Life after breast cancer: moving on, sitting down or standing still? A prospective study of Canadian breast cancer survivors

Physical Activity, Sedentary Time, and Psychosocial Functioning among Adults with Cancer: A Scoping Review

The post-treatment period (after the completion of primary cancer treatment) is a phase during which adults with cancer are particularly vulnerable to the physical and psychological side effects of treatment. Adopting healthy lifestyle habits during this time is essential to mitigate these effects. This scoping review investigated the associations of physical activity (PA) and sedentary time (ST) with two post-treatment psychosocial indicators among adults with cancer: psychological functioning and quality of life (QoL). An exhaustive search was performed in January 2023 across five databases, namely APA PsycInfo, MedLine, SPORTDiscuss, SCOPUS, and CINAHL, adhering to PRISMA guidelines for scoping reviews. Twenty articles met the inclusion criteria; 16 used a cross-sectional design, while 4 used a longitudinal one. PA and ST were assessed mainly with accelerometers (n = 17), and psychosocial indicators with self-reported questionnaires (n = 20). Most studies linked higher PA levels to reduced anxiety (n = 3) and depression (n = 4) symptoms, and elevated ST to higher psychological symptoms (n = 3). Opposite associations were observed for QoL (n = 5). Altogether, PA appeared to be more strongly related to psychological functioning and QoL than ST. This scoping review highlights associations of PA and ST with psychological functioning and QoL among adults with cancer in the post-treatment period. However, future studies must prioritize longitudinal designs to establish directionality.

Perceived autonomy support from healthcare professionals and physical activity among breast cancer survivors: A propensity score analysis

The majority of women treated for breast cancer are physically inactive although physical activity (PA) could attenuate many adverse effects of cancer and treatment. Autonomy support from healthcare professionals may improve PA initiation, adherence and maintenance. This study aimed to determine, using a causal inference approach, whether or not perceived autonomy support (PAS) from healthcare professionals is associated with light, moderate, and vigorous intensity PA among women treated for breast cancer. Data were drawn from the longitudinal study "Life After Breast Cancer: Moving On" (n = 199). PAS was measured with the Health Care Climate Questionnaire and PA was assessed using GT3X triaxial accelerometers. Associations between PAS and PA were estimated with linear regressions and adjusted estimations were obtained using propensity score-based inverse probability of treatment weights (IPTW). Results reveal no association between PAS and PA of light ([Formula: see text](95%CI) = -0.09 (-0.68, 0.49)), moderate ([Formula: see text] (95%CI) = -0.03 (-0.17, 0.11)), or vigorous ([Formula: see text](95%CI) = 0.00 (-0.03, 0.02)) intensity. Different forms of engagement and support by healthcare professionals should be explored to identify the best intervention targets to encourage women to adopt and maintain regular PA in the cancer continuum.

Physical Activity and Cortisol Regulation: A Meta-Analysis

Physical activity participation is associated with effective stress coping, indicated by decreases in both physiological stress reactivity and perceived stress. Quantifying the effect of physical activity on the diurnal regulation of one key physiological stress indicator, the stress hormone, cortisol, across studies may demonstrate the extent to which physical activity participation is associated with diurnal HPA axis regulation. We meta-analyzed studies examining relations between physical activity participation and indices of HPA axis regulation: the diurnal cortisol slope and the cortisol awakening response. We also examined moderators of the relation. The analysis revealed a small, non-zero negative averaged correlation between physical activity and the diurnal cortisol slope (r = -0.043, 95% CI [-0.080, -0.004]). Examination of sample sociodemographic differences, study design characteristics, cortisol measurement methods, and physical activity variables as moderators revealed few effects on the relation between physical activity and diurnal cortisol slope. We did not observe lower levels of variability in the mean cortisol awakening response at higher levels of physical activity participation, and moderator analyses showed little evidence of reductions in heterogeneity for this effect. We found some evidence of systematic publication bias. Findings suggest higher physical activity is associated with a steeper diurnal cortisol slope. However, the cortisol awakening response did not differ by physical activity level. Future studies testing the physical activity and cortisol regulation association should use standardized physical activity measures, follow guidelines for better quality cortisol sampling collection and analysis, and test relations in large-scale empirical studies to confirm the direction and causality of the effect.

Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors

INTRODUCTION

Despite the recommendations for cancer survivors to engage in physical activity (PA), little is known about the effects of both PA and sedentary time (ST) on key health symptoms. This study prospectively examined the lifestyle behaviors of moderate-to-vigorous PA (MVPA) and ST as predictors of depressive symptoms, pain, and fatigue in breast cancer survivors using longitudinal data from early post-treatment to 4-year survivorship.

METHODS

Breast cancer survivors (n = 199, mean(SD) age = 55.0(11.0) years) self-reported depressive symptoms, pain, and fatigue, and wore an accelerometer to measure MVPA and ST every 3 months during the first year (times 1 to 5) and 2 and 4 years (times 6 and 8) post-cancer treatment. Linear mixed models were adjusted for personal (e.g., age, BMI, education) and cancer (e.g., stage, time since treatment) variables.

RESULTS

MVPA and ST were independent predictors of depressive symptoms, but not fatigue, and only ST was associated with pain over 4 years post-treatment. Higher levels of MVPA were associated with lower scores of depressive symptoms ([Formula: see text] (95%CI): - 0.062 (- 0.092, - 0.031) p < .001), whereas higher levels of ST were associated with higher scores of depressive symptoms ([Formula: see text] (95%CI): 0.023 (0.017, 0.028) p < .001). Higher levels of ST were associated with increased pain level over time ([Formula: see text] (95%CI): 0.017 (0.007, 0.027) p = .001).

CONCLUSIONS

Rehabilitation interventions should aim to both increase MVPA and reduce ST to promote health and well-being among breast cancer survivors, in particular during the early post-treatment period.

Association between Fruit and Vegetable Intake and Physical Activity among Breast Cancer Survivors: A Longitudinal Study

This study examines the association between rates of change in daily fruit and vegetable intake and in weekly levels of moderate-to-vigorous intensity physical activity (MVPA) over a 15-month period in women following primary treatment completion for breast cancer. Breast cancer survivors (N = 199) self-reported fruit and vegetable intake and wore an accelerometer for 7 consecutive days to measure levels of MVPA on five occasions every 3 months. Multivariate latent growth modeling revealed that the rate of change in fruit and vegetable intake was not associated with the rate of change in levels of MVPA. Baseline (Mean = 3.46 months post-treatment) levels of MVPA were not associated with the rate of change of daily fruit and vegetable intake; likewise, baseline fruit and vegetable intake was not associated with the rate of change in levels of MVPA. Behavioral interventions promoting fruit and vegetable intake should not be assumed to yield concomitant effects in promoting MVPA or vice versa.

Behavioural, physical, and psychological predictors of cortisol and C-reactive protein in breast cancer survivors: A longitudinal study

Background

Breast cancer survivors (BCS) can exhibit a dysregulation of cortisol and elevated C-reactive protein (CRP) levels post-treatment, which increase the risk of diverse health outcomes. Certain behavioural, physical, and psychological variables may help to predict cortisol and CRP levels post-treatment. The aims of this study were to: (1) describe naturally occurring changes in absolute diurnal cortisol and CRP levels over a period of 1.5 years post-treatment among BCS, (2) assess if absolute diurnal cortisol and CRP levels change in tandem, and (3) assess behavioural, physical, and psychological variables as predictors of absolute diurnal cortisol levels and CRP levels.

Methods

Capillary blood and saliva samples were collected from 201 BCS, on average, 3.5 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2−T5). At each time point, five saliva samples were collected on two nonconsecutive days: at awakening, 30 ​min after awakening, 2:00 p.m., 4:00 p.m., and at bedtime. At each time point, participants also completed self-report questionnaires and wore an accelerometer for seven consecutive days. Data were analyzed using multilevel modeling.

Results

Absolute diurnal cortisol levels did not change significantly over time. CRP levels decreased across time points (B_linear ​= ​−0.31, p ​= ​.01), though the rate of decrease slowed over time (B_quadratic ​= ​0.05, p ​= ​.03). Generally, greater sedentary time predicted higher overall absolute diurnal cortisol levels (B ​< ​0.01, p ​= ​.01); whereas higher physical activity (B ​= ​−0.004, p ​< ​.01), lower body mass index (B ​= ​0.10, p ​< ​.01), and lower health- and cancer-related stress (B ​= ​0.24, p ​= ​.04) predicted lower overall CRP levels. Also, lower absolute diurnal cortisol levels were evident when participants engaged in more sedentary time, as compared to their own average sedentary time (B ​= ​−0.01, p ​< ​.01).

Conclusions

Results offer insight into the nature of change in diurnal cortisol and CRP levels among BCS from treatment completion onwards and offer clinical implications. Helping BCS manage their weight, reduce stress, increase physical activity participation, and decrease sedentary time as soon as possible after treatment may help to reduce physiological dysregulations, thereby lowering the risk of adverse health outcomes in this population. Further research investigating specific intervention parameters such as type, context, frequency, and intensity are warranted for the development of the most optimal interventions.

Physical activity and sedentary time: associations with fatigue, pain, and depressive symptoms over 4 years post-treatment among breast cancer survivors

INTRODUCTION

Despite the recommendations for cancer survivors to engage in physical activity (PA), little is known about the effects of both PA and sedentary time (ST) on key health symptoms. This study prospectively examined the lifestyle behaviors of moderate-to-vigorous PA (MVPA) and ST as predictors of depressive symptoms, pain, and fatigue in breast cancer survivors using longitudinal data from early post-treatment to 4-year survivorship.

METHODS

Breast cancer survivors (n = 199, mean(SD) age = 55.0(11.0) years) self-reported depressive symptoms, pain, and fatigue, and wore an accelerometer to measure MVPA and ST every 3 months during the first year (times 1 to 5) and 2 and 4 years (times 6 and 8) post-cancer treatment. Linear mixed models were adjusted for personal (e.g., age, BMI, education) and cancer (e.g., stage, time since treatment) variables.

RESULTS

MVPA and ST were independent predictors of depressive symptoms, but not fatigue, and only ST was associated with pain over 4 years post-treatment. Higher levels of MVPA were associated with lower scores of depressive symptoms ([Formula: see text] (95%CI): - 0.062 (- 0.092, - 0.031) p < .001), whereas higher levels of ST were associated with higher scores of depressive symptoms ([Formula: see text] (95%CI): 0.023 (0.017, 0.028) p < .001). Higher levels of ST were associated with increased pain level over time ([Formula: see text] (95%CI): 0.017 (0.007, 0.027) p = .001).

CONCLUSIONS

Rehabilitation interventions should aim to both increase MVPA and reduce ST to promote health and well-being among breast cancer survivors, in particular during the early post-treatment period.

Patterns of Sequelae in Women with a History of Localized Breast Cancer: Results from the French VICAN Survey

Breast cancer (BC) remains complex for women both physically and psychologically. The objectives of this study were to (1) assess the evolution of the main sequelae and treatment two and five years after diagnosis in women with early-stage breast cancer, (2) explore patterns of sequelae associated with given sociodemographic, clinical, and lifestyle factors. The current analysis was based on 654 localized BC patients enrolled in the French nationwide longitudinal survey "vie après cancer" VICAN (January-June 2010). Information about study participants was collected at enrollment, two and five years after diagnosis. Changes over time of the main sequelae were analyzed and latent class analysis was performed to identify patterns of sequelae related to BC five years after diagnosis. The mean age (±SD) of study participants at inclusion was 49.7 (±10.5) years old. Six main classes of sequelae were identified two years and five years post-diagnosis (functional, pain, esthetic, fatigue, psychological, and gynecological). A significant decrease was observed for fatigue (p = 0.03) and an increase in cognitive sequelae was reported (p = 0.03). Two latent classes were identified-functional and esthetic patterns. Substantial sequelae remain up to five years after BC diagnosis. Changes in patient care pathways are needed to identify BC patients at a high risk.

An investigation into socio-demographic-, health-, and cancer-related factors associated with cortisol and C-reactive protein levels in breast cancer survivors: a longitudinal study

BACKGROUND

Breast cancer survivors (BCS) may exhibit dysregulated patterns of cortisol and C-reactive protein (CRP). The aims of this study were to describe BCS' cortisol and CRP levels over a 1-year period after treatment, and assess how levels relate to socio-demographic- (age, education level, marital status), health- (body mass index [BMI] category, menopausal status), and cancer-related factors (cancer stage, chemotherapy exposure, time since diagnosis).

METHODS

Participants (N = 201) provided data at 3 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2-T5). At T1, participants completed self-report questionnaires and had their weight and height measured by a trained technician. At T1-T5, they provided five saliva samples at awakening, 30 min after awakening, 2:00 pm, 4:00 pm, and before bedtime on two nonconsecutive days to measure diurnal cortisol, and provided capillary whole blood to measure CRP. Data were analyzed using repeated-measure analyses of variance (ANOVAs) and mixed-design ANOVAs.

RESULTS

Diurnal cortisol and CRP levels fluctuated over time. In univariate models, older age and post-menopausal status were associated with higher cortisol and CRP levels, higher cancer stage and chemotherapy were associated with lower cortisol levels, and higher BMI category was associated with higher CRP levels. In adjusted models, age was no longer associated with CRP levels and shorter time since diagnosis was significantly associated with higher CRP levels.

CONCLUSIONS

Socio-demographic-, health-, and cancer-related factors may help identify BCS at risk of physiological dysregulation who need intervention. Identifying modifiable factors associated with cortisol and CRP will inform cancer care interventions.

Associations between alcohol consumption and physical activity in breast cancer survivors

Alcohol use and physical inactivity are associated with increased risk of cancer diagnosis and recurrence. Physical activity (a health protective behavior) is positively associated with alcohol use (a health risk behavior) in the general population but has yet to be examined in breast cancer survivors. This study examined associations between weekly alcohol use and physical activity in 197 post-treatment breast cancer survivors (Mage = 55.04, SDage = 10.92). Participants wore an accelerometer and provided self-reported alcohol intake for five 7-day waves every 3 months. Survivors who engaged in more light intensity physical activity had increased odds of consuming alcohol (odds ratio = 1.14, p = .02) but did not differ in the amount of alcohol consumed. When promoting physical activity among this population, it is important to consider the increased likelihood of alcohol consumption.

Body image in older breast cancer survivors: A systematic review

OBJECTIVE

Breast cancer is the most common cancer among women world-wide. In North America survival rates are >80%, resulting in a large population of survivors. The goal of this review was to systematically explore the literature to identify the status of body image and factors that can impact the body image of older breast cancer survivors.

METHODS

A systematic review of the literature was conducted and registered with PROSPERO (CRD42019133617). EMBASE and PubMed were searched for articles including terms related to "body image" and "breast cancer." Duplicates were removed and the remaining 322 abstracts were screened. Articles published before 2000, were off-topic, or those that were non-primary research articles were excluded. Sixty-nine remaining full-length articles were screened for language, gender and location. Seven articles underwent quality assessment of which five passed and were reviewed in depth. The remaining two articles were briefly discussed.

RESULTS

The literature review suggests that body image is considered important in older BCS and that body image may impact or be impacted by several factors including age, menopausal status, mental health, treatment modality and exercise. Additionally, themes of dealing with physical changes and the length of time women are impacted following treatment were explored.

CONCLUSION

Our findings highlight that older women may be at an advantage in terms of being post-menopausal, however concerns surrounding physical and emotional changes affecting body image are indeed present. Future studies on breast cancer survivorship should consider the inclusion of body image as an outcome measure in addition to including individuals representing a wide range of ages.

Passion among breast cancer survivors: A 12-month prospective study

We examined the prospective relationship between harmonious passion and post-treatment health outcomes among female breast cancer survivors. Participants reported passion toward a favorite activity, physical pain symptoms, and mental health after their final breast cancer treatment (Time 1, N = 188). Twelve months later (Time 2, N = 148), participants reported their physical pain symptoms and mental health. Harmonious passion at Time 1 predicted fewer physical pain symptoms and higher levels of mental health at Time 2. These results show that breast cancer survivors benefit from being harmoniously passionate toward a meaningful activity following treatment.