A randomized clinical trial of granulocyte macrophage colony stimulating factor mouthwash for oral mucositis in head and neck cancer.

PURPOSE: Oral mucositis (OM) is a significant problem for patients with head and neck cancer (HNC). The purpose of this double-blind, randomized clinical trial (RCT) was to evaluate the effectiveness of the granulocyte macrophage colony stimulating factor (GM-CSF) mouthwash compared to Salt and Soda mouthwash for both the prevention (prior to onset of OM) and treatment (beginning at the onset of OM to its healing) of radiation therapy (RT)-induced OM. METHODS: A total of 91 patients with HNC were randomized to receive: GM-CSF throughout both the prevention and treatment phases (GG group); Salt and Soda throughout both phases (SS group) or Salt and Soda during the prevention phase followed by GM-CSF at the onset of OM (SG group). Three groups were compared on the occurrence and grades of OM, functional status, pain, chewing, and swallowing during and after RT. RESULTS: No significant differences were found in the occurrence and grades of OM in the patients who used GM-CSF vs. Salt and Soda in the prevention phase. In addition, no differences were seen among the three groups in functional status, pain, chewing, and swallowing during and after RT. CONCLUSION: Given that GM-CSF was no more effective than Salt and Soda mouthwash for the prevention or treatment of OM, the readily available and cheaper mouthwash can be used at considerable cost savings.

A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients.

PURPOSE: Evidence for chemotherapy-induced cognitive impairment remains inconclusive. This study was designed to determine the trajectory of cognitive function over time in women with breast cancer, who received doxorubicin and cyclophosphamide (AC) alone or followed by a taxane. Associations between changes in cognitive function and potential covariates including anxiety, depression, fatigue, hemoglobin level, menopausal status, and perception of cognitive function were evaluated. METHODS: The Repeatable Battery for the Assessment of Neuropsychological Status, Stroop Test, and Grooved Pegboard were used to assess cognitive function in a group of 71 women prior to chemotherapy, a week after completing the last cycle of AC, as well as 1 week and 6 months after the completion of all chemotherapy. RESULTS: Cognitive impairment was found in 23% of women prior to chemotherapy. Hierarchical linear modeling showed significant decreases after receiving chemotherapy followed by improvements 6 months after the completion of chemotherapy in the cognitive domains of visuospatial skill (p < 0.001), attention (p = 0.022), delayed memory (p = 0.006), and motor function (p = 0.043). In contrast, immediate memory, language, and executive function scores did not change over time. CONCLUSION: These results suggest that having a breast cancer diagnosis may be associated with cognitive impairment. While chemotherapy may have a negative impact on cognitive function, chemotherapy-related impairments appear to be more acute than chronic side effects of therapy. Further studies are needed to provide insight into the clinical significance and potential mechanisms of cancer and treatment-related cognitive impairments.

Comparison of diagnostic accuracy of clinical measures of breast cancer-related lymphedema: area under the curve.

OBJECTIVE: To compare diagnostic accuracy of measures of breast cancer-related lymphedema (BCRL). DESIGN: Cross-sectional design comparing clinical measures with the criterion standard of previous diagnosis of BCRL. SETTING: University of California San Francisco Translational Science Clinical Research Center. PARTICIPANTS: Women older than 18 years and more than 6 months posttreatment for breast cancer (n=141; 70 with BCRL, 71 without BCRL). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sensitivity, specificity, receiver operator characteristic curve, and area under the curve (AUC) were used to evaluate accuracy. RESULTS: A total of 141 women were categorized as having (n=70) or not having (n=71) BCRL based on past diagnosis by a health care provider, which was used as the reference standard. Analyses of ROC curves for the continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical measures bioimpedance spectroscopy yielded the highest accuracy with an AUC of .88 (95% confidence interval, .80-.96) for women whose dominant arm was the affected arm. The lowest accuracy was found using the 2-cm diagnostic cutoff score to identify previously diagnosed BCRL (AUC, .54-.65). CONCLUSIONS: Our findings support the use of bioimpedance spectroscopy in the assessment of existing BCRL. Refining diagnostic cutoff values may improve accuracy of diagnosis and warrant further investigation.

Predictors of exercise frequency in breast cancer survivors in Taiwan.

AIM: To apply social cognitive theory to elucidate factors that motivate change in exercise frequency in breast cancer survivors during the six months after completing cancer treatment. BACKGROUND: Exercise is now a well-recognised quality-of-life intervention in breast cancer survivors. However, only regular exercise yields long-term benefits. Motivations for exercise have not been analysed in Taiwan patients with cancer. DESIGN: A prospective, longitudinal and repeated measures design was used. METHODS: A convenience sample of 196 breast cancer survivors was recruited from hospitals in metropolitan areas of north and south Taiwan. Study participants were allowed to select their preferred exercised activities. Exercise behaviour and other factors were then recorded using various standardised instruments. Medical charts were also reviewed. Data were analysed by a linear mixed model and by hierarchical multiple regression equations. RESULTS: Exercise frequency significantly changed over time. Explained variance in exercise frequency change was modest. Baseline exercise frequency was the best significant predictor of exercise frequency during the six-month study. The study also identified possible age-related differences in the effect of social support on exercise. The effect of social support for exercise on exercise frequency was apparently larger in older subjects, especially those over 40 years old, than in younger subjects. Mental health, exercise barriers and exercise outcome expectancy significantly contributed to change in exercise frequency during the six-month study. CONCLUSIONS: The analytical results revealed several ways to increase exercise frequency in breast cancer survivors: (1) encourage exercise as early as possible; (2) improve health status and provide social support for exercise, especially in women aged 40 years or older; (3) reduce exercise barriers and promote mental health; (4) reinforce self-efficacy and positive expectations of exercise outcomes and (5) provide strategies for minimising fatigue in early stages of rehabilitation. Relevance to clinical practice. Social cognitive theory provides a useful framework for understanding the motivation to exercise in breast cancer survivors.

Changes in symptom clusters in patients undergoing radiation therapy.

GOALS OF WORK: The goals of the study were to determine the occurrence rates for and the severity of symptoms at the middle, end, and 1 month after the completion of radiation therapy (RT), to determine the number and types of symptom clusters at these three time points, and to evaluate for changes over time in these symptom clusters. MATERIALS AND METHODS: Symptom occurrence and severity were evaluated using the Memorial Symptom Assessment Scale (MSAS) in a sample of patients (n = 160) who underwent RT for breast or prostate cancer. At each time point, an exploratory factor analysis was done to determine the number of symptom clusters (i.e., symptom factors) based on the MSAS symptom severity ratings. MAIN RESULTS: The majority of the patients were male and married with a mean age of 61.1 years. The five symptoms with the highest occurrence rates across all three time points were lack of energy, pain, difficulty sleeping, feeling drowsy, and sweats. Although the number of symptoms and the specific symptoms within each symptom cluster were not identical across the three time points, three relatively similar symptom clusters (i.e., "mood-cognitive" symptom cluster, "sickness-behavior" symptom cluster, "treatment-related", or "pain" symptom cluster) were identified in this sample. The internal consistency coefficients for the mood-cognitive symptom cluster and sickness-behavior symptom cluster were adequate at > or =0.68. CONCLUSIONS: Three relatively stable symptom clusters were found across RT. The majority of the symptom cluster severity scores were significantly higher in patients with breast cancer compared to patients with prostate cancer.

Preliminary results of a longitudinal study of changes in cognitive function in breast cancer patients undergoing chemotherapy with doxorubicin and cyclophosphamide.

OBJECTIVES: Recent studies suggest that standard dose chemotherapy for breast cancer may cross the blood-brain barrier. However, the evidence for chemotherapy-induced cognitive impairments in breast cancer patients is inconsistent. The purposes of this study in a sample of newly diagnosed patients with breast cancer were to (1) evaluate cognitive function prior to the administration of chemotherapy; (2) assess changes in cognitive function over time; and (3) evaluate potential relationships between cognitive function and anxiety, depression, fatigue, hemoglobin level, menopausal status, and perception of cognitive function. METHODS: Thirty women with breast cancer completed neuropsychological testing before the initiation of chemotherapy and after four cycles of doxorubicin and cyclophosphamide. Descriptive statistics were used to summarize sample characteristics, and paired t-tests were carried out to evaluate for changes in neuropsychological test scores prior to and following completion of chemotherapy. Linear mixed model analyses were used to determine whether significant changes in neuropsychological test scores remained after controlling for anxiety, depression, fatigue, hemoglobin level, menopausal status, and perceived cognitive function. RESULTS: Significant decreases in visuospatial skill (p<0.001) and total cognitive scores (p=0.001) were found following chemotherapy. In addition, a significant improvement was found in executive function (p=0.014). Of note, these changes remained significant even after controlling for anxiety, depression, fatigue, hemoglobin level, menopausal status, and perceived cognitive function. CONCLUSIONS: Data from this study supported the hypothesis that chemotherapy may have a negative impact on select domains of cognitive function.

Symptom cluster of fatigue and depression in HIV/AIDS.

Fatigue and depression are among the most frequently rated symptoms of people with HIV/AIDS. This study aimed: (1) to describe severity of fatigue and depression in an outpatient sample (n=372) of men and women with HIV/AIDS, (2) to evaluate sensitivity and discriminant validity for two fatigue and three depression scales and (3) to investigate whether fatigue and depression are conceptually distinct concepts or reciprocally dependent. This was a secondary analysis of a descriptive, cross-sectional study with convenience sampling. Fatigue was assessed with the fatigue factor score of the revised Sign and Symptom Checklist HIV (SSC-HIVrev), and the fatigue scale of the Self-Care Symptom Management for Living with HIV/AIDS Scale SCSMS-F). Depression was assessed with the depression factor score of the SSC-HIVrev, the depression scale of the SCSMC-D and the Center for Epidemiologic Studies Depression Scale (CES-D). Most of the participants were male (67%), with a mean age of 39.9 years, and of African American decent (73%). Dependent on the instrument, the average fatigue severity was moderate and the average depression severity was moderate to severe. Women experienced higher fatigue and depression severity scores than men. The scores on the same instruments for fatigue and depression showed significant correlations (SSC-HIVrev fatigue and depression r=0.62; SCSMS fatigue and depression r=0.64), indicating that both concepts are closely related. Patients seeking help for fatigue and/or depression should always be evaluated for both symptoms. Future research is needed to identify dimensions in different fatigue and depression scales in order to differentiate the impact of both symptoms on people living with HIV/AIDS.

Symptom Cluster Trajectories During Chemotherapy in Breast Cancer Outpatients.

CONTEXT: Breast cancer patients often experience multiple symptoms and substantial discomfort. Some symptoms may occur simultaneously and throughout the duration of chemotherapy treatment. OBJECTIVES: The aim of this study was to investigate symptom severity and symptom cluster trajectories during chemotherapy in outpatients with breast cancer in Taiwan. METHODS: This prospective, longitudinal, repeated measures study administered a standardized questionnaire (M. D. Anderson Symptom Inventory Taiwan version) to 103 breast cancer patients during each day of the third 21-day cycle of chemotherapy. Latent class growth analysis was performed to examine symptom cluster trajectories. RESULTS: Three symptom clusters were identified within the first 14 days of the 21-day chemotherapy cycle: the neurocognition cluster (pain, shortness of breath, vomiting, memory problems, and numbness/tingling) with a trajectory of Y = 2.09 - 0.11 (days), the emotion-nausea cluster (nausea, disturbed sleep, distress/upset, drowsiness, and sadness) with a trajectory ofY = 3.57 - 0.20 (days), and the fatigue-anorexia cluster (fatigue, lack of appetite, and dry mouth) with a trajectory of Y = 4.22 - 0.21 (days). The "fatigue-anorexia cluster" and "emotion-nausea cluster" peaked at moderate levels on chemotherapy days 3-5, and then gradually decreased to mild levels within the first 14 days of the 21-day chemotherapy cycle. CONCLUSION: Distinct symptom clusters were observed during the third cycle of chemotherapy. Systematic and ongoing evaluation of symptom cluster trajectories during cancer treatment is essential. Healthcare providers can use these findings to enhance communication with their breast cancer patients and to prioritize symptoms that require attention and intervention.

Mucositis pain induced by radiation therapy: prevalence, severity, and use of self-care behaviors.

Pain from radiation therapy (RT)-induced mucositis is a significant clinical problem for patients with head and neck cancer (HNC). The purpose of this study was to determine the pattern, severity, and time course of RT-induced mucositis pain; self-care behaviors (SCBs) used to manage mucositis pain; and the effectiveness of these behaviors in relieving such pain. Forty-nine patients with HNC were assessed using the MacDibbs Mouth Assessment Tool to determine the severity of RT-induced mucositis pain over their course of RT and at a one-month follow-up visit. All patients developed pain due to RT-induced mucositis. A Self-Care Diary was used weekly by patients to record SCBs and their effectiveness. The most effective SCBs for RT-induced mucositis pain were mouth rinsing and using oral analgesics. However, more severe pain with swallowing was not managed well throughout the study. Future studies need to test more effective strategies to manage RT-induced mucositis pain.

Perceived breast cancer risk: heuristic reasoning and search for a dominance structure.

Studies suggest that people construct their risk perceptions by using inferential rules called heuristics. The purpose of this study was to identify heuristics that influence perceived breast cancer risk. We examined 11 interviews from women of diverse ethnic/cultural backgrounds who were recruited from community settings. Narratives in which women elaborated about their own breast cancer risk were analyzed with Argument and Heuristic Reasoning Analysis methodology, which is based on applied logic. The availability, simulation, representativeness, affect, and perceived control heuristics, and search for a dominance structure were commonly used for making risk assessments. Risk assessments were based on experiences with an abnormal breast symptom, experiences with affected family members and friends, beliefs about living a healthy lifestyle, and trust in health providers. Assessment of the potential threat of a breast symptom was facilitated by the search for a dominance structure. Experiences with family members and friends were incorporated into risk assessments through the availability, simulation, representativeness, and affect heuristics. Mistrust in health providers led to an inappropriate dependence on the perceived control heuristic. Identified heuristics appear to create predictable biases and suggest that perceived breast cancer risk is based on common cognitive patterns.

Variations in potassium channel genes are associated with distinct trajectories of persistent breast pain after breast cancer surgery.

Persistent pain after breast cancer surgery is a common clinical problem. Given the role of potassium channels in modulating neuronal excitability, coupled with recently published genetic associations with preoperative breast pain, we hypothesized that variations in potassium channel genes will be associated with persistent postsurgical breast pain. In this study, associations between 10 potassium channel genes and persistent breast pain were evaluated. Using growth mixture modeling (GMM), 4 distinct latent classes of patients, who were assessed before and monthly for 6 months after breast cancer surgery, were identified previously (ie, No Pain, Mild Pain, Moderate Pain, Severe Pain). Genotyping was done using a custom array. Using logistic regression analyses, significant differences in a number of genotype or haplotype frequencies were found between: Mild Pain vs No Pain and Severe Pain vs No Pain classes. Seven single-nucleotide polymorphisms (SNPs) across 5 genes (ie, potassium voltage-gated channel, subfamily A, member 1 [KCNA1], potassium voltage-gated channel, subfamily D, member 2 [KCND2], potassium inwardly rectifying channel, subfamily J, members 3 and 6 (KCNJ3 and KCNJ6), potassium channel, subfamily K, member 9 [KCNK9]) were associated with membership in the Mild Pain class. In addition, 3 SNPs and 1 haplotype across 4 genes (ie, KCND2, KCNJ3, KCNJ6, KCNK9) were associated with membership in the Severe Pain class. These findings suggest that variations in potassium channel genes are associated with both mild and severe persistent breast pain after breast cancer surgery. Although findings from this study warrant replication, they provide intriguing preliminary information on potential therapeutic targets.

Healthy Lifestyle Behaviors of Breast Cancer Survivors.

The purpose of this secondary analysis was to describe the extent to which women with breast cancer, who participated in a randomized control trial on exercise, adopted American Cancer Society (ACS) guidelines for healthy lifestyle behaviors. Women in the study exercised during cancer treatment and for 6 months after completion of treatment. The sample included 106 women, average age 50.7 years (SD = 9.6). Adherence to guidelines for 5 servings of fruits and vegetables ranged from 36% (n = 28) to 39% (n = 36). Adherence with alcohol consumption guidelines was 71% (n = 28) to 83% (n = 30). Adherence with meeting a healthy weight ranged from 52% (n = 33) to 61% (n = 31). Adherence with physical activity guidelines ranged from 13% (n = 30) to 31% (n = 35). Alcohol and healthy weight guidelines were followed by more than half of the participants, but physical activity and dietary guidelines were followed by far fewer women. Further prospective clinical studies are indicated to determine whether interventions are effective in producing a healthy lifestyle in cancer survivors.

Occurrence of symptom clusters.

Although concurrent symptoms are frequently reported in clinical practice, symptom management research has not reflected this reality. Concurrent, related symptoms, i.e., symptom clusters, are possibly the next generation of work to be done in the area of symptom management. It has been suggested that certain clusters of symptoms may have a synergistic effect on future patient outcomes, and may predict morbidity. The overall goal of this article is to present initial research in the area, along with strategies for development of the concept of symptom clusters. In addition, a working definition of symptom clusters is offered, as well as current issues with the concept and suggestions for future research.

Behavior of patients with lung cancer: description and associations with oncologic and pain variables.

Although reflexes are recognized as protective responses to noxious stimuli, less is known about voluntary behavioral responses to cancer pain, which could provide clinicians with important diagnostic and therapeutic information. Forty-five patients with lung cancer were studied in their homes on 2 occasions to identify pain behaviors and to examine relationships between behaviors and selected variables. Patients completed the McGill Pain Questionnaire (MPQ) and Visual Analogue scale (VAS). Using a videotape observation method, patients sat, stood, walked, and reclined for 10 min. Videotapes were scored using 5 position-related and 31 pain-related behavior definitions. Within 3 days scored behaviors were described to patients who reported whether each scored behavior was performed: to express pain; because pain prevented usual behavior; to control pain; or as a habit. Patients reported that pain was controlled by 42 different behaviors; the number of different pain-reduction behaviors was correlated with pain intensity (r = 0.44) and pain quality (r = 0.64). Simultaneous multiple regression indicated that length of time pain was experienced, number of pain sites, pain quality, and pain intensity accounted for 41% of the variance in the number of pain control behaviors. None of the taped behaviors was reported as performed to express pain, and few of the patients reported that pain prevented behavior during the video session. Results clarify the pain-behavior construct, provide insight about the multidimensional nature of lung cancer pain, and suggest directions for behavioral interventions to augment pharmacological therapy for lung cancer pain.

Symptom experience of adult hospitalized medical-surgical patients.

The purpose of this study is to describe the symptom experience of adult patients hospitalized in medical/surgical units, to examine the relationship between demographic characteristics and symptom experience, and to explore the relationship between symptom severity and symptom distress. Utilizing the Memorial Symptom Assessment Scale (MSAS), patients (n=334) were asked to convey the presence or absence of each of 31 symptoms, the severity of the symptoms, and the degree to which the symptoms distressed or bothered them. Higher levels of symptom distress were found in women and in those who were unpartnered. The average number of symptoms reported per patient was 9.31 (SD=5.15), with a mean symptom distress rating of 1.8 (SD=0.84) and a mean symptom severity rating of 1.65 (SD=0.83) on a 1-5 scale. The correlation between reports of symptom severity and symptom distress varied greatly by symptom, ranging from r=0.37 to r=0.82. This is the first study to examine the symptom prevalence, severity, and distress of hospitalized medical/surgical patients. The large sample size allowed for the detection of demographic differences in the reporting of symptom distress, and advances the current knowledge in the area.

Self-care intervention to reduce oral candidiasis recurrences in HIV-seropositive persons: a pilot study.

OBJECTIVES: This single-blind randomized controlled pilot study evaluated the efficacy of a behavioral intervention program, PRO-SELF: Candidiasis, to reduce time to recurrence of oral candidiasis over 6 months in susceptible HIV-seropositive persons. The intervention involved instruction by dentists on improving oral hygiene, minimizing sugar intake, and self-diagnosing candidiasis. METHODS: Participants were adults with oral candidiasis responsive to antifungals who presented to the UCSF Stomatology Clinic between 1997 and 2000. At 2-3 weeks of follow-up visits, a dentist "examiner", masked to group assignment, quizzed participants as to the presence of candidiasis, and assessed candidiasis status. A second, unmasked dentist "instructor" then delivered the program to intervention participants. Participants recorded dietary and oral hygiene practices in 24-h recall diaries: intervention participants at each visit and controls at initial and final visits. RESULTS: At randomization, CD4+ cell counts (cells/mm(3)) were 298 +/- 188 among 18 intervention participants and 396 +/- 228 among 17 controls. The candidiasis recurrence rates at 6 months were 78% among intervention compared with 88% among control participants (hazard ratio 0.72; 95% CI 0.35-1.50). Performing oral hygiene after meals/snacks showed the largest relative improvement: intervention-control difference in proportion of meals/snacks affected was 24% (95% CI -1 to 48%). Self-diagnoses of candidiasis were inaccurate, possibly because of mild episodes. CONCLUSIONS: The results weakly indicate that regular instruction from healthcare professionals helps patients delay candidiasis recurrence by improving oral hygiene. Among HIV-seropositive persons, those with poor oral hygiene, and high-sugar diets are most likely to benefit.

Mechanisms for radiation-induced oral mucositis and the consequences.

Radiation therapy remains the primary method of treatment for patients with head and neck cancer. The tissue destruction and functional alterations in the oral cavity lead to the development of oral mucositis. The purpose of this review is to describe the mechanisms, risk factors, prevalence, and magnitude of radiation therapy-related oral mucositis and its morbidities in patients with head and neck cancer. The review concludes with a discussion of the implications for clinical practice. This review provides cancer nurses with the information necessary to identify patients with head and neck cancer who are at high risk for oral mucositis and the significant comorbidities associated with this complication of radiation therapy.

Pain medication management processes used by oncology outpatients and family caregivers part II: home and lifestyle contexts.

CONTEXT: Despite the increasing complexity of medication regimens for persistent cancer pain, little is known about how oncology outpatients and their family caregivers manage pain medications at home. OBJECTIVES: To describe the day-to-day management of pain medications from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management in the context of highly individualized home environments and lifestyles. METHODS: This qualitative study was conducted as part of a randomized clinical trial, in which an embedded mixed methods research design was used. Audio-recorded dialogue among patients, family caregivers, and intervention nurses was analyzed using qualitative research methods. RESULTS: Home and lifestyle contexts for managing pain medications included highly individualized home environments, work and recreational activities, personal routines, and family characteristics. Pain medication management processes particularly relevant in these contexts included understanding, organizing, storing, scheduling, remembering, and taking the medications. With the exception of their interactions with the intervention nurses, most study participants had little involvement with clinicians as they worked through these processes. CONCLUSION: Pain medication management is an ongoing multidimensional process, each step of which has to be mastered by patients and their family caregivers when cancer treatment and supportive care are provided on an outpatient basis. Realistic patient- and family-centered skill-building interventions are needed to achieve effective and safe pain medication management in the contexts of individual home environments and lifestyles.

Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.

CONTEXT: Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. OBJECTIVES: The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. METHODS: We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. RESULTS: The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. CONCLUSION: Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives.

Timing and sustainability of an exercise intervention in women with breast cancer during and after cancer treatment.

PURPOSE/OBJECTIVES: To compare changes in frequency, duration, and intensity of exercise behaviors over time in women with breast cancer between those who started their exercise intervention at the beginning of chemotherapy (EE) and those who started at the completion of chemotherapy (CE). DESIGN: A secondary data analysis of a randomized, controlled trial for exercise intervention. SETTING: Five cancer centers in the San Francisco Bay Area in California. SAMPLE: 66 outpatient women with breast cancer who were receiving chemotherapy. METHODS: Piecewise linear mixed models analysis was used to study changes in exercise behaviors over time in the EE group during and after treatment. In addition, linear mixed models analysis was used to examine changes between the EE and CE groups after treatment. Participants were in the trial for various length of time (EE group: 19-86 weeks; CE group: 6-43 weeks). MAIN RESEARCH VARIABLES: Exercise frequency, intensity, and duration. FINDINGS: In the EE group, weekly exercise duration increased significantly during treatment (p = 0.02). In addition, weekly exercise intensity increased significantly during treatment (p = 0.02) and decreased significantly after treatment (p = 0.003). After treatment, initial weekly exercise duration was significantly lower in the CE group than in the EE group (p = 0.01). No significant differences existed in frequency and intensity over time between the EE and CE groups. CONCLUSIONS: Women with breast cancer can sustain exercise behaviors when they start an exercise intervention in the beginning of chemotherapy treatment. IMPLICATIONS FOR NURSING: Strategies to support patients in maintaining their exercise habit may be needed during the post-treatment period.