NATURAL KILLER CELLS AND LYMPHOCYTES INCREASE IN WOMEN WITH BREAST CANCER FOLLOWING MASSAGE THERAPY A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. Trends in complementary/alternative medicine use by breast cancer survivors: Comparing survey data from 1998 and 2005 A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors Acupuncture for Treatment of Arthralgia Secondary to Aromatase Inhibitor Therapy in Women with Early Breast Cancer: Pilot Study The Effect of Acupuncture on Post-Cancer Fatigue and Well-Being for Women Recovering from Breast Cancer: A Pilot Randomised Controlled Trial Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy Acupuncture relieves menopausal discomfort in breast cancer patients: a prospective, double blinded, randomized study. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Prevalence of depression in breast cancer survivors: a systematic review of observational studies. Expressive writing in early breast cancer survivors. Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. A randomised, controlled trial of the psychological effects of reflexology in early breast cancer. Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial. Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer. Fatigue, psychological distress, coping and quality of life in patients with uterine cancer. Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer.
Women diagnosed with breast cancer received massage therapy or practice d progressive muscle relaxation ( PMR ) for 30-min sessions 3 times a week for 5 weeks or received st and ard treatment . The massage therapy and relaxation groups reported less depressed mood , anxiety , and pain immediately after their first and last sessions . By the end of the study , however , only the massage therapy group reported being less depressed and less angry and having more vigor . Dopamine levels , Natural Killer cells , and lymphocytes also increased from the first to the last day of the study for the massage therapy group . These findings highlight the benefit of these complementary therapies , most particularly massage therapy , for women with breast cancer BACKGROUND Arthralgia is a common and debilitating side-effect experienced by breast cancer patients receiving aromatase inhibitors ( AIs ) and often results in premature drug discontinuation . METHODS We conducted a r and omised controlled trial of electro-acupuncture ( EA ) as compared to waitlist control ( WLC ) and sham acupuncture ( SA ) in postmenopausal women with breast cancer who self-reported arthralgia attributable to AIs . Acupuncturists performed 10 EA/SA treatments over 8 weeks using a manualised protocol with 2 Hz electro-stimulation delivered by a TENS unit . Acupuncturists administered SA using Streitberger ( non-penetrating ) needles at non-traditional acupuncture points without electro-stimulation . The primary end-point was pain severity by Brief Pain Inventory ( BPI ) between EA and WLC at Week 8 ; durability of response at Week 12 and comparison of EA to SA were secondary aims . FINDINGS Of the 67 r and omly assigned patients , mean reduction in pain severity was greater in the EA group than in the WLC group at Week 8 ( -2.2 versus -0.2 , p=0.0004 ) and at Week 12 ( -2.4 versus -0.2 , p<0.0001 ) . Pain-related interference measured by BPI also improved in the EA group compared to the WLC group at both Week 8 ( -2.0 versus 0.2 , p=0.0006 ) and Week 12 ( -2.1 versus -0.1 , p=0.0034 ) . SA produced a magnitude of change in pain severity and pain-related interference at Week 8 ( -2.3 , -1.5 respectively ) and Week 12 ( -1.7 , -1.3 respectively ) similar to that of EA . Participants in both EA and SA groups reported few minor adverse events . INTERPRETATIONS Compared to usual care , EA produced clinical ly important and durable improvement in arthralgia related to AIs in breast cancer patients , and SA had a similar effect . Both EA and SA were safe Background Use of complementary and alternative medicine ( CAM ) by women with breast cancer is often said to be increasing , yet few data exist to confirm this commonly held belief . The purpose of this paper is to compare overall patterns of CAM use , as well as use of specific products and therapies at two different points in time ( 1998 vs 2005 ) by women diagnosed with breast cancer . Methods Surveys were mailed to women r and omly selected from the Ontario Cancer Registry ( Canada ) in the spring of 1998 ( n = 557 ) and again in the spring of 2005(n = 877 ) . Results The response rates were 76.3 % in 1998 and 63 % in 2005 . In 1998 , 66.7 % of women reported using either a  CAM product/therapy or seeing a CAM therapist at some time in their lives as compared with 81.9 % in 2005 ( p = 0.0002 ) . Increases were seen in both use of CAM products/therapies ( 62 % in 1998 vs. 70.6 % in 2005 ) and visits to CAM practitioners ( 39.4 % of respondents in 1998 vs 57.4 % of respondents in 2005 ) . Women in 2005 reported that 41 % used  CAM  for treating their breast cancer . The most commonly used products and practitioners for treating breast cancer as reported in 2005 were green tea , vitamin E , flaxseed , vitamin C , massage therapists and dietitians/nutritionists . Conclusion  CAM use ( both self-medication with products and visits to CAM practitioners ) increased significantly from 1998 to 2005 . Now that more than 80 % of all women with breast cancer report using CAM ( 41 % in a specific attempt to management their breast cancer ) , CAM use can no longer be regarded as an " alternative " or unusual approach to managing breast cancer Up to 50 % of women receiving aromatase inhibitor ( AI ) complain of AI-associated musculoskeletal symptoms ( AIMS S ) and 15 % discontinue treatment . We conducted a r and omized , sham-controlled trial to evaluate whether acupuncture improves AIMS S and to explore potential mechanisms . Postmenopausal women with early stage breast cancer , experiencing AIMS S were r and omized to eight weekly real or sham acupuncture sessions . We evaluated changes in the Health Assessment Question naire Disability Index ( HAQ-DI ) and pain visual analog scale ( VAS ) following the intervention compared to baseline . Serum estradiol , β-endorphin , and proinflammatory cytokine concentrations were measured pre and post-intervention . We enrolled 51 women of whom 47 were evaluable , including 23 r and omized to real and 24 to sham acupuncture . Baseline characteristics were balanced between groups with the exception of a higher HAQ-DI score in the real acupuncture group ( p = 0.047 ) . We did not observe a statistically significant difference in reduction of HAQ-DI ( p = 0.30 ) or VAS ( p = 0.31 ) between the two groups . Following eight weekly treatments , we observed a statistically significant reduction of IL-17 ( p ≤ 0.009 ) in both groups . No significant modulation was seen in estradiol , β-endorphin , or other proinflammatory cytokine concentrations in either group . We did not observe a significant difference in AIMS S changes between real and sham acupuncture . As sham acupuncture used in this study may not be equivalent to placebo , further studies with a non-acupuncture arm may be required to establish whether acupuncture is beneficial for the treatment of AIMS Background Aromatase inhibitors ( AIs ) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer . A substantial proportion of women taking AIs experience joint pain and stiffness . Studies have suggested that acupuncture may be effective in treating joint pain . Objective A pilot study was conducted to evaluate the feasibility , safety and efficacy of using acupuncture to treat AI-induced arthralgia . Methods A total of 32 patients were r and omised to receive either sham or real electroacupuncture ( EA ) twice weekly for 6 weeks . Outcomes of joint pain , stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , overall pain severity and interference with the BPI-SF and quality of life ( QOL ) with the Functional Assessment of Cancer Therapy-General ( FACT-G ) instrument . H and strength was assessed by a grip test , and a serum marker of inflammation ( C reactive protein ( CRP ) ) was also measured . All assessment s were performed at baseline , 6 weeks and 12 weeks , except for blood sample s at baseline and 6 weeks only . Results No serious adverse events were reported during or after acupuncture treatments . There were no significant differences in outcome measures . However , positive trends were observed in stiffness and physical function at week 12 in favour of real EA . Conclusions Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI . A larger study with adequately powered to confirm these results and detect clinical ly relevant effects is needed Objective To determine the feasibility and acceptability of acupuncture in managing fatigue and well-being in breast cancer survivors . Methods A r and omised controlled trial compared acupuncture was with sham acupuncture and wait list controls was performed in Sydney , Australia . A total of 30 women with fatigue following breast cancer treatment participated in the trial . Women received six sessions of acupuncture over 8 weeks . Outcomes related to an assessment of interest to participate in the trial and identification of appropriate recruitment strategies , appropriateness of eligibility criteria and compliance with treatment attendance . Clinical outcomes assessed fatigue and well-being . In-depth interviews were undertaken with seven women , who described their experience of acupuncture . Results Our study demonstrated feasibility with appropriate trial entry criteria , good acceptability and treatment compliance with the study interventions , and with the completion of outcome forms . There was a significant reduction in fatigue for women receiving acupuncture compared with control after 2 weeks mean difference ( MD ) 5.3 , 95 % CI 4.5 to 6.2 , p=0.05 , and a significant improvement in well-being at 6 weeks for acupuncture compared with the sham and wait list control , MD 2.7 , 95 % CI 2.1 to 3.2 , p=0.006 . Women described their experience of acupuncture positively , and interview data may also offer explanations for the improved outcomes of well-being , with women reporting an improvement in sleep , mood and relaxation . Conclusions Fatigue is a common symptom experienced by people recovering from treatment , and an appropriately powered trial to evaluate the effect of acupuncture is needed . Clinical Trial Registration Australian New Zeal and Clinical Trials Registry , www.anzctr.org.au ACTRN12610000720011 OBJECTIVES The aim of the present study was to examine the effect of massage on nausea , anxiety , and depression in patients with breast cancer undergoing chemotherapy . DESIGN This work was a single-center , prospect i ve , r and omized , controlled trial . SETTING S/LOCATION This study was conducted in an oncology clinic , in a hospital in southwestern Sweden . SUBJECTS Thirty-nine ( 39 ) women ( mean age = 51.8 ) with breast cancer undergoing chemotherapy were enrolled . INTERVENTIONS The patients were r and omly assigned to a massage therapy group ( 20 minutes of massage on five occasions ) or a control group ( five 20-minute visits ) . OUTCOME MEASURES All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention . They also completed the Hospital Anxiety and Depression Scale . RESULTS Massage treatment significantly reduced nausea compared with control treatment ( p = 0.025 ) when improvement was measured as a percentage of the five treatment periods . Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated . CONCLUSIONS This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients Background Cancer-related fatigue ( CRF ) is a prominent clinical problem . There are calls for multi-modal interventions . Methods We assessed the feasibility of delivering patient education integrated with acupuncture for relief of CRF in a pilot r and omized controlled trial ( RCT ) with breast cancer survivors using usual care as control . Social cognitive and integrative medicine theories guided integration of patient education with acupuncture into a coherent treatment protocol . The intervention consisted of two parts . First , patients were taught to improve self-care by optimizing exercise routines , improving nutrition , implementing some additional evidence -based cognitive behavioral techniques such as stress management in four weekly 50-minute sessions . Second , patients received eight weekly 50-minute acupuncture sessions . The pre-specified primary outcome , CRF , was assessed with the Brief Fatigue Inventory ( BFI ) . Secondary outcomes included three dimensions of cognitive impairment assessed with the FACT-COGv2 . Results Due to difficulties in recruitment , we tried several methods that led to the development of a tailored recruitment strategy : we enlisted oncologists into the core research team and recruited patients completing treatment from oncology waiting rooms . Compared to usual care control , the intervention was associated with a 2.38-point decline in fatigue as measured by the BFI ( 90 % Confidence Interval from 0.586 to 5.014 ; p < 0.10 ) . Outcomes associated with cognitive dysfunction were not statistically significant . Conclusions Patient education integrated with acupuncture had a very promising effect that warrants conducting a larger RCT to confirm findings . An effective recruitment strategy will be essential for the successful execution of a larger-scale trial . Trial registration Background : Breast cancer patients frequently experience psychological distress during the chemotherapy period . Objectives : This study aim ed to evaluate the effect of relaxation with guided imagery on patients with breast cancer . Patients and Methods : A two-group , pretest-posttest , quasi-experimental design with a r and omized controlled trial was conducted . Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study . These patients were r and omly assigned to the experimental group ( n = 32 ) or to the control group ( n = 33 ) . Both groups received chemotherapy self-care education , but the experimental group also received relaxation with guided imagery training . The training on relaxation with guided imagery was conducted before chemotherapy , and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy . Results : The experimental group showed significant decreases in insomnia ( -0.34 ± 0.83 , P < 0.05 ) , pain ( -0.28 ± 0.58 , P < 0.05 ) , anxiety ( -3.56 ± 2.94 , P < 0.00 ) , and depression ( -2.38 ± 2.70 , P < 0.00 ) between the pretest and the posttest . Comparing the two groups , statistically significant differences were found in the overall symptom distress ( B = 0.11 , P < 0.05 ) , insomnia ( B = 0.50 , P < 0.05 ) , depression ( B = 0.38 , P < 0.05 ) , and numbness in physical symptoms ( B = 0.38 , P < 0.05 ) , as well as in anxiety ( B = 3.08 , P < 0.00 ) and depression ( B = 1.86 , P < 0.00 ) in psychological distress . One week of relaxation with guided imagery can significantly improve the overall symptoms of distress , insomnia , depression , physical symptoms , and anxiety , and can decrease psychological distress . Conclusions : Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients BACKGROUND This study evaluates the effect of acupuncture on hot flashes and disturbed night sleep in patients treated for breast cancer . The effect of acupuncture was tested against a sham-acupuncture group and a no-treatment control group . Plasma estradiol was measured to rule out this as cause of effect . Side effects of the treatment were registered . METHODS We r and omized 94 women into the study : 31 had acupuncture , 29 had sham acupuncture and 34 had no treatment .  FINDINGS In the acupuncture group , 16 patients ( 52 % ) experienced a significant effect on hot flashes compared with seven patients ( 24 % ) in the sham group ( p < 0.05 ) . The effect came after the second acupuncture session and lasted for at least 12 weeks after last treatment . A statistically significant positive effect was seen on sleep in the acupuncture group compared with the sham-acupuncture and no-treatment groups . The effect was not correlated with increased levels of plasma estradiol . No side effects of acupuncture were registered . INTERPRETATION We find that acupuncture significantly relieves hot flashes and sleep disturbances and is a good and safe treatment in women treated for breast cancer PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  TA included full body/auricular acupuncture and joint-specific point prescriptions , whereas SA involved superficial needle insertion at nonacupoint locations . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Modified Score for the Assessment of Chronic Rheumatoid Affections of the H and s ( M-SACRAH ) obtained at baseline and at 3 and 6 weeks . Results Of 51 women enrolled , 43 women were r and omly assigned and 38 were evaluable . Baseline characteristics were comparable between the two groups . Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks , which was lower for TA compared with SA ( 3.0 v 5.5 ; P < .001 ) . We also found differences between TA and SA in pain severity ( 2.6 v 4.5 ; P = .003 ) and pain-related interference ( 2.5 v 4.5 ; P = .002 ) at 6 weeks . Similar findings were seen for the WOMAC and M-SACRAH scores . The acupuncture intervention was well-tolerated . CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness , which was not seen with SA . Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect BACKGROUND Depression is common in breast cancer patients . The aim of this paper was to make a systematic review of its prevalence and associated factors oin breast cancer survivors . MATERIAL S AND METHODS An extensive systematic electronic review ( PUBMED , CINAHL , PsyINFO and Ovid ) and h and search were carried out to retrieve published articles up to November 2012 , using Depression OR Dysthymia AND ( Cancer OR Tumor OR Neoplasms as the keywords . Information about the design of the studies , measuring scale , characteristics of the participants , prevalence of depression and its associated factors from the included studies were extracted and summarized . RESULTS We identified 32 eligible studies that recruited 10,826 breast cancer survivors . Most were cross-sectional or prospect i ve design ed . The most frequent instrument used to screen depression was the  Center for Epidemiological Studies for Depression  ( CES-D , n=11 studies ) followed by the Beck Depression Inventory ( BDI , n=6 studies ) and the  Hospital Anxiety and Depression Scale  ( HADS , n=6 studies ) . CES-D returned about similar prevalence of depression ( median=22 % , range=13 - 56 % ) with BDI ( median=22 % , range=17 - 48 % ) but higher than HADS ( median=10 % , range=1 - 22 % ) . Depression was associated with several socio-demographic variables , cancer-related factors , treatment-related factors , subject psychological factors , lifestyle factors , social support and quality of life . CONCLUSIONS Breast cancer survivors are at risk for depression so that detection of associated factors is important in clinical practice AIMS This article is the report of a study aim ed at determining whether or not expressive writing improves the quality -of-life of early breast cancer survivors . An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results . BACKGROUND The risk of distress can extend well beyond the time of a breast cancer diagnosis . Emotional expression may assist in dealing with this . DESIGN R and omized controlled study . METHODS Participants ( n = 120 ) were r and omized into one of four groups : a control group ( no writing ) or one of three expressive writing groups : breast cancer trauma , any self-selected trauma and facts related to breast cancer . Participants wrote 20 minutes a day for 4 consecutive days . Their quality -of-life was measured , using the ' Functional Assessment of Cancer Therapy-Breast Cancer Version ' , at baseline and at 1 month and 6 months after writing . Paired t-tests , multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment , collected in 2006 . Intention-to-treat analysis was used . RESULTS / FINDINGS Expressive writing about one 's breast cancer , breast cancer trauma and facts related to breast cancer , significantly improved the quality -of-life outcome . CONCLUSION Expressive writing , focusing the instructions on writing about one 's living and dealing with a diagnosis of breast cancer , is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality -of-life 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 OBJECTIVES Women with breast cancer are at risk for elevated depression , anxiety , and decreased natural killer ( NK ) cell number . Stress has been linked to increased tumor development by decreasing NK cell activity . The objectives of this study included examining massage therapy for women with breast cancer for ( 1 ) improving mood and biological measures associated with mood enhancement ( serotonin , dopamine ) , ( 2 ) reducing stress and stress hormone levels , and ( 3 ) boosting immune measures . METHODS Thirty-four women ( M age=53 ) diagnosed with Stage 1 or 2 breast cancer were r and omly assigned postsurgery to a massage therapy group ( to receive 30-min massages three times per week for 5 weeks ) or a control group . The massage consisted of stroking , squeezing , and stretching techniques to the head , arms , legs/feet , and back . On the first and last day of the study , the women were assessed on ( 1 ) immediate effects measures of anxiety , depressed mood , and vigor and ( 2 ) longer term effects on depression , anxiety and hostility , functioning , body image , and avoidant versus intrusive coping style , in addition to urinary catecholamines ( norepinephrine , epinephrine , and dopamine ) and serotonin levels . A subset of 27 women ( n=15 massage ) had blood drawn to assay immune measures . RESULTS The immediate massage therapy effects included reduced anxiety , depressed mood , and anger . The longer term massage effects included reduced depression and hostility and increased urinary dopamine , serotonin values , NK cell number , and lymphocytes . CONCLUSIONS Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood , anxiety , and anger and for enhancing dopamine , serotonin , and NK cell number and lymphocytes 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 Cross-sectional data suggest that many individuals with breast cancer experience significant sleep disturbance across the continuum of care . Underst and ing the longitudinal trajectory of sleep disturbance may help identify factors associated with its onset , severity , or influence on health-related quality of life ( HRQL ) . Study objectives were to observe sleep quality in breast cancer patients prior to , during , and after completion of adjuvant chemotherapy  , evaluate its relationship with HRQL and explore correlates over time . Methods Participants were administered patient-reported outcome measures including the Pittsburgh Sleep Quality Index ( PSQI ) and the Functional Assessment of Cancer Therapy — General ( FACT-G ) , which assesses HRQL . Data were collected prospect ively 3–14 days prior to beginning chemotherapy , cycle 4 day 1 of chemotherapy , and 6 months following initiation of chemotherapy .  Results Participants ( n = 80 ) were primarily women ( 97.5 % ) with stage II ( 69.0 % ) breast cancer .  Total FACT-G scores were negatively correlated with global PSQI scores at each time point ( rho = −0.46 , −0.41 , −0.45 ; all p < 0.001 ) . Poor sleep quality ( PSQI ≥ 5 ) was prevalent at all time points ( 48.5–65.8 % ) ; however , there were no significant changes within participants over time . Correlates with sleep quality varied across time points . Participants with  poor sleep quality reported worse overall HRQL , fatigue , depression , and vasomotor/endocrine symptoms . Conclusions These findings suggest that early identification of sleep disturbance and ongoing assessment and treatment of contributing factors over the course of care may minimize symptom burden associated with chemotherapy and prevent chronic insomnia in survivorship PURPOSE We aim ed to assess the effectiveness of acupuncture for  cancer-related fatigue ( CRF ) in patients with breast cancer . PATIENTS AND METHODS We conducted a pragmatic , r and omized controlled trial comparing acupuncture with enhanced usual care .  Three hundred two out patients with breast cancer participated . We r and omly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care  ( r and om assignment of 1:3 respectively ) with minimization controlling for baseline general fatigue and maintenance treatment . Treatment was delivered by acupuncturists once a week for 6 weeks through needling three pairs of acupoints . The usual care group received a booklet with information about fatigue and its management . Primary outcome was general fatigue at 6 weeks , measured with the  Multidimensional Fatigue Inventory ( MFI ) . Other measurements included the Hospital Anxiety and Depression Scale , Functional Assessment of Cancer Therapy-General quality -of-life scale , and expectation of acupuncture effect . Analyses were by intention to treat . RESULTS Two hundred forty-six of 302 patients r and omly assigned provided complete data at 6 weeks . The difference in the mean General Fatigue score , between those who received the intervention and those who did not , was -3.11 ( 95 % CI , -3.97 to -2.25 ; P < .001 ) . The intervention also improved all other fatigue aspects measured by MFI , including Physical Fatigue and Mental Fatigue  ( acupuncture effect , -2.36 and -1.94 , respectively ; both at P < .001 ) , anxiety and depression ( acupuncture effect , -1.83 and -2.13 , respectively ; both at P < .001 ) , and quality of life ( Physical Well-Being effect , 3.30 ; Functional Well-Being effect , 3.57 ; both at P < .001 ; Emotional Well-Being effect , 1.93 ; P = .001 ; and Social Functioning Well-Being effect , 1.05 ; P < .05 ) . CONCLUSION Acupuncture is an effective intervention for managing the symptom of CRF and improving patients ' quality of life PURPOSE To conduct a pragmatic r and omised controlled trial ( RCT ) to evaluate the effects of reflexology on quality of life ( QofL ) in women with early breast cancer . PATIENTS AND METHODS One hundred and eighty-three women were r and omised 6 weeks post-breast surgery to self-initiated support ( SIS ) ( comparator intervention ) , SIS plus reflexology , or SIS plus scalp massage ( control for physical and social contact ) . Reflexology and massage comprised eight sessions at weekly intervals . The primary end-point was 18 weeks post surgery ; the primary outcome measure was the Trial Outcome Index ( TOI ) of the Functional Assessment of Cancer Therapy ( FACT-B ) - breast cancer version . The secondary end-point was 24 weeks post surgery . Secondary outcome measures were the Hospital Anxiety and Depression Scale ( HADS ) and the Mood Rating Scale ( MRS ) . RESULTS At primary end-point , massage , but not reflexology , was significantly better than SIS on the TOI . Reflexology and massage were both better than SIS for MRS relaxation . Massage was better than reflexology and SIS for MRS easygoingness . At secondary end-point , reflexology , but not massage , was better than SIS on the TOI and MRS relaxation . There were no significant differences between reflexology or massage . There were no significant between group differences in HADS anxiety and depression . Self-reported use of out of study complementary therapies indicated that this was unlikely to have a significant effect on findings . CONCLUSIONS When compared to SIS , reflexology and massage have statistically significant , and , for reflexology , clinical ly worthwhile , effects on QofL following surgery for early breast carcinoma OBJECTIVE To assess the effects of an expressive writing ( EW ) intervention on perceptions of emotional support in women completing treatment for early stage breast cancer . METHODS Women were recruited to the study during their final week of treatment . Of 260 eligible patients , 104 ( 40 % ) agreed to participate , and 93 were r and omised . Women in the writing group wrote for 20 min on four consecutive days . The control group received normal care . Women 's perceptions of emotional support , quality of life ( QOL ) , mood , and healthcare utilisation were assessed at baseline , 1 month , 3 months and 6 months . Interviews were conducted to explore women 's experience of writing . RESULTS Eighty participants completed all follow-ups . There was a significant effect of group on women 's perceptions of social support with those in the intervention group being more satisfied with the emotional support they received ( p<0.05 ) . Satisfaction with emotional support was negatively correlated with depression/dejection ( p<0.05 ) and anger/hostility ( p<0.05 ) and positively correlated with social and family well-being ( p<0.001 ) 6 months post intervention . There were no significant effects of the intervention on mood , QOL or healthcare utilisation . Most participants found writing valuable and did not report any long-term negative effects . CONCLUSION EW was associated with a higher level of satisfaction with emotional support compared with controls . Given the existing evidence supporting the importance of social support in adjustment to breast cancer , it seems feasible to suggest that EW may be a cost effective accessible treatment that could be incorporated into the ongoing care of women OBJECTIVE To examine the effects of an expressive writing intervention ( EWI ) on cancer-related distress , depressive symptoms , and mood in women treated for early stage breast cancer . METHODS A nationwide sample of 507 Danish women who had recently completed treatment for primary breast cancer were r and omly assigned to three 20-min home-based writing exercises , one week apart , focusing on either emotional disclosure ( EWI group ) or a non-emotional topic ( control group ) .  Cancer-related distress [ Impact of Event Scale ( IES ) ] , depressive symptoms ( Beck Depression Inventory-Short Form ) , and negative ( 37-item Profile of Moods State ) and positive mood ( Passive Positive Mood Scale ) were assessed at baseline and at 3 and 9 months post-intervention . Choice of writing topic ( cancer versus other ) , alexithymia ( 20-item Toronto Alexithymia Scale ) , and social constraints ( Social Constraints Scale ) were included as possible moderators . RESULTS Significant ( p<0.01 ) group differences in mood change from before to immediately after each session suggested successful manipulation . Reductions over time in psychological symptoms were seen in both groups ( p<0.05 ) , but no time × group interactions were found . Choice of writing topic moderated effects on IES , with women writing about other themes showing greater reductions in cancer-related avoidance than women writing about their cancer . Fewer depressive symptoms and higher levels of positive mood were seen 3 months post-intervention in women writing about their cancer when compared with the control group . Difficulties describing feelings and externally oriented thinking ( 20-item Toronto Alexithymia Scale ) moderated effects on positive mood and IES-total , while no moderating effects were found of social constraints . CONCLUSIONS In concordance with the majority of previous results with cancer patients , no main effects of EWI were found for cancer-related distress , depressive symptoms , and mood . Moderator analyses suggested that choice of writing topic and ability to process emotional experiences should be studied further PURPOSE / OBJECTIVES To evaluate the safety and efficacy of reflexology , a complementary therapy that applies pressure to specific areas of the feet . DESIGN Longitudinal , r and omized clinical trial . SETTING Thirteen community-based medical oncology clinics across the midwestern United States . SAMPLE A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and /or hormonal therapy . METHODS Following the baseline interview , women were r and omized into three primary groups : reflexology ( n = 95 ) , lay foot manipulation ( LFM ) ( n = 95 ) , or conventional care ( n = 96 ) . Two preliminary reflexology ( n = 51 ) and LFM ( n = 48 ) test groups were used to establish the protocol s. Participants were interviewed again postintervention at study weeks 5 and 11 . MAIN RESEARCH VARIABLES Breast cancer-specific health-related quality of life ( HRQOL ) , physical functioning , and symptoms . FINDINGS No adverse events were reported . A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group ( p = 0.04 ) . Severity of dyspnea was reduced in the reflexology group compared to the control group ( p < 0.01 ) and the LFM group ( p = 0.02 ) . No differences were found on breast cancer-specific HRQOL , depressive symptomatology , state anxiety , pain , and nausea . CONCLUSIONS Reflexology may be added to existing evidence -based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and /or hormonal therapy . IMPLICATION S FOR NURSING Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer BACKGROUND Cancer-related fatigue ( CRF ) is a subjectively experienced symptom that is multidimensional and multifactorial . Patients with cancer have identified fatigue as one of the major troubling symptoms and the primary cause of distress in their lives . AIMS The major aim of the study was to examine how patients diagnosed with uterine cancer describe their experience of fatigue , psychological distress , coping re sources and quality of life . A secondary aim was to describe the relationship between selected variables . METHOD A descriptive and correlational design was used and the study was conducted at a university hospital in Sweden . The study population consisted of women , diagnosed with uterine cancer , who where scheduled to receive curative external radiation therapy . Sixty women participated in the study and data were collected through self-report instruments . Demographic and clinical data were extracted from patient records . The data were collected during year 2000 - 2002 . The Conceptual Model of Symptom Management was used as a framework to guide the study . FINDINGS Patients experienced a low grade of fatigue and psychological distress , but their functional status and global quality of life was high . Significant correlations were found between general fatigue and anxiety and also between general fatigue and depression . There was a significant negative correlation between general fatigue and coping re sources . Depression explained 44 % of the variance in general fatigue . CONCLUSIONS The findings provide knowledge about predictors of CRF in women with uterine cancer , and can serve as a basis for future longitudinal studies in which different prophylactic strategies against therapy-related fatigue are prospect ively studied 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
UNLABELLED Research es have accumulated using non-pharmacologic interventions including acupoint stimulation , massage therapy and expressive writing to manage breast cancer-related symptoms .
Results from r and omized controlled trials ( RCTs ) can get contradictory .
OBJECTIVE A systematic review and meta- analysis were conducted to determine the effects on the quality of life , negative emotions and disease-related symptoms among women with breast cancer .