Fatigue In Breast Cancer Survivors Research Articles

Prevalence and correlates of cancer-related fatigue in breast cancer survivors.

To identify potential correlates of cancer-related fatigue (CRF) after curative breast cancer (BC) treatment. The hypothesis was that fatigue would be more severe among women treated with cardiotoxic drugs, with poor physical condition and those who exercised less. Observational cross-sectional design. Fatigue was evaluated through PERFORM Questionnaire (multi-item, multi-dimensional). Patient-reported assessments and objective information regarding clinical data, physical activity (PA) and physical condition were analysed as potential correlates of CRF. One hundred eighty women who remained free of disease were recruited. The prevalence of fatigue interfering with quality of life was 43%. Weight, resting and recovery heart rate were positively associated with fatigue. Age and time from diagnosis were negatively associated. Previous therapies, objectively assessed weekly PA, cardiorespiratory condition, muscular strength and adherence to Mediterranean diet were not associated with CRF. CRF is a prevalent problem after BC treatment. Objectively assessed PA, cardiorespiratory fitness and muscular strength did not predict CRF. The association of heart rate and fatigue deserves a further insight. Future research should include longitudinal studies and determination of biomarkers. BC survivors, especially younger and overweight women, should be informed about fatigue as a potential persistent symptom through all stages of the cancer trajectory and into survivorship. They also should be routinely screened for CRF.

Tired of feeling tired – The role of circulating inflammatory biomarkers and long-term cancer related fatigue in breast cancer survivors

BackgroundLow-grade inflammation has been associated with cancer related fatigue (CRF). However, most studies focused on CRF during or shortly after treatment. Longitudinal studies are rare with inconsistent results. We assessed the association of inflammatory biomarkers with total CRF and all subdomains (physical, cognitive, affective) in long-term breast cancer survivors. MethodPatients recruited between 2002 and 2005 provided information on CRF at first follow-up (FU1) (N = 1292) and second follow-up (FU2) (N = 1205), after a median of 6.2 years and 11.7 years, respectively. Associations of 11 inflammatory biomarkers with CRF at FU1 and at FU2 were assessed using linear regression models. Logistic regression models were used to compare patients fatigued at both time-points and those never fatigued (N = 932). ResultsC-reactive protein (CRP) was significantly associated with total CRF at FU1 (β = 1.47, 95%CI = 0.62–2.31, p = 0.0007), at FU2 (β = 1.98, 95 %CI = 0.96–2.99, p = 0.0001) and with persistent CRF (OR = 1.29, 95%CI = 1.13–1.47, p < 0.0001). IL-6 levels were associated with total CRF at FU1 (β = 1.01, 95%CI = 0.43–1.59, p = 0.0006), but not with CRF at FU2 or persistent CRF. No association remained significant after adjustment for relevant covariates. DiscussionCRP and Il-6 were associated with risk of CRF in long-term breast cancer survivors, but were not independent of other known risk factors, suggesting that currently studied inflammatory markers are not suitable to identify patients at risk of long-term CRF.

Aquatic Therapy Reduces Pain and Fatigue in Breast Cancer Survivors: A Systematic Review

Background and Purpose: Pain and cancer-related fatigue (CRF) are impairments from breast cancer or the medical and surgical therapies for breast cancer. Aquatic therapy has been found to be effective for the problems of pain and CRF. The purpose of this systematic review was to determine whether aquatic therapy reduced pain and CRF among people with breast cancer and to identify any elements of aquatic therapy associated with those effects. Methods: The protocol for this systematic review was registered with PROSPERO, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards were followed. Four databases were searched, and studies were selected on the basis of predetermined criteria. Data were extracted into a template for analysis and thematic synthesis. Measures of methodological quality (risk of bias) and level of evidence were applied. Results: Six studies involving 137 subjects who received treatment were included. Subjects received aquatic therapy (water-based exercise for rehabilitation) that was compared with various land-based interventions. Studies were evaluated with the Oxford Centre for Evidence-based Medicine—Levels of Evidence for Therapy/Prevention Studies Rating Scale, and all studies had a high or acceptable level of evidence. Studies were evaluated with the APTA Critical Appraisal Tool for Experimental Intervention Studies, and 5 studies had a high or acceptable quality. High-quality evidence supported the use of aquatic therapy for reducing CRF, and acceptable quality evidence supported the use of aquatic therapy for reducing pain. Adverse responses to aquatic therapy were minor symptoms that resolved within days and had no effect on attrition. Limitations: Searches were limited to publications in English. Analysis was confounded by heterogeneity of pain measures. Conclusions: Aquatic therapy is recommended as an intervention for the impairments of pain and CRF associated with breast cancer. Aquatic therapy is safe and feasible for this population.

Exercício físico remoto e fadiga em sobreviventes do câncer de mama: uma intervenção em tempos do COVID-19

O objetivo do presente estudo foi verificar os efeitos de um programa de exercício físico supervisionado remotamente sobre a percepção de fadiga de sobreviventes do câncer de mama durante a pandemia da COVID-19. Participaram do estudo dez mulheres (56,30 ± 14,00 anos) fisicamente ativas, participantes de um programa de extensão universitário e que foram diagnosticadas com câncer de mama entre os estágios I-III (5,65 ± 2,19 anos de diagnóstico). O programa de exercício físico foi realizado de forma supervisionada por meio de chamada de vídeo durante 12 semanas, com duas sessões semanais de 30 minutos, em dias não consecutivos. Os treinos foram compostos por exercícios de mobilidade articular, de força, aeróbios e de equilíbrio, sendo modificados a cada três semanas. A percepção de fadiga relacionada ao câncer foi medida pela Piper Fatigue Scale por meio de chamada telefônica, antes e após as 12 semanas de intervenção. Os dados foram analisados utilizando o teste não-paramétrico Wilcoxon. Os resultados demonstraram valores de todos os domínios da fadiga relacionada ao câncer (fadiga total: p = 0,463; comportamental: p = 0,655; afetiva: p = 0,593; sensorial: p = 0,223; cognitiva: p = 0,141) estatisticamente semelhantes entre os momentos pré e pós intervenção. Conclui-se que, após 12 semanas de um programa de exercício físico supervisionado remotamente por chamada de vídeo, durante o distanciamento social devido a pandemia da COVID-19, a percepção de fadiga de mulheres sobreviventes do câncer de mama permaneceu estável.

Acute effects of aerobic exercise and relaxation training on fatigue in breast cancer survivors: A feasibility trial.

This three-armed randomized controlled feasibility trial tested the acceptability and acute effects of aerobic exercise and technology-guided mindfulness training (relative to standalone interventions) on cancer-related fatigue among breast cancer survivors (BCS). BCS recruited from Central Illinois completed pre- and post-testing using established measures and were randomized to one of three groups (combined aerobic exercise with guided-mindfulness relaxation, aerobic exercise only, and relaxation only), conducted in three 90 min sessions over the course of 7 days in a fitness room and research office on a university campus. We enrolled 40 BCS (Mage = 57.33 ± 8.75), MBMI = 27.38 ± 5.27, Mfatigue = 4.56 ± 1.81 as measured by the Piper Fatigue Scale. More favorable post-intervention evaluations were reported by the combined group, compared to aerobic exercise or relaxation only (p < 0.05). Reductions in fatigue favoring the combined group (p = 0.05) showed a modest effect size (Cohen's d = 0.91) compared to aerobic exercise only. These findings provide preliminary evidence for the feasibility of combining evidence-based techniques to address fatigue among BCS. The combined approach, incorporating mobile health technology, presents an efficacious and well-received design. If replicated in longer trials, the approach could provide a promising opportunity to deliver broad-reaching interventions for improved outcomes in BCS. Preregistered-ClinicalTrials NCT03702712.

Insomnia and Susceptibility to Depressive Symptoms and Fatigue in Diverse Breast Cancer Survivors.

Background: Nearly 40% of breast cancer survivors have insomnia, yet, information how this condition affects their quality of life is lacking. We examined the association between insomnia and depressive symptoms and fatigue in breast cancer survivors.Methods: Participants were recruited from a community health plan. We conducted a cross-sectional analysis to examine the association between current insomnia (using Insomnia Severity Index [ISI]) and current depressive symptoms (using Inventory of Depressive Symptomology [IDS]) and fatigue (using Fatigue Symptom Inventory [FSI]) in 315 breast cancer survivors who did not have major depressive disorder. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression.Results: The cohort included 30% minority women whose median time since breast cancer diagnosis was 6 years. Survivors with current insomnia symptoms (ISI ≥8) had a sixfold greater odds of current depressive symptoms (IDS >14, OR = 5.98, 95% CI: 3.04–11.76), after adjusting for lifetime insomnia history (OR = 2.01, 95% CI: 1.03–3.94) and perceived stress (OR = 6.37, 95% CI: 2.48–16.32). Insomnia symptoms were markedly associated with moderate fatigue (FSI >3, OR = 5.02, 95% CI: 2.66–9.44). Ever use of antidepressants or sleep medications post-breast cancer diagnosis was not associated with lower odds of current depressive symptoms or feeling fatigued in those with insomnia symptoms.Conclusion: Current insomnia symptoms were strongly correlated with current depressive symptoms and fatigue. Survivorship care plans should consider incorporating insomnia screening to that may potentially enhance quality of life domains.

Association of mitochondrial DNA content and displacement loop region sequence variations with cancer-related fatigue in breast cancer survivors receiving chemotherapy

Cancer-related fatigue (CRF) is characterized by a lack of energy, and mitochondrial dysfunction is postulated to contribute to its etiology. This prospective cohort study assesses the self-reported fatigue levels of early-stage breast cancer patients using the validated Multi-Dimensional Fatigue Symptom Inventory–Short Form (MFSI-SF) and blood samples drawn at three time points: before treatment, approximately 6 weeks, and 12 weeks after the initiation of chemotherapy. The aim of this study is to evaluate mitochondrial measures with CRF, over the course of chemotherapy using mitochondrial DNA (mtDNA content) and displacement loop (D-loop) region sequence variations at nucleotide positions 303, 489 and 514. The relative mtDNA copy number was determined via real-time quantitative polymerase chain reaction and compared between study time points and D-loop sequence variants. The association of mtDNA content with MFSI-SF total and sub-domain scores was analyzed in a sample of 155 patients (mean age ± SD: 51.7 ± 8.8 years). The median mtDNA content decreased over 12 weeks after the initiation of chemotherapy (p < 0.001). Baseline mtDNA content was lower for nucleotide position 303 in sequence variations than for the reference sequence (67.2 copies vs 79.1 copies, p = 0.03). Physical fatigue negatively correlated with mtDNA content in both unadjusted (β = −0.0075, p = 0.048) and adjusted models (β = −0.0062, p = 0.042), accounting for age, anxiety, insomnia, haemoglobin levels and body mass index. Our findings add to the literature indicating that mitochondrial function serves as an important target for mitigating CRF.

"Honorable Toward Your Whole Self": Experiences of the Body in Fatigued Breast Cancer Survivors.

IntroductionCancer Related Fatigue (CRF) is one of the most common and detrimental side effects of cancer treatment. Despite its increasing prevalence and severity CRF remains dismissed by the majority of clinicians. One reason for the apparent gap between clinical need and clinical undertaking is the penchant toward reductionist accounts of the disorder: a tendency to discount the interface between the lived experience of sufferers and the multi-dimensional etiology of CRF as it manifests adversely on a day-to-day basis.MethodsIn order to better understand the interplay between social, bodily, and emotional components of the disorder we undertook semi-structured interviews with thirteen Breast Cancer survivors suffering from CRF, and then subsequently analyzed their responses using Team Based Qualitative Analysis.ResultsOur analysis revealed multiple dimensions of the social and bodily underpinnings of fatigue. Most relevantly we found a consistent change in the level and quality of attention to bodily signals. This shift in awareness appeared to be directly connected to the experience of CRF and a newfound, “respect,” for the needs of the body. Furthermore, we found that many of the practices that were described as helpful in alleviating fatigue were oriented around eliciting a sense of embodied awareness, examples being: dance, yoga, and shamanic ritual. This relationship with bodily sensations existed in conjunction with the anxiety and trauma that arose as a result of cancer treatment.ConclusionOur analysis suggests that the quality of awareness and relationship to bodily experience in CRF is a functionally relevant component of the disorder and should be considered as an experiential target moving forward.

Perception, magnitude, and implications of cancer-related fatigue in breast cancer survivors: Study from a developing country.

We have analyzed perceptions, magnitude, interventions adopted, and overall implications of cancer-related fatigue (CRF) in breast cancer survivors (BCSs). BCSs who attended follow-up clinic at our institute between January and June 2018 were asked to fill a questionnaire focused on assessing an individual's perception, severity, potential causes, implications on quality of life, and measures taken to deal with CRF. Sixty-five patients were included. Fifty-four (83%) had undergone surgery, 59 (91%) chemotherapy, 43 (66%) radiation therapy, and 36 (55%) hormonal/targeted therapy. Sixty-two (95%) patients experienced any grade CRF. Fifty-five (85%) patients experienced moderate to severe CRF affecting work (58%) and activities of daily living (27%). CRF was perceived as generalized weakness by 54 (83%) patients, diminished concentration/attention span by 24 (37%) patients, decreased motivation and interest in usual activities by 29 (45%) patients, and emotional labiality by 16 (25%) patients. Fifty-six patients (86%) believed that fatigue was due to the effect of cancer treatment on the body, while only 8 (12%) attributed it to underlying cancer. CRF had negative impact on mood, daily activities, interpersonal relationships, and professional work in 40 (62%), 39 (60%), 13 (20%), and 10 (15%) patients, respectively. Measures taken to overcome CRF were increased physical exercise, psychosocial interventions, mind-body interventions, and pharmacological interventions in 32 (49%), 8 (12%), 28 (43), and 17 (26%) patients, respectively. Thirty-nine (60%) patients reported persistence of CRF after completion of treatment while it took up to 6 months, 6-12 months, and more than 12 months for resolution of CRF in 13, 10, and 3 patients, respectively. Development and persistence of CRF remains a major health concern, and current interventions are not able to mitigate this problem. Further research in this field is warranted.

Pro-inflammatory Cytokine Levels and Cancer-related Fatigue in Breast Cancer Survivors: Effects of an Exercise Adherence Program.

PurposeThis study aimed to determine the effect of an exercise intervention on subjective cancer-related fatigue (CRF) and pro-inflammatory cytokine levels in breast cancer survivors (BCS).MethodsBCS with greater than moderate CRF (≥ 4) were recruited and randomly assigned to experimental or control groups. The experimental group participated in a 12-week exercise adherence program (Better Life after Cancer - Energy, Strength, and Support; BLESS). Interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) levels were determined at 3 time points (M1: baseline, M2: post-intervention, and M4: 6 months after intervention). Subjective fatigue was measured using the Korean version of the revised Piper Fatigue Scale.ResultsIn this analysis of participants with physiological fatigue measures available (19 experimental, 21 control), there were no statistically significant differences in IL-6 (F = 1.157, p = 0.341), TNF-α levels (F = 0.878, p = 0.436), and level of fatigue (F = 2.067, p = 0.118) between the 2 groups at baseline. Fatigue in the experimental group showed statistically significant improvement compared to the control only at M2 (p = 0.022). There was no significant relationship between subjective and physiological fatigue at the 3 measurement points.ConclusionThe BLESS intervention improved CRF in BCS immediately at post-intervention, and this study presents clinical feasibility for the management of CRF in BCS in the early survivorship phase who are already experiencing fatigue.

Feasibility and Effectiveness of an Internet-based Intervention to Manage Fatigue in Breast Cancer Survivors

Feasibility and Effectiveness of an Internet-based Intervention to Manage Fatigue in Breast Cancer Survivors

Post-Treatment Symptoms of Pain, Anxiety, Sleep Disturbance, and Fatigue in Breast Cancer Survivors

BackgroundIn part because of improvements in early detection and treatment, the number of breast cancer survivors is increasing. After treatment, however, breast cancer survivors often experience distressing symptoms, including pain, sleep disturbance, anxiety, and fatigue; at the same time, they have less frequent contact with health care providers. Pain commonly co-occurs with other symptoms and the combination of symptoms contribute to the amount of distress experienced by survivors. Previous studies of post-treatment symptoms include primarily urban and white women. AimsThe purpose of this study was to describe the post-treatment cluster of symptoms, to examine the correlations among these symptoms, and to examine the role pain intensity may play in understanding the variation in sleep disturbance, fatigue, and anxiety in a racially diverse sample of rural breast cancer survivors. DesignThe theoretical framework for this descriptive correlational study was the theory of unpleasant symptoms. SettingsOutpatient university-affiliated cancer clinic. Participants/SubjectsForty women who were between 6 months and 5 years post breast cancer diagnosis. MethodsParticipants completed the following self-report instruments: Patient Reported Outcomes Measurement Information System of pain intensity, pain interference, anxiety, and sleep disturbance and the Piper Fatigue Short Form 12. ResultsThe average age of participants was 58 years, and 57.5% were black. Most women reported sleep disturbance (78%), pain interference (68%), and pain intensity (63%) above the national average for an American adult. Black women reported higher pain intensity than whites. There were moderate to strong correlations among the symptoms (range r = 0.35-0.89). ConclusionsNurses and health care providers in primary care settings need to screen for symptoms, and nursing interventions are needed to assist breast cancer survivors to manage distressing symptoms.

Childhood Trauma, Depression Linked to Fatigue in Breast Cancer Survivors

Childhood Trauma, Depression Linked to Fatigue in Breast Cancer Survivors

OR-052 Effects of Exercise Intervention on Cancer-Related Fatigue in Breast Cancer Survivors

Objective cancer-related fatigue(CRF) is the most commonly reported and most distressing symptom in cancer patient.The purpose of this study was to review the effect of exercise intervention on cancer-related fatigue in breast cancer survivors.&#x0D; Methods From 1998 to 2018 in Chinese and English literature of Wanfang Database, Pubmed, SportDiscus and Springer databases, picked out the randomized controlled trials which up to standard. Keywords cancer, exercise, fatigue, etc. were used for systematic search and tracking. 12 experiments were reviewed to analyze the effect differences between exercise intervention and exercise-related fatigue.&#x0D; Results Most interventions use aerobic exercise as the primary form of exercise. Generally, exercise interventions are effective for cancer-related fatigue, but some findings are not. Many studies have shown that moderate intensity aerobic exercise has a significant effect on cancer-related fatigue, with 50-70% heart rate reserve and 3-5 times of exercise per week for at least 30 minutes each time. Exercise methods mainly include walking, yoga, cycling and tai chi. Firstly, Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors. It has been shown that group-based, supervised exercise produces positive psychosocial‘side-effects’ due to social interactions, improved self-efficacy, and attention from a trainer. Secondly, Cancer fatigue is divided into acute and chronic fatigue, 18 weeks of exercise intervention can reduce the short-term fatigue, at 36 weeks, baseline levels of fatigue index responses and contrast on the issue of the multivariate statistics. Thirdly, usual-care group were reported that they had been actively engaged in regular exercise before study enrollment. During the exercise intervention, most studies on the control ways are according to the daily life or to take care of, but studies have reported, before intervention, to a high level of 40% in the control group often exercise, exercise also as usual during the intervention, which causes the control to the baseline level is higher, but the intervention group and control group will be difference, no significant difference, lead to the result is invalid.&#x0D; Conclusions First, the exercise intervention of cancer-related fatigue needs to be supervised; second, the exercise intervention is effective for short-term cancer-related fatigue; third, the daily exercise level of the control group will affect the intervention effect.

1553P - Perception, magnitude and implications of cancer related fatigue in breast cancer survivors: Study from a developing country

Background: Cancer Related Fatigue(CRF) is one of the most common, distressing & incompletely addressed symptom among breast cancer survivors. We have analyzed perceptions, magnitude & overall implications of CRF in breast cancer survivors. Methods: Breast cancer survivors who attended breast cancer follow-up clinic at our institute between Jan-March 2018 were asked to fill a questionnaire. This questionnaire focused on assessing an individual’s perception, severity, potential causes, implications on quality of life and measures taken to deal with CRF. Results: 65 patients (median age 52 years) completed the CRF questionnaire. Of these 54(83%) had undergone surgery, 59(91%) chemotherapy, 43(66%) radiation therapy and 36(55%) hormonal/targeted therapy. 62(95%) patients experienced any grade CRF. 55(85%) patients experienced moderate to severe CRF affecting work (58%) and activities of daily living (27%). CRF was perceived as generalized weakness by 54(83%), diminished concentration/attention span by 24(37%), decreased motivation and interest in usual activities by 29(45%) and emotional labiality by 16(25%) patients. 56(86%) patients believed that fatigue was due to the effect of cancer treatment on the body, while only 8(12%) attributed it to underlying cancer. 21(32%) also attributed it to psycho-social factors and 5(8%) to genetic/environmental factors. CRF had negative impact on mood, daily activities, interpersonal relationships and professional work in 40(62%), 39(60%), 13(20%) and 10(15%) patients, respectively. Measures taken to overcome CRF were increased physical exercise, psychosocial interventions, mind-body interventions and pharmacological interventions in 32(49%), 8(12%), 28(43) and 17(26%) patients, respectively. 39(60%) patients reported persistence of CRF after completion of treatment while it took upto 6 months, 6-12 months and more than 12 months for resolution of CRF in 13, 10 and 3 patients, respectively. Conclusions: Development and persistence of moderate to severe intensity CRF impacts multiple aspects of Quality of Life of breast cancer survivors. Current interventions are not able to substantially mitigate this problem and further research in this field is warranted. Legal entity responsible for the study: Max Institute of Cancer Care, Delhi. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Incidence and Factors Associated With Attentional Fatigue in Working Long-term Breast Cancer Survivors.

The purpose of this study was to examine the incidence of attentional fatigue and the relationship between sleep disturbance and attentional fatigue in working long-term breast cancer survivors (BCS). A descriptive, correlation design was used. The data for this study were drawn from a larger descriptive study designed to understand the impact of cognitive dysfunction on work-related outcomes. Breast cancer survivors completed questionnaires regarding sleep disturbance, attentional fatigue, and demographic and medical characteristics. Sleep disturbance, a subscale of the Pittsburgh Sleep Quality Index, is measured by asking 9 questions about sleep disturbances. Attentional fatigue was measured by the Attentional Function Index. Descriptive statistics and multiple regression were performed to assess the impact of sleep disturbance on attentional fatigue, controlling for covariates. Sixty-eight female BCS, ranging from 29 to 68 years old (mean [SD], 52.1 [8.6] years old) and, on average, 4.97 (SD, 3.36) years posttreatment, participated. Thirty-four percent of BCS had poor to moderate attention function. Sleep disturbance significantly predicted attentional fatigue (P < .05), explaining 16% of the variance, F4,57 = 2.68, P < .04, R = 0.16. Clinicians can assess and intervene to decrease sleep disturbance, which may also improve attentional fatigue in BCS. However, sleep disturbance is only 1 contributing factor. Further investigation into factors contributing to attentional fatigue in BCS is warranted.

Determinants of physical, affective, and cognitive fatigue during breast cancer therapy and 12 months follow-up.

Fatigue is common in cancer survivors but often insufficiently treated. Due to its complexity a one-size-fits-all treatment seems not appropriate. To gain more information on influencing factors and sub-dimensions of fatigue we investigated potential determinants and correlates of physical, affective, and cognitive fatigue in breast cancer survivors during and after adjuvant therapy. Within the follow-up of two randomized controlled trials physical, affective, and cognitive fatigue were repeatedly assessed during and up to 12 months after cancer therapy with the 20-item Fatigue Assessment Questionnaire in 255 breast cancer survivors. Determinants of the different fatigue dimensions over time were explored with linear mixed models. Chemotherapy appeared as significant precipitating factor for physical fatigue. However, type of cancer therapy had no impact on fatigue one year post-treatment. Obesity was significantly associated with increased physical fatigue throughout all time points (Δ=15.5 at 12 months) whereas exercise appeared to be beneficial (Δ = -6.3). In contrast, affective fatigue was significantly associated with poor social support and worries about the future. In addition, poor sleep quality and previous use of psychopharmaceuticals were significantly associated with physical, affective, as well as cognitive fatigue. Further, hot flashes were associated with increased physical and cognitive fatigue. In conclusion, the broad diagnosis 'fatigue' in cancer survivors needs to be recognized as a diversity of symptoms determined by specific characteristics and likely different etiologies. Taking potential influencing factors such as obesity, physical inactivity, sleep problems, hot flashes, lack of social support, or psychological disorders into consideration might enable a better, individually-tailored fatigue treatment.

Long-Term Benefits of Adapted Physical Activity on Upper Limb Performance and Quality of Life in Breast Cancer Survivors

Current evidence suggests that physical activity interventions can improve quality of life, fitness, and strength, reducing depression and fatigue in breast cancer survivors. However, in the long-term many survivors are insufficiently active. Here, the possible long-term benefits of a specific adapted physical activity (APA) intervention on upper limb functional performance and quality of life in breast cancer survivors were investigated. For this purpose, fifteen survivors were assessed by fitness tests (shoulder-arm mobility, range of motion, back flexibility) at the baseline and at eight weeks post-APA intervention. Quality of life and surgical shoulder and back pain intensity were evaluated by Short Form-12 and numerical rating scale questionnaires, respectively. Five participants, who continued to follow the APA protocol over time, were again evaluated after two years and compared to either five women who were inactive or five others who practiced general physical activity after ending the eight-week APA protocol. Shoulder-arm mobility and self-reported questionnaire data revealed the maintenance and/or improvement of the achieved benefits two years after the APA intervention. Our findings suggest that the long-term practice of APA tailored to individual characteristics should be recommended to breast cancer survivors in order to preserve quality of life and fitness.

Abstract 3264: Evaluating heart-hate variability, salivary cortisol and physical activity as predictors of cancer-related fatigue recovery in breast-cancer survivors over a 12 week period by use of a smartphone application

Abstract Introduction Cancer-related fatigue (CRF) is one of the most prevalent and debilitating problems in breast cancer survivors (BCS) that can persist many years beyond successful cancer treatment. Parasympathetic nervous system activity (measured via heart-rate variability; HRV), cortisol dysregulation and decreased physical activity are plausible, but understudied contributors to CRF. Repeated daily measurements of CRF and tracking daily physical activity over a 12-week period should give more information regarding temporal patterns of CRF among BCS. Objective The purpose of this study is 1) to investigate patterns of CRF in fatigued BCS over time; 2) to assess HRV, salivary cortisol and level of physical activity as predictors of cancer-related fatigue (CRF) in BCS over a 12-week period; and 3) to explore whether a smartphone application intervention results in increased daily physical activity, as well as improved HRV, salivary cortisol and CRF in BCS relative to healthy female controls over a 12 week period. Methods A total of 30 fatigued breast cancer survivors (FACIT-F score ≤ 34) and 30 aged-matched female controls will be randomly assigned to either an intervention or control group. Both groups will receive a smartphone application tracking daily physical activity. While the intervention group will receive this application with feedback regarding their daily physical activity, the control groups will receive the application without feedback. Behavioral data will be collected by means of GPS and Wi-Fi for localization, and accelerometer, barometer, magnetometer and gyroscope for activity recognition. HRV and salivary cortisol will be collected at rest, as well as during and after a significant stressor (Trier Social Stress Test). Fatigue will be measured by the FACIT-F Scale, which will be completed at baseline (T1), 4 weeks (T2) and 12 weeks (T3). Group differences will be tested by one-way analysis of variance (ANOVA) and intervention effects will be analyzed using mixed models with repeated measurements. Hypotheses We hypothesize that HRV, cortisol dysregulation and level of physical activity at baseline can predict CRF-recovery over a 12-week period. The smartphone application will be associated with improved physical activity in the BCS intervention group and that changes of physiological correlates of CRF can be observed (i.e., HRV and salivary cortisol). Conclusion This study will examine associations between HRV, salivary cortisol, physical activity and CRF in BCS over time. The results of this study may provide insight into factors that contribute to the development, persistence and/or consequences of CRF by use of an innovative mobile application. Citation Format: Annina Julia Seiler, Vanessa Klaas, Gerhard Tröster, Kyle W. Murdock, Diana A. Chirinos, Luz M. Garcini, Christopher P. Fagundes. Evaluating heart-hate variability, salivary cortisol and physical activity as predictors of cancer-related fatigue recovery in breast-cancer survivors over a 12 week period by use of a smartphone application [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3264. doi:10.1158/1538-7445.AM2017-3264

Brain Connectivity Patterns Dissociate Action of Specific Acupressure Treatments in Fatigued Breast Cancer Survivors.

Persistent fatigue is a pernicious symptom in many cancer survivors. Existing treatments are limited or ineffective and often lack any underlying biologic rationale. Acupressure is emerging as a promising new intervention for persistent cancer-related fatigue; however, the underlying mechanisms of action are unknown. Our previous investigations suggested that fatigued breast cancer survivors have alterations in brain neurochemistry within the posterior insula and disturbed functional connectivity to the default mode network (DMN), as compared to non-fatigued breast cancer survivors. Here, we investigated if insula and DMN connectivity were modulated by self-administered acupressure by randomizing breast cancer survivors (n = 19) to two distinct treatments: relaxing acupressure or stimulating acupressure. All participants underwent proton magnetic resonance spectroscopy of the posterior insula and functional connectivity magnetic resonance imaging at baseline and immediately following 6 weeks of acupressure self-treatment. As compared to baseline measures, relaxing acupressure decreased posterior insula to dorsolateral prefrontal cortex connectivity, whereas stimulating acupressure enhanced this connectivity (p < 0.05 corrected). For relaxing but not stimulating acupressure, reduced connectivity was associated with sleep improvement. In addition, connectivity of the DMN to the superior colliculus was increased with relaxing acupressure and decreased with stimulating acupressure, whereas DMN connectivity to the bilateral pulvinar was increased with stimulating and decreased with relaxing acupressure (p < 0.05 corrected). These data suggest that self-administered acupressure at different acupoints has specificity in relation to their mechanisms of action in fatigued breast cancer survivors.