Intervention For Breast Cancer Survivors Research Articles

Implementing Indicators and Trajectories of Return to Work After Breast Cancer Diagnosis: A Mixed-Methods Study Using the French National Healthcare Insurance Database and Stakeholder Consultation

PurposeReturn to work (RTW) is important for quality of life after breast cancer but its analysis at the population-level remains limited in France. This study aimed to implement Electronic Healthcare Data (EHD)-based indicators and trajectories to measure RTW after breast cancer diagnosis, and to examine stakeholders’ perspectives regarding these indicators. MethodsWe followed a mixed-methods approach that consisted of (i) implementing RTW indicators and identifying clusters of trajectories using state sequence analysis with data from a representative sample of the French National Health Data System and (ii) exploring, through qualitative focus group and interviews, stakeholders’ perceptions on the interpretation, limitations, and utility of these indicators. ResultsWe extracted data from 317 women aged 25-55 years with a first diagnosis of early-stage breast cancer. The median number of sickness absence periods was 2 for a total of 434 days during the 3-year follow-up, and the median time to sustainable RTW was 240 days. Three clusters of RTW trajectories were identified: “early RTW” (49.5% of the population), “RTW after partial resumption” (37.5%) and “continuous compensation” (12.9%). Feedback from stakeholders highlighted the multi-factorial nature of RTW and underscored the added value of EHD for studying RTW, despite certain limitations. ConclusionsWe demonstrated the feasibility of calculating RTW indicators and identifying trajectories using the French National Health Data System. These indicators can serve as outcome measures in RTW promotion and provide a basis for designing targeted interventions for breast cancer survivors.

Home-based lifestyle intervention for breast cancer survivors: A surprising improvement in the quality of life during the first year of COVID-19 pandemic.

The COVID-19 pandemic induced an extraordinary impact on public mental health to a degree not completely understood, especially in vulnerable populations such as breast cancer (BC) survivors. In this study, we described the short- (after 3-month) and long- (after 12-month) term effects of a multidisciplinary home-based lifestyle intervention in Italian women BC survivors during the first year of COVID-19 pandemic. In total, 30 Italian BC survivors with risk factors for recurrence took part in the ongoing MoviS trial (protocol: NCT04818359). Between January 2020 and January 2021, a 3-month lifestyle intervention based on psychological counseling, nutrition, and exercise was carried out. Participants were asked to fill out psychological questionnaires for the assessment of quality of life (QoL) indicators (European Organization for Research and Treatment of Cancer QoL, EORTC-QLQ-C30) and psychological health measures such as fatigue (Brief Fatigue Inventory, BFI), distress (Distress Thermometer, DT and Psychological Distress Inventory, PDI), cancer-related fatigue (Verbal Rating Scale, VRS), and mood states (Profile of Mood States Questionnaire, POMS). IBM SPSS Statistical Software version 27.0 and R Project for Statistical Computing version 4.2.1 were used to process data. All participants were assessed at four time points: T0 (baseline), T1 (3-month), and follow-up at T2 and T3 (6- and 12-month, respectively) to measure primary (quality of life indicators) and secondary (psychological health) outcomes. Friedman non parametric test and Wilcoxon signed rank test (with Bonferroni correction) were conducted to investigate the statistically significant differences in psychometric scores and between assessment times. Compared to baseline (T0), at T1 most of the QoL indicators (i.e., symptoms of fatigue and general health) were improved (p < 0.017) with the exception of a worsening in participants' social functioning ability. Also, perception of severity of fatigue, distress, cancer-related fatigue, depression, and anger enhanced. Compared to baseline (T0), at T3 we mainly observed a stable condition with T0-T1 pairwise comparison, however other secondary outcomes (i.e., fatigue mood state, confusion, and anxiety) significantly improved. Our preliminary findings support the proposal of this lifestyle intervention for BC survivors. Despite the home-confinement due to the COVID-19 pandemic, the intervention surprisingly improved QoL indicators and psychological health of the participants.

Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study.

Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors. In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis. A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers. Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors. Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.

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

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

Randomized Trial Evaluating a Self-Guided Lifestyle Intervention Delivered via Evidence-Based Materials versus a Waitlist Group on Changes in Body Weight, Diet Quality, Physical Activity, and Quality of Life among Breast Cancer Survivors.

Background: Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials and online videos vs. waitlist group on body weight for breast cancer survivors. Methods: The Lifestyle, Exercise and Nutrition (LEAN) Self-Guided trial randomized breast cancer survivors with a body mass index ≥25 kg/m2 to a 6-month lifestyle intervention (N = 102) or waitlist group (N = 103). Effects of the intervention on self-reported body weight, physical activity (PA), diet quality (via Health Eating Index-2010 (HEI-2010)), and quality of life were assessed using mixed model repeated measures analysis. Results: At 6 months, the intervention arm had significantly greater weight loss compared with the waitlist group (mean difference = -1.3 kg, 95% confidence interval [CI] = -2.5, -0.13). We observed suggestive improvements in PA (mean difference = 18.7 min/week, 95% CI = -24.2, 61.6), diet quality (mean difference in HEI = 3.2 points, 95% CI = -0.20, 6.5), and fatigue (mean difference in Functional Assessment of Chronic Illness Therapy-Fatigue scale = 1.4 points, 95% CI = -1.1, 3.9). Conclusions: The LEAN Self-Guided intervention led to favorable weight changes over 6 months. Low-resource-intensive programs have the potential to be delivered in diverse healthcare settings and may support breast cancer survivors in achieving a healthy body weight.

Changes in gut microbiota composition after 12 weeks of a home-based lifestyle intervention in breast cancer survivors during the COVID-19 lockdown.

Breast cancer (BC) is the second-leading cause of cancer-related death worldwide. This study aimed to investigate the effects of a 12-week home-based lifestyle intervention (based on nutrition and exercise) on gut microbial composition in twenty BC survivors of the MoviS clinical trial (protocol: NCT04818359). Gut microbiota analysis through 16S rRNA gene sequencing, anthropometrics, Mediterranean Diet (MD) adherence, and cardiometabolic parameters were evaluated before (Pre) and after (Post) the lifestyle intervention (LI). Beneficial effects of the LI were observed on MD adherence, and cardiometabolic parameters (pre vs post). A robust reduction of Proteobacteria was observed after LI, which is able to reshape the gut microbiota by modulating microorganisms capable of decreasing inflammation and others involved in improving the lipid and glycemic assets of the host. A significant negative correlation between fasting glucose and Clostridia_vadinBB60 (r = -0.62), insulin and homeostatic model assessment (HOMA) index and Butyricicoccus genera (r = -0.72 and -0.66, respectively), and HDL cholesterol and Escherichia/Shigella (r = -0.59) have been reported. Moreover, positive correlations were found between MD adherence and Lachnospiraceae_ND3007 (r = 0.50), Faecalibacterium (r = 0.38) and Butyricimonas (r = 0.39). These data suggest that adopting a healthy lifestyle, may contribute to ameliorate several biological parameters that could be involved in the prevention of cancer relapses through the modulation of gut microbiota.

Effects of Non-Ablative Solid-State Vaginal Laser (SSVL) for the Treatment of Vulvovaginal Atrophy in Breast Cancer Survivors after Adjuvant Aromatase Inhibitor Therapy: Preliminary Results.

One of the side effects of anti-estrogen treatments in breast cancer survivors (BCSs), especially with aromatase inhibitor (AI) treatment, is the frequent appearance of vulvo-vaginal atrophy (VVA). We aim to evaluate the efficacy, safety and feasibility of a new type of non-ablative Solid-State Vaginal Laser (SSVL) treatment in BCSs with VVA. A total of 30 BCSs with a history of AI use and symptoms of VVA were treated with a non-ablative SSVL (LASEmaR 1500™-EUFOTON)in this non-randomized pilot study. The effects of the laser have been evaluated at baseline, 10 wk and 24 wk using a visual analogue scale (VAS), the Vaginal Health Index (VHI), the Vulvar Health Index (VuHI), the Female Sexual Function Index (FSFI), the EORTC QLQ-BR23, the Vaginal Maturation Index (VMI) and vaginal pH. At 10-week follow-up vs. baseline there were no statistically significant differences in FSFI, lubrication and EORTC QLQ-BR23. In all the subjective (dyspareunia, VHI, VuHI, FSFI, QLQ) and objective parameters (VMI and pH) there was a statistically significant improvement at the 6-month follow-up. Satisfaction was very high (4.7 out of 5), with 95.7% of patients being satisfied, more than or very satisfied. Preliminary results of SSVL treatment of VVA and dyspareunia in BCSs after AI treatment suggest clinical improvement, without relevant side effects and with a high degree of satisfaction.

Promoting physical activity through supervised vs motivational behavior change interventions in breast cancer survivors on aromatase inhibitors (PAC-WOMAN): protocol for a 3-arm pragmatic randomized controlled trial

BackgroundAromatase inhibitors (AI) are frequently used to treat hormone-receptor-positive breast cancer, but they have multiple adverse effects (e.g., osteoporosis, arthralgia), resulting in premature therapy discontinuation/switch. Physical activity (PA) can attenuate these negative effects and improve quality of life (QoL). However, most cancer survivors fail to perform/sustain adequate PA levels, especially in the long-term. Theory-based interventions, using evidence-based behavior change techniques, aimed at promoting long-term behavior change in breast cancer survivors are effective, but remain scarce and fail to promote self-regulatory skills and better-quality motivations associated with sustained PA adoption. This paper describes the design of the PAC-WOMAN trial, which will test the long-term effectiveness and cost-effectiveness of two state of the art, group-based interventions encouraging sustained changes in PA, sedentary behavior, and QoL. Additional aims include examining the impact of both interventions on secondary outcomes (e.g., body composition, physical function), and key moderators/mediators of short and long-term changes in primary outcomes.MethodsA 3-arm pragmatic randomized controlled trial, involving a 4-month intervention and a 12-month follow-up, will be implemented, in a real exercise setting, to compare: 1) brief PA counseling/motivational intervention; 2) structured exercise program vs. waiting-list control group. Study recruitment goal is 122 hormone-receptor-positive breast cancer survivors (stage I-III), on AI therapy (post-primary treatment completion) ≥ 1 month, ECOG 0–1. Outcome measures will be obtained at baseline, 4 months (i.e., post-intervention), 10 and 16 months. Process evaluation, analyzing implementation determinants, will also be conducted.DiscussionPAC-WOMAN is expected to have a relevant impact on participants PA and QoL and provide insights for the improvement of interventions designed to promote sustained adherence to active lifestyle behaviors, facilitating its translation to community settings.Trial registrationApril 20, 2023 – NCT05860621.April 21, 2023 – https://doi.org/10.17605/OSF.IO/ZAQ9NApril 27, 2023 – UMIN000050945.

Correction to: Structural Brain Changes After a Mindfulness-Based Intervention in Breast Cancer Survivors with Cognitive Complaints

Correction to: Structural Brain Changes After a Mindfulness-Based Intervention in Breast Cancer Survivors with Cognitive Complaints

Barriers, Facilitators, and Strategies for Developing a Culturally Informed Lifestyle Intervention for Native Hawaiian, CHamoru, and Filipino Breast Cancer Survivors: Mixed-Methods Findings from Focus Group Participants.

Breast cancer disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Few culturally informed interventions addressing breast cancer survivors exist and none have been developed or tested specifically for Native Hawaiian, CHamoru, and Filipino women. This study aimed to conduct focus groups with Native Hawaiian, CHamoru, and Filipino women previously diagnosed with breast cancer to inform future research in Guam and Hawai'i. Convenience sampling and grounded theory approaches were used. Focus group sessions were conducted during summer 2023 and included questions to understand the barriers, motivators, and implementation recommendations for lifestyle interventions aimed at reducing the risk for breast cancer recurrence among the target population. Data saturation was reached after a total of seven focus groups (an average of four survivors/group per site) were conducted (three in Hawai'i and four in Guam), which represented 28 breast cancer survivors. Themes from the focus groups emerged around developing support systems with other survivors, providing physical activity and nutrition intervention activities and materials in multiple formats, and incorporating activities and foods that accommodate the side effects of breast cancer treatments and are culturally relevant. The average desired intervention length was eight weeks. These findings will inform the development and feasibility testing of a culturally informed lifestyle intervention for breast cancer survivors in Guam and Hawai'i.

PAVING the path to wellness: Lifestyle medicine to improve outcomes in breast cancer survivors.

e24053 Background: Lifestyle medicine emphasizes the role of 6 pillars in preventing chronic disease and improving health: nutrition, physical activity, sleep, stress management, social connection, and avoiding risky substance use. While most oncologists are aware of the role of these factors in reducing risk of recurrence and improving outcomes, there are numerous barriers to addressing these lifestyle factors during clinic visits. The PAVING the Path to Wellness for Breast Cancer Survivors program (PAVING) is a 12-week lifestyle medicine group intervention designed to deliver lifestyle medicine guidelines and practices to cancer survivors in a supportive setting. This study assessed short-term impacts of PAVING on behavioral and psychological outcomes. Methods: 101 women who completed PAVING since 2019 were invited to complete a survey. Inclusion criteria were primary oncology treatment at Massachusetts General Hospital, age &gt; 22, diagnosis of invasive breast cancer (Stages I-III) within past 5 years, ECOG score 0-1, and English fluency. 16 enrolled in the study, 13 of whom fully completed the survey. The REDCap survey included the REAP-S and EHQ nutrition scales, IPAQ-SQ physical activity measure, COPE Inventory for coping skills, Psychological Wellbeing Scale, PROMIS-QOL scale, and ratings of the impact of the program on well-being. Statistical analysis was completed in SPSS. Results: The participants, N = 16, were women above the age of 22 with a primary diagnosis of breast cancer. Analysis found while ASCO recommends a minimum of 150 min/week of moderate-vigorous exercise, PAVING participants achieved a median of 255 min/week (120 to 420). A Spearman’s rank correlation found a significant positive relationship between fruit intake and self-rated dietary improvement due to PAVING, r(13) = .764, p = .002. A significant positive relationship also existed between PAVING-attributed emotional well-being improvements and general mental health, r(13) = .615, p = .025. Participants strongly agreed PAVING improved their confidence in their ability to cope (M = 1.9, SD = .76) and set goals (M = 1.92, SD = .862). Participants agreed their quality of life (QOL) improved since completing PAVING (M = 2, SD = .816); QOL ratings (M = 1.69, SD = .751) reflect very good-to-excellent QOL in the average PAVING participant. Conclusions: PAVING Participants report positive lifestyle practices, many attributed to the program, supporting further investigation of this program for patients with cancer. Mental well-being, QOL, and fruit intake were all positively correlated with self-rated growth resulting from PAVING. Participants exceeded guidelines for physical activity, which has been shown to reduce risk of breast cancer recurrence. PAVING is an effective lifestyle-medicine intervention for breast cancer survivors, and expansion will enable a broader population to improve outcomes following diagnosis and treatment.

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

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

Variables related to health-related quality of life among breast cancer survivors after participation in an interdisciplinary treatment combining mindfulness and physiotherapy.

Breast cancer diagnosis and treatment increase the potential psychological impact on breast cancer survivors (BCS). The objective of this study was to assess the effects of an interdisciplinary intervention during follow-up in BCS and identify variables related to improvements in HRQoL. In a non-randomised quasi-experimental design performed on an outpatient basis in a hospital gynaecology and oncology unit, 60 BCS were assigned to an interdisciplinary experimental group (EG) or a usual care group (CG). The EG underwent 12 sessions of an interdisciplinary program which included Mindfulness and physiotherapy, for 120 min per day, once a week for 6 weeks. At baseline, at 6 weeks and at 3 months after the intervention, participants of EG and CG completed an assessment of HRQoL (EuroQol and EORTC-QLQ-C30) and symptomatology of anxiety and depression. Additionally, EG completed an assessment of satisfaction with the treatment. For data analysis, we used descriptive statistics, Wilcoxon test, Kruskal-Wallis test, Chi-square and Fisher tests and generalised linear models. After 6 weeks, statistically significant differences were apparent in global and cancer-related health symptoms such as fatigue and pain in the EORTC QLQ-C30 and in anxiety and depression, among the EG (n = 30) compared with the CG (n = 30). Patients receiving the intervention reported a high degree of satisfaction with the treatment. Three months after the intervention, patients in the EG continued to show statistically significant improvements compared with the CG. In addition, allocation to the EG was identified as a variable related to improvement of HRQoL (EORTC QLQ-C30) in the multivariable model. The results of our study suggest that a 6-week interdisciplinary intervention may improve HRQoL and symptomatology of anxiety and depression in BCS patients at 3 months. The study presents data that the intervention for BCS appears promising and warrants further study in a randomised controlled trial.

Structural Brain Changes After a Mindfulness-Based Intervention in Breast Cancer Survivors with Cognitive Complaints

Structural Brain Changes After a Mindfulness-Based Intervention in Breast Cancer Survivors with Cognitive Complaints

Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial

BackgroundDepressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors.MethodsThe Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model.ResultsResults from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms.ConclusionsThe ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions.Trial registrationClinicalTrials.gov NCT03060941. Posted February 23, 2017.

Goal Attainment Scaling with a Dance-Based Intervention for Breast Cancer Survivors With CIPN: Pilot Study

Goal Attainment Scaling with a Dance-Based Intervention for Breast Cancer Survivors With CIPN: Pilot Study

Abstract PD12-01: PD12-01 Impact of obesity and post-diagnosis weight change on survival in women with breast cancer diagnosed at Smilow Cancer Hospital from 2013-2019

Abstract Background: The association between obesity and breast cancer risk is well documented, but fewer studies have explored the impact of post diagnosis weight changes on survival especially in more contemporary contexts. The existing evidence has mainly focused on weight gain, been limited by small sample sizes and has evaluated prospective cohorts with restrictive eligibility criteria rather than population-based samples. Our study uniquely contributes to the literature by using a population-based approach and recent clinically measured weight data from the electronic health record (EHR) to explore the impact of weight change following a breast cancer diagnosis on survival. Methods: EHR weight measurements were extracted for women diagnosed with stages I-IV breast cancer at CT’s Smilow Cancer Hospital and Care Network between 2013-2019 (N=6,934). During the follow-up period through April 26, 2020 (mean=3.2 years, standard deviation=1.8), there were 497 deaths. We used multivariable Cox regression models, adjusting for age at diagnosis, race/ethnicity, chemotherapy, radiation therapy, ER/PR subtype, to estimate the association between body mass index (BMI) at diagnosis and all-cause mortality from time since first post-diagnosis clinic visit (within 6 months of diagnosis). Percent weight change at 1-year post-diagnosis was categorized as a 5-level variable (weight stable – change within 5% of weight at diagnosis, moderate weight loss – 5% to &amp;lt; 10% change, large weight loss – ≥10% change, moderate weight gain – 5% to &amp;lt; 10% change, and large weight gain – ≥10% change) and evaluated in relation to all-cause mortality. A non-linear relationship between percent weight change at 1-year post-diagnosis and mortality was evaluated by comparing linear and cubic spline models. Results: Among these 6,934 breast cancer cases, the mean age was 61±13 years, BMI at diagnosis was 29±7 kg/m2 and weight change from diagnosis to 1-year post-diagnosis was -0.47±5.4 kg. Being underweight (BMI&amp;lt; 18.5) or having class II obesity (BMI&amp;gt;35) at diagnosis were statistically significantly independently associated with higher all-cause mortality compared with normal BMI (Hazard Ratio [HR]=1.43, 95% Confidence Interval [CI]=1.11-1.85 and HR=3.32, 95% CI=1.90-5.80, respectively). At 1-year post-diagnosis, 64% of women remained weight stable since diagnosis, 12% gained moderate body weight, 5% had large weight gain, 12% lost moderate weight and 7% experienced a large weight loss. Compared with the weight stable group, there was a positive, non-significant association between moderate weight gain at 1-year post-diagnosis and overall mortality (HR=1.24, 95% CI=0.84-1.81). Greater than 10% weight loss at 1-year post-diagnosis was statistically significantly associated with higher mortality (HR=2.87, 95% CI=2.13-3.87). The test for curvature suggested a non-linear relationship between percent weight change at 1-year and mortality (p&amp;lt; 0.001). Conclusion: In this contemporary, population-based study of women with breast cancer from one large academic medical center, underweight and obesity at diagnosis were associated with poorer survival. Weight loss during the first-year post-diagnosis was also strongly associated with an increased risk of mortality. To further inform weight management strategies and future interventions for breast cancer survivors, we need to better understand changes in body composition in the post-diagnosis period. Citation Format: Leah Puklin, Fangyong Li, Brenda Cartmel, Tara B. Sanft, Alexa Lisevick, Eric Winer, Maryam Lustberg, Mona Sharifi, Melinda L. Irwin, Leah Ferrucci. PD12-01 Impact of obesity and post-diagnosis weight change on survival in women with breast cancer diagnosed at Smilow Cancer Hospital from 2013-2019 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD12-01.

Physical activity intervention benefits persist months post-intervention: randomized trial in breast cancer survivors.

Determine durable effects of the 3-month Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) physical activity (PA) behavior change intervention 12months post-baseline (i.e., 9months after intervention completion). This 2-arm multicenter trial randomized 222 post-primary treatment breast cancer survivors to BEAT Cancer (individualized exercise and group education) vs. usual care (written materials). Assessments occurred at baseline, 3, 6, and 12months, with the 12months assessment reported here. Measures included PA (accelerometer, self-report), cardiorespiratory fitness, muscle strength, body mass index, Functional Assessment of Cancer Therapy (FACT), SF-36, fatigue, depression, anxiety, satisfaction with life, Pittsburgh Sleep Quality Index (PSQI), lower extremity joint dysfunction, and perceived memory. Adjusted linear mixed-model analyses demonstrated statistically significant month 12 between-group differences favoring BEAT Cancer for weekly minutes of moderate-to-vigorous self-report PA (mean between-group difference (M) = 44; 95% confidence interval (CI) = 12 to 76; p = .001), fitness (M = 1.5ml/kg/min; CI = 0.4 to 2.6; p = .01), FACT-General (M = 3.5; CI = 0.7 to 6.3; p = .014), FACT-Breast (M = 3.6; CI = 0.1 to 7.1; p = .044), social well-being (M = 1.3; CI = 0.1 to 2.5; p = .037), functional well-being (M = 1.2; CI = 0.2 to 2.3; p = .023), SF-36 vitality (M = 6.1; CI = 1.4 to 10.8; p = .011), fatigue (M = - 0.7; CI = - 1.1 to - 0.2; p = .004), satisfaction with life (M = 1.9; CI = 0.3 to 3.5; p = .019), sleep duration (M = - 0.2; CI = - 0.4 to - 0.03, p = .028), and memory (M = 1.1; CI = 0.2 to 2.1; p = .024). A 3-month PA intervention resulted in statistically significant and clinically important benefits compared to usual care at 12months. Three months of individualized and group PA counseling causes benefits detectable 9months later. ClinicalTrials.gov NCT00929617 ( https://clinicaltrials.gov/ct2/show/NCT00929617 ; registered June 29, 2009).

Long Term Effects of a Social Capital-Based Exercise Adherence Intervention for Breast Cancer Survivors With Moderate Fatigue: A Randomized Controlled Trial.

This study reports on the long-term effects of the Better Life After Cancer: Energy, Strength, and Support (BLESS) program, a 12-week social capital-based exercise adherence program for breast cancer survivors (BCS), implemented using a randomized controlled trial design. The study investigated outcomes related to cancer-related fatigue (CRF), quality of life (QOL), physical activity, depression, anxiety, sleep quality, and social capital. Participants who had moderate or greater CRF were randomly assigned to the intervention (n = 24), consisting of supervised and home-based exercise, or the control (n = 26), who received exercise leaflets. Generalized estimating equations models were fitted for the outcome variables. The assessment points were baseline (M1), immediately after completing the intervention at 12 weeks (M2), 1 month (M3), and 6 months post-intervention (M4). A significant reduction in the total CRF score was found for both groups. We observed a significant time by group effect at M2, indicating a reduction of behavioral/severity CRF scores and a higher increase of physical activity. Also, there was an increase in the QOL score of both groups at M2, M3, and M4, compared to M1. Both groups had reduced anxiety at M3 and M4 compared to M1. The time by group effect for depression, sleep quality and social capital was not statistically significant. This 12-week exercise adherence program improved behavioral/severity CRF and physical activity post-intervention. Both the experimental group and control group showed significant improvements in CRF, QOL, and anxiety domains compared to the baseline, which extended to 6 months post-intervention. Korean Clinical Research Information Service (KCT0005763).

Aerobic exercise training resets the human skeletal muscle methylome 10 years after breast cancer treatment and survival.

Cancer survivors suffer impairments in skeletal muscle in terms of reduced mass and function. Interestingly, human skeletal muscle possesses an epigenetic memory of earlier stimuli, such as exercise. Long-term retention of epigenetic changes in skeletal muscle following cancer survival and/or exercise training has not yet been studied. We, therefore, investigated genome-wide DNA methylation (methylome) in skeletal muscle following a 5-month, 3/week aerobic-training intervention in breast cancer survivors 10-14 years after diagnosis and treatment. These results were compared to breast cancer survivors who remained untrained and to age-matched controls with no history of cancer, who undertook the same training intervention. Skeletal muscle biopsies were obtained from 23 females before(pre) and after(post) the 5-month training period. InfiniumEPIC 850K DNA methylation arrays and RT-PCR for gene expression were performed. The breast cancer survivors displayed a significant retention of increased DNA methylation (i.e., hypermethylation) at a larger number of differentially methylated positions (DMPs) compared with healthy age-matched controls pre training. Training in cancer survivors led to an exaggerated number of DMPs with a hypermethylated signature occurring at non-regulatory regions compared with training in healthy age-matched controls. However, the opposite occurred in important gene regulatory regions, where training in cancer survivors elicited a considerable reduction in methylation (i.e., hypomethylation) in 99% of the DMPs located in CpG islands within promoter regions. Importantly, training was able to reverse the hypermethylation identified in cancer survivors back toward a hypomethylated signature that was observed pre training in healthy age-matched controls at 300 (out of 881) of these island/promoter-associated CpGs. Pathway enrichment analysis identified training in cancer survivors evoked a predominantly hypomethylated signature in pathways associated with cell cycle, DNA replication/repair, transcription, translation, mTOR signaling, and the proteosome. Differentially methylated region (DMR) analysis also identified genes: BAG1, BTG2, CHP1, KIFC1, MKL2, MTR, PEX11B, POLD2, S100A6, SNORD104, and SPG7 as hypermethylated in breast cancer survivors, with training reversing these CpG island/promoter-associated DMRs toward a hypomethylated signature. Training also elicited a largely different epigenetic response in healthy individuals than that observed in cancer survivors, with very few overlapping changes. Only one gene, SIRT2, was identified as having altered methylation in cancer survivors at baseline and after training in both the cancer survivors and healthy controls. Overall, human skeletal muscle may retain a hypermethylated signature as long as 10-14 years after breast cancer treatment/survival. Five months of aerobic training reset the skeletal muscle methylome toward signatures identified in healthy age-matched individuals in gene regulatory regions.