Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis

Sleep quality and overall survival among cancer survivors in the Netherlands: A PROFILES registry study

BACKGROUND

This study aimed to determine whether: 1) sleep quality was associated with overall survival (OS) among a heterogeneous sample of cancer survivors; 2) this association differed per cancer diagnosis; 3) aspects of sleep quality (e.g., sleep latency, daytime dysfunction) were associated with OS among a subsample of colorectal cancer (CRC) survivors; and 4) adjustment for depressive symptoms changed these associations.

METHODS

Several cohorts from the population-based PROFILES registry, including adult cancer survivors diagnosed between 1990 and 2014 with 11 cancer diagnoses, were used. Data on sleep quality (3 categories: no, non-clinically, and clinically important sleep quality impairment) was collected through the insomnia scale of the EORTC QLQ-C30 and the PSQI for CRC survivors only (n = 1245). Clinical data were obtained through the Netherlands Cancer Registry. Cox regression analysis was used to assess adjusted hazard ratios (HRs).

RESULTS

7195 participants were included, of which 36 % died (median follow-up since inclusion, 9 years). Clinically impaired sleep quality was associated with lower OS (HR, 1.17[1.05; 1.30]) compared to no sleep problems. Stratification by cancer diagnosis suggested a consistent pattern. After adjusting for depressive symptoms, sleep quality was no longer significantly associated with OS (HR, 1.10[0.97; 1.24]). Daytime dysfunction and long sleep duration were significantly associated with lower OS in CRC survivors, also after adjustment for depressive symptoms.

CONCLUSION

Cancer patients reporting clinically low sleep quality had a lower OS. However, this might be partly explained by patients' depressive symptoms. In CRC survivors, daytime dysfunction and long sleep duration were, independent of depressive symptoms, related to lower OS.

ENABLE-App-Based Digital Capture and Intervention of Patient-Reported Quality of Life, Adverse Events, and Treatment Satisfaction in Breast Cancer: Protocol for a Randomized Controlled Trial

BACKGROUND

In recent years, breast cancer treatment has taken the path toward personalized medicine. Based on individual tumor biology, therapy tailored to the particular subtype of cancer is increasingly being used. The aim here is to find the most suitable therapy for the disease. However, the success of therapy depends to a large extent on the patient's adherence to treatment. This, in turn, depends on how the therapy is tolerated and how the treatment team cares for the patient. Patient-centered care seeks to identify and address the individual needs of each patient and to find the best form of care for that person.

OBJECTIVE

In order to improve comprehensive oncological care of patients with breast cancer, the ENABLE trial digitally recorded the health-related quality of life (HRQoL), adverse events (AEs), and patient satisfaction using a mobile smartphone app. The trial provided individualized responses to reported AEs and offered assistance. Additionally, it assessed the impact of a patient-reported outcome-based intervention across various therapy settings.

METHODS

Patients with breast cancer were eligible to participate in the study before neoadjuvant, adjuvant, postneoadjuvant, or palliative systemic therapy against breast cancer was initiated at the Heidelberg, Mannheim, and Tuebingen, Germany, university hospitals. After 1:1 randomization into an intervention and a control group, HRQoL assessments were performed at six fixed time points during the therapy using validated questionnaires. In the intervention group, HRQoL was also assessed briefly every week using a visual analog scale (EQ-VAS). In cases of significant deterioration, therapy-associated side effects were assessed in a graduated manner, recommendations were sent to the patient, and the treatment team was informed. Additionally, the app served as an "eHealth companion" for education, training, and organizational support during therapy.

RESULTS

Recruitment started in March 2021; follow-up was completed in February 2024. In total, 606 patients were enrolled, and 592 patients participated in the study. Enrollment was completed in September 2023, and the last visit was in February 2024. The first results are expected to be published in Q2 2025.

CONCLUSIONS

Participation in the intervention group is expected to improve treatment satisfaction, adherence, detection, and timely treatment of critical AEs. The close-meshed, weekly, brief HRQoL assessment will also be tested as a screening tool to detect relevant side effects during therapy. The study offers a more objective HRQoL assessment across treatment strategies.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00025611; https://drks.de/search/en/trial/DRKS00025611.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/69855.

Implementing a nurse-enabled, integrated, shared-care model involving specialists and general practitioners in early breast cancer post-treatment follow-up (EMINENT): a single-centre, open-label, phase 2, parallel-group, pilot, randomised, controlled trial

Background

Current models of post-treatment cancer care rely heavily on hospital-based, medical specialists and do not sufficiently leverage primary care. Many breast cancer survivors face ongoing unmet needs that may benefit from a multidisciplinary, shared-care approach. We aimed to evaluate the feasibility and preliminary effectiveness of implementing nurse-enabled, shared-follow-up care between the acute and primary care setting for early-stage breast cancer.

Methods

In this single-centre, open-label, phase II, pilot, randomised, controlled trial, individuals diagnosed with breast cancer (Stage 0-III) were randomised 1:1 to either usual care or intervention, which includes a 1) Specialist Nurse Consultation to co-develop a survivorship care plan (SCP), 2) Pharmacist Consultation, 3) Case Conference with General Practitioner (GP), and 4) shared follow-up care arrangements. Feasibility and effectiveness outcome measures, including health-related quality of life (primary outcome), physical activity and nutrition, patient experience, and financial toxicity were collected at baseline, and at 3-, 6-, and 12-months, with health service utilisation data at 24-months. Bivariate and multivariable, intention-to-treat analyses were conducted. This trial is registered at Anzctr.org.au (ACTRN12619001594112).

Findings

From 3rd December 2019 to 13th April 2021, 61 participants were randomised (intervention n = 29; usual care n = 32); mean age 62.9 standard deviation (SD) = 10.9 years. The intervention was feasible with 100% completion rates across all elements of the specialist nurse consultation and GP case conference. Evaluation of the 28 SCPs indicated the top three goals were exercise (n = 23), diet (n = 12) and mental well-being (n = 11). All care goals can be supported by GPs. No differences were observed between groups for health-related quality of life and the other effectiveness outcomes measures listed above at all timepoints (P > 0.05 for all). There were significantly fewer average post-treatment radiation oncology appointments per patient in the intervention group compared to the control group (0.69 versus 1.27, P = 0.013) at 24-months. Number of unplanned hospital presentations at 24-months were low across both intervention (n = 7) and control (n = 4) groups.

Interpretation

Nurse-enabled, shared-care arrangements for women with early-stage breast cancer is feasible, and is as safe as specialist-led model of care. It may provide a more sustainable model of care in a longer term. GPs can meet the survivorship care needs identified breast cancer survivors. This trial can inform a large, pragmatic, hybrid effectiveness-implementation trial.

Funding

Metro South Health Research Support Scheme Project Grant.

Experiences of rehabilitation one year after breast cancer diagnosis-A focus group study from the ReScreen randomized controlled trial

BACKGROUND

Treatment for breast cancer poses major challenges and leads to a variety of side-effects and problems that affect life for a long time. Experiences and symptoms vary, and research indicates a lack of structures for ensuring individualized rehabilitation. This qualitative focus group study aims to explore the experience of women with BC after participating in a complex randomized controlled trial (RCT) (Clinicaltrials.gov NCT03434717) focusing on cancer rehabilitation from a comprehensive perspective.

METHOD

Nine semi-structured focus group interviews with women (n = 30) who participated in the Rescreen RCT were conducted. The women were interviewed divided into three RCT groups (intervention, control, or observation group). Data were initially analyzed inductively using conventional content analysis, followed by a deductive approach, guided by the result from the inductive analysis.

RESULTS

The inductive analysis resulted in two categories and four sub-categories and showed a great variation in experiences and needs. Some women described a well-functioning process, while others described lack of individualized information, continuity with healthcare providers, and clear pathways for support. After the deductive analysis, a variation between the groups appeared. Women in the intervention group expressed that a proactive and individualized approach facilitated rehabilitation and they experienced a feeling of being recognized as a person, which they highlighted as important. On the contrary, women from the control group described feelings of being abandoned from healthcare, hindering rehabilitation. The observation group expressed that their needs had been fulfilled within the healthcare system.

CONCLUSIONS

This study adds important knowledge to the evaluation of the ReScreen model and contributes to existing research on how individualized rehabilitation after breast cancer can be applied in clinical practice. A proactive, person-centered approach in rehabilitation, aimed at those with extended needs, would potentially optimize rehabilitation and facilitate the recovery process after breast cancer treatment.

Survivorship concerns among posttreatment cancer survivors in South Korea: A secondary analysis of a cross-sectional survey

BACKGROUND

Cancer survivors may have a variety of survivorship concerns despite their cancer treatment having ended, with some negatively affecting their health-related quality of life. An in-depth understanding of survivorship concerns is essential for the development of survivorship care programs. However, previous findings have been limited to Western countries, and evidence from Asian countries is lacking.

OBJECTIVE

This study aimed to examine the prevalence of survivorship concerns among posttreatment cancer survivors in South Korea, identify factors associated with survivorship concerns, and explore their relationship with health-related quality of life.

DESIGN

Secondary analysis of a cross-sectional survey.

SETTING

Data were collected through an online survey of five online communities of cancer survivors in South Korea.

PARTICIPANTS

Overall, 1019 cancer survivors diagnosed with breast, colorectal, lung, stomach, and thyroid cancer (top five cancers in South Korea) who completed their cancer treatment.

METHODS

The survey collected data on demographic, disease- and treatment-related characteristics, survivorship concerns, and health-related quality of life. Survivorship concerns were measured using the checklist for survivorship concerns from the National Comprehensive Cancer Network Guidelines for Cancer Survivorship, which includes 12 survivorship concerns (e.g. cardiac toxicity, distress, cognitive dysfunction, fatigue, lymphoedema). Health-related quality of life was assessed using the Korean version of the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire. Data were analysed using descriptive statistics, the Chi-square test, and multiple regression.

RESULTS

The prevalence of survivorship concerns ranged from 34.7 % to 78.4 %. Fatigue (78.4 %), unhealthy lifestyle (74.8 %), cognitive dysfunction (60.5 %), insomnia (58.9 %), and distress (52.9 %) were the five most frequent concerns. Survivors aged in their 50s, those diagnosed with stomach cancer, those with an elapsed time of ≥2 years but <5 years since diagnosis, and those who had received chemotherapy and/or radiotherapy were significantly more likely to report survivorship concerns. Regression analyses revealed that all survivorship concerns were significant predictors of one or more subscales of health-related quality of life. Distress was found to be a significant predictor of all six subscales of the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire.

CONCLUSIONS

This study revealed that posttreatment cancer survivors in South Korea had various survivorship concerns that decreased their health-related quality of life. To improve their health-related quality of life, systematic screening of survivorship concerns and timely appropriate interventions are critical. Our findings can thus contribute to the development of targeted survivorship care programs in Asia.

STUDY REGISTRATION

Not registered.

Demographic and clinical impact on preoperative BREAST-Q ePROM completion and baseline outcomes in women undergoing breast cancer surgery: a quantitative descriptive study at a Danish university hospital

OBJECTIVES

This study aimed to investigate patients' use of electronic Patient-Reported Outcome Measures (ePROMs) and understand the demographic and clinical factors that may be correlated with patient responses to the BREAST-Q at the preoperative stage of breast cancer. The BREAST-Q is a PROM in questionnaire format, developed and validated to assess satisfaction and quality of life for breast surgery patients.The hypothesis tested is that considering disparities in geography, age and education among responders is essential for capturing a diverse patient population in future Patent-Reported Outcome Measures initiatives, examining how these characteristics are associated with Patent-Reported Outcome Measures utilisation and outcomes.

DESIGN

Quantitative descriptive study.

SETTING

Electronic Patient-Reported Outcome Measures were collected between 6 September 2021 and 5 September 2022 from patients recruited from an outpatient clinic at a Plastic- and Breast Surgery Department at a University Hospital in Denmark.

PARTICIPANTS

Participants include a total of 629 Danish-speaking women diagnosed with breast cancer and scheduled for breast cancer surgery, with a final participation rate of 468.

INTERVENTION

Preoperative ePROMs and demographic data were collected between September 2020 and 2021 through patients' secure national digital post-box.

MAIN OUTCOME MEASURES

Demographic variables of both responders and non-responders were assessed using t-tests, Mann-Whitney U tests and χ2 tests. Linear regression models were employed to determine the demographic variables associated with BREAST-Q subscale scores.

RESULTS

The response rate for ePROMs was 72.5% with a median age of responders at 62 years. Older patients reported lower breast satisfaction (unadjusted coefficient bu=-0.26 (95% CI -0.44; -0.07), p=0.006) but better physical well-being (adjusted coefficient ba=0.23 (0.08; 0.37), p<0.001). Lower educational achievement was correlated with reduced breast satisfaction and psychosocial and sexual well-being; for example, patients with a master's/doctoral level education scored 14.29 points higher in psychosocial well-being (95% CI 6.50; 22.07, p<0.001) compared with those with lower secondary education. Cohabiting patients reported psychosocial well-being scores approximately four points higher than those living alone (ba=3.91 (0.06; 7.75), p=0.046). Body mass index (BMI) was negatively associated with sexual well-being, with a 0.75-point decline per additional BMI point (ba=-0.75, (-1.12; -0.37), p<0.001).

CONCLUSIONS

The present study demonstrates a positive attitude towards completing BREAST-Q as ePROMs among women diagnosed with breast cancer in the investigated region in Denmark. However, completion rates for ePROMs varied by demographic factors such as age, marital status and access to healthcare. Younger, more educated, married patients with lower BMI who lived near major cities were more likely to report better pretreatment outcomes.

Long-term behavioral symptom clusters among survivors of early-stage breast cancer: Development and validation of a predictive model

BACKGROUND

Fatigue, cognitive impairment, anxiety, depression, and sleep disturbance are cancer-related behavioral symptoms that may persist years after early-stage breast cancer, affecting quality of life. We aimed to generate a predictive model of long-term cancer-related behavioral symptoms clusters among breast cancer survivors 4 years after diagnosis.

METHODS

Patients with early-stage breast cancer were included from the CANcer TOxicity trial (ClinicalTrials.gov identifier NCT01993498). Our outcome was the proportion of patients reporting cancer-related behavioral symptoms clusters 4 years after diagnosis (≥3 severe symptoms). Predictors, including clinical, behavioral, and treatment-related characteristics; Behavioral Symptoms Score (BSS; 1 point per severe cancer-related behavioral symptom at diagnosis); and a proinflammatory cytokine (interleukin 1b; interleukin 6; tumor necrosis factor α) genetic risk score were tested using multivariable logistic regression, implementing bootstrapped augmented backwards elimination. A 2-sided P less than .05 defined statistical significance.

RESULTS

In the development cohort (n = 3555), 642 patients (19.1%) reported a cluster of cancer-related behavioral symptoms at diagnosis, and 755 (21.2%) did so 4 years after diagnosis. Younger age (adjusted odds ratio for 1-year decrement = 1.012, 95% confidence interval [CI] = 1.003 to 1.020), previous psychiatric disorders (adjusted odds ratio vs no = 1.27, 95% CI = 1.01 to 1.60), and BSS (adjusted odds ratio ranged from 2.17 [95% CI = 1.66 to 2.85] for BSS = 1 vs 0 to 12.3 [95% CI = 7.33 to 20.87] for BSS = 5 vs 0) were predictors of reporting a cluster of cancer-related behavioral symptoms (area under the curve = 0.73, 95% CI = 0.71 to 0.75). Genetic risk score was not predictive of these symptoms. Results were confirmed in the validation cohort (n = 1533).

CONCLUSION

Younger patients with previous psychiatric disorders and higher baseline symptom burden have greater risk of long-term clusters of cancer-related behavioral symptoms. Our model might be implemented in clinical pathways to improve management and test the effectiveness of risk-mitigation interventions among breast cancer survivors.

Adapting and validating the satisfaction, alertness, timing, efficiency, and duration-breast cancer (SATED-BC) scale for measuring sleep health in Spanish women treated for breast cancer

BACKGROUND

After breast cancer (BC), women may face other severe symptoms such as sleep problems. The use of simple, fast, and reliable scales is necessary in the clinic to improve patient benefits, and sleep is an important aspect to be addressed.

OBJECTIVE

This study was conducted to adapt and validate the Spanish version of the satisfaction, alertness, timing, efficiency, and duration (SATED) scale for measuring sleep health in women who have completed treatment for BC in Spain (SATED-BC).

DESIGN

Cross-sectional study.

METHODS

The adaptation process involved adding a sixth item to the SATED-BC scale: "the impact of symptoms experienced after completing breast cancer treatment on sleep" item was not considered for scoring. The SATED-BC score ranged from 0 (poorest sleep health) to 10 (best sleep health). A validation analysis was performed using the Pittsburgh Sleep Quality Index, the Consensus Sleep Diary, and actigraphy, and the results were compared with those obtained using the SATED-BC scale.

RESULTS

The SATED-BC scale was reliable in terms of its internal consistency (Cronbach's α = 0.70; McDonald's ω = 0.72), showed high intrasubject reliability (r = 0.90), and was shown to be valid for use in women who have completed treatment for breast cancer.

CONCLUSION

The SATED-BC scale is a reliable and valid tool for comprehensively evaluating sleep health in women who have completed treatment for breast cancer.

Quality of life in long-term breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes study

PURPOSE

In Sub-Saharan Africa (SSA), breast cancer survivors' (BCS) quality of life (QoL) remains understudied. We compared QoL in BCS to cancer-free (CF) women across SSA settings with different levels of development, healthcare systems, ethnic compositions, and HIV prevalence.

METHODS

In 2022-2023, all 5 + year BCS from the African Breast Cancer-Disparities in Outcomes study and age-matched CF women from the community setting answered the WHOQOL-BREF questionnaire in Namibia, Nigeria, and Uganda. For each WHOQOL-BREF domain and general item, we estimated BCS-CF adjusted mean differences (AMD) in scores in absolute percentage points (p.p.).

RESULTS

Overall, 862 women (BCS 357 vs. CF 505) (mean age ± SD, 57.5 ± 12.5 vs. 55.1 ± 11.2; tertiary education, 30% vs. 20%) were included. BCS reported higher/better overall QoL (AMD (95% CI) 10.65 p.p. (7.56, 13.74), i.e., ~ 40% of a change in QoL category), general health (5.84 (2.71, 8.98)), psychological (3.46 (1.43, 5.49)), social relationships (3.94 (1.25, 6.63)), and environment scores (4.27 (1.88, 6.67)) than CF women. There was no BCS-CF difference for physical health in all settings (1.52 (- 0.82, 3.87)), psychological health in Namibian Black women (0.58 (- 2.90, 4.06)), and social relationships in Nigeria (- 0.33 (- 5.81, 5.14)). BCS reported both lower energy and sexual life satisfaction than CF women.

CONCLUSIONS

In SSA, long-term BCS have slightly better QoL than CF women except for physical health. Areas for which BCS scored lower or similar than CF women may indicate BCS' QoL issues.

IMPLICATIONS FOR CANCER SURVIVORS

BCS-only studies using cancer-specific QoL questionnaires are needed to better characterize BCS' QoL in SSA.

Improve the management of cancer-related cognitive impairment in clinical settings: a European Delphi study

PURPOSE

Cancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers.

METHODS

Twenty-two recommendations were developed based on a literature review and authors' clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3.

RESULTS

Eighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted.

CONCLUSIONS

This survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI.

IMPLICATIONS FOR CANCER SURVIVORS

These recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients' quality of life.

The complexity of needs and roles of family members during breast cancer rehabilitation: a qualitative study

BACKGROUND

Family members play a crucial role in supporting women with breast cancer during their recovery. In the complex situation of being an informal caregiver, their own health and ability to support the patient needs to be acknowledged. The aim was to explore the experiences, needs and roles of family members throughout the rehabilitation process of women with breast cancer.

METHODS

A qualitative study was conducted, involving semi-structured individual telephone interviews with 20 purposefully selected family members of women with breast cancer (13 men aged 24-79 years, 7 women aged 19-76 years). Data analysis utilized conventional content analysis and used "casing" as the analysis technique. The study is part of the ReScreen randomized controlled trial and all participants gave informed consent.

RESULTS

The interviews revealed significant variation among family members, leading to the emergence of different typologies based on their reactions and specific preconditions. These typologies included: 1) The case of the assertive and confident team leader, 2) The case of the frustrated but persistent guardian, 3) The case of the reassured bystander, and 4) The case of the neglected outsider. While not mutually exclusive, the cases demonstrated clear similarities and differences in whether individuals felt secure or insecure in the rehabilitation process and their level of involvement in this process. Some described feelings of being involved and active in the process while others experienced not being involved and described feelings of abandonment. However, regardless of their role, family members reported that their own health was seldom considered by healthcare professionals.

CONCLUSIONS

This study sheds light on the concept of "we-disease," where the role of a family member is interrelated with factors such as their health literacy, supporting role, level of involvement, relationship, and identity during the patient's rehabilitation process. This highlights significant divergence in whether family members perceive the rehabilitation process as a collaborative effort or an individual challenge. These perceptions greatly impact their own well-being and ability to support women with breast cancer, underscoring the importance of recognizing family members as informal caregivers and offering tailored support from healthcare professionals when needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03434717. Registered February 15, 2018.

A bio-behavioral model of systemic inflammation at breast cancer diagnosis and fatigue of clinical importance 2 years later

BACKGROUND

We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance 2 years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation.

PATIENTS AND METHODS

Women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance [European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 ≥40/100] 2 years after diagnosis (year 2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers [interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon γ, IL-1 receptor antagonist, tumor necrosis factor-α, and C-reactive protein], and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling.

RESULTS

Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year 2. High pre-treatment levels of IL-6 (quartile 4 versus 1) were associated with global CRF at year 2 [adjusted odds ratio (aOR): 2.06 (95% confidence interval [CI] 1.40-3.03); P = 0.0002; area under the receiver operating characteristic curve = 0.74]. Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese [62.4%; mean body mass index 28.0 (standard deviation 6.3 kg/m2)] and physically inactive (53.5% did not meet World Health Organization recommendations). Clinical and behavioral associations with CRF at year 2 included pre-treatment CRF [aOR versus no pre-treatment CRF: 3.99 (95% CI 2.81-5.66)], younger age [aOR per 1-year decrement: 1.02 (95% CI 1.01-1.03)], current tobacco smoking [aOR versus never: 1.81 (95% CI 1.26-2.58)], and worse insomnia or pain [aOR per 10-unit increment: 1.08 (95% CI 1.04-1.13), and 1.12 (95% CI 1.04-1.21), respectively]. Secondary analyses indicated additional associations of IL-2 [aOR per log-unit increment: 1.32 (95% CI 1.03-1.70)] and IL-10 [0.73 (95% CI 0.57-0.93)] with global CRF and of C-reactive protein [1.42 (95% CI 1.13-1.78)] with cognitive CRF at year 2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF.

CONCLUSIONS

This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance 2 years later among a large prospective sample of survivors of breast cancer.

The use of mindfulness-based stress reduction (MBSR) for breast cancer patients-meta-analysis

BACKGROUND

Mindfulness-based stress reduction (MBSR) intervention has been widely used to reduce the burden of symptoms in cancer patients, and its effectiveness has been proven. However, the effectiveness of MBSR on depression, anxiety, fatigue, quality of life (QOL), posttraumatic growth (PTG), fear of cancer recurrence (FCR), pain, and sleep in breast cancer patients has not yet been determined. This study aims to determine the role of mindfulness-based stress reduction therapy in patients with breast cancer.

OBJECTIVES

The objective was to systematically review the literature to explore the effect of MBSR on anxiety, depression, QOL, PTG, fatigue, FCR, pain, stress and sleep in breast cancer patients. To explore the effect of 8-week versus 6-week MBSR on the 9 indicators. Data were extracted from the original RCT study at the end of the intervention and three months after baseline to explore whether the effects of the intervention were sustained.

METHODS

We conducted searches on PubMed, Web of Science, Embase, and China National Knowledge Infrastructure from inception to November 2023. Eligible studies included randomized controlled trials of breast cancer patients who received mindfulness stress reduction intervention, reporting outcomes for anxiety, depression, fatigue, QOL, PTG, FCR, pain, stress, and sleep. Two researchers conducted separate reviews of the abstract and full text, extracted data, and independently evaluated the risk of bias using the Cochrane 'Bias Risk Assessment tool'. The meta-analysis utilized Review Manager 5.4 to conduct the study, and the effect size was determined using the standardized mean difference and its corresponding 95% confidence interval.

RESULTS

The final analysis included 15 studies with a total of 1937 patients. At the end of the intervention, the interventions with a duration of eight weeks led to a significant reduction in anxiety [SMD=-0.60, 95% CI (-0.78, -0.43), P < 0.00001, I2 = 31%], depression [SMD=-0.39, 95% CI (-0.59, -0.19), P = 0.0001, I2 = 55%], and QOL [542 participants, SMD = 0.54, 95% CI (0.30, 0.79), P < 0.0001, I2 = 49%], whereas no statistically significant effects were found in the intervention with a duration of six weeks. Similarly, in 3 months after baseline, the interventions with a duration of eight weeks led to a significant reduction in depression and QOL, however, no statistically significant effects were found at the 6-week intervention. MBSR led to a significant improvement in PTG at end of intervention [MD = 6.25, 95% CI (4.26, 8.25), P < 0.00001, I2 = 0%] and PTG 3 months after baseline. We found that MBSR reduced the fatigue status at end of intervention, but had no significant effect on fatigue status 3 months after baseline. There was no significant difference in improving pain, stress, and FCR compared to usual care.

CONCLUSIONS

In terms of effects on QOL, anxiety, depression, and fatigue, the 8-week MBSR intervention showed better results than the 6-week MBSR intervention. The intervention of MBSR on PTG was effective, and the effect lasted until 3 months after baseline. Future studies could further identify the most effective intervention components in MBSR.

TRIAL REGISTRATION

PROSPERO registration number: CRD42023483980.

Impact of pain on functional status and quality of life in Jordanian women with breast cancer

BACKGROUND

Currently, breast cancer is the most prevalent type of cancer affecting women, and the number of newly diagnosed cases continues to increase both in Jordan and globally. Upon receiving a cancer diagnosis, the suffering experienced by patients intensifies as they grapple with the debilitating side effects that hinder their ability to carry out routine activities.

PURPOSE

This study aims to assess the impact of cancer pain on functional status and quality of life (QOL) among Jordanian women with breast cancer.

METHODS

A descriptive cross-sectional design and structured interviews were conducted in the Oncology Unit at Al-Bashir Hospital with a sample of 150 eligible Jordanian women with breast cancer who provided data on pain and functional status, and QOL using four Arabic questionnaires (brief pain inventory, functional status SF-12 questionnaire, and quality of life index) to measure pain and functional status and QOL, descriptive statistics, Pearson correlation, and regression statistical test were utilized to analyze the study data.

RESULTS

A Significant positive correlation (r = 0.342) was found between cancer pain and functional status interference, a significant negative correlation (r = -0.134) between quality of life and functional status interference, and a significant negative correlation (r = -0.211) between pain and quality of life. Patients with higher intensity of cancer pain are more likely to experience low functional status and poor QOL.

CONCLUSION

Breast cancer patients experience alterations in their quality of life as a result of cancer-related pain, which has a detrimental impact on their ability to carry out daily activities and disrupts their functional abilities. Healthcare providers must take these alterations into account and effectively handle them. Understanding the relationship between cancer pain and breast cancer can aid nurses in managing symptoms and providing holistic care, ultimately improving the quality of life.

Psychoeducational Intervention for Pain, Psychological Distress, Hope, and Post-traumatic Growth Among Breast Cancer Patients During Chemotherapy: A Pilot Randomized Controlled Trial

BACKGROUND

Chemotherapy is associated with many side effects, including pain and psychological distress, which affect patients' physical and psychological health.

AIM

The aim of this study was to elucidate the efficacy of a pain management intervention (POLA) to promote pain, psychological distress, hope and post-traumatic growth in breast cancer patients, also, to undertake a preliminary evaluation of the intervention.

METHODS

A pilot randomized controlled trial was conducted in an Iranian hospital involving 42 breast cancer (BC) patients during chemotherapy. The intervention group received a 6-week group therapy (90 minutes per session) administered by a psychologist. Meanwhile, the comparison group received standard care. patients' Pain, psychological distress, hope and post-traumatic growth were measured at 3 time points (baseline, week 6, and 12 weeks postintervention).

RESULTS

The study design was found to be feasible, with a recruitment rate of 61.64% and an attrition rate of 6.66%. Compared to the control group, the intervention group showed a significant reduction in pain, psychological distress, depression, anxiety, and stress, as well as a notable improvement in hope and post-traumatic growth (p < .01). These differences remained significant at follow-up (p < 0.05). The study population found the intervention acceptable, as evidenced by a high attendance rate of 90% and adherence rate of 90.47%.

CONCLUSION

Psychoeducational intervention positively affects the pain, psychological distress, hope and post-traumatic growth of BC patients during chemotherapy.

The effect of time since reconstruction on breast cancer patients' quality of life, self-esteem, shame, guilt, and pride

OBJECTIVES

The aim of this study was to investigate the impact of breast reconstruction time (immediate/at a later time) on women's quality of life, self-esteem, feelings of guilt, and shame. In addition, the study aimed to investigate the association between time till reconstruction in women with later reconstruction on these parameters.

METHODS

Data collection for the study was conducted from a sample of 150 women with breast cancer who had undergone reconstruction. Breast-Q, Rosenberg Self-Esteem Scale, and State Shame and Guilt Scale questionnaires were used to study the above variables.

RESULTS

Immediate reconstruction was associated with higher psychosocial and sexual well-being scores (p = 0.014 and 0.016, respectively). No other quality of life parameters, neither self-esteem, nor feelings of guilt, shame, and pride, were associated with having a mastectomy and reconstruction at the same time or not. Furthermore, for women who did not have immediate reconstruction, the time elapsed until reconstruction was not associated with quality of life, self-esteem, feelings of guilt, shame, and pride.

SIGNIFICANCE OF RESULTS

This study highlights the importance of simultaneous mastectomy and breast reconstruction, as it is associated with higher psychosocial and sexual quality of life. Therefore, simultaneous breast reconstruction is imperative to be provided by health systems.

Effect of Tele-exercise Interventions on Quality of Life in Cancer Patients: A Meta-analysis

PURPOSE

To evaluate the impacts of tele-exercise intervention with cancer patients' quality of life, taking into account the influence of the duration of tele-exercise intervention, type of intervention, and gender of cancer patients on quality of life.

METHODS

The PubMed (MEDLINE), Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO databases were searched from inception to August 21, 2023. The Cochrane Collaboration's risk of bias tool 2 was utilized to estimate the risk of bias, and the Grading of Recommendations, Assessment. For statistical analyses, R Studio was employed.

RESULTS

This meta-analysis contained eight trials. When compared to controls, tele-exercise interventions (SMD = 0.41, 95% CI: 0.12 to 0.70, p < .010; I2 = 54%, p = .030) have a positive influence on boosting the quality of life within cancer patients. Subgroup analyses demonstrated the greater effectiveness of tele-exercise in enhancing the quality of life of cancer patients when the duration was greater than or equal to 10 weeks. Furthermore, tele-exercise was found to have a stronger advantageous effect on quality of life among female cancer. In addition, among the types of interventions for tele-exercise, neither web-based nor telephone-based formats significantly enhanced quality of life among cancer patients.

CONCLUSION

Tele-exercise interventions are a cost-effective and feasible non-pharmacologic complementary way to promote cancer patients' quality of life. Additional large-sample, carefully designed randomized controlled trials are warranted to further validate the impact of tele-exercise concerning cancer patients' quality of life.

REGISTRATION NUMBER

CRD42023477147.

Health-Related Quality of Life and Associated Comorbidities in Community-Dwelling Women with Breast Cancer

Objective: With advancements in treatment, the increasing number of women with breast cancer has led to a growing focus on enhancing their well-being by understanding health-related quality of life (HRQoL). This study aimed to investigate the association between comorbidities and HRQoL in middle-aged and older community-dwelling Korean women with breast cancer. Methods: Data from the Sixth, Seventh, and Eighth Korea National Health and Nutrition Examination Surveys between 2014 and 2020 were used to analyze 12,218 women aged ≥50 years (244 women with breast cancer vs. 11,974 women without breast cancer). HRQoL was assessed using the EQ-5D-3L tool and the EQ-5D index. Associations between comorbidities (arthritis, depression, hypertension, diabetes, and cardiovascular disease) and HRQoL were examined. Results: Among women with breast cancer, arthritis was associated with problems in mobility (OR, 3.24; 95% CI, 1.39-7.53) and pain/discomfort (OR, 7.30; 95% CI, 3.62-14.73). Depression was associated with problems in self-care (OR, 7.02; 95% CI, 1.97-25.01), usual activities (OR, 5.73; 95% CI, 1.52-21.59), pain/discomfort (OR, 5.58; 95% CI, 1.49-20.87), and anxiety/depression (OR, 3.81; 95% CI, 1.14-12.72). Arthritis and depression were also considerably associated with overall HRQoL, as measured by the EQ-5D index. Hypertension, diabetes, and cardiovascular disease were not independently associated with HRQoL. Conclusions: Arthritis and depression were markedly associated with HRQoL in middle-aged and older women in the community who suffer from breast cancer. Public health interventions that focus on managing these comorbidities can enhance the well-being of women with breast cancer.

Effects of web-based interventions on quality of life among patients with breast cancer: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Patients with breast cancer experience decreased quality of life due to various physical and psychological challenges. Web-based interventions are accessible, cost-effective, and convenient for improving their quality of life. This study evaluated whether web-based interventions improve quality of life and included only randomized controlled trials (RCTs) with clear evidence.

METHODS

PubMed, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO were searched for articles published until October 16, 2023. Inclusion criteria were RCTs evaluating the effect of web-based interventions on quality of life in patients with breast cancer. The risk of bias was assessed with Cochrane's Risk of Bias Tool 2.0. Standardized mean differences were calculated with a random effects model using R version 4.0.3, and subgroup and moderator analyses were performed.

RESULTS

Since quality of life was measured using two different instruments in two studies, 21 comparisons were analyzed from 19 RCTs. As a result, the findings suggest that web-based interventions have a small effect size on improving the quality of life for patients with breast cancer (SMD = 0.27, 95% confidence intervals [CIs]: 0.15-0.38, p = 0.03). Heterogeneity was found to be low (I2 = 40%). The quality-of-life subdomain results showed a moderate effect size on the physical functioning and a small effect size on the cognitive and emotional functioning of patients with breast cancer but no significant impact on their role or social functioning.

CONCLUSIONS

Web-based interventions are effective in improving patients' quality of life with breast cancer; they also improve physical, cognitive, and emotional functioning. However, evidence regarding intervention methods remains inconclusive due to the limited number of RCTs, necessitating further research.

Resilience's impact on quality of life and post-traumatic growth in breast cancer patients during treatment

BACKGROUND

This article aims to examine how psychological resilience influences the interplay between quality of life and post-traumatic growth among breast cancer patients receiving follow-up care and treatment in Türkiye.

METHODS

The study involved 119 female individuals diagnosed with breast cancer who visited the Oncology outpatient clinic at a state hospital in Türkiye from January to September 2023. Data were gathered through the administration of a survey form and the utilization of several assessment tools, including the Adult Life Quality Scale in Cancer Survivors (QLACS), the Brief Resilience Scale (BRS), and the Post-traumatic Growth Inventory (PTGI). Data analysis was carried out using SPSS 25 software.

RESULTS

The participants demonstrated an inverse correlation between Post-Traumatic Growth (PTG) and two QLACS sub-dimensions, namely recurrence and family concern. Conversely, a positive association was identified between PTG and the advantages of dealing with cancer. Furthermore, a statistically significant positive association was established between BRS and all QLACS sub-dimensions, except for family concern and appearance. However, it was determined that psychological resilience did not act as a moderator in the relationship between PTG and QLACS.

CONCLUSION

It is important to enhance psychological resilience in women who have survived cancer at all stages of the cancer journey, including the years after treatment, to have a positive impact on post-traumatic growth and quality of life.

Digital Self-Management Intervention Paths for Early Breast Cancer Patients: Results of a Pilot Study

Background

Despite excellent prognosis of early breast cancer, the patients face problems related to decreased quality of life and mental health. There is a need for easily available interventions targeting modifiable factors related to these problems. The aim of this study was to test the use of a new digital supportive intervention platform for early breast cancer patients. Material and Methods. Ninety-seven early breast cancer patients answered questions on wellbeing, exercise, and sociodemographic factors before systemic adjuvant treatment at the Helsinki University Hospital. Based on these answers and predictive algorithms for anxiety and depression, they were guided onto one or several digital intervention paths. Patients under 56 years of age were guided onto a nutrition path, those who exercised less than the current guideline recommendations onto an exercise path, and those at risk of mental health deterioration onto an empowerment path. Information on compliance was collected at 3 months on the amount of exercise and quality of life using EORTC-C30 scale, anxiety and depression using HADS scale at baseline and 12 months, and log-in information at 3 and 12 months.

Results

Thirty-two patients followed the empowerment path, 43 the nutrition path, and 75 the exercise path. On a scale of 1-5, most of the participants (mean = 3.4; SD 0.815) found the interventions helpful and would have recommended testing and supportive interventions to their peers (mean = 3.70; SD 0.961). During the 10-week intervention period, the mean number of log-ins to the empowerment path was 3.69 (SD = 4.24); the nutrition path, 4.32 (SD = 2.891); and the exercise path, 8.33 (SD = 6.293). The higher number of log-ins to the empowerment (rho = 0.531, P=0.008, and n = 24) and exercise paths (rho = 0.330, P=0.01, and n = 59) was related to better global quality of life at one year. The number of log-ins correlated to the weekly amount of exercise in the exercise path (cc 0.740, P value <0.001, and n = 20).

Conclusion

Patients' attitudes towards the interventions were positive, but they used them far less than was recommended. A randomized trial would be needed to test the effect of interventions on patients' QoL and mental health.

Comparative effect of different mindfulness-based intervention types and deliveries on depression in patients with breast cancer: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Breast cancer has become the most common cancer worldwide. Various types of mindfulness-based interventions (e.g., mindfulness-based cognitive therapy, mindfulness-based stress reduction) have been conducted in different delivery methods (including face to face and internet delivered) to help patients with breast cancer mitigate their depression. However, at present, there are no studies that compare the effectiveness of all these types and deliveries of mindfulness-based interventions. Therefore, this protocol aims to conduct a systematic review and network meta-analysis to assess the effectiveness of various types and deliveries of mindfulness-based interventions in mitigating depression in patients with breast cancer.

METHODS

This protocol is according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, including PubMed, Web of Science, the Cochrane Library, Embase, Google Scholar, The China National Knowledge Infrastructure and OpenGrey, will be comprehensively retrieved for related randomised controlled trials (RCTs) from inception to December 2023. Two reviewers will independently assess the risk of bias using the Cochrane Risk of Bias Tool for Randomised Trials 2.0 (RoB 2.0). The network meta-analysis will be performed using the STATA V.16.0, and the assessment of heterogeneity, inconsistency, publication bias, evidence quality, subgroup analyses and sensitivity analyses will be conducted.

ETHICS AND DISSEMINATION

This protocol does not require approval from an ethics committee as it is based on previous research findings. The results will be disseminated via peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42024495996.

You can't spell distress without stress: Expanding our perspective of the intersection between mental and physical health in cancer survivors

Although many breast cancer survivors adjust to cancer treatment and survivorship, a sizable subgroup of women do not do so, resulting in psychological distress. Over time, this psychological distress can contribute to immune dysfunction and accompanying worsened physical symptoms as women navigate survivorship. Dr. Kiecolt-Glaser's work and mentorship has been integral to our understanding of breast cancer survivors' immune risks, and how behavioral factors may enhance these risks. As a postdoctoral fellow in the Stress and Health Lab, under Dr. Kiecolt-Glaser's mentorship, my research focused on understanding how distress is associated with immune functioning and physical health in breast cancer survivors. In this paper, we highlight Dr. Kiecolt-Glaser's influence on our careers as a strong female research and mentor, the work completed under her mentorship, and how the field of psychoneuroimmunology can continue to expand her research to better understand how distress in the cancer context confers long-term health risks.

Latent profile analysis for assessing symptom clusters in women with breast cancer

PURPOSE

To identify symptom clusters among breast cancer survivors and investigate differences in health-related quality of life (HRQoL) and distress based on these discerned symptom clusters using latent profile analysis.

METHODS

We enrolled 655 adult breast cancer survivors aged 19 years and older, registered with the Cancer Survivor Integrated Supportive Center from May 2020 to July 2022. The study measured five symptoms-pain, fatigue, insomnia, anxiety, and depression-using a Visual Analogue Scale ranging from 0 to 10 points. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer, with scores ranging from 0 to 10 points. HRQoL was determined using the EuroQol-5 Dimension questionnaire. Data analysis was conducted using the Jamovi and Mplus 8.8 software programs.

RESULTS

The Cluster with Few Symptoms (46.8%) was the most common, whereas the Psychological Cluster with a very high degree of depression and anxiety accounted for 20.0%, and the Moderate symptom cluster with symptoms of 3 or more points accounted for 14.4%. Distress scores were relatively high in the Psychological Cluster and the Pain-Fatigue-Insomnia Cluster, and were lowest in the Cluster with Few Symptoms (F = 103.92, p < 0.001). HRQoL scores were highest in the Cluster with Few Symptoms and lowest in the Pain-Fatigue-Insomnia Cluster (F = 177.62, p < 0.001).

CONCLUSIONS

Approximately half of breast cancer survivors who had completed the major treatment experienced persistent high symptoms such as depression and anxiety or pain, fatigue, and insomnia.

IMPLICATIONS FOR CANCER SURVIVORS

These findings provide foundational data for developing tailored intervention strategies and programs based on symptom experiences.

Five-year follow-up of the OptiTrain trial on concurrent resistance and high-intensity interval training during chemotherapy for patients with breast cancer

The protocol predefined aim of this study is to assess sustained effects of the OptiTrain trial on several health outcomes, 5 years after the baseline assessment. The OptiTrain study was a prospective, randomised controlled trial with 240 patients with breast cancer undergoing adjuvant chemotherapy that compared the effects of 16 weeks of two exercise programs, RT-HIIT and AT-HIIT, with usual care (UC). After a 5-year follow-up, eligible participants were evaluated for the primary outcome of cancer-related fatigue (CRF) and secondary outcomes including quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, physical activity, and sedentary behavior. Statistical analysis was conducted using linear mixed models adjusted for baseline values. Tumour profile and menopausal status were additionally adjusted for CRF. Mean differences (MD), 95% confidence intervals (CIs), and standardized effect sizes (ES) were reported. At the 5-year follow-up, there were no statistically significant differences in total CRF between the intervention groups and the UC group. RT-HIIT reported significantly reduced pain sensitivity at the gluteus MD = 79.00 (95% CI 10.17, 147.83, ES = 0.55) compared to UC. Clinically meaningful differences for an increase in cognitive CRF and cardiorespiratory fitness were observed for the AT-HIIT versus UC group, and for lower limb strength for the RT-HIIT versus UC group, albeit without statistical significance. Engaging in targeted exercise during adjuvant chemotherapy for breast cancer provides short-term benefits in reducing fatigue and maintaining physical function. However, our 5-year follow-up indicates that these effects are limited in the long term. This underscores the need to support breast cancer survivors maintain their PA levels throughout their survivorship journey.

Primary Care Provider Visits Among Cancer Survivors 5-7 Years Postdiagnosis

PURPOSE

Cancer survivors experience better outcomes when primary care providers (PCPs) are engaged in their care. Nearly all survivors have a PCP engaged in their care in the initial 5 years postdiagnosis, but little is known about sustained PCP engagement. We assessed PCP engagement in survivors' care 5-7 years postdiagnosis and characterized survivors most vulnerable to loss to PCP follow-up.

METHODS

We linked electronic health record ambulatory care and cancer registry data from an National Cancer Institute-Designated Comprehensive Cancer Center to identify eligible survivors (≥18 years; diagnosed with breast, colorectal, or uterine cancer; had an in-network PCP). We used multiple logistic regression to assess associations between survivor demographics, clinical factors, and health care utilization and odds of sustained PCP engagement.

RESULTS

In 5-7 years postdiagnosis, PCPs were engaged in care for 43% of survivors. Survivors with sustained PCP-engagement were on average 4.6 years older than those without (P < .0001); survivors had 1.36 greater odds of having regular PCP visits for each decade increase in age on cancer diagnosis (P = .0030). Survivors were less likely to be lost to PCP follow-up if diagnosed at an earlier stage with odds at 0.57 and 0.10 for stage I and stage IV, respectively (P = .0005), and had 2.70 greater odds of engagement in care with at least one oncology visit annually 5-7 years postdiagnosis (P < .0001).

CONCLUSION

Sustained PCP engagement is endorsed as critical by survivors, PCPs, and oncologists. We found most survivors were lost to PCP follow-up 5-7 years postdiagnosis. Our study is among the first to contribute empirical evidence of survivors being lost in transition. Findings from this study demonstrate the need to bridge gaps in long-term care for cancer survivors.

Who uses connected health technologies after a cancer diagnosis? evidence from the US Health Information National Trends Survey

PURPOSE

As the number of people living with and beyond cancer increases, connected health technologies offer promise to enhance access to care and support, while reducing costs. However, uptake of connected health technologies may vary depending on sociodemographic and health-related variables. This study aimed to investigate demographic and health predictors of connected health technology use among people living with and beyond cancer.

METHODS

Cross-sectional data from the US Health Information National Trends Survey Version 5 Cycle 4 (H5c4) was used. Regression analysis was used to examine associations between sociodemographic factors and the use of connected health technologies. The sample was restricted to individuals who self-reported a cancer diagnosis or history of cancer.

RESULTS

In this cycle, 626 respondents self-reported a cancer diagnosis, with 41.1% using connected health technologies (health and wellness apps and/or wearable devices). Most were female (58.9%) and white (82.5%); 43.4% had graduated college or higher education. One third (33.6%) had a household income of $75,000 or more. Respondents who were younger, have higher education, were living as married, had higher incomes, had higher self-rated health and had higher health-related self-efficacy were significantly more likely to use connected health technologies. There were no significant associations between gender, race, stratum, time since diagnosis, history of anxiety or depression, and use of connected health technologies among people living with and beyond cancer.

CONCLUSIONS

Connected health technology use among people living with and beyond cancer is associated with sociodemographic factors. Future research should examine these demographic disparities as the use of connected health technologies in healthcare continues to gather momentum.

IMPLICATIONS FOR CANCER SURVIVORS

The study underscores a disparity in connected heath technology usage among people living with and beyond cancer. There is a pressing need for research into adoption barriers and interventions to ensure equitable digital healthcare integration among this population, especially with the heightened adoption of technology post COVID-19 pandemic.

Information and communication priorities of patients and healthcare professionals in shared decision making regarding adjuvant systemic breast cancer treatment: A survey study

PURPOSE

To assess information and communication priorities of patients and healthcare professionals in Shared Decision Making about adjuvant systemic treatment of primary breast cancer and identify key decision-relevant information accordingly.

METHODS

Patients (N = 122) and professionals working with breast cancer patients (N = 118), of whom 38 were nurse practitioners and 32 nurses, were recruited using convenience sampling, and surveyed about information/communication aspects key to decision-making, using ranking assignments. We further posed a simple open question, questions about receiving population-based statistics versus personalized statistics concerning treatment outcomes, and their attitude and experience concerning Shared Decision Making. Data were analyzed using descriptive analysis and a qualitative analysis.

RESULTS

Both patients and professionals prioritized information about treatment outcomes (i.e., survival, recurrence) as key decision-relevant information for patients. Patients prioritized information about relatively severe treatment side-effects and late effects (e.g., blood clot, stroke), whilst professionals prioritized information about effects that occur relatively often (e.g., hair loss, fatigue). Patients specifically wanted to know if the benefit of treatment is worth the negative impact. Both groups prioritized personalized statistics over population-based statistics.

CONCLUSIONS

Some differences between patients and professionals were found in information and communication priorities, specifically related to the different side-effects. It seems worthwhile to precisely address these side-effects in Shared Decision Making concerning adjuvant systemic treatment. Furthermore, it seems important to deliberate together on the question if expected benefit of treatment is worth the potential negative impact for the individual patient.

Chronic pain after breast surgery: incidence, risk factors and impact on quality of life

INTRODUCTION AND OBJECTIVES

Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL).

MATERIALS AND METHODS

Six-month observational prospective study conducted in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module.

RESULTS

A total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, and almost all with potentially neuropathic pain. CPBS interfered with patients' daily life and reduced their QoL. Diabetes (p = 0.028), catastrophizing (p = 0.042), and acute postoperative pain severity (p < 0.001) were associated with CPBS.

CONCLUSIONS

This study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information.

Patients' Perceptions and Attitudes to the Use of Artificial Intelligence in Breast Cancer Diagnosis: A Narrative Review

Breast cancer remains the most prevalent cancer among women worldwide, necessitating advancements in diagnostic methods. The integration of artificial intelligence (AI) into mammography has shown promise in enhancing diagnostic accuracy. However, understanding patient perspectives, particularly considering the psychological impact of breast cancer diagnoses, is crucial. This narrative review synthesizes literature from 2000 to 2023 to examine breast cancer patients' attitudes towards AI in breast imaging, focusing on trust, acceptance, and demographic influences on these views. Methodologically, we employed a systematic literature search across databases such as PubMed, Embase, Medline, and Scopus, selecting studies that provided insights into patients' perceptions of AI in diagnostics. Our review included a sample of seven key studies after rigorous screening, reflecting varied patient trust and acceptance levels towards AI. Overall, we found a clear preference among patients for AI to augment rather than replace the diagnostic process, emphasizing the necessity of radiologists' expertise in conjunction with AI to enhance decision-making accuracy. This paper highlights the importance of aligning AI implementation in clinical settings with patient needs and expectations, emphasizing the need for human interaction in healthcare. Our findings advocate for a model where AI augments the diagnostic process, underlining the necessity for educational efforts to mitigate concerns and enhance patient trust in AI-enhanced diagnostics.

Psychosocial experiences of breast cancer survivors: a meta-review

PURPOSE

Advances in breast cancer care have led to a high rate of survivorship. This meta-review (systematic review of reviews) assesses and synthesises the voluminous qualitative survivorship evidence-base, providing a comprehensive overview of the main themes regarding breast cancer survivorship experiences, and areas requiring further investigation.

METHODS

Sixteen breast cancer reviews identified by a previous mixed cancer survivorship meta-review were included, with additional reviews published between 1998 and 2020, and primary papers published after the last comprehensive systematic review between 2018 and 2020, identified via database searches (MEDLINE, Embase, CINAHL, PsycINFO). Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and the CASP (Critical Appraisal Skills Programme Qualitative) checklist for primary studies. A meta-ethnographic approach was used to synthesise data.

RESULTS

Of 1673 review titles retrieved, 9 additional reviews were eligible (25 reviews included in total). Additionally, 76 individual papers were eligible from 2273 unique papers. Reviews and studies commonly focused on specific survivorship groups (including those from ethnic minorities, younger/older, or with metastatic/advanced disease), and topics (including return to work). Eight themes emerged: (1) Ongoing impact and search for normalcy, (2) Uncertainty, (3) Identity: Loss and change, (4) Isolation and being misunderstood, (5) Posttraumatic growth, (6) Return to work, (7) Quality of care, and (8) Support needs and coping strategies.

CONCLUSIONS

Breast cancer survivors continue to face challenges and require interventions to address these.

IMPLICATIONS FOR CANCER SURVIVORS

Breast cancer survivors may need to prepare for ongoing psychosocial challenges in survivorship and proactively seek support to overcome these.

Quality-of-life among women with breast cancer: application of the international classification of functioning, disability and health model

Background

This study aimed to identify the factors that influence Breast Cancer (BC) women's quality of life (QoL) based on the International Classification of Functioning, Disability and Health (ICF) framework.

Method

A cross-sectional study was conducted among 188 women with BC. The dependent variable, QoL, was measured using the Quality of Life Index (QLI-c). The independent variables were measured using the following Arabic-validated questionnaires: Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ).

Results

There was a significant positive correlation between monthly income (r = 0.17, p = 0.016) and QoL, and significant negative correlation between the stage of disease (r = -0.221, p = 0.002) and duration of first diagnosis (r = -0.280, p = 0.004) with QoL. Poor sleep quality, sexual dysfunction, fatigue, depression, and anxiety had significant negative correlations with QoL (p < 0.01). Multiple regression analysis revealed that among the various factors that might affect QoL, sexual dysfunction, poor sleep quality, depression, and anxiety were significant predictors of QoL (p ≤ 0.05).

Conclusion

The ICF provided an excellent framework to explore the factors influencing QoL among women with BC. This study has given evidence for the relationship of demographic, clinical, and body functional factors with QoL among women with BC. Interestingly, sexual dysfunction, poor sleep quality, depression, and anxiety factors are predictors of QoL. Awareness of these factors that predict QoL will guide healthcare professionals to improve the health and QoL of BC women.

Relationship between fear of progression and symptom burden, disease factors and social/family factors in patients with stage-IV breast cancer in Shandong, China

OBJECTIVE

To assess fear of progression (FoP)'s relationship with symptom burden and disease and social/family factors, as well as, determine the status of FoP in women with stage-IV breast cancer in Shandong, China.

METHODS

Two hundred and sixteen women were recruited from the department of breast cancer internal medicine, Shandong Cancer Hospital and Institute. Data for this observational study were collected between October 2020 and January 2021 using the MD Anderson Symptom Inventory, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and a participant information scale. SPSS 23.0 was used for statistical analysis.

RESULTS

After excluding invalid responses, the data of 200 participants were analysed. The average total FoP-Q-SF score was 29.39 ± 9.39 (95% confidence interval, 21.81-27.64). The FoP level among the participants was relatively low. For disease and social/family factors, FoP statistically significantly differed by satisfaction with family emotional support and the Eastern Cooperative Oncology Group (ECOG) score. The ECOG score was positively correlated with FoP. Furthermore, symptom burden was positively correlated with FoP.

CONCLUSIONS

Among patients with stage-IV breast cancer, satisfaction with family emotional support, ECOG score and symptom burden play key roles in FoP. Interventions, including providing appropriate emotional support from family, improving physical fitness and relieving symptom burden, must be considered in future studies, which may improve patients' overall physical and mental status and provide a supportive therapeutic environment.

Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority

PURPOSE

This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors.

METHODS

Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score.

RESULTS

One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z =  - 15.939, P < 0.001) and EQ-VAS scores (Z =  - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z =  - 1.610, P = 0.107), but the difference was not statistically significant.

CONCLUSION

Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.

Post-traumatic growth in cancer survivors: What is its extent and what are important determinants?

Background/Objective

The aim was to investigate the extent and longitudinal determinants of post-traumatic growth (PTG) in cancer survivors.

Methods

A sample of 1316 cancer survivors with various cancer types was examined using the EORTC QLQ-FA12 to assess fatigue, the EORTC QLQ-C30 pain items to assess pain and the Patient Health Questionnaire (PHQ-4) to assess emotional distress two years after diagnosis (t0). Additionally, patients rated how well they felt informed about fatigue at t0. PTG was assessed with the 21-item PTG-Inventory four years after diagnosis (t1) comprising the five subdimensions appreciation of life, relation to others, personal strengths, new possibilities and spiritual change.

Results

Regarding the extent of PTG, most positive developments were experienced in the PTG subdimension appreciation of life whereas the subdimension spiritual change was the least pronounced domain. Fatigue, pain and emotional distress were longitudinal but non-linear predictors of long-term PTG. Additionally, poor informedness about fatigue was associated with less PTG.

Conclusions

PTG can be perceived even years after a traumatic cancer event and is longitudinally associated with common cancer side effects like fatigue, emotional distress and pain. Further research into the role of individuals' informedness contributing to PTG is needed.

Taking their wellbeing into their own hands: Self-educated and peer-recommended techniques used by women with breast cancer to improve sexual functioning during treatment and in survivorship

OBJECTIVE

Coping with sexual dysfunction during and after breast cancer treatment is a persistent challenge for many women, even with clinician-offered standard sexual rehabilitative therapies (i.e., lubricants, counseling). This study sought to explore how women with breast cancer supplement clinician recommendations with self-discovered and peer-recommended techniques for improving sexual functioning and provide insight into how well they work.

METHODS

Adult women with stage I-IV breast cancer were recruited to participate in a one-time online survey via Breastcancer.org. Thematic analysis identified emergent domains and themes focused on techniques for improving sexual function during and after treatment. Frequencies were calculated to quantify technique sources and perceived efficacy levels.

RESULTS

Of 501 women responding to the survey, mean age was 53 years (range 30-79). Overall, 34.7% reported using a technique they discovered themselves or that was recommended by someone other than a clinician to improve sexual functioning. Four main themes regarding techniques included: 1) pain reduction, 2) intimacy and relationship enhancement, 3) desire and arousal enhancement, and 4) emotional coping. Most women discovered coping techniques without the help of clinicians, and 45.7% of women rated their techniques as moderately or more effective when used in addition to or instead of standard techniques offered by clinicians.

CONCLUSIONS

Our study provides insight into how women with breast cancer successfully cope with sexual dysfunction symptoms during and after treatment. To fully understand and share patients' innovative techniques for coping with these symptoms, clinicians should foster open discussion about the potential for dysfuction and treatment for these symptoms, as well as avenues of peer-supported discussion to promote coping self-education and discovery.

Self-Management Strategy Clustering, Quality of Life, and Health Status in Cancer Patients Considering Cancer Stages

BACKGROUND

In the cancer-care continuum, self-management can help cancer patients regardless of their treatment plan or cancer stage. However, research examining self-management strategy clusters considering cancer stages is lacking. Thus, we examined self-management strategy clusters considering cancer stages and the effects of self-management strategy clusters on quality of life (QoL) and overall health status.

METHOD

A total of 256 patients who completed both baseline and second surveys for a 6-month period ultimately participated in this prospective cohort study. To identify the interrelationship between self-management strategies measured by the Smart management strategies for health assessment tool (SAT), we conducted cluster analysis using a principal component analysis in varimax rotation and the k-mean clustering method. We also performed multivariate-adjusted analyses in QoL and overall health status comparisons by dividing the cancer stage into early (I, II) and advanced (III, IV).

RESULTS

All patients experienced two domains of self-management strategies concurrently. However, self-management strategy clusters differed by cancer stage, and the effect of self-management strategy clusters on quality of life and overall health status also differed. Self-management strategy clusters effectively improved the quality of life and overall health status of the entire cohort of patients, even in patients with advanced-stage cancer.

CONCLUSION

This study revealed that the pattern of using self-management strategies might differ by cancer stage. The strategy cluster positively affected QoL and overall health status in cancer patients. Identifying the self-management clusters of cancer patients with different cancer stages may have clinical implications for supporting their health management.

Hair cortisol concentration associates with insomnia and stress symptoms in breast cancer survivors

Stress, depressive symptoms and sleep quality are important and modifiable determinant of health and their association with hair cortisol concentrations (HCC) in breast cancer survivors has not been evaluated. We selected a random sample of 65 participants (mean age 57.9 years old, range 44-75 years) recruited from local patients' associations of breast cancer survivors. Each provided a hair sample at enrollment and basic clinical data and psychological evaluation regarding self-perceived stress (PSS-scale), depressive (GDS scale) and insomnia symptoms (Athens scale). We observed a direct and significant (p = 0.001) association between HCC and stress-levels. Depressive symptoms associated significantly (p < 0.01) with stress levels but not with HCC. There were also a significant and direct correlation between hair cortisol concentration and totals core of insomnia symptoms (p = 0.002), and the subdimension of sleep difficulty symptoms (p = 0.002), and with daytime sleepiness symptoms (p = 0.016). Further investigations into the association between stress and insomnia and changes in HCC in breast cancer survivors are warranted in order to validate this biomarker for diagnosis of psychological alterations and to tailor the effects of interventions aimed to reduced stress and improve sleep quality in these women.

Exploring the Unmet Supportive Care Needs of Breast Cancer Survivors Experiencing Psychological Distress: Qualitative Study

OBJECTIVES

This study aimed to explore the unmet supportive care needs of breast cancer survivors who experience psychological distress.

DATA SOURCES

A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 18 Turkish breast cancer survivors who experienced psychological distress. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study.

CONCLUSION

Three key themes emerged from data analysis: sources of psychological distress, unmet supportive care needs, and barriers to support. The survivors who experienced psychological distress defined a variety of unmet supportive care needs, in the areas of information support, psychological/emotional support, social support, and individualized health care support. They also described personal and health professional-related factors as barriers.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should assess psychosocial well-being and supportive care needs of breast cancer survivors. Survivors should be supported to discuss their experiences of symptoms in the early survival phase, and they should be referred to an appropriate supportive care resource. A multidisciplinary survivorship services model is needed to offer posttreatment psychological support routinely in Turkey. Early, effective psychological care integrated into follow-up services for survivors can be protective against psychological morbidity.

Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review

BACKGROUND

Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed.

OBJECTIVE

The aim of this review was to provide an overview of breast cancer-specific, mobile app-driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being.

METHODS

A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app-driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool.

RESULTS

A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41%) delivered an app-only intervention, and 10 (59%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65%) focused on survivorship. The majority of the studies (14/17, 82%) observed some positive effects on QOL or well-being measures.

CONCLUSIONS

The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors.

Telehealth Utilization Among Occupational Therapists in Oncology: Results From a National Survey

While the COVID-19 pandemic introduced wide expansion of telehealth access in health care, evidence concerning telehealth use in occupational therapy (OT) for cancer survivors remains limited. The objective of this study was to identify the prevalence and perceptions of telehealth services among occupational therapy practitioners (OTPs) in oncology. Descriptive statistics and qualitative content analysis were used to analyze data from a pre-pandemic national survey of OTPs (n = 126) focusing on telehealth. Most OTPs in oncology settings support telehealth use, despite a dearth of access prior to the pandemic. The highest levels of telehealth endorsement among OTPs related to ease of accessibility (48%). Treatments rated as best suited for OT oncology telehealth sessions included education (41%), quality of life/well-being/lifestyle (21%), and psychosocial interventions (19%). These data suggest widespread benefits of telehealth-delivered OT treatment in oncology. Advocacy is needed to ensure the continuation of legislation allowing expanded telehealth access and reimbursement for OT.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Natural patterns of social support for physical activity participation in newly matched breast cancer survivor dyads

BACKGROUND

Physical activity (PA) can be a beneficial strategy to mitigate physical, emotional, and social-related challenges in women living beyond breast cancer treatment (WBC). However, PA levels among WBC remain low. Optimizing social support provided in a peer-matched setting may increase PA behavior. Unfortunately, factors that lead to an ideal peer-match among WBC are not well understood. The purpose of this study was to contextualize the natural social support environment and PA behavior in newly formed peer WBC dyads participating in an ecological momentary assessment study.

METHODS

WBC were matched with a partner and provided with a Fitbit activity tracker. Social support was measured using 21-daily surveys, and a 3-week follow-up survey. Descriptive statistics were calculated. Open-ended survey questions were analyzed using content analysis. Data were analyzed based on (i) social support types (informational, tangible, esteem, and emotional support); and (ii) WBC' reports of being in a good, neutral, or poor match at the end of the study.

RESULTS

Women (n = 46; Mage = 42.4 ± 7.6 years; 89.2% stage I-III breast cancer) connected with their partner (58.1%) and participated in moderate-vigorous PA (MVPA)(77.1%) on most days over the 21-day study period. Women were identified as being in good (63%), neutral (20%), or poor (17%) dyad matches. The most frequently documented social support received by WBC was esteem support. Participants in a good match were more likely to report receiving all types of social support compared to neutral or poor matches.

CONCLUSION & CLINICAL IMPLICATIONS

Findings describe the social support characteristics important to WBC for facilitating their PA participation in a partner-based setting. This study provides valuable insight that can inform the development of partner-based PA interventions for WBC.

Does participation in therapeutic exercise programs after finishing oncology treatment still ensure an adequate health status for long-term breast cancer survivors? A ≥ 5 years follow-up study

PURPOSE

The aims of this study were to evaluate whether the effects of two therapeutic exercise programs are sustained over time (≥ 5 years) in long-term breast cancer survivors (LTBCS). Second, to determine the influence of the current level of physical activity (PA) performed on cancer-related fatigue (CRF) that these patients may present ≥5 years later.

METHODS

A prospective observational study was conducted with a cohort of 80 LTBCS in Granada during 2018. Firstly, considering their participation in one of the programs, they were allocated into two groups: usual care and therapeutic exercise program, to assess CRF, pain and pressure pain sensitivity, muscle strength, functional capacity, and quality of life. Secondly, they were also classified into 3 groups according to current level of weekly PA performed: ≤ 3, 3.1-7.4, and ≥ 7.5 (MET-hour/week) respectively, to assess its impact over CRF.

RESULTS

Although the positive effects of the programs are not sustained over time, a trend toward significance can be observed for a greater reduction in overall CRF levels, lower intensity of pain in the affected arm and cervical region, and greater functional capacity and quality of life in the group that underwent therapeutic exercise. Additionally, 66.25% of LTBCS are inactive ≥ 5 years after completion of the program and furthermore, such inactivity is accompanied by higher CRF levels (P .013 to .046).

CONCLUSION

The positive effects of therapeutic exercise programs are not maintained over time for LTBCS. Additionally, more than half of these women (66.25%) are inactive ≥ 5 years after completion of the program, this inactivity being accompanied by higher levels of CRF.

Non-pharmaceutical interventions in complementary and alternative medicine for insomnia in breast cancer survivors: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Insomnia has a high incidence in patients with breast cancer, which not only affects the quality of life of patients, but also affects the efficiency of later treatment and rehabilitation. Although the sedative and hypnotic drugs commonly used in clinical practice have a rapid onset of action, they are also accompanied by different degrees of sequelae, withdrawal effects and dependence and addiction. Complementary and alternative medicine (CAM) or complementary and integrative medicine, complementary integrative therapies, including natural nutritional supplement therapy, psychotherapy, physical and mental exercise, physiotherapy, have been reported to be used to treat cancer-related insomnia. Its clinical results are increasingly recognised and accepted by patients. However, the effectiveness and safety of these CAM are uneven, and there is no standard clinical application method. Therefore, in order to objectively evaluate the effects of different non-pharmaceutical interventions in CAM on insomnia, we will conduct a network meta-analysis (NMA) to explore the effects of different CAM interventions on improving sleep quality in patients with breast cancer.

METHODS AND ANALYSIS

We will search all Chinese and English databases from the inception of the database to 31 December 2022. The databases include PubMed, Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials and the Chinese literature databases include CBM, CNKI, VIP, WANFANG. The Insomnia Severity Index and the Pittsburgh Sleep Quality Index will be considered as the primary outcomes in the study. STATA V.15.0 software will be used to conduct pairwise meta-analysis and NMA. Finally, we will use the recommended risk assessment tool RoB2 for risk and bias assessment, and use the Grading of Recommendations Assessment, Development and Evaluation evaluation method to evaluate the quality of evidence.

ETHICS AND DISSEMINATION

Ethical approval will not be required because the study will not include the original information of participants. The results will be published in a peer-reviewed journal or disseminated in relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42022382602.

Experience of using a virtual reality rehabilitation management platform for breast cancer patients: a qualitative study

PURPOSES

Postoperative rehabilitation of upper limb function is crucial for breast cancer. Therefore, we developed a rehabilitation management platform using virtual reality to improve rehabilitation compliance and effect. The purpose of this research was to understand the user usability experience of breast cancer patients about the postoperative rehabilitation management of upper limb function using virtual reality.

METHODS

A qualitative descriptive research was designed. We used a maximum difference purpose sampling method. According to the inclusion and exclusion criteria, a 3-armor hospital in Changchun was selected for the recruitment. A one-on-one semi-structured interviews were conducted with patients after breast cancer operation. The Colaizzi seven-step analysis method was used to classify data under summarized themes.

RESULTS

Twenty patients participated in this semi-structured interview. User experience could be summarized into four themes as follows: 1) experience and feeling after using the virtual reality rehabilitation management platform; 2) factors influencing the use of the virtual reality rehabilitation management platform; 3) willingness to recommend the virtual reality rehabilitation management platform to peers; and 4) suggestions to improve the virtual reality rehabilitation management platform.

CONCLUSIONS

Breast cancer patients who used the rehabilitation management platform had a good experience, and their recognition and satisfaction were high. The use of the platform is influenced by many factors, and most patients are willing to recommend this platform to their peers. Future studies should be conducted according to patients' feedback and suggestions on how to further optimize and improve the platform.

Longitudinal changes of health-related quality of life over 10 years in breast cancer patients treated with radiotherapy following breast-conserving surgery

PURPOSES

The study intended to (1) assess changes of health-related quality of life (HRQoL) between early treatment-related time points and 10 years post-treatment in a cohort of breast cancer (BC) patients who received radiotherapy (RT), (2) to evaluate differences in HRQoL between long-term BC survivors and unaffected women from the same geographical region and (3) to identify determinants of long-term HRQoL in the survivor cohort.

METHODS

292 BC patients were recruited prior to RT after breast-conserving surgery between 1998 and 2001 in Germany and prospectively followed up for a median of 11.4 years (range 10.3-12.8 years). HRQoL was assessed using EORTC QLQ-C30 at pre-RT (baseline), during RT, 6 weeks after RT, and at the 10-year follow-up. Changes in mean HRQoL scores over time were assessed using linear-mixed models. HRQoL in long-term survivors and controls was compared using Wilcoxon rank-sum test, stratified by age groups. Multivariable linear regression models were used to identify determinants for HRQoL in long-term BC survivors.

RESULTS

Compared to baseline level (mean summary score of 64.9), global health status/quality of life (GHS/QoL) declined during RT (62.4) and improved 6 weeks after RT (69.9) before decreasing to baseline level at the 10-year follow-up (66.7). Most functional domains deteriorated or remained stable at 10 years post-diagnosis compared to post-RT scores, except for role functioning which improved, while dyspnea and diarrhea significantly deteriorated between those two time points. There were no significant differences in long-term GHS/QoL between BC survivors 10 years post-RT and controls for all age groups (p > 0.05). However, deficits in specific HRQoL domains such as emotional burden, sleep problems or fatigue were found to more strongly affect survivors, in particular those younger than 65 years, compared to controls. In the determinant analysis, being overweight was associated with lower GHS/QoL and physical functioning, while living with others was found to be associated with better physical functioning, and decreased dyspnea and pain levels. Certain comorbidities such as depression had a strong association with multiple HRQoL domains, including lower GHS/QoL and functioning as well as a higher level of fatigue, pain, sleep/intestinal problems, and financial difficulties. Side effects such as lymphedema/pain and fibrosis were associated with worse physical and social functioning, respectively.

CONCLUSION

The long-term GHS/QoL remained comparable when compared with the control population while restrictions in certain functional and symptoms domains in long-term BC survivors persisted over 10 years, in particular among younger survivors. Targeted screening to identify cancer survivors at risk for psychosocial/other impairment accounting also for comorbidities and treatment side effects may be warranted in long-term aftercare to address unmet health needs.

Does the toxicity of endocrine therapy persist into long-term survivorship?: Patient-reported outcome results from a follow-up study beyond a 10-year-survival

BACKGROUND

Endocrine treatment (ET) is a highly effective breast cancer treatment but can distinctly impair breast cancer patients' quality of life (QOL). In a patient-reported outcome (PROs) study conducted by the authors in 2011, patients reported higher ET-induced symptom levels than known from the registration trials, and was underestimated. Based on these study results, we investigated the long-term sequelae of ET reported by breast cancer survivors (BCS) in a follow-up study conducted 5-10 years after an earlier assessment.

METHODS

BCS who had participated in the earlier study (n = 436) were approached for study participation either at one of their routine follow-up appointments or via mail; consenting patients were asked to completed the same PRO assessment used in the original study (FACT-B + ES). BCS with relapse/ progressive disease were excluded from the analysis. We compared long-term endocrine symptomatology and overall QOL outcome (i.e. FACT-G and -ES sum score).

RESULTS

A final sample of 268 BCS was included in the analysis. BCS reported a significant improvement of the overall endocrine symptomatology (baseline mean = 59 vs. follow-up mean = 62, p < 0.001), physical (baseline = 23.9 mean vs. follow-up mean = 24.8, p < 0.01) and functional well-being (baseline mean = 21.7 vs. follow-up mean = 22.7, p = 0.013) and overall QOL (mean baseline = 88.3 vs. mean follow-up = 90.9, p = 0.011). However, the prevalence of particular symptoms, well-known to be ET induced, did not change over time such as joint pain (baseline = 45.5% vs. 44.2%, n.s. difference), lack of energy (36.4% vs 33.8%, n.s. difference), weight gain (36.8% vs. 33.9%, n.s. difference) or vaginal dryness (30.2% vs. 33%, n.s. difference) and the proportion reporting lack of interest in sex increased (40.4% vs. 48.7%, p < 0.05).

CONCLUSION

Presented results indicate that BCS recover well in terms of overall endocrine symptomatology and quality of life but experience some clinically relevant and unfavorable ET-related long-term effects.

Acupuncture therapies for cancer-related fatigue: A Bayesian network meta-analysis and systematic review

BACKGROUND

Cancer-related fatigue (CRF) is one of the most commonly reported symptoms impacting cancer survivors. This study evaluated and compared the effectiveness and safety of acupuncture treatments for CRF.

METHODS

We searched PubMed, Embase, Web of Science, Cochrane Library, China Biology Medicine China National Knowledge Infrastructure, China Science and Technology Journal Database, and WanFang Database from inception to November 2022 to identify eligible randomized controlled trials (RCTs) comparing acupuncture treatments with sham interventions, waitlist (WL), or usual care (UC) for CRF treatment. The outcomes included the Cancer Fatigue Scale (CFS) and Pittsburgh Sleep Quality Index (PSQI), and pair-wise and Bayesian network meta-analyses were performed using STATA v17.0.

RESULTS

In total, 34 randomized controlled trials featuring 2632 participants were included. In the network meta-analysis, the primary analysis using CFS illustrated that point application (PA) + UC (standardized mean difference [SMD] = -1.33, 95% CI = -2.02, -0.63) had the highest probability of improving CFS, followed by manual acupuncture (MA) + PA (SMD = -1.21, 95% CI = -2.05, -0.38) and MA + UC (SMD = -0.80, 95% CI = -1.50, -0.09). Moreover, the adverse events of these interventions were acceptable.

CONCLUSION

This study demonstrated that acupuncture was effective and safe on CRF treatment. However, further studies are still warranted by incorporating more large-scale and high-quality RCTs.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022339769.

Chemotherapy: how to reduce its adverse effects while maintaining the potency?

Chemotherapy is one of the widely used anticancer treatments that involves the use of powerful cytotoxic drugs to stop tumor growth by targeting rapidly dividing cells through various mechanisms, which will be elucidated in this review. Introduced during the early twentieth century, chemotherapy has since lengthened the longevity of innumerable cancer patients. However, the increase in lifespan is at the expense of quality of life as patients are at risk of developing short-term and long-term side effects following chemotherapy, such as alopecia (hair loss), chemotherapy-induced peripheral neuropathy, chemotherapy-induced nausea and vomiting, cardiotoxicity, diarrhea, infertility, and chemo brain. Currently, a number of these chemotherapy-induced adverse effects are managed through supportive care and approved treatments, while the rest of the side effects are unavoidable. Hence, chemotherapeutic drugs associated with inevitable side effects are only administered when their therapeutic role outweighs their chemotoxicity, thus severely limiting the potency of chemotherapy in treating malignancy. Therein, the potential approaches to alleviating side effects of chemotherapy ranging from pharmaceutical drugs to alternative therapies will be discussed in this review in hopes of increasing the tolerance and effectiveness of future chemotherapeutic treatments.