Problem For Breast Cancer Survivors Research Articles

Fear of cancer recurrence in breast cancer survivors carrying a BRCA1 or 2 genetic mutation : a cross-sectional study

BackgroundFear of cancer recurrence (FCR) affects virtually all patients who have been treated for cancer, to varying degrees. Breast cancer survivors who carry a BRCA1 or BRCA2 gene mutation are at high risk of cancer recurrence. No study has yet assessed FCR specifically in this population.ObjectivesThis cross-sectional study, conducted in women who were treated for breast cancer and carrying a BRCA1/2 mutation, aimed to: (1) assess the mean level of FCR and estimate the proportion of patients with clinical levels of FCR; (2) examine the relationships between FCR and selected psychological variables (e.g., avoidance, intolerance to uncertainty) and quality of life; (3) explore whether FCR levels vary as a function of the past preventive treatment received; and (4) to assess the associations between FCR and the presence of decisional conflict or regret regarding the various preventive options.MethodParticipants were recruited through an e-mail sent to an oncogenetic network mailing list (Réseau ROSE). Participants were asked to complete a battery of questionnaires online assessing FCR and other psychological and quality of life variables.ResultsA total of 89 women completed the survey. Most participants had undergone a preventive mastectomy (62.9%) and a preventive salpingo-oophorectomy (75.3%) at the time of the study. The mean Fear of Cancer Recurrence Inventory-severity score was 16.8, which exceeds the clinical cut-off score of 13, and 70.8% of the participants showed a clinical level of FCR. FCR was significantly associated with higher levels of anxiety and depression, and higher avoidance and intolerance of uncertainty, but not with quality of life. No significant difference was observed on the total FCR score between women who had received preventive surgery (mastectomy and/or salpingo-oophorectomy) and those considering it, and those not considering it. The association was significant between higher FRC scores and greater decisional conflicts and regrets about choosing to undergo preventive surgery.ConclusionThese data suggest that FCR is a significant problem for breast cancer survivors carrying a BRCA1/2 genetic mutation, even after undergoing a prophylactic surgery. This highlights the importance of providing these women with specific psychological intervention focusing on FCR.

Management of sexual and reproductive problems in breast cancer survivors

Management of sexual and reproductive problems in breast cancer survivors

Fear of cancer recurrence in breast cancer survivors carrying a BRCA1/2 mutation: A qualitative study.

There is preliminary evidence suggesting that FCR is a major problem for breast cancer survivors carrying a BRCA1/2 mutation. The goal of this qualitative study, conducted among women who were treated for breast cancer, was to provide a deeper understanding of how FCR is experienced in the context of a genetic predisposition to breast cancer. Three focus groups (90-110 min) were conducted with 19 breast cancer survivors carrying a BRCA1/2 mutation. The semistructured interview probed FCR level and impact, the role FCR played in the decision to have a prophylactic bilateral mastectomy and/or salpingo-oophorectomy, the effect that surgery had on FCR, and the relevance of offering a psychological intervention targeting FCR to this population. Findings indicated that FCR was a significant issue in these women, even though a majority had undergone a prophylactic surgery. Patients strongly affirmed the need to develop and provide access to FCR interventions that are specifically adapted to the needs of this group. These results suggest that, although being the most effective medical option to reduce the actual risk of local recurrence (or second breast cancer), prophylactic surgery only partially reduces FCR. A psychological intervention targeting specifically FCR would be an appropriate complement to preventive surgery.

Psychological and sexual problems of cancer survivors.

To explore: 1) the unmet needs of breast cancer patients; 2) the sexual needs experienced by breast cancer survivors; 3) the experiences of cancer patients at the time of relapse, including the biopsychosocial- spiritual aspects of their experiences. Interpretative phenomenological qualitative research by conducting direct in-depth interviews with participants who met the inclusion criteria. Sample analyzed were breast cancer survivors who had experiences related to unmet needs (14 participants) or sexual problems (12 participants); adult cancer patients who experienced recurrences (10 participants). Themes identified for breast cancer patients with unmet needs were i) overcoming health problems in breast cancer survivors; ii) need to access the best health services; iii) women's unmet information needs concerning cancer treatment. For breast cancer survivors: i) information is needed to overcome sexual problems, ii) family support is needed to get sexual information, and iii) health care facilities need to provide sexual information. For patients experiencing recurrences: i) the reaction that occurs when receiving bad news; ii) efforts made during a relapse, iii) self-concept during a relapse. Health-related problems of breast cancer survivors, such as fatigue and fear of cancer recurrence, can lead them to have trouble with social relationships, question their spirituality, and struggle with sex and sexuality. Oncology nurses and other professionals need to be aware of the unmet needs of breast cancer survivors, especially in relation to resolving the sexuality issues of cancer survivors. Understanding of the experiences of patients with relapse of different types of cancer should be improved.

Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients.

Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality of women with hormone-receptor-positive tumors, but poor adherence remains a significant problem. The aim of this study was to analyze AET side effects and their impact on adherence to treatment. A total of 373 breast cancer patients treated with AET filled out a specific questionnaire during their follow up visits at the Breast Unit of our Centre. Side effects were reported by 81% of patients, 84% of those taking tamoxifen and 80% of those taking aromatase inhibitors (AIs). The most common side effect in the tamoxifen group was hot flashes (55.6%), while in the AI group it was arthralgia (60.6%). The addition of GnRH agonists to both tamoxifen and AI significantly worsened all menopausal symptoms. Overall, 12% of patients definitively discontinued AET due to side effects, 6.4% during the first 5 years and 24% during extended therapy. Patients who had previously received chemotherapy or radiotherapy reported a significantly lower discontinuation rate. AET side effects represent a significant problem in breast cancer survivors leading to irregular assumption and discontinuation of therapy. Adherence to AET may be improved by trustful patient-physician communication and a good-quality care network.

Abstract P055: Risk factors for second primary lung cancer among breast cancer survivors

Abstract Introduction: Breast cancer is the most common cancer in women in the U.S. As survival in breast cancer has improved, one of the key clinical problems in breast cancer survivors is the increased risk of second cancers. Over half (55%) of breast cancer survivors die from second cancers, of which lung cancer (i.e., second primary lung cancer [SPLC]) is the most frequent type. While smoking and radiotherapy have been identified as the risk factors for SPLC among breast cancer survivors, other potential factors (e.g., comorbidity, and medication) have been underexamined. In addition, women in general have shown higher susceptibility to smoking-induced lung cancer than men, suggesting the potential involvement of hormonal factors; however, the effect of hormone replacement therapy (HRT) on lung cancer risk has been controversial and has never been examined among breast cancer survivors. We aimed to examine the factors associated with SPLC risk among breast cancer survivors, focusing on the effect of HRT and its interaction with smoking. We also explored the potential of tailored risk-based management of SPLC for breast cancer survivors. Methods: We identified 5,552 patients diagnosed with breast cancer in 1993-2014 from the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening Trial. SPLC was defined as a newly diagnosed lung cancer after 6 months from the time of breast cancer diagnosis. We applied multivariable cause-specific Cox regression to identify new factors associated with SPLC risk, adjusting for multiple testing using the Bonferroni method (P<0.01). We developed a prediction model to predict a 5-year risk of SPLC among breast cancer survivors that included both ever- and never-smokers and evaluated the predictive accuracy vs. a well-established lung cancer risk model, PLCOm2012, that was developed for a cancer-free population who ever smoked. Results: Of 5,552 patients, 89 (1.6%) developed SPLC over 102,545 person-years. Several factors measured at baseline in PLCO were significantly associated with SPLC risk among breast cancer survivors, including liver comorbidity (Hazard Ratio [HR] 3.28; P<.001), prior history of other cancer (HR 2.02; P=0.01), and regular use of ibuprofen (HR 0.52; P=0.01). In addition, ever-use of HRT was associated with a 51% reduction in SPLC risk (HR 0.49; P=0.001). The effect of active smoking on SPLC risk vs non-active smoking (HR 7.09; P<.001) was validated in PLCO. Notably, the effect of active smoking was intensified among ever-HRT users (HR=10.5; P<.001) vs. never-HRT users (HR 4.1; P<.001), thus showing a significant interaction (Pinteraction=0.003). The prediction model for SPLC risk was validated through bootstrap and demonstrated higher discrimination (AUC 0.83) vs. the PLCOm2012 model (AUC 0.79). Conclusions: In a large prospective cohort of breast cancer survivors, smoking and HRT use showed a significant interaction on SPLC risk. The prediction model for SPLC could identify high-risk survivors for SPLC for tailored surveillance to improve the management of breast cancer survivors. Citation Format: Eunji Choi, Justin Lee, Julie T. Wu, Heather A. Wakelee, Lidia Schapira, Allison W. Kurian, Summer S. Han. Risk factors for second primary lung cancer among breast cancer survivors. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P055.

Lokaal gebruik van dehydro-epiandrosteron voor de behandeling van vaginale atrofie na borstkanker

Vaginal dehydroepiandrosterone for the treatment of vaginal atrophy in breast cancer survivors Vaginal atrophy is a common problem in breast cancer survivors, but often remains undiscussed with the health care professional. Vaginal oestrogens are the standard treatment, yet this treatment remains quite controversial in breast cancer survivors. Vaginal dehydroepiandrosterone (DHEA) appears to be a promising alternative. PubMed was screened for clinical trials on offering local DHEA for the treatment of vaginal atrophy in breast cancer survivors. Only 2 published articles, both covering 1 randomized double-blind controlled trial, were found. In that study, 443 participants were equally randomized into 3 arms: each participant receiving daily vaginal administration during 12 weeks of 3.25 mg DHEA, 6.5 mg DHEA and a plain moisturizer. All arms showed improvement in both vaginal dryness and dyspareunia, yet no dose of DHEA administration led to a statistically significant difference on both parameters compared to the plain moisturizer. Some significant self-reported side effects were observed. Serum DHEA sulphate and testosterone increased significantly depending on the DHEA dose in comparison to a plain moisturizer, yet still remaining within the normal postmenopausal range. Oestradiol amounts also increased in the 6.5 mg DHEA group, but not in the 3.25 mg DHEA group and, remarkably, not in women taking an aromatase inhibitor. Vaginal DHEA improves the symptoms of vaginal atrophy, especially in terms of sexual experience. However, further research is needed on the efficacy and safety of long-term use of vaginal DHEA in breast cancer survivors, especially in case of hormone-sensitive breast cancer.

Breast cancer survivors: Main physical and psychosocial problems after completion of treatment at a Brazilian cancer center.

e24057 Background: The number of breast cancer survivors has grown worldwide in recent years due to advances in treatments, however, increased survival lead to the appearance of signs and symptoms after the end of treatment that affect the quality of life of these patients in the long term. Methods: Women aged 20-60 years with a diagnosis of breast cancer and primary treatment for at least 1 year were selected. The Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire was used and sociodemographic data, life habits and clinical conditions of the participants were collected. The primary end point was to identify the main repercussions of breast cancer and its treatments. Results: A total of 87 women were enrolled for this study. The mean age was 48.5 years. The main symptoms identified were pain (15.48%), nausea (13.10%), fatigue (11.90%), hot flashes (9.52%) and insomnia (5.95%). The total FACT-B+4 score was 110.75 (SD 20.02). No statistically significant variables were identified as predictors of worsening quality of life. Conclusions: The main residual problems in breast cancer survivors 1 year after curative treatment at Hospital São Camilo Oncologia were identified, however, it was not possible to establish significant predictors of worsening quality of life. We will conduct a new interview in 1 year using others quality of life assessment instruments.

The association of circadian parameters and the clustering of fatigue, depression, and sleep problems in breast cancer survivors: a latent class analysis.

Circadian rhythms control a wide range of physiological processes and may be associated with fatigue, depression, and sleep problems. We aimed to identify subgroups of breast cancer survivors based on symptoms of fatigue, insomnia, and depression; and assess whether circadian parameters (i.e., chronotype, amplitude, and stability) were associated with these subgroups over time. Among breast cancer survivors, usual circadian parameters were assessed at 3-4months after diagnosis (T0), and symptoms of fatigue, depression, and insomnia were assessed after 2-3years (T1, N = 265) and 6-8years (T2, N = 169). We applied latent class analysis to classify survivors in unobserved groups ("classes") based on symptoms at T1. The impact of each of the circadian parameters on class allocation was assessed using multinomial logistic regression analysis, and changes in class allocation from T1 to T2 using latent transition models. We identified 3 latent classes of symptom burden: low (38%), moderate (41%), and high (21%). Survivors with a late chronotype ("evening types") or low circadian amplitude ("languid types") were more likely to have moderate or high symptom burden compared to "morning types" and "vigorous types," respectively. The majority of survivors with moderate (59%) or high (64%) symptom burden at T1 had persistent symptom burden at T2. A late chronotype and lower circadian amplitude after breast cancer diagnosis were associated with greater symptoms of fatigue, depression, and insomnia at follow-up. These circadian parameters may potentially be novel targets in interventions aimed at alleviating symptom burden among breast cancer survivors.

The Benefits of a Therapeutic Exercise and Educational Intervention Program on Central Sensitization Symptoms and Pain-Related Fear Avoidance in Breast Cancer Survivors

BackgroundCentral sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population. AimsThis study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms. DesignA single group pre–post intervention study was conducted. MethodsPatients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale. ResultsA total of 82 breast cancer survivors participated in the study. Pre–post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p < .001). ConclusionsThe current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.

Abstract P4-11-05: How to stay sexually active and sexually well-functioning after breast cancer - Reporting from the SWEET study

Abstract Background: Sexual challenges are frequently reported by breast cancer survivors (BCSs). The treatment and associated side effects may all contribute to sexual problems in BCSs. Knowledge concerning sexual activity and functioning among long term BCSs (&amp;gt;5 years after diagnosis) is however limited. The aims of this study were therefore to assess the prevalence of sexual activity and to explore modifiable factors associated with reduced sexual functioning in BCSs 7-8 years after diagnosis, with the ultimate aim of improving follow-up care for BCSs. Methods: The SWEET (survivorship-work-sexual health) study is a cross-sectional nation-wide questionnaire study examining work and sexual health among long-term BCSs in Norway. All women diagnosed with early stage breast cancer (BC) at the age of 20-65 years in 2011 or 2012 without pre- or post- malignancies were identified by the Cancer Registry of Norway (CRN) and invited to study-participation during the fall 2019. Of 2803 BCSs invited, 1361(49%) returned the questionnaire. Of these, 54 were excluded due to incomplete questionnaire, inadequate consent or self-reported BC recurrence, resulting in a final sample of 1307 BCSs. Data were collected using validated questionnaires (Sexual Activity Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR23, Fatigue Questionnaire, The Patient Health Questionnaire-9 and Godin Leisure Time Questionnaire) and questions regarding socio-demography, general health, sleep and cancer treatment. Supplementary cancer related information was obtained from the CRN. Logistic regression analyses examined variables associated with partnered sexual activity. Linear regression analyses examined variables associated with sexual pleasure and sexual discomfort in sexually active BCSs. Results were presented as odds ratio (OR) and beta coefficients (B) with p-values (p). Results: Mean age of BCSs was 51.7 years at diagnosis and 59.7 years at survey. Most participants lived with a partner (74%) and had been treated for BC stage I (45%) or II (36%) with breast conserving surgery (59%), radiotherapy (80%), endocrine therapy (65%) and chemotherapy (69%), while 23 % reported current use of endocrine therapy. Forty-eight percent of the BCSs were sexually active with a partner. Living with a partner (OR 5.2, p&amp;lt;0.001) and having a better body image*(OR 1.01, p&amp;lt;0.001) were positively associated with sexual activity, while older age (OR 0.96, p&amp;lt;0.001) and treatment with aromatase inhibitor (OR 0.58, p=0.002) were negatively associated with sexual activity. Physical activity (B 0.61, p=0.04) was associated with more sexual pleasure, while living with a partner (B -1.68, p&amp;lt;0.001) and experiencing a major depression (B -1.04, p 0.046) were associated with less pleasure. Obesity (B -0.63, p=0.005) was associated with less sexual discomfort, while living with partner (B 0.87, p&amp;lt;0.001), treatment with aromatase inhibitor (B 0.61, p=0.003), sleep problems (B 0.37, p=0.03), breast symptoms* (B 0.01, p=0.01) and chronic fatigue (B 0.43, p=0.03) were associated with more discomfort. Conclusion: Almost 50% of BCSs were sexually active 7-8 years post diagnosis. Several modifiable factors associated with sexual challenges were identified, including a negative body image, physical inactivity, major depression, sleep problems, breast symptoms and chronic fatigue. In the follow-up of BCSs experiencing sexual problems, these factors should be assessed and handled appropriately. BCSs treated with aromatase inhibitor should be offered treatment for gynecological symptoms and a switch to tamoxifen may be discussed. *continuous variable with scale 0-100 Citation Format: Solveig Katrine Smedsland, Kathrine Vandraas, Synne Bøhn, Alv Dahl, Cecilie Kiserud, Mette Brekke, Ragnhild Falk, Kristin Reinertsen. How to stay sexually active and sexually well-functioning after breast cancer - Reporting from the SWEET study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-05.

Self-reported arm and shoulder problems in breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes cohort study

BackgroundArm and shoulder problems (ASP), including lymphedema, were common among women with breast cancer in high-income countries before sentinel lymph node biopsy became the standard of care. Although ASP impair quality of life, as they affect daily life activities, their frequency and determinants in Sub-Saharan Africa remain unclear.MethodsAll women newly diagnosed with breast cancer at the Namibian, Ugandan, Nigerian, and Zambian sites of the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort study were included. At each 3-month follow-up interview, women answered the EORTC-QLQ-Br23 questionnaire, including three ASP items: shoulder/arm pain, arm stiffness, and arm/hand swelling. We estimated the cumulative incidence of first self-reported ASP, overall and stratified by study and treatment status, with deaths treated as competing events. To identify determinants of ASP, we estimated cause-specific hazard ratios using Cox models stratified by study site.ResultsAmong 1476 women, up to 4 years after diagnosis, 43% (95% CI 40–46), 36% (33–38) and 23% (20–25), respectively, self-reported having experienced arm/shoulder pain, stiffness and arm/hand swelling at least once. Although risks of self-reported ASP differed between sites, a more advanced breast cancer stage at diagnosis, having a lower socioeconomic position and receiving treatment increased the risk of reporting an ASP.ConclusionASP are very common in breast cancer survivors in Sub-Saharan Africa. They are influenced by different factors than those observed in high-income countries. There is a need to raise awareness and improve management of ASP within the African setting.

Assessment of Arm Volume Using a Tape Measure Versus a 3D Optical Scanner in Survivors with Breast Cancer-Related Lymphedema.

Background: Lymphedema (LE) is a significant clinical problem for breast cancer survivors. While the water displacement test and circumferential assessment using a tape measure (TM) are common methods to assess differences in arm volumes, faster and more reliable methods are needed. Study purposes, in breast cancer survivors (n = 294), were to compare the average total arm volumes and interlimb volume ratios for women with and without a history of LE, using a TM and three-dimensional (3D), whole-body surface scanner (3D scan); compare the level of agreement between arm volumes and interlimb volume ratios obtained using the two devices; and evaluate the percent agreement between the two measures in classifying cases of LE using three accepted thresholds. Methods and Results: Measurements were done using a spring-loaded TM and Fit3D ProScanner. Paired t-tests and Bland-Altman analyses were used to achieve the study aims. For circumference and volume comparisons, compared with the 3D scan, values obtained using the TM were consistently smaller. In terms of level of agreement, the Bland-Altman analyses demonstrated large biases and wide limits of agreement for the calculated arm volumes and volume ratios. In terms of the classification of caseness, using the 200-mL interlimb volume difference criterion resulted in 81.6% overall agreement; using the >10% volume difference between the affected and unaffected arms resulted in 78.5% overall agreement; and using the volume ratio ≥1.04 criterion resulted in 62.5% overall agreement. For all three accepted threshold criteria, the percentage of cases was significantly different between the TM and 3D scan techniques. Conclusions: The 3D technology evaluated in this study has the potential to be used for self-initiated surveillance for LE. With improvements in landmark identification and software modifications, it is possible that accurate and reliable total arm volumes can be calculated and used for early detection.

Effects of physical activity on sleep problems in breast cancer survivors: a meta-analysis.

To investigate the possible role of physical activity (PA) on sleep disturbance in breast cancer patients. Literature in PubMed, Embase, and the Cochrane Library was systematically searched until January 30, 2020. Randomized controlled trials that focused on the role of PA interventions on sleep disturbance were selected. The main outcome measures included the global Pittsburgh Sleep Quality Index (PSQI) score and PSQI subscales. Subgroup analysis was performed based on the study area and intervention time. The stability and authenticity of the results were measured by sensitivity analysis and publication bias analysis, respectively. Six articles were included in this meta-analysis. There were no significant differences in global PSQI scores between the PA intervention group and the usual care group (P = 0.057). As for PSQI subscales, PA intervention could improve sleep quality (weighted mean difference = 0.22; 95% confidence interval 0.04-0.40; P = 0.018). There were no significant differences in sleep duration, sleep medication, sleep latency, habitual sleep efficiency, and daytime dysfunction between the two groups (all P > 0.05). PA serves as an effective intervention to improve sleep quality.

The effect of limb position on the reliability of leg circumference measurements in patients diagnosed with lower limb lymphoedema.

To establish the intrarater reliability of lower limb circumference measures in a sample of individuals who are diagnosed with lower limb lymphoedema and to evaluate if change in limb position has an effect on the reliability of circumferential measures. A sample of forty-one adults diagnosed with a lower limb lymphoedema were recruited. Participants had their affected leg measured three times by a qualified therapist during a standard outpatient appointment: twice in a lying position and once in sitting with knee flexed at 90°. To examine the intrarater reliability, interclass correlation coefficients (ICC) with 95% confident intervals were calculated. Excellent intrarater reliability was established at each measurement point and for the sum of circumferential measures when the limb remeasured in the same position by the same therapist. Changing the position of the limb resulted in lower intrarater reliability values at 10 and 30cm from the base of the foot. The current study provides evidence for the intrarater reliability of lower limb circumference measures and highlights the need for consistency when remeasuring and monitoring the limb of those diagnosed with lower limb lymphoedema. Lymphoedema is a significant problem for breast cancer survivors but also provides lifetime risk to all survivors of lymph node surgery for solid tumours.The monitoring and surveillance of leg circumference measures of people diagnosed with lower limb lymphoedema has been a valuable instrumentwhen reviewing progress of this chronic condition.

Efficacy of ear acupuncture on sleep quality in breast cancer survivors: A randomized controlled trial.

12066 Background: Among females, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40 to 70 % of breast cancer survivors. The aim of this randomized controlled trial was to evaluate the effect of ear acupuncture on sleep quality in breast cancer survivors. Methods: Fifty-two female breast cancer survivors (mean age 55.73 ± 8.10) were randomized to either 10 treatments of ear acupuncture within five weeks (N = 26) or to a single session of psycho-education and given an advice booklet concerning insomnia (N = 26). Both interventions were delivered in a group setting. Primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5 corrected for treatment expectancies. Secondary outcomes were inflammation parameters (interleukin-6) at week 5, sleep quality at week 17, and stress, anxiety, depressive symptoms, quality of life and fatigue 5 weeks and 17 weeks after randomization. Results: Intention-to-treat analysis showed a significantly stronger increase of sleep quality in the ear acupuncture group compared to the psycho-education group ( p= .031; d = 0.64) at week 5. Furthermore, ear acupuncture improved stress ( p= .030; d = 0.64), anxiety ( p = .001; d = 0.97), and fatigue ( p = .012; d = 0.75) at week 5 compared to psycho-education. No significant group difference was found on any outcome at week 17. No serious adverse events occurred during the study period. Conclusions: Group ear acupuncture may be a helpful intervention in tackling sleep problems in breast cancer survivors in the short term and may reduce stress, anxiety and fatigue as well. Long-term effects remain questionable. Clinical trial information: NCT03874598 .

Depression involved in self-reported prospective memory problems in survivors of breast cancer who have received chemotherapy.

To investigate the relationship between depression and the self-reported prospective memory (SPM) problems in breast cancer survivors who have received chemotherapy.Sixty-three breast cancer patients were administered with self-rating depression scale (SDS) and the prospective memory questionnaire as part of extensive neuropsychological assessments before and after chemotherapy. The performance of SDS and SPM were compared, with the level of significance set at P < .05.Compared with the group before chemotherapy, there is a significant difference on the SPM score (t = 6.069, P = .000) in breast cancer patients after chemotherapy. Further, there is also a significant difference on the SPM score (t = −4.348, P = .000) between the patients with and without depression group after chemotherapy.The present result indicated that the depression in breast cancer survivors after chemotherapy may be involved in their chemotherapy-induced SPM impairment.

Psychosocial Interventions for Improving the Quality of Life in Breast Cancer Survivors: A Literature Review

Breast cancer is the most women’s cancer worldwide especially in developing countries including Indonesia. This cancer is affected women’s physically and psychologically. Those effects may influence women’s quality of life (QoL). An appropriate psychosocial intervention would be significant to survivors’ QoL. This study is aimed to identify interventions that effective in dealing with psychosocial problems, and in improving QoL. Methods, this review addresses the question: what interventions are effective in managing psychological problems in breast cancer survivors. We conducted a literature review, we searched Pubmed, Ebsco, Cengage, and Cochrane for articles focusing on any types of psychosocial interventions. Through a database search, 543 articles were identified and after manual review, 7 studies were identified and appraised. Results, there were six randomized control trial and one quasi-experiment method involved in the analysis step. The interventions were 1) mindfulness therapy (4 articles)-2) behavioral therapy (2 articles), 3) acceptance and commitment therapy (1 article). The seven studies reported significant effects in reducing psychological problems such as anxiety, depression, and mood problems. The intervention also improved patients’ QoL. Conclusion and recommendation psychosocial interventions are effective to help breast cancer survivors as an individual, and none of those studies had involved family in interventions. There is a need to develop a study that involves the family in the intervention, as the family is the main support for Indonesian.

Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors.

BackgroundThe incidence of menopausal symptoms, including hot flashes and sleep disturbance, caused by drug treatment is a common problem in breast cancer survivors. Considering the limitations of hormone therapy in such patients, several studies have been conducted to find alternative methods. The aim of this study was to investigate and compare the effectiveness of stellate ganglion block (SGB) with that of paroxetine, which was approved by the US Food and Drug Administration (FDA) as a medicine for the treatment of hot flashes and ensuing sleep disturbance.Patients and methodsA total of 40 patients survived from breast cancer and complaining of these symptoms were equally assigned to two groups of 20 each. In the study group, SGB was performed successfully under sonography guidance using 10 mL of 0.5% bupivacaine, and in the control group (paroxetine), the daily administration of 7.5 mg of paroxetine was conducted for 6 weeks. The frequency and severity of hot flash attacks and sleep quality of patients were evaluated prior to the intervention and after 2, 4 and 6 weeks. The incidence of adverse events during treatment or follow-up was recorded.ResultsA significant decrease in hot flash score and sleep disturbance index (SDI) was observed in both groups. Comparison of the results showed no noticeable difference between the two groups. Two participants in the control group had discontinued medication due to gastrointestinal symptoms, and only one case of mild headache was reported in the study group.ConclusionSGB is as much effective as paroxetine in controlling hot flashes and sleep disturbances in breast cancer survivors and is associated with few complications.

Screening of physical distress in breast cancer survivors: Concurrent validity of the Distress Thermometer and Problem List.

Several studies support the validity and psychometric properties of the DT&PL for measuring psychosocial distress in breast cancer survivors (BCSs). However, next to psychosocial problems, it is equally important to identify distress caused by limitations in physical functioning. Validity of the DT&PL for the identification of physical problems in BCSs has not yet been investigated. Therefore, the purpose of the present study is to investigate the concurrent validity and psychometric properties of the Dutch DT&PL in BCSs for the identification of physical problems. Ninenty BCSs completed the DT&PL, ShortForm-36 (SF-36) and the Dutch Disability of the Arm, Shoulder and Hand questionnaire (DASH). Forty-seven % of BCSs reported a high level of distress on the DT&PL (score ≥5). Distressed BCS showed increased physical and emotional problems and problems at the upper limb region. The scores obtained with the DT&PL correlated weakly to strongly with subscales for physical functioning of the SF-36 (r=-0.224 to r=-0.676; p<0.05) and with limitations in physical functioning at the upper limb region (DASH; r=0.380 to r=0.619; p<0.01). In conclusion, the Dutch DT&PL is a multidimensional instrument showing good concurrent validity for the screening of physical problems.