2024
Real‐world treatment patterns of adjuvant endocrine therapy and ovarian suppression in premenopausal HR+/HER2+ breast cancer
Sukumar J, Sardesai S, Ni A, Williams N, Johnson K, Quiroga D, Ramaswamy B, Wesolowski R, Cherian M, Stover D, Gatti‐Mays M, Pariser A, Sudheendra P, George M, Lustberg M. Real‐world treatment patterns of adjuvant endocrine therapy and ovarian suppression in premenopausal HR+/HER2+ breast cancer. Cancer Medicine 2024, 13: e7317. PMID: 38895891, PMCID: PMC11185945, DOI: 10.1002/cam4.7317.Peer-Reviewed Original ResearchConceptsOvarian suppressionEndocrine therapyAdjuvant endocrine therapyBreast cancerClinicopathological featuresAromatase inhibitorsOS useHR+/HER2+ breast cancerOptimal adjuvant endocrine therapyHuman epidermal growth factor receptor 2Epidermal growth factor receptor 2Real-world treatment patternsCohort of premenopausal womenAnti-HER2 therapyPremenopausal breast cancerClinicopathological risk factorsMultivariable logistic regression assessed associationsLogistic regression assessed associationsPremenopausal BCPrescribed tamoxifenPremenopausal patientsPremenopausal womenBC subtypesContemporary cohortAnti-HER2An Open-Label Study of Subcutaneous CpG Oligodeoxynucleotide (PF03512676) in Combination with Trastuzumab in Patients with Metastatic HER2+ Breast Cancer
Quiroga D, Wesolowski R, Zelinskas S, Pinette A, Benner B, Schwarz E, Savardekar H, Johnson C, Stiff A, Yu L, Macrae E, Lustberg M, Mrozek E, Ramaswamy B, Carson W. An Open-Label Study of Subcutaneous CpG Oligodeoxynucleotide (PF03512676) in Combination with Trastuzumab in Patients with Metastatic HER2+ Breast Cancer. Cancer Control 2024, 31: 10732748241250189. PMID: 38797949, PMCID: PMC11129578, DOI: 10.1177/10732748241250189.Peer-Reviewed Original ResearchConceptsMetastatic HER2+ breast cancerHER2+ breast cancerStable diseaseBreast cancerCpG-ODNTrastuzumab treatmentTreated patientsHuman epidermal growth factor receptor 2 (HER2)-positiveToll-like receptor 9 agonistHER2-positive breast cancerWeek 2Immune profile changesPeripheral blood mononuclear cellsAdvanced/metastatic breast cancerVEGF-D levelsOpen-label phaseNK cell populationEfficacy of current treatmentsOpen-label studyAggressive breast cancerBlood mononuclear cellsCompared to baselineMedian PFSMetastatic HER2Monocytic MDSCs
2023
Patient perceptions of altering chemotherapy treatment due to peripheral neuropathy
Hertz D, Tofthagen C, Rossi E, Bernasconi D, Lim J, Carlson M, Sheffield K, Nekhlyudov L, Grech L, Von Ah D, Mayo S, Ruddy K, Chan A, Alberti P, Lustberg M, Tanay M. Patient perceptions of altering chemotherapy treatment due to peripheral neuropathy. Supportive Care In Cancer 2023, 32: 48. PMID: 38129602, DOI: 10.1007/s00520-023-08209-0.Peer-Reviewed Original ResearchConceptsChemotherapy-induced peripheral neuropathyNeurotoxic chemotherapy treatmentChemotherapy treatmentSymptom resolutionPeripheral neuropathySevere chemotherapy-induced peripheral neuropathyCommon reason participantsMethodsA cross-sectional online surveyBetter patient educationCross-sectional online surveyNeurotoxic chemotherapyCIPN symptomsMedian ageMost patientsTreating clinicianLong-term benefitsPatients' perceptionsPatient educationPractice guidelinesTreatment goalsClinicians' understandingTreatment efficacyConclusionsThis surveyPatientsSymptomsClinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study
Nagaraj G, Vinayak S, Khaki A, Sun T, Kuderer N, Aboulafia D, Acoba J, Awosika J, Bakouny Z, Balmaceda N, Bao T, Bashir B, Berg S, Bilen M, Bindal P, Blau S, Bodin B, Borno H, Castellano C, Choi H, Deeken J, Desai A, Edwin N, Feldman L, Flora D, Friese C, Galsky M, Gonzalez C, Grivas P, Gupta S, Haynam M, Heilman H, Hershman D, Hwang C, Jani C, Jhawar S, Joshi M, Kaklamani V, Klein E, Knox N, Koshkin V, Kulkarni A, Kwon D, Labaki C, Lammers P, Lathrop K, Lewis M, Li X, de Lima Lopes G, Lyman G, Makower D, Mansoor A, Markham M, Mashru S, McKay R, Messing I, Mico V, Nadkarni R, Namburi S, Nguyen R, Nonato T, O'Connor T, Panagiotou O, Park K, Patel J, Patel K, Peppercorn J, Polimera H, Puc M, Rao Y, Razavi P, Reid S, Riess J, Rivera D, Robson M, Rose S, Russ A, Schapira L, Shah P, Shanahan M, Shapiro L, Smits M, Stover D, Streckfuss M, Tachiki L, Thompson M, Tolaney S, Weissmann L, Wilson G, Wotman M, Wulff-Burchfield E, Mishra S, French B, Warner J, Lustberg M, Accordino M, Shah D. Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study. ELife 2023, 12: e82618. PMID: 37846664, PMCID: PMC10637772, DOI: 10.7554/elife.82618.Peer-Reviewed Original ResearchMeSH KeywordsBreast NeoplasmsCohort StudiesCOVID-19FemaleHumansMiddle AgedRetrospective StudiesSARS-CoV-2United StatesConceptsCOVID-19 severityWorse COVID-19 outcomesCOVID-19 outcomesBreast cancerCause mortalityCohort studyAcute respiratory syndrome coronavirus 2 infectionCOVID-19Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectionRegistry-based retrospective cohort studyHistory of BCIntensive care unit admissionNon-Hispanic white patientsSyndrome coronavirus 2 infectionWorse ECOG performance statusMultivariable ordinal logistic regression modelsCare unit admissionCoronavirus 2 infectionECOG performance statusRetrospective cohort studyPacific Islander patientsCoronavirus disease 2019American Cancer SocietyLogistic regression modelsResearch grant supportA troubled heart: Mood disorder history longitudinally predicts faster cardiopulmonary aging in breast cancer survivorship
Madison A, Filatov M, Andridge R, Haas G, Povoski S, Agnese D, Lustberg M, Reinbolt R, Wesolowski R, Williams N, Malarkey W, Kiecolt-Glaser J. A troubled heart: Mood disorder history longitudinally predicts faster cardiopulmonary aging in breast cancer survivorship. PLOS ONE 2023, 18: e0283849. PMID: 37000800, PMCID: PMC10065250, DOI: 10.1371/journal.pone.0283849.Peer-Reviewed Original ResearchConceptsBreast cancer survivorsMood disorder historyExercise stress testCancer survivorsCardiovascular diseaseDisorder historyDepressive symptomsTreatment typeEpidemiologic Studies Depression ScaleNon-cancer causesBreast cancer survivorshipStructured Clinical InterviewAdvanced cancer treatmentStress testCardiotoxic treatmentsAdjuvant treatmentCross-sectional relationshipAntidepressant useTrunk fatCVD developmentVisit 1Depression ScaleCancer survivorshipPhysical activityClinical Interview
2022
Treatment Sequencing Patterns and Associated Direct Medical Costs of Metastatic Breast Cancer Care in the United States, 2011 to 2021
Chehayeb R, Hood A, Wang X, Miksad R, Mougalian S, Lustberg M, Wang S, Greenup R, Pusztai L, Kunst N. Treatment Sequencing Patterns and Associated Direct Medical Costs of Metastatic Breast Cancer Care in the United States, 2011 to 2021. JAMA Network Open 2022, 5: e2244204. PMID: 36445704, PMCID: PMC9709649, DOI: 10.1001/jamanetworkopen.2022.44204.Peer-Reviewed Original ResearchConceptsMetastatic breast cancerErbB2-positive metastatic breast cancerHR-positive metastatic breast cancerLines of therapyMBC subtypesDrug costsBreast cancerMedical costsHuman epidermal growth factor receptor 2 receptor statusMBC treatmentERBB2-negative metastatic breast cancerAssociated direct medical costsEarly-stage breast cancerHormone receptorsFlatiron Health databaseMetastatic recurrence ratesDifferent drug regimensBreast cancer careData of patientsDirect medical costsNovel adjuvant therapySupportive care drugsOutcomes of interestCost-effectiveness analysisAdjuvant therapy
2021
Genomic features of rapid versus late relapse in triple negative breast cancer
Zhang Y, Asad S, Weber Z, Tallman D, Nock W, Wyse M, Bey JF, Dean KL, Adams EJ, Stockard S, Singh J, Winer EP, Lin NU, Jiang YZ, Ma D, Wang P, Shi L, Huang W, Shao ZM, Cherian M, Lustberg MB, Ramaswamy B, Sardesai S, VanDeusen J, Williams N, Wesolowski R, Obeng-Gyasi S, Sizemore GM, Sizemore ST, Verschraegen C, Stover DG. Genomic features of rapid versus late relapse in triple negative breast cancer. BMC Cancer 2021, 21: 568. PMID: 34006255, PMCID: PMC8130400, DOI: 10.1186/s12885-021-08320-7.Peer-Reviewed Original ResearchMeSH KeywordsAdultBiomarkers, TumorChemotherapy, AdjuvantDatasets as TopicDisease-Free SurvivalDNA Copy Number VariationsFemaleFollow-Up StudiesGene Expression ProfilingGene Expression Regulation, NeoplasticHumansLogistic ModelsMastectomyMiddle AgedModels, GeneticMutationNeoadjuvant TherapyNeoplasm Recurrence, LocalPrognosisRisk AssessmentTime FactorsTriple Negative Breast NeoplasmsConceptsLate relapseRapid relapseImmune signaturesBreast cancerAnti-tumor CD8 T cellsBackgroundTriple-negative breast cancerTriple-negative breast cancerCD8 T cellsTumor mutation burdenIndependent validation cohortNegative breast cancerFisher's exact testPearson's chi-squared testChi-squared testLogistic regression modelsLuminal signaturePrimary TNBCTNBC subsetImmune subsetsClinical featuresValidation cohortWhole-genome copy numberPrimary tumorM1 macrophagesT cellsAdverse Events and Perception of Benefit From Duloxetine for Treating Aromatase Inhibitor-Associated Arthralgias
Schnell PM, Lustberg MB, Henry NL. Adverse Events and Perception of Benefit From Duloxetine for Treating Aromatase Inhibitor-Associated Arthralgias. JNCI Cancer Spectrum 2021, 5: pkab018. PMID: 33842832, PMCID: PMC8023424, DOI: 10.1093/jncics/pkab018.Peer-Reviewed Original ResearchConceptsPatient-perceived benefitsAdverse eventsBrief Pain Inventory-Short FormAromatase Inhibitor–Associated ArthralgiaDuloxetine-treated patientsOriginal primary outcomeDouble-blind trialLow-grade toxicityEffect of duloxetineSubgroup of patientsAverage painComparable patientsAppropriate patientsPrimary outcomeMusculoskeletal symptomsBreast cancerPlaceboDuloxetineSide effectsFunctional assessmentPatientsSecondary analysisFavorable effectTreatmentPerceptions of benefitsDissemination of cancer survivorship care plans: who is being left out?
Timsina LR, Zarzaur B, Haggstrom DA, Jenkins PC, Lustberg M, Obeng-Gyasi S. Dissemination of cancer survivorship care plans: who is being left out? Supportive Care In Cancer 2021, 29: 4295-4302. PMID: 33415363, DOI: 10.1007/s00520-020-05915-x.Peer-Reviewed Original ResearchConceptsSurvivorship care plansCancer survivorsCare plansComprehensive survivorship care planCancer survivorship care plansLow educational achievementMultivariable logistic regressionSelf-reported receiptQuality of careAssociation of SDOHYounger patientsSurgeons CommissionCancer patientsPrimary careAmerican CollegeAdult populationSocial determinantsLogistic regressionPatientsSurvivorsLower likelihoodMarital statusCareFuture studiesReceipt
2020
Pilot study of fractional CO2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors
Quick AM, Dockter T, Le-Rademacher J, Salani R, Hudson C, Hundley A, Terstriep S, Streicher L, Faubion S, Loprinzi CL, Coleman JS, Wang KC, Lustberg M. Pilot study of fractional CO2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors. Maturitas 2020, 144: 37-44. PMID: 33358206, PMCID: PMC7773136, DOI: 10.1016/j.maturitas.2020.10.018.Peer-Reviewed Original ResearchConceptsGynecologic cancer survivorsFemale Sexual Functioning IndexVaginal Assessment ScaleCancer survivorsLaser therapyTreatment armsSexual functionFractional COMedian total FSFI scoreMedian UDI-6 scoreRandomized sham-controlled trialUDI-6 scoresUrinary Distress InventorySerious adverse eventsSham-controlled trialProportion of patientsMedian VAS scoreTotal FSFI scoreFractional CO2 laser therapyCO2 laser therapyLaser treatmentPreliminary evidenceAdenocarcinoma histologyUrinary symptomsAdverse eventsFeasibility of implementing a text-based symptom-monitoring program of endometrial, ovarian, and breast cancer patients during treatment
Naughton MJ, Salani R, Peng J, Lustberg M, DeGraffinreid C, Moon J, Loyan H, Beverly Hery CM, Paskett ED. Feasibility of implementing a text-based symptom-monitoring program of endometrial, ovarian, and breast cancer patients during treatment. Quality Of Life Research 2020, 30: 3241-3254. PMID: 33052514, PMCID: PMC8528739, DOI: 10.1007/s11136-020-02660-w.Peer-Reviewed Original ResearchMeSH KeywordsBreast NeoplasmsFatigueFeasibility StudiesFemaleHumansMiddle AgedQuality of LifeSurveys and QuestionnairesConceptsBreast cancer patientsCancer patientsPatient Health QuestionnaireOverall mean ageHealth care teamNon-medical needsNon-Hispanic whitesLay navigatorsPatient navigationMean ageSleep disturbancesCare teamHealth QuestionnaireLow adherencePatient responseAverage adherenceSleep qualitySymptom monitoringBreast patientsPatientsCancer typesMonthly feedbackMonthsGlobal qualitySymptomsPrimary care physician’s confidence and coordination regarding the survivorship care for older breast cancer survivors
Stephens C, Klemanski D, Lustberg MB, Noonan AM, Brill S, Krok-Schoen JL. Primary care physician’s confidence and coordination regarding the survivorship care for older breast cancer survivors. Supportive Care In Cancer 2020, 29: 223-230. PMID: 32338315, DOI: 10.1007/s00520-020-05448-3.Peer-Reviewed Original ResearchConceptsOlder breast cancer survivorsPrimary care physiciansBreast cancer survivorsSurvivorship careCancer survivorsHalf of PCPsShared care modelPCP confidenceChronic comorbiditiesCare physiciansPatient's oncologistCare coordinationLate effectsCare modelPhysician confidenceWeb-based questionnairePractice settingsCancer treatmentOncologistsRoutine partCareFamily practiceSurvivorsLack of trainingPossible need
2019
Partnered, adapted argentine tango dance for cancer survivors: A feasibility study and pilot study of efficacy
Worthen-Chaudhari L, Lamantia M, Monfort S, Mysiw W, Chaudhari A, Lustberg M. Partnered, adapted argentine tango dance for cancer survivors: A feasibility study and pilot study of efficacy. Clinical Biomechanics 2019, 70: 257-264. PMID: 31751861, DOI: 10.1016/j.clinbiomech.2019.08.010.Peer-Reviewed Original ResearchConceptsCancer survivorsPostural controlCOP measuresMean satisfaction rateNeurotoxic cancer treatmentsBalance training programPostural control deficitsTango danceHalf of participantsPreliminary efficacySensorimotor trainingNormal rangePromising treatmentPressure measuresQuiet standingSatisfaction rateBalance deficitsCancer treatmentPilot studySurvivorsMore sessionsFeasibility criteriaTango classesControl deficitsMore studies
2018
PD‐L1 expression and CD8‐positive T cells are associated with favorable survival in HER2‐positive invasive breast cancer
Hou Y, Nitta H, Wei L, Banks P, Lustberg M, Wesolowski R, Ramaswamy B, Parwani A, Li Z. PD‐L1 expression and CD8‐positive T cells are associated with favorable survival in HER2‐positive invasive breast cancer. The Breast Journal 2018, 24: 911-919. PMID: 30230111, PMCID: PMC6724200, DOI: 10.1111/tbj.13112.Peer-Reviewed Original ResearchConceptsPD-L1 expressionCD8-positive T cellsTumor-infiltrating lymphocytesHER2-positive casesLymph node metastasisCytotoxic immune reactionsBreast carcinomaImmune reactionsNode metastasisPD-L1Immune cellsConventional chemotherapyBreast cancerT cellsTissue microarrayHER2-positive invasive breast cancerHER2-positive invasive breast carcinomasHER2-positive breast cancerHER2-positive breast carcinomasTumor cellsPD1/PD-L1 expressionHigh Nottingham gradePD-L1 stainingInvasive breast cancerLower tumor stageAn Evaluation of Factors Predicting Diet Quality among Cancer Patients
Kane K, Ilic S, Paden H, Lustberg M, Grenade C, Bhatt A, Diaz D, Beery A, Hatsu I. An Evaluation of Factors Predicting Diet Quality among Cancer Patients. Nutrients 2018, 10: 1019. PMID: 30081543, PMCID: PMC6116020, DOI: 10.3390/nu10081019.Peer-Reviewed Original ResearchConceptsHealthy Eating Index 2010Higher HEI scoresCancer patientsHEI scoresDiet qualityMean HEI scoreLower HEI scoresDisease-related factorsDisease-related characteristicsOverall HEI scoreHigher diet qualityTypes of cancerGeneral education diplomaPredictive factorsCancer mortalityPoor-quality dietLower riskPatientsHealthcare providersSpecific demographic characteristicsHigh school degreeDemographic characteristicsOne-way ANOVAScoresCancerDietary Long-Chain n-3 Fatty Acid Intake and Arthritis Risk in the Women’s Health Initiative
Krok-Schoen J, Brasky T, Hunt R, Rohan T, Baker T, Li W, Carbone L, Mackey R, Snetselaar L, Lustberg M, Neuhouser M. Dietary Long-Chain n-3 Fatty Acid Intake and Arthritis Risk in the Women’s Health Initiative. Journal Of The Academy Of Nutrition And Dietetics 2018, 118: 2057-2069. PMID: 29921541, PMCID: PMC6204099, DOI: 10.1016/j.jand.2018.04.005.Peer-Reviewed Original ResearchConceptsArthritis riskRA riskPostmenopausal womenWomen's Health Initiative Observational StudyHealth initiativesDietary long chain nClinical trial cohortProspective cohort studyFood frequency questionnairePrevalence of arthritisFatty acid intakeWomen's Health InitiativeCox regression modelAnti-inflammatory propertiesFatty acidsHistory of arthritisEvidence of benefitRheumatoid arthritis riskLong chain nArthritis outcomesCohort studyFrequency questionnaireHazard ratioIncident osteoarthritisTrial cohortUsefulness of Integrating Heart Failure Risk Factors Into Impairment of Global Longitudinal Strain to Predict Anthracycline-Related Cardiac Dysfunction
Milks M, Velez M, Mehta N, Ishola A, Van Houten T, Yildiz V, Reinbolt R, Lustberg M, Smith S, Orsinelli D. Usefulness of Integrating Heart Failure Risk Factors Into Impairment of Global Longitudinal Strain to Predict Anthracycline-Related Cardiac Dysfunction. The American Journal Of Cardiology 2018, 121: 867-873. PMID: 29454478, DOI: 10.1016/j.amjcard.2017.12.022.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnthracyclinesAntibiotics, AntineoplasticAntineoplastic Agents, ImmunologicalAtrial FibrillationAtrial FlutterBreast NeoplasmsCoronary Artery DiseaseDiabetes MellitusDoxorubicinEchocardiographyFemaleHeart FailureHumansHypertensionLogistic ModelsMiddle AgedRenal InsufficiencyReproducibility of ResultsRetrospective StudiesRisk AssessmentRisk FactorsStroke VolumeTrastuzumabVentricular DysfunctionConceptsCancer therapeutics-related cardiac dysfunctionGlobal longitudinal strainRisk factorsEchocardiographic variablesCardiac dysfunctionLongitudinal strainImaging assessmentCertain clinical risk factorsHeart failure risk factorsVentricular global longitudinal strainLeft ventricular longitudinal strainClinical risk factorsLV ejection fractionVentricular longitudinal strainHigh-risk groupRisk prediction toolsFailure risk factorsReceiver-operating characteristicClinical factorsEjection fractionOncologic treatmentLV functionRetrospective studyClinical variablesBreast cancer
2017
Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data
Orchard T, Andridge R, Yee L, Lustberg M. Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data. Journal Of The Academy Of Nutrition And Dietetics 2017, 118: 578-588.e1. PMID: 29233615, PMCID: PMC5869134, DOI: 10.1016/j.jand.2017.09.024.Peer-Reviewed Original ResearchMeSH KeywordsAntineoplastic AgentsBreast NeoplasmsCancer SurvivorsCross-Sectional StudiesDietDrug-Related Side Effects and Adverse ReactionsFemaleHumansInflammationInterleukin-17Interleukin-6Middle AgedPilot ProjectsPostmenopauseQuality of LifeReceptors, Tumor Necrosis Factor, Type IITreatment OutcomeConceptsBreast cancer survivorsBody mass indexQuality of lifeLower IL-6Cancer survivorsDiet qualityIL-6Breast cancerTNFR-2QOL measuresEndocrine receptor-positive breast cancerReceptor-positive breast cancerEarly-stage breast cancerMidwestern cancer centerModifiable lifestyle factorsSerum proinflammatory cytokinesCancer Therapy-BreastHealthy Eating IndexAromatase inhibitor treatmentCross-sectional analysisEndocrine subscaleOverall HEIPrior chemotherapyPostmenopausal womenPrimary therapyGenomic risk prediction of aromatase inhibitor‐related arthralgia in patients with breast cancer using a novel machine‐learning algorithm
Reinbolt R, Sonis S, Timmers C, Fernández‐Martínez J, Cernea A, de Andrés‐Galiana E, Hashemi S, Miller K, Pilarski R, Lustberg M. Genomic risk prediction of aromatase inhibitor‐related arthralgia in patients with breast cancer using a novel machine‐learning algorithm. Cancer Medicine 2017, 7: 240-253. PMID: 29168353, PMCID: PMC5773952, DOI: 10.1002/cam4.1256.Peer-Reviewed Original ResearchRandomized placebo-controlled pilot trial of omega 3 fatty acids for prevention of aromatase inhibitor-induced musculoskeletal pain
Lustberg M, Orchard T, Reinbolt R, Andridge R, Pan X, Belury M, Cole R, Logan A, Layman R, Ramaswamy B, Wesolowski R, Berger M, Patterson E, Loprinzi C, Shapiro C, Yee L. Randomized placebo-controlled pilot trial of omega 3 fatty acids for prevention of aromatase inhibitor-induced musculoskeletal pain. Breast Cancer Research And Treatment 2017, 167: 709-718. PMID: 29101597, PMCID: PMC5809189, DOI: 10.1007/s10549-017-4559-z.Peer-Reviewed Original ResearchConceptsQuality of lifeJoint symptomsRandomized placebo-controlled pilot trialBrief Pain Inventory-Short FormPostmenopausal breast cancer patientsRed blood cell (RBC) nPlacebo-controlled pilot trialFACT-ES scoresPlacebo-controlled studyPain severity scoreBreast cancer survivorsBreast cancer patientsAnti-inflammatory propertiesAdjuvant AICommon toxicitiesFACT-ESPurposeAromatase inhibitorsPrimary endpointDrug adherencePill countSecondary outcomesMusculoskeletal painTreatment armsCancer survivorsFatty acids