Behavioral Symptoms in Patients With Breast Cancer and Survivors

University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 03/2008; 26(5):768-77. DOI: 10.1200/JCO.2007.14.3248
Source: PubMed


Behavioral symptoms are a common adverse effect of breast cancer diagnosis and treatment and include disturbances in energy, sleep, mood, and cognition. These symptoms cause serious disruption in patients' quality of life and may persist for years after treatment. Patients need accurate information about the occurrence of these adverse effects as well as assistance with symptom management. This review considers four of the most common behavioral sequelae of breast cancer, namely fatigue, sleep disturbance, depression, and cognitive impairment. Research on the prevalence, mechanisms, and treatment of each symptom is described, concluding with recommendations for future studies.

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    • "Furthermore, the increasing survival rate has induced to consider the quality of life of women years after diagnosis and treatment. In fact, although recovered from cancer, relational difficulties, emotional dissatisfaction , underfunctioning, compared to personal and socio-family expectations, may persist (Andersen et al., 2008; Bleiker, Pouwer, van der Ploeg, Leer, & Adèr, 2000; Bower, 2008; Shelby, Golden-Kreutz, & Andersen, 2008; Spiegel, 1997). "
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    ABSTRACT: The present study was aimed at investigating the role of coping strategies in predicting emotional distress following breast cancer, over and above the illness severity, operationalized in terms of the type of surgery performed. In order to achieve this goal, two groups of newly diagnosed breast cancer women were selected and compared on the basis of the type of surgical treatment received. A subsample of 30 women with quadrantectomy and sentinel lymph-node biopsy (SLNB) and a subsample of 31 patients with mastectomy and axillary dissection (MAD) filled in the Brief Cope scale and Hospital Anxiety and Depression Scale. Summarizing, results showed that emotional support, venting, and humor explained a statistically significant increment of variance in psychological distress indices. Implication for clinical practice and future research were discussed.
    Full-text · Article · May 2015 · Europe's Journal of Psychology
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    • "Symptoms of chemotherapy-induced cognitive impairment (CICI), or 'chemobrain', are common complaints of cancer survivors. While incidence estimates of CICI vary widely[1], CICI is recognized as a significant morbidity by the National Cancer Institute and patient advocacy groups, and therefore is a high priority in survivorship research. There is a lack of consensus regarding the causality of CICI[2], and this lack of mechanistic understanding has hampered efforts to prevent CICI. "
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    ABSTRACT: Purpose: Chemotherapy-induced cognitive impairment (CICI) is a common sequelae of cancer therapy. Recent preclinical observations have suggested that CICI can be mediated by chemotherapy-induced plasma protein oxidation, which triggers TNF-α mediated CNS damage. This study evaluated sodium-2-mercaptoethane sulfonate (Mesna) co-administration with doxorubicin to reduce doxorubicin-induced plasma protein oxidation and resultant cascade of TNF-α, soluble TNF receptor levels and related cytokines. Methods: Thirty-two evaluable patients were randomized using a crossover design to receive mesna or saline in either the first or second cycle of doxorubicin in the context of a standard chemotherapy regimen for either non-Hodgkin lymphoma or breast cancer. Mesna (360 mg/m2) or saline administration occurred 15 minutes prior and three hours post doxorubicin. Pre-treatment and post-treatment measurements of oxidative stress, TNF-α and related cytokines were evaluated during the two experimental cycles of chemotherapy. Results: Co-administration of mesna with chemotherapy reduced post-treatment levels of TNF-related cytokines and TNF-receptor 1 (TNFR1) and TNF-receptor 2 (TNFR2) (p = 0.05 and p = 0.002, respectively). Patients with the highest pre-treatment levels of each cytokine and its receptors were the most likely to benefit from mesna co-administration. Conclusions: The extracellular anti-oxidant mesna, when co-administered during a single cycle of doxorubicin, reduced levels of TNF-α and its receptors after that cycle of therapy, demonstrating for the first time a clinical interaction between mesna and doxorubicin, drugs often coincidentally co-administered in multi-agent regimens. These findings support further investigation to determine whether rationally-timed mesna co-administration with redox active chemotherapy may prevent or reduce the cascade of events that lead to CICI. Trial registration: NCT01205503.
    Full-text · Article · Apr 2015 · PLoS ONE
    • "For example, breast cancer patients with sleep disturbance display elevated levels of cortisol and norepinepherine, accompanied by increased SNS activity and increased 24- h metabolic rate, indicating physiological hyperarousal (Carlson et al., 2007a). Even though sleep disturbance is a persisting problem, it may not always be dealt with effectively in post-treatment cancer survivor care (Bower, 2008; Ancoli-Israel, 2009). As an alternative to conventional treatments for sleep disturbance in cancer patients and survivors (besides in many other clinical populations), non-pharmacological or behavioral interventions such as mind—body therapies have increasingly shown promise (Carlson and Bultz, 2008; Kwekkeboom et al., 2010). "
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    ABSTRACT: Cancer survivors experience high levels of distress, associated with a host of negative psychological states, including anxiety, depression, and fear of recurrence, which often lead to sleep problems and reduction in quality of life (QOL) and well-being. As a neuropeptide hormone associated with affiliation, calmness, and well-being, oxytocin may be a useful biological measure of changes in health outcomes in cancer survivors. In this exploratory study, which comprised a subset of participants from a larger study, we evaluated (a) the feasibility and reliability of salivary oxytocin (sOT) levels in cancer survivors and (b) the effects of 2 sleep-focused mind-body interventions, mind-body bridging (MBB) and mindfulness meditation (MM), compared with a sleep hygiene education (SHE) control, on changes in sOT levels in 30 cancer survivors with self-reported sleep disturbance. Interventions were conducted in 3 sessions, once per week for 3 weeks. Saliva samples were collected at baseline, postintervention (~1 week after the last session), and at the 2-month follow-up. In this cancer survivor group, we found that intra-individual sOT levels were fairly stable across the 3 time points, of about 3 months' duration, and mean baseline sOT levels did not differ between females and males and were not correlated with age. Correlations between baseline sOT and self-report measures were weak; however, several of these relationships were in the predicted direction, in which sOT levels were negatively associated with sleep problems and depression and positively associated with cancer-related QOL and well-being. Regarding intervention effects on sOT, baseline-subtracted sOT levels were significantly larger at postintervention in the MBB group as compared with those in SHE. In this sample of cancer survivors assessed for sOT, at postintervention, greater reductions in sleep problems were noted for MBB and MM compared with that of SHE, and increases in mindfulness and self-compassion were observed in the MBB group compared with those in SHE. The findings in this exploratory study suggest that sOT may be a reliable biological measure over time that may provide insight into the effects of mind-body interventions on health outcomes in cancer survivors. © The Author(s) 2015.
    No preview · Article · Apr 2015 · Integrative Cancer Therapies
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