Purpose We examined mechanisms through which social relationships influence quality of life (QOL) in breast cancer survivors. Methods This study included 3,139 women from the Pathways Study who were diagnosed with breast cancer from 2006-2011 and provided data on social networks (presence of spouse or intimate partner, religious/social ties, volunteering, and numbers of close friends and relatives), social support (tangible, emotional/informational, affection, positive social interaction), and quality of life (QOL), measured by the FACT-B, approximately two months post-diagnosis. We used logistic models to evaluate associations between social network size, social support, and lower vs. higher than median QOL scores. We further stratified by stage at diagnosis and treatment. Results In multivariate-adjusted analyses, women who were characterized as socially isolated had significantly lower FACT-B (OR=2.18, 95%CI:1.72-2.77), physical well-being (WB) (OR=1.61, 95%CI:1.27-2.03), functional WB (OR=2.08, 95%CI:1.65-2.63), social WB (OR=3.46, 95%CI:2.73-4.39), and emotional WB (OR=1.67, 95%CI:1.33-2.11) scores and higher breast cancer symptoms (OR=1.48, 95%CI:1.18-1.87), compared with socially integrated women. Each social network member independently predicted higher QOL. Simultaneous adjustment for social networks and social support partially attenuated associations between social networks and QOL. The strongest mediator and type of social support that was most predictive of QOL outcomes was “positive social interaction”. However, each type of support was important depending on outcome, stage, and treatment status. Conclusions Larger social networks and greater social support were related to higher QOL after a diagnosis of breast cancer. Effective social support interventions need to evolve beyond social-emotional interventions and need to account for disease severity and treatment status.

Purpose-Few studies have assessed quality of life (QOL) of women diagnosed with breast cancer within the first few weeks of their initial diagnosis. We describe QOL among 950 women recently diagnosed with invasive breast cancer. Methods-Starting in January 2006, we invited women aged ≥21 years who were diagnosed with first primary invasive breast cancer within Kaiser Permanente Northern California (KPNC) to enroll in the Pathways Study, a prospective study of breast cancer survivorship. QOL was measured using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), along with sociodemographic and social support information. Clinical characteristics were obtained from the KPNC cancer registry and electronic medical record. We used multivariable linear regression models to identify factors associated with QOL scores calculated from the FACT-B.Results-The mean age ± SD of the sample was 59.6 years (±11.9 years), and the mean time ± SD from diagnosis until interview was 8.0 weeks (±3.2 weeks). Younger age at diagnosis was associated with lower scores in all QOL domains (p<0.01), and later stage at diagnosis was associated with lower scores in all domains (p<0.05) except for social well-being. Higher levels of social support were associated with higher QOL except for physical well-being (p<0.05). These associations were stronger within two months of breast cancer diagnosis.Conclusion-Quality of life as influenced by a diagnosis of breast cancer is an important factor in cancer survivorship. Age, stage at diagnosis, and social support are key factors in this important variable.

Background-Many women use complementary and alternative medicine (CAM) to maintain or improve their health. We describe CAM use among the first 1,000 participants enrolled in the Pathways Study, an ongoing prospective cohort study of women diagnosed with breast cancer (BC).

Objective-With 2.3 million breast cancer survivors in the U.S. today, identification of modifiable factors associated with breast cancer recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California (KPNC).Methods-Pathways aims to examine the effect on recurrence and survival of 1) lifestyle factors such as diet, physical activity, quality of life, and use of alternative therapies and 2) molecular factors such as genetic polymorphisms involved in metabolism of chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly-diagnosed patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases.Results-Recruitment began in January 9, 2006, and as of January 16, 2008, 1,539 women have been enrolled along with collection of 1,323 blood samples (86%) and 1,398 saliva samples (91%). Conclusions-ThePathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis.

Obesity and low MVPA were associated with CIPN in breast cancer patients who received taxane treatment.

Aims/hypothesis Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than those of the National Diabetes Data Group (NDDG) that have been in use since 1979. We sought to determine the extent to which infants of women meeting only the ADA criteria for GDM are at increased risk of neonatal complications. Materials and methods In a multiethnic cohort of 45,245 women who did not meet the NDDG criteria and were not treated for GDM, we conducted nested case-control studies of three complications of GDM that occurred in their infants: macrosomia (birthweight >4,500 g, n=494); hypoglycaemia (plasma glucose <2.2 mmo/l, n=488); and hyperbilirubinaemia (serum bilirubin ≥342 μmol/l (20 mg/dl), n=578). We compared prenatal glucose levels of the mothers of these infants and mothers of 884 control infants. Results Women with GDM by ADA criteria only (two or more glucose values exceeding the threshold) had an increased risk of having an infant with macrosomia (odds ratio OR = 3.40, 95% CI = 1.55-7.43), hypoglycaemia (OR=2.61, 95% CI=0.99-6.92) or hyperbilirubinaemia (OR=2.22, 95% CI=0.98-5.04). Glucose levels 1 h after the 100-g glucose challenge that exceeded the ADA threshold were particularly strongly associated with each complication. Conclusions/interpretation These results lend support to the ADA recommendations and highlight the importance of the 1-h glucose measurement in a diagnostic test for GDM.

Importance There are long-standing interests in the potential benefits of vitamin D for preventing breast cancer recurrence and mortality; yet data from prospective cohort studies are limited. Objective We investigated a serum biomarker of vitamin D status, 25-hydroxyvitamin D (25OHD) measured at the time of breast cancer diagnosis, with prognosis. Design The Pathways Study is a prospective cohort study of breast cancer survivors established in 2006. Enrollment was completed in 2013; follow up is ongoing. Setting The cohort was established in Kaiser Permanente Northern California (KPNC), a large integrated healthcare delivery system in San Francisco Bay Area and central valley, California. Participants Women diagnosed with incident invasive breast cancer were typically consented and enrolled within 2 months of diagnosis. The overall enrollment rate was 46%. Participants are followed for health outcomes and comorbidities at 12, 24, 48, 72 and 96 months after baseline interview. A case-cohort design was used for efficiency assay of 25OHD, selecting 1,666 cohort members with serum samples and ensuring representation in the sub-cohort of races and clinical subtypes. Main Outcome Measures Primary outcomes are breast cancer recurrence, second primary cancer (SPC), and death. Results Serum 25OHD concentrations were lower in women with advanced stage tumors, and the lowest in premenopausal women with triple-negative cancer. Levels were also inversely associated with hazards of disease progression and death. Compared with the lowest tertile (T1), women with the highest (T3) 25OHD levels had superior overall survival (OS). This association remained after adjustment for clinical prognostic factors [hazards ratio (HR)=0.72, 95% confidence interval (CI): 0.54, 0.98]. Among premenopausal women, the association with OS was stronger, and there were also associations with breast cancer-specific survival (BCSS) and invasive disease-free survival (IDFS) (OS: HR=0.45, 95% CI, 0.21–0.96; BCSS: HR=0.37, 95% CI, 0.15–0.93; IDFS: HR=0.58, 95% CI, 0.34–1.01; all after full adjustment.) Conclusions and Relevance Serum 25OHD levels were independently associated with breast cancer prognostic characteristics and patient prognosis, most prominently among premenopausal women. Our findings from a large, well-characterized prospective cohort provide compelling observational evidence on associations of vitamin D with lower risk of breast cancer morbidity and mortality.

Physical activity offers many benefits to breast cancer survivors, yet research on physical activity during the immediate period following a breast cancer diagnosis is limited. In a prospective cohort study of 1,696 women diagnosed with invasive breast cancer in the Kaiser Permanente Northern California Medical Care Program from 2006–2009, we describe change in self-reported physical activity levels from around diagnosis to six months post-diagnosis and determine factors associated with change. Participants completed a comprehensive physical activity questionnaire at baseline (2 months post-diagnosis) and at follow-up (8 months post-diagnosis). Predictors of physical activity change were determined by multivariable linear regression. Reductions in all physical activity levels were observed (P<0.0001); mean (SD) change (hours/week) of moderate-vigorous physical activity (MVPA) was −1.28 (4.48) and sedentary behavior was −0.83 (6.95). In fully-adjusted models, overweight and obesity were associated with greater declines in MVPA of −1.58 hours/week (SD=0.92) and −1.29 hours/week (SD=0.93), respectively (P=0.0079). Receipt of chemotherapy only was also associated with a greater decrease in MVPA (−2.12 hours/week; SD=0.92; P<0.0001), specifically for recreational activities (−1.62 hours/week; SD=0.64; P=0.0001). These data suggest challenges in maintaining physical activity levels during active treatment among women with breast cancer. Interventions to encourage physical activity in breast cancer survivors should be pursued.