Exploring knowledge, attitudes and experience of genitourinary symptoms in women with early breast cancer on adjuvant endocrine therapy

Clinical trials of adjuvant endocrine therapy in women with early breast cancer have consistently reported that genitourinary symptoms are common. However, little is known about women's experiences of genitourinary symptoms, their views about the symptoms and how they impact on their lives. The aim of this study was to explore knowledge, attitudes and experiences of genitourinary symptoms among women receiving adjuvant endocrine therapy for early breast cancer. Thirty-two semi-structured interviews were conducted and subjected to a rigorous qualitative analysis. Genitourinary symptoms were commonly reported to negatively impact on personal, social and physical activities, were often attributed to anxiety and stress and were a source of embarrassment. Women also commented on the limited information available or provided regarding the potential genitourinary adverse effects of adjuvant endocrine therapy. There was a general lack of awareness that their symptoms could be associated with or exacerbated by adjuvant endocrine therapy. Women indicated a preference to receive information and advice about potential management options from either their general practitioner or specialist. These findings underscore the importance of improving communication and increasing awareness among both clinicians and patients about the potential impact of adjuvant endocrine therapy on genitourinary symptoms.

Colorimetric determinations of lithium levels in drop-volumes of human plasma for monitoring patients with bipolar mood disorder

Lithium preparations are considered the most reliable form of mood stabilizing medication for patients with Bipolar disorder. Nevertheless, lithium is a toxic element and its therapeutic range is extremely narrow, with levels of 0.61.0 mEq considered normal, whereas levels above 1.5 mEq are toxic. Thus unfortunately, many patients reach toxic levels that lead to unnecessary complications. It is believed that personal monitoring of blood lithium levels would benefit patients taking lithium medication. Therefore, our aim is to develop a personal lithium blood level analyzer for patients with bipolar mood disorder, and we report here our initial results of a colorimetric-based method used to test drop-volumes of human plasma that had been spiked with lithium. It was possible to validate results with standard flame photometry readings. Applying the Partial Least Squares (PLS) method on preprocessed spectra, therapeutic concentrations of lithium in a single drop can be predicted in a rapid manner, and furthermore, the calibration results were used to select effective wavelengths which were employed as inputs in Multiple Linear Regression (MLR). The simplified algorithms of this would prove useful when developing a personal lithium analyzer. Overall, both calibration methods gave high correlation and small error outputs with a R2= 0.99036 and RMSEC = 0.03778, and R2= 0.994148 and RMSEC= 0.0294404, for PLS and MLR methods, respectively. The results show that the spectrophotometric determination of blood lithium levels can be extended beyond laboratory applications and indicate the capability of this testing principle to be employed in a personal monitoring device. Future work will now focus on the technical development of a miniaturized system for measurement of lithium levels in blood with an acceptable level of accuracy and sensitivity.

Rapid identification and antimicrobial susceptibility testing of positive blood cultures using MALDI-TOF MS and a modification of the standardised disc diffusion test: a pilot study

AIMS

In an era when clinical microbiology laboratories are under increasing financial pressure, there is a need for inexpensive, yet effective, rapid microbiology tests. The aim of this study was to evaluate a novel modification of standard methodology for the identification and antimicrobial susceptibility testing (AST) of pathogens in positive blood cultures, reducing the turnaround time of laboratory results by 24 h.

METHODS

277 positive blood cultures had a Gram stain performed and were subcultured and incubated at 37°C in a CO2 atmosphere for 4-6 h. Identification of the visible growth was performed using matrix-assisted laser desorption time of flight mass spectrometry (MALDI-TOF MS). Taking a modified approach to the Clinical and Laboratory Standards Institute-standardised AST methodology, an inoculum density of 0.5 McFarland was prepared from the early growth for disc diffusion testing. The standard AST method was also performed on the 18-24 h culture.

RESULTS

96% (n=73/76) of gram-negative organisms were correctly identified by MALDI-TOF MS. Comparative analysis of the rapid and standard AST results showed an overall interpretive category error rate of 7.7% (6.7% minor errors, 0.6% major errors and 0.4% very major errors). 100% of Staphylococcus aureus (n=41) and enterococcus isolates (n=9) were correctly identified after 4-6 h incubation. The overall AST categorical agreement was also 100% for these isolates.

CONCLUSIONS

An incubation of 4-6 h directly from positive blood cultures allowed for both a rapid species identification and an antimicrobial susceptibility result approximately 24 h earlier than is possible using standard methodology.

The effect of vascular changes on the photoplethysmographic signal at different hand elevations

In order to further understand the contribution of venous and arterial effects to the photoplethysmographic (PPG) signal, recordings were made from 20 healthy volunteer subjects during an exercise in which the right hand was raised and lowered with reference to heart level. Red (R) and infrared (IR) PPG signals were obtained from the right index finger using a custom-made PPG processing system. Laser Doppler flowmetry (LDF) signals were also recorded from an adjacent fingertip. The signals were compared with simultaneous PPG signals obtained from the left index finger. On lowering the hand to 50 cm below heart level, both ac and dc PPG amplitudes from the finger decreased (e.g. 18.70 and 63.15% decrease in infrared dc and ac signals respectively). The decrease in dc amplitude most likely corresponded to increased venous volume, while the decrease in ac PPG amplitude was due to regulatory adjustments on the arterial side in response to venous distension. Conversely, ac and dc PPG amplitudes increased on raising the arm above heart level. Morphological changes in the ac PPG signal are thought to be due to vascular resistance changes, predominately venous, as the hand position is changed.

Optical analysis of lithium carbonate: towards the development of a portable lithium blood level analyzer for bipolar disorder patients

Lithium medication is the gold standard of treatment in Bipolar Disorder patients, preventing and reducing mood swings and suicidality. However, despite its effectiveness, it is a potentially hazardous drug requiring regular monitoring of blood levels to ensure toxic levels are not reached. This paper describes the first steps towards developing a new portable device that can be used by Bipolar Disorder patients to facilitate the analysis of lithium blood levels at home. Solutions of lithium carbonate have been optically fingerprinted using a high-end spectrophotometer. Preliminary measurements indicate that while the visible to near infrared region of the absorption spectra fall heavily within the water band, measurements in the Ultraviolet region show a strong distinction between different lithium concentrations. The optical spectra of Lithium in the 220 nm to 230 nm region demonstrated the ability to differentiate between concentrations representing those found in patients.

Abstract P3-08-04: Survivorship care involving a nurse-led survivorship consultation, community support and shared care with primary practitioners

Background

Survivorship care (SC) has gained prominence as the number of patients disease free after breast cancer treatment increases, the specific needs of those patients become recognised, and funding to meet these demands is constrained. Involvement of Primary Care Practitioners in SC is seen as a solution, but models of Shared Care have met varying degrees of success. We report on a model that involves Specialist centres, Primary Care Practitioners and organisations, and a community based patient support organisation.

Patients and Methods

A consortium comprising two hospital based breast services – the Royal Melbourne/Royal Women's and Western Hospitals – a regional consortium of Primary Care Physicians, and BreaCan, a non-government peer support organisation for women diagnosed with breast cancer, collaborated to obtain and implement a government-supported Survivorship Care Program. Patients completing definitive treatment for early breast cancer were invited to a Nurse-led consultation where the disease, its pathology, treatment and follow-up were reviewed. Psychosocial and other issues were explored and a personalised SC plan was devised and agreed upon. This plan included Shared Care with the Primary Care Practitioner in the majority of cases. Unmet needs were identified and addressed. The SC plan was signed off by a senior breast cancer clinician and forwarded to the primary care physician for ratification. Evaluation included satisfaction surveys and interviews with patients and primary care physicians. Intensity of use of hospital based services was calculated and compared to a previous cohort of early breast cancer patients.

Results

282 patients completing definitive treatment were offered Nurse-led survivorship consultation. 29 declined, and 28 cancelled. At 31 May 2013, 148 care plans were completed, 38 were in preparation and 39 appointments were booked. Response to this initiative from hospital based specialists was positive. All believed that this program would reduce the amount of routine consultations and increase capacity for new or returning patients requiring specialist care. Primary care doctors overwhelmingly believed the survivorship care plan contained information needed to allow them to manage breast cancer survivors, and gave them confidence to take on this role, although there was some uncertainty regarding role delineation between Primary Care and hospital. Patient evaluation of the Nurse-led clinics was strongly positive. All reported finding out something during the consultation, and 94% said they considered the hospital and GP to be partners in their on-going follow-up care. Modelling suggests that about 5 fewer hospital appointments will be required for each patient managed under this program compared to routine hospital-based care.

Conclusions

Hospital based specialists embrace Survivorship care including shared care and patients expect it, while Primary physicians will participate if offered education, support and specific direction. A model including an end-of –treatment consultation and Shared care with Primary Practitioners appears to address many of the requirements for a successful Survivorship program.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-04.

Pulse oximetry of body cavities and organs

The focus of this paper will be in the development and in vivo applications of new custom made photoplethysmographic (PPG) and pulse oximetry optical and fiber optic sensors and instrumentation in an effort to investigate their suitability in the estimation of blood oxygen saturation and their contribution in the assessment of organ/tissue perfusion and viability. The paper describes the development of optical and fiber optic PPG and blood oxygen saturation (SpO2) sensors and covers examples of application areas including real-time PPG monitoring from body cavities (esophagus) and solid or hollow organs (bowel, liver, stomach, brain, etc). The clinical studies presented successfully demonstrated the feasibility in acquiring PPGs and estimating blood oxygen saturation values from a variety of organs and tissues. The technological developments and the measurements presented in this work pave the way in a new era of pulse oximetry where direct and continuous monitoring of blood oxygen saturation of internal organs and tissues could be made possible.

Sleep disturbance in menopause

Sleep disturbance during menopause is a common and important complaint faced by many women. There are many factors that may play a role in this problem, including vasomotor symptoms and changing hormone levels, circadian rhythm abnormalities, exacerbation of primary insomnia, mood disorders, coexistent medical conditions as well as lifestyle factors. Sleep can be measured both objectively and subjectively; however, correlation between the two measures is not high. Most of the menopause-related sleep disturbances have been reported as qualitative in nature; however, there have also been studies showing changes in objective measures. This discrepancy has implications with regard to evaluation of research in sleep and menopause, as well as application in the clinical setting. Investigations of inadequate sleep and sleep problems during the menopausal period and obtaining a thorough understanding of the factors contributing to these problems are essential in formulating treatment strategies. Such strategies can vary from hormonal treatment and medications to lifestyle and behavioural modification.

Iatrogenic unscheduled (breakthrough) endometrial bleeding

Erratic, "unscheduled", vaginal bleeding continues to be the greatest disadvantage associated with widespread use of long-acting, progestogen-only methods of contraception. As a consequence, it is also the main reason for premature discontinuation of use of these methods in most cultures. From other perspectives, these methods have high acceptability, very high contraceptive efficacy and a range of valuable, added, non-contraceptive health benefits. There has been widespread awareness of the variability of these vaginal bleeding patterns associated with long-acting methods for several decades and much research has been invested into studying their patterns and implications. Considerable research has also been directed towards trying to understand the underlying mechanisms responsible for the unpredictable bleeding. Much has been clarified about the multiple mechanisms contributing to the appearance of superficial, thin-walled fragile vessels within the endometrium of many of those women with troublesome bleeding, but there is still little understanding of why some women develop these vessels and others have no fragile vessels (and may therefore develop amenorrhea). We now have several medical approaches to reliably stopping a prolonged episode of troublesome bleeding, but no good therapy to produce long-lasting relief from recurrence of erratic bleeding in predisposed women. Future understanding of the variability in individual endometrial responses in different women may be a key to solving this frustrating symptom.

A new fibre optic pulse oximeter probe for monitoring splanchnic organ arterial blood oxygen saturation

A new, continuous method of monitoring splanchnic organ oxygen saturation (SpO(2)) would make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischaemia, and, ultimately, death. In an attempt to provide such a device, a new fibre optic based reflectance pulse oximeter probe and processing system were developed followed by an in vivo evaluation of the technology on seventeen patients undergoing elective laparotomy. Photoplethysmographic (PPG) signals of good quality and high signal-to-noise ratio were obtained from the small bowel, large bowel, liver and stomach. Simultaneous peripheral PPG signals from the finger were also obtained for comparison purposes. Analysis of the amplitudes of all acquired PPG signals indicated much larger amplitudes for those signals obtained from splanchnic organs than those obtained from the finger. Estimated SpO(2) values for splanchnic organs showed good agreement with those obtained from the finger fibre optic probe and those obtained from a commercial device. These preliminary results suggest that a miniaturized 'indwelling' fibre optic sensor may be a suitable method for pre-operative and post-operative evaluation of splanchnic organ SpO(2) and their health.

Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer

BACKGROUND

Fertility is a priority for many young women with breast cancer. Women need to be informed about interventions to retain fertility before chemotherapy so as to make good quality decisions. This study aimed to prospectively evaluate the efficacy of a fertility-related decision aid (DA).

METHODS

A total of 120 newly diagnosed early-stage breast cancer patients from 19 Australian oncology clinics, aged 18-40 years and desired future fertility, were assessed on decisional conflict, knowledge, decision regret, and satisfaction about fertility-related treatment decisions. These were measured at baseline, 1 and 12 months, and were examined using linear mixed effects models.

RESULTS

Compared with usual care, women who received the DA had reduced decisional conflict (β=-1.51; 95%CI: -2.54 to 0.48; P=0.004) and improved knowledge (β=0.09; 95%CI: 0.01-0.16; P=0.02), after adjusting for education, desire for children and baseline uncertainty. The DA was associated with reduced decisional regret at 1 year (β=-3.73; 95%CI: -7.12 to -0.35; P=0.031), after adjusting for education. Women who received the DA were more satisfied with the information received on the impact of cancer treatment on fertility (P<0.001), fertility options (P=0.005), and rated it more helpful (P=0.002), than those who received standard care.

CONCLUSION

These findings support widespread use of this DA shortly after diagnosis (before chemotherapy) among younger breast cancer patients who have not completed their families.

Evaluation and management of depressive and anxiety symptoms in midlife

OBJECTIVES

Evaluation and management of anxiety and depression during the menopausal transition are complicated by the overlap between some symptoms of affective disorder with those of menopausal symptoms, and also by inconsistencies in the literature regarding the relationship between the menopausal transition and affective disorders.

METHODS

We have reviewed key studies over the past three decades addressing depression and anxiety during the menopause transition, in order to present a practical, clinical approach to the evaluation and management of anxiety and depressive symptoms at midlife.

RESULTS

Symptoms of anxiety and depression are common at midlife and may coincide with menopausal symptoms. Some menopausal symptoms are also symptoms of anxiety and/or depression. Management should include treatment of troublesome menopausal symptoms, providing strategies to deal with psychosocial stressors, and exclusion of clinically significant anxiety and depressive disorders. Interventions such as exercise and cognitive behavior therapy may improve mood and general health at menopause, and a multifocal approach is recommended. Depression of greater than moderate severity requires treatment with an antidepressant. Some selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may also improve vasomotor symptoms and these should be considered in women with both affective disorder and vasomotor symptoms.

CONCLUSIONS

There is no clear evidence that the menopause transition alone increases the risk of clinically significant affective disorders, except in women with risk factors such as psychosocial stressors, severe and prolonged vasomotor symptoms and a previous history of affective disorders. Nevertheless, anxiety and depression are common in women and clinicians should be alert to the symptoms of these conditions at all encounters.

Menopausal hot flushes and night sweats: where are we now?

OBJECTIVE

An overview of the current knowledge on the etiology and treatment of vasomotor symptoms in postmenopausal women.

MATERIALS AND METHODS

Acknowledged experts in the field contributed a brief assessment of their areas of interest which were combined and edited into the final manuscript.

RESULTS

Women around the world experience vasomotor symptoms as they enter and complete the menopause transition. Vasomotor symptoms, specifically hot flushes, are caused by a narrowing of the thermoneutral zone in the brain. This effect, although related to estrogen withdrawal, is most likely related to changes in central nervous system neurotransmitters. Peripheral vascular reactivity is also altered in symptomatic women. Estrogen replacement therapy is the most effective treatment for hot flushes. Of the other interventions investigated, selective serotonin and selective norepinephrine reuptake inhibitors and gabapentin show efficacy greater than placebo. Objective monitoring of hot flushes indicates a robust improvement with hormone replacement therapy but little to no change with placebo. These data suggest that the subjective assessment of responses to therapy for vasomotor symptom results in inaccurate data. Hot flushes have recently been associated with increased cardiovascular risks and a lower incidence of breast cancer, but these data require confirmation.

CONCLUSIONS

Vasomotor symptoms are experienced by women of all ethnic groups. They are caused by changes in the central nervous system associated with estrogen withdrawal and are best treated with estrogen replacement therapy. Objective monitoring of hot flushes indicates that placebo has little to no effect on their improvement. Subjective assessments of hot flushes in clinical trials may be inaccurate based on objective measurement of the frequency of hot flushes. Based on preliminary reports, women experiencing hot flushes have an increased risk of cardiovascular disease and a reduced incidence of breast cancer.

Impact of heparan sulfate chains and sulfur-mediated bonds on the mechanical properties of bovine lens capsule

We assessed the importance of glycosaminoglycans and sulfur-mediated bonds for the mechanical properties of lens capsules by comparing the stress-strain responses from control and treated pairs of bovine source. No significant change in mechanical properties was observed upon reduction of disulfide bonds. However, removal of glycosaminoglycan chains resulted in a significantly stiffer lens capsule, whereas high concentrations of reducing agent, which is expected to reduce the recently reported sulfilimine bond of collagen IV, resulted in a significantly less stiff lens capsule. A comparison of the diffraction patterns of the control and strongly reduced lens capsules indicated structural rearrangements on a nanometer scale.