Function In Breast Cancer Survivors Research Articles

Cognitive performance in breast cancer survivors: a ten-year follow-up

Abstract Background Cognitive impairment (CI) has been widely reported as a frequent non-fatal cancer outcome. 15% to 25% of breast cancer (BCa) patients may have CI; however long-term variations of cognitive performance during and after the cessation of the treatments remains unclear. The present study aims to describe the evolution of cognitive performance in BCa survivors that are still in follow-up at breast cancer clinic, 10 years after diagnosis. Methods 506 women with BCa admitted to the Portuguese Institute of Oncology, Porto, in 2012, were evaluated with the Montreal Cognitive Assessment (MoCA) before any treatment, after one, three, five, and ten years. Patients with a MoCA score ≤1.5 standard deviation below the mean of age- and education-specific norms were considered to have probable cognitive impairment (PCI). The 10-year follow up started in October 2022, and is still in progress (as of March, 118 were evaluated). All women that are still being followed at IPO-Porto for consultations and treatments were evaluated with MoCA assessment. Results PCI prevalence at the 10 years was 43.0% (95%Confidence Interval: 34.1%-52.7%). Several pathways for cognitive performance were identified throughout the 10-year follow-up: 58 women (49.2%) never had PCI at baseline assessment or during follow-up; 19 women (16.1%) had PCI at baseline, from whom 5 (4.2%) had PCI in all evaluations, 2 (1.7%) did not have PCI in any follow up evaluation, 2 (1.7%) had PCI during follow up, but not at 10 years and 3 (2.5%) had PCI again only at the 10-year follow-up; 5 women (4.2%) did not have PCI at baseline but had PCI at least once during follow-up but not at 10 years, and 24.6% had PCI for the first time at 10 years. Conclusions The results show a high prevalence of PCI 10 years after diagnosis with a significant part being new cases. These results highlight the need for including regular assessments of cognitive performance as a part of the clinical follow-up of BCa survivors. Key messages • There is a high prevalence of cognitive deficits in breast cancer suvivors 10 years after diagnosis. • Including cognitive evaluations of breast cancer survivors during clinical follow up are recommended.

Role function in postmenopausal women during aromatase inhibitor therapy for breast cancer.

Few studies have examined aromatase inhibitor therapy relating to role function in breast cancer survivors of working age. Our study sought to identify how pre-therapy sociodemographic and health/treatment-related characteristics, as well as patient-reported symptoms measured every six-months, influence role function during 18months of AI therapy for early-stage breast cancer. We performed a secondary analysis of longitudinal study data using linear mixed-effects modeling to examine role physical (RP) and role emotional (RE) functioning measured with the Medical Outcome Study Short Form 36 v2. The sample of postmenopausal women (N = 351) consisted of three cohorts: chemotherapy followed by anastrozole (CFAI), anastrozole only (AI only), and non-cancer controls. Our choice of variables and interpretation of findings was theoretically based on the Cancer Survivorship and Work Model. Stepwise backward deletion determined which predictors to include in the final model, accounting for treatment group. Both treatment groups were associated with greater limitations in RP functioning than controls. CFAI had twice the impact on RP compared to AI only. While the RP model displayed significant predictors across sociodemographic, health/treatment, and symptom characteristics, only symptoms were associated with greater limitations in RE functioning. Findings were significant at p < .05. Transitioning from acute to extended survivorship is a critical juncture in which multiple factors place breast cancer survivors at risk of diminished role function. Early interventions to address role function limitations during systemic treatment may lead to better work outcomes and improve the quality of long-term survivorship.

Consumption of Fish High in Omega-3 Fatty Acids Is Associated with Less Peripheral Inflammation and Better Cognitive Function in Breast Cancer Survivors

Consumption of Fish High in Omega-3 Fatty Acids Is Associated with Less Peripheral Inflammation and Better Cognitive Function in Breast Cancer Survivors

Pain neuroscience education and therapeutic exercise for the treatment of sequelae in breast cancer survivors living with chronic pain: A pilot study

BackgroundBreast cancer represents the most common type of malignant neoplasm worldwide. Advances in diagnosis and treatment have increased the life expectancy of patients. However, the sequelae associated with the treatment of the disease such as chronic pain, kinesiophobia and loss of physical function in breast cancer survivors (BCS) are a long-term health problem. Therapeutic strategies are required for the treatment of chronic sequelae in this population. ObjectivesTo evaluate the effectiveness of a pain neuroscience education (PNE) and therapeutic exercise (TE) for the treatment of chronic sequelae in BCS. MethodsQuasi-experimental repeated measures study. The intervention lasted 9 weeks, with 3 educational and 24 exercise sessions. Pain frequency and intensity (VAS scale), neuropathic pain (DN4), kinesiophobia level (TSK-11V), central sensitization (CSI-Sp), functionality of the affected arm (ULFI-Sp) and active joint range (ROM) with goniometry were measured at baseline, 3rd, 6th and 9th week. Statistical analysis included Friedman's test and ANOVA according to normality criteria. ResultsA total sample of 26 BCS participate in the study. Significant statistical changes were found from the 3rd week of treatment in the frequency and intensity of pain, kinesiophobia and neuropathic pain (p < 0.05). All variables had significant changes at the 9th week (p = 0.001). ConclusionThe results of the present investigation suggest that the combination of PNE and TE are effective in treating sequelae at short term in BCS with chronic pain.

Effects of Rowing on Cardiac Function in Breast Cancer Survivors: Sliding Seat Rowing vs. Fixed Seat Rowing

Effects of Rowing on Cardiac Function in Breast Cancer Survivors: Sliding Seat Rowing vs. Fixed Seat Rowing

Utilizing Pilates to Improve Respiratory Function in Breast Cancer Survivors

Utilizing Pilates to Improve Respiratory Function in Breast Cancer Survivors

Intramuscular adipose tissue, muscle area, and power as predictors of performance in breast cancer survivors.

The decline in physical performance, assessed by physical tests such as the timed up and go (TUG) test, is a consequence of reduced physiological reserves at higher levels of a hierarchical process. This occurs due to changes in muscle architecture, including atrophy and fat infiltration into the muscles, which in turn lead to changes in muscle function, resulting in reduced muscle strength and power and, consequently, affecting physical performance. This study investigated predictive factors for physical performance in breast cancer survivor (BCS), focusing on intramuscular adipose tissue (IMAT), quadríceps muscle area (QMA), and muscular power. This observational, analytical, and cross-sectional study included 23 women without a history of cancer (age, 58.5 ± 8.3years; BMI, 27.2 ± 5.1kg/m2) and 56 BCS (age, 58.5 ± 8.3years; BMI, 27.2 ± 5.1kg/m2). QMA and IMAT were assessed using computed tomography images. Muscular power and physical performance were measured using the 5-repetition sit-to-stand and TUG tests, respectively. IMAT (r = 0.4, P < 0.01) and muscular power (r = - 0.4, P < 0.01) were associated with TUG performance in BCS, whereas QMA (r = - 0.22, P = 0.10) showed no significant association. QMA (r = 0.55, P < 0.01) was associated with muscular power, while no significant association was found between IMAT and muscular power (r = - 0.05, P = 0.73). Age explained 19% (P < 0.01) of TUG performance variability. Adding muscular power increased explanatory power by 12% (P < 0.01), and including IMAT further increased it by 7% (P = 0.02) for TUG performance. Collectively, age, muscular power, and IMAT accounted for 38% of the performance variance in the TUG test (age, B = 0.06, P = 0.043; muscular power, B = - 0.01, P = 0.002; IMAT, B = - 0.05, P = 0.020). Our findings suggest that IMAT and muscular power predict the physical performance of BCS, while QMA does not have the same predictive capability.

Abstract PO1-11-07: Do factors other than type of surgery performed for breast cancer affect quality of life and sexual functioning in breast cancer survivors? An observational study from Northern India

Abstract INTRODUCTION There is an increasing focus of the treating clinicians on issues related to quality of life and sexual functioning in breast cancer survivors. This is even more important in developing countries like India as the incidence of breast cancer in young in also significant here. However, despite this, there is little data from India on the factors affecting quality of life and sexual functioning on breast cancer survivors. Hence, we decided to perform this study. METHODS Patients who had undergone surgery for breast cancer within the last 2-5 years were included. Patients having significant psychiatric illness were excluded and so were patients who developed metastasis or local recurrence during the follow up. Questions on demographics, clinical history, standard of living index, quality of life (SF-36 questionnaire) and sexual function (CSFQ questionnaire) were asked. Data was analyzed using SPSS v22. Normality of continuous data was tested by Kolmogorov–Smirnov and Shapiro–Wilk tests. As a test of significance, chi square was used for qualitative data and t-test, Mann-Whitney U, and Kruskal-Wallis were used (as applicable) for quantitative data. Bonferroni adjustment was made wherever significance was found, if more than 1 group were involved. Multiple linear regression was carried out for quantitative dependent variables where significant risk factors were found. Independent variables with significant collinearity were excluded from linear regression. RESULTS A total of 120 patients were enrolled. In QOL scores, both physical health (B = -13.76, p = 0.007) and emotional problems (B = -10.65, p = 0.035) were affected adversely by endocrine therapy. Patients who had received radiotherapy had worse emotional well-being scores (B = -14.61, p = &amp;lt; 0.001). Patients who received chemotherapy or were married had significantly better social functioning score (B = 15.27, p = 0.020, B = 17.38, p = 0.041 respectively), whereas it was worse in patients who received trastuzumab (B = -18.32, p = 0.024). Pain scores were higher in premenopausal patients (B = 11.95, p = 0.021) and lower in patients having co-morbidities (B = -10.95, p = 0.039). None of the factors affected physical functioning, energy/fatigue, general health or health change scores. In sexual functioning scores, pleasure score (B = 1.27, p = 0.011) frequency scores (B = 1.97, p = 0.012), orgasm score (B = 3.43, p = 0.019) and total score (B = 12.30, p = 0.006) were higher in married women. Pleasure score was found to be lower in patients with co-morbidities (B = -0.82, p = 0.003). None of the factors affected desire or arousal. CONCLUSION Even though sexual functioning depended a lot on having a long-term partner, most of the factors affecting quality of life scores were treatment related. Actively addressing these concerns may help in improving quality of life and in turn, may improve compliance to treatment and follow-up. Citation Format: SIDDHANT KHARE, Devesh Dhamor, R N NAGA SANTOSH IRRINKI, Bijaya Padhi. Do factors other than type of surgery performed for breast cancer affect quality of life and sexual functioning in breast cancer survivors? An observational study from Northern India [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 PO1-11-07.

Continuum of somatosensory profiles in breast cancer survivors with and without pain, compared to healthy controls and patients with fibromyalgia.

The prevalence of persistent pain among breast cancer survivors (BCS) is high, and it is unclear what distinguishes those with persistent pain from those without. Research suggests that differences in somatosensory function evaluated by quantitative sensory testing (QST) may be responsible. This study aimed to describe somatosensory profiles in terms of hyper- and hypoesthesia in BCS with and without persistent pain using reference data from healthy controls. Second, QST parameters of BCS with and without pain were compared with those of healthy controls (i.e., a negative control group) and patients with fibromyalgia (i.e., a positive control group). Participants (n = 128) were divided into four equal groups: healthy controls, BCS with persistent pain, BCS without persistent pain, and patients with fibromyalgia. Nine QST parameters were evaluated at the trunk and at a remote location. Somatosensory profiles were determined by Z-score transformation of QST data using normative data from healthy controls. At the trunk, compared to healthy controls, BCS with persistent pain exhibited sensory aberrations across five out of seven QST parameters: pressure pain threshold, mechanical detection, and thermal thresholds. Pain-free BCS showed similar sensory aberrations across the four QST parameters compared to healthy controls: mechanical detection and thermal thresholds. Temporal summation and conditioned pain modulation were not significantly different between groups. BCS with persistent pain exert aberrations in peripheral processing of nociceptive signals, heightened facilitation of nociceptive signals, and higher psychosocial burden when compared to pain-free BCS, healthy controls, and patients with fibromyalgia. This study investigates the somatosensory function of breast cancer survivors with and without persistent pain using quantitative sensory testing and two control group (i.e., patients with fibromyalgia and healthy controls). Our results indicate somatosensory aberrations within the peripheral, but not central pathways in breast cancer survivors with persistent pain. Our findings contribute to a better understanding of the somatosensory mechanisms underlying persistent pain, which may inform future interventions to prevent the development of persistent pain, and improve treatment modalities.

Effect of Modified PNF Exercises on Upper Limb Strength and Function in Breast Cancer Survivors: A Case Series

Effect of Modified PNF Exercises on Upper Limb Strength and Function in Breast Cancer Survivors: A Case Series

Associations of brain-derived neurotrophic factor rs6265 polymorphism and cognitive function in breast cancer survivors from a cross-sectional study.

Breast cancer survivors (BCS) often complain of cancer-related cognitive impairment (CRCI) during and even months after completing primary cancer treatments, particularly chemotherapy. The etiology of CRCI is unknown, but associations of CRCI with germline genetic polymorphisms have been reported, including Brain-Derived Neurotrophic Factor (BDNF) rs6265 polymorphism. The current study investigated the associations of specific BDNF rs6265 with CRCI. Cancer-related cognitive impairment was assessed using subjective reports of cognitive symptoms (the version 1.0, 8-item short-forms of the Patient-Reported Outcomes Measurement Information System®) and computerized objective cognitive function scores (CANTAB®). BDNF rs6265 genotypes were determined from buccal swabs. The associations of specific BDNF rs6265 with CRCI were examined by either one-way analysis of variance or the Kruskal-Wallis test followed by post hoc tests and rank-based regression analysis. We examined 356 female BCS. The mean (SD) age was 55.6 (9.8) years old, the median (IQR) years since cancer diagnosis were 4.0 (6.0), and 331 (92.7%) were self-described as White. BCS carrying the Met/Met genotype showed poorer results on 'visual episodic memory and new learning' and 'spatial working memory and executive function.' This relationship was observed regardless of prior chemotherapy. Our findings suggest that carrying the BDNF rs6265 Met/Met genotype increases the risk for CRCI in BCS. These results are foundational in nature and provide important information to identify mechanisms underpinning CRCI.

Characterization of functioning in breast cancer survivors: an interpretive descriptive analysis study based on the International Classification of Functioning, Disability, and Health (ICF) and the Item-Perspective Classification Framework

Purpose Breast cancer survivors may experience a variety of disabilities that could potentially compromise their independent functioning. This study aimed to examine their perspectives and experts on their functioning and interpret concepts with the International Classification of Functioning, Disability, and Health (ICF) and the Item-Perspective Classification Framework (IPF). Methods Interpretive descriptive methods were used with in-depth interviewing with 16 breast cancer survivors and 22 experts using a semi-structured interview guide. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The extracted data were linked to the ICF Core Set for Breast cancer and were interpreted by the IPF. Results Four main themes emerged to define the functioning of breast cancer survivors: body functioning, physical functioning, social functioning, and mental functioning. Three other factors were also categorized as modifiers of functioning personal, emotional, and environmental. The 592 extracted meaningful concepts were linked to 38 (47%) categories from the ICF: 16 Body Functions, 14 Activities and Participation, and 8 Environmental Factors. The IPF classified all the extracted concepts, and most rational appraisals fell in the biological (B) domain. The concepts that required emotional appraisal were classified in Psychology (P). Conclusion Psychological and emotional factors were pivotal in defining functioning in patients with BC.

Feasibility of a remotely-delivered yoga intervention on cognitive function in breast cancer survivors: a mixed-methods study

BackgroundCancer-related cognitive impairment (CRCI) is a common, persistent quality of life complaint among breast cancer survivors (BCS), however there remain no proven treatments. There is emerging evidence that aerobic exercise and yoga may improve CRCI. There remains limited research on the safety and feasibility of virtually-supervised, remotely-delivered yoga interventions among cancer survivors, and no yoga studies to date have assessed cognitive function as a primary outcome in BCS. The purpose of this study was to explore the feasibility of an 8-week, remotely-delivered yoga intervention and examine its impact on cognitive function, fatigue, and exercise levels in BCS using a concurrent mixed-methods design.MethodsParticipants completed objective and self-report cognitive function measures (NIH Toolbox remote cognitive battery, PsyToolkit Task Switch test, Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog3]); fatigue (Revised-Piper Fatigue Scale); and exercise activity level (modified Godin Leisure Time Exercise Questionnaire) before and after the yoga intervention. Semi-structured qualitative interviews were conducted post-intervention to understand participants' experiences with the yoga intervention, CRCI, and fatigue.ResultsThe intervention surpassed a priori feasibility indicators (adherence rate = 83.7%, attrition rate = 5.4%, no adverse events). Participants (n = 18, Mage= 52.2 ± 10.1) had significant improvements in objective memory, fatigue, and weekly minutes of moderate-to-vigorous exercise post-intervention. Qualitative themes indicated that participants found the remote intervention to be enjoyable and beneficial.ConclusionsIn this small proof-of-concept study, remotely-delivered yoga appears safe and effective at improving CRCI. Future randomized controlled trials examining the impact of remotely-delivered yoga interventions on cognitive function in BCS are warranted.

Depression, Inflammation, and Intestinal Permeability: Associations with Subjective and Objective Cognitive Functioning throughout Breast Cancer Survivorship.

About one-in-three breast cancer survivors have lingering cognitive complaints and objective cognitive impairment. Chronic inflammation and intestinal permeability (i.e., leaky gut), two risk factors for cognitive decline, can also fuel depression-another vulnerability for cognitive decline. The current study tested whether depression accompanied by high levels of inflammation or intestinal permeability predicted lower subjective and objective cognitive function in breast cancer survivors. We combined data from four breast cancer survivor studies (n = 613); some had repeated measurements for a total of 1015 study visits. All participants had a blood draw to obtain baseline measures of lipopolysaccharide binding protein-a measure of intestinal permeability, as well as three inflammatory markers that were incorporated into an inflammatory index: C-reactive protein, interleukin-6, and tumor necrosis factor-α. They reported depressive symptoms on the Center for Epidemiological Studies depression scale (CES-D), and a binary variable indicated clinically significant depressive symptoms (CES-D ≥ 16). The Kohli (749 observations) and the Breast Cancer Prevention Trial (591 observations) scales assessed subjective cognitive function. Objective cognitive function tests included the trail-making test, Hopkins verbal learning test, Conners continuous performance test, n-back test, FAS test, and animal-naming test (239-246 observations). Adjusting for education, age, BMI, cancer treatment type, time since treatment, study visit, and fatigue, women who had clinically elevated depressive symptoms accompanied by heightened inflammation or intestinal permeability reported poorer focus and marginally poorer memory. However, poorer performance across objective cognitive measures was not specific to inflammation-associated depression. Rather, there was some evidence of lower verbal fluency; poorer attention, verbal learning and memory, and working memory; and difficulties with visuospatial search among depressed survivors, regardless of inflammation. By themselves, inflammation and intestinal permeability less consistently predicted subjective or objective cognitive function. Breast cancer survivors with clinically significant depressive symptoms accompanied by either elevated inflammation or intestinal permeability may perceive greater cognitive difficulty, even though depression-related objective cognitive deficits may not be specific to inflammation- or leaky-gut-associated depression.

Higher Added Sugar Intake Is Associated with Worse Executive Function in Breast Cancer Survivors

Higher Added Sugar Intake Is Associated with Worse Executive Function in Breast Cancer Survivors

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

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

Is there an association between breast cancer and incident adhesive capsulitis of the shoulder? A retrospective cohort study from Germany.

Preliminary data suggest that women with breast cancer are at particularly high risk of adhesive capsulitis of the shoulder. Therefore, this study aimed to investigate the potential association between breast cancer and adhesive capsulitis in adults from Germany. This retrospective cohort study included all women aged ≥ 18years who were diagnosed for the first time with breast cancer in one of 1,274 general practices in Germany between January 2000 and December 2018 (index date). Women without breast cancer were matched (1:1) to those with breast cancer using a propensity score based on age at the index date, index year, and the average number of medical consultations per year during the follow-up. In women without breast cancer, the index date was a randomly selected visit date between 2000 and 2018. The association between breast cancer and the 10-year incidence of adhesive capsulitis was studied using Kaplan-Meier curves and a Cox regression model adjusted for age and several comorbidities. There were 52,524 women included in this study (mean [SD] age 64.2 [12.9] years). The 10-year incidence of adhesive capsulitis was 3.6% in both the group with and the group without breast cancer (log-rank p-value = 0.317). The Cox regression analysis further showed no significant association between breast cancer and adhesive capsulitis (HR = 0.96, 95% CI = 0.86-1.08). In this sample of women from Germany, breast cancer was not significantly associated with adhesive capsulitis. Although the present preliminary findings are reassuring, general practitioners should regularly assess shoulder function in breast cancer survivors.

(550) Sexual Arousal in Premenopausal Breast Cancer Patients on Antihormonal Treatment

Abstract Introduction Breast Cancer is the most common cancer in women and is associated with a severe impairment of general life quality, body-related self-esteem and sexual function and satisfaction. Sexual satisfaction has been shown to have a significant impact on general health and well-being. Nevertheless, research aiming at understanding sexual function in breast cancer patients is very scarce, no vaginal plethysmography data measuring vaginal blood flow on breast cancer patients currently exists. A better understanding of the interplay of the physiological sexual response and subjective sexual arousal in breast cancer survivors could help develop new strategies for treating this specific target group and contributing to improve their health and life quality. Objective The aim of this study is to collect preliminary data on psychophysiological aspects of the sex.al function of premenopausal breast cancer patients on antihormonal therapy and compare them with healthy controls. Specifically, we hypothesized that (1) genital arousal following visual stimuli is less in breast cancer patients than in healthy controls, (2) genital arousal following tactile stimuli is the same in breast cancer patients and healthy controls, (3) genital arousal following tactile stimuli is greater than following visual stimuli in both breast cancer patients and healthy controls. Serum sex hormone levels and self-reported sexual function are analyzed as moderators. Methods Breast cancer survivors (n=60) treated with antihormonal therapy for breast cancer, who are in complete remission for at least one year and healthy controls (n=20), undergo vaginal plethysmography while sexual stimuli (visual, tactile, visual + tactile) are presented. Subjective arousal and genital arousal are recorded continuously. Hormone serum levels, self-reported sexual function, sexual self-esteem, and quality of life measures are analyzed as potential moderators. Results Intraindividual differences (subjective and genital arousal) and interindividual differences (breast cancer patients, healthy controls) are analyzed based on a 2-level mixed effect models for each outcome variable. Pearson correlations are calculated to assess the relationships between subjective arousal and genital arousal for each group. Conclusions This study is the first to provide data on genital and subjective arousal in premenopausal women with breast cancer on antihormonal treatment compared to healthy controls and explore the data in connection with serum hormone levels. Overall, it will give a further insight in sexual function of breast cancer survivors to reveal targets to improve sexual function in this target group. Disclosure Yes, this is sponsored by industry/sponsor: WOW Tech™ Group. Clarification Industry funding only - investigator initiated and executed study.

The long-term burden of a symptom cluster and association with longitudinal physical and emotional functioning in breast cancer survivors

Background Fatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioning Material and Methods Latent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery. Results Two symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year. Discussion These findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.

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

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