Women Undergoing Breast Cancer Surgery Research Articles

Abstract 4134306: Menopausal Status Protects Against Vascular Dysfunction Induced by Breast Cancer Chemotherapy

Introduction: Breast cancer chemotherapy is associated with an increased risk of cardiovascular events, particularly pronounced in postmenopausal women. Vascular damage and docetaxel-caused endothelial dysfunction may underlie these effects, although the role of estrogens and menopausal status remains undefined. Hypothesis: Estrogens protect premenopausal women from neoadjuvant chemotherapy-induced endothelial dysfunction (NACT regimen: docetaxel, doxorubicin, cyclophosphamide) and its component docetaxel. Methods: We studied vascular function and its molecular determinants in mammary artery branches from pre- and postmenopausal women undergoing breast cancer surgery, with or without prior NACT. Mechanisms were investigated in bilaterally ovariectomized female C57BL/6J mice treated with docetaxel or placebo. Results: While NACT evoked endothelial dysfunction characterized by the loss of nitric oxide bioavailability in blood vessels from postmenopausal women, premenopausal women were protected from this phenomenon (Fig. 1) . Furthermore, premenopausal women’s blood vessels exhibited resilience against NACT-induced vascular oxidative stress. In particular, NOX4 expression was markedly lower in NACT-treated arteries from premenopausal women compared to their postmenopausal counterparts. No differences were seen in the non-NACT groups. At the molecular level, NACT incited lower inhibitory phosphorylation of Thr495 eNOS in premenopausal women's arteries compared to those of postmenopausal women post-NACT. In mice following bilateral ovariectomy, docetaxel caused endothelial dysfunction, but did not perturb acetylcholine-induced vasodilation in non-ovariectomized mice. Docetaxel induced blood pressure only in the group of ovariectomized mice. Conclusions: NACT-induced vascular dysfunction, often observed in breast cancer survivors, is absent in premenopausal women. This can be partially attributed to the protective role of estrogens, which prevent excessive production of reactive oxygen species and inhibitory eNOS phosphorylation.

Participation in a High-Risk Program Is Associated with a Diagnosis of Earlier-Stage Disease Among Women at Increased Risk for Breast Cancer Development.

High-risk programs provide recommendations for surveillance/risk reduction for women at elevated risk for breast cancer development. This study evaluated the impact of high-risk surveillance program participation on clinicopathologic breast cancer features at the time of diagnosis. Women followed in the authors' high-risk program (high-risk cohort [HRC]) with a diagnosis of breast cancer from January 2015 to June 2021 were identified and compared with the general population of women undergoing breast cancer surgery at Memorial Sloan Kettering Cancer Center (MSK; general cohort [GC]) during the same period. Patient and tumor factors were collected. Clinicopathologic features were compared between the two cohorts and in a subset of women with a family history of known BRCA mutation. The study compared 255 women in the HRC with 9342 women in the GC. The HRC patients were slightly older and more likely to be white and have family history than the GC patients. The HRC patients also were more likely to present with DCIS (41 % vs 23 %; p < 0.001), to have smaller invasive tumors (pT1: 100 % vs 77 %; p < 0.001), and to be pN0 (95 % vs 81 %; p < 0.001). The HRC patients had more invasive triple-negative tumors (p = 0.01) and underwent less axillary surgery (p < 0.001), systemic therapy (p < 0.001), and radiotherapy (p = 0.002). Among those with a known BRCA mutation, significantly more women in the HRC underwent screening mammography (75 % vs 40 %; p < 0.001) or magnetic resonance imaging (MRI: 82 % vs 9.9 %; p < 0.001) in the 12 months before diagnosis. Women followed in a high-risk screening program have disease diagnosed at an earlier stage and therefore require less-intensive breast cancer treatment than women presenting to a cancer center at the time of diagnosis. Identification of high-risk women and implementation of increased surveillance protocols are vital to improving outcomes.

The influence of body image on psychological symptomatology in breast cancer women undergoing intervention: a pre-post study.

Body image concerns related to breast cancer surgery may challenge patients' quality of life and their treatment outcomes, thus representing a key aspect to be assessed in the psycho-oncological settings. The present longitudinal study is aimed to (1) investigate the association between preoperative body image and postoperative psychological symptoms in breast cancer patients; (2) explore the impact of pre-/post-surgery variation in body image on psychological symptomatology. N = 72 women undergoing breast cancer surgery were preoperatively screened (T1) using the Body Uneasiness Test (BUT) and were assessed postoperatively (T2) using the Symptom Checklist-90 Revised (SCL-90-R) and re-administered the BUT. Spearman's correlation was used to investigate the relationship between age, preoperative body image and postoperative psychological symptoms, and variation in body image. To predict post-surgical psychological symptomatology, two separated multiple regression models were used to evaluate preoperative body image and its variation after surgery controlling for covariates (i.e., education; intervention type). P significance was set as 0.05 for all analyses and adjusted for multiple comparisons. At T1, anxiety in relation to body image scores emerged as the most frequently experienced psychological symptomatology after surgery (all adjusted p < 0.05). Significant correlations were observed between all SCL-90-R scores at T2 and avoidance behaviors and depersonalization scores at T1. The associations were most significantly strong for somatization, depression, anxiety, and hostility (all adjusted p < 0.05). However, change in body image between pre- and post-intervention was not associated with psychological symptomatology at T2 (all adjusted p > 0.05). Pre-surgery body avoidance was significantly associated with post-intervention psychological symptoms (SOMβ = 0.453, p = 0.0001; DEPβ = 0.507, p = 0.0001; AXβ = 0.459, p = 0.0001; HOSβ = 0.410, p=. 0001). However, increased weight phobia between pre- and post-surgery was statistically associated with increased somatization, anxiety, depression and hostility at T2 (βSOM = 0.439, p = 0.0001; βDEP = 0.454, p = 0.0001; βANX = 0.471, p = 0.0001). Overall, pre-/post-intervention body concerns were significantly associated with primary psychological symptoms in breast cancer patients undergoing surgery. Higher levels of body avoidance and weight phobia were significantly associated with the primary psychological dimensions assessed. As body concerns might act as quality-of-life predictors, their evaluation is crucial in fostering patients' well-being and treatment adherence.

Influence of Clinical and Genetic Factors on Propofol Dose Requirements: A Genome-wide Association Study.

Propofol is a widely used intravenous hypnotic. Dosing is based mostly on weight, with great interindividual variation in consumption. Suggested factors affecting propofol requirements include age, sex, ethnicity, anxiety, alcohol consumption, smoking, and concomitant valproate use. Genetic factors have not been widely explored. This study considered 1,000 women undergoing breast cancer surgery under propofol and remifentanil anesthesia. Depth of anesthesia was monitored with State Entropy (GE Healthcare, Finland). Propofol requirements during surgery were recorded. DNA from blood was genotyped with a genome-wide array. A multivariable linear regression model was used to assess the relevance of clinical variables and select those to be used as covariates in a genome-wide association study. Imputed genotype data were used to explore selected loci further. In silico functional annotation was used to explore possible consequences of the discovered genetic variants. Additionally, previously reported genetic associations from candidate gene studies were tested. Body mass index, smoking status, alcohol use, remifentanil dose (ln[mg · kg-1 · min-1]), and average State Entropy during surgery remained statistically significant in the multivariable model. Two loci reached genome-wide significance (P < 5 × 10-8). The most significant associations were for single-nucleotide polymorphisms rs997989 (30 kb from ROBO3), likely affecting expression of another nearby gene, FEZ1, and rs9518419, close to NALCN (sodium leak channel); rs10512538 near KCNJ2 encoding the Kir2.1 potassium channel showed suggestive association (P = 4.7 × 10-7). None of these single-nucleotide polymorphisms are coding variants but possibly affect the regulation of nearby genes. None of the single-nucleotide polymorphisms previously reported as affecting propofol pharmacokinetics or pharmacodynamics showed association in the data. In this first genome-wide association study exploring propofol requirements, This study discovered novel genetic associations suggesting new biologically relevant pathways for propofol and general anesthesia. The roles of the gene products of ROBO3/FEZ1, NALCN, and KCNJ2 in propofol anesthesia warrant further studies.

Opioid prescribing practices in breast oncologic surgery-A retrospective cohort study.

In breast oncologic surgery, 75% of patients receive a postoperative opioid prescription at discharge, and 10%-20% will develop persistent opioid use. To inform future institutional guidelines, the objective of this study was to determine baseline opioid prescribing patterns in a single high-volume, referral-based breast center. We hypothesized that opioid prescribing practices varied between procedures and operating surgeons. A retrospective analysis of all women undergoing breast cancer surgery between January and December 2019. Opioid prescriptions at discharge were converted to morphine milligram equivalents (MME). The primary outcome of interest was MME prescribed at discharge. Multiple linear regression was used to identify factors independently associated with MME prescribed. 392 patients met inclusion criteria; 68.3% underwent partial mastectomy. Median age was 61 (interquartile range [IQR] 51-70). Median MME prescribed at discharge was 112.5 (IQR 75-150); 83.9% of patients were prescribed co-analgesia. The prescriber was a trainee in 37.7% of cases. 15 patients (3.8%) required opioid renewal. On multivariate analysis, axillary procedure was associated with increased MME (ß=17, 95% CI 5.5-28 and ß=32, 95% CI 17-47, for sentinel node and axillary dissection, respectively). However, the factor with the greatest impact on MME was operating surgeon (ß=72, 95% CI 58-87). Residents prescribed less MME compared to attending surgeons (ß=11, 95% CI -22; -0.06). In a tertiary care center, the operating surgeon had the greatest influence on opioid prescribing practices, and trainees tended to prescribe less MME. These findings support the need for a standardized approach to optimize prescribing and reduce opioid-related harms after oncologic breast surgery.

Effects of free dance on the mood state, aging perspective and optimism of women undergoing breast cancer surgery: a randomised clinical trial

ABSTRACT Objective To analyse the effects of 12 weeks of free dance compared to the control group and the reference group without breast cancer, on the mood state, perspective of aging, and optimism of women submitted to breast cancer surgery. Methods This randomised clinical trial enrolled breast cancer women (a) free dance (IG n = 11) and (b) control group (CG n = 11); randomly, and compared the outcomes with (c) healthy group without breast cancer (RGWBC n = 12). The evaluated outcomes were mood state, aging perspective, and optimism. Results There was an intragroup improvement for IG in the mood state variables, in the mental confusion (p = 0.012) and tension (p = 0.005) domains and in the aging perspective variable in the loneliness domain (p = 0.031). In the RGWBC intragroup, there was an improvement in the perspective of aging in the loneliness domain (p = 0.021) and worsening in the happiness (p = 0.001) and integrity domains (p ≤ 0.001). There was a worsening in the tension domain (p = 0.004) of the mood state, in the RGWBC intergroup when compared to the IG. Conclusion Free dancing was positive in the mood (in mental confusion and tension) and in the perspective of aging (loneliness) of women undergoing breast cancer surgery. Clinical registry Brazilian Clinical Trials Registry (ReBEC) (n° 0RBR-772ktp).

FREE DANCE RANDOMIZED CLINICAL TRIAL FOR WOMEN UNDERGOING BREAST CANCER SURGERY

Objective: to analyze the effect of a free dance protocol (pre and post 12-week intervention) on depressive symptoms, body image and sexual function in women undergoing breast cancer surgery. Methods: a randomized clinical trial, composed of 24 women undergoing surgery after the diagnosis of breast cancer, who were randomized into two groups: Free dance Intervention Group and Control Group. The free dance group received the intervention twice a week, 60 minutes per session, for 12 weeks. The control group maintained their routine activities during the 12 weeks. All participants were evaluated before and after the 12 weeks of intervention. Outcomes evaluated were depressive symptoms (Beck Depression Questionnaire - BDI), body image (Body Image after Breast Cancer questionnaire) and sexual function (Female Sexual Function Index questionnaire). Results: Body image showed a significant intragroup difference in free dance in the vulnerability domain (p=0.031), significant intergroup difference in the limitation domain (p=0.045) and concern with the body (p=0.035). Sexual function showed a significant intragroup difference in free dance in the desired domain (p=0.031) and a significant intragroup difference in the control group in the lubrication domain (p=0.021), however in a negative way. No differences were found for depressive symptoms. Conclusions: The practice of free dancing showed a positive effect, even if small, on body image and a negative effect on sexual function in women undergoing breast cancer surgery.

Long-term Efficacy of Pectoserratus Plane Block for Prevention of Post-mastectomy Pain Syndrome: Extended Follow-up From a Randomised Controlled Trial.

Pectoserratus plane block (PSPB) leads to lower postoperative pain intensity. We examined whether PSPB could also reduce the incidence of post-mastectomy pain syndrome (PMPS) in women undergoing breast cancer surgery. We performed an extension study of a randomized trial that compared PSPB versus control in women undergoing mastectomy. The primary outcome was any chronic pain at the surgical site or adjacent areas, defined as persistent/recurrent pain lasting ≥3 months. Secondary outcomes included neuropathic pain (score ≥4 in the Douleur Neuropathique 4 questionnaire), use of analgesic/anti-inflammatory drugs, pain intensity via the short-form McGill Pain Questionnaire, and type, frequency and location of the pain. Of the 60 patients that completed the 24-hour follow-up (short-term trial), 53 (88%) completed the long-term follow-up (27 in the PSPB group and 26 in the placebo group). Six of 27 patients (22%) in the PSPB group and 17 of 26 patients (65%) in the placebo group reported any chronic pain (relative risk [RR], 0.34; 95% confidence interval [95% CI]=0.16-0.73, P=0.005). The risk of neuropathic pain was also lower in the PSPB group than in the placebo group (18.5% vs. 54%, respectively; RR, 0.34; 95% CI=0.14-0.82, P=0.02). There were no differences regarding all other pain-related outcomes considering the patients who developed PMPS. The results suggest that, in the long-term, PSPB-treated participants were associated with a statistically significantly lower risk of PMPS than those who received standard general anesthesia. ClinicalTrials.gov (NCT03966326).

Patient reported symptom burden amongst immigrant and Canadian long-term resident women undergoing breast cancer surgery.

Immigrants are susceptible to marginalization due to social isolation, economic disadvantage and systemic bias. Our goal was to compare symptom burden between immigrant and long-term resident women undergoing breast cancer surgery in Ontario, Canada. A population-level retrospective cohort-study using administrative databases was conducted. Women who underwent surgery for newly diagnosed breast cancer and were treated at regional cancer centers between 2010 and 2016 were included. The primary outcome was a moderate or severe (≥ 4) symptom score on the Edmonton Symptom Assessment System Scale (ESAS). There were 12,250 (87.2%) long-term Canadian residents and 1,806(12.8%) immigrants. Immigrants were younger (mean age 53 vs. 61years); had a higher proportion residing in a lowest income quintile neighbourhood (22.2% vs 15.4%); were less often on a primary-care physician roster (83.7% vs. 90.4%); and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p < 0.01). The proportion of women with scores ≥ 4 was significantly higher amongst immigrant women for 7/9 symptom categories; with the largest differences for depression (24.9% vs. 20.2%, p < 0.01) and pain (28.0% vs. 22.4%, p < 0.01). On multivariable regression analysis, immigration status was associated with scores ≥ 4 for pain (OR 1.13, 95% CI 1.02-1.23). There was an association between moderate/severe pain and region of origin, but not length of stay in Canada or immigration class. This is the first study comparing symptom burden amongst immigrant and non-immigrant women with breast cancer at a population-level. Immigrant women with breast cancer undergoing surgery were found to have a higher burden of pain.

Preliminary Qualitative Findings Of An EMG-Biofeedback Intervention For Women Undergoing Breast Cancer Surgery

Preliminary Qualitative Findings Of An EMG-Biofeedback Intervention For Women Undergoing Breast Cancer Surgery

Metal exposure and breast malignancy: A case-control study of Malwa Region of Punjab

Background: Breast cancer is triggered by uncontrollable breast cell development. These metals may build up in human serum and tissues, causing estrogenic/malignant consequences. Therefore, metals are being studied to investigate whether they enhance the risk of endocrine-related malignancies like breast cancer. Methods: This study assessed the level of metals such as Cd, As, Pb, Ni, Cr, Zn, and Fe in 120 women undergoing breast cancer surgery in the Malwa region of Punjab. Subjects having malignant breast lesions (n=83) were grouped in the cancer case group whereas subjects with benign breast lesions (n=37) were separated as a control group. From each case, blood, breast tumor, surrounding adipose tissue samples were obtained, and metal analysis was carried out using inductively coupled plasma mass spectrometry (ICP-MS). Results: In malignant cases, the amount of metals ranges from 0.04 to 139.18 µg/kg in tumor. Whereas in adipose tissues and blood, it ranges from 0.04 to 1164.0 µg/kg and from 0.02 to 276.61 µg/kg, respectively. In control group, the total amount ranges from 0.05 to 332.72 µg/kg in the tumor, from 0.13 to 125.61 µg/kg in adipose tissues, and from 0.01 to 121.76 µg/kg in the blood. The level of Cd, Cr, Zn, Fe, Ni, and Pb were observed to be statistically significant/extremely significant whereas Arsenic was detected in no groups. Conclusion: The results indicate that Cd, Cr, Zn, Fe, Ni, and Pb may play a significant role in the development of breast cancer. The parenchymal component of tumor tissues accumulates heavy metals at a higher rate.

Abstract P4-03-28: Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery

Abstract Background: Disparities in breast cancer outcomes are well documented, with a burgeoning body of literature shedding light on the influence of multiple factors. Much of the literature comes from the US, with the current situation in Canada less well understood. Canada’s universal health care system may mitigate some, but unlikely all differences. First generation immigrants compromise 21.9% of the Canadian population. Differences in breast cancer screening rates and stage at diagnosis have been demonstrated between immigrant and non-immigrant Canadian women. However, breast cancer outcomes in the Canadian immigrant population have not been well studied. Patient reported outcomes are one such set of outcomes and crucial in understanding the patient experience. The purpose of this study is to compare symptom burden and trajectories between immigrant and Canadian long-term resident women with breast cancer undergoing breast cancer surgery in Ontario. Methods: A population-level retrospective cohort-study using linked Ontario administrative databases was constructed. Women &amp;gt;18 years of age with newly diagnosed breast cancer between 2010-2016 undergoing surgery at a regional cancer center were included. Baseline variables including immigration status, age, stage, comorbidity and income quintile were collected. The proportion of patients reporting moderate/severe Edmonton Symptom Assessment System Scale (ESAS) scores for each of 9 individual symptom categories over time was collected. Multivariable logistic regression models using generalized estimating equations with exchangeable correlation structure to account for repeated measures were constructed to assess the probability of a moderate/severe score for each of the individual ESAS symptom categories. Results: The cohort included 14,056 women, of which 12,250 (87.2%) were categorized as long-term Canadian residents and 1,806 (12.8%) as immigrants. Immigrant women had a younger mean age of diagnosis (53 vs. 61 years), were more likely to reside in a lowest income quintile neighbourhood (22.2% vs 15.4%), were less likely to be on a primary care physician roster within the last 2 years (83.7% vs. 90.4%) and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p&amp;lt; 0.0001). The proportion of women reporting moderate/severe scores was significantly higher amongst immigrant women for 7/9 symptom categories (anxiety, depression, drowsiness, nausea, pain, shortness of breath and well-being) with the largest difference observed for depression (13.1% vs 10.8%, p&amp;lt; 0.0001) and pain (14.8% vs. 12.0%, p&amp;lt; 0.0001). Comparing symptom trajectories, differences between groups were most pronounced within the first 12 months, though for depression and pain, statistically significant differences also existed at 36 months. On multivariable regression analysis, immigration status was persistently associated with higher proportion of moderate/severe score for pain only (OR 1.12, 95% CI 1.02-1.23). Immigration status was associated with a protective effect for anxiety (OR 0.86, 95% CI 0.78-0.94), drowsiness (OR 0.81, 95% CI 0.73-0.89) and tiredness (OR 0.86, 95% CI 0.79-0.94). Conclusions: To our knowledge, this is the first study comparing symptom burden amongst immigrant and non-immigrant Canadian women with breast cancer at a population-level. Immigrant women undergoing breast cancer surgery were found to have a higher burden of symptoms across most categories, and for depression and pain this difference was found to persist even at 3-years. However, the higher burden of symptoms in many categories seemed to be explained by factors such as younger age and more advanced disease. Adjusting for other factors, immigrant women with breast cancer reported more pain, indicating a need for better symptom management in this population. Citation Format: Elena Parvez, Megan M. Chu, David Kirkwood, Aristithes Doumouras, Jessica Bogach. Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-28.

Abstract P4-07-10: Effect of acupuncture and exercise therapy on muscular strength, lymphedema and quality of life in breast cancer survivors: randomized clinical trial

Abstract Introduction: The continuous advance in the early detection and treatment of breast cancer has significantly reduced mortality and, consequently, increased the number of survivors with treatment side effects that act on the quality of life, such as lymphedema, loss of upper limb strength, shoulder dysfunction, decreased functional capacity, flexibility, and joint mobility. Exercise therapy is a recognized practice for the rehabilitation of these disorders; however, acupuncture needs to be better evaluated to compare its equivalence with classical therapy. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing strength, lymphedema and quality of life. Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement in upper limb muscle strength over time in all groups, except for abduction and internal rotation movements. During treatment, there was no increase in the number of patients with lymphedema and there was no statistical difference between the groups. Regarding the EORTC QLQ-C30 quality of life questionnaire, nine of the fifteen factors analyzed showed significant differences between sessions. The factors that did not have significant differences between the three groups were Social Function, Nausea and Vomiting, Dyspnea, Loss of Appetite, Constipation and Diarrhea. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in upper limb muscle strength, lymphedema and quality of life, proved to be effective, without difference between groups, which leads to the conclusion that acupuncture didn’t show superiority of results when compared with exercise therapy, thus being an effective approach for the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Samantha K. Lopes de Almeida Rizzi, Afonso Nazário, Simone Elias. Effect of acupuncture and exercise therapy on muscular strength, lymphedema and quality of life in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-10.

Abstract P4-07-43: Effect of acupuncture and exercise therapy in rehabilitation of physical disfunctions in breast cancer survivors: randomized clinical trial

Abstract Introduction: The treatment of breast cancer can trigger physical dysfunctions and psychological difficulties such as pain, depression, limitation of upper limb function and shoulder range of motion (ROM) deficits. Exercise therapy is a treatment well established in the literature for these disorders and another form of treatment is acupuncture. However, most studies using acupuncture only assess pain. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing pain, depression, upper limb function and range of motion parameters (ROM). Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper ® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement of pain over time in all groups (first session compared with the fifth (p &amp;lt; 0.001) and with the tenth (p &amp;lt; 0.001), but not between groups. There was a statistically significant difference in depressive symptoms using the Beck questionnaire over time in the three groups (between the first and tenth sessions (p = 0.001), between the first and fifth sessions (p = 0.052), but not between groups. Regarding the DASH questionnaire for shoulder function, there were significant differences overtime at all evaluated moments (p&amp;lt; 0.001), but not between groups. There was a statistically significant difference in ROM over time in the three groups, but not between groups. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in pain, depression, upper limb function and ROM, proved to be effective, without statistically difference between the groups, which in leads to the conclusion that acupuncture don’t showed the superiority of results when compared with exercise therapy, thus being an effective approach in the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Afonso Nazário, Samantha K. Lopes de Almeida Rizzi, Simone Elias. Effect of acupuncture and exercise therapy in rehabilitation of physical disfunctions in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-43.

Reliability and Validity of the Malay BREAST-Q in Women Undergoing Breast Cancer Surgery in Malaysia.

This study aims to translate the BREAST-Q into Malay and validate it in breast cancer patients undergoing surgery. The English BREAST-Q was translated to Malay using the back-translation method. A total of 144 newly diagnosed breast cancer patients were sampled conveniently between December 2015 and November 2016. Test-retest was done after two to three weeks. Data were analyzed using SPSS and AMOS software. Content experts agreed the items in the Malay BREAST-Q were measuring the constructs appropriately. Internal consistencies were good for all items in each subscale (Cronbach's alpha = 0.83-0.95). The highest inter-item correlation for each item with at least one other item in the construct ranged from 0.47 to 0.90. The lowest corrected item-total correlation values ranged from 0.47 to 0.72. The test-retest analysis showed good reproducibility (intraclass correlation coefficient = 0.71-0.98). In exploratory factor analysis, the Kaiser-Meyer-Olkin values were excellent in all four subscales (0.76, 0.92, 0.91, and 0.86). For all subscales, the number of factors extracted cumulatively explained more than 50% of the variance. The Malay BREAST-Q demonstrated good reliability, face validity, content validity, and construct validity.

D-Dimers Variability in the Perioperative Period of Breast Cancer Surgery Helps to Predict Cancer Relapse: A Single-Centre Prospective Study.

The importance of D-dimers (DD) assessment in the diagnostic algorithm of venous thromboembolic (VTE) disease is well known. Increase of DD concentration may be also associated with neoplastic disease. Many studies documented that high concentration of DD before solid tumour surgery indicates more advanced disease and poor life expectancy. The prognostic value of the DD concentration variability in the perioperative period, in women undergoing breast cancer surgery, has not been analysed so far. Thus, the aim of the present prospective study was to assess whether the trend of DD concentration changes in the perioperative period may predict cancer recurrence in women undergoing breast cancer surgery. 189 consecutive women with histopathological diagnosis of breast cancer (BC) referred for surgical treatment were included. DD concentration was measured twice in each patient: at the time of admission to hospital and at the time of discharge home. Enoxaparin in standard dose of 40mg daily s. c. was used as primary VTE prophylaxis in all of the patients. The recurrence of BC, within 1year observation time, occurred in 13 patients (6.8%), in 11 (5.8%) patients with DD increase after surgery and only in 2 (1.1%) without an increase in DD, P = .0179. Increase in DD concentration after BC surgery was an independent positive predictor of disease relapse (OR 8.600, LCI 1.451, UCI 96.80, P = .0371) together with the lack of postoperative radiotherapy (OR 6.009, LCI 1.305, UCI 31.95, P = .0245), whereas the lack of postoperative chemotherapy predicted no BC relapse (OR .07355, LCI .0056, UCI .58, P = .0245). Increase of DD in the early postoperative period may be considered as additional independent predictor of recurrence of BC within 1 year.

Acute and subacute postsurgical pain in women with breast cancer: incidence and associations with biopsychosocial predictors—a secondary analysis of a randomized controlled trial

Women who undergo breast cancer surgery risk suffering from postsurgical pain long after their surgery. Still, research on postsurgical pain in the subacute phase has been neglected. This study aims to investigate the incidence, intensity, unpleasantness, and presurgical predictors of acute and subacute postsurgical pain after breast cancer surgery. The study used an observational design through secondary analyses of the control group in a randomized controlled trial. Data from 102 women undergoing breast cancer surgery were included. Levels of acute and subacute pain intensity and unpleasantness were measured using 100 mm Visual Analogue Scales on the day of surgery and 4 weeks postsurgery. Linear regression analyses were performed to identify presurgical biopsychosocial predictors of acute and subacute postsurgical pain. Average levels of postsurgical pain intensity and unpleasantness were as follows: 22.7 mm for acute pain intensity, 19.0 mm for acute pain unpleasantness, 10.3 mm for subacute pain intensity, and 11.7 mm for subacute pain unpleasantness. Pain expectancy predicted acute pain intensity (R2 = 0.04, p = 0.047) and acute unpleasantness (R2 = 0.06, p = 0.02). Perceived social support inversely predicted acute pain unpleasantness (R2 = 0.04, p = 0.014). Mild and moderate acute pain intensity and unpleasantness are common after breast cancer surgery, whereas levels of subacute pain intensity and unpleasantness are low. Pain expectancy predicts acute postsurgical pain intensity and unpleasantness, whereas expected social support inversely predicts acute postsurgical pain unpleasantness.

A Comparison of Skin Staining after Sentinel Lymph Node Biopsy in Women Undergoing Breast Cancer Surgery Using Blue Dye and Superparamagnetic Iron Oxide Nanoparticle (SPIO) Tracers.

Superparamagnetic iron oxide nanoparticles (SPIO) are a tracer for sentinel lymph node (SLN) detection. In a preplanned secondary analysis of a prospective clinical trial (SentiDose) we reported on skin staining after SPIO and blue dye (BD) injections. For SPIO, either a 1.5 mL retroareolar injection on the day of surgery or a 1.0 mL peritumoral/retroareolar injection 1-7 days before surgery was given. A 1.0 mL sub-/intradermal periareolar injection of BD was also administered to all these women. Staining was then assessed at 6, 12 and 24 months after surgery. A total of 270 women received SPIO and were operated on with breast-conserving surgery. Of these, 204 women also received BD. A total of 58 (21.5%) women had an SPIO stain 6 months postoperatively with a median size of 6.8 cm2 (p = 0.56), while 51 (25.0%) had a BD stain with a median size of 8.5 cm2 (p = 0.93). The incidence and size of SPIO and BD staining decreased over time reciprocally. At 24 months, the incidence and median size of SPIO was 23 (8.6%) and 4 cm2, respectively. For BD, the incidence was 14 (6.3%, p = 0.13), and the median size was 3.5 cm2 (p = 0.18). There was, therefore, no statistically significant difference in the incidence or size of skin staining between SPIO and BD over time.

Regional anesthesia for breast cancer surgery: which block is best? A review of the current literature.

Breast cancer is the most common type of cancer worldwide. Fortunately, continual advances in diagnosis and treatment are resulting in increased survival rates. Earlier detection and treatment, to include surgical resection, can greatly improve patientsoutcomes. However, due to the complex innervation of the breast, management of postoperative pain has proven difficult in the past. Approximately, half of all women who undergo breast cancer surgery report postoperative pain syndrome. The paravertebral blockhas long been the anesthesiologist's choice for mitigating pain during and after the procedure. Newer techniques such as the pectoral nerve blockand erector spinae plane block may prove to have some additional benefits. This literature review compares the risks, benefitsand specific uses of these three regional nerve blocks in women undergoing breast cancer surgery. It aims to better inform anesthesiologistswhen they are choosing which technique is best for their patients.

Polymorphisms in Cytokine Receptor and Regulator Genes are Associated with Levels of Exercise in Women Prior to Breast Cancer Surgery.

Background: Little is known about the genetic characteristics associated with exercise in women undergoing breast cancer surgery. Purpose: In a sample of women who were evaluated prior to breast cancer surgery (n = 310), we evaluated for differences in demographic and clinical characteristics between patients who did and did not exercise on a regular basis and evaluated for associations between polymorphisms in genes for pro- and anti-inflammatory cytokines, their receptors, and their transcriptional regulators. Methods: Patients completed an investigator-developed exercise questionnaire. Based on the recommended level of exercise (≥150 minutes/week), survivors were classified into no exercise (NoEx), less exercise (LessEx), or recommended exercise (RecEx) groups. Candidate gene analyses were done to identify relationships between polymorphisms and exercise group membership (i.e., NoEx vs. RecEx). Only 23.5% of the total sample met the recommendations for regular exercise. Results: Compared to the RecEx group (n = 78), patients in the NoEx group (n = 120) had less education; were less likely to report being White or Asia/Pacific Islander; more likely to report a lower household income; had a higher body mass index (BMI), had a poorer functional status; had a higher comorbidity burden; were more likely to self-report high blood pressure; and were more likely to have received neoadjuvant chemotherapy. Polymorphisms in IFNGR1 and NFKB1 were associated with membership in the NoEx group. Conclusions: While they warrant replication, our findings suggest that variations in cytokine-related genes may play a role in exercise behavior, and that clinicians need to assess for barriers to regular exercise and educate patients on its benefits.