Function In Breast Cancer Survivors Research Articles

Low Serum Carotenoids Are Associated with Self-Reported Cognitive Dysfunction and Inflammatory Markers in Breast Cancer Survivors.

Background: Dietary carotenoids may exert anti-inflammatory activities to reduce inflammation-driven cognitive impairments during cancer and cancer treatment. Our objective was to explore if cognitive function in breast cancer survivors (BCS) differs by serum carotenoid concentrations, and if blood carotenoids concentrations are associated with reduced systemic inflammation. Methods: Objective cognitive function and perceived cognitive impairment of 29 BCS and 38 controls were assessed cross-sectionally with the National Institutes of Health Toolbox Cognition Battery and The Functional Assessment of Cancer Therapy-Cognitive Function Questionnaire, respectively. Serum carotenoid and inflammatory marker (sTNF-RII, IL-6, IL-1ra, CRP) concentrations were measured. Results: Low-carotenoid BCS had more cognitive complaints compared to the low-carotenoid controls (Mdiff = −43.0, p < 0.001) and high-carotenoid controls (Mdiff = −44.5, p < 0.001). However, the cognitive complaints of high-carotenoid BCS were intermediate to and not different than the low-carotenoid BCS, or low- or high-carotenoid controls. BCS performed similarly to controls on all objective cognitive measures. Multiple linear regression, controlling for age and body mass index (BMI), demonstrated an inverse association between serum carotenoid concentrations and pro-inflammatory sTNFR-II (β = 0.404, p = 0.005) and IL-6 concentrations (β = −0.35, p = 0.001), but not IL-1ra or CRP. Conclusions: Higher serum carotenoid concentrations may convey cognitive and anti-inflammatory benefits in BCS. Future research should identify dietary components and patterns that support cognitive health in cancer survivors.

Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors

BackgroundEvidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors.MethodsBreast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep.ResultsMVPA was associated with faster Task-switch reaction time in the partition models (stay: B = − 35.31, p = 0.02; switch: B = − 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = − 29.37, p = 0.04) and switch (B = − 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = − 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = − 3.55, p = 0.03; Trails B: B = − 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = − 4.35, p = 0.02) and Trails B (B = − 5.23, p = 0.03) completion.ConclusionsFindings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted.Trial registrationThis study is registered with United States ClinicalTrials.gov (NCT02523677; 8/14/2015).

Effects of high-intensity interval training on vascular function in breast cancer survivors undergoing anthracycline chemotherapy: design of a pilot study

IntroductionCardiovascular disease (CVD) mortality is higher among breast cancer survivors (BCS) who receive chemotherapy compared with those not receiving chemotherapy. Anthracycline chemotherapy is of particular concern due to anthracycline-related impairment...

Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10years following chemotherapy.

Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6months to 10years post chemotherapy. Women 21 to 65years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated. Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs=-0.37 to -0.49, Ps<.00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance. Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research.

Longitudinal follow-up of endothelial function in breast cancer survivors on aromatase inhibitors (AIs).

e12525Background: AIs reduce breast cancer-related mortality however they may increase cardiovascular (CV) risk. We previously presented data demonstrating women on AIs have endothelial dysfunction...

Identifying cytokine predictors of cognitive functioning in breast cancer survivors up to 10 years post chemotherapy using machine learning

IntroductionThe purpose of this study is to explore 13 cytokine predictors of chemotherapy-related cognitive impairment (CRCI) in breast cancer survivors (BCS) 6 months to 10 years after chemotherapy completion using a multivariate, non-parametric approach. MethodsCross sectional data collection included completion of a survey, cognitive testing, and non-fasting blood from 66 participants. Data were analyzed using random forest regression to identify the most significant predictors for each of the cognitive test scores. ResultsA different cytokine profile predicted each cognitive test. Adjusted R2 for each model ranged from 0.71–0.77 (p's < 9.50–10). The relationships between all the cytokine predictors and cognitive test scores were non-linear. ConclusionsOur findings are unique to the field of CRCI and suggest non-linear cytokine specificity to neural networks underlying cognitive functions assessed in this study.

Abstract P6-12-25: Sexual function in breast cancer survivors stratified by adjuvant therapies and surgical modalities

Abstract Background: Breast cancer survivors comprise the largest group of cancer survivors in the United States. With increasing duration of recurrence-free survival, more women sustain the long-term consequences of treatment affecting quality of life. Our study aims to investigate associations of surgical modality, chemotherapy, radiation and endocrine therapy on sexual function of breast cancer survivors. Methods: An anonymous, cross-sectional survey of 585 patients in surveillance after breast cancer therapy was conducted at a single academic breast cancer center. The survey questions included surgical modality, adjuvant therapies, and sexual function using the Female Sexual Function Index (FSFI). Median FSFI (mFSFI) results were stratified by surgery type and by receipt of chemotherapy, radiation, and endocrine therapy. Statistical analysis was performed using Fisher's exact and the Wilcoxon rank-sum tests or the Kruskal-Wallis test. Results: Of the 585 respondents, 55.3% were &amp;lt; 60 years old and 51.3% were sexually active. Surgical modalities included lumpectomy (L=406), mastectomy with reconstruction (MR=129) and mastectomy without reconstruction (M=50). For adjuvant therapy, 405 patients received radiation, 276 received chemotherapy, 117 reported tamoxifen (TAM) use, and 189 reported aromatase inhibitor (AI) use. For all patients stratifying for receipt of adjuvant chemotherapy or radiation therapy, there was no difference in mFSFI scores (radiation: 26.7 vs 28 p=0.2, chemo: 26.5 vs. 27.5 p=0.1). Regarding endocrine therapy, AI patients had statistically significant lower mFSFI compared to no endocrine therapy or TAM (22.2 vs. 27.9 vs 29.6, p &amp;lt;= .0001). mFSFI Scores by Adjuvant TherapiesVariablenmFSFIRangeIQRP valueRadiation: Yes20726.77.2-36.021.5-30.5 Radiation: No7128.010.7-34.822.4-31.70.2 Chemo: Yes13326.57.2-36.021.0-30.5 Chemo: No14527.510.8-35.722.2-31.20.1 TAM and AI223.121.5-24.621.5-24.60.2TAM Only7429.611.6-35.724.6-32.30.07AI Only8522.27.2-35.718.1-28.3&amp;lt;0.0001Neither11227.99.8-36.023.2-31.0Ref Patients on AI had significantly lower scores in all FSFI domains except for orgasm. For patients on TAM, the desire and lubrication domains showed statistically significantly lower scores compared to nonusers of endocrine therapy (p= 0.03). There was no significant difference in mFSFI by surgical type, although patients with MR had the highest score at 28.5. Controlling for surgical modality and stratifying by adjuvant treatment, radiation and chemotherapy did not have statistically significant effects on sexual function. Patients reporting L and TAM use had mFSFI significantly higher than those with AI use (29.4 vs 23.7, p=0.005). For MR patients reporting AI use, mFSFI was significantly lower than those on no endocrine therapy (18.1 vs 29.6, p&amp;lt;0.0001). Conclusions: Our study does not show an association of surgical modality, receipt of chemotherapy or radiotherapy and sexual function as measured by FSFI. Patients receiving endocrine therapy with an AI had significantly lower sexual function scores, than those who received no endocrine therapy or those on tamoxifen. These data may guide clinicians in counseling sexually active breast cancer patients in surgical planning and in survivorship. Citation Format: Gandhi C, Butler EC, Pesek S, Kwait R, Clark M, Raker C, Stuckey A, Gass J. Sexual function in breast cancer survivors stratified by adjuvant therapies and surgical modalities [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-25.

Home Exercise Program is an effective tool in improving upper limb function and quality of life in breast cancer survivors: A retrospective observational study

Background: Home Exercise Program is a mainstay of upper limb dysfunction prevention in breast cancer survivors. However, only subjective assessment instruments have been used until now in order to prove its effectiveness. In the present observational retrospective study, we assessed, for the first time, the effects of Home Exercise Program on the upper limb function of breast cancer survivors via tridimensional motion analysis. We also aimed to show that good upper extremity performance positively influenced the quality of life of breast cancer survivors. Methods: From the 2016 database of breast cancer survivors who underwent upper limb tridimensional motion analysis 1 and 3 months after modified radical mastectomy, we enrolled 15 patients who spontaneously refused to undergo the post-surgical 14-day Home Exercise Program (group A). In addition, 15 patients who were homogeneous to those of group A, but who agreed to normally undergo Home Exercise Program were selected from the same database, in order to compare upper limb performance (group B). The Constant-Murley, Brief Fatigue Inventory and European Organization for Research and Treatment of Cancer quality of life scores during follow-up were analysed and compared. Results: Compared to those in group A, on tridimensional motion analysis, patients in group B showed a wider range of motion of the upper limb, with consequently better shoulder and elbow performance, lower incidence of lymphedema, minor fatigue, and better quality of life. Conclusions: We show objectively, by means of tridimensional motion analysis, that Home Exercise Program is an effective tool for preventing upper extremity dysfunction in breast cancer survivors. Hence, it should always be recommended to such patients as it positively influences their quality of life.

The Effects of Therapeutic Inflatable Ball for Shoulder Pain and Function of Breast Cancer Survivors

The Effects of Therapeutic Inflatable Ball for Shoulder Pain and Function of Breast Cancer Survivors

Modifiable correlates of perceived cognitive function in breast cancer survivors up to 10years after chemotherapy completion.

Cognitive changes following breast cancer treatment are likely multifactorial and have been linked to emotional factors, biophysiological factors, and fatigue, among others. Little is known about the contributions of modifiable factors such as stress, loneliness, and sleep quality. The purpose of this study was to explore the direct and indirect effects of perceived stress, loneliness, and sleep quality on perceived cognitive function (PCF) in breast cancer survivors (BCS) after chemotherapy completion. In this observational study, BCS 6months to 10years post chemotherapy were recruited from the community. We measured perceived stress, loneliness, sleep quality, anxiety, depression, fatigue, and PCF. Data analyses included descriptive statistics, correlations, and mediation analyses utilizing ordinary least square regression. Ninety women who were on average 3years post chemotherapy completion participated in the study. Moderate to largely negative correlations were found between PCF and the psychosocial and sleep variables (r values ranged from -0.31 to -0.70, p values<.0009). Mediation analyses revealed that stress and daytime sleepiness both directly and indirectly impact PCF and that loneliness and sleep quality only have indirect effects (through anxiety and fatigue). Our findings suggest that perceived cognitive changes following breast cancer treatment are multifactorial and that higher stress levels, loneliness, daytime sleepiness, and poorer sleep quality are linked to worse perceived cognitive functioning. Also, stress, loneliness, and sleep quality may affect cognitive functioning through a shared psychobiological pathway. Interventions targeting stress, loneliness, and sleep quality may improve perceived cognitive functioning in breast cancer survivors.

Vascular function in breast cancer survivors on aromatase inhibitors: a pilot study.

Aromatase inhibitors (AI) have been shown to reduce breast cancer-related mortality in women with estrogen positive (ER+) breast cancer. The use of AIs, however, has been associated with higher rates of hypertension, hyperlipidemia, and cardiovascular (CV) events. A cross-sectional study of 25 healthy postmenopausal women and 36 women with curative intent breast cancer on an AI was performed to assess endothelial dysfunction, an indicator of risk for CV events. Consented subjects underwent vascular testing using the HDI/Pulse Wave CR-2000 Cardiovascular Profiling System and the EndoPAT2000 system. Mean age was 61.7 and 59.6years (cases, controls). Most subjects were Caucasian and overweight. Controls had a lower mean systolic blood pressure (128.6mmHg vs. 116.2mmHg, p=0.004). Median estradiol levels were reduced in cases (2 vs. 15pg/ml, p<0.0001). EndoPAT ratio (0.8 vs. 2.7, p<0.0001) was significantly reduced in cases as compared to controls. Median large artery elasticity (12.9 vs. 14.6ml/mmHg×10, p=0.12) and small artery elasticity (5.2 vs. 7.0ml/mmHg×100, p=0.07) were also reduced though not statistically significant. There was no correlation between use of chemotherapy, radiation therapy, type of AI, or duration of AI use and endothelial function. When adjusting for differences in blood pressure, results remained significant. Breast cancer cases on AIs have reductions in endothelial function, a predictor of adverse CV disease. Vascular function changes in breast cancer cases on AIs compared to postmenopausal women. Further work is needed to evaluate vascular changes over time.

The effects of physical activity and fatigue on cognitive performance in breast cancer survivors.

Research suggests that physical activity may be a promising treatment for cancer-related cognitive impairment; however, evidence is limited by small samples and self-report measures and little is known about the underlying mechanisms. The purpose of this study was to examine the effects of physical activity on cognitive function in a national sample of breast cancer survivors (BCSs) using objective measures. We hypothesized that physical activity's effects on cognition would be indirect through survivors' self-reported fatigue. Participants (N=299; M=57.51±9.54years) included BCSs with access to an iPad. Participants wore an accelerometer for seven consecutive days to measure their average daily minutes of moderate-to-vigorous physical activity (MVPA) and completed a battery of questionnaires and neuropsychological tests via an iPad application to measure fatigue and cognitive function. Cognitive function was modeled as two latent factors-executive function and working memory-comprising performance across seven cognitive tasks. A structural equation modeling framework was used to test the hypotheses. MVPA was associated with less fatigue (γ=0.19), which, in turn, was associated with faster times on executive function tasks (γ=-0.18) and greater accuracy on working memory tasks (γ=0.16). The indirect paths from MVPA to cognitive performance were also significant (executive function: β=-0.03, memory: β=0.03). Findings suggest that MVPA may be associated with greater executive function and working memory in BCSs. Further, this effect may be partially indirect through cancer-related symptoms (e.g., fatigue). Results emphasize the need for additional scientific investigation in the context of prospective and efficacy trials.

Measurement of objective shoulder function following breast cancer surgery: a scoping review protocol

Background: Decreased shoulder function is frequently experienced by breast cancer survivors following surgery, and it is associated with both decreased ability to perform daily living tasks and decreased overall quality of life, even several years post-surgery. Shoulder function is often measured with self-reported questionnaires. If objective measurements are taken, they are frequently restricted to range of motion measurement in the cardinal planes of movement. It is not known to what extent shoulder motion in more functional tasks has been investigated. Objectives: This review aims to determine what is known about the objectively evaluated shoulder function following breast cancer and to determine what are the most frequently used methods for evaluation. Methods: This protocol outlines the steps that will be taken to conduct a high quality scoping review on the objective measurement of shoulder function in breast cancer survivors. A comprehensive search of several databases will be performed to identify all relevant research. All identified studies will be screened and those including the objective measurement of shoulder function of breast cancer survivors post-surgery will be included. Data will be extracted by two reviewers and results will be consolidated and presented in narrative form as well as tables and figures. Conclusion: The resulting synthesis of the literature will provide a comprehensive overview of the current methods of evaluating shoulder function in breast cancer survivors. This review will elucidate gaps in knowledge regarding objective measurement of shoulder function and help to develop future research questions.

Effect of an Internet-based telehealth system on functional capacity and cognition in breast cancer survivors: a secondary analysis of a randomized controlled trial.

This trial determines the effect of an Internet-based tailored exercise program compared to usual care control for improving functional capacity and cognition among breast cancer survivors. A two-arm, assessor-blinded, parallel, randomized controlled efficacy trial was conducted. Participants were recruited from the Oncology and Breast unit at the Virgen de las Nieves Hospital (Granada, Spain) between March 2012 to November 2013 and randomized to either the experimental group (an 8-week Internet-based tailored exercise program) or control group (usual care). The outcome measures were the 6-min walk test, Auditory Consonant Trigrams, and Trail Making Test. All were assessed at baseline, post-intervention, and 6-month follow-up. After intervention, the telerehabilitation group had significantly improved distances (d=0.92, P<0.001) as well as percentage of predicted of the 6-min walk test (d=0.93, P<0.001) compared with the control group. Significant improvement was also observed favoring the telerehabilitation group for the number of consonants recalled in total compared with the control group (d=0.47, P=0.04). These findings were maintained after 6-month follow-up (d=0.80, P=0.001; d=0.76, P=0.002; and d=0.57, P=0.02, respectively). Analysis was based on intention-to-treat principle. These findings support the effectiveness of a telehealth system based on an 8-week physical exercise to achieve improvements and maintain them after 6-month follow-up in terms of functional and cognitive performance in breast cancer survivors. This broad-reach modality could help the growing number of cancer survivors to face their disabling side effects.

Pain characteristics as important contributing factors to upper limb dysfunctions in breast cancer survivors at long term

PurposeThe aim of this study was to explore the treatment, patient, and impairment-related risk factors associated with upper limb dysfunctions in breast cancer survivors. MethodsA cross-sectional study was performed in 274 women treated for breast cancer. The following risk factors were analysed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy and trastuzumab); 2) patient's related variables (age and Body Mass Index); 3) and finally impairment-related variables such as pain (intensity, quality and pressure hypersensitivity, signs of central sensitisation, the degree of pain catastrophizing and vigilance and awareness to pain), active ROM and upper limb strength were investigated. The dependent variable was upper limb function measured with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Additionally, a stepwise regression was performed. ResultsAn impaired upper limb function was noted in 170 (62%) of patients. Mean time after surgery was 1.5 (1.6) years. From multivariable analysis, it appears that in particular certain pain characteristics such as pain intensity, pain quality, signs of central sensitisation and pain catastrophizing are contributing to upper limb dysfunctions after breast cancer treatment at long term. Additionally, higher age, shoulder ROM and handgrip strength are possible contributing factors. The stepwise regression analysis revealed that central sensitisation mechanisms alone can explain about 40% of the variance in upper limb function. ConclusionsAt long term, especially pain and central sensitisation mechanisms contribute to upper limb function in breast cancer survivors.

An exploratory study of host polymorphisms in genes that clinically characterize breast cancer tumors and pretreatment cognitive performance in breast cancer survivors.

PurposeInspired by the hypothesis that heterogeneity in the biology of breast cancers at the cellular level may account for cognitive dysfunction symptom variability in survivors, the current study explored relationships between host single-nucleotide polymorphisms (SNPs) in 25 breast cancer-related candidate genes (AURKA, BAG1, BCL2, BIRC5, CCNB1, CD68, CENPA, CMC2, CTSL2, DIAPH3, ERBB2, ESR1, GRB7, GSTM1, MELK, MKI67, MMP11, MYBL2, NDC80, ORC6, PGR, RACGAP1, RFC4, RRM2, and SCUBE2), identified from clinically relevant prognostic multigene-expression profiles for breast cancer, and pretreatment cognitive performance.Patients and methodsThe sample (n=220) was comprised of 138 postmenopausal women newly diagnosed with early stage breast cancer and 82 postmenopausal age- and education-matched healthy controls without breast cancer. Cognitive performance was assessed after primary surgery but prior to initiation of adjuvant chemotherapy and/or hormonal therapy using a comprehensive battery of neuropsychological tests encompassing eight cognitive function composite domains: attention, concentration, executive function, mental flexibility, psychomotor speed, verbal memory, visual memory, and visual working memory. In total, 131 SNPs were included in the analysis. Standard and robust multiple linear regression modeling was used to examine relationships between each domain and the presence or absence of one or more minor alleles for each SNP. Genetic risk/protection scores (GRSs) were calculated for each domain to evaluate the collective effect of possession of multiple risk/protective alleles.ResultsWith the exception of CMC2, MMP11, and RACGAP1, significant (P<0.05) SNP main effect and/or SNP by future prescribed treatment group interactions were observed for every gene between at least one domain and one or more SNPs. All GRSs were found to be significantly (P<0.001) associated with each respective domain score.ConclusionAssociations between host SNPs and computed GRSs and variability in pretreatment cognitive function performance support the study hypothesis, and warrant further investigations to identify biomarkers for breast cancer-related cognitive dysfunction.

Efficacy of Internet-Based Cognitive Behavioral Therapy in Improving Sexual Functioning of Breast Cancer Survivors: Results of a Randomized Controlled Trial.

Purpose We evaluated the effect of Internet-based cognitive behavioral therapy (CBT) on sexual functioning and relationship intimacy (primary outcomes) and body image, menopausal symptoms, marital functioning, psychological distress, and health-related quality of life (secondary outcomes) in breast cancer survivors (BCSs) with a DSM-IV diagnosis of a sexual dysfunction. Patients and Methods We randomly assigned 169 BCSs to either Internet-based CBT or a waiting-list control group. The CBT consisted of weekly therapist-guided sessions, with a maximum duration of 24 weeks. Self-report questionnaires were completed by the intervention group at baseline (T0), midtherapy (T1), and post-therapy (T2) and at equivalent times by the control group. We used a mixed-effect modeling approach to compare the groups over time. Results Compared with the control group, the intervention group showed a significant improvement over time in overall sexual functioning (effect size for T2 [EST2] = .43; P = .031), which was reflected in an increase in sexual desire (EST1 = .48 and EST2 = .72; P < .001), sexual arousal (EST2 = .50; P = .008), and vaginal lubrication (EST2 = .46; P = .013). The intervention group reported more improvement over time in sexual pleasure (EST1 = .32 and EST2 = .62; P = .001), less discomfort during sex (EST1 = .49 and EST2 = .66; P = .001), and less sexual distress (EST2 = .59; P = .002) compared with the control group. The intervention group reported greater improvement in body image (EST2 = .45; P = .009) and fewer menopausal symptoms (EST1 = .39; P = .007) than the control group. No significant effects were observed for orgasmic function, sexual satisfaction, intercourse frequency, relationship intimacy, marital functioning, psychological distress, or health-related quality of life. Conclusion Internet-based CBT has salutary effects on sexual functioning, body image, and menopausal symptoms in BCSs with a sexual dysfunction.

Abstract P4-19-03: A meta-analysis of cognitive impairment in breast cancer survivors treated with chemotherapy

Abstract Background: Cognitive impairment in women with breast cancer has long been attributed to chemotherapy, but the evidence for this has been inconsistent, and more recent research suggests that additional cancer- and treatment-related factors also impact cognition. To systematically evaluate and describe “chemobrain,” a multilevel meta-analysis of objective cognitive function in breast cancer survivors treated with chemotherapy was conducted to estimate the magnitude of impairment across 9 cognitive domains and explore moderating variables. Method: PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and PsycINFO were searched from their inception to May 2016 to identify studies that compared the cognitive performance of survivors treated with chemotherapy to a control group or to their own prechemotherapy testing. Multilevel modelling was used to account for the interdependence among effect sizes obtained within the same study. Results: Seventy-seven studies involving 3417 cancer patients treated with chemotherapy yielded 1548 effect sizes. Cross-sectional comparisons revealed worse overall cognitive performance in survivors treated with chemotherapy relative to healthy controls (d = -0.27, 95% CI [-0.32, -0.21]) but not disease-specific controls (d = -0.07, 95% CI [-0.14, 0.00]). Relative to all controls, cognitive impairment in survivors treated with chemotherapy was observed in tests assessing language (d = -0.25), executive function (d = -0.21), processing speed (d = -0.15), delayed recall (d = -0.15), and attention/concentration (d = -0.14), but not in visual/spatial perception, immediate recall, recognition memory, or psychomotor domains. Because patients and controls were not well matched in many studies on age, education, and IQ, which are known to impact cognitive test performance, group differences in these variables were explored as moderators of observed cognitive deficits in post hoc analyses. Results showed that chemotherapy patients and controls performed equivalently when the controls were 6 years older or had 1 less year of education. Longitudinal comparisons showed improved postchemotherapy performance relative to prechemotherapy baseline, but practice effects were not accounted for in these comparisons. Conclusion: Breast cancer survivors treated with chemotherapy show subtle yet diffuse cognitive impairment. Their cognitive performance was equivalent to that of women in comparison groups who were 6 years older, which suggests that chemotherapy accelerates cognitive aging. Results from breast cancer patients who were not treated with chemotherapy, however, indicate that chemotherapy is not the only determinant of cognitive dysfunction. Group differences in age and education moderated the magnitude of cognitive impairment. The cognitive reserve framework, which posits that individuals differ in the degree of neural disruption they can withstand before exhibiting cognitive deficits, should be considered in future studies in order to better understand moderating effects on cancer-related cognitive dysfunction. In particular, both cross-sectional and longitudinal studies should ensure that comparison cohorts are closely matched on age, education, and other relevant cognitive reserve variables. Citation Format: Bernstein LJ, McCreath GA, Rich JB. A meta-analysis of cognitive impairment in breast cancer survivors treated with chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-03.

Effect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial.

Besides pain, myofascial dysfunctions may contribute to the presence of upper limb impairments such as impaired range of motion, decreased strength, lymphedema, and altered postures and kinematics. Therefore, the aim of this study was to investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of upper limb dysfunctions in breast cancer survivors. Fifty women treated for a unilateral breast cancer with pain and myofascial dysfunctions at the upper limb region. The intervention group received 12 sessions of myofascial therapy consisting of release techniques on myofascial trigger points and adhesions in addition to a standard physical therapy program for 3months. The control group received 12 sessions of a placebo intervention in addition to the same standard physical therapy program during the 3months. Outcome parameters are active shoulder range of motion (inclinometer); arm lymphedema (perimeter); upper limb strength (handheld dynamometer); scapular statics and dynamics (acromion-table and pectoralis minor index, inclinometer); shoulder function (Disability of Shoulder, Arm and Hand questionnaire); and quality of life (Short Form 36). Measures were taken before and after the intervention at 6 and 12months follow-up. No differences between groups were found for all outcome parameters over the course of 1year. However, overall beneficial effects of the standard physical therapy program for active shoulder range of motion and shoulder function were found in both groups up to 1year follow-up. Myofascial therapy has no additional beneficial effect for improvement of upper limb function in breast cancer survivors.

Efficacy of internet-based cognitive behavioral therapy in improving sexual functioning of breast cancer survivors with a DSM-IV diagnosis of sexual dysfunction: results of a randomized controlled trial

Efficacy of internet-based cognitive behavioral therapy in improving sexual functioning of breast cancer survivors with a DSM-IV diagnosis of sexual dysfunction: results of a randomized controlled trial