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Zhang W, Yu Y, Yang F. Single-cell combined with bulk-RNA data reveal a pattern related to angiogenesis in breast cancer patients: Individualized medicine. ENVIRONMENTAL TOXICOLOGY 2024; 39:695-707. [PMID: 37647361 DOI: 10.1002/tox.23947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
Angiogenesis contributes to tumor progression, aggressive behavior, and metastasis. Although several endothelial dysfunction genes (angiogenesis-related genes [ARGs]) have been identified as diagnostic biomarkers of breast cancer in a few studies, the mixed effects of ARGs have not been thoroughly investigated. The RNA sequencing data and patient survival datasets of breast cancer were obtained for further analysis. MSigDB website includes angiogenesis-related mechanisms. The consensus clustering analysis identifies 1082 breast cancer patients as three clusters. differential expression genes (DEGs) were identified by limma package. GO combined with gene set enrichment analysis (GSEA) to identify cytogenetic functions between two predefined clusters. Then Serpin Family F Member 1 (SERPINF1), angiomotin (AMOT), promyelocytic leukemia (PML), and BTG anti-proliferation factor 1 (BTG) were selected to construct prediction models using random forest survival analysis. External validation was performed using the GSE58812 triple-negative breast cancer cohort as the validation set. The median scoring system was used to discern the high- and low-risk groups, and there was a significant difference in their diagnostic results. Immunological infiltration scores were calculated using single sample gene set enrichment analysis (ssGSEA) and xCell algorithms, and consciousness scores were calculated using the R package "oncoPredict" for drugs in the Genomics of Drug Sensitivity in Cancer (GDSC) database. In addition, the single-cell analysis of seven triple-negative breast cancers using scRNA-seq information from GSE118389 demonstrated the interpretation of SERPINF1, AMOT, PML, and BTG1. In conclusion, this investigation engineered ARG-centric disease paradigms that not only prognosticated prospective therapeutic compounds, but also projected their mechanistic trajectories, thereby facilitating the proposition of tailored treatments within diverse patient cohorts diagnosed with breast cancer.
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Affiliation(s)
- Wei Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yan Yu
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fan Yang
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Liu YS, Liu Y, Park C. Association of cardiovascular disease with health-related quality of life among older women with early-stage breast cancer undergoing adjuvant endocrine therapy. J Geriatr Oncol 2023; 14:101598. [PMID: 37549476 DOI: 10.1016/j.jgo.2023.101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Due to the improved overall survival and life expectancy of older women with breast cancer, cardiovascular disease (CVD) arose as the primary cause of non-cancer-related deaths in this population. Therefore, assessing the health-related quality of life (HRQoL) of breast cancer patients with comorbid CVD is becoming increasingly vital. Our study aimed to evaluate the association between comorbid CVD and HRQoL among older women with early-stage breast cancer who are receiving adjuvant endocrine therapy (AET) in the United States. MATERIALS AND METHODS We conducted a retrospective cohort study using the 2006-2017 Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data. We identified female patients over the age of 65 who were diagnosed with stage I-III hormone receptor-positive breast cancer and treated with AET. HRQoL was assessed by the physical and mental component summary (PCS & MCS) in the health survey. CVD was defined as a history of acute myocardial infarction (AMI), congestive heart failure (CHF), angina, stroke, or other heart-related conditions. We performed multivariate linear regression models while controlling for covariates. RESULTS Among 3,904 older women, a history of CHF [β = -1.97, p = 0.025], stroke [β = -3.00, p < 0.010], or other heart-related condition [β = -1.10, p = 0.046] was significantly associated with lower PCS. However, no significant differences in PCS scores were found between women with a history of AMI or angina and those without these conditions. Having a history of CHF [β = -1.72, p = 0.033] or stroke [β = -1.48, p = 0.038] was significantly associated with lower MCS, whereas a history of angina, AMI, or other heart conditions was not associated with significant differences in MCS. Our study did not observe any significant differences in PCS and MCS between the two types AETs. DISCUSSION The study found that older women with early-stage breast cancer who were being treated with AETs had a lower HRQoL if they had a history of CHF or stroke. These comorbidities were identified as strong predictors for decreased HRQoL. The findings highlight the significance of managing cardiovascular diseases in such patients for better HRQoL while they receive AET treatment.
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Affiliation(s)
- Yi-Shao Liu
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Yan Liu
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
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Hill L, Delgado B, Lambrinou E, Mannion T, Harbinson M, McCune C. Risk and Management of Patients with Cancer and Heart Disease. Cardiol Ther 2023; 12:227-241. [PMID: 36757637 PMCID: PMC10209380 DOI: 10.1007/s40119-023-00305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Abstract
Cancer and cardiovascular disease are two of the leading causes of global mortality and morbidity. Medical research has generated powerful lifesaving treatments for patients with cancer; however, such treatments may sometimes be at the expense of the patient's myocardium, leading to heart failure. Anti-cancer drugs, including anthracyclines, can result in deleterious cardiac effects, significantly impacting patients' functional capacity, mental well-being, and quality of life. Recognizing this, recent international guidelines and expert papers published recommendations on risk stratification and care delivery, including that of cardio-oncology services. This review will summarize key evidence with a focus on anthracycline therapy, providing clinical guidance for the non-oncology professional caring for a patient with cancer and heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, UK.
- College of Nursing and Midwifery, Mohammed Bin Rashid University, Dubai, United Arab Emirates.
| | - Bruno Delgado
- Cardiology Department, University Hospital Centre of Oporto, Stº António Hospital, Oporto, Portugal
- Institute of Health Sciences, Portuguese Catholic University, Oporto, Portugal
| | | | - Tara Mannion
- Beaumont Hospital, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Mark Harbinson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire McCune
- School of Medicine Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Belfast Health and Social Care Trust, Belfast, UK
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Larsen CM, Garcia Arango M, Dasari H, Arciniegas Calle M, Adjei E, Rico Mesa J, Scott CG, Thompson CA, Cerhan JR, Haddad TC, Goetz MP, Herrmann J, Villarraga HR. Association of Anthracycline With Heart Failure in Patients Treated for Breast Cancer or Lymphoma, 1985-2010. JAMA Netw Open 2023; 6:e2254669. [PMID: 36735254 PMCID: PMC9898820 DOI: 10.1001/jamanetworkopen.2022.54669] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Anthracyclines increase the risk for congestive heart failure (CHF); however, long-term cumulative incidence and risk factors for CHF after anthracycline therapy are not well defined in population-based studies. OBJECTIVE To compare the long-term cumulative incidence of CHF in patients with breast cancer or lymphoma treated with anthracycline therapy compared with healthy controls from the same community. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based case-control study included data from the Rochester Epidemiology Project. Participants included residents of Olmsted County, Minnesota, diagnosed with breast cancer or lymphoma from January 1985 through December 2010 matched for age, sex, and comorbidities with healthy controls, with a final ratio of 1 case to 1.5 controls. Statistical analysis was performed between July 2017 and February 2022. EXPOSURES Cancer treatment and CHF risk factors. MAIN OUTCOMES AND MEASURES The main outcome was new-onset CHF, as defined by the modified Framingham criteria. Cox proportional hazards regression was used to estimate hazard ratios (HRs) to compare the risk of CHF in participants with cancer vs controls, adjusted for age, sex, diabetes, hypertension, hyperlipidemia, coronary artery disease, obesity, and smoking history. RESULTS A total of 2196 individuals were included, with 812 patients with cancer and 1384 participants without cancer. The mean (SD) age was 52.62 (14.56) years and 1704 participants (78%) were female. Median (IQR) follow-up was 8.6 (5.2-13.4) years in the case group vs 12.5 (8.7-17.5) years in the control group. Overall, patients with cancer had higher risk of CHF compared with the control cohort even after adjusting for age, sex, diabetes, hypertension, coronary artery disease, hyperlipidemia, obesity, and smoking status (HR, 2.86 [95% CI, 1.90-4.32]; P < .001). After adjusting for the same variables, CHF risk was greater for patients with cancer receiving anthracycline (HR, 3.25 [95% CI, 2.11-5.00]; P < .001) and was attenuated and lost statistical significance for patients with cancer not receiving anthracyclines (HR, 1.78 [95% CI, 0.83-3.81]; P = .14). Higher cumulative incidence for patients treated with anthracyclines vs comparator cohort was observed at 1 year (1.81% vs 0.09%), 5 years (2.91% vs 0.79%), 10 years (5.36% vs 1.74%), 15 years (7.42% vs 3.18%), and 20 years (10.75% vs 4.98%) (P < .001). There were no significant differences in risk of CHF for patients receiving anthracycline at a dose of less than 180 mg/m2 compared with those at a dose of 180 to 250 mg/m2 (HR, 0.54 [95% CI, 0.19-1.51]) or at a dose of more than 250 mg/m2 (HR, 1.23 [95% CI, 0.52-2.91]). At diagnosis, age was an independent risk factor associated with CHF (HR per 10 years, 2.77 [95% CI, 1.99-3.86]; P < .001). CONCLUSIONS AND RELEVANCE In this retrospective population-based case-control study, anthracyclines were associated with an increased risk of CHF early during follow-up, and the increased risk persisted over time. The cumulative incidence of CHF in patients with breast cancer or lymphoma treated with anthracyclines at 15 years was more than 2-fold that of the control group.
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Affiliation(s)
- Carolyn M. Larsen
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | | | - Harika Dasari
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Effie Adjei
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Juan Rico Mesa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - James R. Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Tufia C. Haddad
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Matthew P. Goetz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Yu C, Pathan F, Tan TC, Negishi K. The Utility of Advanced Cardiovascular Imaging in Cancer Patients-When, Why, How, and the Latest Developments. Front Cardiovasc Med 2021; 8:728215. [PMID: 34540922 PMCID: PMC8446374 DOI: 10.3389/fcvm.2021.728215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023] Open
Abstract
Cardio-oncology encompasses the risk stratification, prognostication, identification and management of cancer therapeutics related cardiac dysfunction (CTRCD). Cardiovascular imaging (CVI) plays a significant role in each of these scenarios and has broadened from predominantly quantifying left ventricular function (specifically ejection fraction) to the identification of earlier bio-signatures of CTRCD. Recent data also demonstrate the impact of chemotherapy on the right ventricle, left atrium and pericardium and highlight a possible role for CVI in the identification of CTRCD through tissue characterization and assessment of these cardiac chambers. This review aims to provide a contemporary perspective on the role of multi-modal advanced cardiac imaging in cardio-oncology.
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Affiliation(s)
- Christopher Yu
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Faraz Pathan
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Timothy C Tan
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Blacktown Hospital, Sydney, NSW, Australia
| | - Kazuaki Negishi
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
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Koop Y, van Zadelhof N, Maas AHEM, Atsma F, El Messaoudi S, Vermeulen H. Quality of life in breast cancer patients with cancer treatment-related cardiac dysfunction: a qualitative study. Eur J Cardiovasc Nurs 2021; 21:235-242. [PMID: 34252175 DOI: 10.1093/eurjcn/zvab057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/16/2021] [Accepted: 06/08/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although improved breast cancer (BC) treatment has decreased mortality, these anti-cancer regimens may have serious cardiovascular side effects that affect patients' long-term prognosis and quality of life (QoL). BC patients with cancer treatment-related cardiac dysfunction (CTRCD) can suffer from a variety of symptoms, such as dyspnoea and fatigue. The impact of CTRCD after BC treatment on patients' daily life has not been qualitatively explored yet. AIMS This study aims to explore the influence of CTRCD on QoL of women with BC, as defined by the concept of positive health. Second, we aim to evaluate the personal experience with cardiac surveillance during the BC trajectory. METHODS AND RESULTS A qualitative study with semi-structured interviews was conducted and thematically analysed to explore the QoL and healthcare experiences of BC patients with CTRCD. Twelve patients participated in this study. Five themes are selected in response to the study objective: (i) patients: overwhelming fatigue, (ii) patients: mental burden of anxiety, (iii) social setting: lack of understanding and acceptance, (iv) medical specialists: lack of knowledge and acknowledgement, and (v) patients: need for personalized care. CONCLUSION This study identified core components of the impact CTRCD has on the QoL of BC patients. Patients experienced an increased health-related burden due to CTRCD, affecting their physical, social, and psychosocial well-being. Healthcare experiences were largely affected by a lack of acknowledgement and professional communication. Patients underlined the need for personalized care during follow-up.
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Affiliation(s)
- Yvonne Koop
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, 6500 HB Nijmegen, the Netherlands
| | - Nikita van Zadelhof
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, 6500 HB Nijmegen, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, 6500 HB Nijmegen, the Netherlands
| | - Femke Atsma
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Geert Grooteplein 10 - route 114, 6500 HB Nijmegen, the Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, 6500 HB Nijmegen, the Netherlands
| | - Hester Vermeulen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Geert Grooteplein 10 - route 114, 6500 HB Nijmegen, the Netherlands.,Research Department of Emergency and Critical Care, Faculty of Health and Social Studies, HAN University of Applied Sciences, Kapittelweg 33, 6503GL Nijmegen, the Netherlands
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7
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Breast cancer survivors: physical and mental quality of life 10 years following diagnosis, a case-control study. Breast Cancer Res Treat 2021; 188:273-282. [PMID: 33818651 DOI: 10.1007/s10549-021-06156-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/20/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Improvements in diagnosis and treatment of Breast Cancer (BC) have resulted in an increase in the life expectancy of survivors and in the importance of quality of life in BC survivorship care. The current study aimed to assess the Health-Related Quality Of Life (HRQOL) of BC survivors and to investigate the association of comorbidities with HRQOL compared to a group of women with no history of cancer. METHODS Women were residents of the central district in Israel, the case group included 250 women diagnosed with BC between 1999 and 2003, with no prior cancer history and no evidence of disease after 8-12 years. The comparison group included 250 women with no cancer history, individually matched to cases by age and area of residence. Data were collected through in-person interviews, and HRQOL was assessed using the Short Form-36 (SF-36) questionnaire. Regression analyses were performed evaluating the influence of demographic, socioeconomic, lifestyle characteristics and comorbidities on physical and mental HRQOL. RESULTS The physical and mental summary scores means, were 48.5 ± 11.1 and 49.2 ± 10.8 compared to 51.5 ± 10.2 and 50.9 ± 10.6, in BC survivors and the comparison group, respectively (p = 0.002 and p = 0.097). BC survivors and controls did not differ in number and type of comorbidities and for both groups a negative association was seen with HRQOL. Controlling for age, income, number of comorbidities, BMI and physical activity, BC survivor had decreased physical (b = -2.49, p = 0.001) and mental summary scores (b = -1.27, p = 0.18). CONCLUSION HRQOL of BC survivors should gain more attention in the area of cancer care, especially when comorbidities are present.
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8
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Sheikhalipour Z, Ghahramanian A, Fateh A, Onyeka TC. Functional status of women after cancer and its related factors: A study based on Roy adaptation model. Eur J Cancer Care (Engl) 2020; 30:e13378. [PMID: 33295041 DOI: 10.1111/ecc.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role strain is still high for women within Iranian families. This can be further compounded by diseases such as cancer. The aim of this study was to investigate the functional status of women with cancer and its relationship with symptoms experienced by women during the period of the disease. METHODS This cross-sectional study was carried out with 150 women with the cancer diagnosis who were referred to the Cancer Clinic of Shahid Ghazi Tabatabai Hospital in Tabriz, Iran. The Comprehensive Inventory of Functioning (CIF-CA) was used to evaluate their functional status. RESULT The mean total performance of participants was 3.06(± 0.51), and the range of mean variation scores was between 1.83 and 5. Regarding the housework dimension, women reported less function in all of activities while in the social dimension, participation in social and religious activities waned. In the dimension of personal activities, majority of women reported rest and sleep during the day. CONCLUSION Clinicians should explore the use of rehabilitation programmes to ensure that a holistic approach to care for women with cancer is given priority in order to improve the quality of life of these women and subsequently their roles in family and society.
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Affiliation(s)
- Zahra Sheikhalipour
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alavieh Fateh
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tonia C Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Park J, Rodriguez JL, O'Brien KM, Nichols HB, Hodgson ME, Weinberg CR, Sandler DP. Health-related quality of life outcomes among breast cancer survivors. Cancer 2020; 127:1114-1125. [PMID: 33237602 DOI: 10.1002/cncr.33348] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Data from a nationwide sample of US breast cancer survivors were used to examine associations between patient characteristics (breast cancer clinical features, prognostic factors, and treatments) and health-related quality of life (HRQOL). Associations between postdiagnosis HRQOL and mortality were then evaluated. METHODS The authors identified female breast cancer survivors (n = 2453) from the Sister Study or Two Sister Study who were at least 1 year from breast cancer diagnosis and who had responded to a survivorship survey in 2012. HRQOL was assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 10 measures. Multivariable linear regression was used to assess predictors associated with HRQOL. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HRQOL and all-cause mortality. RESULTS HRQOL, assessed an average of 4.9 years after the cancer diagnosis (standard deviation of 1.9 years), was negatively associated with a higher cancer stage at diagnosis; a higher comorbidity score at the survey; experience of surgical complications; dissatisfaction with breast surgery; and experience of any recent recurrence, metastasis, or secondary malignancy. Since the completion of the survey, there were 85 deaths (3.5%) during a mean follow-up of 4 years (standard deviation of 0.5 years). In multivariate models, decreases in PROMIS physical T scores and mental T scores were associated with increased mortality (HR for physical T scores, 1.08; 95% CI, 1.05-1.11; HR for mental T scores, 1.03; 95% CI, 1.01-1.06). CONCLUSIONS Prognostic and cancer treatment-related factors affect HRQOL in breast cancer survivors and may inform targeted survivorship care. PROMIS global health measures may offer additional insights into patients' well-being and mortality risk. LAY SUMMARY Findings from a study suggest that prognostic and cancer treatment-related factors affect health-related quality of life (HRQOL) in breast cancer survivors and that poor HRQOL may increase the mortality risk. The evaluation of HRQOL is important because it may hold potential as a tool for optimizing survivorship care.
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Affiliation(s)
- Jihye Park
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
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Anker MS, Hadzibegovic S, Lena A, Belenkov Y, Bergler‐Klein J, de Boer RA, Farmakis D, von Haehling S, Iakobishvili Z, Maack C, Pudil R, Skouri H, Cohen‐Solal A, Tocchetti CG, Coats AJ, Seferović PM, Lyon AR. Recent advances in cardio-oncology: a report from the 'Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019'. ESC Heart Fail 2019; 6:1140-1148. [PMID: 31884717 PMCID: PMC6989292 DOI: 10.1002/ehf2.12551] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
While anti-cancer therapies, including chemotherapy, immunotherapy, radiotherapy, and targeted therapy, are constantly advancing, cardiovascular toxicity has become a major challenge for cardiologists and oncologists. This has led to an increasing demand of cardio-oncology units in Europe and a growing interest of clinicians and researchers. The Heart Failure 2019 meeting of the Heart Failure Association of the European Society of Cardiology in Athens has therefore created a scientific programme that included four dedicated sessions on the topic along with several additional lectures. The major points that were discussed at the congress included the implementation and delivery of a cardio-oncology service, the collaboration among cardio-oncology experts, and the risk stratification, prevention, and early recognition of cardiotoxicity. Furthermore, sessions addressed the numerous different anti-cancer therapies associated with cardiotoxic effects and provided guidance on how to treat cancer patients who develop cardiovascular disease before, during, and after treatment.
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Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research)partner site Berlin and Department of Cardiology, Charité Campus Benjamin FranklinBerlinGermany
| | - Sara Hadzibegovic
- Division of Cardiology and Metabolism, Department of CardiologyCharité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research)partner site Berlin and Department of Cardiology, Charité Campus Benjamin FranklinBerlinGermany
| | - Alessia Lena
- Division of Cardiology and Metabolism, Department of CardiologyCharité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research)partner site Berlin and Department of Cardiology, Charité Campus Benjamin FranklinBerlinGermany
| | | | | | - Rudolf A. de Boer
- Department of CardiologyUniversity of GroningenUniversity Medical Center Groningen, GroningenThe Netherlands
| | - Dimitrios Farmakis
- University of Cyprus Medical SchoolNicosiaCyprus
- Department of Cardiology, Cardio‐Oncology Clinic, Heart Failure UnitAthens University Hospital ‘Attikon’, National and Kapodistrian University of AthensAthensGreece
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, German Center for Cardiovascular Medicine (DZHK)University of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Fund, and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC)University Clinic WürzburgWürzburgGermany
| | - Radek Pudil
- 1st Department of Medicine–Cardioangiology, Faculty of MedicineUniversity HospitalHradec KrálovéCzech Republic
| | - Hadi Skouri
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Alain Cohen‐Solal
- Department of Cardiology, Lariboisière Hospital and U942 INSERM, BIOCANVAS (Biomarqueurs Cardiovasculaires)Paris UniversityParisFrance
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Sciences (CIRCET)Federico II UniversityNaplesItaly
| | | | - Petar M. Seferović
- Faculty of Medicine and Heart Failure CenterBelgrade University Medical Center, University of BelgradeBelgradeSerbia
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Howden EJ, Bigaran A, Beaudry R, Fraser S, Selig S, Foulkes S, Antill Y, Nightingale S, Loi S, Haykowsky MJ, La Gerche A. Exercise as a diagnostic and therapeutic tool for the prevention of cardiovascular dysfunction in breast cancer patients. Eur J Prev Cardiol 2018; 26:305-315. [PMID: 30376366 DOI: 10.1177/2047487318811181] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anthracycline chemotherapy may be associated with decreased cardiac function and functional capacity measured as the peak oxygen uptake during exercise ( V·O2 peak). We sought to determine (a) whether a structured exercise training program would attenuate reductions in V·O2 peak and (b) whether exercise cardiac imaging is a more sensitive marker of cardiac injury than the current standard of care resting left ventricular ejection fraction (LVEF). METHODS Twenty-eight patients with early stage breast cancer undergoing anthracycline chemotherapy were able to choose between exercise training (mean ± SD age 47 ± 9 years, n = 14) or usual care (mean ± SD age 53 ± 9 years, n = 14). Measurements performed before and after anthracycline chemotherapy included cardiopulmonary exercise testing to determine V·O2 peak and functional disability ( V·O2 peak < 18 ml/min/kg), resting echocardiography (LVEF and global longitudinal strain), cardiac biomarkers (troponin and B-type natriuretic peptide) and exercise cardiac magnetic resonance imaging to determine stroke volume and peak cardiac output. The exercise training group completed 2 × 60 minute supervised exercise sessions per week. RESULTS Decreases in V·O2 peak during chemotherapy were attenuated with exercise training (15 vs. 4% reduction, P = 0.010) and fewer participants in the exercise training group met the functional disability criteria after anthracycline chemotherapy compared with those in the usual care group (7 vs. 50%, P = 0.01). Compared with the baseline, the peak exercise heart rate was higher and the stroke volume was lower after chemotherapy ( P = 0.003 and P = 0.06, respectively). There was a reduction in resting LVEF (from 63 ± 5 to 60 ± 5%, P = 0.002) and an increase in troponin (from 2.9 ± 1.3 to 28.5 ± 22.4 ng/mL, P < 0.0001), but no difference was observed between the usual care and exercise training group. The baseline peak cardiac output was the strongest predictor of functional capacity after anthracycline chemotherapy in a model containing age and resting cardiac function (LVEF and global longitudinal strain). CONCLUSIONS The peak exercise cardiac output can identify patients at risk of chemotherapy-induced functional disability, whereas current clinical standards are unhelpful. Functional disability can be prevented with exercise training.
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Affiliation(s)
- Erin J Howden
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia
| | - Ashley Bigaran
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,2 Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
| | - Rhys Beaudry
- 3 Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing & Health Innovation, University of Texas Arlington, USA
| | - Steve Fraser
- 4 Institute for Physical Activity and Nutrition, Deakin University, Australia.,5 School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Steve Selig
- 5 School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Steve Foulkes
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,4 Institute for Physical Activity and Nutrition, Deakin University, Australia.,5 School of Exercise and Nutrition Sciences, Deakin University, Australia
| | | | - Sophie Nightingale
- 7 Surgical Oncology Department, Peter MacCallum Cancer Centre, Australia
| | - Sherene Loi
- 8 Translational Breast Cancer Genomics Laboratory, Peter MacCallum Cancer Centre, Australia
| | - Mark J Haykowsky
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,3 Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing & Health Innovation, University of Texas Arlington, USA
| | - André La Gerche
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,9 Cardiology Department, St Vincent's Hospital Melbourne, Melbourne VIC, Australia
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Harrison J, Friese C, Barton D, Janz N, Pressler S, Davis M. Heart Failure and Long-Term Survival Among Older Women With Breast Cancer. Oncol Nurs Forum 2018. [DOI: 10.1188/18.onf.77-87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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