Social Functioning Research Articles

CAHQL: A patient reported outcome instrument to assess health-related quality of life in congenital adrenal hyperplasia.

Measuring health-related quality of life (HRQoL) is a crucial aspect of evaluating health care outcomes. Patients with congenital adrenal hyperplasia (CAH) often self-report deficiencies in HRQoL. The aim of our study was to develop a disease-specific patient reported outcome (PRO) instrument to evaluate the HRQoL of patients >16 years old with classic congenital adrenal hyperplasia (CAH). Following the FDA guidelines for developing PRO instruments, we developed a conceptual framework for the instrument. A preliminary instrument was created after interviewing a representative sample of 12 patients with CAH between 16 to 68 years old and 3 parents, and obtaining expert feedback from 4 endocrinologists. The instrument was edited after cognitive interviews with 6 patients. Internal consistency of the instrument was evaluated using Cronbach's alpha. Validity was assessed by comparing the scores of our instrument with scores from widely used validated instruments for HRQoL and PRO not specific to CAH. Sixty-nine patients 16 to 75 years old participated in validating our preliminary instrument. The final questionnaire consists of 44 questions within 7 domains: General Health, Adrenal Insufficiency, Glucocorticoid Excess, Physical Functioning, Mental Health and Cognition, Social Functioning, and Sexual Functioning, with acceptable internal consistency (Chronbach's alpha≥0.6) and validity (r = -0.350 to 0.866). CAHQL is the first validated PRO instrument to capture disease specific HRQoL outcomes in CAH. In addition to its anticipated use in the clinical setting, the instrument could be used to assess the efficacy of novel treatments in development.

Changes in Perceived Emotions in Facial Paralysis Patients After Depressor Anguli Oris Excision.

Depressor anguli oris (DAO) excision can improve clinician-graded, objective, and patient-reported smile outcomes in patients with nonflaccid facial paralysis (NFFP). However, no prior research has studied changes in perceived emotions after surgery. This study quantifies changes in perceived emotions with smiling after DAO excision in the largest case series presented to date. Prospectively collected data from patients with NFFP who underwent DAO excision at a tertiary care facial nerve center were reviewed. Patient-reported, clinician-graded, and objective smile metrics were compared before and after surgery. Videos of faces at rest and while smiling were analyzed by artificial intelligence-derived facial expression analysis software to quantify perceived emotions. Sixty-eight patients underwent isolated DAO excision between August 2021 and August 2023. Patients conveyed significantly more perceived happiness with smile and at rest after surgery (p < 0.001 and p = 0.012, respectively). DAO excision improved oral commissure excursion (p < 0.001), dental show (p < 0.001), and smile angle (p < 0.001) symmetry. Patients reported significant improvements in smiling and social function after surgery. This study demonstrates DAO excision increases perceived happiness conveyed by patients with NFFP while smiling and at rest. It confirms improved objective, clinician-graded, and patient-reported smile outcomes after surgery. Level 4 Laryngoscope, 2024.

Longitudinal Trajectories of Premorbid Social and Academic Adjustment in Youth at Clinical High Risk for Psychosis: Implications for Conversion.

Social and academic adjustment deteriorate in the years preceding a psychotic disorder diagnosis. Analyses of premorbid adjustment have recently been extended into the clinical high risk for psychosis (CHR) syndrome to identify risk factors and developmental pathways toward psychotic disorders. Work so far has been at the between-person level, which has constrained analyses of premorbid adjustment, clinical covariates, and conversion to psychosis. Growth-curve models examined longitudinal trajectories in retrospective reports of premorbid social and academic adjustment from youth at CHR (n = 498). Interaction models tested whether known covariates of premorbid adjustment problems (attenuated negative symptoms, cognition, and childhood trauma) were associated with different premorbid adjustment trajectories in converters vs non-converters (ie, participants who did/did not develop psychotic disorders within 2-year follow-up). Converters reported poorer social adjustment throughout the premorbid period. Converters who developed psychosis with an affective component reported poorer academic adjustment throughout the premorbid period than those who developed non-affective psychosis. Tentatively, baseline attenuated negative symptoms may have been associated with worsening social adjustment in the premorbid period for non-converters only. Childhood trauma impact was associated with fewer academic functioning problems among converters. Cognition effects did not differ based on conversion status. Premorbid social function is an important factor in risk for conversion to psychosis. Negative symptoms and childhood trauma had different relationships to premorbid functioning in converters vs non-converters. Mechanisms linking symptoms and trauma to functional impairment may be different in converters vs non-converters, suggesting possible new avenues for risk assessment.

Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol

IntroductionNegative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive–behavioural therapy...

A digito-linguistic analysis of the 2019 Democracy Day speech of former Nigeria’s President Muhammadu Buhari

ABSTRACT This study undertakes a digito-linguistic analysis of the 2019 Inauguration/Democracy speech of former Nigerian President Muhammadu Buhari’s with a view to identifying the various discursive structures in the speech and the social functions they perform. The study adopts van Dijk’s socio-cognitive theory of critical discourse analysis as a theoretical framework. Data were selected through the purposive sampling method and subjected to qualitative and quantitative analysis. The study identifies fourteen discursive structures: actor description, authority, comparison, disclaimer, euphemism, evidentiality, example/illustration, irony, lexicalisation, metaphor, self-glorification, norm expression, number game, us-them, pervading the five discourse strategies in Buharis’s speech. The discourse strategies which include: number game; self-glorification; validation of the Nigeria project; highlighting of achievements, and deployment of escapist statements, are engaged to: express commitment to the development of the nation, give a positive self-representation, and dissociate from Nigeria’s woes. Voyant tools reveal the preponderance of Buhari’s expression of commitment to the Nigerian course. The study concludes that Buhari uses his Democracy/Inauguration speech to emphasise the importance of the Nigeria project and to call for social change among Nigerians.

The Chinese keratoconus (CKC) cohort study.

The Chinese keratoconus (CKC) cohort study is a population-based longitudinal prospective cohort study in the Chinese population involving a clinical database and biobanks. This ongoing study focuses on the prevention of KC progression and is the first to involve the effect of gene‒environment interactions on KC progression. The CKC cohort is hospital-based and dynamic and was established in Zhengzhou, China; KC patients (n = 1114) from a large geographical area were enrolled from January 2019 to June 2023, with a mean age of 22.23 years (6‒57 years). Demographic details, socioeconomic characteristics, lifestyle, disease history, surgical history, family history, and visual and social function data are being collected using questionnaires. General physical examination, eye examination, biological specimen collection, and first-degree relative data were collected and analyzed in the present study. The primary focus of the present study was placed on gene, environment and the effect of gene‒environment interactions on KC progression. The follow-up of the CKC cohort study is expected to include data collection at 3 months, 6 months, and 1 year after the initial examination and then at the annual follow-up examinations. The first follow-up of the CKC cohort study was recorded. A total of 918 patients completed the follow-up by June 1, 2023, with a response rate of 82.40%. Aside from the younger age of patients who were followed up, no significant differences were found between patients who were followed up and patients who were not.

Sensorimotor regulation of facial expression - an untouched frontier.

Facial expression is a critical form of nonverbal social communication which promotes emotional exchange and affiliation among humans. Facial expressions are generated via precise contraction of the facial muscles, guided by sensory feedback. While the neural pathways underlying facial motor control are well characterized in humans and primates, it remains unknown how tactile and proprioceptive information reaches these pathways to guide facial muscle contraction. Thus, despite the importance of facial expressions for social functioning, little is known about how they are generated as a unique sensorimotor behavior. In this review, we highlight current knowledge about sensory feedback from the face and how it is distinct from other body regions. We describe connectivity between the facial sensory and motor brain systems, and call attention to the other brain systems which influence facial expression behavior, including vision, gustation, emotion, and interoception. Finally, we petition for more research on the sensory basis of facial expressions, asserting that incomplete understanding of sensorimotor mechanisms is a barrier to addressing atypical facial expressivity in clinical populations.

The effects of psychosocial interventions applied to forensic psychiatry patients on social functioning and anger level: a meta-analysis study

ABSTRACT This study was conducted to determine the effects of psychosocial interventions on social functioning and anger levels in forensic psychiatry patients. Data for this meta-analysis study were gathered by searching databases such as PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center, without any year restriction, from September to December 2023. After a thorough review, 12 studies were deemed appropriate for the analysis. The findings of this meta-analysis indicate that psychosocial treatments administered to forensic psychiatry patients led to an increase in their level of social functioning (SMD: 0.513, 95% CI: 0.072 – 0.995; Z = 2.280; p < .05) and a decrease in their level of anger (SMD: −0.701, 95% CI: −1.301 to −0.100;Z = −2.287; p < .05). It was also observed that the effectiveness of the psychosocial intervention was not influenced by the type of psychotherapy, the country where the study was conducted, or the duration of the treatment. Psychosocial interventions for forensic psychiatry patients positively affect the mental health of individuals.

Understanding the Interplay of Race in the Criminal Justice System

Purpose: The purpose of this study was to investigate and understand the interplay of race in the criminal justice system. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the interplay of race, class and gender in the criminal justice system. Preliminary empirical review revealed that that pervasive racial disparities exist within this institution, as evidenced by disproportionate treatment of racial minorities at various stages of the criminal justice process. It found that despite efforts to promote fairness and equity, implicit biases and systemic racism continued to influence decision-making, leading to disparities in arrests, prosecutions, and sentencing. The study highlighted the interconnectedness of race with other social factors such as socioeconomic status and neighborhood characteristics and underscored the urgency of implementing evidence-based interventions and policy reforms to address racial disparities effectively. Recommendations included diversifying law enforcement agencies, implementing implicit bias training programs, and reforming sentencing guidelines to promote fairness and reduce disparities in incarceration rates. Unique Contribution to Theory, Practice and Policy: The Critical Race theory, Labeling theory and Structural Functionalism may be used to anchor future studies on the interplay between race and the outcomes within criminal justice. The study provided recommendations that contributed to theory, practice, and policy. It integrated critical race theory into the analysis to explore systemic racism's role in perpetuating racial disparities. Practically, evidence-based policing strategies and procedural justice principles were emphasized, alongside community policing initiatives and accountability measures to address bias and misconduct. Policy recommendations included reforming sentencing laws, investing in alternatives to incarceration, and addressing social determinants of crime. The study contributed to theory by examining intersecting identities' impact and advocated for community-driven interventions, trauma-informed approaches, and reforms to reduce racial bias and enhance accountability within the criminal justice system.

Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well-being.

In 1993, the British Journal of Clinical Psychology published my paper titled 'Defence and safety: Their function in social behaviour and psychopathology'. The paper highlightsthat to understand people's sensitivity to threat, we also need to understand their ability to identify what is safe. This paper offers an update on these concepts, highlighting distinctions that were implicit but not clearly defined at the time. Hence, the paper seeks to clarify distinctions between: (i) threat detection and response, (ii) safety and safety seeking, (iii) safeness and (iv) their social and non-social functions and forms. Threat detection and response are to prevent or minimize harm (e.g., run from a predator or fire). Safety checking relates to monitoring for the absence and avoidance of threat, while safety seeking links to the destination of the defensive behaviour (e.g., running home). Safety seeking also relates to maintaining vigilance to the appearance of potential harms and doing things believed to avoid harm. Threat-defending and safety checking and seeking are regulated primarily through evolved threat processing systems that monitor the nature, presence, controllability and/or absence of threat (e.g., amygdala and sympathetic nervous system). Safeness uses different monitoring systems via different psychophysiological systems (e.g., prefrontal cortex, parasympathetic system) for the presence of internal and external resources that support threat-coping, risk-taking, resource exploration. Creating brain states that recruit safeness processing can impact how standard evidence-based therapies (e.g., exposure, distress tolerance and reappraisal) are experienced and produce long-term change.

Abstract PO3-27-06: Investigating The Association Between Exercise and Quality of Life Among Breast Cancer Survivors in The Black Women’s Health Study

Abstract Background: Black breast cancer survivors (BCS) experience suboptimal quality of life (QoL) compared to White BCS. QoL is a multi-dimensional concept focused on different aspects of wellbeing. Exercise (a subset of physical activity) has been shown to improve QoL in cancer survivors. However, there is limited evidence on the benefits of exercise in relation to QoL among Black BCS and warrants further investigation. Purpose: To examine the association between exercise intensity (e.g., moderate activity) and multiple domains of QoL (e.g., physical wellbeing) among BCS in the Black Women’s Health Study (BWHS). Methods: The BWHS is the largest prospective cohort study following 59,000 Black women in the United States since 1995. Self-reported questionnaires are distributed every two years to obtain current health information, including lifestyle factors and disease occurrence. The 2019 survey data, completed by 3,608 Black BCS, were used to address the primary aim. Of the 3,608 Black BCS, 1,085 females were eligible to participate in this cross-sectional study. The primary predictors were moderate and vigorous exercise intensity. The outcomes (physical, mental, functional, social functioning, and financial wellbeing) were categorized as excellent, very good or good, and fair or poor health. The covariates were marital status, occupation, education, age, body mass index, time since diagnosis, breast cancer stage, and general health. Adjusted multinomial logistic regressions were performed to estimate the odds ratios and 95% confidence intervals for the associations with each predictor. Multiple imputation was used to address missing data. Results: At baseline, the majority of the BCS were 64 years or younger (99%), premenopausal (69%), employed (95%), and had more than a high school degree (86%). About 50% of the participants were married or living as married. There were significant and positive associations between exercise intensity and QoL (p&amp;lt; .05). Compared to BCS who reported little or no exercise (&amp;lt; 60 minutes/week), those who reported at least 60 minutes/week of vigorous exercise had greater odds of experiencing excellent QoL including financial wellbeing (OR=1.70, 95% CI: 1.08-2.67), functional wellbeing (OR=3.64, 95% CI: 1.56-8.49), social functioning (OR=4.56, 95% CI: 2.42-8.60), and physical wellbeing (OR=4.26, 95% CI: 2.12-8.52). Similarly, BCS who engaged in at least 150 minutes of moderate exercise/week had increased odds of reporting excellent social functioning (OR=2.59, 95% CI: 1.41-4.76) and functional wellbeing (OR=4.40, 95% CI: 1.89-10.24) than those who engaged in less than 150 minutes/week of moderate exercise. Conclusions: Black BCS who engage in certain durations (e.g., 150 minutes/week) and exercise intensities (e.g., moderate activity) tend to have better QoL. These findings may help to build upon the relevance of exercise in the context of supportive care for racial and ethnic minority cancer survivors and encourage healthcare professionals to assess the frequency, intensity, time, and type of exercise during routine or follow-up care. Future longitudinal studies are needed to examine the proposed associations among Black BCS and to compare the current study findings. Citation Format: Natasha Burse, Chris Wiesen, Todd Schwartz, Shawn Kneipp, Ashley Leak Bryant. Investigating The Association Between Exercise and Quality of Life Among Breast Cancer Survivors in The Black Women’s Health Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-06.

Investigation of high-dose radiotherapy's effect on brain structure aggravated cognitive impairment and deteriorated patient psychological status in brain tumor treatment

This study aims to investigate the potential impact of high-dose radiotherapy (RT) on brain structure, cognitive impairment, and the psychological status of patients undergoing brain tumor treatment. We recruited and grouped 144 RT-treated patients with brain tumors into the Low dose group (N = 72) and the High dose group (N = 72) according to the RT dose applied. Patient data were collected by using the HADS and QLQ-BN20 system for subsequent analysis and comparison. Our analysis showed no significant correlation between the RT doses and the clinicopathological characteristics. We found that a high dose of RT could aggravate cognitive impairment and deteriorate patient role functioning, indicated by a higher MMSE and worsened role functioning in the High dose group. However, the depression status, social functioning, and global health status were comparable between the High dose group and the Low dose group at Month 0 and Month 1, while being worsened in the High dose group at Month 3, indicating the potential long-term deterioration of depression status in brain tumor patients induced by high-dose RT. By comparing patient data at Month 0, Month 1, Month 3, Month 6, and Month 9 after RT, we found that during RT treatment, RT at a high dose could aggravate cognitive impairment in the short term and lead to worsened patient role functioning, and even deteriorate the overall psychological health status of patients in the long term.

Abstract PO2-10-09: Professional Support for Eating and Nutrition among Women Living with Breast Cancer: Implications for Mental Health and Quality of Life

Abstract Background: Within oncology, nutrition and eating behaviors are often tied to cancer prevention, incidence rates, progression, and healthy survivorship, as well as symptom and side effect management. While many nutrition-related resources and guidelines focus on physical health outcomes, support around nutrition and eating behaviors can have critical implications for mental health and quality of life outcomes among breast cancer patients and survivors. Methods: 232 women with breast cancer enrolled in the online Cancer Experience Registry and provided sociodemographic and clinical characteristics, answered questions about their eating and nutrition experiences, including utilization of a Registered Dietitian for professional eating and nutrition support since being diagnosed with cancer, and completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29v2.0 + 2-item Cognitive Function Short Form). Frequencies were calculated and group differences among those who wanted professional support for eating and nutrition but either did or did not receive it were assessed using independent-samples t-tests. Results: The sample was 81% Non-Hispanic (NH) White, 9% NH Black. Participants varied in age (mean=61 yrs; SD=9.2), time since diagnosis (median=7 yrs, range: &amp;lt; 1-39) and socioeconomic status (16% household income &amp;lt; $40K; 32% employer-provided insurance coverage). 44% were currently receiving treatment, with 70% in remission, 12% with metastatic disease, and 21% with history of recurrence. Over one-third (36%) received professional support for eating and nutrition from a Registered Dietitian since being diagnosed with cancer, including 12% receiving that support in the last 6 months. Participants wanted professional support for eating and nutrition during active treatment (51%), after treatment (44%), at initial diagnosis (23%), before treatment (18%), before being diagnosed with cancer (11%) . The most commonly reported eating and nutrition needs driving the desire for professional support included weight-related support (54%; maintenance, gain, or loss), achieving healthy eating patterns (52%), increasing energy level (46%) and physical fitness/strength (45%). However, experiences with professional support for eating and nutrition varied: 54% wanted eating and nutrition support since being diagnosed with cancer, but only 68% of those who wanted this support were able to access care. Irrespective of access to professional eating and nutrition support, participants report changing their eating patterns to manage SSEs (50%) or improve long-term health (57%). Among those who desired professional support for eating and nutrition since being diagnosed with cancer (n=102), those who did not get the desired support (n=34) compared to those who did (n=68) reported higher levels of anxiety, depression, sleep disturbance, and pain, as well as lower levels of physical and cognitive function (all ps &amp;lt; .05). Levels of fatigue and social function were not significantly different between groups. Conclusion: While there is a strong desire for professional support surrounding eating and nutrition among women with breast cancer, when that support is needed and what it aims to address varies greatly. Among those interested in receiving professional support for eating and nutrition, those who accessed professional support reported greater mental health and quality of life. Further research is needed to understand barriers to accessing eating and nutrition support among those who are not able to obtain it. Community-based advocacy organizations that offer access to professional support services for eating and nutrition are critical for addressing unmet needs in this area to improve health and well-being among women with breast cancer. Citation Format: Victoria Morris, Melissa Miller, Susan Weldon, Gail Kelly. Professional Support for Eating and Nutrition among Women Living with Breast Cancer: Implications for Mental Health and Quality of Life [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-09.

Abstract PO5-11-10: Quality of life in Brazilian women with early breast cancer on adjuvant endocrine therapy

Abstract Background: There is a significant scarcity of quality of life (QOL) data among the Brazilian population with breast cancer. This study aims to evaluate QOL in Brazilian women with early breast cancer treated with adjuvant endocrine therapy (ET) and to explore its relationships with patients’ clinical and social characteristics, type and duration of endocrine therapy and type of healthcare insurance. Methodology: Women with a history of early-stage estrogen-receptor positive invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study. QOL assessment was conducted using the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires. Demographic and medical information were collected from medical records. Data collection performed using RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Multiple linear regression models with Stepwise procedure. P &amp;lt; 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. A total of 233 women (50.54%) were treated in private institutions. Mean age was 56.02 years (range 22-93), 47.69% were non-white and 38.7% were premenopausal. A total of 62.34% had prior lumpectomy, 43.1% had tumor stage II, 61.69% received prior chemotherapy and 15.18% were HER2 positive. Regarding ET, 45.2% were on aromatase inhibitors (AI), 40.61% on tamoxifen (TMX) and 14.19% on ovarian function suppression plus ET (OFS). Median duration of ET use was 2.78 years. From the adjustment of the multiple regression model, it was found that the variable patients with a higher educational level were a significant predictor for the Physical Functioning score (p &amp;lt; 0.0001). The Role Functioning score had the variables treatment in a private hospital (p = 0.0462) and a higher educational level (p = 0.0357) as significant predictors. The variables age &amp;gt; 60 years (p = 0.0006) and marital status: single (p = 0.0267) were significant predictors for the Emotional Functioning score. Cognitive Functioning was correlated with the variables age &amp;gt; 60 years (p &amp;lt; 0.0001) and treatment duration &amp;lt; 2 years (p = 0.0475). Social Functioning had significant predictors such as hormone therapy with AI (p = 0.0305) and hormone therapy with TMX (p = 0.0267) when compared to OFS, as well as treatment duration &amp;lt; 2 years (p = 0.0175). The variable age &amp;gt; 60 years was a predictor for the Fatigue score (p = 0.0233). The Pain score correlated with variables such as higher educational level (p = 0.0003) and treatment duration &amp;lt; 2 years (p = 0.0032). The variables treatment in a public hospital (p = 0.0066), age &amp;lt; 60 years (p = 0.0471), and treatment duration &amp;lt; 2 years (p = 0.0054) were predictors for a higher Arm Symptoms score. Regarding the Breast Symptoms score, the variables treatment in a public hospital (p = 0.0005), Caucasian ethnicity (p = 0.0006), radiation therapy (p = 0.0098), and treatment duration &amp;lt; 2 years (p = 0.0203) were predictors for the total score. Body Image correlated with variables such as age &amp;gt; 60 years (p = 0.0322), surgical approach: mastectomy (p = 0.0445), tumor size &amp;lt; 50mm (p = 0.0446), and radiation therapy (p = 0.0405). The Global health status score did not correlate with any variable. Conclusion: Lower educational level, age&amp;lt; 60 years, duration of ET less than 2 years had a significant impact in many domains of QOL. Radiotherapy was the treatment modality with more impact in QOL scores. The identification of modifiable factors related to QOL in this study provides valuable insights for the development of a customized intervention in Brazilian population. Citation Format: Danielle Santos, Cristiano Souza, Maria Cristina Magalhães, Daniela Pereira, Fernanda Moura, Sulene Oliveira, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Andrea Shimada, Yuri Beckedorff, Carlos Paiva, Heloísa Resende, Angelica Rodrigues, Daniela Rosa, Daniele Assad-Suzuki, Romualdo Barroso-Sousa. Quality of life in Brazilian women with early breast cancer on adjuvant endocrine therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-10.

Abstract PO2-12-04: Suboptimal adherence to adjuvant endocrine therapy (ET) in Brazilian women with early-stage estrogen receptor-positive (ER+) breast cancer

Abstract Background: Adjuvant ET reduces breast cancer recurrence and increases overall survival among patients with early-stage ER+ breast cancer, however a suboptimal number of patients in fact takes oral medicine as prescribed. In Brazil, there is a paucity of data about adherence to adjuvant ET. This study aims to evaluate adherence to adjuvant ET in Brazilian women with early breast cancer and to evaluate clinical and sociodemographic characteristics associated with higher or lower adherence. Methods: Women with history of early-stage ER+ invasive carcinoma of the breast on adjuvant ET for at least 6 months were invited to participate of this study. Adherence was assessed with questionnaire Morisky Medication Adherence Scale (MMAS-8) and high adherence was defined by a MMAS-8 score=8. Demographic and medical information, site of treatment (private versus public), degree of education (completed high school vs not) were reviewed from medical records. Quality of life was assessed using EORTC QLQ C30 and BR-23 forms, sexuality was evaluated with the Female Sex Function Index questionnaire. Additionally, patients were interviewed about return to work. Data collection was done with RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Poisson regression. P &amp;lt; 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. The mean age was 56.0 years (range 22-93), 47.7% were non-white and 38.7% were premenopausal. A total of 233 women (50.6%) had private insurance and the remaining were treated in public institutions. Median duration of ET use was 2.78 years (range 6 months- 9.61 years). High adherence to adjuvant endocrine therapy was present in 55.7% of patients. Median age of high adherent woman was higher than low adherent (p=0.005). Factors significantly associated with high adherence were no use of ovarian suppression (p=0.0095), use of anti-Her2 therapy (p=0.0462). Furthermore, higher scores for EORTC QLQ-C30 global health status (p=0.017) and in specific domains, including role functioning (p=0.007), emotional functioning (p&amp;lt; 0.0001), cognitive functioning (p&amp;lt; 0.001), social functioning (p = 0,0005), higher scores for EORTC BR23 body image (p&amp;lt; 0.001) and future perspective (p = 0.0198) were also associated with high adherence. Higher EORTC QLQ-C30 cognitive function score was the only variable associated with high adherence (p &amp;lt; 0.0001) to ET in multivariate model. Conclusion: Using the MMAS-8, only 55.7% of Brazilian women with stage I-III ER+ breast cancer reported high adherence to endocrine therapy. This suboptimal adherence rate leads to important questions such as the impact on the prognosis of this population Charactheristic with adjusted prevalence ratio for the occurrence of High adherence PR: Prevalence ratio; EORTC: European Organisation for Research and Treatment of Cancer Citation Format: Daniele Assad-Suzuki, Heloísa Resende, Danielle Santos, Fernanda Moura, Sulene Oliveira, Andrea Shimada, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Yuri Beckedorff, Maria Cristina Magalhães, Cristiano Souza, Carlos Paiva, Daniela Pereira, Angelica Rodrigues, Daniela Rosa, Romualdo Barroso-Sousa. Suboptimal adherence to adjuvant endocrine therapy (ET) in Brazilian women with early-stage estrogen receptor-positive (ER+) breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-04.

Abstract GS02-10: Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study

Abstract INTRODUCTION: Patients with metastatic breast cancer (mBC) often experience cancer- and treatment-related side effects that can impair daily life activities and health-related quality of life (HRQoL). Interventions are needed that improve HRQoL by alleviating fatigue and other side effects during palliative BC cancer treatment. Recent evidence-based international guidelines (ASCO, ACSM) recommend exercise for patients with BC during adjuvant treatment for reducing side effects. However, evidence of the effectiveness of exercise in patients with mBC is scarce. The PREFERABLE-EFFECT study (NCT04120298) was designed to assess the effects of a 9-month supervised exercise program in patients with mBC on fatigue, HRQoL, and other cancer- and treatment-related side effects. METHODS: PREFERABLE-EFFECT is a multinational, randomized controlled trial including patients with mBC from five European countries (Germany, Poland, Spain, Sweden, The Netherlands) and Australia. Participants were randomly assigned to usual care or an individualized, structured exercise program consisting of aerobic, resistance, and balance training. The first six months included twice weekly supervised exercise sessions of one hour. In the last three months, one supervised session was replaced by an unsupervised session, supplemented by an exercise App. All participants received general exercise advice (physical activity ≥ 30 min/day) and an activity tracker. Our primary outcomes, physical fatigue (subscale of the EORTC QLQ-FA12) and HRQoL (summary score of the EORTC QLQ-C30), were assessed at baseline, 3, 6, and 9 months. Among other physical fitness outcomes, maximal short exercise capacity was assessed with the Steep Ramp Test. The intervention effects (intention-to-treat) were determined by comparing the change from baseline to 3, 6 (i.e., primary endpoint) and 9 months between groups using separate mixed models for repeated measures, adjusted for baseline values of the outcome variable and stratification factors (mBC line of treatment (1st/2nd vs. 3rd or higher) and study center). A significant improvement of either or both primary outcomes (applying the Bonferroni-Holm method) was considered as successful. RESULTS: Between 2019-2022, we included 357 patients with mBC, with 178 patients randomized to the exercise intervention and 179 to usual care. Patients were, on average, 55.4 years of age (SD=11.1), most patients received 1st or 2nd line of treatment at study enrollment (74.8%) and had bone metastases (73.9%). At 6 months (primary endpoint), participation in the exercise intervention resulted in statistically significant positive effects on both primary outcomes, compared to usual care: physical fatigue was lower (mean difference: -5.3, 95% CI -10.0; -0.6, p=0.027, effect size (ES)=0.22) and HRQoL was better (+4.8, 95% CI 2.2; 7.4, p=0.0003, ES=0.33). Beneficial effects were also found at 3 months (physical fatigue: -3.4, -7.8; 1.0, ES=0.14 and QoL: 3.9, 1.5; 6.3, ES=0.27) and 9 months (physical fatigue: -5.6, -10.9; -0.4, ES=0.24 and QoL: +4.3, 1.4; 7.3, ES=0.31). Further, at the primary endpoint, we found positive exercise effects on physical fitness (+24.3 Watts, 15.5; 33.1, ES=0.42) and numerous QLQ-C30 scales, including social functioning (+5.5, 0.2; 10.8, ES=0.20), pain (-7.1, -12.1; -1.9, ES=0.28) and dyspnea (-7.6, -12.2; -3.0, ES=0.28). Two SAEs occurred (one wrist fracture and one sacral stress fracture), neither related to bone metastases. CONCLUSION: This large multinational study demonstrated significant beneficial effects of a supervised exercise intervention offered during palliative treatment on mBC patients’ fatigue, HRQoL, and other clinically relevant outcomes. Based on these findings, we recommend supervised resistance and aerobic exercise as part of supportive care regimens during palliative treatment of mBC. Citation Format: Anne May, Anouk Hiensch, Johanna Depenbusch, Martina Schmidt, Evelyn Monninkhof, Mireia Pelaez, Dorothea Clauss, Philipp Zimmer, Jon Belloso, Mark Trevaskis, Helene Rundqvist, Joachim Wiskemann, Jana Muller, Carlo Fremd, Renske Altena, Joanna Kufel-Grabowska, Rhode Bijlsma, Lobke van Leeuwen-Snoeks, Daan ten Bokkel-Huinink, Gabe Sonke, Bruce Mann, Prudence Francis, Gary Richardson, Isabel Álvarez, Wolfram Malter, Elsken Van der Wall, Neil Aaronson, Elżbieta Senkus, Ander Urriticoechea, Eva Zopf, Wilhelm Bloch, Martijn Stuiver, Yvonne Wengström, Karen Steindorf. Effects of a structured and individualized exercise program on fatigue and health-related quality of life in patients with metastatic breast cancer: the multinational randomized controlled PREFERABLE-EFFECT study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr GS02-10.

Abstract PO1-12-03: Quality of Life in Patients Diagnosed and Treated for Breast Cancer in Uruguay

Abstract Introduction: Breast cancer (BC) and its treatment can impair patient quality of life (QOL), and those undergoing more aggressive treatments may be more severely impacted. Objective: Assess the level of perception of the QOL of patients treated for BC at the Hospital de Clínicas and the Hospital Departamental de Soriano. Materials and Methods: A questionnaire for cancer patients (EORTC, QLQ-C30) and one specific for BC (EORTC QLQ-BR23) were used. Results: A total of 158 patients who had completed chemotherapy treatment at least one year prior to the evaluation were enrolled. The average age was 61 years old. QLQ-C30 questionnaire: the global QOL score (GQOL) was high: 70.9. Patients undergoing conservative surgery (CS) had better scores in physical and emotional functioning (p &amp;lt; 0.005) and presented less frequently with: pain, constipation and financial difficulties (p &amp;lt; 0.005). Those undergoing sentinel lymph node biopsy (SLNB) had higher scores for GQOL and for physical, role and social functioning scales (p &amp;lt; 0.001) and had less fatigue, pain, insomnia and financial difficulties (p &amp;lt; 0.005). Questionnaire QLQ-BR23: sexual functioning and sexual enjoyment scales were relatively low. Patients undergoing CS had better scores on the functional scales: body image and future outlook; and fewer breast symptoms (p &amp;lt; 0.005). Those undergoing SLNB also had better scores on the functional scales for body image and future outlook future and presented less frequently with symptoms (p &amp;lt; 0.005). Conclusion: Patients had high values on the GQOL scale, those undergoing CS and SLNB had better scores on most functional and problem/symptom scales. The implementation of intervention strategies aimed at improving the quality of life and the physical and emotional care of patients is recommended. Citation Format: Natalia Camejo, Dahiana Amarillo, Cecilia Castillo, Maria Guerrina, Florencia Savio, Mariana Carrasco, Noelia Strazzarino, Ana laura Hernandez, Guadalupe Herrera, Gabriel Krygier. Quality of Life in Patients Diagnosed and Treated for Breast Cancer in Uruguay [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-12-03.

Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps.

This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.

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

Abstract INTRODUCTION There is an increasing focus of the treating clinicians on issues related to quality of life and sexual functioning in breast cancer survivors. This is even more important in developing countries like India as the incidence of breast cancer in young in also significant here. However, despite this, there is little data from India on the factors affecting quality of life and sexual functioning on breast cancer survivors. Hence, we decided to perform this study. METHODS Patients who had undergone surgery for breast cancer within the last 2-5 years were included. Patients having significant psychiatric illness were excluded and so were patients who developed metastasis or local recurrence during the follow up. Questions on demographics, clinical history, standard of living index, quality of life (SF-36 questionnaire) and sexual function (CSFQ questionnaire) were asked. Data was analyzed using SPSS v22. Normality of continuous data was tested by Kolmogorov–Smirnov and Shapiro–Wilk tests. As a test of significance, chi square was used for qualitative data and t-test, Mann-Whitney U, and Kruskal-Wallis were used (as applicable) for quantitative data. Bonferroni adjustment was made wherever significance was found, if more than 1 group were involved. Multiple linear regression was carried out for quantitative dependent variables where significant risk factors were found. Independent variables with significant collinearity were excluded from linear regression. RESULTS A total of 120 patients were enrolled. In QOL scores, both physical health (B = -13.76, p = 0.007) and emotional problems (B = -10.65, p = 0.035) were affected adversely by endocrine therapy. Patients who had received radiotherapy had worse emotional well-being scores (B = -14.61, p = &amp;lt; 0.001). Patients who received chemotherapy or were married had significantly better social functioning score (B = 15.27, p = 0.020, B = 17.38, p = 0.041 respectively), whereas it was worse in patients who received trastuzumab (B = -18.32, p = 0.024). Pain scores were higher in premenopausal patients (B = 11.95, p = 0.021) and lower in patients having co-morbidities (B = -10.95, p = 0.039). None of the factors affected physical functioning, energy/fatigue, general health or health change scores. In sexual functioning scores, pleasure score (B = 1.27, p = 0.011) frequency scores (B = 1.97, p = 0.012), orgasm score (B = 3.43, p = 0.019) and total score (B = 12.30, p = 0.006) were higher in married women. Pleasure score was found to be lower in patients with co-morbidities (B = -0.82, p = 0.003). None of the factors affected desire or arousal. CONCLUSION Even though sexual functioning depended a lot on having a long-term partner, most of the factors affecting quality of life scores were treatment related. Actively addressing these concerns may help in improving quality of life and in turn, may improve compliance to treatment and follow-up. Citation Format: SIDDHANT KHARE, Devesh Dhamor, R N NAGA SANTOSH IRRINKI, Bijaya Padhi. Do factors other than type of surgery performed for breast cancer affect quality of life and sexual functioning in breast cancer survivors? An observational study from Northern India [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-07.

Tooth loss and depression in Chilean participants of the National Health Survey 2016–2017: Oral and social functions mediation analysis

BackgroundPrevious studies have indicated the association between poor oral health and depression in adults. This study evaluated oral and social functions contribution to the association between tooth loss and depressive symptoms in Chilean individuals. MethodsWe used data from the Chilean National Health Survey. The number of remaining teeth (≤19 versus ≥20 teeth) and anterior tooth losses were the exposure variables. Outcome was depression, measured through a self-report question and with the Composite International Diagnostic Interview – Short Form (CIDI SF). Mediating variables were determined by five questions, including problems regarding “speaking”, “pain and suffering”, “eating”, “daily activities”, and “social relationships”. We performed logistic regression models adjusted by multiple confounders variables. Finally, we calculated indirect, direct effect, total effect, and the proportion mediated (PM). ResultsWe included 5383 participants. The self-reported depression and suspected depression prevalence were 22,1 % and 14,0 % respectively. The total effect of fewer remaining teeth (≤19) on self-reported depression was 1.21 (95 % CI 1.02–1.44), and 1.09 (95 % CI 0.90–1.33) for suspected depression. All five variables of oral and social functions significantly mediated the association between tooth loss and depression. Feeling uncomfortable when speaking or eating discomfort were the most significant mediators. LimitationsThe mediation analysis should be interpreted with caution due to the cross-sectional design. ConclusionsDeterioration of oral and social functions was a significant mediator in the association between tooth loss and depression, in particular feeling uncomfortable when speaking or eating. This mechanism should be considered in interventions to improve mental health.