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Saatchi Y, Schanen P, Cheung RA, Petty HR. Computer Vision Identifies Recurrent and Nonrecurrent Ductal Carcinoma in Situ Lesions with Special Emphasis on African-American Women. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1195-1207. [PMID: 37355038 DOI: 10.1016/j.ajpath.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023]
Abstract
Although nonrecurrent and recurrent forms of ductal carcinoma in situ (DCIS) of the breast are observed, no evidence-based test can make this distinction. The current retrospective case-control study used archival DCIS samples stained with anti-phospho-Ser226-glucose transporter type 1 and anti-phosphofructokinase type L antibodies. Immunofluorescence micrographs were used to create machine learning models of recurrent and nonrecurrent biomarker patterns, which were evaluated in cross-validation studies. Clinical performance was assessed by holdout studies using patients whose data were not used in training. Micrographs were stratified according to the recurrence probability of each image. Recurrent patients were defined by at least one image with a probability of recurrence ≥98%, whereas nonrecurrent patients had none. These studies found no false-negatives, identified true-positives, and uniquely identified true-negatives. Roughly 20% of the microscope fields of recurrent lesions were computationally recurrent. Strong prognostic results were obtained for both white and African-American women. This machine tool provides the first means to accurately predict recurrent and nonrecurrent patient outcomes. Data indicate that at least some false-positive findings were true-positive findings that benefited from surgical intervention. The intracellular locations of phospho-Ser226-glucose transporter type 1 and phosphofructokinase type L likely participate in cancer recurrences by accelerating glucose flux, a key feature of the Warburg effect.
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MESH Headings
- Female
- Humans
- Black or African American
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/ethnology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/ethnology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Case-Control Studies
- Glucose Transporter Type 1/metabolism
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Retrospective Studies
- White
- Recurrence
- Diagnosis, Computer-Assisted
- Microscopy, Fluorescence
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Affiliation(s)
| | - Parker Schanen
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Richard A Cheung
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Howard R Petty
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
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Azizoddin DR, Soens MA, Beck MR, Flowers KM, Edwards RR, Schreiber KL. Perioperative Sleep Disturbance Following Mastectomy: A Longitudinal Investigation of the Relationship to Pain, Opioid Use, Treatment, and Psychosocial Symptoms. Clin J Pain 2023; 39:76-84. [PMID: 36650603 PMCID: PMC9968504 DOI: 10.1097/ajp.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Sleep disturbance negatively impacts the quality of life and recovery. Our objective was to evaluate the relationship between the individual patient and surgical factors with greater sleep disturbance following breast surgery. METHODS In this prospective longitudinal study, patients completed validated measures regarding sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Univariable and multivariable generalized estimating equations evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after breast surgery. RESULTS Female patients (n=259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain and psychosocial factors (eg, anxiety, depression, and affect). Independent preoperative predictors of worse sleep disturbance included younger age (B=-0.09, P =0.006), opioid use (B=3.09, P =0.02), and higher pain (B=0.19, P =<0.001) and anxiety (B=0.45, P =<0.001) at baseline. In addition, higher baseline positive affect (B=-0.14, P =<0.012) and the surgical category total mastectomy without reconstruction (B=-2.81, P =<0.006) were independently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks postsurgery was associated with disturbed sleep. DISCUSSION Certain patient characteristics, including younger age and baseline anxiety, positive affect, pain, and opioid use, were associated with greater sleep disturbance in the first year after breast surgery. Sleep disturbance was also associated with the greater perioperative and postoperative opioid requirements. Preoperative interventions (eg, anxiety management, cultivating positive affect, and multimodal pain management) in high-risk individuals may enhance sleep and recovery postoperatively, and allow more moderate and less prolonged opioid use.
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Affiliation(s)
- Desiree R Azizoddin
- Department of Emergency Medicine
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Mieke A Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | | | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Support Care Cancer 2022; 31:85. [PMID: 36574040 DOI: 10.1007/s00520-022-07491-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The latest systematic review on the prevalence of pain in cancer survivors was published 5 years ago. The current review aims to provide an extended overview on the prevalence of pain, pain mechanisms, pain characteristics, and assessment methods in cancer survivors. METHODS A systematic research was conducted on 17th of April 2020 using MEDLINE, Embase, Scopus, Web of Science, and Cochrane looking at studies from 2014 to 2020. Studies had to report pain prevalence rates in cancer survivors with a solid tumor who finished curative treatment at least 3 months ago. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute quality appraisal tool. Characteristics of the included studies, participants and reported pain prevalence rates were extracted. The reported prevalence rates of the individual studies were pooled within a meta-analysis. Meta-regressions were performed to identify possible determinants of the pooled pain prevalence. RESULTS After deduplication, 7300 articles were screened, after which 38 were included in the meta-analysis. Risk of bias was rated low in 26 articles and moderate in 12 articles. The pooled pain prevalence was 47% (95%CI 39-55), with a heterogeneity of 98.99%. CONCLUSION This meta-analysis suggests that nearly half of cancer survivors report pain after completing curative treatment at least 3 months ago. However, substantial unexplained heterogeneity warrants cautious interpretation of these results. Meta-regression using cancer type, treatment location, pain measurement, and follow-up time as a covariate could not explain influencing factors explaining the high heterogeneity.
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Petty HR. Using Machine Vision of Glycolytic Elements to Predict Breast Cancer Recurrences: Design and Implementation. Metabolites 2022; 13:metabo13010041. [PMID: 36676966 PMCID: PMC9866082 DOI: 10.3390/metabo13010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
A major goal of biomedical research has been the early and quantitative identification of patients who will subsequently experience a cancer recurrence. In this review, I discuss the ability of glycolytic enzyme and transporter patterns within tissues to detect sub-populations of cells within ductal carcinoma in situ (DCIS) lesions that specifically precede cancer recurrences. The test uses conventional formalin fixed paraffin embedded tissue samples. The accuracy of this machine vision test rests on the identification of relevant glycolytic components that promote enhanced glycolysis (phospho-Ser226-glucose transporter type 1 (phospho-Ser226-GLUT1) and phosphofructokinase type L (PFKL)), their trafficking in tumor cells and tissues as judged by computer vision, and their high signal-to-noise levels. For each patient, machine vision stratifies micrographs from each lesion as the probability that the lesion originated from a recurrent sample. This stratification method removes overlap between the predicted recurrent and non-recurrent patients, which eliminates distribution-dependent false positives and false negatives. The method identifies computationally negative samples as non-recurrent and computationally positive samples are recurrent; computationally positive non-recurrent samples are likely due to mastectomies. The early phosphorylation and isoform switching events, spatial locations and clustering constitute important steps in metabolic reprogramming. This work also illuminates mechanistic steps occurring prior to a recurrence, which may contribute to the development of new drugs.
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Affiliation(s)
- Howard R Petty
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
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Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery. Pain Rep 2021; 6:e976. [PMID: 34841183 PMCID: PMC8613357 DOI: 10.1097/pr9.0000000000000976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Examining the divergence of prevalence and predictors of postsurgical numbness vs positive neuropathic symptoms gives insights into variation in clinical postoperative pain experienced by patients. Introduction: Both positive (burning, stabbing, and allodynia) and negative (numbness) neuropathic symptoms may arise after surgery but likely contribute differently to patients' postoperative pain experience. Numbness has been identified as divergent from positive neuropathic symptoms and therefore excluded from some neuropathic assessment tools (Neuropathic Pain Scale for PostSurgical patients [NeuPPS]). Objectives: In this prospective longitudinal study of patients undergoing breast surgery, we aimed to delineate the time course of numbness and its coincidence with NeuPPS and to contrast the association of surgical, psychosocial, and psychophysical predictors with the development of negative vs positive neuropathic symptoms. Methods: Patients reported surgical area sensory disturbances at 2 weeks and 3, 6, and 12 months postoperatively. Association of baseline demographic, surgical, psychosocial, and psychophysical factors with NeuPPS and numbness across time was investigated using generalized estimating equation linear and logistic regression. Results: Numbness was consistently reported by 65% of patients; positive neuropathic symptoms were less common, often decreasing over time. Neuropathic Pain scale for PostSurgical patients and numbness co-occurred in half of patients and were both associated with greater clinical pain severity and impact, younger age, axillary surgery, and psychosocial factors. More extensive surgery and chemotherapy were only associated with numbness. Conversely, other chronic pain, lower physical activity, perioperative opioid use, negative affect, and lower baseline pressure pain threshold and tolerance were only associated with NeuPPS. Patients reporting numbness alone did not endorse substantial clinical pain. Conclusions: Differentiation of predictors, prevalence, and time course of numbness vs NeuPPS in breast surgical patients revealed important distinctions, suggesting that their independent assessment is worthwhile in future studies of postsurgical pain.
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Rokhtabnak F, Sayad S, Izadi M, Djalali Motlagh S, Rahimzadeh P. Pain Control After Mastectomy in Transgender Patients: Ultrasound-guided Pectoral Nerve Block II Versus Conventional Intercostal Nerve Block: A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e119440. [PMID: 35070905 PMCID: PMC8771815 DOI: 10.5812/aapm.119440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background Mastectomy is sometimes performed in transgender patients, which may damage the regional nerves such as the pectoral and intercostobrachial nerves, leading to postoperative pain. An ultrasound-guided nerve block can be used to track and block the nerves properly. Objectives This study aimed to compare the ultrasound-guided type-II pectoral nerve block with the blind (conventional) intercostal nerve block (ICNB) for pain control after breast tissue reconstruction surgery in transgender patients. Methods In the present single-blind randomized clinical trial, 47 patients were randomly divided into two groups: (A) Ultrasound-guided type-II pectoral nerve block (n = 23) and (B) blind intercostal nerve block (n = 24). After nerve block in both groups, pain intensity at 3, 6, 12, and 24 hours after surgery, upper limb paresthesia, frequency of nausea and vomiting, shortness of breath, hematoma, and the length of hospital stay were assessed. Results Patients who received the ultrasound-guided type-II pectoral nerve block had a greater reduction in pain intensity (24 h after surgery), opioid use (24 h after surgery), nausea, vomiting, and hospital stay than those who received ICNB, whereas the recovery time did not differ between the study groups. Conclusions The pectoral nerve block under ultrasound guidance, compared to the intercostal nerve block, in transgender patients can reduce the required dosage of opioids within 24 hours, pain intensity within 24 hours after surgery, the incidence of postoperative nausea, and vomiting, and the hospital stay of patients.
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Affiliation(s)
- Faranak Rokhtabnak
- Department of Anesthesiology, Pain and Intensive Care, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Sayad
- Department of Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Izadi
- Department of Anesthesiology, Pain and Intensive Care, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Djalali Motlagh
- Department of Anesthesiology, Pain and Intensive Care, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Pain and Intensive Care, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
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Moloney NA, Pocovi NC, Dylke ES, Graham PL, De Groef A. Psychological Factors Are Associated with Pain at All Time Frames After Breast Cancer Surgery: A Systematic Review with Meta-Analyses. PAIN MEDICINE 2021; 22:915-947. [PMID: 33547465 DOI: 10.1093/pm/pnaa363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This systematic review aimed to 1) assess associations between psychological factors and pain after breast cancer (BC) treatment and 2) determine which preoperative psychological factors predicted pain in the acute, subacute, and chronic time frames after BC surgery. DESIGN A systematic review with meta-analysis. SUBJECTS Women with early-stage BC. METHODS The Medline, EMBASE, CINAHL, and Web of Science databases were searched between 1990 and January 2019. Studies that evaluated psychological factors and pain after surgery for early-stage BC were included. Associations between psychological factors and pain, from early after surgery to >12 months after surgery, were extracted. Effect size correlations (r equivalents) were calculated and pooled by using random-effects meta-analysis models. RESULTS Of 4,137 studies, 47 were included (n = 15,987 participants; 26 studies ≤12 months after surgery and 22 studies >12 months after surgery). The majority of the studies had low to moderate risk of bias. Higher preoperative anxiety and depression were weak but significant predictors of pain at all time points up to 12 months (r equivalent: 0.15-0.22). Higher preoperative pain catastrophizing and distress were also weak but significant predictors of pain during the acute (0-7 days) and chronic (3-12 months) periods (r equivalent: 0.10-0.20). For the period >12 months after surgery, weak but significant cross-sectional associations with pain were identified for anxiety, depression, pain catastrophizing, and distress (r equivalents: 0.15, 0.17, 0.25, 0.14, respectively). CONCLUSION Significant pooled effect size correlations between psychological factors and pain were identified across all time frames. Though weak, these associations should encourage assessment of key psychological factors during preoperative screening and pain assessments at all postoperative time frames.
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Affiliation(s)
- Niamh A Moloney
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Natasha C Pocovi
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth S Dylke
- Faculty of Medicine and Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Petra L Graham
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, and Macquarie University, Sydney, NSW, Australia
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Schreiber KL, Zinboonyahgoon N, Flowers KM, Hruschak V, Fields KG, Patton ME, Schwartz E, Azizoddin D, Soens M, King T, Partridge A, Pusic A, Golshan M, Edwards RR. Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive Preoperative Assessment of Biopsychosocial Pain Modulators. Ann Surg Oncol 2021; 28:5015-5038. [PMID: 33452600 DOI: 10.1245/s10434-020-09479-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Persistent post-mastectomy pain (PPMP) is a significant negative outcome occurring after breast surgery, and understanding which individual women are most at risk is essential to targeting of preventive efforts. The biopsychosocial model of pain suggests that factors from many domains may importantly modulate pain processing and predict the progression to pain persistence. METHODS This prospective longitudinal observational cohort study used detailed and comprehensive psychosocial and psychophysical assessment to characterize individual pain-processing phenotypes in 259 women preoperatively. Pain severity and functional impact then were longitudinally assessed using both validated surgery-specific and general pain questionnaires to survey patients who underwent lumpectomy, mastectomy, or mastectomy with reconstruction in the first postsurgical year. An agnostic, multivariable modeling strategy identified consistent predictors of several pain outcomes at 12 months. RESULTS The preoperative characteristics most consistently associated with PPMP outcomes were preexisting surgical area pain, less education, increased somatization, and baseline sleep disturbance, with axillary dissection emerging as the only consistent surgical variable to predict worse pain. Greater pain catastrophizing, negative affect, younger age, higher body mass index (BMI), and chemotherapy also were independently predictive of pain impact, but not severity. Sensory disturbance in the surgical area was predicted by a slightly different subset of factors, including higher preoperative temporal summation of pain. CONCLUSIONS This comprehensive approach assessing consistent predictors of pain severity, functional impact, and sensory disturbance may inform personalized prevention of PPMP and also may allow stratification and enrichment in future preventive studies of women at higher risk of this outcome, including pharmacologic and behavioral interventions and regional anesthesia.
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Affiliation(s)
- Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valerie Hruschak
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan E Patton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Schwartz
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Desiree Azizoddin
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mieke Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Pusic
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mehra Golshan
- Department of Surgery, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Rob R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Nickel B, McCaffery K, Houssami N, Jansen J, Saunders C, Spillane A, Rutherford C, Dixon A, Barratt A, Stuart K, Robertson G, Hersch J. Views of healthcare professionals about the role of active monitoring in the management of ductal carcinoma in situ (DCIS): Qualitative interview study. Breast 2020; 54:99-105. [PMID: 32971350 PMCID: PMC7509786 DOI: 10.1016/j.breast.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is an in-situ (pre-cancerous) breast malignancy whereby malignant cells are contained within the basement membrane of the breast ducts. Increasing awareness that some low-risk forms of DCIS might remain indolent for many years has led to concern about overtreatment, with at least 3 clinical trials underway internationally assessing the safety of active monitoring for low-risk DCIS. This study aimed to understand healthcare professionals' (HCPs) views on the management options for patients with DCIS. METHODS Qualitative study using semi-structured interviews with HCPs involved in the diagnosis and management of DCIS in Australia and New Zealand. Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis method. RESULTS Twenty-six HCPs including 10 breast surgeons, 3 breast physicians, 6 radiation oncologists, and 7 breast care nurses participated. There was a strong overall consensus that DCIS requires active treatment. HCPs generally felt uncomfortable recommending active monitoring as a management option for low-risk DCIS as they viewed this as outside current standard care. Overall, HCPs felt that active monitoring was an unproven strategy in need of an evidence base; however, many acknowledged that active monitoring for low-risk DCIS could be appropriate for patients with significant co-morbidities or limited life expectancy. They believed that most patients would opt for surgery wherever possible. CONCLUSIONS This study highlights the important need for robust randomised controlled trial data about active monitoring for women with low-risk DCIS, to provide HCPs with confidence in their management recommendations and decision-making.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | | | - Andrew Spillane
- The University of Sydney, Northern Clinical School, St Leonards, NSW, Australia; Mater Hospital, Wollstonecraft, NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Claudia Rutherford
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; The University of Sydney, Faculty Medicine and Health, Sydney Nursing School, Sydney, NSW, Australia
| | - Ann Dixon
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kirsty Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead, NSW, Australia; Westmead Breast Cancer Institute, Westmead, NSW, Australia; Western Clinical School, The University of Sydney, NSW, Australia
| | | | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
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11
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Mendonça AB, Pereira ER, Magnago C, Costa Rosa Andrade Silva RM, Meira KC, de Oliveira Martins A. Distress and the religious and spiritual coping of Brazilians living with cancer: A cross-sectional study. Eur J Oncol Nurs 2020; 48:101825. [DOI: 10.1016/j.ejon.2020.101825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
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12
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Dominici LS, Rosenberg SM. Ductal carcinoma in situ (DCIS): The importance of patient-reported outcomes (PRO). CURRENT BREAST CANCER REPORTS 2020; 12:90-97. [PMID: 32747864 DOI: 10.1007/s12609-020-00363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose Patient reported outcomes (PROs) are an optimal method for assessing quality of life (QOL), including physical and psychosocial health. This review summarizes PROs frequently assessed in the setting of a DCIS diagnosis. Recent findings Health-related QOL has generally been found to be modestly affected in women with DCIS and similar to women with invasive breast cancer. Several studies reported a substantial negative impact on sexual health and body image, including some differences based on surgery type. Some patients experience pain after treatment, although many physical symptoms resolve. The prevalence of anxiety and depression varied based on assessment timing, with symptoms improving over time. Women with DCIS often overestimate the risks associated both with DCIS and invasive cancer. Summary PROs provide critical information regarding the experiences of women following a DCIS diagnosis. Continued inclusion of PROs in clinical trials is warranted, further informing treatment decisions and adequately preparing patients for what to expect following treatment.
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Affiliation(s)
- Laura S Dominici
- Brigham and Women's Hospital, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
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Ryser MD, Weaver DL, Zhao F, Worni M, Grimm LJ, Gulati R, Etzioni R, Hyslop T, Lee SJ, Hwang ES. Cancer Outcomes in DCIS Patients Without Locoregional Treatment. J Natl Cancer Inst 2020; 111:952-960. [PMID: 30759222 PMCID: PMC6748726 DOI: 10.1093/jnci/djy220] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/26/2018] [Accepted: 11/29/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The vast majority of women diagnosed with ductal carcinoma in situ (DCIS) undergo treatment. Therefore, the risks of invasive progression and competing death in the absence of locoregional therapy are uncertain. METHODS We performed survival analyses of patient-level data from DCIS patients who did not receive definitive surgery or radiation therapy as recorded in the US National Cancer Institute's Surveillance, Epidemiology, and End Results program (1992-2014). Kaplan-Meier curves were used to estimate the net risk of subsequent ipsilateral invasive cancer. The cumulative incidences of ipsilateral invasive cancer, contralateral breast cancer, and death were estimated using competing risk methods. RESULTS A total of 1286 DCIS patients who did not undergo locoregional therapy were identified. Median age at diagnosis was 60 years (inter-quartile range = 51-74 years), with median follow-up of 5.5 years (inter-quartile range = 2.3-10.6 years). Among patients with tumor grade I/II (n = 547), the 10-year net risk of ipsilateral invasive breast cancer was 12.2% (95% confidence interval [CI] = 8.6% to 17.1%) compared with 17.6% (95% CI = 12.1% to 25.2%) among patients with tumor grade III (n = 244) and 10.1% (95% CI = 7.4% to 13.8%) among patients with unknown grade (n = 495). Among all patients, the 10-year cumulative incidences of ipsilateral invasive cancer, contralateral breast cancer, and all-cause mortality were 10.5% (95% CI = 8.5% to 12.4%), 3.9% (95% CI = 2.6% to 5.2%), and 24.1% (95% CI = 21.2% to 26.9%), respectively. CONCLUSION Despite limited data, our findings suggest that DCIS patients without locoregional treatment have a limited risk of invasive progression. Although the cohort is not representative of the general population of patients diagnosed with DCIS, the findings suggest that there may be overtreatment, especially among older patients and patients with elevated comorbidities.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor
- Breast Neoplasms/epidemiology
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Disease Progression
- Female
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Prognosis
- SEER Program
- Survival Analysis
- Young Adult
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Affiliation(s)
- Marc D Ryser
- Correspondence to: Marc D. Ryser, PhD, Department of Population Health Sciences and Department of Mathematics, Duke University Medical Center, 215 Morris St., Durham, NC 27701 (e-mail: )
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Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, Rico V, Ariello K, Dasios M, Lam H, DeAngelis C, Chow E. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Breast 2018; 42:113-127. [DOI: 10.1016/j.breast.2018.08.105] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 12/12/2022] Open
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Carreira H, Williams R, Müller M, Harewood R, Stanway S, Bhaskaran K. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. J Natl Cancer Inst 2018; 110:1311-1327. [PMID: 30403799 PMCID: PMC6292797 DOI: 10.1093/jnci/djy177] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/08/2018] [Accepted: 08/31/2018] [Indexed: 01/02/2023] Open
Abstract
Background We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. Methods Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. Results Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. Conclusions There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
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Affiliation(s)
- Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Rhea Harewood
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Liede A, Cai M, Crouter TF, Niepel D, Callaghan F, Evans DG. Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat 2018; 171:435-442. [PMID: 29808287 PMCID: PMC6096880 DOI: 10.1007/s10549-018-4824-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed. METHODS This observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan® database) measured BRCA testing and RRBM rates among females ≥ 18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed. RESULTS Angelina Jolie's NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P < 0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P = 0.70) was unchanged. After excluding women with in-situ tumors, the editorial's effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie's announcement. CONCLUSION The Angelina Effect-a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling-represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mona Cai
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Tamara Fidler Crouter
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
- SimulStat Incorporated, Solana Beach, CA, USA
| | | | - Fiona Callaghan
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
- Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort). Cancer Epidemiol 2018; 55:123-129. [DOI: 10.1016/j.canep.2018.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 12/27/2022]
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Severe depression more common in patients with ductal carcinoma in situ than early-stage invasive breast cancer patients. Breast Cancer Res Treat 2017; 167:205-213. [DOI: 10.1007/s10549-017-4495-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 11/12/2022]
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