Life In Breast Cancer Survivors Research Articles

Impact of Inertial Training on Muscle Strength and Quality of Life in Breast Cancer Survivors.

The aim of the study was to evaluate the impact of inertial training on the muscle strength, on breast-cancer-related lymphedema, and on quality of life in breast cancer survivors. After a mastectomy, 24 women (age, 66.2 ± 10.6 years) were randomized to a training (n = 12) or control group (n = 12). The training group performed inertial training twice per week for 6 weeks with a training load of about 70% of the maximal force. Before and after training, we tested the maximum force of shoulder flexors, extensors, abductors, and adductors; body composition; breast-cancer-related lymphedema; and disabilities of the arm, shoulder, and hand. Inertial training significantly improved the strength in all tested muscles (from 32 to 68%; effect size (ES) from 0.89 to 1.85 in the impaired limb and from 31 to 64%; ES from 0.86 to 1.57 in the unimpaired limb). However, changes in the control group were not significant. Quality of life improved following treatment; the disabilities of the arm, shoulder, and hand score decreased significantly by 24.5% (ES from—0.29 to 1.38), p ≤ 0.05 in the training group and by 3.99% (ES from −0.49 to 1.14) in the control group p > 0.05. Breast-cancer-related lymphedema and body composition did not change significantly after the intervention in either group. We recommend inertial training for increasing muscle strength and improving quality of life in breast cancer survivors.

The Effects of a Pilates Exercise Program on Pain, Functional Capacity, and Quality of Life in Breast Cancer Survivors One Year Postsurgery.

To evaluate the effects of Pilates exercises on functional capacity, pain, and quality of life in breast cancer survivors one year postsurgery. 44 breast cancer survivors who participated in a 24-session Pilates exercise program at a physiotherapy clinic in Brazil. This prospective longitudinal study evaluated breast cancer survivors who performed Pilates exercises for 60 minutes twice weekly. Functional capacity was analyzed using the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and the Shoulder Pain and Disability Index (SPADI). Pain and quality of life were also analyzed. Scores were measured on admission, after 12 sessions, and after 24 sessions. Median DASH and SPADI scores improved by 61% after 24 Pilates exercise sessions. The average number of breast cancer survivors who performed complex tasks without difficulty after 12 sessions and 24 sessions increased considerably. Pain scores significantly decreased, and quality of life significantly improved after all sessions. Incorporating a Pilates exercise program can decrease pain and improve functional status and quality of life among breast cancer survivors at least one year postsurgery.

Abstract P4-10-12: The relevance of chemobrain in breast cancer survivors: An Italian exploratory study to measure incidence and psycho-social impact

Abstract Breast Cancer is the most frequently diagnosed cancer among women. Despite the decreasing death-rate, a large portion of patients experience long-term side effects. One of the most common is “chemobrain”: a series of subtle but persistent cognitive deficits that affect attention, memory, and speed of processing. There is a lack of consensus regarding the exact rate of “chemobrain” incidence(from 12% to 86% of patients complaining cognitive sequelae after adjuvant-therapies) primarily due to the heterogeneity of assessment measures used to quantify it. Our first aim was to estimate the prevalence of perceived cognitive deficits in breast cancer-survivors, and to address the relevance of psycho-social factors that might affect perceived cognitive functioning. The second aim was to better understand the specific impact on patients comparing possible differences in perceived cognitive functioning between a cohort of breast cancer-survivors and an age-matched group of women without oncologic diagnosis. A total of 216 subjects submitted an anonymous online questionnaire that included FACTCog v.3and 41 items investigating clinical history, cognitive reserve, sleep quality, dietary and health habits. Inclusion criteria were being female, aged between 25 and 75, lack of known psychiatric or neurological diseases. The study was approved by the Ethical Committee of University of Trieste. The study sample comprised 90 oncological patients, recruited through clinical oncology practices between Trieste - ASU GI and Cremona - ASST Breast Cancer Units, and 126 age-matched controls enrolled through LILT (Lega Italiana Lotta Tumori) - Trieste (Italy). To perform within and between groups comparisons, both populations (Breast-cancer patients’ and age-matched controls’) were subdivided in two subgroups each, based on FACTCog PCI18 score according to Van Dyk et al.(2020), cutpoints: Subjective Cognitive Complaints - SCC (PCI18<54) and No Subjective Cognitive Complaints - NSCC (PCI18 ≥54).Statistical analysis revealed that 36% of breast-cancer patients reported perceived cognitive deficits, while only for 18% of the age-matched control group this was the case (p<.001). We found a significant difference in perceived cognitive abilities (CogPCA p<.001), quality of life (CogQOL p<.001) and frequency of aerobic activity (moderate physical activity p<.01) between SCC versus NSCC patients with the former group showing worse scores in all reported measures. Between group analysis performed on breast-cancer group versus age-matched control group revealed a significant interaction of oncological diagnosis and SCC on measures of perceived cognitive abilities (CogPCA p<.001) and quality of life (CogQOL p<.001), indicating that SCC patients had worse scores on these measures. On the other hand, NSCC patients had higher scores on measures regarding how others (e.g., family members or close friends) perceived their cognitive abilities (p<.05).A significant effect of oncological diagnosis but not of SCC (or interaction between the two) was found on measures concerning sleep (Sleep quality index p<.05), indicating a strong effect of cancer diagnosis on sleep quality. Conversely when comparing the effect of cancer diagnosis on measures of physical activity no significant effect was found, instead a strong effect of SCC emerged (Physical activity index p<.01). Subjective perceived cognitive deficit affects the quality of life of breast cancer survivors, thus suggesting the usefulness of specific educational interventions to prevent stress-related effects. Citation Format: Thomas West, Bruna Scaggiante, Rita Ceccherini, Silva Foladore, Daniele Generali, Francesco Versace, Corrado Cavallero. The relevance of chemobrain in breast cancer survivors: An Italian exploratory study to measure incidence and psycho-social impact [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-12.

Abstract P4-11-18: Arm lymphatic pulsing changes after mastectomy or breast-conserving surgery with axillary lymph node dissection, detected with near-infrared fluorescence lymphatic imaging

Abstract Introduction: Axillary lymph node dissection (ALND) that accompanies mastectomy or breast-conserving surgery is assumed to disrupt arm lymphatic fluid pumping that normally flows in a one-way, distal-to-proximal path to transit cellular waste, immune cells, and large molecules to the thorax. Any resulting stagnation of lymph is surmised to drive the development of lymphedema (LE), with potential lifelong, detrimental effects on quality of life for breast cancer survivors, yet the majority of breast cancer survivors receiving ALND never encounter LE. To date, no objective before-and-after-ALND lymphatic pumping data has been published. Methods: In a prospective, ongoing, longitudinal clinical study (NCT02949726) of breast cancer patients undergoing neoadjuvant chemotherapy, axillary lymph node dissection (ALND) with mastectomy or breast-conserving surgery, and radiation treatment (RT), we used near-infrared fluorescence lymphatic imaging (NIRF-LI) to observe changes in arm lymphatics anatomy and pulsing. NIRF-LI, using a custom-built imaging system, with indocyanine green (ICG) contrast, allows “see through the skin” visualization of arm lymph pumping through lymphatic vessels, and captured videos of 58 locally advanced breast cancer patients before and approximately four weeks after mastectomy or breast-conserving surgery with ALND. Lymphatic pumping frequencies (pulses per minute) were determined from fluorescence intensity fluctuations through regions of interest (ROIs) along lymphatic vessels, quantitated with ImageJ (NIH) free software. Ipsilateral and contralateral arm dorsal, ventral, and axillary-feeding (ventral upper arm) vessel pulsing was classified as 1) static or improved to normal range (improved), or 2) transitioning to abnormal ranges (worsened) after surgery. The number of vessels in each category were tallied and reported herein. Results: After ALND, arm lymphatic pulsing frequencies improved or worsened as shown in Table 1. Conclusions: NIRF-LI allowed objective quantitation of arm lymphatic pumping frequencies captured before and after ALND accompanying mastectomy or breast-conserving surgery for breast cancer. Pulsing frequencies in detectable vessels improved in more axilla-feeding vessels, surprisingly, but worsened or did not change in more ipsilateral and ventral vessels, on both ipsilateral and contralateral sides. While cancer surgery with ALND may be associated with increased risk of BCRL, other factors, such as neoadjuvant chemotherapy, cancer severity, and radiation treatment may contribute to LE etiology. Table 1.Anatomical position (arm)# of Vessels Improved# of Vessels WorsenedIpsilateral dorsal6499Ipsilateral ventral73107Ipsilateral axilla-feeding5626Contralateral dorsal97112Contralateral ventral8988Contralateral axilla-feeding10323 Citation Format: Melissa B Aldrich, Meghan E McWain, Wenyaw Chan, John C Rasmussen, Sarah DeSnyder, Eva M Sevick-Muraca, Simona F Shaitelman. Arm lymphatic pulsing changes after mastectomy or breast-conserving surgery with axillary lymph node dissection, detected with near-infrared fluorescence lymphatic imaging [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-18.

Dermal Backflow, Detected by Near-infrared Fluorescence Lymphatic Imaging, Is an Early Prognostic Marker of Breast Cancer-related Lymphedema

Breast cancer-related lymphedema (BCRL) is a complication for millions of patients receiving chemotherapy, axillary lymph node dissection (ALND), and radiation therapy (RTx). Ipsilateral arm swelling of 5% to 10% over baseline, at least 3 months after RTx, is commonly used as a BCRL diagnostic, yet this criteria may only be realized after significant, permanent, lymphatic damage has occurred. As timely complete decongestive treatment has been shown by others to stall or even prevent BCRL, “catching it early” could optimize patient outcomes. We sought to evaluate whether longitudinal near-infrared fluorescence lymphatic imaging (NIRF-LI) of lymphatic dysfunction provides an early predictor of BCRL in advanced breast cancer patient undergoing ALND and RTx. In an ongoing clinical study (NCT02949726), patients with breast cancer were imaged before and after ALND, as well as at 6, 12, and 18 months after RTx, NIRF-LI to visualize dysfunctional lymphatics. Perometer readings of arm volumes were recorded at each imaging session to provide objective diagnosis of BCRL from arm swelling of >5% at or after 6 months after RTx. Perometer readings were compared to pretreatment baseline measurements. Dermal backflow, an NIRF-LI pattern indicating lymph that either fails to enter primary lymphatics and progress to collector vessels, or counterfluxes from collector vessels, appeared in 23 out of 24 women thus far diagnosed with BCRL at time of this report (August 27, 2021). Dermal backflow occurred at the time of diagnosis in 39% of patients, or prior to BCRL diagnosis (mean, 10.4 months; range, 6-25.5 months) in the remaining 61% patients. Of all BCRL diagnoses, 34% were diagnosed at 6 months after RTx. Prior to 6 months after RTx, dermal backflow, but not >5% arm volume increases, were predictive of BCRL. One patient taking biologics for treatment of previously diagnosed rheumatoid arthritis was diagnosed with BCRL prior to appearance of dermal backflow. Another patient developed dermal backflow at study end point and thus, could have developed BCRL beyond the study end point. From a total of 32 patients who have completed the study, NIRF-LI dermal backflow had a specificity and sensitivity of 89% and 96% and an overall accuracy for predicting or detecting BCRL of 97%. Preliminary results show that longitudinal screening of patients with breast cancer with NIRF-LI enables earlier diagnosis of BCRL that could enable optimized outcomes, healthcare cost savings, and improved quality of life for breast cancer survivors. NIRF-LI screening during the first six months after RTx could detect those patients developing lymphatic dysfunction before onset of arm swelling can be used as a benchmark to prescribe complete decongestive treatment.

Self-administration of complex decongestive therapy facilitated by the mobile application WeChat improves lymphedema and quality of life in breast cancer survivors: an observational study.

BackgroundLymphedema is the most common complication of breast cancer patients. Complex decongestive therapy (CDT) is often recommended but the efficacy varies due to the complexity of management. This study investigated a novel model of CDT based on a mobile application with the aim of improving the management of lymphedema in China.MethodsWe developed a novel model of CDT for breast cancer survivors with lymphedema, including 5 days of CDT therapy with training provided by medical staff in the outpatient clinic and 3 weeks of self-administrated CDT with daily online instructions during phase I, and a life-long maintenance treatment with online instructions once a week for phase II, which delivered by WeChat public accounts. The breast cancer and lymphedema symptom experience index (BCLE-SEI) and the Short-Form Health Survey (SF-36) were used to assess lymphatic symptoms and quality of life. Arm volume and lymphatic symptoms were assessed at baseline, and at 5 days, 1 month, and 3 months post-treatment. The quality of life was assessed at baseline and at 3 months post-treatment.ResultsA total of 88 patients with lymphedema were recruited, of whom, 61 followed the protocols and were further analyzed for this study. The mean relative excess arm volume (EAV) was reduced from a baseline value of 30.72% to 22.05%, 18.46%, and 16.67% at 5 days, 1 month, and 3 months post-therapy, respectively (P=0.000). The BCLE-SEI scores of lymphatic pain, heaviness, and impaired limb mobility were all significantly improved after 3 months of treatment (P<0.05). Moreover, according to the subscale of SF-36, the general health and vitality were significantly improved after 3 months of therapy (56.64 vs. 62.93, P=0.008; and 64.26 vs. 70.08, P=0.024, respectively).ConclusionsThe proposed model of CDT based on the mobile application WeChat achieved promising outcomes. The volume of the affected arm, the lymphedema symptoms, and the quality of life were all significantly improved.

Effect of myofascial release, stretching, and strengthening on upper torso posture, spinal curvatures, range of motion, strength, shoulder pain and disability, and quality of life in breast cancer survivors.

Breast cancer survivors are known to develop upper torso pain and stiffness including shoulder elevation and ipsilateral inclination of the trunk within a short period of time as a result of cancer adjuvant therapies correlating with the type and side of surgery. Hence, the study. Twenty-two breast cancer survivors at a tertiary care hospital, Belgaum, Karnataka, have participated in this pre-post experimental study which included myofascial release (MFR), stretching, and strengthening for four sessions per week for 3weeks that is, a total of 12 sessions. The participants were assessed at baseline and post-intervention using photogrammetry for Posture and shoulder range of motion (ROM), flexicurve for spinal curvatures, digital inclinometer for cervical ROM, manual muscle testing and hand dynamometer for strength of the upper back, shoulder muscles and hand grip, Shoulder Pain and Disability Index (SPADI) for shoulder impairment and Functional Assessment of Cancer Therapy-Breast (FACT-B) for quality of life. The outcomes were analyzed with a p-value set at ≤0.05. The results of the study demonstrated a substantial improvement in the posture alignment (p=0.001), shoulder and cervical ROM (p=0.001), upper back and shoulder muscle and hand grip strength (p=0.001), SPADI (p=0.001), and FACT-B (p=0.001) values. The upper torso malalignment and muscular imbalance is seen in patients who has undergone surgeries involving the chest wall and early physiotherapy intervention can benefit the patients overall physical performance and quality of life. Hence, MFR, stretching and strengthening has shown to be beneficial in improving upper torso malalignment in breast cancer survivors. The suggested techniques can be applied at a larger scale which can involve patients with head and neck cancer since the areas of intervention are identical. CTRI (Clinical Trial Registry- India) Registration No.: CTRI/2021/01/030453.

The mediator role of resilience between psychological predictors and health-related quality of life in breast cancer survivors: a cross-sectional study

BackgroundAlthough many psychological factors have been associated with health-related quality of life (HRQoL), the mediator role of resilience between psychological predictors (i.e., coping styles and perceived social support) and HRQoL has rarely been explored in breast cancer survivors (BCSs).MethodsA total of 231 BCSs participated in this cross-sectional survey. Pearson correlation was performed to analyze the relationships among coping styles (confrontation, avoidance, and resignation), perceived social support, resilience, and HRQoL. A multivariate linear regression analysis was applied to identify the psychological predictors of HRQoL and resilience, respectively. A structural equation modeling (SEM) was employed to examine the mediating role of resilience between coping styles, perceived social support, and HRQoL.ResultsPerceived social support and resilience were positively associated with confrontation. Resilience was positively associated with perceived social support. HRQoL had positive correlations with confrontation/avoidance, perceived social support, and resilience. Resilience and resignation/avoidance were significant independent predictors of HRQoL, while resignation/confrontation and perceived social support were significant independent predictors of resilience. Confrontation/resignation, perceived social support, and resilience had significant direct effects on HRQoL; confrontation/resignation and perceived social support had significant direct effects on resilience; resilience had significant mediator roles between confrontation/resignation, perceived social support, and HRQoL.ConclusionsResilience was a significant mediator between coping styles, perceived social support, and HRQoL. A resilience-oriented intervention is recommended to alleviate the detrimental influences of low resilience on HRQoL, providing a new strategy for improving the health status of BCSs.

HDAC6 inhibition reverses long-term doxorubicin-induced cognitive dysfunction by restoring microglia homeostasis and synaptic integrity.

Breast cancer is the most common female malignancy in both the developed and developing world. Doxorubicin is one of the most commonly used chemotherapies for breast cancer. Unfortunately, up to 60% of survivors report long-term chemotherapy-induced cognitive dysfunction (CICD) characterized by deficits in working memory, processing speed and executive function. Currently, no therapeutic standard for treating CICD exists. Here, we hypothesized that treatment with a blood-brain barrier permeable histone deacetylase 6 (HDAC6) inhibitor can successfully reverse long-term doxorubicin-induced cognitive dysfunction.Methods: The puzzle box test and novel object/place recognition test were used to assess cognitive function following a therapeutic doxorubicin dosing schedule in female mice. Mitochondrial function and morphology in neuronal synaptosomes were evaluated using the Seahorse XF24 extracellular flux analyzer and transmission electron microscopy, respectively. Hippocampal postsynaptic integrity was evaluated using immunofluorescence. Hippocampal microglia phenotype was determined using advanced imaging techniques and single-nucleus RNA sequencing.Results: A 14-day treatment with a blood-brain barrier permeable HDAC6 inhibitor successfully reversed long-term CICD in the domains of executive function, working and spatial memory. No significant changes in mitochondrial function or morphology in neuronal synaptosomes were detected. Long-term CICD was associated with a decreased expression of postsynaptic PSD95 in the hippocampus. These changes were associated with decreased microglial ramification and alterations in the microglia transcriptome that suggest a stage 1 disease-associated microglia (DAM) phenotype. HDAC6 inhibition completely reversed these doxorubicin-induced alterations, indicating a restoration of microglial homeostasis.Conclusion: Our results show that decreased postsynaptic integrity and a neurodegenerative microglia phenotype closely resembling stage 1 DAM microglia contribute to long-term CICD. Moreover, HDAC6 inhibition shows promise as an efficacious pharmaceutical intervention to alleviate CICD and improve quality of life of breast cancer survivors.

Body image disturbances among breast cancer survivors: A narrative review of prevalence and correlates

Body image is an essential aspect of femininity. Body image disturbances occurring due to breast cancer pose a difficult challenge, which can impact the quality of life of breast cancer survivors. Various treatment modalities used to cure cancer may result in major alterations of body image. The purpose of this review is to describe the magnitude of body image disturbances and the associated factors which influence the quality of life. A thorough literature search was performed to identify articles related to body image disturbances in patients with breast cancer. Google Scholar, PubMed, Scopus, and Web of Science databases were searched using key terms such as “body image disturbances,” “sexuality,” “women,” and “breast cancer.” Original research articles, systematic reviews, and meta-analyses published in English from 2000 to 2020 that reported on body image as the main variable using standardized tools and had a sample size of at least 100 were considered eligible for inclusion in the review. A total of 40 articles matched the inclusion criteria, out of 100 that were identified from the database search. Our review suggests that in patients with breast cancer, the type of treatment, primarily modified radical mastectomy, and age have a significant association with disturbed body image, resulting in physical or psychological distress, eventually leading to difficulty in partnered relationships and sexual intimacy. Body image disturbance is an indispensable part of female health, and due care must be taken along with treatment to avoid psychological and physical distress.

Hubungan Aktivitas Fisik Harian dengan Kualitas Hidup Penyintas Kanker Payudara

This study aims to determine the relationship of daily physical activity with the quality of life of breast cancer survivors. The research design used is correlative with a cross-sectional approach. The results showed 53.9% of respondents aged &gt; 60 years, 50.6% of respondents had higher education, 61.8% of respondents did not work, 49.1% of stage IIIA respondents, 55.1% of respondents had moderate daily physical activity, and 73,0% of respondents have a reasonable quality of life. Most respondents have moderate physical activity, 55.1%, with most of the quality of life being 73.0%. The results of the bivariate analysis showed that (p-value = 0.034). In conclusion, there is a relationship between daily physical activity and the quality of life of breast cancer survivors at RSUP Dr. M. Djamil Padang.&#x0D; &#x0D; Keywords: Physical Activity, Breast Cancer, Quality of Life

FR-101 Dressing May Alleviate Radiation-Irritated Skin After Radiotherapy in Breast Cancer Patients ― A Pilot Clinical Trial

Whole breast radiotherapy after breast-conserving surgery reduces the risk of recurrence and death and is widely used as standard treatment for breast cancer. Radiation-irritated skin, defined as "post-radiotherapy pruritic dry skin easily irritated by external stimulation, such as seasonal change or topical products", affects quality of life of breast cancer survivors undergoing whole breast radiotherapy. FR-101 dressing is a novel dressing combined with biocellulose membrane and repair peptides to repair the damaged skin after radiotherapy. This study is aimed to test the safety and efficacy to alleviate radiation-irritated skin symptoms.The study was a single-arm, open label, single center pilot clinical study to evaluate the safety and clinical outcome of the FR-Mask intervention in breast cancer patients after WBRT. Patients who complete the post-operative radiotherapy and meet the inclusion and exclusion criteria had been enrolled into the study after the study team obtains their informed consent. Each subject had received 12 packages of FR-Mask (1 mask in each individual package) and be instructed to put the patch on the irritated-skin area caused by radiation for 20 minutes every 3 days. Subjects came back to clinics for evaluation every 4 weeks for 4 months, and received physical examination and investigations including questionnaires, skin observer measurement, and taking pictures. The total study duration for each subject took 4.5 months. This study had been conducted in China Medical University Hospital.A total of 10 subjects were enrolled, and all subjects applied FR-101 dressing. No one experienced adverse events during the study period. Efficacy evaluation revealed that 40% patients showed visible differences between the affected breast skin and the healthy breast skin. FR-101 dressing application may increase moisture and oil level of the affected breast skin, P = 0.08 and P = 0.01, respectively. Results of comparisons between the affected breast skin and the healthy breast skin showed a trend to improve breast sensitivity. (P = 0.08) CONCLUSION: Our findings demonstrate FR-101 dressing is a novel, safe, and feasible dressing for breast cancer patients undergoing whole breast radiotherapy. This pilot study also suggests that FR-101 dressing may promote the repair of the damaged skin appendages after radiotherapy and alleviate their radiation-irritated skin symptoms.

Absolute and Relative Handgrip Strength as Indicators of Self-Reported Physical Function and Quality of Life in Breast Cancer Survivors: The EFICAN Study.

Simple SummaryBreast cancer is the most diagnosed type of cancer worldwide and it has a high survival rate. Thus, side effects related to breast cancer and treatments compromise lots of people’s physical functions and health-related quality of life. For this reason, it is important to manage these side effects in the follow up after treatments. The handgrip strength and the handgrip strength relative to body mass index may constitute useful, simple, quick and economically feasible tools that may help clinicians detecting these side effects, which is key to undertake actions for improving the physical function and health-related quality of life of breast cancer survivors.Background: Although breast cancer (BC) is the most prevalent type of cancer in the world, its high survival rate implies that many people live long after the treatments and face their side effects. The physical function (PF) and health-related quality of life (HRQoL) of people surviving BC decreases significantly, which makes important to identify markers that may be associated with a better health status and prognosis. Previous studies suggest that handgrip strength (HGS) and HGS relative to the body mass index (rHGS) are good indicators of PF and HRQoL in different populations. However, it is unknown whether this applies to BC survivors. This study aimed to evaluate the association of HGS and rHGS with PF and HRQoL in this population. Methods: Sixty female BC survivors participated. Handgrip strength was assessed with a dynamometer. Arm volume was estimated and upper limb impairments, as well as cancer-related fatigue, depression, life satisfaction and HRQoL, were assessed using standardized questionnaires. Results: Higher levels of HGS and rHGS were associated with higher levels of HRQoL, lower cancer-related fatigue, and fewer problems with the affected arm. Conclusions: These results suggest that HGS may be a good indicator of self-reported PF and HRQoL in female BC survivors.

Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center.

Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.

Quality of Life and Sexual Functioning of Women after Breast Cancer Surgery

BACKGROUND: Women with breast cancer can experience changes in sexual functioning and body images that can seriously affect their quality of life. AIM: The aim of this research was to study the quality of life and sexual functioning of women after a mastectomy and after a breast-conserving surgery and to compare post-operative quality of life. SUBJECTS AND METHODS: This cross-sectional study included 204 participants, 101 patients after a mastectomy and 103 patients after a quadrantectomy. The research was conducted using the Croatian version of the questionnaire of the European Organization for Research and Treatment of Breast Cancer, the questionnaire with the breast cancer module EORTC QLQ - BR 23. RESULTS: On the EORTC QLQ –BR23 scale, participants with mastectomy rated their sexual functioning (p &lt; 0.001), sexual pleasure (p &lt; 0.001), and systemic side effects (p = 0.04) lower comparing to women after breast-conserving surgery. The overall functionality scale was significantly lower (p = 0.03) for women who underwent mastectomy compared to those who underwent breast-conserving surgery. Participants under 51 years of age had worse body image 1 month after mastectomy (p = 0.006), while sexual functioning was better (p = 0.03) than in older age groups. In breast-conserving surgery group, 1 month after surgery, participants in the age group of 61 years and older assessed body image better (p = 0.04) than in the younger age group. Sexual functioning was rated better by women aged 51–60 years (p = 0.03). CONCLUSION: Results of this study show that women after breast conserving surgery have better quality of life, better sexual functioning and less side effects of systemic therapy compared to women after mastectomy. The type of surgery, patient’s age and time passed after completion of treatment are important factors which influence sexual functioning and quality of life in breast cancer survivors.

Developing and validating a prediction model for lymphedema detection in breast cancer survivors.

Early detection and intervention of lymphedema is essential for improving the quality of life of breast cancer survivors. Previous studies have shown that patients have symptoms such as arm tightness and arm heaviness before experiencing obvious limb swelling. Thus, this study aimed to develop a symptom-warning model for the early detection of breast cancer-related lymphedema. A cross-sectional study was conducted at a tertiary hospital in Beijing between April 2017 and December 2018. A total of 24 lymphedema-associated symptoms were identified as candidate predictors. Circumferential measurements were used to diagnose lymphedema. The data were randomly split into training and validation sets with a 7:3 ratio to derive and evaluate six machine learning models. Both the discrimination and calibration of each model were assessed on the validation set. A total of 533 patients were included in the study. The logistic regression model showed the best performance for early detection of lymphedema, with AUC=0.889 (0.840-0.938), sensitivity=0.771, specificity=0.883, accuracy=0.825, and Brier scores=0.141. Calibration was also acceptable. It has been deployed as an open-access web application, allowing users to estimate the probability of lymphedema individually in real time. The application can be found at https://apredictiontoolforlymphedema.shinyapps.io/dynnomapp/. The symptom-warning model developed by logistic regression performed well in the early detection of lymphedema. Integrating this model into an open-access web application is beneficial to patients and healthcare providers to monitor lymphedema status in real-time.

Effects of a Yoga-Based Exercise Program on Health-Related Quality of Life in Breast Cancer Survivors

Research Objectives To examine the impact of six months of exercise on a Health Related Quality of Life (HR-QOL) outcomes in post treatment breast cancer survivors in the San Antonio area in Texas. Design Randomized Controlled Trial. Setting The exercise program was run at a comprehensive cancer care facility. Participants Women with breast cancer (n=94) were randomized into one of three groups: yoga-based exercise (YE; n=31); “conventional” comprehensive exercise (aerobic, resistance and flexibility; CE; n=31); or a comparison group allowing participants to choose their own preferred exercise activities (C; n=32). 72 participants completed the 6 month long exercise program (YE: n=20; CE: n=26 and C: n=26). One year retention testing was completed by 64 participants (YE: n=17; CE: n=21, C: n=24). Interventions All groups exercised three hours weekly over six months. The YE group had a structured Hatha yoga exercise program emphasizing breath awareness and postures. The exercise program for the CE group included aerobic, resistance, and flexibility training. The C group could choose from a variety of activities including aerobics, strength training, Tai Chi, and water aerobics. Main Outcome Measures The SF-36 Physical and Mental Component Scales [PCS, MCS] were used to evaluate HrQoL. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). SF-36 data was collected at baseline, post and retention. PSQI data was collected baseline and post-intervention only. Results At retention testing, PCS scores improved significantly in the YE group compared C and CE groups (p < 0.025). All participants improved PCS and MCS scores with no between group differences. No change was seen in PSQI scores. Conclusions A yoga-based exercise program can positively impact the physical component of HR-QOL in breast cancer survivors, particularly after completion of the intervention. Whether the HR-QOL continues to improve beyond one year needs further research. Author(s) Disclosures The authors would like to acknowledge all the participants for their commitment to the study and support of Dr. Amy Lang, the ThriveWell Cancer Foundation, and the START Center for Cancer Care. The authors have no other conflicts of interest to declare. To examine the impact of six months of exercise on a Health Related Quality of Life (HR-QOL) outcomes in post treatment breast cancer survivors in the San Antonio area in Texas. Randomized Controlled Trial. The exercise program was run at a comprehensive cancer care facility. Women with breast cancer (n=94) were randomized into one of three groups: yoga-based exercise (YE; n=31); “conventional” comprehensive exercise (aerobic, resistance and flexibility; CE; n=31); or a comparison group allowing participants to choose their own preferred exercise activities (C; n=32). 72 participants completed the 6 month long exercise program (YE: n=20; CE: n=26 and C: n=26). One year retention testing was completed by 64 participants (YE: n=17; CE: n=21, C: n=24). All groups exercised three hours weekly over six months. The YE group had a structured Hatha yoga exercise program emphasizing breath awareness and postures. The exercise program for the CE group included aerobic, resistance, and flexibility training. The C group could choose from a variety of activities including aerobics, strength training, Tai Chi, and water aerobics. The SF-36 Physical and Mental Component Scales [PCS, MCS] were used to evaluate HrQoL. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). SF-36 data was collected at baseline, post and retention. PSQI data was collected baseline and post-intervention only. At retention testing, PCS scores improved significantly in the YE group compared C and CE groups (p < 0.025). All participants improved PCS and MCS scores with no between group differences. No change was seen in PSQI scores. A yoga-based exercise program can positively impact the physical component of HR-QOL in breast cancer survivors, particularly after completion of the intervention. Whether the HR-QOL continues to improve beyond one year needs further research.

Sustained effects of mantra meditation compared to music listening on neurocognitive outcomes of breast cancer survivors: A brief report of a randomized control trial

ObjectiveCancer-related cognitive impairment is common following the end of adjuvant treatment and there are limited treatment options for it. We compared the sustained cognitive (primary) and psychological (secondary) effects of mantra meditation to classical music listening 8 weeks after interventions ended (Time 3) compared to baseline (Time 1). MethodsA two-group parallel random assignment experimental design was used in a community setting. Thirty one breast cancer survivors (ages 21 to 75, received chemotherapy, and reported cognitive complaints) were randomly assigned to practice mantra meditation (n = 16) or listen to classical music (n = 15) 12 min a day for 8 weeks. No blinding was used. Repeated measures analysis of variance models were used to compare Time 1 and Time 3 data for the 26 survivors (13 per group) who completed the interventions and Time 3 data collection. ResultsVerbal fluency (p < .001, ηp2 = 0.58), attention (p = .002, ηp2 = 0.33), immediate memory recall (p < .001, ηp2 = 0.38), perceived cognitive impairment (p < .001, ηp2 = 0.39), and quality of life (p = .001, ηp2 = 0.35) improved significantly across time for both groups. The two conditions did not differ significantly in changes across time. There were no adverse effects. ConclusionDaily mantra meditation or classical music listening may be beneficial for cognitive outcomes and quality of life of breast cancer survivors with cancer-related cognitive impairment. The cognitive benefits appear to be sustained beyond the initial intervention period.Clinical Trials Registration number: NCT03696056, recruitment status completed.The study details can be accessed at: https://clinicaltrials.gov/ct2/show/NCT03696056 Key messageThere are limited treatment options for managing cancer-related cognitive impairments. Daily mantra meditation or classical music listening for 12 min a day may improve cognitive outcomes and quality of life for cancer survivors, with no negative side effects.

유방암 생존자의 증상, 불확실성이 삶의 질에 미치는 영향

Purpose: This study was to identify the effect of symptom experience and uncertainty on the quality of life in breast cancer survivors. Methods: Data were collected from 151 breast cancer survivors who participated actively in a self-help group from May 1st to 30th, 2015. Data were analyzed using Pearson correlation and stepwise multiple regression. Results: The severity of symptom experience, uncertainty, and quality of life of breast cancer survivors were moderate. Symptom experience, uncertainty, and quality of life showed a significant correlation. The most influential factor on quality of life was symptom experience which showed 66.0% of explanatory power. When uncertainty was added, the explanatory power increased to 74%. Conclusion: The finding showed the symptom and uncertainty affected the quality of life of breast cancer survivors. In order to improve the quality of life of breast cancer survivors, it is necessary to develop an intervention program that can reduce uncertainty and the symptoms experienced by breast cancer survivors.

The Influence of Rehabilitation on Quality of Life in Breast Cancer Survivors: A Clinical Study.

Background: Breast cancer survivors report negative impacts of cancer, augmented by specific vulnerabilities to body changes, negative self-assessment, and quality-of-life concerns. The main objective of our work was to test the effect of a rehabilitation program on breast cancer patients by evaluating the change in their physical well-being during an outpatient rehabilitation setting and, subsequently, in a home rehabilitation setting, considering the individual personality profile. Methods: Patients who underwent total mastectomy with breast prostheses or tissue expanders were enrolled. Outcome assessments (Pain, Quality of Life, Personality traits for the Minnesota Multiphasic Personality Inventory-2) before treatment (T0), at the end of the rehabilitative treatment (T1 = 10 sessions 2/week, one hour/each), and after two months of follow-up (T2) were performed. Results: The data of 38 included patients were analyzed. The quadratic trend of the Visual Analogue Scale can be explained by the fact that patients have a strong reduction in the perceived pain immediately after rehabilitation in the clinic. This reduction remains constant for the home period of the rehabilitation. The personality profiles of all the participants were substantially valid. Only three patients obtained scores higher than 65 points. Conclusions: The study evidenced that in the initial phase of the rehabilitation, psychological traits such as anxiety, depression, and preoccupation could have a strong association especially with the autonomous functions and the perceived physical symptoms. However, during the therapeutic process, this association decreased and these decrements were higher when patients performed their rehabilitation at home, in a more familiar and comfortable setting.