Prevalence and Risk Factors for Insomnia in Breast Cancer Survivors Receiving Aromatase Inhibitors

Purpose: Insomnia is increasingly recognized as a major symptom outcome in oncology; however, its prevalence and risk factors have not been previously defined in women receiving aromatase inhibitors (AI) for breast cancer.Patients and Methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with stage 0-III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic at a large university hospital. The validated Insomnia Severity Index (ISI) was the primary outcome (Cronbach's alpha of 0.91 in this population). According to ISI, Insomnia was categorized as: no clinically significant insomnia, 0-7; sub-threshold insomnia 8-14; clinical insomnia (moderate severity), 15-12; clinical insomnia (severe), 22-28. We defined anyone who had clinical insomnia with a score of 15 or above. Multivariate logistic regression analyses were performed to assess risk factor(s).Results: 367 patients have been analyzed, with a mean age of 61.6 +/- 10 years. 83.6% were White and 12.9% Black. While 124 (34.1%) had sub-threshold insomnia, 67 (18.4%) met criteria for clinical insomnia based on ISI: 58 (15.9%) for clinically moderate insomnia and 9 (2.5%) clinically severe insomnia. Of the entire sample, 31% considered seeking treatment for insomnia over the previous month. In a multivariate logistic regression model, clinical insomnia was independently associated with current joint pain (odds ratio [OR], 4.41, 95% confidence interval [CI], 2.17-8.96, p<0.001) and hot flashes (OR, 3.00, 95% CI, 1.58-5.71, p=0.001). While education level (college only vs. graduate or professional degree) was also associated with increased risk for clinical insomnia (OR, 2.46, 95% CI, 1.18-5.14, p=0.016), no other demographic, clinical or treatment variable was related to clinical insomnia.Conclusions: Insomnia is a substantial problem among breast cancer survivors receiving aromatase inhibitors and is highly associated with joint pain and hot flashes. Thus, effective treatment of joint pain and hot flashes may help improve insomnia in this population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1062.

Factors associated with willingness to participate in an acupuncture clinical trial for arthralgia among breast cancer patients

6596

Background: Many breast cancer patients use complementary and alternative medicine (CAM), which warrant rigorous evaluation of the safety and efficacy of these therapies. As with conventional cancer treatment studies, researchers face challenges in accruing patients to CAM trials. This study aims to identify the factors associated with willingness to participate (WTP) in a trial evaluating use of acupuncture for arthralgia among breast cancer patients. Methods: We conducted a cross-sectional survey study among outpatient postmenopausal breast cancer patients who were receiving aromatase inhibitors. Self-reported WTP in an acupuncture trial was used as the main outcome variable. Expectation towards acupuncture efficacy was measured using a previously validated Acupuncture Expectancy Scale. Multivariate logistic regression was used to identify factors associated with WTP. Results: 300 patients participated (92% response rate), with a mean age of 61 ± 10 years, 252 (84%) White, and 38 (13%) Black. Of the participants, 148 (49.8%) reported WTP in an acupuncture trial should they be offered an opportunity for such research. In a multivariate model, higher likelihood of WTP was associated with having a college education, adjusted odds ratio (95% confidence interval), 3.78 (1.83–7.81); having previous radiation therapy 2.02 (1.13–3.62); and current experience of arthralgia 2.36 (1.11–4.98). Positive expectancy of acupuncture outcome was also associated with greater likelihood of WTP 1.20 (1.12–1.28). Age and race were not predictors of WTP in the multivariate model. Conclusions: Almost half of the outpatient breast cancer patients expressed WTP in an acupuncture clinical trial for arthralgia. Higher education, previous radiation therapy, current experience of arthralgia, and positive expectancy related to acupuncture may affect breast cancer patients’ willingness to participate in an acupuncture trial for arthralgia.

No significant financial relationships to disclose.

Body shape in American and British adults: between-country and inter-ethnic comparisons

BACKGROUND

Recent studies indicate differences between British and American white adults, and between income and ethnic groups within the United States, in the population distribution of lifestyle diseases. Differential prevalence of obesity has been suggested as a contributing factor; however, the conventional approach to categorizing obesity, body mass index, is confounded by ethnic variability in physique.

OBJECTIVE

To compare indices of shape between white British and American adults, and between white, African and Hispanic American adults.

DESIGN

Analysis of two large National Sizing Surveys, using identical study design and three-dimensional (3D) body-scanning instrumentation, on adults aged 17+ years from the UK (3907M and 4710F white), and from the USA (1744M and 3329F white, 709M and 1106F African and 639M and 839F Hispanic).

OUTCOME MEASURES

Weight, height, body circumferences.

RESULTS

In the United States, socio-economic status was associated with increasing height and decreasing waist girth in white and Hispanic, but not African Americans. Compared to white British, white Americans had larger weight and girths, especially waist girth in men. Relative to white Americans, African Americans had smaller relative waist girth, but larger thigh girth, whereas Hispanic Americans had larger relative waist girth.

CONCLUSIONS

Body shape of white American adults differs from that of their UK counterparts. Within Americans, ethnic differences in body shape closely track reported differences in prevalence of the metabolic syndrome, implicating variability in central abdominal fat as a key contributing factor. 3D photonic scanning offers a novel approach for categorizing risk of the metabolic syndrome and monitoring treatment success.

Discrepancies in parent and teacher ratings of adaptive behavior of children with multiple disabilities

Parent and teacher ratings of adaptive skills of 59 children with multiple disabilities (mean age 6 years) in a rehabilitation day treatment setting were compared. The Vineland Adaptive Behavior Scales Classroom and Survey Editions were administered to each child's teacher and mother or other primary caretaker, respectively. Correlational analyses indicated a robust relation between Vineland forms; however, mean score comparisons indicated that teachers systematically rated the children as more skilled in both the global and the specific domains of adaptive behavior than did caretakers. Sources of interrater disagreement and implications for assessment of children with multiple disabilities were discussed.

Late injury of cancer therapy on the female reproductive tract

The purpose of this article is to review the late effects of cancer therapy on the female reproductive tract. The anatomic sites detailed are the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. The available pathophysiology is discussed. Clinical syndromes are presented. Tolerance doses of irradiation for late effects are rarely presented in the literature and are reviewed where available. Management strategies for surgical, radiotherapeutic, and chemotherapeutic late effects are discussed. Endpoints for evaluation of therapeutic late effects have been formulated utilizing the symptoms, objective, management, and analytic (SOMA) format. Late effects on the female reproductive tract from cancer therapy should be recognized and managed appropriately. A grading system for these effects is presented. Endpoints for late effects and tolls for the evaluation need to be further developed.

Cognitive antecedents of coronary heart disease

The purpose was to explore cognitive antecedents of CHD proneness in an attempt to avoid some of the problems besetting research focused on type A. The theoretical framework was the cognitive orientation theory by Kreitler and Kreitler which shows how cognitive contents, primarily beliefs about goals, norms, the self and reality guide human behavior and enable its prediction and change. The hypotheses referred to endorsement of beliefs orienting towards CHD-involved behaviors, inconsistencies among belief types and the relation of the beliefs to risk factors in CHD patients as compared to the controls. A self-administered questionnaire was constructed assessing endorsement of four belief types. Subjects were 92 males under 60: 44 with CHD, and two control groups: 28 orthopedic patients without CHD, and 20 healthy subjects. Results showed that CHD individuals scored higher than the controls on the overall beliefs measure, beliefs about norms and about self, had higher inconsistency scores, and had more correlations between belief measures and risk factors (e.g. blood pressure, cholesterol). Discussion centered on suggesting a definition of CHD-proneness as consisting of a sustained externally-maintained tension-producing cognitive-motivational conflict, and on the psychometric and practical implications of the findings.