فصلنامه بیماری های پستان ایران
سال سیزدهم شماره 4 (پیاپی 51، زمستان 1399)

Breast cancer-related lymphedema is a chronic swelling accompanied by physical discomfort and prolonged treatment negatively affecting patients’ quality of life (QoL). Self-management is a vital phase in managing the results of treatment. So, the study aims to compare the effect of in-person and virtual self-management education on women’s quality of life.

This was a randomized clinical trial conducted on 70 women with breast cancer-related lymphedema in the last one year, attending to Seyed_Khandan rehabilitation center in Tehran. Sampling was done by random allocation method in blocks of 2 with 35 subjects in each group. All subjects received routine lymphedema treatment. The in-person and virtual groups received the education at the clinic and the Telegram messenger, respectively. QoL was assessed using the Persian version of EORTC QLQ-C30 and QLQ-BR23 questionnaires on before, immediately, and three months after the intervention.

The mean age of the individuals was 51.42±9.71. Most subjects were married, had a diploma or higher, and the mean duration of lymphedema was 6.88 months. At the end of the study compared to the beginning of the study, physical, role, emotional and social functions decreased significantly in the virtual group compared with the in-person group. In this way, the status of the mentioned variables in the in-person group was better than the virtual one (P=0.006, P=0.026, P=0.014, P=0.023, respectively). Three months after the intervention, median scores on global health (P=0.21), physical functioning (P=0.004), role functioning (P=0.009), emotional functioning (P<0.001), social functioning (P=0.048) were still significantly greater for the in-person group. Also, the in-person group had a greater reduction in the median scores of systemic therapy side effects (P=0.002) and arm symptoms (P=0.45) compare with the virtual group.

Self-management education led to improved quality of life, and in the comparison between the two methods, in-person method was more effective than virtual method. However, further studies are needed to investigate the efficacy and cost-effectiveness of both methods in educating patients with lymphedema.

Cancer-related fatigue is one of the most common and debilitating complications of breast cancer. Cancer patients have been found to have lower levels of melatonin, and fatigue has been shown to be correlated with both melatonin and interleukin (IL-6) in cancer patients. This study aimed to evaluate the fatigue and serum level of IL-6 in response to melatonin treatment in breast cancer patients.

In this double-blinded clinical trial, 74 women with breast cancer were evaluated for the effect of melatonin on fatigue induced by adjuvant chemotherapy and radiotherapy. The intervention group (n = 38) started receiving 6 mg of oral melatonin from 6 to 7 days before the start of adjuvant therapy until the disease progression, while the control group (n = 36) received a placebo during this time. The fatigue scores and serum IL-6 levels of both groups were measured at baseline and after the intervention, and the changes were compared.

The mean age of participants in the control group was 46.05 ± 10.55 y, and that of the intervention group was 50.47 ± 10.79 y (P = 0.223). The mean postintervention fatigue scores for the placebo and melatonin groups were 52.61 ± 4.57 and 25.16 ± 15.86, respectively (P < 0.001). There was no difference in the mean IL-6 level between the groups (P = 0.721).

Administering melatonin in women with breast cancer undergoing adjuvant chemotherapy and radiotherapy leads to a significant reduction in fatigue but does not affect serum IL- 6 levels.

This study aimed to compare the cytology results obtained by the conventional smear method with those obtained by the liquid-based method for the diagnosis of palpable breast masses in women referred to the clinic of Shahid Mohammadi Hospital in Bandar Abbas city.

The research method was descriptive–cross-sectional. The research sample was selected based on purposive and availability sampling. Accordingly, 67 patients referred to the surgical clinic of Shahid Mohammadi Hospital in 2019-2020 were evaluated. The diagnostic sensitivity, diagnostic specificity, positive predictive value, and negative predictive value of conventional smear method and liquid-based method were compared.

The diagnostic sensitivity of the conventional smear method was 88.4%, specificity 94.9%, positive predictive value 92%, and negative predictive value 92.5%. The diagnostic sensitivity of the liquid-based method was 84%, specificity 90%, positive predictive value 80.7%, and negative predictive value 90%.

Liquid-based method is better than conventional smear because of the ease of processing, faster screening, and preservation of cells and nuclear details. And it can be a promising and reliable method to diagnose palpable breast masses before surgery.

Because of the nature of cancer and related hormonal changes, as well as the conditions resulting from stress tolerance, relational problems and aggression are major problems facing couples with breast cancer in wives. The aim of this study was to investigate the effect of emotionally focused couples therapy (EFCT) on relational aggression in couples with breast cancer in wives.

This study was conducted with a pretest-posttest design and a control group. Twenty-two couples meeting the inclusion criteria were selected by convenience sampling from among people with breast cancer living in Tehran and randomly assigned to the experimental and control group. The experimental group received a 6-session (120 minutes per session) intervention of an adapted version of emotionally focused group therapy for couples (HMT). This intervention was meant to improve the psychological and relational indicators related to the quality of life of couples where the female partner was diagnosed with, or had a recurrence of, breast cancer and was in active treatment process or had gone through the treatments. The control group did not receive any intervention. Both groups answered the Buss-Perry Aggression Questionnaire (29-item instrument to measure physical aggression, verbal aggression, anger, and hostility) before and after the intervention. Analysis of covariance was used to evaluate the effect of treatment.

The experimental group demonstrated a decline in the mean of all factors after receiving the training program, as compared to the control group. The decrease was 11.01 points for physical aggression, 5.78 for verbal aggression, 8.37 for anger, and 10.95 for hostility. In contrast, the control group had a decrease of 0.41 points in anger and 0.17 points in hostility factors. The control group also displayed an increase of 0.06 points in the mean scores on both physical and verbal aggression components. Analysis of covariance revealed that EFCT had a significant decreasing effect on all the components of aggression in the experimental group as compared to the control group (P < 0.01).

Through the education of correct mutual emotional understanding for couples and creating an atmosphere of trust and communication between them, EFCT intervention provides a ground for increasing marital satisfaction and reducing aggression in couples coping with breast cancer in wives. Accordingly, the intervention can be used to improve the quality of marital relations.

Tumor size is a contributing factor in cancer prognosis. On the other hand, regular exercise may play an important role in inhibiting tumor growth in breast cancer. Because of the key role of tumor volume in tumor metastasis, the aim of the present study was to compare the effects of a 4-week and a 12-week aerobic training on tumor volume in female mice with breast cancer.

Forty female BALB/c mice (4-5 weeks old weighing 18 ± 2g) were randomly divided into the following 5 groups of 8 after cancer induction: primary prevention group, secondary prevention group, treatment, exercise, and cancer control. Aerobic exercise was performed for 4 weeks at different stages (prevention, during treatment, and after cancer) at an intensity equal to 40% to 50% of the maximal oxygen consumption. The exercise group performed aerobic exercise for 40 minutes at 18 m/min at a zero-degree incline 5 times a week for 12 weeks. At the end of the training intervention period, all mice were sacrificed and tumor volume was measured using a digital caliper. Data were analyzed using the ANOVA test on SPSS v.22.

After 4 weeks of exercise intervention, a significant decrease in tumor volume was observed in the primary prevention and control groups (P = 0.001), and after 12 weeks of aerobic training, a decrease in tumor volume was observed in the exercise and control groups (P = 0.007). However, there was no significant difference in the other groups.

Moderate-intensity aerobic exercise can be used as an effective treatment method to reduce the volume of breast tumors. However, more research is needed to reach definitive results.

The aim of this study was to investigate the effect of aerobic exercise with detraining in different phases of prevention on Bcl-2 gene expression and protein.

For this purpose, 32 female BALB-c mice (18-20 g) were purchased and randomly assigned to four groups of primordial prevention (A), primary prevention (B), secondary prevention (C), and control (D). Group A performed aerobic exercise for 4 weeks, followed by injection of 4T1 cells and 8 weeks of detraining after the injection. Group B performed aerobic exercise for 4 weeks immediately after the injection of 4T1 cells and then detrained for 4 weeks. Group C received a 4T1 cell injection and maintained a sedentary life for 4 weeks, followed by 4 weeks of aerobic exercise. The subjects were killed 48 hours after the last training session and detraining courses and tumor tissues were removed. Real-time polymerase chain reaction was used to measure gene expression and western blotting was used to measure protein content.The one-way ANOVA test was used to analyze the data.

The mean gene expression due to aerobic exercise was significantly (P<0.001) lower in groups A (0.481), B (0.323), and C (0.035) compared with group D (1.711). Also, aerobic exercise caused a significant decrease in Bcl-2 (P=0.005) protein expression in groups A (0.692), B (0.821), and C (0.670) compared with group D (1.000). It should be noted that tumor growth in experimental groups was not significantly different from the control group (P=0.092).

Exercise may be able to reduce anti-apoptotic agents in tumor cells, leading to apoptosis of tumor cells and reduced tumor growth.