فصلنامه بیماری های پستان ایران
سال سیزدهم شماره 3 (پیاپی 50، پاییز 1399)

Depression and anxiety are more common in breast cancer patients. Anxiety and depression not only affect breast cancer patients’ quality of life, but also affect their lifestyle. The aim of this study was to determine the effect of logotherapy along with nutrition counseling on anxiety and depression in breast cancer survivors.

In this randomized controlled clinical trial, 90 breast cancer survivors with a depression score above 14 were recruited. The participants were assigned to either a nutritional counceling (control) or a nutritional counseling plus logotherapy group. The control group received nutrition counseling at baseline and at the end of the fourth week of the study, while the intervention group received 8 weeks of logotherapy in addition to nutrition counseling. Both groups completed the Beck Depression Inventory and underwent anthropometric measurements before and after the intervention period. Data were analyzed using SPSS.

The mean (SD) age of the participants was 49 (10) years (range, 28-68 years). More than 50% of people in both groups had an education level of up to diploma or higher; most of them were married; and more than 60% were employed. In the nutrition counseling group, 80% had stage I and II cancer, 11% stage III. In the nutrition counseling plus logo therapy, 65% had stage I and II cancer, and 24% had stage III cancer. Within-group comparisons revealed significant decreases in anxiety and depression scores in both groups (P< 0.001). Also, the improvement in anxiety and depression was significantly greater in the nutrition counseling plus logo therapy group compared with the nutrition counseling group (P< 0.001).

This study shows that nutritional counseling and psychotherapy together can improve depression in breast cancer survivors. The use of psychotherapeutic interventions from the beginning of treatment not only balances the mind and mental health, but also improves the lifestyle and prevents its complications.

The younger mean age of breast cancer incidence in Iranian women and the longer survival of these patients necessitate the evaluation of diverse aspects of their health and quality of life, such as sexual life quality. The first step in addressing this subject is to understand the extent of this problem in these patients, as compared with healthy women. The present study aimed to compare sexual dysfunction between women with breast cancer and normal women.

This descriptive-analytical study was performed in 2019 in Bushehr, Iran. A total of 46 married women with breast cancer who had their last chemotherapy session at least three months earlier were selected through the census method. Moreover, 100 healthy married women were selected for the study through a simple random sampling method. Data collection tools included a demographic information form and the Female Sexual Function Index. The data were analyzed using descriptive statistics, an independent t test, the chi-square test, and logistic regression.

The findings showed that breast cancer patients were more likely to experience disturbance in libido (OR = 7.145, P = 0.022), sexual arousal (OR = 3.898, P = 0.006), genital moisture during sexual intercourse (OR = 4.88, P = 0.001), orgasm (OR = 2.937, P = 0.018), sexual satisfaction (P = 0.001, OR = 5.287), and overall sexual dysfunction (OR = 11.492, P < 0.001) compared with healthy women. The two groups were not significantly different in pain during sexual intercourse (P = 0.1).

The results revealed that the chance of sexual dysfunction is significantly higher in women with breast cancer than in healthy individuals. In breast cancer cases, planning for treating the side effects of the disease, such as sexual function disorder, should be taken into consideration along with cancer treatment.

Emotions play an important role in marital life and constitute an effective factor in couples’ marital intimacy. Accordingly, examining emotions is important for improving the couple’s relationship. This study aimed to investigate the effectiveness of Emotionally Focused Couples Therapy (EFT) on the marital intimacy of couples with women with breast cancer.

The study had a pretest-posttest control group design. Twenty-two persons meeting the inclusion criteria were selected by cluster sampling in Tehran. The subjects were randomly divided into the intervention (n = 11) and control (n = 11) groups. The intervention group received EFT for 6 sessions (120 min per session), but the control group did not receive any intervention. Both groups were assessed before and after the intervention using the Marital Intimacy Questionnaire Bagarozzi (MIQB-44). Data were analyzed using independent t tests and analysis of covariance.

After receiving the educational program, the intervention group showed increases in the mean scores for all components of marital intimacy compared with the control group. The mean increase was 11.72 points for emotional intimacy, 6.23 for psychological intimacy, 6.05 for rational intimacy, 4.36 for sexual intimacy, 3.31 for physical intimacy, 3.82 for spiritual intimacy, 3.68 for aesthetic intimacy, and 4.64 for socio-recreational intimacy. Meanwhile, the control group showed declines in all components except psychological intimacy, which increased <0.5 points. Analysis of covariance showed that EFT had a significant positive effect on all components of intimacy in the experimental group as compared with the control group (P < 0.01).

EFT improves the components of marital intimacy as well as increasing people’s resilience to socio-psychosocial disorders. Therefore, EFT can be considered a novel approach to changing perceptions in translating emotion regulation processes in people dealing with chronic physical illnesses. It provides a better response to situations and prevents deep distress in life and marital relationships.

Slowing down the process of angiogenesis in the tumor tissue is an emerging area in the treatment of breast cancer. The purpose of this study was to investigate the effect of quercetin supplementation on the expression of key angiogenesis factors in the tumor tissue of mice with breast cancer.

Sixteen female BALB /c mice were injected subcutaneously with estrogen receptor dependent breast cancer cells MC4L2 and divided into two groups of tumor (T) and tumor + quercetin (TQ). The mice in the TQ group were injected subcutaneously with 110 mg/kg quercetin solution for 6 weeks, 3 days a week. Forty-eight hours after the last injection, the animals were killed and their tumors were removed, frozen in liquid nitrogen and stored at -70° C. ΔCt, ΔΔCt, fold change and Mann-Whitney test at the significance level of (P<0.05) were calculated with GENEX software.

The results showed that quercetin supplementation significantly decreased the expression of ANGPT-2 (P<0.00), TIE-2 (P<0.00) and VEGF-A (P<0.00) genes in the TQ group compared with the T group. But ANGPT-1 expression increased, although this increase was not significant.

Quercetin supplementation may inhibit tumor angiogenesis and breast tumor growth.

The Il4/Stat-6 signaling axis is one of the most important pathways involved in the growth and development of breast cancer. Hence, the aim of the present study was to investigate the synergistic effect of endurance training along with curcumin on the intratumoral expression of Il4 and Stat-6 in female BALB/c mice with breast cancer.

Forty BALB/c mice (4-5 weeks old) were randomly divided into four groups including exercise, curcumin, exercise-curcumin, and control. The 4T1 breast Tumors were transplanted subcutaneously in the right flank of all mice. Then, endurance training (5 days per week) was performed, and curcumin (6 times per week) was given by gavage for five weeks. The intratumoral expression of Il4 and Stat-6 were measured using the qRT-PCR method. One-way analysis of variance followed by LSD post hoc test, was used for the statistical analysis. P< 0.05 was considered statistically significant.

A significant decline in tumor growth was observed in all intervention groups compared with the control group (P<0.05). Endurance training with curcumin resulted in a significant reduction in the intratumoral expression of Il4 and Stat-6 in comparison with the control group (P=0.001 for both genes). Significant reductions in the expression of Il4 (P=0.019) and Stat-6 (P=0.001) were also observed in the endurance exercise group. Curcumin only reduced Stat-6 gene expression compared with the control group (P=0. 001).

Five weeks of endurance training with curcumin seems to be more effective in treatment of cancer compared with either of these non-pharmacological strategies alone.

Limiting cancer-induced cardiac atrophy is a highly important for improving the survival rates and quality of life in cancer patients. The purpose of this study was to evaluate the effect of 10 weeks of high-intensity interval training (HIIT) on cardiac muscle weight, NF-kB protein expression, and expression of Atrogin-1 and MuRF-1 genes in the heart muscle of breast cancer–bearing female mice.

In this experimental study, 12 BALB/c mice with induced breast cancer were divided into control and HIIT groups. The HIIT protocol consisted of six intervals of running at 85%-90% V̇O2 peak, interspersed with 90 seconds of active rest, and five minutes of warm-up and cool-down. The left ventricular tissue was extracted 24 h following the last training session. Western blotting was used to measure protein levels of NF-kB, and quantitative real-time polymerase chain reaction was used to measure Atrogin-1 and MuRF-1 expression in the heart tissue. Data were analyzed using an independent t test at a 0.05 significance level.

The mean cardiac muscle weight in the HIIT group was greater than in the control group (P < 0.001). A significant reduction in NF-kB protein levels (P = 0.004) and expression of Atrogin-1 (P < 0.001) and MuRF-1 (P < 0.001) were observed in the HIIT group when compared with control group.

Ten weeks of HIIT may inhibit NF-kB/Atrogin-1/MuRF-1 axis, leading to decreased atrophy and increased heart weight in mice with breast cancer.