Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review

Patterns of Change in Emotional and Functional Well-Being Following Breast Cancer Diagnosis

BACKGROUND

Understanding the change in emotional well-being (EWB) and functional well-being (FWB) in breast cancer survivors can facilitate targeted support for unmet needs.

METHODS

Among 2,767 women with breast cancer in the Carolina Breast Cancer Study Phase 3, we assessed EWB and FWB with the Functional Assessment of Cancer Therapy - Breast instrument at 5 (baseline), 25, and 84 months after diagnosis. We identified well-being trajectories using latent class growth analysis, and relative frequency differences (RFD) with 95% confidence intervals (CI) were estimated for associations between trajectory group membership and demographic or clinical characteristics.

RESULTS

Five trajectory groups were identified for both EWB and FWB. Most participants (∼70%) were classified into "good well-being" ("stable high" or "stable medium"). A small percentage (∼10%) fell into "very low baseline" or "early decrease", and the rest were "stable low" (∼20%). Overall, younger vs. older age was associated with "stable low" EWB (25.4% vs. 19.3%; RFD 6.1%; 95% CI, 3.0%-9.2%). Black participants more frequently had "stable low" FWB (24.2% vs. 16.6%; RFD 7.6%; 95% CI, 4.6%-10.6%). Breast cancer recurrence was strongly associated with "stable low" EWB (28.7% vs. 21.3%; RFD 7.3%; 95% CI, 2.3%-12.3%) and FWB (28.7% vs. 19.2%; RFD 8.6%; 95% CI, 3.7%-13.5%). Being unmarried, lower income, having nonprivate insurance, advanced stage, mastectomy vs. breast conservation surgery, and chemotherapy were also predictors of poor well-being trajectories.

CONCLUSIONS

Demographics and clinical features are associated with sustained poor well-being after breast cancer.

IMPACT

Improvements in long-term well-being may warrant targeted support.

Incident mental disorders after breast cancer: A matched population-based cohort

OBJECTIVE

To assess the risk of mental disorders and contributing factors of depression in breast cancer survivors, as well as to estimate the risk of death.

METHODS

A total of 20,440 women diagnosed with breast cancer between 1997 and 2017 were identified in the Utah Cancer Registry and matched to a general population of women without cancer. To assess the risk of mental disorders and death following breast cancer, hazard ratios (HRs) and 99 % confidence intervals (CI) were estimated using Cox proportional-hazards models overall, within 2, > 2 to 5, and > 5-years of follow-up.

RESULTS

Compared with women without cancer, breast cancer survivors had an elevated risk of depression notably within 2 years of follow-up for depression (HR 2.64, 99 %CI 2.43, 2.87), anxiety (HR 2.89, 99 %CI 2.66, 3.15), bipolar (HR 1.85, 99 %CI 1.45, 2.37), alcohol (HR 1.88, 99 %CI 1.43, 2.46), and substance-related disorders (HR 1.95, 99 %CI 1.59, 2.39). Although the risks were attenuated compared to the immediate follow-up, the burden of alcohol- and substance-disorders persisted within 5 and depression and anxiety >5 years post cancer. Breast cancer survivors diagnosed with substance-related disorders within 2 years of cancer had a 2.3-fold higher risk of death (HR 2.28, 99 % CI 1.72, 3.03) compared to those without during the same time period. Depression predictors included obesity, ≥2 comorbidities, chemotherapy, or being separated.

CONCLUSION

Compared with women without cancer, breast cancer survivors had an elevated risk of multiple mental disorders. The risk of death was notably increased among breast cancer survivors with substance-related disorders.

Effects of Web-Based Interventions on Anxiety and Depression in Patients With Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study evaluated the effects of web-based interventions on anxiety and depression in patients with breast cancer by conducting a meta-analysis of relevant randomized controlled trials (RCTs).

METHODS

We searched the PubMed, Web of Science, Cochrane Library, Cumulated Index to Nursing and Allied Health Literature, Embase, and PsycINFO databases from their inception to January 5, 2024. When substantial heterogeneity was observed among the studies, a random-effects model was applied to calculate effect sizes in terms of the standardized mean difference (SMD) and assessed the quality of the included studies using the updated Cochrane risk-of-bias tool for RCTs.

RESULTS

Fourteen RCTs were included in this study. The meta-analysis indicated that web-based intervention alleviated anxiety (SMD = -0.26, 95% CI = -0.44 to -0.07, p < 0.01, I2 = 68%) and depression (SMD = -0.15, 95% CI = -0.25 to -0.06, p = 0.19, I2 = 26%) in patients with breast cancer. There was substantial heterogeneity in anxiety, and the analysis of potential causes revealed that the intervention method was a factor influencing the variability in the actual effect size.

CONCLUSIONS

This study showed that web-based interventions may help reduce anxiety and depression in patients with breast cancer. It also suggested the potential of these interventions as a strategy for alleviating symptoms in non-face-to-face settings. However, the limited number of studies and high heterogeneity in the subgroup analysis made it difficult to assess the effects of different intervention methods. Further high-quality research is needed to provide more reliable data on the effectiveness of various intervention methods.

The Role of Rehabilitation for Women with Cancer

As the prevalence of female cancer survivors increases, their quality of life (QOL) and function have become key areas of focus in the context of survivorship and rehabilitation needs. Although behavioral modifications may help to decrease the development of malignancy, women are still at increased risk of developing a cancer diagnosis in their lifetime. Cancer and its treatment can lead to significant functional impairments and symptomatic challenges. However, rehabilitation interventions and medical management provide options to address these issues throughout the oncological continuum of care. With appropriate treatment, women are enabled to experience improved QOL and performance status.

Cognitive behavioral stress management effects on cancer-related distress and neuroendocrine signaling in breast cancer: differential effects by neighborhood disadvantage

PURPOSE

Women residing in disadvantaged neighborhoods experience disparities in breast cancer (BC) survival which persist when accounting for individual-level socioeconomic/treatment factors. The chronic stress of living in a disadvantaged neighborhood may compound the stress of a new cancer diagnosis, leading to neuroendocrine dysregulation. Cognitive Behavioral Stress Management (CBSM) has shown efficacy at reducing distress and modulating neuroendocrine functioning, but it is unknown whether it is efficacious in this population.

METHODS

This is a secondary analysis of a randomized trial of 10-week group-based CBSM (versus a psycho-educational control) in women with nonmetastatic BC. The Area Deprivation Index (ADI) was calculated, and women were categorized as living in low (n = 175) versus high disadvantage (n = 50). Women completed a measure of cancer-related distress (Impact of Events Scale-Intrusions) and underwent blood draws to collect PM cortisol at baseline, 6 months, and 12 months. Hierarchical linear modeling tested whether condition predicted the slope of outcomes, and whether ADI moderated these relationships.

RESULTS

CBSM was associated with greater reductions in cancer-specific distress and cortisol, though these effects were not found to be moderated by ADI. Exploratory simple slope analyses showed that CBSM was associated with decreased cancer-related distress across ADI categories, while CBSM resulted in decreased cortisol among low ADI women only.

CONCLUSION

CBSM reduced cancer-related distress across neighborhoods, but this was only accompanied by cortisol changes among those in advantaged neighborhoods. Neighborhood disadvantage may represent a particularly salient stressor that is distinct from cancer-specific distress. Future interventions targeting this population should consider modifications to increase relevance and accessibility.

The interplay of coping styles and optimism/pessimism in shaping mental health in long-term survivors of malignant melanoma: a register-based cohort study

BACKGROUND

Optimism and pessimism are stable, overarching dispositions that influence mental health, especially in stressful life situations, such as cancer survival. They have been associated with more specific coping strategies. This study sought to investigate a theoretically-based model of their interplay in shaping depressive and anxiety symptoms to inform prevention and intervention efforts.

METHODS

The registry-based study included 689 survivors of malignant melanoma. We assessed sociodemographic and disease-related variables, optimism/pessimism (LOT-R), coping strategies (BC), depressive (PHQ-9), and anxiety symptoms (GAD-7). A structural equation model was conducted to analyse the hypothesized associations, modelling coping strategies (denial/self-blame, seeking external support, active coping) as mediators of the relationship of optimism/pessimism with depressive and anxiety symptoms. As a sensitivity analysis, gender-stratified models were tested.

RESULTS

The proposed model fit the data well. In the full sample, optimism was directly related to depression and anxiety, and the effects of optimism and pessimism were mediated via denial/self-blame. This indirect effect accounted for 60.8% of the total effect of pessimism on depression, and for 79.55% on anxiety. Stratified analyses showed different patterns of associations by gender, in the sense that the mediation effect was more relevant among men.

CONCLUSION

This study shows the relevance and need of gender-sensitive psychosocial-care. Especially in men, psychosocial interventions should target maladaptive coping strategies. Within women, fostering optimism seems to be particularly important. As the model did not fit as well for women, more gender-sensitive research is needed to understand potentially different risk/protective factors and needs of support.

Effects of resistance training vs high intensity interval training on body composition, muscle strength, cardiorespiratory fitness, and quality of life in survivors of breast cancer: a randomized trial

PURPOSE

Breast cancer treatments often lead to unfavourable changes in body composition, physical fitness, and quality of life (QoL). We compared the effects of resistance training (RT) and high-intensity interval training (HIIT) on these outcomes in survivors of breast cancer.

METHODS

Twenty-eight survivors of breast cancer, post-treatment (Stage I-III), aged 55.5 ± 8.8 years and body mass index 27.9 ± 5 kg/m2 were randomly allocated to a 12-week supervised RT (n = 14) or HIIT (n = 14) intervention, 3 days per week. Body composition (dual energy x-ray absorptiometry), upper and lower body muscle strength (1-repetition maximum), cardiorespiratory fitness (CRF) (Ekblom Bak Cycle Test), and QoL domains (EORTC QLQ-C30 and EORTC QLQ-BR45) were assessed at baseline and 12 weeks.

RESULTS

There were no significant differences between groups at baseline. Exercise attendance ranged from 81 to 85%. Between groups, there were significant differences (p ≤ 0.001) after 12 weeks in chest press strength for RT (mean difference [MD] = 4.7 kg) and CRF for HIIT (MD = 1.9 ml/min/kg). Within groups, there were significant improvements (p < 0.05) for % lean mass and % fat mass in both RT and HIIT, as well as for upper and lower body muscle strength, CRF, and QoL domains. No major adverse events were noted.

CONCLUSION

Both exercise groups improved body composition, physical fitness, and QoL domains over 12 weeks of RT or HIIT, although mode-specific benefits were apparent with more substantial improvements in lean mass and muscle strength with RT and reductions in % fat mass and improved CRF with HIIT. Tailored exercise programs should address the specific health needs of each patient.

Psychological Distress and Coping Mechanisms Among Women Diagnosed With Breast Cancer: A Cross-Sectional Study of Anxiety, Depression, and Social Support

Introduction Breast cancer is one of the most prevalent malignancies and a leading cause of cancer-related mortality among women. Beyond its physical impact, it significantly affects mental health, leading to anxiety, depression, and psychological distress. Coping mechanisms and social support play a crucial role in emotional resilience; however, limited research has examined these factors in Pakistani women. This study investigates the relationship between psychological distress, coping strategies, and social support among women diagnosed with breast cancer. Method This cross-sectional study included 100 women (N = 100, 100% female) diagnosed with breast cancer, recruited from private hospitals and clinics. Standardized instruments assessed generalized anxiety (Generalized Anxiety Disorder 7-item scale (GAD-7)), depression (Patient Health Questionnaire-9 (PHQ-9) 9-item scale), coping strategies (Brief Coping Orientation to Problems Experienced (COPE) Inventory 28-item scale), and social support (Multidimensional Scale of Perceived Social Support (MSPSS) 12-item scale). Data analysis was conducted using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States), employing correlation analysis and group comparisons based on education, employment, and chemotherapy history. Results Higher generalized anxiety levels correlated with increased use of coping mechanisms (r = 0.133, p < 0.01), while perceived social support was positively associated with coping responses (r = 0.130, p < 0.01). Participants receiving chemotherapy reported higher social support (p = 0.016, Cohen's d = 0.71), whereas non-recipients exhibited more significant depression (p = 0.001, Cohen's d = 0.75). Conclusion Findings highlight the psychological burden of breast cancer and the critical role of coping strategies and social support. Tailored interventions are crucial for enhancing mental well-being, coping efficacy, and treatment outcomes, particularly among vulnerable groups.

Sexual dysfunction in women with breast cancer: a systematic review

PURPOSE

This systematic review aims to assess the prevalence, incidence, and risk factors for sexual dysfunction (SdF) in women with breast cancer (BC).

METHODS

A systematic search was conducted in MEDLINE (PubMed), PsycINFO, Web of Science, and CINAHL to identity longitudinal, observational studies assessing SdF in women with BC. Data extraction followed PRISMA guidelines. The Joanna Briggs Institute checklist was used to assess methodological quality. Results were narratively synthesised.

RESULTS

A total of 16 studies involving 4058 women met the inclusion criteria. Overall, the reported prevalence of SdF ranged from 17.5% before BC diagnosis to 86% after 6 months of hormone therapy. Only one study reported incidence data. The six most commonly studied SdF domains were desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia. A significant number of risk factors associated with different dimensions of SdF were identified.

CONCLUSION

SdF is highly prevalent in women with BC, particularly in the first year after diagnosis and treatment. These findings strongly suggest that SdF should be routinely assessed as part of survivorship care protocols. Due to the scant data on incidence rates and the wide variability in reported risk factors, significant gaps remain in our understanding of the onset and progression of SdF in patients with BC. Well-designed cohort studies are needed to better establish the incidence and aetiology of SdF in this patient population.

Psychological Intervention for Patients with Biopsychosocial Late Effects Following Surgery for Colorectal Cancer with Peritoneal Metastases-A Feasibility Study

Background: Up to 80% of patients experience late effects (LE) one year after surgery for peritoneal metastases (PM) from colorectal cancer (CRC). We tested the feasibility and outcome of a treatment strategy to address LEs. Methods: During January 2021-May 2023, patients who had undergone surgery for CRC-PM in Denmark were screened for biopsychosocial LEs (anxiety, depression, fear of cancer recurrence, insomnia, cognitive impairment, pain, fatigue). Patients scoring according to clinical cut-offs were referred to a Multi-Disciplinary Team conference (MDT). The patients, surgeon(s), nurse(s), and psychologists participated in the MDT, identified key concerns and proposed a personalized intervention. Pre- and post-intervention, patients completed a "Measure Yourself Concerns and Wellbeing" (MYCaW) questionnaire, rating the two most distressing LEs and general wellbeing on a 7-point Likert scale. Results: Of 28 eligible patients, 13 (59 years (mean), 85% women) accepted referral, participated in the MDT, and were offered a personalized intervention. The intervention was completed by 11 patients. Improvement in MYCaW score was observed 1 month postintervention for all three items: (1) the primary LE (p = 0.003, Hedges's g 1.54), (2) the secondary LE (p < 0.001, Hedges's g 1.65), and (3) general wellbeing (p = 0.005, Hedges's g 1.09). This improvement was sustained 6 months postintervention. The 15 non-participants were, in general, older (66 years (mean), men 73%). Conclusions: Screening for LEs and conducting an MDT can provide a personalized intervention plan, which patients are able to complete and may benefit from.

Family-centered online positive psychological intervention for breast cancer patients and family caregivers: a single-arm pre-post study of feasibility and preliminary effects

BACKGROUND

Breast cancer patients and their family caregivers would experience positive changes after diagnosed. We aimed to construct an online positive psychological intervention program for breast cancer patients and their caregivers and evaluate its feasibility and preliminary effects on positive psychological experience and quality of life.

METHODS

A single-arm pretest and posttest quasi-experimental design was used in this study. Thirty-five dyads of chemotherapeutic breast cancer patients and caregivers were recruited. Four modules of online positive psychological interventions were developed, each lasting 20-30 min. Participants received a 4-week online positive psychological intervention during chemotherapy. Feasibility was assessed, including the rates of enrollment, retention, adherence and acceptability. Resilience, hope, perceived benefit, positive aspects of caregiving, and quality of life were assessed as the preliminary effects of the intervention. 62.5% of recruited individuals participated in the intervention. The mean number of watching modules was 2.8 ± 0.8 for breast cancer patients and 2.6 ± 0.8 for caregivers. 52.2% of patients and 47.8% of caregivers watched three modules in the intervention. For the loving-kindness meditation practice, 34.8% of patients practiced for 15 to 21 days and 52.2% of caregivers practiced for < 7 days. For the three good things practice, 56.5% of patients and 47.8% of caregivers practiced for 7 to 14 days. Mean scores on the acceptable scale for patients and caregivers were 27.61 ± 3.71 and 25.91 ± 3.01, respectively. The results of a linear mixed model showed that the preliminary effects of the intervention on participants' resilience, hope, perceived benefits, positive aspects of caregiving, and quality of life were significant (p < 0.05).

CONCLUSIONS

The online positive psychological interventions for breast cancer patients and family caregivers are feasible, and has significant preliminary effects on participants' resilience, hope, perceived benefits, positive aspects of caregiving, and quality of life, however, the effects warrant further randomized controlled trials.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR) ChiCTR2300072809. Registered on 26 June 2023Retrospectively registered.

Banana Supplementation for Breast Cancer Surgery Patients: A Two-Center Experience

Introduction

Patients frequently encounter both physical and mental challenges after undergoing surgery for breast cancer, leading to a negative impact on their general well-being. Our objective was to investigate the beneficial effects of dietary supplementation with bananas on patients after breast cancer surgery.

Methods

Among breast cancer patients who had undergone breast surgery, the banana group (n = 77) consumed an additional banana daily alongside their regular diet, while the non-banana group (n = 77) did not. Negative emotions, sleep quality, sexual health, complication rates, length of hospital stay, and quality of life were assessed.

Results

Compared to the non-banana group, patients in the banana group exhibited lower levels of depression and anxiety, better sleep quality, more satisfactory sexual quality of life, and a higher overall quality of life postoperatively. Nonetheless, the complication rates and length of hospital stay did not show any notable variances between the 2 groups.

Conclusion

This study highlights the novel finding that simple dietary supplementation with bananas significantly enhances mental well-being and overall quality of life in breast cancer patients following surgery, despite no notable impact on physical recovery metrics.

Factors contributing to sexual dissatisfaction in women with breast cancer: The specific role of conjugal relationship quality

PURPOSE

The purpose of this study was (1) to investigate the personal, interpersonal, social, and cultural factors related to sexual dissatisfaction in women with breast cancer and (2) to explore these differences regarding surgery (lumpectomy vs. mastectomy).

METHODS

This cross-sectional study included women diagnosed with breast cancer (n = 87). Women were invited to complete questionnaires assessing sexual satisfaction, relationship satisfaction, conjugal support, quality of life, subjective health, anxiodepressive symptomatology, body image, self-esteem, and religiosity. Partial least squares path modeling (PLS‒PM) was used.

RESULTS

No direct links were observed between resources (intraindividual and social) and sexual dissatisfaction (SD) or between vulnerability (physical and emotional) and SD. The quality of the conjugal relationship acted as a mediator between these different variables. Intraindividual resources are influenced directly by physical and emotional vulnerability. Age influenced only SD in women who had undergone a lumpectomy compared with those who had undergone a mastectomy. Finally, religiosity and the length of the couple relationship had no influence on SD.

CONCLUSION

The results highlight the importance of considering different levels of variables when considering SD in women with breast cancer, particularly the role of the conjugal relationship. Hence, these results encourage the need to promote conjugal relationship quality to improve sexual satisfaction.

Symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes:A cross-sectional survey

AIM

To investigate symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes, explore the impact of sentinel symptoms on patients' quality of life and psychological distress, provide a basis for implementing accurate symptom management.

DESIGN

A cross-sectional survey.

METHODS

The study was conducted from September 2021 to December 2022. We recruited 281 patients who were re-examined in an outpatient department of a tertiary hospital in Hebei Province. The European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire - Core30 (QLQ-C30), the EORTC Quality-of-Life Questionnaire Breast Cancer - 23 (QLQ-BR23), the Hospital Anxiety and Depression Scale (HADS) were used to conduct the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. Correlation analysis was used to explore the relationship between sentinel symptoms and quality of life, correlation with psychological distress. This paper adhered to the STROBE guidelines.

RESULTS

Breast cancer survivors have a wide range of self-reported symptoms in the form of four symptom clusters: a fatigue symptom cluster, a gastrointestinal symptom cluster, a sickness symptom cluster and a surgical trauma-related symptom cluster. Three sentinel symptoms were explored: pain, alopecia and limited function of the upper limbs. Except for sexual function, all of the sentinel symptoms were negatively correlated with patients' quality of life and positively correlated with psychological distress (p < .05).

CONCLUSIONS

Breast cancer survivors have a variety of symptoms in the form of four symptom clusters. Pain, alopecia and limited function of the upper limbs are the sentinel symptoms, which affect patients' quality of life and psychological distress.

Mental Health Challenges in Cancer Survivors From Diverse Backgrounds During COVID-19 Pandemic: Insights From the All of Us Research Program

BACKGROUND

The COVID-19 pandemic exacerbated mental health challenges. This study aimed to investigate the mental health impact of the pandemic on cancer survivors from diverse backgrounds using the All of Us Research Program's COVID-19 Participant Experience (COPE) survey.

METHODS

This analysis included respondents of the COPE survey with average depression, anxiety, and self-harm metrics computed for individuals completing multiple survey iterations. Multivariable logistic regression assessed the relationship between cancer survivorship, demographic factors, and mental health outcomes. Sensitivity analyses were conducted to investigate peak mental health challenges and time trend.

RESULTS

Among 100,203 respondents, 20,561 (20.5%) were cancer survivors. Cancer survivors differed demographically from the general population, tending to be older and more likely to report higher socioeconomic status. Cancer survivors exhibited significantly higher odds of self-harm (aOR = 1.09, 95% CI 1.01-1.18). Sensitivity analyses focusing on peak mental health scores revealed that cancer survivors had significantly increased odds of experiencing anxiety (aOR = 1.11, 95% CI 1.06-1.17), depression (aOR = 1.11, 95% CI 1.06-1.17), and self-harm tendencies (aOR = 1.09, 95% CI 1.01-1.18) compared to non-cancer survivors. Within the cancer survivor subgroup, younger age, gender and sexual minority status, lower income, and widowed/separated/divorced status were associated with worse mental health outcomes.

CONCLUSION

During the COVID-19 pandemic, cancer survivors exhibited significantly higher odds of depression, anxiety, and self-harm compared to non-survivors, with certain subgroups demonstrating heightened vulnerability. Our study highlights the critical need for integrated mental health services in cancer survivorship care programs, especially among those from underserved groups who are at high risk, as we continue to evolve with the pandemic.

Effects of Health Education on Self-efficacy, Negative Emotions, and Life Quality in Breast Cancer Patients: A Systematic Review and Meta-analysis

BACKGROUND

Breast cancer patients encounter challenges managing acute and chronic symptoms during and after treatment, leading to emotional fluctuations and diminished quality of life. Health education aims to improve knowledge and life skills; however, its specific impact on breast cancer patients' self-efficacy is unclear.

OBJECTIVE

To assess the effects of health education on self-efficacy, depressive symptoms, anxiety, distress, and life quality in breast cancer patients.

METHODS

Randomized controlled studies were systematically screened in 7 databases from inception of the database to May 1, 2024. Literature quality was assessed using the Cochrane Risk of Bias Assessment tool. Results were pooled using random-effects meta-analyses and reported as standardized mean difference. Heterogeneity was reported using I2 statistic.

RESULTS

Sixteen articles were included. Participants in the intervention group exhibited enhanced self-efficacy in posttest (standardized mean difference [SMD], 0.12; 95% confidence interval [CI], 0.01-0.23; P = .04, I2 = 8%) and during the follow-up period (SMD, 0.30; 95% CI, 0.09-0.52; P = .006, I2 = 63%), decreased depressive symptoms (SMD, -0.30; 95% CI, -0.52 to -0.08; P = .0007, I2 = 17%), and increased life quality (SMD, 0.25; 95% CI, 0.01-0.49; P = .04, I2 = 48%) during the follow-up period.

CONCLUSIONS

Health education can enhance self-efficacy, reduce depressive symptoms, and improve the life quality of breast cancer patients. However, more rigorous research is needed to evaluate their effectiveness due to suboptimal blinding.

IMPLICATIONS FOR PRACTICE

The study underscores the critical role of health education in breast cancer management, emphasizing the necessity of integrating comprehensive health education programs into standard care protocols.

Development and Validation of a Predictive Model for Anxiety Trajectories in Patients with Breast Cancer: A Retrospective Study

Objective

This study aims to develop and validate a predictive model for short-term post-treatment anxiety trajectories in patients with breast cancer, utilizing baseline patient characteristics and initial anxiety scores to inform precise clinical interventions.

Methods

Baseline characteristics were collected from 424 patients diagnosed with breast cancer who underwent surgical treatment at our hospital between January 1, 2021, and December 30, 2022. Anxiety levels were assessed using the Self-Rating Anxiety Scale (SAS) scores at admission and at 3-, 6-, 9-, and 12-months post-treatment. Distinct trajectories of SAS score changes were identified and categorized. Variables were screened, and multiple models were developed. The optimal model was identified through comparative analysis, and a nomogram was generated following model simplification.

Results

We found three distinct trends in the trajectory of anxiety, but we grouped them into two broad categories: gradual reduction of anxiety and persistent anxiety. LM Model was established by logistic regression, and Model 1 and Model 2 were established by Random Forest (RF) and eXtreme Gradient Boosting (Xgboost) screening variables. The ROC curve areas in the validation set were 0.822 (0.757-0.887), 0.757 (0.680-0.834) and 0.781 (0.710-0.851), respectively. Model comparison, using Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI), identified the Lm model as optimal, which underwent further simplification and value assignment. Decision Curve Analysis (DCA) and Clinical Impact Curve (CIC) analyses confirmed the superiority of model-based interventions over general interventions.

Conclusion

Distinct anxiety trajectories are observed in patients diagnosed with breast cancer during the first 12 months post-treatment. Predictive modeling based on baseline characteristics is feasible although though further research is warranted.

Different exercise interventions on quality of sleep in breast cancer survivors-a network meta-analysis of randomized controlled trials

Introduction

Breast cancer is currently the most prevalent cancer globally; however, it generally has a favorable prognosis and is linked to a high survival rate. While effective treatments can extend survival and mitigate associated side effects, not all survivors are exempt from complications. Notably, a significant proportion of survivors experience sleep disorders following surgery, which can severely impact their quality of life. Exercise is frequently recommended as a non-pharmacological intervention to enhance sleep quality among breast cancer survivors and may also play a role in reducing recurrence rates. Recognizing that various forms of exercise may yield different outcomes in addressing sleep disorders in this population, we conducted a network review meta-analysis to assess the effectiveness of diverse exercise modalities for breast cancer survivors suffering from sleep disturbances.

Methods

We searched four electronic databases for randomized controlled trials of individuals diagnosed breast cancer with sleep disorders by different exercise therapy. The primary outcomes included Yoga, Pilates, Qigong, Tai Chi, Walking, Dance, Resistance training, Football, Virtual reality therapy, Activity change exercise, Software-guided exercises. The methodological quality of the included studies was assessed using the Cochrane Bias risk Assessment tool, and network meta-analysis was performed using Stata15 software. The review was pre-registered (PROSPERO ID: CRD42023442892).

Results

Data on 3083 breast cancer survivors with sleep disturbances from 34 eligible randomized controlled trials were analyzed, with 23 classified as medium risk and 2 as high risk. Network meta-analysis showed that walking exercise [Standard Median Different (SMD) =3.06, 95% Confidence Interval (95%CI)=(-5.89,-0.23)] significantly improved sleep disorder (Surface Under the Cumulative Ranking curve, SUCRA: 84.5%) and reduced Pittsburgh sleep quality index (PSQI) score.

Discussion

Based on the network ranking table, we can conclude that walking exercise offers greater benefits compared to other exercise interventions for improving sleep quality in breast cancer patients. This finding presents a novel perspective on exercise interventions for breast cancer survivors experiencing sleep disorders.

Systematic review registration

PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=442892, identifier CRD42023442892.

Individual Rumination in Adult Cancer Care: A Concept Analysis

OBJECTIVE

To conceptualize rumination in adult cancer care.

METHODS

Walker and Avant's concept analysis method was used to examine rumination in adults with cancer. A systematic search was conducted across psychology, nursing, medicine, and public health disciplines in PsycINFO, PubMed, Web of Science, CINAHL, and Scopus databases from their inception to April 2024. Additional records were identified by manually searching reference lists of relevant studies.

RESULTS

Analysis of 50 articles identified rumination's three defining attributes (intrusions, brooding, instrumentality), antecedents (cancer-related adversity, pre-existing susceptibilities), and consequences (psychophysiological functioning impairments, long-term adaptation). Key features included trait-state duality, internal variability, external cyclicality, and high emotional correlation.

CONCLUSIONS

This concept analysis establishes a preliminary conceptual model of rumination in adult cancer care, integrating its attributes, antecedents, and consequences. The model offers insights into rumination mechanisms, highlighting its complexity and variability, and may inform the development of targeted interventions and theoretical development for cancer population. Further research is needed to validate the model and explore its clinical applications.

IMPLICATIONS FOR NURSING PRACTICE

Understanding rumination in adult cancer care helps nurses identify and support at-risk patients. By recognizing key signs, nurses can implement targeted interventions to improve patients' emotional and psychological well-being, ultimately enhancing their long-term adaptation and quality of life.

Systematic review on the effectiveness of mobile health applications on mental health of breast cancer survivors

PURPOSE

Breast cancer survivors are more likely to report psychological distress and unmet need for support compared to healthy controls. Psychological mobile health interventions might be used in follow-up care of breast cancer patients to improve their mental health.

METHODS

We searched MEDLINE, PsychINFO, Cochrane and PROSPERO for articles on controlled trials examining the effectiveness of psychological mobile health interventions compared to routine care regarding mental health outcomes of adult breast cancer survivors. This review followed the PRISMA statement and was registered on PROSPERO (CRD42022312972). Two researchers independently reviewed publications, extracted data and assessed risk of bias.

RESULTS

After screening 204 abstracts published from 2005 to February 2023, eleven randomised trials involving 2249 patients with a mean age between 43.9 and 56.2 years met the inclusion criteria. All interventions used components of cognitive behavioural therapy. Most studies applied self-guided interventions. Five studies reported percentages of patients never started (range = 3-15%) or discontinued the intervention earlier (range = 3-36%). No long-term effect > 3 months post intervention was reported. Three of seven studies reported a significant short-term intervention effect for distress. Only one study each showed an effect for depression (1/5), anxiety (1/5), fear of recurrence (1/4) and self-efficacy (1/3) compared to a control group.

CONCLUSIONS

A wide variance of interventions was used. Future studies should follow guidelines in developing and reporting their mobile interventions and conduct long-term follow-up to achieve reliable and comparable results.

IMPLICATIONS FOR CANCER SURVIVORS

No clear effect of psychological mobile health interventions on patients' mental health could be shown.

REGISTRATION

PROSPERO ID 312972.

Medication patterns and potentially inappropriate medication in patients with metastatic breast cancer: results of the BRE-BY-MED study

BACKGROUND

The treatment of metastatic breast cancer (mBC) focuses on prolonging patient survival, providing adequate symptom management, and maintaining quality of life (QoL). This includes supportive therapy to prevent or treat potential side effects and handle comorbidities. The combination of mBC therapy, supportive therapy, and treatment for comorbidities increases the risk for polypharmacy, potential drug-drug interactions (pDDI), potentially inappropriate medication (PIM), and potentially missing drugs (pMD). Therefore, the aim of this study was to assess medication patterns of mBC patients in routine care within a cohort study from South Germany.

METHODS

Between July 2022 and February 2024 individuals with advanced or mBC, aged ≥ 18 years, living in Bavaria, and who gave written informed consent, were included in the BRE-BY-MED "Breast Cancer Care in Bavaria for Patients with Metastatic Disease" cohort study (DRKS00026601). BRE-BY-MED was carried out at the University Hospital Würzburg with the primary aim of estimating the prevalence of guideline-concordant treatment. For the present analysis cross-sectional data from the baseline assessment was used. Medication was extracted from routine medical records. PIM, pDDI and pMD were assessed using established criteria. Polypharmacy was defined as ≥ 5 concomitantly prescribed drugs.

RESULTS

Ninety-three patients with a median age of 57 years (IQR = 48-64 years), were consecutively enrolled in the BRE-BY-MED study. One patient was male. At baseline, a total of 668 drugs were documented for all patients, including 131 unique substances, of which 44% were mBC therapy, 18% supportive therapy and 38% treatment for comorbidities or supplements. Patients took a median of 6 (IQR = 5-9) concomitant drugs. Polypharmacy (i.e. ≥ 5 concomitant drugs) was observed in 80.6% (n = 75) of the patients. PIM were documented in 9.7% (n = 9), pDDI in 12.9% (n = 12) and pMD in 64.5% (n = 60) of the patients.

CONCLUSION

We observed a high drug burden in mBC patients, largely due to treatment for comorbidities. These drugs might not only be associated with additional risk for side effects, pDDI, or PIM use, yet might also contribute to low medication adherence, higher medication costs and impaired QoL. Considering the burden of mBC and the predicted life expectancy, mBC patients might benefit from closer monitoring of their medication.

Cardiovascular Health Considerations for Primary Care Physicians Treating Breast Cancer Survivors

Breast cancer (BC) survivors are at increased risk for cardiovascular disease (CVD) and require their primary care physicians to manage their long-term general medical care, including cardiovascular (CV) health. Yet, evidence exists that some primary care physicians possess insufficient knowledge about survivorship care. With the goal of bridging these knowledge gaps, a PubMed review was conducted from July 7, 2020, through October 2, 2020, with an updated PubMed review from January 3, 2024, through April 28, 2024, focusing on CV health considerations in the primary care of BC survivors. Search terms included variations of "breast cancer survivors" and "cardiovascular." In total, 152 publications were included. Breasts cancer survivors may have increased CVD risk because some anticancer therapies are cardiotoxic and risk factors for BC often also increase the risk for CVD. Multiple risk factors overlap for BC and CVD such as older age, Western diet, early menarche, physical inactivity, high body mass index, and smoking. In this review, results are summarized from studies that report the presence of CV risk factors and CVD in BC survivors. Also described are the CV effects of BC therapies (chemotherapy, hormonal agents, targeted therapies, and radiotherapy) and the type of CV evaluation (cardiac imaging and measurement of biomarkers) that these patients may need. Primary care physicians have an important role in managing the CV health of BC survivors from preventing, assessing, and managing CV risk factors to referring patients to appropriate specialists when needed.

Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort

BACKGROUND

Research indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking.

METHODS

Data was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders).

RESULTS

The sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men.

LIMITATIONS

Although the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk.

CONCLUSION

This study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.

Identifying Factors Associated With Heightened Anxiety During Breast Cancer Diagnosis Through the Analysis of Social Media Data on Reddit: Mixed Methods Study

BACKGROUND

More than 85% of patients report heightened levels of anxiety following breast cancer diagnosis. Anxiety may become amplified during the early stages of breast cancer diagnosis when ambiguity is high. High levels of anxiety can negatively impact patients by reducing their ability to function physically, make decisions, and adhere to treatment plans, with all these elements combined serving to diminish the quality of life.

OBJECTIVE

This study aimed to use individual social media posts about breast cancer experiences from Reddit (r/breastcancer) to understand the factors associated with breast cancer-related anxiety as individuals move from suspecting to confirming cancer diagnosis.

METHODS

We used a mixed method approach by combining natural language processing-based computational methods with descriptive analysis. Our team coded the entire corpus of 2170 unique posts from the r/breastcancer subreddit with respect to key variables, including whether the post was related to prediagnosis, diagnosis, or postdiagnosis concerns. We then used Linguistic Inquiry and Word Count (LIWC) to rank-order the codified posts as low, neutral, or high anxiety. High-anxiety posts were then retained for deep descriptive analysis to identify key themes relative to diagnostic progression.

RESULTS

After several iterations of data analysis and classification through both descriptive and computational methods, we identified a total of 448 high-anxiety posts across the 3 diagnostic categories. Our analyses revealed that individuals experience higher anxiety before a confirmed cancer diagnosis. Analysis of the high-anxiety posts revealed that the factors associated with anxiety differed depending on an individual's stage in the diagnostic process. Prediagnosis anxiety was associated with physical symptoms, cancer-related risk factors, communication, and interpreting medical information. During the diagnosis period, high anxiety was associated with physical symptoms, cancer-related risk factors, communication, and difficulty navigating the health care system. Following diagnosis, high-anxiety posts generally discussed topics related to treatment options, physical symptoms, emotional distress, family, and financial issues.

CONCLUSIONS

This study has practical, theoretical, and methodological implications for cancer research. Content analysis reveals several possible drivers of anxiety at each stage (prediagnosis, during diagnosis, and postdiagnosis) and provides key insights into how clinicians can help to alleviate anxiety at all stages of diagnosis. Findings provide insights into cancer-related anxiety as a process beginning before engagement with the health care system: when an individual first notices possible cancer symptoms. Uncertainty around physical symptoms and risk factors suggests the need for increased education and improved access to trained medical staff who can assist patients with questions and concerns during the diagnostic process. Assistance in understanding technical reports, scheduling, and patient-centric clinician behavior may pinpoint opportunities for improved communication between patients and providers.

Association between sleep duration, depression and breast cancer in the United States: a national health and nutrition examination survey analysis 2009-2018

OBJECTIVE

Breast cancer is the most common cancer in women, threatening both physical and mental health. The epidemiological evidence for association between sleep duration, depression and breast cancer is inconsistent. The aim of this study was to determine the association between them and build machine-learning algorithms to predict breast cancer.

METHODS

A total of 1,789 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the study, and 263 breast cancer patients were identified. Sleep duration was collected using a standardized questionnaire, and the Nine-item Patient Health Questionnaire (PHQ-9) was used to assess depression. Logistic regression yielded multivariable-adjusted breast cancer odds ratios (OR) and 95% confidence intervals (CI) for sleep duration and depression. Then, six machine learning algorithms, including AdaBoost, random forest, Boost tree, artificial neural network, limit gradient enhancement and support vector machine, were used to predict the development of breast cancer and find out the best algorithm.

RESULTS

Body mass index (BMI), race and smoking were statistically different between breast cancer and non-breast cancer groups. Participants with depression were associated with breast cancer (OR = 1.99, 95%CI: 1.55-3.51). Compared with 7-9h of sleep, the ORs for <7 and >9 h of sleep were 1.25 (95% CI: 0.85-1.37) and 1.05 (95% CI: 0.95-1.15), respectively. The AdaBoost model outperformed other machine learning algorithms and predicted well for breast cancer, with an area under curve (AUC) of 0.84 (95%CI: 0.81-0.87).

CONCLUSIONS

No significant association was observed between sleep duration and breast cancer, and participants with depression were associated with an increased risk for breast cancer. This finding provides new clues into the relationship between breast cancer and depression and sleep duration, and provides potential evidence for subsequent studies of pathological mechanisms.

Role of Cancer History in Cardiovascular Mortality Among Different Age-group Patients With Differentiated Thyroid Cancer

Background

Cardiovascular disease (CVD) is the leading cause of noncancer-related mortality among differentiated thyroid cancer (DTC) survivors, which accounts for a large portion of subsequent primary malignancies in childhood cancer survivors. This study aims to assess the risk of cardiovascular mortality among DTC as a second primary malignancy (DTC-2) patients compared with DTC as a first primary malignancy (DTC-1) and the general population.

Methods

Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 159 395 DTC-1 and 20 010 DTC-2 patients diagnosed older than 30 between 1975 and 2020 and the corresponding US population (71 214 642 person-years; 41 420 893 cardiovascular deaths). Compared with general-population and DTC-1 patients, we calculated incidence rate ratios (IRRs) of cardiovascular deaths among DTC-2 patients using Poisson regression. To adjust for unmeasured confounders, we performed a nested, case-crossover analysis among DTC-2 patients who died from CVD.

Results

Although DTC-2 patients had a comparable risk compared with the population (IRR 1.01) and a mildly increased risk of cardiovascular mortality compared with DTC-1 patients (IRR 1.26), the association was pronounced among individuals aged 30 to 74 years, especially 30 to 44 years (DTC-2 vs population: IRR 8.89; DTC-2 vs DTC-1: IRR 3.00). The risk elevation was greatest within the first month after diagnosis, compared with the population. The case-crossover analysis confirmed these results.

Conclusion

DTC-2 patients are at increased risk of cardiovascular mortality. Clinicians should carefully monitor CVD and manage other CVD-related factors, such as exogenous thyroxine and emotional distress, for DTC-2 patients, especially for those under 75 years.

Novelty and Impact Statements

This study is the first comprehensive investigation into the cardiovascular mortality of DTC-2, revealing a higher risk compared to DTC-1 and the general population, especially for cases between 30 and 74 years old. The risk elevation was greatest within the first month after diagnosis. These findings emphasize the restriction of thyroid hormone suppression therapy and reinforce stress management to prevent premature DTC-2 patients from cardiovascular death.

Sociocultural and Clinical Determinants of Sexual Dysfunction in Perimenopausal Women with and Without Breast Cancer

Breast cancer survivorship is a recognized risk factor for sexual dysfunction, with various clinical, sociocultural, and psychological factors potentially interacting differently across populations. This study compared sexual dysfunction, anxiety, and depression between females with breast cancer and those without, aiming to identify associated factors. A total of 362 females participated, including 227 with sexual dysfunction and 135 controls. Among them, 195 are breast cancer survivors, while 167 have no personal history of cancer. Key variables were analyzed using Student's t-test for quantitative data and Fisher's exact test for categorical data, while logistic regression models were used to assess the association between sexual dysfunction and various factors. Multivariate analysis revealed that, in sexually active females, breast cancer survivorship increased the odds of sexual dysfunction 2.7-fold (95% CI: 1.17-6.49; p = 0.020). Anxiety was significantly associated with sexual dysfunction, regardless of cancer status (AdOR 6.00; 95% CI: 2.50-14.43; p < 0.001). The interaction between cancer survival and anxiety further increased the odds of sexual dysfunction by more than 11-fold (AdOR 11.55; 95% CI: 3.81-35.04; p < 0.001). Additionally, obesity was found to be a protective factor among cancer survivors (AdOR 0.149; 95% CI: 0.027-0.819; p = 0.029). In conclusion, breast cancer has a significant impact on sexual function, with psychological factors like anxiety playing a crucial role. Addressing these issues requires a holistic, patient-centered approach that considers the complex interplay of physical, emotional, and sociocultural factors.

Nurse-Led Mobile App Effect on Quality of Life in Breast Cancer Patients After Surgery: Nonrandomized Controlled Prospective Cohort Study (Step 3)

BACKGROUND

Following surgery, women with breast cancer (BC) frequently experience emotional and physiological negative consequences.

OBJECTIVE

To evaluate the effect of a nurse-led mobile app (NL-Mapp) intervention on quality of life (QoL) in patients after surgery for BC.

METHODS

This single-center, 12-month, nonrandomized controlled trial, with 2 parallel groups, represents the final stage of 3-step research. In this study, women were assigned to either the intervention (n = 45) or control (n = 45) group. The intervention group participated in the NL-Mapp, whereas participants in the control group received standard care. The main outcomes were measured using the Functional Assessment of Cancer Therapy-Breast at 3 time points (baseline and 1 and 12 months after the intervention). Clinical Trial number: NCT06505538.

RESULTS

The intervention participants reported significant improvement in physical well-being, emotional well-being, and the BC-specific subscale compared with the control group at the 1-month postsurgery mark. Equally noteworthy, at the 1-year follow-up, consistent improvements were observed across all QoL subscale scores for the intervention group, except for the BC-specific subscale for additional concerns.

CONCLUSION

Our study revealed a notable enhancement in the QoL among postoperative women with BC who utilized the NL-Mapp. This program emerges as an effective intervention for providing short-term and longer-term supportive care to women affected by BC, leading to tangible improvements in their QoL.

IMPLICATION FOR NURSING

The study's findings offer valuable evidence supporting the integration of mobile health services into clinical and transitional nursing care.

Current status and hotspots in breast cancer patient self-management research: A bibliometric and visual analysis via CiteSpace

BACKGROUND

Breast cancer remains a leading cause of cancer-related mortality worldwide. Patient self-management plays a pivotal role in enhancing outcomes and quality of life for individuals affected by this disease. This study employed bibliometric and visual analysis techniques utilizing CiteSpace to elucidate the current status and research hotspots in breast cancer patient self-management from January 1, 2005, to August 31, 2023.

METHODS

A comprehensive search was conducted in the Web of Science Core Collection (WoSCC). The retrieved literature was subjected to visualization and analysis using CiteSpace, focusing on publication timeline, article count, geographical distribution, institutional affiliations, journal sources, reference co-citation networks, and keyword analysis.

RESULTS

The analysis encompassed 1413 English-language documents. The United States emerged as the most prolific contributor, while the University of Toronto demonstrated the highest institutional output. The two-map overlay revealed prominent citation paths, indicating strong interconnections between publications in "Medicine, Medicine, Clinical" and "Health, Nursing, Medicine," as well as "Psychology, Education, Health" and "Health, Nursing, Medicine." The most frequently co-cited reference was "Self-Management: Enabling and Empowering Patients Living with Cancer as a Chronic Illness." High-frequency keywords identified included quality of life, chronic disease, self-management, patient education, randomized controlled trials, education, and intervention. These keywords formed 11 distinct clusters related to intervention content, methodologies, outcome indicators, and emerging research trends. Keyword burst analysis predicted future research hotspots focusing on patient needs, psychological distress, Internet technology, and mobile applications.

CONCLUSIONS

Research in breast cancer self-management is experiencing significant growth. Enhanced collaboration between countries, regions, and institutions is imperative. Further investigation is warranted, particularly in the domains of "quality of life," "patient education," and "mobile health." These findings provide valuable insights to guide future research directions in this critical field.

Combined healthy lifestyle factors and psychosocial outcomes among cancer survivors: a systematic review and meta-analysis

PURPOSE

This systematic review aims to summarize the associations between combined healthy lifestyles and psychosocial outcomes (health-related quality of life (HRQOL), depression, anxiety, psychological distress (PD), and posttraumatic stress disorder (PTSD)) among cancer survivors.

METHODS

PubMed, Web of Science, Cochrane Library, and EMBASE were searched for observational and interventional studies examining healthy lifestyle scores (HLS, calculated by a combination of at least three lifestyles) and psychosocial outcomes among cancer survivors from inception to April 2024. A minimum of two studies with the same study design were pooled using random effects models.

RESULTS

Twenty-one studies (44,812 survivors) were included. Of all studies, 16 of which were included in meta-analysis. The pooling of cross-sectional evidence shows significant association between HLS and overall, physical, and psychosocial HRQOL. Significance was only observed for overall and physical HRQOL but not for psychosocial HRQOL in cohort studies. The estimations and 95% confidence interval (CI) with 1-point increase in HLS were 1.47 (0.83-2.12) and 1.42 (0.19-2.65) for overall and physical HRQOL, respectively. The evidence from interventional studies also indicated that interventions on multiple lifestyles have positive effects on the physical but not psychosocial HRQOL. Despite the limited number of studies, significant associations were found between HLS and depression, anxiety, PD, and PTSD.

CONCLUSIONS

Although evidence is limited, we found that the combination of multiple healthier lifestyles is associated with better psychosocial outcomes in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This review underscores the potential for adhering to multiple healthy lifestyles to improve psychosocial outcomes and enhance HRQOL for cancer survivors.

Suicide Risk Among Patients With Cancer by Sex in Japan: A Population-based Study

BACKGROUND

In Japan, few studies have examined suicide risk for 5-year relative survival rates for cancer sites. Since 5-year relative survival rates differ by sex, we aim to examine suicide risk for patients with cancer separately for men and women.

METHODS

We estimated the risk of suicide among patients with cancer by sex in Japan compared to the general population, using standardized mortality ratios (SMRs). Patients with cancer diagnosed between January 1, 1985-December 31, 2013 and registered in the Osaka Cancer Registry were followed for up to 10 years. The outcome was suicide death. In addition, cancer sites were classified into three prognosis groups based on 5-year relative survival rates: good (>70%), moderate (40-70%), poor (<40%).

RESULTS

Among 623,995 patients with cancer observed for 2,349,432 person-years, 1,210 patients died by suicide (867 men and 343 women). The SMRs were almost equal for men (1.66; 95% confidence interval [CI], 1.55-1.77) and women (1.65; 95% CI, 1.48-1.83). SMRs for cancer prognosis groups were 1.01 (95% CI, 0.84-1.22) for men and 1.47 (95% CI, 1.24-1.73) for women in the good group, 1.53 (95% CI, 1.39-1.68) for men and 1.74 (95% CI, 1.47-2.05) for women in the moderate group, and 2.54 (95% CI, 2.27-2.85) for men and 1.87 (95% CI, 1.43-2.46) for women in the poor group.

CONCLUSION

In this population, both sexes had higher suicide risk with poor prognosis, but the difference in SMRs between the good and poor groups was smaller for women than men.

Effect of Internet-Based Cognitive Behavioral Therapy on Psychological Distress and Quality of Life Among Breast Cancer Survivors: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

This meta-analysis was to critically evaluate the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) on psychological distress and quality of life in breast cancer survivors.

METHODS

A search was conducted across eleven databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest, CINAHL, CBM, CNKI, VIP and Wanfang) to identify relevant randomized controlled trials (RCTs) published from databases inception to September 2023. Two reviewers independently conducted study screening, data extraction, and quality assessment of the included studies. Review Manager 5.4 and Stata 18.0 were utilized for analysis.

RESULTS

Ten studies with 1409 patients were included. Meta-analysis indicated that ICBT alleviated anxiety [SMD = -0.34, 95% CI (-0.64, -0.04), p = 0.03] and depression [SMD = -0.43, 95% CI (-0.76, -0.09), p = 0.01] in breast cancer patients. Therapist-guided ICBT outperformed self-guided ICBT, with interventions lasting ≤ 9 weeks better than > 9 weeks, and module quantity didn't affect the results. Additionally, ICBT significantly improved quality of life [SMD = 0.37, 95% CI (0.21, 0.52), p < 0.001], yet didn't reduce fatigue [SMD = -0.13, 95% CI (-0.59, 0.34), p = 0.60], insomnia [MD = -2.24, 95% CI (-5.77, 1.28), p = 0.21], or fear of progression [SMD = -0.10, 95% CI (-0.31, 0.11), p = 0.34].

CONCLUSIONS

ICBT, especially therapist-guided and lasting for ≤ 9 weeks, can effectively relieve anxiety and depression, as well as enhance breast cancer patients' quality of life. Nevertheless, it fails to improve fatigue, insomnia, or fear of progression. High-quality, large-sample studies must be conducted in the future for further validation.

Molecular signaling and clinical implications in the human aging-cancer cycle

It is well documented that aging is associated with cancer, and likewise, cancer survivors display accelerated aging. As the number of aging individuals and cancer survivors continues to grow, it raises additional concerns across society. Therefore, unraveling the molecular mechanisms of aging in tissues is essential to developing effective therapies to fight the aging and cancer diseases in cancer survivors and cancer patients. Indeed, cellular senescence is a critical response, or a natural barrier to suppress the transition of normal cells into cancer cells, however, hypoxia which is physiologically required to maintain the stem cell niche, is increased by aging and inhibits senescence in tissues. Interestingly, oxygen restriction or hypoxia increases longevity and slows the aging process in humans, but hypoxia can also drive angiogenesis to facilitate cancer progression. In addition, cancer treatment is considered as one of the major reasons that drive cellular senescence, subsequently followed by accelerated aging. Several clinical trials have recently evaluated inhibitors to eliminate senescent cells. However, some mechanisms of aging typically can also retard cancer cell growth and progression, which might require careful strategy for better clinical outcomes. Here we describe the molecular regulation of aging and cancer in crosstalk with DNA damage and hypoxia signaling pathways in cancer patients and cancer survivors. We also update several therapeutic strategies that might be critical in reversing the cancer treatment-associated aging process.

Breast Cancer and Mental Health: Incidence and Influencing Factors-A Claims Data Analysis from Germany

BACKGROUND/OBJECTIVES

With breast cancer (BC) survival improving due to optimized therapy, enhancing quality of life has become increasingly important. Both diagnosis and treatment, with their potential side effects, pose risks to mental well-being. Our study aimed to analyze the incidence and potential risk factors for mental disorders in BC patients.

METHODS

This retrospective analysis used claims data from AOK Baden-Wuerttemberg, including 11,553 BC patients diagnosed via ICD code C50 between 2010 and 2020 and 31,944 age-matched controls. Patients with mental disorders in the 12 months prior to diagnosis were excluded. Mental disorders were categorized into eight groups based on ICD codes: anxiety, obsessive compulsive disorder, adjustment disorder, dissociative disorder, hypochondriac disorder, affective disorder, mania, and other neuroses.

RESULTS

Mental disorders were significantly more common in BC patients than in controls (64.2% vs. 38.1%, p < 0.01, OR 2.91, 95%CI [2.79, 3.04]). In particular, hypochondriac, anxiety, affective, and adjustment disorders occurred significantly more often in BC patients. No differences were found for mania, bipolar disease, other neuroses, obsessive compulsive-, or dissociative disorders. Furthermore, endocrine therapy was associated with psychological comorbidities (OR 1.69, p < 0.001, 95%CI [1.53, 1.86]), while primarily metastasized patients (stage C) had a lower risk than adjuvant patients in stage A (OR 0.55, p < 0.0001, 95%CI [0.49, 0.61]). Regarding surgical treatment, mastectomy patients showed lower rates of mental illnesses (61.2%) than those with breast-conserving treatment (71.6%), or especially breast reconstruction (78.4%, p < 0.01). Breast reconstruction was also associated with more hypochondriac (p < 0.01) and adjustment disorders (p < 0.01).

CONCLUSIONS

So, BC patients experience significantly more mental disorders than controls, particularly when treated with endocrine therapy and breast reconstructive surgery.

Moderators of Intervention Efficacy in the Pathways to Wellness Trial of Survivorship Education and Mindfulness Meditation for Younger Breast Cancer Survivors

PURPOSE

Depression is associated with poor outcomes in breast cancer survivors (BCSs), with higher prevalence among younger women. The Pathways to Wellness (PTW; ClinicalTrials.gov identifier: NCT03025139) randomized controlled trial (RCT) demonstrated beneficial effects of two behavioral interventions (survivorship education [SE] and mindful awareness practices [MAPs]) on depressive symptoms in younger BCS. We conducted an exploratory secondary analysis to identify moderators of intervention effects.

METHODS

Women diagnosed with stage 0 to III breast cancer at or before age 50 years who completed cancer treatment were randomly assigned to 6 weeks of SE (n = 81), MAPs (n = 85), or waitlist control (WLC; n = 81). Moderators assessed at baseline included psychological distress (depression and anxiety), intervention preference, preparedness for survivorship, and time since initial diagnosis. Linear regression models tested the modifying effects of each variable on postintervention depression in SE versus WLC and MAPs versus WLC.

RESULTS

Baseline levels of depression (β = -.03, P < .01) and anxiety (β = -.64, P = .02) moderated effects of SE on depressive symptoms, as did preparedness for survivorship (β = 3.17, P = .02). Participants randomly assigned to SE who had the highest levels of depression or anxiety and who felt least prepared for survivorship showed the largest reductions in depressive symptoms from preintervention to postintervention. Similar effects were not observed for MAPs. Intervention preference and time since diagnosis did not moderate intervention effects for either SE or MAPs.

CONCLUSION

Our 6-week, group-based SE program may be most beneficial for women with higher levels of psychological distress and those who feel least prepared for cancer survivorship. By contrast, a 6-week mindfulness awareness practice intervention appears to benefit younger BCS regardless of pretreatment characteristics.

Newly Diagnosed Mental Health Disorders in Patients With Breast Cancer Receiving Radiation Therapy

PURPOSE

Patients with a mental health disorder (MHD) have higher age-adjusted mortality compared with the general population. Few reports investigate factors contributing to MHD among patients with breast cancer receiving radiation therapy. We report the incidence of acquired MHD after the diagnosis of breast cancer and treatment with radiation therapy.

METHODS AND MATERIALS

Using a single institution, prospectively maintained database, we analyzed patients with breast cancer treated with radiation therapy between 2012 and 2017. We cross-referenced these patients with newly acquired International Classification of Diseases, Tenth Revision (ICD-10) MHD codes (F01-F99) within 3 years postbreast cancer diagnosis. The study included baseline National Comprehensive Cancer Network® (NCCN) distress tool scores and area deprivation index (ADI). Univariate and multivariable (MVA) Cox regression analyses were conducted to evaluate factors affecting new MHD onset.

RESULTS

Of the 967 included patients, 318 (33%) developed an MHD after their breast cancer diagnosis, which was predominately anxiety (45.1%) and depression (20.1%) related, with a median (IQR) time to diagnosis of 30 (24-33) months. Univariate analysis showed lymph node-positive disease, receipt of chemotherapy, receipt of a mastectomy, high comorbidity index, divorced status, retired status, and fourth-quartile ADI as significant predictors. On MVA, only receipt of chemotherapy (hazard ratio [HR], 1.70; P = .014) and divorced status (HR, 2.04; P = .009) remained significant. Fourth-quartile ADI, retired status, and high comorbidity index showed trends toward significance (HR, 1.78, P = .065; HR, 1.46, P = .094; HR, 1.41, P = .059, respectively). On MVA examining the effects of the radiation therapy type on MHD, whole breast with regional nodal irradiation (HR, 2.31, P = .015) and postmastectomy radiation therapy (HR, 1.88, P = .024) were both strong predictors of MHD development. Additionally, an NCCN distress tool score of >3 was also predictive of MHD onset.

CONCLUSIONS

In this cohort, 1 in 3 patients with localized breast cancer developed a new MHD, predominantly related to anxiety and depression. MHD risk was higher among divorced patients, those receiving chemotherapy, and patients receiving postmastectomy radiation therapy or whole breast with regional nodal irradiation. These findings highlight the importance of future studies and targeted interventions to support this vulnerable population.

Early, medium and long-term mental health in cancer survivors compared with cancer-free comparators: matched cohort study using linked UK electronic health records

Background

We aimed to compare the risk of incident depression, anxiety, non-fatal self-harm and completed suicide in survivors from a wide range of cancers versus cancer-free individuals.

Methods

We used electronic health records from the United Kingdom Clinical Practice Research Datalink linked to cancer registry data, hospital admissions data and death records between 1998 and 2021. Adult survivors of the 20 most common cancers were matched (age, sex, general practice) 1:10 to cancer-free individuals. Cox regression models, adjusted for shared risk factors, were used to estimate associations between cancer survivorship and mental health outcomes.

Findings

853,177 adults with cancer diagnosed in 1998-2018 were matched to 8,106,643 cancer-free individuals. Survivors of all 20 cancer types under study had a higher risk of experiencing a new episode of anxiety and depression during follow-up compared with cancer-free individuals; there was also evidence of raised risks of non-fatal self-harm in 17/20 cancers and completed suicide in 8/20 cancers. Effect sizes were greatest in cancers with poorer 5-year survival: hazard ratios (HRs) for anxiety and depression of 1.1-1.2 were seen for malignant melanoma survivors, while HRs for both outcomes were >2.5 for lung and oesophageal cancer survivors. HRs were highest in the first year from cancer diagnosis, reducing over time since diagnosis. However, 5-year cancer survivors still experienced elevated risks of a subsequent new episode of anxiety or depression, in 18/20 cancers.

Interpretation

Survivors of the 20 most common cancers were at increased risk of experiencing depression and anxiety, and these increased risks persisted in medium-to long-term cancer survivors. Substantially raised risks of non-fatal self-harm and completed suicide were also seen for several types of cancer. The risks of all mental health outcomes were generally higher in survivors of cancers with poorer prognosis. Our findings suggest a need for improved psychological support for all patients with cancer.

Funding

Wellcome Trust.

Tumor-infiltrating nerves functionally alter brain circuits and modulate behavior in a mouse model of head-and-neck cancer

Cancer patients often experience changes in mental health, prompting an exploration into whether nerves infiltrating tumors contribute to these alterations by impacting brain functions. Using a mouse model for head and neck cancer and neuronal tracing, we show that tumor-infiltrating nerves connect to distinct brain areas. The activation of this neuronal circuitry altered behaviors (decreased nest-building, increased latency to eat a cookie, and reduced wheel running). Tumor-infiltrating nociceptor neurons exhibited heightened calcium activity and brain regions receiving these neural projections showed elevated Fos as well as increased calcium responses compared to non-tumor-bearing counterparts. The genetic elimination of nociceptor neurons decreased brain Fos expression and mitigated the behavioral alterations induced by the presence of the tumor. While analgesic treatment restored nesting and cookie test behaviors, it did not fully restore voluntary wheel running indicating that pain is not the exclusive driver of such behavioral shifts. Unraveling the interaction between the tumor, infiltrating nerves, and the brain is pivotal to developing targeted interventions to alleviate the mental health burdens associated with cancer.

The impacts of cancer treatment on lifestyle habits and mental health in Vietnamese women: an exploratory qualitative study

AIMS

This qualitative study explores the experiences of women after cancer treatment in terms of habit changes and mental health impact.

METHOD

The study involved 10 women who had undergone cancer treatment, recruited from three major hospitals in Hanoi, Vietnam. Data were collected through semi-structured interviews, which were transcribed and analyzed using thematic analysis.

RESULTS

The findings of the study shed light on the various factors influencing lifestyle behavior and mental health changes among women after cancer treatment. Ten participants, aged 39 to 64 years, shared experiences including dietary changes, sleep disruptions, and reliance on non-scientific sources for health decisions. Initially shocked by their diagnosis, many transitioned to acceptance, adopting a "giving-in" attitude. Cultural beliefs, word-of-mouth sharing, and social support networks played significant roles in shaping post-treatment lifestyle changes, coping mechanisms, information-seeking behaviors, and mental health.

CONCLUSION

The study highlights the need for accessible and scientifically verified information for women after cancer treatment to make informed decisions about their health. It emphasizes the importance of addressing traditional beliefs and promoting evidence-based practices. Moreover, the study underscores the importance of social support and relationships in coping with the challenges of post-cancer experiences.

The intersection of the nervous system and breast cancer

Breast cancer (BC) represents a paradigm of heterogeneity, manifesting as a spectrum of molecular subtypes with divergent clinical trajectories. It is fundamentally characterized by the aberrant proliferation of malignant cells within breast tissue, a process modulated by a myriad of factors that govern its progression. Recent endeavors outline the interplay between BC and the nervous system, illuminate the complex symbiosis between neural structures and neoplastic cells, and elucidate nerve dependence as a cornerstone of BC progression. This includes the neural modulations on immune response, neurovascular formation, and multisystem interactions. Such insights have unveiled the critical impact of neural elements on tumor dynamics and patient prognosis. This revelation beckons a deeper exploration into the neuro-oncological interface, potentially unlocking novel therapeutic vistas. This review endeavors to delineate the intricate mechanisms between the nervous system and BC, aiming to accentuate the implications and therapeutic strategies of this intersection for tumor evolution and the formulation of innovative therapeutic approaches.

Psychological impact of exceptional response in people with advanced cancer: a qualitative exploration

BACKGROUND

In the cancer context, exceptional response incorporates unusual or unexpected response to anti-cancer treatment. For this study, exceptionally 'good' responses are defined as progression-free survival of more than three times the median from comparable trials. We aimed to explore how people meeting the definition of exceptional response to systemic cancer treatment experience adjust to their unexpected survivorship.

METHODS

Individuals with 'exceptional response' to anti-cancer therapy nationally were referred by their treating clinicians to the Exceptional Responders Program. We conducted a qualitative sub-study involving semi-structured interviews with purposively selected participants. Those eligible had metastatic cancer, had survived at least 3 times the expected time since diagnosis, spoke English, and were aged > 18 years. Interviews were audiorecorded, transcribed and analysed thematically; and continued until thematic saturation was achieved.

RESULTS

Twenty participants were interviewed. Thirteen were male (65%) with a median age of 63 years. Median time since cancer diagnosis was 6.5 years (range 3-18); survival times ranged between 3 and 10 times that expected. We identified four themes which varied in importance between individuals and over time.

CONCLUSION

Exceptional responders may benefit from routine screening of distress and unmet needs to provide psychosocial support. Clinical services must focus on first capturing and then tailoring care to meet the diverse needs of this growing cohort.

IMPLICATIONS FOR CANCER SURVIVORS

Adjustment to a diagnosis of advanced cancer and subsequent unexpected long-term survival is an often isolating experience and is common amongst exceptional responders. Seeking psychological and social support may assist with adjustment.

Unveiling the Hidden Burden: Exploring the Psychological Impact of Gynecological Cancers and Predictive Modeling of Depression in Southwest China

Objective

To explore the psychological impact of gynecological cancers on middle-aged women in Southwest China and identify the risk factors for moderate to severe depressive symptoms.

Methods

This cross-sectional study included 500 patients from Southwest China, divided into two groups: depression (n = 220) and no depression (n = 280). Data on demographics, clinical characteristics, and socioeconomic factors were collected. We developed a logistic regression model to predict depressive symptoms and assessed its accuracy using the area under the receiver operating characteristic curve (AUC).

Results

The study cohort consisted of 500 middle-aged and young female cancer patients with a median age of 44 years. Significant predictors of depressive symptoms included younger age, higher economic stress levels, and out-of-pocket medical expenses. A comparative analysis showed that 220 patients exhibited depression symptoms, with these patients being generally younger (median age 41 years) compared to those without depression (median age 47 years, p < 0.001). Economic stress was consistently higher in the depression group across all cancer types. Patients with ovarian cancer had a reduced risk of depression compared to those with cervical cancer. The predictive model demonstrated high accuracy in identifying depression risk, with an AUC of 0.888. Internal validation yielded an average AUC of 0.885, and external validation produced an AUC of 0.872, underscoring the model's robustness and reliability. These findings emphasize the complex interplay of demographic, socioeconomic, and clinical factors in the psychological well-being of gynecological cancer patients, highlighting the need for tailored psychological and financial support interventions.

Conclusion

Gynecological cancer patients in Southwest China experience significant psychological challenges, particularly younger women and those facing economic stress. Our predictive model can aid in early identification of those at risk for depression, emphasizing the importance of holistic care. Interventions should focus on both psychological and financial support to improve patient outcomes.

Emotional and functional well-being in long-term breast cancer survivorship

PURPOSE

Emotional and functional well-being (EWB and FWB) are important components of mental health and quality of life. This study aims to evaluate long-term EWB and FWB in breast cancer (BC) survivors.

METHODS

The Carolina Breast Cancer Study Phase 3 oversampled Black and younger (< 50 years in age) women so that they each represent approximately 50% of the study population and assessed participants' EWB and FWB with the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5- (baseline), 25-, and 84-months post diagnosis. Multinomial logit models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and well-being change relative to baseline.

RESULTS

Among 2,781 participants with BC, average EWB and FWB improved with time since diagnosis. Persistent FWB decrements were associated with Black race [OR 1.4 (95% CI 1.2-1.7) and 1.3 (95% CI 1.1-1.6), at 25-months and 84-months respectively], older age [OR 1.4 (95% CI 1.1-1.7) and 1.5 (95% CI 1.2-1.8), respectively], no chemotherapy, and recurrence [OR 2.9 (95% CI 1.8-4.8) and 3.1 (95% CI 2.1-4.6), respectively]. EWB decrements were associated with advanced stage and recurrence. Decrements in combined (FWB+EWB) well-being were associated with recurrence at both follow-up survey timepoints [ORs 4.7 (95% CI 2.7-8.0) and 4.3 (95% CI 2.8-6.6), respectively].

CONCLUSIONS

Long-term well-being varies by demographics and clinical features, with Black women and women with aggressive disease at greatest risk of long-term decrements.

Does yoga improve sexual function? A systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Yoga practice can increase blood flow in the genital area, increase muscular strength, and improve body perception, which is related to sexual function. This study aimed to summarize the available evidence about the effects of yoga on sexual function in adults.

METHODS

Systematic searches of five databases were conducted from inception to April 28, with the last update on September 28, 2023. Randomized clinical trials (RCTs) that compared yoga with nonintervention control groups on sexual function in adults. Risk of bias and certainty of evidence were assessed by the Cochrane risk of bias tool 2, and the GRADE approach, respectively. Summary effect size measures were calculated using a random-effects model estimation and are reported as standardized mean differences and 95% confidence intervals. Reporting followed the PRISMA guidelines.

RESULTS

Ten RCTs that comprised 730 adults (range mean age, 26.64-68.2 years; 680 [93.2 %] women) were included. For the primary outcome, yoga intervention was associated with a significant small improvement in sexual function (-0.31; -0.47 to -0.15, p = 0.0002), with some concerns about risk of bias in nine RCTs (90%) and low-certainty evidence. Subgroup analyses revealed that yoga interventions performed by women (-0.36; -0.52 to -0.21, p < 0.00001), healthy individuals (-0.38; -0.59 to -0.16, p = 0.0006), or middle-aged individuals (-0.44; -0.63 to -0.25, p < 00001) significantly improved sexual function compared with control groups.

CONCLUSION

Yoga was associated with a small improvement in sexual function compared with nonintervention control groups in adults. However, high-quality, larger RCTs are required to draw more definitive conclusions.

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.

Quercetin inhibits neuronal Ferroptosis and promotes immune response by targeting lipid metabolism-related gene PTGS2 to alleviate breast cancer-related depression

BACKGROUND

Quercetin, the key ingredient in Xiaoyao Kangai Jieyu Formula, has been previously found to relieve breast cancer-related depression (BCRD).

PURPOSE

We want to explore the potential mechanisms and therapeutic targets of quercetin alleviating BCRD.

METHODS

BALB/c mice were injected subcutaneously with 4T1 cells and corticosterone (CORT) to create a BCRD mice model. The primary hippocampal neurons were co-induced with 10 μg/ml lipopolysaccharide (LPS) and 200 μM CORT for 6 h to establish an in vitro model of BCRD. Quercetin was applied to explore its effect on disease symptoms, gut microbiota, and lipid metabolism of BCRD mice. Lipid metabolism-related genes were screened based on network pharmacology. Molecular docking was employed to prove whether quercetin bound to prostaglandin-endoperoxide synthase 2 (PTGS2). PTGS2 overexpression was carried out to explore the underlying mechanism of quercetin treatment on BCRD.

RESULTS

Quercetin treatment not only altered the composition and abundance of gut microbiota but also alleviated abnormal lipid metabolism in BCRD mice. In particular, quercetin down-regulated BCRD and lipid metabolism-related genes screened by network pharmacology, especially PTGS2. Further, molecular docking verified the stable binding between quercetin and PTGS2. In hippocampal neurons, quercetin promoted proliferation but reduced ferroptosis-related markers (total Fe, Fe2+, MDA, and ROS) levels by targeting PTGS2. In BCRD mice, quercetin reduced the high immobility time and increased the sucrose preference rate and serotonin (5-HT), dopamine (DA), and noradrenaline (NE) levels. Meanwhile, quercetin increased CD4+/CD8+ T cells ratio and IL-2 and IFN-γ levels but reduced CA153 and IL-10 levels to alleviate BCRD development. However, PTGS2 overexpression reversed these effects of quercetin on BCRD.

CONCLUSION

Quercetin inhibited neuronal ferroptosis and promoted immune responses in BCRD mice by targeting the lipid metabolism-related gene PTGS2. This provided a reference for quercetin in the treatment of BCRD.

An Overview of Long-Acting GnRH Agonists in Premenopausal Breast Cancer Patients: Survivorship Challenges and Management

Managing breast cancer in premenopausal women poses unique challenges due to its considerable effect on both morbidity and mortality. Goserelin, a gonadotropin-releasing hormone agonist, has emerged among the various modalities as a preferred option for ovarian function suppression, owing to its efficacy in reducing ovarian estrogen production in premenopausal women with hormone receptor-positive breast cancer. Recent studies have affirmed the efficacy and safety of long-acting (LA) goserelin 10.8 mg every 12 weeks, offering comparable outcomes to monthly injections. This flexibility enables personalized treatment approaches, potentially enhancing patient satisfaction. Off-label utilization of goserelin LA surged during the coronavirus disease pandemic, prompting initiatives to broaden its use for breast cancer treatment. Switching to goserelin LA can streamline treatment, boost adherence, and optimize resource utilization. With the recent approval of goserelin 10.8 mg LA by Health Canada on 6 May 2024, for use in breast cancer, Canada is the latest to join over 60 countries worldwide to expand the accepted indications for goserelin LA and ensure its availability to potentially enhance healthcare delivery, patient care, and breast cancer outcomes. Goserelin LA offers premenopausal patients a means to more effectively manage the constraints imposed by breast cancer treatment and its impact on survivorship.

Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey-National Death Index Linked Study

Breast cancer (BC) and depression are globally prevalent problems. Numerous reviews have indicated the high prevalence of depression among BC survivors. However, the long-term impact of depression on survival among BC survivors has not been well explored. For this investigation, we aimed to explore the relationship between BC, depression, and mortality from a national random sample of adult American women. Data from the U.S. National Health and Nutrition Examination Survey (years 2005-2010) were linked with mortality data from the National Death Index up to December 31st, 2019. A total of 4719 adult women (ages 45 years and older) were included in the study sample with 5.1% having breast cancer and more than a tenth (12.7%) having depression. The adjusted hazard ratio (HR) for all-cause mortality risk among those with BC was 1.50 (95% CI = 1.05-2.13) compared to those without BC. In the adjusted analysis, the risk of all-cause mortality was highest among women with both depression and BC (HR = 3.04; 95% CI = 1.15-8.05) compared to those without BC or depression. The relationship between BC and mortality was moderated by cardiovascular diseases, anemia, smoking, age, PIR, and marital status. Our analysis provides vital information on factors that could be helpful for interventions to reduce mortality risk among those with BC and depression. In addition, given the higher risk of mortality with co-occurring BC and depression, collaborative healthcare practices should help with widespread screening for and treatment of depression among BC survivors.

Baseline Association between Healthy Eating Index-2015 and Health-Related Quality of Life in Breast Cancer Patients Enrolled in a Randomized Trial

Health-related quality of life (HRQoL) represents one of the most concerning aspects for cancer patients. The Healthy Eating Index (HEI) is an a priori diet quality index directly associated with health outcomes and HRQoL in cancer survivors in North American populations. We evaluated, in a Mediterranean population, the baseline associations between HEI-2015 and HRQoL in 492 women with breast cancer recruited in a DEDiCa lifestyle trial. Dietary data were obtained from 7-day food records; HRQoL was assessed through the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) and the C30 Summary Score (SumSc). Analysis of variance and multivariable linear and log-gamma regression models were performed. Mean and standard deviation for HEI-2015 score was 68.8 ± 11.2; SumSc was 81.5 ± 12.9. Women with lower HEI-2015 score had higher BMI, were more frequently exposed to tobacco smoke and had fewer years of education. Patients with a HEI-2015 score greater than 68.7 (median value) showed a significant increase in SumSc of 4% (p = 0.02). HEI-2015 components also associated with SumSc were beans and greens (β = 1.04; p = 0.02). Weak associations were found for total vegetables and saturated fats. Higher diet quality in breast cancer survivors was associated with higher overall HRQoL in this cross-sectional analysis.