Functional Assessment Of Cancer Therapy-Breast Research Articles

Abstract PO2-11-07: Early Integration of Exercise into Breast Cancer Care: The MSK Healthy Living Program

Abstract Background: In patients with early-stage breast cancer, quality of life (QoL) worsens within 3-6 months following diagnosis. Physical activity (PA) can mitigate the adverse effects of treatment and improve QoL, and low PA level is associated with cancer recurrence and mortality. However, PA interventions are not included in standard cancer care. Early intervention to increase PA levels may improve QoL during active cancer therapy. The Healthy Living Program (HLP) at Memorial Sloan Kettering Cancer Center (MSK) is a lifestyle and survivorship program that engages early-stage breast cancer patients at the time of diagnosis using lifestyle risk stratification and matched referrals. We investigated whether early exercise intervention through the MSK HLP impacts QoL within the first months after cancer diagnosis. Methods: At the time of diagnosis, patients complete a lifestyle questionnaire (LQ), which is a composite of validated instruments, including the Godin Leisure Time Exercise Questionnaire (GLTEQ). Patients not meeting PA guidelines per the GLTEQ are offered a referral to an exercise physiologist (EP). The EP creates an individualized, home-based exercise program using the FITT Principle (Frequency, Intensity, Time, and Type). Patients meet with the EP every 4 weeks for 16 weeks; if exercise recommendations continue to be unmet, the program is extended. The Functional Assessment of Cancer Therapy-Breast (FACT-B) and 36-Item Short Form Survey Instrument (SF-36) were completed at baseline and the 16-week follow-up. Results: 252 patients enrolled between April 2020 – February 2023, of whom 92 volunteered to complete the QoL assessments. Median age was 53 years [range 23-84]; 12/252 (13.0%) of patients had ductal carcinoma in situ, 60/252 (65.2%) had Stage 1 disease, 17/252 (18.5%) had Stage 2 disease, and 3/252 (3.1%) had Stage 3 disease. 29/252 (31.5%) received chemotherapy, 62/252 (67.4%) received radiation, and 79/252 (85.9%) received hormone therapy. The mean baseline FACT scores were FACT-B: 116, FACT-G: 87, and FACT-B Trial Outcome Index (TOI): 73. At the 16-week follow-up, all QOL scores remained stable from baseline (means FACT-B: 118, FACT-G: 89, and TOI: 75). Improvements were observed among the subscales of the SF-36 from baseline to follow-up. The largest improvements were observed in physical and emotional role function scores, with 22% and 13% improvements from baseline to follow-up, respectively. Conclusions: A clinically implemented exercise intervention embedded in standard of care prevented decreases in QoL and improved physical and emotional functioning during the initial course of adjuvant breast cancer therapy. These findings support early implementation of lifestyle modification after a breast cancer diagnosis. Citation Format: Kylie Rowed, Sherry Shen, Andrea Smith, Bridget Kelly, Rocco Magnoli, Stacie Corcoran, Melissa Emerzian, Cynthia Cruz, Erica Salehi, Cara Anselmo, Mark Robson, Neil Iyengar. Early Integration of Exercise into Breast Cancer Care: The MSK Healthy Living Program [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 PO2-11-07.

Abstract PS02-09: Nurse-led individualized follow-up versus regular physician-led visits after early breast cancer (MyHealth) - a randomized, controlled trial

Abstract Background: Follow-up after breast cancer with regular specialist-led visits has failed to prove superiority over other strategies in terms of recurrence detection and survival, but it is still a cornerstone in breast cancer follow-up in many healthcare systems. Follow-up provided by the general practitioner or a specialist nurse has been reported more cost-effective and non-inferior in terms of patient-reported health-related quality of life (HRQoL) and in meeting the needs of breast cancer survivors. However, no follow-up strategies have demonstrated indisputable superiority over other strategies. Methods: In this randomized controlled trial (MyHealth), patients who recently completed surgery, and chemo-/radiotherapy if indicated, for stage I–II breast cancer were randomly assigned to intervention or control follow-up at Zealand University Hospital, Denmark. The nurse-led intervention comprised three to five individual self-management sessions during the first six months, and regular reporting of symptoms with nurse navigation to relevant healthcare services during three years of follow-up. The control comprised outpatient visits with oncologist every six months for three years. The primary outcome was breast cancer-specific HRQoL measured by the Trial Outcome Index-Physical/Functional/Breast (TOI-PFB) summary score of the Functional Assessment of Cancer Therapy-Breast (FACT-B) two years after randomization. Secondary outcomes were fear of recurrence, anxiety, depression, and healthcare utilization. Results: From January 2017 to January 2019, 503 patients were randomly assigned to intervention (n=251) or control (n=252) follow-up. At two years, patients in the intervention group reported a significantly higher HRQoL (mean 75·69 (SD 12·27)) than patients in the control group (mean 71·26 (SD 14·08)), a mean difference of 5·05 (95% CI; 3·30–6·79), which is considered clinically relevant. The intervention group also reported significantly less fear of recurrence, anxiety, and depression as shown in Table 1. Furthermore, patients in the intervention group had fewer physician consultations but more nurse contacts, and an unchanged diagnostic imaging pattern as shown in Table 2. The effect on all outcomes was stable through three years of follow up. Conclusions: The MyHealth study suggests a new strategy for follow-up after early breast cancer providing significant improvements in HRQoL, fear of recurrence, anxiety, and depression without inflicting extra expenses to the healthcare system. (Funded by the Danish Cancer Society, Region Zealand and Copenhagen University Hospital; Clinicaltrials.gov number; NCT02949167.) Table 1: Outcome findings by study group at baseline, 6, 12, 24, and 36 months Data are mean (SD) unless otherwise stated. The effect estimates are based on the mixed model assuming no difference between groups at baseline. The QoL and fear of recurrence variables are continuous, and the estimates describe the mean difference in score between patients in the two groups. For anxiety and depression, data were zero-inflated. These estimates describe the exponential coefficients of anxiety and depression scores in the intervention group compared to the control group. Cohen’s d is a measure of effect size, and interpreted as small for Cohen’s d = 0·2, medium for Cohen’s d = 0·5, and large for Cohen’s d = 0·8 Table 2: Number of contacts and diagnostic imaging examinations during the first three years of follow-up by study group Data are numbers and mean (SD) per patient during the first three years of follow-up. 1 Most telephone consultations were scheduled as outpatient visits according to the protocol, but changed to telephone consultations due to the COVID-19 pandemic Citation Format: Lena Saltbæk, Pernille Bidstrup, Randi Karlsen, Beverley Høeg, Trine Horsboel, Federica Belmonte, Elisabeth Andersen, Vibeke Zoffmann, Anne Friberg, Mads Svendsen, Helle Christensen, Vesna Glavicic, Dorte Nielsen, Susanne Dalton, Christoffer Johansen. Nurse-led individualized follow-up versus regular physician-led visits after early breast cancer (MyHealth) - a randomized, controlled trial [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 PS02-09.

Abstract PO3-11-03: A Randomized Controlled Trial to Assess the Benefit of Art & Music Therapy on Quality of Life in Patient with Breast Cancer

Abstract Introduction: Quality of life (QoL) in oncology captures the well-being of a patient and is considered a significant outcome criterion. Breast cancer (BC) is the most diagnosed cancer in women, however, standardizing integrative therapies to alleviate the burden of cancer and improve QoL is still an unmet need. Art and music therapy might mitigate psychological and emotional distress. We sought to evaluate their efficacy compared to control among patients with BC during or after active therapy. Methods: Seventy-six treated patients with Stages I-III BC were randomly assigned to art, music therapy, or routine oncology care standard of care arm (SOC) for 3 months and received two sessions per month by a licensed therapist (including in-person/virtual and group sessions). The primary outcome was an improvement in QoL measured by the Functional Assessment of Cancer Therapy–Breast (FACT-B) questionnaire and secondary outcomes included: cognitive function measured by Functional Assessment of Cancer Therapy–Cognition (FACT-Cog), response to a 4-component Cleveland Clinic Visual Analog Scale (CCVAS), indicators of anxiety and depression assessed by the Generalized Anxiety Disorder-7 item (GAD-7) and Patient Health Questionnaire-9 item (PHQ-9). All questionnaires were assessed at baseline, 30, 90, and 180 days. Statistical considerations included stratified randomization, and a mean difference in 15 points between either of the interventions. SOC arm was considered relevant at the 3-month mark. Mean improvement within groups was performed using paired t-tests whereas independent t-tests were used to evaluate mean improvement between interventions (1 or 2 vs. SOC arm). All analyses were performed using SPSS version 26 (IBM, Armonk, NY). Results: Forty-five participants completed the study to date and were included in the interim analysis. Median age was 58 (57-59), white race (51.1%), patients on active treatment (45%), art therapy group (n=16), music therapy (n=15) and standard of care (n=14). Significant improvement was noted in the art therapy arm at 3 months in FACT-B physical well-being (p=0.04), functional well-being (p=0.008) domains as well as GAD-7 (p=0.003), PHQ-9 (p=0.04) and FACT-Cog section “impact on quality of life” (p=0.03). At 6 months, the art therapy arm demonstrated lower scores in the CCVAS questionnaire total score, emotional distress (p=0.01) and anxiety (p=0.004) scales. Music therapy participants reported a significant improvement only in GAD-7 index(p=0.04) at 3 and 6 months compared to SOC. No significant difference was found between art and music therapy arms. Conclusion: Art therapy patients exhibited significant improvement in overall QoL (including anxiety, depression, improvement in cognitive function) and 4-scale CCVAS (emotional distress, anxiety, depression, and pain). Music therapy improved anxiety scores (GAD-7). Art and music therapy should be considered in the care of patients to manage cancer associated distress and improve their quality of life. Table 1. Comparison of test changes from 3 months to baseline within groups Table 2. Comparison of test changes from 6 months to baseline within groups Citation Format: Maria Herran, Mohamed Mohanna, Saad Sabbagh, Barbara Dominguez, Kaylee Sarna, Rachel Upton-Rice, Angie Burdine, Zeina Nahleh. A Randomized Controlled Trial to Assess the Benefit of Art & Music Therapy on Quality of Life in Patient with Breast Cancer [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 PO3-11-03.

Validation of Patient-Reported Outcomes in Patients With Nonmetastatic Breast Cancer Receiving Comprehensive Nodal Irradiation in the RadComp Trial

Our purpose was to evaluate the measurement properties of patient-reported outcome (PRO) measures used in the ongoing RadComp pragmatic randomized clinical trial (PRCT). The deidentified and blinded data set included 774 English-speaking female participants who completed their 6-month posttreatment assessment. Eleven PRO measures were evaluated, including the Trial Outcome Index from the Functional Assessment of Cancer Therapy-Breast (FACT-B), Satisfaction with Breast Cosmetic Outcomes, the BREAST-Q, and selected Patient-Reported Outcomes Measurement Information System (PROMIS) measures. PROs were measured at 3 timepoints: baseline, completion of radiation therapy (RT), and 6 months post-RT. Ten variables were used as validity anchors. Pearson or Spearman correlations were calculated between PROs and convergent validity indicators. Mean PRO differences between clinically distinct categories were compared with analysis of variance methods (known-groups validity). PRO change scores were mapped to change in other variables (sensitivity to change). Most correlations between PROs and validity indicators were large (≥0.5). Mean score for Satisfaction with Breast Cosmetic Outcomes was higher (better) for those with a lumpectomy compared with those with a mastectomy (P < .001). Mean scores for the FACT-B Trial Outcome Index and for PROMIS Fatigue and Ability to Participate in Social Roles and Activities were better for those with good baseline performance status compared with those with poorer baseline performance status (P < .05). At completion of RT and post-RT, mean scores for Satisfaction with Breast Cosmetic Outcomes and BREAST-Q Radiation were significantly different (P < .001) across categories for all Functional Assessment of Chronic Illness Therapy -Treatment Satisfaction - General items. There were medium-sized correlations between change scores for FACT-B Trial Outcome Index, Fatigue, Anxiety, and Ability to Participate in Social Roles and change scores in the Visual Analog Scale. For patients with nonmetastatic breast cancer receiving radiation in the RadComp PRCT, our findings demonstrate high reliability and validity for important PRO measures, supporting their psychometric strength and usefulness to reflect the effect of RT on health-related quality of life.

Emotional and functional well-being in long-term breast cancer survivorship.

Emotional and functional well-being (EWB and FWB) are important components of mental health and quality of life. This study aims to evaluate long-term EWB and FWB in breast cancer (BC) survivors. The Carolina Breast Cancer Study Phase 3 oversampled Black and younger (< 50years in age) women so that they each represent approximately 50% of the study population and assessed participants' EWB and FWB with the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5- (baseline), 25-, and 84-months post diagnosis. Multinomial logit models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and well-being change relative to baseline. Among 2,781 participants with BC, average EWB and FWB improved with time since diagnosis. Persistent FWB decrements were associated with Black race [OR 1.4 (95% CI 1.2-1.7) and 1.3 (95% CI 1.1-1.6), at 25-months and 84-months respectively], older age [OR 1.4 (95% CI 1.1-1.7) and 1.5 (95% CI 1.2-1.8), respectively], no chemotherapy, and recurrence [OR 2.9 (95% CI 1.8-4.8) and 3.1 (95% CI 2.1-4.6), respectively]. EWB decrements were associated with advanced stage and recurrence. Decrements in combined (FWB+EWB) well-being were associated with recurrence at both follow-up survey timepoints [ORs 4.7 (95% CI 2.7-8.0) and 4.3 (95% CI 2.8-6.6), respectively]. Long-term well-being varies by demographics and clinical features, with Black women and women with aggressive disease at greatest risk of long-term decrements.

Perceived control, self-management efficacy, and quality of life in patients treated with radiation therapy for breast cancer: a longitudinal study.

This longitudinal study aims to examine the present state of perceived control, self-management efficacy, and overall quality of life (QoL) in patients with breast cancer undergoing radiotherapy, and gain insight into the dynamic trends and factors that influence the quality of life experienced by patients during the course of radiotherapy. Participants completed the Cancer Experience and Efficacy Scale (CEES), Strategies Used by People to Promote Health (SUPPH), and Functional Assessment of Cancer Therapy- Breast (FACT-B). The data was analyzed using the software SPSS26.0. Repeated measures analysis of variance (ANOVA) and mixed-effects linear models were used to analyze trends in perceived control, self-management efficacy, and QoL at three-time points, as well as factors affecting QoL during radiotherapy. Perceived control and self-management efficacy were associated with QoL over the course of the radiotherapy. Self-management efficacy (β = 0.30, P < 0.001), presence of chemotherapy (β = 18.33, P = 0.024), and duration of illness (β = 2.25, P = 0.028) had a positive effect on the change in QoL, while time (β = - 2.95, P < 0.001), cancer experience (β = - 0.46, P < 0.001), and type of medical insurance (β = - 2.77, P = 0.021) had the negative effect on the change in QoL. The QoL, perceived control, and self-efficacy of patients with breast cancer show dynamic changes during radiotherapy. The higher the self-efficacy, the better the QoL, and the worse the QoL when the sense of disease control is poor. At the same time, more attention should be paid to the QoL of breast cancer radiotherapy patients with a long course of the disease, receiving chemotherapy, and different medical payment methods.

The Impact of Fear of Cancer Recurrence on the Quality of Life in Breast Cancer Patients: A Longitudinal Study of the Mediation Effect of Cortisol and Hope

ObjectiveThis longitudinal study sought to explore the impact of cortisol and hope levels on Fear of Cancer Recurrence (FCR) and Quality of Life (QOL) in a cohort of 552 breast cancer patients from three centers in Wuhan City. MethodA longitudinal study involving 552 breast cancer patients from three centers in Wuhan City utilized Chinese versions of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Herth Hope Index (HHI), and the Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. Cortisol levels were measured thrice daily, and data was collected longitudinally three times. Data analysis was conducted using SPSS 26.0 and Mplus 8.3, employing a longitudinal path model constructed via the cross-lagged method. ResultsThe results showed there were significant correlations between FCR, cortisol levels, and QOL at different time points. A significant mediating model was found with outcomes related to hope levels. Specifically, FCR predicted a decrease in hope levels (β = -0.163, p < 0.001), which in turn led to a decrease in overall QOL (β = -0.078, p < 0.001), with a mediation effect accounting for 10.34%. Although there were correlations between FCR, cortisol levels, and QOL at different time points, further analysis revealed that cortisol levels did not exhibit a mediating effect between the two (95% confidence interval: -0.002 to 0.001). ConclusionThis study demonstrated there were significant correlations among FCR, QOL, and hope levels. Considering hope as a crucial mediator between FCR and QOL, potential intervention strategies for optimizing the QOL of breast cancer patients are proposed.

Nurse-Led Individualized Follow-Up Versus Regular Physician-Led Visits After Early Breast Cancer (MyHealth): A Phase III Randomized, Controlled Trial.

Follow-up after breast cancer with regular visits has failed to detect recurrences, be cost-effective, and address patient needs. MyHealth is a phase III randomized controlled trial (ClinicalTrials.gov identifier: NCT02949167). Patients, who recently completed primary treatment for stage I-II breast cancer, were randomly assigned in variable block sizes and stratified by age and human epidermal growth factor receptor 2 status to intervention or control follow-up. The nurse-led intervention comprised three to five individual self-management sessions, regular reporting of symptoms, and navigation to health care services. The control follow-up comprised regular outpatient visits with the physician. The primary outcome was breast cancer-specific quality of life (QoL) measured by the Trial Outcome Index-Physical/Functional/Breast summary score of the Functional Assessment of Cancer Therapy-Breast 2 years after random assignment. Secondary outcomes were fear of recurrence, anxiety, depression, and health care utilization. Analyses were intention-to-treat and P values were two-sided with 95% confidence level set at 0.005 because of multiple comparisons. Among 1,101 eligible patients, 875 were invited and 503 were randomly assigned to control (n = 252) or intervention (n = 251) follow-up. At 2 years, patients in the intervention group reported a significantly and clinically relevant higher QoL (mean, 75.69 [standard deviation [SD], 12.27]) than patients in the control group (71.26 [SD, 14.08]), with a mean difference of 5.05 (95% CI, 3.30 to 6.79; P < .001). The intervention group reported significantly less fear of recurrence, anxiety, and depression; they had fewer physician consultations but more nurse contacts and an unchanged diagnostic imaging pattern. The effect on all outcomes was stable through a 3-year follow-up. The MyHealth study suggested a new strategy for follow-up after early breast cancer as it provided significant improvements in QoL.

A WeChat-based nursing intervention program improves the postoperative rehabilitation of breast cancer patients: results from a randomized controlled trial.

In postoperative setting, breast cancer (BC) patients can experience adverse effects, including fatigue, sleep disorders, and pain, which substantially affect their health-related quality of life (HRQoL). This study sought to assess the effectiveness of a WeChat-based multimodal nursing program (WCBMNP) that was specifically designed for the rehabilitation of women following BC surgery. BC patients were randomly, single-blinded allocated to either the intervention (n=62) or control (n=63) cohorts. Over a period of 6 months (24 weeks), the intervention cohort received a WCBMNP in addition to routine nursing care, while the control cohort received routine nursing care only. To evaluate patients' fear of cancer recurrence (FCR), their overall fear score was assessed using the Japanese version of the Concerns About Recurrence Scale (CARS-J) for primary outcome. The initial outcome (HRQoL) and secondary results, such as fatigue, sleep, and pain, were examined using the Functional Assessment of Cancer Therapy-Breast (FACT-B, version 4.0) and Nursing Rating Scale (NRS), respectively. Two hundred and ten participants, 85 participants were excluded. Compared to the controls (n=63), the intervention cohort (n=62) showed statistically significant improvements in their CARS-J scores. The intervention cohort aggregate scores on the FACT-B improved significantly but were affected by the compounding influences of cohort dynamics, temporal progression, and their interaction. Similar improvements were observed in the social/family and functional well-being domains. Emotional well-being was improved based on the effects of time and group-time interaction. In the intervention cohort, the "BC-specific subscale for additional concerns" was affected by group and time, whereas physical well-being was only affected by time. Conversely, there were no statistically significant changes in the variables of fatigue, sleep, and pain. The WCBMNP reduced FCR and significantly increased the HRQoL of female patients with BC postoperatively. The WCBMNP could be implemented as a postoperative rehabilitation intervention in this patient population to improve outcomes. Chinese Clinical Trial Registry (ChiCTR2400081557).

A prospective longitudinal study of post-traumatic stress symptoms and its risk factors in newly diagnosed female breast cancer patients

BackgroundPost-traumatic stress symptoms are one of the most commonest, but un-recognized psychological morbidity found in female breast cancer patients. However, there are insufficient prospective studies concerning the trajectory of post-traumatic stress symptoms and their risk factors in Nigerian women living with breast cancer.ObjectiveTo determine the changes in the prevalence and risk factors of post-traumatic stress symptoms among newly diagnosed female breast cancer patients across different timelines over 6 months.MethodThis was a prospective longitudinal study of 183 newly diagnosed female breast cancer patients selected using a systematic random sampling method. The Six-Item Impact of Events Scale, Visual Analogue Scale of Pain, Functional Assessment of Cancer Therapy-Breast, and a Socio-Demographic questionnaire were administered to the participants.ResultsThe prevalence of post-traumatic stress symptoms was 46%, 31%, and 22% at baseline, 3 months, and 6 months respectively, indicating a decline in post-traumatic stress symptoms over time. In the final assessment at 6 months, identified risk factors of post-traumatic stress symptoms were: religiosity, accessibility to treatment, illness perception, chemotherapy, and quality of life.ConclusionPost-traumatic stress symptoms are prevalent in newly diagnosed female breast cancer patients, there is a need for regular screening of these symptoms in these women to allow for early psycho-social intervention, and better treatment outcomes.

Abstract B144: Associations between experiences of discrimination and quality of life in a cohort of Black/African American breast cancer survivors

Abstract Introduction: Racism and discrimination have been associated with poorer mental and physical health, and decreased health-related quality of life (QoL) in the general population, however; there are limited studies examining the impact of discrimination in cancer survivors. We examined the relationship between experiences of discrimination and QoL in Black women diagnosed with breast cancer. Methods: Data were obtained from women enrolled in the Women’s Circle of Health Follow-up Study, a population-based cohort study of Black breast cancer survivors in New Jersey, enrolled within 10 months of diagnosis. Women included in these analyses were diagnosed between 2015-2019. Self-reported experiences of discrimination along with information on potential covariates and effect modifiers were collected during baseline in-person interviews. QoL was assessed at follow-up visits approximately 24 months post-diagnosis using a validated self-reported QoL of measure, the Functional Assessment of Cancer Therapy – Breast (FACT-B), which consists of 5 individual domains (emotional, functional, social/family, and physical wellbeing, as well as a disease specific domain for breast cancer). We examined the association of experiences of discrimination (none, low (&amp;lt;median 43%), high (≥ median 43%)) with continuous total QoL score using linear regression, adjusted for age at diagnosis, tumor stage, educational attainment, household income, smoking status, insurance, and body mass index. We also examined statistical interaction by neighborhood socioeconomic index (nSES), coping strategy (assessed using the Brief Resilient Coping Scale), and spirituality (assessed using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (FACIT-Sp-12) scale) using cross-product terms with experiences of discrimination. Results: Of 220 study participants, 73% of participants reported experiencing any discrimination. In age adjusted models, women who reported the highest experiences of discrimination had lower QoL for overall FACT-B scores and the subscale scores (no discrimination, mean overall FACT-B:117.7, 95% confidence interval (CI): 112.4, 122.9; high discrimination, mean overall FACT-B: 106.8, 95% CI: 102.1, 111.5). Similar associations were observed in fully adjusted models, where women who reported the highest experiences of discrimination had lower QoL. For example, for women who reported no discrimination the mean overall FACT-B score was 114.7 (95% CI: 107.9, 121.4) and 100.8 (95% CI: 94.2, 107.5) for women who reported the highest level of discrimination. No evidence of statistically significant interaction was observed for nSES, spirituality, or coping strategy. Conclusions: In a population-based study of Black breast cancer survivors, experiences of discrimination were associated with poorer QoL, as measured by FACT-B. Citation Format: Nur Zeinomar, Marley M. Perlstein, Bo Qin, Hari S. Iyer, Jesse J. Plascak, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Associations between experiences of discrimination and quality of life in a cohort of Black/African American breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B144.

Fatigue and quality of life during neoadjuvant chemotherapy of early breast cancer: a prospective multicenter cohort study

BackgroundFew measurements of fatigue and quality of life have been performed during neoadjuvant chemotherapy of early breast cancer. This study evaluates fatigue and quality of life experienced by early breast cancer patients during neoadjuvant chemotherapy and their association with different clinical parameters.MethodsFifty-four stage I–III patients’ responses to the Multidimensional Fatigue Inventory (MFI) and to the Functional Assessment of Cancer Therapy-Breast (FACT-B) were analyzed by a linear covariance pattern model. Chemotherapy regimen, age, baseline fatigue level, body-mass-index and cancer stage were added to the model to estimate their impact on both outcomes.ResultsAll fatigue dimensions worsened in clinically relevant levels. Physical fatigue worsened the most, mental fatigue the least. For quality of life, physical and functional well-being worsened the most. Only emotional well-being improved during chemotherapy. Physical well-being worsened more during standard than during dose-dense chemotherapy, and more during anthracycline than during taxane cycles. Age, body-mass-index and cancer stage had no impact. The higher the fatigue levels at baseline, the less they worsened during chemotherapy.ConclusionsFurther actions to reduce fatigue and improve quality of life during neoadjuvant chemotherapy of early breast cancer are needed. Focus should be laid on the physical dimension. Future research should also investigate the impact of different chemotherapy sequences and densities on fatigue and quality of life.Study registrationThe study was registered in the German Clinical Trials Register in May 2019 (DRKS00016761).

The impact of metastatic breast cancer (mBC) treatment on patient reported productivity loss among patients with HER2+ mBC in the U.S.

352 Background: Little is known about the impact of treatments and other factors on productivity loss among HER2+ mBC patients. This study aimed to assess the work productivity and activity impairment among employed women with HER2+ mBC. Methods: A cross-sectional survey was completed by the members of two patient advocacy organizations in the U.S. Those who were employed for paid work (≥20 hours/week) and receiving systemic treatments for HER2+ mBC for the past 3-months were recruited. Participants self-reported their sociodemographic, clinical and treatment history, time burden related to disease management, and completed the work productivity and activity impairment (WPAI) and Functional Assessment of Cancer Therapy Breast (FACT-B) quality of life (QoL) questionnaires. Patients were grouped based on their current regimen: (1) Oral only, (2) one parenteral drug (1 IV), (3) 2 IVs, (4) 3+ IVs. Association between WPAI scores and sociodemographic and clinical characteristics was assessed using simple linear regression. Results: A total of 118 HER2+ mBC patients participated [mean (SD) age 47.2 (9.5) years, 69.5% were employed full-time and 30.5% part-time, 89% were White, 13.6% resided in rural area]. Among 118 patients, 38 (32.2%) were on 1 IV, 38 (32.2%) on 2 IVs, 31 (26.6%) on 3+ IVs and 11 (9.3%) on oral only regimen. The median travel time (4 hrs vs. 6 hrs) and time spent at healthcare visits (7.3 hrs vs.13.4 hrs) was numerically higher among those on 3+ IVs than those on 1 IV. The median percent work time missed (7.7% vs. 5.8%), overall work impairment (38.2% vs.31.3%) and activity impairment (40.0% vs. 30.0%) in the past 7 days was numerically higher in patients on 3+ IVs than on 1 IV. Working part-time, residing in rural area, having low household income (&lt;25K vs. &gt;75K) and non-commercial insurance was associated with greater overall work impairment (all p-values &lt;0.05). Longer time since mBC diagnosis, longer time on treatment and higher QoL score were associated with lower overall work impairment (all p-values &lt;0.05). Working part-time, low household income, non-commercial insurance, longer time on treatment and higher QoL score were similarly associated with activity impairment (all p-values &lt;005). Conclusions: Socioeconomic and geographical factors were important determinants of work productivity loss among HER2+ mBC patients. IV treatment is the mainstay of therapy for HER2+ mBC patients and being on a simpler regimen for a longer time is likely to reduce work productivity loss and activity impairment. Improving access to novel monotherapy infusion treatment in rural community oncology practices may offer an opportunity to reduce patient time burden and work productivity loss among HER2+ mBC patients and improve health-related quality of life. Additional research from a larger diverse sample is warranted to further understand health disparities in HER2+ mBC patients.

Curcumin for Aromatase Inhibitor-Induced Joint Pain in Breast Cancer Survivors - The CurPain Trial: A Randomized, Double-Blind, Phase III, Multicenter Clinical Trial

Introduction: Adjuvant treatment with aromatase inhibitors (AIs) is extremely important in hormone-positive breast cancer survivors, reducing the early recurrence of the disease. Arthralgia and musculoskeletal symptoms resulting from AIs-toxicity can be observed in approximately one-third of the treated patients and are the leading cause of AIs-treatment discontinuation. However, there is no sufficient standard treatment. Analgesic and anti-inflammatory effects of curcumin in chronic joint pain are reported. This study protocol will determine whether curcumin supplementation reduces joint pain in breast cancer survivors under AIs therapy. Methods: This study protocol is a phase III, randomized, blinded, placebo-controlled, multicentric, parallel arm design. The study population targets post-menopause women with stage I, luminal, unilateral, non-metastatic, receptor-positive breast cancer after breast-conserving surgery healed per primary intention. 160 participants will be enrolled. Daily curcumin supplementation (500 mg thrice daily) for twelve weeks is planned. Brief Pain Inventory-Worst Pain (Δ BPI-WP) will assess joint pain change after twelve weeks of follow-up as the primary outcome. Secondary outcomes include Quality of Life assessed by Functional Assessment of Cancer Therapy-Breast, further Brief Pain Inventory-Short Form items, Patient Health Questionnaire-8, and Quantitative Analgesic Questionnaire at six and twelve weeks. Discussion: We present a randomized clinical trial to provide scientific evidence that supports the efficacy of curcumin supplementation on joint pain alleviation, pain-relieving medication reduction, and AIs-treatment adherence improvement in a predefined breast cancer survivor population.

The Relationship Between Taste and Smell Alterations and Quality of Life Among Women With Breast Cancer Receiving Chemotherapy.

To understand taste and smell alterations (TSAs) and their relationship with quality of life among women with breast cancer receiving chemotherapy. A descriptive correlational study was conducted with 121 women with breast cancer receiving chemotherapy, and data were collected through an online survey. The Taste and Smell Survey was used to measure TSAs, and the Functional Assessment of Cancer Therapy-Breast was used to measure quality of life. More than half of the participants experienced severe TSAs. The longest-lasting taste after the start of chemotherapy was a bitter taste, and participants experienced it more strongly after starting chemotherapy than before. The more severe the TSAs, the lower the overall quality of life, particularly physical well-being and functional well-being. Nurses should be vigilant about whether people with cancer receiving chemotherapy are experiencing TSAs. It is recommended to educate women in this population about avoiding bitter foods and foods with strong smells. Providing information about TSAs before treatment can help people with cancer cope.

Change in quality of life of metastatic breast cancer patients seeking treatment at Komfo Anokye Teaching Hospital, Ghana.

e24111 Background: Despite developments in breast cancer screening for early diagnosis and treatment, 20-85% of women go on to develop distant metastasis, based on tumor biology, stage at presentation and treatment modalities received. The primary goal of treating metastatic breast cancer (MBC) is to improve quality of life (QoL). This study assessed the change in QoL for patients with MBC seeking treatment at Komfo Anokye Teaching Hospital (KATH). Methods: Women with MBC seen at KATH had QoL assessed using the Functional Assessment of Cancer Therapy Breast (FACT-B) questionnaire before, and 3 months after they were supposed to have received systemic treatment - chemotherapy, hormonal, target therapy. Data was analyzed using STATA v17 software. The higher the FACT scores, the better the QoL. Results: Fifty-six women with MBC were interviewed. Their mean age was 51.7 years. Only 27 (48%) of them received some systemic treatment – chemotherapy, hormonal, target therapy – over the study period. Baseline median QoL scores in the wellbeing domains were physical (PWB) = 17.5, social/family (SWB) = 16.0, emotional (EWB) = 12.0, functional (FWB) = 8.0, breast cancer subscale (BCS) = 22.0. Their median total QoL scores were FACT-B = 77.5; FACT-B TOI = 48.5 and FACT-G = 54.5. At follow up, 28 (50%) of participants were alive. About a third (9/28) of them received no systemic treatment. Of the remaining 19; 4, 1 and 14 received one, two and three cycles of systemic treatment respectively. Their median QoL scores were PWB = 20.5, SWB = 16.0, EWB = 16.0, FWB = 15.0, BCS = 22.5, FACT-G = 72.0, FACT-B = 94.5, and FACT-B TOI = 61.0. Fourteen had improved, and 14 had deteriorated QoL. The median minimally important difference (MID) for the improved QoL group was MID FACT-B = -22, MID FACT-B TOI = -10 and MID BCS = -4, and for the deteriorated QoL group was MID FACT-B = 26.9, MID FACT-B TOI = 18 and MID BCS = 5. Being dead at follow up was related to receiving no treatment (AOR = 6.97, CI: 1.91 – 25.47, p-value = 0.003) and having one metastatic site at baseline (AOR = 5.23, CI:1.43 – 19.12, p-value = 0.01). Conclusions: Mortality among women with MBC was high (50%), especially among those who did not receive any systemic treatment or had one metastatic site. Of the survivors, equal proportions had significantly improved and significantly deteriorated QoL scores albeit varying treatment courses received. Further studies are needed to explore how systemic treatment or not impact QoL changes and survival outcomes of MBC patients in KATH.

Early integration of exercise into breast cancer care: The MSK healthy living program.

e24047 Background: In patients diagnosed with breast cancer, quality of life (QoL) has been reported to decrease during and after treatment. Physical activity (PA) mitigates adverse effects from treatment and improves QoL, and insufficient PA is associated with cancer recurrence and mortality. However, PA interventions are not included in standard cancer care. Early intervention to increase PA levels may improve QoL during active cancer therapy. The Healthy Living Program (HLP) at Memorial Sloan Kettering Cancer Center (MSK) is a lifestyle and survivorship program that engages early-stage breast cancer patients at the time of diagnosis using lifestyle risk stratification and matched referrals. We investigated whether early exercise intervention through the MSK HLP impacts QoL within the first months after cancer diagnosis. Methods: At the time of diagnosis, patients complete a lifestyle questionnaire (LQ), which is a composite of validated instruments, including the Godin Leisure Time Exercise Questionnaire (GLTEQ). Patients not meeting PA guidelines per the GLTEQ are offered a referral to an exercise physiologist (EP). The EP creates an individualized, home-based exercise program using the FITT Principle (Frequency, Intensity, Time, and Type). Patients meet with the EP every 4 weeks for 16 weeks; if exercise recommendations continue to be unmet, the program is extended. The Functional Assessment of Cancer Therapy-Breast (FACT-B) and 36-Item Short Form Survey Instrument (SF-36) were completed at baseline (BL) and follow-up (FU). Results: 206 patients enrolled between April 2020 – September 2022, of which 72 volunteered to complete the QoL assessments (median age 53 years [range 23-84]; 11.1% ductal carcinoma in situ, 69.4% Stage 1, 16.7% Stage 2, and 2.8% Stage 3). Among these patients, 30.6% received chemotherapy, 66.7% received radiation, 83.3% received hormone therapy, and 6% declined treatment. The mean baseline FACT scores were FACT-B: 116, FACT-G: 87, and FACT-B Trial Outcome Index (TOI): 72. At FU, scores were maintained with no significant changes (means FACT-B: 117, FACT-G: 88, and TOI: 74). Improvements were observed among the subscales of the SF-36 from BL to FU. The largest improvements were observed in physical and emotional role function scores, with 26% and 15% improvements from BL to FU, respectively. Conclusions: A clinically implemented exercise intervention embedded in standard of care prevented decreases in QoL and improved physical and emotional functioning during the initial course of adjuvant breast cancer therapy. These findings support early implementation of lifestyle modification after a breast cancer diagnosis.

Feasibility of nutrition counseling for breast cancer survivors: Results from the force trial.

e24054 Background: Certain dietary choices and body mass index (BMI) are associated with increased risk of breast cancer (BC) recurrence. Most patients (pts) consider nutrition very important but also report feeling confused about nutrition information. Many do not have access to a registered dietitian (RD) and nutrition education in medical schools is often lacking. Health coaching, education, goal-setting, and motivation are factors that can improve healthy habits and increase adherence to lifestyle modifications. We aimed to evaluate the feasibility of a 12-week (wk) pilot program of individualized nutrition counseling by a RD for BC survivors in a community oncology setting. Methods: We conducted a single-center, prospective, single arm trial to evaluate the feasibility of individualized nutrition counseling by a RD in pts with stage I-IV BC. Counseling focused on the American Cancer Society healthy eating pattern recommendations. Stage I-III BC pts must have completed all planned surgery, chemotherapy and radiation. Pts with stage IV/metastatic BC were eligible at any point during their treatment. Participants had three planned visits over a 12-week (wk) period: baseline, 4 wk follow-up visit, &amp; 12 wk follow-up visit. Feasibility was measured by adherence to a three-visit protocol over a 12 wk period. Secondary objectives included effect of nutrition counseling on quality of life using Functional Assessment of Cancer Therapy-Breast (FACT-B) and on physical activity using Godin Leisure-Time Exercise Questionnaire (GLTEQ). Demographic and medical variables were collected. Results: N = 50 participants signed consent for the study, &amp; all had baseline visits. Mean age 56 yrs (33-77). Pts: Stage I (N = 38); Stage II (N = 8); Stage III (N = 1); metastatic (N = 3). Mean BMI: 28.64 (17.7-48). Pts: ER+/HER2- (N = 37); ER+/HER2+ (N = 7); ER-/HER2+ (N = 2); ER-/HER2- (N = 4). 42 pts were on endocrine therapy during their participation on study. 36 pts (72%) completed the 12-wk program in its entirety. Average visit adherence for the whole cohort was 84.7%. Reasons for the 14 pts (28%) who did not complete the program included no virtual option available (N = 6); no time to attend (N = 2); not interested (N = 1) &amp; unknown (N = 5). 9 only attended Visit 1 and 5 attended Visits 2 and 3. Pts who completed the program experienced an improvement in self-reported energy level (p = 0.01) as assessed in FACT-B from baseline to 12 wks. There was no significant difference in GLTEQ from baseline to 12 wks (p = 0.21). Remainder of QoL assessments to be presented. Conclusions: Individualized nutrition counseling in a community oncology program was feasible and led to improvement in self-reported energy levels. It is imperative to expand the reach and access of nutrition counseling to reach a more diverse patient population and maintain continuity. Future work will focus on testing this intervention in larger and more diverse populations of BC survivors and thrivers.

The effect of the PERMA model-based positive psychological intervention on the quality of life of patients with breast cancer

ObjectiveThis research focused on exploring the impact of the PERMA model-based positive psychological intervention according to the negative emotions and quality of life of individuals with breast cancer. MethodsA total of 82 individuals with breast cancer from our hospital were categorized into two groups randomly; the control group and the observation group (41 affected individuals each). The individuals in the control group underwent routine nursing intervention, while the ones in the observation group underwent PERMA nursing as per routine nursing intervention. Self-rating anxiety and depression scales along with Functional Assessment of Cancer Therapy-Breast were employed for the evaluation and analysis of patient status in both groups before and after the intervention. ResultsFollowing the intervention, the observation group's scores on self-rating anxiety and depression scales were considerably lower when compared with those in the control group (P < 0.001), and the physical, social, family, emotional, and functional statuses, along with additional attention and the total score of quality of Functional Assessment of Cancer Therapy-Breast in the observation group were considerably lower in comparison with those in the control group (P < 0.001). ConclusionThe PERMA model-based positive psychological intervention program can ease the anxiety and depression of individuals with breast cancer, improve their quality of life, and has a good prospect of clinical application.

Construction of the structural equation model of stigma, self-disclosure, social support, and quality of life of breast cancer patients after surgery-a multicenter study.

Stigma is common in patients with breast cancer after surgery, which has a negative impact on the quality of life (QOL). This study aimed to investigate the QOL of breast cancer patients after surgery and to analyze the multiple chains mediating effects of self-disclosure and social support between stigma and QOL. A total 292 patients of breast cancer patients after operation were recruited in this study. A questionnaire survey was conducted using the general information questionnaire, the consumer experiences of stigma questionnaire (CESQ), the distress disclosure index(DDI), the perceived social support scale(PSSS), and the functional assessment of cancer therapy-breast(FACT-B). Path analysis was conducted to test the hypothesized serial multiple mediation model. The total scores of stigma, self-disclosure, social support and QOL were 15 (10 ~ 22), 39 (31 ~ 46), 58 (50 ~ 67) and 88 (74 ~ 104) respectively. QOL of breast cancer patients after the operation was negatively correlated with stigma (p < 0.01), and positively correlated with self-disclosure and social support (p < 0.01). Self-disclosure and social support played a complete mediating effect between stigma and QOL, and the total mediating effect value was 85. 87%. Self-disclosure and social support play a complete intermediary role between stigma and QOL. In order to improve the quality of life of patients, medical staff should pay attention to the assessment of stigma, encourage patients to express their emotions, and encourage their families and friends to respond to their expression and needs of patients.