Early rehabilitation program in postmastectomy patients: a prospective clinical trial. Psychometric properties of cancer survivors’ unmet needs survey Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy. Cognitive behavioral therapy and physical exercise for climacteric symptoms in breast cancer patients experiencing treatment-induced menopause: design of a multicenter trial Impact of a Combined Resistance and Aerobic Exercise Program on Motivational Variables in Breast Cancer Survivors: A Randomized Controlled Trial Pectoral stretching program for women undergoing radiotherapy for breast cancer Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial Implications of a Postoperative Rehabilitation Program on Quality of Life in Women with Primary Breast Cancer Treated with Sentinel Lymph Node Biopsy or Complete Axillary Lymph Node Dissection Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: a preliminary study Low-dose urokinase infusions to treat fibrinous obstruction of venous access devices in cancer patients. Randomized Controlled Trial of a Structured Training Program in Breast Cancer Patients with Tumor-Related Chronic Fatigue Breast cancer epidemiology according to recognized breast cancer risk factors in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial Cohort A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy--a randomized study. Dance and Movement Program Improves Quality‐of‐Life Measures in Breast Cancer Survivors A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. A randomized controlled trial of a brief self-help coping intervention designed to reduce distress when awaiting genetic risk information. Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors. Clinical practice improvement approach in multiple sclerosis rehabilitation: a pilot study The Impact of Rehabilitation Support Services on Health-related Quality of Life for Women with Breast Cancer Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD. An Intervention to Increase Quality of Life and Self-Care Self-Efficacy and Decrease Symptoms in Breast Cancer Patients The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: A randomized study Applying the clinical practice improvement approach to stroke rehabilitation: methods used and baseline results. Rehabilitation of the mastectomy patient: a randomized, blind, prospective study. Feasibility, psychometric performance, and stability across modes of administration of the CARES-SF. Breast Cancer: Education, Counseling, and Adjustment Among Patients and Partners: A Randomized Clinical Trial Self-Help Intervention Project. Women receiving breast cancer treatment. Effects of Aerobic Interval Training on Cancer Patients' Functional Capacity Randomized controlled trial of the Breast Cancer Recovery Program for women with breast cancer-related lymphedema. Effects of a Step-by-Step Inpatient Rehabilitation Programme on Quality of Life in Breast Cancer Patients. A Prospective Randomised Study
The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program  showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only .  Data were obtained at preoperatively , three days after operation , at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint , upper extremity circumferential measurements , as well as 10 elements of shoulder function . Postoperatively , both groups showed an increased range of motion of the shoulder joint and improved functional activities , but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment . This study also showed that an early rehabilitation program did not increase postoperative complications . We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion , and significantly better in a rehabilitation group Purpose This study aims to develop a psychometrically rigorous instrument to measure the unmet needs of adult cancer survivors who are 1 to 5 years post-cancer diagnosis . “ Unmet needs ” distinguishes between problems which survivors experience and problems which they desire help in managing . Methods The survey was developed from a comprehensive literature review , qualitative analysis of the six most important unmet needs of 71 cancer survivors , review of the domains and items by survivors and experts , cognitive interviews and a pilot test of 100 survivors . A stratified r and om sample of 550 cancer survivors , selected from a population -based Cancer Registry , completed a mailed survey to establish reliability and validity . Results The final 89-item  Survivors Unmet Needs Survey ( SUNS ) has high acceptability , item test – retest reliability and internal consistency ( Chronbach ’s alpha 0.990 ) , face , content and construct validity . Five subscales measure Emotional Health needs ( 33 items , 19.4 % of variance ) , Access and Continuity of Care ( 22 items , 15.1 % ) , Relationships ( 15 items , 12.1 % ) , Financial Concerns ( 11 items , 10.3 % ) and Information needs ( eight items , 8.1 % of the variance ) . Conclusions This instrument has strong psychometric properties and is useful for determining the prevalence and predictors of cancer survivors ’ unmet needs across types of cancer , length of survivorship and socio-demographic characteristics . Use of the SUNS will enable more effective targeting of programmes and services and guide policy and health planning decisions . Relevance This study is an important step toward evidence -based planning and management of problems which the growing survivor population requires assistance in managing Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes Breast cancer radiotherapy can be an emotionally difficult experience . Despite this , few studies have examined the effectiveness of psychological interventions to reduce negative affect , and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients . The present study examined the effectiveness of a multimodal psychotherapeutic approach , combining cognitive-behavioral therapy and hypnosis ( CBTH ) , to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy . Participants were r and omly assigned to receive either CBTH or st and ard care . Participants completed weekly self-report measures of positive and negative affect . Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [ F(1 , 38)=13.49 ; p=.0007 , omega(2)=.56 ] , and increased levels of positive affect [ F(1 , 38)=9.67 ; p=.0035 , omega(2)=.48 ] , during the course of radiotherapy . Additionally , relative to the control group , the CBTH group demonstrated significantly more intense positive affect [ F(1 , 38)=7.09 ; p=.0113 , d=.71 ] and significantly less intense negative affect [ F(1 , 38)=10.30 ; p=.0027 , d=.90 ] during radiotherapy . The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect ( 85 % of days assessed for the CBTH group versus 43 % of the Control group ) [ F(1 , 38)=18.16 ; p=.0001 , d=1.16 ] . Therefore , the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy Background Premature menopause is a major concern of younger women undergoing adjuvant therapy for breast cancer . Hormone replacement therapy is contraindicated in women with a history of breast cancer . Non-hormonal medications show a range of bothersome side-effects . There is growing evidence that cognitive behavioral therapy ( CBT ) and physical exercise can have a positive impact on symptoms in naturally occurring menopause . The objective of this study is to investigate the efficacy of these interventions among women with breast cancer experiencing treatment-induced menopause . Methods / design In a r and omized , controlled , multicenter trial , we are evaluating the effectiveness of CBT/relaxation , of physical exercise and of these two program elements combined , in reducing menopausal symptoms , improving sexual functioning , reducing emotional distress , and in improving the health-related quality of life of younger breast cancer patients who experience treatment-induced menopause . 325 breast cancer patients ( aged < 50 ) are being recruited from hospitals in the Amsterdam region , and r and omly allocated to one of the three treatment groups or a ' waiting list ' control group . Self-administered question naires are completed by the patients at baseline , and at 12 weeks ( T1 ) and 6 months ( T2 ) post- study entry . Upon completion of the study , women assigned to the control group will be given the choice of undergoing either the CBT or physical exercise program . Discussion Cognitive behavioral therapy and physical exercise are potentially useful treatments among women with breast cancer undergoing treatment-induced , premature menopause . For these patients , hormonal and non-hormonal therapies are contraindicated or have a range of bothersome side-effects . Hence , research into these interventions is needed , before dissemination and implementation in the current health care system can take place . Trial registration The study is registered at the Netherl and s Trial Register ( NTR1165 ) and Clinical Trials.gov ( NCT00582244 ) Background Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed . Purpose To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory ( SDT ) . MethodS ixty breast cancer survivors were r and omized in a cross-over design to either an immediate exercise group  ( IEG ; n = 30 )  that exercised from baseline to week 12 or a delayed exercise group  ( DEG  ; n = 30 )  that exercised from week 12 to 24 .  SDT variables were assessed at baseline , 6 , 12 , 18 and 24 weeks using the  Behavioral Regulation for Exercise Question niare-2 and the Basic Psychological Needs Satisfaction Scale . Results Fifty-eight participants completed the follow-up assessment s and achieved a 61.3 % adherence rate . Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods . For example , autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points ( mean group difference = 2.0 , p < 0.001 ) . The cross-over results further supported the main findings . ConclusionS upervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence Surgery and radiotherapy commonly cause adverse musculoskeletal problems , particularly loss of strength and range of motion , in the upper quadrant of breast cancer patients . Few well- design ed studies have investigated whether these impairments can be prevented . Stretching is an effective technique for increasing range of motion , hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer . Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery . Participants were r and omised to either a control or stretch group . Participants in both groups were review ed by the physical therapist on a weekly basis for approximately 6 weeks , and were given general information about skin care and lymphedema . The control group received no advice about exercise . The stretch group received instruction on low-load , prolonged pectoral stretches , which were to be performed daily and were checked at weekly visits . Shoulder range of motion , strength , arm circumference , and quality of life measurements were taken prior to , and at completion of radiotherapy , and at 7 months after radiotherapy . There was no difference in any outcome between groups . Breast symptoms increased for both groups during radiotherapy , without loss of strength or range of movement . The incidence of lymphedema during the study was low for both groups and did not differ between groups . The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register Background The aim of this clinical study was to evaluate quality of life ( QoL ) in early-stage breast cancer patients and to investigate the effects of a comprehensive rehabilitation program comparing women undergoing sentinel node biopsy ( SNB ) versus complete axillary lymph node dissection ( ALND ) .  QoL was assessed with the Functional Assessment of Cancer Therapy — General and Functional Assessment of Cancer Therapy — Breast ( FACT-B ) question naire . Methods Eighty-nine women with histologically confirmed primary breast cancer stages I – II were enrolled . Recruitment began on May 2006 and ended on December 2007 . According to current st and ards of care , 58 women were found clinical ly fit to undergo SNB , and the other 31 were elected for ALND . Thirty women who underwent SNB were r and omly allocated to participate in a comprehensive postoperative rehabilitation program , and the 28 remaining were dismissed and scheduled to return for clinical follow-up . Results Women undergoing ALND had a better QoL within 30 days of surgery on the FACT-B , FACT-G , Trial Outcome Index ( TOI ) , emotional well-being ( EWB ) , and breast concern subscale ( BCS ) ( P < .005 ) and at 6 months after surgery on the EWB subscale only . Women undergoing SNB had a significant improvement in QoL only on the EWB subscale 6 months after surgery in the group with rehabilitation and 30 days after surgery in the group without rehabilitation . Conclusion Women undergoing ALND benefited from a rehabilitation program and had a better QoL. Women undergoing BLS , regardless of rehabilitation , showed improvement in QoL for the emotional well-being subscale only Objective This pilot study examined the effects of a self-administered , home-based exercise ( HBE ) rehabilitation programme design ed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection . Methods Twenty-seven women who were scheduled for surgery were r and omly assigned to either a  post-surgical experimental HBE rehabilitation group  ( n = 16 ) or a  usual care group  ( UC ; n = 11 ) . Women assigned to the HBE group followed an 11 day ( days 3–14 post-surgery ) , home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape . The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society . Results As a result of the exercise programme intervention , there was a time × group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion ( ROM ) ( p = 0.003 ) and abduction ROM ( p = 0.036 ) when compared to the UC . There were no statistical differences in shoulder strength between groups over time . External rotation ( p = 0.036 ) and grip strength ( p = 0.001 ) significantly increased in both groups during the intervention period but there were no interaction effects . With respect to the forearm circumferences , there was a significant decrease over time ( p < 0.001 ) but no interaction between groups . Conclusion This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery PURPOSE This study was undertaken to determine the role of low-dose urokinase infusions in treating fibrinous occlusions of venous access devices ( VADs ) in cancer patients . PATIENTS AND METHODS Forty-two patients with VAD occlusions refractory to routine urokinase instillations were documented by x-ray ( cathetergram ) to have fibrin sleeves at the catheter tips . They were r and omized to receive infusions of either urokinase ( 40,000 U/h ) or urokinase with heparin ( 320 U/h ) through their catheters . After 1 , 3 , 6 , and 12 hours of treatment , the function of the VADs was reassessed . Whenever the obstruction had been relieved , the infusion was stopped and a repeat cathetergram was performed . The status of the unoccluded catheters was followed to determine the longevity of the restored function . RESULTS Twenty-one catheters were treated with urokinase alone and 21 with the combination of urokinase and heparin . In each group , 16 VADs opened within 12 hours of treatment and five did not . By actuarial analysis , the probability was only 0.28 that a reopened catheter would reocclude within 6 months . CONCLUSION Low-dose urokinase infusions can restore function to the majority of catheters occluded by fibrin sleeves . Adding heparin to the urokinase does not enhance the efficacy of the infusions . The restored function often persists until the VADs are removed Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients Background Multidisciplinary attempts to underst and the etiology of breast cancer are exp and ing to increasingly include new potential markers of disease risk . Those efforts may have maximal scientific and practical influence if new findings are placed in context of the well-understood lifestyle and reproductive risk factors or existing risk prediction models for breast cancer . We therefore evaluated known risk factors for breast cancer in a cancer screening trial that does not have breast cancer as a study endpoint but is large enough to provide numerous analytic opportunities for breast cancer . Methods We evaluated  risk factors for breast cancer ( N = 2085 ) among 70,575 women who were r and omized in the Prostate , Lung , Colorectal and Ovarian Cancer Screening Trial . Using Poisson regression , we calculated adjusted relative risks [ RRs , with 95 % confidence intervals ( CIs ) ] for lifestyle and reproductive factors during an average of 5 years of follow-up from date of r and omization . Results As expected , increasing age , nulliparity , positive family history of breast cancer , and use of menopausal hormone therapy were positively associated with breast cancer . Later age at menarche ( 16 years or older vs. < 12 : RR = 0.81 , 95 % CI , 0.65–1.02 ) or menopause ( 55 years or older vs. < 45 : RR = 1.29 , 95 % CI , 1.03–1.62 ) were less strongly associated with breast cancer than was expected . There were weak positive associations between taller height and heavier weight , and only severe obesity [ body mass index ( BMI ; kg/m2 ) 35 or more vs. 18.5–24.9 : RR = 1.21 , 95 % CI , 1.02–1.43 ] was statistically significantly associated with breast cancer . Conclusion The ongoing PLCO trial offers continued opportunities for new breast cancer investigations , but these analyses suggest that the associations between breast cancer and age at menarche , age at menopause , and obesity might be changing as the underlying demographics of these factors change . Clinical Trials Registration http://www . clinical trials.gov , NCT00002540 PURPOSE / OBJECTIVES To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy . DESIGN Experimental . SETTING Breast evaluation clinics of two New Engl and medical centers with comprehensive cancer treatment programs . SAMPLE 14 women ( mean age = 44 years ) receiving adjuvant chemotherapy for breast cancer ( 86 % stage II ) following surgical treatment . METHODS Subjects were assigned r and omly to the experimental group or the usual care group . Experimental group members began a structured exercise program of walking and attended support group meetings . All subjects were tested before beginning chemotherapy , during the course of chemotherapy , and one month following chemotherapy completion . MAIN RESEARCH VARIABLES Performance status , physical functioning , psychosocial adjustment , self-concept and body image , and 12 symptoms ( e.g. , fatigue , nausea , anxiety ) . FINDINGS Measures of physical performance , psychosocial adjustment , and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program . CONCLUSIONS Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy . IMPLICATION S FOR NURSING PRACTICE Although more detailed research is necessary to answer some of the questions raised by this study , implementing the walking program and forming a support group are achievable in an outpatient setting PURPOSE Cancer survivors are at increased risk for cardiovascular disease , diabetes , osteoporosis , and second primary tumors . Healthful lifestyle practice s may improve the health and well-being of survivors . The FRESH START trial tested the efficacy of sequentially tailored versus st and ardized mailed material s on improving cancer survivors ' diet and exercise behaviors . METHODS Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America . Participants were r and omly assigned either to a 10-month program of tailored mailed print material s promoting fruit and vegetable ( F&V ) consumption , reducing total/saturated fat intake , and /or increasing exercise or to a 10-month program of nontailored mailed material s on diet and exercise available in the public domain . Telephone surveys conducted at baseline and 1 year assessed body mass index ( BMI ) , dietary consumption , physical activity , and other psychosocial/behavioral indices . Clinical assessment s were conducted on a 23 % sub sample ; information was used to vali date self-reports . RESULTS Five hundred nineteen participants completed the 1-year follow-up ( 4.4 % attrition ; sample characteristics : 57 + /- 10.8 years old , 83 % white , 56 % female , 64 % overweight/obese , and 0 % underweight ) . Although both arms significantly improved their lifestyle behaviors ( P < .05 ) , significantly greater gains occurred in the FRESH START intervention versus the control arm ( practice of two or more goal behaviors : + 34 % v + 18 % , P < .0001 ; exercise minutes per week : + 59.3 v + 39.2 minutes , P = .02 ; F&V per day : + 1.1 v + 0.6 servings , P = .01 ; total fat : -4.4 % v -2.1 % , P < .0001 ; saturated fat : -1.3 % v -0.3 % , P < .0001 ; and BMI : -0.3 v + 0.1 kg/m2 , respectively , P = .004 ) . CONCLUSION Mailed material interventions , especially those that are tailored , are effective in promoting healthful lifestyle changes among cancer survivors . Further study is needed to determine sustainability , cost to benefit , and generalizability to other cancer population The purpose of this r and omized study was to investigate whether a nursing intervention using Orem 's self-care theory as a framework would affect subjective distress , side effects and quality of life as perceived by breast cancer patients receiving curative radiation therapy .  The intervention consisted of five 30-min sessions once a week during the treatment period and two follow-up sessions after completion of treatment . The experimental group consisted of 67 patients , as did the control group .  Measurements were collected five times : at baseline before commencement of treatment , at weeks 3 and 5 ( completion of treatment ) and follow-up periods of 2 weeks and 3 months . No measurable effect of the nursing intervention was found for side effects or quality of life but nursing intervention proved to have a positive effect in minimizing stress reactions ( p = < 0.05 ) . It is suggested that a nursing intervention should be implemented for breast cancer patients receiving curative radiation therapy A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years . Thirty-five women completed the trial that included a 12-week intervention , using The Lebed Method , Focus on Healing Through Movement and Dance . The study design was a r and omized control trial with a wait list control group crossover to active treatment in weeks 13 to 25 , with the treatment group receiving the program in weeks 1 to 12 , and no program in weeks 13 to 25 . Outcome measures were the Breast Cancer Quality of Life ( FACT-B ) , Shoulder range of motion ( ROM ) , and Body Image Scale . FACT-B significantly improved in the intervention group at 13 weeks from 102.0 ± 15.8 to 116.7 ± 16.9 , compared to the wait list group 108.1 ± 16.4 to 107.1 ± 21.3 ( time × group effect , P = .008 ) . During the crossover phase , the FACT-B score increased in the wait list group and was stable in the treatment group . The overall effect of the training at 26 weeks was significant ( time effect , P = .03 ) , and the order of training was also significant ( P = .015 ) . Shoulder ROM increased in both groups at 13 weeks —15 ° and 8 ° in the intervention and wait list groups ( Time effect , P = .03 ; time × group , P = .58 ) . Body Image improved similarly in both groups at 13 weeks ( time effect , P = .001 ; time × group , P = .25 ) , and at 26 weeks . There was no significant effect of the order of training for these outcome measures . A dance movement program that addressed the physical and emotional needs of women following treatment for breast cancer substantially improved a breast cancer – specific quality -of-life measure . Larger studies are justified to determine the acceptability of this therapy as part of the continuum of care for breast cancer survivors This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy . The study was design ed as a r and omised controlled trial ( RCT ) . Physical functioning , fatigue and Quality of Life ( QoL ) outcomes were evaluated pre and post a 12-week intervention . The results showed that after 12 weeks the women who participated in the exercise programme ( n = 12 ) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls ( n = 10 ) . Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance . These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe , well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer . Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women . Future studies need to address these issues and determine if these short-term benefits can be sustained OBJECTIVE The aim of this study was to evaluate the effectiveness of a distraction-based coping leaflet in reducing distress in women undergoing genetic risk assessment for breast/ovarian cancer . METHOD One hundred sixty-two women participated in a r and omized controlled trial , receiving either the intervention or st and ard information . Data were collected through a postal question naire at entry into a genetic risk assessment programme and 1 month later . RESULT Analysis of covariance revealed a nonsignificant reduction in distress in all women , and a significant reduction of distress among those with high baseline stress , who received the intervention . No gains were found among the control group . Measures of emotional response while thinking about cancer genetic assessment suggested these benefits were achieved in the absence of any rebound emotional response . CONCLUSION The intervention offers a low-cost effective coping intervention , which could be integrated into existing services with minimal disruption and may also be appropriate for other periods of waiting and uncertainty The U.S. population is aging , bringing with it an increased prevalence of chronic disease and concomitant declines in physical function . The risk of developing cancer increases significantly with age , and functional decline is much more likely once a cancer diagnosis is rendered . Thus , functional status in later life is a key concern , one that is heightened among elders who have been diagnosed with cancer . To date , however , there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients , and to our knowledge , none has focused on preserving or enhancing physical functioning . This paper describes the study design and method ological considerations of a r and omized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer . This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline , but also as a " teachable moment " - an opportune time when elders may be more receptive to making beneficial lifestyle changes . Undoubtedly , as cure rates for cancer increase and intersect with ever-growing numbers of elderly , there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome . In reporting our methods , we hope to give others " a leg up , " so that they can hurdle with greater ease the barriers we experienced , and thus advance the field more rapidly The objective of this study was to explore methods examining patient complexity and therapy interventions in relation to functional outcomes from an inpatient multiple sclerosis ( MS ) rehabilitation program . Retrospective and prospect i ve data for 24 consecutive in patients at a tertiary rehabilitation facility assessed ( i ) impairment/disability – Exp and ed Disability Status Scale , Neurological Impairment Set , ( ii ) complexity of intervention – Rehabilitation Complexity Scale , Northwick Park Therapy Dependency Assessment ( NPTDA ) , the type and duration of therapy , ( iii ) Function – Barthel Index ( BI ) , functional independence measure ( FIM ) , ( iv ) hospital length of stay , discharge destination . The mean length of stay was 20 days ( SD=15.7 ) ; male : female ratio was 10 : 14 ; 11 ( 46 % ) had Exp and ed Disability Status Scale scores more than 6.5 , and all discharged to community . Over one-half had ‘ moderate – severe ’ scores for fatigue , and deficits in motor function and mood that result ed in significant functional limitation . Rehabilitation Complexity Scale scores showed substantial complexity with two-thirds requiring specialized nursing . The NPTDA score ( median 22 interquartile range 20–23 ) showed moderate dependency on admission in the following domains : physical , cognitive and psychosocial programs and preparing for discharge . The mean physiotherapy and occupational therapy  received was 45.76 and 24.04 min/day , respectively . Functional gains from admission to discharge for FIM and BI were significant ( P<0.001 ) . There were strong correlations between the total NPTDA and FIM motor scores ( Spearman 's ρ −0.80 ) and BI ( ρ −0.83 ) , but only weak correlations with the FIM cognitive score ( ρ −0.33 ) . In conclusion , this pilot study provided information about the complex interplay of patient and process factors , and their interrelationships that impact functional outcomes in MS rehabilitation . A prospect i ve study is now planned using appropriate tools to underst and the ‘ black box ’ of rehabilitation . Gegenst and der vorliegenden Studie waren die Method en der Untersuchung der Patientenkomplexität und der Therapieinterventionen in Bezug auf die funktionellen Beh and lungsergebnisse bei einem Reha-Programm für stationär beh and elte Patienten mit multipler Sklerose ( MS ) . Die retrospektiven und prospektiven Date n für 24 nachein and er stationär beh and elte Patienten in einer tertiären Reha-Einrichtung dienten der Beurteilung der ( i ) Schädigung/Behinderung – EDSS-Leistungsskala ( Exp and ed Disability Status Scale ) , Neurological Impairment Set , ( ii ) Komplexität der Intervention – Rehabilitation Complexity Scale  , Northwick Park Therapy Dependency Assessment ( NPTDA ) , Art und Dauer der Therapie , ( iii ) Funktion – Barthel-Index ( BI ) , funktionaler Selbständigkeitsindex ( Functional Independence Measure , FIM ) , ( iv ) Dauer des Krankenhausaufenthalts , Adresse nach der Entlassung . Die mittlere Aufenthaltsdauer betrug 20 Tage ( SD = 15,7 ) ; das Verhältnis Männer : Frauen betrug 10 : 14 ; 11 ( 46 ) wiesen Exp and ed Disability Status Scale-Scores von mehr als 6,5 auf , und alle wurden zurück in die Gemeinschaft entlassen . Mehr als die Hälfte der Patienten wiesen die Scores ‘ mittelschwer – schwer ’ für Ermüdung und Mängel i m Bereich der Motorik und Gemütsverfassung auf , die zu signifikanten Funktionseinschränkungen führten . Die Rehabilitation Complexity Scale-Scores erwiesen sich als äußerst komplex , und zwei Drittel der Patienten mussten speziell gepflegt werden . Der NPTDA-Score ( medianer Bereich : 22 , Interquartilbereich : 20–23 ) wies bei der Aufnahme in folgenden Domänen eine mäßige Abhängigkeit auf : physische , kognitive und psychosoziale Programme und Vorbereitung auf die Entlassung . I m Durchschnitt erhielten die Patienten 45.76 Min/Tag Physiotherapie bzw . 24.04 Min/Tag Ergotherapie . Die Funktionsgewinne von der Krankenhauseinweisung bis zur Entlassung waren beim FIM und BI signifikant ( P<0.001 ) . Es zeigten sich starke Korrelationen zwischen den NPTDA- und FIM-Motor-Scores insgesamt ( Spearman ρ −0.80 ) und BI ( ρ −0.83 ) , aber nur schwache Korrelationen beim FIM kognitiven Score ( ρ −0.33 ) . Zusammenfassend lässt sich sagen , dass diese Pilotstudie Informationen über das komplexe Wechselspiel zwischen Patient und Prozessfaktoren und ihre Zusammenhänge lieferte , die sich auf die funktionellen Beh and lungsergebnisse bei der MS-Rehabilitation auswirken . Jetzt ist eine Prospektivstudie unter Zuhilfenahme geeigneter Tools geplant , um so die ‘ Grauzone ’ der Rehabilitation verstehen zu können . El objetivo de este estudio fue explorar posibles métodos para valorar el tipo de tratamiento y la complejidad de éste en cada paciente , con relación a los result ados de las capacidades funcionales en el tratamiento de rehabilitación hospitalaria de pacientes con esclerosis múltiple ( EM ) . Se recolectaron datos retrospectivos y prospect ivos de 24 pacientes consecutivos hospitalizados en un centro de atención terciaria de rehabilitación , con el objetivo de valorar : 1 ) la deficiencia / discapacidad — mediante la Escala Exp and ida para la Valoración del Grado de Discapacidad , las Pruebas de Valoración del Grado de Deficiencia Neurológica— ; 2 ) el grado de complejidad del tratamiento — mediante la Escala de Complejidad del Tratamiento de Rehabilitación , la Valoración de Northwick Park de la Dependencia al Tratamiento ( NPTDA , por sus siglas en inglés ) , el tipo de tratamiento y la duración de éste ; 3 ) el funcionamiento — mediante el Índice de Barthel [ IB ) y la medida de la independencia funcional ( MIF ) ; 4 ] duración de la estancia hospitalaria y el lugar de destino del paciente después del alta . El valor medio de la duración del estancia hospitalaria fue de 20 días ( DE=15,7 ) ; la proporción varones : mujeres fue de 10 : 14 ; en 11 ( 46 % ) de estos pacientes los valores de la Escala Exp and ida para la Valoración del Grado de Discapacidad fue mayor que 6,5 , y después del alta todos regresaron a su hogar . En más de la mitad de los pacientes el grado de astenia fue de entre moderado e intenso , y presentaron alteraciones de las funciones motoras y del estado de ánimo que causaron importantes limitaciones funcionales . Los puntajes de la Escala de Complejidad del Tratamiento de Rehabilitación mostraron que el grado de complejidad suele ser alto , pues dos tercios de los pacientes necesitan atención especializada de enfermería . Los puntajes la NPTDA ( la mediana del intervalo entre cuartilas , de entre 20 y 23 ) mostró un grado de dependencia moderado al ingreso en los siguientes dominios : físico , cognitivo , y psicológico , y durante la preparación para el alta . La media de la duración del tratamiento de fisioterapia y de terapia ocupacional fueron de 45.76 y 24.04 min/día , respectivamente . Se logró una gran mejoría en la esfera funcional desde el momento del ingreso hasta el alta , según los puntajes de la MIF y del IB ( P<0.001 ) . Se hallaron importantes correlaciones entre los puntajes totales de la NPTDA y de la MIF de la esfera motora ( coeficiente de correlación de Spearman , ρ −0.80 ) y el IB ( ρ −0.83 ) , pero las correlaciones entre la NPTDA y de la MIF de la esfera cognitiva ( ρ −0.33 ) . En conclusión , este estudio preliminar aportó información importante sobre la compleja interacción entre los pacientes y los factores del proceso a rehabilitación , y las interrelaciones entre estos que influyen en los result ados funcionales de la rehabilitación de pacientes con EM . Se realizará un estudio prospect ivo utiliz and o las herramientas adecuadas para lograr descifrar la « caja negra » de la rehabilitación . Cette étude avait pour objet d'explorer des méthodes qui examinent la complexité des patients et les interventions de thérapie par rapport aux résultats fonctionnels d'un programme de rééducation de patients hospitalisés souffrant de sclérose en plaques . Les données rétrospectives et prospect ives pour 24 patients consécutifs hospitalisés dans un établissement de rééducation tertiaire évaluaient ( i ) la déficience ou l'invalidité - échelle de statut d'incapacité augmenté , jeu d'affections neurologiques , ( ii ) la complexité de l'intervention – échelle de complexité de la rééducation , évaluation NPTDA ( Northwick Park Therapy Dependency Assessment ) , le type et la durée du traitement , ( iii ) les fonctions - indice de Barthel  ( BI ) , la mesure d'indépendance fonctionnelle ( FIM ) , ( iv ) la durée du séjour hospitalier , la destination à la sortie de l'hôpital . La durée moyenne du séjour était de 20 jours ( écart type = 15.7 ) ; le ratio homme : femmes était de 10 : 14 ; 11 sujets ( 46 ) présentaient des scores supérieurs à 6.5 , sur l'échelle de statut d'incapacité augmenté et tous ont été replacés dans la collectivité à la sortie de l'hôpital . Plus de la moitié présentaient des scores modérés à sévères pour la fatigue , et des déficits de la fonction motrice et de l'humeur qui provoquaient de significatives limitations fonctionnelles . Les scores sur l'échelle de complexité de la rééducation indiquaient une complexité considérable , les deux tiers nécessitant des soins spécialisés . Le score NPTDA ( médiane de 22 , écart interquartile 20–23 ) faisaient apparaître une dépendance modérée à l'admission dans les domaines suivantsprogrammes physiques , cognitifs et psychosociaux et préparation au départ de l'hôpital . La moyenne reçue par la physiothérapie et l'ergothérapie était de 45.76 et 24.04 min/jour , respectivement . Les gains fonctionnels de l'admission au départ pour le FIM et le BI étaient significatifs ( P<0.001 ) . On a constaté de fortes corrélations entre les scores moteurs NPTDA et FIM totaux ( ρ de Spearman 0.80 ) et BI ( ρ −0.83 ) , mais seulement des corrélations faibles avec le score cognitif FIM ( ρ −0.33 ) . En conclusion , cette étude pilote a apporté des informations sur l'interaction complexe des patients et des facteurs du processus et leurs interrelations qui influent sur les résultats de la rééducation fonctionnelle de la sclérose en plaques . Une étude prospect i ve est maintenant planifiée en utilisant les outils appropriés pour comprendre la « boîte noire » As the number of women surviving breast cancer increases , with implication s for the health system , research into the physical and psychosocial sequelae of the cancer and its treatment is a priority . This research estimated self-reported health-related quality of life ( HRQoL ) associated with two rehabilitation interventions for breast cancer survivors , compared to a non-intervention group . Women were selected if they received an early home-based physiotherapy intervention ( DAART , n = 36 ) or a group-based exercise and psychosocial intervention ( STRETCH , n = 31 ) . Question naires on HRQoL , using the Functional Assessment of Cancer Therapy – Breast Cancer plus Arm Morbidity module , were administered at pre- , post-intervention , 6- and 12-months post-diagnosis . Data on a  non-intervention group ( n = 208 ) were available 6- and 12-months post-diagnosis . Comparing pre/post-intervention measures , benefits were evident for functional well-being , including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis . In contrast , minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis . Overall , mean HRQoL scores ( adjusted for age , chemotherapy , hormone therapy , high blood pressure and occupation type ) improved gradually across all groups from 6- to 12-months post-diagnosis , and no prominent differences were found . However , this obscured declining HRQoL scores for 20–40 % of women at 12 months post-diagnosis , despite receiving supportive care services . Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory . Early physiotherapy after surgery has the potential for short-term functional , physical and overall HRQoL benefits PURPOSE Declines in physical functioning ( PF ) among elderly cancer patients threaten quality of life and the ability to maintain independence . Adherence to healthy lifestyle behaviors may prevent functional decline . PATIENTS AND METHODS Project Leading the Way in Exercise and Diet ( LEAD ) , an intervention development study of the Pepper Older Americans Independence Center , aim ed to determine whether breast and prostate cancer survivors ( age 65 + years ) assigned to a 6-month home-based diet and exercise intervention  experienced improvements in PF when compared with an attention control arm receiving general health information . An accrual target was set at 420 , and PF ( Short Form-36 subscale ) , physical activity ( Community Healthy Activities Models Program for Seniors ) , and diet quality ( index from 3-day recalls ) were assessed at baseline and at 6 and 12 months ( 6 months after intervention ) . RESULTS This developmental project did not achieve its accrual target ( N = 182 ) ; however , PF change scores were in the direction and of the magnitude projected . Baseline to 6-month change scores in the intervention versus the control arms were as follows : PF , + 3.1 v -0.5 ( P = .23 ) ; physical activity energy expenditure , + 111 kcal/wk v -400 kcal/wk ( P = .13 ) ; and diet quality index , + 2.2 v -2.9 ( P = .003 ) , respectively . Differences between arms diminished during the postintervention period . CONCLUSION These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors , changes that trend toward improved PF . Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends ; these efforts will require adequate planning and re sources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population This study tested effects of a nurse-administered self-efficacy intervention given on five monthly occasions and design ed to enhance  patients ’ self-care self-efficacy . The hypotheses were that at four months and eight months after beginning chemotherapy the efficacy-enhancing experimental group would have significantly higher scores on quality of life and self-care self-efficacy than the control group and significantly less symptom distress .  Fifty-six women receiving chemotherapy for breast cancer were r and omized to the experimental and control groups . Outcome variables were quality of life , measured by the Functional Assessment of Cancer Treatment-Breast ( FACT-B ) , symptom distress , measured by the Symptom Distress Scale ( SDS ) , and factors of self-care self-efficacy  , measured by  Strategies Used by Patients to Promote Health ( SUPPH ) . The interaction effects for the FACT-B ranged from small for functional concerns ( eta square = .03 ) to large for social concerns ( eta square = .110 ) ; effects for the SDS were large ( eta square = .140 ) , and for factors on the SUPPH effect sizes ranged from small ( eta square = .01 ) for Enjoying Life and Stress Reduction to medium ( eta square = .089 ) for Coping , and large ( eta square = .141 ) for Making Decisions . Interventions to promote self-efficacy may increase quality of life and decrease symptom distress for women diagnosed with breast cancer The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer was examined through a r and omized controlled trial . One hundred and thirty-nine patients with newly diagnosed breast cancer were enrolled in the study . Sixty-two ( 45 % ) had Breast Conserving Therapy and 77 ( 55 % ) had Modified Radical Mastectomy ( Axillary dissection of level I and II was included in both procedures ) . Enrolled patients were r and omized to either group A or group B. Group A was offered , team instructed physiotherapy consisting of 12 sessions of 60 min , two sessions a week . The treatment was instituted between the sixth and eight postoperative week . Group B was also offered team instructed physiotherapy , consisting of 12 sessions of 60 minute two sessions a week , but not until the 26th postoperative week . The patients were seen for follow-up examinations four times during the first postoperative year ( after 7 , 13 , 26 and 56 weeks ) . Shoulder function was assessed by the Constant Shoulder Score preoperatively and at the four follow-up examinations . Team instructed physiotherapy was found to improve the shoulder function significantly in patients treated surgically for breast cancer . The effect of the treatment was influenced by the type of surgery performed , and in mastectomised patients , also by the application of radiation therapy .  Compromised shoulder function is a less frequent and less severe side effect to breast conserving therapy as compared to modified radical mastectomy UNLABELLED Gassaway J , Horn SD , DeJong G , Smout RJ , Clark C , James R. Applying the clinical practice improvement approach to stroke rehabilitation :  methods used and baseline results . OBJECTIVES To describe the methods used and baseline data for the Post-Stroke Rehabilitation Outcomes Project ( PSROP ) . DESIGN Prospect i ve observational cohort study . SETTING Seven inpatient rehabilitation facilities ( IRFs ) in the United States and New Zeal and . PARTICIPANTS Consecutive convenience sample of 1291 poststroke rehabilitation patients , age older than 18 , who were treated between 2001 and 2003 in 7 IRFs ( 1161 patients in 6 U.S. IRFs ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Change in FIM score , change in severity of illness , and discharge destination . RESULTS For the U.S. sample , the average age was 66 years , 52 % were men , 60 % were white , and 23 % were black . Medicare was the most frequent payer . Seventy-seven percent of strokes were ischemic , with 43 % in the left brain , 44 % in the right brain , and 11 % bilateral . Mean admission total FIM score was 61 , with a mean motor FIM score of 40 and mean cognitive FIM score of 21 . Lower FIM scores are associated with higher severity-of-illness scores . Mean rehabilitation length of stay was 18.6 days ; 78 % of patients were discharged home . At discharge , the average increase in total FIM score was 26 , in motor FIM score was 22 , and in cognitive FIM score was 4 . CONCLUSIONS This article outlines methods used in the PSROP , provides an overview of participating IRFs , describes the data base , and summarizes key characteristics to enable readers of subsequent articles to better interpret study findings and determine generalizability After biopsy confirmation of breast carcinoma , women who were scheduled to undergo a modified radical mastectomy had demographic data collected , goniometric measurements of shoulder flexion and abduction , and functional evaluation of the ipsilateral shoulder performed , and upper extremity circumferential measurements at five levels determined . Patients were then r and omly assigned either to a group that received immediate postoperative physical therapy or to one that did not . Results represent the combination of data from a pilot study and this subsequent study following appropriate statistical analysis . Sixty-four women in the treatment group showed a statistically significant increase in shoulder range of motion in both abduction and flexion as compared to 51 women who received no physical therapy . The treated group also had fewer problems with five of the six upper extremity functional tasks that were assessed . There were no significant differences between the groups for length of hospital stay , postoperative complications , or upper extremity edema . The authors conclude that early physical therapy intervention makes a significant contribution to return to normal function without increasing the incidence of postoperative complications or prolonging hospital stay BACKGROUND The primary objective was to investigate the validity and reliability of the Cancer Rehabilitation Evaluation System-Short Form ( the CARES-SF ) as a quality of life instrument in clinical trials [ 10 ] . PATIENTS AND METHODS A heterogeneous sample of 485 cancer patients completed the CARES-SF before treatment ( T1 ) , one month later ( T2 ) , and three months following T2 ( T3 ) . At T3 the patients completed the question naire either by mail , in a telephone interview , or in the clinic . A sub- sample of patients completed the CARES-SF a fourth time ( T4 ) one week following T3 , for purpose s of test-retest reliability estimation . RESULTS On average , the CARES-SF required 11 minutes for completion and could be completed by 90 % of the patients without assistance . However , 82 % of the patients reported difficulty with at least one item . Multitrait scaling analysis and factor analysis generally confirmed the hypothesized scale structure . Internal consistency reliability coefficients exceeded the 0.70 criterion for four of six multi-item scales . The test-retest reliability coefficients of the six scales were above 0.70 . No systematic differences were found in the psychometrics of the CARES-SF across administration conditions . In the mail condition the proportion of missing items was significantly higher , and patients reported having significantly more problems than in both the telephone and in-clinic condition . According to expectation , selective scales distinguished clearly between patients differing in disease stage , performance status , treatment modality and tumor response . Additionally , selective scales were responsive to changes in health status over time . CONCLUSION These results lend support to the reliability and validity of the CARES-SF in assessing the quality of life of patients with cancer . At the same time , efforts to refine the question naire are recommended Background : Although various forms of psychoeducation and counseling interventions have been examined among patients with a variety of diagnoses , the unique contribution of phase-specific psychoeducation and telephone counseling ( TC ) to the ongoing process of adjustment has not been explored among patients with breast cancer and their partners . Objective : To conduct a r and omized controlled clinical trial of phase-specific evidence -based psychoeducation and TC interventions to enhance emotional , physical , and social adjustments in patients with breast cancer and their partners . Methods : A purposive sample of 249 patient-partner dyads were assigned r and omly to one of four groups : ( a ) control group receiving disease management ( DM ) , ( b ) st and ardized psychoeducation ( SE ) , ( c ) TC , or ( d ) st and ardized psychoeducation plus telephone counseling ( SE + TC ) . Data were collected at baseline , diagnostic , postsurgery , adjuvant therapy , and ongoing recovery phases measuring emotional , physical , and social adjustments . Results : Patients showed poorer adjustment over time in the DM group relative to those receiving interventions on selected measures of emotional adjustment . All patients showed improvement over time in overall health and adjustment in social and vocational environments . Partners in all groups exhibited improvement over time for measures of adjustment in the social environment but no changes in psychological well-being or overall health . Partners in the TC group had poorer scores on physical symptoms compared with the SE + TC group and poorer vocational scores compared with the DM group . Discussion : Findings from this study provide preliminary support for the value of phase-specific SE and TC interventions to enhance selected adjustment outcomes for patients with breast cancer and their partners PURPOSE The purpose of this study was to determine the efficacy of self-care/self-help promotion and uncertainty management interventions offered by the Self-Help Intervention Project ( SHIP ) for women receiving chemotherapy , radiation therapy , or hormone therapy for breast cancer . DESCRIPTION OF STUDY One hundred ninety-three women were r and omly assigned either to one of three intervention groups ( self-help course , uncertainty management , or self-help course plus uncertainty management ) or to a control group . Data were analyzed by a repeated measures multivariate analysis of variance procedure using a two-level blocking factor ( high and low re source fulness ) and four outcome variables ( self-care , self-help , psychological adjustment , and confidence in cancer knowledge ) . Data were collected at baseline ( T1 ) , which was after initiation of adjuvant therapy , allowing for the emergence of treatment-related side effects ; 6 to 8 weeks after T1 ( T2 ) ; and 3 months after T2 ( T3 ) . RESULTS At baseline , women having high re source fulness compared with women having low re source fulness evidence d greater self-care , self-help , psychological adjustment , and confidence in cancer knowledge . Participation in SHIP interventions result ed in higher levels of self-care , self-help , psychological adjustment , and confidence in cancer knowledge by time effect in a significant number of women regardless of their baseline re source fulness . Women participating in SHIP interventions who had low baseline re source fulness demonstrated the greatest change over time in the outcome variables . Post hoc results indicated that the effect primarily was the result of changes in psychological adjustment , confidence in cancer knowledge , and self-care . CLINICAL IMPLICATION S The findings of this study address both the treatment effect for supportive care interventions and the needs that have emerged from review of the last 20 years of supportive care research . Some SHIP interventions evidence d more strength than others ; data indicated that large percentages of women with low re source fulness who received no SHIP interventions experienced a decrement in self-care , self-help , confidence in cancer knowledge , and psychological adjustment over the time that they received adjuvant therapy . Women 's level of confidence in their knowledge about cancer being sufficient for self-management and self-help activities was not linked to baseline re source fulness level . Thus , inherent re source fulness was not a factor in need for supportive services that could maintain or increase confidence in cancer knowledge usefulness for self-management and self-help . Healthcare providers should note that although the women with low re source fulness benefited the most from the interventions , women who evidence d high re source fulness at baseline reported the same level of need for confidence in cancer knowledge and for self-help The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity ( VO2Lmax ) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied . Subjects were stratified by baseline functional capacity ( ± 1 MET ) and r and omized to experimental ( EX ) , placebo ( PL ) , and control ( CO ) groups . EX subjects completed a 10-week , 3 times/week exercise training program ; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises ; the CO group maintained normal activities . The EX group showed significant , p < .05 , improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups . The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy Evidence -based exercise and relaxation recommendations for people with breast cancer-related lymphedema ( BCRL ) are needed . We report a r and omized controlled study of one program , design ed to achieve synergistic improvements in physical and emotional BCRL symptoms . People in the treatment group received an exercise and relaxation program , The Breast Cancer Recovery Program ( N=16 ) . The  control participants ( N=16 )  continued with health professionals ' recommendations .  Participants were tested at entry , 2.5 weeks , 5 weeks , and 3 months . Treatment group participants , compared with control participants , demonstrated significant treatment effects for improved bioimpedance z , arm flexibility , quality of life , mood at 3 months , and weight loss . Adherence was high for this safe and effective program , which improved lymphedema physical and emotional symptoms The aim of this study was to compare a conventional oncological inpatient rehabilitation programme with an inpatient step-by-step rehabilitation programme with regard to quality of life in breast cancer patients . Patients and Methods : Women with the diagnosis of breast cancer were r and omly assigned to either the step-by-step programme ( group A : 3-week rehabilitation plus 4 and 8 months later a 1-week sojourn each time ) or the conventional rehabilitation programme ( group B : 4- week stay and no further interventions afterwards ) . Quality of life was assessed with the QLQ-C30 of the EORTC at t0 ( beginning of the study ) , t1 ( end of 3- or 4-week stay ) and t2 ( 12 months after t0 , end of study ) . Results : Between t0 and t1 , a tendency ( 0.1 > p = 0.05 ) could be shown in group B towards better improvement in global quality of life and emotional function . In the subgroup of patients that had impaired functions of quality of life at t0 , superiority in group B reached significance ( p < 0.05 ) for emotional and cognitive function at t1 . Between t1 and t2 , cognitive function improved further in group A , but diminished in group B. For the subgroup of patients with impaired cognitive function at t0 , this difference between both groups became significant ( p = 0.0098 ) . Conclusions : Although not generally superior to conventional inpatient rehabilitation programmes , the analysed stepby- step rehabilitation provided marked benefits for patients with cognitive impairments
BACKGROUND Breast cancer is the most common malignancy in women worldwide .
Multidisciplinary rehabilitation aims to improve outcomes for women but the evidence base for its effectiveness is yet to be established .
OBJECTIVES To assess the effects of organised multidisciplinary rehabilitation during follow-up in women treated for breast cancer .