1
|
Cavalcante LG, Domingues RAR, Junior BDO, Fernandes MAR, Pessoa EC, Abbade LPF. Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study. An Bras Dermatol 2024; 99:57-65. [PMID: 37657957 DOI: 10.1016/j.abd.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. OBJECTIVE To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. METHODS Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. RESULTS The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR=1.14 [95% CI 1.04-1.26]; p=0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR=4.27 [95% CI 1.11-16.42]; p=0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR=0.55 [95% CI 0.36-0.82]; p=0.004). STUDY LIMITATIONS The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. CONCLUSIONS There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.
Collapse
Affiliation(s)
- Loren Giagio Cavalcante
- Department of Nursing, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil; Sector of Radiotherapy, Hospital das Clínicas de Botucatu, Botucatu, SP, Brazil
| | | | | | - Marco Antônio Rodrigues Fernandes
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Eduardo Carvalho Pessoa
- Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Luciana Patrícia Fernandes Abbade
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| |
Collapse
|
2
|
Maheshwari A, Shankar A, Tyagi K, Verma R. Dermatological Aspects of Nursing Oncology: Meaningful Observations Ensuring Better Quality of Life. Indian J Palliat Care 2022; 28:216-220. [PMID: 35673687 PMCID: PMC9168281 DOI: 10.25259/ijpc_147_2021] [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: 12/19/2021] [Accepted: 01/30/2022] [Indexed: 12/03/2022] Open
Abstract
Modern cancer management has changed over the period of time and now shifted to multidisciplinary care approach to ensure a better quality of life (QOL) of the surfing patients. Every form of cancer treatment has side effects and affects the QOL. Many of the side effects have been discussed in detail because of the need for timely interventions to prevent the consequences of the side effects. Dermatological adverse events due to cancer treatment are important but most commonly ignored in our clinical practice. Nursing staffs have a critical role in the early identification of such events and by briefing and training of the nursing staff in the identification of adverse events which can aid in the prevention of complications. As dermatologists may not be available round the clock, nursing staff are looking after the patients round the clock can prove very vital in screening cutaneous AE and adequately setting up referrals to aid early recognition and treatment of not only mild but also potentially life-threatening complications. The nursing staff, which is a cadre of health caregivers that are intimately involved in cancer care, can be trained to identify timely, skin-related adverse events. A literature search of scientific publications was done using the electronic databases PubMed, Science Direct, Cochrane Library, and Google Scholar. The search included terms 'Adverse events (AEs) post-chemotherapy,' 'AE post-radiotherapy,' 'AE post-immunotherapy,' 'AE post-hormonal therapy for cancer' and 'AE post-cancer surgery.' Data obtained from these studies and case reports were compiled and interpreted to prepare this review. This review focuses on various ways in which skin can be involved adversely as a part of cancer management and their classic and tell-tale signs to help the nurses in their better and quicker identification so that dermatologists are timely intimated and the treatment can be instituted to improve the patient's QOL.
Collapse
Affiliation(s)
- Apoorva Maheshwari
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kashish Tyagi
- Department of Dermatology, Medanta Medicity, Gurgaon, Haryana, India
| | - Richa Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|
3
|
Sharaf B, AlMasri R, Abdel-Razeq N, Salama O, Hamad I, Abunasser M, Abdel-Razeq H. Vitiligo-Like Lesions in a Patient with Metastatic Breast Cancer Treated with Cyclin-Dependent Kinase (CDK) 4/6 Inhibitor: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:5-10. [PMID: 35023941 PMCID: PMC8743357 DOI: 10.2147/ccid.s344867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022]
Abstract
Background Cyclin-dependent kinase (CDK) 4/6 inhibitors have revolutionized the treatment landscape of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer, with an impressive efficacy and safety profile. Cytopenia is the main adverse event, which is both predictable and manageable. Here, we report a case of CDK4/6 inhibitor-induced vitiligo-like lesions. Vitiligo or vitiligo-like lesions are a rare adverse event; only a few cases are reported in the literature. Case Presentation A 71-year-old female patient was diagnosed initially with early-stage right breast cancer (HR+/HER2−) and was treated with breast-conserving surgery followed by chemotherapy, radiotherapy, and hormonal therapy. A few years later, she developed metastatic disease to the hilar lymph nodes, and to multiple skeletal sites, including the left scapula, left shoulder, left iliac bone, and dorsal vertebrae, for which she was treated with ribociclib and letrozole. While on treatment, she developed hypopigmented lesions involving both hands, feet, and face, which were described as vitiligo-like lesions. Conclusion CDK4/6 inhibitor-induced vitiligo is a rare and unpredictable adverse event. This case report highlights the rarity of this adverse event, the dilemma related to the optimal treatment, and decisions related to continuation, holding, or switching CDK4/6 inhibitors.
Collapse
Affiliation(s)
- Baha' Sharaf
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rama AlMasri
- Department of Internal Medicine, Istishari Hospital, Amman, Jordan
| | - Nayef Abdel-Razeq
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Osama Salama
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ibrahim Hamad
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abunasser
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| |
Collapse
|
4
|
Rossi AM, Hibler BP, Navarrete-Dechent C, Lacouture ME. Restorative oncodermatology: Diagnosis and management of dermatologic sequelae from cancer therapies. J Am Acad Dermatol 2020; 85:693-707. [PMID: 32781177 DOI: 10.1016/j.jaad.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/19/2022]
Abstract
The long-term survival of patients with cancer has risen dramatically during the last few decades. Despite this remarkable success, the same treatments that have enabled cure or remission often secondarily affect the skin, hair, and nails. Conditions including scarring, striae distensae, persistent alopecia, pigmentary changes, nail alterations, chronic radiation dermatitis, and radiation fibrosis have been associated with anxiety, depression, decreased quality of life, and impaired function. These dermatologic changes are cosmetically disfiguring, may limit activities, and are a visual reminder of past illness. Interventions toward improving these untoward sequelae and restoring the appearance and function of skin and appendages are critical for normalization and may contribute to improved quality of life in cancer survivors. Here, we outline dermatologic sequelae of cancer therapies with a review of medical and procedural treatment strategies to restore dermatologic health in the survivorship population.
Collapse
Affiliation(s)
- Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Brian P Hibler
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario E Lacouture
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| |
Collapse
|
5
|
Alizadeh N, Mirpour SH, Darjani A, Rafiei R, Rafiei E, Mohammadhoseini M. Dermatologic adverse effects of breast cancer chemotherapy: a longitudinal prospective observational study with a review of literature. Int J Dermatol 2020; 59:822-828. [PMID: 32406107 DOI: 10.1111/ijd.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast cancer patients may experience an increased chance of survival with adjuvant chemotherapy. However dermatologic adverse effects can cause major discomfort due to physical or cosmetic problems. This study aims to describe dermatologic complications in breast cancer patients during chemotherapy. METHODS This longitudinal prospective observational study included data on women with non-metastatic breast cancer whom were treated with AC-T protocol (anthracycline, cyclophosphamide, and taxane) adjuvant chemotherapy and consecutively enrolled during two years. The study was performed in an educational and tertiary referral center. The patients' information including age, body mass index (BMI), past medical history, and different dermatologic complications were collected for all participants. RESULTS Of 190 enrolled women, all patients experienced alopecia, which occurred in 131 patients (68.9%) after the first cycle. Skin, mucosal, and nail involvement were respectively seen in 46 (24.2%), 51 (26.8%), and 86 (45.2%) cases. Cutaneous complications were observed mainly between the third and sixth chemotherapy cycles. Palmoplantar erythema and palmoplantar dysesthesia were the most common cutaneous complications. Dermatologic adverse effects were significantly more frequent in the patients with an underlying disease. CONCLUSION These findings suggest that dermatologic adverse effects of adjuvant chemotherapy are common and could be induced by all components of AC-T regimen. These complications should be skillfully managed to increase patients' comfort.
Collapse
Affiliation(s)
- Narges Alizadeh
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyyed Hossein Mirpour
- Department of Hematology and Oncology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Darjani
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Rana Rafiei
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Rafiei
- Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Mohammadhoseini
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
6
|
Adeel M, Asif M, Faisal MN, Chaudary MH, Malik MS, Khalid M. Comparative study of adjuvant chemotherapeutic efficacy of docetaxel plus cyclophosphamide and doxorubicin plus cyclophosphamide in female breast cancer. Cancer Manag Res 2019; 11:727-739. [PMID: 30697066 PMCID: PMC6339652 DOI: 10.2147/cmar.s180802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose This retrospective study presents a comparative analysis of the overall survival and toxicities, as side effects, of docetaxel plus cyclophosphamide (TC) and doxorubicin plus cyclophosphamide (AC). The study measured their efficacies during adjuvant chemotherapy, treating Pakistani breast cancer patients by validating the results obtained, with the published analysis of the same treatment given to US patients. Patients and methods Between June 2015 and September 2017, for four chemotherapy cycles, 189 patients out of 358 received TC (75 mg/m2 of docetaxel, 600 mg/m2 of cyclophosphamide) and 169 were treated with AC (60 mg/m2 of doxorubicin, 600 mg/m2 of cyclophosphamide). On the basis of using pathological markers to assess patients, toxicities, as side effects, (due to docetaxel, doxorubicin, and cyclophosphamide) were listed in the database of this study. Common factors with respect to common terminology criteria for adverse events version 5.0 and side effects listed in MedlinePlus, NIH US database, and from the database of this study were then separated to be included in comparison for this study. Statistically, chi-squared test was used at α=0.05. Results There was no statistically significant difference between the proportions of patients with vomiting, extreme tiredness, diarrhea, mild anemia, stability, and overall survival because P-value >0.05. However, AC remained less toxic (P-value <0.05) by 22.6%, 25.7%, 25.3%, 12.4%, 20.8%, and 16.4% compared to TC for changes in taste, muscle pain, burning hands, change in hemoglobin level, moderate anemia, and needing blood transfusion respectively, whereas TC remained less toxic by 52.9%, 32.5%, and 26.3% for dizziness, weight loss, and sores in throat and mouth, respectively. Conclusion At 27 months, TC was more toxic than AC, whereas both combinations had the same overall survival rate.
Collapse
Affiliation(s)
- Muhammad Adeel
- Department of Computer Science, Faculty of Science, National Textile University, Faisalabad, Punjab, Pakistan,
| | - Muhammad Asif
- Department of Computer Science, Faculty of Science, National Textile University, Faisalabad, Punjab, Pakistan,
| | - Muhammad Naeem Faisal
- Faculty of Veterinary Science, Institute of Pharmacy, Physiology, and Pharmacology, University of Agriculture, Faisalabad, Punjab, Pakistan
| | | | - Muhammad Sheraz Malik
- Department of Information Technology, Government College University, Faisalabad, Punjab, Pakistan
| | - Muhammad Khalid
- Oncology Department, Faisalabad Medical University, Allied Hospital, Faisalabad, Punjab, Pakistan
| |
Collapse
|