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Effect of moderate running training and Mindfulness-based Stress Reduction (MBSR) on immune system and quality of life in women with breast cancer receiving aromatase inhibitors

Johannes F Mattes

Department of Oncology, VAMED Rehaklinik Ahrenshoop GmbH, Germany

DOI: 10.15761/JCA.1000105

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Introduction and summary

Women with breast cancer receiving aromatase inhibitors often cannot resume normal life because their quality of life is affected severely from side effects.

At the moment these physical side effects of aromatase inhibitors cannot be avoided effectively so that a stress reduction by undergoing a mindfulness-based stress (MBSR) reduction training seems to be a chance to enhance the quality of life for affected women.

In this context our randomized control trial examines the hypothesis, whether an MBSR training of 8 weeks improves quality of life for women of the MBSR group (MBSR group n=10). By contrast women of the control group (n=15) take part in Nordic walking once per week.

Surprisingly, results reveal that women of the MBSR group noticed an increase of breast pain located in their breast affected by cancer and also an increase of insomnia. The cortisol level in the afternoon had fallen slightly at the end of 8 weeks in participants of the control group and had risen in participants of the MBSR group.

However, as a long-term effect the cognitive functioning in the MBSR group was improved after 16 weeks.

Methods

Participants of the MBSR group (intervention group, limited to N=10) and control group with Nordic walking training were randomized. All women had breast cancer, were aged 50-79, had hormon-rezeptive tumors, and a tumor stage UICC I-III [1].

The period of training was 8 weeks for both groups. Three measurements were taken in each group:

  • t1: before the beginning of 8 weeks training
  • t2: 8 weeks after the beginning of training (at the end of training)
  • t3: 16 weeks after the beginning of training (8 weeks after training)

Primary endpoint (measuring time points t1 and t2) were the physiological parameters of serum cortisol and serum prolactin. Secondary endpoint was the quality of life at the measuring time points t2 and t3 according to the inventary of EORTC-questionnaire (Figure 1)

Figure 1. Consort Flow Chart

  • EORTC QLQ-C30 Version 3.0 and
  • EORTC QLQ-BR23

Statistical methods

Considering the small sample, we focused the effect size to get valuable information to clinical effects despite not having significance.

We did an analysis of covariance (ANCOVA) with timepoint t1 (= beginning of the intervention) as covariate.

The effect size ƞ2 was calculated related to the effect of the factor “group”. For interpretation of the effect size we used Table 1 [1].

Table 1. Interpretation of effect size

 

small

moderate

large

r

< 0.3

0.3 – 0.5

> 0.5

   d

< 0.5

0.5 – 0.8

< 0-8

  ƞ²

0.06

0.06 – 0.14

> 0.14

Results

Results of the physiological parameters

Analysis of covariance: Timepoints t1 and t2: Participants of the MBSR group had a small increase of postprandial cortisol at 2 p.m., whereas participants of the Nordic walking group had a small decrease of postprandial cortisol at 2 p.m. (ƞ2=0,162, Table 2).

Table 2. Physiological parameters.

Parameters

Mean values (and SD)

t1

MBSR

t2

MBSR

t1

Nordic

walking

t2

Nordic

walking

 

ANCOVA (t1 = covariate)

 

effect size*

Cortisol

at 2 pm  

 (SD)

304,2

(109,309)

 

318

(102,177)

279,867

(151,394)

228,533

(100,904)

F=4,252 df=1    p = 0,051 (group)

 ƞ²=0,162

Prolaktin

at 2 pm

 (SD)

8,659

(1,773)

9,386

(2,1)

8,549

(2,643)

9,996

(4,078)

F=0,262 df=1    p = 0,614 (group)

ƞ²=0,012

*effect size related to the effect of the factor “group“

[cortisol standard value in serum: 138 – 690 nmol/l; prolactin standard value in serum: 4,79 – 23.3 µg/l]

Results of the EORTC-Questionnaires

Analysis of covariance timepoints t1 (beginning of intervention) and t2 = 8 weeks (end of intervention/training). Participants of the MBSR group reported an increase of breast pain, Table 3 (p = 0,042; ƞ2=0,175) and an increase of isomnia (ƞ2=0,113, Table 3), which disappeared 8 weeks after the end of MBSR training.

Table 3. Analysis of covariance: timepoints t1 and t2=8 weeks.

Parameters

Mean values (and SD)

t1

MBSR

t2

MBSR

t1

Nordic walking

t2

Nordic walking

 

ANCOVA (t1 = covariate)

 

effect size*

Quality of Life (SD)

53,33

(16,29)

61,67

(18,92)

65,00

(21,41)

64,44

(21,47)

F=1,100 df=1 (group)

  p = 0,306

Ƞ2=0,048

Physical

Functioning (SD)

71,33

(12,98)

74,00

(13,86)

80,44

(21,30)

81,33

(18,89)

F=0,004 df=1 (group)

  p = 0,951

Ƞ2=0,001

Role

Functioning (SD)

61,67

(17,66)

61,67

(24,91)

67,78

(34,20)

71,11

(26.33)

F=0,624 df=1 (group)

  p = 0,438

Ƞ2=0,028

Emotional

Functioning (SD)

55,83

(26,95)

61,67

(24,91)

58,89

(31,88)

70,56

(26,14)

F=1,383 df=1 (group)

  p = 0,252

Ƞ2=0,059

Cognitive

Functioning

(SD)

70,00

(30,23)

71,67

(26,12)

71,11

(31,16)

70,00

(32,85)

F=0,179 df=1 (group)

  p = 0,677

Ƞ2=0,008

Social

Functioning (SD)

60,00

(43,18)

71,67

(27,27)

64,44

(36,11)

70,00

(34,62)

F=0,216 df=1 (group)

  p = 0,646

Ƞ2=0,010

Fatigue

48,89

(29,26)

46,67

(27,12)

38,52

(28,75)

36,30

(29,83)

F=0,058 df=1 (group)

  p = 0,811

Ƞ2=0,003

Nausea and

Vomiting (SD)

 

 

5,56

(17,44)

3,33

(12,91)

F=0,381 df=1 (group)

  p = 0,544

Ƞ2=0,017

Pain (SD)

38,33

(24,91)

45,00

(30,48)

36,67

(32,24)

38,89

(27,94)

F=0,308 df=1 (group)

  p = 0,585

Ƞ2=0,014

Dyspnoea (SD)

23,33

(22,50)

20,00

(28,11)

33,33

(37,80)

28,89

(27,79)

F=0,090 df=1 (group)

  p = 0,768

Ƞ2=0,004

Insomnia (SD)

56,67

(38,65)

 

60,00

(37,84)

57,78

(36,66)

44,44

(39,17)

F=2,792 df=1 (group)

  p = 0,109

Ƞ2=0,113

Appetite loss (SD)

20,00

(35,83)

16,67

(36,00)

11,11

(24,12)

6,67

(18,69)

F=0,262 df=1 (group)

  p = 0,614

Ƞ2=0,012

Constipation (SD)

13,33

(32,20)

20,00

(35,83)

22,22

(27,22)

17,78

(24,77)

F=1,113 df=1 (group)

  p = 0,303

Ƞ2=0,048

Diarrhoea (SD)

3,33

(10,54)

3,33

(10,54)

6,67

(18,69)

0,00

(0,00)

F=2,391 df=1 (group)

  p = 0,136

Ƞ2=0,098

Financial

Diffuculties

(SD)

30,00

(42,89)

20,00

(32,20)

26,67

(38,21)

(24,44

(38,76)

F=1,502 df=1 (group)

  p = 0,233

Ƞ2=0,064

Body Image (SD)

52,50

(35,15)

59,17

(35,67)

62,78

(36,31)

66,11

(37,86)

F=0,078 df=1 (group)

  p = 0,782

Ƞ2=0,004

Sexual

Functioning (SD)

77,08

(30,78)

78,57

(31,50)

72,22

(33,73)

76,19

(25,08)

F=0,285 df=1 (group)

  p = 0,600

Ƞ2=0,016

Sexual

Enjoyment (SD)

66,67

(47,14)

66,67

(47,14)

50,00

(43,03)

66,67

(27,22)

 not possible to evaluate

 

 

Future

Perspective (SD)

50,00

(28,33)

53,33

(32,20)

46,67

(41,40)

35,56

(36,66)

F=2,427 df=1 (group)

  p = 0,134

Ƞ2=0,099

Systemic

Therapy

Side Effects (SD)

34,76

(19,83)

29,96

(22,07)

27,94

(14,94)

26,03

(17,90)

F=1,043 df=1 (group)

  p = 0,318

Ƞ2=0,045

Breast

Symptoms

(SD)

15,83

(19,02)

25,00

(19,25)

25,00

(21,13)

22,22

(21,52)

F=4,663 df=1 (group)

  p = 0,042

Ƞ2=0,175

Arm Symptoms

(SD)

33,33

(29,63)

35,56

(30,45)

37,04

(27,11)

31,48

(21,99)

F=1,610 df=1 (group)

  p = 0,218

Ƞ2=0,068

Upset by Hair

loss (SD)

67,67

 

22,22

(38,49)

61,11

(38,97)

41,67

(42,72)

F=1,812 df=1 (group)

  p = 0,236

Ƞ2=0,266

*effect size related to the effect of the factor “group“

Analysis of covariance timepoints t1 (beginning of intervention) und t3 = 16 weeks (= 8 weeks after finishing intervention). Participants of the MBSR group had an increase of cognitive functioning (ƞ2=0,131, Table 4).

Table 4. Analysis of covariance: timepoints t1 and t3=16 weeks.

Parameters

Mean values  (and SD)

t1

MBSR

t3

MBSR

t1

Nordic

walking

t3

Nordic

walking

 

ANCOVA (t1 = covariate)

 

effect size*

Quality of Life (SD)

53,3

(16,3)

56,7

(26,6)

65,0

(21,4)

65,6

(20,9)

F=0,010 df=1

   p = 0,919 (group)

Ƞ2=0,001

Physical

Functioning (SD)

71,3

(13,0)

77,3

(15,8)

80,4

(21,3)

80,9

(18,7)

F=0,276 df=1

   p = 0,610 (group)

Ƞ2=0,012

Role

Functioning (SD)

61,7

(17,7)

60,0

(29,6)

67,8

(34,2)

73,3

(24,2)

F=1,324 df=1

   p = 0,262 (group)

Ƞ2=0,057

Emotional

Functioning (SD)

55,8

(26,9)

54,2

(26,7)

58,9

(31,9)

63,9

(32,5)

F=0,864 df=1

   p = 0,363 (group)

Ƞ2=0,038

Cognitive

Functioning (SD)

70,0

(30,2)

78,3

(23,6)

71,1

(31,2)

65,6

(34,2)

F=3,322 df=1

   p = 0,082 (group)

Ƞ2=0,131

Social

Functioning (SD)

60,0

(43,2)

65,0

(32,8)

64,4

(36,1)

70,0

(36,3)

F=0,043 df=1

   p = 0,838 (group)

Ƞ2=0,002

Fatigue (SD)

48,9

(29,3)

47,8

(28,2)

38,5

(28,8)

34,8

(27,8)

F=0,552 df=1

   p = 0,465 (group)

Ƞ2=0,024

Nausea and

Vomiting (SD)

,0

(,0)

3,3

(10,5)

5,6

(17,4)

3,3

(9,3)

F=0,073 df=1

   p = 0,790 (group)

Ƞ2=0,003

Pain (SD)

38,3

(24,9)

41,7

(28,6)

36,7

(32,2)

40,0

(31,4)

F=0,003 df=1

   p = 0,954 (group)

Ƞ2=0,001

Dyspnoea (SD)

23,3

(22,5)

23,3

(27,4)

33,3

(37,8)

26,7

(33,8)

F=0,206 df=1

   p = 0,654 (group)

Ƞ2=0,009

Insomnia (SD)

56,7

(38,7)

56,7

(41,7)

57,8

(36,7)

48,9

(39,6)

F=0,861 df=1

   p = 0,363 (group)

Ƞ2=0,038

Appetite loss (SD)

20,0

(35,8)

23,3

(41,7)

11,1

(24,1)

4,4

(11,7)

F=2,323 df=1

   p = 0,142 (group)

Ƞ2=0,096

Constipation (SD)

13,3

(32,2)

23,3

(31,6)

22,2

(27,2)

15,6

(21,3)

F=1,733 df=1

   p = 0,202 (group)

Ƞ2=0,073

Diarrhoea (SD)

3,3

(10,5)

10 (22,5)

6,7

(18,7)

2,2

(8,6)

F=1,939 df=1

   p = 0,178 (group)

Ƞ2=0,081

Financial

Diffuculties (SD)

30,0

(42,9)

30,0

(36,7)

26,7

(38,2)

28,6

(38,9)

F=0,702 df=1

   p = 0,412 (group)

Ƞ2=0,032

Body Image (SD)

52,5

(35,1)

53,9

(32,3)

62,8

(36,3)

66,7

(36,2)

F=0,301 df=1

   p = 0,589 (group)

Ƞ2=0,013

Sexual

Functioning (SD)

77,1

(30,8)

77,1

(19,8)

72,2

(33,7)

81,0

(24,3)

F=1,341 df=1

   p = 0,262 (group)

Ƞ2=0,069

Sexual

Enjoyment (SD)

66,7

(47,1)

44,4

(19,2)

50,0

(43,0)

50,0

(43,0)

F=2,400 df=1

   p = 0,261 (group)

2=0,545 )

Future

Perspective (SD)

50,0

(28,3)

56,7

(31,6)

46,7

(41,4)

48,9

(39,6)

F=0,373 df=1

   p = 0,548 (group)

Ƞ2=0,017

Systemic Therapy

Side Effects (SD)

34,8

(19,8)

33,3

(19,0)

27,9

(14,9)

27,0

(19,3)

F=0,015 df=1

   p = 0,904 (group)

Ƞ2=0,001

Breast Symptoms (SD)

15,8

(19,0)

21,7

(22,3)

25,0

(21,1)

28,9

(24,6)

F=0,005 df=1

   p = 0,942 (group)

Ƞ2=0,001

Arm Symptoms

(SD)

33,3

(29,6)

30,0

(29,7)

37,0

(27,1)

41,5

(25,7)

F=1,494 df=1

   p = 0,234 (group)

Ƞ2=0,064

Upset by Hair loss (SD)

66,7

(,0)

33,3

(,0)

61,1

(39,0)

53,3

(47,7)

F=1,143 df=1 p = 0,397 (group)

2=0,364)

* effect size related to the effect of the factor „group“

Discussion

The quality of life was not improved for participants of both groups as a short-time effect after 8 weeks of training, thus Nordic walking or MBSR training were both equally ineffective to improve quality of life.

The striking result for MBSR training was the increased sensitization for unpleasant body sensations in breasts. Accordingly, most participants of the MBSR group did not answer the EORTC-questionnaire as to questions concerning sexual enjoyment and only one participant could report to have still pleasant sexual experiences.

This result of a disturbed acceptance of parts of the body could be an effect of the attention and self-reflection which is induced by MBSR training. Women might have located unconsciously their fear of breast cancer in their body experience. Therefore, we propose individual psychotherapy to develop confidence in their own body sensations after cancer treatment.

Further studies are necessary because of the small sample in this study.

References

Mattes J (2017) Awareness Culture and Health: A Prospective, Randomized and Controlled Study of Spiritual Practice in Breast Cancer Patients. Marburg, Tectum Verlag, ISBN 978-3-8288-3907-6.

Editorial Information

Editor-in-Chief

J A Z Jankowski
University Morecambe Bay Hospitals Trust

Article Type

Case Report

Publication history

Received date: July 01, 2019
Accepted date: July 09, 2019
Published date: July 12, 2019

Copyright

©2019 Mattes JF. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Mattes JF (2019) Effect of moderate running training and Mindfulness-based Stress Reduction (MBSR) on immune system and quality of life in women with breast cancer receiving aromatase inhibitors. Cancer Arch 1: DOI: 10.15761/JCA.1000105

Corresponding author

Johannes F Mattes

Department of Oncology, VAMED Rehaklinik Ahrenshoop GmbH, Dorfstrasse 55, 18347 Ostseebad Ahrenshoop, Germany

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Figure 1. Consort Flow Chart

Table 1. Interpretation of effect size

 

small

moderate

large

r

< 0.3

0.3 – 0.5

> 0.5

   d

< 0.5

0.5 – 0.8

< 0-8

  ƞ²

0.06

0.06 – 0.14

> 0.14

Table 2. Physiological parameters.

Parameters

Mean values (and SD)

t1

MBSR

t2

MBSR

t1

Nordic

walking

t2

Nordic

walking

 

ANCOVA (t1 = covariate)

 

effect size*

Cortisol

at 2 pm  

 (SD)

304,2

(109,309)

 

318

(102,177)

279,867

(151,394)

228,533

(100,904)

F=4,252 df=1    p = 0,051 (group)

 ƞ²=0,162

Prolaktin

at 2 pm

 (SD)

8,659

(1,773)

9,386

(2,1)

8,549

(2,643)

9,996

(4,078)

F=0,262 df=1    p = 0,614 (group)

ƞ²=0,012

*effect size related to the effect of the factor “group“

[cortisol standard value in serum: 138 – 690 nmol/l; prolactin standard value in serum: 4,79 – 23.3 µg/l]

Table 3. Analysis of covariance: timepoints t1 and t2=8 weeks.

Parameters

Mean values (and SD)

t1

MBSR

t2

MBSR

t1

Nordic walking

t2

Nordic walking

 

ANCOVA (t1 = covariate)

 

effect size*

Quality of Life (SD)

53,33

(16,29)

61,67

(18,92)

65,00

(21,41)

64,44

(21,47)

F=1,100 df=1 (group)

  p = 0,306

Ƞ2=0,048

Physical

Functioning (SD)

71,33

(12,98)

74,00

(13,86)

80,44

(21,30)

81,33

(18,89)

F=0,004 df=1 (group)

  p = 0,951

Ƞ2=0,001

Role

Functioning (SD)

61,67

(17,66)

61,67

(24,91)

67,78

(34,20)

71,11

(26.33)

F=0,624 df=1 (group)

  p = 0,438

Ƞ2=0,028

Emotional

Functioning (SD)

55,83

(26,95)

61,67

(24,91)

58,89

(31,88)

70,56

(26,14)

F=1,383 df=1 (group)

  p = 0,252

Ƞ2=0,059

Cognitive

Functioning

(SD)

70,00

(30,23)

71,67

(26,12)

71,11

(31,16)

70,00

(32,85)

F=0,179 df=1 (group)

  p = 0,677

Ƞ2=0,008

Social

Functioning (SD)

60,00

(43,18)

71,67

(27,27)

64,44

(36,11)

70,00

(34,62)

F=0,216 df=1 (group)

  p = 0,646

Ƞ2=0,010

Fatigue

48,89

(29,26)

46,67

(27,12)

38,52

(28,75)

36,30

(29,83)

F=0,058 df=1 (group)

  p = 0,811

Ƞ2=0,003

Nausea and

Vomiting (SD)

 

 

5,56

(17,44)

3,33

(12,91)

F=0,381 df=1 (group)

  p = 0,544

Ƞ2=0,017

Pain (SD)

38,33

(24,91)

45,00

(30,48)

36,67

(32,24)

38,89

(27,94)

F=0,308 df=1 (group)

  p = 0,585

Ƞ2=0,014

Dyspnoea (SD)

23,33

(22,50)

20,00

(28,11)

33,33

(37,80)

28,89

(27,79)

F=0,090 df=1 (group)

  p = 0,768

Ƞ2=0,004

Insomnia (SD)

56,67

(38,65)

 

60,00

(37,84)

57,78

(36,66)

44,44

(39,17)

F=2,792 df=1 (group)

  p = 0,109

Ƞ2=0,113

Appetite loss (SD)

20,00

(35,83)

16,67

(36,00)

11,11

(24,12)

6,67

(18,69)

F=0,262 df=1 (group)

  p = 0,614

Ƞ2=0,012

Constipation (SD)

13,33

(32,20)

20,00

(35,83)

22,22

(27,22)

17,78

(24,77)

F=1,113 df=1 (group)

  p = 0,303

Ƞ2=0,048

Diarrhoea (SD)

3,33

(10,54)

3,33

(10,54)

6,67

(18,69)

0,00

(0,00)

F=2,391 df=1 (group)

  p = 0,136

Ƞ2=0,098

Financial

Diffuculties

(SD)

30,00

(42,89)

20,00

(32,20)

26,67

(38,21)

(24,44

(38,76)

F=1,502 df=1 (group)

  p = 0,233

Ƞ2=0,064

Body Image (SD)

52,50

(35,15)

59,17

(35,67)

62,78

(36,31)

66,11

(37,86)

F=0,078 df=1 (group)

  p = 0,782

Ƞ2=0,004

Sexual

Functioning (SD)

77,08

(30,78)

78,57

(31,50)

72,22

(33,73)

76,19

(25,08)

F=0,285 df=1 (group)

  p = 0,600

Ƞ2=0,016

Sexual

Enjoyment (SD)

66,67

(47,14)

66,67

(47,14)

50,00

(43,03)

66,67

(27,22)

 not possible to evaluate

 

 

Future

Perspective (SD)

50,00

(28,33)

53,33

(32,20)

46,67

(41,40)

35,56

(36,66)

F=2,427 df=1 (group)

  p = 0,134

Ƞ2=0,099

Systemic

Therapy

Side Effects (SD)

34,76

(19,83)

29,96

(22,07)

27,94

(14,94)

26,03

(17,90)

F=1,043 df=1 (group)

  p = 0,318

Ƞ2=0,045

Breast

Symptoms

(SD)

15,83

(19,02)

25,00

(19,25)

25,00

(21,13)

22,22

(21,52)

F=4,663 df=1 (group)

  p = 0,042

Ƞ2=0,175

Arm Symptoms

(SD)

33,33

(29,63)

35,56

(30,45)

37,04

(27,11)

31,48

(21,99)

F=1,610 df=1 (group)

  p = 0,218

Ƞ2=0,068

Upset by Hair

loss (SD)

67,67

 

22,22

(38,49)

61,11

(38,97)

41,67

(42,72)

F=1,812 df=1 (group)

  p = 0,236

Ƞ2=0,266

*effect size related to the effect of the factor “group“

Table 4. Analysis of covariance: timepoints t1 and t3=16 weeks.

Parameters

Mean values  (and SD)

t1

MBSR

t3

MBSR

t1

Nordic

walking

t3

Nordic

walking

 

ANCOVA (t1 = covariate)

 

effect size*

Quality of Life (SD)

53,3

(16,3)

56,7

(26,6)

65,0

(21,4)

65,6

(20,9)

F=0,010 df=1

   p = 0,919 (group)

Ƞ2=0,001

Physical

Functioning (SD)

71,3

(13,0)

77,3

(15,8)

80,4

(21,3)

80,9

(18,7)

F=0,276 df=1

   p = 0,610 (group)

Ƞ2=0,012

Role

Functioning (SD)

61,7

(17,7)

60,0

(29,6)

67,8

(34,2)

73,3

(24,2)

F=1,324 df=1

   p = 0,262 (group)

Ƞ2=0,057

Emotional

Functioning (SD)

55,8

(26,9)

54,2

(26,7)

58,9

(31,9)

63,9

(32,5)

F=0,864 df=1

   p = 0,363 (group)

Ƞ2=0,038

Cognitive

Functioning (SD)

70,0

(30,2)

78,3

(23,6)

71,1

(31,2)

65,6

(34,2)

F=3,322 df=1

   p = 0,082 (group)

Ƞ2=0,131

Social

Functioning (SD)

60,0

(43,2)

65,0

(32,8)

64,4

(36,1)

70,0

(36,3)

F=0,043 df=1

   p = 0,838 (group)

Ƞ2=0,002

Fatigue (SD)

48,9

(29,3)

47,8

(28,2)

38,5

(28,8)

34,8

(27,8)

F=0,552 df=1

   p = 0,465 (group)

Ƞ2=0,024

Nausea and

Vomiting (SD)

,0

(,0)

3,3

(10,5)

5,6

(17,4)

3,3

(9,3)

F=0,073 df=1

   p = 0,790 (group)

Ƞ2=0,003

Pain (SD)

38,3

(24,9)

41,7

(28,6)

36,7

(32,2)

40,0

(31,4)

F=0,003 df=1

   p = 0,954 (group)

Ƞ2=0,001

Dyspnoea (SD)

23,3

(22,5)

23,3

(27,4)

33,3

(37,8)

26,7

(33,8)

F=0,206 df=1

   p = 0,654 (group)

Ƞ2=0,009

Insomnia (SD)

56,7

(38,7)

56,7

(41,7)

57,8

(36,7)

48,9

(39,6)

F=0,861 df=1

   p = 0,363 (group)

Ƞ2=0,038

Appetite loss (SD)

20,0

(35,8)

23,3

(41,7)

11,1

(24,1)

4,4

(11,7)

F=2,323 df=1

   p = 0,142 (group)

Ƞ2=0,096

Constipation (SD)

13,3

(32,2)

23,3

(31,6)

22,2

(27,2)

15,6

(21,3)

F=1,733 df=1

   p = 0,202 (group)

Ƞ2=0,073

Diarrhoea (SD)

3,3

(10,5)

10 (22,5)

6,7

(18,7)

2,2

(8,6)

F=1,939 df=1

   p = 0,178 (group)

Ƞ2=0,081

Financial

Diffuculties (SD)

30,0

(42,9)

30,0

(36,7)

26,7

(38,2)

28,6

(38,9)

F=0,702 df=1

   p = 0,412 (group)

Ƞ2=0,032

Body Image (SD)

52,5

(35,1)

53,9

(32,3)

62,8

(36,3)

66,7

(36,2)

F=0,301 df=1

   p = 0,589 (group)

Ƞ2=0,013

Sexual

Functioning (SD)

77,1

(30,8)

77,1

(19,8)

72,2

(33,7)

81,0

(24,3)

F=1,341 df=1

   p = 0,262 (group)

Ƞ2=0,069

Sexual

Enjoyment (SD)

66,7

(47,1)

44,4

(19,2)

50,0

(43,0)

50,0

(43,0)

F=2,400 df=1

   p = 0,261 (group)

2=0,545 )

Future

Perspective (SD)

50,0

(28,3)

56,7

(31,6)

46,7

(41,4)

48,9

(39,6)

F=0,373 df=1

   p = 0,548 (group)

Ƞ2=0,017

Systemic Therapy

Side Effects (SD)

34,8

(19,8)

33,3

(19,0)

27,9

(14,9)

27,0

(19,3)

F=0,015 df=1

   p = 0,904 (group)

Ƞ2=0,001

Breast Symptoms (SD)

15,8

(19,0)

21,7

(22,3)

25,0

(21,1)

28,9

(24,6)

F=0,005 df=1

   p = 0,942 (group)

Ƞ2=0,001

Arm Symptoms

(SD)

33,3

(29,6)

30,0

(29,7)

37,0

(27,1)

41,5

(25,7)

F=1,494 df=1

   p = 0,234 (group)

Ƞ2=0,064

Upset by Hair loss (SD)

66,7

(,0)

33,3

(,0)

61,1

(39,0)

53,3

(47,7)

F=1,143 df=1 p = 0,397 (group)

2=0,364)

* effect size related to the effect of the factor „group“