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Background The Exercise Intensity Trial ( EXcITe ) is a r and omized trial to compare the efficacy of supervised moderate-intensity aerobic training to moderate to high-intensity aerobic training , relative to attention control , on aerobic capacity , physiologic mechanisms , patient-reported outcomes , and biomarkers in women with operable breast cancer following the completion of definitive adjuvant therapy . Methods / Design Using a single-center , r and omized design , 174 postmenopausal women ( 58 patients / study arm ) with histologically confirmed , operable breast cancer presenting to Duke University Medical Center ( DUMC ) will be enrolled in this trial following completion of primary therapy ( including surgery , radiation therapy , and chemotherapy ) . After baseline assessment s , eligible participants will be r and omized to one of two supervised aerobic training interventions ( moderate-intensity or moderate/high-intensity aerobic training ) or an attention-control group ( progressive stretching ) . The aerobic training interventions will include 150 mins.wk-1 of supervised treadmill walking per week at an intensity of 60%-70 % ( moderate-intensity ) or 60 % to 100 % ( moderate to high-intensity ) of the individually determined peak oxygen consumption ( VO2peak ) between 20 - 45 minutes/session for 16 weeks . The progressive stretching program will be consistent with the exercise interventions in terms of program length ( 16 weeks ) , social interaction ( participants will receive one-on-one instruction ) , and duration ( 20 - 45 mins/session ) . The primary study endpoint is VO2peak , as measured by an incremental cardiopulmonary exercise test . Secondary endpoints include physiologic determinants that govern VO2peak , patient-reported outcomes , and biomarkers associated with breast cancer recurrence/mortality . All endpoints will be assessed at baseline and after the intervention ( 16 weeks ) . Discussion EXCITE is design ed to investigate the intensity of aerobic training required to induce optimal improvements in VO2peak and other pertinent outcomes in women who have completed definitive adjuvant therapy for operable breast cancer . Overall , this trial will inform and refine exercise guidelines to optimize recovery in breast and other cancer survivors following the completion of primary cytotoxic therapy . Trial Registration Goals of workOur aim was to compare the effects of l and versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors . Patients and methods Ninety-eight breast cancer survivors were assigned to three groups : control , l and exercise , and water exercise . Both exercise groups participated in an 8-week multimodal program . Adiposity was measured by anthropometry ( body mass index , waist circumference ) and bioelectrical impedance ( body fat and muscle lean body mass ) . Incidence of clinical ly significant secondary lymphedema was also assessed . Finally , specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23.Main Results Using ANCOVA , significant group × time interactions for body fat percentage ( F = 3.376 ; P = 0.011 ) and lean body mass ( F = 3.566 ; P = 0.008 ) were found . Breast cancer survivors in the l and exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise ( P < 0.001 ) and control ( P = 0.002 ) groups . The ANCOVA revealed a significant group × time interaction for waist circumference ( F = 4.553 ; P = 0.002 ) : breast cancer survivors in the control group showed a greater waist circumference when compared to water ( P = 0.003 ) and l and ( P < 0.001 ) exercise groups . A significant group × time interaction was also found for breast symptoms ( F = 9.048 ; P < 0.001 ) : participants in the water exercise group experienced a greater decrease of breast symptoms than those in the l and exercise ( P < 0.01 ) and control ( P < 0.05 ) groups . Conclusion L and exercise produced a greater decrease in body fat and an increase in lean body mass , whereas water exercise was better for improving breast symptoms PURPOSE The purpose of our study was to evaluate the effect of cognitive behavioral therapy ( CBT ) , physical exercise ( PE ) , and of these two interventions combined ( CBT/PE ) on menopausal symptoms ( primary outcome ) , body image , sexual functioning , psychological well-being , and health-related quality of life ( secondary outcomes ) in patients with breast cancer experiencing treatment-induced menopause . PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms ( N=422 ) were r and omly assigned to CBT ( n=109 ) , PE ( n=104 ) , CBT/PE ( n=106 ) , or to a waiting list control group ( n=103 ) . Self-report question naires were completed at baseline , 12 weeks , and 6 months . Multilevel procedures were used to compare the intervention groups with the control group over time . RESULTS Compared with the control group , the intervention groups had a significant decrease in levels of endocrine symptoms ( Functional Assessment of Cancer Therapy-Endocrine Symptoms ; P<.001 ; effect size , 0.31 - 0.52 ) and urinary symptoms ( Bristol Female Lower Urinary Tract Symptoms Question naire ; P=.002 ; effect size , 0.29 - 0.33 ) , and they showed an improvement in physical functioning ( 36-Item Short Form Health Survey physical functioning subscale ; P=.002 ; effect size , 0.37 - 0.46 ) . The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats ( problem rating scale of the Hot Flush Rating Scale ; P<.001 ; effect size , 0.39 - 0.56 ) and an increase in sexual activity ( Sexual Activity Question naire habit subscale ; P=.027 ; effect size , 0.65 ) . Most of these effects were observed at both the 12-week and 6-month follow-ups . CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and , to a lesser degree , on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause . Future work is needed to improve the design and the planning of these interventions to improve program adherence Recovering from cancer treatment can be a difficult experience , both physically and psychologically . This paper describes a r and omized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer . To facilitate behaviour change , exercise counselling is also included as an integral component in the exercise therapy intervention .  Participants are r and omized to one of three groups : exercise therapy , body conditioning ( placebo control ) or a normal care control group .  The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks . Outcome measures include quality of life , physical self-perceptions , depression , satisfaction with life , exercise behaviour , aerobic capacity and percentage body fat . All outcomes are assessed at baseline , 4 weeks during the intervention and at the end of the 8-week intervention . Follow-up assessment s of outcomes take place at 3 and 6 months post-intervention . As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life , it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier Excess body weight at diagnosis and weight gain after breast cancer are associated with poorer long-term prognosis . This study investigated the effects of a lifestyle intervention on body weight and other health outcomes influencing long-term prognosis in overweight women ( BMI > 25.0 kg/m2 ) recovering from early-stage ( stage I – III ) breast cancer . A total of 90 women treated 3–18 months previously were r and omly allocated to a 6-month exercise and hypocaloric healthy eating program ( n = 47 , aged 55.6 ± 10.2 year ) or  control group ( n = 43 , aged 55.9 ± 8.9 year ) . Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice , supplemented by weekly nutrition seminars . Body weight , waist circumference , waist/hip ratio [ WHR ] , cardiorespiratory fitness , blood biomarkers associated with breast cancer recurrence and cardiovascular disease risk , and quality of life ( FACT-B ) were assessed at baseline and 6 months . Three-day diet diaries were used to assess macronutrient and energy intakes . A moderate reduction in body weight in the intervention group ( median difference from baseline of −1.09 kg ; IQR −0.15 to −2.90 kg ; p = 0.07 ) was accompanied by significant reductions in waist circumference ( p < 0.001 ) , WHR ( p = 0.005 ) , total ( p = 0.021 ) and saturated fat ( p = 0.006 ) intakes , leptin ( p = 0.005 ) , total cholesterol ( p = 0.046 ) , and resting diastolic blood pressure ( p = 0.03 ) . Cardiopulmonary fitness ( p < 0.001 ) and FACT-B quality of life ( p = 0.004 ) also showed significant improvements in the intervention group . These findings suggest that an individualized exercise and a hypocaloric healthy eating program can positively impact upon health outcomes influencing long-term prognosis in overweight women recovering from early-stage breast cancer BACKGROUND During the last decade , survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy . Limited data exist on the psychosocial aspects of the transitional period between the end of primary treatment and survivorship . We investigated the baseline psychosocial status of women enrolled in a r and omized trial testing two psychosocial interventions for women at the end of primary treatment . METHODS Participants , identified within 1 month after surgery ( registration ) , provided demographic information and limited measures of quality of life . They were followed until they finished primary treatment ( enrollment ) , at which time they completed a mailed baseline survey that included st and ardized measures of quality of life ( including st and ardized scales of physical and emotional functioning ) , mood , symptoms , and sexual functioning .  A total of 558 patients ( mean age = 56.9 years ) were enrolled in the study between July 1 , 1999 , and June 30 , 2002 . Health outcomes were examined according to treatment received : mastectomy with and without chemotherapy , and lumpectomy with and without chemotherapy . All statistical tests were two-sided . RESULTS Among all treatment groups , patients who had a mastectomy had the poorest physical functioning at registration ( P<.001 ) and at enrollment ( P=.05 ) . At enrollment , mood and emotional functioning were similar among all patients , with no differences by type of treatment received . At enrollment , symptoms , including muscle stiffness , breast sensitivity , aches and pains , tendency to take naps , and difficulty concentrating , were common among patients in all groups and were statistically significantly associated with poor physical functioning and emotional well-being . Sexual functioning was worse for women who received chemotherapy than for those who did not , regardless of type of surgery ( P<.001 ) . CONCLUSIONS At the end of primary treatment for breast cancer , women in all treatment groups report good emotional functioning but report decreased physical functioning , particularly among women who have a mastectomy or receive chemotherapy . Clinical interventions to address common symptoms associated with treatment should be considered to improve physical and emotional functioning at the end of primary treatment for breast cancer Exercise is considered to be a key aspect of lymphoedema treatment , although there is little evidence for the therapeutic effect of exercise in managing breast cancer-related lymphoedema ( BCRL ) . This small r and omised controlled trial ( RCT ) was design ed to determine the feasibility , prior to undertaking a larger RCT , of research ing a daily home-based exercise programme to treat stable BCRL . An experimental design compared the exercise intervention combined with st and ard lymphoedema self-care to self-care alone over a 6-month period . Twenty-three women with stable unilateral BCRL of ≥10 % excess limb volume ( ELV )  were r and omly allocated to a daily home-based exercise programme and self-care ( n = 11 ) or self-care measures alone ( n = 12 ) . The primary objective was to determine difference in limb volume reduction for the two groups . Secondary objectives were to monitor change in other areas that impact BCRL : quality of life , arm function and range of shoulder movement . All 23 women completed the trial , providing full data for each time point . The intervention group showed a clinical ly and statistically significant improvement in relative ELV at week 26 ( 95 % confidence interval ( CI ) −26.57 to −5.12 ) , whereas the control group improvement crossed the line of no effect ( 95 % CI −17.71 to 1.1 ) . This study demonstrated the feasibility of conducting a RCT of exercise as a therapeutic intervention in the management of BCRL . Although the sample was small , the results support the findings of other exercise studies which have shown trends towards improvement Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm . Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse . In clinical practice , this often translates into risk aversive guidance to avoid using the arm . This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living . Further , such guidance poses an additional barrier to staying physically active , potentially translating to weight gain , which has been shown to be associated with worse clinical course for women with lymphedema . We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity . Theoretically , this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side . The Physical Activity and Lymphedema ( PAL ) Trial is a recently completed r and omized controlled exercise intervention trial that recruited 295 breast cancer survivors ( 141 with lymphedema at study entry , 154 at risk for lymphedema at study entry ) . The purpose of this report is to provide detail regarding the study design , statistical design , and protocol of the PAL trial OBJECTIVE Although chemotherapy-induced cognitive impairment is common among breast cancer patients , evidence for effective interventions addressing cognitive deficits is limited . This r and omized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation ( TSM ) program to improve cognitive function and quality of life in breast cancer patients . METHODS Forty-seven breast cancer patients ( mean age 56.3 years ) , who were staged I-III at diagnosis , 6 - 60 months post-chemotherapy , and reported cognitive impairment at study entry were recruited . Participants were r and omized to either two weekly TSM sessions for 6 weeks or a wait list control group . Neuropsychological assessment s  were completed at baseline and 1 month post-treatment . Self-report measures of cognitive function ( Functional Assessment of Cancer Therapy (FACT)-Cog ) , quality of life ( SF-36 ) , depressive symptoms ( Center for Epidemiologic Studies Depression Scale ) , sleep disturbance ( Pittsburgh Sleep Quality Index ) , fatigue ( Brief Fatigue Inventory ) , and spirituality ( FACT-Sp ) were completed at baseline , the end of treatment , and 1 month later . RESULTS Relative to the control group , women in the TSM group performed better on the verbal memory test ( Rey Auditory Verbal Learning Test trial 1 ) ( p = 0.06 ) and the short-term memory and processing speed task ( Digit Symbol ) ( p = 0.09 ) and reported improved cognitive function ( p = 0.06 ) , cognitive abilities ( p = 0.08 ) , mental health ( p = 0.04 ) , and spirituality ( p = 0.05 ) at the end of treatment but not 1 month later . CONCLUSIONS This r and omized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short-term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT OBJECTIVES Considerable morbidity persists among survivors of breast cancer ( BC ) including high levels of psychological stress , anxiety , depression , fear of recurrence , and physical symptoms including pain , fatigue , and sleep disturbances , and impaired quality of life . Effective interventions are needed during this difficult transitional period . METHODS We conducted a r and omized controlled trial of 84 female BC survivors ( Stages 0-III ) recruited from the H. Lee Moffitt Cancer and Research Institute . All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and /or chemotherapy .  Subjects were r and omly assigned to a 6-week Mindfulness-Based Stress Reduction ( MBSR ) program design ed to self-regulate arousal to stressful circumstances or symptoms ( n=41 ) or to usual care ( n=43 ) . Outcome measures compared at 6 weeks by r and om assignment included vali date d measures of psychological status ( depression , anxiety , perceived stress , fear of recurrence , optimism , social support ) and psychological and physical subscales of quality of life ( SF-36 ) . RESULTS Compared with usual care , subjects assigned to MBSR(BC ) had significantly lower ( two-sided p<0.05 ) adjusted mean levels of depression ( 6.3 vs 9.6 ) , anxiety ( 28.3 vs 33.0 ) , and fear of recurrence ( 9.3 vs 11.6 ) at 6 weeks , along with higher energy ( 53.5 vs 49.2 ) , physical functioning ( 50.1 vs 47.0 ) , and physical role functioning ( 49.1 vs 42.8 ) . In stratified analyses , subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning . CONCLUSIONS Among BC survivors within 18 months of treatment completion , a 6-week MBSR(BC ) program result ed in significant improvements in psychological status and quality of life compared with usual care To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC ) .  Women were r and omly assigned into MBSR(BC ) or Usual Care ( UC ) . Eligible women were ≥ 21 years , had been diagnosed with breast cancer and completed treatment within 18 months of enrollment . Symptoms and interference with daily living were measured pre- and post-MBSR(BC ) using the M.D. And erson Symptom Inventory . Symptoms were reported as highly prevalent but severity was low . Fatigue was the most frequently reported and severe symptom among groups . Symptoms clustered into 3 groups and improved in both groups . At baseline , both  MBSR(BC ) and the control groups showed similar mean symptom severity and interference ; however , after the 6-week post-intervention , the MBSR(BC ) group showed statistically-significant reduction for fatigue and disturbed sleep ( P < 0.01 ) and improved symptom interference items , compared to the control group . For the between-group comparisons , 11 of 13 symptoms and 5 of 6 interference items had lower means in the MBSR(BC ) condition than the control condition . These results suggest that MBSR(BC ) modestly decreases fatigue and sleep disturbances , but has a greater effect on the degree to which symptoms interfere with many facets of life . Although these results are preliminary , MBSR intervention post-treatment may effectively reduce fatigue and related interference in QOL of breast cancer survivors The purpose of this study was to evaluate the preliminary efficacy and satisfaction/acceptability of training in memory or speed of processing versus wait-list control for improving cognitive function in breast cancer survivors . 82 breast cancer survivors completed a three-group r and omized , controlled trial . Primary outcomes were objective neuropsychological tests of memory and speed of processing . Secondary outcomes were perceived cognitive functioning , symptom distress ( mood disturbance , anxiety , and fatigue ) , quality of life , and intervention satisfaction/acceptability . Data were collected at baseline , post-intervention , and 2-month follow-up . Using repeated- measures mixed-linear ANCOVA models , each intervention was compared to wait-list control while adjusting for age , education , and baseline measures . The effect sizes for differences in means and the reliable improvement percentage were reported . The results show that domain-specific effects were seen for both interventions : memory training improved memory performance at 2-month follow-up ( p = 0.036 , d = 0.59 ) ; speed of processing training improved processing speed post-intervention ( p = 0.040 , d = 0.55 ) and 2-month follow-up ( p = 0.016 ; d = 0.67 ) . Transfer effects to non-trained domains were seen for speed of processing training with improved memory post-intervention ( p = 0.007 , d = 0.75 ) and 2-month follow-up ( p = 0.004 , d = 0.82 ) . Both interventions were associated with improvements in perceived cognitive functioning , symptom distress , and quality of life . Ratings of satisfaction/acceptability were high for both interventions . It was concluded that while both interventions appeared promising , speed of processing training result ed in immediate and durable improvements in objective measures of processing speed and verbal memory . Speed of processing training may have broader benefits in this clinical population Background Sexual dysfunction is a prevalent , long-term complication of breast cancer and its treatment and can be treated effectively with face-to-face sexual counselling . However , relatively few women actually opt for face-to-face sex therapy , with many women indicating that it is too confronting . Internet-based interventions might be a less threatening and more acceptable approach , because of the convenience , accessibility and privacy it provides . Recent studies have demonstrated the efficacy of internet-based programs for improving sexual functioning in the general population . The objective of the current study is to investigate the efficacy of an internet-based cognitive behavioral therapy ( CBT ) program in alleviating problems with sexuality and intimacy in women who have been treated for breast cancer . Methods / design In a multicenter , r and omized controlled trial we are evaluating the efficacy of an internet-based CBT program in reducing problems with sexuality and intimacy in breast cancer survivors . Secondary outcomes include body image , marital functioning , psychological distress , menopausal symptoms , and health-related quality of life . We will recruit 160 breast cancer survivors ( aged 18 - 65 years ) with a formal DSM-IV diagnosis of sexual dysfunction from general and academic hospitals in the Netherl and s. Women are r and omized to either an intervention or waiting-list control group . Self-report question naires are completed by the intervention group at baseline ( T0 ) , ten weeks after start of therapy ( T1 ) , post-treatment ( T2 ) , 3 months post-treatment ( T3 ) , and 9 months post-treatment ( T4 ) . The control group completes question naires at T0 , T1 and T2 . Discussion There is a need for accessible and effective interventions for the treatment of sexual dysfunctions in breast cancer survivors . This study will provide evidence about the efficacy of an internet-based approach to delivering a CBT intervention targeted specifically at these sexual health issues . If proven to be effective , internet-based CBT for problems with sexuality and intimacy will be a welcome addition to the care offered to breast cancer survivors . Hopefully this therapy will lower the barrier to seeking help for these problems , result ing in improved quality of life after breast cancer . Trial registration The study is registered at Clinical Trials.gov ( NCT02091765 ) PURPOSE To compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope : mindfulness-based cancer recovery ( MBCR ) and supportive-expressive group therapy ( SET ) . PATIENTS AND METHODS This multisite , r and omized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR , SET , or a 1-day stress management control condition . MBCR focused on training in mindfulness meditation and gentle yoga , whereas SET focused on emotional expression and group support . Both intervention groups included 18 hours of professional contact . Measures were collected at baseline and after intervention by assessors blind to study condition . Primary outcome measures were mood and diurnal salivary cortisol slopes . Secondary outcomes were stress symptoms , quality of life , and social support . RESULTS Using linear mixed-effects models , in intent-to-treat analyses , cortisol slopes were maintained over time in both SET ( P = .002 ) and MBCR ( P = .011 ) groups relative to the control group , whose cortisol slopes became flatter . Women in MBCR improved more over time on stress symptoms compared with women in both the SET ( P = .009 ) and control ( P = .024 ) groups . Per- protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group ( P = .005 ) and in social support compared with the SET group ( P = .012 ) . CONCLUSION In the largest trial to date , MBCR was superior for improving stress levels , quality of life and social support [ CORRECTED ] for distressed survivors of breast cancer . Both SET and MBCR also result ed in more normative diurnal cortisol profiles than the control condition . The clinical implication s of this finding require further investigation Summary Background Hot flushes and night sweats ( HFNS ) affect 65–85 % of women after breast cancer treatment ; they are distressing , causing sleep problems and decreased quality of life . Hormone replacement therapy is often either undesirable or contraindicated . Safe , effective non-hormonal treatments are needed . We investigated whether cognitive behavioural therapy ( CBT ) can help breast cancer survivors to effectively manage HFNS . Methods In this r and omised controlled trial , we recruited women from breast clinics in London , UK , who had problematic HFNS ( minimum ten problematic episodes a week ) after breast-cancer treatment . Participants were r and omly allocated to receive either usual care or usual care plus group CBT ( 1:1 ) . R and omisation was done in blocks of 12–20 participants , stratifying by age ( younger than 50 years , 50 years or older ) , and was done with a computer-generated sequence . The trial statistician and research ers collecting outcome measures were masked to group allocation . Group CBT comprised one 90 min session a week for 6 weeks , and included psycho-education , paced breathing , and cognitive and behavioural strategies to manage HFNS . Assessment s were done at baseline , 9 weeks , and 26 weeks after r and omisation . The primary outcome was the adjusted mean difference in HFNS problem rating ( 1–10 ) between CBT and usual care groups at 9 weeks after r and omisation . Analysis of the primary endpoint was done by modified intention to treat . The trial is registered , IS RCT N13771934 , and was closed March 15 , 2011 . Findings Between May 5 , 2009 , and Aug 27 , 2010 , 96 women were r and omly allocated to group CBT ( n=47 ) or usual care ( n=49 ) . Group CBT  significantly reduced HFNS problem rating at 9 weeks after r and omisation compared with usual care ( mean difference −1·67 , 95 % CI −2·43 to −0·91 ; p<0·0001 ) and improvements were maintained at 26 weeks ( mean difference −1·76 , −2·54 to −0·99 ; p<0·0001 ) . We recorded no CBT-related adverse events . Interpretation Group CBT seems to be a safe and effective treatment for women who have problematic HFNS after breast cancer treatment with additional benefits to mood , sleep , and quality of life . The treatment could be incorporated into breast cancer survivorship programmes and delivered by trained breast cancer nurses . Funding Cancer Research UK Introduction Healthy body weight is an important factor for prevention of breast cancerrecurrence . Yet , weight loss and weight gain are not currently included in clinical - practice guidelines for posttreatment of breast cancer . The work reportedaddresses one of the questions that must be considered in recommending weight lossto patients : does it matter what diet plan is used , a question of particular importance because breast cancer treatment can increase risk for cardiovasculardisease . Methods Women who completed treatment for breast cancer were enrolled in a nonr and omized , controlled study investigating effects of weight loss achieved by using twodietary patterns at the extremes of macronutrient composition , although both dietarms were equivalent in protein : high fat , low carbohydrate versus low fat , highcarbohydrate . A nonintervention group served as the control arm ; women wereassigned to intervention arms based on dietary preferences . During the 6-monthweight-loss program , which was menu and recipe defined , participants had monthly clinical visits at which anthropometric data were collected and fasting blood wasobtained for safety monitoring for plasma lipid profiles and fasting glucose . Results from 142 participants are reported . Results Adverse effects on fasting blood lipids or glucose were not observed in eitherdietary arm . A decrease in fasting glucose was observed with progressive weightloss and was greater in participants who lost more weight , but the effect was notstatistically significant , even though it was observed across both diet groups(P = 0.21 ) . Beneficial effects of weight loss on cholesterol ( 4.7%;P = 0.001 ) , triglycerides ( 21.8 % ; P = 0.01 ) , and low-densitylipoprotein ( LDL ) cholesterol ( 5.8 % ; P = 0.06 ) were observed in bothgroups . For cholesterol ( P = 0.07 ) and LDL cholesterol ( P = 0.13 ) , greater reduction trends were seen on the low-fat diet pattern ; whereas , for triglycerides ( P = 0.01 ) and high-density lipoprotein (HDL)cholesterol ( P = 0.08 ) , a decrease or increase , respectively , was greateron the low-carbohydrate diet pattern . Conclusions Because an individual 's dietary preferences can affect dietary adherence and weight-loss success , the lack of evidence of a negative effect of dietary patternon biomarkers associated with cardiovascular risk is an important consideration inthe development of breast cancer practice guidelines for physicians who recommendthat their patients lose weight . Whether dietary pattern affects biomarkers thatpredict long-term survival is a primary question in this ongoing clinical trial AIM to evaluate the effect of this treatment programme on  lymphoedema specific fluid volume , pain , discomfort , limb function and quality of life outcomes . DESIGN prospect i ve , descriptive study . SAMPLE AND SETTING a convenience sample of four women with breast cancer related lymphoedema referred to a community-based specialist oncology nurse consultant programme in Canada that involved manual lymph drainage combined with compression b and aging .  MEASURES circumferential arm measurements to assess fluid volume , visual analogue scales to assess the impact of lymphoedema on specific practical , physical and psychosocial problems known to be affected by lymphoedema and field notes . RESULTS although a reduction in arm volume was observed , quality of life outcomes worsened for most of the women as they realized that this symptom would require lifelong management , serving as a reminder of their breast cancer experience . CONCLUSIONS lymphoedema treatment programmes must ensure that the multidimensional impact of this symptom on women 's lives is recognized and addressed as part of the treatment process OBJECTIVES To examine predictors of  physical activity ( PA )  6 months after a r and omized controlled trial . METHODS Breast cancer survivors ( N=377 ) completed assessment s at baseline , postintervention , and 6 months after the intervention . Data were collected on demographic , medical , psychosocial , motivational , and behavioral variables at baseline , postintervention , and 6 months . RESULTS Survivors meeting PA guidelines at baseline ( OR = 5.54 , 95 % CI = 2.99 - 9.82 , P < 0.001 ) and postintervention ( OR = 2.92 , 95 % CI = 1.63 - 5.23 , P < 0.001 ) had a greater likelihood of meeting PA guidelines at 6 months follow-up . CONCLUSIONS Interventions promoting PA maintenance should focus on optimizing PA behavior , psychosocial functioning , and motivation Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients UNLABELLED This r and omized controlled trial assessed the effect of a SMART ( Stress Management and Resiliency Training ) program among 25 women diagnosed with breast cancer .  Resilience , perceived stress , anxiety , and quality of life improved at 12 weeks in the active but not the control arm . A brief training in the SMART program can enhance resilience and quality of life and decrease stress and anxiety . INTRODUCTION Patients with breast cancer experience stress and anxiety related to their diagnosis , with result ing lower quality of life . The purpose of this study was to assess the effect of a SMART ( Stress Management and Resiliency Training ) program for increasing resiliency and for decreasing stress and anxiety among mentors who themselves were previously diagnosed with breast cancer . MATERIAL S AND METHODS The program consisted of two 90-minute group training sessions , a brief individual session , and 3 follow-up telephone calls . Twenty-four mentors at Mayo Clinic in Rochester , Minnesota , were r and omized in a single-blind , wait-list controlled clinical trial to either the SMART intervention or a control group for 12 weeks . Primary outcome measures assessed at baseline and at week 12 included the Connor Davidson Resilience Scale , Perceived Stress Scale , Smith Anxiety Scale , and Linear Analog Self Assessment Scale . RESULTS Twenty patients completed the study . A statistically significant improvement in resilience , perceived stress , anxiety , and overall quality of life at 12 weeks , compared with baseline was observed in the study arm . No significant difference in any of these measures was noted in the control group . CONCLUSION This study demonstrates that a brief , predominantly group-based resilience training intervention is feasible in patients with previous breast cancer ; also , it may be efficacious AIM This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue , mood and quality of life in breast cancer survivors . BACKGROUND Women who receive primary treatment for breast cancer often complain of insomnia . Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue , mood and quality of life . METHOD Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease . Women were r and omly assigned to either the cognitive behavioural therapy for insomnia group , which received stimulus control instructions , sleep restriction therapy and sleep education and hygiene , or the component control group which received sleep education and hygiene only . The 10-week study consisted of 2 weeks of pre-treatment , 6 weeks of treatment and 2 weeks of post-treatment . Fatigue , mood and quality of life were measured at pre- and post-treatment . FINDINGS Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue , trait anxiety , depression and quality of life . The component control group also had statistically significant increases in quality of life , with a trend suggestive of lower depression at post-treatment . CONCLUSION Globally , as the number of survivors in this population continues to grow , it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue , anxiety and depression OBJECTIVE The aim of this prospect i ve cohort study was to identify factors associated with fatigue in women with breast cancer who attended a 6-day rehabilitation course .  Furthermore , to investigate level of fatigue 1 year after the rehabilitation course , after accounting for baseline fatigue levels . METHODS Between 2002 and 2005 we included 775 women with breast cancer and measured fatigue , emotional functioning and insomnia  using the EORTC subscales and sociodemographics from a baseline question naire prior to participation in the rehabilitation course . Information on disease-specific and treatment factors was obtained from a nationwide clinical data base . From the 12-month follow-up question naire we obtained level of fatigue . We estimated the influence of factors on the relative risk for a 10-points increase in fatigue score in generalised linear models . For the analysis of fatigue at 12 months follow-up we added fatigue level at baseline and relapse since baseline . RESULTS Higher tumour grade and insomnia predicted higher levels of fatigue , whereas better emotional functioning was associated with lower levels . After 12 months of follow-up fatigue levels were associated with level at baseline and with emotional functioning , insomnia , relapse and being on sick leave or unemployed . Emotional level , insomnia and high grade were associated with level of fatigue . After 1 year , a high level at baseline , insomnia and low emotional functioning was associated with greater fatigue . CONCLUSIONS These longitudinal results support that cancer-related fatigue can be a persistent phenomenon and that focus on psychological distress and sleeping problems might be beneficial in these women Background To improve adherence to physical activity ( PA ) , behavioural support in the form of behavioural change counselling may be necessary . However , limited evidence of the effectiveness of home-based PA combined with counselling in breast cancer patients exists . The aim of this current r and omised controlled trial with a parallel group design was to evaluate the effectiveness of a home-based PA intervention on PA levels , anthropometric measures , health-related quality of life ( HRQoL ) , and blood biomarkers in breast cancer survivors . Methods Eighty post-adjuvant therapy invasive breast cancer patients ( age = 53.6 ± 9.4 years ; height = 161.2 ± 6.8 cm ; mass = 68.7 ± 10.5 kg ) were r and omly allocated to a 6-month home-based PA intervention or usual care . The intervention group received face-to-face and telephone PA counselling aim ed at encouraging the achievement of current recommended PA guidelines . All patients were evaluated for our primary outcome , PA ( International PA Question naire ) and secondary outcomes , mass , BMI , body fat % , HRQoL ( Functional assessment of Cancer Therapy-Breast ) , insulin resistance , triglycerides ( TG ) and total ( TC ) , high-density lipoprotein ( HDL-C ) and low-density lipoprotein ( LDL-C ) cholesterol were assessed at baseline and at 6-months . Results On the basis of linear mixed-model analyses adjusted for baseline values performed on 40 patients in each group , total , leisure and vigorous PA significantly increased from baseline to post-intervention in the intervention compared to usual care ( between-group differences , 578.5 MET-min∙wk−1 , p = .024 , 382.2 MET-min∙wk−1 , p = .010 , and 264.1 MET-min∙wk−1 , p = .007 , respectively ) . Both body mass and BMI decreased significantly in the intervention compared to usual care ( between-group differences , −1.6 kg , p = .040 , and −.6 kg/m2 , p = .020 , respectively ) . Of the HRQoL variables , FACT-Breast , Trial Outcome Index , functional wellbeing , and breast cancer subscale improved significantly in the PA group compared to the usual care group ( between-group differences , 5.1 , p = .024 ; 5.6 , p = .001 ; 1.9 p = .025 ; and 2.8 , p = .007 , respectively ) . Finally , TC and LDL-C was significantly reduced in the PA group compared to the usual care group ( between-group differences , −.38 mmol∙L−1 , p = .001 ; and −.3 mmol∙L−1 , p = .023 , respectively ) . Conclusions We found that home-based PA result ed in significant albeit small to moderate improvements in self-reported PA , mass , BMI , breast cancer specific HRQoL , and TC and LDL-C compared with usual care . Clinical Trials.gov identifierNCT02408107 ( March 25 , 2015 PURPOSE Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality . Therefore , we report the feasibility and preliminary outcomes of a pilot r and omized trial design ed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy . METHODS Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I , II , or IIIA breast cancer were r and omly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care . RESULTS Recruitment was 34 % , intervention adherence was 99 % , and complete follow-up data were obtained on 93 % . Most participants ( 93 % ) were white with mean age of 53 + /- 9 yr . Differences favoring the intervention group were noted for accelerometer physical activity counts ( mean difference = 72,103 ; 95 % confidence interval ( CI ) = 25,383 - 119,000 ; effect size ( d ) = 1.02 ; P = 0.004 ) , aerobic fitness ( mean difference = 2.9 ; 95 % CI = -0.1 to 5.8 ; d = 0.64 ; P = 0.058 ) , back/leg muscle strength ( mean difference = 12.3 ; 95 % CI = 0.4 - 15.9 ; d = 0.81 ; P = 0.017 ) , waist-to-hip ratio ( mean difference = -0.05 ; 95 % CI = -0.01 to -0.08 ; d = -0.77 ; P = 0.018 ) , and social well-being ( mean difference = 2.0 ; 95 % CI = 0.3 - 3.8 ; d = 0.76 ; P = 0.03 ) . However , the intervention group also reported a greater increase in joint stiffness ( mean difference = 1.1 ; 95 % CI = 0.1 - 2.2 ; d = 0.70 ; P = 0.04 ) . CONCLUSIONS A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes . Confirmation in a larger study is warranted To investigate the mechanism(s ) of action of mindfulness based stress reduction ( MBSR(BC ) ) including reductions in fear of recurrence and other potential mediators . Eighty-two post-treatment breast cancer survivors ( stages 0–III ) were r and omly assigned to a 6-week MBSR(BC ) program ( n = 40 ) or to usual care group ( UC ) ( n = 42 ) . Psychological and physical variables were assessed as potential mediators at baseline and at 6 weeks . MBSR(BC ) compared to UC experienced favorable changes for five potential mediators : ( 1 ) change in fear of recurrence problems mediated the effect of MBSR(BC ) on 6-week change in perceived stress ( z = 2.12 , p = 0.03 ) and state anxiety ( z = 2.03 , p = 0.04 ) ; and ( 2 ) change in physical functioning mediated the effect of MBSR(BC ) on 6-week change in perceived stress ( z = 2.27 , p = 0.02 ) and trait anxiety ( z = 1.98 , p = 0.05 ) . MBSR(BC )  reduces fear of recurrence and improves physical functioning which reduces perceived stress and anxiety . Findings support the beneficial effects of MBSR(BC ) and provide insight into the possible cognitive mechanism of action PURPOSE To examine the effects of aerobic exercise therapy on quality of life ( QoL ) and associated outcomes in women treated for breast cancer . Evidence suggests that exercise may be beneficial , but no trial has included an exercise-placebo and a usual-care group to control for the attention effects that might be associated with aerobic exercise interventions in cancer patients . PATIENTS AND METHODS A total of 108 women who had been treated for breast cancer 12 to 36 months previously were r and omly assigned to supervised aerobic exercise therapy ( n = 34 ) , exercise-placebo ( body conditioning ; n = 36 ) , or usual care ( n = 38 ) . Exercise therapy and exercise-placebo sessions took place three times per week for 8 weeks . Outcomes included QoL , depression , exercise behavior , aerobic fitness ; outcomes were assessed at baseline and at the 8- and 24-week follow-up . RESULTS Analyses of covariance revealed a significant mean difference of 9.8 units in Functional Assessment of Cancer Therapy-General ( primary outcome ) favoring aerobic exercise therapy at 8 weeks , relative to usual care . Significant differences that favored aerobic exercise therapy relative to usual care were recorded for Functional Assessment of Cancer Therapy-Breast , social/family well-being , functional well-being , and breast cancer subscale scores at 8-week follow-up . Psychological health outcomes improved modestly for both intervention groups ; these improvements were sustained for several end points . CONCLUSION Exercise therapy had large , clinical ly meaningful , short-term beneficial effects on QoL in women treated for breast cancer ; this finding can not be attributable to attention , given that the exercise-placebo group did not report similar effects relative to usual care PURPOSE To determine the effects of exercise training on cardiopulmonary function and quality of life ( QOL ) in postmenopausal breast cancer survivors who had completed surgery , radiotherapy , and /or chemotherapy with or without current hormone therapy use . METHODS Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control ( n = 28 ) group . The exercise group trained on cycle ergometers three times per week for 15 weeks at a power output that elicited the ventilatory equivalent for carbon dioxide . The control group did not train . The primary outcomes were changes in peak oxygen consumption and overall QOL from baseline to postintervention . Peak oxygen consumption was assessed by a grade d exercise test using gas exchange analysis . Overall QOL was assessed by the Functional Assessment of Cancer Therapy-Breast scale . RESULTS Fifty-two participants completed the trial . The exercise group completed 98.4 % of the exercise sessions . Baseline values for peak oxygen consumption ( P = .254 ) and overall QOL ( P = .286 ) did not differ between groups . Peak oxygen consumption increased by 0.24 L/min in the exercise group , whereas it decreased by 0.05 L/min in the control group ( mean difference , 0.29 L/min ; 95 % confidence interval [ CI ] , 0.18 to 0.40 ; P < .001 ) . Overall QOL increased by 9.1 points in the exercise group compared with 0.3 points in the control group ( mean difference , 8.8 points ; 95 % CI , 3.6 to 14.0 ; P = .001 ) . Pearson correlations indicated that change in peak oxygen consumption correlated with change in overall QOL ( r = 0.45 ; P < .01 ) . CONCLUSION Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors 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 The aim of this study was to explore the effects of exercise on angiogenesis and apoptosis-related molecules , quality of life , fatigue and depression in patients who completed breast cancer treatment . Sixty breast cancer patients were r and omised into three groups , as supervised exercise group , home exercise group and education group .  Angiogenesis and apoptosis-related cytokine levels and quality of life ( EORTC QOL-C30 : European Organisation for Research and Treatment of Cancer Quality of Life C30 ) , fatigue ( Brief Fatigue Inventory ) and depression ( BDI : Beck Depression Inventory ) scores were compared before and after a 12-week exercise programme . After the exercise programme , statistically significant decreases were found in interleukin-8 and neutrophil activating protein-78 levels in the home exercise group ( P < 0.05 ) . The education group showed a statistically significant increase in monocyte chemoattractant protein-1 level ( P < 0.05 ) . Functional score and global health score of EORTC QOL-C30 in the supervised exercise group and functional score of EORTC QOL-C30 in the home exercise group increased significantly after exercise programme ( P < 0.05 ) . BDI score was significantly lower in the supervised exercise group after the exercise programme ( P < 0.05 ) . Changes in angiogenesis and apoptosis-related molecules in the study groups suggest a possible effect of exercise on these parameters . Exercise programmes are safe and effective on quality of life and depression in breast cancer patients whose treatments are complete Purpose : We previously reported the effectiveness of a 12-week physical activity behavior change intervention for breast cancer survivors postintervention with this report , aim ing to determine delayed and /or persistent effects 3 months after intervention completion . Methods : Forty-one sedentary women with stage I , II , or IIIA breast cancer currently receiving hormonal therapy were r and omly assigned to receive the 12-week Better Exercise Adherence after Treatment for Cancer intervention or usual care . Assessment s occurred at baseline , postintervention , and 3 months postintervention . Results : Weekly minutes of greater than or equal to moderate intensity physical activity measured by accelerometer showed a significant group by time interaction ( F = 3.51 ; P = 0.035 ; between group difference in the mean change from baseline to 3 months postintervention , 100.1 minute , P = 0.012 ) . Significant group by time interactions also showed sustained improvements from baseline to 3 months postintervention in strength ( F = 3.82 ; P = 0.027 ; between group difference , 11.2 kg ; P = 0.026 ) , waist-to-hip ratio ( F = 3.36 ; P = 0.041 ; between group difference , −0.04 ; P = 0.094 ) , and social well-being ( F = 4.22 ; P = 0.023 ; between group difference , 3.9 ; P = 0.039 ) . A delayed reduction in lower extremity dysfunction 3 months postintervention was noted ( F = 3.24 ; P = 0.045 ; between group difference in the mean change from postintervention to 3 months follow-up ; P = −7.6 ; P = 0.015 ) . No group by time effect was noted for fitness , body mass index , percent fat , bone density , total quality of life ( Functional Assessment of Cancer Therapy-General ) , fatigue , endocrine symptoms , cognitive function , or sleep . Conclusions : The intervention result ed in sustained improvements in physical activity , strength , central adiposity , and social well-being with lower extremity function benefits appearing 3 months after intervention completion . Testing translation in a multisite study is warranted . ( Cancer Epidemiol Biomarkers Prev 2009;18(5):1410–8 Introduction Breast cancer survival rates are lower for African American women than for white women . Obesity , high-fat diets , and lack of regular physical activity increase risk for breast cancer recurrence , comorbid conditions , and premature death . Eighty-two percent of African American women are overweight or obese , partly because of unhealthy eating and exercise patterns . Although successful weight loss and lifestyle interventions for breast cancer survivors are documented , none has considered the needs of African American breast cancer survivors . This study assessed the feasibility and impact of Moving Forward , a culturally tailored weight loss program for African American breast cancer survivors . Methods The study used a pre-post design with a convenience sample of 23 African American breast cancer survivors . The 6-month intervention was theory-based and incorporated qualitative data from focus groups with the targeted community , urban African American breast cancer survivors .  Data on weight , body mass index ( BMI ) , diet , physical activity , social support , and quality of life were collected at baseline and at 6 months . Results After the intervention , we noted significant differences in weight , BMI , dietary fat intake , vegetable consumption , vigorous physical activity , and social support . Conclusion This is the first published report of Moving Forward , a weight loss intervention design ed for African American breast cancer survivors . Although a r and omized trial is needed to establish efficacy , the positive results of this intervention suggest that this weight loss intervention may be feasible for African American breast cancer survivors . Lifestyle interventions may reduce the disparities in breast cancer mortality rates Background Loss of lean body mass ( LBM ) is a common occurrence after treatment for breast cancer and is related to deleterious metabolic health outcomes [ Clin Oncol , 22(4):281–288 , 2010 ; Appl Physiol Nutr Metab , 34(5):950–956 , 2009 ] . The aim of this research is to determine the effectiveness of long chain omega-3 fatty acids ( LCn-3s ) and exercise training alone , or in combination , in addressing LBM loss in breast cancer survivors . Methods / design A total of 153 women who have completed treatment for breast cancer in the last 12 months , with a Body Mass Index ( BMI ) of 20 to 35 kg/m2 , will be r and omly assigned to one of 3 groups : 3g/d LCn-3s ( N-3 ) , a 12-week nutrition and exercise education program plus olive oil ( P-LC ) or the education program plus LCn-3s ( EX+N-3 ) . Participants r and omised to the education groups will be blinded to treatment , and will receive either olive oil placebo ( OO+N-3 ) or LCn-3 provision , while the N-3 group will be open label . The education program includes nine 60 - 75min sessions over 12 weeks that will involve breast cancer specific healthy eating advice , plus a supervised exercise session run as a resistance exercise circuit . They will also be advised to conduct the resistance training and aerobic training 5 to 7 days per week collectively . Outcome measures will be taken at baseline , 12-weeks and 24-weeks . The primary outcome is % change in LBM as measured by the air displacement plethysmograhy . Secondary outcomes include quality of life ( FACT-B + 4 ) and inflammation ( C-Reactive protein : CRP ) . Additional measures taken will be erythrocyte fatty acid analysis , fatigue , physical activity , menopausal symptoms , dietary intake , joint pain and function indices . Discussion This research will provide the first insight into the efficacy of LCn-3s alone or in combination with exercise in breast cancer survivors with regards to LBM and quality of life . In addition , this study is design ed to improve evidence -based dietetic practice , and how specific dietary prescription may link with appropriate exercise interventions .Trials registration ACTRN12610001005044 ; and World Health Organisation Universal trial number : U1111 - 1116 - 8520 The purpose of the present paper was to evaluate the effects of an 8-week multimodal program focused on core stability exercises and recovery massage with DVD support for a 6-month period in physical and psychological outcomes in breast cancer survivors . A r and omized controlled clinical trial was performed . Seventy-eight ( n = 78 ) breast cancer survivors were assigned to experimental ( core stability exercises plus massage-myofascial release ) and control ( usual health care ) groups . The intervention period was 8 weeks . Mood state , fatigue , trunk curl endurance , and leg strength were determined at baseline , after the last treatment session , and at 6 months of followup . Immediately after treatment and at 6 months , fatigue , mood state , trunk curl endurance , and leg strength exhibited greater improvement within the experimental group compared to placebo group . This paper showed that a multimodal program focused on core stability exercises and massage  reduced fatigue , tension , depression , and improved vigor and muscle strength after intervention and 6 months after discharge BACKGROUND In this r and omized trial , Project CARE , we examined whether participation in a cognitive-behavioral stress management and breast cancer wellness and education program improved psychological outcomes among a sample of underserved black breast cancer survivors . METHODS Both complementary medicine interventions were 10-sessions , manualized , group-based , and were culturally adapted for black women in the community from evidence -based interventions . Participants were 114 black women ( mean age = 51.1 , 27 - 77 years ) who had completed breast cancer treatment 0 - 12 months before enrollment ( stages 0-IV , mean time since cancer diagnosis = 14.1 months ) . Women were enrolled upon completion of curative treatment  ( ie , surgical , chemotherapy , radiation oncology ) and  r and omized to receive cognitive-behavioral stress management or cancer wellness and education program . RESULTS There was a remarkable 95 % retention rate from baseline to 6-month follow-up . Participants in both conditions showed statistically significant improvement on indices of psychological well-being , including overall quality of life ( Functional Assessment of Cancer Therapy-Breast ) , intrusive thoughts ( Impact of Event Scale-Revised ) , depressive symptoms ( Center for Epidemiologic Studies -Depression ) , and stress levels ( Perceived Stress Scale ) over the 6-month postintervention follow-up ( all repeated measures analysis of variance within-subjects time effects : P < .05 , except for overall mood ; Profile of Mood States-Short Version ) . Contrary to hypotheses , however , condition × time effects were not statistically significant . CONCLUSIONS Findings suggest that improvements in multiple measures over time may have been due to intensive training in stress management , extensive provision of breast cancer information , or participation in an ongoing supportive group of individuals from a similar racial background . Implication s bear on decisions about appropriate control groups , the timing of intervention delivery during the treatment trajectory , and perceived support from the research team BACKGROUND There are very few r and omized controlled studies on exercise in cancer patients . Consequently , there are no guidelines available with regard to the exercises that can be recommended and difficulties are encountered in the clinical practice as to which exercise is more suitable to the patients . AIM The purpose of this study was to investigate the impact of pilates exercises on physical performance , flexibility , fatigue , depression and quality of life in women who had been treated for breast cancer . DESIGN R and omized controlled trial . SETTING Out patient group , Department of Physical Medicine and Rehabilitation and Medical Oncology Department , University Hospital . POPULATION Fifty-two patients with breast cancer were divided into either pilates exercise ( group 1 ) and control group ( group 2 ) . METHODS Patients in Group 1 performed pilates and home exercises and patients in group 2 performed only home exercises . Pilates exercise sessions were performed three times a week for a period of eight weeks in the rehabilitation unit . MAIN OUTCOME MEASURES Subjects were assessed before and after rehabilitation program , with respect to , 6-min walk test ( 6MWT ) , modified sit and reach test , Brief Fatigue Inventory ( BFI ) , Beck Depression Index ( BDI ) and the European Organisation for Research and Treatment of Cancer Quality of Life C30 ( EORTC QLQ-C30 ) and EORTC QLQ BR23 . RESULTS After the exercise program , improvements were observed in Group 1 in 6-minute walk test , BDI , EORTC QLQ-C30 functional , and EORTC QLQ-C30 BR23 functional scores ( P<0.05 ) . In contrast , no significant improvement was observed in Group 2 after the exercise program in any of parameters in comparison to the pre-exercise period ( P>0.05 ) . When the two exercise groups were compared , there were significant differences in 6MWT in pilates-exercise group ( P<0.05 ) . CONCLUSION Pilates exercises are effective and safe in female breast cancer patients . There is a need for further studies so that its effect can be confirmed . CLINICAL REHABILITATION IMPACT This study addressed the effects of pilates exercise , as a new approach , on functional capacity , fatigue , depression and quality of life in breast cancer patients in whom there are doubts regarding the efficacy and usefulness of the exercise BACKGROUND Menopausal symptoms ( e.g. , hot flashes , vaginal dryness , and stress urinary incontinence ) are very common in breast cancer survivors and can not be managed with st and ard estrogen replacement therapy ( ERT ) in these patients . The purpose of this study was to test the efficacy of a comprehensive menopausal assessment ( CMA ) intervention program in achieving relief of symptoms , the improvement in quality of life ( QOL ) , and sexual functioning in breast cancer survivors . METHODS Using a two-group , r and omized controlled design , we assigned 76 postmenopausal breast cancer survivors with at least one severe target symptom either to the intervention group or to a usual-care group . Seventy-two women were evaluable at the end of the study period . The CMA intervention , delivered by a nurse practitioner , focused on symptom assessment , education , counseling and , as appropriate , specific pharmacologic and behavioral interventions for each of the three target symptoms . Psychosocial symptoms were assessed with the use of a self-report screening instrument , and distressed women were referred for counseling if needed . The intervention took place over a 4-month period . Outcomes measured were scores on a composite menopausal symptom scale , the R AND Short Form Health Survey Vitality Scale , and the Cancer Rehabilitation Evaluation System ( CARES ) Sexual Functioning Scale at baseline and at 4-month follow-up . All statistical tests were two-sided and were performed at the alpha = . 05 significance level . RESULTS Patients receiving the intervention demonstrated statistically significant improvement ( P = .0004 ) in menopausal symptoms but no significant change in vitality ( P = .77 ) . Sexual functioning was statistically significantly improved ( P = .04 ) in the treatment group compared with the usual-care group . CONCLUSIONS A clinical assessment and intervention program for menopausal symptom management in breast cancer survivors is feasible and acceptable to patients , leading to reduction in symptoms and improvement in sexual functioning . Measurable improvement in a general QOL measure was not demonstrated Abstract Background There is a need for improvement of information provision and post-treatment care for cancer survivors . A Survivorship Care Plan ( SCP ) is recommended by the American Institute of Medicine and the Dutch Health Council , which is a summary of patients ' course of treatment as a formal document , and includes recommendations for subsequent cancer surveillance , management of late effects , and strategies for health promotion . Until now , evidence on the effects of implementing the SCP in clinical practice is lacking . The rationale and study design of a pragmatic cluster r and omized trial , aim ing to assess the impact of SCP care in routine clinical practice , is presented . Methods / Design A  web-based patient registration system ' Registration system Oncological GYnecology ' ( ROGY ) is used by gynecologists in the South of the Netherl and s since 2006 . A personalized SCP can automatically be generated out of ROGY . In this pragmatic cluster r and omized controlled trial , 12 hospitals are r and omized to either ' usual care ' or ' SCP care ' . In patients with ' usual care ' , the gynecologist provides care as usual . In patients with ' SCP care ' , information about the tumor stage and treatment is personally discussed with the patient and a document is h and ed to the patient . Prospect ively , all patients diagnosed with endometrial or ovarian cancer in the participating hospitals will be approached for study participation . Patients will complete question naires after surgery , and before additional treatment , and after 6 , 12 , 18 and 24 months . In addition , health care providers will be asked their opinion about implementation of SCP care . Primary outcome is defined as patient satisfaction with information provision and care . Secondary outcomes are illness perception , health-related quality of life , health care use , prevalence , course and referral rate of survivors with psychosocial distress , and health care providers ' evaluation of SCP care . Discussion The ROGY Care trial will help to gain insight into the impact of SCP care on patient reported outcomes , and on the evaluation of cancer survivors and health care providers of the different elements of the SCP . Therefore , results will contribute to efforts to improve quality of care for cancer survivors . Trial registration Trial Registration : http://www . Clinical Trials.gov . Identifier : NCT01185626 Medical Research Ethics Committee Reference Number : NL33429.008.10 Grant Reference Number : UVT2010 - Background : With continual improvements in screening uptake and adjuvant cancer treatments , the number of Canadian women surviving breast cancer continues to grow . Preliminary findings suggest yoga can improve quality of life ( QoL ) in breast cancer survivors , but few studies have focused on Iyengar yoga ( IY ) . Objective : The purpose of this pilot study was to evaluate the impact of IY on QoL and psychosocial functioning in a select sample of breast cancer survivors . Methods : Breast cancer survivors ( N = 24 ) participating in IY classes completed a question naire measuring generic and disease-specific QoL and psychosocial functioning , before and after the 12-week classes . Results : Postprogram question naires were completed by 17 participants ( 71 % ) who attended an average of 78.9 % of the IY sessions . Several indicators of generic QoL improved significantly , including mental health ( mean change , + 4.2 ; P = .045 ) , vitality ( mean change , + 4.9 ; P = .033 ) , role-emotional ( mean change , + 6.4 ; P = .010 ) , and bodily pain ( mean change , + 4.4 ; P = .024 ) . Other improvements in QoL and psychosocial functioning were meaningful but were not statistically significant . Findings were further substantiated by participant 's evaluation of the program 's benefits and motivational value . Conclusion : In this pilot study of breast cancer survivors participating in IY , we found improvements in QoL and psychosocial functioning . Moreover , positive program evaluation and motivational profile provide support for the acceptability of IY with breast cancer survivors . R and omized controlled trials comparing IY to usual care and other forms of yoga in breast cancer survivors are warranted . Implication s for Practice : Nurses may consider IY as a possible intervention strategy to help breast cancer survivors improve their QoL and psychosocial functioning PURPOSE To examine the effect of a progressive upper-body exercise program on  lymphedema secondary to breast cancer treatment . METHODS Fourteen breast cancer survivors with unilateral upper extremity lymphedema were r and omly assigned to an exercise ( n = 7 ) or control group ( n = 7 ) . The exercise group followed a progressive , 8-week upper-body exercise program consisting of resistance training plus aerobic exercise using a Monark Rehab Trainer arm ergometer . Lymphedema was assessed by arm circumference and measurement of arm volume by water displacement . Patients were evaluated on five occasions over the experimental period . The Medical Outcomes Trust Short-Form 36 Survey was used to measure quality of life before and after the intervention . Significance was set at alpha < or = 0.01 . RESULTS No changes were found in arm circumference or arm volume as a result of the exercise program . Three of the quality -of-life domains showed trends toward increases in the exercise group : physical functioning ( P = .050 ) , general health ( P = .048 ) , and vitality ( P = .023 ) . Mental health increased , although not significantly , for all subjects ( P = .019 ) . Arm volume measured by water displacement was correlated with calculated arm volume ( r = .973 , P < .001 ) , although the exercise and control group means were significantly different ( P < .001 ) . CONCLUSIONS Participation in an upper-body exercise program caused no changes in arm circumference or arm volume in women with lymphedema after breast cancer , and they may have experienced an increase in quality of life . Additional studies should be done in this area to determine the optimum training program This study examined the efficacy of a couple-focused group intervention on psychological adaptation of women with early stage breast cancer and evaluated whether perceived partner unsupportive behavior or patient functional impairment moderated intervention effects . Two hundred thirty-eight women were r and omly assigned to receive either 6 sessions of a couple-focused group intervention or usual care . Intent-to-treat growth curve analyses indicated that participants assigned to the couples ' group reported lower depressive symptoms . Women rating their partners as more unsupportive benefited more from the intervention than did women with less unsupportive partners , and women with more physical impairment benefited more from the intervention group than did women with less impairment . Subgroup analyses comparing women attending the couple-focused group intervention with women not attending groups and with usual care participants indicated that women attending sessions reported significantly less distress than did women receiving usual care and women who dropped out of the intervention OBJECTIVE This multi-site r and omized trial evaluates the quality of life ( QOL ) benefits of an imagery-based group intervention titled ' Envision the Rhythms of Life'(ERL ) . METHODS Breast cancer survivors > 6 weeks post-treatment were r and omized to attend five weekly 4-h group sessions at a community center with therapist present ( live delivery ( LD ) , n = 48 ) , therapist streamed via telemedicine ( telemedicine delivery ( TD ) , n = 23 ) , or to a waitlist control ( WL ) group ( n = 47 ) . Weekly individual phone calls to encourage at-home practice began at session one and continued until the 3-month follow-up . Seven self-report measures of QOL were examined at baseline , 1-month and 3-month post-treatments including health-related and breast cancer-specific QOL , fatigue , cognitive function , spirituality , distress , and sleep . RESULTS The Bonferroni method was used to correct for multiple comparisons , and alpha was adjusted to 0.01 . Linear multilevel modeling analyses revealed less fatigue , cognitive dysfunction , and sleep disturbance for LD and TD compared with WL across the follow-up ( p 's < 0.01 ) . Changes in fatigue , cognitive dysfunction , sleep disturbance , and health-related and breast cancer-related QOL were clinical ly significant . There were no differences between LD and TD . CONCLUSIONS Both the live and telemedicine delivered ERL intervention result ed in improvements in multiple QOL domains for breast cancer survivors compared with WL . Further , there were no significant differences between LD and TD , suggesting telemedicine delivered ERL intervention may represent an effective and viable option for cancer survivors in remote areas Goals Health-related quality of life ( HRQL ) and self-esteem are often diminished among women diagnosed and treated for breast cancer .  Tai Chi is a moderate form of exercise that may be an effective therapy for improving HRQL and self-esteem among these women . We sought to compare the efficacy of Tai Chi Chuan ( TCC ) and psychosocial support ( PST ) for improving HRQL and self-esteem among breast cancer survivors . Patients and methods A group of 21 women diagnosed with breast cancer , who had completed treatment within the last 30 months were r and omized to receive 12 weeks of TCC or PST . Participants in both groups met three times a week for 60 minutes . HRQL and self-esteem were assessed at baseline , 6 weeks , and 12 weeks . Results The TCC group demonstrated significant improvements in HRQL , while the PST group reported declines in HRQL , with the differences between the two groups approaching significance at week 12 . Additionally , the TCC group exhibited improvements in self-esteem , while the PST group reported declines in self-esteem , with the differences between groups reaching statistical significance at week 12 . These findings , coupled with a visual inspection of the raw change scores , support the plausibility of a dose-response relationship concerning Tai Chi . Conclusions In this pilot investigation , the TCC group exhibited improvements in HRQL and self-esteem from baseline to 6 and 12 weeks , while the support group exhibited declines . R and omized , controlled clinical trials with larger sample sizes are needed Purpose Regular exercise and healthy eating are routinely recommended for breast cancer survivors , and past studies show benefits in quality of life and decreased inflammation . However , this has not been tested specifically in triple-negative breast cancer survivors . Increasing physical activity and losing body fat are thought to positively affect inflammatory biomarkers that have been associated with breast cancer . Therefore , the primary purpose of this study was to determine if participation in an exercise and dietary counseling program can improve body fat , physical function , and quality of life in survivors of this aggressive breast cancer . Secondarily , we sought to determine if participation in the program had beneficial effects on obesity-related markers of the adipokine profile . Methods Sixty-six survivors of triple-negative breast cancer with BMI > 25 were invited to participate . Twenty-eight enrolled and 23 completed the r and omized , controlled trial ( 13 intervention , 10 control ) . Moderate-intensity aerobic exercise ( 150 min per week , for 12 weeks ) and diet counseling were compared to usual care , education only . The primary outcome of interest was weight loss ( body mass , BMI , % fat ) , and secondary outcomes included physical function ( exercise capacity ) , quality of life ( Function After Cancer Therapy — Breast ( FACT-B ) ) , cytokines ( C-reactive protein ( CRP ) , TNF-α , IL-6 ) , and adipokine profile ( leptin , adiponectin , insulin ) . Results Participants in the program  lost more body fat ( 2.4 % loss vs. 0.4 % gain , p < 0.05 ) than the control group . The intervention group also improved quality of life ( FACT-B total score + 14 pts ) and decreased sedentary time but did not improve peak exercise capacity . The intervention had no effect on serum cytokines and adipokines after 12 weeks in the program . However , serum leptin and adiponectin and their ratio were significantly correlated with BMI in the intervention group ( p < 0.05 ) . Conclusions Exercise and dietary counseling led to loss of body fat and improved quality of life in survivors of triple-negative breast cancer . BMI was associated with favorable changes in leptin and adiponectin which may reflect a change in adiposity with intervention . Exercise and healthy eating may be equally effective in this high-risk population as in other breast cancer survivors and should be encouraged as a part of a cancer survivorship program Purpose To obtain estimates of time to recruit the study sample , retention , facility-based class attendance and home practice for a study of yoga in breast cancer survivors , and its efficacy on fatigue , quality of life ( QOL ) , and weight change . Methods Sixty-three post-treatment stages 0–III borderline overweight and obese ( body mass index ≥24 kg/m2 ) breast cancer survivors were r and omly assigned to a 6-month , facility- and home-based viniyoga intervention ( n = 32 ) or a waitlist control group ( n = 31 ) . The yoga goal was five practice s per week . Primary outcome measures were changes in QOL , fatigue , and weight from baseline to 6 months . Secondary outcomes included changes in waist and hip circumference . Results It took 12 months to complete recruitment . Participants attended a mean of 19.6 classes and practice d at home a mean of 55.8 times during the 6-month period . At follow-up , 90 % of participants completed question naires and 87 % completed anthropometric measurements . QOL and fatigue improved to a greater extent among women in the yoga group relative to women in the control group , although no differences were statistically significant . Waist circumference decreased 3.1 cm ( 95 % CI , −5.7 and −0.4 ) more among women in the yoga compared with the control group , with no difference in weight change . Conclusions This study provides important information regarding recruitment , retention , and practice levels achieved during a 6-month , intensive yoga intervention in overweight and obese breast cancer survivors .  Yoga may help decrease waist circumference and improve quality of life ; future studies are needed to confirm these results The aim of the study was to assess the feasibility and effectiveness of aquatic-based exercise in the form of deep water running ( DWR ) as part of a multimodal physiotherapy programme ( MMPP ) for breast cancer survivors . A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community-based Primary Care Centres . Patients in the experimental group received a MMPP incorporating DWR , 3 times a week , for an 8-week period . The control group received a leaflet containing instructions to continue with normal activities . Statistically significant improvements and intergroup effect size were found for the experimental group for Piper Fatigue Scale-Revised total score ( d = 0.7 , P = 0.001 ) , as well as behavioural/severity ( d = 0.6 , P = 0.05 ) , affective/meaning ( d = 1.0 , P = 0.001 ) and sensory ( d = 0.3 , P = 0.03 ) domains . Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5 , P < 0.05 ) and quality of life ( d = 1.3 , P < 0.05 ) . All participants attended over 80 % of sessions , with no major adverse events reported . The results of this study suggest MMPP incorporating  DWR decreases cancer-related fatigue and improves general health and quality of life in breast cancer survivors . Further , the high level of adherence and lack of adverse events indicate such a programme is safe and feasible PURPOSE / OBJECTIVES To pilot a second support group intervention study promoting self-transcendence perspectives and activities and to document changes over time in well-being in support group participants compared with non participants . DESIGN Quasiexperimental , partial r and omization , preference trial design . SETTING An urban breast cancer re source center established by survivors . SAMPLE 41 women with newly diagnosed breast cancer were recruited , and 39 completed the study . 22 women participated in three intervention support groups ; 17 were in a comparison group . METHODS The intervention was an eight-week , closed support group based on self-transcendence theory . Data were collected three times during 14 months . MAIN RESEARCH VARIABLES Support group intervention , self-transcendence , and emotional and physical well-being . FINDINGS The intervention group had lower scores than the comparison group on self-transcendence and well-being variables at baseline ( time [ T ] 1 ) . Scores were higher for both groups postintervention ( T2 ) , with no differences between groups . One year postintervention ( T3 ) , intervention group scores again were lower than comparison group scores . Intervention group T3 scores were unchanged from T2 . CONCLUSIONS Most potential participants were unwilling to risk being r and omized into a nonpreferred group . Activities based on self-transcendence theory were associated with exp and ed perspectives and activities and an improved sense of well-being in support group participants at the end of the intervention , but not one year later . Findings from the pilot studies informed a study currently in progress . IMPLICATION S FOR NURSING Nurses should maintain awareness of local re sources for support and make that information available to women when they are newly diagnosed with breast cancer , during their treatment , and later 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 PURPOSE / OBJECTIVES To describe women 's unexpected and distressing symptom experiences after breast cancer treatment . RESEARCH APPROACH Qualitative and descriptive . SETTING Depending upon their preference , participants were interviewed in their homes or in a private office space in a nearby library . PARTICIPANTS Purposive sample of 13 women 1 - 18 years after breast cancer treatment . METHOD OLOGIC APPROACH Secondary analysis of phenomenologic data ( constant comparative method ) . MAIN RESEARCH VARIABLES Breast cancer symptom distress , ongoing symptoms , and unexpected experiences . FINDINGS Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment . Symptoms included pain , loss of energy , impaired limb movement , cognitive disturbance , changed sexual experience , and lymphedema . Four central themes were derived : living with lingering symptoms , confronting unexpected situations , losing precancer being , and feeling like a has-been . Distress intensified when women expected symptoms to disappear but symptoms persisted instead . Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been . Findings suggest that symptom distress has temporal , situational , and attributive dimensions . CONCLUSIONS Breast cancer survivors ' perceptions of ongoing and unexpected symptoms have important influences on quality of life . Underst and ing temporal , situational , and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment . INTERPRETATION Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur . Prospect i ve studies are needed to examine symptom distress in terms of temporal , situational , and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment While quality of life for most breast cancer survivors ( BCS ) returns to normal by 1 year post-treatment , problems in sexual function and intimacy often persist . The present study tested the efficacy of a 6-week psycho-educational group intervention in improving BCS ’s sexual well-being . We conducted a mailed survey of BCS 1–5 years post-diagnosis to identify a sample of women who reported moderately severe problems in body image , sexual function or partner communication , and were deemed eligible for the r and omized intervention trial . Using a pre-r and omized design , 70 % ( n = 284 ) were assigned to a 6-week psycho-educational group intervention and 30 % ( n = 127 ) were assigned to a control condition ( print material only ) ; however , only 83 BCS agreed to participate in the intervention . Four months post-intervention , the intervention and control groups were not significantly different on the primary outcome of emotional functioning ; however , BCS r and omized to the intervention group were more likely to report improvements in relationship adjustment and communication as well as increased satisfaction with sex compared to controls . Members of the intervention group who were the least satisfied with their sexual relationship appeared to improve the most . Although modest in its effects , this intervention can be delivered in st and ard clinical setting s. Having an identified treatment may help reduce physician reluctance to ask BCS about problems in intimacy and as appropriate , refer them for timely help PURPOSE We design ed a peer counseling program to improve sexual function , increase knowledge about reproductive health , and decrease menopausal symptoms and infertility-related distress for African American breast cancer survivors . PATIENTS AND METHODS Women were r and omly assigned to immediate counseling or a 3-month waitlist . Three peer counselors conducted a 3-session intervention using a detailed workbook . Question naires at baseline , after the waitlist period , at posttreatment , and at 3-month follow-up assessed spirituality , sexual function , menopause symptoms , emotional distress , relationship satisfaction , fertility concerns , and knowledge about reproductive health and breast cancer . At the postcounseling assessment , women rated the workbook , their counselor , and the program . RESULTS Of 93 women screened , 60 women ( 65 % ) enrolled in the study . Women who completed counseling ( 80 % ; N = 48 ) had a mean age of 49 years ( st and ard deviation [ SD ] , 8 years ) and a mean follow-up of 4.5 years ( SD , 3.8 years ) since cancer diagnosis . Almost all rated the workbook as very easy to underst and ( 94 % ) and their counselor as very knowledgeable ( 96 % ) and very skillful ( 98 % ) . Eighty-one percent rated the program as " very useful to me . " Immediate counseling and waitlist groups did not differ at baseline in psychologic adjustment , nor did scores change during the waitlist period . Therefore , the groups were combined in analyzing outcomes . Knowledge of reproductive issues improved significantly from baseline to 3-month follow-up ( P < .0001 ) , as did emotional distress ( P = .0047 ) and menopause symptoms ( P = .0128 ) . Sexually dysfunctional women became less distressed ( P = .0167 ) . CONCLUSION Women valued the Sisters Peer Intervention in Reproductive Issues After Treatment program highly and found it relevant . The program had positive effects on knowledge and target symptoms 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 BACKGROUND / AIMS Treatment for breast cancer produces side effects that diminish functional capacity and quality of life ( QOL ) among survivors .  Tai Chi Chuan ( TCC ) is a moderate form of exercise that may improve functional capacity and QOL in these individuals . Women who completed treatment for breast cancer were r and omized to receive TCC or psychosocial support therapy for 12 weeks ( 60 min ; three times weekly ) . RESULTS The TCC group demonstrated significant improvements in functional capacity , including aerobic capacity , muscular strength , and flexibility , as well as QOL ; the psychosocial support therapy group showed significant improvements only in flexibility , with declines in aerobic capacity , muscular strength , and QOL . CONCLUSIONS The TCC group exhibited significant improvements in functional capacity and QOL . These data suggest that TCC may enhance functional capacity and QOL among breast cancer survivors The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments Obesity is a risk factor for breast cancer recurrence and death . Women who reside in rural areas have higher obesity prevalence and suffer from breast cancer treatment-related disparities compared to urban women . The objective of this 5-year r and omized controlled trial is to compare methods for delivering extended care for weight loss maintenance among rural breast cancer survivors .  Group phone-based counseling via conference calls addresses access barriers , is more cost-effective than individual phone counseling , and provides group support which may be ideal for rural breast cancer survivors who are more likely to have unmet support needs . Women ( n=210 ) diagnosed with Stage 0 to III breast cancer in the past 10 years who are ≥ 3 months out from initial cancer treatments , have a BMI 27 - 45 kg/m(2 ) , and have physician clearance were enrolled from multiple cancer centers . During Phase I ( months 0 to 6 ) , all women receive a behavioral weight loss intervention delivered through group phone sessions . Women who successfully lose 5 % of weight enter Phase II ( months 6 to 18 ) and are r and omized to one of two extended care arms : continued group phone-based treatment or a mail-based newsletter . During Phase III , no contact is made ( months 18 to 24 ) . The primary outcome is weight loss maintenance from 6 to 18 months . Secondary outcomes include quality of life , serum biomarkers , and cost-effectiveness . This study will provide essential information on how to reach rural survivors in future efforts to establish weight loss support for breast cancer survivors as a st and ard of care Most breast cancer survivors ( BCS ) are not meeting recommended physical activity guidelines . Here , we report the effects of the Better Exercise Adherence after Treatment for Cancer ( BEAT Cancer ) behavior change intervention on physical activity , aerobic fitness , and quality of life ( QoL ) . We r and omized 222 post- primary treatment BCS to the 3-month intervention ( BEAT Cancer ) or usual care ( UC ) . BEAT Cancer combined supervised exercise , face-to-face counseling , and group discussion s with tapering to home-based exercise . Assessment s at baseline , immediately post-intervention ( month 3 ; M3 ) , and 3 months post-intervention ( month 6 ; M6 ) included accelerometer and self-reported physical activity , submaximal treadmill test , and QoL [ Functional Assessment of Cancer Therapy (FACT)-Breast scale ] . Adjusted linear mixed-model analyses demonstrated significant effects of BEAT Cancer compared to UC on weekly minutes of ≥moderate intensity physical activity at M3 by accelerometer [ mean between group difference ( M ) = + 41 ; 95 % confidence interval ( CI ) = 10–73 ; p = 0.010 ] and self-report ( M = + 93 ; CI = 62–123 ; p < 0.001 ) . Statistical significance remained at M6 for self-reported physical activity ( M = + 74 ; CI = 43–105 ; p < 0.001 ) . BEAT  Cancer participants were significantly more likely to meet physical activity recommendations at both time points [ accelerometer M3 adjusted odds ratio ( OR ) = 2.2 ; CI = 1.0–4.8 and M6 adjusted OR = 2.4 ; CI = 1.1–5.3 ; self-report M3 adjusted OR = 5.2 ; CI = 2.6–10.4 and M6 adjusted OR = 4.8 ; CI = 2.3–10.0 ] . BEAT Cancer significantly improved fitness at M6 ( M = + 1.8 ml/kg/min ; CI = 0.8–2.8 ; p = 0.001 ) and QoL at M3 and M6 ( M = + 6.4 ; CI = 3.1–9.7 ; p < 0.001 and M = + 3.8 ; CI = 0.5–7.2 ; p = 0.025 , respectively ) . The BEAT Cancer intervention  significantly improved physical activity , fitness , and QoL with benefits continuing 3 months post-intervention PURPOSE The purpose of this study was to determine whether participation in a group psychosocial intervention by patients with breast cancer would result in an improvement in psychological measures and in reduced billings in general medical expenses . DESCRIPTION OF STUDY Eligible women who had completed treatment for stage 0 , I , or II primary breast cancer were prospect ively and r and omly assigned to either the  intervention ( n=46 ) or control ( n=43 ) group . Both groups received the usual psychosocial care ; however , the intervention group also participated in six weekly cognitive/behavioral psychosocial meetings . All were assessed on psychiatric symptoms , mood , depression , and coping strategies at four time periods : pre-intervention , post-intervention , 1-year follow-up , and 2-year follow-up . Alberta Healthcare billing records were obtained covering the 2-year follow-up period to determine the amount billed per person over the course of the study . RESULTS Women in the intervention group had less depression , less overall mood disturbance , better overall quality of life , and fewer psychiatric symptoms than those in the control group , beginning immediately post-intervention and remaining so at 2 years post-intervention . Billing in the intervention group was an average of $ 147 less than in the control group , a 23.5 % reduction . CLINICAL IMPLICATION S This is the first study to show that a psychosocial intervention can reduce direct healthcare billings in a sample of patients with cancer . Importantly , these findings help to justify the routine availability of such programs in cancer treatment facilities worldwide PURPOSE Chronic insomnia is highly prevalent in cancer patients .  Cognitive-behavioral therapy ( CBT ) is considered the treatment of choice for chronic primary insomnia . However , no r and omized controlled study has been conducted on its efficacy for  insomnia secondary to cancer . Using a r and omized controlled design , this study conducted among breast cancer survivors evaluated the effect of CBT on sleep , assessed both subjectively and objective ly , and on hypnotic medication use , psychological distress , and quality of life . PATIENTS AND METHODS Fifty-seven women with insomnia caused or aggravated by breast cancer were r and omly assigned to CBT ( n = 27 ) or a waiting-list control condition ( n = 30 ) . The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control , sleep restriction , cognitive therapy , sleep hygiene , and fatigue management . Follow-up evaluations were carried out 3 , 6 , and 12 months after the treatment . RESULTS Participants who received the insomnia treatment had significantly better subjective sleep indices ( daily sleep diary , Insomnia Severity Index ) , a lower frequency of medicated nights , lower levels of depression and anxiety , and greater global quality of life at post-treatment compared with participants of the control group after their waiting period . Results were more equivocal on polysomnographic indices . Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinical ly significant . CONCLUSION This study supports the efficacy of CBT for insomnia secondary to breast cancer Background : Post-treatment survivorship has not been extensively studied , despite long-st and ing evidence that after breast cancer treatment , women need continuing support to deal with their physical and psychosocial concerns . Objective : The purpose of this experimental pilot study was to examine the quality of life ( QOL ) and symptom outcomes of a psychoeducational support program for women in the first year of post – breast cancer treatment survivorship . Methods : The sample consisted of 48 female breast cancer survivors r and omly assigned to an intervention group ( n = 25 ) and control group ( n = 23 ) . The psychoeducational support program consisted of individual face-to-face education , telephone-delivered health-coaching sessions , and small-group meetings . Study instruments were the Memorial Symptom Assessment Scale – Short Form and Functional Assessment of Cancer Therapy – Breast question naire . Results : Compared with the control group , survivors in the intervention group reported higher QOL overall and higher emotional well-being . The intervention group reported lower psychological symptom distress than the control group . Conclusions : A psychoeducational support program may promote a better overall QOL and symptom experience in transition to survivorship among female breast cancer survivors . Implication s for Practice : Oncology nurses are in a position to provide education and support to assist breast cancer survivors in managing their symptoms and adjusting to life after primary treatment . Research to determine optimal strategies to improve breast cancer survivors ’ overall health and QOL is needed Breast cancer patients suffer impairment in cardiorespiratory fitness after treatment for primary disease , affecting patients ’ health and survival . The aim of this study was to evaluate the ability of a pragmatic exercise intervention to improve cardiorespiratory fitness of breast cancer patients after primary treatment . Between February 2013 and December 2014 , 94 women with early stage ( I – III ) breast cancer , 1–36 months post-chemotherapy , and radiotherapy were r and omly assigned to an intervention program ( EX ) combining supervised aerobic and resistance exercise ( n = 44 ) or usual care ( CON ) ( n = 45 ) for 12 weeks . Primary study endpoint was VO2max . Secondary endpoints were muscle strength , shoulder range of motion , body composition , and quality of life ( QoL ) . Assessment s were undertaken at baseline , 12-week , and 6-month follow-ups . Eighty-nine patients aged 29–69 years were assessed at baseline and 12 weeks . The EX group showed significant improvements in VO2max , muscle strength , percent fat , and lean mass ( p ≤ 0.001 in all cases ) and QoL compared with usual care ( CON ) . Apart from body composition , improvements were maintained for the EX at 6-month follow-up . There were no adverse events during the testing or exercise intervention program . A combined exercise intervention produced considerable improvement in cardiorespiratory fitness , physical function , and quality of life in breast cancer patients previously treated with chemotherapy and radiation therapy . Importantly , most of these benefits were maintained 6 months after ceasing the supervised exercise intervention Breast cancer is the most prevalent type of cancer in American women .  Exercise appears to diminish many of the side effects result ing from breast cancer and its treatment . Very little research , however , has compared the outcomes of varying lengths of combined aerobic and resistance training exercise interventions on physiological and psychological parameters in breast cancer survivors . The purpose of this study was to compare the physiological and psychological outcomes following 3 and 6 months of exercise in breast cancer survivors . Breast cancer survivors ( N = 114 ) participated in either 3 months of prescriptive , individualized exercise ( 3 M ; n = 29 ) , 6 months of prescriptive , individualized exercise ( 6 M ; n = 68 ) , or served as sedentary controls  ( C ; n = 17 ) . Cancer survivors completed a medical evaluation and assessment at baseline followed by a predetermined 3- or 6-month exercise intervention .  Cancer survivors in the control group performed no exercise between the initial assessment and 6-month re assessment . Cardiovascular endurance , pulmonary function , muscular endurance , fatigue , and symptoms of depression were assessed at baseline and post intervention . Repeated measures ANCOVA revealed improvements ( P < 0.05 ) in cardiovascular endurance , fatigue , and symptoms of depression in breast cancer survivors undergoing 3- and 6-month individualized exercise interventions . Breast cancer survivors exercising for 6 months showed additional improvements ( P < 0.05 ) in pulmonary function and muscular endurance . Cancer survivors in the control group did not improve in cardiovascular endurance , pulmonary function , muscular endurance , or fatigue . Three months of individualized , prescriptive exercise leads to improved cardiovascular endurance , fatigue , and symptoms of depression in breast cancer survivors . Additional benefits are seen if exercise is continued for a total of 6 months Background : Older breast cancer survivors ( BCSs ) are at risk for late and long-term treatment effects on quality of life ( QOL ) , including lower physical functioning and fear of recurrence . Two promising approaches to address this include dance/movement therapy and mindfulness . Objective : The purpose of this 2-group r and omized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program ( MMP ) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment . Methods : Consented participants were r and omized to an experimental group ( EG ) ( 12 weekly MMP sessions ) or a control group  ( no sessions ) . All completed question naires 3 times . The EG participants kept home practice diaries . Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects . Results : Participants ( n = 49 ) ranged in age from 50 to 90 years ( average , 65.6 years ) and were at 9.8 years since diagnosis ( range , 1–32 years ) , and the majority were white , unpartnered , and retired . After intervention , EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude . At 6 weeks , initial effects were retained . Conclusions : The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude . Although these findings are promising , a larger study is needed to determine more specifically what short- and long-term effects are possible . Implication s for Practice : The combination of self-directed movement and mindfulness , as tested here , may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer The aim of this study was to evaluate a manualized cognitive behavioral group intervention for early-stage breast cancer patients . Sixty-nine women were recruited at an Irish specialist oncology hospital and assigned to a 6-week cognitive behavior therapy ( CBT ) program or an educational control group . Participants were assessed at baseline , 6 weeks , and 6-month follow-up . Groups × Time ( 2 × 3 ) ANOVAs showed that the program did not lead to greater improvement on st and ardized measures of coping , quality of life , or mood compared with the control group . Regression analyses showed that maladaptive coping and distress at baseline were predictive of psychological adjustment at follow-up . Level of distress was also predictive of quality of life at follow-up . Repeated measures ANOVAs of data from cases in the intervention group showed that patients who completed the program showed significant improvement in problem severity , impact of problems , coping ability , and goal attainment from pre- to posttreatment , and these gains were maintained at follow-up for problem severity and impact of problems , but not for coping ability or goal attainment . Participation in the program did not lead to less health service usage during the period from baseline to follow-up , compared with the educational control group . A controlled trial provided limited evidence for the effectiveness of brief cognitive behavior intervention  in enhancing psychological adjustment of early-stage breast cancer patients with non clinical ly significant levels of psychological distress . Future research should evaluate the effectiveness of the program for patients with elevated levels of psychological distress and limited coping re sources PURPOSE / OBJECTIVES To evaluate a mind-body medicine ( MBM ) program for its impact on  persistent fatigue following breast cancer treatment . DESIGN Quasiexperimental . SETTING An urban community hospital and a health department in a semirural county , both in Maryl and . SAMPLE 68 breast cancer survivors who were at least six months postadjuvant chemotherapy and /or radiation therapy and had a baseline fatigue score of 50 or lower per the vitality subscale of the SF-36 ® Health Survey . METHODS A 10-week group-based MBM program for breast cancer survivors with persistent fatigue  was evaluated using a pretest/post-test study design . MAIN RESEARCH VARIABLES Sustained change in fatigue severity as measured by the Piper Fatigue Scale ( PFS ) , SF-36 vitality subscale , and 10 cm visual analog scale ( VAS ) . FINDINGS Participants were 2.6 years post-treatment , with a mean age of 56.8 years . Overall , fatigue scores improved by 40 % . The mean PFS improved from a score of 6 ( SD = 1.6 ) at baseline to 4.2 ( SD = 2 ) at the end of the program ( p < 0.001 ) , with additional improvement at two months and sustained at six months ( X = 3.6 , SD = 2 , p < 0.001 ) . Results from the SF-36 and VAS also showed significant improvement in fatigue ( p < 0.001 ) . CONCLUSIONS The findings support the use of a holistic MBM intervention to reduce persistent fatigue  in breast cancer survivors . Results should be confirmed with a r and omized clinical trial . IMPLICATION S FOR NURSING Nurses and other healthcare team members can effectively impact persistent fatigue in breast cancer survivors through the use of a multipronged MBM program PURPOSE / OBJECTIVES To test the feasibility and acceptability of an individualized representational intervention to improve symptom management ( IRIS ) in older breast cancer survivors and test the short-term effects of an IRIS on symptom distress . DESIGN Two small r and omized clinical trials and one pre-experimental study . SETTING Oncology clinic and community . SAMPLE 41 women with breast cancer ( aged 65 years and older ) in pilot study 1 , 20 in pilot study 2 , and 21 in pilot study 3 . METHODS In pilot study 1 , women were r and omized to the IRIS or usual care control . In pilot study 2 , women were r and omized  to the IRIS or delayed IRIS ( wait list ) control . In pilot study 3 , all women received the IRIS by telephone . Measures were collected at baseline , postintervention , and follow-up ( up to four months ) . MAIN RESEARCH VARIABLES Feasibility , acceptability , symptom distress , symptom management behaviors , symptom management barriers , and quality of life . FINDINGS Across three pilot studies , 76 % of eligible women participated , 95 % completed the study , 88 % reported the study was helpful , and 91 % were satisfied with the study . Some measures of symptom distress decreased significantly after the IRIS , but quality of life was stable . Women in the IRIS group changed their symptom management behaviors more than controls . CONCLUSIONS Preliminary evidence supports the need for and feasibility of an IRIS . IMPLICATION S FOR NURSING Nurses may help older breast cancer survivors manage their numerous chronic symptoms more effectively by assessing women 's beliefs about their symptoms and their current symptom management strategies Background When diagnosed with breast cancer , most women ’s lives change as well as their perspectives on and appreciation of life . The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life ( HRQOL ) and fatigue during the first year after diagnosis . Material and methods Of 382 patients with newly diagnosed breast cancer , 191 patients were r and omized to an intervention group and 191 patients were r and omized to a routine control group .  The intervention group received support intervention that lasted 1 week on a residential basis , followed by 4 days of follow-up 2 months later . The support intervention included informative educational parts , relaxation training , mental visualization , and nonverbal communication .  HRQOL was measured using the European Organization for Research and Treatment of Cancer ( EORTC ) QLQ-C30 and QLQ-BR23 question naires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2 , 6 , and 12 months after intervention . Result There was a time-dependent improvement in both functional and symptom scales between baseline and 12 months as measured by the EORTC QLQ-C30 and BR23 question naires and there was a decrease in fatigue between baseline and after 2 months with further improvement up to 12 months in both groups , but there were no differences between the intervention and control groups at any point in time . Conclusion HRQOL improves and symptoms of fatigue decrease over time , but we could not see any additional effect from the rehabilitation program in this setting CONTEXT Exercise benefits patients with cancer , but studies of home-based approaches , particularly among those with Stage IV disease , remain small and exploratory . OBJECTIVES To conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures . METHODS Sixty-six adults with Stage IV lung or colorectal cancer were r and omized , in an eight-week trial , to usual care or incremental walking and home-based strength training . The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week ; training and step-count goals were advanced during bimonthly telephone calls . The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form . Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities ( Ambulatory Post Acute Care Daily Activities Short Form ) , quality of life ( Functional Assessment of Cancer Therapy-General ) , and fatigue ( Functional Assessment of Cancer Therapy-Fatigue ) . RESULTS Three participants dropped out and seven died ( five in the intervention and two in the control group , P=0.28 ) . At Week 8 , the intervention group reported improved mobility ( P=0.01 ) , fatigue ( P=0.02 ) , and sleep quality ( P=0.05 ) compared with the usual care group , but did not differ on the other measures . CONCLUSION A home-based exercise program seems capable of improving the mobility , fatigue , and sleep quality of patients with Stage IV lung and colorectal cancer OBJECTIVES This study aim ed to identify demographic , psychological , health-related , and geographic predictors of adherence to home-based and supervised components of a yoga intervention in breast cancer survivors . METHODS Participants were the 32 post-treatment breast cancer survivors who were r and omized to the Viniyoga intervention arm of a controlled trial . Participants were asked to practice yoga 5 times per week for 6 months , including at least one weekly facility-based session . Adherence was monitored using sign-in sheets and logs . Height and weight were measured ; other potential predictors of adherence were obtained from baseline question naires . RESULTS Participants attended 19.6±13.0 yoga classes and performed 55.8±32.8 home-based yoga sessions . Participants adhered to 58 % of the overall yoga practice goal ( 75 % of the goal for yoga classes and 54 % of the goal for home based-sessions ) . Higher class attendance and home practice were predicted by greater self-efficacy for yoga ( p=0.004 and 0.06 , respectively ) . Additionally , employment outside the home was associated with greater class attendance ( p=0.004 ) , while higher waist circumference was marginally associated with lower adherence to home-based yoga ( p=0.05 ) . CONCLUSIONS High levels of facility- and home-based yoga practice were achieved . Breast cancer survivors who have lower self-efficacy for yoga or who have a higher waist circumference may benefit from additional support or intervention tailoring . Adherence may also be improved by ensuring that class times are convenient to both working and nonworking women The Telephone Counseling Trial for Breast Cancer Survivors is a r and omized , controlled study design ed to test the impact of a telephone-based counseling intervention on quality of life of early-stage breast cancer patients who have completed adjuvant treatment . A psychoeducational counseling model is utilized to promote adaptive coping to re-entry stressors and survivorship issues . Adaptation is fostered through the exploration of thematic material s , application of active coping strategies , encouragement of a personal expression of the breast cancer experience and the provision of psychological support . Patients are being recruited in collaboration with two NCI- design ated clinical cooperative oncology groups : the Eastern Cooperative Oncology Group ( ECOG ) and the Southwest Cooperative Oncology Group ( SWOG ) . The recruitment goal is 400 breast cancer survivors with Stage 1 , Stage 2 and Stage 3 disease ( with no greater than 10 positive lymph nodes involved ) . Patients are being enrolled by data managers on-site during their last treatment visit . The intervention is being delivered by the Cancer Information and Counseling Line ( CICL ) of the AMC Cancer Research Center . It includes 16 telephone outcalls which are delivered over a 12-month period . Primary outcome measures are quality of life , mood , social support , self-efficacy , and sexual functioning , assessed at baseline , 3 , 6 , 12 and 18 months follow-up . This article provides a description of the intervention protocol and study design . It is argued that this study could provide a model for developing and testing other psychosocial interventions within clinical cooperative groups nationwide Purpose The purpose s of this study are to examine ( 1 ) the feasibility and efficacy of two different home-based exercise protocol s on the level of physical activity ( PA ) , and ( 2 ) the effect of increased PA via home-based exercise program on biomarkers of colorectal cancer . Methods Seventeen patients ( age 55.18 ± 13.3 years ) with stage II – III colorectal cancer completed the 12-week home-based exercise program . Subjects were r and omized into either casually intervened home-based exercise group ( CIHE ) or intensely intervened home-based exercise group ( IIHE ) . The primary outcome was the level of PA . Furthermore , insulin , homeostasis model assessment of insulin resistance , insulin-like growth factor axis , and adipocytokines were measured . Results Both CIHE and IIHE program significantly increased the level of PA at 12 weeks compared to its level at baseline ( CIHE , 10.00 ± 8.49 vs. 46.07 ± 45.59 ; IIHE , 12.08 ± 11.04 vs. 35.42 ± 27.42 MET hours per week ) . Since there was no difference in PA change between groups ( p = 0.511 ) , the data was combined in analyzing the effects of increased PA on biomarkers . Increase in PA significantly reduced insulin ( 6.66 ± 4.58 vs. 4.86 ± 3.48 μU/ml , p = 0.006 ) , HOMA-IR ( 1.66 ± 1.23 vs. 1.25 ± 1.04 , p = 0.017 ) , and tumor necrosis alpha-α ( TNF-α 4.85 ± 7.88 vs. 2.95 ± 5.38 pg/ml , p = 0.004 ) , and significantly increased IGF-1 ( 135.39 ± 60.15 vs. 159.53 ng/ml , p = 0.007 ) , IGF binding protein (IGFBP)-3 ( 2.67 ± 1.48 vs. 3.48 ± 1.00 ng/ml , p = 0.013 ) , and adiponectin ( 6.73 ± 3.07 vs. 7.54 ± 3.96 μg/ml , p = 0.015 ) . Conclusion CIHE program was as effective as IIHE program in increasing the level of PA , and the increase in PA result ed in significant change in HOMA-IR , IGF-1 axis , TNF-α , and adiponectin levels in stage II – III colorectal cancer survivors PURPOSE The efficacy of a home-based physical activity ( PA ) intervention for early-stage breast cancer patients was evaluated in a r and omized controlled trial . PATIENTS AND METHODS Eighty-six sedentary women ( mean age , 53.14 years ; st and ard deviation , 9.70 years ) who had completed treatment for stage 0 to II breast cancer were r and omly assigned to a PA or contact control group . Participants in the PA group received 12 weeks of PA counseling ( based on the Transtheoretical Model ) delivered via telephone , as well as weekly exercise tip sheets . Assessment s were conducted at baseline , after treatment ( 12 weeks ) , and 6 and 9 month after baseline follow-ups . The post-treatment outcomes are reported here . RESULTS Analyses showed that , after treatment , the PA group reported significantly more total minutes of PA , more minutes of moderate-intensity PA , and higher energy expenditure per week than controls . The PA group also out-performed controls on a field test of fitness . Changes in PA were not reflected in objective activity monitoring . The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines . No significant group differences were found in body mass index and percent body fat . Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group . There was a positive trend in intervention effects on overall mood and body esteem . CONCLUSION The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients . The success of a home-based PA intervention has important implication s for promoting recovery in this population INTRODUCTION Today , cancer survivors have an added new role to self manage living with the medical , emotional and role tasks that can affect their quality of life ( QOL ) . The purpose of the study was to evaluate the QOL of women two years after participating in a self-management intervention program .  METHOD The clinical trial was conducted at University Malaya Medical Centre between 2006 and 2008 . The experimental group underwent a 4-week self management program , and the control group underwent usual care . Two years after the intervention , question naires were r and omly posted out to the participants . RESULTS A total of 51 question naires returned . There were statistically differences between groups in psychological , self-care , mobility and participation aspects in PIPP ( p<0.05 ) . The experimental group reported having higher confidence to live with breast cancer compared to control group ( p<0.05 ) . There were significant between-group changes in anxiety scores at T2 ( immediately after intervention ) to T4 ( two years later ) , and the differences in anxiety scores within groups between time point T2 and T4 were significantly different ( p<0.05 ) . CONCLUSION The SAMA program is potentially capable to serve as a model intervention for successful transition to survivorship following breast cancer treatment . The program needs to be further tested for efficacy in a larger trial involving more diverse population s of women completing breast cancer treatment OBJECTIVE The objective was to develop effective weight-loss methods for women who have had breast cancer , because obesity may result in an adverse prognosis . RESEARCH METHODS AND PROCEDURES This r and omized pilot study tested an individualized approach toward weight loss in obese women who have had a diagnosis of breast cancer . An individualized approach was applied either alone or combined with the commercial Weight Watchers program .  Forty-eight women ( body mass index of 30 to 44 kg/m(2 ) ) were enrolled . RESULTS Weight change after 12 months of intervention was as follows ( mean + /- SD ) : 0.85 + /- 6.0 kg in the control group , -2.6 + /- 5.9 kg in the Weight Watchers group , -8.0 + /- 5.5 kg in the individualized group , and -9.4 + /- 8.6 kg in the comprehensive group that used both individualized counseling and Weight Watchers .  Weight loss relative to control was statistically significant in the comprehensive group 3 , 6 , and 12 months after r and omization , whereas weight loss in the individualized group was significant only at 12 months . Weight loss of 10 % or more of initial body weight was observed in 6 of 10 women in the comprehensive group at 12 months . In the comprehensive and Weight Watchers-only groups , weight loss was significantly related to frequency of attendance at Weight Watchers meetings , and attendance was more frequent in the comprehensive group . DISCUSSION These data indicate that the most weight loss was achieved when the counseling approach combined both Weight Watchers and individualized contacts . This was effective even though most of the individualized contacts were by telephone PURPOSE There is little economic research on psychosocial interventions . We aim ed to collect data alongside a r and omized trial to compare the costs and benefits of three psycho-educational strategies to improve transition to cancer survivorship . METHODS We evaluated the incremental delivery costs per unit increase in energy ( using the Medical Outcomes Study vitality scale ) or decrease in distress ( from the Revised Impact of Events Scale ) in the 6 months postintervention . We also evaluated 1-year post-treatment health care costs . RESULTS The costs of the control , video , and video plus counseling arms were $ 11.30 , $ 25.85 , and $ 134.47 per person , respectively . The  video costs were $ 2.22 per unit increase in energy compared with control ; among women who were the least prepared for transition , the video was more effective , result ing in even lower costs . The  video cost $ 7,275 per unit change in distress versus control , but costs were lower in the subgroup least prepared for transition ( $ 355 ) . The counseling arm was more expensive and less effective than the video for virtually all end points . However , in one group , women more prepared for transition , counseling cost $ 1,066 per unit decrease in distress compared with the video .  Health care costs tended to increase as intervention intensity increased . CONCLUSION There are no st and ards for evaluating cost-effectiveness of trials with psychosocial end points . In this trial , the educational video was the most cost-effective way to improve transition to survivorship . It will be important to confirm whether there is an increased use of services after such interventions and if this represents appropriate use of rehabilitative and supportive care or over-use The aim of this study was to evaluate the impact of a twice-weekly strength training intervention on perceptions of body image in 234 breast cancer survivors ( 112 with lymphedema ) who participated in the Physical Activity and Lymphedema ( PAL ) trial . The study population included two hundred and thirty-four women r and omly assigned to twice-weekly strength training or control group that completed the 32-item Body Image and Relationships Scale ( BIRS ) at baseline and 12 months . Percent change in baseline to 12-month BIRS total and subscale scores , upper and lower body strength , and general quality of life ( QOL ) were compared by intervention status . A series of multiple linear regression models including indicator variables for subgroups based on age , marital status , race , education , BMI , and strength change were used to examine differential intervention impact by subgroup . Strength and QOL variables were assessed as mediators of the intervention effect on BIRS . Results : Baseline BIRS scores were similar across intervention and lymphedema status . Significantly greater improvement in BIRS total score was observed from baseline to 12 months in treatment vs. control participants ( 12.0 vs. 2.0 % ; P < 0.0001 ) . A differential impact of the intervention on the Strength and Health subscale was observed for older women ( > 50 years old ) in the treatment group ( P = 0.03 ) . Significantly greater improvement was observed in bench and leg press among treatment group when compared to control group participants , regardless of lymphedema . Observed intervention effects were independent of observed strength and QOL changes . Twice-weekly strength training positively impacted self-perceptions of appearance , health , physical strength , sexuality , relationships , and social functioning . Evidence suggests the intervention was beneficial regardless of prior diagnosis of lymphedema . Strength and QOL improvements did not mediate the observed intervention effects PURPOSE / OBJECTIVES To examine the effectiveness of a psychoeducational intervention on quality of life ( QOL ) in breast cancer survivors in post-treatment survivorship . DESIGN A r and omized controlled trial . SETTING An academic center collaborating with a regional cancer center in the southeastern United States . SAMPLE 256 breast cancer survivors . METHODS Women were r and omly assigned to the experimental or wait control group . The Breast Cancer Education Intervention ( BCEI ) study was delivered in three face-to-face sessions and five monthly follow-up sessions ( three by telephone and two in person ) . The control group received four monthly attention control telephone calls and the BCEI at month 6 . Data were collected at baseline , three and six months after the BCEI for the experimental group , and one month after the BCEI ( at month 7 ) for the wait control group . MAIN RESEARCH VARIABLES Primary endpoints were overall QOL and physical , psychological , social , and spiritual well-being . FINDINGS No differences in QOL were reported at baseline between groups . The experimental group reported improved QOL at three months , whereas the wait control group reported a significant decline in QOL . The experimental group reported continued maintenance of QOL at six months . Although the wait control group reported improved QOL at six months , significant differences continued to exist between the groups . CONCLUSIONS The BCEI was an effective intervention in improving QOL during the first year of breast cancer survivorship . Treatment effects were durable over time . IMPLICATION S FOR NURSING Post-treatment survivorship has not been empirically studied to a large degree . The BCEI is one of the few interventions demonstrating effectiveness among survivors after primary treatment , suggesting that oncology nurses may be uniquely positioned to provide safe passage using education and support OBJECTIVE To assess the effectiveness of a multidisciplinary ambulatory rehabilitation programme for women following definitive breast cancer treatment in an Australian community cohort . METHODS Eighty-five women in the community r and omized to a  treatment group ( n = 43 ) for individualized high-intensity programme , or a control group ( n = 42 ) comprising usual activity . The primary outcome Depression Anxiety Stress Scale ( DASS ) scale measured restriction in participation . Secondary measures included Perceived Impact Problem Profile ( PIPP ) and Cancer Rehabilitation Evaluation System Short-Form ( CARES-SF ) ; and Functional Independence Measure ( FIM ) motor subscale for activity limitation . Assessment s were at baseline and 4 months . RESULTS Intention-to-treat analysis of data showed a significant difference between both groups in DASS Depression scores ( p = 0.006 ) ( moderate effect size , r > 0.3 ) , PIPP Mobility ( p = 0.05 ) and Participation ( p = 0.04 ) scales , and CARES-SF Global score ( p = 0.02 ) ( small effect size , r < 0.3 ) . The treatment group , compared with control group , showed significant improvement in the DASS Depression scores : 22/42 ( 52.4 % ) vs 12/37 ( 32.4 % ) ( p = 0.02 ) . No difference between groups was noted in the FIM scale . CONCLUSION Rehabilitation can benefit participation in breast cancer survivors . Evidence for specific rehabilitation interventions is needed . Integrated cancer programmes allow opportunities to evaluate patients in various setting s , but require outcome research to develop service models for survivorship issues In 2006 , the IOM released a report citing the importance of “ survivorship plans ” to improve quality of life and care coordination for cancer survivors , but little has been done to evaluate their efficacy . Women with early-stage breast cancer were r and omized within 6 weeks of completing adjuvant therapy to a survivorship intervention group ( SI ) or control group ( CG ) . All subjects were given the NCI publication , “ Facing Forward : Life after Cancer Treatment . ” The SI also met with a nurse/nutritionist to receive a treatment summary , surveillance , and lifestyle recommendations . Both groups completed question naires on the impact of cancer ( IOC ) , patient satisfaction ( FACIT-TS-PS ) , and assessment of survivor concerns ( ASC ) at baseline , 3 and 6 months . Within and between group t tests and linear regression analyses were performed . Among 126 women ( 60 CG , 66 SI ) , mean age was 54 years , 48 % were Hispanic , and the groups were well-balanced by baseline characteristics . No significant differences between the CG and SI on the FACIT-TS-PS or IOC at 3 and 6 months were seen . The ASC health worry subscale was lower ( less worry ) in the SI compared to CG ( p = 0.02 ) . At all time-points , Hispanic women had higher ( worse ) health worry ( p = 0.0008 ) , social-life interference ( p = 0.009 ) , and meaning of cancer scales ( p = 0.0004 ) , and more trust in medical professionals ( p = 0.03 ) compared to non-Hispanic women . While the SI did not lead to significant improvements in most patient-reported outcomes , it was associated with decreased health worry . Future interventions should determine the most efficient and effective method for delivering survivorship care plans PURPOSE The purpose of this study was to examine the longer-term effects of pedometers and print material s on changes in physical activity ( PA ) and health-related quality of life ( HRQoL ) in breast cancer survivors who participated in a 3-month behavior change intervention . METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive either ( a ) a st and ard public health recommendation for PA ( SR ) , ( b ) previously developed breast cancer-specific PA print material s ( PM ) , ( c ) a step pedometer ( PED ) , or ( d ) a combination of the two ( COM ) . The primary endpoint was self-reported moderate/vigorous PA minutes per week at 6-month follow-up after the initial 3-month intervention period . RESULTS Seventy-one percent ( 266/377 ) of participants completed the 6-month follow-up assessment . According to intention-to-treat linear mixed-model analyses , self-reported moderate to vigorous PA increased by 9 min x wk(-1 ) in the SR group compared with 39 min x wk(-1 ) in the PM group ( mean difference = 30 min x wk(-1 ) ; 95 % CI = -44 to 104 ; P = 0.425 ) , 69 min x wk(-1 ) in the PED group ( mean difference = 60 min x wk(-1 ) ; 95 % CI = -13 to 132 ; P = 0.107 ) , and 56 min x wk(-1 ) in the COM group ( mean difference = 47 min x wk(-1 ) ; 95 % CI = -26 to 119 ; P = 0.210 ) . The same pattern was observed for self-reported , brisk walking . No differences were found for HRQoL or fatigue . CONCLUSION ( S ) Breast cancer-specific PM and PED did not maintain significantly higher PA or HRQoL at 6-month follow-up in breast cancer survivors , but the magnitude of the effect on PA ( 30 - 60 min x wk(-1 ) ) was consistent with the immediate postintervention effect observed at the 3-month postintervention time point . Issues of power result ing from additional loss to follow-up may account for the failure to achieve statistical significance . Additional research with larger sample sizes and more complete follow-up is warranted Breast cancer survivors often use clues to convey their concerns to their oncologists . The authors conducted a r and omized trial of a communication coaching intervention in which 22 female breast cancer survivors were r and omized to the coaching and 22 to treatment as usual .  They hypothesized that the intervention would increase breast cancer self-efficacy , improve mood , and reduce fears of recurrence . Through a series of ANCOVAs they found that the intervention led to increases in self-efficacy . Changes in self-efficacy predicted changes in anxiety , depression , and womanhood fears . This coaching intervention shows promise but requires additional studies to establish is efficacy and effectiveness PURPOSE / OBJECTIVES To examine the effect of cognitive-behavioral therapy for insomnia ( CBTI ) on sleep improvement , daytime symptoms , and quality of life ( QOL ) in breast cancer survivors ( BCSs ) after cancer treatment . DESIGN A prospect i ve , longitudinal , r and omized , controlled trial . SETTING Oncology clinics , breast cancer support groups , and communities in Colorado . SAMPLE 56 middle-aged BCSs with chronic insomnia . METHODS Women were r and omly assigned to CBTI or behavioral placebo treatment ( BPT ) and completed measures of sleep , QOL , functioning , fatigue , and mood at baseline , postintervention , and at three- and six-month follow-ups . MAIN RESEARCH VARIABLES Sleep outcomes ( e.g. , sleep efficiency , sleep latency , total sleep time , wake after sleep onset , number of nightly awakenings ) ; secondary variables included sleep medication use , insomnia severity , QOL , physical function , cognitive function , fatigue , depression , anxiety , and sleep attitudes or knowledge . FINDINGS Sleep efficiency and latency improved more in the CBTI group than the BPT group ; this difference was maintained during follow-up . Women in the CBTI group had less subjective insomnia , greater improvements in physical and cognitive functioning , positive sleep attitudes , and increased sleep hygiene knowledge . No group differences in improvement were noted relative to QOL , fatigue , or mood . CONCLUSIONS Nurse-delivered CBTI appears to be beneficial for BCSs ' sleep latency/efficiency , insomnia severity , functioning , sleep knowledge , and attitudes more than active placebo , with sustained benefit over time . IMPLICATION S FOR NURSING Oncology nurses are in a unique position to identify insomnia in cancer survivors . When sleep disturbances become chronic , nurses need to make recommendations and referrals PURPOSE To estimate prevalence and severity of patients ' self-perceived supportive care needs in the immediate post-treatment phase and identify predictors of unmet need . PATIENTS AND METHODS A multicenter , prospect i ve , longitudinal survey was conducted . Sixty-six centers recruited patients for 12 weeks . Patients receiving treatment for the following cancers were recruited : breast , prostate , colorectal , and gynecologic cancer and non-Hodgkin 's lymphoma . Measures of supportive care needs , anxiety and depression , fear of recurrence , and positive and negative affect were completed at the end of treatment ( T0 ) and 6 months later ( T1 ) . RESULTS Of 1,850 patients given question naire packs , 1,425 ( 79 % ) returned question naires at T0 , and 1,152 ( 62 % ) returned question naires at T1 . Mean age was 61 years ; and most respondents were female ( 69 % ) and had breast cancer ( 57 % ) . Most patients had no or few moderate or severe unmet supportive care needs . However , 30 % reported more than five unmet needs at baseline , and for 60 % of these patients , the situation did not improve . At both assessment s , the most frequently endorsed unmet needs were psychological needs and fear of recurrence . Logistic regression revealed several statistically significant predictors of unmet need , including receipt of hormone treatment , negative affect , and experiencing an unrelated significant event between assessment s. CONCLUSION Most patients do not express unmet needs for supportive care after treatment . Thirty percent reported more than five moderate or severe unmet needs at both assessment s. Unmet needs were predicted by hormone treatment , negative mood , and experiencing a significant event . Our results suggest that there is a proportion of survivors with unmet needs who might benefit from the targeted application of psychosocial re sources OBJECTIVE It is well documented that stress is associated with negative health outcomes in cancer patients . The purpose of this study was to assess the effects of a novel mindfulness intervention called mindfulness-based art therapy ( MBAT ) versus st and ard educational support , on indices of stress and quality of life in breast cancer patients with high stress levels . METHODS A total of 191 women were enrolled , stratified by age and stress level , and r and omized to receive either an 8-week MBAT intervention or a breast cancer educational support program of equal time and duration . Psychosocial stress was measured using the Symptoms Checklist-90-Revised , and quality of life was measured using the Medical Outcomes Study Short-Form Health Survey at baseline , immediately post-intervention , and at 6 months . RESULTS Results showed overall significant improvements in psychosocial stress and quality of life in both the MBAT and educational support groups immediately post-intervention ; however , participants with high stress levels at baseline had significantly improved overall outcomes only in the MBAT group , both immediately post-intervention and at 6 months . In addition , at 6 months follow-up , participants attending five or more sessions trended toward retaining treatment effects better in the MBAT than in the control group . Finally , black women and white women were similar in terms of how they benefited from the MBAT intervention , even though white participants tended to have higher educational level and marital status . CONCLUSIONS In conclusion , MBAT is associated with significant , sustained benefits across a diverse range of breast cancer patients , particularly those with high stress levels CONTEXT Five-year survival rates for early stage colorectal , breast , and prostate cancer currently exceed 90 % and are increasing . Cancer survivors are at greater risk for second malignancies , other comorbidities , and accelerated functional decline . Lifestyle interventions may provide benefit , but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status . OBJECTIVE To determine whether a telephone counseling and mailed print material -based diet and exercise intervention is effective in reorienting functional decline in older , overweight cancer survivors . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of 641 overweight ( body mass index > or = 25 and < 40 ) , long-term ( > or = 5 years ) survivors ( aged 65 - 91 years ) of colorectal , breast , and prostate cancer , who were r and omly assigned to an intervention group ( n = 319 ) or delayed intervention ( control ) group ( n = 322 ) in Canada , the United Kingdom , and 21 US states . Individuals were recruited for the Reach out to Enhance Wellness ( RENEW ) trial from July 1 , 2005 , through May 17 , 2007 . INTERVENTION A 12-month , home-based tailored program of telephone counseling and mailed material s promoting exercise , improved diet quality , and modest weight loss . The control group was wait-listed for 12 months . MAIN OUTCOME MEASURES Change in self-reported physical function on the Short-Form 36 physical function subscale ( score range , 0 - 100 ; a high score indicates better functioning ) from baseline to 12 months was the primary end point . Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index ( score range , 0 - 100 ) , physical activity , body mass index , and overall health-related quality of life . RESULTS The mean baseline Short-Form 36 physical function score was 75.7 . At the 12-month follow-up , the mean function scores declined less rapidly in the intervention group ( -2.15 ; 95 % confidence interval [ CI ] , -0.36 to -3.93 ) compared with the control group ( -4.84 ; 95 % CI , -3.04 to -6.63 ) ( P = .03 ) . The mean baseline basic lower extremity function score was 78.2 . The mean changes in basic lower extremity function were 0.34 ( 95 % CI , -0.84 to 1.52 ) in the intervention group compared with -1.89 ( 95 % CI , -0.70 to -3.09 ) in the control group ( P = .005 ) . Physical activity , dietary behaviors , and overall quality of life increased significantly in the intervention group compared with the control group , and weight loss also was greater ( 2.06 kg [ 95 % CI , 1.69 to 2.43 kg ] vs 0.92 kg [ 95 % CI , 0.51 to 1.33 kg ] , respectively ; P < .001 ) . CONCLUSION Among older , long-term survivors of colorectal , breast , and prostate cancer , a diet and exercise intervention reduced the rate of self-reported functional decline compared with no intervention . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00303875 BACKGROUND Research has shown that self-directed stress management training improves mental well-being in patients undergoing chemotherapy . The present study extends this work by evaluating separate and combined effects of stress management training and home-based exercise . METHOD Following assessment of mental and physical well-being , depression , anxiety , exercise , and stress reduction activity before chemotherapy started , patients were r and omized to stress management training ( SM ) , exercise ( EX ) , combined stress management and exercise ( SMEX ) , or usual care only ( UCO ) . Outcomes were reassessed 6 and 12 weeks after chemotherapy started . Significance testing of group-by-time interactions in 286 patients who completed all assessment s was used to evaluate intervention efficacy . RESULTS Interaction effects for mental and physical well-being scores were not significant . Depression scores yielded a linear interaction comparing UCO and SMEX ( p = 0.019 ) , with decreases in SMEX but not UCO . Anxiety scores yielded a quadratic interaction comparing UCO and SMEX ( p = 0.049 ) , with trends for changes in SMEX but not UCO . Additional analyses yielded quadratic interactions for exercise activity comparing UCO and SMEX ( p = 0.022 ) , with positive changes in SMEX but not UCO , and for stress management activity comparing UCO and SM ( p < 0.001 ) and UCO and SMEX ( p = 0.013 ) , with positive changes in SM and SMEX but not UCO . CONCLUSION Only the combined intervention yielded effects on quality of life outcomes , and these were limited to anxiety and depression . These findings are consistent with evidence that only the combined intervention yielded increases in both exercise and stress management activity . Future research should investigate ways to augment this intervention to enhance its benefits This investigation used a non-r and omized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction ( MBSR ) program on immune function , quality of life ( QOL ) , and coping in women recently diagnosed with breast cancer . Early stage breast cancer patients , who did not receive chemotherapy  , self-selected into an 8-week MBSR program or into an assessment only , control group . Outcomes were evaluated over time . The first assessment was at least 10 days after surgery and prior to adjuvant therapy , as well as before the MBSR start-up . Further assessment s were mid-MBSR , at completion of MBSR , and at 4-week post-MBSR completion . Women with breast cancer enrolled in the control group ( Non-MBSR )  were assessed at similar times . At the first assessment ( i.e. , before MBSR start ) , reductions in peripheral blood mononuclear cell NK cell activity ( NKCA ) and IFN-gamma production with increases in IL-4 , IL-6 , and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breast cancer patients . Over time women in the MBSR group re-established their NKCA and cytokine production levels . In contrast , breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN-gamma production with increased IL-4 , IL-6 , and IL-10 production . Moreover , women enrolled in the MBSR program had reduced cortisol levels , improved QOL , and increased coping effectiveness compared to the Non-MBSR group . In summary , MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence for beneficial effects of MBSR ; on immune function , QOL , and coping Introduction Breast cancer survivors experience diminished health-related quality of life ( HRQOL ) . We report on the influence of tai chi chuan exercise ( TCC ) on HRQOL and explore associations between changes in HRQOL and biomarkers . Methods Breast cancer survivors ( N = 21 ) were r and omly assigned to TCC or st and ard support therapy ( SST ) for 12 weeks ( three times/week ; 60 min/session ) . Interleukin-6 , interleukin-8 ( IL-8 ) , insulin-like growth factor-1 ( IGF-1 ) , insulin-like growth factor-binding protein (IBFBP)-1 , IGFBP-3 , glucose , insulin , and cortisol were measured pre- and postintervention . Overall HRQOL and subdomains were assessed at preintervention ( T1 ) , midintervention ( T2 ) and postintervention ( T3 ) and biomarkers at T1 and T3 . Results The TCC group improved in total HRQOL ( T1–T2:CS = 8.54 , P = 0.045 ) , physical functioning ( T1–T2:CS = 1.89 , P = 0.030 ) , physical role limitations ( T1–T2 CS = 1.55 , P = 0.023 ) , social functioning ( T1–T3:CS = 1.50 , P = 0.020 ) , and general mental health ( T1–T2:CS = 2.67 , P = 0.014 ; T1–T3:CS = 2.44 , P = 0.019 ) . The SST  improved in social functioning ( T1–T2:CS = 0.64 , P = 0.043 ) and vitality ( T1–T2:CS = 0.90 , P = 0.01 ) . There were relationships between changes in IGF-1 and overall HRQOL ( r = −0.56 ; P < 0.05 ) , physical role limitation ( r = −0.68 ; P < 0.05 ) , and social functioning ( r = −0.56 ; P < 0.05 ) . IGFBP-1 changes were associated with physical role limitations changes ( r = 0.60 ; P < 0.05 ) . IGFBP-3 changes were associated with physical functioning changes ( r = 0.46 ; P ≤ 0.05 ) . Cortisol changes were associated with changes in physical role limitations ( r = 0.74 ; P < 0.05 ) and health perceptions ( r = 0.46 ; P < 0.05 ) . Glucose changes were associated with emotional role limitation changes ( r = −0.70 ; P < 0.001 ) . IL-8 changes were associated with emotional role limitation changes ( r = 0.59 ; P < 0.05 ) . Discussion / conclusions TCC may improve HRQOL by regulating inflammatory responses and other biomarkers associated with side effects from cancer and its treatments . Implication s for cancer survivorsTCC may be an intervention capable of improving HRQOL in breast cancer survivors 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 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 . Chronic fatigue is one of the most restricting symptoms following primary breast cancer treatment , but clinical studies on symptom management are rare . The objective was to evaluate the impact of a multimodal mind – body program ( MMMT ) , including moderate physical activity as compared with a walking intervention alone , on chronic fatigue symptoms of women with stage I to IIIA breast cancer . Patients and Methods . Sixty-four women ( mean age = 56.7 years ) suffering from chronic fatigue after active tumor treatment were r and omly assigned to either an experimental or a control ( n = 32 each ) intervention ( 10 weeks ) . Fatigue , quality of life ( QoL ) , functional well-being , anxiety , and depression were measured with st and ard question naires at baseline , after 10 weeks , and after 3 months . Results . Compared with baseline , both groups had reduced fatigue scores after treatment without any significant difference between groups ( posttreatment , Δ = −0.3 , confidence interval = −1.6 to 1.0 , P = .678 ; follow-up , Δ = −0.4 , confidence interval = −1.8 to 0.9 , P = .510 ) . All patients also improved regarding QoL and general functional well-being . Conclusion . Since both interventions reduced fatigue symptoms and enhanced QoL to a similar extent , we observed no verifiable add-on effect of the MMMT  regarding fatigue symptoms . Considering the higher costs with additional expenditure related to MMMT , home-based walking intervention is recommended PURPOSE / OBJECTIVES To investigate whether quality of life ( QOL ) assessed before weight loss intervention predicts weight loss and , in turn , what the effect of weight loss is on QOL measures after 12 months in early-stage breast cancer survivors . DESIGN A clinical trial of a weight loss intervention in breast cancer survivors . SETTING Community-wide recruitment in Detroit , MI . SAMPLE 39 breast cancer survivors ( body mass index = 30 - 44 kg/m2 ) , within three years of initial diagnosis and at least three months after chemotherapy or radiation therapy .  METHODS Participants were r and omized to one of three weight loss methods  or a control group . The Functional Assessment of Cancer Therapy-Anemia ( FACT-An ) QOL question naire was administered at baseline and after the intervention . MAIN RESEARCH VARIABLES Six subscales of the FACT-An and weight change . FINDINGS Modest but statistically significant associations were found for the physical and functional subscales of the FACT-An with  weight loss for 39 subjects who completed 12 months of the study . Those reporting relatively impaired physical or functional QOL at baseline lost more weight , which accounted for 8%-9 % of the weight loss variance beyond that result ing from the diet arm assignment . At 12 months , greater weight loss was associated with significant improvements in overall FACT-An score and in the physical , functional , fatigue , and anemia subscales ( p < 0.05 ) . CONCLUSIONS Relatively low physical function at baseline was not a barrier to weight loss ; indeed , it may have been a motivating factor in adherence to the weight loss intervention . Weight loss was associated with improvement in several QOL subscale measures in breast cancer survivors , but the emotional and social subscales were not affected . IMPLICATION S FOR NURSING Counseling for weight loss that includes recommendations for exercise should not be withheld for patients with relatively low physical functioning Background : Interventions addressing cancer survivors ’ posttreatment concerns can be time-intensive and require specialized staff . Research is needed to identify feasible minimal intervention strategies to improve survivors ’ quality of life after treatment . Objectives : The objective of this study was to evaluate the feasibility and short-term impact of a minimal clinic intervention on breast cancer survivors ’ quality of life , unmet needs , distress , and cancer worry . Interventions / Methods : In this r and omized controlled pilot trial , we enrolled breast cancer survivors at the end of treatment and administered baseline surveys . Participants were r and omized to study arm ( 4-week video plus educational booklet intervention group and usual care group ) and completed follow-up surveys at 10 weeks . Linear regression was used to examine intervention effects on quality of life outcomes controlling for clinical and demographic factors . Open-ended questions were used to examine program satisfaction and obtain feedback to improve the intervention . Results : We enrolled 92 survivors in the trial . Participants rated the intervention highly and reported feeling less isolated and having more realistic expectations about their recovery after completing the program . Despite positive qualitative findings , no significant intervention effects were observed for quality of life , unmet needs , distress , or cancer worry in unadjusted or adjusted analyses . Conclusions : Future research is needed to define optimal intervention elements to prepare breast cancer survivors for the posttreatment period . Implication s for Practice : Effective survivorship interventions may require more intensive components such as clinical input and longer follow-up periods PURPOSE To assess the effectiveness of mindfulness-based stress reduction ( MBSR ) for mood , breast- and endocrine-specific quality of life , and well-being after hospital treatment in women with stage 0 to III breast cancer . PATIENTS AND METHODS A r and omized , wait-listed , controlled trial was carried out in 229 women after surgery , chemotherapy , and radiotherapy for breast cancer . Patients were r and omly assigned to the 8-week MBSR program or st and ard care .  Profile of Mood States ( POMS ; primary outcome ) , Functional Assessment of Cancer Therapy-Breast ( FACT-B ) , Functional Assessment of Cancer Therapy-Endocrine Symptoms ( FACT-ES ) scales and the WHO five-item well-being question naire ( WHO-5 ) evaluated mood , quality of life , and well-being at weeks 0 , 8 , and 12 . For each outcome measure , a repeated- measures analysis of variance model , which incorporated week 0 measurements as a covariate , was used to compare treatment groups at 8 and 12 weeks . RESULTS There were statistically significant improvements in outcome in the experimental group compared with control group at both 8 and 12 weeks ( except as indicated ) for POMS total mood disturbance ( and its subscales of anxiety , depression [ 8 weeks only ] , anger [ 12 weeks only ] , vigor , fatigue , and confusion [ 8 weeks only ] ) , FACT-B , FACT-ES , ( and Functional Assessment of Cancer Therapy subscales of physical , social [ 8 weeks only ] , emotional , and functional well-being ) , and WHO-5 . CONCLUSION MSBR improved mood , breast- and endocrine-related quality of life , and well-being more effectively than st and ard care in women with stage 0 to III breast cancer , and these results persisted at three months . To our knowledge , this study provided novel evidence that MBSR can help alleviate long-term emotional and physical adverse effects of medical treatments , including endocrine treatments . MBSR is recommended to support survivors of breast cancer PURPOSE / OBJECTIVES To test the effectiveness of a bilingual education intervention to improve the quality of life ( QOL ) of Latina breast cancer survivors ( BCSs ) after completing primary treatment for breast cancer . DESIGN A two-group prospect i ve , longitudinal , r and omized , controlled trial . SETTING An ambulatory-care setting of a design ated comprehensive cancer center in southern California . SAMPLE 52 English- and Spanish-speaking Latina BCSs . METHODS Women were r and omly assigned to the experimental or attention control group and completed measures of QOL , uncertainty , distress , and acculturation at baseline , and at three and six months postintervention . MAIN RESEARCH VARIABLES QOL , uncertainty , and distress . FINDINGS After controlling for acculturation , the four dimensions of QOL increased slightly in the groups or remained unchanged without significant group-by-time interaction . The social and psychological well-being subscales had the lowest scores , followed by physical and spiritual well-being . Although the group-by-time interaction was not statistically significant , the post-hoc difference for total QOL between time 2 and time 3 in the experimental group approached significance , with a slight increase in total QOL . CONCLUSIONS Latina BCSs have multiple survivorship and QOL concerns that might put them at risk for poor QOL . IMPLICATION S FOR NURSING More culturally congruent intervention studies are needed to address the paucity of intervention research with Latina BCS . KNOWLEDGE TRANSLATION Core values must be incorporated in the development of health education programs . Those programs also should be linguistically appropriate and available to non-English-speaking Latinas . In this way , the informational and supportive needs of all BCSs can be met OBJECTIVE This paper will report the results of a pilot test of a 6-month , 21-session intervention to increase breast cancer survivors ' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines ( lifestyle intervention ) . The effect of the intervention on physical performance , quality of life , and physical activity are reported . METHODS Sixty breast cancer survivors were r and omized to either a  lifestyle intervention  or a  st and ard care control group .  Physical performance , quality of life ( Medical outcomes study short form-36 [ SF-36 ] ) , and physical activity ( 7-day recall and motivation readiness ) , were assessed at baseline and 6 months . RESULTS The lifestyle group had significantly better performance in the 6-min walk task than the controls ( p=0.005 ) at 6 months . The intervention had positive effects on the bodily pain ( p=0.020 ) and general health ( p=0.006 ) subscales from the SF-36 . The lifestyle group had a greater motivational readiness for physical activity at 6-month than st and ard care , but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did > or = 30 min of moderate or more intense activity . CONCLUSIONS Despite the small sample size , the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity , and should be tested in a larger r and omized trial . PRACTICE IMPLICATION S If the lifestyle approach is shown to be effective in a larger trial , it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment This paper reports on a r and omised controlled trial assessing two types of outpatient follow up for women previously treated for stage 1 breast cancer now in remission . These were  st and ard clinic follow up ( n = 31 , age range : 48 - 83 years ) and patient initiated follow up ( n = 30 , age range 53 - 87 years ) . The latter method involved giving the women written information on the signs and symptoms of recurrence and instructing them to telephone the Breast Care Nurse if they encountered any problems . The groups were compared in terms of cancer and breast cancer-specific quality of life , and psychological morbidity at recruitment , 6 months and 1 year . Satisfaction with follow up was assessed at 6 months and 1 year . Details regarding contact with healthcare professionals were collected at 1 year . There were no major differences in quality of life and psychological morbidity between the groups although more women in the st and ard clinic group reported reassurance and being checked as advantages whereas more women in the patient initiated follow up group reported convenience as an advantage . Patient initiated follow up is a potential alternative to st and ard clinic follow up for this group of women and appears to have no adverse effects . This could enable a cost saving to be made PURPOSE Most women with breast cancer are diagnosed at an early stage and more than 80 % will be long-term survivors . Routine follow-up marks the transition from intensive treatment to survivorship . It is usual practice for routine follow-up to take place in specialist clinics . This study tested the hypothesis that follow-up by the patient 's family physician is a safe and acceptable alternative to specialist follow-up . PATIENTS AND METHODS A multicenter , r and omized , controlled trial was conducted involving 968 patients with early-stage breast cancer who had completed adjuvant treatment , were disease free , and were between 9 and 15 months after diagnosis . Patients may have continued receiving adjuvant hormonal therapy . Patients were r and omly allocated to follow-up in the cancer center according to usual practice ( CC group ) or follow-up from their own family physician ( FP group ) . The primary outcome was the rate of recurrence-related serious clinical events ( SCEs ) . The secondary outcome was health-related quality of life ( HRQL ) . RESULTS In the FP group , there were 54 recurrences ( 11.2 % ) and 29 deaths ( 6.0 % ) . In the CC group , there were 64 recurrences ( 13.2 % ) and 30 deaths ( 6.2 % ) . In the FP group , 17 patients ( 3.5 % ) compared with 18 patients ( 3.7 % ) in the CC group experienced an SCE ( 0.19 % difference ; 95 % CI , -2.26 % to 2.65 % ) . No statistically significant differences ( P < .05 ) were detected between groups on any of the HRQL question naires . CONCLUSION Breast cancer patients can be offered follow-up by their family physician without concern that important recurrence-related SCEs will occur more frequently or that HRQL will be negatively affected Evidence -based exercise and relaxation recommendations for people with breast cancer-related lymphedema ( BCRL ) are needed . We report a r and omized controlled study of one program , design ed to achieve synergistic improvements in physical and emotional BCRL symptoms . People in the treatment group received an exercise and relaxation program , The Breast Cancer Recovery Program ( N=16 ) . The  control participants ( N=16 )  continued with health professionals ' recommendations .  Participants were tested at entry , 2.5 weeks , 5 weeks , and 3 months . Treatment group participants , compared with control participants , demonstrated significant treatment effects for improved bioimpedance z , arm flexibility , quality of life , mood at 3 months , and weight loss . Adherence was high for this safe and effective program , which improved lymphedema physical and emotional symptoms 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 OBJECTIVE A needs assessment can be used as a direct index of what patients perceive they need help with . The purpose s of this study were to investigate the association between patients ' perceived needs and psychological distress and /or quality of life ( QOL ) and to clarify the characteristics of patients with a high degree of unmet needs . METHODS R and omly selected ambulatory female patients with breast cancer participated in this study . The patients were asked to complete the Short-form Supportive Care Needs Survey question naire , which covers five domains of need ( health system and information , psychological , physical , care and support , and sexuality needs ) ; the Hospital Anxiety and Depression Scale ; and the European Organization for Research and Treatment of Cancer QLQ-C 30 . RESULTS Complete data were available for 408 patients . The patients ' needs were significantly associated with both psychological distress ( r=0.63 , p<0.001 ) and QOL ( r=-0.52 , p<0.001 ) . A multiple regression analysis revealed that employment status ( without full-time /part-time job ) , duration since diagnosis ( less than 6 months ) , advanced stage , and a lower performance status were significantly associated with higher total needs . Only sexuality needs were significantly associated with a younger age , while the other domains were significantly associated with duration since diagnosis , advanced stage , and a lower performance status . CONCLUSIONS Moderate to strong associations exist between patients ' needs and psychological distress and /or QOL . The characteristics associated with patients ' needs are multi-factorial , and interventions to respond to patients ' needs may be one possible strategy for ameliorating psychological distress and enhancing QOL Breast cancer is the most common invasive cancer among women in developed countries . Obesity is a major risk factor for breast cancer recurrence and mortality in both pre- and postmenopausal women . Co-morbid medical conditions are common among breast cancer survivors . The Exercise and Nutrition to Enhance Recovery and Good Health for You ( ENERGY ) study is a 4-year r and omized clinical trial of 693 overweight/obese women aged ≥21years diagnosed with any early stage breast cancer ( stages I[≥1cm]-III ) within the previous five years , design ed to demonstrate the feasibility of achieving sustained weight loss and to examine the impact of weight loss on quality of life and co-morbidities , and to enable future exploration of biochemical mechanisms linking obesity to lower likelihood of disease-free survival . This trial is strategically design ed as a vanguard for a fully-powered trial of women who will be evaluated for breast cancer recurrence and disease-free survival . Participants were recruited between 2010 and 2012 at four sites , had completed initial therapies , and had a body mass index between 25 and 45kg/m(2 ) . The intervention featured a group-based cognitive-behavioral weight loss program with telephone counseling and tailored newsletters to support initial weight loss and subsequent maintenance  , with the goal of 7 % weight loss at two years . This study has high potential to have a major impact on clinical management and outcomes after a breast cancer diagnosis . This trial initiates the effort to establish weight loss support for overweight or obese breast cancer survivors as a new st and ard of clinical care Background About one third of breast cancer survivors suffer from persistent severe fatigue after completion of curative cancer treatment . Face-to-face cognitive behavioral therapy ( F2F CBT ) , especially design ed for fatigue in cancer survivors , was found effective in reducing fatigue . However , this intervention is intensive and treatment capacity is limited . To extend treatment options , a web-based version of CBT requiring less therapist time was developed . This intervention is aim ed at changing fatigue-perpetuating cognitions and behaviors . The efficacy of web-based CBT will be examined in a multicenter r and omized controlled trial . Methods In total , 132 severely fatigued breast cancer survivors will be recruited and r and omized to either an intervention condition or care as usual ( ratio 1:1 ) . Participants will be assessed at baseline and 6 months thereafter . The intervention group will receive web-based CBT , consisting of three F2F sessions and maximally eight web-based modules over a period of 6 months . The care as usual group will be on a waiting list for regular F2F CBT . The total duration of the waiting list is 6 months . The primary outcome of the study is fatigue severity . Secondary outcomes are functional impairments , psychological distress and quality of life . Discussion If web-based CBT is effective , it will provide an additional treatment option for fatigue in breast cancer survivors . Web-based CBT is expected to be less time-consuming for therapists than regular F2F CBT , which would result in an increased treatment capacity . Moreover , the intervention would become more easily accessible for a larger number of patients , and patients can save travel time and costs . Trial registration Dutch Trial Registry -
BACKGROUND The prognosis and survival rate of women with breast cancer have significantly improved worldwide .
Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women 's quality of life for their successful transition to rehabilitation and normal life .
It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life  in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer , or both .
OBJECTIVES To assess the effects of home-based , multidimensional survivorship ( HBMS ) programmes on maintaining or improving the quality of life in breast cancer survivors .