Intervention For Breast Cancer Survivors Research Articles

A 4-Month Whole-Systems Ayurvedic Medicine Nutrition and Lifestyle Intervention Is Feasible and Acceptable for Breast Cancer Survivors: Results of a Single-Arm Pilot Clinical Trial.

PurposeOngoing symptoms and impairments in quality of life (QOL) among breast cancer survivors remain a significant problem. We tested the feasibility and acceptability of a manualized Ayurvedic nutrition and lifestyle intervention for breast cancer survivors.MethodsEligible participants had Stage I–III breast cancer, underwent treatment within the past year that included chemotherapy, and were without active disease. The 4-month individualized Ayurvedic intervention included counseling on nutrition, lifestyle, yoga, and marma (like acupressure) during 8 one-on-one visits with an Ayurvedic practitioner. Feasibility and acceptability were the primary outcomes. QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ C30]) and symptoms—sleep disturbance (General Sleep Disturbance Scale [GSDS]), fatigue (Lee Fatigue Scale [LFS]), depressive symptoms (Center for Epidemiological Studies—Depression Scale [CES-D]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI-S, STAI-T]), and stress (Perceived Stress Scale [PSS])—were measured prior to, at midpoint, and at the end of the 4-month intervention. Effect sizes (Cohen’s d) were calculated along with paired t tests comparing baseline to end of month 4 time points. Mixed effects models were used for repeated measures analyses.ResultsParticipants (n = 32) had a mean age of 48 years (SD = 10). Retention at the end of the intervention was 84%. Among those who completed the intervention (n = 27), adherence was high (99.5% of visits with practitioners attended). Large improvements were seen in QLQ-C30 emotional functioning (d = 0.84, P < 0.001), QLQ-C30 cognitive functioning (d = 0.86, P < 0.001), GSDS (d = –1.23, P < 0.001), and CES-D (d = –1.21, P < 0.001). Moderate improvements were seen in QLQ-C30 global health (d = 0.65, p = 0.003), LFS (d = –0.68, P = 0.002), and PSS (d = –0.75, P < 0.001). No adverse events were observed due to the intervention.ConclusionThis 4-month Ayurvedic whole-systems multimodal nutrition and lifestyle intervention was feasible and acceptable for breast cancer survivors. Promise of clinical benefit was seen in terms of improvements in symptoms and QOL that warrants further investigation.

Differential DNA methylation following chemotherapy for breast cancer is associated with lack of memory improvement at one year

ABSTRACTThe biological basis underlying cognitive dysfunction in women with early-stage breast cancer (BC) remains unclear, but could reflect gene expression changes that arise from the acquisition and long-term retention of soma-wide alterations in DNA methylation in response to chemotherapy. In this longitudinal study, we identified differences in peripheral methylation patterns present in women prior to treatment (T1) and 1 year after receiving chemotherapy (T4) and evaluated relationships among the differential methylation (DM) ratios with changes in cognitive function. A total of 58 paired (T1 and T4) blood specimens were evaluated. Methylation values were determined for DNA isolated from whole blood using a genome-wide array . Cognitive function was measured using the validated, computerized CNS Vital Signs platform. Relationships between methylation patterns and cognitive domain scores were compared using a stepwise linear regression analysis, with demographic variables as covariates. The symptom comparison analysis was restricted to 2,199 CpG positions showing significant methylation ratio changes between T1 and T4. The positions with DM were enriched for genes involved in the modulation of cytokine concentrations. Significant DM ratios were associated with memory domain (56 CpGs). Eight of the ten largest DM ratio changes associated with lack of memory improvement were localized to genes involved in either neural function (ECE2, PPFIBP2) or signalling processes (USP6NL, RIPOR2, KLF5, UBE2V1, DGKA, RPS6KA1). These results suggest that epigenetic changes acquired and retained for at least one year in non-tumour cells following chemotherapy may be associated with a lack of memory improvement following treatment in BC survivors.

Impact of an osteoporosis specialized unit on bone health in breast cancer survivals treated with aromatase inhibitors

ObjectiveConsidering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start. Material and methodsRetrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years. ResultsThe final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50–77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023). ConclusionsThe preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients.

Body Composition, Strength, and Physical Function Following Two Training Interventions for Breast Cancer Survivors

Body Composition, Strength, and Physical Function Following Two Training Interventions for Breast Cancer Survivors

Activity Tracker to Prescribe Various Exercise Intensities in Breast Cancer Survivors.

To prescribe different physical activity (PA) intensities using activity trackers to increase PA, reduce sedentary time, and improve health outcomes among breast cancer survivors. The maintenance effect of the interventions on study outcomes was also assessed. The Breast Cancer and Physical Activity Level pilot trial randomized 45 breast cancer survivors to a home-based, 12-wk lower (300 min·wk at 40%-59% of HR reserve) or higher-intensity PA (150 min·wk at 60%-80% of HR reserve), or no PA intervention/control. Both intervention groups received Polar A360® activity trackers. Study outcomes assessed at baseline, 12 and 24 wk included PA and sedentary time (ActiGraph GT3X+), health-related fitness (e.g., body composition, cardiopulmonary fitness/V˙O2max), and patient-reported outcomes (e.g., quality of life). Intention-to-treat analyses were conducted using linear mixed models and adjusted for baseline outcomes. Increases in moderate-vigorous intensity PA (least squares adjusted group difference [LSAGD], 0.6; 95% confidence interval [CI], 0.1-1.0) and decreases in sedentary time (LSAGD, -1.2; 95% CI, -2.2 to -0.2) were significantly greater in the lower-intensity PA group versus control at 12 wk. Increases in V˙O2max at 12 wk in both interventions groups were significantly greater than changes in the control group (lower-intensity PA group LSAGD, 4.2; 95% CI, 0.5-8.0 mL·kg·min; higher-intensity PA group LSAGD, 5.4; 95% CI, 1.7-9.1 mL·kg·min). Changes in PA and V˙O2max remained at 24 wk, but differences between the intervention and control groups were no longer statistically significant. Increases in PA time and cardiopulmonary fitness/V˙O2max can be achieved with both lower- and higher-intensity PA interventions in breast cancer survivors. Reductions in sedentary time were also noted in the lower-intensity PA group.

The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors

BackgroundTo assess the relationship between radiation doses to the coronary arteries (CAs) and location of a coronary stenosis that required intervention after three-dimensional conformal radiotherapy (3DCRT) for breast cancer (BC).MethodsThe study population consisted of 182 women treated for BC in Sweden between 1992 and 2012. All women received 3DCRT and subsequently underwent coronary angiography due to a suspected coronary event. CA segments were delineated in the patient’s original planning-CT and radiation doses were recalculated based on the dose distribution of the original radiotherapy (RT) plan. The location of the CA stenosis that required intervention was identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Logistic regression analysis was used to assess the relationship between CA radiation doses and risk of a later coronary intervention at this specific location.ResultsThe odds ratio (OR) varied by radiation dose to the mid left anterior descending artery (LAD) (p = 0.005). Women receiving mean doses of 1–5 Gray (Gy) to the mid LAD had an adjusted OR of 0.90 (95% CI 0.47–1.74) for a later coronary intervention compared to women receiving mean doses of 0–1 Gy to the mid LAD. In women receiving mean doses of 5–20 Gy to the mid LAD, an adjusted OR of 1.24 (95% CI 0.52–2.95) was observed, which increased to an OR of 5.23 (95% CI 2.01–13.6) for mean doses over 20 Gy, when compared to women receiving mean doses of 0–1 Gy to the mid LAD.ConclusionsIn women receiving conventional 3DCRT for BC between 1992 and 2012, radiation doses to the LAD remained high and were associated with an increased requirement of coronary intervention in mid LAD. The results support that the LAD radiation dose should be considered in RT treatment planning and that the dose should be kept as low as possible. Minimising the dose to LAD is expected to diminish the risk of later radiation-induced stenosis.

Gut microbiota diversity is associated with cardiorespiratory fitness in post-primary treatment breast cancer survivors.

What is the central question of this study? Does the link between cardiorespiratory fitness and gut microbiota diversity persist after adjusting for the potential effects of percentage body fat and activity-related energy expenditure (AEE)? What is the main finding and its importance? This is the first study to examine the link between cardiorespiratory fitness and gut microbiota diversity while accounting for the underlying effects of percentage body fat and free-living AEE. Results from the present work suggest that cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity among post-primary treatment, non-metastatic breast cancer survivors. Cancer treatment uniquely triggers multiple physiological shifts detrimental to overall health. Although previous research indicates a link between the gut microbiota and cardiorespiratory fitness, it is unclear whether these findings are attributable to potential underlying effects of percentage body fat or free-living activity energy expenditure (AEE). The microbe composition of faecal specimens from 37 breast cancer survivors was determined using 16S microbiome analyses. Individual-sample microbiota diversity (α-diversity) and between-sample community differences (β-diversity) were examined. Peak oxygen uptake ( ) was estimated from a graded exercise test consistent with the modified Naughton protocol, in which exercise terminates at 85% of age-predicted maximal heart rate. The AEE was measured over 10days using doubly labelled water, wherein the percentage body fat was calculated from total body water. Pearson correlations revealed α-diversity indices (Chao1, observed species, PD whole tree and Shannon) to be positively associated with (r=0.34-0.51; P<0.05), whereas the percentage of maximal heart rate during stages1-4 of the graded exercise test (r=-0.34 to -0.50; P<0.05) and percentage body fat (r=-0.32 to -0.41; P<0.05) were negatively associated with the same α-diversity indices. Multiple linear regression models showed that accounted for 22 and 26% of the variance in taxonomic richness (observed species) and phylogenic diversity after adjustment for percentage body fat and menopausal status. Unweighted UniFrac (β-diversity) was significant for several outcomes involving cardiorespiratory fitness, and significant taxa comparisons were found. Associations between gut microbiota and free-living AEE were not found. Results from the present work suggest that cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity.

Abstract P6-11-02: Reduced sedentary time intervention for breast cancer survivors: objectively-measured outcomes for activity and metabolism

Abstract Physical activity (PA) promotion and sedentary behavior reduction among cancer survivors is a national priority and the number of PA-based behavioral interventions has expanded considerably in recent years. However, due in part to past limitations related to precise quantitative measurement of sedentary behaviors, there have been relatively few trials focused on reduction of sedentary time among cancer survivors. Additionally, many PA interventions rely on clinic-based coaching, which is both time-intensive and unrealistic for many clinics. The purpose of this study was to investigate the effects of a home-based 6-week reduced sedentary time intervention (RSTI) in breast cancer survivors who had completed primary treatment. Questionnaires, anthropometric measures, fasting blood glucose, lipid profiles and other cancer-relevant biomarkers, and an oral glucose tolerance test to assess dynamic insulin were completed at baseline and post-intervention. Participants wore ActivPALs (on right thigh) for 7 days at baseline and post-intervention. The mailed RSTI included tailored feedback on PA and sedentary habits and provision of personalized visual displays generated from baseline ActivPal data, with specific tips for how to reduce sedentarism through environmental modifications to home and work spaces (example: moving your printer from next to your desk to down the hall). Eligibility criteria included: females ages 20-80; not meeting national exercise guidelines (150 minutes per week); diagnosis of Stage I-III breast cancer treated &amp;gt;6 months and &amp;lt;5 years prior; overweight or obese (BMI &amp;gt;25); no history of diabetes. Sixteen enrolled and 13 completed the study. Average BMI at baseline was 31.9 and all participants' daily step counts were significantly below national recommendations (mean=6190 steps/d, SD: 2086 steps/d). Post-intervention changes from baseline were analyzed using non-parametric statistics. No statistically significant changes in daily bouts of sedentarism, energy expenditure, or total steps were detected, although participants' mean daily steps post-intervention were 6326/d (SD: 2788/d), still well below recommended guidelines. Leptin levels also showed a significant reduction pre/post (p&amp;lt;0.01). Results indicate that similar home-based RSTIs are safe, acceptable to survivors, and feasible to implement by cancer center staff. Further research with larger samples is required to establish efficacy and effect sizes for the intervention. A larger intervention dose may be required to see clinically-meaningful changes in sedentarism, daily activity, and metabolism. Citation Format: Walker RK, Viskochil R, Barham R, Moraitis A, Gagliarducci J, Makari-Judson G. Reduced sedentary time intervention for breast cancer survivors: objectively-measured outcomes for activity and metabolism [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-11-02.

A review of home-based physical activity interventions for breast cancer survivors.

As breast cancer relative survival continues to increase, many breast cancer patients face many issues, including recurrence of cancer and cancer-related side effects that impact several aspects of their quality of life. With breast cancer patients living longer, there is more of a concern for negative breast cancer outcomes. Although physical activity is an affordable and relatively convenient way to improve breast cancer outcomes, only about one-third of breast cancer survivors engage in the recommended level of physical activity. This article reviews articles published to date to examine whether home-based physical activity interventions are effective in improving physical activity and other outcomes among breast cancer survivors who have completed primary therapy for the disease. The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1980 through February 28, 2019 were identified. A total of 360 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 20 studies that met the eligibility criteria. Three of the studies were pre-/post-test trials and 17 were randomized controlled trials. home-based exercise programs are effective in improving physical activity among breast cancer survivors who have completed primary therapy for the disease. Home-based exercise programs such as walking programs offer a convenient and affordable option for women who wish to increase their physical activity and maintain a healthy lifestyle.

Feasibility study - individual physical activity behaviour change intervention for breast cancer survivors within the NHS

Feasibility study - individual physical activity behaviour change intervention for breast cancer survivors within the NHS

Perceptions of a Breast Cancer Survivorship Intervention: Pearls of Wisdom from Young African American Women.

African American (AA) women ages 20-44 develop breast cancer at higher rates compared with Caucasian women. These young survivors (<45 years) also have disparate quality of life (QOL). Little is known about survivorship information needs of young AA survivors. The purpose of this study was to explore young AA survivors' perceptions of an existing QOL intervention for breast cancer survivors, identifying information needs to address using a targeted intervention. Two semistructured interviews were conducted with each of 15 young AA survivors who had completed breast cancer treatment. This article focuses on the second interview in which young AA survivors reviewed intervention materials and described their perceptions of the intervention. Content analysis was used to identify themes, which were validated by participants. Participants (n: 15; mean age at study entry: 35 years) reported that the existing evidence-based intervention discussed relevant but general survivorship information. They suggested adapting the information for young AA survivors: addition of content geared toward finances, how to better communicate to manage dating and relationships, how to engage in healthful activities, and how to find local resources for any stage of survivorship. Furthermore, they suggested multiple modes of information delivery and inclusion of diverse imagery. Engaging young AA survivors yielded pearls of wisdom, highlighting the general nature of an existing intervention and suggesting adaptations to meet young AA survivors' information needs. Applying such pearls can be a powerful method to target survivorship interventions for this disparate group of cancer survivors.

Patient Satisfaction with Mobile Health (mHealth) Application for Exercise Intervention in Breast Cancer Survivors

This study aimed to assess user satisfaction with mobile health (mHealth) application in breast cancer survivors after a 12-week exercise program and provide developers with reference points for mHealth applications from the perspective of patients and physicians. This is a retrospective review of prospectively collected multicenter data of 88 breast cancer survivors who carried out a 12-week exercise program via smartphone application with pedometer. Personalized programs including aerobic and resistance exercise were prescribed by physiatrists. Also, telephone counseling was performed at the 3rd and 9th week. All patients completed the user satisfaction questionnaire at the end of the intervention. The mean achievement rates of aerobic and resistance exercise for 12weeks were 78.8 and 71.3%, respectively. The mean score of overall satisfaction rated on the 5-point Likert scale was 4.22 ± 0.73. When the patients were grouped according to age, the overall satisfaction score increased significantly with age (P = 0.040). Also, the satisfaction scores of patients with radiotherapy were significantly higher than patients without radiotherapy (P = 0.001). In terms of system characteristics, the most satisfying was data transmission accuracy (4.32 ± 0.74). In addition, patients were very satisfied with telephone counseling (4.55 ± 0.62). The results suggest the direction of mHealth should go to meet the detailed requirements of the specific user group as a more targeted approach. In addition, if a mutual feedback platform can be implanted in mHealth applications, it will increase user loyalty and make mHealth a more available motivational technology in our lives.

PO-285 A review of effects of exercise on the quality of life in breast cancer survivors

Objective Breast cancer is one of the most common malignant tumors in women.The number of women diagnosed with breast cancer each year is also increasing.It is also the leading cause of cancer deaths in women, accounting for 14-23% of cancer deaths.However, with the development of medical technology, the survival rate of breast cancer patients is improving.In general, the treatment of breast cancer mainly includes surgical treatment, adjuvant chemotherapy and radiotherapy，But these treatments can do a lot of damage to breast cancer patients.These injuries can limit some of the physical activity of breast cancer patients, and can be accompanied by significant psychological damage，Therefore, the quality of life of breast survivors is largely destroyed.Physical exercise is one of the important ways to improve the overall health of the human body.It also plays an important role in increasing people's mood and quality of life.So whether physical exercise has a positive impact on improving the quality of life of breast cancer survivors or there is some doubt.Therefore, the main purpose of this study is to explore the impact of physical exercise on the quality of life of breast cancer survivors, and then to prove the impact of supervised exercise and individual exercise on the quality of life of breast cancer survivors.&#x0D; Methods Data bases searched were MEDLINE, EMBASE, CINAHL, PubMed.Keywords were“breast cancer and quality of life” in combination with “exercise”or “physical activity”.At the same time, the references of the included articles were reviewed to obtain more relevant studies.In terms of the criteria for inclusion and exclusion of literature, the paper was initially screened to determine whether the title and abstract of the paper were consistent with the research topic.The criteria for inclusion are ①the subjects were breast cancer survivors,②the type of intervention was physical exercise,③the measured result is quality of life,④the type of experiment is randomized controlled trial.The exclusion criteria of the article are ①the subject's occupation was athlete，②quality of life is not measured on a formal scale，③article type is review or abstract.&#x0D; Results A total of 14 articles are included in our review.Quality of life was measured using scale tools in all included studies, of which two scales were used in all included articles.The two scales used can reflect the real life quality of the subjects, of which FACT-G is a mass life quality scale and FACT-B is a life quality scale designed specifically for breast cancer patients. Both scales are globally recognized by the public.In our review, we found that exercise significantly improved the quality of life of breast cancer survivors, particularly aerobic exercise.In the studies included in our study, except Nanette et al. used aerobic exercise combined with resistance strength training as the intervention method in their study, all the other studies used aerobic exercise as the intervention method for the subjects.Among the 14 included studies, 10 indicated that physical exercise significantly increased the quality of life of breast cancer survivors, and 4 found that compared with the control group, the quality of life of breast cancer survivors did not have significant changes, but there was a trend of improving the quality of life.At the same time, our review found that monitoring breast cancer survivors improved quality of life.In two of the studies we included, subjects were divided into individual exercise groups and supervised exercise groups.In their study, Anne et al. divided the recruited research samples into the supervision intervention group and the routine control group. Among them, the supervision intervention group received physical exercise 5 times a week for 12 weeks, and the quality of life of breast cancer survivors was significantly improved.In the study of Cadmus et al., the subjects recruited were divided into individual exercise group, supervised exercise group and routine control group, and the exercise group performed physical exercise with the same load and frequency. The result was that there was no physical activity in the home individual exercise group or the routine control group that improved the quality of life for breast cancer survivors.However, in the supervised exercise group, breast cancer survivors' scores for FACT-B and SF-36 (a measure reflecting quality of life) were significantly improved.&#x0D; Conclusions Exercise can improve the quality of life for breast cancer survivors, especially aerobic exercise. Supervised exercise intervention for breast cancer survivors can better improve their quality of life and alleviate social and psychological problems than individual exercise.The supervised aerobic exercise can be integrated into the life of breast cancer survivors so as to better promote the recovery of breast cancer survivors.

Dietary intervention among breast cancer survivors increased adherence to a Mediterranean-style, anti-inflammatory dietary pattern: the Rx for Better Breast Health Randomized Controlled Trial

The goal of this education and culinary-based dietary intervention was to increase adherence to a Mediterranean-style, anti-inflammatory dietary pattern in breast cancer survivors (BCS) by promoting the consumption of anti-inflammatory foods, herbs, and spices. Overweight and obese, early-stage, BCS were randomized to the Intervention (n = 76) or Control (n = 77). The 6-month intervention included monthly nutrition and cooking workshops, Motivational Interviewing telephone calls, and individualized newsletters. Control participants received monthly informational brochures and no navigational services. Dietary intakes were collected via questionnaire and 3-day food records at baseline and 6months. One hundred twenty-five BCS (n = 60 I; n = 65C) completed post-testing (81.7%) and were included in analyses. Adherence to Mediterranean diet guidelines significantly increased in the intervention group, but not in the control group (+ 22.5% vs. + 2.7%, P < 0.001). Upon further analysis of adherence to individual dietary guidelines, the intervention group significantly improved adherence to only three guidelines: consuming ≥ 3 servings of fish or shellfish/week, reducing red meat intake to < 1 serving/day, and limiting consumption of commercial sweets and baked goods to < 3 times/week. The intervention arm increased the use of spices and herbs compared to control (+ 146.2% vs. +33.3%, P < 0.001), including significantly more frequent consumption of cinnamon, turmeric, garlic, ginger, black pepper, and rosemary. An education and culinary-based intervention in BCS successfully increased adherence to a more Mediterranean-style, anti-inflammatory dietary pattern by increasing the consumption of anti-inflammatory foods, spices, and herbs and decreasing the consumption of pro-inflammatory foods.

Qigong intervention for breast cancer survivors with complaints of decreased cognitive function.

The purpose of this pilot study was to evaluate the feasibility of an 8-week Qigong intervention to improve objectively and subjectively assessed cognitive function in breast cancer survivors who were 2months to 8years post completion of chemotherapy and radiation therapy. A randomized, single-blind, three-arm intervention pilot was conducted to compare Qigong to gentle exercise and survivorship support. Feasibility was measured by recruitment, group session attendance, and adherence to home practice for the two exercise groups. Changes in self-report and objectively measured cognitive function were compared between the three groups from baseline (T1) to completion of the intervention (T2) and 4weeks post intervention (T3). Fifty participants consented (83% of desired sample) with an overall attrition rate of 28%. Attrition was highest for the gentle exercise group (50%). Group attendance adherence ranged from 44 to 67%. The a priori established rate of 75% weekly attendance was not achieved, nor was the goal of 75% adherence to home practice for the two exercise groups (7 to 41%). Self-report of cognitive function improved most for the Qigong group (p = .01). Improvement was demonstrated for the Trail Making A (gentle exercise, p = .007) and F-A-S verbal fluency (support group, p = .02) tests. Qigong participants reported the most reduction of distress (p = .02). The study results suggest that mindfulness-based exercise may be superior to gentle exercise alone or survivorship support for improving self-report of cognitive function and distress after treatment for breast cancer. The mindfulness component may enhance the positive impact of exercise on cognitive function.

A pilot study of a body image intervention for breast cancer survivors

Body image interventions for breast cancer survivors are lacking in empirical support. Examining existing research on effective body image interventions for women in midlife more broadly may provide useful insights. This pilot study assessed the acceptability, feasibility, and preliminary effects of a Cognitive Behavioural Therapy-based intervention adapted from women in midlife to promote positive body image among breast cancer survivors. Twenty-two breast cancer survivors received the 7-week group intervention, co-facilitated by a clinical psychologist and peer. Participant evaluations suggested the intervention was both acceptable (e.g., 94% would recommend it) and feasible (e.g., 91% completed the intervention). Improvements were identified at either post-test or 1-month follow-up in nearly all body image measures. Maintained improvements were found in body appreciation, weight and shape concern, acceptance of aging-related appearance changes, and self-esteem. This study suggests that the adapted intervention is acceptable, feasible, and demonstrates preliminary efficacy in improving body image and secondary outcomes among breast cancer survivors.

Impact of surgery type on physical fitness following a 16-week exercise intervention in breast cancer survivors

Breast cancer survivors (BCS) undergo different types of surgery (e.g. lumpectomy, partial mastectomy, bilateral mastectomy) that may impair physical fitness. Regular participation in exercise is an effective strategy to improve physical fitness after surgery in BCS. The purpose of this study is to examine whether surgery type influences the effects of a 16-week exercise intervention on physical fitness in BCS. Sedentary, overweight/obese (BMI > 25 kg/m 2 ) BCS (Stages I–III) were enrolled as part of a larger ongoing RCT. BCS underwent supervised, progressive moderate-to-vigorous aerobic and resistance exercise sessions 3 times/week for 16 weeks. Cardiorespiratory fitness (CRF) and muscular strength (MS) were assessed at baseline and post-intervention. CRF was measured by calculating estimated VO 2 max using the 4-minute walk test. MS was assessed from 10-RM (repetition maximum) tests of the leg extension (LE), leg flexion (LF), chest press (CP), and lat pulldown (LP) to estimate 1-RM values. Surgery type was abstracted from medical records. Paired t -test and one-way ANOVA were used to examine the effects of exercise training and surgery variables on physical fitness. Forty-six (52.7 ± 10.4 y), primarily postmenopausal (56.1%), Hispanic (63.1%) BCS completed the intervention. CRF (mean % change 20.1 ± 7.2%) and MS (LE: 42.6 ± 28.1%; LF: 43.9 ± 21.4%; CP: 58.5 ± 55.0%; LP: 35.4 ± 14.1%) significantly increased following the intervention ( P < 0.01). Post-intervention, MS was significantly higher in BCS who had mastectomy surgery when compared to those who had lumpectomy surgery ( P < 0.001). Surgery type may impact improvements in physical fitness following a structured exercise intervention in BCS. Further research is required to understand whether surgical history impacts the effect of exercise on physical fitness in BCS.

Obesity at diagnosis and after treatment in breast cancer survivors and risk of neuropathy.

e22085Background: Guidelines recommend that breast cancer survivors maintain a healthy body weight as obesity (BMI≥30 kg/m2) predicts worse survival outcomes. We sought to identify patient characte...

Muscle Strength and Fasting Insulin Levels Following a Combined Exercise Intervention in Breast Cancer Survivors

PURPOSE: Breast cancer treatments may lead to elevated fasting insulin levels and gains in fat mass causing insulin resistance in skeletal muscle and subsequent reductions in muscle strength (MST). Exercise is a non-pharmacologic strategy to improve elevated insulin and reduced MST. In particular, combined aerobic and resistance exercise (CE) reduces insulin levels and improves MST, and has been shown to be superior to resistance or aerobic exercise alone at reducing insulin resistance in patients with type 2 diabetes. The purpose of this study was to determine whether fasting insulin levels and muscle strength (MST) can be improved following a 16-week supervised CE intervention in overweight and obese breast cancer survivors (BCS). We further sought to determine whether exercise-induced changes in fasting insulin are associated with changes in MST. METHODS: Sedentary, overweight/obese (BMI >25 kg/m2) BCS (Stage I-III) were randomized to the Control (CON) or the Exercise (EX) groups. EX underwent supervised CE sessions 3 times per week for 16 weeks. CON was asked to maintain their current level of activity. Fasting serum insulin was measured using enzyme-linked immunoabsorbent assays. MST was assessed from 10-RM (repetition maximum) tests of the leg extension (LE) and chest press (CP) to estimate 1-RM values. Repeated measures ANOVA was used to examine the effects of exercise on MST and insulin. Pearson’s correlations were performed to examine the association between MST changes for each exercise and insulin. RESULTS: At baseline, EX (n=48) and CON (n=46) did not differ by age (53.0 ± 10.4 yr), insulin (35.2 ± 15.4 pmol/L), or BMI (33.5 ± 5.5 kg/m2). Post-intervention, insulin was significantly reduced (-13.5 ± 3.1%) and all MST measures (35.9 ± 6.7%) significantly increased in EX compared to CON (P<0.01). Significant correlations were found between reduced insulin and improved MST for LE (r=-0.67, p=0.001) and CP (r=-0.81, p=0.01) in EX. CONCLUSION: A 16-week supervised CE intervention is an effective approach to reduce insulin, and increase MST, and reductions in insulin are associated with improved muscle strength in BCS. Collectively, this supports the utilization of aerobic and resistance exercise as vital components of cancer rehabilitation following completion of cancer treatment.

Home-Based Psychoeducational Intervention for Breast Cancer Survivors.

It is important to manage psychological distress and improve the quality of life (QOL) in patients after breast cancer treatment. The aim of this study was to evaluate the effects of a home-based, psychoeducational program on distress, anxiety, depression, and QOL in breast cancer survivors. The study was a single-group pretest and posttest quasi-experimental design. The data were collected using the Distress Thermometer, the Hospital Anxiety and Depression Scale, and the Turkish version of the World Health Organization Quality of Life Instrument, short form. The home-based, individual, face-to-face psychoeducational program was structured according to breast cancer survivors' needs and the Neuman Systems Model. A total of 32 Turkish breast cancer survivors participated in this study. There were statistically significant differences in the mean scores for distress, anxiety, and depression in the breast cancer survivors over 4 measurements. The mean scores for all subscales of the QOL at 6 months postintervention were significantly higher than the mean scores at baseline. The results indicated that the psychoeducational program may be effective in reducing distress, anxiety, and depression and in improving the QOL in breast cancer survivors. Psychoeducational programs may be effective and should be considered as part of the survivorship care for breast cancer survivors.