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Choi HR, Chang Y, Park J, Cho Y, Kim C, Kwon MJ, Kang J, Kwon R, Lim GY, Ahn J, Kim KH, Kim H, Hong YS, Park J, Zhao D, Cho J, Guallar E, Park HY, Ryu S. Early-onset vasomotor symptoms and development of depressive symptoms among premenopausal women. J Affect Disord 2024; 354:376-384. [PMID: 38503358 DOI: 10.1016/j.jad.2024.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND We investigated the association between vasomotor symptoms (VMSs) and the onset of depressive symptoms among premenopausal women. METHODS This cross-sectional study included 4376 premenopausal women aged 42-52 years, and the cohort study included 2832 women without clinically relevant depressive symptoms at baseline. VMSs included the symptoms of hot flashes and night sweats. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale; a score of ≥16 was considered to define clinically relevant depressive symptoms. RESULTS Premenopausal Women with VMSs at baseline exhibited a higher prevalence of depressive symptoms compared with women without VMSs at baseline (multivariable-adjusted prevalence ratio 1.76, 95 % confidence interval [CI] 1.47-2.11). Among the 2832 women followed up (median, 6.1 years), 406 developed clinically relevant depressive symptoms. Women with versus without VMSs had a significantly higher risk of developing clinically relevant depressive symptoms (multivariable-adjusted hazard ratio, 1.72; 95 % CI 1.39-2.14). VMS severity exhibited a dose-response relationship with depressive symptoms (P for trend <0.05). LIMITATIONS Self-reported questionnaires were only used to obtain VMSs and depressive symptoms, which could have led to misclassification. We also could not directly measure sex hormone levels. CONCLUSIONS Even in the premenopausal stage, women who experience hot flashes or night sweats have an increased risk of present and developed clinically relevant depressive symptoms. It is important to conduct mental health screenings and provide appropriate support to middle-aged women who experience early-onset VMSs.
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Affiliation(s)
- Hye Rin Choi
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea.
| | - Jungeun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Yoosun Cho
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Chanmin Kim
- Department of Statistics, Sungkyunkwan University, Seoul 03063, Republic of Korea
| | - Min-Jung Kwon
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Ria Kwon
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
| | - Ga-Young Lim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Kye-Hyun Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Yun Soo Hong
- Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jihwan Park
- Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Di Zhao
- Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Juhee Cho
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea; Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Hyun-Young Park
- Department of Precision Medicine, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea.
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Goyal N, Levine BJ, Crawford SL, Avis NE. Sleep disturbance among breast cancer survivors and controls from midlife to early older adulthood: Pink SWAN. J Cancer Surviv 2024; 18:489-498. [PMID: 35982358 PMCID: PMC9938082 DOI: 10.1007/s11764-022-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To compare sleep disturbance from 5 years pre- to 5 years post-diagnosis between breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different sleep trajectories. METHODS Analyses included data from 152 BCS and 2163 controls from 20 years of follow-up in the longitudinal Study of Women's Health Across the Nation (SWAN), a multi-racial/ethnic cohort study. SWAN participants were assessed approximately annually from 1995 to 2015 using a standardized protocol. Pink SWAN focused on women who reported no cancer at SWAN enrollment and developed incident breast cancer after enrollment or did not develop breast cancer. Nonparametric locally weighted scatterplot smoothing plots and linear mixed models were used to compare the prevalence of the most frequently reported sleep problem, frequently waking several times a night (a sleep maintenance problem) during the previous 2 weeks, between BCS and controls in the 5 years pre- to 5 years post-diagnosis. We characterized heterogeneity among BCS on this sleep problem using group-based trajectories and examined pre-diagnosis variables as predictors of group membership. RESULTS No differences were found between BCS and controls in prevalence of frequent nighttime awakenings either before or after diagnosis. Among BCS, three trajectory groups were identified. Thirty-seven percent of BCS had consistently low prevalence of waking several times per night, 30% had high prevalence, and 33% had increasing prevalence which started 2 years pre-diagnosis. Prevalence of pre-diagnosis vasomotor symptoms, anxiety, depressive symptoms, and smoking differed among these groups. CONCLUSION Among mid-aged women diagnosed with breast cancer, this diagnosis did not trigger/amplify a sleep maintenance problem. The majority of BCS had similar levels of this sleep problem from pre- to post-diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Although sleep maintenance problems were not amplified by a cancer diagnosis, a subset of BCS may have sleep issues that should be monitored and treated, as indicated.
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Affiliation(s)
- Neha Goyal
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sybil L Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MB, USA
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Beverly Hery CM, Janse SA, Van Zee KJ, Naftalis EZ, Paskett ED, Naughton MJ. Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer. Breast Cancer Res Treat 2023; 202:155-165. [PMID: 37542630 PMCID: PMC10504151 DOI: 10.1007/s10549-023-07058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE We examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients. METHODS Women with stage I-III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women's Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms). RESULTS At baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time. CONCLUSIONS Insomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.
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Affiliation(s)
- Chloe M Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Sarah A Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Elizabeth Z Naftalis
- Director of Breast Services, Health Texas Community Health Services Corporate, Dallas, TX, 75001, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
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Dibble KE, Baumgartner RN, Boone SD, Baumgartner KB, Connor AE. Treatment-related side effects among Hispanic and non-Hispanic white long-term breast cancer survivors by tamoxifen use and duration. Breast Cancer Res Treat 2023; 199:155-172. [PMID: 36892724 PMCID: PMC10897699 DOI: 10.1007/s10549-023-06900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To determine the associations between ethnicity, age at diagnosis, obesity, multimorbidity, and odds of experiencing breast cancer (BC) treatment-related side effects among long-term Hispanic and non-Hispanic white (NHW) survivors from New Mexico and explore differences by tamoxifen use. METHODS Lifestyle and clinical information including self-reported tamoxifen use and presence of treatment- related side effects were collected at follow-up interviews (12-15 years) for 194 BC survivors. Multivariable logistic regression models were used to examine associations between predictors and odds of experiencing side effects overall and by tamoxifen use. RESULTS Women ranged in age at diagnosis (30-74, M = 49.3, SD = 9.37), most were NHW (65.4%) and had in-situ or localized BC (63.4%). Less than half reportedly used tamoxifen (44.3%), of which 59.3% reported using > 5 years. Overall, survivors who were overweight/obese at follow-up were 5.42 times more likely to experience treatment-related pain (95% CI 1.40-21.0) compared to normal weight survivors. Survivors with multimorbidity, compared to survivors without, were more likely to report treatment-related sexual health issues (aOR 6.90, 95% CI 1.43-33.2) and poorer mental health (aOR 4.51, 95% CI 1.06-19.1). The statistical interactions between ethnicity and overweight/obese with tamoxifen use were significant (p-interaction < 0.05) for treatment-related sexual health issues. CONCLUSION Our results demonstrate that survivors with overweightness/obesity or multimorbidity may be more likely to experience BC treatment-related side effects. Tamoxifen use modifies associations between ethnicity, being overweight/obese, and sexual health issues following treatment. The likelihood of experiencing treatment-related side effects were more favorable for those on tamoxifen or those who had used tamoxifen for longer durations. These findings highlight the importance of fostering side effect awareness and applying appropriate interventions to assist with disease management throughout BC survivorship care.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Richard N Baumgartner
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Stephanie D Boone
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Kathy B Baumgartner
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
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Price SN, Hamann HA, Halaby L, Trejo JI, Corella F, Weihs KL. Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behav Sleep Med 2023; 21:45-60. [PMID: 35098834 DOI: 10.1080/15402002.2022.2033243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management. METHODS Participants were 140 adults with cancer who screened positive for depression through routine, practice-based assessment with the Patient Health Questionnaire (PHQ-9 ≥ 8) and were referred to a study of collaborative care for depression. Demographics, clinical characteristics, subjective sleep quality, and sleep recommendations received were self-reported by patients prior to intervention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10, and depressive symptoms were measured using the PHQ-9. RESULTS Of 138 patients with complete data, 123 (89.1%) reported poor sleep quality, and 87 (63%) met the threshold for possible insomnia. The strongest correlates of poor subjective sleep were female gender (β = 0.19, p = .02), greater depressive symptom severity (β = 0.28, p = .001), and worse physical health (β = -0.19, p = .04). Of 118 patients reporting problems with sleep since their cancer diagnosis, 95 discussed the issue with a medical provider; medications were recommended most often (37; 38.9%); only 9 (9.5%) received recommendations for cognitive-behavioral therapy for insomnia (CBT-I) or other CBT. CONCLUSIONS Patients with cancer seeking treatment for depression report very high rates of poor subjective sleep quality and insomnia, underscoring the importance of providing and referring to guideline-concordant sleep interventions in oncology supportive care contexts.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.,Departments of Family and Community Medicine and Psychiatry, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Laila Halaby
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Juanita I Trejo
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
| | - Fernanda Corella
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Karen L Weihs
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.,Departments of Family and Community Medicine and Psychiatry, University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
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Tan JY(B, Wang T, Zhao I, Polotan MJ, Eliseeva S. An Evidence-Based Somatic Acupressure Intervention Protocol for Managing the Breast Cancer Fatigue-Sleep Disturbance-Depression Symptom Cluster: Development and Validation following the Medical Research Council Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11934. [PMID: 36231235 PMCID: PMC9565572 DOI: 10.3390/ijerph191911934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Somatic acupoint stimulation (SAS) has been frequently utilised as a promising intervention for individual cancer-related symptom management, such as fatigue, sleep disturbance and depression. However, research evidence regarding the role of SAS in mitigating the fatigue-sleep disturbance-depression symptom cluster (FSDSC) has been scant. This study was conducted to develop an evidence-based SAS intervention protocol that can be further implemented in a Phase II randomized controlled trial (RCT) to manage the FSDSC in breast cancer survivors. METHODS The Medical Research Council Framework for Developing and Evaluating Complex Intervention (MRC framework) was employed to guide the development procedures of the SAS intervention protocol, including the identification of an existing evidence base, the identification of theories and practice standards, and the validation of the SAS intervention protocol. A content validity study was performed through an expert panel to assess the scientific and practical appropriateness of the SAS intervention protocol. The content validity index (CVI), including item-level CVI and protocol-level CVI, were calculated to evaluate the consensus level of the expert panel. RESULTS Key components of the SAS protocol, including the acupoint formula, the SAS modality, technique, intensity and frequency were identified for both a true and placebo SAS intervention based on the best available research evidence retrieved from systematic reviews, clinical trials, and relevant theories, particularly regarding the inflammatory process, yin-yang theory, zang-fu organs and meridians theory, and acupressure practical standards. The true SAS intervention was determined as daily self-administered acupressure on specific acupoints for seven weeks. The placebo SAS was designed as light acupressure on non-acupoints with the same frequency and duration as the true SAS. Excellent content validity was achieved after one round of expert panel assessment, with all the key components of the true and placebo SAS protocols rated as content valid (CVI ranged from 0.86 to 1.00). CONCLUSIONS A research-informed, theory-driven and practically feasible SAS intervention protocol for the FSDSC management in breast cancer survivors was developed following the MRC framework. The feasibility and acceptability of the SAS intervention will be further tested in breast cancer survivors through a Phase II RCT.
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Affiliation(s)
- Jing-Yu (Benjamin) Tan
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT 0810, Australia
| | - Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, Brisbane Centre, 410 Ann Street, Brisbane, QLD 4000, Australia
| | - Isabella Zhao
- College of Nursing and Midwifery, Charles Darwin University, Brisbane Centre, 410 Ann Street, Brisbane, QLD 4000, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4000, Australia
| | - Mary Janice Polotan
- College of Nursing and Midwifery, Charles Darwin University, Brisbane Centre, 410 Ann Street, Brisbane, QLD 4000, Australia
- Thornlands General Practice, Thornlands, QLD 4164, Australia
| | - Sabina Eliseeva
- College of Nursing and Midwifery, Charles Darwin University, Brisbane Centre, 410 Ann Street, Brisbane, QLD 4000, Australia
- Thornlands General Practice, Thornlands, QLD 4164, Australia
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Hwang Y, Conley S, Jeon S, Redeker NS, Sanft T, Knobf MT. Factors associated with sleep health in young women after breast cancer treatment. Res Nurs Health 2022; 45:680-692. [DOI: 10.1002/nur.22264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Youri Hwang
- School of Nursing Yale University Orange Connecticut USA
| | | | - Sangchoon Jeon
- School of Nursing Yale University Orange Connecticut USA
| | | | - Tara Sanft
- School of Medicine Yale University New Haven Connecticut USA
| | - M. Tish Knobf
- School of Nursing Yale University Orange Connecticut USA
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Sleep health in young women with breast cancer: a narrative review. Support Care Cancer 2022; 30:6419-6428. [PMID: 35288784 DOI: 10.1007/s00520-022-06953-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this narrative review was to synthesize the evidence on sleep health in young women with breast cancer and provide recommendations for clinical practice and research. METHODS Multiple databases were searched (OVID Medline, OVID PsycINFO, OVID Embase, and Scopus) using the search terms "breast neoplasm", "young women", "sleep", "sleep disturbance", "sleep problems", "sleep deficiency", and "insomnia". There were 467 titles and abstracts screened, and 82 full-text papers were reviewed, yielding 11 research publications for inclusion. RESULTS Sleep problems are prevalent among young women with breast cancer and are associated with vasomotor symptoms of menopause and psychological symptom distress. The evidence, however, is weak due to methodological and design aspects of the studies. CONCLUSIONS Poor sleep health in women with breast cancer is a clinically relevant problem that persists after treatment. As sleep is multidimensional and multifactorial, future research should evaluate sleep with objective sleep measures as well as self-reports; consider longitudinal designs; include factors that potentially contribute to poor sleep quality, such as physical and psychological symptom distress, family stressors, and competing life demands for this age group; and explore the perspective of this younger population of survivors on sleep. For clinical practice, survivorship visits should incorporate sleep assessment for all breast cancer survivors, especially younger women.
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Sleep macro- and microstructure in breast cancer survivors. Sci Rep 2022; 12:2557. [PMID: 35169245 PMCID: PMC8847579 DOI: 10.1038/s41598-022-06664-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/04/2022] [Indexed: 12/31/2022] Open
Abstract
Complaints of sleep disturbance are prevalent among breast cancer (BC) patients and are predictors of quality of life. Still, electrophysiological measures of sleep are missing in patients, which prevents from understanding the pathophysiological consequences of cancer and its past treatments. Using polysomnography, sleep can be investigated in terms of macro- (e.g. awakenings, sleep stages) and micro- (i.e. cortical activity) structure. We aimed to characterize sleep complaints, and macro- and microstructure in 33 BC survivors untreated by chemotherapy and that had finished radiotherapy since at least 6 months (i.e. out of the acute effects of radiotherapy) compared to 21 healthy controls (HC). Compared to HC, BC patients had a larger number of awakenings (p = 0.008); and lower Delta power (p < 0.001), related to sleep deepening and homeostasis; greater both Alpha (p = 0.002) and Beta power (p < 0.001), related to arousal during deep sleep; and lower Theta power (p = 0.004), related to emotion regulation during dream sleep. Here we show that patients have increased cortical activity related to arousal and lower activity related to sleep homeostasis compared to controls. These results give additional insights in sleep pathophysiology of BC survivors and suggest sleep homeostasis disruption in non-advanced stages of BC.
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Wang T, Tan JYB, Liu XL, Zheng SL, Zhao I, Eliseeva S, Polotan MJ, Cheng HL, Huang HQ. Implementing an evidence-based somatic acupressure intervention in breast cancer survivors with the symptom cluster of fatigue, sleep disturbance and depression: study protocol of a phase II randomised controlled trial. BMJ Open 2022; 12:e054597. [PMID: 35058263 PMCID: PMC8783815 DOI: 10.1136/bmjopen-2021-054597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/20/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The fatigue-sleep disturbance-depression (FSD) symptom cluster, as one of the most common symptom clusters in breast cancer (BC) survivors, can significantly decrease patients' quality of life. Since the management of the FSD symptom cluster has been unsatisfactory with the use of pharmacological treatments alone, non-pharmacological approaches have, therefore, been recommended. Somatic acupressure (SA) is a promising approach given its potential benefits of cancer-related symptom alleviation and the convenience of self-practice. However, research evidence on using acupressure to manage the FSD symptom cluster has been limited. The proposed trial aims to examine the feasibility and preliminary effects of an evidence-based SA intervention for FSD symptom cluster management in BC survivors. METHODS AND ANALYSIS This study will be a phase II randomised controlled trial with three study arms and 1:1:1 allocation. Fifty-one early-stage BC survivors who are experiencing the FSD symptom cluster will be randomly assigned to a true SA group, a sham SA group or a usual care group. All participants will receive an education booklet regarding FSD symptom cluster management advice as the usual care package. The participants in the true SA group will additionally receive a 7-week self-administered SA intervention. The participants in the sham SA group will additionally receive self-administered light acupressure at non-acupoints with the same frequency, session and duration as the true SA group. The primary outcomes will be feasibility outcomes related to subject recruitment and completion of study questionnaires and interventions. The secondary outcomes will be the effects of SA on fatigue, sleep disturbance, depression and quality of life. Descriptive statistics will be used to present all the outcomes. The secondary outcomes will be analysed using an intent-to-treat approach. ETHICS AND DISSEMINATION Ethical approvals of this trial have been granted by the Human Research Ethics Committee at Charles Darwin University (H19017) and the Clinical Trial Ethics Committee at The Affiliated Hospital of Southwest Medical University (KY2019039). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences. TRIAL REGISTRATION NUMBER This trial was registered at ClinicalTrials.gov and the registration number is NCT04118140, with the stage at Recruiting.
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Affiliation(s)
- Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queesland, Australia
| | - Jing-Yu Benjamin Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queesland, Australia
| | - Si-Lin Zheng
- Department of Nursing, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Isabella Zhao
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queesland, Australia
- Cancer and Palliative Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sabina Eliseeva
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queesland, Australia
- Thornlands General Practice, Brisbane, Queensland, Australia
| | - Mary Janice Polotan
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queesland, Australia
- Thornlands General Practice, Brisbane, Queensland, Australia
| | - Hui-Lin Cheng
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queesland, Australia
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Hou-Qiang Huang
- Department of Nursing, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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11
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Wang CC, Han EY, Jenkins M, Hong X, Pang S, Whitehead L, Kirk DL, Williams A. The safety and efficacy of using moxibustion and or acupuncture for cancer-related insomnia: a systematic review and meta-analysis of randomised controlled trials. Palliat Care Soc Pract 2022; 16:26323524211070569. [PMID: 35036916 PMCID: PMC8755931 DOI: 10.1177/26323524211070569] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: This study aimed to synthesise the best available evidence on the safety and
efficacy of using moxibustion and/or acupuncture to manage cancer-related
insomnia (CRI). Methods: The PRISMA framework guided the review. Nine databases were searched from its
inception to July 2020, published in English or Chinese. Randomised clinical
trials (RCTs) of moxibustion and or acupuncture for the treatment of CRI
were selected for inclusion. Methodological quality was assessed using the
method suggested by the Cochrane collaboration. The Cochrane Review Manager
was used to conduct a meta-analysis. Results: Fourteen RCTs met the eligibility criteria. Twelve RCTs used the Pittsburgh
Sleep Quality Index (PSQI) score as continuous data and a meta-analysis
showed positive effects of moxibustion and or acupuncture
(n = 997, mean difference (MD) = −1.84, 95% confidence
interval (CI) = −2.75 to −0.94, p < 0.01). Five RCTs
using continuous data and a meta-analysis in these studies also showed
significant difference between two groups (n = 358, risk
ratio (RR) = 0.45, 95% CI = 0.26–0.80,
I2 = 39%). Conclusion: The meta-analyses demonstrated that moxibustion and or acupuncture showed a
positive effect in managing CRI. Such modalities could be considered an
add-on option in the current CRI management regimen.
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Affiliation(s)
- Carol Chunfeng Wang
- Carol Chunfeng Wang Researcher and Lecturer, School of Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Ellen Yichun Han
- School of Pharmacy, The University of Western Australia, Perth, WA, Australia
| | | | - Xuepei Hong
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shuqin Pang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Deborah L Kirk
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Anne Williams
- Discipline of Nursing, Murdoch University, Perth, WA, Australia
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12
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Wang CC, Geraghty S, Fox-Harding C, Wang C. Effects of a nurse-led Tai Chi programme on improving quality of life, mental wellbeing, and physical function of women with breast cancer: Protocol for a randomized controlled trial. WOMEN'S HEALTH 2022; 18:17455057221127813. [PMID: 36165224 PMCID: PMC9520183 DOI: 10.1177/17455057221127813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Quality of life, mental wellbeing, and physical function deteriorate among women with breast cancer. Tai Chi is a moderate form of exercise that may be effective in improving the mental and physical wellbeing, therefore, the quality of life of women with breast cancer. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi programme on breast cancer management. Methods: The study will be an interventional, single-blind, double-armed, randomized, and controlled trial involving a 12-week Tai Chi programme for women with breast cancer. Forty participants aged 18 years and above who are diagnosed with breast cancer from the general community will be recruited. All participants will be randomized to either a Tai Chi programme or a waiting list control group. The Tai Chi programme will involve 12 weeks of group Tai Chi sessions, with 45 min per session, twice a week. The primary outcome will be potential improvements to the quality of life, and secondary outcomes will be potential improvements in mental wellbeing (anxiety and depression), and physical function (pain, flexibility, obesity, and vital signs). These outcomes will be assessed via self-administered online assessments and physical examinations pre-and post-intervention. Linear mixed modelling will be used to assess changes in outcomes. Discussion and dissemination: Tai Chi is a safe, easy to learn, inexpensive, and low-intensity exercise with increasing popularity worldwide. If the intervention improves the quality of life in women with breast cancer, this study will build research capacity and increase awareness of the potential for Tai Chi to empower patients and engage them in self-management of breast cancer symptoms. Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications.
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Affiliation(s)
- Carol Chunfeng Wang
- Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Perth, WA, Australia
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Sadie Geraghty
- Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, Perth, WA, Australia
| | - Caitlin Fox-Harding
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Exercise Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Calvin Wang
- Qiology: Acupuncture & Chinese Medicine, Perth, WA, Australia
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13
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Longitudinal Analysis of Sleep Disturbance in Breast Cancer Survivors. Nurs Res 2022; 71:177-188. [PMID: 35026802 PMCID: PMC9038645 DOI: 10.1097/nnr.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Breast cancer survivors (BCS) often report poor sleep quality and wakefulness throughout the night as the greatest challenges experienced during and posttreatment. OBJECTIVES This study aimed to elucidate characteristics of sleep disturbances and determine potential predictors that affect sleep disturbances in BCS for 2 years postchemotherapy. METHODS This is a secondary analysis of data from the EPIGEN study, which longitudinally examined sociodemographic and cancer-related factors, lifestyle, symptom characteristics, and epigenetic factors at baseline prior to chemotherapy (T1), the midpoint (T2), 6-month (T3), 1-year (T4), and 2-year (T5) time points postchemotherapy. Temporal lifestyle changes, symptom characteristics, and epigenetic factors were explored using linear mixed-effects models with a random intercept. A linear regression model was fitted to identify significant predictors of sleep disturbances at each time point. RESULTS In 74 BCS with an average age of 51 years and 70% non-Hispanic White, BCS experienced severe sleep disturbances at T2, which gradually improved over time. Significant temporal changes in midsleep awakenings, early awakenings, and fatigue at work were observed, with disturbances being elevated at T2. Anxiety (T1, T2, and T4), fatigue (T3 and T4), and perceived stress (T3) were significant predictors after adjusting for radiation therapy, surgery, and adjuvant endocrine therapy. DISCUSSION This study highlights that predictors of sleep disturbances change over time, with anxiety being a factor earlier in the treatment trajectory (prechemotherapy) and continuing over time with fatigue and perceived stress being involved later in the treatment trajectory. Our results indicate that symptom management strategies to address sleep disturbances should be tailored to the temporal factors that may change in severity during active treatment and early survivorship period. Findings gained from this study on sleep disturbance patterns and the potential risk factors can be incorporated into clinical practice in planning education and developing interventions.
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14
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Hu Y, Xu J, Wang X, Shi Y, Chen M, Im EO. Socio-Ecological Environmental Characteristics of Young Chinese Breast Cancer Survivors. Oncol Nurs Forum 2021; 48:481-490. [PMID: 34411083 DOI: 10.1188/21.onf.481-490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the environmental characteristics of young breast cancer survivors (YBCSs) in China. PARTICIPANTS & SETTING 17 participants aged 18-45 years were recruited from hospitals and through participant referral in Shanghai, China. METHODOLOGIC APPROACH Semistructured interviews were conducted to explore the environmental characteristics of YBCSs. Content analysis was performed to analyze the data. FINDINGS The following four domains emerged from the analysis. IMPLICATIONS FOR NURSING The study provides insights into the specific issues of YBCSs at different environmental levels. Nurses should collaborate with the healthcare team, family members, and other stakeholders in addressing these issues to support YBCSs. Culturally tailored support should be developed to release the burden of socially desired roles and other cultural issues for Chinese YBCSs.
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Affiliation(s)
- Yun Hu
- Shanghai Jiao Tong University
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15
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Peate M, Saunders C, Cohen P, Hickey M. Who is managing menopausal symptoms, sexual problems, mood and sleep disturbance after breast cancer and is it working? Findings from a large community-based survey of breast cancer survivors. Breast Cancer Res Treat 2021; 187:427-435. [PMID: 33575860 DOI: 10.1007/s10549-021-06117-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine the nature and severity of vasomotor symptoms, sexual problems, mood and sleep disturbance in community-dwelling breast cancer patients, whether and where they received treatment for these symptoms and their satisfaction with treatment received. METHODS Online cross-sectional survey distributed through Breast Cancer Network Australia (BCNA). RESULTS 524/2286 women responded to the invitation to participate. Of these, 74% (385/523) reported symptoms of interest and were included in the analysis. Mean age was 55.2 years and mean time since breast cancer diagnosis was 5.7 years. Most (66%) had received chemotherapy and were taking endocrine therapy (64%). The most common symptoms were hot flushes/night sweats and sleep disturbance (both 89%), vaginal dryness (75%), mood swings (62%) and sexual problems (60%). Symptoms were mild (21-33%) or moderate (21-38%) in around one third and severe in up to one quarter (8-26%). Symptoms affected the ability to "get on with their life" for 36%, predicted by severity of hot flushes (OR 1.4), sleep disturbance (OR 1.3), mood disturbance (OR 1.3), and sexual problems (OR 1.3). Only 32% were offered treatment, mostly delivered by GPs (33%) or oncologists (26%). Only 49% found this "somewhat effective" and 34% found it ineffective. The majority (60%) wanted more support to manage their symptoms. CONCLUSION Menopausal symptoms, sexual problems, mood and sleep difficulties are common after breast cancer and often not effectively managed. There is an unmet need for coordinated care providing effective treatments.
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Affiliation(s)
- Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Christobel Saunders
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia School of Surgery, Murdoch, WA, 6150, Australia
| | - Paul Cohen
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, 6009, Australia
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia
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16
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Tejada M, Viele C, Kober KM, Cooper BA, Paul SM, Dunn LB, Hammer MJ, Wright F, Conley YP, Levine JD, Miaskowski C. Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms. Sleep 2020; 42:5541565. [PMID: 31361899 DOI: 10.1093/sleep/zsz151] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/31/2019] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES Purposes of this study were to identify subgroups of patients with distinct sleep disturbance profiles and to evaluate for differences in demographic, clinical, and various sleep characteristics, as well for differences in the severity of co-occurring symptoms among these subgroups. METHODS Outpatients with breast, gynecological, gastrointestinal, or lung cancer (n = 1331) completed questionnaires six times over two chemotherapy cycles. Self-reported sleep disturbance was evaluated using the General Sleep Disturbance Scale (GSDS). Latent profile analysis was used to identify distinct subgroups. RESULTS Three latent classes with distinct sleep disturbance profiles were identified (Low [25.5%], High [50.8%], Very High [24.0%]) across the six assessments. Approximately 75% of the patients had a mean total GSDS score that was above the clinically meaningful cutoff score of at least 43 across all six assessments. Compared to the Low class, patients in High and Very High classes were significantly younger, had a lower functional status, had higher levels of comorbidity, and were more likely to be female, more likely to have childcare responsibilities, less likely to be employed, and less likely to have gastrointestinal cancer. For all of the GSDS subscale and total scores, significant differences among the latent classes followed the expected pattern (Low < High < Very High). For trait and state anxiety, depressive symptoms, morning and evening fatigue, decrements in attentional function, and decrements in morning and evening energy, significant differences among the latent classes followed the expected pattern (Low < High < Very High). CONCLUSIONS Clinicians need to perform in-depth assessments of sleep disturbance and co-occurring symptoms to identify high-risk patients and recommend appropriate interventions.
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Affiliation(s)
- Maria Tejada
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Carol Viele
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Laura B Dunn
- Department of Physiological Nursing, School of Medicine, Stanford University, Stanford, CA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
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17
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Gisiger-Camata S, Nolan TS, Vo JB, Bail JR, Lewis KA, Meneses K. Lessons Learned from the Young Breast Cancer Survivorship Network. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:304-308. [PMID: 29189987 DOI: 10.1007/s13187-017-1302-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Young Breast Cancer Survivors Network (Network) is an academic and community-based partnership dedicated to education, support, and networking. The Network used a multi-pronged approach via monthly support and networking, annual education seminars, website networking, and individual survivor consultation. Formative and summative evaluations were conducted using group survey and individual survivor interviews for monthly gatherings, annual education meetings, and individual consultation. Google Analytics was applied to evaluate website use. The Network began with 4 initial partnerships and grew to 38 in the period from 2011 to 2017. During this 5-year period, 5 annual meetings (598 attendees), 23 support and networking meetings (373), and 115 individual survivor consultations were conducted. The Network website had nearly 12,000 individual users and more than 25,000 page views. Lessons learned include active community engagement, survivor empowerment, capacity building, social media outreach, and network sustainability. The 5-year experiences with the Network demonstrated that a regional program dedicated to the education, support, networking, and needs of young breast cancer survivors and their families can become a vital part of cancer survivorship services in a community. Strong community support, engagement, and encouragement were vital components to sustain the program.
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Affiliation(s)
- Silvia Gisiger-Camata
- School of Nursing, University of Alabama at Birmingham, Medical Towers Room 415A, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA.
| | - Timiya S Nolan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Jacqueline B Vo
- School of Nursing, University of Alabama at Birmingham, Medical Towers Room 415A, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Jennifer R Bail
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kayla A Lewis
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Medical Towers Room 415A, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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The bidirectional relationship between vasomotor symptoms and depression across the menopausal transition: a systematic review of longitudinal studies. Menopause 2018; 25:109-120. [PMID: 28719420 DOI: 10.1097/gme.0000000000000949] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the nature of the bidirectional relationship between vasomotor symptoms (VMS) and depression, and to determine whether hot flashes and night sweats differentially affect the association between VMS and depression through their effect on sleep disruption. METHODS Multiple databases were searched from 1961 until July 31, 2016, and a manual search of reference lists of identified articles was conducted. Sixteen articles that involved 10,008 participants were identified and analyzed. RESULTS The methods of analyses and measurement of VMS and depression varied across the studies. Two studies explored the bidirectional association, but only one was significant in both directions (odds ratio [OR] depression to VMS 3.06, 95% confidence interval [CI] 1.43-6.58; OR VMS to depression 8.88, 95% CI 2.57-30.68). In both cases, the association between VMS leading to depressive symptoms was stronger than the opposite. Eleven studies examined VMS leading to depression, but only five showed a significant effect (OR 1.57-1.81, P ≤ 0.02). Treating VMS and depressive symptoms as continuous variables (n = 3) diminished the relationship. Three studies showed a significant association of depression leading to VMS (OR 1.62-1.94, P ≤ 0.01). We found little evidence for a specific effect of night sweats on the association between VMS and depressive symptoms. The effect might not be related to sleep disruption. CONCLUSIONS There is a bidirectional association between VMS and depressive symptoms. The menopausal transition appears to increase the risk of recurrent episodes of depression that might not be explained only by VMS. Further investigation is needed to explain the differential effect of night sweats and hot flashes on depression.
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19
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Pudkasam S, Polman R, Pitcher M, Fisher M, Chinlumprasert N, Stojanovska L, Apostolopoulos V. Physical activity and breast cancer survivors: Importance of adherence, motivational interviewing and psychological health. Maturitas 2018; 116:66-72. [PMID: 30244781 DOI: 10.1016/j.maturitas.2018.07.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/01/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
Behavioral change theories have been used to support interventions that increase both motivation for and adherence to physical activity programs for breast cancer survivors. Most of the programs can improve psychological health-related quality of life. Depressive and anxious symptoms seem to be associated with some stressors, such as the perception of breast cancer, prognosis, long-term treatment-related side-effects and fear of cancer recurrence. Beyond physical fitness, several physical activity programs for breast cancer survivors have been reported to improve psychosocial wellness and life satisfaction. However, many physical activity programs have failed to motivate breast cancer survivors due to barriers such as general health issues and lack of time. More specifically, women may have little confidence in the benefits of physical activity and breast cancer outcomes. Therefore, engaging breast cancer survivors in physical activity is challenging for health care professionals. Herein, we identify cancer-related mental distress, coping style and behavioral theories applied to physical activity programs in breast cancer survivors. More specifically, we discuss the effectiveness and limitations of 3 psychological theories and 2 concepts related to behavioral change, including the theory of planned behavior, social cognitive theory, self-determination theory, transtheoretical model and motivational interviewing for physical activity adherence in breast cancer survivors.
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Affiliation(s)
- Supa Pudkasam
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia; Faculty of Nursing Science, Assumption University, Bangkok, Thailand
| | - Remco Polman
- School Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Meron Pitcher
- Breast Cancer Services, Western Health, Melbourne, VIC, Australia
| | - Melanie Fisher
- Breast Cancer Services, Western Health, Melbourne, VIC, Australia
| | | | - Lily Stojanovska
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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20
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Pope ZC, Zeng N, Zhang R, Lee HY, Gao Z. Effectiveness of Combined Smartwatch and Social Media Intervention on Breast Cancer Survivor Health Outcomes: A 10-Week Pilot Randomized Trial. J Clin Med 2018; 7:E140. [PMID: 29880779 PMCID: PMC6025572 DOI: 10.3390/jcm7060140] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022] Open
Abstract
Physical activity (PA) among breast cancer survivors (BCS) can improve this population's health and quality of life (QoL). This study evaluated the effectiveness of a combined smartwatch- and social media-based health education intervention on BCS's health outcomes. Thirty BCS ( X ¯ age = 52.6 ± 9.3 years; X ¯ Wt = 80.2 ± 19.6 kg) participated in this 10-week, 2-arm randomized trial, with BCS randomized into: (1) experimental group (n = 16): received Polar M400 smartwatches for daily PA tracking and joined a Facebook group wherein Social Cognitive Theory-related PA tips were provided twice weekly; and (2) comparison group (n = 14): only joined separate, but content-identical Facebook group. Outcomes included PA, physiological, psychosocial, and QoL variables. Specifically, PA and energy expenditure (EE) was assessed by ActiGraph GT3X+ accelerometers while physiological, psychosocial, and QoL were examined via validated instruments at baseline and post-intervention. No baseline group differences were observed for any variable. Ten BCS dropped out of the study (experimental: 4; comparison: 6). Compared to completers, dropouts differed significantly on several outcomes. Thus, a per-protocol analysis was performed, revealing significant group differences for changes in social support (t = -2.1, p = 0.05) and barriers (t = -2.2, p = 0.04). Interestingly, the comparison group demonstrated improvements for both variables while the intervention group demonstrated slightly decreased social support and no change in barriers. Notably, both groups demonstrated similarly increased daily light PA, moderate-to-vigorous PA, EE, and steps of 7.7 min, 5.1 min, 25.1 kcals, and 339 steps, respectively, over time. Despite extensive user training, several experimental BCS found the Polar M400 use difficult-possibly decreasing intervention adherence. Future interventions should utilize simpler smartwatches to promote PA among middle-aged clinical/non-clinical populations.
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Affiliation(s)
- Zachary C Pope
- School of Kinesiology, University of Minnesota, 1900 University Ave. SE, Minneapolis, MN 55455, USA.
| | - Nan Zeng
- School of Kinesiology, University of Minnesota, 1900 University Ave. SE, Minneapolis, MN 55455, USA.
| | - Rui Zhang
- School of Kinesiology, University of Minnesota, 1900 University Ave. SE, Minneapolis, MN 55455, USA.
- College of Pharmacy, and Institute for Health Informatics, University of Minnesota, 8-116 Phillips-Wangensteen Building, 516 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Hee Yun Lee
- School of Social Work, The University of Alabama, 1022 Little Hall, Box 870314, Tuscaloosa, AL 35487, USA.
| | - Zan Gao
- School of Kinesiology, University of Minnesota, 1900 University Ave. SE, Minneapolis, MN 55455, USA.
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21
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Henneghan AM, Carter P, Stuifbergan A, Parmelee B, Kesler S. Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy. Psychooncology 2018; 27:1937-1943. [PMID: 29683228 DOI: 10.1002/pon.4745] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia Carter
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | | | - Brennan Parmelee
- School of Nursing, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Han JA, Choi SY, Lee S. Effects of Menopausal Symptoms and Depression on the Quality of Life of Premenopausal Women With Breast Cancer in Korea. J Transcult Nurs 2018; 30:8-16. [PMID: 29690858 DOI: 10.1177/1043659618771475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION As breast cancer survivors have increased, improving quality of life of the survivors becomes an important issue. The purpose of this study was to examine relationships among menopausal symptoms, depression, and quality of life and to identify the factors affecting the quality of life in premenopausal women with breast cancer. METHOD This was a descriptive, correlational study using structured questionnaires for 90 premenopausal women with breast cancer attending the outpatient clinic of a tertiary hospital in Korea. RESULTS Menopausal symptoms ( r = -0.770, p < .001) and depression ( r = -0.715, p < .001) negatively affected the participants' quality of life. The major factors affecting quality of life were employment ( t = -2.065, p = .042), depression ( t = -2.375, p = .020), and menopausal symptoms ( t = -3.863, p < .001). Menopausal symptoms were the strongest negative factor (β = -.508) affecting quality of life. DISCUSSION AND CONCLUSIONS Developing nursing intervention congruent with the culture of Korean breast cancer women with treatment-induced menopausal symptoms is a high priority.
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Affiliation(s)
- Jeong Ae Han
- 1 Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea
| | - So Young Choi
- 2 College of Nursing, Gyeongsang National University, Jinju, Gyeongnam, Republic of Korea
| | - Seonah Lee
- 3 College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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23
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Zheng Y, Zhou Y, Zhu J, Hua Q, Tao M. A simple risk score based on sleep quality for predicting depressive symptoms in menopausal women: a multicenter study. Postgrad Med 2018; 130:264-270. [PMID: 29380646 DOI: 10.1080/00325481.2018.1429792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We aim to establish a simple risk score based on sleep quality for predicting depressive symptoms in menopausal women through a cross-sectional investigation. MATERIALS AND METHODS A total of 705 Chinese women aged 40-60 years were included in this cross-sectional investigation of a self-report questionnaire from the Physical Examination Center at Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Depressive symptoms and sleep quality were evaluated using self-rating depressive symptom scale (SDS)and the Pittsburgh Sleep Quality Index (PSQI), respectively. After setting up a logistic regression model and computing the odds ratio value, we further calculated and predicted the risk score for depressive symptoms and then established a risk score system. Finally, we validated the risk score in two investigations (Validation 1 and Validation 2). RESULTS The risk scoring system for predicting depressive symptoms included a history of cancer, subjective sleep quality, sleep disorder and daytime dysfunction, with total scores ranging from 0-35 points. The receiver operating characteristic (ROC) sample curve was 0.801 (95% CI 0.753-0.848). The Area Under the Curve (AUC) was 0.832 (95% CI 0.738-0.925) in Validation 1 and 0.799 (95%CI 0.667-0.930) in Validation 2. The best cutoff point for depressive symptoms in the sample population was ≥8 points, and the sensitivity and specificity were 0.698 and 0.824, respectively. The sensitivity was 0.775 and 0.667 in Validation 1 and Validation 2, respectively. CONCLUSIONS The risk score for predicting depressive symptoms in menopausal women based on sleep is convenient. Because there is no complex assessment of multiple scales requiredIt may be a preliminary screening tool for depressive symptoms in menopausal women.
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Affiliation(s)
- Yanwei Zheng
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - Yang Zhou
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - Jieping Zhu
- b Department of Gynecology and Obstetrics , Shanghai Sixth People's Hospital East Branch , Shanghai , People's Republic of China
| | - Qi Hua
- c Department of Gynecology and Obstetrics , International Peace Maternal and Child Health Hospital of the China Welfare Institute , Shanghai , People's Republic of China
| | - Minfang Tao
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
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Syrowatka A, Motulsky A, Kurteva S, Hanley JA, Dixon WG, Meguerditchian AN, Tamblyn R. Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Res Treat 2017; 165:229-245. [PMID: 28553684 PMCID: PMC5543195 DOI: 10.1007/s10549-017-4290-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/10/2017] [Indexed: 12/12/2022]
Abstract
Purpose Unmanaged distress has been shown to adversely affect survival and quality of life in breast cancer survivors. Fortunately, distress can be managed and even prevented with appropriate evidence-based interventions. Therefore, the objective of this systematic review was to synthesize the published literature around predictors of distress in female breast cancer survivors to help guide targeted intervention to prevent distress. Methods Relevant studies were located by searching MEDLINE, Embase, PsycINFO, and CINAHL databases. Significance and directionality of associations for commonly assessed candidate predictors (n ≥ 5) and predictors shown to be significant (p ≤ 0.05) by at least two studies were summarized descriptively. Predictors were evaluated based on the proportion of studies that showed a significant and positive association with the presence of distress. Results Forty-two studies met the target criteria and were included in the review. Breast cancer and treatment-related predictors were more advanced cancer at diagnosis, treatment with chemotherapy, longer primary treatment duration, more recent transition into survivorship, and breast cancer recurrence. Manageable treatment-related symptoms associated with distress included menopausal/vasomotor symptoms, pain, fatigue, and sleep disturbance. Sociodemographic characteristics that increased the risk of distress were younger age, non-Caucasian ethnicity, being unmarried, and lower socioeconomic status. Comorbidities, history of mental health problems, and perceived functioning limitations were also associated. Modifiable predictors of distress were lower physical activity, lower social support, and cigarette smoking. Conclusions This review established a set of evidence-based predictors that can be used to help identify women at higher risk of experiencing distress following completion of primary breast cancer treatment. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4290-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ania Syrowatka
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Aude Motulsky
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Siyana Kurteva
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - James A Hanley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,Health eResearch Centre, Farr Institute, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Ari N Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.,Department of Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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Reich RR, Lengacher CA, Klein TW, Newton C, Shivers S, Ramesar S, Alinat CB, Paterson C, Le A, Park JY, Johnson-Mallard V, Elias M, Moscoso M, Goodman M, Kip KE. A Randomized Controlled Trial of the Effects of Mindfulness-Based Stress Reduction (MBSR[BC]) on Levels of Inflammatory Biomarkers Among Recovering Breast Cancer Survivors. Biol Res Nurs 2017; 19:456-464. [PMID: 28460534 DOI: 10.1177/1099800417707268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this substudy of a large randomized controlled trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction (Breast Cancer) (MBSR[BC]) program compared to usual care (UC) in normalizing blood levels of pro-inflammatory cytokines among breast cancer survivors (BCS). METHOD A total of 322 BCS were randomized to either a 6-week MBSR(BC) program or a UC. At baseline and 6 and 12 weeks, 10 ml of venous blood and demographic and clinical data were collected and/or updated. Plasma cytokines (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor [TNF] α, transforming growth factor [TGF] β1, soluble tumor necrosis factor receptor [sTNFR] 1) were assayed. Linear mixed models were used to assess cytokine levels across three time points (baseline and 6 and 12 weeks) by group (MBSR[BC] vs. UC). RESULTS Of the six measured cytokines, three were nondetectable at rates greater than 50% (IL-10, IL-1β, TGF-β1) and, because of overall low prevalence, were not analyzed further. For the remaining cytokines (TNFα, IL-6, sTNFR1), results showed that TNFα and IL-6 increased during the follow-up period (between 6 and 12 weeks) rather than during the MBSR(BC) training period (between baseline and 6 weeks), while sTNFR1 levels did not change significantly across the 12-week period. CONCLUSIONS Study results suggest that MBSR(BC) affects cytokine levels in BCS, mainly with increases in TNFα and IL-6. The data further suggest that B-cell modulation may be a part of immune recovery during breast cancer management and that increases in TNFα and IL-6 may be markers for MBSR(BC)-related recovery.
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Affiliation(s)
- Richard R Reich
- 1 Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Thomas W Klein
- 3 Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Cathy Newton
- 3 Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steve Shivers
- 4 Breast Health Clinical and Research Integrated Strategic Program, University of South Florida, Tampa, FL, USA
| | - Sophia Ramesar
- 2 College of Nursing, University of South Florida, Tampa, FL, USA
| | - Carissa B Alinat
- 2 College of Nursing, University of South Florida, Tampa, FL, USA
| | | | - Alice Le
- 2 College of Nursing, University of South Florida, Tampa, FL, USA
| | - Jong Y Park
- 1 Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Maya Elias
- 2 College of Nursing, University of South Florida, Tampa, FL, USA
| | - Manolete Moscoso
- 2 College of Nursing, University of South Florida, Tampa, FL, USA
| | - Matthew Goodman
- 7 Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kevin E Kip
- 8 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
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Cohen PA, Brennan A, Marino JL, Saunders CM, Hickey M. Managing menopausal symptoms after breast cancer - A multidisciplinary approach. Maturitas 2017; 105:4-7. [PMID: 28473176 DOI: 10.1016/j.maturitas.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 01/01/2023]
Abstract
More than 6 million women worldwide are living with a past diagnosis of breast cancer. Most survive their illness, and management of the long-term consequences of treatment has become a priority in cancer care. Menopausal symptoms affect most breast cancer survivors and may significantly impair quality of life. We describe a multidisciplinary model to evaluate and manage these women using a patient-focused approach. The 'Multidisciplinary Menopause After Cancer Clinic' includes gynecologists, endocrinologists, GPs, a psychologist and a clinical nurse specialist. Benefits of this model include improved coordination of patient care, education, communication and evidence-based decision making.
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Affiliation(s)
- Paul A Cohen
- St. John of God Hospital Bendat Family Comprehensive Cancer Centre, 12 Salvado Road, Subiaco, Western Australia 6008, Australia; School of Women's and Infants' Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Institute for Health Research, University of Notre Dame Australia, 32 Mouat Street Fremantle, Western Australia 6160, Australia.
| | - Annabelle Brennan
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Christobel M Saunders
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
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