Physical exercise and quality of life in breast cancer survivors

An important goal for cancer patients is to improve the quality of life (QOL) by maximising functions affected by the disease and its therapy. Preliminary research suggests that exercise may be an effective intervention for enhancing QOL in cancer survivors. Research has provided preliminary evidence for the safety, feasibility, and efficacy of exercise training in breast cancer survivors. The aim of this study was to assess the association between physical exercise and quality of life in a population of female breast cancer survivors, followed up from diagnosis to the off-treatment time period, and investigated about their exercise habits in pre-diagnosis.A total of 212 female breast cancer survivors consecutively registered from January 2002 to December 2006 at a Supportive Care Unit in an Italian Oncology Department were enrolled. Exercise behaviour was assessed by the Leisure Score Index (LSI) of the Godin Leisure-Time Exercise Questionnaire. Patients were asked to report their average weekly exercise for three cancer-related time periods, i.e. pre-diagnosis, during active treatment and off-treatment. Quality of life was assessed by the Italian version of the WHOQOL-BREF standardised instrument. Statistical analysis indicated significant differences across the cancer-relevant time-periods for all exercise behaviour outcomes: the exercise behaviour was significantly lower during both on- and off- treatment than during prediagnosis; exercise during active treatment was significantly lower than during off-treatment. QOL strongly decreases during active treatment. Significant correlations were found between total exercise on- and off-treatment and all QOL indicators. Strenuous exercise is strongly correlated with QOL. Absent/mild exercise seems to be inversely correlated with a positive perception of disease severity and with quality of life on all axes. Need clearly results for inclusion of physical activity programs in comprehensive, complementary treatment regimes for breast cancer patients in Italian oncology departments.     

Cognitive processing of traffic signs in immersive virtual reality environment: An ERP study

The virtual reality environment can provide an immersive feeling as in the real word. So, using virtual reality technology to construct realistic experimental scenarios, the mechanism of cognitive processing in the human brain could be better studied. In this paper, we have designed an experiment, where through the presentation of traffic signs with correct or incorrect background colors in a virtual reality traffic environment, and studied the cognitive processing in the human brain using event-related potential (ERP) method. The results showed that whether the background colors of traffic signs were correct or not, the degrees of familiarity to these traffic signs in the human brain were similar, and the degree of contrast between the background colors and foreground colors of traffic signs would influence the degree of difficulty in cognitive processing. The degree of complexity in contents of traffic signs appears related to the cognitive speed in the human brain. In sum, simpler contents and larger contrast between the background colors and foreground colors of traffic signs would make the human brain respond faster.     

积极情绪对整体和局部知觉的影响:事件相关电位研究

目的:采用启动范式和事件相关电位方法,研究积极情绪如何调制视觉系统选择性加工刺激整体特征和局部特征的神经机制。方法:对22名大学生,采用Neuroscan公司64导脑电系统记录其在3种情绪图片启动条件下执行整体和局部加工任务时的事件相关电位(ERPs)和行为学结果。结果:250～320ms时间段内,积极情绪和中性情绪启动条件下整体加工引起的事件相关脑电波幅大于局部加工的脑电波幅(P<0.01),差异主要分布于额-中央区;350～500ms时间段内,积极情绪启动的整体加工(局部加工)诱发的事件相关脑电波幅大于消极情绪启动的整体加工(局部加工)诱发的脑电波幅(P<0.01),差异主要分布于顶-枕区。结论:积极情绪促进整体和局部知觉加工的神经机制,可能存在差别,ERP早期成分的差异可能与额-中央区活动关系密切,晚期成分与顶-枕区活动联系可能更为密切。     

Shyness and emotional face processing in schizophrenia: An ERP study

Shyness in healthy controls has been related to early event-related potential (ERP) responses to emotional faces. Patients with schizophrenia typically demonstrate increased shyness that is stable and related to reduced social functioning. We indexed early ERP responses to emotional faces in relation to shyness in 40 outpatients with schizophrenia and 39 healthy controls. Patients with low-to-medium shyness showed reductions in P100 amplitude to emotional compared to neutral faces as shyness increased. Patients reporting medium-to-high shyness demonstrated the opposite pattern; P100 amplitude sharply increased as shyness increased, possibly reflecting heightened vigilance. When a restricted range of shyness scores was used to equalize scores between groups, patients showed increased N170 amplitude to emotional faces as shyness increased, whereas controls demonstrated the opposite pattern. The implications of the findings are discussed with respect to informing vulnerability to social functioning impairment and psychosocial stress in this population.     

Acute psychological stress promotes general alertness and attentional control processes: An ERP study

The current study investigated the influence of acute psychological stress on selective attention processes. After an acute stressor or a control condition, 20 participants performed an arrow-based version of the Eriksen flanker task, while ERPs (N1, N2, P3), reaction times, accuracy, subjective stress, and electrocardiogram signal were measured. Results showed elevated self-report stress, negative affect, state anxiety, heart rate, and reduced high-frequency heart rate variability in the stress block than in the control block, indicating that the flanker task was performed in a stressful situation. In the flanker task, faster response and larger flanker effect of accuracy were observed for the stress block relative to the control block, indicating increased arousal level and improved conflict detection under stress. Event-related potentials locked to target stimuli in the flanker task revealed that (a) frontal N1 was amplified in the stress block than in the control block, indicating elevated vigilance level under stress; (b) frontal N2 was increased in the stress block than in the control block for both congruent and incongruent trials, indicating more intensive attention control under stress; and (c) Increased P3 in the stress block than in the control block may reflect more allocation of neural resources as a consequence of improved attentional control under stress. These findings suggest that acute psychological stress increases general alertness and promotes attentional control in selective attention processes.     

Physical activity and biomarkers in breast cancer survivors: A systematic review

Breast cancer is the most common cancer among women. The number of breast cancer survivors has increased due to screening and improved treatment methods, which makes it important to increase knowledge on their health and well-being. Physical activity has been reported to improve quality of life, decrease fatigue and reduce all-cause and breast cancer-specific mortality in breast cancer survivors. The beneficial effects of physical activity may manifest themselves in circulating levels of insulin, insulin-growth factors (IGFs) I and II and their binding proteins (IGFBPs), or inflammatory biomarkers. The aim of this report was to review available randomized controlled trials (RCTs) on the effects of physical activity on biomarkers in breast cancer survivors. We identified 12 publications based on nine RCTs that fulfilled our inclusion criteria published until 19th June 2012. The RCTs were small (16–101 breast cancer survivors); mean BMI was ≥25 and the mean age in 8 out of 9 RCTs was approximately 50 years. Five RCTs reported statistically significant effects of physical activity on insulin, IGF-I, IGF-II and IGFBP-3 in breast cancer survivors, but the results were not consistent. None of four RCTs found any evidence for a role of investigated interleukines. One trial reported some evidence that exercise may decrease C-reactive protein levels. In conclusion, available RCTs have produced some evidence that physical activity may result in beneficial changes in levels of insulin, IGFs, IGFBPs, and inflammatory biomarkers in breast cancer survivors. However, further larger RCTs on physical activity and biomarkers in breast cancer survivors are warranted.     

Effects of cue frequency and repetition on prospective memory: An ERP investigation

Prospective memory involves the formation and completion of delayed intentions and is essential for independent living. In this study (n = 33), event-related potentials (ERPs) were used to systematically evaluate the effects of PM cue frequency (10% versus 30%) and PM cue repetition (high versus low) on ERP modulations. PM cues elicited prospective positivity and frontal positivity but not N300, perhaps due to the semantic nature of the task. Results of this study revealed an interesting interaction between PM cue frequency and PM cue repetition for prospective positivity and frontal positivity, highlighting the importance of taking both factors into account when designing future studies.     

Dissociable effects of psychopathic traits on cortical and subcortical visual pathways during facial emotion processing: An ERP study on the N170

This study examined the relation between psychopathic traits and the brain response to facial emotion by analyzing the N170 component of the ERP. Fifty‐four healthy participants were assessed for psychopathic traits and exposed to images of emotional and neutral faces with varying spatial frequency content. The N170 was modulated by the emotional expressions, irrespective of psychopathic traits. Fearless dominance was associated with a reduced N170, driven by the low spatial frequency components of the stimuli, and dependent on the tectopulvinar visual pathway. Conversely, coldheartedness was related to overall enhanced N170, suggesting mediation by geniculostriate processing. Results suggest that different dimensions of psychopathy are related to distinct facial emotion processing mechanisms and support the existence of both amygdala deficits and compensatory engagement of cortical structures for emotional processing in psychopathy.     

Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial

Objectives

This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies.

Design

A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL).

Methods

N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes.

Results

CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from .44–.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's < .05). CM experienced greater improvements in catastrophizing immediately post-intervention, with a trending effect at follow-up. However, we could not reject the null hypothesis of identical between-group effects for refocusing on planning both immediately post-intervention and at follow-up. Exploratory analyses revealed inconsistent between-module effects.

Conclusions

In its entirety, CM is a promising intervention for improving and maintaining cancer survivors' adaptive emotion regulation, especially for mindfulness and experiential avoidance. This may have important clinical implications for promoting cancer survivors’ emotional functioning and general well-being.     

Neural mechanisms of subliminal priming for traumatic episodic memory: An ERP study

Event-related brain potentials (ERPs) were measured to study the electrophysiological mechanisms of subliminal priming of traumatic episodic memory. Twenty-four Chinese subjects who had experienced the great Sichuan earthquake in 2008 were classified either as normal control or as post-traumatic stress disorder (PTSD) subjects. Results showed that subliminally presented earthquake-related words elicited two significantly more positive ERP deflections (P2 and P300) than did earthquake-unrelated words between 250–300 ms and 340–400 ms post-stimulus periods for the PTSD group, but not for the control group. Dipole source analysis showed that the P2 was mainly generated in the posterior cingulate cortex (PCC), which appeared to be related to unconscious attentional resource allocation to the earthquake-related words. In addition, the P300 was found to be generated in the parahippocampal gyrus, which seemed to be related to the involuntary activation of traumatic episodic memory. These results indicated that catastrophic earthquake experiences made some subjects extremely sensitive and hyper-responsive to trauma-related information.     

Assisted reproduction in male cancer survivors: fertility treatment and outcome in 67 couples

BACKGROUND: Many male cancer survivors experience fertility problems due to antineoplastic treatment. We report the fertility outcome in 67 couples referred to assisted reproduction treatment (ART) because of male factor infertility due to cancer. METHODS: This was a retrospective study assessing the following parameters: diagnosis, cancer treatment, type of fertility treatment and type of sperm used, number of pregnancies and pregnancy outcome. RESULTS: Testicular cancer and lymphomas were the most prevalent diagnoses. Adjuvant treatment with chemo- and/or radiation therapy had been given to 90% of the men. Semen was cryopreserved in 82% of the men prior to treatment. Following antineoplastic treatment, 43% of the men had motile spermatozoa in the ejaculate, but 57% were azoospermic. A total of 151 ART cycles were performed [55 intra-uterine insemination (IUI), 82 ICSI and 14 ICSI-frozen embryo replacement (FER)]. The clinical pregnancy rate per cycle was 14.8% after IUI, 38.6% after ICSI and 25% after ICSI-FER. The corresponding delivery rates were 11.1, 30.5 and 21%. Cryopreserved semen was used in 58% of the pregnancies. The delivery rate per cycle was similar after use of fresh or cryopreserved spermatozoa. CONCLUSIONS: Male cancer survivors have a good chance of fathering a child by using either fresh ejaculated sperm or cryopreserved sperm.     

Adapting a peer-led self-management program for breast cancer survivors in Switzerland using a co-creative approach

ObjectiveThe peer-led Cancer Thriving and Surviving Program (CTS) has demonstrated improved health outcomes for cancer survivors. We describe a co-creative process for adapting the CTS for breast cancer survivors in Switzerland and integrating the program into the clinical pathway of Swiss breast centers.MethodsA co-creative approach was employed. Breast cancer survivors and health care professionals (total n = 81) participated in three workshops, an online rating, and a consensus conference. An iterative cycle (evidence, ideas, refining, rating, and synthesis) guided the adaptation process.ResultsSurvivors involvement in the adaptation process allowed to tailor the self-management program to the psychosocial needs identified as the highest priority. New contents “Being a woman”, “Breast cancer and my (working) life” and “My exercise” were added to the CTS. Program duration was expanded from 6 to 7 weeks. Transition to follow-up care was considered as the optimal time point for program integration into the clinical pathway.ConclusionThe co-creative process may serve as a model in adapting supportive interventions for cancer. A subsequent pilot testing examined the feasibility and preliminary efficacy.Practice implicationsCombining expertise of health care professionals and patients to co-create a peer-led breast cancer self-management program may enhance acceptability and adoption.     

Event‐related potentials of emotional and neutral memories: The role of encoding position and delayed testing

Previous research found that memory is not only better for emotional information but also for neutral information that has been encoded in the context of an emotional event. In the present ERP study, we investigated two factors that may influence memory for neutral and emotional items: temporal proximity between emotional and neutral items during encoding, and retention interval (immediate vs. delayed). Forty‐nine female participants incidentally encoded 36 unpleasant and 108 neutral pictures (36 neutral pictures preceded an unpleasant picture, 36 followed an unpleasant picture, and 36 neutral pictures were preceded and followed by neutral pictures) and participated in a recognition memory task either immediately (N = 24) or 1 week (N = 25) after encoding. Results showed better memory for emotional pictures relative to neutral pictures. In accordance, enhanced centroparietal old/new differences (500–900 ms) during recognition were observed for unpleasant compared to neutral pictures, most pronounced for the 1‐week interval. Picture position effects, however, were only subtle. During encoding, late positive potentials for neutral pictures were slightly lower for neutral pictures following unpleasant ones, but only at trend level. To summarize, we could replicate and extend previous ERP findings showing that emotionally arousing events are better recollected than neutral events, particularly when memory is tested after longer retention intervals. Picture position during encoding, however, had only small effects on elaborative processing and no effects on memory retrieval.     

The family's functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model

Despite the high rates of breast cancer in the child-rearing mother, there is extremely limited research on the effects of the illness on the children, marriage, and parent-child relationship. The current study tested an explanatory model of family functioning with breast cancer based on data obtained from standardized questionnaires from 80 diagnosed mothers and partners with young school-age children. Path analysis results for data obtained from both the mothers and the partners revealed a similar pattern. More frequently experienced illness demands were associated with higher levels of parental depressed mood which negatively affected the marriage. When the marriage was less well adjusted, it negatively affected the family's coping behavior. Household functioning was positively affected by heightened coping activity and by higher levels of marital adjustment. Children functioned better when the non-ill parent more frequently interacted with them and their families coped more frequently with their problems.This research was supported by a grant from the Center for Nursing Research, National Institutes of Health (R01-NR-01000), and an American Cancer Society Oncology Nursing Professorship awarded to the senior author.     

Treatment of climacteric symptoms in breast cancer patients: A retrospective study from a medication databank

Introduction

Women affected by breast cancer (BC) will often go through menopause at an earlier age and display more frequent and severe symptoms than women who have a natural menopause. The safety of hormone replacement therapy (HRT) and vaginal estrogens for BC survivors has been debated over time and remains unclear. Non hormonal therapies such as antidepressants, gabapentine and clonidine may be useful for those patients but there are few data about their safety.

Aim

This retrospective study analyses the use by BC patients of treatments known to alleviate climacteric symptoms.

Material and method

Post-menopausal Estrogen Receptors positive (ER+) BC patients, aged 45–69, were identified as having bought, at least once, an aromatase inhibitor (AI) or tamoxifen between the years 2000 and 2012 through a pharmaceutical databank in Belgium. Among them, we defined users of a climacteric treatment those who bought, at least once, HRT, vaginal topical estrogens, antidepressants, clonidine and gabapentine.

Results

We identified 2530 BC patients. Among them, 45% were buying a treatment known to alleviate menopausal symptoms. The majority of these treatments were non-HRT therapies. HRT and vaginal estrogens were seldom bought (respectively 1.1% and 6%), but 3% bought vaginal estrogens while buying AI. About 9.2% of tamoxifen users patients bought antidepressants implicated in tamoxifen metabolism at the same time as tamoxifen.

Conclusions

Most BC patients follow current guidelines contra-indicating the use of HRT after BC, they use non hormonal therapies. In some cases they use unfortunately antidepressants that may alter the metabolism of tamoxifen.     

A novel approach to management of sleep-associated problems in patients with breast cancer (MOSAIC) during chemotherapy : A pilot study

Study ObjectivesThis pilot randomized controlled trial (RCT) was conducted to assess the preliminary effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) delivered by trained research staff in comparison to a sleep hygiene pamphlet control and to assess moderators of treatment effect in patients with breast cancer undergoing chemotherapy.MethodsOf 74 participants recruited, 37 were randomized to BBT-CI and 37 were randomized to the control condition. Trained staff members delivered the intervention during chemotherapy treatments to reduce patients’ burden. Insomnia was assessed with the Insomnia Severity Index (ISI), anxiety was assessed with the Spielberger State-Trait Anxiety Inventory, symptom burden was assessed with the Symptom Inventory (SI), and study staff recorded previous treatments and surgeries received by patients.ResultsPatients randomized to BBT-CI showed significantly greater improvements in their ISI scores compared to the sleep hygiene group. Additionally, several treatment moderators were identified. The effect of BBT-CI was greater among individuals with lower baseline state-trait anxiety, with previous surgery for cancer, and with higher baseline somatic symptom severity.ConclusionsBBT-CI shows preliminary efficacy compared to the sleep hygiene handout on insomnia in cancer patients undergoing chemotherapy. A large-phase III RCT needs to be conducted to replicate the preliminary findings.     

Evidence-based care for breast cancer survivors: Communicating the Institute of Medicine Guidelines in medical practice

Objective

To investigate patient reports of physician communication about the 2006 Institute of Medicine (IOM) Guidelines for Survivorship Care, and patient follow-up care behaviors in a sample of African American and Caucasian breast cancer survivors.

Methods

Fifteen-minute telephone interviews were conducted in a cross-sectional study with a sample of African American (n = 30) and Caucasian (n = 69) breast cancer patients, who were within 5 years of their diagnosis and primary treatment for breast cancer at two Baltimore, Maryland medical centers, during the summer of 2006. Multiple items assessed patient reports of physician discussions about IOM Guidelines, their recurrence concerns, and their follow-up treatment, screening, diet and exercise practices.

Results

Patients with higher incomes, more education, female physicians, and of younger ages reported more complete physician discussions of the IOM Guidelines. No significant differences were noted between African American and Caucasian patients.

Conclusion

Patients at greatest risk for breast cancer recurrence – those with less education, income, and resources – report limited guidance from their physicians about evidence-based, follow-up care guidelines, designed to minimize their risk.

Practice implications

Physicians need strategies for effectively delivering the IOM Guidelines for Survivorship Care to disadvantaged breast cancer patients, to promote enhanced quality of life and reduced risk of recurrence.     

Subtyping of male breast cancer by PAM50 and immunohistochemistry: a pilot study of a consecutive Danish cohort

Male breast cancer (MBC) is a rare disease that is still to be fully understood. In female breast cancer, molecular subtyping by gene expression has proven its significance. In this study, we characterize a consecutive cohort of MBC patients surgically treated from 1997 to 2017, identified at our institution (N = 37), and report the association between molecular subtypes found by a surrogate panel of immunohistochemical (IHC) markers, and the PAM50 signature, as well as risk of recurrence score and overall survival for the different subtypes. PAM50 subtypes were determined using the nCounter FLEX system instrument and software. The distribution of molecular subtypes according to the PAM50 signature was as follows: 56% luminal B, 39% luminal A, and 5% basal-like. None of the tumors were HER2-enriched. Using IHC surrogate markers, we found 80% luminal B-like, 15% luminal A-like, and 5% basal-like. None were HER2-positive (non-luminal). We found a strong statistical association between subtypes found by PAM50 signature and the IHC surrogate markers (p < 0.001). Furthermore, we found luminal A tumors to be smaller in size compared to luminal B tumors (p = 0.04). Patients with luminal A subtype tumors had the lowest ROR scores with a mean of 39, whereas patients with luminal B subtype tumors had a mean ROR score of 69. Significant worse overall survival for luminal B tumors compared to luminal A tumors was seen (p = 0.02). Male breast cancer seems to be a mainly luminal disease, with luminal B being the most frequent subtype. Further studies are needed to ensure correct therapeutic strategies for this select group of patients.