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Ginzberg SP, Grady CB, Fayanju OM, Edmonds CE. Disparities in the Use of Preoperative Breast Magnetic Resonance Imaging After Breast Cancer Diagnosis. JCO Oncol Pract 2024:OP2300831. [PMID: 38950325 DOI: 10.1200/op.23.00831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 04/22/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE Preoperative magnetic resonance imaging (MRI) after breast cancer diagnosis is increasingly used to improve locoregional staging, particularly among women with dense breasts, extensive ductal carcinoma in situ, and lobular histology. The goals of this study were to (1) assess whether use of preoperative MRI varies by race and insurance type; and (2) determine whether preoperative MRI is associated with downstream surgical management. MATERIALS AND METHODS We performed a retrospective cohort study of women with stage 0-III breast cancer who were treated with surgical resection within our academic health system (2016-2019). Patients were categorized by race and insurance type. The primary outcome was receipt of preoperative MRI. Secondary outcomes included surgery extent (lumpectomy v mastectomy) and receipt of a second operation. RESULTS A total of 1,410 women (27% Black, 73% White; 67% private insurance, 26% Medicare, 6% Medicaid) were included. Black patients were significantly less likely to undergo preoperative MRI than White patients (odds ratio [OR], 0.54 [95% CI, 0.38 to 0.76]; P < .001). There was no association between insurance type and preoperative MRI (Medicare v private: OR, 0.77 [95% CI, 0.52 to 1.15]; P = .208; Medicaid v private: OR, 0.67 [95% CI, 0.36 to 1.25]; P = .210). White patients who underwent preoperative MRI were less likely to undergo lumpectomy versus those who did not (OR, 0.53 [95% CI, 0.37 to 0.76]; P < .001). Likelihood of re-excision was lower for Black women who had undergone MRI versus those who had not (OR, 0.43 [95% CI, 0.20 to 0.93]; P = .031). CONCLUSION Black patients were less likely than White patients to undergo preoperative MRI, yet Black women who underwent MRI were less likely to require re-excision. Standardizing preoperative MRI use may mitigate provider- and system-level biases and promote more equitable care.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Connor B Grady
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Oluwadamilola M Fayanju
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Rena Rowan Breast Center, Penn Medicine, Philadelphia, PA
| | - Christine E Edmonds
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA
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Heidinger M, Loesch JM, Levy J, Maggi N, Eller RS, Schwab FD, Kurzeder C, Weber WP. Association of relative resection volume with patient-reported outcomes applying different levels of oncoplastic breast conserving surgery - A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108478. [PMID: 38885597 DOI: 10.1016/j.ejso.2024.108478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/12/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The American Society of Breast Surgeons (ASBrS) recently classified oncoplastic breast conserving surgery (OBCS) into two levels. The association of resection ratio during OBCS with patient-reported outcomes (PRO) is unclear. MATERIALS AND METHODS Patients with stage 0-III breast cancer undergoing OBCS between 01/2011-04/2023 at a Swiss university hospital, who completed at least one postoperative BREAST-Q PRO questionnaire were identified from a prospectively maintained institutional database. Outcomes included differences in PROs between patients after ASBrS level I (<20 % of breast tissue removed) versus level II surgery (20-50 %). RESULTS Of 202 eligible patients, 129 (63.9 %) underwent level I OBCS, and 73 (36.1 %) level II. Six patients (3.0 %) who underwent completion mastectomy were excluded. The median time to final PROs was 25.4 months. Patients undergoing ASBrS level II surgery were more frequently affected by delayed wound healing (p < 0.001). ASBrS level was not found to independently predict any BreastQ domain. However, delayed wound healing was shown to reduce short-term physical well-being (estimated difference -26.27, 95 % confidence interval [CI] -39.33 to -13.22, p < 0.001). Higher age was associated with improved PROs. CONCLUSION ASBrS level II surgery allows the removal of larger tumors without impairing PROs. Preventive measures for delayed wound healing and close postoperative follow-up to promptly treat wound healing disorders may avoid short-term reductions in physical well-being.
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Affiliation(s)
- Martin Heidinger
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Julie M Loesch
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Jeremy Levy
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Ruth S Eller
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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3
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Chauhan H, Jiwa N, Nagarajan VR, Thiruchelvam P, Hogben K, Al-Mufti R, Hadjiminas D, Shousha S, Cutress R, Ashrafian H, Takats Z, Leff DR. Clinicopathological Predictors of Positive Resection Margins in Breast-Conserving Surgery. Ann Surg Oncol 2024; 31:3939-3947. [PMID: 38520579 PMCID: PMC11076377 DOI: 10.1245/s10434-024-15153-8] [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: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is associated with risk of positive resection margins following breast-conserving surgery (BCS) and subsequent reoperation. Prior reports grossly underestimate the risk of margin positivity with IBC containing a DCIS component (IBC + DCIS) due to patient-level rather than margin-level analysis. OBJECTIVE The aim of this study was to delineate the relative risk of IBC + DCIS compared with pure IBC (without a DCIS component) on margin positivity through detailed margin-level interrogation. METHODS A single institution, retrospective, observational cohort study was conducted in which pathology databases were evaluated to identify patients who underwent BCS over 5 years (2014-2019). Margin-level interrogation included granular detail into the extent, pathological subtype and grade of disease at each resection margin. Predictors of a positive margin were computed using multivariate regression analysis. RESULTS Clinicopathological details were examined from 5454 margins from 909 women. The relative risk of a positive margin with IBC + DCIS versus pure IBC was 8.76 (95% confidence interval [CI] 6.64-11.56) applying UK Association of Breast Surgery guidelines, and 8.44 (95% CI 6.57-10.84) applying the Society of Surgical Oncology/American Society for Radiation Oncology guidelines. Independent predictors of margin positivity included younger patient age (0.033, 95% CI 0.006-0.060), lower specimen weight (0.045, 95% CI 0.020-0.069), multifocality (0.256, 95% CI 0.137-0.376), lymphovascular invasion (0.138, 95% CI 0.068-0.208) and comedonecrosis (0.113, 95% CI 0.040-0.185). CONCLUSIONS Compared with pure IBC, the relative risk of a positive margin with IBC + DCIS is approximately ninefold, significantly higher than prior estimates. This margin-level methodology is believed to represent the impact of DCIS more accurately on margin positivity in IBC.
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MESH Headings
- Humans
- Female
- Margins of Excision
- Mastectomy, Segmental/methods
- Retrospective Studies
- Middle Aged
- Breast Neoplasms/surgery
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Aged
- Adult
- Follow-Up Studies
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Prognosis
- Aged, 80 and over
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Affiliation(s)
- Hemali Chauhan
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Natasha Jiwa
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Paul Thiruchelvam
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Katy Hogben
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Ragheed Al-Mufti
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Dimitri Hadjiminas
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Sami Shousha
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
- North West London Pathology, Imperial College NHS Trust, London, UK
| | - Ramsey Cutress
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zoltan Takats
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
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Wang Y, He Y, Wu S, Xie S. Disparities in quality of life among patients with breast cancer based on surgical methods: a cross-sectional prospective study. Sci Rep 2024; 14:11364. [PMID: 38762615 PMCID: PMC11102424 DOI: 10.1038/s41598-024-62105-z] [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: 10/05/2023] [Accepted: 05/14/2024] [Indexed: 05/20/2024] Open
Abstract
To determine the impact of breast conservation on quality of life and identify treatment-related and other demographic factors associated with post-breast cancer treatment quality of life. A prospective study was conducted on 392 women who underwent breast cancer surgery at Hangzhou Cancer Hospital from January 1, 2013, to December 31, 2022. Operable breast cancer patients who had completed all treatments except endocrine therapy were included. Patients with tumor recurrence/metastasis, bilateral or male breast cancer, and other primary malignancies were excluded. After enrollment, patients were asked to complete the BREAST-Q scale, and their pathological and medical records were reviewed. Analysis of variance was used to compare the quality of life scores among the groups. Univariate and multivariate linear regression analyses were performed to identify independent factors associated with quality of life scores in different domains. Participants completed the BREAST-Q scale at a median of 4.6 years after surgery. Quality of life scores varied based on the therapeutic strategy. Breast conservation has significant advantages over mastectomy in terms of breast satisfaction, psychosocial, and sexual well-being. Compared to oncoplastic breast-conserving surgery, mastectomy was independently associated with decreased breast satisfaction, psychosocial, and sexual well-being, while conventional breast-conserving surgery showed comparable outcomes to oncoplastic breast-conserving surgery in terms of these factors. Breast conservation leads to an improvement in quality of life compared to mastectomy. Oncoplastic breast-conserving surgery does not lead to a decrease in quality of life compared to conventional breast-conserving surgery and offers better outcomes compared to mastectomy.
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Affiliation(s)
- Yi Wang
- Division of Breast Surgery, Department of Surgical Oncology, Hangzhou Cancer Hospital, Zhejiang, China
| | - Yibo He
- Division of Breast Surgery, Department of Surgical Oncology, Hangzhou Cancer Hospital, Zhejiang, China
| | - Shiyan Wu
- Division of Breast Surgery, Department of Surgical Oncology, Hangzhou Cancer Hospital, Zhejiang, China
| | - Shangnao Xie
- Division of Breast Surgery, Department of Surgical Oncology, Hangzhou Cancer Hospital, Zhejiang, China.
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Kar S, Shrivastava V, Meena JK, Mohapatra I, Sahoo SR, Kar M. A Pilot Study to Show Longitudinal Trends in Health-Related Quality of Life (HRQOL) in a Cohort of Breast Cancer Patients Under Treatment at a Tertiary Healthcare Facility in Bhubaneswar, India. Indian J Community Med 2024; 49:501-507. [PMID: 38933792 PMCID: PMC11198538 DOI: 10.4103/ijcm.ijcm_390_23] [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: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Breast cancer incidence has overtaken that of cervical cancer among women in India according to the Globacon 2020 reports. Cancer management is also being streamlined at the Center and district levels, such that comprehensive integrated management is offered to cases to optimize the best results. In breast cancer, there are two modes of surgery namely Breast Conservation Surgery(BCS) and Modified Radical Mastectomy (MRM) now over 2 decades, with recommended Chemo radiation depending on the extent of the disease. HRQOL (Health-related Quality of Life) studies have been done in these groups of patients, due to their added relevance in terms of the loss of a vital organ like the breast. EORTC 30 and BR23 are standardized and detailed tools that have been seen to estimate QOL, keeping in mind a whole array of domains that are affected by the disease. Objective To evaluate the "Body Image" and "Quality of life" (QOL) in operated breast cancer patients using BR -23 and EORTC - QLQ- questionnaire at 1month (after surgery) and then 3 to 4 months after surgery. Methods This article attempts to draw a comparison among of EORTC30 and BR 23 scores calculated for 46 breast cancer patients operated during the pandemic time in one center and consenting to repeat the measures at pre-decided three time periods during the course of management. Results No significant differences are noted in the mean scores for EORTC 30 and BR23 for the two types of surgeries. Visit 1 scores for both modes of surgery are over 75 and by Visit 3 become less than 55 for EORTC. BR 23 (which measures the symptoms core to Breast cancer) at all 3 visits are between 45 to 55. Friedman's test shows that the scores are not significant for age groups, the number of living children, or lifestyle factors like alcohol or tobacco chewing, though quadratic graphs depict the distinct variations in the scores at the 3 times reinforcing the need for follow-up of mental health in these subjects at intervals. The study largely brings out a strong need for repeated follow-up and counseling at regular and short intervals, post-surgery in breast cancer patients. EORTC 30 and BR 23 tools are excellent to use to essay information on the mental health of patients with breast cancer.
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Affiliation(s)
- Sonali Kar
- Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Varsha Shrivastava
- Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | | | - Ipsa Mohapatra
- Department of Surgical Oncology, KIMS, KIIT University and ED AIIMS Darbhanga, Bihar, India
| | - Saroj Ranjan Sahoo
- Department of Surgical Oncology, KIMS, KIIT University and ED AIIMS Darbhanga, Bihar, India
| | - Madhabananda Kar
- Department of Surgical Oncology, KIMS, KIIT University and ED AIIMS Darbhanga, Bihar, India
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6
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Qu HM, Zhong HY, Xiao T, Li YJ, Ren P, Chen XJ. Perceived control, self-management efficacy, and quality of life in patients treated with radiation therapy for breast cancer: a longitudinal study. Support Care Cancer 2024; 32:284. [PMID: 38607445 DOI: 10.1007/s00520-024-08485-4] [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: 12/07/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This longitudinal study aims to examine the present state of perceived control, self-management efficacy, and overall quality of life (QoL) in patients with breast cancer undergoing radiotherapy, and gain insight into the dynamic trends and factors that influence the quality of life experienced by patients during the course of radiotherapy. METHODS Participants completed the Cancer Experience and Efficacy Scale (CEES), Strategies Used by People to Promote Health (SUPPH), and Functional Assessment of Cancer Therapy- Breast (FACT-B). The data was analyzed using the software SPSS26.0. Repeated measures analysis of variance (ANOVA) and mixed-effects linear models were used to analyze trends in perceived control, self-management efficacy, and QoL at three-time points, as well as factors affecting QoL during radiotherapy. RESULTS Perceived control and self-management efficacy were associated with QoL over the course of the radiotherapy. Self-management efficacy (β = 0.30, P < 0.001), presence of chemotherapy (β = 18.33, P = 0.024), and duration of illness (β = 2.25, P = 0.028) had a positive effect on the change in QoL, while time (β = - 2.95, P < 0.001), cancer experience (β = - 0.46, P < 0.001), and type of medical insurance (β = - 2.77, P = 0.021) had the negative effect on the change in QoL. CONCLUSION The QoL, perceived control, and self-efficacy of patients with breast cancer show dynamic changes during radiotherapy. The higher the self-efficacy, the better the QoL, and the worse the QoL when the sense of disease control is poor. At the same time, more attention should be paid to the QoL of breast cancer radiotherapy patients with a long course of the disease, receiving chemotherapy, and different medical payment methods.
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Affiliation(s)
- Hai-Mei Qu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Nursing, Xuanhan County People's Hospital, Dazhou, Sichuan, China
| | - Hong-Yue Zhong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Tian Xiao
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Yan-Jun Li
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Nursing, Suining Central Hospital, Suining, Sichuan, China
| | - Pan Ren
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiao-Ju Chen
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China.
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7
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Laughlin BS, Corbin KS, Toesca DAS, Thorpe CS, Golafshar MA, Pockaj B, Cronin P, McGee LA, Halyard MY, Mutter RW, Keole SR, Park SS, Shumway DA, Vern-Gross TZ, Vallow L, Wong WW, DeWees TA, Vargas CE. Physician- and Patient-Reported Outcomes of the MC1635 Phase 3 Trial of Ultrahypofractionated Versus Moderately Hypofractionated Adjuvant Radiation Therapy After Breast-Conserving Surgery. Int J Radiat Oncol Biol Phys 2024; 118:1049-1059. [PMID: 37914139 DOI: 10.1016/j.ijrobp.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/21/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Our aim was to report physician- and patient-reported outcomes of patients with localized breast cancer treated with moderate versus ultrahypofractionated whole breast irradiation (WBI) after breast-conserving surgery (BCS). METHODS AND MATERIALS Between February 2018 and February 2020, patients with localized breast cancer (pT0-3 pN0-1 M0) were offered participation in a phase 3 randomized clinical trial assessing adjuvant moderate hypofractionation (MHF) to 40 Gy in 15 fractions versus ultrahypofractionation (UHF) to 25 Gy in 5 fractions after BCS, with an optional simultaneously integrated boost. Toxicities, cosmesis, and quality of life were assessed at baseline, end of treatment (EOT), and 3 months, 1 year, 2 years, and 3 years from irradiation using validated metric tools. RESULTS One hundred seven patients were randomized to MHF (n = 54) or UHF (n = 53) adjuvant WBI. The median follow-up was 42.8 months. Grade 2 radiation dermatitis was experienced by 4 patients (7.4%) in the MHF arm and 2 patients (3.7%) in the UHF arm at EOT (P = .726). No grade 3 or higher toxicities were observed. Deterioration of cosmesis by physician assessment was observed in 2 (6.7%) patients treated in the UHF arm and 1 (1.9%) patient treated in the MHF arm at EOT (P = .534), whereas at 3 months, only 1 (1.8%) patient treated in the MHF arm demonstrated deterioration of cosmesis (P = .315). At EOT, 91% and 94% of patients reported excellent/good cosmesis among those treated with MHF and UHF regimens, respectively (P = .550). At 3 months, more patients within the MHF arm reported excellent/good cosmesis compared with those in the UHF arm (100% vs 91%; P = .030). However, the difference in patient-reported cosmesis disappeared at the 1-, 2-, and 3-year time points. CONCLUSIONS UHF WBI showed similar treatment-related late toxicities and similar provider-scored cosmesis compared with MHF radiation in patients treated adjuvantly after BCS.
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Affiliation(s)
| | | | | | - Cameron S Thorpe
- Department of Radiation Oncology, Sanford Health, Fargo, North Dakota
| | - Michael A Golafshar
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | - Barbara Pockaj
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Patricia Cronin
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Dean A Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Laura Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Todd A DeWees
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
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8
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Vrancken Peeters NJMC, Vlooswijk C, Bijlsma RM, Kaal SEJ, Kerst JM, Tromp JM, Bos MEMM, van der Hulle T, Lalisang RI, Nuver J, Kouwenhoven MCM, van der Ploeg IMC, van der Graaf WTA, Husson O. Sexual quality of life of adolescents and young adult breast cancer survivors. ESMO Open 2024; 9:102234. [PMID: 38281325 PMCID: PMC10937205 DOI: 10.1016/j.esmoop.2024.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND With increasing survival rates of adolescents and young adults (AYAs) with breast cancer, health-related quality of life (HRQoL) becomes more important. An important aspect of HRQoL is sexual QoL. This study examined long-term sexual QoL of AYA breast cancer survivors, compared sexual QoL scores with that of other AYA cancer survivors, and identified factors associated with long-term sexual QoL of AYA breast cancer survivors. MATERIALS AND METHODS Data of the SURVAYA study were utilized for secondary analyses. Sexual QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). Descriptive statistics were used to describe sexual QoL of AYA cancer survivors. Linear regression models were constructed to examine the effect of cancer type on sexual QoL and to identify factors associated with sexual QoL. RESULTS Of the 4010 AYA cancer survivors, 944 had breast cancer. Mean sexual QoL scores of AYA breast cancer survivors ranged from 34.5 to 60.0 for functional domains and from 25.2 to 41.5 for symptom-orientated domains. AYA breast cancer survivors reported significantly lower sexual QoL compared to AYA survivors of other cancer types on all domains. Age, time since diagnosis, relationship status, educational level, chemotherapy, hormonal therapy, breast surgery, body image, and coping were associated with sexual QoL of AYA breast cancer survivors. CONCLUSIONS AYA breast cancer survivors experience decreased sexual QoL in the long term (5-20 years) after diagnosis and worse score compared to AYA survivors of other cancer types, indicating a clear need to invest in supportive care interventions for those at risk, to enhance sexual well-being.
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Affiliation(s)
- N J M C Vrancken Peeters
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam
| | - C Vlooswijk
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht
| | - R M Bijlsma
- Department of Medical Oncology, University Medical Centre, Utrecht
| | - S E J Kaal
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen
| | - J M Kerst
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - J M Tromp
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam
| | - M E M M Bos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam
| | - T van der Hulle
- Department of Medical Oncology, Leiden University Medical Centre, Leiden
| | - R I Lalisang
- Department of Internal Medicine, Division of Medical Oncology, GROW-School of Oncology and Reproduction, Maastricht UMC+ Comprehensive Cancer Centre, Maastricht
| | - J Nuver
- Department of Medical Oncology, University Medical Centre Groningen, Groningen
| | - M C M Kouwenhoven
- Department of Neurology, Amsterdam UMC, Amsterdam University Medical Centres, Amsterdam
| | - I M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam
| | - O Husson
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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9
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Liu YT, Khan NH, Bordes MC, Reece GP, Francis AM, Chen TA, Bravo K, Markey MK. Impact of autologous breast reconstruction on bra fit. Support Care Cancer 2024; 32:105. [PMID: 38221586 DOI: 10.1007/s00520-023-08281-6] [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: 05/03/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction. METHODS We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t-test or Wilcoxon signed-rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction. RESULTS Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit. CONCLUSION Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.
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Affiliation(s)
- Yen-Tung Liu
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Novera H Khan
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Mary Catherine Bordes
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashleigh M Francis
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tzuan A Chen
- HEALTH Research Institute, University of Houston, Houston, TX, USA
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Karen Bravo
- Independent Fashion Designer, Austin, TX, USA
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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10
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Chang WH, Lai AG. Pan-cancer analyses of the associations between 109 pre-existing conditions and cancer treatment patterns across 19 adult cancers. Sci Rep 2024; 14:464. [PMID: 38172343 PMCID: PMC10764847 DOI: 10.1038/s41598-024-51161-0] [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: 10/17/2022] [Accepted: 01/01/2024] [Indexed: 01/05/2024] Open
Abstract
Comorbidities present considerable challenges to cancer treatment and care. However, little is known about the effect of comorbidity on cancer treatment decisions across a wide range of cancer types and treatment modalities. Harnessing a cohort of 280,543 patients spanning 19 site-specific cancers, we explored pan-cancer frequencies of 109 comorbidities. Multinomial logistic regression was used to analyse the relationship between comorbidities and cancer treatment types, while binomial logistic regression examined the association between comorbidities and chemotherapy drug types, adjusting for demographic and clinical factors. Patients with comorbidity exhibited lower odds of receiving chemotherapy and multimodality treatment. End-stage renal disease was significantly associated with a decreased odds of receiving chemotherapy and surgery. Patients with prostate cancer who have comorbid non-acute cystitis, obstructive and reflux uropathy, urolithiasis, or hypertension were less likely to receive chemotherapy. Among patients with breast cancer, dementia, left bundle branch block, peripheral arterial disease, epilepsy, Barrett's oesophagus, ischaemic stroke, unstable angina and asthma were associated with lower odds of receiving multimodal chemotherapy, radiotherapy and surgery. Comorbidity is also consistently associated with the lower odds of receiving chemotherapy when comparing across 10 drug classes. Patients with comorbid dementia, intracerebral haemorrhage, subarachnoid haemorrhage, oesophageal varices, liver fibrosis sclerosis and cirrhosis and secondary pulmonary hypertension were less likely to receive antimetabolites. Comorbidity can influence the effectiveness and tolerability of cancer treatment and ultimately, prognosis. Multi-specialty collaborative care is essential for the management of comorbidity during cancer treatment, including prophylactic measures to manage toxicities.
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Affiliation(s)
- Wai Hoong Chang
- Institute of Health Informatics, University College London, London, UK.
| | - Alvina G Lai
- Institute of Health Informatics, University College London, London, UK.
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11
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Ofri A, Elstner K, Mann GB, Kumar S, Warrier S. Neoadjuvant chemotherapy in non-metastatic breast cancer: The surgeon's perspective. Surgeon 2023; 21:356-360. [PMID: 37088639 DOI: 10.1016/j.surge.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Breast cancer is the most common non-skin cancer in Australia, affecting 1 in 7 women by the age of 85 years. Current management of early breast cancer is becoming increasingly variable and complex. The typical range of treatments include some combination of surgery, chemotherapy and targeted therapy, immunotherapy, radiotherapy, and endocrine therapy. Neoadjuvant chemotherapy (NACT) in carefully selected patients can facilitate increased rates of breast conservation therapy, and when successful, offers improved cosmesis due to less extensive resection of tissue. A neoadjuvant approach also provides biological insight into a patient's tumour, prognostication based on a patient's response to therapy, as well as enabling their treating oncologist to personalise adjuvant strategies based on the presence or absence of residual cancer at surgery. Neoadjuvant chemotherapy has become an integral element in the provision of breast conserving surgery to selected early-stage breast cancer patients. Appreciating the indications and understanding the likely outcomes from NACT in select situations, can result in significant improvements in patient tailored care.
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Affiliation(s)
- A Ofri
- Department of Surgery, Mater Hospital, North Sydney NSW 2060, Australia; St Vincent's Clinical School, University of New South Wales, Sydney NSW 2052, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown NSW 2050, Australia.
| | - K Elstner
- Department of Breast Services, Monash Health, Bentleigh East VIC 3165, Australia
| | - G B Mann
- Department of Surgery, The University of Melbourne, Parkville, VIC 3052, Australia
| | - S Kumar
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead NSW 2145, Australia; Westmead Breast Cancer Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - S Warrier
- Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown NSW 2050, Australia; Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050, Australia
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12
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Haussmann J, Budach W, Corradini S, Krug D, Jazmati D, Tamaskovics B, Bölke E, Pedotoa A, Kammers K, Matuschek C. Comparison of adverse events in partial- or whole breast radiotherapy: investigation of cosmesis, toxicities and quality of life in a meta-analysis of randomized trials. Radiat Oncol 2023; 18:181. [PMID: 37919752 PMCID: PMC10623828 DOI: 10.1186/s13014-023-02365-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE/OBJECTIVE Adjuvant whole breast radiotherapy and systemic therapy are part of the current evidence-based treatment protocols for early breast cancer, after breast-conserving surgery. Numerous randomized trials have investigated the therapeutic effects of partial breast irradiation (PBI) compared to whole breast irradiation (WBI), limiting the treated breast tissue. These trials were designed to achieve equal control of the disease with possible reduction in adverse events, improvements in cosmesis and quality of life (QoL). In this meta-analysis, we aimed to investigate the differences between PBI and WBI in side effects and QoL. MATERIAL/METHODS We performed a systematic literature review searching for randomized trials comparing WBI and PBI in early-stage breast cancer with publication dates after 2009. The meta-analysis was performed using the published event rates and the effect-sizes for available acute and late adverse events. Additionally, we evaluated cosmetic outcomes as well as general and breast-specific QoL using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. RESULTS Sixteen studies were identified (n = 19,085 patients). PBI was associated with a lower prevalence in any grade 1 + acute toxicity and grade 2 + skin toxicity (OR = 0.12; 95% CI 0.09-0.18; p < 0.001); (OR = 0.16; 95% CI 0.07-0.41; p < 0.001). There was neither a significant difference in late adverse events between the two treatments, nor in any unfavorable cosmetic outcomes, rated by either medical professionals or patients. PBI-technique using EBRT with twice-daily fractionation schedules resulted in worse cosmesis rated by patients (n = 3215; OR = 2.08; 95% CI 1.22-3.54; p = 0.007) compared to WBI. Maximum once-daily EBRT schedules (n = 2071; OR = 0.60; 95% CI 0.45-0.79; p < 0.001) and IORT (p = 0.042) resulted in better cosmetic results grade by medical professionals. Functional- and symptom-based QoL in the C30-scale was not different between PBI and WBI. Breast-specific QoL was superior after PBI in the subdomains of "systemic therapy side effects" as well as "breast-" and "arm symptoms". CONCLUSION The analysis of multiple randomized trials demonstrate a superiority of PBI in acute toxicity as well breast-specific quality of life, when compared with WBI. Overall, late toxicities and cosmetic results were similar. PBI-technique with a fractionation of twice-daily schedules resulted in worse cosmesis rated by patients.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, Ludwig Maximillian University, Munich, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Bálint Tamaskovics
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alessia Pedotoa
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Kai Kammers
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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13
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Oei SL, Thronicke A, Grieb G, Schad F, Groß J. Evaluation of quality of life in breast cancer patients who underwent breast-conserving surgery or mastectomy using real-world data. Breast Cancer 2023; 30:1008-1017. [PMID: 37587322 DOI: 10.1007/s12282-023-01494-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Due to advances in the fight against breast cancer, aesthetic aspects and the prevention of breast deformities are playing an important role in surgical procedures. Currently the main form of breast cancer surgery is breast-conserving surgery (BCS), and even if mastectomy (MAS) is required, oncoplastic surgery and reconstruction options can improve outcomes, including health-related quality of life (QoL) of cancer patients. The purpose of this study was to assess whether surgery options induce different outcomes in self-reported QoL in guide-line treated breast cancer patients of the Network Oncology (NO). METHODS This prospective Real-World-Data (RWD) study was conducted using data from the NO-clinical registry. QoL was assessed by evaluation of the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30). Association factors between type of surgery options, without or with immediate breast reconstructions the EORTC QLQ-C30-scales at baseline after surgery, 6, 12, and 24 months later were analyzed with adjusted multivariate regression analysis, considering age, cancer stage, and treatment regimens, using software R. RESULTS A total of 623 primary breast cancer patients (all tumor stages, median age 58 (ICR: 50-68) diagnosed and guide-line treated between 2013 and 2021), 524 BCS and 99 MAS, 24 of whom received immediate breast reconstruction (MBR), were eligible for analyses. Compared with BCS patients, MBR patients self-reported considerably lower global health, physical and social functioning, and higher burden of pain and financial difficulties at baseline. In later follow-up surveys, functional scales increased and symptoms decreased in all patients, and the differences between MAS and BCS equalized. Longitudinal analyses after 24 months were obtained from 258 patients and revealed that compared to 224 BCS, the 34 MAS patients reported increased social functioning (p = 0.04). CONCLUSIONS At 24 months after MAS, breast cancer patients' QoL improved compared with BCS, although impairments in QoL were reported immediately after MAS. A growing expertise in surgical procedures as well as supportive care is critical to optimizing patients' well-being. These findings may be considered when counseling breast cancer patients pre- and post-surgery. TRIAL REGISTRATION NUMBER DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Friedemann Schad
- Research Institut Havelhöhe gGmbH at, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
- Interdisciplinary Oncology and Supportive Cancer Medicine, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
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14
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Björnström M, Niinikoski L, Arlan K, Meretoja TJ, Ståhls A, Hukkinen K. Vacuum-assisted excision of small breast cancers under ultrasound guidance. Eur J Radiol 2023; 167:111049. [PMID: 37611442 DOI: 10.1016/j.ejrad.2023.111049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The purpose of this study was to evaluate if it is possible to completely remove small breast cancer tumours with vacuum-assisted excision (VAE) under ultrasound guidance. METHODS Women ≥ 50 years old with a biopsy proven invasive cancer ≤ 10 mm were selected between October 2021 and November 2021 based on referrals and enrolled in this prospective study. The patients underwent VAE within six weeks following biopsy to remove the tumour. After the tumour was excised and the biopsy cavities margins were shaved, a radioactive seed was inserted into the biopsy cavity. The VAE excision cavity and surrounding tissue were surgically excised. Preliminary VAE results were evaluated after ten patients. For the study to proceed at least 80 % of the breast cancer tumours had to be completely removed by VAE. RESULTS The tumours median size in mammography was 8.5 mm (6-9 mm) and in ultrasound 6.5 mm (4-9 mm). The shape of the lesion was round in three (30 %), oval in two (20 %) and irregular in five (50 %) patients. None of the tumours were completely removed in the first VAE specimen, meaning that there was invasive cancer or ductal carcinoma in situ (DCIS) in the "shaved margins" and/or the surgical specimen. In five (50 %) cases, the surgical specimen was free of invasive cancer and DCIS. CONCLUSIONS None of the small invasive breast cancers were completely excised with VAE under ultrasound guidance, therefore it is not a reliable method to remove small breast cancers.
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Affiliation(s)
- Michaela Björnström
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Laura Niinikoski
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Kirill Arlan
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Tuomo J Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Anders Ståhls
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Katja Hukkinen
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
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15
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Wetzl M, Wenkel E, Steiding C, Ruth V, Emons J, Wasser MN, Uder M, Ohlmeyer S. Feasibility of In Vivo Metal Artifact Reduction in Contrast-Enhanced Dedicated Spiral Breast Computed Tomography. Diagnostics (Basel) 2023; 13:3062. [PMID: 37835805 PMCID: PMC10572310 DOI: 10.3390/diagnostics13193062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Radiopaque breast markers cause artifacts in dedicated spiral breast-computed tomography (SBCT). This study investigates the extent of artifacts in different marker types and the feasibility of reducing artifacts through a metal artifact reduction (MAR) algorithm. METHODS The pilot study included 18 women who underwent contrast-enhanced SBCT. In total, 20 markers of 4 different types were analyzed for artifacts. The extent of artifacts with and without MAR was measured via the consensus of two readers. Image noise was quantitatively evaluated, and the effect of MAR on the detectability of breast lesions was evaluated on a 3-point Likert scale. RESULTS Breast markers caused significant artifacts that impaired image quality and the detectability of lesions. MAR decreased artifact size in all analyzed cases, even in cases with multiple markers in a single slice. The median length of in-plain artifacts significantly decreased from 31 mm (range 11-51 mm) in uncorrected to 2 mm (range 1-5 mm) in corrected images (p ≤ 0.05). Artifact size was dependent on marker size. Image noise in slices affected by artifacts was significantly lower in corrected (13.6 ± 2.2 HU) than in uncorrected images (19.2 ± 6.8 HU, p ≤ 0.05). MAR improved the detectability of lesions affected by artifacts in 5 out of 11 cases. CONCLUSION MAR is feasible in SBCT and improves the image quality and detectability of lesions.
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Affiliation(s)
- Matthias Wetzl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany (S.O.)
| | - Evelyn Wenkel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany (S.O.)
| | | | - Veikko Ruth
- AB-CT–Advanced Breast-CT GmbH, Henkestrasse 91, 91052 Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Universitätsstraße 21/23, 91054 Erlangen, Germany
| | - Martin N. Wasser
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany (S.O.)
| | - Sabine Ohlmeyer
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany (S.O.)
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16
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Afshar-Bakshloo M, Albers S, Richter C, Berninger O, Blohmer JU, Roehle R, Speiser D, Karsten MM. How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes. BMC Cancer 2023; 23:705. [PMID: 37507687 PMCID: PMC10375629 DOI: 10.1186/s12885-023-11172-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. METHODS EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. RESULTS BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). CONCLUSIONS Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
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Affiliation(s)
- Melissa Afshar-Bakshloo
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Albers
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Chiara Richter
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ottilia Berninger
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dorothee Speiser
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Liu YT, Khan NH, Bordes MC, Reece GP, Francis AM, Chen TA, Bravo K, Markey MK. Impact of Autologous Breast Reconstruction on Bra Fit. RESEARCH SQUARE 2023:rs.3.rs-2891426. [PMID: 37214881 PMCID: PMC10197764 DOI: 10.21203/rs.3.rs-2891426/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction. Methods We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t test or Wilcoxon signed rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction. Results Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit. Conclusion Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.
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El Haidari R, Nerich V, Abou-Abbas L, Abdel-Sater F, Anota A. Pre-operative and early postoperative health-related quality of life of breast cancer woman: a Lebanese prospective study. BMC Womens Health 2023; 23:187. [PMID: 37081444 PMCID: PMC10116656 DOI: 10.1186/s12905-023-02348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
Breast cancer (BC) is a major health concern in Lebanon, with an increasing incidence rate due to advancements in treatment modalities. Evaluating the impact of the BC and its treatment on a woman's Health-Related Quality of Life (HRQoL), and comparing these patterns before and after breast conserving surgery is important to identify areas where interventions may be needed to improve the overall well-being of women with BC. This study aimed to evaluate the HRQoL pre and post-operative breast conserving surgery and just prior to initiation of adjuvant therapy in newly diagnosed patients with BC in Lebanon, specifically focusing on changes in body image. A prospective cohort study was conducted on 120 patients in two health care facilities in Lebanon, collecting sociodemographic and clinical data, and using the EORTC QLQ-C30 and QLQ-BR23 questionnaires to evaluate HRQoL. The outcomes were measured at baseline and then one-day post-operative breast surgery. Results revealed a statistically and clinically significant decrease in body image (mean difference of 8.1 points (95% 4.3;11.1)), physical functioning (mean difference of 6.1 points (95% 3.3;8.5)), and emotional functioning (mean difference of -8.4 points (95%-12.4; -4.9) after surgery. Positive change of physical functioning score was observed among married women. Positive change of emotional functioning score was observed among patients with poor body image score and high future perspective score. Our findings provide valuable insights for clinicians and researchers on the impact of breast conserving surgery on HRQoL in Lebanese women.
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Affiliation(s)
- Rana El Haidari
- Environments and Health Doctoral School, University of Bourgogne Franche-Comté, Besançon, France.
- INSPECT-LB (Institut National de Santé Publique, Epidémiologie Clinique Et Toxicologie-Liban), Beirut, Lebanon.
- INSERM UMR1098, University of Bourgogne, Franche-Comté, Besançon, France.
| | - Virginie Nerich
- INSERM UMR1098, University of Bourgogne, Franche-Comté, Besançon, France
- Department of Pharmacy, University Hospital of Besançon, Besançon, France
| | - Linda Abou-Abbas
- INSPECT-LB (Institut National de Santé Publique, Epidémiologie Clinique Et Toxicologie-Liban), Beirut, Lebanon
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Fadi Abdel-Sater
- Laboratory of Molecular Biology and Cancer Immunology, Faculty of Science, Lebanese University, Hadath, Lebanon
| | - Amelie Anota
- INSERM UMR1098, University of Bourgogne, Franche-Comté, Besançon, France
- Direction of Clinical Research and Innovation & Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
- French National Platform Quality of Life and Cancer, Besançon, France
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19
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Nafissi N, Meshkati Yazd SM, Shahriarirad R, Zangeneh S, Ghorbani S, Farazmand B, Karoobi M, Mirzaei HR. Postoperative cosmetic outcome of intraoperative radiotherapy in comparison to whole breast radiotherapy in early stage breast cancer; a retrospective cohort study. BMC Cancer 2023; 23:9. [PMID: 36597031 PMCID: PMC9811768 DOI: 10.1186/s12885-022-10468-9] [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: 06/16/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In this study, we aim to evaluate the cosmetic outcome differences between Intraoperative electron beam radiation therapy (IOERT) and whole breast radiotherapy (WBR) with further investigation of boosted IOERT. METHODS This retrospective cohort study was conducted in two referral centers in Tehran, Iran. 116 women aged 30 to 79 with early-stage breast cancer (T0-2N0-1M0) eligible for breast conservation were divided into two groups of 58 based on the intervention they received, and further subgroups were defined based on receiving boosted IOERT. Patients in both groups underwent breast conservation surgery and those in the IOERT group received either a 21 Gy radical dose (radical IOERT) or 12 Gy boosted electron beam radiotherapy and a routine fractionated dose of 50 Gy in 25 sessions of WBR (boosted IOERT). Those in the WBR group were administered 50Gy in 32 sessions. Physician-assessed cosmetic outcome was defined as the primary result and incidence of fat necrosis and fibrosis and post-operative chronic pain were secondary outcomes. RESULTS Post-operative cosmetic outcome scores and chronic pain, showed no significant difference between the two groups. The median cosmetic score in both groups was 9. Fat necrosis and fibrosis had significantly higher rates in the IOERT group (P. VALUE 0.001). However, the majority (21/34 or 61.8%) of this complication was observed in the boosted IOERT subgroup and no statistical significance was recorded between the radical IOERT subgroup and the WBR group. CONCLUSIONS In early-stage breast cancer treatment, radical IOERT has noninferiority compared to WBR in terms of cosmesis. Regarding fat necrosis and fibrosis, boosted IOERT was associated with higher rates in comparison to other groups. Therefore, radical IOERT seems to be a better treatment option for selected patients.
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Affiliation(s)
- Nahid Nafissi
- grid.411746.10000 0004 4911 7066Department of Breast, Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mostafa Meshkati Yazd
- grid.411705.60000 0001 0166 0922Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 01136746911 Iran
| | - Reza Shahriarirad
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saba Zangeneh
- grid.411135.30000 0004 0415 3047Fasa University of Medical Sciences, Fasa, Iran
| | - Sahar Ghorbani
- grid.411746.10000 0004 4911 7066Department of Breast, Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Borna Farazmand
- grid.411705.60000 0001 0166 0922Radiation Oncology Research Center, Iran Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Karoobi
- grid.411705.60000 0001 0166 0922Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 01136746911 Iran ,grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Mirzaei
- grid.411600.2Cancer Research Center, Shohadae Tajrish Hospital, Department of Radiation Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Koppiker C, Joshi S, Mishra R, Kelkar DA, Chigurupati P, Joshi A, John J, Kadu S, Bagdia A, Thakkar D, Deshmukh C, Allampati H, Sharan G, Dhar U, Nare S, Nagarkar S, Busheri L, Varghese B, Pai M. Therapeutic mammoplasty: a "wise" oncoplastic choice-lessons from the largest single-center cohort from Asia. Front Oncol 2023; 13:1131951. [PMID: 37124516 PMCID: PMC10141318 DOI: 10.3389/fonc.2023.1131951] [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: 12/26/2022] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The majority of breast cancer patients from India usually present with advanced disease, limiting the scope of breast conservation surgery. Therapeutic mammoplasty (TM), an oncoplastic technique that permits larger excisions, is quite promising in such a scenario and well suited to breast cancer in medium-to-large-sized breasts with ptosis and in some cases of large or multifocal/multicentric tumors. Here, we describe our TM cohort of 205 (194 malignant and 11 benign) patients from 2012 to 2019 treated at a single surgeon center in India, the largest Asian dataset for TM. Methods All patients underwent treatment after careful discussions by a multidisciplinary tumor board and patient counseling. We report the clinicopathological profiles and surgical, oncological, cosmetic, and patient-related outcomes with different TM procedures. Results The median age of breast cancer patients was 49 years; that of benign disease patients was 41 years. The breast cancer cohort underwent simple (n = 84), complex (n = 71), or extreme (n = 44) TM surgeries. All resection margins were analyzed through intra-operative frozen-section assessment with stringent rad-path analysis protocols. The margin positivity rate was found to be 1.4%. A majority of the cohort was observed to have pT1-pT2 tumors, and the median resection volume was 180 cc. Low post-operative complication rates and good-to-excellent cosmetic scores were observed. The median follow-up was 39 months. We observed 2.07% local and 5.7% distal recurrences, and disease-specific mortality was 3.1%. At median follow-up, the overall survival was observed to be 95.9%, and disease-free survival was found to be 92.2%. The patient-reported outcome measures (PROMs) showed good-to-excellent scores for all types of TMs across BREAST-Q domains. Conclusion We conclude that in India, a country where women present with large and locally advanced tumors, TM safely expands the indications for breast conservation surgery. Our results show oncological and cosmetic outcomes at acceptable levels. Most importantly, PROM scores suggest improved overall wellbeing and better satisfaction with the quality of life. For patients with macromastia, this technique not only focuses on cancer but also improves self-image and reduces associated physical discomfort often overlooked by women in the Indian setting. The popularization of this procedure will enable Indian patients with breast cancer to receive the benefits of breast conservation.
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Affiliation(s)
- Chaitanyanand Koppiker
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
- International School of Oncoplastic Surgery, Pune, India
- Jehangir Hospital, Pune, India
- *Correspondence: Chaitanyanand Koppiker,
| | - Sneha Joshi
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Rupa Mishra
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Devaki A. Kelkar
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | | | - Anjali Joshi
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Jisha John
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Shweta Kadu
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | | | - Deepti Thakkar
- International School of Oncoplastic Surgery, Pune, India
| | - Chetan Deshmukh
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
| | | | - Gautam Sharan
- Department of Radiation Oncology, Inlaks and Budhrani Hospital, Pune, India
| | - Upendra Dhar
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Jehangir Hospital, Pune, India
| | - Smeeta Nare
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Sanket Nagarkar
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
| | - Laleh Busheri
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
| | - Beenu Varghese
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
| | - Mugdha Pai
- Orchids Breast Health Centre, Prashanti Cancer Care Mission, Pune, India
- Centre for Translational Cancer Research: A Joint Initiative of Indian Institute of Science Education and Research (IISER), Pune and Prashanti Cancer Care Mission (PCCM), Pune, India
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21
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McKevitt E, Saleeb M, Liu G, Warburton R, Pao JS, Dingee C, Bazzarelli A, Tang K, Crump T, Sutherland JM. Differences in Preoperative Health-Related Quality of Life between Women Receiving Mastectomy or Breast Conserving Surgery in a Prospectively Recruited Cohort of Breast Cancer Patients. Curr Oncol 2022; 30:118-129. [PMID: 36661659 PMCID: PMC9857337 DOI: 10.3390/curroncol30010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
As rates of total mastectomy rise, the relationships between surgery modality with domains of health-related quality of life is not well understood. This study reports differences in depression, anxiety, pain, and health status among a cohort of women scheduled to receive total mastectomy or breast-conserving surgery. Patient-reported outcomes measured preoperative differences between patients receiving total mastectomy or breast-conserving surgery in a cross-sectional design. Regression analyses was used to model health outcomes and adjust for patient demographics on patient measures. Participants scheduled for total mastectomy were more likely to report more severe symptoms of depression and anxiety. This association was non-significant after adjusting for demographic differences. Younger participants were more likely to be scheduled for total mastectomy. Age was negatively associated with symptoms of depression and anxiety. Screening patients for mental health symptoms may be particularly important among younger patients who were more likely to report depression and anxiety before their surgery and were more likely to receive total mastectomy.
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Affiliation(s)
- Elaine McKevitt
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Maria Saleeb
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Rebecca Warburton
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Jin-Si Pao
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Carol Dingee
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Amy Bazzarelli
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Katelynn Tang
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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22
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Alvarez-Pardo S, Romero-Pérez EM, Camberos-Castañeda N, de Paz JA, Horta-Gim MA, González-Bernal JJ, Mielgo-Ayuso J, Simón-Vicente L, Fernández-Solana J, González-Santos J. Quality of Life in Breast Cancer Survivors in Relation to Age, Type of Surgery and Length of Time since First Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16229. [PMID: 36498299 PMCID: PMC9741017 DOI: 10.3390/ijerph192316229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 05/11/2023]
Abstract
(1) Background: Quality of life assessment is a critical aspect of breast cancer patient outcomes, as diagnosis, prognosis and treatment can have a major impact on quality of life. The aim of this study was to describe the characteristics of the sample and to verify the relationship between quality of life (QOL) in women diagnosed with breast cancer (BC) and their age, type or surgery and time since treatment; (2) Methods: a cross-sectional, descriptive study was conducted with 183 women diagnosed with BC, aged 30−80 years in Mexico. Women’s QOL was assessed using two questionnaires, The European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire (EORTC QLQ-C30) and The Breast Cancer Module (EORTC QLQ-BR23). (3) Results: the results show significant differences in several items when the variable age is taken into account, indicating that younger women have poorer social and sexual function, as well as poorer sexual enjoyment and lower expectations of the future. The type of surgery also indicates a significantly better QOL in those women who receive conservative treatment versus a mastectomy; the time elapsed since surgery does not show any significant results, except for sexual functioning and breast-related symptoms where >5 years implies better scores on the items. (4) Conclusions: in conclusion, it is important to take into account the characteristics of women with BC, particularly at the time of treatment, in order to mitigate the impact of the disease on their QOL with the help of a multidisciplinary team.
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Affiliation(s)
| | | | | | | | | | | | - Juan Mielgo-Ayuso
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
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23
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Williams AD, Dang CT, Sevilimedu V, Morrow M, Barrio AV. Neoadjuvant Chemotherapy for Breast Cancer In the Elderly: Are We Accomplishing Our Treatment Goals? Ann Surg Oncol 2022; 29:8002-8011. [PMID: 35871672 PMCID: PMC10162805 DOI: 10.1245/s10434-022-12206-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/25/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Rates of downstaging and tolerability to NAC in women age ≥ 70 years with operable breast cancer have not been well studied. We sought to compare downstaging rates and NAC completion between women age 50-69 years and age ≥ 70 years. METHODS Consecutively treated women age ≥ 50 years with cT1-3N0-1 breast cancer receiving NAC followed by surgery from November 2013 to April 2020 were studied. Rates of downstaging from breast-conserving surgery (BCS)-ineligible to BCS-eligible and avoidance of axillary dissection (ALND) in cN1 patients were compared between patients age 50-69 and ≥ 70 years. NAC regimens and rates of completion also were assessed. RESULTS Overall, 651 women, age ≥ 50 years, with 668 cT1-3N0-1 breast cancers that were treated with NAC, were identified; 75 (11.1%) were age ≥ 70 years. Patients age ≥ 70 years were less likely to have lobular cancers (5% vs. 10%, p = 0.03), receive an anthracycline-based regimen (69% vs. 93%, p < 0.001), and complete their entire prescribed regimen (57% vs. 78%, p < 0.001). Of 312 BCS-ineligible patients eligible for downstaging, conversion rates to BCS-eligibility were similar between age groups (72% [≥ 70] vs. 74% [50-69], p > 0.9). Women age ≥ 70 years who converted to BCS-eligible post-NAC were more likely to undergo BCS than younger patients (93% vs. 74%, p = 0.04). Of 390 cN1 patients, 162 (42%) achieved a nodal pCR; ALND avoidance was similar between age groups (43% [≥ 70] vs. 42% [50-69], p > 0.9). CONCLUSIONS While patients age ≥ 70 years received less anthracycline-based NAC and were less likely to complete their prescribed regimen, they experienced high rates of breast and axillary downstaging, similar to younger patients, suggesting that well-selected elderly patients can safely receive NAC with substantial clinical benefit.
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Affiliation(s)
- Austin D Williams
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chau T Dang
- Breast Cancer Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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24
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Verma N, Blackford AL, Thorner E, Lehman J, Snyder C, Stearns V, Smith KL. Factors associated with worsening sexual function during adjuvant endocrine therapy in a prospective clinic-based cohort of women with early-stage breast cancer. Breast Cancer Res Treat 2022; 196:535-547. [PMID: 36197536 PMCID: PMC10084786 DOI: 10.1007/s10549-022-06750-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/17/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Sexual function problems are common but under-reported among women receiving adjuvant endocrine therapy for breast cancer. Worsening scores on patient-reported outcomes (PROs) may identify those at risk for sexual function problems during treatment. We performed a secondary analysis of prospectively collected PROs in women receiving adjuvant endocrine therapy to identify factors associated with worsening sexual function. METHODS Women with stage 0-III breast cancer initiating adjuvant endocrine therapy participating in a prospective cohort completed PROs at baseline, 3, 6, 12, 24, 36, 48, and 60 months. Sexual function was evaluated by the MOS-SP measure. Other measures included PROMIS pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance and the Endocrine Symptom Subscale of the FACT-ES. We evaluated associations between score worsening of at least the minimal important difference (MID) in PROMIS T-scores (4 points) and FACT-ES scores (5 points) with score worsening of at least the MID in MOS-SP scores (8 points) using logistic regression. RESULTS Among 300 participants, 45.7% experienced ≥ 8-point worsening of MOS-SP score at any time point compared to baseline. Worsening endocrine symptoms (OR 1.34, 95% CI 1.22-1.49, p < 0.001), worsening physical function (OR 1.09, 95% CI 1.00-1.18, p = 0.06), and prior mastectomy (OR 1.45, 95% CI 0.94-2.23, p = 0.09) were associated with MOS-SP score worsening by at least the MID. CONCLUSION Worsening endocrine symptoms and physical function identified on PROs are associated with worsening sexual function during adjuvant endocrine therapy. Routine assessment of these domains with PROs may identify women at risk for sexual function problems. TRIAL REGISTRATION NUMBER NCT01937052; Date of Registration: 09/09/2013.
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Affiliation(s)
- Neha Verma
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa Thorner
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lisa Smith
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Medical Oncology, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, First Floor, Building B, 5255 Loughboro Road, NW, Washington, DC, 20016, USA.
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25
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Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148546. [PMID: 35886396 PMCID: PMC9323042 DOI: 10.3390/ijerph19148546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023]
Abstract
A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3−31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3−33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.
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26
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Magnoni F, Sacchini V, Veronesi P, Bianchi B, Bottazzoli E, Tagliaferri V, Mazzotta E, Castelnovo G, Deguidi G, Rossi EMC, Corso G. Surgical Management of Inherited Breast Cancer: Role of Breast-Conserving Surgery. Cancers (Basel) 2022; 14:3245. [PMID: 35805017 PMCID: PMC9265273 DOI: 10.3390/cancers14133245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023] Open
Abstract
Recent studies have demonstrated that hereditary breast cancer (BC) has a prevalence of 5-10% among all BC diagnoses. Nowadays, significant technological advances in the identification of an increasingly broad spectrum of genetic mutations allow for the discovery of an ever-growing number of inherited pathogenic (P) or likely pathogenic (LP) variants of breast cancer susceptibility genes. As the management of BC patients carrying mutations in the BRCA1/2 genes or other high-penetrance genes is currently a challenge, extensive research is being carried out and a lively scientific debate has been taking place on what the most appropriate local therapy, especially surgical treatment, of patients with inherited BC should be. In many studies, BC outcomes in BRCA carriers and non-carriers have been compared. A number of them showed that, when compared with mastectomy, breast-conserving surgery in BRCA patients is oncologically safe in terms of overall survival, although an increased risk of ipsilateral recurrence was reported. In these patients, devising a specific therapeutic strategy is an inevitably complex process, as it must take into consideration a series of factors, require a multimodal approach, guarantee personalization, strictly adhere to scientific international guidelines, and consider all available evidence. The present narrative review purposes to identify and illustrate evidence from significant selected studies that discussed those issues, as well as to suggest useful tools to clinicians managing this specific clinical condition in daily clinical practice.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Beatrice Bianchi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Elisa Bottazzoli
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Valentina Tagliaferri
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Erica Mazzotta
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Giulia Castelnovo
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Giulia Deguidi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Elisabetta Maria Cristina Rossi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Giovanni Corso
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Impacto do tratamento oncológico na qualidade de vida de idosas com câncer de mama atendidas pelo Sistema Único de Saúde. PAJAR - PAN AMERICAN JOURNAL OF AGING RESEARCH 2022. [DOI: 10.15448/2357-9641.2022.1.43014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivos: avaliar a qualidade de vida (QV), as interações medicamentosas e a adesão ao tratamento em pacientes idosas com câncer de mama que realizaram tratamento oncológico pelo Sistema Único de Saúde (SUS).Métodos: coorte prospectiva, com seis meses de seguimento, que incluiu pacientes idosas com câncer de mama atendidas em Hospital Universitário de Porto Alegre e atendidas pelo SUS. Foram selecionadas mulheres com idade ≥ 60 anos, divididas em dois grupos (60-69 anos e ≥ 70 anos).Resultados: 38 pacientes foram incluídas nas análises sobre QV e adesão ao tratamento. Dentro da classificação molecular, os subtipos mais diagnosticados foram, Luminal B/Her2- (34,2%), Luminal A (26,3%), Luminal B/HER2+ (21,1%). Os sintomas físicos mais relacionados à doença, no momento do diagnóstico, foram insônia, rigidez musculoesquelética, preocupação com os outros e com o futuro. Em contrapartida, seis meses depois os resultados menos favoráveis foram fadiga, náusea e vômito, dispneia, dor, inapetência, constipação, diarreia, problemas financeiros, efeitos adversos da terapia sistêmica, sintomas nas mamas e braços e alopecia. Baixos níveis de adesão ao tratamento foram identificados em 67,6% das pacientes. A polifarmácia foi evidenciada em 60,6%, e foi observada ao menos uma interação medicamentosa potencial em 78,8% da amostra. A média de medicamentos utilizados foi de 7,24 (DP= 3,77).Conclusões: este estudo demonstrou a importância do acompanhamento da população idosa com câncer de mama que faz uso de tratamento quimioterápico, a fim de compreender as implicações da senescência, bem como melhorar as taxas de adesão à terapia e a qualidade de vida desta população.
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Trends in surgery and adjuvant treatment for early-stage breast cancer: a population-based study in Queensland, Australia. Breast Cancer Res Treat 2022; 193:175-185. [PMID: 35254604 DOI: 10.1007/s10549-022-06551-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/18/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Our aim was to describe variations in the treatment of early-stage breast cancer and to examine factors associated with disease-specific survival (DSS). METHODS The study used linked data for 24,190 women with a T1 (≤ 20 mm) breast cancer who underwent surgery from 2005 to 2019. Multivariate logistic regression was used to model predictors of receiving breast-conserving surgery (BCS) compared to mastectomy and a multinomial model was used to examine factors associated with type(s) of treatment received. RESULTS Overall, 70.3% had BCS, with a reduced likelihood of BCS observed for younger women (p < 0.001), rural residence, (p < 0.001), socioeconomic disadvantage (p = 0.004), higher tumour grade (p < 0.001) and surgery in a public versus private hospital (p < 0.001). Compared to women who received BCS and radiation therapy (RT), those having mastectomy alone or mastectomy plus RT were more likely to be younger (p < 0.001), live in a rural area (p < 0.001), have higher-grade tumours (p < 0.001) and positive lymph nodes (p < 0.001). Overall 5-year survival was 95.3% and breast cancer-specific survival was 98.3%. Highest survival was observed for women having BCS and RT and lowest for those having mastectomy and RT (p < 0.001). CONCLUSION Our results indicate some variation in the management of early-stage breast cancer. Lower rates of BCS were observed for rural and disadvantaged women and for those treated in a public or low-volume hospital. Whilst survival was high for this cohort, differences in tumour biology likely explain the differences in survival according to treatment type.
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Baker BG, Chadwick S, Patel N, Jeevan R. Comparative UK Cross-sectional Study of Breast Cancer Patient-Reported Outcomes for Breast-Conserving Surgery and Immediate Reconstruction, Including Contribution to an International Collaborative Pilot Study. J Plast Reconstr Aesthet Surg 2022; 75:2172-2179. [PMID: 35341709 DOI: 10.1016/j.bjps.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Breast-conserving surgery (BCS) with adjuvant radiotherapy is oncologically comparable to mastectomy with immediate breast reconstruction (IBR) in treating breast cancer. This tertiary UK centre cross-sectional study compared BCS patient-reported outcomes with those of immediate implant-based (IBR) and free flap reconstruction (FFR), and included a contribution to a pilot international collaboration co-ordinated through the Organisation for Economic Cooperation and Development (OECD). METHODS Validated BREAST-Q™ 'satisfaction with breasts' modules were administered to 271 consecutive patients for six months after unilateral BCS, IBR, or FFR were conducted between June and October 2018. Risk adjustment data were collected on age, body mass index, smoking, radiotherapy, specimen weight, and tumour burden. RESULTS A total of 190 women returned completed questionnaires (131 BCS, 42 IBR, 17 FFR; 70% response rate). BCS scores (mean 68, standard deviation (SD) 23) were higher than those for IR overall (62, SD 23, p=0.04) and IBR (61, 24, p=0.03) but equivalent to those for FFR (66, SD 23, p=0.33). There was no significant difference in Q-Scores between the IBR and FFR groups (p=0.77). Scores were only minimally changed by risk adjustment and comparable to OECD mean international scores for IBR (61) and FFR (66). CONCLUSIONS This is the first study to compare BCS and IR outcomes using a validated scale. BREAST-Q™ 'satisfaction with breasts' scores were comparable between BCS and FFR but significantly lower following IBR.
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Affiliation(s)
- Benjamin G Baker
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Chadwick
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Naomi Patel
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ranjeet Jeevan
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
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Deng Y, Li H, Zheng Y, Zhai Z, Wang M, Lin S, Li Y, Wei B, Xu P, Wu Y, Deng X, Yang S, Lyu J, Hu J, Dong H, Dai Z. Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients. Front Oncol 2021; 11:779185. [PMID: 34888251 PMCID: PMC8650152 DOI: 10.3389/fonc.2021.779185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background The treatment for locally advanced breast cancer (LABC) is a severe clinical problem. The postoperative radiotherapy is a conventional treatment method for patients with LABC, whereas the effect of preoperative radiotherapy on outcome of LABC remains controversial. This study aimed to examine and compare the overall survival (OS) in patients with LABC who underwent preoperative radiotherapy or postoperative radiotherapy. Methods This retrospective cohort study included 41,618 patients with LABC from the National Cancer Database (NCDB) between 2010 and 2014. We collected patients’ demographic, clinicopathologic, treatment and survival information. Propensity score was used to match patients underwent pre-operative radiotherapy with those who underwent post-operative radiotherapy. Cox proportional hazard regression model was performed to access the association between variables and OS. Log-rank test was conducted to evaluate the difference in OS between groups. Results The estimated median follow-up of all included participants was 69.6 months (IQR: 42.84-60.22); 70.1 months (IQR: 46.85-79.97) for postoperative radiotherapy, 68.5 (IQR: 41.13-78.23) for preoperative radiotherapy, and 67.5 (IQR: 25.92-70.99) for no radiotherapy. The 5-year survival rate was 80.01% (79.56-80.47) for LABC patients who received postoperative radiotherapy, 64.08% (57.55-71.34) for preoperative radiotherapy, and 59.67% (58.60-60.77) for no radiotherapy. Compared with no radiation, patients receiving postoperative radiotherapy had a 38% lower risk of mortality (HR=0.62, 95%CI: 0.60-0.65, p<0.001), whereas those who received preoperative radiotherapy had no significant survival benefit (HR=0.88, 95%CI: 0.70-1.11, p=0.282). Propensity score matched analysis indicated that patients treated with preoperative radiotherapy had similar outcomes as those treated with postoperative radiotherapy (AHR=1.23, 95%CI: 0.88-1.72, p=0.218). Further analysis showed that in C0 (HR=1.45, 95%CI: 1.01-2.07, p=0.044) and G1-2 (AHR=1.74, 95%CI: 1.59-5.96, p=0.001) subgroup, patients receiving preoperative radiotherapy showed a worse OS than those who received postoperative radiotherapy. Conclusions Patients with LABC underwent postoperative radiotherapy had improved overall survival, whereas no significant survival benefit was observed in patients receiving preoperative radiotherapy. Preoperative radiotherapy did not present a better survival than postoperative radiotherapy for LABC patients.
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Affiliation(s)
- Yujiao Deng
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hongtao Li
- Department of Breast Head and Neck Surgery, The 3rd Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Tumor Hospital), Urumqi, China
| | - Yi Zheng
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhen Zhai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meng Wang
- Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuai Lin
- Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yizhen Li
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bajin Wei
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Peng Xu
- Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ying Wu
- Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyue Deng
- Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Si Yang
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingjing Hu
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Huaying Dong
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhijun Dai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Oncology, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Toxicity of Hypofractionated Whole Breast Radiotherapy Without Boost and Timescale of Late Skin Responses in a Large Cohort of Early-Stage Breast Cancer Patients. Clin Breast Cancer 2021; 22:e480-e487. [PMID: 34955430 DOI: 10.1016/j.clbc.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022]
Abstract
AIM To report toxicity of hypofractionated whole-breast radiotherapy in a large cohort of early-stage breast cancer (BCaients. MATERIALS AND METHODS From 02/2009-05/2017, 1325 consecutive BCa patients were treated with 40.05 Gy/15 fractions, without boost. Median age was 62 (IQR:51.1-70.5) years. Chemotherapy was prescribed for 28% of patients, hormonal therapy for 80.3%, monoclonal antibodies for 8.2%. RESULTS Median follow-up was 72.4 (IQR: 44.6-104.1) months. Acute RTOG toxicity was: 69.8% Grade (G) 1, 14.3% G2 and 1.7% G3. Late SOMA-LENT toxicities were: edema-hyperpigmentation (E-H): G1 28.67%, G2 4.41%, G3 0.15%; fibrosis-atrophy-telangiectasia-pain (F-A-T-P): G1 14.6%, G2 3.2%, G3 0.8%, G4 0.1%. Median time to first occurrence was 6 and 18 months, respectively. Aesthetic result after surgery was excellent in 28.7%, good in 41.5%, acceptable in 20.3% and poor in 9.5% of patients. Change in breast appearance after radiotherapy was mild in 6.9%, moderate in 2.3% and marked in 1.3% of patients. Concomitant chemotherapy, obesity, smoking, use of bolus and planning target volume (PTV) were associated with higher acute toxicity. Patients ≥55 years old were less likely to experience acute toxicity. PTV and acute G2 toxicity were associated with ≥G2 E-H. PTV, concomitant chemotherapy, hypertension and ≥G2 acute toxicity were associated with increased risk of F-A-T-P. CONCLUSION Hypofractionated whole-breast radiotherapy without boost demonstrated mild acute and late toxicity in a large cohort of consecutive patients. Moderate and marked changes in breast appearance were registered for 3.6% of patients and occurred between 18 to 42 months.
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Dieterich M, Allmendinger S, Gerber B, Reimer T, Hartmann S, Stachs A, Stubert J. Prevalence, Clinical Significance and Risk Factors for Developing Scar Pain and Sensibility Disorders in Breast Cancer Patients after Breast-Conserving Therapy and Mastectomy. Breast Care (Basel) 2021; 16:507-515. [PMID: 34720810 DOI: 10.1159/000513241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to gather information on the prevalence and risk factors for scar pain and sensibility disorders after breast cancer surgery, as only limited information of these complaints are available. Material and Methods A clinical cohort study using a non-validated questionnaire was conducted among women who presented to routine follow-up at the Breast Cancer Center Rostock, Germany. The subjects were informed that the subjective perception and sensation were in the foreground and that the questionnaire had to be filled out independently according to the current feeling. Results Overall 175 patients could be evaluated. The prevalence of scar pain was 30.8% after breast conserving therapy (BCT) and 34.5% after mastectomy. Following BCT 87.5%, respectively 81.8% of women after mastectomy were very satisfied or satisfied with the scarring. Sensory disorders were increased in the mastectomy group (p = 0.001). Scar pain after previous surgery was a risk factor to develop sensory disorders after BCT (p = 0.008) and mastectomy (p = 0.029). For patients receiving mastectomy, sensory disorders after previous breast surgeries increased the risk for sensory disorders (p = 0.029). Smoking was a risk factor for sensory disorders after mastectomy (p = 0.048). Multivariate analysis could not confirm any of the risk factors. Conclusion This study demonstrated a high satisfaction with scarring after breast surgery and a low level of scar pain. A lack of postoperative information, as well as a low level of actually performed scar care after surgery were observed. Increased focus should be on improved information on postoperative scare care.
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Affiliation(s)
- Max Dieterich
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Sophie Allmendinger
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Steffi Hartmann
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Johannes Stubert
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
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Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial. Cancers (Basel) 2021; 13:cancers13205107. [PMID: 34680257 PMCID: PMC8534073 DOI: 10.3390/cancers13205107] [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: 08/20/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T2-3 N0-2 M0 invasive breast cancer (BC) not amenable to upfront breast conserving treatment (BCS) were included in this prospective, non-randomized phase II study. Chemotherapy (CT) consisted of four cycles of continuous 5-FU infusion and Vinorelbine. Starting concurrently with the second CT cycle, normofractionated RT was delivered to the breast and LN. Breast surgery was then performed. Results: Median follow-up (FU) was 13 years [3-18]. BCS was performed in 41 (69%) patients and mastectomy in 18 patients, with pathological complete response rate of 27%. Overall and distant-disease free survivals rates at 13 years were 70.9% [95% CI 59.6-84.2] and 71.5% [95% CI 60.5-84.5] respectively. Loco regional and local controls rates were 83.4% [95% CI 73.2-95.0] and 92.1% [95% CI 83.7-100], respectively. Late toxicity (CTCAE-V3) was assessed in 51 patients (86%) with a median follow-up of 13 years. Fifteen presented grade 2 fibrosis (29.4%), 8 (15.7%) had telangiectasia, and 1 had radiodermatitis. Conclusions: This combined treatment provided high long-term local control rates with limited side-effects.
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Pačarić S, Orkić Ž, Milostić-Srb A, Turk T, Farčić N, Mikšić Š, Adamčević S, Erić I, Gvozdanović Z, Srb N. Quality of Life and Sexual Functioning of Women after Breast Cancer Surgery. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Women with breast cancer can experience changes in sexual functioning and body images that can seriously affect their quality of life.
AIM: The aim of this research was to study the quality of life and sexual functioning of women after a mastectomy and after a breast-conserving surgery and to compare post-operative quality of life.
SUBJECTS AND METHODS: This cross-sectional study included 204 participants, 101 patients after a mastectomy and 103 patients after a quadrantectomy. The research was conducted using the Croatian version of the questionnaire of the European Organization for Research and Treatment of Breast Cancer, the questionnaire with the breast cancer module EORTC QLQ - BR 23.
RESULTS: On the EORTC QLQ –BR23 scale, participants with mastectomy rated their sexual functioning (p < 0.001), sexual pleasure (p < 0.001), and systemic side effects (p = 0.04) lower comparing to women after breast-conserving surgery. The overall functionality scale was significantly lower (p = 0.03) for women who underwent mastectomy compared to those who underwent breast-conserving surgery. Participants under 51 years of age had worse body image 1 month after mastectomy (p = 0.006), while sexual functioning was better (p = 0.03) than in older age groups. In breast-conserving surgery group, 1 month after surgery, participants in the age group of 61 years and older assessed body image better (p = 0.04) than in the younger age group. Sexual functioning was rated better by women aged 51–60 years (p = 0.03).
CONCLUSION: Results of this study show that women after breast conserving surgery have better quality of life, better sexual functioning and less side effects of systemic therapy compared to women after mastectomy. The type of surgery, patient’s age and time passed after completion of treatment are important factors which influence sexual functioning and quality of life in breast cancer survivors.
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Lopes-Conceição L, Brandão M, Araújo N, Severo M, Dias T, Peleteiro B, Fontes F, Pereira S, Lunet N. Quality of life trajectories during the first three years after diagnosis of breast cancer: the NEON-BC study. J Public Health (Oxf) 2021; 43:521-531. [PMID: 31883015 DOI: 10.1093/pubmed/fdz159] [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: 11/14/2022] Open
Abstract
BACKGROUND We aimed to identify and characterize quality of life trajectories up to 3 years after breast cancer diagnosis. METHODS A total of 460 patients were evaluated at baseline (before treatments), and after 1- and 3-years. Patient-reported outcomes, including quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, QLQ-C30), anxiety, depression and sleep quality, were assessed in all evaluations. Model-based clustering was used to identify quality of life trajectories. RESULTS We identified four trajectories without intersection during 3 years. The two trajectories characterized by better quality of life depicted relatively stable scores; in the other trajectories, quality of life worsened until 1 year, though in one of them the score at 3 years improved. Sociodemographic and clinical characteristics at baseline did not differ between trajectories, except for mastectomy, which was higher in the worst trajectory. Anxiety, depression and poor sleep quality increased from the best to the worst trajectory. CONCLUSIONS The type of surgery and the variation of other patient-reported outcomes were associated with the course of quality of life over 3 years. More research to understand the heterogeneity of individual trajectories within these major patterns of variation is needed.
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Affiliation(s)
- Luisa Lopes-Conceição
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Mariana Brandão
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Academic Promoting Team, Institut Jules Bordet, 1000 Brussels, Belgium
| | - Natália Araújo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Teresa Dias
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-075 Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Filipa Fontes
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-075 Porto, Portugal
| | - Susana Pereira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-075 Porto, Portugal
| | - Nuno Lunet
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
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Ratosa I, Plavc G, Pislar N, Zagar T, Perhavec A, Franco P. Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer. Cancers (Basel) 2021; 13:cancers13164044. [PMID: 34439197 PMCID: PMC8393026 DOI: 10.3390/cancers13164044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The majority of patients with breast cancer are suitable for either breast-conserving therapy, consisting of breast-conserving surgery and radiation therapy, or mastectomy alone. In the present study, we compared survival outcomes in 1360 patients affected with early-stage breast cancer (stage I-IIA) according to the type of local treatment. We confirmed that patients treated with breast-conserving therapy had a lower rate of local, regional, and distant disease recurrences, and at least equivalent overall survival compared to those treated with mastectomy alone. Our results add to previous research showing a potential benefit of breast-conserving therapy when compared to mastectomy in patients suitable for both treatments at baseline. Abstract In the current study, we sought to compare survival outcomes after breast-conserving therapy (BCT) or mastectomy alone in patients with stage I-IIA breast cancer, whose tumors are typically suitable for both locoregional treatments. The study cohort consisted of 1360 patients with stage I-IIA (T1–2N0 or T0–1N1) breast cancer diagnosed between 2001 and 2013 and treated with either BCT (n = 1021, 75.1%) or mastectomy alone (n = 339, 24.9%). Median follow-ups for disease-free survival (DFS) and overall survival (OS) were 6.9 years (range, 0.3–15.9) and 7.5 years (range, 0.2–25.9), respectively. Fifteen (1.1%), 14 (1.0%) and 48 (3.5%) patients experienced local, regional, and distant relapse, respectively. For the whole cohort of patients, the estimated 5-year DFS and OS were 96% and 97%, respectively. After stratification based on the type of local treatment, the estimated 5-year DFS for BCT was 97%, while it was 91% (p < 0.001) for mastectomy-only treatment. Inverse probability of treatment weighting matching based on confounding confirmed that mastectomy was associated with worse DFS (HR 2.839, 95% CI 1.760–4.579, p < 0.0001), but not with OS (HR 1.455, 95% CI 0.844–2.511, p = 0.177). In our study, BCT was shown to have improved disease-specific outcomes compared to mastectomy alone, emphasizing the important role of adjuvant treatments, including postoperative radiation therapy, in patients with early-stage breast cancer at diagnosis.
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Affiliation(s)
- Ivica Ratosa
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (I.R.); (G.P.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gaber Plavc
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (I.R.); (G.P.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Nina Pislar
- Department of Surgery, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Tina Zagar
- Department of Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Andraz Perhavec
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Surgery, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Radiation Oncology Unit, AOU “Maggiore della Carità”, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3733725
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Huynh V, Yang J, Bronsert M, Ludwigson A, Ahrendt G, Kim S, Matlock DD, Cohen J, Hampanda K, Tevis SE. Choosing Between Mastectomy and Breast-Conserving Therapy: Is Patient Distress an Influencing Factor? Ann Surg Oncol 2021; 28:8679-8687. [PMID: 34160707 DOI: 10.1245/s10434-021-10323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast-conserving therapy (BCT) offers oncologic outcomes similar to those of mastectomy, yet many patients, when provided the option, choose mastectomy. This study aimed to evaluate the relationship between patient-reported distress and surgical decisions and to determine factors predictive of choosing BCT versus mastectomy. METHODS Patients with newly diagnosed breast cancer deemed candidates for BCT who completed a distress screen at their initial visit to an academic institution between 2016 and 2019 were retrospectively reviewed. This screening tool captures distress in emotional, social, health, and practical domains on a scale of 0 to 10. The distress scores were compared against surgical decisions using nonparametric Wilcoxon rank-sum tests. Patient factors associated with surgical choice were analyzed using chi-square, Fisher's exact, and Student's t tests. A two-sided p value lower than 0.05 was considered significant. RESULTS Of 506 patients deemed eligible for BCT, 430 (85%) chose BCT and 76 (15%) pursued mastectomy. The distress levels did not differ significantly between the surgical options. The patients who underwent mastectomy were on the average younger (50.7 vs 60.4 years; p < 0.0001), presented with palpable masses (p < 0.0001), had stage 0, 2, or 3 versus stage 1 disease (p < 0.0001), sought consultation for second opinions (19.7% vs 8.6%; p = 0.0032), received neoadjuvant chemotherapy (31.6% vs 16.3%; p = 0.0016), or had deleterious gene mutations (21.1% vs 5.1%; p < 0.0001). CONCLUSIONS Distress was not associated with the pursuit of surgical treatment. Rather, younger age, search for a second opinion, and a palpable mass present at presentation were associated with more aggressive surgical decisions. Understanding factors that influence surgical decision-making is critical in guiding informed decisions that reflect patient values.
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Affiliation(s)
- Victoria Huynh
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jerry Yang
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | | | - Gretchen Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Simon Kim
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel D Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Justin Cohen
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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The Impact of Socioeconomic Determinants on the Quality of Life of Moroccan Breast Cancer Survivors Diagnosed Two Years Earlier at the National Institute of Oncology in Rabat. Obstet Gynecol Int 2021; 2021:9920007. [PMID: 34257668 PMCID: PMC8249154 DOI: 10.1155/2021/9920007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/11/2021] [Indexed: 01/30/2023] Open
Abstract
Introduction The objective of this study was to investigate the impact of socioeconomic determinants on the quality of life of Moroccan women with breast cancer two years after their diagnosis who are followed up at the National Institute of Oncology (INO) in Rabat. Methods This is a cross-sectional study that was conducted between May 2019 and September 2020. The sample size was 304 women. Data were collected using the EORTC QLQ-C30 and EORTC QLQ-BR 23 questionnaires in the Moroccan dialect. Results The mean age of participants was 53.5 ± 12.4 years, where the majority resided in urban areas and more than half were illiterate. Moreover, three-quarters of the survivors were not working, and almost all have basic medical coverage. Nearly one-third of the respondents had experienced discrimination from those around them, and nearly half attributed the decrease in income to their state of health. In addition, 38.2 percent of participants stated that they had great difficulty living on their monthly income after the illness, whereas more than half of the survivors had a good quality of life in terms of overall health (GHS/QOL). Besides, social function obtained the highest score, while emotional function obtained the lowest score. Furthermore, financial difficulty was the most distressing symptom. Indeed, income adjustment after the disease, discrimination, distance between home and treatment center, professional status, and medical coverage were correlated with GHS/QOL. Regression analysis revealed that income adjustment after illness and discrimination were significant predictors of GHS/QOL. Conclusion The data suggest establishing a financial support program and the development of education and awareness-raising policies to combat discrimination.
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Bhutiani N, Holland MM, Mercer MK, Donaldson M, Berry TS, McMasters KM, Ajkay N. Effect of the Ductal Carcinoma In Situ Margin Consensus Guideline Implementation on Re-Excision Rates, Satisfaction, and Cost. Ann Surg Oncol 2021; 28:7432-7438. [PMID: 34043091 DOI: 10.1245/s10434-021-10120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The 2016 consensus guideline on margins for breast-conserving surgery (BCS) with whole-breast irradiation (WBI) for ductal carcinoma in situ (DCIS) recommended 2 mm margins to decrease local recurrence rates. We examined re-excision rates, cost, and patient satisfaction before and after guideline implementation. METHODS From an Institutional Review Board-approved database, patients with DCIS who underwent BCS with over 1 year of follow-up at one academic institution and one community cancer center were evaluated. Two groups were compared based on when they received treatment, i.e. before (pre-consensus [PRE]) and after November 2016 (post consensus [POST]), with respect to outcome and cost parameters. RESULTS After consensus guideline implementation, re-excision rate (32.1% vs. 20.0%) and mastectomy conversion (8.3% vs. 2.3%) significantly increased, although total resection volume, operative cost per patient, and satisfaction with breast scores did not differ. Not all patients with <2 mm margins were re-excised, although the re-excision rate among this subset significantly increased (62.4% vs. 31.3%). On multivariable analysis controlling for age, estrogen receptor status, WBI use, and margin status, surgery after consensus guideline publication was independently associated with a higher re-excision rate (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.08-3.59, p = 0.03) and a higher rate of conversion to mastectomy (OR 6.84, 95% CI 1.67-28.00, p = 0.007). CONCLUSIONS Implementation of the 2016 margin consensus guideline for DCIS resulted in an increase in re-excisions and mastectomy conversions at two institutions. Research is needed for operative tools and strategies to decrease DCIS re-excision rates.
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Affiliation(s)
- Neal Bhutiani
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Michelle M Holland
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Megan K Mercer
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Marilyn Donaldson
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Tiffany S Berry
- Division of Breast Surgery, Department of Surgery, Norton Hospital, Louisville, KY, USA
| | - Kelly M McMasters
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Nicolás Ajkay
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
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Tsangaris E, Klassen AF, Kaur MN, Voineskos S, Bordeleau L, Zhong T, Broyles J, Pusic AL. Development and Psychometric Validation of the BREAST-Q Sensation Module for Women Undergoing Post-Mastectomy Breast Reconstruction. Ann Surg Oncol 2021; 28:7842-7853. [PMID: 33988795 DOI: 10.1245/s10434-021-10094-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reconstructive techniques for restoring sensation to the breast after mastectomy continue to evolve. The BREAST-Q is a patient-reported outcome measure that can be used to evaluate outcomes of breast cancer treatments; however, it previously lacked scales to measure breast sensation. This paper outlines the development and validation of the BREAST-Q Sensation Module. METHODS Phase 1 (January 2017 through December 2018) involved qualitative and cognitive interviews with women who had undergone breast reconstruction, as well as expert input, to develop and refine the scales. In phase 2 (March through June 2019), Love Research Army (LRA) members completed the scales, and Rasch Measurement Theory (RMT) analysis was performed to examine the reliability and validity of the scales. RESULTS In this study, 36 qualitative and 7 cognitive interviews were conducted, and input from 18 experts was obtained. Three scales were developed to measure breast Symptoms (e.g., throbbing, burning, tingling), Sensation (e.g., feeling with light touch, through clothing, sexually), and Quality of Life impact of sensation loss. In phase 2, 1204 LRA members completed the scales. Data for each scale fit the RMT model. Reliability was high, with Person Separation Index, Cronbach alpha, and intraclass correlation coefficient values of 0.81 or higher (with and without extremes) for all three scales. Mean scores were higher (better) on the Symptoms and Quality of Life impact scales for the participants with unilateral (vs. bilateral) and autologous (vs. alloplastic) reconstruction, and for the participants who were farther out from their reconstruction. CONCLUSION The BREAST-Q Sensation Module can be used alone or in conjunction with other BREAST-Q scales to inform clinical care and to evaluate outcomes of new surgical approaches to restoration of breast sensation.
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Affiliation(s)
- Elena Tsangaris
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | | | | | | | | | - Toni Zhong
- Toronto General Hospital, Toronto, ON, Canada
| | - Justin Broyles
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea L Pusic
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Dudley CM, Wiener AA, Stankowski-Drengler TJ, Schumacher JR, Francescatti AB, Poore SO, Greenberg CC, Neuman HB. Rates of Ipsilateral Local-regional Recurrence in High-risk Patients Undergoing Immediate Post-mastectomy Reconstruction (AFT-01). Clin Breast Cancer 2021; 21:433-439. [PMID: 34103255 DOI: 10.1016/j.clbc.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some surgeons remain hesitant to perform immediate breast reconstruction (IBR) in patients with higher risk cancers owing to concerns about cancer recurrence and/or detection. Our objective was to determine the rate of ipsilateral local-regional recurrence for stage II/III patients who underwent IBR. METHODS The National Cancer Database special study mechanism was used to create a stratified sample of women diagnosed with stage II/III breast cancer from 1217 facilities. Demographic, tumor, and recurrence data for women who underwent mastectomy with or without IBR were abstracted, including location of recurrence and method of detection. Estimates of 5-year local-regional recurrence rates were calculated and factors associated with recurrence were identified with multivariable Cox regression. RESULTS Some 13% (692/5318) of stage II/III patients underwent IBR after mastectomy. Patients undergoing IBR were younger (P < .001), with fewer comorbid conditions (P < .001), and with lower tumor burden in the breast (P = .001) and the lymph nodes (P = 0.01). The 5-year rate of ipsilateral local-regional recurrence was 3.6% with no significant difference between patients with or without IBR (3.0% vs. 3.7%, P = .4). Most recurrences were detected by the patient (45%) or on physician examination (24%). Reconstruction was not associated with recurrence on multivariable analysis (hazard ratio = 0.83, P = .52). CONCLUSION Women with stage II/III breast cancer selected for IBR had similar rates of ipsilateral local-regional recurrence compared with those undergoing mastectomy alone. Offering IBR after mastectomy in a patient-centered manner to select patients with stage II/III breast cancer is an acceptable consideration.
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Affiliation(s)
- Christina M Dudley
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Alyssa A Wiener
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Trista J Stankowski-Drengler
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Samuel O Poore
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Jayasinghe R, Fernando A, Jayarajah U, Seneviratne S. Post treatment quality of life among Sri Lankan women with breast cancer. BMC Cancer 2021; 21:305. [PMID: 33757446 PMCID: PMC7988899 DOI: 10.1186/s12885-021-08055-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast cancer and its treatment imposes a significant effect in the quality of life (QOL) of women. Being a developing country with contrasting social and cultural norms to the West, Sri Lankan women may have a different experience on QOL following surgical treatment of breast cancer. This study was conducted to evaluate post-treatment QOL in breast cancer patients and to determine its association with the type of surgery. METHODS A cross sectional study was carried out. Fifty four women with non-metastatic breast cancer who underwent surgery for breast cancer at the Professorial Surgical Unit, Colombo during 2015-2018 and completed a minimum of one year follow up after surgery were invited to participate. Fifty-four women who responded were assessed using the validated EORTC QLQ-C30 and QLQ-BR23 questionnaires. Non-parametric tests were used for statistical analyses. RESULTS The mean age was 59 years (range 36-81). A majority (61%, n = 35) underwent mastectomy and the rest (n = 19, 45%) breast conservation surgery (BCS). The mean QLQ-C30 score was 68.8 (range 8.3-100) and the mean scores for physical function, role function, emotional function, cognitive function, and social function were 71.4, 81.5, 77.0, 80.2, and 86.4, respectively. The mean scores for body image, sexual functioning, sexual enjoyment, future perspective, systemic therapy, breast symptoms, arm symptoms, and hair loss assessed by the QLQ-BR23 were 76.4, 18.3, 33.3, 73.6, 30.5, 16.2, 23.4 and 32.7, respectively. No significant differences (P > 0.05) were noted in global health status, physical function, role function, emotional function, cognitive function and social function between BCS and mastectomy. QLQ-BR23 body image, sexual functioning, sexual enjoyment and future perspective also did not differ significantly (p > 0.05) between the two groups. CONCLUSIONS Sexual functioning and enjoyment, breast and arm symptoms and hair loss contributed to poor QOL while the impact on global health status including physical, social and emotional functions were minimal. Type of surgery did not appear to be associated with QOL. Future studies with a larger sample sizes will be helpful to further study these factors.
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Affiliation(s)
- Ravindri Jayasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province Sri Lanka
| | - Ashan Fernando
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province Sri Lanka
| | - Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province Sri Lanka
| | - Sanjeewa Seneviratne
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province Sri Lanka
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Favez N, Cairo Notari S. Body image, sexual activity, and side effects of treatments across the first year after surgery in women facing breast cancer: The influence of attachment insecurity. J Psychosoc Oncol 2021; 39:749-764. [PMID: 33660590 DOI: 10.1080/07347332.2021.1890306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The aim of this study was to assess, across the first year after surgery, the influence of attachment insecurity, that is, avoidant and anxious tendencies, on body image, sexual activity, and side effects of treatments in women diagnosed with breast cancer.Design: A total of 110 women with non-metastatic breast cancer were surveyed 2 weeks (T1), 3 months (T2), and 12 months (T3) after surgery.Methods: Self-reported questionnaires were used to assess attachment tendencies (avoidance and anxiety), medical data (cancer stage, oncological treatment), sociodemographic data (age, socioeconomic level, relational status), and the three outcomes.Results: Generalized linear modeling showed that (1) having more avoidant and anxious attachment tendencies predicted a more negative body image, as did being younger and having undergone a mastectomy; (2) having more avoidant attachment tendencies predicted being sexually inactive, as did having undergone neoadjuvant chemotherapy or adjuvant hormonal therapy, whereas being younger and in a committed relationship predicted being sexually active; and (3) attachment tendencies did not predict the intensity of side effects, whereas a higher cancer stage and being at the beginning of treatment predicted more side effects.Conclusions: Women with avoidant and anxious attachment tendencies may be especially vulnerable to the consequences of oncological treatment, in particular regarding body image and sexual activity.
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Affiliation(s)
- Nicolas Favez
- Faculty of Psychology and Educational Sciences, Department of Psychology, University of Geneva, Switzerland
| | - Sarah Cairo Notari
- Faculty of Psychology and Educational Sciences, Department of Psychology, University of Geneva, Switzerland
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Bonci EA, Țîțu Ș, Petrușan AM, Hossu C, Gâta VA, Ghomi MT, Kubelac PM, Bonci TI, Piciu A, Cosnarovici M, Hîțu L, Kirsch-Mangu AT, Pop DC, Lisencu IC, Achimaș-Cadariu P, Piciu D, Schmidt H, Fetica B. Does Surgical Margin Width Remain a Challenge for Triple-Negative Breast Cancer? A Retrospective Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57030203. [PMID: 33652670 PMCID: PMC7996718 DOI: 10.3390/medicina57030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Local and distant relapse (LR, DR) in breast cancer vary according to its molecular subtypes, with triple-negative breast cancer (TNBC) being the most aggressive. The surgical resection margin width (SRMW) for breast-conserving surgery (BCS) has been intensely debated, especially for the aforementioned subtype. The aim of this study was to examine the impact of SRMW on LR following BCS in TNBC patients. Materials and Methods: We conducted a retrospective study including all patients with TNBC for whom BCS was performed between 2005 and 2014. Results: Final analysis included a total of 92 patients, with a median tumor size of 2.5 cm (range 0-5 cm) and no distant metastasis at the time of diagnosis. A total of 87 patients had received neoadjuvant and/or adjuvant chemotherapy, and all patients had received adjuvant whole-breast radiotherapy. After a median follow-up of 110.7 months (95% CI, 95.23-126.166), there were 5 local recurrences and 8 regional/distant recurrences with an overall LR rate of 5.4%. The risk of LR and DR was similar between groups of patients with several SRMW cut-off values. Conclusions: Our study supports a safe "no ink on tumor" approach for TNBC patients treated with BCS.
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Affiliation(s)
- Eduard-Alexandru Bonci
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Ștefan Țîțu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Alexandru Marius Petrușan
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Claudiu Hossu
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Vlad Alexandru Gâta
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Morvarid Talaeian Ghomi
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Paul Milan Kubelac
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
- Correspondence: (P.M.K.); (I.C.L.)
| | - Teodora Irina Bonci
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Andra Piciu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Maria Cosnarovici
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Liviu Hîțu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Alexandra Timea Kirsch-Mangu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Radiotherapy, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Diana Cristina Pop
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Radiotherapy, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Ioan Cosmin Lisencu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
- Correspondence: (P.M.K.); (I.C.L.)
| | - Patriciu Achimaș-Cadariu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Doina Piciu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Nuclear Medicine, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Hank Schmidt
- Division of Breast Surgery, Tisch Cancer Institute, Mount Sinai Health System, New York, NY 10029, USA;
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bogdan Fetica
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Anatomical Pathology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
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Walcott-Sapp S, Srour MK, Lee M, Luu M, Amersi F, Giuliano A, Chung A. Can Radiologic Tumor Size Following Neoadjuvant Therapy Reliably Guide Tissue Resection in Breast Conserving Surgery in Patients with Invasive Breast Cancer? Am Surg 2021; 86:1248-1253. [PMID: 33284669 DOI: 10.1177/0003134820964209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Optimum tissue resection volume for patients with invasive breast cancer undergoing breast conserving surgery following neoadjuvant therapy (NAT) is not known. We compared positive margin and in-breast tumor recurrence (IBTR) between 2 groups that were created based on radiologic tumor size (RTS (cm3)) at diagnosis, RTS post-NAT, and volume of tissue resected (VTL): Pre-NAT group, patients with VTL closer to RTS at diagnosis, and post-NAT group, patients with VTL closer to post-NAT RTS. 82 patients with 84 breast cancers treated with NAT between 2007 and 2017 who had pre- and post-NAT imaging were identified from a prospectively maintained database. RTS at diagnosis, RTS post-NAT, and VTL were determined. Clinical and treatment characteristics, IBTR, and disease-free survival (DFS) were compared between pre-NAT (n = 51) and post-NAT (n = 33) groups. Compared to post-NAT patients, pre-NAT patients had smaller RTS at presentation (9.2 vs. 33.5 cm3, P < .001) and post-NAT (1.2 vs. 8.2 cm3, P = .024). At median follow-up of 4 years, there were no differences between groups in pathologic tumor size, positive margin rate, adjuvant therapy, IBTR, or DFS. Resection volumes that matched RTS on post-NAT imaging were not associated with increased positive margins or IBTR. It may be appropriate to use post-NAT imaging to guide lumpectomy volume.
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Affiliation(s)
| | | | - Minna Lee
- UCLA Jonsson Cancer Center, Los Angeles, CA, USA
| | - Michael Luu
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Alice Chung
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Favez N, Antonini T, Delaloye JF, Notari SC. From breast cancer surgery to survivorship: Insecure attachment tendencies predict negative psychological outcomes. Health Psychol Open 2021; 8:2055102920987463. [PMID: 33598303 PMCID: PMC7863168 DOI: 10.1177/2055102920987463] [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: 12/24/2022] Open
Abstract
Little is known about the variables explaining individual variability in the long-term adaptation of breast cancer survivors. Attachment tendencies have, however, been shown to explain negative psychological outcomes in the postsurgical period. The present study aimed to assess the continuing influence of attachment tendencies in the survivorship period. A sample of 28 women were surveyed 2 weeks, 3 months, 12 months, and 5 to 7 years after surgery. Attachment tendencies and psychological outcomes (distress, body image, sexuality) were assessed through questionnaires, and medical and sociodemographic data collected. Results show that insecure attachment tendencies predict negative body image and elevated distress.
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47
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Kohli P, Penumadu P, Dharanipragada K, Friji MT. Lateral Thoracodorsal Flap Revisited: An Underappreciated Workhorse. World J Plast Surg 2020; 9:206-212. [PMID: 32934934 PMCID: PMC7482543 DOI: 10.29252/wjps.9.2.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although, the lateral thoracodorsal flap is a well described technique, its utility seems to be lost in the ever evolving world of oncoplastic breast surgery. This study reviews the technique, its indications and limitations and the advantage of this technique. METHODS Between January 2016 and January 2018, data from 7 consecutive patients who underwent partial breast mastectomy with lateral thoracodorsal flap were enrolled. A wedge shaped flap was designed using the pinch test using the index finger and the thumb in small defects, while larger defects required a convex shaped incision with curved superior and inferior borders. Incision was made along the marked margins of the proposed flap and deepened to the underlying serratus anterior and latissimus dorsii muscle. The flap was transposed in the defect and the symmetry of mound between the two breasts confirmed in sitting and supine position. RESULTS All patients were satisfied by cosmetic outcomes on visual analog scale (VAS). Cosmetic results based on Harvard scale showed good to excellent scores. Evaluation by Breast Cancer Conservation Treatment (BCCT) core software illustrated good to excellent cosmetic outcomes. There was no delayed wound healing, marginal skin ornecrosis and no evidence of any fat necrosis in the follow up period. CONCLUSION The versatility of latissimus dorsii flap, good aesthetic and functional results and its simple execution made it an important option in the armamentarium of the oncoplastic breast surgeon. Also, morbidity of the donor site was minimized without sacrificing muscles or nerves.
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Affiliation(s)
- Pavneet Kohli
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Kadambari Dharanipragada
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - M T Friji
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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48
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Agrawal SK, Shakya SR, Nigam S, Sharma A, Datta SS, Ahmed R. Chest wall perforator flaps in partial breast reconstruction after breast conservation surgery: an additional oncoplastic surgical option. Ecancermedicalscience 2020; 14:1073. [PMID: 32863867 PMCID: PMC7434511 DOI: 10.3332/ecancer.2020.1073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Indexed: 11/19/2022] Open
Abstract
Partial breast reconstruction using chest wall perforator flaps (CWPF) is a recent option used by breast surgeons, mainly for lateral quadrant defects with a relatively large volume of excision. We report a single-centre experience of CWPF with surgery details, complications, re-excision, aesthetic and oncological outcomes. This was a prospective observational cohort study of patients who had undergone breast conservation surgery (BCS) plus CWPF reconstruction. All variables were recorded prospectively in the institutional database. A survey was done to analyse patient satisfaction at about 6 months after completion of radiotherapy. Forty patients had CWPF based reconstruction in 3 years. 57.5 % of patients had lateral intercostal artery perforator (LICAP) flap, 5% had lateral thoracic artery perforator (LTAP) flap, 27.5% had combined LICAP plus LTAP and 10% patients had anterior intercostal artery perforator (AICAP) flap. Tumour excision cavity defect was of the lateral quadrant in 82.5%, central quadrant in 10% and medial quadrant in 7.5% of patients. The margin was positive for five patients, out of which four required cavity shave and one had a mastectomy. One patient had complete flap loss, and two patients developed surgical site infection. 96% of patients were satisfied with the scar, and 88% were happy with the treated breast in comparison to the opposite breast. 92% were comfortable going out in public and felt that in retrospect their decision not to have a mastectomy was correct. With a median follow up of 18 (10, 22) months, one patient died, and four had recurrences. CWPF may be used for partial breast reconstruction in the small non-ptotic breast with excellent outcome and high patient satisfaction scores.
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Affiliation(s)
| | - Sudip Ratna Shakya
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Shashank Nigam
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Abhishek Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Soumitra S Datta
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata 700156, India.,MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, WC1V 6LJ, United Kingdom
| | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
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49
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A Novel Breast-Conserving Surgical Technique in the Management of Phyllodes Tumours of the Breast. World J Surg 2020; 44:4149-4152. [PMID: 32862277 DOI: 10.1007/s00268-020-05748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite advances in oncoplastic breast-conserving techniques, very large phyllodes tumours (PT) may still be recommended for mastectomy. METHODS We report a novel 2-staged breast-conserving technique that enables smaller excisional volumes whilst maintaining safe oncological excision. Stage-1 is a capsular dissection via a posterior glandular approach without sacrifice of native breast volume. Stage-2 is a delayed localised resection of the seroma cavity providing a circumferential "margin". Two cases are presented. CONCLUSION This novel technique preserves the breast, optimises cosmesis and is a safe approach to the surgical management of large PT.
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50
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Arabandi P, Slade AN, Sutton AL, McGuire KP, Sheppard V. Racial differences in the relationship between surgical choice and subsequent patient-reported satisfaction outcomes among women with early-stage hormone-positive breast cancer. Breast Cancer Res Treat 2020; 183:459-466. [PMID: 32676991 DOI: 10.1007/s10549-020-05784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The last fifteen years has seen a rising proportion of women who are eligible for breast conserving therapy (BCT) choosing mastectomy despite equivalent survival in early-stage breast cancer. We aim to explore potential racial differences in the association of surgical choice with subsequent patient-reported satisfaction outcomes. METHODS Women who were within one year of diagnosis with hormone receptor (HR)-positive breast cancer were asked the Short Version of Patient Satisfaction Questionnaire (PSQ-18), which assesses their overall satisfaction with their medical care. We conducted bivariate analyses, including paired t-tests, to clarify differences in these patient-reported factors by surgical choice and race. Multivariable linear regression models were used to adjust for clinical and demographic control variables. RESULTS For the sample of 279 women who underwent definitive surgery, women who received a mastectomy had lower levels of overall satisfaction, 71 vs. 75 (out of 90) (p = .001). In stratifying this relationship by race, the difference in total satisfaction score was largest among Black women (69 among mastectomy patients vs. 75 among BCT patients; p = 0.016). On multivariable linear regression, Black race and mastectomy status (together) exhibited a significantly large negative association with total satisfaction score, with negative associations across all domains of the PSQ-18. CONCLUSION Despite the high prevalence of mastectomy among Black women with early-stage, HR-positive breast cancer, this population is more likely to report lower levels of patient satisfaction compared to patients receiving BCT. These findings suggest there may be potential racial differences in the psychosocial consequences of surgical choice.
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Affiliation(s)
- Prudvi Arabandi
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Alexander N Slade
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, VA, USA.
| | - Arnethea L Sutton
- Department of Health Behavior & Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Kandace P McGuire
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Vanessa Sheppard
- Department of Health Behavior & Policy, Virginia Commonwealth University, Richmond, VA, USA
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