Effects of neoadjuvant chemotherapy on respiratory function in patients with breast cancer

Knowledge discovery of patients reviews on breast cancer drugs: Segmentation of side effects using machine learning techniques

Breast cancer stands as the most frequently diagnosed life-threatening cancer among women worldwide. Understanding patients' drug experiences is essential to improving treatment strategies and outcomes. In this research, we conduct knowledge discovery on breast cancer drugs using patients' reviews. A new machine learning approach is developed by employing clustering, text mining and regression techniques. We first use Latent Dirichlet Allocation (LDA) technique to discover the main aspects of patients' experiences from the patients' reviews on breast cancer drugs. We also use Expectation-Maximization (EM) algorithm to segment the data based on patients' overall satisfaction. We then use the Forward Entry Regression technique to find the relationship between aspects of patients' experiences and drug's effectiveness in each segment. The textual reviews analysis on breast cancer drugs found 8 main side effects: Musculoskeletal Effects, Menopausal Effects, Dermatological Effects, Metabolic Effects, Gastrointestinal Effects, Neurological and Cognitive Effects, Respiratory Effects and Cardiovascular. The results are provided and discussed. The findings of this study are expected to offer valuable insights and practical guidance for prospective patients, aiding them in making informed decisions regarding breast cancer drug consumption.

Impact of neoadjuvant chemotherapy on perioperative immune function in breast cancer patients: a propensity score-matched retrospective study

To evaluate the impact of neoadjuvant chemotherapy on perioperative immune function in breast cancer patients, focusing on CD3+, CD4+, CD8+, and natural killer (NK) cells, as well as the CD4+/CD8+ ratio. We retrospectively reviewed medical records of breast cancer patients who underwent surgery with or without neoadjuvant chemotherapy at our medical center from January 2020 to December 2022. Patients were matched 1:1 based on propensity scores. Immune cell proportions and the CD4+/CD8+ ratio were compared on preoperative day one and postoperative days one and seven. Among matched patients, immune cell proportions and the CD4+/CD8+ ratio did not significantly differ between those who received neoadjuvant chemotherapy and those who did not at any of the three time points. Similar results were observed in chemotherapy-sensitive patients compared to the entire group of patients who did not receive neoadjuvant chemotherapy. However, chemotherapy-insensitive patients had significantly lower proportions of CD4+ and NK cells, as well as a lower CD4+/CD8+ ratio, at all three time points compared to patients who did not receive neoadjuvant chemotherapy. Neoadjuvant chemotherapy may impair immune function in chemotherapy-insensitive patients, but not in those who are sensitive to the treatment.

Understanding changes in pulmonary function and functional status in breast cancer patients after systemic chemotherapy and radiotherapy: a prospective study

BACKGROUND

Respiratory complications in breast cancer (BC) patients after chemotherapy (CT) and radiotherapy (RT) have been well acquainted and these complications should be investigated to prevent secondary problems and/or improve BC patients' clinical outcomes. Therefore, this study aimed to assess the potential acute effect of systemic chemotherapy and radiotherapy on respiratory function and functional status of patients with breast cancer.

METHODS

A total of 25 BC patients who were candidates for systemic chemotherapy and radiotherapy were recruited after oncological examination and included in this study. Respiratory function and functional status were assessed with the Pulmonary Function Test (PFT) and the Six-Minute Walk Test (6MWT), respectively. Patients were assessed before CT (c0), after CT (c1), and after RT (r1).

RESULTS

25 BC patients were assessed in c0 and c1 while only 15 out of 25 patients (60%) were assessed in r1. The actual values of Forced vital capacity (FVC) (t = 2.338, p =.028), Forced expiratory volume in 1s (FEV1 (t = 2.708, p =.012), and the forced expiratory flow of between 25% and 75% of vital capacity (FEF25-75%) (t = 2.200, p =.038) were found significantly different after systemic CT. Inspiratory (MIP) and expiratory (MEP) muscle strength also did not show a significant change from c0 to c1. A significant effect of the type of surgery was found (Wilks' lambda, F [1, 19] = 6.561, p =.019, ηp2 = 0.25) between c0 and c1 in actual FVC value. The main effect of time was found significant in FVC (F [2, 28] = 4.840, p =.016, ηp2 = 0.25) from c0 to r1. Pairwise comparisons with Bonferroni correction showed that there was a significant difference between c0 and r1 (p =.037).

DISCUSSION

The present study showed decreased FVC and FEV1 actual values and percent predicted rates from baseline to the completion of treatment. Since the interactional effect of the type of surgery was significant, we suggest that clinical and demographic factors such as age should be considered when interpreting the early changes in PFT. In addition, the significant linear trend of decreasing in some specific outcomes in respiratory function also highlighted the need for continuous monitoring of potential respiratory problems in patients with BC from baseline to the completion of chemotherapy and radiotherapy.

Investigation of the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in unilateral breast cancer surgery survivors: a cross-sectional study

PURPOSE

Despite the research on structural and functional changes that may occur in breast cancer survivors, no study has investigated the relationship between spinal characteristics and the respiratory system. Therefore, we aimed to investigate the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in breast cancer patients who have completed their treatment METHODS: This cross-sectional study included 38 female breast cancer surgery survivors. Participants underwent the following evaluations: Chest wall mobility with a tapeline; postural assessments (spinal curvature, spinal mobility, and spinal inclination) with a non-invasive, computer-assisted electromechanical device; and pulmonary function test and respiratory muscle strength with a portable digital spirometer device. The relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions was analyzed by the bivariate correlation analysis.

RESULTS

Increased thoracic curvature angle was associated with decreased FEV1 (r=-0.360, p=0.026) and decreased subcostal mobility (r=-0.385, p=0.017), and the increase in thoracic frontal mobility was associated with decrease in PEF (r=-0.342, p=0.036). Increased lumbar mobility was associated with increased FVC (r=0.324, p=0.047), and increased total spinal inclination mobility was associated with decreased MIP (r=-0.396, p=0.017). Chest wall mobility was associated with postural assessments at varying rates (the r value ranged from -0.357 to 0.661, p<0.05).

CONCLUSION

The changes in spinal posture and mobility of women who have undergone unilateral breast cancer surgery were associated with respiratory parameters and thoracic cage mobility. These patients' spinal posture and mobility should be taken into account in conjunction with respiratory functions for a comprehensive assessment.

Impact of adjuvant radiotherapy on patient-reported shortness of breath in patients with breast cancer using the ESAS

BACKGROUND AND PURPOSE

As breast cancer radiotherapy (RT) has been shown to give rise to adverse pulmonary outcomes, such as radiation pneumonitis, trends in patient-reported shortness of breath (SOB) associated with RT were investigated. Adjuvant RT is commonly administered for local and/or regional control of breast cancer and was therefore included.

METHODS

The Edmonton Symptom Assessment System (ESAS) was used to observe changes in SOB during RT, up to 6 weeks after RT completion, and one to three months post-RT. Patients with at least one completed ESAS were included in the analysis. Generalized linear regression analysis was performed to identify associations between demographic factors and SOB.

RESULTS

A total of 781 patients were included in the analysis. There was a significant association between ESAS SOB scores and adjuvant chemotherapy when compared to neoadjuvant chemotherapy (p=0.0012). Meanwhile, loco-regional RT had no significant impact on ESAS SOB scores in comparison to local RT. SOB scores were stable over time (p>0.05) from baseline to follow-up appointments.

CONCLUSION

The findings of this study suggest that RT was not associated with changes in SOB from baseline to 3 months post-RT. However, patients who underwent adjuvant chemotherapy reported significant higher SOB scores over time. Additional research is recommended to analyze the lasting effects of adjuvant breast cancer RT on SOB during physical activity.

The evaluation of DLCO changes in patients with relatively higher lung shunt fractions receiving TARE

OBJECTIVE

Transarterial radioembolization (TARE) with Yttrium-90 (⁹⁰Y) labeled microspheres is an effective locoregional treatment option for patients with primary and metastatic liver cancer. However, TARE is also associated with radiation-induced lung injury due to hepatopulmonary shunting. If a large proportion of the injected radionuclide microspheres (more than 15%) is shunted, a rare but lethal complication may develop: radiation-induced pneumonitis (RP). Diffusion capacity of the lungs for carbon monoxide (DLCO) is a valuable test to assess lung function and a decrease in DLCO may indicate an impairment in gas exchange caused by the lung injury. Some previous researches have been reported the most consistent changes in pulmonary function tests after external beam radiotherapy are recorded with DLCO. This study aimed to examine the changes in DLCO after TARE with glass microspheres in newly treated and retreated patients with relatively higher lung shunt fractions.

METHODS

We prospectively analyzed forty consecutive patients with liver malignancies who underwent lobar or superselective TARE with ⁹⁰Y glass microspheres. DLCO tests were performed at baseline and on days 15, 30, and 60 after the treatment. All patients were followed up clinically and radiologically for the development of RP.

RESULTS

A statistically significant decrease was found in the DLCO after the first treatment (81.4 ± 13.66 vs. 75.25 ± 13.22, p = 0.003). The frequency of the patients with impaired DLCO at baseline was significantly increased after the first treatment (37.5 vs 57.5% p < 0.05). In the retreated group (n = 8), neither the DLCO (71.5 ± 10.82 vs. 67.50 ± 11.24, p = 0.115) nor the frequency of patients with impaired DLCO (25 vs 25%, p = 1) did not significantly change. Also, the change in DLCO values did not significantly correlate with lung shunt fraction, administered radiation dose, and absorbed lung dose after the first and second treatments (p > 0.05 for all). None of the patients developed RP.

CONCLUSION

Our study showed that a significant reduction in DLCO after TARE may occur in patients with relatively higher lung shunt fractions. Further studies with larger sample sizes are needed to better investigate the changes in DLCO in patients with high lung shunt fractions.

Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients

BACKGROUND

Dyspnea is a common and distressing symptom for oncology patients.However, dyspnea is not well-characterized and often underestimated by clinicians. This systematic review summarizes the prevalence, intensity, distress, and impact of dyspnea in oncology patients and identifies research gaps.

METHODS

A search of all of the relevant databases was done from 2009 to May 2022. A qualitative synthesis of the extant literature was performed using established guidelines.

RESULTS

One hundred-seventeen studies met inclusion criteria. Weighted grand mean prevalence of dyspnea in patients with advanced cancer was 58.0%. Intensity of dyspnea was most common dimension evaluated, followed by the impact and distress. Depression and anxiety were the most common symptoms that co-occurred with dyspnea.

CONCLUSION

Numerous methodologic challenges were evident across studies. Future studies need to use valid and reliable measures; evaluate the impact of dyspnea; and determine biomarkers for dyspnea.

Quality of life in patients with breast cancer with neoadjuvant chemotherapy: a systematic review

OBJECTIVES

The aims of this systematic review were to assess the impact of neoadjuvant chemotherapy (NAC) on breast cancer (BC) patients' quality of life (QOL), to compare the different regimens of NAC on BC patients' QOL, to compare NAC versus adjuvant chemotherapy on BC patients' QOL and to identify predictors of QOL on patients with BC receiving NAC.

DESIGN

The design used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Cinahl, Embase, Pubmed, Scopus, Web of Science, Cochrane library and PsycINFO were searched through 27 December 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The inclusion criteria were included: patients with BC receiving NAC, outcome measures related to QOL and published in English. The exclusion criteria were included: duplicates or overlapping participants, not original research, data or full text not available and qualitative study.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used standardised methods to search, screen and code included studies. The risk of bias in individual studies was evaluated with Cochrane collaboration's tool for assessing risk bias, Newcastle Ottawa Score or Joanna Briggs Institute Critical Appraisal tool. This systematic review performs narrative synthesis based on several different themes.

RESULTS

The initial search resulted in 2994 studies; 12 of these studies fulfilled inclusion criteria. There was no significant difference in the QOL of BC before and after NAC, but patients experienced adverse reactions and depression during chemotherapy. Different regimens of NAC have different effects on patients' QOL. Patients with NAC had more severe physical discomfort than those with adjuvant chemotherapy. However, BC patients' QOL can be improved by intervening on social or family support, and these predictors, including chronotype, QOL before NAC and depression.

CONCLUSIONS

More original research is needed in future to understand the profile and predictors of QOL in patients with BC on NAC, which will help clinicians and patients make decisions and deal with NAC-related issues.