Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial. Individual Psychosocial Support for Breast Cancer Patients: A Randomized Study of Nurse Versus Psychologist Interventions and Standard Care A Psychological Intervention Reduces Inflammatory Markers by Alleviating Depressive Symptoms: Secondary Analysis of a Randomized Controlled Trial Effect of paroxetine hydrochloride (Paxil®) on fatigue and depression in breast cancer patients receiving chemotherapy Immune response, depression and fatigue in relation to support intervention in mammary cancer patients Effectiveness of guaraná (Paullinia cupana) for postradiation fatigue and depression: results of a pilot double-blind randomized study. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Fatigue and quality of life outcomes of exercise during cancer treatment. Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: impact on health-related quality of life in a randomized trial Randomized pilot test of a simultaneous stage-matched exercise and diet intervention for breast cancer survivors. The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial Short-term effects of telephone therapy for breast cancer patients. Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Guarana (Paullinia cupana) improves fatigue in breast cancer patients undergoing systemic chemotherapy. Complementary medicine for fatigue and cortisol variability in breast cancer survivors The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer Telephone therapy for patients with breast cancer. Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. Randomized, double-blind, placebo-controlled crossover trials of venlafaxine for hot flashes after breast cancer. The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Health-related quality of life during hormone therapy after breast cancer: a randomized trial Long-term telephone therapy outcomes for breast cancer patients. Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: a randomized controlled pilot trial Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: Immunologic effects. Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer.
Abstract Objective : To assess the medical and psychosocial effects of  early hospital discharge after surgery for breast cancer on complication rate , patient satisfaction , and psychosocial outcomes . Design : R and omised trial comparing discharge from hospital 4 days after surgery ( with drain in situ ) with discharge after drain removal ( mean 9 days in hospital ) . Psychosocial measurements performed before surgery and 1 and 4 months after . Setting : General hospital and cancer clinic in Rotterdam with a socioeconomically diverse population . Subjects : 125 women with operable breast cancer . Main outcome measures : Incidence of complications after surgery for breast cancer , patient satisfaction with treatment , and psychosocial effects of short stay or long stay in hospital . Results : Patient satisfaction with the short stay in hospital was high ; only 4 % ( 2/56 at 1 month after surgery and 2/52 at 4 months after surgery ) of patients indicated that they would have preferred a longer stay . There were no significant differences in duration of drainage from the axilla between the short stay and long stay groups ( median 8 v 9 days respectively , P=0.45 ) or the incidence of wound complications ( 10 patients v 9 patients ) . The median number of seroma aspirations per patient was higher for the long stay group ( 1 v 3.5 , P=0.04 ) . Leakage along the drain occurred more frequently in short stay patients ( 21 v 10 patients , P=0.04 ) . The two groups did not differ in scores for psychosocial problems ( uncertainty , anxiety , loneliness , disturbed sleep , loss of control , threat to self esteem ) , physical or psychological complaints , or in the coping strategies used . Before surgery , short stay patients scored higher on scales of depression ( P=0.03 ) and after surgery they were more likely to discuss their disease with their families ( at 1 month P=0.004 , at 4 months P=0.04 ) . Conclusions : Early discharge from hospital after surgery for breast cancer is safe and is well received by patients . Early discharge seems to enhance the opportunity for social support within the family . Key messages Early discharge from hospital after breast cancer surgery does not lead to an increase in the incidence of wound infection or seroma formation A short stay in hospital , with support from community nurses on the patient 's return home , is acceptable to patients Psychosocial rehabilitation is not influenced by early discharge Recovery in the family environment may facilitate discussion of the illness Patients recovering from surgery for breast cancer need not spend more than three days in hospital provided that they are in good physical condition and there is adequate nursing support available in the OBJECTIVES To assess whether omission of postoperative radiotherapy in women with ' low-risk ' axillary node negative breast cancer ( T0 - 2 ) treated by breast-conserving surgery and endocrine therapy improves quality of life and is more cost-effective . DESIGN A r and omised controlled clinical trial , using a method of minimisation balanced by centre , grade of cancer , age , lymphatic/vascular invasion and preoperative endocrine therapy , was performed . A non-r and omised cohort was also recruited , in order to complete a comprehensive cohort study . SETTING The setting was breast cancer clinics in cancer centres in the UK . PARTICIPANTS Patients aged 65 years or more were eligible provided that their cancers were considered to be at low risk of local recurrence , were suitable for breast-conservation surgery , were receiving endocrine therapy and were able and willing to give informed consent . INTERVENTIONS The st and ard treatment of postoperative breast irradiation or the omission of radiotherapy . MAIN OUTCOME MEASURES Quality of life was the primary outcome measure , together with anxiety and depression and cost-effectiveness . Secondary outcome measures were recurrence rates , functional status , treatment-related morbidity and cosmesis . The principal method of data collection was by question naire , completed at home with a research nurse at four times over 15 months . RESULTS The hypothesised improvement in overall quality of life with the omission of radiotherapy was not seen in the EuroQol assessment or in the functionality and symptoms summary domains of the European Organisation for Research in the Treatment of Cancer ( EORTC ) scales . Some differences were apparent within subscales of the EORTC question naires , and insights into the impact of treatment were also provided by the qualitative data obtained by open-ended questions . Differences were most apparent shortly after the time of completion of radiotherapy . Radiotherapy was then associated with increased breast symptoms and with greater fatigue but with less insomnia and endocrine side-effects . Patients had significant concerns about the delivery of radiotherapy services , such as transport , accommodation and travel costs associated with receiving radiotherapy . By the end of follow-up , patients receiving radiotherapy were expressing less anxiety about recurrence than those who had not received radiotherapy .  Functionality was not greatly affected by treatment . Within the r and omised controlled trial , the Barthel Index demonstrated a small but significant fall in functionality with radiotherapy compared with the no radiotherapy arm of the trial . Results from the non-r and omised patients did not confirm this effect , however . Cosmetic results were better in those not receiving radiotherapy but this did not appear to be an important issue to the patients . The use of home-based assessment s by a research nurse proved to be an effective way of obtaining high- quality data . Costs to the NHS associated with postoperative radiotherapy were calculated to be of the order of 2000 pounds per patient . In the follow-up in this study , there were no recurrences , and the quality of life utilities from EuroQol were almost identical . CONCLUSIONS Although there are no differences in overall quality of life scores between the patients treated with and without radiotherapy , there are several dimensions that exhibit significant advantage to the omission of irradiation . Over the first 15 months , radiotherapy for this population is not a cost-effective treatment . However , the early postoperative outcome does not give a complete answer and the eventual cost-effectiveness will only become clear after long-term follow-up . Extrapolations from these data suggest that radiotherapy may not be a cost-effective treatment unless it results in a recurrence rate that is at least 5 % lower in absolute terms than those treated without radiotherapy . Further research is needed into a number of areas including the long-term aspects of quality of life , clinical outcomes , costs and consequences of omitting radiotherapy In a prospect i ve , r and omized study , an individual psychosocial support intervention performed by specially trained oncology nurses , or psychologists , were compared with st and ard care .  Consecutive primary breast cancer patients about to start adjuvant therapy ( n = 179 ) were included . Data were supplied by the question naires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life question naire with 30 questions ( EORTC QLQ-C30 ) and Breast Cancer Module with 23 questions ( BR23 ) , the Hospital Anxiety and Depression Scale , Spielberger 's State-Trait Anxiety Inventory , and the Impact of Event Scale before r and omization and 1 , 3 , and 6 months later . Patient files provided data on utilization of psychosocial support offered in routine care . Global quality of life/health status , nausea and vomiting , and systemic therapy side effects were the subscales showing significant Group by Time interactions , favoring the interventions . Intervention groups improved statistically significantly more than the st and ard care group regarding insomnia , dyspnea , and financial difficulties . Nurse patients experienced less intrusion compared with the st and ard care group . All groups showed statistically and clinical ly significant improvements with time on several subscales . The intervention groups , however , improved to a greater extent . Fewer patients in the intervention groups used psychosocial hospital support compared with the st and ard care group . In conclusion , psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care Objectives : To test experimentally whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients and to test one mechanism for the intervention effects . Depression and inflammation are common among cancer patients . Data suggest that inflammation can contribute to depressive symptoms , although the converse remains untested . Methods : As part of a r and omized clinical trial , newly diagnosed breast cancer patients ( n = 45 ) with clinical ly significant depressive symptoms were evaluated and r and omized to psychological intervention with assessment or assessment only study arms . The intervention spanned 12 months , with assessment s at baseline , 4 , 8 , and 12 months . Mixed-effects modeling tested the hypothesis that the intervention reduced self-reported depressive symptoms ( Center for Epidemiological Studies Depression scale , Profile of Mood States Depression and Fatigue subscales , and Medical Outcomes Study -Short Form 36 Bodily Pain subscale ) and immune cell numbers that are elevated in the presence of inflammation ( white blood cell count , neutrophil count , and helper/suppressor ratio ) . Mediation analyses tested whether change in depressive symptoms , pain , or fatigue predicted change in white blood cell count , neutrophil count , or the helper/suppressor ratio . Results : The intervention reduced significantly depressive symptoms , pain , fatigue , and inflammation markers . Moreover , the intervention effect on inflammation was mediated by its effect on depressive symptoms . Conclusions : This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation . Data show that the intervention reduced directly depressive symptoms and reduced indirectly inflammation . Psychological treatment may treat effectively depressive symptoms , pain , and fatigue among cancer patients . CES-D = Center for Epidemiological Studies -Depression scale , Iowa short form ; SF-36 = Medical Outcomes Study -Short Form 36 ; KPS = Karnofsky Performance Status Summary Background . Fatigue can significantly interfere with a cancer patient ’s ability to fulfill daily responsibilities and enjoy life . It commonly co-exists with depression in patients undergoing chemotherapy , suggesting that administration of an antidepressant that alleviates symptoms of depression could also reduce fatigue . Methods . We report on a double-blind clinical trial of 94 female breast cancer patients receiving at least four cycles of chemotherapy r and omly assigned to receive either  20 mg of the selective serotonin re-uptake inhibitor ( SSRI ) paroxetine ( Paxil ® , SmithKline Beecham Pharmaceuticals ) or an identical-appearing placebo . Patients began their study medication seven days following their first on- study treatment and continued until seven days following their fourth on- study treatment . Seven days after each treatment , participants completed question naires measuring fatigue ( Multidimensional Assessment of Fatigue , Profile of Mood States-Fatigue/Inertia subscale and Fatigue Symptom Checklist ) and depression ( Profile of Mood States-Depression subscale [ POMS-DD ] and Center for Epidemiologic Studies -Depression [ CES-D ] ) . Results . Repeated- measures ANOVAs , after controlling for baseline measures , showed that paroxetine was more effective than placebo in reducing depression during chemotherapy as measured by the CES-D ( p=0.006 ) and the POMS-DD ( p=0.07 ) but not in reducing fatigue ( all measures , ps > 0.27 ) . Conclusions . Although depression was significantly reduced in the 44 patients receiving paroxetine  compared to the 50 patients receiving placebo , indicating that a biologically active dose was used , no significant differences between groups on any of the measures of fatigued were observed . Results suggest that modulation of serotonin may not be a primary mechanism of fatigue related to cancer treatment Goal of workTo study the effect of support intervention on immune function in breast cancer patients . Material s and methods Breast cancer patients from an ongoing prospect i ve r and omised quality -of -life study were chosen for assaying immune functions in relation to a support-group intervention program running on a residential basis . Twenty-one women received adjuvant-combined radio-chemotherapy ( CT-RT ) and 20 women radiotherapy ( RT ) . Eleven CT-RT and ten RT patients were r and omised to  support-group intervention , the rest served as controls .  Immune tests for NK cells and NK-cell cytotoxicity , as well as lymphocyte sub population s and response to antigen were performed before intervention , 2 , 6 , and 12 months later , in parallel to controls and healthy volunteers ( n = 11 ) .  Depression , anxiety and fatigue were evaluated by the Hospital Anxiety and Depression ( HAD ) and the Norwegian Fatigue question naire . The density of NK cell receptors and in vitro quantitation of functional NK cytotoxicity against K562 cell line were evaluated . Four-colour flow cytometry was used to detect signal transduction molecules and cytokine expression . T-cell proliferate response to purified protein derivate ( PPD ) antigen was evaluated . Results No significant immune effect of support intervention could be found . The immune variables were severely disarranged compared to healthy volunteers but showed a statistically significant improvement over time . The majority of patients suffered from fatigue but had low scores for depression and anxiety . Conclusion No effect on immune parameters could be detected from support intervention . The long-lasting immune suppression might override a putative effect of the intervention . Low depression scores may contribute to the absence of a detectable effect CONTEXT AND OBJECTIVE Guaraná ( Paullinia cupana ) has been used medicinally for centuries . The aim of this study is evaluate the effectiveness of guaraná in the treatment of postradiation depression and fatigue . DESIGN AND SETTING This study had a double-blind r and omized design with crossover between experimental arms , at Faculdade de Medicina da Fundação do ABC . METHODS We conducted a r and omized double-blind crossover trial with 36 patients with breast cancer undergoing adjuvant radiation therapy . We r and omized patients to either guaraná 75 mg daily p.o . or to placebo . Patients were switched to the other experimental arm at the middle of the radiation treatment , which consisted of 28 daily fractions of 180 cGy . Evaluations were conducted at the beginning , at the middle , and at the end of radiation therapy . RESULTS We were unable to show any statistically significant differences between the guaraná and the placebo-treated group with any of the measured scores . Also , within the same group , we did not see any statistically significant associations during either the guaraná- or placebo-treated periods with any of the aforementioned measures . CONCLUSIONS We were unable to show that patients with breast cancer undergoing radiation therapy derive any advantage with guaraná over placebo for both fatigue and depressive symptoms PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerobic nor resistance exercise significantly improved cancer-specific QOL  in breast cancer patients receiving chemotherapy , but they did improve self-esteem , physical fitness , body composition , and chemotherapy completion rate without causing lymphedema or significant adverse events PURPOSE Despite the recognition of fatigue as a common and distressing symptom during cancer treatment , there are few evidence -based interventions available to manage such fatigue . The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue , physical functioning , emotional distress , and quality of life ( QOL ) during breast cancer treatment . DESCRIPTION OF STUDY Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design . Subjects were r and omly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer . Symptoms , physical functioning , and QOL were measured at baseline , midtreatment , and at the end of treatment . RESULTS Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment . CLINICAL IMPLICATION S A home-based walking exercise program is a potentially effective , low-cost , and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer . This health-promoting self-care activity needs further testing in large r and omized clinical trials PURPOSE / OBJECTIVES To compare the effectiveness of a prescribed home-based walking exercise intervention with usual care in older women receiving hormonal treatment for breast cancer , and to examine relationships among levels of the cortisol , serotonin , interleukin-6 , and bilirubin biomarkers and fatigue , sleep disturbances , and depressive symptoms . DESIGN Longitudinal r and omized clinical trial . SETTING A National Cancer Institute- design ated cancer center in the southeastern United States . SAMPLE 20 women ( aged 55 years or older ) with breast cancer receiving hormonal treatment . METHODS Participants were r and omized to a walking exercise intervention or usual care . Laboratory sample s and the Pittsburgh Sleep Quality Index ( PSQI ) , the Piper Revised Fatigue Scale , and the Center for Epidemiological Studies -Depression Scale were collected at the initial clinic visit and at 12 weeks from the groups . Question naires also were collected at weeks 2 and 14 . MAIN RESEARCH VARIABLES Fatigue , sleep disturbances , depressive symptoms , biomarkers , and exercise . FINDINGS Effect of the exercise intervention on sleep scores was highly significant between groups . Exercise group scores on the PSQI decreased significantly over time ( indicating improved sleep quality ) , although scores did not change significantly within the control group . Sleep actigraphy also showed significantly shorter actual wake time and less movement in the exercise group . Serotonin levels also were significantly affected by the intervention . CONCLUSIONS Data suggest that a walking exercise intervention improves sleep in older women receiving hormonal treatment for their breast cancer . Serotonin levels may be a useful biomarker when assessing sleep disturbances in this group . IMPLICATION S FOR NURSING Clinicians need to be aware that older women receiving hormonal treatment for their breast cancer may experience fatigue , sleep disturbances , and depressive symptoms . Homebased walking activity may reduce symptom severity in this group This study examined the effect of informational audiotapes on patients ' self-care behaviors ( SCBs ) to manage chemotherapy side effects of fatigue , anxiety , and sleep disturbance .  Seventy-one women with breast cancer participated . Thirty-three received audiotapes on SCBs to manage side effects . Three telephone interviews were conducted . Overall , women who received education demonstrated more SCBs , a wider range of SCBs , increased use of SCBs over time , and less anxiety . Nursing time for education in busy clinics is minimal . Patient anxiety in the clinic environment interferes with learning . Audiotapes are an effective tool for use at home , providing for teaching and reinforcement of patient education BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment . Cognitive and behavioural techniques are not yet well established in France . A multi-site r and omized study was conducted to evaluate the effects of a psycho-educational group intervention in this population . METHODS Two hundred and three patients , recruited after primary treatment , were r and omly assigned either to a treatment group ( psycho-educational intervention ) or to a waiting-list control group . The 8-week programme of 2 h sessions comprised of thematic discussion s , information and training in stress management techniques . Evaluation at baseline , after 8 sessions , and 1 month after programme completion , included evaluations using the STAI , POMS , MAC , EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales . RESULTS We observed a significant reduction in anxiety ( STAI , POMS ) among group participants , a reduction in anger , depression and fatigue ( POMS ) , a significant improvement in vigor and interpersonal relationships ( POMS ) , in emotional and role functioning , in health status and fatigue level ( EORTC QLQ-C30 ) . In contrast , coping strategies ( MAC ) were not significantly different between groups . No group-related negative effects were observed and the global satisfaction levels were very high . CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention , which can accelerate the reduction of those negative affects which are present at the end of treatment . It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support , widely proposed in France , and should now be tested in groups with other types of cancer and at other disease phases Summary Background Ovarian ablation is an effective adjuvant therapy for primary breast cancer but little is known about its quality of life impact relative to the more widely used adjuvant chemotherapy . This r and omized study compared quality of life outcomes of adjuvant ovarian ablation versus cyclophosphamide , methotrexate , fluoracil ( CMF ) chemotherapy . Methods The Danish Breast Cancer Cooperative Group ( DBCG ) trial 89-b r and omized premenopausal patients with receptor-positive , primary breast cancer between nine cycles of CMF chemotherapy given every 3 weeks and ovarian ablation by oophorectomy .  In total , 317 r and omized patients were invited to take part in a longitudinal quality of life study with assessment s at 1 , 3 , 5 , 9 , 15 , and 24 months after r and omization . The question naire included the EORTC QLQ-C30 , the Hospital Anxiety and Depression Scale , and additional items assessing potential symptoms not included in the st and ard instruments . Results After 2 years , 260 women were alive and recurrence-free , and 196 of these ( 75 % ) had completed all six question naires . Overall , patients in the chemotherapy group had more symptomatology at the first three assessment s ( i.e. , during the 6 months treatment period ) , except for hot flushes/sweats . There were few differences between groups at later assessment s. In chemotherapy patients , the likelihood of preserving ovarian function decreased steeply with increasing age . CMF chemotherapy and ovarian ablation have similar impact on recurrence and survival . Conclusion Chemotherapy had more negative impact on health-related quality of life but preserved ovarian function in some younger patients PURPOSE / OBJECTIVES To investigate the feasibility and preliminary effects of a simultaneous stage-matched exercise and diet ( SSED ) intervention in breast cancer survivors . DESIGN R and omized , controlled trial . SETTING Oncology outpatient treatment clinics at the National Cancer Center in South Korea . SAMPLE 45 women with breast cancer who completed their cancer therapy . METHODS Participants were assigned to the SSED intervention group ( n = 23 ) or a control group ( n = 22 ) . Participants in the SSED group received a 12-week individualized intervention promoting prescribed exercise and a balanced diet through stage-matched telephone counseling and a workbook . MAIN RESEARCH VARIABLES Program feasibility , behavioral outcomes ( stage of motivational readiness for exercise and diet , physical activity , and diet quality ) , and quality -of-life ( QOL ) outcomes ( functioning and global QOL , fatigue , anxiety , and depression ) . FINDINGS Participant evaluations of the SSED intervention indicated that it was feasible and acceptable . All women felt that the overall intervention contents were appropriate , and 95 % believed that the intervention helped to promote healthy behaviors . Objective data also supported the SSED intervention 's feasibility ( i.e. , 91 % completed the trial and 100 % of intervention calls were received ) . When compared to control , the SSED intervention group showed significantly greater improvement in motivational readiness for exercise and diet , emotional functioning , fatigue , and depression . CONCLUSIONS Preliminary results suggest that the SSED intervention delivered via telephone counseling and workbook is feasible and beneficial for positive behavioral and QOL outcomes . IMPLICATION S FOR NURSING Nurse-led lifestyle interventions may improve QOL for cancer survivors Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0.01 ) . None of these latter changes were significant between groups . At baseline , very high correlations were noted between measures of quality of life , mood , and spiritual integration . At the end of the intervention , the CAM group showed higher satisfaction ( P=0.006 ) and fewer dropouts ( P=0.006 ) compared to the st and ard group . Better outcomes in quality of life in the CAM group were associated with lower initial fighting spirit ( r=-.39 , P=0.001 ) . No baseline factors predicted better outcomes in the St and ard group . In summary , the study found equivalence on most psychosocial outcomes between the two interventions Goal of workBreast cancer survivors have limited options for the treatment of hot flashes and related symptoms . Further , therapies widely used to prevent recurrence in survivors , such as tamoxifen , tend to induce or exacerbate menopausal symptoms . The aim of this preliminary , r and omized controlled trial was to evaluate the effects of a yoga intervention on menopausal symptoms in a sample of survivors of early-stage breast cancer ( stages IA – IIB ) . Material s and methods Thirty-seven disease-free women experiencing hot flashes were r and omized to the 8-week Yoga of Awareness program ( gentle yoga poses , meditation , and breathing exercises ) or to wait-list control . The primary outcome was daily reports of hot flashes collected at baseline , posttreatment , and 3 months after treatment via an interactive telephone system . Data were analyzed by intention to treat . Main results At posttreatment , women who received the yoga program showed significantly greater improvements relative to the control condition in hot-flash frequency , severity , and total scores and in levels of joint pain , fatigue , sleep disturbance , symptom-related bother , and vigor . At 3 months follow-up , patients maintained their treatment gains in hot flashes , joint pain , fatigue , symptom-related bother , and vigor and showed additional significant gains in negative mood , relaxation , and acceptance . Conclusions This pilot study provides promising support for the beneficial effects of a comprehensive yoga program for hot flashes and other menopausal symptoms in early-stage breast cancer survivors The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients . Women ( N = 222 ) with breast cancer were recruited and r and omly assigned to cancer education , emotional expression , or st and ard care . Oncology nurses conducted 6 individual 30-min-therapy phone sessions . Women in the cancer education condition reported greater perceived control than women in the st and ard care condition . No treatment effects were obtained for mood or quality of life . These are the 1st data from a large-scale study testing telephone therapy , and they suggest that such therapies may be ineffective . Explanations for the results include therapy type and delivery , participant characteristics , short- versus long-term results , therapy conent , and whether therapy is necessary for breast cancer patients OBJECTIVE The concept of symptom clusters is relatively new in cancer patients ' symptom management . This study , which spanned four cycles of chemotherapy , combined three commonly seen pre-treatment symptoms in cancer patients ( i.e. sleep disturbances , fatigue and depression ) into one symptom cluster , to explore the associations between pre-treatment cluster categories and longitudinal profiles of these same symptoms during chemotherapy . METHODS This was a prospect i ve study . Seventy-six women with newly diagnosed stage I-III breast cancer , scheduled to receive at least four cycles of adjuvant or neoadjuvant anthracycline-based chemotherapy participated . Data were collected at seven time points before and during treatment . Sleep quality was measured with the  Pittsburgh Sleep Quality Index  . Fatigue was measured with the Multidimensional Fatigue Symptom Inventory -- Short Form . Depressive symptoms were measured with the Center of Epidemiological Studies --Depression . Patients were divided into three groups based on the number of symptoms they experienced before the start of chemotherapy ( i.e. no symptoms , 1 - 2 symptoms or all three symptoms ) and a symptom cluster index ( SCI ) was computed . RESULTS All women reported worse sleep , more fatigue and more depressive symptoms during treatment compared with baseline ( all p's<0.01 ) ; however , those women with a higher SCI ( i.e. more symptoms pre-treatment ) continued to experience worse symptoms during treatment compared with those who began with fewer symptoms ( all p's<0.01 ) . CONCLUSIONS A higher clinical ly relevant-based pre-treatment symptom cluster was associated with more sleep disturbances , greater fatigue and more depressive symptoms during chemotherapy . Specific interventions for these pre-treatment symptoms may improve the frequency and severity of these same symptoms during chemotherapy , when they are most severe and most disruptive to quality of life BACKGROUND In patients with breast cancer ( BC ) undergoing systemic chemotherapy , cancer-related fatigue ( CRF ) is a common problem that can negatively impact quality of life . Guarana ( Paullinia cupana ) is a plant native to the Amazon basin that has been used as a stimulant since pre-Columbian times . OBJECTIVE The purpose of this study was to evaluate the effectiveness of guarana extract on fatigue , sleep quality , anxiety , depression symptoms , and menopause in a group of BC chemotherapy patients . PATIENTS AND METHODS Patients with progressive fatigue after their first cycle of chemotherapy were r and omized to receive either guarana 50 mg by mouth twice daily ( 32 patients ) or placebo ( 43 patients ) for 21 days . After a 7-day washout period , patients were crossed over to the opposite experimental arm . All patients were evaluated on days 1 , 21 , and 49 . The primary endpoint was the Functional Assessment of Chronic Illness Therapy-Fatigue ( FACIT-F ) question naire score , and secondary endpoints were the results of the Functional Assessment of Chronic Illness Therapy-Endocrine Symptoms ( FACT-ES ) , Brief Fatigue Inventory ( BFI ) , Pittsburg Sleep Quality Index , Chalder Fatigue Scale , and Hospital Anxiety and Depression Scale . RESULTS Guarana significantly improved the FACIT-F , FACT-ES , and BFI global scores compared to placebo on days 21 and 49 ( p < 0.01 ) . The Chalder Scale improved significantly on day 21 ( p < 0.01 ) but not on day 49 ( p = 0.27 ) . Guarana did not produce any Common Terminology Criteria for Adverse Events grade s 2 , 3 , or 4 toxicities and did not worsen sleep quality or cause anxiety or depression . CONCLUSIONS Guarana is an effective , inexpensive , and nontoxic alternative for the short-term treatment of fatigue  in BC patients receiving systemic chemotherapy . Further studies are needed to confirm these results and to evaluate their generalizability to chronic CRF and to other types of cancer Fatigue is a chief complaint in cancer patients , and warrants effective treatment . Biofield therapies are complementary medicine approaches used by cancer population s. There is little information about their efficacy To investigate the efficacy of classical massage on stress perception and mood disturbances , 34 women diagnosed with primary breast cancer were r and omized into an intervention or control group . For a period of 5 weeks , the intervention group ( n = 17 ) received biweekly 30-min classical massages . The control group ( n = 17 ) received no additional treatment to their routine health care . The  Perceived Stress Question naire ( PSQ ) and the Berlin Mood Question naire ( BSF ) were used and the patients ’ blood was collected at baseline ( T1 ) , at the end of the intervention period ( T2 ) , and 6 weeks after T2 ( T3 ) . Compared with control group , women in the intervention group reported significantly lower mood disturbances , especially for anger ( p = 0.048 ) , anxious depression ( p = 0.03 ) at T2 , and tiredness at T3 ( p = 0.01 ) . No group differences were found in PSQ scales , cortisol and serotonin concentrations at T2 and T3 . However , perceived stress and cortisol serum levels ( p = 0.03 ) were significantly reduced after massage therapy ( T2 ) compared with baseline in the intervention group . Further research is needed to vali date our findings PURPOSE / OBJECTIVES To test the value of telephone-administered cognitive-behavioral therapy in a study of patients with breast cancer . DESIGN Women were assigned r and omly to a therapy group or an assessment -only control group . SETTING A tertiary cancer treatment center serving rural areas of North Dakota and Minnesota . SAMPLE Women were recruited within three to four months of stage I ( n = 27 ) or stage II ( n = 26 ) breast cancer diagnosis . Age ranged from 30 - 82 ( mean = 51.5 years ) . Most participants ( n = 35 ) underwent a modified radical mastectomy ; 17 underwent a lumpectomy .  METHODS Therapy involved 10 30-minute ( or less ) telephone sessions . Data that were collected from mailed question naires included psychological distress ( Profile of Mood States ) , perceived stress , coping ( Coping Response Indices-Revised ) , quality of life ( Medical Outcome Scale ) , and satisfaction with therapy . Measures were completed at baseline and at 4- and 10-month follow-up intervals . MAIN RESEARCH VARIABLES Telephone therapy , stress , coping , and quality of life . FINDINGS With time , women in the therapy and control groups reported reduced stress and improved quality of life . However , significant reductions in some kinds of distress ( anxiety , anger , depression , and confusion ) were not observed . Most therapy participants liked the telephone treatment sessions but showed only modest improvement ( less anxiety and confusion ) compared with women in the control group . CONCLUSIONS Most patients reported being comfortable with the telephone therapy and said that they felt better as a result of it . However , the outcome data showed that telephone therapy -- as carried out in this study --produced only modest benefits . Research ers need to consider who is best for delivering such therapy . IMPLICATION S FOR NURSING PRACTICE Providing telephone therapy to patients with breast cancer has potential benefits , and nurses may be the appropriate professionals to administer the therapy BACKGROUND Although high-dose chemotherapy is rapidly gaining acceptance as a treatment option for a number of cancers , the long-term toxic effects of such therapy are a concern . Cognitive deficits ( e.g. , problems with memory and concentration ) are not uncommon after chemotherapy , but they have not been documented systematic ally . In this study , we assessed the prevalence of cognitive deficits in a group of patients with high-risk breast cancer who were r and omly assigned to receive either high-dose or st and ard-dose adjuvant chemotherapy plus tamoxifen  , and we investigated whether high-dose chemotherapy impaired cognitive functioning more than st and ard-dose chemotherapy . METHODS Cognitive functioning was evaluated by use of a battery of neuropsychologic tests . In addition , patients were interviewed with regard to cognitive problems , health-related quality of life , anxiety , and depression . Results from patients who received adjuvant systemic therapy were compared with results from patients who had early stage breast cancer not treated with such therapy ( control patients ) . RESULTS The study population consisted of 34 patients treated with high-dose chemotherapy plus tamoxifen , 36 patients treated with st and ard-dose chemotherapy plus tamoxifen , and 34 control patients . For all patients , the average time since the completion of last nonhormonal therapy was 2 years . Cognitive impairment was found in 32 % of the patients treated with high-dose chemotherapy , in 17 % of the patients treated with st and ard-dose chemotherapy , and in 9 % of the control patients . In comparison with the control patients , patients treated with high-dose chemotherapy appeared to have an 8.2-times higher risk of cognitive impairment ( odds ratio ; 95 % confidence interval [ CI ] = 1.8 - 37.7 ) ; in comparison with the patients who received st and ard-dose chemotherapy , this risk of impairment was 3.5-times higher ( 95 % CI = 1.0 - 12.8 ) . CONCLUSION High-dose chemotherapy appears to impair cognitive functioning more than st and ard-dose chemotherapy .  Central nervous system toxicity may be a dose-limiting factor in high-dose chemotherapy regimens BACKGROUND Although venlafaxine reduces self-reported hot flashes , no data have established the drug 's impact on physiologically documented hot flashes . Two r and omized , double-blind , placebo-controlled crossover trials examined the efficacy of two doses of venlafaxine in relation to physiological and self-reported hot flashes and other outcomes , including negative affect , fatigue , sleep , and quality of life . METHODS SAMPLE 57 breast cancer survivors in the low-dose study ; 20 in the high-dose study . SETTING university cancer clinics in the Southeast and Midwest . INTERVENTION 37.5 mg of venlafaxine ( low-dose study ) or 75 mg of venlafaxine ( high-dose study ) . MEASURES hot flash frequency ( physiological monitor , diary , and event marker ) , hot flash severity ( diary ) , hot flash bother ( diary ) , and question naires for hot flash impact on daily life , negative affect , fatigue , sleep , and quality of life . RESULTS Subjective but not physiological hot flash measures showed placebo effects . Venlafaxine result ed in modest decreases in hot flashes , but only hot flash interference improved differentially at the higher dose . The timing of venlafaxine 's effects on hot flashes varied by dose . Only women with a > or = 50 % decrease in physiological hot flashes experienced significant improvement in fatigue , sleep quality , and quality of life . Although side effects were mild , most patients discontinued venlafaxine long-term . CONCLUSIONS Although venlafaxine result ed in modest and acute reductions in hot flashes with few side effects , it may not be tolerable to some patients long-term . At least 50 % relief in physiological hot flashes may be needed for patients to demonstrate improvement in other outcomes , including decreased fatigue , improved sleep , and improved quality of life STUDY OBJECTIVE Fatigue and sleep disturbances are two of the most common and distressing symptoms of cancer patients . A relationship between the two symptoms was reported in symptom cluster studies ; however , only subjective measurements of sleep were examined and most studies were cross-sectional . In this study of women with breast cancer undergoing chemotherapy  , we explored the longitudinal relationship between fatigue and sleep measured both subjectively and objective ly . DESIGN Prospect i ve study . Data were collected at 7 time points : before ( baseline ) and during the 3 weeks of cycle 1 and cycle 4 chemotherapy . PARTICIPANTS Ninety-seven women with newly diagnosed stage I-III breast cancer who were scheduled to receive at least four 3-week cycles of chemotherapy .  MEASUREMENT AND RESULTS Objective sleep parameters were measured with an Actillume actigraph ( Ambulatory Monitoring Inc. ) . Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index ( PSQI ) . Fatigue was assessed with the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . Fatigue became worse during both cycles of chemotherapy ( P-values < 0.01 ) . Subjective sleep quality was poor at baseline and remained unchanged throughout treatment . Objective nighttime and daytime total sleep time increased compared to baseline during the treatment administration week of both cycles ; daytime total wake time decreased during the treatment week of both cycles and during the last 2 week of cycle 4 . Mixed model results revealed that fatigue was positively associated with total PSQI scores and with objective measures of total nap time , and negatively associated with total wake time during the day ( all P-values < 0.01 ) . CONCLUSION Fatigue was significantly associated with subjective reports of poor sleep and objective measures of daytime sleepiness , but not with nocturnal sleep as measured with actigraphy . This relationship between fatigue and sleep warrants further studies to explore their possible common underlying etiology Aim To study the effects of menopausal hormone therapy ( HT ) on health-related quality of life in women after breast cancer . Patients and methods In the Stockholm trial , breast cancer survivors were r and omized to HT ( estradiol and progestogen ) or to a control group ( no treatment ) .  A subgroup of 75 women was studied ( 38 with HT , 37 controls ) . Fifty patients were on concomitant tamoxifen .  Patients completed three question naires ( EORTC QLQ C-30 , EORTC QLQ-BR 23 and the Hospital Anxiety and Depression Scale ( HADS ) ) during 1 year of treatment . Results A significant group-by-time interaction was found for improvement of insomnia in the HT group ( p < 0.001 ) . Within the HT group , but not in the control group , there was significant improvement for HADS anxiety , HADS depression , emotional , cognitive , and social functions and global quality of life . When HT was added to tamoxifen , the increase in global quality of life was significant ( p < 0.01 ) . Conclusion The effects of HT on quality of life in breast cancer survivors have not previously been reported . The present data suggest that this controversial treatment may improve quality of life after breast cancer We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone . Women ( N = 218 ) with Stages I , II , or III breast cancer were r and omly assigned to breast cancer health education or emotional expression interventions , or to a st and ard care control condition . Outcome and process measures were obtained at baseline , 6-month and 13-month follow-ups . Oncology certified nurses conducted the therapies in six , 30-minute individual phone sessions . Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions . No treatment effects , however , were obtained for quality of life or mood , and all women generally improved on these measures over time . Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping . The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women . Overall , this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood Objective : To examine the effects of a scapula-oriented exercise on upper limb dysfunction in breast cancer survivors . Study design : A prospect i ve r and omized , controlled pilot trial with historical control . Setting : Rehabilitation department at a university hospital . Subjects : Thirty-two women with breast cancer were r and omly assigned to  scapula-oriented exercise group ( n = 16 ) and general exercise group ( n = 16 ) . An historical control group ( n = 18 ) without exercise was enrolled from breast cancer survivors . Interventions : The scapula-oriented exercises were design ed focusing on scapulothoracic movement . The general exercise group performed body conditioning exercise . Exercise therapies were performed for one session per week for eight weeks . Main outcome measures : Pain and physical disabilities related to upper limb dysfunction , quality of life and depression were used as subjective outcomes . Objective outcome measures included shoulder range of motion and strength . Outcomes were assessed at baseline and post exercise . Results : At baseline , no significant difference was observed among the three groups . The scapula-oriented exercise group showed improvements in pain , physical function , social function , and global quality of life compared with baseline , whereas the general exercise group showed improved fatigue and range of motion . The change in global quality of life ( P = 0.067 ; effect size , 0.33 ) and strength of external rotation ( P = 0.001 ; effect size , 0.55 ) were significantly greater in the scapula-oriented exercise group than in the general exercise and control group . Conclusion : Scapula-oriented exercise had beneficial effects on pain , quality of life and aspects of strength . The sample size required in a larger definitive study is 32 subjects per group BACKGROUND To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy ( BT ) [ Individualized Sleep Promotion Plan ( ISPP ) ] including modified stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . METHODS R and omized-controlled trial based on Piper Integrated Fatigue Model , 219 stages I-IIIA breast cancer patients . Prior to the initial chemotherapy treatment , BT participants developed an ISPP plan that was regularly reinforced and revised . Controls received healthy eating information and attention . Pittsburgh Sleep Quality Index ( PSQI ) , daily diary , actigraph , and Piper Fatigue Scale ( PFS ) data were collected 2 days prior , during the 7 days after each treatment , and 30 days after the last treatment . Repeated measures analysis of variance was used . RESULTS Prior to chemotherapy , participants reported mild fatigue and fairly poor sleep quality . All variables changed over time . A group by time interaction was found for sleep quality ( PSQI ) improving in the BT group . Diary revealed group differences on number of awakenings , minutes awake after sleep onset , and sleep efficiency . Fatigue ( PFS ) was similar between groups . CONCLUSIONS The BT group showed improved sleep quality over time and better sleep ( diary ) . Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph , or result in lower fatigue PURPOSE Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation . However , there is a definite need for experimental studies on this question . The goal of this r and omized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy ( CBT ) for chronic insomnia on immune functioning of breast cancer survivors . Previous analyses of this study showed that CBT was associated with improved sleep and quality of life , and reduced psychological distress . PATIENTS AND METHODS Fifty-seven women with chronic insomnia secondary to breast cancer were r and omly assigned to CBT ( n = 27 ) or to a waiting-list control condition ( WLC ; n = 30 ) . Peripheral-blood sample s were taken at baseline and post-treatment ( and postwaiting for WLC patients ) , as well as at 3- , 6- , and 12-month follow-up for immune measures , including enumeration of blood cell counts ( ie , WBCs , monocytes , lymphocytes , CD3 + , CD4 + , CD8 + , and CD16+/CD56 + ) and cytokine production ( ie , interleukin-1-beta [ IL-1beta ] and interferon gamma [ IFN-gamma ] ) . RESULTS Patients treated with CBT had higher secretion of IFN-gamma and lower increase of lymphocytes at post-treatment compared with control patients . Pooled data from both treated groups indicated significantly increased levels of IFN-gamma and IL-1beta from pre- to post-treatment . In addition , significant changes in WBCs , lymphocytes , and IFN-gamma were found at follow-up compared with post-treatment . CONCLUSION This study provides some support to the hypothesis of a causal relationship between clinical  insomnia  and immune functioning . Future studies are needed to investigate the clinical impact of such immune alterations BACKGROUND . A r and omized controlled trial was conducted to investigate the efficacy of classical massage treatment in reducing breast cancer-related symptoms and in improving mood disturbances . METHODS . Women diagnosed with primary breast cancer were r and omized into an intervention group and a control group . For a period of 5 weeks , the intervention group received bi-weekly 30-min classical massages in the back and head-neck areas . The control group received no additional treatment to their routine healthcare . To evaluate treatment efficacy , the following vali date d question naires were administrated at baseline ( T1 ) , at the end of the intervention ( T2 ) , and at a followup at 11 weeks ( T3 ) : the Short Form-8 Health Survey , the European Organization of Research and Treatment of Cancer quality of life question naire breast module ( EORTC QLQ-BR23 ) , the Giessen Complaints Inventory ( GBB ) , and the Berlin Mood Question naire ( BSF ) . RESULTS . Eighty-six eligible women ( mean age : 59 years ) were enrolled in the study . A significantly higher reduction of physical discomfort was found in the intervention group compared with the control group at T2 ( p=0.001 ) and at T3 ( p=0.038 ) . A decrease in fatigue was also observed . Women in the intervention group reported significantly lower mood disturbances at T2 ( p<0.01 ) but not at T3 . The effect of treatment on mood disturbances was significantly higher if a patient was treated continuously by the same masseur . CONCLUSION . Classical massage seems to be an effective adjuvant treatment for reducing physical discomfort and fatigue , and improving mood disturbances in women with early stage breast cancer
PURPOSE While fatigue , sleep disturbance , and depression often co-occur in breast cancer patients , treatment efficacy for this symptom cluster is unknown .
A systematic review was conducted to determine whether there are specific interventions ( ie , medical , pharmacological , behavioral , psychological , and complementary medicine approaches ) that are effective in mitigating the  fatigue-sleep disturbance-depression symptom cluster in breast cancer patients , using the Rapid Evidence Assessment of the Literature ( REAL ( © ) ) process .