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Arraras JI, Illarramendi JJ, Manterola A, de la Cruz S, Zarandona U, Ibañez B, Salgado E, Visus I, Barrado M, Teiejira L, Martinez MI, Martinez E, Vera R. Quality of life in Spanish postmenopausal breast cancer patients with localized disease who finish endocrine treatment: a prospective study. Menopause 2023; 30:613-620. [PMID: 37022296 DOI: 10.1097/gme.0000000000002178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE In this article, the quality of life (QOL) of Spanish postmenopausal early-stage breast cancer patients who have finished endocrine therapy (ET), QOL changes after endocrine therapy cessation, and the differences between two endocrine therapy modalities (tamoxifen or aromatase inhibitor [AI]) are studied. More QOL information after endocrine therapy cessation is needed. METHODS A prospective cohort study was performed. Participating in the study were 158 postmenopausal patients who had received tamoxifen or AI for 5 years. In some cases, endocrine therapy may have changed during those 5 years.Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR45 questionnaires at baseline, after 6 months, and after 1 year of follow-up. Patients older than 65 years also completed the QLQ-ELD14. Linear mixed-effect models were used to evaluate longitudinal changes in QOL and differences in QOL between endocrine therapy modalities. RESULTS QOL scores for the whole sample throughout follow-up were high (>80/100 points) in most QOL areas. Moderate limitations (>30 points) occurred in the QLQ-BR45 in sexual functioning and sexual enjoyment, future perspective, and joint symptoms. Moderate limitations also occurred in the QLQ-ELD14 in worries about others, maintaining purpose, joint stiffness, future worries, and family support. In those who had finished endocrine therapy, pain was reduced in all three assessments conducted during the 1-year follow-up period in both groups. Tamoxifen patients showed better QOL in functioning (role functioning, global QOL, financial impact), symptoms (pain), and emotional areas (future perspective and worries about others) than AI patients but worse QOL in skin mucosis symptoms. CONCLUSIONS The results of this study show that postmenopausal early-stage breast cancer patients adapted well to their disease and endocrine therapy treatment. QOL improvements in the 1-year follow-up period appeared in one key area: pain. Differences between endocrine therapy modalities suggested QOL was better in the tamoxifen group than in the AI group.
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Affiliation(s)
| | - Jose Juan Illarramendi
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Manterola
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Susana de la Cruz
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Berta Ibañez
- Navarrabiomed, RICAPPS, Unidad de Metodología, Pamplona, Spain
| | - Esteban Salgado
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ignacio Visus
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Marta Barrado
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Lucia Teiejira
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - María Isabel Martinez
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Enrique Martinez
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ruth Vera
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
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Mokhatri-Hesari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes 2020; 18:338. [PMID: 33046106 PMCID: PMC7552560 DOI: 10.1186/s12955-020-01591-x] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer still is a topic. This overview of the literature aimed to update the current knowledge on quality of life in breast cancer patients. METHODS A review of literature in MEDLINE, Cochrane Database of Systematic Reviews and Google Scholar were carried out to identify review papers on health-related quality of life in breast cancer during the 2008 to 2018. All publications were screened using the PRISMA guideline. The methodological quality of reviews was assessed using the AMSTAR. The findings were summarized and tabulated accordingly. RESULTS Within over a decade, a total of 974 review papers were identified which according to the study selection criteria finally we have evaluated 82 reviews. Of these about 85% had a reasonable methodological quality. The findings were mainly summarized on several headings including instruments used to measure quality of life, treatment, supportive care, psychological distress, and symptoms. Questionnaires had a good performance to quantify quality of life in breast cancer patients. Most reviews were focused on the impact of treatment including endocrine therapy as well as integrating complementary and alternative medicine into the current practice. According to the reviews, yoga was the most recommended exercise to improve quality of life in breast cancer patients. CONCLUSION Overall, the findings from this overview indicated that quality of life in breast cancer patients enhanced during the last decade. Several simple but effective interventions such as physical activity and psychosocial interventions proved to be effective in improving quality of life in this population. However, management of symptoms such as pain, and lymphedema, issues related to worry, sexual function especially for young patients, and the future outlooks all are among topics that deserve further consideration. Also, this overview indicated that methodological issues in measuring quality of life in breast cancer patients improved greatly, but still there is a long way to go to understand what really matter to patients.
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Affiliation(s)
- Parisa Mokhatri-Hesari
- Integrative Oncology Research Group, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.,Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. .,Faculty of Humanity Sciences, University of Science and Culture, ACECR, Tehran, Iran.
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Zhou K, Wang W, Zhao W, Li L, Zhang M, Guo P, Zhou C, Li M, An J, Li J, Li X. Benefits of a WeChat-based multimodal nursing program on early rehabilitation in postoperative women with breast cancer: A clinical randomized controlled trial. Int J Nurs Stud 2020; 106:103565. [PMID: 32272281 DOI: 10.1016/j.ijnurstu.2020.103565] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 01/01/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary treatments for early-stage breast cancer can cause adverse effects, such as pain, fatigue, and sleep disturbance, that can markedly affect the patients' health-related quality of life. OBJECTIVE This study aimed to evaluate the benefits of a WeChat-based multimodal nursing program on early rehabilitation in postoperative women with breast cancer. DESIGN Clinical randomized controlled trial. SETTING Surgical breast cancer department of a general hospital in Shaanxi Province, China. PARTICIPANTS Women with breast cancer were recruited via convenience sampling. The inclusion criteria were (1) age ≥18 years, (2) newly diagnosed with breast cancer, (3) stage I-III disease, and (4) indicated for surgery with adjuvant therapy. Exclusion criteria were (1) comorbidity with other malignant tumors and infections and (2) cognitive or psychiatric disorders. METHODS We recruited patients with breast cancer and randomly allocated them to the intervention (n = 56) and control (n = 55) groups. The former was subjected to the WeChat-based multimodal nursing program plus routine nursing care for 6 months, whereas the latter received only routine nursing care. The primary endpoint (health-related quality of life) and secondary endpoints (pain, fatigue, and sleep) were measured using the Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0) and the Numerical Rating Scale at 4 time points (i.e., pre-surgery and 1, 3, and 6 months post-surgery). RESULTS The intervention group had significantly improved total FACT-Bv4.0 scores owing to the effects of group (F = 16.28, P < 0.001), time (F = 28.82, P < 0.001), and group-time interaction (F = 5.35, P = 0.001). Similar improvements were also found in social/family well-being and functional well-being (P < 0.05). Emotional well-being was improved based on the effects of time (F = 42.12, P < 0.001) and group-time interaction (F = 10.20, P < 0.001). The 'breast cancer-specific subscale for additional concerns' was affected by group (F = 21.55, P < 0.001) and time (F = 28.96, P < 0.001), whereas physical well-being was only affected by time (F = 35.39, P < 0.001). Pain, fatigue, and sleep were not significantly influenced by group effects. CONCLUSIONS We found a significant improvement in the health-related quality of life of postoperative women with breast cancer who used the WeChat-based multimodal nursing program during early rehabilitation. This demonstrated that the program is an effective intervention for postoperative rehabilitation in such patients. Findings of the study will provide evidence for eHealth services in clinical and transitional nursing care.
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Affiliation(s)
- Kaina Zhou
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China.
| | - Wen Wang
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Wenqian Zhao
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Lulu Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Mengyue Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Pingli Guo
- Surgical Breast Cancer Department, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Can Zhou
- Surgical Breast Cancer Department, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Minjie Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Jinghua An
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China.
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, Shaanxi 710061, China.
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Cheng J, Liu Y, He L, Liu W, Chen Y, Liu F, Guo Y, Ran H, Yang L. Novel Multifunctional Nanoagent for Visual Chemo/Photothermal Therapy of Metastatic Lymph Nodes via Lymphatic Delivery. ACS OMEGA 2020; 5:3194-3206. [PMID: 32118135 PMCID: PMC7045339 DOI: 10.1021/acsomega.9b03258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/30/2020] [Indexed: 05/15/2023]
Abstract
Breast cancer is one of the major diseases that threaten women's health. Lymph node (LN) metastasis is the most common metastatic path of breast cancer. Finding a simple, effective, and safe strategy to eliminate metastatic tumors in LNs is highly desired for clinical use. Carbon nanoparticles (CNs), as an LN tracer, have been widely used in the clinical setting. In addition, previous experiments have confirmed that CNs have good photoacoustic imaging and photothermal effects. In this study, we used CNs as a photothermal conversion material and drug carrier, poly(lactic-co-glycolic acid) (PLGA) as a film-forming material, and docetaxel as a chemotherapy drug to prepare multifunctional nanoparticles (DOC-CNPs). The prepared DOC-CNPs present as a black solution, which shows smooth spherical particles under light microscopy and transmission electron microscopy (TEM), and they have a good ability for liquid-gas phase transition, good dispersibility, high drug-loading capacity, and low cytotoxicity. In vitro, they can release drugs and inhibit tumor cells after laser irradiation. The photoacoustic (PA) signal intensity and the photothermal conversion efficiency increased with an increase in the concentration of DOC-CNPs. In vivo, after administration, the DOC-CNPs reached the LNs. After laser irradiation, the DOC-CNPs absorbed laser energy, and the temperature of the LNs increased high enough to achieve photothermal therapy under PA and ultrasound monitoring. Fracture of the DOC-CNPs was caused by the liquid-gas phase transition with the increased temperature, and the ruptured DOC-CNPs released docetaxel to achieve targeted chemotherapy. These findings suggested that DOC-CNPs can achieve precise treatment for metastatic LNs of breast cancer with PA and ultrasound visualization.
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Affiliation(s)
- Juan Cheng
- Ultrasound
Department, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
- Chongqing
Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Ying Liu
- Department
of Breast and Thyroid Surgery, Second Affiliated
Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Lingyun He
- Department
of Scientific Research and Education Section, Chongqing Health Center for Women and Children, Chongqing 401120, China
| | - Weiwei Liu
- Ultrasound
Department, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
- Chongqing
Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Yuli Chen
- Ultrasound
Department, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
- Chongqing
Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Fengqiu Liu
- Ultrasound
Department, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
- Chongqing
Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Yuan Guo
- Ultrasound
Department, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
- Chongqing
Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Haitao Ran
- Ultrasound
Department, Second Affiliated Hospital of
Chongqing Medical University, Chongqing 400010, China
- Chongqing
Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Lu Yang
- Department
of Breast and Thyroid Surgery, Second Affiliated
Hospital of Chongqing Medical University, Chongqing 400010, China
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Schadendorf D, Hauschild A, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Lesimple T, Plummer R, Schachter J, Dasgupta K, Manson S, Koruth R, Mookerjee B, Kefford R, Dummer R, Kirkwood JM, Long GV. Patient-reported outcomes in patients with resected, high-risk melanoma with BRAF V600E or BRAF V600K mutations treated with adjuvant dabrafenib plus trametinib (COMBI-AD): a randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2019; 20:701-710. [PMID: 30928620 DOI: 10.1016/s1470-2045(18)30940-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND In the phase 3 COMBI-AD study, patients with resected, stage III melanoma with BRAFV600E or BRAFV600K mutations received adjuvant dabrafenib plus trametinib or placebo. The primary analysis showed that dabrafenib plus trametinib significantly improved relapse-free survival at 3 years. These results led to US Food and Drug Administration approval of dabrafenib plus trametinib as adjuvant treatment for patients with resected stage III melanoma with BRAFV600E or BRAFV600K mutations. Here, we report the patient-reported outcomes from COMBI-AD. METHODS COMBI-AD was a randomised, double-blind, placebo-controlled, phase 3 study done at 169 sites in 25 countries. Study participants were aged 18 years or older and had complete resection of stage IIIA (lymph node metastases >1 mm), IIIB, or IIIC cutaneous melanoma as per American Joint Committee on Cancer 7th edition criteria, with BRAFV600E or BRAFV600K mutations, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (1:1) via an interactive voice response system, stratified by mutation type and disease stage, to receive oral dabrafenib (150 mg twice daily) plus oral trametinib (2 mg once daily) or matching placebos for 12 months. Patients, physicians, and the investigators who analysed the data were masked to treatment allocation. The primary endpoint was relapse-free survival, reported elsewhere. Health-related quality of life, reported here, was a prespecified exploratory endpoint, and was assessed with the European Quality of Life 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire in the intention-to-treat population. We used a mixed-model repeated-measures analysis to assess differences in health-related quality of life between groups. This study is registered with ClinicalTrials.gov, number NCT01682083. The trial is ongoing, but is no longer recruiting participants. FINDINGS Between Jan 31, 2013, and Dec 11, 2014, 870 patients were enrolled and randomly assigned to receive dabrafenib plus trametinib (n=438) or matching placebos (n=432). Data were collected until the data cutoff for analyses of the primary endpoint (June 30, 2017). The median follow-up was 34 months (IQR 28-39) in the dabrafenib plus trametinib group and 33 months (20·5-39) in the placebo group. During the 12-month treatment phase, there were no significant or clinically meaningful changes from baseline between groups in EQ-5D-3L visual analogue scale (EQ-VAS) or utility scores. During treatment, there were no clinically meaningful differences in VAS scores or utility scores in the dabrafenib plus trametinib group between patients who did and did not experience the most common adverse events. During long-term follow-up (range 15-48 months), VAS and utility scores were similar between groups and did not differ from baseline scores. At recurrence, there were significant decreases in VAS scores in both the dabrafenib plus trametinib group (mean change -6·02, SD 20·57; p=0·0032) and the placebo group (-6·84, 20·86; p<0·0001); the mean change in utility score also differed significantly at recurrence for both groups (dabrafenib plus trametinib -0·0626, 0·1911, p<0·0001; placebo -0·0748, 0·2182, p<0·0001). INTERPRETATION These findings show that dabrafenib plus trametinib did not affect patient-reported outcome scores during or after adjuvant treatment, and suggest that preventing or delaying relapse with adjuvant therapy could be beneficial in this setting. FUNDING Novartis.
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Affiliation(s)
- Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Heidelberg, Germany.
| | | | | | - Victoria Atkinson
- Princess Alexandra Hospital, Gallipoli Medical Research Foundation, University of Queensland, QLD, Australia
| | - Mario Mandalà
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | | | | | - Marta Nyakas
- Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Caroline Dutriaux
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint-André, Bordeaux, France
| | | | | | | | - Thierry Lesimple
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - Ruth Plummer
- Northern Centre for Cancer Care, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK
| | - Jacob Schachter
- Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Roy Koruth
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | | | - Richard Kefford
- Macquarie University, Sydney, NSW, Australia; Melanoma Institute Australia, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Reinhard Dummer
- University Hospital Zürich Skin Cancer Center, Zürich, Switzerland
| | - John M Kirkwood
- Melanoma Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Georgina V Long
- Melanoma Institute Australia, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia; Mater Hospital, Sydney, NSW, Australia
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