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Background: Women who receive a breast cancer diagnosis often have to cope with physical and psychological issues, even some years after diagnosis and treatments. Physical changes and negative inner sensations damage body image, leading to reduced contact with the body and social relationships due to shame and increased fear of cancer recurrence. Several psychological interventions have been conducted to manage psycho‐emotional issues involving bodily sensations and emotions. Aims: This study aimed to propose a virtual reality (VR) intervention to improve awareness and management of bodily sensations. Materials and Methods: Thirteen women participated in a study design in which they were guided to focus their attention on three different parts of their body (i.e. arms, chest and legs) in a randomised way. Participants followed a light as a virtual visual stimulation and heard the researcher's voice. Results: Findings showed that physical discomfort and negative emotions related to the body significantly decreased after the VR intervention. Additionally, the present VR intervention decreased anxiety. Accordingly, women qualitatively stated being satisfied with the intervention, considering VR as a helpful tool to be more focused on their inner sensations and decrease discomfort. Discussion: In conclusion, VR may be implemented to promote bodily awareness in women with a breast cancer diagnosis, improving bodily awareness and the management of negative emotions. Conclusion: Directions for future research and clinical implications are given. [ABSTRACT FROM AUTHOR]

Background: Breast cancer survivors are at a higher risk of cardiovascular disease (CVD) morbidity and mortality compared with the general population. The impact of objective social and built neighborhood attributes on CVD risk in a cohort of female breast cancer survivors was examined. Methods: The 3975 participants came from the Pathways Study, a prospective cohort of women with invasive breast cancer from an integrated health care system in northern California. Women diagnosed with breast cancer from 2006 through 2013 were enrolled on average approximately 2 months after diagnosis. Their baseline addresses were geocoded and appended to neighborhood attributes for racial/ethnic composition, socioeconomic status (SES), population density, urbanization, crime, traffic density, street connectivity, parks, recreational facilities, and retail food environment. Incident CVD events included ischemic heart disease, heart failure, cardiomyopathy, or stroke. Cox proportional hazards models estimated associations of neighborhood attributes with CVD risk, which accounted for clustering by block groups. Fully adjusted models included sociodemographic, clinical, and behavioral factors. Results: During follow‐up through December 31, 2018, 340 participants (8.6%) had CVD events. A neighborhood racial/ethnic composition measure, percent of Asian American/Pacific Islander residents (lowest quintile hazard ratio [HR], 1.85; 95% CI, 1.03–3.33), and crime index (highest quartile HR, 1.48; 95% CI, 1.08–2.03) were associated with the risk of CVD events independent of individual SES, hormone receptor status, treatment, cardiometabolic comorbidities, body mass index, and physical activity. Conclusions: With the application of a socio‐ecological framework, how residential environments shape health outcomes in women with breast cancer and affect CVD risk in this growing population can be understood. Neighborhood attributes associated with the risk of cardiovascular disease among a diverse cohort of breast cancer survivors were examined. Neighborhood racial and ethnic composition as well as crime were found to be associated with risk, which has provided evidence of the need to understand the more upstream factors contributing to health outcomes. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy related cognitive impairment (CRCI) is a type of memory and cognitive impairment induced by chemotherapy and has become a growing clinical problem. Breast cancer survivors (BCs) refer to patients from the moment of breast cancer diagnosis to the end of their lives. Managing Cancer and Living Meaningfully (CALM) is a convenient and easy‐to‐apply psychological intervention that has been proven to improve quality of life and alleviate CRCI in BCs. However, the underlying neurobiological mechanisms remain unclear. Resting‐state functional magnetic resonance imaging (rs‐fMRI) has become an effective method for understanding the neurobiological mechanisms of brain networks in CRCI. The fractional amplitude of low‐frequency fluctuations (fALFF) and ALFF have often been used in analyzing the power and intensity of spontaneous regional resting state neural activity. Methods: The recruited BCs were randomly divided into the CALM group and the care as usual (CAU) group. All BCs were evaluated by the Functional Assessment of Cancer Therapy Cognitive Function (FACT‐Cog) before and after CALM or CAU. The rs‐fMRI imaging was acquired before and after CALM intervention in CALM group BCs. The BCs were defined as before CALM intervention (BCI) group and after CALM intervention (ACI) group. Results: There were 32 BCs in CALM group and 35 BCs in CAU group completed the overall study. There were significant differences between the BCI group and the ACI group in the FACT‐Cog‐PCI scores. Compared with the BCI group, the ACI group showed lower fALFF signal in the left medial frontal gyrus and right sub‐gyral and higher fALFF in the left occipital_sup and middle occipital gyrus. There was a significant positive correlation between hippocampal ALFF value and FACT‐Cog‐PCI scores. Conclusions: CALM intervention may have an effective function in alleviating CRCI of BCs. The altered local synchronization and regional brain activity may be correlated with the improved cognitive function of BCs who received the CALM intervention. The ALFF value of hippocampus seems to be an important factor in reflect cognitive function in BCs with CRCI and the neural network mechanism of CALM intervention deserves further exploration to promote its application. [ABSTRACT FROM AUTHOR]

Background: Breast cancer diagnosis and treatment increase the potential psychological impact on breast cancer survivors (BCS). The objective of this study was to assess the effects of an interdisciplinary intervention during follow‐up in BCS and identify variables related to improvements in HRQoL. Materials and Methods: In a non‐randomised quasi‐experimental design performed on an outpatient basis in a hospital gynaecology and oncology unit, 60 BCS were assigned to an interdisciplinary experimental group (EG) or a usual care group (CG). The EG underwent 12 sessions of an interdisciplinary program which included Mindfulness and physiotherapy, for 120 min per day, once a week for 6 weeks. At baseline, at 6 weeks and at 3 months after the intervention, participants of EG and CG completed an assessment of HRQoL (EuroQol and EORTC‐QLQ‐C30) and symptomatology of anxiety and depression. Additionally, EG completed an assessment of satisfaction with the treatment. For data analysis, we used descriptive statistics, Wilcoxon test, Kruskal–Wallis test, Chi‐square and Fisher tests and generalised linear models. Results: After 6 weeks, statistically significant differences were apparent in global and cancer‐related health symptoms such as fatigue and pain in the EORTC QLQ‐C30 and in anxiety and depression, among the EG (n = 30) compared with the CG (n = 30). Patients receiving the intervention reported a high degree of satisfaction with the treatment. Three months after the intervention, patients in the EG continued to show statistically significant improvements compared with the CG. In addition, allocation to the EG was identified as a variable related to improvement of HRQoL (EORTC QLQ‐C30) in the multivariable model. Conclusions: The results of our study suggest that a 6‐week interdisciplinary intervention may improve HRQoL and symptomatology of anxiety and depression in BCS patients at 3 months. The study presents data that the intervention for BCS appears promising and warrants further study in a randomised controlled trial. [ABSTRACT FROM AUTHOR]

Background: Although the cancer‐related cognitive impairment (CRCI) is a common symptom incurred by the breast cancer survivors (BCS), more emphasis is needed in identifying acceptable interventions for survivors. Purpose: The purpose of this qualitative descriptive study was to examine the acceptability of cognitive programs by identifying the facilitators and barriers for implementing computerized cognitive training (BrainHQ) and computerized global cognitive stimulating‐based games (e.g., computerized word‐find, puzzles, etc.) comparator delivered remotely to improve CRCI from the perspective of BCS. Methods: BCS (n = 35) who enrolled and completed a randomized controlled trial of computerized cognitive training: 19 cognitive training (BrainHQ) and 16 global cognitive stimulating‐based games (crosswords, puzzles, etc.) were interviewed post‐training. Semi‐structured questions were used, recorded, and transcribed verbatim. Qualitative data were analyzed using standard content analytic procedures for each intervention. Results: Facilitators of training varied by intervention with cognitive training seen as challenging, engaging, and gave a sense of accomplishment whereas global stimulating games were seen as a way of taking mind off issues, enjoyable, and easy to navigate. Barriers of cognitive training included an awareness of failing whereas global stimulating games were deemed to be too repetitive. Both groups endorsed the convenience/flexibility of online training and common concerns of time constraints and fatigue to complete the training. Each group also provided recommendations for improvement. Conclusions: Cognitive training and global stimulating games were generally well received by BCS. Designing more support elements to promote engagement may be key to successful long‐term implementation. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy‐related cognitive impairment (CRCI) is a common but easily overlooked condition that markedly affects the quality of life (QOL) of patients with breast cancer. The rs671 is a common gene polymorphism of aldehyde dehydrogenase 2 (ALDH2) in Asia that is involved in aldehyde metabolism and may be closely related to CRCI. However, no study has yet summarised the association between ALDH2 and CRCI. Methods: This study enrolled one hundred and twenty‐four patients diagnosed with breast cancer according to the pathology results, genotyped for ALDH2 single‐nucleotide polymorphisms (SNP) to explore these. The mini‐mental state exam (MMSE), verbal fluency test (VFT), and digit span test (DST) results were compared in these patients before and after chemotherapy (CT). Results: We found that patients with ALDH2 gene genotypes of rs671_GG, rs886205_GG, rs4648328_CC, and rs4767944_TT polymorphisms were more likely to suffer from cognitive impairment during chemotherapy. A trend toward statistical significance was observed for rs671_GG of DST (z = 2.769, p = 0.006), VFT (t = 4.624, P<0.001); rs886205_GG of DST (z = 3.663, P<0.001); rs4648328_CC of DST (z = 2.850, p = 0.004), VFT (t = 3.477, p = 0.001); and rs4767944_TT of DST (z = 2.967, p = 0.003), VFT (t = 2.776, p = 0.008). The cognitive indicators of these patients significantly decreased after chemotherapy (p < 0.05). The difference in ALDH2 rs671 was most obvious. Conclusion: Our results showed what kinds of ALDH2 genotyped patients that are more likely to develop CRCI. In the future, it may be possible to infer the risk of CRCI by detecting the single‐nucleotide locus of ALDH2 that is conducive to strengthening clinical interventions for these patients and improving their QOL. More importantly, this study has important implications for Asian women with breast cancer as ALDH2 rs671 is a common polymorphism in Asians. [ABSTRACT FROM AUTHOR]

Fatigue is prevalent and pervasive among breast cancer survivors. Mothers are particularly susceptible to fatigue due to the ongoing demands of their caring role. While fatigue has been associated with psychological distress in prior research, the pathway by which fatigue translates into psychological distress is unclear. Given the theoretical and empirical links between fatigue, fear of cancer recurrence (FCR) and psychological distress, the role of FCR in mediating the relationship between fatigue and psychological distress in mothers who are breast cancer survivors was investigated. Ninety‐two mothers who were breast cancer survivors completed the Depression, Anxiety and Stress Scale, PROMIS‐Cancer Fatigue Short Form and Concerns About Cancer Recurrence scale in an online survey. Mediation analysis via PROCESS was used to examine whether fatigue predicted depression, anxiety or stress through FCR. Fear of cancer recurrence mediated the relationships between fatigue and anxiety and fatigue and stress, while fatigue directly predicted depression. This study highlights FCR as a potential pathway to anxiety and stress in response to ongoing fatigue, and as a mechanism of action to reduce psychological distress among mothers who are breast cancer survivors. Future research examining this pathway from fatigue to psychological distress should also explore the nature of mothers' fears about their cancer recurring. [ABSTRACT FROM AUTHOR]

Aim: This study examined the associations of body mass index (BMI) and weight change with inflammatory markers among breast cancer survivors in Korea. Methods: A total of 495 women were included who had been diagnosed with primary breast cancer and survived for at least 6 months since the surgery. Information on the body weight and height of the participants was collected both at the study enrollment and diagnosis. The plasma levels of inflammatory markers were measured, including high‐sensitivity C‐reactive protein, interleukin (IL)‐6, IL‐8, tumor necrosis factor‐α, and adiponectin. A summary z‐score was calculated by summing up the z‐scores of each biomarker. The least‐square means and 95% confidence intervals (CIs) were calculated using a generalized linear model and odds ratios (ORs) and 95% CIs for the elevated levels of inflammatory markers with a multivariate logistic regression model. Results: Participants with a BMI ≥27.5 kg/m2 at the study enrollment and at diagnosis were significantly associated with elevated summary z‐scores compared to those with a BMI < 23 kg/m2; the ORs (95% CIs) were 5.42 (2.15–13.71) for current BMI and 3.66 (1.68–7.98) for BMI at diagnosis, respectively. Additionally, a weight loss > 5% since diagnosis was associated with a lower prevalence of high summary z‐scores; the OR (95% CI) was.20 (.08–.52) compared to a stable weight. Conclusions: A high BMI at diagnosis and current BMI with a greater degree were associated with unfavorable levels of inflammatory markers among breast cancer survivors. Additionally, weight loss since diagnosis was inversely associated with these markers. [ABSTRACT FROM AUTHOR]

Objective: Fear of Cancer Recurrence (FCR) is a universal phenomenon widely reported as an unmet need among cancer survivors. The present study aims to determine the patterns of FCR and its associated factors among breast cancer survivors in South India. Methods: A longitudinal study was carried out with pre and post‐assessment. Results: Two hundred and forty eight breast cancer survivors (BCSv) were included in the study. The main finding for the pre versus post‐study was the pattern of mean scores. It is observed that in all factors, the pre‐mean scores were steadily higher than the post‐mean scores the predictors for FCR scores were decrease of age (p = 0.016), BCSv living in joint family (p = 0.008) and who were self‐funded (p = 0.031). Conclusions: FCR was a relatively common symptom reported by BCSv. The predictors for FCR were younger age, BCSv living in a joint family and who were self‐funding for their treatment. In the pre and post‐assessment, it could be concluded that BCSv has reported that the overall FCR and on other variables higher FCR mean scores were reported during the preassessment period. [ABSTRACT FROM AUTHOR]

Background: The benefits of moderate to vigorous physical activity (MVPA) for breast cancer survivors are well established. However, most are insufficiently active. Fit2Thrive used the Multiphase Optimization Strategy methodology to determine the effect of 5 intervention components on MVPA in this population. Methods: Two hundred sixty‐nine participants (mean age, 52.5 years; SD, 9.9 years) received a core intervention (the Fit2Thrive self‐monitoring app and Fitbit) and were randomly assigned to 5 intervention components set to on/off in a full factorial experiment: support calls, deluxe app, buddy, online gym, and text messages. The intervention was delivered over 12 weeks with a 12‐week follow‐up. MVPA was measured via accelerometry at the baseline (T1), at 12 weeks (T2), and at 24 weeks (T3). The main effects and interaction effects at each time point were examined for all components. Results: Trial retention was high: 91.8% had valid accelerometer data at T2 or T3. Across all conditions, there were significant increases in MVPA (+53.6 min/wk; P <.001) and in the proportion of survivors meeting MVPA guidelines (+22.3%; P <.001) at T2 that were maintained but attenuated at T3 (MVPA, +24.6 min/wk; P <.001; meeting guidelines, +12.6%; P <.001). No individual components significantly improved MVPA, although increases were greater for the on level versus the off level for support calls, buddy, and text messages at T2 and T3. Conclusions: The Fit2Thrive core intervention (the self‐monitoring app and Fitbit) is promising for increasing MVPA in breast cancer survivors, but the components provided no additional increases in MVPA. Future research should evaluate the core intervention in a randomized trial and determine what components optimize MVPA behaviors in breast cancer survivors. Systematically testing 5 technology‐supported physical activity promotion intervention components alongside the Fit2Thrive core intervention (Fit2Thrive self‐monitoring app and Fitbit) results in an increase in physical activity after the intervention and at a 12‐week follow‐up in breast cancer survivors. However, increases are not significantly greater with any component turned on versus off. This indicates that the Fit2Thrive core is a promising scalable strategy for increasing moderate to vigorous physical activity. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of partnErship‐based, needs‐tailored self‐Management support Program fOr Women with breast cancER (EMPOWER), a partnership‐based, needs‐tailored, self‐management (SM) support intervention designed to empower post‐treatment breast cancer survivors (BCSs) and ultimately improve their health outcomes. Methods: This multi‐center, two‐armed, randomized controlled trial comprised 94 female BCSs who had completed primary cancer treatment in South Korea. Participants were randomly assigned (1:1) to the intervention group or the wait‐list control group. The intervention group received a 7‐week EMPOWER intervention via telephone counseling. The primary outcome was empowerment. Secondary outcomes included self‐efficacy for post‐treatment SM behaviors, mental adjustment, anxiety, depression, and health‐related quality of life. Data were collected via a self‐reported questionnaire at baseline (T0) and at 8 (T1) and 20 weeks (T2) of follow‐up. Linear mixed models were used to assess group differences over time. Effective sizes were calculated using Cohen's d. Results: Retention rates were excellent (95.7% at T1; 94.7% at T2). Linear mixed model analyses revealed that the EMPOWER group showed significantly improved empowerment (mean difference 2.24, 95% CI = 0.18 to 4.29; p = 0.016) and general health perception (mean difference 3.68, 95% CI = 0.67 to 6.72; p = 0.037) compared with the control group. Time point analysis showed that several secondary outcomes significantly improved at T1, but the effects were not sustained. Conclusion: EMPOWER was effective in improving empowerment and general health perception among post‐treatment BCS. Further studies are needed to determine the effectiveness of the EMPOWER intervention in other cancer populations. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer beliefs are widely studied to improve preventative screening behaviors in women without cancer; however, limited research has examined breast cancer beliefs among breast cancer survivors. To fill this gap in research we investigated racial differences and the predicting role of influential factors (e.g., stage) in survivors' beliefs about their breast cancer. Methods: This study is a secondary analysis of data from the Narrowing Gap in Adjuvant Therapy Study (2006–2011), where Black (N = 210) and White women (N = 149) were interviewed within 20 weeks following their breast cancer diagnosis and primary surgery in Washington DC and Detroit, MI. Outcomes of this analysis were perceived susceptibility to a breast cancer recurrence and perceived severity of breast cancer. Bivariate analyses were conducted to assess racial differences in sample characteristics, and on the study outcomes. Adjusted multiple regression models examined correlates between independent variables (e.g., sociodemographic/clinical) and women's breast cancer beliefs about susceptibility of a recurrence and disease severity. Results: Most of the sample were Black women (58%), had breast‐conserving surgery (64%), and were privately insured (67%). Black women reported higher perceived disease severity beliefs than White women (p = 0.004). Other associated factors with greater perceived severity beliefs included lower education (p = 0.008), public health insurance (p = 0.021) and greater levels of medical mistrust (p = 0.016). In our adjusted multiple regression models' women with lower satisfaction regarding financial aspects of their healthcare were more likely to have higher perceived severity beliefs (p = 0.007); women with stage II cancer compared to stage I had greater susceptibility beliefs to a cancer recurrence (p = 0.001). Conclusion: We found racial differences in women's perceived severity beliefs, and identified theory‐based clinical and psychosocial correlates in survivor's breast cancer beliefs by race. Specifically, women diagnosed at stage (II) compared to stage (I) reported greater perceived susceptibility to a recurrence. Survivors diagnosed at stage (I) and (III) cancers may serve as important target groups to monitor their surveillance and follow‐up behaviors. This study contributes salient predictors in survivors' beliefs about their BC and informs navigation strategies to improve cancer survivorship recommendations in the context of psycho‐oncology and follow‐up cancer care. [ABSTRACT FROM AUTHOR]

Background: Aquatic therapeutic exercise can be equally effective or even superior to land‐based exercise in improving several clinical variables. However, there is still a lack of knowledge on the effects compared to land‐based interventions particularly in breast cancer (BC) patients. Objective: The objective of this study is to examine the effects of aquatic therapeutic exercise on pain, shoulder mobility, lymphedema, cardiorespiratory fitness, muscle strength, body composition, pulmonary function, cancer‐related fatigue (CRF) and health‐related quality of life (HRQoL) and which parameters are effective compared to similar land‐based interventions. Methods: The databases used were PubMed, Scopus, Web of Science, Cochrane Library and CINAHL, retrieving 145 articles. Results: Eleven studies were included. Aquatic therapeutic exercise is feasible, safe, well tolerated and achieved high percentages of adherence. As for the assessed outcomes, moderate to large improvements were found compared to usual care or to land‐based physical exercise interventions in pain, shoulder range of motion, pulmonary function, HRQoL, cardiorespiratory fitness and muscle strength. Inconclusive results were found for lymphedema, body composition and CRF. Conclusions: Aquatic therapeutic exercise interventions using a combination of endurance, strength, mobility, stretching and breathing exercises resulted in improvements in common side effects of BC and its treatments. More studies on CRF, body composition and lymphedema need to be done to further evaluate the impact of the intervention on these outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the dietary practices and factors affecting Malaysian breast cancer survivors' dietary behaviours. Methods: We conducted an in‐depth qualitative interview on 20 participants from a cohort study. An ecological framework was used to construct the semi‐structured topic guide. The interviews were audio‐recorded and transcribed verbatim. Thematic analysis with theoretical saturation was used in data analysis. Results: The participants were found to have variable dietary practices that either followed or did not follow dietary recommendations. The social environment was critical as most women relied on family and friends for food choices; additionally, individuals in charge of food preparation had to prepare food based on their family member preferences. Furthermore, individuals had difficulty sustaining healthy dietary changes during the acute survivorship phase due to a lack of health consciousness and difficulty in healthy food access. Notably, there was a lack of dietary guidance from health care professionals, especially dietitians, in long‐term survivorship care. Conclusion: This study highlights the lack of breast cancer survivors' healthy diet and lifestyle knowledge. A holistic multidisciplinary approach involving individual, social, physical, and macro‐level environmental elements are crucial to influencing healthy eating behaviours. [ABSTRACT FROM AUTHOR]

Aim: To examine the body image and hopelessness status of early‐stage breast cancer survivors who received a one‐time dressing change after surgery and were ready to be discharged from a hospital in China. Design: A cross‐sectional study. Methods: Participants were 211 women with breast cancer who had received a one‐time dressing change postsurgery. Spearman's correlation and structural equation modelling were used for data analysis. Results: Participants in the 35–45 age group and those who underwent bilateral mastectomy presented higher scores for hopelessness. Married participants showed lower scores for the feelings about the future subscale compared to other subscales. Body image was significantly and positively associated with and had a positive effect on hopelessness. Women with a more positive appraisal of their body image tended to report lower levels of hopelessness. Healthcare providers should evaluate patients' distress levels after a mastectomy to identify women who may require early psychosocial intervention. [ABSTRACT FROM AUTHOR]

Context: Breast cancer survivors (BCS) with comorbid diabetes mellitus (DM) and of racial and ethnic minority status are at higher risk of cancer‐related post‐traumatic stress (PTS) and severe illness beliefs. These affective and cognitive outcomes influence self‐management and treatment adherence in patients with chronic conditions, yet little is known regarding the interplay of these processes in diverse BCS with comorbid DM. Objectives: The purposes of this study were to (1) describe racial and ethnic differences in cancer‐related PTS and illness perceptions; and (2) examine the relationship between PTS and illness perceptions in BCS with comorbid DM. Methods: Female BCS with DM completed measures of cancer related stress (Impact of Events Scale‐Revised) and cancer and DM illness perception (Illness Perception Questionnaire‐Revised). Logistic regression analyses were used to assess the association between PTS, race and illness perceptions. Results: Of the 135 BCS with comorbid DM, the mean (standard deviation) age was 65.3 (7.1) years, 38% were Black, 31% Non‐Hispanic White (NHW), 13% Hispanic/Latina, and 18% were "other." Minority women were more likely to report cancer‐related PTS (p < 0.01). In adjusted analyses, PTS was associated with chronicity (odds ratio [OR] = 9.79, p = 0.005), time‐cycle (OR = 6.71, p = 0.001), negative consequences (OR = 3.95, p = 0.018), and negative emotional impact (OR = 12.63, p < 0.001) of cancer. Conclusion: Minority BCS with comorbid DM report higher rates of cancer‐related PTS and lower cancer illness coherence relative to NHW survivors. Cancer‐related PTS influences cancer and DM illness perceptions. Culturally sensitive care is needed to improve these outcomes in minority BCS. Key Message: This article presents findings from a cross sectional cohort of an understudied population of racially and ethnically diverse BCS with comorbid diabetes. The results indicate that the occurrence of PTS is significantly higher in racial and ethnic minority women and is strongly associated with more severe illness perceptions. [ABSTRACT FROM AUTHOR]

Aim: To describe the experience of empowerment for breast cancer survivors in order to increase quality of life after treatment. Design: We adopted a qualitative design in this study. Methods: A qualitative descriptive approach guided by interpretive description methodology as the theoretical framework was used in this study. Semi‐structured group and individual interviews were conducted with eleven female Chinese breast cancer survivors (mean age 54.18 years, 100% female). Results: Many survivors reported that they continued to experience disease‐related discomfort from the physiological aspect, but they use multiple ways to improve quality of life. Breast cancer survivors experienced empowerment after treatment. Empowerment mainly required three components: a belief in good health, capability of self‐management and acquisition of a good social support system. [ABSTRACT FROM AUTHOR]

Complicated, high‐resource surgeries are being developed and performed to prevent breast cancer–related lymphedema. Determining risk factors for lymphedema development is critical to optimize patient selection for such procedures. [ABSTRACT FROM AUTHOR]

Adjuvant chemotherapy and endocrine therapy can induce early iatrogenic menopause or worsen pre‐existing menopausal symptoms in breast cancer survivors (BCS). The second most frequent menopausal symptom after hot flushes is the genitourinary syndrome (GSM). Since hormone replacement therapy is contraindicated in BCS, vaginal laser might represent a new nonhormonal option for GSM. This study aims at evaluating the effectiveness of the fractional CO₂ vaginal laser for GSM in BCS compared with healthy women. This is a retrospective study on 135 postmenopausal women (45 BCS and 90 healthy women) who underwent fractional CO2 laser for GSM. Objective (VHI and VVHI) and subjective outcomes (VAS for dyspareunia and vaginal dryness and a pain questionnaire) were evaluated at baseline visit and at every follow‐up visit. Subjective and objective parameters improved significantly in both groups after laser therapy. The improvement was progressive and long‐lasting up to 12 months after the end of the treatment. No severe adverse events were observed during the treatment. Fractional CO₂ vaginal laser induces a significant and long‐lasting improvement on GSM symptoms in BCS. However, this improvement is slower than in healthy women undergoing the same treatment. Laser therapy turns out to be safe and well‐tolerated. [ABSTRACT FROM AUTHOR]

Objective: We report results of a community‐based multisite, randomized controlled trial of Nuevo Amanecer (NA‐II), a 10‐week stress management program for rural, low literacy Latina breast cancer survivors. Methods: Trained peers delivered NA‐II to Spanish‐speaking Latinas with non‐metastatic breast cancer in three rural communities. Women were randomized to receive the program immediately or wait 6 months. Assessments were conducted at baseline, 3 months, and 6 months. Primary outcomes were breast cancer‐specific quality of life domains; secondary outcomes included general distress symptoms and stress management skills. Intention‐to‐treat analyses using repeated‐measures linear regression models estimated changes in slope between groups. Results: Of 153 participants (76 randomized to intervention, 77 to control group), 92% were retained at 6 months. Mean age was 54.8 years (SD = 10.5); 80% had less than high school education. There were no statistically significant treatment × time effects on quality of life. Compared to women in the control group, intervention group women reported greater improvements in anxiety at 6 months (−0.20 vs −0.02, P =.049; range 0‐4) as well as three stress management skills: relaxation at 3 months (+0.98 vs −0.07, P <.0001; range 0‐4) and 6 months (+0.82 vs +0.04, P <.001), awareness of tension at 3 months (+0.31 vs −0.19, P <.01; range 0‐4) and 6 months (+0.29 vs −0.11, P <.05), and coping confidence at 3 months (+0.12 vs −0.23, P <.01; range 0‐4). Conclusions: Stress management programs delivered by trained peers in rural community settings can reduce anxiety and improve stress management skills among Latina breast cancer survivors. [ABSTRACT FROM AUTHOR]

This cross‐sectional design study aimed to explore health problems among breast cancer survivors after completing conventional treatments. Purposive sampling was adopted to recruit 160 breast cancer survivors from a regional tertiary care hospital and hospital with a specialist cancer center in southern Thailand. STROBE checklist of items for cross‐sectional studies is applied to report the study. Five most frequent, severe, and distressing symptoms faced in the first 3 years after cancer treatment were reported as numbness to the affected side, difficulty sleeping, fatigue, pain, and skin changes. Almost half of the participants reported symptoms indicating a definite diagnosis of anxiety, and nearly 70% of them rated themselves as borderline depressed or depressed. Approximately 50% of participants reported no change in their relationships with significant people, and about 60% of them reported a high‐level fear of recurrence. Symptom frequency, severity, and distress were positively associated with anxiety, depression, and menopausal symptoms, while relationship changes were negatively associated with menopausal symptoms, anxiety, and depression. Support and information for these women are required after active treatment has ceased to deal with ongoing symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Less is known about sexual attitudes of breast cancer survivors (BCSs) and its association with sexual activity and sexual dissatisfaction. Methods: We investigated the proportion of sexual activity and sexual dissatisfaction in a cross‐sectional study among 341 Chinese BCSs aged 30‐75 years old, and we described their association with sexual attitudes, as well as socio‐demographic characteristics, physical health conditions, and mental health problems. Results: Only 83 (24.3%) individuals reported sexual activity in the past year. More than 50% of BCSs considered that sexual activity had adverse impact on their disease recovery. The sexual attitudes such as "sexual activity may impede disease recovery" (adjusted odds ratio [AOR] = 0.51; 95% confidence interval, 95% CI: 0.30‐0.88), "sexual activity may cause cancer recurrence or metastasizes" (AOR = 0.51; 95% CI: 0.30‐0.87), and "their partner fear contracting cancer by sexuality" (AOR = 0.47; 95% CI: 0.23‐0.98) were significantly associated with decreased likelihood of reporting sexual activity in the past year. Although 201 (58.9%) BCSs reported that breast cancer decreased the frequency of their sexual activity, only 37 (10.9%) had ever discussed sexuality with a doctor to seek advice. Conclusions: Most Chinese BCSs were sexually inactive. The sexual misconceptions about cancer were great barriers of sexual activity. Professional sexual education and consultation may be regarded as easy and effective intervention measures to correct BCSs' misguided sexual attitudes, and finally improving the overall sexual health for BCSs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to describe a user-centered (e.g., cancer survivors and clinicians) development process of an eHealth tool designed to facilitate self-management of cancer survivorship follow-up care.Methods: Guided by Cognitive-Social Health Information Processing (C-SHIP) model and informed by core self-management skills, we engaged in a user-centered design process. In phase I, we conducted in-depth interviews with survivors of breast (n = 33), prostate (n = 4), and colorectal (n = 6) cancers, and (n = 9) primary care providers to develop content and design of the web tool. Phase II utilized iterative user testing interviews (n = 9) to test the web-based tool prototype. Data from both phases were independently coded using a template/content analytic approach.Results: The top 5 functions identified in phase I for the web-based platform included: (a) educational materials to learn and prepare for health encounters (80%); (b) questions for health providers (74%); (c) ability to track contact information of providers (67%); (d) provide general information (64%); and, (e) support information (62%). Users of the prototype reported patient burden, tool fatigue, introduction timing of the tool, relevance, and security/privacy as concerns in phase II.Conclusions: This study demonstrates the value of using a theoretically informed and user-centered design process to develop relevant and patient-centered eHealth resources to support cancer survivorship. A larger study is needed to establish the efficacy of this eHealth tool as an intervention to improve adherence to follow-up care guidelines. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity is associated with better quality of life (QOL) among breast cancer survivors. However, it is unknown the extent to which time spent sedentary or replacing this time with active behaviors may affect QOL. Our aim was to determine the effect of substituting time between sedentary and active behaviors on QOL indicators in breast cancer survivors.Methods: An isotemporal substitution approach was used to examine the associations of reallocating time to sedentary and active behaviors measured by accelerometry with Functional Assessment of Cancer Treatment-Breast (FACT-B; total, physical, social, emotional, functional well-being, and breast cancer-specific concerns) and the Hospital Anxiety and Depression Scale (HADS) scores in a pooled analysis of breast cancer survivors (n = 753; Mage  = 56.9 ± 9.5 y) from two observational studies.Results: Reallocating 30 minutes of sedentary time to 30 minutes of moderate-to-vigorous intensity physical activity (MVPA) was associated with improved FACT-B total (B = 3.0; 95% CI, 0.6-4.5), physical well-being (B = 0.8; 95% CI, 0.33-1.2), and functional well-being (B = 0.6; 95% CI, 0.03-1.2) scores. Reallocating 30 minutes of light activity to 30 minutes of MVPA was associated with improved FACT-B total (B = 2.4; 95% CI, 0.3-6.0) and physical well-being (B = 0.72; 95% CI, 0.27-1.2) scores. There was no significant substitution of time effects on HADS scores.Conclusions: Substituting sedentary time with MVPA showed the greatest range of effects across QOL indicators. These results can inform intervention development interventions and more comprehensive activity recommendations for breast cancer survivors. [ABSTRACT FROM AUTHOR]

Objective: We investigated the prevalence of anxiety and depression at diagnosis and at 1, 3, and 5 years after breast cancer diagnosis. We hypothesized that a low level of optimism (pessimism) at diagnosis could predict change in anxiety and depression 5 years later.Methods: Three hundred sixty-seven women with operable breast cancer were included, and data were collected at all five-time points for 293 of these. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Dispositional optimism/pessimism was measured using the Life Orientation Test-Revised (LOT-R). Frequency analysis was used to determine the prevalence of anxiety and depression. Logistic regression was used to examine dispositional optimism/pessimism as a predictor of change in anxiety and depression 5 years after diagnosis.Results: The prevalence rates of anxiety and depression 5 years after diagnosis were 26.3% and 9.6%, respectively. Predictors of change in anxiety 5 years after diagnosis were pessimism (odds ratio [OR] = 0.82; 95% confidence interval [CI]: 0.76-0.89, P < .001); younger age (OR = 0.96; 95% CI: 0.93-0.99, P = .005); and anxiety at diagnosis (OR = 2.41; 95% CI: 1.33-4.37, P = .004). Predictors of change in depression 5 years after diagnosis were pessimism (OR = 0.84; 95% CI: 0.77-0.94, P < .001) and comorbidity (OR = 1.51, 95% CI: 1.10-2.06, P = 0.01).Conclusion: Anxiety and depression did not decrease after the first postoperative year. Pessimism was a predictor of change in both anxiety and depression 5 years after breast cancer diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy.Methods: Women 21 to 65 years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated.Results: Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = -0.37 to -0.49, Ps < .00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance.Conclusions: Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research. [ABSTRACT FROM AUTHOR]

The goal of this study was to study central sensitization (CS)‐related symptoms in breast cancer (BC) survivors and to find if there are differences in clinical and functional variables. In this cross‐sectional study, 25 women aged between 32 and 69 years participated. CS pain was measured with the Central Sensitization Inventory (CSI). Forty points was considered the cutoff value. Cancer‐related fatigue (CRF), Quality of life, functional capacity, and handgrip strength (HGS) was assessed. A 60% of BC survivors showed a CSI score from 0 to 40, while the rest 40% of women had a score higher than 40, CSI scores being 38.35 ± 14.54 points in the whole sample. Significant differences were found in functional capacity, CRF and QoL (p < .011). However, there were no differences in HGS (p = .089). This is the first study to report BC survivors CS‐related symptoms. The high CS‐related symptoms group showed differences in some symptoms and functional capacity in this population. Future research including a wider sample and more variables related to pain should be carried out. [ABSTRACT FROM AUTHOR]

Interventions offering peer mentoring programmes promoting moderate‐to‐vigorous physical activity (MVPA) have shown improvements in MVPA and well‐being from baseline; however, research is limited. The purpose of this study was to compare the physical activity (PA) levels and psychosocial well‐being of coaches and participants at baseline and following a 12‐week intervention. Breast cancer survivors (<5 years) were recruited and randomised into either exercise (Reach‐to‐Recovery (RTR) + PA) or control (RTR Control). Participants in both groups were individually assigned one of the 18 available coaches who delivered either the MVPA intervention or the control condition via telephone. PA (7‐Day PA Recall), psychosocial well‐being, fatigue and mood were assessed at baseline and intervention completion. Seventy‐six breast cancer survivors (average age = 55.62 (±9.55)) were randomised. At baseline, all participants showed significantly lower MVPA (p = .001) and well‐being (p < .05) as compared to coaches. However, post‐intervention showed significant improvement in PA and well‐being in RTR + PA, so that they were no longer significantly different from the coaches. Post‐intervention, MVPA (p < .01), quality of life (p < .05) and fatigue (p < .05) remained significantly lower in RTR Controls compared to coaches. Future interventions should consider the behavioural patterns not only of the participants, but also of those who deliver the interventions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Depression symptoms are prevalent among breast cancer survivors (BCS). Reducing sedentary behavior (SED) may be a non‐pharmaceutical strategy for alleviating depression symptoms. However, little is known about SED among BCS. The present study aimed to: (i) describe SED behaviors among BCS and identify unique SED groups based on different SED dimensions; (ii) identify personal and cancer‐specific factors that discriminate SED clusters; and (iii) examine the association between SED clusters and depression symptoms. Methods: Baseline self‐report demographic and medical information was collected from 187 BCS. SED and physical activity were assessed over seven days using an accelerometer. Self‐reported depression symptoms were reported three months later. Multiple dimensions of SED were identified and examined in cluster analysis. The clusters were examined for differences using multivariate analysis of variance and chi‐square analyses. The difference in depression symptoms among SED groups was assessed using an analysis of covariance. Results: High and low SED groups were identified. Survivors in the high SED cluster were significantly older, heavier, less physically active, reported less education, and were more likely to have undergone lymph/axial node dissection. Women in the high SED cluster reported significantly higher depression symptoms prospectively (M = 9.50, SD = 6.07) compared to women in the low SED group (M = 6.89, SD = 5.18), F(8,179) = 4.97, p = 0.03, R2 = 0.34. Conclusions: The importance of understanding multiple dimensions of SED among BCS was highlighted. Reducing SED during the early survivorship period may alleviate depression symptoms. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement.Methods: A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad.Results: The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large.Conclusions: These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer. [ABSTRACT FROM AUTHOR]

Objective: The aims of the study were to modify the Cancer Survivor's Unmet Need (CaSUN) Scale into a short form and then test its psychometric scale-specific properties for breast cancer survivors in Taiwan.Methods: Using convenience sampling, recruited breast cancer survivors were separated into 2 samples (sample 1, n = 150, and sample 2, n = 162). First, we translated and modified the CaSUN to ensure cultural adaptation. Second, we used statistical methods to eliminate some items and conducted an exploratory factor analysis (EFA) using sample 1 to explore the factor structure of the CaSUN-C. Finally, we conducted a confirmatory factor analysis using sample 2 to confirm the structure suggested by the EFA and tested the criterion validity and known-group validity of the CaSUN-C.Results: Twenty items within 4 factors (information, physical /psychological, medical care, and communication needs) were identified for the CaSUN-C. Each factor had acceptable internal consistency (Cronbach's Alpha = .61 to .82). The criterion validity was supported by the significant correlations between the CaSUN-C scores and scores on fear of recurrence and depression. Known-group comparisons revealed that women who survived more than 60 months had fewer physical/psychological needs than those less 60 months, which supported the validity of CaSUN-C.Conclusion: The CaSUN-C demonstrated acceptable reliability and validity for assessing unmet needs among breast cancer survivors in Taiwan. Using this simple assessment to target the individual needs of these survivors can help healthcare professionals provide personalized care efficiently. [ABSTRACT FROM AUTHOR]

This study investigated the efficacy of post‐treatment hydrotherapy as supportive care for management of persistent/long‐lasting dermatologic adverse events (dAEs) induced in breast cancer survivors by adjuvant therapy, and its impact on quality of life (QoL). Patients in complete remission after standardised (neo)adjuvant chemotherapy, surgery and radiotherapy combination treatment for infiltrating HR+/HER2‐breast carcinoma were enrolled in this randomised, multicentre controlled study 1–5 weeks after completing radiotherapy. The control group (CG, n = 33) received best supportive care and the treatment group (HG, n = 35) received 3‐weeks of specific hydrotherapy. The primary criterion was change in QoL (QLQ‐BR23) after hydrotherapy. Clinical grading of dAEs, cancer‐related QoL (QLQ‐C30), dermatologic QoL (DLQI) and general psychological well‐being (PGWBI) were assessed. Significant dAEs were found at inclusion in both groups (n = 261). Most items showed significantly greater improvement in the HG versus CG group: QLQ‐BR23 (breast [p = .0001] and arm symptoms [p = .0015], systemic therapy side effects [p = .0044], body image [p = .0139]), some dAE grading, DLQI (p = .0002) and PGWBI (p = .0028). Xerosis (88% of patients at inclusion) completely healed in all HG patients. Specific hydrotherapy is an effective supportive care for highly prevalent and long‐lasting dAEs occurring after early breast cancer treatment, including chemotherapy, and leads to improved QoL and dermatologic toxicities. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain in breast cancer survivors (BCSs) impacts the health-related quality of life (HRQoL) and participation in activities of daily living tremendously[1-5]. Over the past decades, the use of pain neuroscience education (PNE) has been shown to be effective in reducing pain[6-8]. Since PNE alone has relatively small effect sizes, it should ideally be combined with a physical component[6], such as behavioural graded activity (BGA)[9,10]. Therefore, this study aims to investigate the effectiveness of PNE with BGA compared to usual care on chronic pain in BCSs. Methods: Two hundred BCSs with chronic pain will be randomly assigned to the intervention or usual care group. The intervention group will receive a 12-week treatment program consisting of 6 sessions, in which PNE and BGA are integrated. Whereas the usual care group will receive an information leaflet regarding "Pain in and after cancer". The primary outcome is pain, and the secondary outcomes are endogenous hyperalgesia and HRQoL. Explanatory variables such as pain cognitions, sleep, depression will be inventoried as well. All variables will be assessed at baseline, immediate, 3-and, 12-months post-treatment. To examine the added effect of PNE and BGA, a linear mixed model for repeated measurements will be conducted[11,12]. Results: We hypothesise that PNE with BGA will lead to more beneficial outcomes compared to usual care in BCSs with chronic pain. Discussion: PNE with BGA might lead to proper non-pharmacological treatment for pain in BCS. Process evaluation: Currently, 82/200 participants were recruited. The recruitment was delayed due to the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Given the 3.1 million breast cancer survivors in America, quality of life (QoL) is a vital issue. Bio-psychosocial milieu of survivorship is increasingly important. This study assesses the impact of Bio-psychosocial Intervention ( BPSI) on the QoL of breast cancer survivors utilizing Functional Assessment of Cancer Therapy - Breast ( FACT-B) instrument. A prospective randomized trial was designed; intervention arm included a 4-hour BPSI coping skills class; control arm received standard of cancer and follow-up care ( SOC). Women diagnosed within 2 years of study initiation were eligible. Sample size was based on 8-point difference in FACT-B score, 90% power, 5% type I error, and 20% attrition. FACT-B questionnaire was administered to all patients at baseline and at 6-month intervals. SAS 9.3 software was used to analyze data using Chi-square test for categorical and Wilcoxon rank sum for ordinal data; linear mixed modeling was used for longitudinal analysis. One-hundred and three of 120 (86%) patients were available for analysis. Forty-seven patients were in BSPI arm, and 56 received SOC. For BPSI arm versus SOC arm, the median (interquartile) age (60 [52.68] versus 58 [52.68] years, p = 0.9135), cancer-stage (0:1:2:3 = 11%:41%:35%:13% versus 18%:46%:22%:15%, p = 0.4645), and biology ( ER+:triple negative: HER2+ = 74%:9%:16% versus 72%:7%:20%, p = 0.8454), respectively, was similar. Median (25th to 75th centile) FACT-B scores in BPSI versus SOC arms at baseline were 109 (95.121) versus 112 (95, 122) (p = 0.6125); mean ( SE) change since baseline at 6, 12, 18, and 24 months was: 7.42 (2.22) versus 7.04 (1.97) (p = 0.8862); 17.0 (2.64) versus −6.09 (2.37) (p < 0.0001); 16.03 (2.53) versus 3.58 (2.29) (p = 0.0004), and 15.48 (1.89) versus 16.4 (1.71) (p = 0.7966), respectively. The inter-group differences remained after adjusting for confounding variables at baseline. The p-value for interaction among groups over 2 years remained <0.0001 except for breast cancer specific concerns. BPSI coping skills class significantly improved the QoL of breast cancer survivors by 1 year post-intervention time point; this difference narrowed at 18 months and disappeared at 24 months. [ABSTRACT FROM AUTHOR]

Diagnosis and treatment of breast cancer is a very emotionally aversive and stressful life event, which can lead to impaired cognitive functioning and mental health. Breast cancer survivors responding with repressive emotion regulation strategies often show less adaptive coping and adverse outcomes. We investigated cognitive functioning and neural correlates of emotion processing using ERPs. Self-report measures of depression, anxiety, and fatigue, as well as hair cortisol as an index of chronic stress, were assessed. Twenty breast cancer survivors (BCS) and 31 carefully matched healthy controls participated in the study. After neuropsychological testing and subjective assessments, participants viewed 30 neutral, 30 unpleasant, and 30 pleasant pictures, and ERPs were recorded. Recognition memory was tested 1 week later. BCS reported stronger complaints about cognitive impairments and more symptoms of depression, anxiety, and fatigue. Moreover, they showed elevated hair cortisol levels. Except for verbal memory, cognitive functioning was predominantly in the normative range. Recognition memory performance was decreased in cancer survivors, especially for emotional contents. In ERPs, survivors showed smaller late positive potential amplitudes for unpleasant pictures relative to controls in a later time window, which may indicate less elaborative processing of this material. Taken together, we found cognitive impairments in BCS in verbal memory, impaired emotional picture memory accuracy, and reduced neural activity when breast cancer survivors were confronted with unpleasant materials. Further studies and larger sample sizes, however, are needed to evaluate the relationship between altered emotion processing and reduced memory in BCS in order to develop new treatment strategies. [ABSTRACT FROM AUTHOR]

Background In France, the Cancer Plan II 2009-2013 was launched to improve post-cancer management and promote greater involvement of general practitioners ( GPs) in follow-up care. Objectives We investigated how women experienced the post-treatment management of breast cancer and perceived the role of the GP in follow-up care. Design We conducted a qualitative study based on semi-structured interviews with women with breast cancer in remission. The interviews were transcribed and analysed in accordance with the principles of thematic analysis. Setting and participants We interviewed 21 patients aged between 30 and 86. Eighteen breast cancer survivors were recruited from GP practices and five from a patients' association. Results Four themes emerged from the thematic analysis: that breast cancer is a life-changing event; how patients managed the effects of treatment; how patients viewed the future; and patients' expectations of their GP. Discussion and conclusion French survivors of breast cancer perceived the physical changes caused by their illness to impact their womanhood, leading to difficulties with sexual relations, a diminished sense of self and fears for the future. They felt abandoned at the end of treatment and desired support. They appreciated the ease of contacting their GP but considered follow-up care outside their remit. They agreed to be followed up by their GP, provided that they co-operated closely with a cancer specialist. This is in accordance with the French Cancer Plan II 2009-2013, which recommends greater involvement of GPs in a monitoring protocol shared with cancer specialists. [ABSTRACT FROM AUTHOR]

Background: Soy foods possess both antiestrogenic and estrogen-like properties. It remains controversial whether women diagnosed with breast cancer should be advised to eat more or less soy foods, especially for those who receive hormone therapies as part of cancer treatment.Methods: The association of dietary intake of isoflavone, the major phytoestrogen in soy, with all-cause mortality was examined in 6235 women with breast cancer enrolled in the Breast Cancer Family Registry. Dietary intake was assessed using a Food Frequency Questionnaire developed for the Hawaii-Los Angeles Multiethnic Cohort among 5178 women who reported prediagnosis diet and 1664 women who reported postdiagnosis diet. Cox proportional-hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Results: During a median follow-up of 113 months (approximately 9.4 years), 1224 deaths were documented. A 21% decrease was observed in all-cause mortality for women who had the highest versus lowest quartile of dietary isoflavone intake (≥1.5 vs < 0.3 mg daily: HR, 0.79; 95% confidence interval CI, 0.64-0.97; Ptrend  = .01). Lower mortality associated with higher intake was limited to women who had tumors that were negative for hormone receptors (HR, 0.49; 95% CI, 0.29-0.83; Ptrend  = .005) and those who did not receive hormone therapy for their breast cancer (HR, 0.68; 95% CI, 0.51-0.91; Ptrend  = .02). Interactions, however, did not reach statistical significance.Conclusions: In this large, ethnically diverse cohort of women with breast cancer living in North America, a higher dietary intake of isoflavone was associated with reduced all-cause mortality. Cancer 2017;123:2070-2079. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Aim Obesity is associated with poor prognosis and risk of treatment side-effects in breast cancer survivors. This pilot study assessed the feasibility, acceptability, safety and efficacy of a telephone-delivered weight loss intervention, among women (BMI 25-40 kg/m2) following treatment for stage I-III breast cancer, on weight loss (primary outcome), quality of life and treatment-related side-effects ( vs usual care). Methods Ninety women (mean ± SD age: 55.3 ± 8.7years; BMI: 31.0 ± 4.3 kg/m2; 15.9 ± 2.9 months postdiagnosis), recruited from a state-based cancer registry, were randomized to a weight loss (diet and physical activity) intervention ( n = 45) or usual care ( n = 45). Data collected at baseline and 6 months included weight, body composition, quality of life, fatigue and body image. Acceptability and satisfaction were assessed in intervention participants. Results Oncologists provided consent to contact 82.6% of patients, with 84.1% of those women contacted and eligible consenting to participate. Compared with usual care, mean weight loss was significantly greater in the intervention arm (−3.1 kg [95% CI, −5.4 to −0.7]; −3.7% baseline weight [95% CI, −6.6 to −0.9]), as were reductions in fat mass (−2.1 kg [95% CI, −4.2 to −0.1]) and waist circumference (−4.0 cm [95% CI, −6.6 to −1.3]). No other statistically significant intervention effects were observed. Participants were highly satisfied with the intervention overall and it is timing in relation to diagnosis/treatment. One reported adverse event (musculoskeletal injury) was attributable to the intervention. Conclusions This weight loss intervention was feasible, acceptable, safe and effective for women 1-2 years after a breast cancer diagnosis. The effect of weight loss on quality of life and treatment-related side-effects should be examined further in fully-powered studies. [ABSTRACT FROM AUTHOR]

The article presents a study focusing on the prevalence of sexual dysfunction and phobic anxiety in patients who survived breast cancer. Topics discussed include the analysis of the Female Sexual Function Index (FSFI) score of patients; the quality of life of survivors; and the use of relaxation or behavioral therapy to treat sexual dysfunction.

Background: Cognitive complaints are common amongst breast cancer survivors, and no standard treatment exists. The present study evaluates whether web-based cognitive training can alleviate subjectively reported and objectively assessed cognitive complaints in a sample of breast cancer survivors. The primary and secondary outcomes were an objective measure of working memory and a measure of perceived cognitive functioning. Additional outcomes were neuropsychological tests of memory, executive function, working memory and questionnaire-based assessment of anxiety, depression and somatization.Methods: A total of 157 female breast cancer survivors were recruited from an existing cohort and through announcements in open access cancer-related Internet fora and randomly allocated to either web-based cognitive training (eCogT) with telephone support (n = 94) or a waitlist control (WLC) condition (n = 63). eCogT encompassed 30 training sessions over 6 weeks. Neuropsychological assessments were undertaken over the telephone, and questionnaire data was collected online. Data was collected at baseline, post-intervention and at 5-month follow-up.Results: Mixed linear models revealed no statistically significant change in primary or secondary outcome at follow-up in either group. Statistically significant improvements (p 0.040-0.043) were found in the eCogT group for verbal learning and on a working memory test.Conclusions: Web-based cognitive training did not result in improvements of the primary or secondary outcome. Improved performance was observed on verbal learning and working memory. These effects were observed at 5-month follow-up, indicating long-term effects of training. The intervention may be applied in a clinical setting at low cost and without risk of adverse effects.© 2016 The Authors Psycho-Oncology Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to evaluate the benefits of resistance training ( RT) on quality of life ( QOL) and fatigue in breast cancer survivors as an adjunct to usual care. We recruited 39 women who had survived breast cancer [mean age (y) 51.9 ± 8.8; time since diagnosis (m) 11.6 ± 13.2]. Primary outcomes were fatigue as assessed by the Functional Assessment of Chronic Illness Therapy - Fatigue ( FACIT) scale and QOL as assessed by the Functional Assessment of Cancer Therapy - General ( FACT-G) scale. ANCOVA was used to assess the change in the primary outcomes while controlling for baseline values, with effect sizes (ES) displayed as partial Eta squared. The experimental group received supervised RT 3 days per week in a university clinic for 16 weeks. Perceptions of fatigue improved significantly in the RT group compared to controls [mean ( SD) 6.7 (7.5) points vs. 1.5 (3.7) points], ( P = 0.006, ES = 0.20) as did QOL [6.9 (8.5) points vs. 1.6 (4.4) points], ( P = 0.015, ES = 0.16). We demonstrated both statistically and clinically important improvements in fatigue and QOL in response to RT in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Background: The primary purpose of the current study was to determine prospective associations of accelerometer-assessed physical activity intensity and sedentary time with health-related quality of life (HRQOL) indicators among survivors of breast cancer.Methods: A total of 358 survivors of breast cancer wore an accelerometer for 7 days at baseline to assess different activity intensities (light, lifestyle, and moderate to vigorous) and sedentary behavior. Six months later, survivors completed online questionnaires that assessed HRQOL indicators (disease-specific HRQOL, fatigue, depression, and anxiety) and relevant covariates. Relationships between activity and sedentary behavior quartiles and HRQOL indicator scores were examined using generalized liner models with Bonferroni multiple comparison adjustment.Results: After adjustment for covariates and sedentary time, each increasing lifestyle activity quartile was associated with reduced fatigue duration (P for trend, .03). Each increasing baseline moderate-to-vigorous physical activity (MVPA) quartile was found to be significantly associated with higher Physical Well-Being, Functional Assessment of Cancer Therapy-Breast (FACT-B) total, and trial outcome index scores; fewer breast cancer-specific concerns; and lower fatigue interference, and these differences were statistically and clinically significant between survivors in quartile 1 and quartile 4. After controlling for covariates and MVPA, relationships between sedentary time and HRQOL were mostly null with the exception of lower fatigue duration.Conclusions: Objectively measured MVPA was found to be positively associated with many HRQOL indicators. Lifestyle activity was found to be only inversely associated with fatigue duration whereas sedentary time was found to be positively associated with fatigue duration. Future research is warranted to explore these relationships further. [ABSTRACT FROM AUTHOR]

Introduction: After completing breast cancer treatment, a great number of patients experience pain but are not monitored in an interdisciplinary and integrated manner1. This study describes the development of an integrated aftercare approach for managing (chronic) pain after breast cancer treatment in Flanders, Belgium. Methods: We used an intervention mapping approach to guide our development and planning process. This approach consists of six steps2. Results: The different steps of intervention mapping are described, resulting in an integrated aftercare approach to stimulate prevention and an interdisciplinary response in treating (chronic) pain among breast cancer survivors. Several change mechanisms are targeted, such as awareness/knowledge, beliefs, professional confidence, outcome expectancies, and professional role/identity3. The developed aftercare approach consists of an e-learning for healthcare providers, a guideline with facilitating tools for screening and referral regarding pain in breast cancer aftercare, and a reminder system. Additionally, the implementation and evaluation plan are presented. Discussion: Intervention mapping offers a useful framework to undertake a theory-based and ecological approach for decision-making during developing and planning an intervention. This study can be used as a reference for the future development of aftercare approaches. Process evaluation: We would like to address the need to develop interventions that also aim to change the awareness and knowledge of society regarding (chronic) pain after breast cancer treatment. Our qualitative research on the current needs of breast cancer survivors and healthcare providers regarding pain management showed that the environment is not always aware of the long-term side effects of breast cancer treatment. [ABSTRACT FROM AUTHOR]

Introduction: Twenty-two percent of breast cancer survivors (BCSs) with pain are experiencing perceived injustice (PI)1. PI predicts adverse pain outcomes and opioid prescription due to increased pain behavior2. Educational interventions including reassurance and encouragement towards activity re-engagement are suggested to target PI3. Methods: Female BCSs (n = 156) experiencing pain+PI (=3 months post oncological treatment) are recruited. PI-targeted pain neuroscience education (PI-PNE) including motivational interviewing (rather biopsychosocially driven) is compared with biomedical pain education. The randomisation is done separately for each of the 6 treatment locations. Both interventions include an online session, information leaflet, and three one-to-one sessions. Online questionnaires assess pain, quality of life (QoL), PI, healthcare costs, sleep, fatigue, and cognitive-emotional factors at baseline and 0-, 6-, 12-, and 24-months post-intervention. A linear mixed model for repeated measures will evaluate whether the groups differ in terms of pain, PI, opioid use, and QoL after 12 months. Results: We expect that PI-PNE is superior to biomedical education at reducing pain, PI, and opioid use, and improving QoL in BCSs with pain and PI. Discussion: This is the first randomized controlled trial investigating the effectiveness of PI-PNE as a non-pharmacological strategy in BCSs with pain+PI. Process evaluation: Preparational work (e.g., ethical approval, interventions) is finalized. Recruitment started in April 2021 but is going slow due to COVID-19. Analyses are planned in 2023. [ABSTRACT FROM AUTHOR]

Background Evidence supports strong associations between healthful eating patterns and maintaining a healthy weight with favourable health outcomes for breast cancer survivors ( BCS). The present study aimed to evaluate the diet quality of Australian BCS and to determine whether diet quality differed between BCS and age-matched healthy controls ( HC) or by geographical location. Methods This cross-sectional study included 281 BCS and 4069 HC from the Australian Longitudinal Study on Women's Health mid-aged cohort completing Survey 3 in 2001. Data from the Dietary Questionnaire for Epidemiological Studies food frequency questionnaire were used to calculate the Australian Recommended Food Score ( ARFS), a validated summary estimate of diet quality based on adherence to the Australian dietary guidelines. Results The mean (SD) ARFS of the BCS group was 33.2 (9.4) out of a maximum of 74. Mean (SD) total ARFS and component scores of BCS did not differ from the HC group [32.9 (8.7)] and no differences were found in ARFS between urban and rural BCS. Conclusions This is the first study dedicated exclusively to describing the diet quality of Australian BCS. Although no difference was found when comparisons were made with a HC group, there is considerable room for improvement in the diet quality of Australian BCS. Given research suggesting higher risk of chronic conditions such as obesity amongst BCS, and the recognition of optimising diet quality as a key factor in health promotion for all population groups, data from the present study suggest the need for research targeting the feasibility and impact of improving diet quality of Australian BCS. [ABSTRACT FROM AUTHOR]

Objective This study aimed to understand the dyadic relationships between family communication and quality of life (QOL) and between coping and QOL in Chinese-American and Korean-American breast cancer survivor (BCS)-family member dyads. Methods A cross-sectional survey design was used. A total of 32 Chinese-American and Korean-American BCS-family member dyads were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County, California, USA. The dyadic data were analyzed using a pooled regression actor-partner interdependence model. Results The study findings demonstrated that the survivors' general communication and use of reframing coping positively predicted their own QOL. The survivors' and family members' general communication was also a strong predictor of the family members' physical-related QOL score specifically. Meanwhile, each person's use of mobilizing coping negatively predicted his or her partner's QOL. Conclusions The study findings add important information to the scarce literature on the QOL of Asian-American survivors of breast cancer. The findings suggest that Chinese-American and Korean-American BCS and their family members may benefit from interventions that enhance communication and coping within the family unit. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Obesity has been associated with poor health outcomes in breast cancer survivors. Thus, weight loss is recommended for overweight and obese survivors. We systematically reviewed studies (published up to July 2013) that evaluated behaviourally based, weight loss interventions in women with breast cancer exclusively. Completed randomized trials, single-arm trials and ongoing trials were reviewed. Within-group and between-group differences for weight loss were extracted, as was data on secondary outcomes, i.e. clinical biomarkers, patient-reported outcomes, adverse events. Ten completed randomized trials, four single-arm trials and five ongoing trials were identified. Statistically significant within-group weight loss was observed over periods of 2 to 18 months in 13 of the 14 trials, with six randomized and two single-arm trials observing mean weight loss ≥5%. Clinical biomarkers, psychosocial and patient-reported outcomes were measured in a small number of studies. No serious adverse events were reported. Only two trials assessed maintenance of intervention effects after the end-of-intervention and none reported on cost-effectiveness. The studies included in this review suggest that weight loss is feasible to achieve and is safe in women following treatment for breast cancer. Future studies should assess (and be powered for) a range of biomarker and patient-reported outcomes, and be designed to inform translation into practice. [ABSTRACT FROM AUTHOR]

Objective: Lymphedema is a distressing and chronic condition affecting up to 30% of breast cancer survivors. Using a cross-sectional study design, we examined the impact of self-reported lymphedema-related distress on psychosocial functioning among breast cancer survivors in the Women's Healthy Eating and Living Study. The Women's Healthy Eating and Living Study has a dataset that includes self-report data on lymphedema status, symptoms, and distress. Methods: Chi-square tests and binary logistic regression models were used to examine how specific participant characteristics, including lymphedema-related distress, were associated with physical health and mental health as measured by the SF-36-Item Health Survey and depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale screening form. Results: Of the 2431 participants included in the current study population, 692 (28.5%) self-reported ever having lymphedema. A total of 335 (48.9%)women reportedmoderate to extreme distress as a result of their lymphedema and were classified as having lymphedema-related distress. The logistic regression models showed that women with lymphedema-related distress had 50% higher odds of reporting poor physical health (p = 0.01) and 73% higher odds of having poor mental health (p<0.01) when compared with women without lymphedema. In contrast, even though lymphedema-related distress was significantly associated (p = 0.03) with elevated depressive symptoms in the bivariate analyses, it was not significant in the logistic regression models. Conclusion: Breast cancer survivors with lymphedema-related distress had worse physical health and mental health outcomes than women with lymphedema who were not distressed and women with no lymphedema. Our findings provide further evidence of the relationship between lymphedema and psychosocial outcomes in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Objective Mechanisms underlying the relationship between physical activity and quality of life (QOL) in breast cancer survivors are not well understood. The purpose of the present study was to longitudinally test a model examining self-efficacy and health status as potential mediators of this relationship. Methods At baseline and 6 months, breast cancer survivors ( n = 1527) completed physical activity, self-efficacy, health status, and QOL measures, and a subsample ( n = 370) wore an accelerometer. Panel analysis within a covariance modeling framework was used to test the hypothesis that physical activity indirectly influences QOL across time. Results The hypothesized model provided a good fit in the full sample ( χ2 = 409.06; d.f. = 91, p < 0.001; comparative fit index (CFI) = 0.98; standardized root mean residual (SRMR) = 0.04) and the accelerometer subsample ( χ2 = 320.96, d.f. = 134, p < 0.001; CFI = 0.95; SRMR = 0.05), indicating that physical activity indirectly, via self-efficacy and health status indicators, influences QOL across time. Conclusions Physical activity may influence QOL in breast cancer survivors through more proximal, modifiable factors. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the feasibility and effectiveness of aquatic-based exercise in the form of deep water running ( DWR) as part of a multimodal physiotherapy programme ( MMPP) for breast cancer survivors. A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community-based Primary Care Centres. Patients in the experimental group received a MMPP incorporating DWR, 3 times a week, for an 8-week period. The control group received a leaflet containing instructions to continue with normal activities. Statistically significant improvements and intergroup effect size were found for the experimental group for Piper Fatigue Scale- Revised total score ( d = 0.7, P = 0.001), as well as behavioural/severity ( d = 0.6, P = 0.05), affective/meaning ( d = 1.0, P = 0.001) and sensory ( d = 0.3, P = 0.03) domains. Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5, P < 0.05) and quality of life ( d = 1.3, P < 0.05). All participants attended over 80% of sessions, with no major adverse events reported. The results of this study suggest MMPP incorporating DWR decreases cancer-related fatigue and improves general health and quality of life in breast cancer survivors. Further, the high level of adherence and lack of adverse events indicate such a programme is safe and feasible. [ABSTRACT FROM AUTHOR]