Performance In Breast Cancer Patients Research Articles

Abstract PO1-12-11: How do chemotherapy and age affect physical performance in breast cancer patients over 12 months of treatment? Results from the UPBEAT Study (UPBEAT WF-97415)

Abstract Introduction: Chemotherapy-associated functional decline is a concern for women with breast cancer. Objective: To assess effects of chemotherapy and age on objectively measured physical performance among women with breast cancer over time. Methods: Analyses utilized the multicenter, longitudinal Understanding and Predicting fatigue, cardiovascular decline, and events after BrEast cAncer sTudy (UPBEAT), a study conducted through the Wake Forest NCORP Research Base (5UG1CA189824). We examined physical performance at baseline and at 3 and 12 months and compared means across time by age group (< 65 years v. 65+ years at baseline) and by cancer/control group. For the latter variable, we had 3 groups of participants: 1) newly diagnosed breast cancer patients with Stage 1-3 breast cancer who received chemotherapy (CC; n= 201); 2) newly diagnosed breast cancer patients receiving no chemotherapy (CNC; n=57); and age-matched healthy controls (HC; n=145). The primary outcome was the Short Physical Performance Battery (SPPB) score (range 0-12, worst to best performance, including chair stands, gait speed, and balance testing). Effects of cancer/control group, age group, and time (treated categorically rather than ordinally) were estimated in a mixed model with a random subject effect and fixed effects of time (baseline, 3 month, 12 month) and cancer/control group. In the model we included all first-order interactions as well as the one second-order interaction between all three predictors. We also used linear contrasts to compare estimated means within groups. Analyses were conducted in SAS 9.4. A two-tailed alpha of 0.05 was used throughout to denote statistical significance. Results: Among 403 patients accrued through the Wake Forest Research Base of NCORP, 201 were in the CC group, and 18.9% of these were aged 65 and older; 57 were in the CNC group, and 33.3% were older; and 145 were in the HC group, and 15.9% were 65 or older. We observed a significant (p< 0.0001) main effect of older age group in our model: across all 3 groups, and all 3 time points, those who were 65 years of age or older had worse SPPB scores than those who were younger. Healthy controls tended to have better mean scores than the other 2 cancer/control groups, though the main effect of group did not achieve statistical significance (p=0.06). We observed no significant interaction terms; in other words, the effect of being older (in terms of association with worse SPPB scores) did not vary by time or group. Within the CC group, both the older and the younger groups declined significantly (p=0.04) in mean SPPB at 3 months compared to baseline, but by 12 months, the means had returned to their starting points. No other groups showed significant changes over time. Conclusions: Chemotherapy was associated with decline in SPPB score over the 12-month time period regardless of age. Older adults, regardless of chemotherapy status and time point, had lower SPPB scores. Citation Format: Shirley Bluethmann, Beverly Levine, Brianna Leitzelar, Katherine Ansley, Alexandra Thomas, Nancy Avis, Gregory Hundley, Heidi Klepin, Kathryn Weaver, Glenn Lesser. How do chemotherapy and age affect physical performance in breast cancer patients over 12 months of treatment? Results from the UPBEAT Study (UPBEAT WF-97415) [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 PO1-12-11.

A novel tumor-associated neutrophil gene signature for predicting prognosis, tumor immune microenvironment, and therapeutic response in breast cancer

Tumor-associated neutrophils (TANs) can promote tumor progression. This study aimed to investigate the molecular signature that predict the prognosis and immune response of breast cancer (BRCA) based on TAN-related gene (TANRG) expression data. The RNA-seq data of BRCA were gathered from The Cancer Genome Atlas (TCGA) and gene expression omnibus (GEO) datasets. Univariate Cox regression analysis and the least absolute shrinkage and selection operator for selecting prognostic genes. A neo-TAN-related risk signature was constructed by multivariate Cox regression analysis. Time-dependent receiver operating characteristic (ROC) curve analyses and Kaplan–Meier analyses were performed to validate the signature in GEO cohorts and the triple-negative breast cancer (TNBC) subtype. We constructed an independent prognostic factor model with 11 TANRGs. The areas under the ROC curve (AUCs) of the TCGA training cohorts for 3-, 5-, and 7-year overall survival were 0.72, 0.73, and 0.73, respectively. The AUCs of the GEO test cohorts for 3-, 5-, and 7-year overall survival were 0.83, 0.89, and 0.94 (GSE25066) and 0.67, 0.69, and 0.73 (GSE58812), respectively. The proportion of immune subtypes differed among the different risk groups. The IC50 values differed significantly between risk groups and can be used as a guide for systemic therapy. The prognostic model developed by TANRGs has excellent predictive performance in BRCA patients. In addition, this feature is closely related to the prediction of survival, immune activity and treatment response in BRCA patients.

SIOG2022-0073 - How do chemotherapy and age affect physical performance in breast cancer patients over the first 3 months of treatment?

SIOG2022-0073 - How do chemotherapy and age affect physical performance in breast cancer patients over the first 3 months of treatment?

Longitudinal Effects of Breast Cancer Treatment on Neural Correlates of Attention.

Cognitive dysfunction has been observed consistently in a subset of breast cancer survivors. Yet, the precise physiological and processing origins of dysfunction remain unknown. The current study examined the utility of methods and procedures based on cognitive neuroscience to study cognitive change associated with cancer and cancer treatment. We used electroencephalogram and behavioral measures in a longitudinal design to investigate pre- versus post-treatment effects on attention performance in breast cancer patients (n = 15) compared with healthy controls (n = 24), as participants completed the revised Attention Network Test, a cognitive measure of alerting, orienting, and inhibitory control of attention. We found no group differences in behavioral performance from pretest to posttest, but significant event-related potential effects of cancer treatment in processing cue validity: After treatment, patients revealed decreased N1 amplitude and increased P3 amplitude, suggesting a suppressed early (N1) response and an exaggerated late (P3) response to invalid cues. The results suggest that treatment-related attentional disruption begins in early sensory/perceptual processing and extends to compensatory top-down executive processes.

Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8.

ObjectivesComprehensive Geriatric Assessment (CGA), the gold standard for detecting frailty in elderly cancer patients, is time-consuming and hard to apply in routine clinical practice. Here we compared the performance of two screening tools for frailty, G8 and SAOP2 for their accuracy in identifying vulnerable patients.Material and MethodsWe tested G8 and SAOP2 in 282 patients aged 65 or older with a diagnosis of solid cancer and candidate to undergo surgical, medical and/or radiotherapy treatment. CGA, including functional and cognitive status, depression, nutrition, comorbidity, social status and quality of life was used as reference. ROC curves were used to compare two screening tools.ResultsMean patient age was 79 years and 54% were female. Colorectal and breast cancer were the most common types cancer (49% and 24%). Impaired CGA, G8, and SAOP2 were found in 62%, 89%, and 94% of the patients, respectively. SAOP2 had a better sensitivity (AUC 0.85, p<0.032) than G8 (AUC 0.79), with higher performance in breast cancer patients (AUC 0.93) and in patients aged 70-80 years (AUC 0.87).ConclusionsG8 and SAOP2 both showed good screening capacity for frailty in the cancer patient population we examined with SAOP2 showing a slightly better performance than G8.

Cognitive Impairment in a Subset of Breast Cancer Patients After Systemic Therapy—Results From a Longitudinal Study

ContextStudies indicate adverse effects of breast cancer (BC) and cancer treatment on cognitive function. ObjectivesTo investigate the effects of systemic treatment on cognitive performance in BC patients. MethodsParticipants were BC patients scheduled to receive systemic treatment (BC + SYST; n = 31), or no systemic treatment (BC; n = 24) and no-cancer (NC) controls (n = 33). Neuropsychological examinations were used to study cognitive performance on 18 tests grouped into eight cognitive domains, before adjuvant treatment (T1) and six months after chemotherapy (T2), or at similar intervals. We also assessed health-related quality of life, anxiety and depression, mood, stress, and cognitive problems. Analysis of variance was used to assess group differences of cognitive performance and multivariate normative comparison to classify impairment, comparing scores of each participant against the distribution of the scores of NC controls. ResultsOf BC + SYST, 16% were cognitively impaired at T2, compared to 4% in BC and 6% in NC. Although not significant, we observed moderate effect sizes for worse performance in the BC + SYST group compared to NC (Flanker congruent [effect size {ES} = 0.44] and stimulus incongruent [ES = 0.44]) and compared to BC (Controlled Oral Word Association Test [ES = 0.47], digit span [ES = 0.41], and Hopkins Verbal Learning Test immediate [ES = 0.71] and delayed recall [ES = 0.65]). Cognitively impaired patients had a significantly lower estimated premorbid intelligence, worse physical and social functioning, and more distress at T2 compared to unimpaired patients. ConclusionOur findings indicate that cognitive impairment after systemic treatment occurs in a subset of BC patients. The predictive value of demographic and psychosocial factors in cognitive impairment should be further investigated in a larger sample of impaired patients.

Decision-making impairments in breast cancer patients treated with tamoxifen

The selective estrogen receptor modulator tamoxifen (TAM) is most commonly prescribed for patients with hormone-sensitive breast cancer. Although TAM can bind to estrogen receptors in the nervous system, it is unknown whether it acts as an estrogen agonist or antagonist in the human brain. Several studies have reported the negative effects of TAM on cognitive function; however, its effects on decision-making function have not been previously explored. The present study aimed to investigate the decision-making function under ambiguity and risk in breast cancer patients treated with TAM. Participants included breast cancer patients taking TAM (TAM, n=47) and breast cancer patients not taking TAM (non-TAM, n=45) as well as their matched healthy controls (HC, n=50). All participants were given the Iowa Gambling Task (IGT) to assess their decision-making under conditions involving ambiguity, the Game of Dice Task (GDT) to assess their decision-making under conditions involving risk, and a battery of neuropsychological tests. Our results indicated that patients in the TAM group were significantly impaired as assessed by both the IGT and GDT and performed significantly worse on some aspects of various tasks involving memory and information processing. Furthermore, we found that decreased performance on verbal memory testing significantly correlated with IGT performance, and executive dysfunction was associated with poor GDT performance in breast cancer patients undergoing TAM treatment. This study demonstrates that breast cancer patients taking TAM have several decision-making impairments. These findings may support the idea that TAM resulting in cognitive changes plays an antagonistic role in the areas of the brain where estrogen receptors are present, including the prefrontal cortex, hippocampus and amygdala.

Systemically Treated Breast Cancer Patients and Controls: An Evaluation of the Presence of Noncredible Performance

This study sought to define the frequency of noncredible performance in breast cancer patients before, during and after completion of systemic treatment, as well as predictors of noncredible performance. We examined six datasets investigating the cognitive effects of chemotherapy and/or endocrine therapy. Embedded performance validity test (PVT) measures were identified and used to evaluate the datasets. One dataset included a standalone PVT. Possible noncredible performance was operationally defined as performance below criterion on three or more PVT indices. This was undertaken as cancer patients have been observed clinically to fail PVTs both in the context of external gain and independent of such motivators. A total of 534 breast cancer patients and 214 healthy controls were included in the analysis. Percentages of patients performing below cutoff on one or more PVT varied from 0% to 21.2%. Only 1 patient met the criterion of noncredible performance. Calculation of post-test probabilities indicated a more than 90% chance to detect noncredible performance. There is no evidence to suggest noncredible performance in breast cancer patients and healthy controls who choose to participate in research studies examining cognitive function. Thus, the observational data showing that non-central nervous system (CNS) cancer and therapies not targeting the CNS can have untoward effects on cognitive function are unlikely to be due to noncredible performance.

Exercise intervention in breast cancer patients with aromatase inhibitor-associated arthralgia: a pilot study

Aromatase inhibitors (AIs) block estrogen synthesis and are commonly used as adjuvant treatments for breast cancer patients. A common side effect is joint pain. This was a pilot study to examine implementation of an exercise program in reducing joint pain and improving quality of life (QoL) and functional performance in breast cancer patients treated with AIs. Twenty-six participants completed an 8-week, home-based program that combined upper and lower body resistance exercises with self-selected aerobic exercises. We measured: (1) anthropometry (2) functional performance (grip strength, biceps curl to exhaustion, and sit-to-stand and cardiovascular endurance (3-min step test). Joint pain and QoL were assessed using self-administered surveys. Participants reported a significantly lower number of painful joints, an improvement in QoL and a reduction in depressive symptoms. Significant improvements in grip strength, biceps curl, and sit-to-stand (by 14%, 51% and 15% respectively) were also observed. However, we found no significant changes in cardiovascular endurance or in anthropometric measures. An 8-week, home-based exercise program may provide potential benefit to the breast cancer patients undergoing AI treatment by reducing joint pain, improving functional performance and QoL, and reducing depressive symptoms. Further studies are needed to confirm these results.

Exercise Intervention in Breast Cancer Patients with Treatment-Induced Arthralgia

Aromatase inhibitors (AIs) are widely used as an adjuvant treatment in postmenopausal women with estrogen receptor-positive breast cancer. AIs arrest the final step in the synthesis of estrogen by blocking the activity of the enzyme aromatase. One of the most common side effects of AI treatment is joint pain, particularly in the hand and fingers. PURPOSE: To examine the effectiveness of an 8-week home-based exercise program in reducing joint pain and improving quality of life (QOL) and functional performance in breast cancer patients treated with AIs. METHODS: Participants underwent baseline measures of height, body mass, waist and hip circumference, and body composition. Functional performance was evaluated using grip strength, arm curl to exhaustion, and sit-to-stand. A 3-minute step test determined subject's cardiovascular endurance. Subjective measures of joint pain and QOL were conducted using self-administered surveys. Participants were instructed how to execute lower and upper body resistance exercises using Thera-BandR exercise bands and different hand exercises using an elastic band. A video was provided to each participant illustrating these exercises, as well as warm up, flexibility, and cool down. Participants were instructed how to monitor heart rate in order to pace aerobic activity. This was an 8 week, individualized, home-based program in which participants recorded daily activity on exercise logs and received interactive weekly phone calls to provide support. RESULTS: No significant pre-post changes were observed in the anthropometric measures (BMI, WHR, body composition). Grip strength, bicep curls to exhaustion and sit-to-stand improved significantly (8%, 45%, and 19%, respectively). HR recovery after the step test trended toward significance (5% reduction). Subjectively, participants reported an improvement in QOL, but no change in joint pain. CONCLUSIONS: An 8-week, home-based exercise program significantly improved functional performance and QOL in breast cancer patients suffering joint pain secondary to treatment with aromatase inhibitors. Supported by Susan G Komen for the Cure, WNY Affiliate.

Effect of a vigorous aerobic regimen on physical performance in breast cancer patients — a randomized controlled pilot trial

This randomized, controlled pilot trial was carried out to assess the feasibility and efficacy of an aerobic exercise in enhancing physical performance of breast cancer patients after adjuvant treatments. The potential of the training regimen to prevent accompanying bone loss was also assessed. Thirty patients, 41–65 years of age, were randomly assigned into training or control groups shortly after adjuvant chemo- or radiotherapy. The 12-week training included a guided aerobic exercise session once a week (the effective part being either step aerobic- or circuit-training in alternate weeks) and similar home exercise sessions twice a week. Adherence to the guided sessions was 78%, while home training was performed an average 2.1 times per week. Agility assessed with figure-8 running test and peak jumping power showed significant between-group treatment-effects (∼5% and ∼10%, respectively). Judged from the accelerometer data, reaction forces up to six times body weight occurred during the training, which implies that the training could also have potential to affect bone mass. The present exercise regimen turned out to be feasible and effective among breast cancer patients in terms of physical performance. Large controlled trials are necessary to confirm these findings.