Therapy In Breast Cancer Survivors Research Articles

Mid-term Effectiveness Of An Unsupervised Exercise Prescription Program In Breast Cancer Survivors

PURPOSE: The efficacy of physical exercise prescription as therapy in breast cancer survivors is largely documented in literature. Unsupervised exercise produces short- term improvements in physical fitness of breast cancer survivors, but regarding the mid-term effectiveness only few studies are available. The purpose of this study was to assess the effects of an unsupervised exercise prescription program on body composition, physical fitness and Health Related Quality of Life of breast cancer survivors. METHODS: Forty-two (average age 52.0±10.1 years) women were enrolled. Assessments performed at baseline and after 6 months of exercise prescription: - body composition (anthropometric parameters and bioimpedance analysis); - physical fitness: aerobic capacity by Six-Minute Walk Test (6 MWT), limbs strength by Hand Grip Test and Chair Stand Test, flexibility by Sit and Reach Test; TOGLIERE PRESSIONI - Health Related Quality of Life (SF-36). Statistical analysis was conducted by Student’s t-tests and multiple regression. RESULTS: Body composition improvements: - BMI (T0=27.3±4.2; T5=26.1±3.9 kg/m2; p<0,001); - waist circumference (T0=90.2±10.8; T5=85.3±9.8 cm; p<0,001); - extracellular water (T0=17.5±1.9; T5=16.8±1.9 L; p<0,01); - fat mass (T0=25.0±8.1; T5=22.6±7.2 kg; p<0,001). Physical fitness improvements: - 6 MWT (T0=518.6±133.0; T5=584.8±97.2 m; p<0,001); - Hand Grip (T0=24.3±4.8; T5=26.5±4.5 kg; p<0,01); - Chair Test (T0=14.5±3.8; T5=18.3±4.3 repetitions; p<0,001); - Sit and Reach (T0=2.6±9.3; T5=8.5±7.1 cm; p<0,001). Health Related Quality of Life improvements: - Physical Functioning (T0=72.7±24.6; T5=83.7±17.1 %; p<0,001); - General Health (T0=64.7±20.4; T5=69.1±18.9%; p<0,001); - Social Functioning (T0=60.5±24.5; T5=67.6±22.9%; p<0,05); - Mental Health (T0=63.4±14.8; T5=67.3±12.5%; p<0,05). The percentage change in fat mass has been associated with adjuvant cancer therapy (intercept= -0,016; b=8,629; p<0,05). CONCLUSIONS: An unsupervised exercise prescription program improves body composition, physical fitness and Health Related Quality of Life in breast cancer survivors. Longer term follow-up studies to establish the real capacity of this program to induce long-term changes in lifestyle are needed.

A Social Cognitive Theory-based Framework for Monitoring Medication Adherence Applied to Endocrine Therapy in Breast Cancer Survivors.

Poor adherence to long-term therapies for chronic diseases, such as cancer, compromises effectiveness of treatment and increases the likelihood of disease progression, making medication adherence a critical issue in population health. While the field has documented many eers to adherence to medication, it has also come up with few efficacious solutions to medication adherence, indicating that new and innovative approaches are needed. In this paper, we evaluate medication-taking behaviors based on social cognitive theory (SCT), presenting patterns of adherence stratified across SCT constructs in 33 breast cancer survivors over an 8-month period. Findings indicate that medication adherence is a very personal experience influenced by many simultaneously interacting factors, and a deeper contextual understanding is needed to understand and develop interventions targeting non-adherence.

Hope in Life after Narrative Therapy for Breast Cancer Survivors

Hope in Life after Narrative Therapy for Breast Cancer Survivors

The compliance assessment of endocrine therapy for breast cancer survivors: a review

Breast cancer is one of the most common cancers in China. With increasing of the incidence and mortality, the harm to women is becoming much serious. Estrogen positive patients need to take 5-10 years′ endocrine drugs to prolong survival and prevent recurrence. Endocrine therapy has become one of the most common and effective methods in the treatment of breast cancer. In order to achieve the desired effect of cancer treatment, reduce cancer metastasis and recurrence rate, good compliance is essential. In conclusion, this review summarizes the evaluation of compliance, various evaluation tools and their use. Key words: Breast neoplasm; Endocrine therapy; Compliance; Assessment tool

Interventions for the Treatment of Aromatase Inhibitor-Associated Arthralgia in Breast Cancer Survivors: A Systematic Review and Meta-analysis.

Aromatase inhibitors (AIs) have been established as successful adjuvant therapy for breast cancer survivors. Unfortunately, nearly half of women taking AIs report joint pain, AI-associated arthralgia (AIA). Aromatase inhibitor-associated arthralgia often results in noncompliance, which could lead to cancer recurrence. The purpose of this study was to identify current pain management of AIA and to evaluate the study quality and effects of interventions. Nineteen articles published from 2000 to August 2015 were identified using PubMed, CINAHL, PsycINFO, Web of Science, and additional records. Study quality was evaluated by the Quality Assessment Tool for Quantitative Studies. Meta-analysis was used to obtain effect sizes of interventions on pain and subgroups. Five types of interventions emerged: pharmacological approaches, acupuncture, nutritional supplementation, relaxation techniques, and physical exercise. Six studies were strong, 8 were moderate, and 5 were weak in quality. The overall effect size of the interventions on pain was large; pharmacological approaches, acupuncture, and relaxation techniques showed moderate to large effects on pain, whereas nutritional supplementation and physical exercise had no significant effects on it. The evidence was based on a body of research with moderate study quality. Although the overall effect of interventions is large, further investigation into the influence of nutrition and physical exercise is needed to better discern their potential for pain management. Oncology nurses may be able to implement such validated interventions as pain management modalities to mitigate the symptoms so that breast cancer survivors remain compliant with AIA therapy.

Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance).

To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n=1280) completed baseline interviews; follow-up was conducted annually for up to 7years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n=990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1year); midpoint (1-3years); and late discontinuation (>3-5years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Survivors were 65-91years old (mean 72.6years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p<0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

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.

Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study

Adjuvant endocrine therapy (AET) has been shown to improve survival in hormone receptor-positive breast cancer survivors, but as many as half do not complete recommended treatment. Management of medication-related side effects and engagement with providers are two potentially modifiable factors, but their associations with adherence are not well understood. The aims were to build on survey results to qualitatively explore survivors' experiences with prescribed AET to (a) describe appraisal and management of AET side effects and (b) deconstruct decisions to initiate, discontinue, or maintain AET. . The authors used a mixed-methods explanatory sequence research design with a qualitative emphasis. . Survivors were recruited from a clinical cancer registry maintained at the University of Texas Southwestern Medical Center, which includes the Harold C. Simmons Comprehensive Cancer Center (National Cancer Institute-designated), in Dallas. . 452 survivors completed a survey, and 30 took part in telephone interviews. . Qualitative methods were used in which the authors recorded and transcribed interviews for analysis and used open coding to reduce data into themes. . Among adherent survivors, the themes of tolerance of side effects and perseverance were strong. Nonadherent survivors expressed more difficulty managing side effects and perceived fewer benefits when side effects were bothersome. The most common side effects mentioned by all survivors were menopausal symptoms and joint pain; less common side effects were cognitive decline and cardiac distress. Some sought advice from their oncology team. Nonadherent survivors appeared initially motivated to maintain AET but identified a tolerance limit for side effects after which a provider's recommendation was less influential in their decision to maintain or discontinue AET. . This study elucidated adherence as a complex continuum of behaviors, appraisals, and decision points. These insights may be particularly useful in counseling survivors taking AET and promoting timely delivery of clinical interventions to enhance adherence. . Nurses should be involved in the planning and implementation of clinical interventions to manage side effects and other barriers to AET adherence.

Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review.

PurposeNonadherence to hormone therapy in breast cancer survivors is common and associated with increased risk of mortality. Consistent predictors of nonadherence and nonpersistence are yet to be identified, and little research has examined psychosocial factors that may be amenable to change through intervention. This review aimed to identify predictors of nonadherence and nonpersistence to hormone therapy in breast cancer survivors in order to inform development of an intervention to increase adherence rates.MethodsStudies published up to April 2016 were identified through MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and gray literature. Studies published in English measuring associations between adherence or persistence and any predictor variables were included. Eligible studies were assessed for methodological quality, data were extracted and a narrative synthesis was conducted.ResultsSixty-one eligible articles were identified. Most studies focused on clinical and demographic factors with inconsistent results. Some evidence suggested that receiving specialist care and social support were related to increased persistence, younger age and increased number of hospitalizations were associated with nonadherence, and good patient–physician relationship and self-efficacy for taking medication were associated with better adherence. A small amount of evidence suggested that medication beliefs were associated with adherence, but more high-quality research is needed to confirm this.ConclusionSome psychosocial variables were associated with better adherence and persistence, but the results are currently tentative. Future high-quality research should be carried out to identify psychosocial determinants of nonadherence or nonpersistence that are modifiable through intervention.

Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors.

The aim of this study was to evaluate the efficacy of fractional CO2 laser therapy in breast cancer survivors as a therapeutic method for vulvovaginal atrophy (VVA) dyspareunia. 50 patients (mean age 53.3years) underwent fractional microablative CO2 laser treatment for dyspareunia in oncological menopause (mean time of menopause 6.6years). The Gloria Bachmann's Vaginal Health Index (VHI) score was chosen as system to evaluate the presence of VVA and its improvement after the treatment. Intensity of dyspareunia was evaluated using a visual analog scale (VAS). Data indicated a significant improvement in VVA dyspareunia (p<1.86e-22) in breast cancer survivors who had undergone 3 sessions of vaginal fractional CO2 laser treatment. Moreover, VHI scores were significantly higher 30days post-treatment (T4) (p<0.0001). 76% of patients were satisfied or very satisfied with the treatment results. The majority (52%) of patients were satisfied after a long-term follow-up (mean time 11months). No adverse events due to fractional CO2 laser treatment occurred. The treatment with fractionated CO2 laser appeared to be a feasible and effective treatment for VVA dyspareunia in breast cancer survivors with contraindications to hormonal treatments.

Couple-based treatment for sexual problems following breast cancer: A review and synthesis of the literature.

Although there are many physical and psychological impacts on women's sexuality following breast cancer diagnosis and treatment, sexual problems often remain unaddressed in these cancer survivors. Given the crucial role of the partner in sexual issues, couple-based sex therapy would appear to be a logical first-line treatment for this population, but there is scant research on the efficacy of couple-based treatments and/or sex therapy in breast cancer survivors. A review of the literature was conducted using the PMC, PsycINFO, EMBASE, and MEDLINE databases. Articles were included that presented the results of an experimental or quasi-experimental clinical trial evaluating a psychosexual intervention for couples, targeted women diagnosed with breast cancer and their partners, and included outcome measures of sexual function and sexuality. Studies were excluded if the primary intervention was not focused on sexual problems or if they were published in a language other than English. From 2231 records, five articles met criteria for inclusion in the present review. Couple-based sex therapy appears to be an effective and highly accepted treatment for addressing sexual problems in breast cancer patients. These interventions were associated with improvements in sexual physiology, sexual functioning, sexual self-image, and sexual relationships, as well as improved psychological well-being of both breast cancer patients and their partners. Based on this review, the authors address clinical implications, particularly incorporating psychological treatment for sexual problems in comprehensive cancer care, and provide recommendations for further study.

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.

Effectiveness of a multimodal and combined therapy in breast cancer survivors with cancer-related fatigue on self-regulation and internal coherence

Effectiveness of a multimodal and combined therapy in breast cancer survivors with cancer-related fatigue on self-regulation and internal coherence

Multimodal and combined multimodal-aerobic therapy in breast cancer survivors with cancer-related fatigue.

e20717 Background: Cancer-related fatigue (CRF) and insomnia are major issues in breast cancer survivors (BC). While aerobic training (AT) is the standard therapy in BC with CRF, the effect-size is only minor to moderate. Other evidence-based treatments are cognitive behavioral therapy e.g. sleep education/restriction (SE) or psycho-education (PE) and mindfulness-based therapies. We investigated a 10-week multimodal program (MT) consisting of SE, PE, eurythmy and painting therapy separately or in combination with AT (CT) and compared MT and CT each with AT. Methods: In a comprehensive cohort design study BC with chronic CRF (6-36 months after adjuvant treatment, Fatigue Numerical Scale ≥ 4) were evenly randomized or allocated by patient preference. Primary endpoint was a composite outcome of the Pittsburgh Sleep Quality Index (PSQI) and the Cancer Fatigue Scale (CFS-D) after 10 weeks (T1); a second endpoint included a six months later (T2) follow-up. We tested confirmatively for non-inferiority of MT vs. ...

Contributors to nonadherence and nonpersistence with endocrine therapy in breast cancer survivors recruited from an online research registry.

Rates of adherence and persistence with endocrine therapy regimens (i.e., tamoxifen, aromatase inhibitors) by breast cancer survivors are suboptimal, with negative implications for prognosis. This study identified potential contributors to nonadherence and nonpersistence. From an online breast cancer research registry (Army of Women) including approximately 51,000 breast cancer survivors, we recruited 1,371 women who currently were taking endocrine therapy and 94 nonpersisters (i.e., diagnosed during the prior 5years and on endocrine therapy within the prior 12months, but no longer taking it). Participants completed an online questionnaire assessing demographic/medical characteristics, general and cancer-related psychosocial variables (i.e., depressive symptoms, anxiety, patient-oncologist relationship quality, cancer recurrence worry, general symptoms), and endocrine therapy-specific variables (i.e., endocrine therapy-related symptoms, perceived endocrine therapy necessity, long-term therapy use concern, endocrine therapy-related emotions). Two weeks later, current users were re-contacted to complete an endocrine therapy adherence measure. In a final regression model, patient-reported nonadherence among current users was significantly associated with lower financial status, a prior switch in endocrine therapies, a poorer relationship with the oncologist, and lower perceived need for and more negative emotions regarding endocrine therapy (adjusted R (2)=0.15, P<0.001). In a final logistic regression model, endocrine therapy nonpersisters were significantly more likely than current users to report depressive symptoms, as well as more negative emotions and lower positive emotions related to endocrine therapy (adjusted R (2)=0.10, P<0.001). In addition to demographic/medical variables, several potentially modifiable psychosocial characteristics are likely to contribute to endocrine therapy nonadherence and nonpersistence.

Randomized controlled trial of a clinic-based survivorship intervention following adjuvant therapy in breast cancer survivors

In 2006, the IOM released a report citing the importance of "survivorship plans" to improve quality of life and care coordination for cancer survivors, but little has been done to evaluate their efficacy. Women with early-stage breast cancer were randomized within 6 weeks of completing adjuvant therapy to a survivorship intervention group (SI) or control group (CG). All subjects were given the NCI publication, "Facing Forward: Life after Cancer Treatment." The SI also met with a nurse/nutritionist to receive a treatment summary, surveillance, and lifestyle recommendations. Both groups completed questionnaires on the impact of cancer (IOC), patient satisfaction (FACIT-TS-PS), and assessment of survivor concerns (ASC) at baseline, 3 and 6 months. Within and between group t tests and linear regression analyses were performed. Among 126 women (60 CG, 66 SI), mean age was 54 years, 48 % were Hispanic, and the groups were well-balanced by baseline characteristics. No significant differences between the CG and SI on the FACIT-TS-PS or IOC at 3 and 6 months were seen. The ASC health worry subscale was lower (less worry) in the SI compared to CG (p = 0.02). At all time-points, Hispanic women had higher (worse) health worry (p = 0.0008), social-life interference (p = 0.009), and meaning of cancer scales (p = 0.0004), and more trust in medical professionals (p = 0.03) compared to non-Hispanic women. While the SI did not lead to significant improvements in most patient-reported outcomes, it was associated with decreased health worry. Future interventions should determine the most efficient and effective method for delivering survivorship care plans.

Cognitive-Behavioral Group Therapy for Breast Cancer Survivors: Description of a Program and Preliminary Evaluation of its Effectiveness

Aim: Cognitive-behavioural therapy (CBT) has already been shown to be highly effective, namely in psycho-oncology field. There are few descriptions of how a CBT programme for cancer patients groups can be structured and delivered, as well as, there are few efficacy studies of this programs, especially in Portugal. We present a description of an 8-session CBT programme that has been developed by our team, for delivery to breast cancer survivors groups, as well as, the preliminary results of its efficacy. Method: It was used a sample of 20 participants selected from Reach to Recovery of Centre Delegation of Portuguese Cancer League (16 was submitted to the intervention program described and four performed the control group). Evaluation procedures consisted on voluntary fill-out of the following instruments: Courtauld Emotion Control Scale (CEC), Hospital Anxiety and Depression Scale (HADS), Clinical Inventory of Self-concept (ICAC), Life Orientation Test - Revised version (LOT-R) and the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C-30 and supplement BR-23). Description of components and contents of the sessions are presented. Results: Preliminary results of the programme application are presented. Until now, it was not possible to verify significant results from pre- to post-test. Conclusion: It is important to take in consideration the group therapy programme presented and replicate it with cancer patients in order to obtain clear results of its efficacy. The relevance of this conclusion is emphasized by the cost-effectiveness associated with the group therapy format.

A Case Study: Investigation of Yoga’s Potential to Treat Breast Cancer Survivors Facing Cancer Related Fatigue

Purpose of this study was to investigate efficiency of Yoga as an adjuvant therapy for breast cancer survivors who faced Cancer Related Fatigue, after post treatments like chemotherapy, radiation therapy etc. We prepared a randomized trial with yoga in Stan Cancer Rogi Seva Kendra, Radiotherapy Dept, SMS Hospital, Jaipur (India) in collaboration with the “Koshish” and the “Green Earth Foundation”. The authors of the manuscript are associated with both of them. We organized Yoga classes for 5 days in a week for two months (Monday to Friday) non stop. Among 93 of the participants, 62 were allowed to attend Yoga sessions and 31 were kept as control. There was a slow decrease in depressive symptoms on the Beck Depression Inventory-II (BDI-II) for experimental group of participants that were age above fifty from first intervention to second intervention of the session to intervention periods (mean:1st intervention- 70.790 to 2nd intervention-69.368), this showed that the first intervention were quite effective and the patients were benefited from the yoga. Also for the other experimental group of participants i.e. below the age of fifty where the value arose from (mean: 1st intervention-68.081 to 2nd intervention-57.174) they were improved in their depressive symptoms and their quality of life.

Attitudes towards massage modify effects of manual therapy in breast cancer survivors: a randomised clinical trial with crossover design

Our aims were to investigate the immediate effect of myofascial release on heart rate variability and mood state, and the influence of attitude towards massage in breast cancer survivors with cancer-related fatigue. Twenty breast cancer survivors reporting moderate to high cancer-related fatigue participated in this crossover study. All patients presented to the laboratory at the same time of the day on two occasions separated by a 2-week interval. At each session, they received either a massage intervention or control intervention. Holter electrocardiogram recordings and Profile of Mood States questionnaire (six domains: tension-anxiety, depression-dejection, anger-hostility, vigour, fatigue, confusion) were obtained before and immediately after each intervention. The attitude towards massage scale was collected before the first session in all breast cancer survivors. The results showed a significant session × time interaction for standard deviation of the normal-to-normal interval (SDNN) (F= 5.063, P= 0.039), square root of mean squared differences of successive normal-to-normal intervals (RMSSD) (F= 8.273, P= 0.010), high-frequency component (HF) (F= 7.571, P= 0.013), but not for index heart rate variability (F= 3.451, P= 0.080), low-frequency component (LF) (F= 0.014, P= 0.997) and ratio LF/HF (F= 3.680, P= 0.072): significant increases in SDNN, RMSSD and HF domain (P < 0.05) were observed after the manual therapy intervention, with no changes after placebo (P > 0.6). No influence of the attitude scale on heart rate variability results was found. A significant session × time interaction was also found for fatigue (F= 5.101, P= 0.036) and disturbance of mood (F= 6.690, P= 0.018) scales of the Profile of Mood States: patients showed a significant decrease in fatigue and disturbance of mood (P < 0.001) after manual therapy, with no changes after placebo (P > 0.50). A significant influence of the attitude scale was observed in tension-anxiety, depression-dejection and anger-hostility scales. This controlled trial suggests that massage leads to an immediate increase of heart rate variability and an improvement in mood in breast cancer survivors with cancer-related fatigue. Further, the positive impact of massage on cancer-related fatigue is modulated by the attitude of the patient towards massage.

I144 Hormone replacement therapy in breast cancer survivors

I144 Hormone replacement therapy in breast cancer survivors