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Verlingue L, Boyer C, Olgiati L, Brutti Mairesse C, Morel D, Blay JY. Artificial intelligence in oncology: ensuring safe and effective integration of language models in clinical practice. THE LANCET REGIONAL HEALTH. EUROPE 2024; 46:101064. [PMID: 39290808 PMCID: PMC11406067 DOI: 10.1016/j.lanepe.2024.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/07/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024]
Abstract
In this Personal View, we address the latest advancements in automatic text analysis with artificial intelligence (AI) in medicine, with a focus on its implications in aiding treatment decisions in medical oncology. Acknowledging that a majority of hospital medical content is embedded in narrative format, natural language processing has become one of the most dynamic research fields for developing clinical decision support tools. In addition, large language models have recently reached unprecedented performance, notably when answering medical questions. Emerging applications include prognosis estimation, treatment recommendations, multidisciplinary tumor board recommendations and matching patients to recruiting clinical trials. Altogether, we advocate for a forward-looking approach in which the community efficiently initiates global prospective clinical evaluations of promising AI-based decision support systems. Such assessments will be essential to validate and evaluate potential biases, ensuring these innovations can be effectively and safely translated into practical tools for oncological practice. We are at a pivotal moment, where continued advancements in patient care must be pursued with scientific rigor.
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Affiliation(s)
- Loïc Verlingue
- Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, France
- INSERM U1030, Molecular Radiotherapy, Villejuif, France
| | - Clara Boyer
- Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, France
| | - Louise Olgiati
- Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, France
| | | | - Daphné Morel
- INSERM U1030, Molecular Radiotherapy, Villejuif, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Jean-Yves Blay
- Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, France
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Rassy E, Mosele MF, Di Meglio A, Pistilli B, Andre F. Precision oncology in patients with breast cancer: towards a 'screen and characterize' approach. ESMO Open 2024; 9:103716. [PMID: 39303452 DOI: 10.1016/j.esmoop.2024.103716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Affiliation(s)
- E Rassy
- Gustave Roussy, Département de Médecine Oncologique, Villjuif; Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, Villejuif
| | - M F Mosele
- Gustave Roussy, Département de Médecine Oncologique, Villjuif; Université Paris-Saclay, Gustave Roussy, Inserm U981, Villejuif
| | - A Di Meglio
- Gustave Roussy, Département de Médecine Oncologique, Villjuif; Université Paris-Saclay, Gustave Roussy, Inserm U981, Villejuif
| | - B Pistilli
- Gustave Roussy, Département de Médecine Oncologique, Villjuif; INSERM U1279, Gustave Roussy, Villejuif, France
| | - F Andre
- Gustave Roussy, Département de Médecine Oncologique, Villjuif; Université Paris-Saclay, Gustave Roussy, Inserm U981, Villejuif.
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Wang Y, Tian L, Wang W, Pang W, Song Y, Xu X, Sun F, Nie W, Zhao X, Wang L. Development and validation of machine learning models for predicting cancer-related fatigue in lymphoma survivors. Int J Med Inform 2024; 192:105630. [PMID: 39293162 DOI: 10.1016/j.ijmedinf.2024.105630] [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: 05/24/2024] [Revised: 08/14/2024] [Accepted: 09/13/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND New cases of lymphoma are rising, and the symptom burden, like cancer-related fatigue (CRF), severely impacts the quality of life of lymphoma survivors. However, clinical diagnosis and treatment of CRF are inadequate and require enhancement. OBJECTIVE The main objective of this study is to construct machine learning-based CRF prediction models for lymphoma survivors to help healthcare professionals accurately identify the CRF population and better personalize treatment and care for patients. METHODS A cross-sectional study in China recruited lymphoma patients from June 2023 to March 2024, dividing them into two datasets for model construction and external validation. Six machine learning algorithms were used in this study: Logistic Regression (LR), Random Forest, Single Hidden Layer Neural Network, Support Vector Machine, eXtreme Gradient Boosting, and Light Gradient Boosting Machine (LightGBM). Performance metrics like the area under the receiver operating characteristic (AUROC) and calibration curves were compared. The clinical applicability was assessed by decision curve, and Shapley additive explanations was employed to explain variable significance. RESULTS CRF incidence was 40.7 % (dataset I) and 44.8 % (dataset II). LightGBM showed strong performance in training and internal validation. LR excelled in external validation with the highest AUROC and best calibration. Pain, total protein, physical function, and sleep disturbance were important predictors of CRF. CONCLUSION The study presents a machine learning-based CRF prediction model for lymphoma patients, offering dynamic, data-driven assessments that could enhance the development of automated CRF screening tools for personalized management in clinical practice.
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Affiliation(s)
- Yiming Wang
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, China
| | - Lv Tian
- Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wenqiu Wang
- Department of Hematology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, China
| | - Weiping Pang
- Department of Hematology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, China
| | - Yue Song
- Department of Hematology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, China
| | - Xiaofang Xu
- Department of Hematology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, China
| | - Fengzhi Sun
- Department of Hematology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, China
| | - Wenbo Nie
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, China
| | - Xia Zhao
- Department of Hematology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, China.
| | - Lisheng Wang
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, China; Yanda Medical Research Institute, Hebei Yanda Hospital, Langfang, 065201, China; Laboratory of Molecular Diagnosis and Regenerative Medicine, Medical Research Center, the Affiliated Hospital of Qingdao University, Wutaishan Road 1677, Qingdao, 266000, China.
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Franzoi MA, Pages A, Papageorgiou L, Di Meglio A, Laparra A, Martin E, Barbier A, Renvoise N, Arvis J, Scotte F, Vaz-Luis I. Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study. JMIR Res Protoc 2024; 13:e52841. [PMID: 39186774 PMCID: PMC11384181 DOI: 10.2196/52841] [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: 09/17/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC. OBJECTIVE The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration. METHODS This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients' distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network's Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly). RESULTS The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled. CONCLUSIONS This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care. TRIAL REGISTRATION ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52841.
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Affiliation(s)
| | - Arnaud Pages
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Loula Papageorgiou
- Interdisciplinary Department for the Organization of Patient Pathways - DIOPP, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Cancer Survivorship Group (INSERM U981), Gustave Roussy, Villejuif, France
| | - Ariane Laparra
- Interdisciplinary Department for the Organization of Patient Pathways - DIOPP, Gustave Roussy, Villejuif, France
| | - Elise Martin
- Cancer Survivorship Group (INSERM U981), Gustave Roussy, Villejuif, France
| | - Aude Barbier
- Cancer Survivorship Group (INSERM U981), Gustave Roussy, Villejuif, France
| | - Nathalie Renvoise
- Interdisciplinary Department for the Organization of Patient Pathways - DIOPP, Gustave Roussy, Villejuif, France
| | - Johanna Arvis
- Cancer Survivorship Group (INSERM U981), Gustave Roussy, Villejuif, France
| | - Florian Scotte
- Interdisciplinary Department for the Organization of Patient Pathways - DIOPP, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Cancer Survivorship Group (INSERM U981), Gustave Roussy, Villejuif, France
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Kok M, Gielen RJ, Adams S, Lennerz JK, Sharma P, Loibl S, Reardon E, Sonke G, Linn S, Delaloge S, Lacombe D, Robinson T, Badve S, Martin M, Balko JM, Ignatiadis M, Curigliano G, Wolff AC, Mittendorf EA, Loi S, Pusztai L, Tolaney SM, Salgado R. Academic Uphill Battle to Personalize Treatment for Patients With Stage II/III Triple-Negative Breast Cancer. J Clin Oncol 2024:JCO2400372. [PMID: 39038259 DOI: 10.1200/jco.24.00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/17/2024] [Accepted: 05/08/2024] [Indexed: 07/24/2024] Open
Affiliation(s)
- Marleen Kok
- Departments of Medical Oncology and Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Robbert-Jan Gielen
- Departments of Medical Oncology and Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sylvia Adams
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY
| | | | | | - Sibylle Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
- Centre for Haematology and Oncology, Bethanien, and Goethe University, Frankfurt, Germany
| | | | - Gabe Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sabine Linn
- Departments of Medical Oncology and Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Tim Robinson
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Winship Cancer Institute, Atlanta, GA
| | - Miguel Martin
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sherene Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Lajos Pusztai
- Department of Medicine, Yale Cancer Center, Yale University, New Haven, CT
| | | | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
- Division of Research, PeterMacCallum Cancer Centre, Melbourne, VIC, Australia
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Leclercq A, Chatrenet A, Bourgeois H, Cojocarasu O, Mathie C, Martin T, Rahmani A, Morel B. Multidisciplinary analysis of cancer-related fatigue at the time of diagnosis: preliminary results of the BIOCARE FActory cohort. Support Care Cancer 2024; 32:319. [PMID: 38689167 DOI: 10.1007/s00520-024-08520-4] [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: 09/27/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a common side effect of cancer and cancer treatment that significantly impairs the quality of life and can persist for years after treatment completion. Although fatigue is often associated with cancer treatment, it is also a result of the disease itself, even before intervention. CRF at the time of diagnosis may affect treatment timing or completion and is a consistent predictor of post-treatment fatigue at any time. The mechanisms underlying CRF are multidimensional and not well understood, particularly at the time of diagnosis. METHODS Sixty-five breast cancer patients at the time of diagnosis were included. The participants completed self-assessment questionnaires about CRF, sleep disturbances, and emotional symptoms and wore an accelerometer to assess levels of spontaneous physical activity and sleep quality. During the experimental session, the participants underwent cognitive, neuromuscular, and exercise metabolism evaluations. RESULTS Using augmented backward elimination regression, this study found that emotional symptoms and perceived sleep disturbances were the strongest predictors of CRF (adjusted r2 = 0.51). Neuromuscular fatigability and sleep disturbance were also associated with physical dimensions, whereas cognitive performance was associated with cognitive dimensions. CONCLUSION At the time of diagnosis, emotional and cognitive dimensions are over-represented compared to the general population, and specific subdimensions have specific predictors that support the idea of distinct mechanisms. Evaluating CRF subdimensions and their potential mechanisms at the time of diagnosis would be particularly relevant for identifying high-risk patients and offering them appropriate interventions. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT04391543) in May, 2020.
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Affiliation(s)
- A Leclercq
- Laboratoire Movement, Interactions, Performance, MIP-UR 4334, Le Mans Université Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France.
| | - A Chatrenet
- Laboratoire Movement, Interactions, Performance, MIP-UR 4334, Le Mans Université Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France
- APCoSS-Institute of Physical Education and Sports Sciences (IFEPSA), UCO, Angers, France
| | - H Bourgeois
- Elsan-Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - O Cojocarasu
- Centre Hospitalier Le Mans (CHM), Le Mans, France
| | - C Mathie
- Centre Hospitalier Le Mans (CHM), Le Mans, France
| | - T Martin
- Laboratoire Movement, Interactions, Performance, MIP-UR 4334, Le Mans Université Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France
| | - A Rahmani
- Laboratoire Movement, Interactions, Performance, MIP-UR 4334, Le Mans Université Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France
| | - B Morel
- Laboratoire Interuniversitaire de Biologie de La Motricité, Université Savoie Mont Blanc, EA 7424, F-73000, Chambéry, France
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Gu Z, Yang C, Zhang K, Wu H. Development and validation of a nomogram for predicting sever cancer-related fatigue in patients with cervical cancer. BMC Cancer 2024; 24:492. [PMID: 38637740 PMCID: PMC11025233 DOI: 10.1186/s12885-024-12258-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: 03/01/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Cancer-related fatigue (CRF) has been considered the biggest influencing factor for cancer patients after surgery. This study aimed to develop and validate a nomogram for severe cancer-related fatigue (CRF) patients with cervical cancer (CC). METHODS A cross-sectional study was conducted to develop and validate a nomogram (building set = 196; validation set = 88) in the Department of Obstetrics and Gynecology of a Class III hospital in Shenyang, Liaoning Province. We adopted the questionnaire method, including the Cancer Fatigue Scale (CFS), Medical Uncertainty in Illness Scale (MUIS), Medical Coping Modes Questionnaire (MCMQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Sense of Coherence-13 (SOC-13). Binary logistic regression was used to test the risk factors of CRF. The R4.1.2 software was used to develop and validate the nomogram, including Bootstrap resampling method, the ability of Area Under Curve (AUC), Concordance Index (C-Index), Hosmer Lemeshow goodness of fit test, Receiver Operating Characteristic (ROC) curve, Calibration calibration curve, and Decision Curve Analysis curve (DCA). RESULTS The regression equation was Logit(P) = 1.276-0.947 Monthly income + 0.989 Long-term passive smoking - 0.952 Physical exercise + 1.512 Diagnosis type + 1.040 Coping style - 0.726 Perceived Social Support - 2.350 Sense of Coherence. The C-Index of the nomogram was 0.921 (95% CI: 0.877∼0.958). The ROC curve showed the sensitivity of the nomogram was 0.821, the specificity was 0.900, and the accuracy was 0.857. AUC was 0.916 (95% CI: 0.876∼0.957). The calibration showed that the predicted probability of the nomogram fitted well with the actual probability. The DCA curve showed when the prediction probability was greater than about 10%, the benefit of the nomogram was positive. The results in the validation group were similar. CONCLUSION This nomogram had good identifiability, accuracy and clinical practicality, and could be used as a prediction and evaluation tool for severe cases of clinical patients with CC.
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Affiliation(s)
- ZhiHui Gu
- Department of Social Medicine, School of Health Management, China Medical University, No.77 PuHe Road, Shenyang North New District, 110122, Shenyang, Liaoning, People's Republic of China
| | - ChenXin Yang
- Department of Social Medicine, School of Health Management, China Medical University, No.77 PuHe Road, Shenyang North New District, 110122, Shenyang, Liaoning, People's Republic of China
| | - Ke Zhang
- Department of Social Medicine, School of Health Management, China Medical University, No.77 PuHe Road, Shenyang North New District, 110122, Shenyang, Liaoning, People's Republic of China
| | - Hui Wu
- Department of Social Medicine, School of Health Management, China Medical University, No.77 PuHe Road, Shenyang North New District, 110122, Shenyang, Liaoning, People's Republic of China.
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Di Meglio A, Vaz-Luis I. Systemic inflammation and cancer-related frailty: shifting the paradigm toward precision survivorship medicine. ESMO Open 2024; 9:102205. [PMID: 38194879 PMCID: PMC10820355 DOI: 10.1016/j.esmoop.2023.102205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- A Di Meglio
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif.
| | - I Vaz-Luis
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif; Interdisciplinary Department for the Organization of Patient Pathways (DIOPP), Gustave Roussy, Villejuif, France
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Pezzolato M, Spada GE, Fragale E, Cutica I, Masiero M, Marzorati C, Pravettoni G. Predictive Models of Psychological Distress, Quality of Life, and Adherence to Medication in Breast Cancer Patients: A Scoping Review. Patient Prefer Adherence 2023; 17:3461-3473. [PMID: 38143947 PMCID: PMC10748751 DOI: 10.2147/ppa.s440148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose An interplay of clinical and psychosocial variables affects breast cancer patients' experiences and clinical trajectories. Several studies investigated the role of socio-demographic, clinical, and psychosocial factors in predicting relevant outcomes in breast cancer care, thus developing predictive models. Our aim is to summarize predictive models for specific psychological and behavioral outcomes: psychological distress, quality of life, and medication adherence. Specifically, we aim to map the determinants of the outcomes of interest, offering a thorough overview of these models. Methods Databases (PubMed, Scopus, Embase) have been searched to identify studies meeting the inclusion criteria: a breast cancer patients' sample, development/validation of a predictive model for selected psychological/behavioral outcomes (ie, psychological distress, quality of life, and medication adherence), and availability of English full-text. Results Twenty-one papers describing predictive models for psychological distress, quality of life, and adherence to medication in breast cancer were included. The models were developed using different statistical approaches. It has been shown that treatment-related factors (eg, side-effects, type of surgery or treatment received), socio-demographic (eg, younger age, lower income, and inactive occupational status), clinical (eg, advanced stage of disease, comorbidities, physical symptoms such as fatigue, insomnia, and pain) and psychological variables (eg, anxiety, depression, body image dissatisfaction) might predict poorer outcomes. Conclusion Predictive models of distress, quality of life, and adherence, although heterogeneous, showed good predictive values, as indicated by the reported performance measures and metrics. Many of the predictors are easily available in patients' health records, whereas others (eg, coping strategies, perceived social support, illness perceptions) might be introduced in routine assessment practices. The possibility to assess such factors is a relevant resource for clinicians and researchers involved in developing and implementing psychological interventions for breast cancer patients.
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Affiliation(s)
- M Pezzolato
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - G E Spada
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - E Fragale
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - I Cutica
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - C Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Burgers VWG, Reuvers MJP, Taphoorn MJB, Kok M, de Langen AJ, van den Bent MJ, Frissen SAMM, Harthoorn NCGL, Dickhout A, Husson O, van der Graaf WTA. A qualitative study on the healthcare experiences of adolescents and young adults (AYA) with an uncertain or poor cancer prognosis. Support Care Cancer 2023; 31:721. [PMID: 38008874 DOI: 10.1007/s00520-023-08149-9] [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: 04/24/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Treatment advancements have improved life expectancy for adolescents and young adults (AYAs) with an uncertain and/or poor cancer prognosis (UPCP) and change clinical practice. This improved survival requires a different approach and specific expertise to meet the needs of this group. The aim of this study is to explore the health care experiences of AYAs with a UPCP. METHODS We conducted a multicenter qualitative study using semi-structured interviews and elements of the grounded theory by Corbin and Strauss. RESULTS Interviews were conducted with 46 AYAs with a UPCP. They were on average 33.4 years old (age range 23-44), and most of them were woman (63%). Additionally, five AYAs with a UPCP participated as AYA research partners in two focus groups. They were on average 31.8 years old and four of them were woman. AYAs with a UPCP reported four pillars for a satisfied healthcare experience: (1) trust, (2) tailored communication, (3) holistic empathic open attitude, and (4) care being offered (pro-)actively. They reported both optimal and suboptimal experiences about distrust based on a delay in diagnostic trajectory, lack of tailored communication and discussion of sensitive topics, preference for a holistic approach, and struggles with finding the way to get additional healthcare support. CONCLUSION For AYAs with a UPCP, it is important that both age-specific issues and issues related to the UPCP are understood and addressed; however, this seems not yet optimally implemented in clinical practice. This emphasizes the importance of providing this patient group with tailored care incorporating both aspects. Healthcare professionals need to be supported with training and tools to understand the healthcare needs of AYAs with a UPCP. AYAs can be empowered to take more control over their own healthcare needs.
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Affiliation(s)
- Vivian W G Burgers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Milou J P Reuvers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Annemiek Dickhout
- AYA Research Partner, Amsterdam, the Netherlands
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW-School of Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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11
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Kabirian R, Franzoi MA, Havas J, Coutant C, Tredan O, Levy C, Cottu P, Dhaini Mérimèche A, Guillermet S, Ferrero JM, Giacchetti S, Petit T, Dalenc F, Rouanet P, Everhard S, Martin AL, Pistilli B, Lambertini M, Vaz-Luis I, Di Meglio A. Chemotherapy-Related Amenorrhea and Quality of Life Among Premenopausal Women With Breast Cancer. JAMA Netw Open 2023; 6:e2343910. [PMID: 37971739 PMCID: PMC10654794 DOI: 10.1001/jamanetworkopen.2023.43910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Younger survivors of breast cancer frequently report more treatment-related symptoms, mostly related to the menopausal transition. Objective To assess factors associated with chemotherapy-related amenorrhea (CRA) and to evaluate its association with long-term quality of life (QOL). Design, Setting, and Participants The prospective, longitudinal Cancer Toxicities Study, a multicenter French cohort study, includes women with a diagnosis of stage I to III breast cancer and collects data approximately yearly after diagnosis. The current study reports outcomes up to 4 years after diagnosis for participants enrolled from 2012 to 2017. Participants included premenopausal women younger than 50 years treated with chemotherapy and not receiving adjuvant ovarian function suppression. Data analysis was performed from September 2021 to June 2023. Exposures Clinical, socioeconomic, tumor, and treatment characteristics assessed at diagnosis (for the analysis of factors associated with CRA) and persistent CRA (for the QOL analysis). Main Outcomes and Measures The main outcome of interest was CRA at year 1 (Y1), year 2 (Y2), and year 4 (Y4) after diagnosis. Generalized estimating equations assessed associations of exposure variables with CRA. In the QOL analysis, QOL at Y4 (assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23) was the outcome of interest. Multivariable random-effect mixed models assessed the association of persistent CRA (ie, never recovering menses after treatment) with QOL. Results Among 1636 women, the mean (SD) age at diagnosis was 42.2 (5.6) years. Overall, 1242 of 1497 women (83.0%) reported CRA at Y1, 959 of 1323 women (72.5%) reported it at Y2, and 599 of 906 women (66.1%) reported it at Y4. Older age vs 18 to 34 years (adjusted odds ratio [OR] for 35 to 39 years, 1.84 [95% CI, 1.32 to 2.56]; adjusted OR for 40 to 44 years, 5.90 [95% CI, 4.23 to 8.24]; and adjusted OR for ≥45 years, 21.29 [95% CI, 14.34 to 31.61]) and receipt of adjuvant tamoxifen (adjusted OR, 1.97 [95% CI, 1.53 to 2.53]) were associated with higher likelihood of CRA. In the QOL analysis, 416 of 729 women (57.1%) had persistent CRA. However, late menses recovery among women aged 18 to 34 years with no menses at Y2 were reported by 11 of 21 women (52.4%) between Y2 and Y4. Persistent CRA was associated with worse insomnia (mean difference vs recovery at any time, 9.9 points [95% CI, 3.2 to 16.5 points]; P = .004), systemic therapy-related adverse effects (mean difference, 3.0 points [95% CI, 0.2 to 5.8 points]; P = .04), and sexual functioning (mean difference, -9.2 points [95% CI, -14.3 to -4.1 points]; P < .001) at Y4. Conclusions and Relevance In this cohort study of premenopausal women with breast cancer, persistent CRA was common, although some women recovered menses late, and was associated with worse long-term QOL. This study can help inform risk communication, personalized counseling, and early supportive care referrals for such patients.
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Affiliation(s)
- Rayan Kabirian
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Sorbonne Université, Paris, France
| | - Maria Alice Franzoi
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Asma Dhaini Mérimèche
- Institut de Cancérologie de Lorraine–Alexis Vautrin, Vandœuvre-lès-Nancy, France
- Now with Centre Hospitalier de Lunéville-Ghemm, Pôle Mère-Enfant, Lunéville, France
| | | | | | | | - Thierry Petit
- Centre Paul Strauss Centre de Lutte Contre le Cancer, Strasbourg, France
| | | | | | | | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine University of Genova, Genova, Italy
- Department of Medical Oncology, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Département Interdisciplinaire d’Organisation des Parcours Patients, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
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12
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Rosas JC, Aguado-Barrera ME, Azria D, Briers E, Elliott R, Farcy-Jacquet MP, Giraldo A, Gutiérrez-Enríquez S, Rancati T, Rattay T, Reyes V, Rosenstein B, De Ruysscher D, Sperk E, Stobart H, Talbot C, Vega A, Taboada-Valladares B, Veldeman L, Ward T, Webb A, West C, Chang-Claude J, Seibold P. (Pre)treatment risk factors for late fatigue and fatigue trajectories following radiotherapy for breast cancer. Int J Cancer 2023; 153:1579-1591. [PMID: 37403702 DOI: 10.1002/ijc.34640] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 07/06/2023]
Abstract
Fatigue is common in breast-cancer survivors. Our study assessed fatigue longitudinally in breast cancer patients receiving adjuvant radiotherapy (RT) and aimed to identify risk factors associated with long-term fatigue and underlying fatigue trajectories. Fatigue was measured in a prospective multicenter cohort (REQUITE) using the Multidimensional Fatigue Inventory (MFI-20) and analyzed using mixed models. Multivariable logistic models identified factors associated with fatigue dimensions at 2 years post-RT and latent class growth analysis identified individual fatigue trajectories. A total of 1443, 1302, 1203 and 1098 patients completed the MFI-20 at baseline, end of RT, after 1 and 2 years. Overall, levels of fatigue significantly increased from baseline to end of RT for all fatigue dimensions (P < .05) and returned to baseline levels after 2 years. A quarter of patients were assigned to latent trajectory high (23.7%) and moderate (24.8%) fatigue classes, while 46.3% and 5.2% to the low and decreasing fatigue classes, respectively. Factors associated with multiple fatigue dimensions at 2 years include age, BMI, global health status, insomnia, pain, dyspnea and depression. Fatigue present at baseline was consistently associated with all five MFI-20 fatigue dimensions (ORGeneralFatigue = 3.81, P < .001). From latent trajectory analysis, patients with a combination of factors such as pain, insomnia, depression, younger age and endocrine therapy had a particularly high risk of developing early and persistent high fatigue years after treatment. Our results confirmed the multidimensional nature of fatigue and will help clinicians identify breast cancer patients at higher risk of having persistent/late fatigue so that tailored interventions can be delivered.
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Affiliation(s)
- Juan C Rosas
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians University, Munich, Germany
| | - Miguel E Aguado-Barrera
- Instituto de Investigación Sanitaria de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain
| | - David Azria
- University of Montpellier, INSERM U1194 IRCM, Institut du Cancer Montpellier (ICM), Montpellier, France
| | | | | | - Marie-Pierre Farcy-Jacquet
- Federation Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut du Cancer Du Gard (ICG), CHU Carémeau, Nîmes, France
| | - Alexandra Giraldo
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tiziana Rancati
- Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| | | | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Barry Rosenstein
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirk De Ruysscher
- Maastro Clinic, Maastricht, The Netherlands
- KU Leuven, Leuven, Belgium
| | - Elena Sperk
- Universitätsmedizin Mannheim, Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Ana Vega
- Instituto de Investigación Sanitaria de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain
- Biomedical Network on Rare Diseases (CIBERER), Seville, Spain
| | - Begoña Taboada-Valladares
- Instituto de Investigación Sanitaria de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Liv Veldeman
- Ghent University Hospital, Ghent, Belgium
- Ghent University, Ghent, Belgium
| | | | - Adam Webb
- University of Leicester, Leicester, UK
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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14
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Li Z, Shen G, Shi M, Zheng Y, Guan Y, Xin Y, Wang M, Zhao F, Ren D, Zhao J. Association between high body mass index and prognosis of patients with early-stage breast cancer: A systematic review and meta-analysis. CANCER PATHOGENESIS AND THERAPY 2023; 1:205-215. [PMID: 38327841 PMCID: PMC10846319 DOI: 10.1016/j.cpt.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 02/09/2024]
Abstract
Background A high body mass index (BMI) can indicate overweight or obesity and is a crucial risk factor for breast cancer survivors. However, the association between high BMI and prognosis in early-stage breast cancer (EBC) remains unclear. We aimed to assess the effects of high BMI on the prognosis of patients with EBC. Methods The PubMed, Embase, and Cochrane Library databases and proceedings of major oncological conferences related to the effects of BMI on the prognosis of breast cancer were searched up to November 2021. Fixed- and random-effects models were used for meta-analyses. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free survival (DFS) and overall survival (OS) were extracted from the included literature. Results Twenty retrospective cohort studies with 33,836 patients with EBC were included. Overweight patients had worse DFS (HR: 1.16, 95% CI: 1.05-1.27, P = 0.002) and OS (HR: 1.20; 95% CI: 1.09-1.33, P < 0.001). Obesity also had adverse effects on DFS (HR: 1.17, 95% CI: 1.07-1.29, P = 0.001) and OS (HR: 1.30, 95% CI: 1.17-1.45, P < 0.001). Likewise, patients with high BMI had worse DFS (HR: 1.16, 95% CI: 1.08-1.26, P < 0.001) and OS (HR: 1.25, 95% CI: 1.14-1.39, P < 0.001). In subgroup analyses, overweight had adverse effects on DFS (HR: 1.11, 95% CI: 1.04-1.18, P = 0.001) and OS (HR: 1.18, 95% CI: 1.11-1.26, P < 0.001) in multivariate analyses, whereas the relationship that overweight had negative effects on DFS (HR: 1.21, 95% CI: 0.99-1.48, P = 0.058) and OS (HR: 1.39, 95% CI: 0.92-2.10, P = 0.123) was not statistically significant in univariate analysis. By contrast, obesity had adverse effects on DFS (HR: 1.21, 95% CI: 1.06-1.38, P = 0.004 and HR: 1.14, 95% CI: 1.08-1.22, P < 0.001) and OS (HR: 1.33, 95% CI: 1.15-1.54, P < 0.001 and HR: 1.23, 95% CI: 1.15-1.31, P < 0.001) in univariate and multivariate analyses, respectively. Conclusions Compared with normal weight, increased body weight (overweight, obesity, and high BMI) led to worse DFS and OS in patients with EBC. Once validated, these results should be considered in the development of prevention programs.
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Affiliation(s)
| | | | | | - Yonghui Zheng
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Yumei Guan
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Yuanfang Xin
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Miaozhou Wang
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Fuxing Zhao
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Dengfeng Ren
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
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15
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吴 俊, 周 伟, 王 伟, 尚 少. [Latest Findings in Key Research Areas of Precision Nursing for Chronic Diseases in Older Adults]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:731-735. [PMID: 37545065 PMCID: PMC10442624 DOI: 10.12182/20230760507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 08/08/2023]
Abstract
The advent of the era of biomedical big data has helped promote the development of precision nursing. Precision nursing for chronic diseases in older adults is an interdisciplinary research field in which accurate individualized data are utilized to carry out early screening and health management of older adult populations at high risk for chronic diseases and early intervention of diseases, which plays an important role in improving the prognosis of diseases and the health level of the older adult population. Herein, we introduced the concept of precision nursing, and discussed the latest research findings in the key areas of precision nursing for chronic diseases in older adults, including precision symptom management in cancer patients and precision nursing in older patients with multimorbidity. At present, research concerning precise symptom management of cancer patients is mainly focused on prediction modelling for risks of symptoms, longitudinal change trajectories, core symptom identification, etc. Investigations in the precise nursing of cancer patients are conducted in the following areas, risk prediction, the timing of interventions, and intervention targets. Research on precision nursing for multimorbidity is mainly focused on assessment of chronic disease multimorbidity, multimorbidity pattern recognition, and health management of multimorbidity. We also discussed potential opportunities and challenges of precision nursing in the future, in order to provide a scientific basis for the improving the practice and theories of precision nursing. In the future, precision nursing will play an ever more important role in uncovering pathogenic information, the diagnosis and treatment of diseases, the health of the research population, and the promotion of medical research.
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Affiliation(s)
- 俊慧 吴
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
| | - 伟娇 周
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
| | - 伟轩 王
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
| | - 少梅 尚
- 北京大学护理学院 (北京 100191)School of Nursing, Peking University, Beijing 100191, China
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16
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Dejonckheere CS, Abramian A, Lindner K, Bachmann A, Layer K, Anzböck T, Layer JP, Sarria GR, Scafa D, Koch D, Leitzen C, Kaiser C, Faridi A, Schmeel LC. Objective, Clinician- and Patient-Reported Evaluation of Late Toxicity Following Adjuvant Radiation for Early Breast Cancer: Long-Term Follow-Up Results of a Randomised Series. J Clin Med 2023; 12:4212. [PMID: 37445247 DOI: 10.3390/jcm12134212] [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: 05/30/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Background and Purpose: This study aimed to differentially assess the frequency and severity of late radiation-induced toxicity following adjuvant whole-breast irradiation for early breast cancer with conventional fractionation (CF) and moderate hypofractionation (mHF). Materials and Methods: Patients recruited in a previous randomised controlled trial comparing acute toxicity between CF and mHF without disease recurrence were included in a post hoc analysis. Spectrophotometric and ultrasonographic examinations were performed for an objective evaluation and subsequent comparison of long-term skin toxicity. Furthermore, patient- and clinician-reported outcomes were recorded. Results: Sixty-four patients with a median age of 58 (37-81) years were included. The median follow-up was 57 (37-73) months. A total of 55% underwent CF and 45% mHF. A total of 52% received a sequential boost to the tumour bed. A significant decrease in mean L* (p = 0.011) and an increase in a* (p = 0.040) and b* values (p < 0.001) were observed, indicating hyperpigmentation. In comparison with the non-irradiated breast, there was a significant increase in both cutis (+14%; p < 0.001) and subcutis (+17%; p = 0.011) thickness, significantly more pronounced in CF patients (p = 0.049). In CF patients only, a sequential boost significantly increased the local cutis thickness and oedema compared to non-boost regions in the same breast (p = 0.001 and p < 0.001, respectively). Conclusions: mHF objectively resulted in reduced long-term skin toxicity compared to CF. A sequential boost increased the local fibrosis rate in CF, but not in mHF. This might explain the subjectively reported better cosmetic outcomes in patients receiving mHF and reinforces the rationale for favouring mHF as the standard of care.
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Affiliation(s)
| | - Alina Abramian
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Kira Lindner
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Anne Bachmann
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Katharina Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Teresa Anzböck
- Department of Gynaecology, Division of Gynaecology and Gynaecological Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christina Kaiser
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
| | - Andree Faridi
- Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany
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17
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Franzoi MA, Degousée L, Martin E, Semedo PM, Aupomerol M, Soldato D, Di Meglio A, Chiodi C, Barbier A, Chaouachi H, Renvoisé N, Boinon D, Fasse L, Ribeiro J, Le-Provost JB, Arvis J, Lazorthes C, di Palma M, de Jesus A, Raynard B, Pagès A, Delaloge S, Pistilli B, Scotté F, Vaz-Luis I. Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer. JCO Oncol Pract 2023; 19:353-361. [PMID: 37307673 DOI: 10.1200/op.23.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/15/2023] [Accepted: 04/21/2023] [Indexed: 06/14/2023] Open
Abstract
PURPOSE Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.
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Affiliation(s)
- Maria Alice Franzoi
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Lena Degousée
- Breast Oncology Unit, Gustave Roussy, Villejuif, France
| | - Elise Martin
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
- CNRS-UAR3683 MSH Paris-Saclay, Gif sur Yvette, France
| | | | | | - Davide Soldato
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Camila Chiodi
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Aude Barbier
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Hajer Chaouachi
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Nathalie Renvoisé
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Diane Boinon
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Léonor Fasse
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Joana Ribeiro
- Breast Oncology Unit, Gustave Roussy, Villejuif, France
| | | | - Johanna Arvis
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | | | - Mario di Palma
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Anne de Jesus
- Patient Committee, Gustave Roussy, Villejuif, France
| | - Bruno Raynard
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Arnaud Pagès
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
| | | | | | - Florian Scotté
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
- Breast Oncology Unit, Gustave Roussy, Villejuif, France
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
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18
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Soldato D, Arecco L, Agostinetto E, Franzoi MA, Mariamidze E, Begijanashvili S, Brunetti N, Spinaci S, Solinas C, Vaz-Luis I, Di Meglio A, Lambertini M. The Future of Breast Cancer Research in the Survivorship Field. Oncol Ther 2023:10.1007/s40487-023-00225-8. [PMID: 37005952 DOI: 10.1007/s40487-023-00225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.
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Affiliation(s)
- D Soldato
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - E Agostinetto
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M A Franzoi
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital Tbilisi, Tbilisi, Georgia
| | - N Brunetti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - S Spinaci
- Division of Breast Surgery, Villa Scassi Hospital, Genoa, Italy
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico Duilio Casula, Monserrato, Italy
| | - I Vaz-Luis
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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19
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Licaj I, Coquan E, Dabakuyo-Yonli TS, Dauchy S, Vaz Luis I, Charles C, Lemogne C, Tredan O, Vanlemmens L, Jouannaud C, Levy C, Rigal O, Fournier M, Petit T, Dalenc F, Rouanet P, Lemonnier J, Everhard S, Cottu P, Joly F. Baseline quality of life and chemotherapy toxicities in patients with early breast cancer. Cancer 2023; 129:1085-1095. [PMID: 36642837 DOI: 10.1002/cncr.34643] [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: 09/27/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The authors used the French breast cancer Cancer and Toxicities (CANTO) cohort to study the associations between baseline quality of life and chemotherapy dose-reductions (CDRs) or postchemotherapy-toxicities (PCTs). METHODS In total, 3079 patients with breast cancer who received chemotherapy were included in this analysis. The associations between baseline physical functioning (PF) and fatigue measured using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30, and two endpoints-CDRs during adjuvant or neoadjuvant chemotherapy; and selected PCTs were estimated with odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) using logistic regression models. RESULTS Among the 3079 patients from the CANTO cohort who were included, 718 (33.0%) received chemotherapy in the neoadjuvant setting, and 2361 (67.0%) received chemotherapy as adjuvant treatment. The chemotherapy included taxanes in 94.2% of patients and anthracyclines in 90.5% of patients. Overall, 15.5% of patients experienced CDRs and, 31.0% developed PCTs. Women with low baseline PF scores (<83) had higher multivariate odds of developing CDRs compared with those who had PF scores ≥83 (OR, 1.54; 95% CI, 1.13-2.09). The corresponding OR for PCTs was 1.50 (95% CI, 1.13-2.00). Women with high baseline fatigue scores had higher odds of CDRs (OR, 1.43; 95% CI, 1.13-1.76) and PCTs (OR, 1.32; 95% CI, 1.10-1.59). CONCLUSIONS By using the national CANTO cohort, baseline PF and fatigue were independently associated with CDRs and PCTs.
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Affiliation(s)
- Idlir Licaj
- Clinical Research Department, Centre Francois Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elodie Coquan
- Clinical Research Department, Centre Francois Baclesse, Caen, France.,Medical Oncology, Centre Francois Baclesse, Caen, France
| | | | - Sarah Dauchy
- Supportive Care Department, Gustave Roussy, Villejuif, France
| | | | - Cecile Charles
- Supportive Care Department, Gustave Roussy, Villejuif, France
| | - Cedric Lemogne
- Psychiatry Department, Hopital Europeén Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Olivier Tredan
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | | | | | - Christelle Levy
- Department of Clinical Research Unit and Medical Oncology, Centre François Baclesse, Caen, France
| | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Marion Fournier
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Philippe Rouanet
- Department of Surgery, Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Florence Joly
- Clinical Research Department, Centre Francois Baclesse, Caen, France.,ANTICIPE Unit, Institut National de la Sante et de la Recherche Medicale, University of Caen Normandie, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, France
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20
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Zhang Y, Sang R, Bao J, Jiang Z, Qian D, Zhou Y, Su W, Wei J, Zhao L, Wei Z, Zhao Y, Shi M, Chen G. Schwann cell-derived CXCL2 contributes to cancer pain by modulating macrophage infiltration in a mouse breast cancer model. Brain Behav Immun 2023; 109:308-320. [PMID: 36754246 DOI: 10.1016/j.bbi.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Pain is one of the most severe complications affecting the quality of life of cancer patients. Although substantial progress has been made in the diagnosis and treatment of cancer, the neurobiological mechanism of cancer pain is still unclear. In the present study, we identified the critical role of CXC chemokine 2 (CXCL2), released by Schwann cells after being activated by cancer cells, in maintaining cancer-induced macrophage infiltration and the resulting mechanical hypersensitivity and persistent spontaneous nociception. In vitro, Schwann cells cocultured with breast cancer cells exhibited a significant increase in CXCL2 expression; in addition, conditioned medium from Schwann cells activated by breast cancer cells had a similar effect to recombinant CXCL2 in terms of inducing macrophage migration. Targeting CXCL2 signaling by both CXC chemokine receptor 2 (CXCR2) antagonist pharmacological blockade and anti-CXCL2 mAb immunological blockade robustly prevented conditioned medium-induced macrophage migration. In vivo, both application of recombinant CXCL2 and perineural breast cancer cell implantation resulted in mechanical hypersensitivity and persistent spontaneous nociception in mice, along with increased macrophage infiltration into the sciatic nerves. Similar to the in vitro results, inhibition of CXCL2/CXCR2 signaling or conditional knockdown of CXCL2 in sciatic nerve Schwann cells effectively attenuated breast cancer cell-induced mechanical hypersensitivity, persistent spontaneous nociception, and macrophage recruitment in the sciatic nerve. Mechanistically, we found that redox effector factor-1 (Ref-1) secreted by breast cancer cells activated hypoxia inducible factor-1α (HIF-1α) expression and inhibited reactive oxygen species (ROS) production in Schwann cells, ultimately inducing CXCL2 expression in Schwann cells. In brief, the present study expands new insights into cancer pain mechanisms from promising animal models to provide new strategies for the control of cancer pain.
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Affiliation(s)
- Yonghui Zhang
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China; Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Rui Sang
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China
| | - Jingyin Bao
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China
| | - Zhihao Jiang
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China
| | - Danni Qian
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China
| | - Yi Zhou
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Wenfeng Su
- Key Laboratory of Neuroregeneration of Jiangsu and the Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jinhuan Wei
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China
| | - Long Zhao
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China
| | - Zhongya Wei
- Key Laboratory of Neuroregeneration of Jiangsu and the Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yayu Zhao
- Key Laboratory of Neuroregeneration of Jiangsu and the Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Minxin Shi
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong 226001, Jiangsu Province, China.
| | - Gang Chen
- Basic Medical Research Center, Medical School of Nantong University, Co-Innovation Center of Neuroregeneration, Nantong 226001, Jiangsu Province, China; Key Laboratory of Neuroregeneration of Jiangsu and the Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China; Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China.
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21
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Lambertini M, Massarotti C, Havas J, Pistilli B, Martin AL, Jacquet A, Coutant C, Coussy F, Mérimèche AD, Lerebours F, Rousset-Jablonski C, Jouannaud C, Rigal O, Fournier M, Soulie P, Franzoi MA, Del Mastro L, Partridge AH, André F, Vaz-Luis I, Di Meglio A. Contraceptive Use in Premenopausal Women With Early Breast Cancer. JAMA Netw Open 2022; 5:e2233137. [PMID: 36149651 PMCID: PMC9508662 DOI: 10.1001/jamanetworkopen.2022.33137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE As life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant. OBJECTIVE To examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer. DESIGN, SETTING, AND PARTICIPANTS The Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022. EXPOSURES Contraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2). MAIN OUTCOMES AND MEASURES Contraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis. RESULTS A total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P < .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44). CONCLUSIONS AND RELEVANCE Findings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, School of Medicine, University of Genova, Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Julie Havas
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | - Charles Coutant
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | | | | | | | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Marion Fournier
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Patrick Soulie
- Department of Medical Oncology, Institut de Cancérologie de L’ouest-Paul Papin, Angers, France
| | - Maria Alice Franzoi
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fabrice André
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
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22
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Vaz-Luis I, Di Meglio A, Havas J, El-Mouhebb M, Lapidari P, Presti D, Soldato D, Pistilli B, Dumas A, Menvielle G, Charles C, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Dauchy S, Delaloge S, Lin NU, Ganz PA, Partridge AH, André F, Michiels S. Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis. J Clin Oncol 2022; 40:2148-2162. [PMID: 35290073 PMCID: PMC9242405 DOI: 10.1200/jco.21.01958] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Fatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors. METHODS We performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models. RESULTS Three trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors. CONCLUSION Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.
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Affiliation(s)
- Ines Vaz-Luis
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Antonio Di Meglio
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Pietro Lapidari
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Daniele Presti
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Davide Soldato
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Agnes Dumas
- Universite de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | | | | | | | | | - Sarah Dauchy
- Gustave Roussy, Supportive Care, IPLESP, Paris, France
| | | | | | | | | | - Fabrice André
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, INSERM, University Paris-Saclay, Villejuif, France
- Equipe labellisée Ligue Contre le Cancer, Villejuif, France
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23
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André L, Antherieu G, Boinet A, Bret J, Gilbert T, Boulahssass R, Falandry C. Oncological Treatment-Related Fatigue in Oncogeriatrics: A Scoping Review. Cancers (Basel) 2022; 14:2470. [PMID: 35626074 PMCID: PMC9139887 DOI: 10.3390/cancers14102470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/17/2022] Open
Abstract
Fatigue is a highly prevalent symptom in both cancer patients and the older population, and it contributes to quality-of-life impairment. Cancer treatment-related fatigue should thus be included in the risk/benefit assessment when introducing any treatment, but tools are lacking to a priori estimate such risk. This scoping review was designed to report the current evidence regarding the frequency of fatigue for the different treatment regimens proposed for the main cancer indications, with a specific focus on age-specific data, for the following tumors: breast, ovary, prostate, urothelium, colon, lung and lymphoma. Fatigue was most frequently reported using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) versions 3 to 5. A total of 324 regimens were analyzed; data on fatigue were available for 217 (67%) of them, and data specific to older patients were available for 35 (11%) of them; recent pivotal trials have generally reported more fatigue grades than older studies, illustrating increasing concern over time. This scoping review presents an easy-to-understand summary that is expected to provide helpful information for shared decisions with patients regarding the anticipation and prevention of fatigue during each cancer treatment.
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Affiliation(s)
- Louise André
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Gabriel Antherieu
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Amélie Boinet
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Judith Bret
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Thomas Gilbert
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- Research on Healthcare Professionals and Performance RESHAPE, Inserm U1290, Lyon 1 University, 69008 Lyon, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France;
- FHU OncoAge, 06000 Nice, France
- Faculty of Medicine, University of Nice Sofia Antilpolis, 06000 Nice, France
| | - Claire Falandry
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- FHU OncoAge, 06000 Nice, France
- CarMeN Laboratory, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Bâtiment CENS-ELI 2D, Hôpital Lyon Sud Secteur 2, 69310 Pierre-Bénite, France
- UCOGIR—Auvergne-Rhône-Alpes Ouest–Guyane, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
- Faculty of Medicine and Maieutics Charles Mérieux, Lyon 1 University, 69310 Pierre-Bénite, France
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24
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Di Meglio A, Havas J, Gbenou AS, Martin E, El-Mouhebb M, Pistilli B, Menvielle G, Dumas A, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Joly F, Delaloge S, Ganz PA, André F, Partridge AH, Jones LW, Michiels S, Vaz-Luis I. Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy. J Clin Oncol 2022; 40:3190-3204. [PMID: 35446677 PMCID: PMC9509127 DOI: 10.1200/jco.21.00277] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.
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Affiliation(s)
- Antonio Di Meglio
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Arnauld S Gbenou
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Elise Martin
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Agnes Dumas
- Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | | | | | | | | | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | - Fabrice André
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Oncostat Inserm U1018, Université Paris- Saclay, Equipe labellisée Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
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25
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Di Meglio A, Martin E, Crane TE, Charles C, Barbier A, Raynard B, Mangin A, Tredan O, Bouleuc C, Cottu PH, Vanlemmens L, Segura-Djezzar C, Lesur A, Pistilli B, Joly F, Ginsbourger T, Coquet B, Pauporte I, Jacob G, Sirven A, Bonastre J, Ligibel JA, Michiels S, Vaz-Luis I. A phase III randomized trial of weight loss to reduce cancer-related fatigue among overweight and obese breast cancer patients: MEDEA Study design. Trials 2022; 23:193. [PMID: 35246219 PMCID: PMC8896231 DOI: 10.1186/s13063-022-06090-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology. Methods Patients (N = 220) with stage I–III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight loss intervention plus health education. Both arms receive a health education program focusing on healthy living. Patients in the intervention arm are paired with an individual lifestyle coach, who delivers the intervention through 24 semi-structured telephone calls over 1 year. Intervention goals include weight loss ≥ 10% of baseline, caloric restriction of 500–1000 Kcal/day, and increased physical activity (PA) to 150 (initial phase) and 225–300 min/week (maintenance phase). The intervention is based on the social cognitive theory and is adapted from the Breast Cancer Weight Loss trial (BWEL, A011401). The primary endpoint is the difference in self-reported CRF (EORTC QLQ-C30) between arms. Secondary endpoints include the following: QOL (EORTC QLQ-C30, -BR45, -FA12), anxiety, and depression (HADS); weight and BMI, dietary habits and quality, PA, and sleep; health care costs (hospital-admissions, all-drug consumption, sick leaves) and cost-effectiveness (cost per quality-adjusted life-year); and patient motivation and satisfaction. The primary analysis of MEDEA will compare self-reported CRF at 12 months post-randomization between arms, with 80.0% power (two-sided α = 0.05) to detect a standardized effect size of 0.40. Discussion MEDEA will test the impact of a weight loss intervention on CRF among overweight or obese BC survivors, potentially providing additional management strategies and contributing to establish weight loss support as a new standard of clinical care. Trial registration ClinicalTrials.govNCT04304924
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Affiliation(s)
- Antonio Di Meglio
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France.,Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | - Anne Lesur
- Institut de cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | | | - Julia Bonastre
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, Equipe labellisee Ligue Contre le Cancer, Villejuif, France
| | | | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, Equipe labellisee Ligue Contre le Cancer, Villejuif, France
| | - Ines Vaz-Luis
- INSERM Unit 981-Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France. .,Gustave Roussy, Villejuif, France.
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