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Chen JC, Elsaid MI, Handley D, Anderson L, Andersen BL, Carson WE, Beane JD, Kim A, Skoracki R, Pawlik TM, Obeng-Gyasi S. Allostatic load as a predictor of postoperative complications in patients with breast cancer. NPJ Breast Cancer 2024; 10:44. [PMID: 38866818 PMCID: PMC11169387 DOI: 10.1038/s41523-024-00654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024] Open
Abstract
Allostatic load (AL) is a biological measure of cumulative exposure to socioenvironmental stressors (e.g., poverty). This study aims to examine the association between allostatic load (AL) and postoperative complications (POC) among patients with breast cancer. Females ages 18+ with stage I-III breast cancer who received surgical management between 01/01/2012-12/31/2020 were identified in the Ohio State Cancer registry. The composite AL measure included biomarkers from the cardiovascular, metabolic, immune, and renal systems. High AL was defined as composite scores greater than the cohort's median (2.0). POC within 30 days of surgery were examined. Univariable and multivariable regression analysis examined the association between AL and POC. Among 4459 patients, 8.2% had POC. A higher percentage of patients with POC were unpartnered (POC 44.7% vs no POC 35.5%), government-insured (POC 48.2% vs no POC 38.3%) and had multiple comorbidities (POC 32% vs no POC 20%). Patients who developed POC were more likely to have undergone sentinel lymph node biopsy followed by axillary lymph node dissection (POC 51.2% vs no POC 44.6%). High AL was associated with 29% higher odds of POC (aOR 1.29, 95% CI 1.01-1.63). A one-point increase in AL was associated with 8% higher odds of POC (aOR 1.08, 95% CI 1.02-1.16) and a quartile increase in AL was associated with 13% increased odds of POC (aOR 1.13, 95% CI 1.01-1.26). Among patients undergoing breast cancer surgery, increased exposure to adverse socioenvironmental stressors, operationalized as AL, was associated with higher odds of postoperative complications.
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Affiliation(s)
- J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lisa Anderson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | | | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Joal D Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Alex Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Roman Skoracki
- Division of Reconstructive Oncologic Plastic Surgery, Department of Plastic Surgery, The Ohio State University, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
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Obeng-Gyasi S, Chen JC, Elsaid M, Handley D, Anderson L, Andersen B, Carson W, Beane J, Kim A, Skoracki R, Pawlik T. Allostatic Load as a Predictor of Postoperative Complications in Patients with Breast Cancer. RESEARCH SQUARE 2024:rs.3.rs-3873505. [PMID: 38405905 PMCID: PMC10889069 DOI: 10.21203/rs.3.rs-3873505/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: 02/27/2024]
Abstract
BACKGROUND Allostatic load (AL) is a biological measure of cumulative exposure to socioenvironmental stressors (e.g., poverty). This study aims to examine the association between allostatic load (AL) and postoperative complications (POC) among patients with breast cancer. METHODS Assigned females at birth ages 18 + with stage I-III breast cancer who received surgical management between 01/01/2012-12/31/2020 were identified in the Ohio State Cancer registry. The composite AL measure included biomarkers from the cardiovascular, metabolic, immune, and renal systems. High AL was defined as composite scores greater than the cohort's median (2.0). POC within 30 days of surgery were examined. Univariable and multivariable regression analysis examined the association between AL and POC. RESULTS Among 4,459 patients, 8.2% had POC. A higher percentage of patients with POC were unpartnered (POC 44.7% vs no POC 35.5%), government-insured (POC 48.2% vs no POC 38.3%) and had multiple comorbidities (POC 32% vs no POC 20%). Patients who developed POC were more likely to have undergone sentinel lymph node biopsy followed by axillary lymph node dissection (POC 51.2% vs no POC 44.6%). High AL was associated with 29% higher odds of POC (aOR 1.29, 95% CI 1.01-1.63). A one-point increase in AL was associated with 8% higher odds of POC (aOR 1.08, 95% CI 1.02-1.16) and a quartile increase in AL was associated with 13% increased odds of POC (aOR 1.13, 95% CI 1.01-1.26). CONCLUSION Among patients undergoing breast cancer surgery, increased exposure to adverse socioenvironmental stressors, operationalized as AL, was associated with higher odds of postoperative complications.
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Pochert N, Schneider M, Köpke MB, Wild M, Mattmer A, Sagasser J, Golas MM, Banys-Paluchowski M, Metz A, Hinske C, Reiger M, Jeschke U, Dannecker C, Neumann A, Traidl-Hoffmann C, Untch M, Kühn T, Ditsch N. Th2/Th17 cell associated cytokines found in seroma fluids after breast cancer surgery. Arch Gynecol Obstet 2023; 308:1621-1627. [PMID: 37243864 PMCID: PMC10520137 DOI: 10.1007/s00404-023-07074-w] [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: 03/29/2023] [Accepted: 05/04/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The development of a seroma after breast cancer surgery is a common postoperative complication seen after simple mastectomy and axillary surgery. We could recently demonstrate that breast cancer patients undergoing a simple mastectomy with subsequent seroma formation developed a T-helper cell increase within the aspirated fluid measured by flow cytometry. The same study revealed a Th2 and/or a Th17 immune response in peripheral blood and seroma fluid of the same patient. Based on these results and within the same study population, we now analyzed the Th2/Th17 cell associated cytokine content as well as the best known clinical important cytokine IL-6. METHODS Multiplex cytokine measurements (IL-4, IL-5, IL-13, IL-10, IL-17, and IL-22) were done on 34 seroma fluids (Sf) after fine needle aspiration of patients who developed a seroma after a simple mastectomy. Serum of the same patient (Sp) and that of healthy volunteers (Sc) were used as controls. RESULTS We found the Sf to be highly cytokine rich. Almost all analyzed cytokines were significantly higher in abundance in the Sf compared to Sp and Sc, especially IL-6, which promotes Th17 differentiation as well as suppresses Th1 differentiation in favor of Th2 development. CONCLUSION Our Sf cytokine measurements reflect a local immune event. In contrast, former study results on T-helper cell populations in both Sf and Sp tend to demonstrate a systemic immune process.
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Affiliation(s)
- Nicole Pochert
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Mariella Schneider
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
| | - Melitta B Köpke
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
| | - Mathis Wild
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
- Department of Data Management and Clinical Decision Support, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Angelika Mattmer
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
| | - Jacqueline Sagasser
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
| | - Monika M Golas
- Human Genetics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maggie Banys-Paluchowski
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Aline Metz
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Christian Hinske
- Department of Data Management and Clinical Decision Support, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Matthias Reiger
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany.
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
| | - Avidan Neumann
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Thorsten Kühn
- Department of Obstetrics and Gynecology, Die Filderklinik, Filderstadt, Germany
| | - Nina Ditsch
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany
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Papautsky EL. Patient decision making in recovering from surgery. Front Psychol 2023; 14:1170658. [PMID: 37408966 PMCID: PMC10319058 DOI: 10.3389/fpsyg.2023.1170658] [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: 02/21/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
Patient work in surgery recovery is fraught with complex judgments and decisions. These decisions are not unlike ones that professionals make that we traditionally study with the Naturalistic Decision Making (NDM) theoretical lens and methods. Similarly, patients are making decisions in naturalistic settings and doing so with the objective of minimizing risk and maximizing safety. What is different is that patients are put in a position to perform complex, high level, high consequence work in the absence of any training, education, or decision support. Using a lived experience, I illustrate that the burden of judgement and decision making in surgery recovery work (e.g., caring for surgical sites, managing drains, managing medications, supporting activities of daily living) can be understood through a macrocognitive paradigm. Thus, the NDM theoretical lens and the associated methods is appropriate to study this problem space.
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Otto-Dobos LD, Santos JC, Strehle LD, Grant CV, Simon LA, Oliver B, Godbout JP, Sheridan JF, Barrientos RM, Glasper ER, Pyter LM. The role of microglia in 67NR mammary tumor-induced suppression of brain responses to immune challenges in female mice. J Neurochem 2023:10.1111/jnc.15830. [PMID: 37084026 PMCID: PMC10589388 DOI: 10.1111/jnc.15830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
It is poorly understood how solid peripheral tumors affect brain neuroimmune responses despite the various brain-mediated side effects and higher rates of infection reported in cancer patients. We hypothesized that chronic low-grade peripheral tumor-induced inflammation conditions microglia to drive suppression of neuroinflammatory responses to a subsequent peripheral immune challenge. Here, Balb/c murine mammary tumors attenuated the microglial inflammatory gene expression responses to lipopolysaccharide (LPS) and live Escherichia coli (E. coli) challenges and the fatigue response to an E. coli infection. In contrast, the inflammatory gene expression in response to LPS or a toll-like receptor 2 agonist of Percoll-enriched primary microglia cultures was comparable between tumor-bearing and -free mice, as were the neuroinflammatory and sickness behavioral responses to an intracerebroventricular interleukin (IL)-1β injection. These data led to the hypothesis that Balb/c mammary tumors blunt the neuroinflammatory responses to an immune challenge via a mechanism involving tumor suppression of the peripheral humoral response. Balb/c mammary tumors modestly attenuated select circulating cytokine responses to LPS and E. coli challenges. Further, a second mammary tumor/mouse strain model (E0771 tumors in C57Bl/6 mice) displayed mildly elevated inflammatory responses to an immune challenge. Taken together, these data indicate that tumor-induced suppression of neuroinflammation and sickness behaviors may be driven by a blunted microglial phenotype, partly because of an attenuated peripheral signal to the brain, which may contribute to infection responses and behavioral side effects reported in cancer patients. Finally, these neuroimmune effects likely vary based on tumor type and/or host immune phenotype.
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Affiliation(s)
- L D Otto-Dobos
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - J C Santos
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - L D Strehle
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - C V Grant
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - L A Simon
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - B Oliver
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
| | - J P Godbout
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
- Department of Neuroscience, The Ohio State University, Columbus, Ohio, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio, USA
| | - J F Sheridan
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
- Department of Neuroscience, The Ohio State University, Columbus, Ohio, USA
- Division of Biosciences College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - R M Barrientos
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
- Department of Neuroscience, The Ohio State University, Columbus, Ohio, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - E R Glasper
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
- Department of Neuroscience, The Ohio State University, Columbus, Ohio, USA
| | - L M Pyter
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
- Department of Neuroscience, The Ohio State University, Columbus, Ohio, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Seroma after Simple Mastectomy in Breast Cancer-The Role of CD4+ T Helper Cells and the Evidence as a Possible Specific Immune Process. Int J Mol Sci 2022; 23:ijms23094848. [PMID: 35563236 PMCID: PMC9101279 DOI: 10.3390/ijms23094848] [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: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Seroma development after breast cancer surgery is the most common postoperative complication seen after mastectomy but neither its origin nor its cellular composition is known. To investigate the assumption of immunological significance, one of the first aims of this pilot study is to describe the cellular content of collected seroma fluids and its corresponding serum in patients with simple mastectomy after needle aspiration, as well as the serum of healthy controls. The content of red blood cells (RBC) was measured by haemato-counter analyses, and the lymphocyte identification/quantification was conducted by flow cytometry analyses in seroma fluid (SFl) and the sera of patients (PBp) as well as controls (PBc). Significantly lower numbers of RBCs were measured in SFl. Cytotoxic T cells are significantly reduced in SFl, whereas T helper (Th) cells are significantly enriched compared to PBp. Significantly higher numbers of Th2 cells were found in SFl and PBp compared to PBc. The exact same pattern is seen when analyzing the Th17 subgroup. In conclusion, in contrast to healthy controls, significantly higher Th2 and Th17 cell subgroup-mediated immune responses were measured in seroma formations and were further confirmed in the peripheral blood of breast cancer (including DCIS) patients after simple mastectomy. This could lead to the assumption of a possible immunological cause for the origin of a seroma.
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Hughes TM, Ellsworth B, Berlin NL, Sinco B, Bredbeck B, Baskin A, Wang T, Nathan H, Dossett LA. Statewide Episode Spending Variation of Mastectomy for Breast Cancer. J Am Coll Surg 2022; 234:14-23. [PMID: 35213456 DOI: 10.1097/xcs.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Centralizing complex cancer operations, such as pancreatectomy and esophagectomy, has been shown to increase value, largely due to reduction in complications. For high-volume operations with low complication rates, it is unknown to what degree value varies between facilities, or by what mechanism value may be improved. To identify possible opportunities for value enhancement for such operations, we sought to describe variations in episode spending for mastectomy with a secondary aim of identifying patient- and facility-level determinants of variation. STUDY DESIGN Using the Michigan Value Collaborative risk-adjusted, price-standardized claims data, we evaluated mean spending for patients undergoing mastectomy at 74 facilities (n = 7,342 patients) across the state of Michigan. Primary outcomes were 30- and 90-day episode spending. Using linear mixed models, facility- and patient-level factors were explored for association with spending variability. RESULTS Among 7,342 women treated across 74 facilities, mean 30-day spending by facility ranged from $11,129 to $20,830 (median $14,935). Ninety-day spending ranged from $17,303 to $31,060 (median $23,744). Patient-level factors associated with greater spending included simultaneous breast reconstruction, bilateral surgery, length of stay, and readmission. Among women not undergoing reconstruction, variation persisted, and length of stay, bilateral surgery, and readmission were all associated with increased spending. CONCLUSION Michigan hospitals have significant variation in spending for mastectomy. Reducing length of stay through wider adoption of same-day discharge for mastectomy and reducing the frequency of bilateral surgery may represent opportunities to increase value, without compromising patient safety or oncologic outcomes.
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Affiliation(s)
- Tasha M Hughes
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Brandon Ellsworth
- the University of Michigan School of Medicine, Ann Arbor, MI (Ellsworth, Baskin)
| | - Nicholas L Berlin
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Brandy Sinco
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Brooke Bredbeck
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Alison Baskin
- the University of Michigan School of Medicine, Ann Arbor, MI (Ellsworth, Baskin)
| | - Ton Wang
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Hari Nathan
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Lesly A Dossett
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
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