Survivorship care plans and adherence to lifestyle recommendations among breast cancer survivors.

PURPOSE: The effectiveness of survivorship care plans has not been widely tested. We evaluated whether a one-time brief lifestyle consultation as part of a broader survivorship care plan was effective at changing diet and lifestyle patterns. METHODS: A diverse sample of women with stage 0-III breast cancer were randomized to control or intervention groups within 6 weeks of completing adjuvant treatment. Both groups received the National Cancer Institute publication, "Facing Forward: Life after Cancer Treatment." The intervention group also met with a nurse (1 h) and a nutritionist (1 h) to receive personalized lifestyle recommendations based upon national guidelines. Diet, lifestyle, and perceived health were assessed at baseline, 3 and 6 months. Linear regression analyses evaluated the effects of the intervention adjusted for covariates. RESULTS: A total of 126 women completed the study (60 control/66 intervention, 61 Hispanic/65 non-Hispanic). At 3 months, the intervention group reported greater knowledge of a healthy diet (P = 0.047), importance of physical activity (P = 0.03), and appropriate use of dietary supplements (P = 0.006) and reported lower frequency of alcohol drinking (P = 0.03) than controls. At 6 months, only greater knowledge of a healthy diet (P = 0.01) persisted. The intervention was more effective among non-Hispanics than Hispanics on improving attitude towards healthy eating (P = 0.03) and frequency of physical activity (P = 0.006). CONCLUSIONS: The intervention changed lifestyle behaviors and knowledge in the short-term, but the benefits did not persist. IMPLICATIONS FOR CANCER SURVIVORS: Culturally competent long-term behavioral interventions should be tested beyond the survivorship care plan to facilitate long-term behavior change among breast cancer survivors.

A novel mobile phone application to assess nutrition environment measures in low- and middle-income countries.

BACKGROUND: Consumer nutrition environment measures are important to understanding the food environment, which affects individual dietary intake. A nutrition environment measures survey for supermarkets (NEMS-S) has been designed on paper for use in Guatemala. However, a paper survey is not an inconspicuous data collection method. OBJECTIVE: To design, pilot test, and validate the Guatemala NEMS-S in the form of a mobile phone application (mobile app). METHODS: CommCare, a free and open-source software application, was used to design the NEMS-S for Guatemala in the form of a mobile app. Two raters tested the mobile app in a single Guatemalan supermarket. Both the interrater and the test-retest reliability of the mobile app were determined using percent agreement and Cohen's kappa score and compared with the interrater and test-retest reliability of the paper version. RESULTS: Interrater reliability was very high between the paper survey and the mobile app (Cohen's kappa > 0.90). Test-retest reliability ranged from kappa 0.78 to 0.91. Between two certified NEMS-S raters, survey completion time using the mobile app was 5 minutes less than that with the paper form (35 vs. 40 minutes). CONCLUSIONS: The NEMS-S mobile app provides for more rapid data collection, with equivalent reliability and validity to the NEMS-S paper version, with advantages over a paper-based survey of multiple language capability and concomitant data entry.

Association between patient reported outcomes and quantitative sensory tests for measuring long-term neurotoxicity in breast cancer survivors treated with adjuvant paclitaxel chemotherapy.

Neurotoxicity is a common side-effect during taxane therapy. The prevalence and severity of long-term neurotoxicity following therapy is unknown. The authors conducted a cross-sectional study of 50 consecutive patients with stage I-III BC, who were within 6 months and 2 years of completing adjuvant taxane therapy and a prospective study of 50 women initiating taxane therapy. Patients in the cross-sectional study underwent a one-time evaluation while patients in the prospective study underwent evaluation at baseline, following therapy, and 3, 6, 9, and 12 months after completing therapy. Assessments included quantitative sensory testing (QST) for touch perception and vibration threshold and the FACT-GOG Neurotaxane (FACT/GOG-Ntx). For the cross-sectional study, 81% of the women reported symptoms of numbness and/or discomfort in the hands and/or feet in the past week. Severe symptoms were reported in 27% of patients for the hands and 25% for the feet. In the cross-sectional analysis, hand numbness/discomfort correlated with hand vibration QST. In the prospective study, the mean scores on the FACT/GOG-Ntx decreased from 37.5 to 28.7 post-treatment (P = 0.0002), and remained low 12 months after treatment. The changes in hand/foot numbness/discomfort were significantly associated with change in vibration threshold. No significant change was seen in touch perception. Numbness and discomfort in the hands and feet are common for up to 2 years following taxane therapy, and are associated with vibration threshold. The FACT/GOG-Ntx is an appropriate outcome measure for clinical trials evaluating ways to prevent long-term neurotoxicity in BC survivors.

Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer.

PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience joint symptoms that can lead to discontinuation of effective therapy. We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC. METHODS We conducted a randomized, controlled, blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs. TA included full body/auricular acupuncture and joint-specific point prescriptions, whereas SA involved superficial needle insertion at nonacupoint locations. Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks. Results Of 51 women enrolled, 43 women were randomly assigned and 38 were evaluable. Baseline characteristics were comparable between the two groups. Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks, which was lower for TA compared with SA (3.0 v 5.5; P < .001). We also found differences between TA and SA in pain severity (2.6 v 4.5; P = .003) and pain-related interference (2.5 v 4.5; P = .002) at 6 weeks. Similar findings were seen for the WOMAC and M-SACRAH scores. The acupuncture intervention was well-tolerated. CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness, which was not seen with SA. Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect.

Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer.

PURPOSE: Aromatase inhibitors (AIs) improve survival in postmenopausal women with hormone-sensitive breast cancer, but can cause joint pain and stiffness. The purpose of the current study was to evaluate the prevalence of and identify risk factors for AI-related joint symptoms. PATIENTS AND METHODS: We performed a cross-sectional survey of consecutive postmenopausal women receiving adjuvant AI therapy for early-stage hormone-sensitive breast cancer at an urban academic breast oncology clinic. Patients completed a 25-item self-administered questionnaire assessing the presence of joint symptoms that started or worsened after initiating AIs. Multivariate regression was used to compare those with AI-related arthralgia with those who did not report symptoms, adjusting for demographic and clinical factors. RESULTS: Of 200 patients who completed the survey, 94 (47%) reported having AI-related joint pain and 88 (44%) reported AI-related joint stiffness. In multiple logistic regression analysis, being overweight (body mass index of 25 to 30 kg/m(2)) and prior tamoxifen therapy were inversely associated with AI-related joint symptoms. Patients who received taxane chemotherapy were more than four times more likely than other patients to have AI-related joint pain and stiffness (odds ratio [OR] = 4.08, 95% CI, 1.58 to 10.57 and OR = 4.76; 95% CI, 1.84 to 12.28, respectively). CONCLUSION: Our study suggests that AI-related joint symptoms are more prevalent than what has been described previously in clinical trials. The success of AI therapy depends on patients' ability to adhere to treatment recommendations; therefore, additional studies of interventions that may alleviate these symptoms are needed.