Female Breast Cancer Survivors Research Articles

Infrared laser moxibustion for cancer-related fatigue in breast cancer survivors: a randomized controlled trial

BackgroundCancer-related fatigue (CRF) is a pervasive, persistent, and distressing symptom experienced by cancer patients, for which few treatments are available. We investigated the efficacy and safety of infrared laser moxibustion (ILM) for improving fatigue in breast cancer survivors.MethodsA three-arm, randomized, sham-controlled clinical trial (6-week intervention plus 12-week observational follow-up) was conducted at a tertiary hospital in Shanghai, China. The female breast cancer survivors with moderate to severe fatigue were randomized 2:2:1 to ILM (n = 56) sham ILM (n = 56), and Waitlist control (WLC)(n = 28) groups. Patients in the ILM and sham ILM (SILM) groups received real or sham ILM treatment, 2 sessions per week for 6 weeks, for a total of 12 sessions. The primary outcome was change in the Brief Fatigue Inventory (BFI) score from baseline to week 6 with follow-up until week 18 assessed in the intention-to-treat population.ResultsBetween June 2018 and July 2021, 273 patients were assessed for eligibility, and 140 patients were finally enrolled and included in the intention-to-treat analysis. Compared with WLC, ILM reduced the average BFI score by 0.9 points (95% CI, 0.3 to 1.6, P = .007) from baseline to week 6, with a difference between the groups of 1.1 points (95% CI, 0.4 to 1.8, P = .002) at week 18. Compared with SILM, ILM treatment resulted in a non-significant reduction in the BFI score (0.4; 95% CI, -0.2 to 0.9, P = .206) from baseline to week 6, while the between-group difference was significant at week 18 (0.7; 95% CI, 0.2 to 1.3, P = .014). No serious adverse events were reported.ConclusionWhile ILM was found to be safe and to significantly reduce fatigue compared with WLC, its promising efficacy against the sham control needs to be verified in future adequately powered trials.Trial registrationClinicaltrials.gov: NCT04144309. Registered 12 June 2018.

Abstract PO2-10-03: Clinical characteristics and survival trends of male breast cancer in the United States: A propensity score matched analysis

Abstract Introduction Male breast cancer (MBC) is extremely rare and represents less than 1% of breast cancer (BC). There are limited studies investigating clinical outcomes of MBC. Although the survival of female breast cancer (FBC) has increased over the years; there is a substantial knowledge gap regarding survival trends of MBC. Given the rarity of MBC, recommendations on the treatment of MBC are scarce and mainly extrapolated from the data from FBC. We aim to analyze the clinical characteristics and annual trend in the survival of MBC compared to FBC. Methods We queried the National Cancer Database for BC patients (pts) diagnosed during 2004-2020. The demographic, clinicopathological and treatment characteristics were summarized by sex. An inverse-propensity weighted cox regression model was used to assess the association between sex and overall survival. Propensity weights were based on age, race, insurance, T, N, M-stages, subtype, grade, chemotherapy (CT), radiation (RT), hormone therapy (HT), and time to definitive treatment. To compare survival trends over time, year of diagnosis and its interaction with sex were included in the model. All analyses were performed at a significance level of 0.05. Results A total of 24, 055 MBC and 2,532,470 FBC pts were identified. MBC pts were older (mean age: 65.6 vs 61.4 years), Blacks (12.8 vs 11.2%) and had more government insurance (55.7% vs 45.8%) compared to FBC (all p< 0.001). Compared with FBC, more MBC pts had stage IV (7% vs 4.7%), fewer pts had stage I (33.4% vs 44.8%), more pts had larger tumors (cT4: 6% vs 3.7%), and node positive disease (18.5% vs 15.5%) (all p< 0.001). MBC were more likely estrogen (ER) (88.5% vs 78.5%) and progesterone receptor (PR) (79.6% vs 68%) positive and less likely HER2 receptor positive (7.9% vs 9.3%) or triple negative (2.8% vs 7.6%) compared to FBC (all p < 0.001). Male pts with BC received less CT (38.7% vs 41.2%), RT (32% vs 52.6%), HT (59.8% vs 62.5%) compared to females with BC (p < 0.001). The overall survival (OS) rates were lower in MBC compared to FBC (5-year: 73% vs 83%; 10-year: 54% vs 70%, p < 0.001). In the propensity weighted cox-regression model, males had higher mortality compared to females with BC (HR 2.8, 95% CI 2.88 - 2.9, p < 0.001). This difference in OS was observed in TNBC (HR 1.2, 95% CI 1.21 - 1.24) and HER2+ (HR 2, 95% CI 1.9 - 2.0), but not in ER/PR+ HER2- BC (HR 0.78, 95% CI 0.78 - 0.79), all p < 0.001. The 5-year and 10-year OS of early-stage MBC and advanced MBC was lower compared to FBC (Early-stage:- 5-year: 77% vs 86%, 10-year: 57% vs 72%, HR 2.9, 95% CI 2.9-2.92; Advanced: 5-year: 23% vs 28%, 10-year: 8% vs 13%, HR 1.14, 95% CI 1.14 – 1.2, both p < 0.001) The 5-year OS rates increased steadily for FBC from 2004-2015; however, the survival rates were not improved for MBC (Table 1) (p-value for interaction of sex and year of diagnosis was 0.02). Conclusion MBC pts have higher mortality rates and poor clinical outcomes compared to FBC pts. We demonstrate that the survival of MBC pts has not improved over the last decade, even after adjusting for clinicopathological and treatment characteristics. These findings suggest the need to investigate personalized treatment interventions for male breast cancer pts, especially given the disparate trends in survival among male and female BC over a period of time. Table 1: Survival trend by sex - overall BC cohort Citation Format: Arya Mariam Roy, Anthony George, Archit Patel, Malak Alharbi, Kristopher Attwood, Shipra Gandhi. Clinical characteristics and survival trends of male breast cancer in the United States: A propensity score matched analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-03.

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

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

Abstract PO1-11-08: Late effects of breast cancer treatment among long term breast cancer survivors in the Carolina Breast Cancer Study

Abstract Background: Improved precision in breast cancer treatment has contributed to better overall survival. Intensive breast cancer treatments may have long-term impacts on survivor quality of life. Survivors may experience late effects including lymphedema, peripheral neuropathy, and cardiotoxicity from surgery, radiation, or chemotherapy. Estimates of the long-term burden of chronic breast cancer related conditions are important for managing the care of survivors. Methods: The Carolina Breast Cancer Study 3 is a population-based study of female breast cancer survivors diagnosed from 2008 to 2013 in North Carolina. Black and younger (< 50 years at diagnosis) women were oversampled. We calculated the cumulative prevalence of self-reporting of ever being diagnosed with lymphedema, peripheral neuropathy, or cardiac/heart problems as a result of breast cancer treatment over a 10-year follow-up period. Prevalence differences (PD) and 95% confidence intervals (CI), adjusted for age and race, were calculated to describe the differences in late effects in relation to patient characteristics (including latent class SES and access to care barriers). Additionally, we assessed racial disparities in the prevalence of late effects. Results: We included 1133 women who completed follow-up assessments at a mean of 11.2 years (SD=0.5) post diagnosis. The sample was predominately diagnosed with early stage (89.2%) and ER+ disease (75.2%). Treatments included lymph node removal ( >5 lymph nodes 57.9%), anthracycline chemotherapy (34.1%), taxane chemotherapy (60.3%), breast conserving surgery (58.7%), and mastectomy (41.0%). The prevalence of self-reporting lymphedema was 39.9% and was more common among younger (< 50 vs ≥50 PD: 10.2%, CI 4.7-15.7) and Black women (vs. White PD: 19.1%, CI 13.5-24.7), and those with fewer access to care barriers (vs more PD: -19.5%, CI -31.1- -8). The prevalence of peripheral neuropathy was 64.9% and was more common among younger (< 50 vs ≥50 PD: 5.6%, CI 0.2-11.0) and Black women (vs. White PD: 16.5%, CI 11.1-21.9), and those of lower SES (high vs low PD: -11.7%, CI -17.6- -5.7). Rural survivors were less likely to report peripheral neuropathy (PD: -9.7%, CI: -17.5- -2.0). Cardiac problems were reported in 16.7% of the sample and were more common among those of high SES (vs. low PD: -7.7%, CI -12.5, -3.0). All three late effects were associated with higher stage disease, ER+ disease, number of lymph nodes removed, anthracycline chemotherapy, and taxane chemotherapy. Both lymphedema and peripheral neuropathy were associated with mastectomy. Lymphedema was associated with trastuzumab use. Peripheral neuropathy was associated with recurrence. In stratified analyses by ER status, Black women were 13.7-28.8% more likely to have lymphedema in both ER+ and ER- disease (ER+ PD Black vs. White: 13.7%, CI 7.9-20.3; ER- PD Black vs. White: 28.8%, CI 18.3-39.3). Similar patterns were seen in analyses stratified by number of lymph nodes removed and by taxane chemotherapy. Other associations were not suggestive of racial disparities; with one exception. Black women were more likely to have cardiac problems at both high and low levels of SES (High Black vs White PD: 2.8%, CI -3.0, 8.6; low Black vs White PD: -7.0%, CI -15.2, 1.2). Conclusions: This study identified patient characteristics associated with an increased burden of late effects. Black and younger women experience a higher burden of lymphedema and peripheral neuropathy. Disease stage, ER status, lymph nodes removed, and chemotherapy received were associated with a higher prevalence of all three late effects and this is consistent with the observation that the burden of late effects increases with factors associated with more advanced stage of disease. Improved surveillance and prevention measures for breast cancer late effects can help improve survivorship care. Citation Format: Rina Yarosh, Hazel Nichols, Rachel Hirschey, Erin Kent, Lisa Carey, Melissa Troester, Eboneé Butler. Late effects of breast cancer treatment among long term breast cancer survivors in the Carolina Breast Cancer Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-08.

Abstract PO3-27-07: Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland

Abstract Background: Weight management is now included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines due to its clinical impact on breast cancer (BC) survivorship outcomes. While numerous individual-level risk factors for weight gain after BC diagnosis have been identified, such as younger age at diagnosis, cancer stage, and cancer treatments (chemotherapy), there are limited data on the impact of neighborhood-level factors associated with weight change postdiagnosis among Black BC survivors. Methods: Utilizing social media recruitment strategies and survivor networks, we recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022, and August 18, 2022. To capture the food environment, we utilized the 2023 Food Environment Index County Health Rankings, which accounts for access to healthy foods due to proximity and income (considering the distance an individual lives from a grocery store or supermarket, locations for health food purchases in most communities, and the inability to access healthy food because of cost barriers). The index ranges from 0 (worst) to 10 (best). Our outcome of postdiagnosis weight gain was calculated as percent weight change from time at diagnosis to time of survey, calculated as ([weight at survey – weight at diagnosis]/weight at diagnosis) × 100. Participants were grouped into mutually exclusive categories of stable weight (within ± 3%) or weight loss (≤-3%) compared to weight gain (≥ 3%). Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for the associations between clinical factors, county-level food environment index, and postdiagnosis weight gain. Results: The average ages at time of survey and at primary BC diagnosis were 58.6 years (standard deviation [SD]= 10.1) and 49.1 years (SD=10.2), respectively. Most women (70%) were diagnosed with invasive BC and only 22% were currently undergoing treatment at the time of the survey. While only 7% reported being obese at the time of BC diagnosis, 54% reported being obese at the time of survey which was on average 9 years post-BC diagnosis; and while 61 women had weight loss or stable weight, 34 women experienced weight gain postdiagnosis. Among the 95 women included in multivariable models who reported weight and height measurements for calculating weight change, women ≥50 years of age at BC diagnosis (versus < 50 years) were 3.43 times more likely to gain weight after diagnosis (95% CI 1.13-11.50). Women living in counties with a Food Environment Index ≥8.8 (median cut-point compared to < 8.8) were significantly less likely to experience weight gain (aOR 0.11; 95% CI 0.01-0.90). Stage and BC treatments were not significantly associated with weight gain. Conclusions: Our study findings demonstrate the importance of evaluating the food environment during BC survivorship and longitudinal monitoring of weight postdiagnosis to mitigate weight gain among Black BC survivors. Our findings will be used to inform a larger prospective study and future interventions among this population. Citation Format: Avonne Connor, Katherine Ho, Kate Dibble, Kala Visvanathan. Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-07.

Perceived work self-efficacy, and characteristics of return to work in women survivors of breast cancer at two reference centers in Colombia

Return to work and permanence in employment of women who survive breast cancer are topics that become important as incidence and survival rates increase. Self-efficacy as a modifiable element is of special interest in this process. The objective of this study is to measure the level of self-efficacy in female breast cancer survivors, according to sociodemographic, work and treatment characteristics and their relationship with return to work. This was a cross-sectional study, based on a survey of breast cancer patients about their demographic and work characteristics, the return to work process, permanence in the same job and the level of work self-efficacy. Differences in the level of self-efficacy with respect to characteristics were evaluated using bivariate analyses and hypothesis statistical testing. A value of p<0.05 was considered statistically significant. One hundred and twenty-four women were included, 87.9% had returned to work, the majority (56.4%) between one and six months after treatment, 67.7% remained in the same job. Higher levels of work self-efficacy were related to a higher probability of returning to work and staying there, and a shorter time to return to work; these differences were statistically significant. Occupational health and risk prevention services must consider and strengthen work self-efficacy and organizational support in breast cancer survivors to achieve a successful return to work.

Abstract 4835: Demographic factors and risk of persistent opioid use in a diverse cohort of breast cancer survivors

Abstract Background: Persistent opioid use (POU), in breast cancer survivors after they have completed active cancer treatment is an emerging area of concern. We examined rates and identified risk with POU in breast cancers survivors in the year after active cancer treatment going forward, and if these risks differed by race/ethnicity. Methods: We assembled a cohort of female breast cancer survivors diagnosed in 2009-2019 treated for early-stage disease (in situ, local, regional), and had at least two opioid prescriptions after one year of survivorship in a large health plan in southern California. Data were captured from the tumor registry, electronic health records, and pharmacy databases. The primary outcome was POU defined as continuously receiving at least 90 days supplied of opioids during follow-up. Patients were followed through the date once they met POU criteria, died, disenrolled from health plan, or reached study’s end (12/31/2021), whichever came first. We calculated rates as the number of patients who experienced POU per 1,000 person-years (PY). We identified the predictors and estimated hazard ratios (HR) associated with POU using multivariable proportional hazard regression and stratified by race/ethnicity. Results: The cohort included 14,347 breast cancer survivors who used opioids followed for a maximum of 12 years (median: 6.6 years). Overall, the cohort was diverse: 9% Asian/Pacific Islander (API); 14% Black; 22% Hispanic; and 54% White women. Out of 14,347 patients who used opioids, 2,285 (16%) patients developed POU. POU rates was the highest in Whites (36.2 per 1,000 PY) compared other race/ethnicity groups including Blacks, Hispanics, APIs (30.7, 17.3, 10.6 per 1,000 PY, respectively). Patients who developed POU had longer annualized median opioid duration, especially in Black patients (175.0 vs. 5.3 days) and were prescribed stronger opioids (median maximum daily morphine milligram equivalent 83.7 vs 50.0), compared to those who did not develop POU. In adjusted analyses of POU risk, Black (HR, 0.81; 95% CI: 0.72-0.92), API (HR, 0.59; 95% CI, 0.52-0.66), and Hispanic women (HR, 0.59; 95% CI, 0.52-0.66) were less likely to develop POU compared to White women. Patients with older age, Elixhauser Comorbidity Index ≥3, smoking, breast cancer stage (regional); type of opioid (Oxycodone); and who used other psychiatric and pain medications had significantly greater POU risk. In stratified analysis, the POU risk was 2.6 times greater (HR, 2.61; 95% CI, 1.32-5.15) in Hispanic patients aged≥65 vs &amp;lt;40 years. The highest HR was in APIs who were current smokers (HR, 4.26; 95% CI, 1.77-10.29) compared with non-smokers. Conclusion: The findings suggest that patients who are older, current smokers, with more comorbidities, and diagnosed with higher cancer stage were most vulnerable to developing POU. Citation Format: Lie Hong Chen, Rulin C. Hechter, Jiaxiao Shi, Zheng Gu, Moira Brady-Rogers, Rowan T. Chlebowski, Reina Haque. Demographic factors and risk of persistent opioid use in a diverse cohort of breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4835.

Abstract 3474: Racial disparities in receipt of surveillance mammography after breast cancer diagnosis

Abstract Background: The 5-year survival rate for breast cancer (BC) stands at an estimated 91%, with approximately 3.8 million BC survivors in the U.S. This large population of breast cancer survivors remains at risk of loco-regional recurrence, with variations noted across racial groups. White survivors face a locoregional breast cancer recurrence rate of 1.8%, whereas Black, Asian, and Hispanic survivors experience higher rates of 3.9%, 3.6%, and 3.1%, respectively. Notably, Black BC survivors with recurrent breast cancer exhibit a median survival time of 1.8 years compared with 3.6 years observed for White BC survivors. Current recommendations from the U.S. Preventative Services Task Force and the American College of Radiology advocate for surveillance through annual mammography and routine clinical visits following breast-conserving surgery and lumpectomies. However, there are gaps in the data available regarding disparities in the utilization of surveillance mammography by race/ethnicity. Thus, the goal of this study is to estimate race/ethnic disparities in surveillance mammography utilization and its impact on survival among breast cancer survivors at a large comprehensive cancer center. Methods: A retrospective cohort study of female breast cancer survivors ≥19 years diagnosed and/or treated at the Duke Cancer Institute (DCI) between 2014 and 2022 was conducted. Data was abstracted on patient socio-demographics, cancer type (invasive ductal and ductal in situ carcinomas) and utilization of surveillance mammography within 2-5 years post initial breast cancer diagnosis. Chi-squared testing will be used to analyze rates of mammography surveillance receipt among different races presenting with BC at DCI. Kaplan-Meier estimates will be used for analysis on survival. Results: A total of 10,904 women with a mean age of 43.7 years were included in the study. The study cohort is comprised of 69% non-Hispanic (NH) White, 24% NH Black, 2.2% Hispanic, 0.5% NH Native American, 1% NH other, and 3.2% NH Asian women. There were 1,791 cases of ductal in situ carcinomas and 9,113 invasive ductal carcinoma cases. NH Black women had the lowest 5-year relative survival rate (81.5%) of all represented racial groups: NH White 89.1%, Hispanic 95.3%, NH Native 87.8%, Asian 97.9%, and NH Other 88.0%. Ongoing analysis will be completed to estimate disparities in the use of post-treatment surveillance mammography amongst breast cancer survivors. Conclusions: This study will inform efforts to increase post-treatment surveillance and improve adherence to survivorship guidelines with the ultimate goal of reducing mortality disparities among breast cancer survivors. Citation Format: Jasmine G. Wilkerson, Frances Wang, Yadurshini Raveendran, Tomi Akinyemiju. Racial disparities in receipt of surveillance mammography after breast cancer diagnosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3474.

Relationship between physical exercise load and return-to-work in female breast cancer survivors

Introduction: Evidence has shown physical exercise leads health benefits in breast cancer survivors, for example reducing return-to-work (RTW) time. However, what exercise component has (if any) the greatest impact on the recovery time after breast cancer. The aim of this study is to determine the exercise load variables (type, frequency, intensity, exercise time, volume, density and progression) that are best associated with recovery time in female breast cancer survivors (measured as time off work). Methods: In this systematic review, we included experimental, cohort, and observational studies of female breast cancer survivors engaging in physical exercise programs. We searched PubMed, Web of Science, Sport Discus, and Scopus (Sep 2021-Sep 2022) using the PICOS strategy and PRISMA 2020 guidelines. Studies were independently screened and data extracted into a database, focusing on exercise variables association with return-to-work time. Methodological quality was assessed using ROB 2.0, considering study design, intervention details, and bias risk. Results: Following screening, seven studies were included in this review, with five defining a minimum of one exercise component. Two studies specified frequency and density, while three defined the type, frequency, volume, intensity, density, and progression of interventions. No study found a direct correlation between exercise components and RTW time. Conclusions: In the literature reviewed in this systematic review, it is not possible to identify which exercise variable(s) have the strongest correlation with RTW outcomes. The existing studies demonstrate a lack of comprehensive intervention descriptions, limiting our understanding of the distinct exercise components and their potential effects on RTW results.

Coping with breast cancer during medical and occupational rehabilitation: a qualitative study of strategies and contextual factors

PurposeThis study aimed to gain a deeper understanding of the coping processes of breast cancer survivors (BCSs) during medical and occupational rehabilitation after acute treatment.MethodsThis study is part of the mixed-methods Breast Cancer Patients’ Return to Work study conducted in Germany. Data were collected through semistructured interviews with 26 female BCSs 5–6 years after their diagnosis. A qualitative content analysis was conducted to investigate the coping strategies and contextual factors of coping of BCSs.ResultsThe participants used different strategies for coping with their breast cancer, namely, approach- versus avoidance-oriented coping and emotion- versus problem-focused coping. During the medical rehabilitation process, coping behavior was used mainly to address disease management and its consequences. During the occupational rehabilitation process, most coping strategies were used to overcome discrepancies between the patient’s current work capacity and the job requirements. The contextual factors of coping were in the health, healthcare, work-related, and personal domains.ConclusionThe study findings provide in-depth insights into the coping processes for BCSs during the rehabilitation phase and highlight the importance of survivorship care after acute cancer treatment.Implications for Cancer survivorsThe results indicate that BCSs employ approach- and avoidance-oriented strategies to cope with their cancer during rehabilitation. As both attempts are helpful in the short term to cope with physical and emotional consequences of the cancer, healthcare and psychosocial personnel should respect the coping strategies of BCSs while also being aware of the potential long-term negative impact of avoidance-oriented coping on the rehabilitation process.

Effect of chemotherapy on hippocampal volume and shape in older long-term breast cancer survivors.

The objective of this study was to assess changes in hippocampal volume and shape in older long-term breast cancer survivors who were exposed to chemotherapy 5-15 years prior. This study recruited female long-term breast cancer survivors aged 65 years or older with a history of chemotherapy (C+), age-matched breast cancer survivors who did not receive chemotherapy (C-), and healthy controls (HC). The participants were recruited 5-15 years after chemotherapy at time point 1 (TP1) and were followed up for 2 years at time point 2 (TP2). Assessments included hippocampal volume and shape from brain MRI scans and neuropsychological (NP) tests. At TP1, each of the three groups was comprised of 20 participants. The C+ group exhibited a hippocampal volume loss estimated in proportion with total intracranial volume (ICV) in both the left and right hemispheres from TP1 to TP2. Regarding the hippocampal shape at TP1, the C+ group displayed inward changes compared to the control groups. Within the C+ group, changes in right hippocampal volume adjusted with ICV were positively correlated with crystalized composite scores (R = 0.450, p = 0.044). Additionally, in C+ groups, chronological age was negatively correlated with right hippocampal volume adjusted with ICV (R = -0.585, p = 0.007). The observed hippocampal volume reduction and inward shape deformation within the C+ group may serve as neural basis for cognitive changes in older long-term breast cancer survivors with history of chemotherapy treatment.

Investigating fear of cancer recurrence among female breast cancer survivors and their spouses in southwest China: a cross-sectional study

ObjectivesExamining fear of cancer recurrence (FCR) among breast cancer survivors and their spouses, and the protective effect of family resilience on FCR among couples affected by breast cancer.DesignCross-sectional survey design.SettingTen...

Efficacy of a Home-Based, Unsupervised Physical Activity Program on Fatigue, Sleep Quality, and Quality of Life in Survivors of Breast Cancer.

Women with breast cancer (BC) experience symptoms related to fatigue, sleep quality, and quality of life (QOL) in the post- treatment period. Oncology nurses need to plan interventions such as physical activity (PA) aimed at reducing the symptoms experienced by patients. The aim of this article is to determine the efficacy of a home-based, unsupervised PA program on fatigue, sleep quality, and QOL in survivors of BC. This study was an experimental study with a prospective control group. Female survivors of BC were randomly assigned to either the home-based, unsupervised PA intervention group or the control group for 12 weeks. Fatigue, sleep quality, and QOL were assessed with questionnaires at baseline and the 12th week. The home-based, unsupervised PA program yielded positive effects on fatigue and QOL among participants. The program did not affect sleep quality.

Effect of physical activity on the relationship between adiposity and cardiac autonomic modulation in female breast cancer survivors: a longitudinal study

ABSTRACT This longitudinal study aimed to analyze the influence of physical activity (PA) on the relationship between body adiposity and cardiac autonomic modulation (CAM) in women survivors of breast cancer. We collected body adiposity through electrical bioimpedance considering body fat percentage (BFP), CAM through heart rate variability (considering RMSSD, SDNN, PNN50, LF (m2), HF (m2), SD1 indexes and SD1/SD2 ratio) and PA through a questionnaire in 64 participants (58.0 ± 9.6 years), recruited through the local association of support for breast cancer and by direct indications from city mastologists. After insertion of PA into the multivariate statistical model, significant attenuation was observed in the relationship between body adiposity and CAM for the indices: SDNN (β = −0.94; 95 percent CI: −1.93; 0.04; p = .060) and SD1/SD2 (β = −0.01;95 percent CI = −0.02; 0.001; p = .065). In conclusion, it was observed that PA was able to mitigate the relationships between BFP and CAM (considering SDNN index and SD1/SD2 ratio) in breast cancer survivors.

Suffering and adjustment: a grounded theory of the process of coping with financial toxicity among young women with breast cancer.

To explore the process of coping with financial toxicity among young women with breast cancer and formulate a grounded theory that serves as a foundation for creating intervention strategies aimed at supporting cancer survivors. A qualitative study using the Corbin and Strauss variant of grounded theory. A series of in-depth interviews were carried out with young women with breast cancer (n = 29) using the theoretical sampling method. We analyzed data by coding core categories in the patients' coping processes and developing theory around these categories. Data collection and analysis were performed simultaneously. A substantial theory of the process of coping with financial toxicity among young female breast cancer survivors was constructed. Two core concepts, suffering and adjustment, were identified. Young women with breast cancer suffered from financial toxicity, which was related to risk factors, coping resources, and unmet needs. To overcome financial toxicity, young women with breast cancer adjusted by reshaping consumption concept, re-dividing of family functions, re-planning of occupation career, and rebuilding life confidence. This qualitative study constructed a theory delineating the coping strategies employed by young women with breast cancer in response to financial toxicity, offering profound insights into the intricacies of cancer-related financial toxicity. Identifying risk factors, enhancing coping resources, and meeting unmet needs would be helpful to patients' adjustment to financial stress.

Association between trajectories of prescription opioid use and risk of opioid use disorder and overdose among US nonmetastatic breast cancer survivors.

To examine the association between prescription opioid use trajectories and risk of opioid use disorder (OUD) or overdose among nonmetastatic breast cancer survivors by treatment type. This retrospective cohort study included female nonmetastatic breast cancer survivors with at least 1 opioid prescription fill in 2010-2019 Surveillance, Epidemiology and End Results linked Medicare data. Opioid mean daily morphine milligram equivalents (MME) calculated within 1.5years after initiating active breast cancer therapy. Group-based trajectory models identified distinct opioid use trajectory patterns. Risk of time to first OUD/overdose event within 1year after the trajectory period was calculated for distinct trajectory groups using Cox proportional hazards models. Analyses were stratified by treatment type. Four opioid use trajectories were identified for each treatment group. For 38,030 survivors with systemic endocrine therapy, 3 trajectories were associated with increased OUD/overdose risk compared with early discontinuation: minimal dose (< 5 MME; adjusted hazard ratio [aHR] = 1.73 [95% CI 1.43-2.09]), very low dose (5-25 MME; 2.67 [2.05-3.48]), and moderate dose (51-90 MME; 6.20 [4.69-8.19]). For 9477 survivors with adjuvant chemotherapy, low-dose opioid use was associated with higher OUD/overdose risk (aHR = 7.33 [95% CI 2.52-21.31]) compared with early discontinuation. For 3513 survivors with neoadjuvant chemotherapy, the differences in OUD/OD risks across the 4 trajectories were not significant. Among Medicare nonmetastatic breast cancer survivors receiving systemic endocrine therapy or adjuvant chemotherapy, compared with early discontinuation, low-dose or moderate-dose opioid use were associated with six- to sevenfold higher OUD/overdose risk. Breast cancer survivors at high-risk of OUD/overdose may benefit from targeted interventions (e.g., pain clinic referral).

Exploring long-term breast cancer survivors' care trajectories using dynamic time warping-based unsupervised clustering.

Long-term breast cancer survivors (BCS) constitute a complex group of patients, whose number is estimated to continue rising, such that, a dedicated long-term clinical follow-up is necessary. A dynamic time warping-based unsupervised clustering methodology is presented in this article for the identification of temporal patterns in the care trajectories of 6214 female BCS of a large longitudinal retrospective cohort of Spain. The extracted care-transition patterns are graphically represented using directed network diagrams with aggregated patient and time information. A control group consisting of 12412 females without breast cancer is also used for comparison. The use of radiology and hospital admission are explored as patterns of special interest. In the generated networks, a more intense and complex use of certain healthcare services (eg, radiology, outpatient care, hospital admission) is shown and quantified for the BCS. Higher mortality rates and numbers of comorbidities are observed in various transitions and compared with non-breast cancer. It is also demonstrated how a wealth of patient and time information can be revealed from individual service transitions. The presented methodology permits the identification and descriptive visualization of temporal patterns of the usage of healthcare services by the BCS, that otherwise would remain hidden in the trajectories. The results could provide the basis for better understanding the BCS' circulation through the health system, with a view to more efficiently predicting their forthcoming needs and thus designing more effective personalized survivorship care plans.

Work Ability, Anxiety, and Depression among Long-Term Breast Cancer Survivors of Northern Kerala, India; A Historical Cohort Study.

Increasing number of breast cancer cases, and improved survival due to advancements in early detection, and treatment resulted in an increase in women living beyond a cancer diagnosis. Survivors have to face long-term physical effects as well as psychosocial issues post-treatment. This study aims to study survivourship in terms of work ability, anxiety and depression. Retrospective cohort study on female breast cancer survivors from Hospital Based Cancer Registry (HBCR) of a Tertiary Cancer Centre (TCC). Data from 2016 (n=534) were collected from the medical records, and a follow-up survey (n=209) was conducted in 2022 to study their survivorship issues. In 2022, the mean age of the cohort (n=209) was 55.45 ± 9.36. The mean work ability score was 40.7±5.73 (95% CI 39.92 to 41.48). In the multivariate binary logistic regression model, those who were married (OR 7.15, 95%CI 2.61 to 19.55), disease-free (OR 15.27, 95% CI 2.36 to 98.7), employed (OR 9.09, 95%CI 1.12 to 73.5), having no fatigue (OR 2.6, 95% CI 1.05 to 6.48), no pain (OR 3.11, 95% CI 1.16 to 8.35), and no depression (OR 6.58, 95% CI 1.82-23.8) were found to have optimal work ability. Anxiety (OR 4.93, 95% CI 1.76 to 13.76), and sub-optimal work ability (OR 4.22, 95% CI 1.39 to 12.77) were predictors of depression among survivors. Disease status and fatigue were associated with all three dimensions of survivorship in our study. Understanding survivorship will help improve health outcomes in this population. In our study, work ability, anxiety, depression, and their associated factors were found to be interrelated. Interventions in these areas can go a long way in improving breast cancer survivorship.

Effect of perceived injustice-targeted pain neuroscience education compared with biomedically focused education in breast cancer survivors: a study protocol for a multicentre randomised controlled trial (BCS-PI trial)

IntroductionCurrent treatments for pain in breast cancer survivors (BCSs) are mostly biomedically focused rather than biopsychosocially driven. However, 22% of BCSs with pain are experiencing perceived injustice, which is a...

Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study.

Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments. The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up. Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models. On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; β=-112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; β=-101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; β=-.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; β=-1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; β=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; β=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; β=-4.78; P=.02). This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors.