U.S. Army Medical Research and Materiel Command

Point of Contact:
Chuck Dasey, (301) 619-7071
July 20, 2000

For Immediate Release:

Two Studies Elucidate "Quality of Life" Issues in Testing and Treatment for Breast Cancer
Research Results from "Era of Hope" Department of Defense Breast Cancer Research Program Meeting

ATLANTA, June 9, 2000 - At today's "Era of Hope" Department of Defense Breast Cancer Research Program meeting, researchers examine the impact of both external (spousal support) and internal (body rhythms) factors to distress, fatigue and depression - debilitating conditions that compound the daily challenges of breast cancer.

Research Identifies Marital Issues that Affect Stress during Genetic Testing

A new study shows that spousal reactions contribute importantly to distress levels of participants in genetic testing programs for breast cancer-related defects.

Using a battery of standard and study-specific psychological surveys, researchers are assessing distress and anxiety, marital quality, and spousal supportiveness among testing participants and their partners at four time periods: at baseline (before participants receive genetic counseling), and at one month, six months, and one year after couples know the test results.

"Once we have the final data, we expect that they will help to identify genetic testing participants and spouses who may be at risk for adverse psychological reactions during the testing process," said Sharon Manne, Ph.D., member of the Population Science Division at Fox Chase Cancer Center in Philadelphia, PA. "Ultimately, these findings may lead to the development of interventions to help participants and spouses adjust to test results."

To date, baseline evaluations are available for 143 wives and 117 husbands involved in the genetic testing program at Georgetown University Medical Center in Washington, DC. Dr. Manne is collaborating with Janet Audrain, Ph.D., and Caryn Lerman, Ph.D., of Georgetown. Enrollment in the study will continue for six months. At the "Era of Hope" meeting, Dr. Manne will present data for participants who have completed surveys through the six-month follow up. This research initiative was funded with a Department of Defense Breast Cancer Research Program "IDEA" grant, an award category designed to support novel, untested and high-risk ideas, as well as the participation of young, promising scientists.

Preliminary study data indicate that husbands can substantially influence their wife's anxiety, lowering distress with supportive behavior and heightening it with unsupportive responses. "Supportive spouses listen to their wife's concerns about the testing process, discuss the subject freely, and convey encouragement consistently. Unsupportive spouses exhibit subtle signs of discomfort, such as changing the subject when their wife expresses concerns," Dr. Manne explained.

According to preliminary data, spousal responses tend to track with the outcome of the genetic test. Women who learn that they do not have a BRCA mutation report a subsequent drop in their husband's unsupportive behavior. Women who have positive or ambiguous results (family anomalies not yet clearly identified with breast cancer), however, report no decline in unsupportive spousal reactions.

Individuals undergo testing for BRCA 1 and 2 - the two mutations known to be associated with inherited risk of breast cancer - because they have a family history of the disease. Some have already been treated for breast cancer and want to clarify their children's risk; others use test results to make decisions about self-monitoring and childbearing. Although earlier research has explored the psychological impact of genetic testing on participants, no studies have examined the impact on spouses or the contribution of marital quality to participants' distress.

Circadian Rhythms Linked to Fatigue in Breast Cancer Patients

Disruption of the "body clock" may contribute to fatigue and depression in women undergoing chemotherapy for breast cancer, researchers reported today.

"These findings suggest that possible interventions such as treatments for sleep disturbances could substantially improve quality of life for many breast cancer patients," said Gary Morrow, Ph.D., University of Rochester Cancer Center, Rochester, NY.

In this study, the researchers found that patients with more regular circadian rhythms reported less fatigue and depression. Patients with the most irregular patterns of sleep and activity - a sign of circadian rhythm disruption - reported the most fatigue and depression.

Seventy-six patients wore motion monitors on their wrists, electronic devices the size of a wristwatch, for 72 hours. The monitors (widely used in sleep research) recorded the patients' wrist movements minute by minute. Computer analysis converted the wrist-movement data into a measurement of circadian rhythms. Patients also completed questionnaires that assessed fatigue and depression.

According to Dr. Morrow, the study results support further research on circadian rhythm disruption in cancer patients and suggest that treatments for sleep disturbance may be helpful for cancer patients suffering from fatigue.

During chemotherapy, up to 80% of breast cancer patients experience fatigue and as many as one-third experience depression. Treatment-related fatigue frequently is not relieved by rest, and in approximately a third of women, can persist for years after completion of chemotherapy. Medications to boost the blood count and regulate hormonal imbalances can help relieve fatigue in some breast cancer patients, but in many cases, doctors can offer no adequate remedy for patients' fatigue.

"Era of Hope" is a forum for the presentation of research supported by the U.S. Department of Defense's Breast Cancer Research Program (BCRP), an unprecedented partnership between the military, scientists, clinicians, and breast cancer survivors. Since 1992, the BCRP has been working to prevent and cure breast cancer by fostering new directions in research, addressing underserved populations and issues, encouraging the work of new and young scientists and inviting the voice of breast cancer survivors to be heard in all aspects of the program. One of 53 congressional research programs managed by the U.S. Army Medical Research and Materiel Command, the BCRP has received more than $1 billion to date from Congress for innovative breast cancer research.

"Spousal Impact of BRCA 1 / 2 Testing"
Sharon Manne, Janet Audrain, Caryn Lerman

• General Session: Friday, June 9, 3:30 p.m. - 5:00 p.m., Grand Salon D
• Poster Session: Friday, June 9, 6:30 p.m. - 8:00 p.m., Galleria, Posterboard H-1

"Preventing Fatigue in Women with Breast Cancer Treated with Chemotherapy"
Gary R. Morrow

• Poster Session: Sunday, June 11, 6:20 p.m. - 8:00 p.m., Galleria, Posterboard EE-10