Insulin resistance and weight gain in women treated for early stage breast cancer.

PURPOSE: Both weight gain and insulin resistance have been associated with poorer prognosis in women receiving adjuvant therapy for early stage breast cancer, however, interactions between weight gain and insulin resistance have not been explored longitudinally throughout the breast cancer treatment continuum. METHODS: One hundred non-diabetic women with early stage breast cancer receiving adjuvant chemotherapy and /or hormonal therapy were enrolled in this prospective, observational study. Metrics of weight, body composition (BMI, waist/hip circumference ratio (WHR)), and cardiometabolic health (fasting insulin, glucose and triglycerides) were obtained prior to adjuvant therapy (baseline) and repeated 6, 12, and 24 months post-diagnosis. Insulin resistance was calculated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). RESULTS: Complete data were available for 95 participants. Compared to baseline, body weight was significantly higher at the 12-month time-point (75.3 ± 15.7 vs. 76.2 ± 16.7, p = 0.03), however there was no difference in waist circumference (p = 0.96) or WHR (p = 0.52). HOMA-IR tended to increase 6 months after diagnosis (2.36 ± 2.17 vs. 2.70 ± 2.83, p = 0.06), largely driven by adverse responses in patients treated with chemotherapy (mean change + 0.53 (chemotherapy) vs - 0.64 (no chemotherapy), p = 0.005). Despite 12-month weight gain, the 6-month increase in HOMA-IR was fully abrogated 12 months after diagnosis. CONCLUSION: Breast cancer patients experience small but significant weight gain in the year following diagnosis, and those who receive chemotherapy experience significant short-term metabolic impairments suggestive of insulin resistance. While the acute insulin resistance appears to attenuate over time, the long-term ramifications are unclear and may help explain weight gain in this population.

Does therapeutic touch ease the discomfort or distress of patients undergoing stereotactic core breast biopsy? A randomized clinical trial.

OBJECTIVE: To determine whether therapeutic touch administered at the time of stereotactic core biopsy of suspicious breast lesions results in a reduction in anxiety and pain. DESIGN: Randomized, patient-blinded, controlled trial of either Krieger-Kunz therapeutic touch administered by a trained practitioner or a sham intervention mimicking therapeutic touch delivered during core biopsy. SETTING: Stereotactic breast biopsy unit of a comprehensive breast center. PATIENTS: Women with mammographically detected, nonpalpable breast lesions requiring biopsy. OUTCOME MEASURES: Changes in pain and anxiety measured by visual analog scales immediately before and after stereotactic core biopsy. RESULTS: A total of 82 patients were accrued: 42 received actual therapeutic touch and 40 sham therapeutic touch. No significant differences were found between the arms for age, ethnicity, educational background, or other demographic data. The sham arm had a preponderance of left breast biopsies (48% vs 58%; P = 0.07) and received a slightly higher volume of epinephrine-containing local anesthetic (6.5 +/- 6.1 vs 4.5 +/- 4.5 mL; P = 0.09). Therapeutic touch patients were more likely to have an upper breast lesion location (57% vs 53%; P = 0.022). No significant differences between the arms were seen regarding postbiopsy pain (P = 0.95), anxiety (P = 0.66), fearfulness, or physiological parameters. Similarly, no differences were seen between the arms when change in parameters from prebiopsy to postbiopsy was considered for any of the psychological or physiological variables measured. These findings persisted when confounding variables were controlled for. CONCLUSIONS: Women undergoing stereotactic core breast biopsy received no significant benefit from therapeutic touch administered during the procedure. Therapeutic touch cannot be routinely recommended for patients in this setting.

Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience.

PURPOSE: To assess the effects of removal of all ultrasonographic (US) evidence of breast lesions by using a vacuum-assisted biopsy (VAB) device. MATERIALS AND METHODS: Thirty-four women with breast masses underwent US-guided biopsy with an 11-gauge VAB device, with which removal of all evidence of the lesion was attempted. Histologic findings were compared with results of surgery and follow-up imaging. Patient tolerance and perceptions of the procedure and the ability of the procedure to eliminate a palpable finding were evaluated with questionnaires and findings at follow-up physical examination. RESULTS: The biopsy protocol was completed in all cases. Twenty-six benign lesions (76%) and eight malignancies (24%) were diagnosed. After VAB, 10 patients (29%) underwent surgery on the basis of histologic findings of invasive carcinoma (n = 7), ductal carcinoma in situ (n = 1), lobular neoplasia (n = 1), or atypical ductal hyperplasia (n = 1). VAB resulted in complete excision of four of 10 lesions: two of eight malignancies and two of two benign lesions. Among 21 patients with benign lesions who underwent 6-month follow-up imaging, eight (38%) had a definite residual mass. At 6-month follow-up examination, VAB was seen to have eliminated the palpable abnormality in seven (88%) of eight patients with initially palpable benign masses. Thirty-two patients (94%) described no or mild pain during biopsy, and 33 patients (97%) rated care as excellent. CONCLUSION: After removal of all US evidence of breast masses with a VAB device, there was a substantial probability that residual lesion that was not visualized during the procedure would later be found at surgery or follow-up imaging. A palpable mass (< or =1.2 cm in mean diameter) was eliminated in 88% of cases, and patient tolerance and perceptions of the procedure were favorable.