Symptoms In Breast Cancer Survivors Research Articles

Association between blood polyunsaturated fatty acid levels and depressive symptoms in breast cancer survivors

In contrast to the cumulative evidence suggesting the inverse association of n-3 polyunsaturated fatty acids (PUFAs) with depression, few studies have examined the association of n-6 PUFAs with depression. In particular, no study has examined the relationship between n-6 PUFAs and depression in cancer patients. Thus, we conducted this cross-sectional study to comprehensively examine the association of n-3 and n-6 PUFAs with depressive symptoms in breast cancer survivors. Adults who had been diagnosed with invasive breast cancer and were not undergoing chemotherapy were enrolled. Blood PUFA composition was determined using capillary blood. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Among 126 participants, the mean age (standard deviation) was 58 (11) years and 47% had stage I cancer. Multiple regression analysis controlling for possible confounders revealed that the level of total n-6 PUFAs and linoleic acid was significantly associated with the HADS total score (beta = 0.175, p = 0.046 for total n-6 PUFAs; beta = 0.174, p = 0.048 for LA). No significant associations were found for other PUFAs. These findings provide the first evidence suggesting that a higher blood level of total n-6 PUFAs and linoleic acid is significantly associated with higher depressive symptoms among breast cancer survivors. Further studies should examine the positive effects of a reduction in n-6 PUFAs on depressive symptoms in breast cancer survivors using prospective studies, including randomized control trials.

Systematic review of genetic polymorphisms associated with psychoneurological symptoms in breast cancer survivors.

Psychoneurological (PN) symptoms, such as anxiety, cognitive impairment, depression, fatigue, sleep disturbances, and pain, are highly prevalent in breast cancer patients undergoing cancer treatment. Emerging evidence suggests that genetic polymorphisms may contribute to differential symptom susceptibility. We aimed to systematically review associations between genetic polymorphisms and PN symptoms during or after cancer treatment for early-stage breast cancer. Twenty-six eligible articles published until October 2017 were identified in PubMed, PsycINFO, Web of Science, and additional records. Information on study characteristics, genetic polymorphisms, and PN symptoms was extracted. Study quality was evaluated by the STrengthening the REporting of Genetic Association (STREGA) guideline. Genes included in the analysis were categorized by biological pathways based on the Reactome database. A total of 54 single nucleotide polymorphisms and haplotypes that are significantly associated with PN symptoms were identified; half of them were associated with increased severity of PN symptoms, while the other half contributed to the decrease of PN symptoms. Pain has the known highest number of associated genetic polymorphisms reported, followed by fatigue, cognitive impairment, depressive symptoms, sleep disturbances, and anxiety. The majority of genetic polymorphisms were involved in immune system and neuronal system pathways. Most studies were unsuccessful in meeting the STREGA guideline, which requires transparent reporting of methods and results. This review provides comprehensive evidence of genetic polymorphisms underlying PN symptoms, which may pave the way for the development of personalized therapeutics targeting these symptoms. More well-designed genome-wide association studies are required to validate and replicate these findings.

Effects of cognitive behavioral therapy for depression on improving insomnia and quality of life in Chinese women with breast cancer: results of a randomized, controlled, multicenter trial.

PurposeCognitive behavioral therapy (CBT) for depression had been found to be effective in reducing depressive and anxiety symptoms in breast cancer survivors. It is not known whether CBT for depression would also improve insomnia and quality of life (QOL). The aim of this study was to investigate whether CBT for depression would improve insomnia and QOL in a randomized controlled multicenter trial.Patients and methodsIn this study, breast cancer survivors (n=392) were randomly allocated to the following three groups: CBT (n=98), self-care management (SCM, n=98), and usual care (UC, n=196) in a ratio of 1:1:2. CBT and SCM received a series of nine sessions for 12 weeks, whereas UC received UC only. Insomnia and QOL were evaluated using Athens Insomnia Scale (AIS) and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire at baseline, 4, 12, and 24 weeks.ResultsThere was a significant intergroup difference in AIS and FACT-B scores (both P<0.01). CBT showed less insomnia problems and better overall QOL compared with those in SCM and UC (both P<0.01). No significant differences were found between SCM and UC in insomnia problems and overall QOL. Moreover, the effects of CBT on insomnia and QOL were maintained during the follow-up period.ConclusionCBT for depression can be effective in improving insomnia problems and QOL in the Chinese breast cancer survivors.

A brief psychoeducational intervention improves memory contentment in breast cancer survivors with cognitive concerns: results of a single-arm prospective study.

One in three breast cancer survivors experiences persistent cognitive changes that can negatively impact daily functioning and quality of life. In our cancer center, the largest tertiary cancer center in Canada, patients with self-reported cancer-related cognitive dysfunction (CRCD) are offered psychoeducation intended to reduce distress about CRCD symptoms and improve everyday cognitive performance, but evidence regarding this intervention's impact is lacking. Here, we assess whether a 1-hour (h), individual psychoeducational intervention designed to promote self-management of CRCD symptoms can improve attitudes and coping with memory-related difficulties in women with breast cancer. Breast cancer survivors with self-reported CRCD (N = 100) were assessed immediately before, immediately after, and 6weeks following the intervention. Participants' memory contentment, knowledge of CRCD, symptom distress, and self-efficacy to cope with symptoms were measured. Participants showed improvements in memory contentment immediately after the intervention (Cohen's d effect size and 95% CI = 0.87 [0.58, 1.16]) and 6weeks later (d = 0.77 [0.48, 1.05]). Significant improvements in secondary study outcomes, including knowledge of CRCD (d = 1.32 [1.01, 1.63]), symptom distress (d = - 0.82 [- 1.11, - 0.53]), and self-efficacy to cope with cognitive symptoms (d = 1.45 [1.14, 1.76]), were also observed. A single, 1-hour psychoeducational intervention can achieve lasting and improved adjustment to memory symptoms in breast cancer survivors with self-reported CRCD. Further investigation using a randomized controlled study design is warranted. Comparisons with previously reported psychoeducational interventions for CRCD are made, and next steps for this research are discussed.

Long-term peripheral neuropathy symptoms in breast cancer survivors.

Peripheral neuropathy (PN) is a common and distressing complication from chemotherapy. Symptoms often, but not always, improve with time. The prevalence of long-term PN symptoms in breast cancer survivors is not well known. We sought to explore PN symptoms and associated risk factors among breast cancer survivors at least 2years out from diagnosis. We performed a cross-sectional retrospective study investigating the prevalence of patient-reported numbness, tingling, and anesthesia symptoms as a surrogate for PN in breast cancer survivors. We included patients with stage 0-III breast cancer who completed a clinical questionnaire at a survivorship visit that occurred 2 or more years after diagnosis. We estimated the prevalence of PN and identified risk factors for PN. Six hundred and five patients assessed between April 2009 and October 2016 met eligibility for analysis. Median age was 60years. Median number of years from diagnosis to assessment was 6.3. All patients had surgery and 62% had chemotherapy. Twenty-seven percent reported PN. On univariable analysis, obesity, stage II and III, mastectomy, PN before diagnosis, and receipt of taxane chemotherapy were associated with higher risk of PN (all p<0.05); older age, exercise, ER-positive disease, and endocrine therapy were associated with lower risk of PN (all p<0.05). On multivariable analysis, only receipt of docetaxel (OR 2.18, CI 1.22-3.88) or paclitaxel (OR 4.07, CI 2.54-6.50) and reporting PN symptoms before diagnosis (OR 3.28, CI 1.49-7.21) were associated with higher risk of PN. Overall, 17, 20, 31, and 44% reported long-term PN symptoms after no chemotherapy, non-taxane chemotherapy, docetaxel chemotherapy, and paclitaxel chemotherapy, respectively. Long-term peripheral neuropathy symptoms are reported by a significant minority of breast cancer survivors, particularly following paclitaxel or docetaxel chemotherapy. These study findings can help inform patients and clinicians regarding long-term PN risk following chemotherapy.

An Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a pilot study

Previous studies demonstrated that a cognitive behavioral therapy (CBT) program delivered in group sessions is effective in alleviating treatment-induced menopausal symptoms in women with breast cancer, but also that in-person CBT is inconvenient for some women and can result in low levels of program compliance. A promising, alternative approach is to use the Internet to make this form of CBT more accessible and feasible for patients. The objective of this study was to evaluate the feasibility and to generate preliminary data on the efficacy of a guided, Internet-based CBT program. Twenty-one participants with treatment-induced menopausal symptoms started the guided Internet-based CBT program. Self-report questionnaires were completed at baseline and at 10 weeks (posttreatment). Counselors' evaluations were obtained via interviews. Primary outcomes were program usage, compliance rates, and participant and counselor satisfaction. Secondary outcomes were overall levels of endocrine symptoms and hot flush/night sweats problem rating. Ninety percent of participants completed the program as planned. Satisfaction rates were high among participants and counselors. Small revisions to the program were advised. There was a significant decrease over time in overall levels of endocrine symptoms and hot flush/night sweats problem rating. These findings suggest that an Internet-based CBT program for women with treatment-induced menopausal symptoms is feasible and promising in terms of efficacy. The efficacy of the CBT program is currently being investigated in a larger randomized controlled trial.

Internet-based cognitive behavioral therapy to alleviate treatment-induced menopausal symptoms in breast cancer survivors: Results of the EVA-online pilot study

Internet-based cognitive behavioral therapy to alleviate treatment-induced menopausal symptoms in breast cancer survivors: Results of the EVA-online pilot study

Long term peripheral neuropathy symptoms in breast cancer survivors.

e21599 Background: Peripheral neuropathy (PN) is a common complication from chemotherapy (CTX), associated with significant morbidity, and may improve with time. The prevalence of long-term PN symptoms in breast cancer survivors is not well known. We sought to explore PN symptoms and associated risk factors among breast cancer survivors at least 2 years out from diagnosis. Methods: We performed a cross-sectional retrospective study investigating the prevalence of patient-reported numbness/tingling symptoms as a surrogate for PN in breast cancer survivors at our institution. We included patients with stage 0-III breast cancer who completed a questionnaire about symptoms and life-style habits at a survivorship visit that occurred 2 or more years after initial diagnosis. We evaluated the prevalence of PN and associated risk factors using univariable and multivariable logistic regression analysis; results are shown as odds ratio (OR) and 95% confidence interval (CI). Results: 605 patients assessed between April 2009 and October 2016 met eligibility for analysis. Median age was 60 (31-93) years. Median number of years from diagnosis to assessment was 6.3 (2-21). All patients had surgery and 62% had CTX. Twenty-seven percent reported PN. On univariable analysis, obesity, stage II &amp; III, mastectomy, PN before diagnosis, and receipt of taxane CTX were associated with PN (all p &lt; 0.05). Patients who were older, exercised before diagnosis, had ER/PR-positive disease and who received endocrine therapy reported less PN (all p &lt; 0.05). On multivariable analysis, only receipt of docetaxel (OR: 2.18, CI: 1.22- 3.88) or paclitaxel (OR: 4.07, CI: 2.54-6.50) and reporting PN symptoms before diagnosis (OR: 3.28, CI: 1.49-7.21) were associated with PN. Among patients without pre-existing PN symptoms, 15%, 19%, 28% and 43% reported long-term PN after no CTX, non-taxane CTX, docetaxel CTX and paclitaxel CTX respectively. Conclusions: At a median follow-up of 6.3 years from diagnosis, 28% of survivors in our cohort who had received docetaxel and 43% who had received paclitaxel report long-term PN symptoms compared with 15-19% in those who received no or non-taxane CTX. These data can help inform patients and clinicians regarding long-term PN risk following CTX.

The effects of yoga and self-esteem on menopausal symptoms and quality of life in breast cancer survivors—A secondary analysis of a randomized controlled trial

ObjectivesPrevious research has found that yoga can enhance quality of life and ease menopausal symptoms of breast cancer survivors. The study examined whether self-esteem mediated the effects of yoga on quality of life, fatigue and menopausal symptoms, utilizing validated outcome measures. Study designThis is a secondary analysis of a randomized controlled trial comparing the effects of yoga with those of usual care in 40 breast cancer survivors who suffered from menopausal symptoms. All participants completed all 3 assessments (week 0, week 12, and week 24) and provided full data. Main outcome measuresOutcomes were measured using self-rating instruments. Mediation analyses were performed using SPSS. ResultsSelf-esteem mediated the effect of yoga on total menopausal symptoms (B=−2.11, 95% BCI [−5.40 to −0.37]), psychological menopausal symptoms (B=−0.94, 95% BCI [−2.30 to −0.01]), and urogenital menopausal symptoms (B=−0.66, 95% BCI [−1.65 to −0.15]), quality of life (B=8.04, 95% BCI [3.15–17.03]), social well-being (B=1.80, 95% BCI [0.54–4.21]), emotional well-being (B=1.62, 95% BCI [0.70–3.34]), functional well-being (B=1.84, 95% BCI [0.59–4.13]), and fatigue (B=4.34, 95% BCI [1.28–9.55]). Self-esteem had no effect on somatovegetative menopausal symptoms (B=−0.50, 95% BCI n.s.) or on physical well-being (B=0.79, 95% BCI n.s.). ConclusionsFindings support the assumption that self-esteem plays a vital role in the beneficial effect of yoga and that yoga can have long-term benefits for women diagnosed with breast cancer and undergoing menopausal transition.

Changes in light-, moderate-, and vigorous-intensity physical activity and changes in depressive symptoms in breast cancer survivors: a prospective observational study.

Despite the recommendations for cancer survivors to engage in either moderate or vigorous physical activity, light-intensity physical activity may also have beneficial effects on mental health. The purpose of this study was to examine the associations between light, moderate, and vigorous physical activity and depressive symptoms in breast cancer survivors over 1year post-treatment. Participants (N=201) were a sample of breast cancer survivors who self-reported depressive symptoms and wore an accelerometer for seven consecutive days to measure physical activity, on five occasions every 3months post-treatment for cancer. Based on the results of hierarchical linear modeling, relative to others (i.e., between-person effects) and to oneself (i.e., within-person effects), higher levels of light- and moderate-intensity physical activity, but not vigorous-intensity physical activity, were associated with lower scores of depressive symptoms. In the first year post-treatment, increases in light- and moderate-intensity physical activity, but not vigorous-intensity physical activity, were associated with lower scores of depressive symptoms in relation to other study participants (i.e., between-person effects) and when participants were compared to their own typical levels of physical activity (i.e., within-person effects). The findings may have implications for physical activity recommendations following treatment for breast cancer as light-intensity physical activity may play a role in mitigating depressive symptoms over the first year.

Addressing Cognitive Impairment After Breast Cancer: What Do Women Want?

Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on daily life. Breast cancer survivors frequently engage in self-management strategies to lessen the impact of these cognitive symptoms. There is little information from the perspective of BCS as to their preference of interventions. The purpose of this study was to explore how BCSs cope and self-manage the symptoms associated with cognitive changes, their preferences for the type of intervention(s), and perceived facilitators and barriers to interventions. A qualitative descriptive study using content analysis was conducted. Semistructured telephone interviews were conducted with 13 BCSs. Breast cancer survivors articulated that validation and self-management strategies were used to relieve cognitive symptoms. Nonpharmacologic, evidence-based interventions that use a combined onlinein-person approach and include follow-up with healthcare providers are preferred by BCSs. Ease of use, accessibility, and convenience were identified by BCSs as most important to facilitate participation. Cost, time intensiveness, and distance to travel hampered participation. Patient-centered interventions tailored to meet the needs of BCSs should be considered when implementing programs or interventions to maximize their utilization and benefit. The process of implementation should be dynamic and include an ongoing collaboration between BCSs and clinical nurse specialists.

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.

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy.

There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.

Design of a randomized controlled trial of Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors.

BackgroundMenopausal symptoms are common and may be particularly severe in younger women who undergo treatment-induced menopause. Medications to reduce menopausal symptoms are either contra-indicated or have bothersome side effects. Previous studies have demonstrated that face-to-face cognitive behavioral therapy (CBT) is effective in alleviating menopausal symptoms in women with breast cancer. However, compliance with face-to-face CBT programs can be problematic. A promising approach is to use the Internet to make this form of CBT more accessible and feasible for patients. This study is evaluating the efficacy and cost-effectiveness of an Internet-based CBT program, with or without therapist guidance, in alleviating or reducing the severity of menopausal symptoms.Methods/designIn a multicenter, randomized controlled trial we are evaluating the efficacy of two Internet-based CBT programs in alleviating or reducing the impact of menopausal symptoms, and particularly hot flushes and night sweats, in breast cancer survivors who have experienced a treatment-induced menopause. Secondary outcomes include sexual functioning, sleep quality, hot flush frequency, psychological distress, health-related quality of life and cost-effectiveness. We will recruit 248 women who will be randomized to either a therapist guided or a self-management version of the 6-week Internet-based CBT program, or to a usual care, waiting list control group. Self-administered questionnaires are completed at baseline (T0), and at 10 weeks (T1) and 24 weeks (T2) post-randomization.DiscussionInternet-based CBT is a potentially useful treatment for reducing menopausal symptoms in breast cancer survivors. This study will provide evidence on the efficacy and cost-effectiveness of such an Internet-based CBT program, with or without therapist support. If demonstrated to be efficacious and cost-effective, the availability of such structured supportive intervention programs will be a welcome addition to standard medical treatment offered to cancer patients with treatment-induced menopause.Trial registrationThe study is retrospectively registered at ClinicalTrials.gov on January 26th 2016 (NCT02672189).

Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors.

Among individuals coping with cancer, emotional approach coping-expressing and processing emotions following negative events-has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.

Effects of Acupuncture on Menopause-Related Symptoms in Breast Cancer Survivors: A Meta-analysis of Randomized Controlled Trials.

Evidence regarding the effects of acupuncture on hot flashes in breast cancer survivors is conflicting. Little is known about the intermediate-term effects of acupuncture on hot flashes and other menopause-related symptoms in breast cancer survivors. The objective of this study was to evaluate the short-term and intermediate-term effects of acupuncture on menopause-related symptoms and particularly on hot flashes in breast cancer survivors. Electronic databases including EMBASE, PubMed, PsycINFO, Web of Science, CINAHL, Wanfang Data Chinese Database, and China Knowledge Resource Integrated Database from inception until June 15, 2014, were searched. Randomized controlled trials in which acupuncture was compared with sham controls or other interventions according to the reduction of hot flashes or menopause-related symptoms in breast cancer survivors were included. We analyzed 7 studies involving 342 participants. Acupuncture significantly reduced the frequency of hot flashes and severity of menopause-related symptoms (g = -0.23 and -0.36, respectively) immediately after the completion of treatment. In comparison with sham acupuncture, effects of true acupuncture on the frequency and severity of hot flashes were not significantly different. At 1 to 3 months' follow-up, the severity of menopause-related symptoms remained significantly reduced (g = -0.56). Acupuncture yielded small-size effects on reducing hot-flash frequency and the severity of menopause-related symptoms. Acupuncture may be used as a complementary therapy for breast cancer survivors experiencing hot flashes and other menopause-related symptoms; however, whether acupuncture exerts specific treatment effects other than needling or placebo effects needs to be further evaluated.

Experiences and insomnia-associated factors in Chinese breast cancer survivors: a qualitative study.

This study aimed to explore the experiences and factors associated with insomnia in Chinese breast cancer survivors. Insomnia is a common and significant symptom in breast cancer survivors. Quantitative studies are unable to describe the experience of insomnia and the sleep-associated factors from a personal point of view. A profound understanding of the experience of insomnia in breast cancer survivors can provide information for health workers and caregivers to allow them to provide more effective support. A descriptive qualitative research was adopted. In-depth interviews were conducted with 22 insomniac breast cancer survivors. A qualitative content analysis was used to analyse the data. Three themes emerged concerning the experiences of insomnia, including sleep neglect, insomnia perception and insomnia anxiety. Participants reported their own opinions on three insomnia-associated factors, including factors associated with hospitalisation, factors associated with breast cancer and the therapies and too much attention placed on sleep. Survivors would neglect their sleep problems in the early stage after diagnosis. When they became aware of their sleep problems, they were inclined to worry too much and sought help from traditional Chinese medicine. Anticipatory sleep anxiety, excessive negative cognitive activities and insomnia became a vicious circle for insomniac breast cancer survivors. The findings provide detailed information to help nurses understand the experiences of breast cancer survivors with insomnia. Nurses could provide proper care to help prevent insomnia or improve sleep.

(211) Differences in the spatial distribution of pain are related to increased symptoms in breast cancer survivors

(211) Differences in the spatial distribution of pain are related to increased symptoms in breast cancer survivors

Abstract PD4-06: Acupressure for persistent fatigue in breast cancer survivors

Abstract Background: Persistent fatigue is a common and debilitating symptom in breast cancer survivors (BCS), yet treatments remain limited. The purpose of this study was to examine the effect of two types of self-administered acupressure on fatigue versus usual care in BCS. Methods: This was a 10-week randomized trial that enrolled adult female BCS (stage 0-III), who had completed cancer treatments at least 12 months previously and who reported persistent mild-moderate fatigue (≥ 4 on the Brief Fatigue Inventory [BFI]). BCS were randomized equally into relaxation acupressure (RA), stimulating acupressure (SA) or usual care (UC). The primary endpoint was change in BFI from baseline to week 6 when acupressure was stopped and at week 10 to assess carryover effects of acupressure. Secondary analyses were conducted on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and 14-day sleep diaries; quality of life was assessed with the Long-Term Quality of Life in BCS (LTQL). Intent-to-treat analyses were conducted using linear mixed models. Results: 288 BCS were randomized (98 RA, 94 SA, and 96 UC). 228 BCS completed the 6-week visit and 223 the 10-week visit (71 RA, 69 SA, and 83 UC). There were no significant group differences on baseline sociodemographic, clinical characteristics, BFI, PSQI, sleep diary parameters, or LTQL. At week 6 the mean change in BFI from baseline was significantly lower in the RA and SA arms than UC (RA = -2.57 ± 1.5, SA = -1.98 ± 1.5, and UC = -1.07 ± 1.6; p &amp;lt; 0.001 for both RA and SA vs. UC), but there was no significant difference between acupressure arms (p = 0.29). At week 10 the mean change in BFI from baseline ± SD was maintained and continued to be lower in RA and SA arms than UC (RA = -2.27 ± 1.4, SA = -1.96 ± 1.5, and UC = -0.99 ± 1.5; p &amp;lt; 0.001 for both RA and SA vs. UC), but no significant difference between acupressure arms (p &amp;gt;0.99). At week 6 the mean change in PSQI from baseline mean ± SD for RA = -1.93 ± 3.3 was significantly different from UC = -0.46 ± 3.1 (p = 0.03) but not SA = -1.34 ± 3.2 (p = 0.96). At week10 there was no significant difference on the PSQI between arms (RA vs. UC, p = 0.40; SA vs. UC, p &amp;lt;= .99; RA vs. SA, p = 0.79); however PSQI scores remained lower and stable in the RA arm. There were no significant differences between the three arms at any time point for the sleep diary parameters sleep efficiency, total sleep time, sleep onset latency, or wake after sleep onset. Women in the RA arm were significantly improved versus UC for three of four quality of life subscales at both 6- and 10-week visits (somatic, p=0.03week 6, p=0.04 week 10; physical fitness, p=0.04 week 6, p=0.01 week 10; and social support, p=0.03 week 6, p=0.04 week 10; spirituality, p=0.55 week 6, p=0.17 week 10). The SA group was not significantly different from UC for any subscale at any time point. Conclusions: Both acupressure arms significantly reduced fatigue compared to UC, but only RA had a significant effect on improving sleep quality and quality of life in BCS. Improvements in fatigue, sleep, and quality of life continued to persist for 4 weeks after cessation of acupressure. Self-administered RA offers an inexpensive easy to learn method to manage fatigue, sleep quality and overall quality of life in BCS with persistent fatigue. Citation Format: Zick SM, Wyatt GK, Murphy SL, Arnedt JT, Sen A, Harris RE. Acupressure for persistent fatigue in breast cancer survivors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-06.

Improved sleep after Qigong exercise in breast cancer survivors: A pilot study

Objective:Sleep disorder and fatigue are among a few major concerns of breast cancer survivors across the survivorship trajectory. The purpose of this pilot study was to examine feasibility and trends in multiple outcomes after a 6-week Qigong exercise program in breast cancer survivors.Methods:Eight female adults (mean age 55.4 ± 9.4 years, mean time after the completion of cancer treatment 3.9 ± 5.7 years) who had a diagnosis of breast cancer and were at least 3 months postcompletion of primary cancer treatment prior to participation in this study. Baseline evaluation was administered using subjective questionnaires on sleep quality, insomnia, fatigue, and quality of life. All subjects participated in two training sessions to learn the “Six Healing Sound” Qigong exercise and attended group Qigong sessions once per week in the following 6 weeks. In addition to the group sessions, subjects were asked to perform the Qigong exercises twice at home right before going to bed in the evening and immediately after getting up in the morning. Following the 6-week intervention, subjects were re-assessed using the same questionnaires. Pre- and post-intervention scores were analyzed for statistical significance.Results:Compliance rate was 89.6% for group sessions and 78.5% (ranging from 65.6% to 90.7%) for daily home Qigong exercises. No participant reported any adverse event or side effect during the study. All participants indicated in the end-intervention questionnaire that they would highly recommend the intervention to others. Significant improvements were observed in sleeping quality score (from 10.3 ± 3.6 to 5.4 ± 2.3, P < 0.01), insomnia index score (from 16.2 ± 3.2 to 6.8 ± 4.8, P < 0.01), fatigue score (from 60.3 ± 9.4 to 49.1 ± 8.6, P < 0.01), and SF-36 score (from 66.8 ± 7.7 to 80.9 ± 3.9, P < 0.01).Conclusions:Results of this single arm pilot study showed the feasibility and potential of “Six Healing Sounds” Qigong exercise for improving sleep and other symptoms in breast cancer survivors.