Problem For Breast Cancer Survivors Research Articles

Effectiveness of Meaning-Centered Psychotherapy on Existential Anxiety and Fear of Cancer Recurrence in Breast Cancer Survivors: A Randomized Clinical Trial

Background: Breast cancer as a chronic disease is associated with many physical and psychological problems that necessitate the use of psychological treatments. Objectives: This study was aimed to investigate the efficacy of meaning-centered psychotherapy on existential anxiety and fear of cancer recurrence in breast cancer survivors. Methods: In a randomized controlled clinical trial with pre-test, post-test, and follow-up along with a control group, 28 breast cancer survivors were selected by random sampling among patients that attended the Cancer and Hematology specialized clinic of Semnan University of Medical Sciences. The participants were randomly assigned to two intervention (group treatment, n = 7; individual treatment, n = 7) and one control group (n = 14). Data were collected by existential anxiety scale (EAS) and fear of cancer recurrence inventory (FCRI) and analyzed with the repeated multiple analysis of variance (MANOVA) using the SPSS-23 software. Results: There were significant differences between the experimental groups and the control group on existential anxiety and fear of cancer recurrence (P < 0.001) in breast cancer survivors. Group and individual interventions reduced existential anxiety and fear of cancer recurrence in post-test and follow up in experimental groups compared to the control group (P < 0.001). The interaction of the groups and time assessment was statistically significant (P < 0.001). Conclusions: Meaning-centered psychotherapy reduces existential anxiety and fear of cancer recurrence in breast cancer survivors. This intervention is useful to recover psychological problems in breast cancer survivors.

Abstract 3264: Evaluating heart-hate variability, salivary cortisol and physical activity as predictors of cancer-related fatigue recovery in breast-cancer survivors over a 12 week period by use of a smartphone application

Abstract Introduction Cancer-related fatigue (CRF) is one of the most prevalent and debilitating problems in breast cancer survivors (BCS) that can persist many years beyond successful cancer treatment. Parasympathetic nervous system activity (measured via heart-rate variability; HRV), cortisol dysregulation and decreased physical activity are plausible, but understudied contributors to CRF. Repeated daily measurements of CRF and tracking daily physical activity over a 12-week period should give more information regarding temporal patterns of CRF among BCS. Objective The purpose of this study is 1) to investigate patterns of CRF in fatigued BCS over time; 2) to assess HRV, salivary cortisol and level of physical activity as predictors of cancer-related fatigue (CRF) in BCS over a 12-week period; and 3) to explore whether a smartphone application intervention results in increased daily physical activity, as well as improved HRV, salivary cortisol and CRF in BCS relative to healthy female controls over a 12 week period. Methods A total of 30 fatigued breast cancer survivors (FACIT-F score ≤ 34) and 30 aged-matched female controls will be randomly assigned to either an intervention or control group. Both groups will receive a smartphone application tracking daily physical activity. While the intervention group will receive this application with feedback regarding their daily physical activity, the control groups will receive the application without feedback. Behavioral data will be collected by means of GPS and Wi-Fi for localization, and accelerometer, barometer, magnetometer and gyroscope for activity recognition. HRV and salivary cortisol will be collected at rest, as well as during and after a significant stressor (Trier Social Stress Test). Fatigue will be measured by the FACIT-F Scale, which will be completed at baseline (T1), 4 weeks (T2) and 12 weeks (T3). Group differences will be tested by one-way analysis of variance (ANOVA) and intervention effects will be analyzed using mixed models with repeated measurements. Hypotheses We hypothesize that HRV, cortisol dysregulation and level of physical activity at baseline can predict CRF-recovery over a 12-week period. The smartphone application will be associated with improved physical activity in the BCS intervention group and that changes of physiological correlates of CRF can be observed (i.e., HRV and salivary cortisol). Conclusion This study will examine associations between HRV, salivary cortisol, physical activity and CRF in BCS over time. The results of this study may provide insight into factors that contribute to the development, persistence and/or consequences of CRF by use of an innovative mobile application. Citation Format: Annina Julia Seiler, Vanessa Klaas, Gerhard Tröster, Kyle W. Murdock, Diana A. Chirinos, Luz M. Garcini, Christopher P. Fagundes. Evaluating heart-hate variability, salivary cortisol and physical activity as predictors of cancer-related fatigue recovery in breast-cancer survivors over a 12 week period by use of a smartphone application [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3264. doi:10.1158/1538-7445.AM2017-3264

Vaginal Atrophy in Breast Cancer Survivors: Attitude and Approaches Among Oncologists

BackgroundVulvovaginal atrophy (VVA) is a relevant problem for breast cancer survivors (BCSs), in particular for those who receive aromatase inhibitors (AIs). We conducted a survey, to assess the attitude of oncologists toward the diagnosis and treatment of VVA in BCSs. Materials and MethodsIn 2015, 120 computer-assisted Web interviews were performed among breast oncologists. ResultsAccording to oncologists' perceptions, 60% of postmenopausal BCSs and 39.4% of premenopausal BCSs will suffer from VVA. Despite that none of the physicians considered VVA as a transient event or a secondary problem in BCSs, only half of the oncologists (48%) directly illustrated VVA to the patients as a possible consequence. Forty-one percent of the oncologists refer BCSs to gynaecologist to define VVA treatment, whereas 35.1% manages it alone. Nonhormonal treatments are preferred by most oncologists (71%). The main reason not to prescribe vaginal estrogen therapy in BCSs is the fear of increased cancer recurrence, the possible interference with tamoxifen, or AIs and the fear of medical litigation. ConclusionVVA is a relevant problem for BCSs. Great effort should be done to correctly inform health care providers about VVA problems and on the different possible available treatments.

Sleep problems in breast cancer survivors 1-10 years posttreatment.

A total of 200 patients at a comprehensive cancer center who were 1-10 years posttreatment for primary stage I-III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL. The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality. Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.

Effect of myofascial techniques in addition to standard physical therapy for treatment of pain and upper limb problems in breast cancer survivors: Randomized controlled trial

Effect of myofascial techniques in addition to standard physical therapy for treatment of pain and upper limb problems in breast cancer survivors: Randomized controlled trial

Minimal-trauma fracture in women with breast cancer surviving for at least 5years from diagnosis.

Minimal-trauma fracture is an important issue in breast cancer survivors, especially rib fracture. The likelihood of fracture is affected by menopausal status and a diagnosis of osteoporosis prior to breast cancer. Most women reported at least one assessment of bone mineral density. We have investigated the self-reported frequency and pattern of minimal-trauma fracture (MTF) in breast cancer (BC) survivors at least 5 years from diagnosis, along with the use of bone mineral density (BMD) assessment. This study was carried out within the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study which is a questionnaire-based prospective cohort study of 1683 women diagnosed with their first invasive breast cancer between 2004 and 2006 and followed for at least 5 years. One thousand two hundred and five women, who remained free of recurrence or new breast cancer, completed the fifth annual follow-up. One hundred sixty-four (13.6%) reported at least one MTF. Rib fracture was the most common (52 fractures in 46 women). Compared with women who remained pre-/peri-menopausal, either being postmenopausal at diagnosis (OR 3.53, 95% Confidence Interval (CI) 1.09-11.44, p=0.036) or changing from pre- to postmenopausal during follow-up (OR 3.97, 95% CI 1.21-13.10, p=0.023) was associated with a higher likelihood of fracture, as was having a diagnosis of osteoporosis at the time of diagnosis (OR 1.74, 95% CI 1.00-2.99, p=0.047). Most women (64.9%) reported at least one BMD assessment. Overall MTF is a problem for breast cancer survivors, with rib fracture a particular issue for women in our study. Both pre-existing osteoporosis and being postmenopausal are risk factors for subsequent MTF in women treated for breast cancer. Clinicians need to be mindful of fracture prevention medication in these groups.

Yoga and self-reported cognitive problems in breast cancer survivors: a randomized controlled trial.

Cancer survivors often report cognitive problems. Furthermore, decreases in physical activity typically occur over the course of cancer treatment. Although physical activity benefits cognitive function in noncancer populations, evidence linking physical activity to cognitive function in cancer survivors is limited. In our recent randomized controlled trial, breast cancer survivors who received a yoga intervention had lower fatigue and inflammation following the trial compared with a wait list control group. This secondary analysis of the parent trial addressed yoga's impact on cognitive complaints. Posttreatment stage 0-IIIA breast cancer survivors (n = 200) were randomized to a 12-week, twice-weekly Hatha yoga intervention or a wait list control group. Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline, immediately postintervention, and 3-month follow-up. Cognitive complaints did not differ significantly between groups immediately postintervention (p = 0.250). However, at 3-month follow-up, yoga participants' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23% lower than wait list participants' scores (p = 0.003). These group differences in cognitive complaints remained after controlling for psychological distress, fatigue, and sleep quality. Consistent with the primary results, those who practiced yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practiced less frequently (p < 0.001). These findings suggest that yoga can effectively reduce breast cancer survivors' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems.

Factor Analysis of the Pittsburgh Sleep Quality Index in Breast Cancer Survivors

ContextSleep is a significant problem in breast cancer survivors (BCS) and measured frequently using the Pittsburgh Sleep Quality Index (PSQI). Thus, it is important to evaluate its factor structure. The two-process model of sleep regulation was the theoretical framework for this study. ObjectivesTo perform a confirmatory factor analysis of the PSQI in BCS and compare results between African-American and Caucasian BCS. MethodsThis was a secondary analysis of cross-sectional data using local and regional health care facilities and Eastern Cooperative Oncology Group referrals. The study included 1174 nondepressed BCS (90% Caucasian), with a mean age of 57 years and median PSQI global scores at the cutoff for poor sleep (median=6.00, interquartile range=4.00–9.00). Measurements included self-reported demographics, medical history, depression, and sleep. ResultsAcceptable fit was not reached for the traditional one-factor model that would be consistent with current PSQI scoring or for alternative models in the published literature from other populations. A new two-factor model (i.e., sleep efficiency and perceived sleep quality) best fit the data but nested-model comparisons by race showed different relationships by race for 1) sleep quality-sleep latency and 2) sleep efficiency-sleep quality. ConclusionResults were inconsistent with current PSQI scoring that assumes a single global factor and with previously published literature. Although a new two-factor model best fit the data, further quantitative and qualitative analyses are warranted to validate our results in other populations before revising PSQI scoring recommendations. Additional recommendations are described for research.

P2-01-16: Dissecting the Cellular Mechanism of Induction and Sustenance of Dormancy by Rho GTPases in Breast Cancer.

Abstract Tumor dormancy has been a very real problem in breast cancer survivors where recurrences are common and usually fatal. Molecular mechanisms involved in this process are often poorly understood and are a hot spotin breast cancer research today. We have found that Rho GTPases, specifically RhoC, is hyperactivated in low metastatic dormant breast tumor cells while RhoA is downregulated. We also found RhoC causes phosphorylation of c-jun NH2 terminal kinase (JNK) in these cells which in turn activates the process of autophagy, a possible mode of cell survival in dormant tumor cells. Modulating RhoC affected phosphorylation of JNK. Also, abrogating JNK by a pharmacological inhibitor SP600125 inhibited expression of the autophagy marker LC3B-II. Autophagy genes like Atg 5 and Atg 12 were expressed along with the autophagy marker LC3B-II. On inhibiting autophagy by a specific inhibitor 3-Methyladenine (3-MA), cells did not readily undergo apoptosis but on stressing them doubly with LY294002, an inhibitor of Class I PI3K, along with 3-MA (inhibitor of Class III PI3K), significant number of dormant cells underwent apoptosis as observed by TUNEL staining. We also found that p190RhoGAP was activated in these dormant cells which may lead to the observed downregulation of RhoA activation levels. Involvement of beta-1 integrin along with c-src in activation of RhoC was observed in these dormant cells. We are in the process of further elucidating these signal transduction processes that might be involved in cellular dormancy of breast cancer. A better understanding of some of the cellular mechanisms of induction and sustenance of dormancy may aid in formulating therapies for annihilating these dormant tumor cells thus preventing the often fatal relapses in breast cancer survivors. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-01-16.

Abstract P4-06-10: Altered Activity of RhoA and RhoC GTPases Phosphorylate C-Jun N-Terminal Kinase and Induce Cellular Dormancy in Breast Cancer Cells

Abstract Tumor dormancy has been a very real problem in breast cancer survivors where recurrences are common and usually fatal. Molecular mechanisms involved in this process are often poorly understood and are a “hot-spot” in breast cancer research today. Ongoing efforts in our laboratory has shown that Rho GTPases, specifically RhoA and RhoC, play a significant role in dormancy of breast cancer. We have currently established two in vitro models of breast tumor dormancy — one involving growth of the breast cancer cell line MCF7 on fibronectin and subsequent treatment with basic fibroblast growth factor and the other involving treatment of MCF7 cells with the farnesyl transferase inhibitor FTI-L-744,832. In both these models, we find high levels of active RhoC and almost undetectable levels of active RhoA GTPases in quiescent breast tumor cells. Investigating further downstream we found c-jun N-terminal kinase (JNK) is phosphorylated in these dormant cells but not p38mitogen activated protein kinase(MAPK) or extracellular signalregulated kinase(ERK1/2). On inhibiting JNK with a pharmacological inhibitor specific for JNK, SP600125, we found dormancy could be interrupted and cell proliferation was induced. JNK has been implicated in inducing autophagy in cells by activating autophagy gene Atg5 and Beclin1 (BCN1) [Byun et al., Carcinogenesis, 2009]. Since autophagy can be a mode of survival for the dormant tumor cell [Matthew et al., Cancer Cell, 2006] we explored the possibility of autophagy being induced in these dormant tumor cells via JNK by employing the autophagy marker LC3-II. We found upregulation of the autophagy marker, thus revealing autophagy as a strategy for survival for these tumor cells in unfavorable tumor microenvironment. We are currently investigating the molecular mechanisms underlying the induction of dormancy in breast tumor cells by Rho GTPases through JNK and the dormant tumor survival strategy through autophagy. We believe that targeting these implicated molecules like RhoA and RhoC GTPases, JNK or some of the autophagy genes might yield therapeutic benefits for breast cancer patients in remission and wipe out fears of deadly metastatic recurrences thus prolonging survival. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-06-10.

Sexual problems in breast cancer survivors

Sexual problems in breast cancer survivors

Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life

Background. Except for lymphedema, the consequences of arm/shoulder problems (ASPs), at long-term in breast cancer survivors (BCSs) have hardly been studied. We examined demography, lifestyle, quality of life (QoL) and somatic morbidity in BCSs with and without ASPs. We also compared the associations of restricted shoulder abduction and lymphedema with QoL. Methods. We used a cross-sectional case-control design. A sample of 256 BCSs all with lymph node metastases were examined at a mean of 4.1 (SD 0.9) years post-surgery. Based on objective examinations and self-rating the sample were separated into 81 BCSs (32%) with definite ASP (ASP+ group) and 175 (68%) with minimal or no ASP (ASP− group). The self-rating contained among other schedules the Short Form-36 (SF-36) and the Kwan's arm/shoulder problem scale (KAPS). Results. In univariate analysis ASP+ was associated with not being employed, having had mastectomy, longer follow-up time, radiotherapy to axilla, poorer self-rated health and physical condition, minimal physical activity, increased body mass index, regularly intake of analgesics, and poorer physical QoL. Multivariate analysis showed that mastectomy, longer follow-up time, minimal physical activity and poorer physical QoL were associated with belonging to ASP+ group. All domains of the SF-36 were significantly associated with having impaired shoulder abduction (≥25° difference) while none of the associations with lymphedema were significant. Discussion. In BCSs, at four years after treatment, having ASP was associated with mastectomy, minimal physical activity and poorer physical QoL. Poor physical QoL is strongly associated with reduced shoulder abduction rather than with lymphedema.

Predicting stress-related problems in long-term breast cancer survivors

Introduction Little is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors. Methods We used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support. Results Hierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress ( R 2=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance ( R 2=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations. Discussion/Conclusion Symptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.

Sexual Dysfunction after Premenopausal Stage I and II Breast Cancer: Do Androgens Play a Role?

Sexual dysfunction after breast cancer has been attributed to a variety of treatment associated and psychological factors. Data on the role of a treatment-induced decrease of testosterone for the development of sexual problems in breast cancer survivors have remained inconclusive. However, androgen metabolites constitute a more reliable measure for total androgen activity. To measure levels of total androgen activity in breast cancer patients and to investigate relevant predictors of sexual dysfunction after breast cancer. Twenty-nine patients with a premenopausal diagnosis of Stage I or II breast cancer and terminated adjuvant treatment, completed questionnaires on sexuality, quality of relationship, body image, and depression. In addition, blood samples were taken for the analysis of sex steroids. Female Sexual Function Index (FSFI), Relationship (PFB), Beck Depression Inventory, and European Organization for Research and Treatment of Cancer quality of life questionnaire. Analysis of dihydroepiandrosterone, dihydroepiandrosterone-sulfate, androstenedione, 17beta-diol, testosterone, dihydrotestosterone, androsterone, and ADT-G, 3-alpha-diol-3G, 3-alpha-diol-17G. Low levels of sex steroids reflected the medication-induced postmenopausal status independent of the type of chemotherapy treatment. Sexual dysfunction was present in 68% of the study group. Women with a history of chemotherapy were more affected in all of the FSFI-domains. The only predictor for desire was quality of relationship, while chemotherapy was predictive for problems with arousal, lubrication, orgasm, and sexual pain. Sexual satisfaction and higher FSFI sum scores were predicted by better quality of relationship and no history of chemotherapy, together explaining 54.2% and 49.7% of the variance. Sexual dysfunction after breast cancer is common and women should be informed properly at an early stage of treatment. Specific interventions have to be offered considering person-related preexisting factors and couples at risk should be supported in the transition to sexual life after breast cancer.

Fatigue after treatment for early stage breast cancer

Evidence suggests that fatigue may be a greater problem for cancer survivors than people without cancer. The present study sought to determine whether fatigue was greater in women who had completed treatment for early-stage breast cancer relative to a demographically matched comparison group of women with no cancer history. As part of a larger study, women with stage 0-II breast cancer were recruited before the start of chemotherapy and radiotherapy (n = 100) or radiotherapy only (n = 121). Fatigue was assessed at the end of treatment and 2, 4, and 6 months later. An age- and geographically matched sample of women with no history of cancer was recruited and assessed for comparison purposes. Relative to comparison subjects, breast cancer survivors reported more days of fatigue in the past week at all 4 study assessments (P < .05). These differences appeared to be clinically meaningful in that a greater percentage of patients than nonpatients earned scores in the abnormal range on this measure at each assessment (P < .05). Additional analyses indicated that differences in fatigue between patients and comparison subjects were attributable primarily to heightened fatigue in women who received both chemotherapy and radiotherapy. Findings suggest that fatigue is a greater problem for breast cancer survivors in the 6 months after completion of chemotherapy than for women with no cancer history. Future research should include longer-term follow-up to determine the persistence of fatigue in this population of survivors.

The hyfrecator: a treatment for radiation induced telangiectasia in breast cancer patients

Radiation induced telangiectasia is a common problem in breast cancer survivors. By interfering with choice of clothing and acting as an unpleasant visible reminder of their disease, it negatively affects quality of life. The hyfrecator, based on the principles of electrosurgery, is a standard treatment modality for facial telangiectasia. This study aims to demonstrate the efficacy and tolerability of the hyfrecator as a treatment for radiation induced telangiectasia. Patients with radiation induced telangiectasia of breast or chest wall were prospectively identified from the breast cancer follow up clinic and offered treatment with the hyfrecator (sessions at 8 weekly intervals). Pre- and post-treatment photographs were obtained in a standardized manner and two blinded physician observers evaluated response. A linear analogue scale (LAS) was used by the patients to evaluate treatment response and any discomfort. At the end of treatment, patients completed a quality of life questionnaire. Of 16 patients enrolled, 15 completed the study. Treatment benefited all patients with severe or marked telangiectasia. Complete disappearance of telangiectasia was achieved in the majority (88%) of patients by the end of treatment. A median of six sessions (range 3-9) was required. All but one (93%) considered the treatment worthwhile. The majority (69%) judged the treatment to be painless or only mildly painful. 73% reported an improvement in self-confidence. The treatment was well tolerated by all the patients. All patients showed a remarkable clearance of vessels with a high degree of satisfaction with the results. Treatment with the hyfrecator is very effective for radiation induced telangiectasia. Three to four sessions achieve a substantial objective and subjective reduction in telangiectasia with a concomitant improvement in quality of life. It is a cost effective, ambulant out patient procedure requiring no local anaesthesia.

Estrogen deficiency symptom management in breast cancer survivors in the changing context of menopausal hormone therapy

Vasomotor symptoms associated with menopause or cancer therapies represent an increasingly common problem for breast cancer survivors given the increasing use of ovarian suppression in premenopausal women and aromatase inhibitors in postmenopausal women. Although estrogen and/or progestin effectively reduce vasomotor symptoms, a recent Women’s Health Initiative (WHI) randomized trial identified an unfavorable risk/benefit balance on life-threatening diseases, including increased breast cancer, for combined estrogen plus progestin use in otherwise healthy postmenopausal women. As a result, use of menopausal hormone therapy (MHT) for chronic disease risk reduction in any population cannot be supported. In addition, the safety of estrogen and/or progestin regarding risk of recurrence or new cancer development in breast cancer survivors has not been demonstrated. For vasomotor symptoms in this population, neuroendocrine agents, including selective seratonin reuptake inhibitors (SSRIs) or gabapentin, are reasonable choices with substantial impact on hot flashes and moderate toxicity profiles. When rigorously evaluated, most other nonhormonal pharmacologic and herbal interventions have been found to have either modest or no efficacy and/or limiting toxicity. In breast cancer survivors even local vulvar/vaginal symptoms are best treated by nonhormone products since drug absorption with systemic estrogen-like effects has been reported. Estrogen/progestin use in breast cancer survivors should be considered only for women with severe vasomotor symptoms refractory to other approaches after extensive informed decision-making including review of current Food and Drug Administration labeling concerns with use limited to the lowest dose and shortest duration possible.

Sexual functioning in breast cancer survivors.

A growing body of evidence suggests that sexual dysfunction may be among the more common and distressing symptoms experienced by breast cancer survivors. This report reviews studies in which sexual functioning in breast cancer survivors has been investigated. Included are reports on the prevalence and nature of sexual difficulties, the relationship between specific breast cancer treatments and sexual difficulties, and the treatment of sexual dysfunction following completion of breast cancer treatment. A review of the literature suggests a wide range of rates for the prevalence of sexual problems in breast cancer survivors. Factors that may affect prevalence rates include the methods used to determine prevalence and the demographic and medical characteristics of the patients studied. With regard to treatment effects, evidence suggests that breast cancer patients who undergo chemotherapy are at high risk for sexual dysfunction after treatment. In contrast, there is little evidence of a link between type of surgical treatment (eg, lumpectomy vs mastectomy) or treatment with tamoxifen and sexual functioning outcomes. A growing body of evidence suggests that sexual problems can be a long-term side effect of breast cancer treatment. Oncology professionals should initiate communication about sexual difficulties, perform comprehensive assessments, and educate and counsel patients about the management of these difficulties.