Category: Women’s Medicine

Long-term Use of Adjuvant Melatonin Decreases Fatigue in Women with Breast Cancer

In this randomized clinical trial, women with stage I-III breast cancer received either melatonin 18mg daily or placebo, starting 1 week prior to the initiation of adjuvant treatment, and continuing until 2 years post completion of adjuvant treatment. The Brief Fatigue Inventory (BFI) was used pre and post intervention to assess fatigue. 92 subjects completed the trial in the placebo group, and 91 in the melatonin group.

Baseline BFI scores were no different in the 2 groups. At the completion of the trial, melatonin group subjects had a significantly lower mean fatigue score compared to placebo subjects (2.93 ± 1.04 vs 1.99 ± 1.02, p <0.001, p ≤0.05). There was also a greater reduction in the fatigue score over time in the melatonin group (p ≤0.001). Melatonin was generally well tolerated, with 6 of 102 subjects initially enrolled in the melatonin group withdrawing due to nausea.

Citation:

Sedighi Pashaki A, Sheida F, Moaddab Shoar L, Hashem T, Fazilat-Panah D, Nemati Motehaver A, Ghanbari Motlagh A, Nikzad S, Bakhtiari M, Tapak L, Keshtpour Amlashi Z, Javadinia SA, Keshtpour Amlashi Z. A Randomized, Controlled, Parallel-Group, Trial on the Long-term Effects of Melatonin on Fatigue Associated With Breast Cancer and Its Adjuvant Treatments. Integr Cancer Ther. 2023 Jan-Dec;22:15347354231168624. doi: 10.1177/15347354231168624. PMID: 37139718; PMCID: PMC10161337.

Link:

Integrative Cancer Therapies

Pre-Diagnosis Selenium Level, Survival, and Tumor Characteristics in Women with Breast Cancer

This study utilized data from the Malmö Diet and Cancer Study, a population‐based cohort, including 17,035 women recruited from 1991 to 1996. Women with incident breast cancer (N=1066) were included (those with DCIS or bilateral breast cancer were excluded) and compared to controls without breast cancer from both matching (N=694) as well as randomization (N=492). Prediagnostic serum selenium levels were then compared, and risk of specific tumor characteristics or subtypes was determined. Breast cancer subjects were also followed for overall mortality and breast cancer-specific mortality.

While there was no association between serum selenium quartiles and tumor characteristics or subtypes, women in the highest compared to lowest selenium quartiles had lower overall mortality (HR 0.63, 95% CI: 0.44‐0.89) as well as breast cancer-specific mortality (HR 0.60, 95% CI: 0.37‐0.98).

This study adds to our knowledge about how selenium levels might affect breast cancer. Previous data (including a Cochrane systematic review) indicate that it is unlikely that serum selenium levels impact the overall risk of breast cancer, but that breast cancer mortality may be impacted by serum levels or by selenium intake. The protective effects of selenium may be limited to clinical outcomes in women with existing breast cancers, rather than to overall incidence. The benefit of baseline selenium level in this trial does not seem tied to specific subtypes or tumor characteristics.

Citation:

Sandsveden M, Nilsson E, Borgquist S, Rosendahl AH, Manjer J. Prediagnostic serum selenium levels in relation to breast cancer survival and tumor characteristics. Int J Cancer. 2020;147(9):2424-2436. doi:10.1002/ijc.33031

Link:

https://onlinelibrary.wiley.com/doi/10.1002/ijc.33031

48-Hour Water Fasting During Chemotherapy for Gynecologic Cancer

In this small randomized controlled trial (N= 20), women with gynecologic cancer (11 with ovarian, 8 with uterine, and 1 with cervical cancer) receiving at least 6 cycles of chemotherapy were randomized to either a fasting or non-fasting group. The fasting group maintained a water-only fast for 24 hours before through 24 hours after each chemotherapy cycle. Most participants (90%) were receiving platinum-taxane doublet, and most (80%) had stage 3 or 4 disease.

Analysis included data from 120 cycles of chemo. Hospitalization rates and weight loss were no different between the two groups. Mean QOL scores were not significantly different between the two groups. There were fewer dose reductions and treatment delays among women in the fasting group (8.3% among fasters compared to 13.3% in the control group).

Additionally, mean serum glucose (at cycle day 1) was significantly lower among fasters, and mean platelet counts remained significantly higher (p<0.0001 and p=0.009).

It was concluded that fasting was well tolerated, did not increase weight loss or hospitalizations, and resulted in fewer treatment modifications.

Citation:

Riedinger CJ, Kimball KJ, Kilgore LC, Bell CW, Heidel RE, Boone JD. Water only fasting and its effect on chemotherapy administration in gynecologic malignancies. Gynecol Oncol. 2020;159(3):799-803. doi:10.1016/j.ygyno.2020.09.008

Link:

https://www.gynecologiconcology-online.net/article/S0090-8258(20)33901-9/fulltext

Light at Night and Postmenopausal Breast Cancer Risk

This analysis examined an estimation of outdoor light at night (LAN) exposure from satellite imagery in association with postmenopausal breast cancer, utilizing data from the NIH-AARP Diet and Health Study. LAN was estimated at baseline from 1996, in 186,981 postmenopausal women. Over a 16 year follow up period, 12,318 cases of breast cancer were detected.

Comparing women in the lowest to highest quintile of baseline LAN, there was a 10% increase in the risk of postmenopausal breast cancer among women in the highest quintile of exposure (HR 1.10, p-trend=0.002). This association was stronger for ER+ breast cancer compared to ER(-) breast cancer (HR 1.12, p-trend=0.007).

The authors also found that important lifestyle factors, such as BMI, physical activity habits, hormone replacement therapy, smoking status, and alcohol consumption, along with environmental and social factors such as poverty rate, may interact with LAN to affect risk. For example, there were somewhat stronger associations for women who were current smokers, and also stronger associations for women consuming ≥ 1 alcohol drink daily. LAN may influence postmenopausal breast cancer risk via synergistic interactions with these factors, potentially via alteration of melatonin or estrogen pathways.

Citation:

Xiao Q, James P, Breheny P, et al. Outdoor light at night and postmenopausal breast cancer risk in the NIH-AARP diet and health study. Int J Cancer. 2020; 147(9):2363-2372. doi:10.1002/ijc.33016

Link:

https://onlinelibrary.wiley.com/doi/10.1002/ijc.33016

Melatonin reduces fatigue during adjuvant treatment in women with early stage or locally advanced breast cancer

In this double-blind randomized prospective trial, women with stage I-III breast cancer (n=74) were randomized to receive either melatonin at a dose of 18mg nightly, or a placebo, starting 1 week before and continuing through 4 weeks after adjuvant therapy (adjuvant treatment consisted of 16 weeks of dose dense AC-T and 5 weeks of radiation). Thirty-seven women were included in each group. Menopausal status was not given.

At the completion of the trial, fatigue was significantly lower in women who received melatonin (p<0.001) and the incidence of severe fatigue was also significantly lower, 42% in the melatonin group compared to 83% in the placebo group (p<0.001).

This study did not assess impact on sleep (or on other treatment-related side effects), so it is unclear if these effects may have been related to sleep quality itself or if they occur independent of that. Nonetheless, these results agree with previous studies (Palmer et al 2020, Semiglazova et al 2019) finding an impact of melatonin supplements on energy levels in women undergoing adjuvant or neoadjuvant breast cancer treatment.

Citation:

Sedighi Pashaki, A., Mohammadian, K., Afshar, S., Gholami, M. H., Moradi, A., Javadinia, S. A., & Keshtpour Amlashi, Z. (2021). A Randomized, Controlled, Parallel-Group, Trial on the Effects of Melatonin on Fatigue Associated with Breast Cancer and Its Adjuvant Treatments. Integrative cancer therapies, 20, 1534735420988343.

Link:

https://journals.sagepub.com/doi/10.1177/1534735420988343