Purpose Although fatigue, sleep disturbance, depression, and anxiety are associated with pain in breast cancer patients, it is unknown if acupuncture can decrease these co-morbid symptoms in cancer patients with pain. This study aimed at evaluating the effect of electro-acupuncture on fatigue, sleep, and psychological distress in breast cancer survivors who experience joint pain related to aromatase inhibitors (AIs). Patients and methods We performed a randomized controlled trial of an eight-week course of electro-acupuncture (EA) as compared to waitlist control (WLC) and sham acupuncture (SA) in postmenopausal women with breast cancer who self-reported joint pain attributable to aromatase inhibitors. Fatigue, sleep disturbance, anxiety, and depression were measured by the Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). The effects of EA and SA vs. WLC on these outcomes were evaluated using mixed-effects models. Results Of the 67 randomly assigned patients, baseline pain interference was associated with fatigue (Pearson correlation coefficient r =0.75, p<0.001), sleep disturbance (r=0.38, p=0.0026), and depression (r= 0.58, p<0.001). Compared to the WLC, EA produced significant improvement in fatigue (p=0.0095), anxiety (p=0.044), and depression (p=0.015) and non-significant improvement in sleep disturbance (p=0.058) during the 12 week intervention and follow up period. In contrast, SA did not produce significant reduction in fatigue and anxiety symptoms, but produced significant improvement in depression compared with WLC (p=0.0088). Conclusion Compared to usual care, EA produced significant improvement in fatigue, anxiety, and depression, whereas SA improved only depression in women experiencing AI-related arthralgia. Clinical Trial Registration NCT01013337

Purpose CIPN is a common toxicity associated with chemotherapy, but researchers rarely study its risk factors, fall risk, and prevalence in long-term breast cancer survivors. We aimed to determine CIPN prevalence, risk factors, and association with psychological distress and falls among long-term breast cancer survivors. Methods We conducted cross-sectional analyses among postmenopausal women with a history of stage I–III breast cancer who received taxane-based chemotherapy. Participants reported neuropathic symptoms of tingling/numbness in hands and/or feet on a 0–10 numerical rating scale. We conducted multivariate logistic regression analyses to evaluate risk factors associated with the presence of CIPN and the relationship between CIPN and anxiety, depression, insomnia, and patient-reported falls. Results Among 296 participants, 173 (58.4%) reported CIPN symptoms, 91 (30.7%) rated their symptoms as mild and 82 (27.7%) rated them moderate to severe. Compared with women of normal weight, being obese was associated with increased risk of CIPN, (adjusted OR 1.94, 95% CI: 1.03–3.65). Patients with CIPN reported greater insomnia severity, anxiety, and depression than those without (all p<0.05). Severity of CIPN was associated with higher rates of falls, with 23.8%, 31.9%, and 41.5% in the “no CIPN,” “mild,” and “moderate-to-severe” groups, respectively, experiencing falls (p=0.028). Conclusions The majority of long-term breast cancer survivors who received taxane-based chemotherapy reported CIPN symptoms; obesity was a significant risk factor. Those with CIPN also reported increased psychological distress and falls. Interventions need to target CIPN and comorbid psychological symptoms, and incorporate fall prevention strategies for aging breast cancer survivors.

Objective Sleep disturbance is a major consequence of hot flashes among breast cancer survivors. This study evaluated the effects of electro-acupuncture vs. gabapentin for sleep disturbances among breast cancer survivors experiencing daily hot flashes. Methods We analyzed data from a randomized controlled trial involving 58 breast cancer survivors experiencing bothersome hot flashes at least two times per day. Participants were randomly assigned to receive eight weeks of electro-acupuncture or daily gabapentin (total dose of 900 mg per day). The primary outcome was change in the total Pittsburgh Sleep Quality Index (PSQI) score between groups at Week 8. Secondary outcomes include specific PSQI domains. Results By the end of treatment at Week 8, the mean reduction in PSQI total score was significantly greater in the electro-acupuncture group as compared to the gabapentin group (−2.6 vs. −0.8, p=0.044). The electro-acupuncture also had improved sleep latency (−0.5 vs. 0.1, p=0.041) and sleep efficiency (−0.6 vs. 0.0, p=0.05) compared to the gabapentin group. By Week 8, the electro-acupuncture group improved sleep duration, sleep disturbance, sleep latency, daytime dysfunction, sleep efficiency, and sleep quality (p<0.05 for all) compared to baseline, whereas the gabapentin group improved in duration and sleep quality only (p<0.05). Conclusions Among women experiencing hot flashes, the effects of electro-acupuncture are comparable to gabapentin for improving sleep quality, specifically in the areas of sleep latency and efficiency. Larger randomized controlled trials with longer follow-ups are needed to confirm this preliminary finding. Clinical Trial Registration NCT01013337

Introduction COVID-19 increased stress levels while reducing access to mind-body services in patients with cancer. We describe the rapid deployment of remotely delivered mind-body services to people with cancer during COVID-19, rates of participation, and acceptability from patients' perspectives. Methods Eligible participants were patients with cancer age ≥ 18 years enrolled in a single academic cancer center's online patient portal. Interventions included mind-body group therapy sessions in fitness, meditation, yoga, dance, tai chi, and music delivered using Zoom video conferencing. Sessions were 30-45 min and led by an integrative medicine clinician. Following each session, participants were asked to complete a three-item questionnaire assessing (1) satisfaction with the class session, (2) reduction in stress/anxiety, and (3) likelihood of recommending the class to others. Patients could also provide comments in real-time using the Zoom chat function. Results Among 5948 unique visits, the most frequently attended classes were fitness (n = 2513, 42.2%) followed by meditation (n = 1176, 19.8%) and yoga (n = 909, 15.3%). Of these visits, 3902 (65.6%) had an associated completed questionnaire. Across class types, a large majority of participants reported being extremely satisfied (n = 3733, 95.7%), experiencing extreme reductions in anxiety/stress (n = 3268, 83.8%), and being extremely likely to recommend the class to others (n = 3605, 92.4%). Fitness had the highest endorsement among class types (all p values < 0.001). Themes from the chat responses included gratitude, expressions of helpfulness, and feelings of connection. Conclusion High utilization of and satisfaction with these virtual mind-body services demonstrate the significant potential of remote delivery to facilitate patient access to services.

An integrative Reiki volunteer program shows promise as a component of supportive care for cancer patients. More research is needed to evaluate and understand the impact that Reiki may have for patients, caregivers, and staff whose lives have been affected by cancer.

Background. Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating adverse effect of neurotoxic chemotherapy that significantly worsens cancer survivors' quality of life. Materials and Methods. Solid tumor survivors with persistent moderate-to-severe CIPN defined as numbness, tingling, or pain rated ≥4 on an 11-point numeric rating scale (NRS) were randomized in a 1:1:1 ratio to eight weeks of real acupuncture (RA) versus sham acupuncture (SA) versus usual care (UC). We previously reported the primary endpoint (NRS); here we report health-related quality of life endpoints: Functional

Moderate to severe fatigue complaints exceed 50% among AI users. Fatigue is highly related to younger age, higher education level, higher BMI, pain severity and insomnia.

Purpose Acupuncture is a complementary and alternative medicine (CAM) modality that shows promise as a component of supportive breast cancer care. Lack of robust recruitment for clinical trial entry has limited the evidence-base for acupuncture as a treatment modality among breast cancer survivors. The objective of this study is to identify key decision making factors among breast cancer survivors considering entry into an acupuncture clinical trial for treatment of symptoms. Methods Semi-structured interviews were conducted among African-American (n=12) and Caucasian (n=13) breast cancer survivors. Verbatim transcripts were made and analyzed by two or more independent coders using NVivo software. Major recurring themes were identified and a theoretical framework developed. Results Six themes emerged reflecting key attributes of the decision to enter a clinical trial: 1) symptom appraisal, 2) practical barriers (e.g. distance, travel), 3) beliefs about the interventions (e.g. fear of needles, dislike of medications), 4) comfort with elements of clinical trial design (e.g., randomization, the nature of the control intervention, and blinding), 5) trust, and 6) altruism. African-American and Caucasian women weighed similar attributes but differed in the information sources sought regarding clinical trial entry and in concerns regarding the use of a placebo in a clinical trial. Conclusions We present of a theoretical framework of decision making for breast cancer survivors considering entry into a CAM clinical trial for symptom management. This framework can inform both research studies and programmatic initiatives to support a shared decision making process and robust recruitment to CAM trials among cancer survivors.