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"Schmidt, Martina"
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Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis
Purpose After cancer treatment, it is desirable to maintain or regain a high quality of life (QoL) and the ability to accomplish everyday tasks well. Therefore, we substantiated the scarce knowledge regarding long-term QoL after breast cancer, burdensome problems, and unmet needs for more support. Methods Disease-free breast cancer survivors (n=190) who had participated in two randomized controlled exercise trials during primary treatment were followed up to 5 years post-diagnosis. QoL-related functions and symptoms (EORTC-QLQ-C30/-BR23), health problems, and support needs were assessed. EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany. Results QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references, but largely improved over time. Yet, cognitive function and sleep were still significantly impaired at 5-year follow-up. Other common long-term problems included sexual issues (45% of survivors), hot flashes (38%), pain (34%), fatigue (24%), and polyneuropathy (21%). Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders (43%), physical performance (39%), sleep problems (38%), arthralgia (37%), cognitive problems (36%), weight problems (32%), and fatigue (31%). Conclusions While QoL in disease-free breast cancer survivors 5 years post-diagnosis was largely comparable to the general population on average, still many survivors suffered from adverse effects. There appears to be a need for ongoing screening and support regarding fatigue, sleep problems, cognitive problems, arthralgia/pain, menopausal/sexual symptoms, physical performance, and weight problems during and several years following breast cancer therapy.
Journal Article
Effects of physical and mind–body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis
PurposeWe conducted a meta-analysis evaluating the effects of different exercise interventions on self-reported and objective sleep measurements during or after breast cancer treatment.MethodsThree databases were systematically searched for randomized controlled trials with any type of exercise intervention in women with breast cancer. Outcomes were self-reported or objective sleep measurements. Standardized mean differences (SMDs) were calculated using random-effects models.ResultsThe meta-analysis included 22 trials with 2107 participants. Of these, 17 studies used the Pittsburgh Sleep Quality Index (PSQI), six studies included objective sleep assessments (ActiGraph). Physical exercise interventions included walking, aerobic exercise, resistance exercise or a combination of both. Mind–body exercise interventions included yoga, Tai Chi and Qigong. Most interventions were supervised. Both, physical (SMD − 0.32; 95% CI − 0.54 to − 0.10) and mind–body exercise interventions (SMD − 0.27; 95% CI − 0.44 to − 0.09), resulted in improvements of total sleep scores. Subgroup analyses revealed no clear differences between interventions conducted during versus after breast cancer treatment. Considering the PSQI subscales, exercise resulted in improvements of sleep quality (SMD − 0.28; 95% CI − 0.44 to − 0.11) and sleep disturbances (SMD − 0.26; 95% CI − 0.45 to − 0.06). Regarding the objective measurements, no significant effects were found.ConclusionsPhysical as well as mind–body exercise can improve subjective sleep problems in breast cancer patients. In contrast, there was no effect of exercise on objective sleep measures. Future studies should clarify which type of intervention might be most effective depending on individual patients’ and treatments’ characteristics.
Journal Article
Knowledge, perceptions, and management of cancer-related fatigue: the patients' perspective
PurposeThis study aimed to assess cancer patients’ knowledge and perceptions regarding fatigue and to provide up-to-date information on the current fatigue management from the patients’ perspective.MethodsThe FiX study recruited 2508 cancer patients approximately 2 years after diagnosis via a cancer registry in Germany. Participants completed a questionnaire on their knowledge and perceptions of fatigue and the management received.ResultsMore than half of respondents (58%), especially among the elderly patients, did not feel well informed about fatigue. Overall, 41% reported having never been asked about being exhausted by their treating physician. Even fewer patients stated that general practitioners or nurses have asked if they felt exhausted. Only 13% of patients who had experienced severe fatigue had received a fatigue assessment by means of a rating scale or questionnaire—although this is recommended by existing guidelines for fatigue screening. Health care professionals seemed less likely to address fatigue with elderly as well as female patients. The most commonly reported measure against fatigue was exercise or regular physical activity (68%). However, this was mostly done on patients’ own initiative. Psychological support was rarely used (13%) and only in approximately half of the cases upon the advice of a physician. Yoga, another promising intervention against fatigue, was performed by only 9% of patients.ConclusionsOur study indicates deficits in terms of knowledge, education, screening, counseling, and treatment for fatigue and highlights starting points for targeted improvements in fatigue management based on patients’ needs.
Journal Article
Long-term effects of exercise interventions on physical activity in breast cancer patients: a systematic review and meta-analysis of randomized controlled trials
Background
Benefits of exercise interventions for cancer patients are well established. This systematic review aimed to investigate the sustainability of exercise interventions with respect to physical activity behaviour of breast cancer patients in the longer term.
Methods
The databases Pubmed, Cochrane, Embase, and Web of Science were systematically searched for randomized controlled trials (RCTs) investigating aerobic exercise, resistance exercise, or combined exercise interventions in breast cancer patients and assessing physical activity at least 2 months after the intervention. Random-effect models were used to calculate standardized mean differences (SMD).
Results
A total of 27 RCTs with 4120 participants were included in the review, of which 11 RCTs with 1545 participants had appropriate data for the meta-analyses. Physical activity was mainly self-reported, and most exercise interventions were supervised. Exercise interventions tended to show a moderate significant effect up to 6 months for moderate to vigorous physical activity (SMD [95% CI] = 0.39 [0.07, 0.70]) and small, non-significant effects on total physical activity at 6 months (SMD [95% CI] = 0.14 [− 0.00, 0.28]) and up to 60 months after the intervention (SMD = 0.29 [-0.31, 0.90]). Differences between intervention characteristics, such as supervised versus unsupervised, were inconclusive due to the small number of RCTs.
Conclusions
The physical activity behaviour in breast cancer patients remained improved for several months beyond the end of exercise interventions, but effects were small to moderate and diminished over time. Future studies should clarify how to maintain a healthy level of physical activity after completion of an exercise intervention.
Journal Article
Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy
PurposeTo characterize sleep problems and to compare subjective and objective assessments in breast cancer patients starting neoadjuvant chemotherapy.MethodsSleep characteristics of 54 breast cancer patients starting neoadjuvant chemotherapy were analyzed. Subjective sleep characteristics were assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measurements with an accelerometer (ActiGraph wGT3X-BT) worn on the wrist for 7 consecutive days.ResultsAccording to the common PSQI cut-off of 8, 10 (18.87%) of the patients were poor sleepers. ActiGraph measures did not mirror this classification as values for poor, and good sleepers did not differ significantly. Overall, Bland-Altman plots illustrated higher ActiGraph values for sleep efficiency and effective sleep time and lower values for sleep latency, compared with PSQI. For total sleep time, less disagreement between both measures was observed. Actigraphy was limited in precise identification of sleep begin and sleep latency but provided supplementary information about number and minutes of awakenings during the night.ConclusionSubjective and objective measurement methods differed substantially in various parameters, with limitations in both methods. A combination of both methods might be most promising.Trial RegistrationClinicaltrials.gov: NCT02999074
Journal Article
Patient–physician communication about cancer-related fatigue: a survey of patient-perceived barriers
Purpose
Cancer-related fatigue is a subjective, distressing, and common sequela of cancer which is often disregarded and underdiagnosed. Fatigue is assessed by self-report requiring communication between patient and physician. In this study, we investigated the patients’ perspective on the patient–physician communication about fatigue.
Methods
On average five months after diagnosis 1179 cancer patients, recruited in Germany, completed a survey as part of the LIFT project. The survey included questions on sociodemographic data, fatigue, depression, fatigue management, patient–physician communication, and communication barriers. Data were analyzed descriptively and using logistic regression analyses.
Results
Half of the participants reported that their physician had never asked them whether they felt exhausted. Patients undergoing chemo-, radio-, or immunotherapy were more likely to be asked about fatigue, while older age and major depression decreased the likelihood. Sixty-four percent of the patients felt impeded by communication barriers. Common barriers were not knowing who to turn to for fatigue (39%), time constraints (31%), and the fear of being perceived as weak (22%). Almost half of the participants indicated that their physicians were not appreciative and did not deal adequately with fatigue-related questions.
Conclusion
This study revealed gaps in the patient–physician communication regarding cancer-related fatigue. Contrary to guideline recommendations a minority of physicians addressed fatigue. On the other hand, cancer patients felt reluctant to bring up this topic due to structural barriers and fears. Physicians should routinely address fatigue and adopt a communication style which encourages patients to likewise state their symptoms and raise their questions.
Trial registration
Clinicaltrials.gov, identifier: NCT04921644. Registered in June 2021.
Journal Article
The cancer patients’ perspective on feasibility of using a fatigue diary and the benefits on self-management: results from a longitudinal study
Purpose
To evaluate the patients’ perspective on feasibility of using a fatigue diary and its benefits on self-management.
Methods
This longitudinal study enrolled 50 cancer patients in routine care. Following baseline (t0) assessment, patients were asked to complete a 7-day fatigue diary and subsequently obtained written diary evaluation. Feasibility, benefits, and fatigue-related attitudes were assessed via self-report 1 (t1) and 4 months (t2) after distributing the diary. Data were analyzed descriptively and using Wilcoxon signed-rank tests.
Results
Most patients (94%) completed the diary for 7 days and rated feasibility as high. After diary completion and receiving the evaluation, fewer patients felt helpless in the face of fatigue (t1: 21% vs. t0: 53%). Additionally, more patients addressed fatigue with their general practitioner (t2: 49% vs. t0: 36%) and pro-actively searched for information and help (t2: 59% vs. t0: 38%). The diary enabled a majority of patients to be aware of their fatigue patterns, to plan daily routines accordingly and to take adequate actions against fatigue.
Conclusion
The study showed that symptom monitoring via a fatigue diary was considered feasible and enhanced self-management in cancer patients. Thus, fatigue diaries might be a useful measure contributing to an improved fatigue management. The results reinforce guideline recommendations for routine application of fatigue diaries in clinical care. Healthcare professionals should encourage patients to fatigue diary use and provide individually tailored counseling based on diary entries.
Journal Article
Muscle strength in breast cancer patients receiving different treatment regimes
Background Muscle dysfunction and sarcopenia have been associated with poor performance status, an increased mortality risk, and greater side effects in oncologic patients. However, little is known about how performance is affected by cancer therapy. We investigated muscle strength in breast cancer patients in different adjuvant treatment settings and also compared it with data from healthy individuals. Methods Breast cancer patients (N = 255) from two randomized controlled exercise trials, staged 0–III and aged 54.4 ± 9.4 years, were categorized into four groups according to their treatment status. In a cross‐sectional design, muscle function was assessed bilaterally by isokinetic dynamometry (0°, 60°, 180°/s) as maximal voluntary isometric contraction (MVIC) and maximal isokinetic peak torque (MIPT) in shoulder rotators and knee flexors and extensors. Additionally, muscular fatigue index (FI%) and shoulder flexibility were evaluated. Healthy women (N = 26), aged 53.3 ± 9.8 years, were tested using the same method. Analysis of covariance was used to estimate the impact of different cancer treatments on skeletal muscle function with adjustment for various clinical and socio‐demographic factors. Results Consistently, lower muscle strength was measured in shoulder and knee strength in patients after chemotherapy. On average, patients had up to 25% lower strength in lower extremities and 12–16% in upper extremities in MVIC and MIPT during cancer treatment compared with healthy women. No substantial difference between patient groups in shoulder strength, but significantly lower shoulder flexibility in patients with radical mastectomy was measured. Chemotherapy‐treated patients had consistently higher FI%. No serious adverse events were reported. Conclusions Breast cancer patients showed markedly impaired muscle strength and joint dysfunctions before and after anticancer treatment. The significant differences between patients and healthy individuals underline the need of exercise therapy as early as possible in order to prevent or counteract the loss of muscle function after curative surgery as well as the consequences of neo‐/adjuvant chemotherapy.
Journal Article
Effects of aerobic or resistance exercise on sleep and cancer-related fatigue in patients with breast cancer during or after neoadjuvant chemotherapy: a 3-arm randomized controlled trial
Background
The aim of this secondary analysis of the BENEFIT randomized controlled trial was to investigate the effects of aerobic training (AT) or resistance training (RT) during neoadjuvant chemotherapy (NACT) on sleep and cancer-related fatigue (CRF), compared to a waitlist control group (WCG) that performed RT after surgery.
Methods
In the BENEFIT study, 184 patients with breast cancer with scheduled NACT (mean age = 50 years, standard deviation = 11) were randomized to AT (
n
= 62), RT (
n
= 62), or WCG (
n
= 60). While the AT and RT groups trained during NACT (two supervised and one home-based session weekly), the WCG completed the same training as the RT group but only after breast surgery. Self-reported sleep quality (Pittsburgh Sleep Quality Index) and CRF (EORTC QLQ-FA12) were collected before NACT (T0), after 9 weeks (T1), after NACT and before surgery (T2), 6 months after surgery (T3), and 12 months after surgery (T4). At T0, T2, and T3, sleep was additionally objectively measured by actigraphy.
Results
Longitudinal analyses of covariance examining changes from baseline suggested no clear difference of AT and RT compared to the WCG regarding sleep and CRF parameters post-intervention (T2). In contrast, at T3 the WCG, which exercised between T2 and T3, showed more favorable mean values compared to the AT group in total CRF (adjusted mean difference (AMD): − 10.53, 95% CI [− 19.63, − 1.42]) and physical CRF (AMD: − 14.28 [− 26.02, − 2.54] on 0–100 scale), and a tendency toward lower scores in self-reported global sleep quality (AMD: − 0.24 [− 0.48, 0.01] on log-transformed scale). Moderation analyses further suggested that group differences in total CRF at T3 in favor of the WCG were more pronounced among participants with at least mild emotional distress at baseline. There were no clear differences between groups in objective sleep parameters at T2 or T3, or regarding self-reported sleep or fatigue endpoints at T4.
Conclusions
The findings suggest that exercise interventions in the post-NACT phase may be more effective than during NACT for managing fatigue, while providing limited benefits for sleep.
Trial registration
The BENEFIT study has been registered at ClincialTrials.gov (NCT02999074).
Journal Article