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Smith-Graziani DJ, Parker PA, Peterson SK, Bedrosian I, Shen Y, Black DM, DeSnyder SM, Hunt KK, Dong W, Brewster AM. Prospective Study of Pain Outcomes Associated With Breast Surgery in Women With Nonhereditary Breast Cancer. Ann Surg 2023; 277:e617-e623. [PMID: 33938495 PMCID: PMC10657557 DOI: 10.1097/sla.0000000000004925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess pain severity and interference with life in women after different types of breast cancer surgery and the demographic, treatment-related, and psychosocial variables associated with these pain outcomes. SUMMARY OF BACKGROUND DATA Data are conflicting regarding pain outcomes and quality of life (QOL) among women who undergo different types of breast surgery. METHODS Women with nonhereditary breast cancer completed the brief pain inventory before surgery and at 1, 6, 12, and 18 months postsurgery. We assessed associations between pain outcomes and CPM status and mastectomy status using multivariable repeated measures models. We assessed associations between pain outcome and QOL and decision satisfaction. RESULTS Of 288 women (mean age 56 years, 58% non-Hispanic White), 50 had CPM, 75 had unilateral mastectomy, and 163 had BCS. Mean pain severity scores were higher at one (2.78 vs 1.9, P = 0.016) and 6 months (2.79 vs 1.96, P = 0.031) postsurgery in women who had CPM versus those who did not, but there was no difference at 12 and 18 months. Comparing mastectomy versus BCS, pain severity was higher at 1 and 12 months. There was a significant interaction between pain severity and time point for CPM ( P = 0.006), but not mastectomy status ( P = 0.069). Regardless of surgery type, Black women had higher pain severity ( P = 0.004) than White women. Higher pain interference was associated with lower QOL ( P < 0.001) and lower decision satisfaction ( P = 0.034). CONCLUSIONS Providers should counsel women considering mastectomy about the potential for greater acute pain and its impact on overall well-being. Racial/ethnic disparities in pain exist and influence pain management in breast surgical patients.
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Affiliation(s)
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dalliah M Black
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Telerehabilitation for Managing Daily Participation among Breast Cancer Survivors during COVID-19: A Feasibility Study. J Clin Med 2022; 11:jcm11041022. [PMID: 35207294 PMCID: PMC8878496 DOI: 10.3390/jcm11041022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023] Open
Abstract
We aimed to examine the feasibility and impact of a short-term occupation-based telerehabilitation intervention (Managing Participation with Breast Cancer (MaP-BC)) on daily participation, health-related quality-of-life, and breast-cancer-related symptoms and understand women's perspectives regarding strategies to manage daily participation and symptoms during COVID-19 pandemic. A mixed-methods study (single-arm pre-post with a qualitative component) included 14 women after their primary medical treatment for breast cancer. Women received six weeks of occupation-based intervention using a video-communication. Sessions focused on identifying functional goals and training strategies to manage daily participation. The primary outcome was perceived performance and satisfaction with meaningful activities by the Canadian Occupational Performance Measure (COPM). Secondary outcomes were participation in the Activity Card Sort (ACS), upper-extremity functioning of Disability Arm Shoulder Hand, self-reported symptom severity, executive-functioning, health-related quality of life, and a question regarding strategies used to manage daily participation. Women significantly improved their daily participation in meaningful activities in the COPM, most ACS activity domains, self-reported executive functioning, and health-related-quality-of-life. Qualitative findings revealed three main themes: (1) daily life under the threats of breast cancer and COVID-19, (2) women's own strategies to overcome challenges, and (3) contribution of the MaP-BC. Providing telerehabilitation during the COVID-19 pandemic is feasible and successful in improving women's daily participation after breast cancer.
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Jang MK, Kim SH, Ko YH, Han J, Kim SY, Kim S. Comparing Disease-Specific and Generic Quality of Life in Korean Breast Cancer Survivors Using the FACT-B and QLI: The Importance of Instrument Selection. Integr Cancer Ther 2022; 21:15347354221085491. [PMID: 35289219 PMCID: PMC8928382 DOI: 10.1177/15347354221085491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Quality of life (QOL) has become an important indicator for evaluating patients' symptoms and their overall satisfaction with life. Thus, examining QOL is essential for fully understanding the life satisfaction of breast cancer survivors (BCS). However, selecting the appropriate instrument for QOL measurement is challenging, and few studies have compared disease-specific and generic QOL measures and how they reflect the impact of cancer-related symptoms on QOL in BCS. We examined QOL in BCS using both disease-specific and generic instruments and compared their representation of the QOL impacts of anxiety, depression, sleep, fatigability, and posttraumatic growth. METHODS This study involved analysis of follow-up data for an exercise intervention called the BLESS (Better Life after cancer, Energy, Strength, and Support) program, which included 40 BCS treated at 1 medical center in South Korea. Their QOL was assessed using both the Functional Assessment of Cancer Therapy-Breast (FACT-B) and Quality of Life Index (QLI). RESULTS Both FACT-B and QLI total scores revealed that Korean BCS had low levels of QOL. Furthermore, both FACT-B and QLI total scores were significantly related to anxiety, depression, sleep, fatigability, and posttraumatic growth in the participants. Notably, multivariate regression analysis of FACT-B and QLI total scores showed different predictors for QOL: with the FACT-B, depression was the only significant predictor, while with the QLI, posttraumatic growth was the only significant predictor. CONCLUSION The selection of a given QOL instrument may affect the overall findings and interpretation of the impacts of related symptoms. The FACT-B should be considered for studies of symptoms such as depression, while the QLI is more appropriate for examining overall QOL and posttraumatic growth.
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Affiliation(s)
| | | | | | | | | | - Sue Kim
- Yonsei University, Seoul, Korea
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Aesthetic monitoring-based assessment of oncological safety of oncoplastic management of breast cancer: a multi-center research study. BMC Surg 2021; 21:414. [PMID: 34876090 PMCID: PMC8650427 DOI: 10.1186/s12893-021-01410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oncoplastic Breast surgeries (OBS) in breast cancer have evolved to preserve the cancerous breast rather than its amputation to improve postoperative cosmetic results. The lack of evidence to support the oncological safety and benefits of OBS is questionable. In this study, we evaluate various aspects of oncoplastic surgeries with a focused monitoring of aesthetic results and oncological safety. METHODS This was a multi-center observational study focused on the statistics of data collected from cases who underwent oncoplastic surgeries from the cohort of breast cancer candidates at Mansoura University Hospitals/Egypt and King Faisal Medical Complex/KSA from January 2015 to June 2018. All data were analyzed carefully using SPSS v-26. RESULTS Eighty cases who underwent different oncoplastic surgeries were included and reviewed for the aesthetic outcome and oncological safety. The recurrence rate was found to be 2.5%. The breast impact treatment scale assessment method was used to analyze the aesthetic outcomes, and average scores were accepted in 90% of patients. CONCLUSIONS The oncoplastic breast surgeries are feasible and they had a high rate of oncological safety with the maintenance of good aesthetic outcomes and patient satisfaction.
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Gordon R, Fawson S, Moss-Morris R, Armes J, Hirsch CR. An experimental study to identify key psychological mechanisms that promote and predict resilience in the aftermath of treatment for breast cancer. Psychooncology 2021; 31:198-206. [PMID: 34529295 DOI: 10.1002/pon.5806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Women living with and beyond breast cancer (BC) frequently encounter cancer-related information in day-to-day life. The extent they are emotionally resilient to this information differs between women. Identifying key modifiable psychological mechanisms predicting resilience in these women could highlight targets for interventions to improve resilience in others. This study investigates resilience over time in women living beyond BC and how this relates to individual differences in the way the brain processes information. METHODS Seventy women within a year of finishing first-line treatment for BC (clinical and community recruitment) completed computerised tasks to assess the tendency to attend to cancer information (dot-probe task), the tendency to draw negative cancer-related interpretations from ambiguous information (ambiguous scenarios task) and extent of executive functioning (attentional network task). Questionnaires were completed assessing resilience, and other clinically relevant psychological variables (fear of cancer recurrence, distress, quality of life, and worry) at the time of the laboratory tasks (T1) and again 6 months later (T2). RESULTS The only cognitive process associated with self-reported resilience was interpretation bias. Generating more negative cancer-related interpretations of ambiguous information at T1 significantly predicted resilience at T2, whilst controlling for T1 resilience and other clinically relevant variables. Furthermore, resilience scores were relatively stable over time and moderately correlated with other clinically relevant variables. CONCLUSIONS This study is the first to identify a key cognitive mechanism that predicts resilience in women living beyond BC. This finding suggests interventions to reduce cancer-related interpretations of ambiguous information could promote resilience in women living beyond BC.
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Affiliation(s)
- Rola Gordon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sophie Fawson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Loubani K, Kizony R, Milman U, Schreuer N. Hybrid Tele and In-Clinic Occupation Based Intervention to Improve Women's Daily Participation after Breast Cancer: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5966. [PMID: 34199448 PMCID: PMC8199623 DOI: 10.3390/ijerph18115966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women after breast cancer (BC) cope with decreased daily participation and quality of life (QOL) due to physical, cognitive, and emotional symptoms. This study examined a hybrid occupation-based intervention, Managing Participation with Breast Cancer (MaP-BC), to improve daily participation in their meaningful activities. METHODS Thirty-five women after BC phase were randomly allocated to the MaP-BC intervention (n = 18) or control (n = 17) group (standard care only). Assessments were administered at baseline (T1), 6-week (T2), and 12-week (T3) post-T1. MAIN OUTCOME perceived performance and performance-satisfaction with meaningful activities according to the Canadian Occupational Performance Measure. SECONDARY OUTCOMES retained activity levels (Activity Card Sort), QOL (Functional Assessment of Cancer Therapy-Breast), cognitive abilities (Montreal Cognitive Assessment and Behavior Rating Inventory of Executive Function), and upper-extremity functioning (Disability of Arm, Shoulder, Hand). Results showed significant interaction (group x time) effects for the primary outcome in performance, F(2,66) = 29.54, p = 0.001, ɳP2 = 0.472, and satisfaction, F(2,66) = 37.15, p = 0.000, ɳP2 = 0.530. The intervention group improved more in performance, t = 5.51, p = 0.0001, d = 1.298, and satisfaction, t = -5.32, p = 0.0001, d = 1.254, than the control group between T1 and T2. Secondary outcomes demonstrated within-group improvements. CONCLUSION MaP-BC, a comprehensive occupation-based hybrid intervention tailored to women's functional daily needs after BC, improved participation in meaningful activities within a short period.
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Affiliation(s)
- Khawla Loubani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
- Clalit Health Services, Haifa and Western Galilee, Tel Aviv 62098, Israel;
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
- Sheba Medical Center, Department of Occupational Therapy, Tel Hashomer, Ramat Gan 52621, Israel
| | - Uzi Milman
- Clalit Health Services, Haifa and Western Galilee, Tel Aviv 62098, Israel;
| | - Naomi Schreuer
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
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Weng JK, Lei X, Schlembach P, Bloom ES, Shaitelman SF, Arzu IY, Chronowski G, Dvorak T, Grade E, Hoffman K, Perkins G, Reed VK, Shah SJ, Stauder MC, Strom EA, Tereffe W, Woodward WA, Hortobagyi GN, Hunt KK, Buchholz TA, Smith BD. Five-Year Longitudinal Analysis of Patient-Reported Outcomes and Cosmesis in a Randomized Trial of Conventionally Fractionated Versus Hypofractionated Whole-Breast Irradiation. Int J Radiat Oncol Biol Phys 2021; 111:360-370. [PMID: 33992718 DOI: 10.1016/j.ijrobp.2021.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE There are limited prospective data on predictors of patient-reported outcomes (PROs) after whole-breast irradiation (WBI) plus a boost. We sought to characterize longitudinal PROs and cosmesis in a randomized trial comparing conventionally fractionated (CF) versus hypofractionated (HF) WBI. METHODS AND MATERIALS From 2011 to 2014, women aged ≥40 years with Tis-T2 N0-N1a M0 breast cancer who underwent a lumpectomy with negative margins were randomized to CF-WBI (50 Gray [Gy]/25 fractions plus boost) versus HF-WBI (42.56 Gy/16 fractions plus boost). At baseline (pre-radiation), at 6 months, and yearly thereafter through 5 years, PROs included the Breast Cancer Treatment Outcome Scale (BCTOS), Functional Assessment of Cancer Therapy-Breast (FACT-B), and Body Image Scale; cosmesis was reported by the treating physician using Radiation Therapy Oncology Group cosmesis values. Multivariable mixed-effects growth curve models evaluated associations of the treatment arm and patient factors with outcomes and tested for relevant interactions with the treatment arm. RESULTS A total of 287 patients were randomized, completing a total of 14,801 PRO assessments. The median age was 60 years, 37% of patients had a bra cup size ≥D, 44% were obese, and 30% received chemotherapy. Through 5 years, there were no significant differences in PROs or cosmesis by treatment arm. A bra cup size ≥D was associated with worse BCTOS cosmesis (P < .001), BCTOS pain (P = .001), FACT-B Trial Outcome Index (P = .03), FACT-B Emotional Well-being (P = .03), and Body Image Scale (P = .003) scores. Physician-rated cosmesis was worse in patients who were overweight (P = .02) or obese (P < .001). No patient subsets experienced better PROs or cosmesis with CF-WBI. CONCLUSIONS Both CF-WBI and HF-WBI confer similar longitudinal PROs and physician-rated cosmesis through 5 years of follow-up, with no relevant subsets that fared better with CF-WBI. This evidence supports broad adoption of hypofractionation with boost, including in patients receiving chemotherapy and in a population with a high prevalence of obesity. The associations of large breast size and obesity with adverse outcomes across multiple domains highlight the opportunity to engage at-risk patients in lifestyle intervention strategies, as well as to consider alternative radiation treatment regimens.
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Affiliation(s)
- Julius K Weng
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Isidora Y Arzu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Tomas Dvorak
- Orlando Health UF Health Cancer Center, Orlando, Florida
| | - Emily Grade
- Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Karen Hoffman
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Perkins
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie K Reed
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shalin J Shah
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Eric A Strom
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Welela Tereffe
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Kelly K Hunt
- University of Texas MD Anderson Cancer Center, Houston, Texas
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Chapman BV, Lei X, Patil P, Tripathi S, Nicklaus KM, Grossberg AJ, Shaitelman SF, Thompson AM, Hunt KK, Buchholz TA, Merchant F, Markey MK, Smith BD, Reddy JP. Quantitative 3-Dimensional Photographic Assessment of Breast Cosmesis After Whole Breast Irradiation for Early Stage Breast Cancer: A Secondary Analysis of a Randomized Clinical Trial. Adv Radiat Oncol 2020; 5:824-833. [PMID: 33083644 PMCID: PMC7557136 DOI: 10.1016/j.adro.2020.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Our purpose was to use 3-dimensional (3D) surface photography to quantitatively measure breast cosmesis within the framework of a randomized clinical trial of conventionally fractionated (CF) and hypofractionated (HF) whole breast irradiation (WBI); to identify how 3D measurements are associated with patient- and physician-reported cosmesis; and to determine whether objective measures of breast symmetry varied by WBI treatment arm or transforming growth factor β 1 (TGFβ1) status. Methods and Materials From 2011 to 2014, 287 women age ≥40 with ductal carcinoma in situ or early-stage invasive breast cancer were enrolled in a multicenter trial and randomized to HF-WBI or CF-WBI with a boost. Three-dimensional surface photography was performed at 3 years posttreatment. Patient-reported cosmetic outcomes were recorded with the Breast Cancer Treatment Outcome Scale. Physician-reported cosmetic outcomes were assessed by the Radiation Therapy Oncology Group scale. Volume ratios and 6 quantitative measures of breast symmetry, termed F1-6C, were calculated using the breast contour and fiducial points assessed on 3D surface images. Associations between all metrics, patient- and physician-reported cosmesis, treatment arm, and TGFβ1 genotype were performed using the Kruskal-Wallis test and multivariable logistic regression models. Results Among 77 (39 CF-WBI and 38 HF-WBI) evaluable patients, both patient- and physician-reported cosmetic outcomes were significantly associated with the F1C vertical symmetry measure (both P < .05). Higher dichotomized F1C and volumetric symmetry measures were associated with improved patient- and physician-reported cosmesis on multivariable logistic regression (both P ≤ .05). There were no statistically significant differences in vertical symmetry or volume measures between treatment arms. Increased F6C horizontal symmetry was observed in the CF-WBI arm (P = .05). Patients with the TGFβ1 C-509T variant allele had lower F2C vertical symmetry measures (P = .02). Conclusions Quantitative 3D image-derived measures revealed comparable cosmetic outcomes with HF-WBI compared with CF-WBI. Our findings suggest that 3D surface imaging may be a more sensitive method for measuring subtle cosmetic changes than global patient- or physician-reported assessments.
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Affiliation(s)
- Bhavana V. Chapman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prithvi Patil
- Department of Engineering Technology, University of Houston, Houston, Texas
- The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shikha Tripathi
- Department of Engineering Technology, University of Houston, Houston, Texas
| | - Krista M. Nicklaus
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas
| | - Aaron J. Grossberg
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Simona F. Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alastair M. Thompson
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, Texas
| | - Kelly K. Hunt
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A. Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Scripps MD Anderson Cancer Center, La Jolla, California
| | - Fatima Merchant
- Department of Engineering Technology, University of Houston, Houston, Texas
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas
- Department of Computer Science, University of Houston, Houston, Texas
| | - Mia K. Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas
- Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding author: Jay P. Reddy, MD, PhD
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Quality of Life Indicators in Patients Operated on for Breast Cancer in Relation to the Type of Surgery-A Retrospective Cohort Study of Women in Serbia. ACTA ACUST UNITED AC 2020; 56:medicina56080402. [PMID: 32796629 PMCID: PMC7466215 DOI: 10.3390/medicina56080402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/09/2023]
Abstract
Background and objectives: Quality of life (QoL) after breast cancer surgery is an important public health issue. The aim of this study was to determine the relationship between the levels of perceived quality of life in patients operated on for breast cancer in relation to the type of surgery, using the standardized questionnaires. Materials and Methods: We assessed 425 women after surgery for breast cancer. The assessment included the application of the WHOQOL-bref (The World Health Organization Quality of Life-Bref), and FACT-B (Functional Assessment of Cancer Therapy-Breast) questionnaires. The statistical analysis of the data included multiple linear regression and correlation tests. Results: Multiple linear regression analysis found that education, existence of comorbidities, time elapsed since surgery, and type of surgery were significant predictors of overall quality of life. Women’s overall quality of life and general health has increased by 0.16 times for each subsequent year of surgery, and by 0.34 times for each subsequent higher education level. Breast-conserving surgery or mastectomy with breast reconstruction were statistically significant (β = 0.18) compared to total mastectomy. Conclusions: There is a significant difference in the quality of life perceived by patients in whom the breast has been preserved or reconstructed in relation to patients in whom total mastectomy has been performed.
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Delaloge S, Cella D, Ye Y, Buyse M, Chan A, Barrios CH, Holmes FA, Mansi J, Iwata H, Ejlertsen B, Moy B, Chia SKL, Gnant M, Smichkoska S, Ciceniene A, Martinez N, Filipović S, Ben-Baruch NE, Joy AA, Langkjer ST, Senecal F, de Boer RH, Moran S, Yao B, Bryce R, Auerbach A, Fallowfield L, Martin M. Effects of neratinib on health-related quality of life in women with HER2-positive early-stage breast cancer: longitudinal analyses from the randomized phase III ExteNET trial. Ann Oncol 2019; 30:567-574. [PMID: 30689703 DOI: 10.1093/annonc/mdz016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We report longitudinal health-related quality-of-life (HRQoL) data from the international, randomized, double-blind, placebo-controlled phase III ExteNET study, which demonstrated an invasive disease-free survival benefit of extended adjuvant therapy with neratinib over placebo in human epidermal growth factor receptor-2-positive early-stage breast cancer. PATIENTS AND METHODS Women (N = 2840) with early-stage HER2-positive breast cancer who had completed trastuzumab-based adjuvant therapy were randomly assigned to neratinib 240 mg/day or placebo for 12 months. HRQoL was an exploratory end point. Patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) and EuroQol 5-Dimensions (EQ-5D) questionnaires at baseline and months 1, 3, 6, 9, and 12. Changes from baseline were compared using analysis of covariance with no imputation for missing values. Sensitivity analyses used alternative methods. Changes in HRQoL scores were regarded as clinically meaningful if they exceeded previously reported important differences (IDs). RESULTS Of the 2840 patients (intention-to-treat population), 2407 patients were evaluable for FACT-B (neratinib, N = 1171; placebo, N = 1236) and 2427 patients for EQ-5D (neratinib, N = 1186; placebo, N = 1241). Questionnaire completion rates exceeded 85%. Neratinib was associated with a decrease in global HRQoL scores at month 1 compared with placebo (adjusted mean differences: FACT-B total, -2.9 points; EQ-5D index, -0.02), after which between-group differences diminished at later time-points. Except for the FACT-B physical well-being (PWB) subscale at month 1; all between-group differences were less than reported IDs. The FACT-B breast cancer-specific subscale showed small improvements with neratinib at months 3-9, but all were less than IDs. Sensitivity analyses exploring missing data did not change the results. CONCLUSIONS Extended adjuvant neratinib was associated with a transient, reversible decrease in HRQoL during the first month of treatment, possibly linked to treatment-related diarrhea. With the exception of the PWB subscale at month 1, all neratinib-related HRQoL changes did not reach clinically meaningful thresholds. ClinicalTrials.gov: NCT00878709.
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Affiliation(s)
- S Delaloge
- Department of Medicine, Institut Gustave Roussy, Villejuif, France.
| | - D Cella
- Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago
| | - Y Ye
- Puma Biotechnology Inc, Los Angeles, USA
| | - M Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - A Chan
- Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
| | - C H Barrios
- Oncology Research Unit, Pontifical Catholic University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
| | | | - J Mansi
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, UK
| | - H Iwata
- Department of Breast Oncology, Aichi Cancer Center, Chikusa-ku, Nagoya, Japan
| | - B Ejlertsen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - B Moy
- Department of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, USA
| | - S K L Chia
- Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - M Gnant
- Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - S Smichkoska
- University Clinic for Radiotherapy and Oncology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - A Ciceniene
- Oncology Institute of Vilnius University, Vilnius, Lithuania
| | - N Martinez
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S Filipović
- Clinic of Oncology, Clinical Center Niš, Nis, Serbia
| | - N E Ben-Baruch
- Department of Oncology, Kaplan Medical Center, Rehovot, Israel
| | - A A Joy
- Cross Cancer Institute, Edmonton, Canada
| | - S T Langkjer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - F Senecal
- Northwest Medical Specialties PLLC, Tacoma, USA
| | - R H de Boer
- Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia
| | - S Moran
- Puma Biotechnology Inc, Los Angeles, USA
| | - B Yao
- Puma Biotechnology Inc, Los Angeles, USA
| | - R Bryce
- Puma Biotechnology Inc, Los Angeles, USA
| | - A Auerbach
- Puma Biotechnology Inc, Los Angeles, USA
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - M Martin
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain
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11
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Parker PA, Peterson SK, Shen Y, Bedrosian I, Black DM, Thompson AM, Nelson JC, DeSnyder SM, Cook RL, Hunt KK, Volk RJ, Cantor SB, Dong W, Brewster AM. Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer. J Clin Oncol 2018; 36:2630-2638. [PMID: 30044695 DOI: 10.1200/jco.2018.78.6442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( Pinteraction < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( Pinteraction = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.
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Affiliation(s)
- Patricia A Parker
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Susan K Peterson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Yu Shen
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Isabelle Bedrosian
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Dalliah M Black
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Alastair M Thompson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Jonathan C Nelson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Sarah M DeSnyder
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert L Cook
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Kelly K Hunt
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert J Volk
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Scott B Cantor
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Wenli Dong
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Abenaa M Brewster
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
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12
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Reddy JP, Lei X, Huang SC, Nicklaus KM, Fingeret MC, Shaitelman SF, Hunt KK, Buchholz TA, Merchant F, Markey MK, Smith BD. Quantitative Assessment of Breast Cosmetic Outcome After Whole-Breast Irradiation. Int J Radiat Oncol Biol Phys 2017; 97:894-902. [PMID: 28333010 PMCID: PMC5685181 DOI: 10.1016/j.ijrobp.2016.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/17/2016] [Accepted: 12/14/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE To measure, by quantitative analysis of digital photographs, breast cosmetic outcome within the setting of a randomized trial of conventionally fractionated (CF) and hypofractionated (HF) whole-breast irradiation (WBI), to identify how quantitative cosmesis metrics were associated with patient- and physician-reported cosmesis and whether they differed by treatment arm. METHODS AND MATERIALS From 2011 to 2014, 287 women aged ≥40 with ductal carcinoma in situ or early invasive breast cancer were randomized to HF-WBI (42.56 Gy/16 fractions [fx] + 10-12.5 Gy/4-5 fx boost) or CF-WBI (50 Gy/25 fx + 10-14 Gy/5-7 fx). At 1 year after treatment we collected digital photographs, patient-reported cosmesis using the Breast Cancer Treatment and Outcomes Scale, and physician-reported cosmesis using the Radiation Therapy Oncology Group scale. Six quantitative measures of breast symmetry, labeled M1-M6, were calculated from anteroposterior digital photographs. For each measure, values closer to 1 imply greater symmetry, and values closer to 0 imply greater asymmetry. Associations between M1-M6 and patient- and physician-reported cosmesis and treatment arm were evaluated using the Kruskal-Wallis test. RESULTS Among 245 evaluable patients, patient-reported cosmesis was strongly associated with M1 (vertical symmetry measure) (P<.01). Physician-reported cosmesis was similarly correlated with M1 (P<.01) and also with M2 (vertical symmetry, P=.01) and M4 (horizontal symmetry, P=.03). At 1 year after treatment, HF-WBI resulted in better values of M2 (P=.02) and M3 (P<.01) than CF-WBI; treatment arm was not significantly associated with M1, M4, M5, or M6 (P≥.12). CONCLUSIONS Quantitative assessment of breast photographs reveals similar to improved cosmetic outcome with HF-WBI compared with CF-WBI 1 year after treatment. Assessing cosmetic outcome using these measures could be useful for future comparative effectiveness studies and outcome reporting.
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Affiliation(s)
- Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheng-Cheng Huang
- Department of Biomedical Engineering, University of Texas, Austin, Texas
| | - Krista M Nicklaus
- Department of Biomedical Engineering, University of Texas, Austin, Texas
| | - Michelle C Fingeret
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fatima Merchant
- Department of Engineering Technology, University of Houston, Houston, Texas
| | - Mia K Markey
- Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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13
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Swanick CW, Lei X, Shaitelman SF, Schlembach PJ, Bloom ES, Fingeret MC, Strom EA, Tereffe W, Woodward WA, Stauder MC, Dvorak T, Thompson AM, Buchholz TA, Smith BD. Longitudinal analysis of patient-reported outcomes and cosmesis in a randomized trial of conventionally fractionated versus hypofractionated whole-breast irradiation. Cancer 2016; 122:2886-94. [PMID: 27305037 DOI: 10.1002/cncr.30121] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/25/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The authors compared longitudinal patient-reported outcomes and physician-rated cosmesis with conventionally fractionated whole-breast irradiation (CF-WBI) versus hypofractionated whole-breast irradiation (HF-WBI) within the context of a randomized trial. METHODS From 2011 to 2014, a total of 287 women with American Joint Committee on Cancer stage 0 to stage II breast cancer were randomized to receive CF-WBI (at a dose of 50 grays in 25 fractions plus a tumor bed boost) or HF-WBI (at a dose of 42.56 grays in 16 fractions plus a tumor bed boost) after breast-conserving surgery. Patient-reported outcomes were assessed using the Breast Cancer Treatment Outcome Scale (BCTOS), the Functional Assessment of Cancer Therapy-Breast, and the Body Image Scale and were recorded at baseline and 0.5, 1, 2, and 3 years after radiotherapy. Physician-rated cosmesis was assessed at the same time points. Outcomes by treatment arm were compared at each time point using a 2-sided Student t test. Multivariable mixed effects growth curve models assessed the effects of treatment arm and time on longitudinal outcomes. RESULTS Of the 287 patients enrolled, 149 were randomized to CF-WBI and 138 were randomized to HF-WBI. At 2 years, the Functional Assessment of Cancer Therapy-Breast Trial Outcome Index score was found to be modestly better in the HF-WBI arm (mean 79.6 vs 75.9 for CF-WBI; P = .02). In multivariable mixed effects models, treatment arm was not found to be associated with longitudinal outcomes after adjusting for time and baseline outcome measures (P≥.14). The linear effect of time was significant for BCTOS measures of functional status (P = .001, improved with time) and breast pain (P = .002, improved with time). CONCLUSIONS In this randomized trial, longitudinal outcomes did not appear to differ by treatment arm. Patient-reported functional and pain outcomes improved over time. These findings are relevant when counseling patients regarding decisions concerning radiotherapy. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2886-2894. © 2016 American Cancer Society.
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Affiliation(s)
- Cameron W Swanick
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela J Schlembach
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth S Bloom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle C Fingeret
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric A Strom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Welela Tereffe
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael C Stauder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tomas Dvorak
- Department of Radiation Oncology, University of Florida Health Cancer Center at Orlando Health, Orlando, Florida
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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