Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Fear of Cancer Recurrence: A Model Examination of Physical Symptoms, Emotional Distress, and Health Behavior Change

PURPOSE

Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrence stemming from physical symptoms accounts for emotional distress in a large sample of adult survivors of cancer and to extend the model to explain postdiagnosis self-reported health behavior change.

METHODS

In 2016, 258 survivors of cancer at an academic hospital completed a survey of psychosocial needs. Items assessed physical symptoms (checklist), fear of cancer recurrence (Assessment of Survivor Concerns), emotional distress (anxiety and depressed mood), and health behaviors (current alcohol use, physical activity, diet, and sunscreen use, as well as changes after cancer diagnosis) informed by National Comprehensive Cancer Network survivorship guidelines. Indirect effects regression models accounting for relevant covariates (age and treatment history) used 5,000-iteration bootstrapping.

RESULTS

Higher fear of cancer recurrence was associated with greater number of physical symptoms (P < .001), greater emotional distress (P < .05), lower moderate or vigorous physical activity (P < .05), higher sunscreen use (P < .05), and postdiagnosis increases in alcohol use (P < .01) and reductions in physical activity (P < .01). Fear of cancer recurrence models accounted for almost half of the variance in distress of survivors of cancer (R² = 0.44, P < .001) and, to a lesser yet significant extent, changes in alcohol consumption (R² = 0.09, P < .001) and physical activity (R² = 0.06, P = .003).

CONCLUSION

Fear of cancer recurrence plays a central role in the emotional distress and key health behaviors of survivors of cancer. These findings support fear of cancer recurrence as a potential target for emotional health and health behavior change interventions.

Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review

The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.

Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network

PURPOSE

Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL.

METHODS

Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener.

RESULTS

Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction.

CONCLUSIONS

A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.

A brief intervention to enhance breast cancer clinicians' communication about sexual health: Feasibility, acceptability, and preliminary outcomes

OBJECTIVE

Sexual concerns are often unaddressed for breast cancer patients; one reason is inadequate clinician training. We examined the feasibility, acceptability, and potential benefits of a novel intervention, improving Sexual Health and Augmenting Relationships through Education (iSHARE) for breast cancer clinicians.

METHODS

Clinicians received training in communicating about sexual concerns with breast cancer patients. Intervention feasibility and acceptability were measured through enrollment/participation and postintervention program evaluations, respectively. Intervention effects were assessed through (1) clinician self-reported beliefs about sexual health communication, assessed at baseline, post-intervention, and 1- or 6-month follow-up, (2) clinical communication coded from audio recorded, transcribed clinic encounters at preintervention or postintervention, and (3) patient satisfaction with clinical care, reported immediately after the clinic visit. Patients also reported sociodemographic characteristics and level of sexual concerns.

RESULTS

Seven breast cancer clinicians enrolled (88% participation), completed the intervention, and were audio recorded in clinic encounters with 134 breast cancer outpatients (67 each at preintervention or postintervention). Program evaluations supported intervention acceptability. Effect sizes suggest iSHARE increased clinicians' self-efficacy (d = 0.27) and outcome expectancies for communicating about sexual concerns (d = 0.69) and reduced communication barriers (d = -0.14). Clinicians' sexual health communication behaviors increased from baseline to postintervention, including for raising the topic (28% vs 48%), asking questions (33% vs 45%), and offering information (18% vs 24%). Neither patient satisfaction nor duration of sexual health communication changed (mean duration less than 1 minute at both time points).

CONCLUSIONS

The iSHARE intervention was feasible and well received by clinicians and may change breast cancer clinicians' beliefs and communication behaviors regarding sexual health.

Endometrial Cancer: An Overview of Pathophysiology, Management, and Care

OBJECTIVE

To provide an overview of the etiology, diagnosis, treatment, and survivorship concerns surrounding endometrial cancer.

DATA SOURCES

A review of articles dated 2006-2018 from PubMed and NCCN guidelines.

CONCLUSION

Endometrial cancer is the most common gynecologic malignancy. Staging and treatment are primarily surgical, with adjuvant radiation and chemotherapy administered as indicated by grade and stage.

IMPLICATIONS FOR NURSING PRACTICE

Cancer prevention, response to treatment, and quality of life can be affected by lifestyle factors, including nutrition, exercise, and tobacco use. Nurses in diverse roles and practice settings can educate patients about lifestyle choices that can affect individuals across the cancer trajectory.

Finding sexual health aids after cancer: are cancer centers supporting survivors' needs?

PURPOSE

Sexual dysfunction is one of the most prevalent and distressing treatment-related side effects for both male and female cancer survivors. Survivorship care guidelines recommend therapeutic sexual aids to help improve sexual problems. However, little is known about the availability of sexual aids and resources at cancer centers.

METHODS

Twenty-five comprehensive cancer centers affiliated with both the National Cancer Institute and the National Comprehensive Care Network were surveyed using the "mystery shopper" method to determine whether various types of sexual aids were available at the centers. Staffs from cancer center staff retail stores and patient boutiques were queried in separate telephone calls regarding the availability of these aids for and women.

RESULTS

Of the 25 centers contacted, 23 (92%) responded about aids for men, and 22 (88%) responded about aids for women. Eighty-seven percent of the centers reported having no sexual aids available for men, and 72% of centers reported having no aids available for women. The most common advice given to mystery shoppers was a suggestion to use the internet. Only one center had numerous aids/resources for both men and women.

CONCLUSIONS

The large majority of cancer centers reported having no sexual aids or other sexual health resources available for men or women.

IMPLICATIONS FOR CANCER SURVIVORS

Results underscore the widespread lack of resources to promote sexual health rehabilitation at major cancer centers, both for male and female survivors.

Future health of AYA survivors

Adolescent and young adult (AYA) oncology patients (ages 15-39) have been identified as a group with healthcare disparities including gaps and challenges in diagnosis, access to care, research, clinical trial participation, and cure rates. Like other patient groups with cancer or other chronic illnesses, disparities can lead to poor future health and outcomes, which is a well-recognized concern within the AYA population. Cancer is the leading disease-related cause of death in this age range. Numerous interested groups including the National Cancer Institute have met to address the research and cancer care needs of AYAs. This review highlights how these gaps in care during and after treatment can affect future health of this population of patients. Access to care, models of survivorship care, and lack of provider education are discussed. Survivorship care and use of guidelines, and promotion of psychosocial support and health behaviors during treatment and beyond are essential to optimizing future health of AYA patients.

Advanced Practice Providers and Survivorship Care: They Can Deliver

INTRODUCTION

As the number of cancer survivors grows, new models of survivorship care are being implemented, but there is limited evaluation to date. This retrospective review assesses the concordance of care provided to adult-onset cancer survivors by advanced practice providers (nurse practitioners and physician assistants) with Institute of Medicine guidelines for survivorship care.

METHODS

Records from three survivorship clinics at a single institution were reviewed for frequency of recurrence surveillance, screening for second cancers, symptom management (physical, psychological), health promotion education (alcohol, tobacco, cholesterol, and bone density screenings; diet/exercise discussion), care coordination, and provision of care plan. Data were characterized using descriptive statistics.

RESULTS

Over 2 years, 9,052 unique survivorship visits occurred; 210 breast, 208 prostate, and 204 colorectal visits were randomly selected for review. All patients with breast cancer underwent surveillance for recurrence; 99% were screened for new cancers. Discussion of health promotion activities ranged from 83% to 100%; 91% of patients were reviewed for physical symptoms, and 93% were reviewed for psychological symptoms. All patients with prostate cancer underwent recurrence surveillance; 97% were screened for new primaries. Health promotion activities ranged from 70% to 97%, and symptoms were discussed in 89% of visits. All patients with colorectal cancer underwent a surveillance colonoscopy for recurrence; 97% had a carcinoembryonic antigen test. Among women, 97% had mammograms, and 96% had a Papanicolaou test; 83% of men had a prostate-specific antigen test. Health promotion activities ranged from 69% to 100%, and symptoms were discussed in 93% to 97% of visits.

CONCLUSIONS

Findings suggest that advanced practice providers can provide survivorship care in accordance with Institute of Medicine standards, which provide a normative standard. This assessment is an important step in evaluating survivorship outcomes.

Survivorship needs of adolescent and young adult cancer survivors: a concept mapping analysis

PURPOSE

Adolescents and young adults (AYAs) with cancer are known to have complex medical and psychosocial needs throughout treatment; however, information is lacking about the challenges AYA survivors face after treatment has ended. Focus groups were conducted using a concept mapping framework to better understand the most important issues these patients face in transitioning to survivorship and how prepared they felt to face them.

METHODS

AYAs diagnosed between 18 and 39 years old and at least 2 years post-treatment participated in one of six focus groups based on age group and follow-up status. Using a concept mapping design, participants provided important issues during the transition to survivorship and appraised them on three core areas of interest.

RESULTS

Analyses revealed salient themes shared across age and follow-up group status, particularly related to the psychosocial, emotional, and cognitive effects of treatment. Differential concerns included those related to patients' developmental concerns-namely, finding a new identity, financial burden of treatment, and fertility concerns after treatment.

CONCLUSIONS

AYA cancer survivors continue to have a myriad of issues beyond the immediate treatment phase. Despite a complex list of challenges, these issues largely remained unaddressed by their oncology provider and left patients feeling overwhelmingly ill-prepared to manage their transition to survivorship.

IMPLICATIONS FOR CANCER SURVIVORS

AYA cancer survivors have many unaddressed concerns as they transition out of active cancer treatment, largely related to developmental issues they are facing. Survivorship care for these patients would benefit from care planning that takes these unique concerns into account.

Physical activity, functional ability, and quality of life after breast cancer surgery

This cross-sectional study aimed to assess the influence of different surgical treatment modalities on the level of physical activity, functional capacity, and quality of life of breast cancer survivors. One hundred eighty women aged 30-60 years old were selected and allocated to control group (CG, women without breast cancer, n = 45), breast-conserving surgery group (BCG, n = 45), mastectomy group (MG, n = 45), and breast reconstruction group (BRG, n = 45). Physical activity, functional capacity, and quality of life were assessed, respectively, using the following self-report questionnaires validated for use in Brazil: International Physical Activity Questionnaire (IPAQ), Stanford Health Assessment Questionnaire (HAQ-20), and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The groups were homogeneous relative to sociodemographic variables. The scores for physical activity (IPAQ) did not differ between CG and BRG, whereas they were better for CG than for BCG and MG (p = 0.0270). The results for functional capacity (HAQ-20) were better for CG than for MG (p = 0.0450), with no difference between the remaining groups. Differences were found for the SF-36 domains "physical functioning" (p < 0.01), "physical role functioning" (p < 0.001), "emotional role functioning" (p = 0.0174), and "general health" (p = 0.0307). CG and BRG differed significantly relative to the domains "physical role functioning" and "emotional role functioning" only. We concluded that patients who underwent breast reconstruction exhibited higher levels of physical activity and quality of life than patients subjected to mastectomy alone or breast-conserving surgery.

Cardiac Toxicities in the Era of Precision Medicine: Underlying Risk Factors, Targeted Therapies, and Cardiac Biomarkers

Cancer therapies can cause a variety of cardiac toxicities, including ischemia, cardiomyopathy, heart failure, myocarditis, arrhythmias, vascular disease, hypertension, and hyperlipidemia. Addressing cardiovascular risk at baseline, before initiating therapy, during cancer treatment, and in the survivorship period is imperative. It may be useful to risk stratify individuals with cardiovascular risk factors using biomarkers or imaging before they receive potentially cardiotoxic therapies. Additionally, new guidelines recommend cardiac imaging with echocardiography in the survivorship period 6 to 12 months after completing cancer therapy for these high-risk individuals. Close collaboration between cardiology and oncology in both clinical practice and future research is essential.

Sexual quality of life in men and women after cancer

More than 60% of people treated for cancer have long-term sexual dysfunction. However, fewer than 25% of those with sexual problems get help from a health professional. Although cancer-related sexual problems usually begin with physiological damage from cancer treatment, a patient's coping skills and the quality of the sexual relationship are crucial in sexual rehabilitation. Barriers to care for people treated for cancer include a lack of discussion with the oncology team. In repeated surveys, fewer than half of patients recall discussing sex or fertility with their care providers, even during informed consent. Practice guidelines on sexuality and cancer were published in 2017 by the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). Both agree the following: The oncology team should initiate discussions of sexuality and cancer during treatment planning and at follow-up visits. Psychosocial and medical assessment should take place when a concern or problem is identified. Referrals should be offered for multidisciplinary treatment, since sexual problems frequently have both psychosocial and physiological causes.This article describes a system of care that can meet the guidelines while providing sustainable revenue.

The treasure of now and an uncertain future: Delay discounting and health behaviors among cancer survivors

BACKGROUND

The identification of new therapeutic targets to improve health behaviors among cancer survivors (CS) is likely to improve cancer treatment outcomes. Delay discounting (DD) rate is the degree to which one devalues rewards as a function of time to receipt. Lower DD rates (ie, prioritizing long-term over immediate rewards) are associated with healthier behaviors. CS often experience distress and thoughts of early mortality that can potentially shift priorities to the present and negatively impact DD rates, especially when newly diagnosed. Understanding relations between DD and health behaviors among CS will contribute to the examination of DD as a therapeutic target for improving health behaviors for CS.

METHOD

CS (n = 1001) were recruited from a web panel and administered a web-based questionnaire. Multivariate models examined relations among DD rate, years since diagnosis, and 10 health behavior indicators. We hypothesized that 1) higher DD rates would be associated with fewer years since diagnosis, and 2) lower DD rates would be associated with healthier behaviors, moderated by years since diagnosis.

RESULTS

In general, higher DD rates were associated with fewer years since diagnosis. Higher DD rates were associated with more alcohol consumption, cigarette smoking, other tobacco use, tanning booth use, and conversely, greater adherence to annual primary care visits. A significant interaction between DD rate and years since diagnosis was not found.

CONCLUSION

Lower DD rates are associated with several important healthy lifestyle behaviors. DD rate is a promising therapeutic target for new interventions to improve multiple health behaviors among CS.

Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors

The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion-adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.

Obese Breast Cancer Patients and Survivors: Management Considerations

Excess body weight is a significant risk factor for many cancers, especially breast cancer. Patients with breast cancer or those with a history of the disease who are overweight or obese have an increased risk of therapy-related morbidity, recurrence, and breast cancer-related mortality. Obesity may also affect quality-of-life factors for survivors, including sexual dysfunction, neuropathy, cardiotoxicity, chronic fatigue, and lymphedema. Most cancer guidelines recommend that breast cancer survivors who are overweight or obese lose weight and that those with a normal body mass index (BMI) maintain a stable body weight. The cornerstone of interventions to treat or prevent obesity is lifestyle modification with diet and exercise; however, integrating these things into clinical practice is challenging. This article will present feasible weight loss interventions, and will discuss practical implications of ongoing chemotherapy and endocrine therapy with regard to weight gain, and the impact of obesity on therapy-related conditions during breast cancer survivorship.

Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study

INTRODUCTION

Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs.

METHODS

We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs).

RESULTS

Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation.

CONCLUSION

SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.

Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement

Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks ("pathways") that connect patients with exercise-related resources. In the present paper, we describe a pathway model and related resources that were developed by an expert panel of practitioners and researchers in the field of exercise and rehabilitation in oncology and that support the transition from health care practitioner to exercise programs or services for people with cancer. The model acknowledges the nuanced distinctions between research and exercise programming, as well as physical activity promotion, that, depending on the available programming in the local community or region, might influence practitioner use. Furthermore, the pathway identifies and provides examples of processes for referral, screening, medical clearance, and programming for people after a cancer diagnosis. The pathway supports the implementation of exercise guidelines and should serve as a model of enhanced care delivery to increase the health and well-being of people with cancer.

Severity, course, and predictors of sleep disruption following hematopoietic cell transplantation: a secondary data analysis from the BMT CTN 0902 trial

Sleep disruption has received little attention in hematopoietic cell transplantation (HCT). The goal of this study was to describe severity, course, and predictors of sleep disruption following HCT. A secondary data analysis was conducted of the Blood and Marrow Transplantation Clinical Trials Network (BMT CTN) 0902 study. Participants completed a modified version of the Pittsburgh Sleep Quality Index prior to transplant and 100 and 180 days post-transplant. Growth mixture models were used to characterize subgroups of patients based on baseline sleep disruption and change over time. A total of 570 patients (mean age 55, 42% female) were included in the current analyses. Patients could be grouped into four distinct classes based on sleep disruption: 1) clinically significant sleep disruption at baseline that did not improve over time (20%); 2) clinically significant sleep disruption at baseline that improved over time (22%); 3) sleep disruption that did not reach clinical significance at baseline and did not improve over time (45%); and 4) no sleep disruption at baseline or over time (13%). These data provide a more comprehensive understanding of sleep disruption that can be used to develop interventions to improve sleep in HCT recipients.

Talking about women's sexual health after cancer: Why is it so hard to move the needle?

Despite increasing calls to integrate sexual health into routine cancer care, the majority of women diagnosed with cancer do not receive information about how their cancer treatments will affect their sexual health. With the significant challenges that exist to clinical discussion of sexual health, efforts on multiple fronts are needed to close the gap in the care of women diagnosed with cancer.

Psychosocial interventions in breast cancer survivorship care

Cancer distress screening and subsequent referral for psychosocial intervention has been mandated for continued cancer center accreditation. Increasing emphasis is being placed on the referral component of this mandate, ensuring that patient distress is not only identified but also effectively treated. Many evidence-based interventions exist for cancer distress. Specific interventions can effectively target biopsychosocial impacts of stress and promote adaptive coping, focusing on problem-solving, social support utilization, assertive communication, sexual health and intimacy, adherence to medical and supportive care recommendations, health behavior change, and emotional processing and expression. In randomized clinical trials, specific interventions have also been associated with biological improvements, including neuroendocrine and immune functioning, decreased rates of breast cancer recurrence, and improved survival rates. As cancer treatments advance and patients live longer, it is pertinent to treat the impacts of breast cancer with evidence-based interventions.

Perceptions of Cancer Risk: Differences by Weight Status

Despite the strong link between obesity and cancer development, individuals are less likely to identify obesity as a risk factor for cancer than family history. Family history of cancer has been documented to influence perceived risk of developing cancer, yet it is unclear if excess weight impacts cancer risk perceptions. The purpose of this study was to examine absolute and relative risk perceptions for cancer by weight status. Cross-sectional data were obtained from the National Cancer Institute's 2011 Health Information National Trends Survey (n = 2585). Demographics, anthropometric data, family history of cancer, health behaviors, and absolute and relative cancer risk perceptions were evaluated. The effect of weight and family history on absolute and relative cancer risk perceptions was analyzed through weighted descriptive and logistic regression analyses. 22.8 and 28.6 % of subjects reported that they were very unlikely/unlikely to develop cancer in their lifetime (absolute risk) and when compared to others their age (relative risk), respectively. Findings indicated differences in risk perceptions between those with and without a family history of cancer (p < 0.0001). No significant differences were found between BMI categories for absolute cancer risk perceptions despite stratification by family history. Obese subjects were more likely to have an increased relative risk perception of cancer compared to healthy weight subjects (p = 0.0066); this association remained significant when stratified by family history (p = 0.0161). Educating individuals, especially those who are overweight/obese, about the impact of excess weight on cancer risk may improve risk accuracy and promote cancer risk reduction through weight management.

Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial

PURPOSE

The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe.

PATIENTS AND METHODS

A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects.

RESULTS

Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC).

CONCLUSION

The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.