hormonal therapy, versus non- hormonal therapy group (22.3 +/- 2.15 versus 21.9 +/- 2.23, p=0.718). When individual domain were compared desire, arousal and pain showed more reduction in hormonal group as compared to non-hormonal group, however the differences were not statistically significant. Overall, high incidence of sexual dysfunction was seen in breast cancer survivors, which was significantly more in patients who underwent mastectomy. Further studies are needed to address sexual dysfunction in breast cancer survivors and measures to alleviate the same.

Effect of Graded Theraband Exercise on Myofascial Dysfunctions in Breast Cancer Survivors

Background: Cancer is the leading cause of morbidity and mortality .Breast cancer is the most commonform of cancer among women. Many breast cancer surgeries leads to dissection of muscles and soft tissuestructures. After the breast cancer treatment many complications are seen in breast cancer survivors. Inthat myofascial dysfunctions are common. These dysfunctions are one of the common sources of pain anddiscomfort. Not only pain but this dysfunction also leads to decreased range of motion, decreased strength,and altered posture. Because of dysfunctions, an upper body function decreases and affects the activity ofdaily living. Graded theraband exercises are effective in improving muscle strength and shoulder range ofmotion in breast cancer survivors. And also helps to enhance functional capacity. Early rehabilitation can beimplanted to reduce pain, improve strength and flexibility which will be helpful in minimize restrictions indaily living activities and improve quality of life. This effectiveness study will help to enlighten the status ofmyofascial dysfunctions in breast cancer survivors. The objectives of the study were as follows: To find outthe effect of graded theraband exercise on myofascial dysfunctions in breast cancer survivors.Methods: A total 40 females who underwent breast cancer surgeries along with chemotherapy or radiotherapyor hormone therapy, were included based on inclusion criteria. All the females received thera- bandexercises along with medications for five days per week and pre and post assessment was done with manualmuscle testing (MMT), shoulder range of motion (ROM), and Shoulder Pain and Disability Index (SPADI)questionnaire.Result: The result concluded that strengthening with thera-band showed better effect in the breast cancersurvivors. Strengthening exercise program with resistance band showed significant improvement in theshoulder strength, ROM and activities of daily life.