Indiana University-Purdue University Indianapolis (IUPUI) / Current evidence shows that sleep-wake disturbances are a persistent problem in women surviving breast cancer. The purpose of this study was to refine the knowledge regarding the incidence, prevalence, and predictive factors of sleep-wake disturbances in breast cancer survivors (BCS) compared to age-matched women without breast cancer (WWBC). The cross-sectional, convenience-sample consisted of secondary data from BCS and WWBC who were recruited by two parent quality of life studies. Subjects were matched within +/- 5 years of age. The sample consisted of 246 BCS and 246 WWBC who were a mean age of 48 years old (SD=8.50), Caucasian (70%), employed (69%), married or partnered (76%), postmenopausal (59%), with a college education (56%), and with at least one concurrent medical problem (95%). Results showed that BCS had more prevalent sleep-wake disturbances (65%) compared to WWBC (55%). The poorest sleepers were BCS, women with hot flashes, poor physical functioning, depressive symptoms, or with moderate or high levels of distress related to a life event. BCS had higher PSQI scores indicating poorer sleep quality and higher sleep disturbances compared to WWBC. Predictors of the severity of poor sleep quality and sleep disturbances were BCS, women with higher number of co-morbidities, women with hot flashes, lower levels of physical functioning, higher depressive symptoms, and greater impact of a life event. Disease and treatment related factors did not predict poor sleep or sleep quality in BCS. Sleep disturbances are a problem in long-term BCS. Knowledge of contributing factors provides useful information during clinical evaluations and treatment of BCS reporting poor sleep. Additional research is needed to determine the impact of poor sleep on quality of life and develop/test effective interventions for long-term BCS.

Cancer-related fatigue (CRF) is a persistent and debilitating problem for many breast cancer survivors. Although many CRF measurement tools are available, no consensus exists on the most appropriate tool to use for breast cancer survivors. The purpose of this project was to identify the best method of assessing CRF in breast cancer survivors. The practice-focused question inquired about the most appropriate way to assess fatigue in breast cancer survivors. The central concepts of the project were CRF and cancer survivorship. This project was informed by the theory of health as expanding consciousness and Mishel's theory of uncertainty in illness. The sources of evidence included multi-database searches and literature from professional organizations. Results were tracked using preferred reporting items for systematic reviews and metasystems and a literature review matrix. The search identified 14 sources, which were assessed for quality using the grading of recommendations, assessment, development, and evaluation process. The results of this systematic review did not support the use of any particular assessment tool; however, 2 clinical practice guidelines recommended screening using a numerical severity scale followed by detailed assessment of clinically significant fatigue using available assessment tools. Screening can be implemented into the survivorship clinic, allowing nurses to identify potentially clinically significant fatigue so that further workup is done and interventions are implemented. Identifying, assessing, and intervening for clinically significant fatigue can improve the quality of life for breast cancer survivors, contributing to positive social change.

Thesis (Ph.D.)--Indiana University, 2008. / Title from screen (viewed on June 1, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). ADVISOR(S): Janet S. Carpenter. Includes vita. Includes bibliographical references (leaves 227-243).

The concept of sickness behavior offers a framework to view both the neurovegetative and psychological symptoms that accompany illness as a common entity that results from increased inflammatory activation. Despite the prevalence of sickness behavior in medical populations, to our knowledge this study provides the first attempt to develop a standardized measure to assess sickness behavior using standard self-report questionnaires commonly used with cancer patients. The set of items included in the measure match theoretical conceptualizations of sickness behavior and target symptoms that comprise anhedonia, depressed mood, cognitive dysfunction, social disinterest, fatigue, low libido, poor appetite, somnolence, sensitivity to pain, and malaise. The measure showed high internal consistency, adequate test-retest reliability, and good convergent validity with both psychological and biological correlates. A confirmatory factor analysis also determined that a two-factor, rather than a single-factor measurement model, encompassing a physical and a psychological sickness symptom dimension, accounted for sickness behavior. Future psychometric work is still needed to further validate this new practical assessment tool. Descriptive analyses revealed relatively low levels of sickness behavior symptoms in the sample as a whole with both physical and psychological sickness behavior symptoms exhibiting a significant linear decrease over time. As expected, both physical and psychological sickness behavior symptoms showed associations with two pro-inflammatory cytokine markers, IL6 and TNF-alpha and a neuroendocrine marker, cortisol. Longitudinal associations suggest that higher levels of the pro-inflammatory cytokine TNF-alpha may impact the progressive decline of physical sickness symptoms over time with symptoms taking longer to disappear. Because cortisol was associated with more rather than less physical sickness symptoms, results raise the question of whether the anti-inflammatory neuroendocrine activity may be dysregulated in breast cancer survivors. The mechanistic basis for these associations requires further examination. In this study it was also evaluated whether a cognitive behavioral stress management intervention and relaxation training intervention could reduce sickness symptoms over time. Breast cancer survivors were assessed at baseline and then randomly assigned to a 10-week cognitive behavioral stress management intervention (N = 70) or a 1-day control condition (N = 55). Psychosocial measures, urine, and blood were obtained from participants at 3 months, 6 months, and 12 months post-intervention to assess relevant behavioral, endocrine and immune variables. Relative to the control group, the experimental group showed marginally more prevalence of physical sickness behavior symptoms in the short term (post-intervention, 3-months; p = .08) and a steadier decline of symptoms in the long-term (15-month follow-up period). The adaptive nature of sickness behavior as a motivational strategy that helps restore homeostatic balance in the long run may be one possible interpretation of these results. Whether these intervention effects on sickness behavior were mediated by changes in pro-inflammatory cytokines or cortisol was examined but not supported by these data and needs to be further examined in future studies.

The purpose of this study was threefold; to examine the unique challenges faced among young breast cancer survivors’ self-concepts; to explore the identity reformulation process as they adjust to a new lifestyle after completing medical treatment; and to identify women’s creative problem solving solution used to mitigate any long-term distress and discontinuity between past, current and ideal selves. In-person semi-structured interviews were conducted with 10 young breast cancer survivors (aged 32-45). The results indicated that exploring women’s narratives through the identity reformulation process created an alternative approach to the four prescribed quality of life domains used to understand survivors’ overall wellbeing. The results also identified three shared domains of social location (gender, youth and health status) that intersected in women’s identity reformulation process. These findings have implications for psychosocial oncology literature, as well as clinical practice for mental health practitioners. Limitations and recommendations for areas of future research were discussed.

The long-term natural history of ovarian reserve after adjuvant chemotherapy for breast cancer has been poorly described. We recruited 52 breast cancer survivors treated with adjuvant chemotherapy before 40 years of age who remained premenopausal after chemotherapy treatment. Twenty (38.5%) were more than five years out from treatment. Ovarian reserve estimates were compared with a control group. Anti-Müllerian hormone (AMH), follicle stimulating hormone and luteinizing hormone demonstrated significant differences consistent with reduced ovarian reserve in breast cancer survivors. Mean AMH was 6.65 pmol/l in survivors compared to 17.43 in controls (p < 0.001). Attained age and age at the time of treatment were correlated with AMH levels in breast cancer survivors. Conclusion: Ovarian reserve is significantly reduced in young breast cancer survivors. Age is the major predictor of AMH level in survivors. A 35 year old breast cancer survivor has an AMH level similar to a 45 year old control.

The long-term natural history of ovarian reserve after adjuvant chemotherapy for breast cancer has been poorly described. We recruited 52 breast cancer survivors treated with adjuvant chemotherapy before 40 years of age who remained premenopausal after chemotherapy treatment. Twenty (38.5%) were more than five years out from treatment. Ovarian reserve estimates were compared with a control group. Anti-Müllerian hormone (AMH), follicle stimulating hormone and luteinizing hormone demonstrated significant differences consistent with reduced ovarian reserve in breast cancer survivors. Mean AMH was 6.65 pmol/l in survivors compared to 17.43 in controls (p < 0.001). Attained age and age at the time of treatment were correlated with AMH levels in breast cancer survivors. Conclusion: Ovarian reserve is significantly reduced in young breast cancer survivors. Age is the major predictor of AMH level in survivors. A 35 year old breast cancer survivor has an AMH level similar to a 45 year old control.

No description available.

Breast cancer is the most common cancer in North America (American Cancer Society [ACS], 2012; Canadian Cancer Society [CCS], 2012). Women diagnosed with breast cancer undergo a traumatic experience that disrupts their quality of life (Holmberg, Scott, Alexy, & Fife, 2001). In the psychological domain of quality of life, body image is disrupted due to the changes associated with breast cancer surgeries and treatments (Hormes et al., 2008). This is important because breast cancer survivors’ quality of life is an essential part of their survivorship (Kaiser, 2008). Evidence has suggested that physical activity shows improvements in body image, survival rates, and decreased risk of mortality (Schmitz, 2011). Furthermore, a unique form of physical activity associated with breast cancer that has risen among this population is endurance sporting events, such as dragon boating and running (Canadian Breast Cancer Foundation [CBCF], 2012; Parry, 2008). Endurance sporting events are common among breast cancer organizations to raise funds and spread breast cancer awareness (Kaiser, 2008). However, they also provide breast cancer survivors with a fun and healthy sporting environment to explore their body image as well as shared experiences with other breast cancer survivors. Researchers have shown endurance sporting events to be a comfortable environment for breast cancer survivors to allow their experiences to unfold (McDonough, Sabiston, & Crocker, 2008; Sabiston, McDonough, & Crocker, 2007). Due to the uniqueness of each woman’s breast cancer experience, it is important to explore their body image experiences to understand their personal stories and provide meaning to enhance their quality of life as breast cancer survivors. The general purpose of this dissertation is to explore the body image and camaraderie experiences of breast cancer survivors in endurance sporting events. Furthermore, the guiding research question of this dissertation is: What are the body image and camaraderie experiences of breast cancer survivors participating in endurance sporting events? Narrative research methodology will be used to provide insight into this research question across two studies. To address the gap in the literature, Study 1 of my dissertation provided narratives of three breast cancer survivors’ body image experiences as they trained for and participated in the CIBC Run for the Cure 5k. Two individual semi-structured interviews, prolonged engagement, and blogging were used as sources of data collection over a time period of 10 weeks. Data analyses led to the emergence of three themes: "new normal", goal setting, and camaraderie. Camaraderie, representing the shared breast cancer survivors’ experiences that allowed the women to focus on their physical capabilities, accept their bodies, and create an overall body image experience, was a particularly salient theme to the women throughout their training. Hence, the purpose of Study 2 was to explore the camaraderie narrative experiences of breast cancer survivors in a season of dragon boating. Focus group interviews and creative practices were conducted with a core group of 11 breast cancer survivors over a six month time period. The women defined camaraderie as fellowship, teamwork, and support shared between women with breast cancer experiences. Subsequent data analyses resulted in five themes: attention please, paddles up, take it away, hold the boat, and reach. Overall, camaraderie was shown to be crucial to the survivorship of the women, as social experiences are an important component to life after breast cancer. The findings were written as a collective (e.g., camaraderie) narrative. Taken together, these two studies demonstrated that body image and camaraderie are important components to breast cancer survivors’ participation in endurance sporting events. More specifically, both studies informed the literature by describing the relationship between the camaraderie and body image experiences for the women involved in both the CIBC Run for the Cure 5k and a season of dragon boating. Camaraderie was the motive that created an overall positive body image experience for the women. Furthermore, endurance sporting events associated with breast cancer formed natural, comfortable, and safe environments for the women to express their experiences. In addition, camaraderie seemed to be a key process through which the women were able to accept their bodies and the body-related changes that resulted from cancer. In both studies, breast cancer survivors’ participation in endurance sports included camaraderie experiences that led to fulfilling the physical, emotional, and social needs as a mode for the women to move beyond their breast cancer experiences.

The purpose of this study was threefold; to examine the unique challenges faced among young breast cancer survivors’ self-concepts; to explore the identity reformulation process as they adjust to a new lifestyle after completing medical treatment; and to identify women’s creative problem solving solution used to mitigate any long-term distress and discontinuity between past, current and ideal selves. In-person semi-structured interviews were conducted with 10 young breast cancer survivors (aged 32-45). The results indicated that exploring women’s narratives through the identity reformulation process created an alternative approach to the four prescribed quality of life domains used to understand survivors’ overall wellbeing. The results also identified three shared domains of social location (gender, youth and health status) that intersected in women’s identity reformulation process. These findings have implications for psychosocial oncology literature, as well as clinical practice for mental health practitioners. Limitations and recommendations for areas of future research were discussed.