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Purpose: We aimed to examine whether cardiorespiratory fitness and leg strength can be estimated based on their relationship with physical performance tests in Japanese breast cancer survivors., Methods: Participants were 50 sedentary women aged 20 to 59 years who have received breast surgery in the past 2 to 13 months after diagnosis of invasive breast cancer (stage I-IIa). Cardiorespiratory fitness and leg strength were measured by peak oxygen consumption (VO 2 peak), and one-repetition maximum for leg press (leg press 1RM). Physical performance tests were performed 6-min walk test, chair stand test, and grip strength. Using multiple regression analysis, we developed prediction equations for VO 2 peak and leg strength based on their associations with the physical performance tests. The validity of the estimation equations was assessed using Bland-Altman plots., Results: Mean age, VO 2 peak, and leg press 1RM were 48 ± 6 years, 25.0 ± 3.6 mL/kg/min, and 95 ± 32 kg, respectively. Multiple regression analysis yielded 6-min walk test distance, age, height, and body weight as predictors of VO 2 peak. Measured VO 2 peak and predicted VO 2 peak showed a moderate positive correlation (r = 0.463, p < 0.001). Chair stand test, grip strength, age, height, and body weight were selected as predictors of leg press 1RM. There was a strong positive correlation between predicted and measured leg press 1RM (r = 0.754, p < 0.001)., Conclusion: The results suggest that leg strength can be predicted using physical performance tests. However, further examination may be needed to determine whether cardiorespiratory fitness can be predicted based on 6-min walk test., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: A known barrier to getting breast cancer survivors (BCSs) to engage in habitual exercise is a lack of information on recommended physical activity levels provided to them by oncology care providers (OCPs). However, the actual situation in Japan remains unclear. This study sought to clarify OCPs' awareness and practice related to Japan's physical activity recommendation for BCSs and to ascertain barriers to routine information provision., Methods: We conducted a web-based survey involving members of the Japanese Breast Cancer Society (JBCS) and the Japanese Association of Cancer Rehabilitation between Dec. 2018 and Feb. 2019., Results: Of 10,830 members, 1,029 (9.5%) responded. Only 19.1% were aware of the details of the JBCS physical activity recommendation, and only 21.2% routinely provided physical activity information to BCSs. Factors related to being aware of the recommendation details were 1) availability of the guidelines, 2) experience reading relevant parts of the guidelines, and 3) involvement in multidisciplinary team case meetings. Barriers to routine information provision were 1) absence of perceived work responsibility, 2) underestimation of survivors' needs, 3) lack of resources, 4) lack of self-efficacy about the recommendation, and 5) poor knowledge of the recommendation., Conclusions: Only one fifth of the OCPs routinely provided physical activity information. Barriers to provision were poor awareness, self-efficacy, and attitudes and unavailable resources. The physical activity recommendation needs to be disseminated to all OCPs and an information delivery system needs to be established for BCSs to receive appropriate information and support to promote their engagement in habitual physical activity., (© 2021. The Author(s).)

Background: A strategy for maintaining and/or improving cardiorespiratory fitness (CRF) in the growing population of cancer survivors is of major clinical importance, especially in the COVID-19 era. The effect of unsupervised high-intensity interval training (HIIT) on increasing CRF in breast cancer survivors is unknown., Purpose: The purpose of this study was to determine whether the newly developed habit-B programme, which involves home-based smartphone-supported HIIT using body weight exercises, improves CRF in early-stage breast cancer survivors., Methods: This single-centre, 12-week, parallel-group, single-blind, randomised controlled trial involved 50 women with stage I-IIa breast cancer, aged 20-59 years, who had completed initial treatment except for hormone therapy. Participants were randomised to either the exercise or control group. The primary outcome was the 12-week change in peak oxygen uptake [Formula: see text]. Other outcomes included muscle strength, 6 min walk test, resting heart rate, physical activity, fatigue, safety and quality of life., Results: The change in [Formula: see text] and leg strength increased significantly in the exercise group compared with the control group (p<0.01). Changes in other outcomes were not significantly different between the groups., Conclusion: A home-based HIIT intervention can lead to improve CRF and muscle strength in early-stage breast cancer survivors., Competing Interests: Competing interests: EO has received research support from Nippon Suisan Kaisha. AK has received speaking fees from Chugai Pharmaceutical. TU is a president and shareholder of SUSMED. YM has received speaker fees from Suntory, Pfizer, Mochida, Eli Lilly, Morinaga Milk and Cimic., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Insomnia is an increasingly recognized major symptom of breast cancer which can seriously disrupt the quality of life during and many years after treatment. Sleep problems have also been linked with survival in women with breast cancer. The aims of this study were to estimate the prevalence of insomnia in breast cancers survivors, clarify the clinical characteristics of their sleep difficulties and use machine learning techniques to explore clinical insights., Methods: Our analysis of data, obtained in a nationwide questionnaire survey of breast cancer survivors in Japan, revealed a prevalence of suspected insomnia of 37.5%. With the clinical data obtained, we then used machine learning algorithms to develop a classifier that predicts comorbid insomnia. The performance of the prediction model was evaluated using 8-fold cross-validation., Results: When using optimal hyperparameters, the L2 penalized logistic regression model and the XGBoost model provided predictive accuracy of 71.5 and 70.6% for the presence of suspected insomnia, with areas under the curve of 0.76 and 0.75, respectively. Population segments with high risk of insomnia were also extracted using the RuleFit algorithm. We found that cancer-related fatigue is a predictor of insomnia in breast cancer survivors., Conclusions: The high prevalence of sleep problems and its link with mortality warrants routine screening. Our novel predictive model using a machine learning approach offers clinically important insights for the early detection of comorbid insomnia and intervention in breast cancer survivors., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Background: To review the settings and outcomes of high-intensity interval training (HIIT) interventions for breast cancer survivors, and to explore the feasibility of prescribing exercise for breast cancer survivors., Methods: A systematic search of electronic databases was conducted for studies published up to May 31, 2020. Eligibility criteria included randomized controlled trials of HIIT intervention in breast cancer survivors. Studies were grouped by whether the intervention was conducted during or after breast cancer treatment, and intervention methods and outcomes were reviewed within each group., Results: Twenty-six studies were identified, and 13 satisfied the inclusion criteria. Intervention was conducted during treatment in 8 studies, and after treatment in 5. Intervention duration ranged from 3 to 16 weeks, with 2 or 3 sessions per week, for a total of 9 to 36 sessions. All interventions were supervised; 12 were lab-based, and 1 was community-based. One of most promising outcomes was improvement of cardiorespiratory fitness by HIIT., Conclusion: This review found that all studies on HIIT for breast cancer survivors investigated lab-based, supervised interventions, but not home-based or unsupervised. HIIT is a time-efficient method for increasing cardiovascular function in breast cancer survivors, but further research is necessary to determine its effects on other outcomes.

Background: The integrity of data in a clinical trial is essential, but the current data management process is too complex and highly labor-intensive. As a result, clinical trials are prone to consuming a lot of budget and time, and there is a risk for human-induced error and data falsification. Blockchain technology has the potential to address some of these challenges., Objective: The aim of the study was to validate a system that enables the security of medical data in a clinical trial using blockchain technology., Methods: We have developed a blockchain-based data management system for clinical trials and tested the system through a clinical trial for breast cancer. The project was conducted to demonstrate clinical data management using blockchain technology under the regulatory sandbox enabled by the Japanese Cabinet Office., Results: We verified and validated the data in the clinical trial using the validation protocol and tested its resilience to data tampering. The robustness of the system was also proven by survival with zero downtime for clinical data registration during a Amazon Web Services disruption event in the Tokyo region on August 23, 2019., Conclusions: We show that our system can improve clinical trial data management, enhance trust in the clinical research process, and ease regulator burden. The system will contribute to the sustainability of health care services through the optimization of cost for clinical trials., (©Tomonobu Hirano, Tomomitsu Motohashi, Kosuke Okumura, Kentaro Takajo, Taiyo Kuroki, Daisuke Ichikawa, Yutaka Matsuoka, Eisuke Ochi, Taro Ueno. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.06.2020.)

Background: Dysfunctional processing of fear memory may be involved in the pathophysiology of fear of cancer recurrence (FCR), which is cited as the major unmet psychological need of cancer survivors. Emerging evidence has shown that the microbiota-gut-brain (MGB) axis affects depressive and anxiety disorders, and chemotherapy-associated psychological distress. We therefore hypothesized that the gut microbiota is associated with FCR in cancer survivors., Methods: This cross-sectional study enrolled women diagnosed with invasive breast cancer who were not currently undergoing chemotherapy. Fecal samples were obtained to assess the gut microbiota. FCR grade was assessed using the Concerns About Recurrence Scale (CARS)., Results: Mean age of the participants (n = 126) was 58 years; 47% had stage I disease. Multiple regression analysis with adjustment for possible confounders showed that the relative abundance of the Bacteroides genus (beta = 0.180, p = 0.03) was significantly and directly associated with FCR. In the 57 participants with a history of chemotherapy, higher FCR was associated with lower microbial diversity (p = 0.04), lower relative abundance of Firmicutes (p = 0.03) and higher relative abundance of Bacteroidetes (p = 0.04) at the phylum level, and higher relative abundance of Bacteroides (p < 0.01) and lower relative abundance of Lachnospiraceae.g (p = 0.03) and Ruminococcus (p = 0.02) at the genus level., Conclusion: Our findings provide the first evidence of an association between the gut microbiota and FCR and suggest that chemotherapy-induced changes in gut microbiota can influence FCR. Further studies should examine the effects of the gut microbiota on FCR using a prospective design., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: A major concern is that few cancer survivors meet the guidelines for recommended levels of physical activity. No studies have investigated physical activity among breast cancer survivors nationwide in Japan. Therefore, the aims of this study are to identify the levels of physical activity among breast cancer survivors, to examine factors-related physical activity among breast cancer survivors and to identify breast cancer survivors' preferences for and interest in exercise programmes in order to inform the future programme development., Methods and Analysis: We will administer a cross-sectional survey using a self-report questionnaire to breast cancer survivors. At each of 50 facilities selected to include a variety of institutional backgrounds according to the population distribution of different regions throughout Japan, we will consecutively distribute the questionnaire to 30 outpatients who have completed initial treatments, except for hormone therapy. The target sample size is 1500 survivors. We will calculate descriptive statistics for each measurement item and perform univariate and multivariate analyses using outcome measures (eg, physical activity and quality of life) related to physical, psychological, social and environmental factors., Discussion: This is the first nationwide survey of physical activity levels among breast cancer survivors in Japan. Identifying the factors associated with physical activity will help us to develop, disseminate and implement programmes that encourage more survivors to adhere to physical activity guidelines., Ethics and Dissemination: The protocol was approved by the Institutional Review Board (IRB) of the National Cancer Center on 11 January 2019 (ID: 2018-295). In addition, many of the participating facilities required ethical approval from their local IRBs, while others did not. Accordingly, approval from the local IRBs of individual facilities was obtained when required. The findings will be disseminated through peer-reviewed publications and conference presentations., Competing Interests: Competing interests: EO has received research support from Nippon Suisan Kaisha. YM has received speaker fees from Pfizer, Mochida, Eli Lilly, Morinaga Milk and NTT Data and has conducted collaborative research with Morinaga Milk. AK has received speaking fees from Chugai Pharmaceutical. All other authors declare that they have no competing interests regarding this work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence., Methods: In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4)., Results: In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240)., Conclusions: Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate., (© 2019 American Cancer Society.)

Background: The pathophysiology of fear of cancer recurrence (FCR), the leading unmet psychological need of cancer survivors, may involve the dysfunctional processing of fear memory. n-3 polyunsaturated fatty acids (PUFAs) have beneficial effects on psychiatric disorders, including depressive disorder and anxiety disorders, and are involved in fear memory processing. We hypothesized that n-3 PUFA composition is associated with FCR in cancer survivors., Methods: We conducted a cross-sectional study to examine the relationship between n-3 PUFAs and FCR among breast cancer survivors. Adults who had been diagnosed with invasive breast cancer and were not undergoing chemotherapy were asked to participate. Blood PUFA composition was evaluated by using capillary blood. We directly administered the Concerns About Recurrence Scale (CARS) to assess the grade of FCR., Results: Among 126 participants used for the analysis, the mean age (SD) was 58 (11) years and 47% had stage I cancer. Multiple regression analysis controlling for possible confounders, depressive symptoms, and post-traumatic stress disorder (PTSD) symptoms revealed that the alpha-linolenic acid (ALA) level was significantly inversely associated with the average score on the CARS overall fear index (beta = -0.165, p = 0.04). No significant associations were found for other PUFAs., Limitations: Our findings were obtained from a cross-sectional study in a single institute., Conclusion: These findings provide the first evidence of a beneficial effect of ALA on FCR and indicate the need for prospective study of this association. FCR among breast cancer survivors might be controllable by prudent selection of ALA-containing cooking oil., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The mechanisms underlying cognitive decline after radiotherapy not directed at brain areas remains unclear. We previously suggested that adjuvant breast radiotherapy in breast conservation therapy could lower memory function soon after therapy, and that the process might be partially mediated by plasma interleukin (IL)-6 levels. The present study investigated how that relationship changes longitudinally., Methods: We performed the Wechsler Memory Scale-Revised (WMS-R) test and measured plasma IL-6 levels for 47 breast cancer surgical patients within 1 year after the initial therapy (study 1) and more than 2 years after study 1 (study 2). We also performed 2 × 2 mixed [the radiotherapy group (n = 25) or the no-radiotherapy group (n = 22) × study 1 or study 2] analysis of covariance on the WMS-R indices and plasma IL-6 levels. The association between changes in plasma IL-6 levels and changes in the WMS-R indices between the two studies was evaluated using Pearson's correlation coefficient., Results: The Immediate Verbal Memory Index was significantly higher in study 2. The Delayed Recall Index was significantly higher in study 2 and significantly lower in the radiotherapy group only in study 1. There was a significant correlation between changes in plasma IL-6 levels and changes only in the Delayed Recall Index of the WMS-R., Conclusions: Memory decline in breast cancer patients soon after adjuvant breast radiotherapy was restored approximately 3 years after treatment, and decreased plasma IL-6 levels might be involved in the recovery process.

In contrast to the cumulative evidence suggesting the inverse association of n-3 polyunsaturated fatty acids (PUFAs) with depression, few studies have examined the association of n-6 PUFAs with depression. In particular, no study has examined the relationship between n-6 PUFAs and depression in cancer patients. Thus, we conducted this cross-sectional study to comprehensively examine the association of n-3 and n-6 PUFAs with depressive symptoms in breast cancer survivors. Adults who had been diagnosed with invasive breast cancer and were not undergoing chemotherapy were enrolled. Blood PUFA composition was determined using capillary blood. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Among 126 participants, the mean age (standard deviation) was 58 (11) years and 47% had stage I cancer. Multiple regression analysis controlling for possible confounders revealed that the level of total n-6 PUFAs and linoleic acid was significantly associated with the HADS total score (beta = 0.175, p = 0.046 for total n-6 PUFAs; beta = 0.174, p = 0.048 for LA). No significant associations were found for other PUFAs. These findings provide the first evidence suggesting that a higher blood level of total n-6 PUFAs and linoleic acid is significantly associated with higher depressive symptoms among breast cancer survivors. Further studies should examine the positive effects of a reduction in n-6 PUFAs on depressive symptoms in breast cancer survivors using prospective studies, including randomized control trials., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Although protracted cognitive impairment has been reported to occur after radiotherapy even when such therapy is not directed to brain areas, the mechanism remains unclear. This study investigated whether breast cancer patients exposed to local radiotherapy showed lower cognitive function mediated by higher plasma interleukin (IL)-6 levels than those unexposed. We performed the Wechsler Memory Scale-Revised (WMS-R) and measured plasma IL-6 levels for 105 breast cancer surgical patients within 1 year after the initial therapy. The group differences in each of the indices of WMS-R were investigated between cancer patients exposed to adjuvant regional radiotherapy (n = 51) and those unexposed (n = 54) using analysis of covariance. We further investigated a mediation effect by plasma IL-6 levels on the relationship between radiotherapy and the indices of WMS-R using the bootstrapping method. The radiotherapy group showed significantly lower Immediate Verbal Memory Index and Delayed Recall Index (P = 0.001, P = 0.008, respectively). Radiotherapy exerted an indirect effect on the lower Delayed Recall Index of WMS-R through elevation of plasma IL-6 levels (bootstrap 95% confidence interval = -2.6626 to -0.0402). This study showed that breast cancer patients exposed to adjuvant regional radiotherapy in conservation therapy might have cognitive impairment even several months after their treatment. The relationship between the therapy and the cognitive impairment could be partially mediated by elevation of plasma IL-6 levels., (© 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Although smaller hippocampi and amygdalae were found in cancer survivors with intrusions, associations between cancer-related posttraumatic stress disorder (PTSD) and these volumes are unknown. The authors performed MRI volumetric analyses of these regions in 15 cancer survivors with PTSD, 15 cancer survivors without PTSD, and 15 healthy comparison subjects. The authors also examined the correlation between PTSD symptom scores of the Impact of Event Scale and these volumes in the PTSD group. These volumes were not significantly different among the groups, but the intrusion score was inversely associated with the hippocampal volume. Results suggest intrusions, not PTSD diagnosis, might be associated with hippocampal volume.

Background: Previous studies have shown cognitive impairment in breast cancer survivors who were exposed to adjuvant chemotherapy. Neural damage by chemotherapy might have played some part in these findings. The current study explored the regional brain volume difference between breast cancer survivors exposed to adjuvant chemotherapy (C+) and those unexposed (C-)., Methods: High-resolution 1.5-tesla brain magnetic resonance imaging (MRI) databases of breast cancer survivors and healthy controls were used. Brain images were preprocessed for optimal voxel-based morphometry. Comparisons of gray matter and white matter were performed between the C+ and the C- groups, by using MRI scans from within 1 year (the 1-year study, n = 51 and n = 55, respectively) or 3 years after their cancer surgery (the 3-year study, n = 73 and n = 59, respectively). As exploratory analyses, correlation analyses were performed between indices of the Wechsler Memory Scale-Revised and regional brain volume where the volume were significantly smaller. As a reference, MRI scans of cancer survivors were compared with those of healthy controls (n = 55 for the 1-year study and n = 37 for the 3-year study)., Results: The C+ patients had smaller gray matter and white matter including prefrontal, parahippocampal, and cingulate gyrus, and precuneus in the 1-year study. However, no difference was observed in the 3-year study. The volumes of the prefrontal, parahippocampal gyrus, and precuneus were significantly correlated with indices of attention/concentration and/or visual memory. Comparisons with healthy controls did not show any significant differences., Conclusions: Adjuvant chemotherapy might have an influence on brain structure, which may account for previously observed cognitive impairments., ((c) 2006 American Cancer Society.)

A previous study reported abnormally large cavum septi pellucidi (CSP) in posttraumatic stress disorder (PTSD). We utilized magnetic resonance imaging to examine the frequency of large CSP, as defined by Nopoulos et al. (1997), in cancer survivors with and without intrusive recollections in a sample identical to that of our previous study. The frequency of large CSP did not differ between the two groups. The results suggest that alteration in midline structures during the course of neurodevelopment may lead to severe PTSD, while subthreshold PTSD, such as intrusive recollections, appear not to be associated with such alterations.

Goals of Work: Studies on fatigue in disease-free breast cancer patients have consistently found a significant association between fatigue and depression; and some characteristics of this fatigue may be confused with and/or concealed by those of depression. To clarify the characteristics of fatigue in disease-free breast cancer patients, we examined the frequency of fatigue and associated factors in disease-free breast cancer patients without major depression., Patients and Methods: Seventy-nine ambulatory breast cancer patients without major depression who had been disease-free for more than 3 years since their surgery completed the Cancer Fatigue Scale (CFS), a multidimensional scale assessing cancer-related fatigue. Participants also completed the Short-form Eysenck Personality Questionnaire-Revised (EPQR) for assessing their personalities. Sociodemographic, physical, and treatment-related factors were also obtained by interview., Main Results: We found that 36.7% of the patients exhibited fatigue and that fatigue was significantly associated with neuroticism., Conclusions: These results suggest that a considerable number of disease-free breast cancer patients without major depression experience fatigue and that careful attention to those exhibiting high neuroticism may be of benefit in ameliorating their fatigue.

We investigated the adverse effects of adjuvant chemotherapy on the hippocampus in Japanese breast cancer survivors with (n=44) and without (n=31) adjuvant chemotherapy. There were no significant differences in hippocampal volume (magnetic resonance imaging) or additionally in memory function (Wechsler Memory Scale-Revised) between the two groups.

The authors' aim was to identify the determinants of intrusive recollections related to receiving a cancer diagnosis in women after cancer treatment. A consecutive series of breast cancer patients at 3-15 months after surgery, consisting of subjects with (N=63) and without (N=92) intrusive recollections was examined. Logistic regression analysis revealed that neuroticism, precancer intrusive recollections, and the number of cancer patients in relatives by marriage were final significant determinants, and receiving radiotherapy was an associated factor. These results suggest that biopsychosocial factors contribute to intrusive recollections and have clinical implications for the use of these characteristics in screening and early intervention.

Objective: Patients experiencing their first major depressive episode after receiving a diagnosis of cancer are frequently seen in clinical oncology settings; however, little is known about the neurobiological basis of the first episode. In previous studies, a smaller hippocampus than in healthy comparison subjects has been observed in patients with a history of recurrent and prolonged major depressive episodes. The purpose of the present study was to investigate whether there is an association between hippocampal volume and a first major depressive episode after cancer diagnosis in cancer survivors., Method: The subjects were 68 female cancer survivors who had undergone breast cancer surgery 3 or more years earlier (mean interval=4.3 years, SD=0.9). The hippocampal volume and delayed recall function of the 17 cancer survivors who had their first major depressive episode after receiving their cancer diagnosis and the 51 with no history of major depressive episode at any time during their lives were measured by magnetic resonance imaging and the Wechsler Memory Scale-Revised, respectively., Results: The mean duration of the major depressive episode after cancer diagnosis was 11.9 weeks (SD=14.2). There were no significant differences in left or right hippocampal volume or in delayed recall function between the cancer survivors with and without a major depressive episode after cancer diagnosis., Conclusions: First major depressive episodes after cancer diagnosis in female cancer survivors do not appear to be associated with hippocampal volume. However, a longitudinal study with healthy comparison subjects is needed to draw a definite conclusion.

Background: Intrusive recollections, one of the re-experiencing symptoms of posttraumatic stress disorder (PTSD), frequently occur in cancer survivors rather than the full spectrum of the symptoms of PTSD. Functional neuroimaging studies of PTSD have revealed hyperresponsiveness to threat-related stimuli in the amygdala, but no volumetric studies have ever found alteration in the volume of the amygdala. The aim of the present study was to assess the possibility of structural alteration of the amygdala in cancer survivors with intrusive recollections., Methods: Magnetic resonance imaging volumetric analysis of the amygdala was performed in 35 breast cancer survivors with a history of cancer-related intrusive recollections and 41 control breast cancer survivors who had no such history. The groups were similar in age, height, handedness, alcohol consumption, and medical characteristics except for past major depressive disorder., Results: The total volume of the amygdala was significantly smaller in subjects with a history of intrusive recollections as compared with the control subjects. This finding continued to be significant after controlling for age, height, and major depressive disorder., Conclusions: These results suggest a difference in volume of the amygdala of cancer survivors according to whether they have had cancer-related intrusive recollections.

Objective: Having cancer is extremely stressful, and distressing cancer-related recollections are frequently reported by cancer survivors. Smaller hippocampal volume has been observed in stress-related neuropsychiatric disorders, such as posttraumatic stress disorder (PTSD) and major depression. The aim of this study was to determine whether there is a similar association between distressing cancer-related recollections and hippocampal volume., Method: The subjects were 67 women who had had breast cancer surgery 3 or more years earlier and had no history of PTSD or major depression before the cancer. Each woman was evaluated with a semistructured interview to determine whether she had a history of distressing cancer-related recollections. Hippocampal volume was measured by three-dimensional magnetic resonance imaging, and memory function was assessed by the Wechsler Memory Scale-Revised., Results: The volume of the left hippocampus was significantly smaller (5%) in the subjects with a history of distressing cancer-related recollections (N=28) than in those without any such history (N=39). There was no significant difference in right hippocampal volume or whole brain volume measured as a control. There were no significant differences in delayed memory or percentage retention. However, significantly worse immediate visual memory, but not verbal memory, was observed in the subjects with a history of distressing cancer-related recollections., Conclusions: Having distressing cancer-related recollections is associated with smaller left hippocampal volume in survivors of breast cancer.

Intrusive thoughts are one of the re-experiencing symptoms in posttraumatic stress disorder, and have been suggested as a predictor for the continuous presence of psychological distress in cancer survivors. The aim of this preliminary study was to examine the possibility of using cancer-related intrusive thoughts (CITs) as an indicator of psychological distress and adjustment after breast surgery. A consecutive series of ambulatory breast cancer survivors at 3 or more years after surgery were given the Structured Clinical Interview for DSM-IV (SCID) and self-report questionnaires, including Profile Of Mood States (POMS), Impact of Event Scale (IES) and Mental Adjustment to Cancer (MAC) scale, to measure psychological distress and/or adjustment. The SCID identified a history of CITs in 34 (46%) of the 74 participants. No significant differences were found in the POMS and IES psychological distress scores between subjects with and without a history of CITs. Subjects with a history of CITs showed significantly higher levels of anxious preoccupation, one of the MAC subscale scores. The association continued to be significant after controlling for potential confounders such as social support, depression, avoidance, arousal, and neuroticism. The results indicated that CITs might be useful for indicating poor psychological adjustment, but not distress, in patients at 3 or more years after breast surgery.