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Aizpurua-Perez I, Arregi A, Gonzalez D, Urruticoechea A, Labaka A, Minguez-Alcaide X, Ugartemendia G, Pascual-Sagastizabal E, Echeverria R, Perez-Tejada J. A randomized controlled trial of the effectiveness of a one-to-one peer support intervention on resilience, social support, and salivary cortisol in recently diagnosed women with breast cancer. Eur J Oncol Nurs 2024; 71:102616. [PMID: 38885598 DOI: 10.1016/j.ejon.2024.102616] [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: 10/29/2023] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Peer support has been suggested as a way to help women diagnosed with breast cancer to better cope with their situation, but studies on its effectiveness have conflicting results. This randomized controlled trial aimed to study the effectiveness of a one-to-one peer support intervention on psychological resilience, social support, and salivary cortisol among breast cancer patients. METHODS The sample consisted of 121 newly diagnosed women at Onkologikoa Hospital. Patients who were prescribed chemotherapy were randomly assigned to Intervention Group 1 (IG1) or Control Group 1 (CG1). Similarly, those prescribed adjuvant radiotherapy were assigned to IG2 or CG2. Women in IG1 received 8 biweekly social support sessions from volunteer survivors who had successfully overcome breast cancer, while IG2 received 6 biweekly sessions. CG1 and CG2 only received standard care. Resilience, social support, and salivary cortisol were assessed at baseline (T1) and at the end of the intervention (T2). RESULTS We found a non-significant, yet a small to moderate size increase in resilience from T1 to T2 in IG1 (p = 0.246; dDc = 0.47). Upon regression analysis, we observed that this increase was determined by changes in cortisol (β = -0.658, p = 00.010), affective support (β = -0.997, p = 00.014), and emotional support (β = 0.935, p = 00.008). We also found a significant decrease in resilience levels in CG2 from T1 to T2 (p = 0.003; dDc = 0.88). CONCLUSION The present study suggests that peer support can exert a protective psychological influence on women diagnosed with breast cancer, and further indicates an exciting avenue for future intervention development in the breast cancer care continuum. TRIAL REGISTRATION ClinicalTrials.gov NCT05077371.
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Affiliation(s)
- Ibane Aizpurua-Perez
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | - Amaia Arregi
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | | | | | - Ainitze Labaka
- Department of Nursing II, University of the Basque Country, San Sebastian, Spain.
| | - Xavier Minguez-Alcaide
- Department of Social Psychology, University of the Basque Country, San Sebastian, Spain.
| | | | - Eider Pascual-Sagastizabal
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
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Vrancken Peeters NJMC, van Til JA, Huberts AS, Siesling S, Husson O, Koppert LB. Internal Responsiveness of EQ-5D-5L and EORTC QLQ-C30 in Dutch Breast Cancer Patients during the First Year Post-Surgery: A Longitudinal Cohort Study. Cancers (Basel) 2024; 16:1952. [PMID: 38893073 PMCID: PMC11170999 DOI: 10.3390/cancers16111952] [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: 04/26/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
The EuroQoL 5-Dimension 5-Level questionnaire (EQ-5D-5L) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) are commonly used Patient-Reported Outcome Measures (PROMs) for breast cancer. This study assesses and compares the internal responsiveness of the EQ-5D-5L and EORTC QLQ-C30 in Dutch breast cancer patients during the first year post-surgery. Women diagnosed with breast cancer who completed the EQ-5D-5L and EORTC QLQ-C30 pre-operatively (T0), 6 months (T6), and 12 months post-surgery (T12) were included. Mean differences of the EQ-5D-5L and EORTC QLQ-C30 between baseline and 6 months (delta 1) and between baseline and 12 months post-surgery (delta 2) were calculated and compared against the respective minimal clinically important differences (MCIDs) of 0.08 and 5. Internal responsiveness was assessed using effect sizes (ES) and standardized response means (SRM) for both deltas. In total, 333 breast cancer patients were included. Delta 1 and delta 2 for the EQ-5D-5L index and most scales of the EORTC QLQ-C30 were below the MCID. The internal responsiveness for both PROMs was small (ES and SRM < 0.5), with greater internal responsiveness for delta 1 compared to delta 2. The EQ-5D-5L index showed greater internal responsiveness than the EORTC QLQ-C30 Global Quality of Life scale and summary score. These findings are valuable for the interpretation of both PROMs in Dutch breast cancer research and clinical care.
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Affiliation(s)
- Noëlle J. M. C. Vrancken Peeters
- Department of Surgical Oncology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Anouk S. Huberts
- Department of Quality and Patient Care, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands
| | - Olga Husson
- Department of Surgical Oncology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
| | - Linetta B. Koppert
- Department of Surgical Oncology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Quality and Patient Care, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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3
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Wiranata JA, Hutajulu SH, Astari YK, Leo B, Bintoro BS, Hardianti MS, Taroeno-Hariadi KW, Kurnianda J, Purwanto I. Patient-reported outcomes and symptom clusters pattern of chemotherapy-induced toxicity in patients with early breast cancer. PLoS One 2024; 19:e0298928. [PMID: 38394281 PMCID: PMC10890761 DOI: 10.1371/journal.pone.0298928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE This study aims to characterize patient-reported chemotherapy-induced toxicity in patients with breast cancer, determine its association with treatment regimens and patient characteristics, identify toxicity symptom clusters within a specific chemotherapy timeframe and analyze the correlation between symptom clusters within and between the timeframe to understand the changes and influences across chemotherapy. METHODS Forty-six patient-reported toxicities during neoadjuvant/adjuvant chemotherapy for breast cancer were evaluated using adapted CTCAE version 4.0. Chi-Square/Fisher's Exact test was performed to analyze the difference in the incidence of toxicity symptoms by chemotherapy regimens. Poisson regression performed to assess factors associated with patient's total chemotherapy toxicity. Exploratory factor analysis (EFA) conducted to identify symptom clusters at T1 (first half) and T2 (second half of planned cycle). Factor scores were generated and Spearman correlation performed to explore the factor scores correlation between symptom clusters. RESULTS A total of 142 patients with stage I-III breast cancer were included. The incidence of several toxicities differed significantly among three chemotherapy regimens. Subjects age ≥51 years are associated with lower number of reported toxicity (IRR/incidence rate ratio = 0.94, 95% confidence interval/CI 0.88 to 0.99, p = 0.042). Receiving more chemotherapy cycles are associated with higher number of reported toxicity (IRR = 1.06, 95% CI 1.03 to 1.10, p<0.001). Two symptom clusters identified at T1 (psychoneurological-pain/PNP-T1 and gastrointestinal-psychological/GIP-T1 cluster) and three at T2 (psychoneurological-pain/PNP-T2, epithelial/EPI-T2, and gastrointestinal cluster/GI-T2), with moderate-strong positive correlation between PNP-T1 and GIP-T2 (p<0.001), PNP-T1 and PNP-T2 (p<0.001), and GIP-T1 and PNP-T2 (p<0.001). CONCLUSIONS This study investigated 46 patient-reported toxicities prospectively during adjuvant/neoadjuvant chemotherapy for early breast cancer. Anthracycline-taxane combination regimen had higher proportions of toxicity incidence. Subject's age and number of chemotherapy cycles significantly associated with total number of toxicity symptoms. Two symptom clusters at T1 and three at T2 were identified, with significant correlation between symptom clusters within and between chemotherapy timeframe.
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Affiliation(s)
- Juan Adrian Wiranata
- Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susanna Hilda Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yufi Kartika Astari
- Research Scholar, Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Benedreky Leo
- Specialty Program in Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bagas Suryo Bintoro
- Department of Health Behaviour, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mardiah Suci Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Kartika Widayati Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Vrancken Peeters NJMC, Kaplan ZLR, Clarijs ME, Mureau MAM, Verhoef C, van Dalen T, Husson O, Koppert LB. Health-related quality of life (HRQoL) after different axillary treatments in women with breast cancer: a 1-year longitudinal cohort study. Qual Life Res 2024; 33:467-479. [PMID: 37889384 PMCID: PMC10850260 DOI: 10.1007/s11136-023-03538-3] [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] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE As life expectancy continues to rise, post-treatment health-related quality of life (HRQoL) of breast cancer patients becomes increasingly important. This study examined the one-year longitudinal relation between axillary treatments and physical, psychosocial, and sexual wellbeing and arm symptoms. METHODS Women diagnosed with breast cancer who received different axillary treatments being axilla preserving surgery (APS) with or without axillary radiotherapy or full axillary lymph node dissection (ALND) with or without axillary radiotherapy were included. HRQoL was assessed at baseline, 6- and 12-months postoperatively using the BREAST-Q and the European Organization for Research and Treatment of Cancer QoL Questionnaire Breast Cancer Module (EORTC QLQ-BR23). Mixed regression models were constructed to assess the impact of axillary treatment on HRQoL. HRQoL at baseline was compared to HRQoL at 6- and at 12-months postoperatively. RESULTS In total, 552 patients were included in the mixed regressions models. Except for ALND with axillary radiotherapy, no significant differences in physical and psychosocial wellbeing were found. Physical wellbeing decreased significantly between baseline and 6- and 12-months postoperatively (p < 0.001, p = 0.035) and psychosocial wellbeing decreased significantly between baseline and 12 months postoperatively (p = 0.028) for ALND with axillary radiotherapy compared to APS alone. Arm symptoms increased significantly between baseline and 6 months and between baseline and 12 months postoperatively for APS with radiotherapy (12.71, 13.73) and for ALND with radiotherapy (13.93, 16.14), with the lowest increase in arm symptoms for ALND without radiotherapy (6.85, 7.66), compared to APS alone (p < 0.05). CONCLUSION Physical and psychosocial wellbeing decreased significantly for ALND with radiotherapy compared to APS alone. Shared decision making and expectation management pre-treatment could be strengthened by discussing arm symptoms per axillary treatment with the patient.
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Affiliation(s)
- N J M C Vrancken Peeters
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Z L R Kaplan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M E Clarijs
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - M A M Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - T van Dalen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - O Husson
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands.
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Diao K, Lei X, He W, Jagsi R, Giordano SH, Smith GL, Caudle A, Shen Y, Peterson SK, Smith BD. Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction. Ann Surg 2023; 278:e1096-e1102. [PMID: 37232937 PMCID: PMC10592600 DOI: 10.1097/sla.0000000000005920] [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] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare long-term quality of life (QOL) outcomes in breast cancer survivors who received breast-conserving surgery with radiotherapy (BCS+RT) with those who received a mastectomy and reconstructive surgery (Mast+Recon) without radiotherapy and identify other important factors. BACKGROUND The long-term differences in patient-reported QOL outcomes following BCS+RT and Mast+Recon are not well understood. METHODS We identified patients from the Texas Cancer Registry with stage 0-II breast cancer diagnosed in 2009-2014 after BCS+RT or Mast+Recon without radiotherapy. Sampling was stratified by age and race and ethnicity. A paper survey was sent to 4800 patients which included validated BREAST-Q and PROMIS modules. Multivariable linear regression models were implemented for each outcome. Minimal clinically important difference for BREAST-Q and PROMIS modules, respectively, was 4 points and 2 points. RESULTS Of 1215 respondents (25.3% response rate), 631 received BCS+RT and 584 received Mast+Recon. The median interval from diagnosis to survey completion was 9 years. In adjusted analysis, Mast+Recon was associated with worse BREAST-Q psychosocial well-being (effect size: -3.80, P =0.04) and sexual well-being (effect size: -5.41, P =0.02), but better PROMIS physical function (effect size: 0.54, P =0.03) and similar BREAST-Q satisfaction with breasts, physical well-being, and PROMIS upper extremity function ( P >0.05) compared with BCS+RT. Only the difference in sexual well-being reached clinical significance. Older (≥65) patients receiving BCS+RT and younger (<50) patients receiving autologous Mast+Recon typically reported higher QOL scores. Receipt of chemotherapy was associated with detriments to multiple QOL domains. CONCLUSIONS Patients who underwent Mast+Recon reported worse long-term sexual well-being compared with BCS+RT. Older patients derived a greater benefit from BCS+RT, while younger patients derived a greater benefit from Mast+Recon. These data inform preference-sensitive decision-making for women with early-stage breast cancer.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Weiguo He
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abigail Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K. Peterson
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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Grusdat NP, Stäuber A, Tolkmitt M, Schnabel J, Schubotz B, Wright PR, Heydenreich M, Zermann DH, Schulz H. Cancer treatment regimens and their impact on the patient-reported outcome measures health-related quality of life and perceived cognitive function. J Patient Rep Outcomes 2022; 6:16. [PMID: 35190938 PMCID: PMC8861246 DOI: 10.1186/s41687-022-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background and purpose Breast cancer can be a significant challenge for those affected. Knowledge of physical function, social-emotional challenges, and perceived cognitive function based on the cancer treatment regimens may help to inform adequate support. Methods For this prospective observational pilot study, we collected data of seventy-nine women (mean age 54.6 ± 9.5 years) before (T0) and after (T1) initial breast cancer treatment. Functional Assessment of Cancer Therapy-Breast (FACT-B) and Functional Assessment of Cancer Therapy–Cognitive-Function (FACT-Cog) were used to collect data of four treatment subgroups: SCR = Surgery + Chemotherapy + Radiation Therapy; SC = Surgery + Chemotherapy; SR = Surgery + Radiation Therapy; S = Surgery. A mixed ANOVA and posthoc analysis (Tukey, Games-Howell) were used to detect interactions (group by time) and the main effect. A repeated-measures ANOVA displayed individual group differences (time). Results Significant interaction showed more deterioration was experienced with SC and SCR than SR and S for FACT-B (p < 0.01) and FACT-Cog (p < 0.001). The longitudinal comparison between T0 and T1 indicated a significant group main effect on all subscales (p < 0.001) except for Emotional Well-Being. Significant reductions (p < 0.05) in FACT-B, (− 19%); FACT-Cog, (− 21%) with most pronounced effect in Physical Well-Being (− 30%), Functional Well-Being (− 20%), Breast Cancer Subscale (− 20%), Perceived Cognitive Impairments (− 18%) and Impact of Cognitive Impairments on Quality of Life (− 39%) were detected for SCR. Conclusion Our study showed that the extent of change in health-related quality of life (HRQoL) and perceived cognitive function (PCF) depends on the treatment regimen. Multidisciplinary support initiated early in breast cancer therapy is needed, especially for women undergoing combined cancer treatment. Routine assessment of patient-reported outcomes (PROs) in oncology practice may increase the transparency of patients’ perceived circumstances, leading to personalized and optimized acute and survivorship care.
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Sharifi Tabar M, Francis H, Yeo D, Bailey CG, Rasko JEJ. Mapping oncogenic protein interactions for precision medicine. Int J Cancer 2022; 151:7-19. [PMID: 35113472 PMCID: PMC9306658 DOI: 10.1002/ijc.33954] [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: 09/27/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/10/2022]
Abstract
Normal protein‐protein interactions (normPPIs) occur with high fidelity to regulate almost every physiological process. In cancer, this highly organised and precisely regulated network is disrupted, hijacked or reprogrammed resulting in oncogenic protein‐protein interactions (oncoPPIs). OncoPPIs, which can result from genomic alterations, are a hallmark of many types of cancers. Recent technological advances in the field of mass spectrometry (MS)‐based interactomics, structural biology and drug discovery have prompted scientists to identify and characterise oncoPPIs. Disruption of oncoPPI interfaces has become a major focus of drug discovery programs and has resulted in the use of PPI‐specific drugs clinically. However, due to several technical hurdles, studies to build a reference oncoPPI map for various cancer types have not been undertaken. Therefore, there is an urgent need for experimental workflows to overcome the existing challenges in studying oncoPPIs in various cancers and to build comprehensive reference maps. Here, we discuss the important hurdles for characterising oncoPPIs and propose a three‐phase multidisciplinary workflow to identify and characterise oncoPPIs. Systematic identification of cancer‐type‐specific oncogenic interactions will spur new opportunities for PPI‐focused drug discovery projects and precision medicine.
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Affiliation(s)
- Mehdi Sharifi Tabar
- Gene & Stem Cell Therapy Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Cancer & Gene Regulation Laboratory Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Habib Francis
- Gene & Stem Cell Therapy Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Cancer & Gene Regulation Laboratory Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Dannel Yeo
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Li Ka Shing Cell & Gene Therapy Program, The University of Sydney, Camperdown, NSW, Australia.,Cell & Molecular Therapies, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
| | - Charles G Bailey
- Gene & Stem Cell Therapy Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Cancer & Gene Regulation Laboratory Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - John E J Rasko
- Gene & Stem Cell Therapy Program Centenary Institute, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Li Ka Shing Cell & Gene Therapy Program, The University of Sydney, Camperdown, NSW, Australia.,Cell & Molecular Therapies, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
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Shagisultanova E, Crump LS, Borakove M, Hall JK, Rasti AR, Harrison BA, Kabos P, Lyons TR, Borges VF. Triple Targeting of Breast Tumors Driven by Hormonal Receptors and HER2. Mol Cancer Ther 2022; 21:48-57. [PMID: 34728571 PMCID: PMC8742793 DOI: 10.1158/1535-7163.mct-21-0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/26/2021] [Accepted: 10/29/2021] [Indexed: 01/07/2023]
Abstract
Breast cancers that express hormonal receptors (HR) and HER2 display resistance to targeted therapy. Tumor-promotional signaling from the HER2 and estrogen receptor (ER) pathways converges at the cyclin D1 and cyclin-dependent kinases (CDK) 4 and 6 complex, which drives cell-cycle progression and development of therapeutic resistance. Therefore, we hypothesized that co-targeting of ER, HER2, and CDK4/6 may result in improved tumoricidal activity and suppress drug-resistant subclones that arise on therapy. We tested the activity of the triple targeted combination therapy with tucatinib (HER2 small-molecule inhibitor), palbociclib (CKD4/6 inhibitor), and fulvestrant (selective ER degrader) in HR+/HER2+ human breast tumor cell lines and xenograft models. In addition, we evaluated whether triple targeted combination prevents growth of tucatinib or palbociclib-resistant subclones in vitro and in vivo Triple targeted combination significantly reduced HR+/HER2+ tumor cell viability, clonogenic survival, and in vivo growth. Moreover, survival of HR+/HER2+ cells that were resistant to the third drug in the regimen was reduced by the other two drugs in combination. We propose that a targeted triple combination approach will be clinically effective in the treatment of otherwise drug-resistant tumors, inducing robust responses in patients.
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Affiliation(s)
- Elena Shagisultanova
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado
| | - Lyndsey S. Crump
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado.,Cancer Biology Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michelle Borakove
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado
| | - Jessica K. Hall
- Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado
| | - Aryana R. Rasti
- Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado
| | - Benjamin A. Harrison
- Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado
| | - Peter Kabos
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Traci R. Lyons
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado
| | - Virginia F. Borges
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Young Women's Breast Cancer Translational Program, University of Colorado Cancer Center, Aurora, Colorado.,Corresponding Author: Virginia F. Borges, University of Colorado School of Medicine, PO Box 6511, MS 8117, 12801 East 17th Avenue, Room 8121, Aurora, CO 80045. Phone: 303-724-0186; Fax: 303-724-3889; E-mail:
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Pavlović Mavić M, Šeparović R, Tečić Vuger A, Vazdar L. Difference in Estimation of Side Effects of Chemotherapy between Physicians and Patients with Early-Stage Breast Cancer: The Use of Patient Reported Outcomes (PROs) in the Evaluation of Toxicity in Everyday Clinical Practice. Cancers (Basel) 2021; 13:5922. [PMID: 34885032 PMCID: PMC8657299 DOI: 10.3390/cancers13235922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Knowledge about the patient's experience and perception of side effects and their impact on daily life is crucial for the adequate planning of interventions to provide the highest attainable levels of quality of life during oncology treatment. We conducted a study on consecutive samples of 69 early breast cancer patients treated with four cycles of neoadjuvant or adjuvant anthracycline-based chemotherapy. Patients completed the questionnaire about side effects experienced after the previous cycle of chemotherapy. The questionnaire was a modified PRO for the evaluation of treatment toxicity consisting of 18 questions related to the very common and common side effects of doxorubicin and cyclophosphamide, valued from 0 to 3 according to the subjective assessment of the patient. During the same cycles of therapy, data were also collected by the physician who completed a questionnaire consisting of the same questions as the questionnaire for patients, on the same scale. Most of the side effects reported by patients were mild to moderate in intensity, while physicians reported side effects much less frequently. The results also indicated a disproportionate reporting, in which physicians reported statistically significantly fewer side effects than patients. This study reported a level of disagreement between patients and physicians in the experience of therapy toxicity. In conclusion, use of PRO in clinical practice can help us avoid physician subjectiveness in the estimation of side effects and determine the group of patients who can benefit from additional and individualized supportive care measures, which could lead to better adherence to therapy and ultimately best outcomes.
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Affiliation(s)
- Mirjana Pavlović Mavić
- University Hospital Center “Sestre milosrdnice”, University Hospital for Tumors, 10000 Zagreb, Croatia or (R.Š.); (A.T.V.); (L.V.)
| | - Robert Šeparović
- University Hospital Center “Sestre milosrdnice”, University Hospital for Tumors, 10000 Zagreb, Croatia or (R.Š.); (A.T.V.); (L.V.)
- Medical School, Juraj Dobrila University of Pula, 52100 Pula, Croatia
| | - Ana Tečić Vuger
- University Hospital Center “Sestre milosrdnice”, University Hospital for Tumors, 10000 Zagreb, Croatia or (R.Š.); (A.T.V.); (L.V.)
| | - Ljubica Vazdar
- University Hospital Center “Sestre milosrdnice”, University Hospital for Tumors, 10000 Zagreb, Croatia or (R.Š.); (A.T.V.); (L.V.)
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10
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Emens LA, Adams S, Cimino-Mathews A, Disis ML, Gatti-Mays ME, Ho AY, Kalinsky K, McArthur HL, Mittendorf EA, Nanda R, Page DB, Rugo HS, Rubin KM, Soliman H, Spears PA, Tolaney SM, Litton JK. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of breast cancer. J Immunother Cancer 2021; 9:e002597. [PMID: 34389617 PMCID: PMC8365813 DOI: 10.1136/jitc-2021-002597] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Breast cancer has historically been a disease for which immunotherapy was largely unavailable. Recently, the use of immune checkpoint inhibitors (ICIs) in combination with chemotherapy for the treatment of advanced/metastatic triple-negative breast cancer (TNBC) has demonstrated efficacy, including longer progression-free survival and increased overall survival in subsets of patients. Based on clinical benefit in randomized trials, ICIs in combination with chemotherapy for the treatment of some patients with advanced/metastatic TNBC have been approved by the United States (US) Food and Drug Administration (FDA), expanding options for patients. Ongoing questions remain, however, about the optimal chemotherapy backbone for immunotherapy, appropriate biomarker-based selection of patients for treatment, the optimal strategy for immunotherapy treatment in earlier stage disease, and potential use in histological subtypes other than TNBC. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew upon the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for breast cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence-based and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with breast cancer.
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Affiliation(s)
- Leisha A Emens
- Department of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Langone, New York, New York, USA
| | - Ashley Cimino-Mathews
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary L Disis
- Cancer Vaccine Institute, University of Washington, Seattle, Washington, USA
| | - Margaret E Gatti-Mays
- Pelotonia Institute for Immuno-Oncology, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Kalinsky
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rita Nanda
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois, USA
| | - David B Page
- Earle A Chiles Research Institute, Portland, Oregon, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Krista M Rubin
- Center for Melanoma, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Hatem Soliman
- Department of Breast Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Dano D, Hénon C, Sarr O, Ka K, Ba M, Badiane A, Thiam I, Diene P, Diop M, Dem A, Marino P, Mancini J, Annede P, Gonçalves A, Diouf D, Monneur A. Quality of Life During Chemotherapy for Breast Cancer in a West African Population in Dakar, Senegal: A Prospective Study. J Glob Oncol 2020; 5:1-9. [PMID: 31322991 PMCID: PMC6690633 DOI: 10.1200/jgo.19.00106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The prevalence of breast cancer is increasing in low- to middle-income countries such as Senegal. Our prospective study assessed the quality of life (QoL) of patients with breast cancer undergoing chemotherapy in Senegal. PATIENTS AND METHODS Our study included women with breast cancer undergoing chemotherapy as initial treatment at the Center Aristide Le Dantec University Hospital in Dakar. Clinical, sociodemographic, and QoL data were collected and analyzed at three different times: baseline, 3 months, and 6 months after the start of systemic therapy. Health-related QoL was assessed using a Functional Assessment of Cancer Therapies-Breast (FACT-B) questionnaire after translation into the Wolof language. Linear mixed-effects models were performed to assess the changes in QoL scores. RESULTS Between July 2017 and February 2018, 120 patients were included in the study. Their median age was 45 years. Most patients (n = 105; 92%) had locally advanced disease (T3 to T4 stage) and lymph node involvement (n = 103; 88%), and half had metastatic disease. The FACT-B total scores significantly improved over time (β = 1.58; 95% CI, 0.50 to 2.67; P < .01). Nausea and vomiting were significantly associated with a decrease in FACT-B total scores (β = −16.89, 95% CI, −29.58 to −4.24, P = .012; and β = −13.44, 95% CI, −25.15 to −1.72, P = .028, respectively). CONCLUSION Our study confirmed the feasibility of standardized QoL assessment in Senegalese patients with breast cancer. Our results indicated a potential improvement of QoL over the course of chemotherapy. Optimizing nausea and vomiting prevention may improve QoL.
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Affiliation(s)
| | | | | | - Kanta Ka
- Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | | | - Papa Diene
- Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | - Patricia Marino
- Institut Paoli-Calmettes, Marseille, France.,Aix Marseille University, Marseille, France
| | - Julien Mancini
- Institut Paoli-Calmettes, Marseille, France.,Aix Marseille University, Marseille, France.,Timone University Hospital, Marseille, France
| | | | - Anthony Gonçalves
- Institut Paoli-Calmettes, Marseille, France.,Aix Marseille University, Marseille, France
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12
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Chen IH, Wang CH, Wang SY, Cheng SY, Yu TJ, Kuo SF. Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer. BMC Womens Health 2020; 20:101. [PMID: 32393366 PMCID: PMC7216339 DOI: 10.1186/s12905-020-00968-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. METHODS A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. RESULTS In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p < 0.001; B = 15.666, SE = 4.542, p = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL (R2 = 0.51, F = 5.41, p < 0.001). CONCLUSIONS During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.
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Affiliation(s)
- I-Hui Chen
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
| | - Chia-Hui Wang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
| | - Shu-Yi Wang
- Loretto Heights School of Nursing, Rueckert-Hartman College for Health Professions, Regis University, 3333 Regis Boulevard, G-8, Denver, CO 80221-1099 USA
| | - Sue-Yueh Cheng
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
| | - Tzu-Jou Yu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
| | - Shu-Fen Kuo
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
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13
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Sheinson D, Wong WB, Wu N, Mansfield AS. Impact of delaying initiation of anaplastic lymphoma kinase inhibitor treatment on survival in patients with advanced non-small-cell lung cancer. Lung Cancer 2020; 143:86-92. [PMID: 32276206 DOI: 10.1016/j.lungcan.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Several obstacles may delay receipt of targeted treatment in patients with anaplastic lymphoma kinase positive (ALK+) non-small-cell lung cancer (NSCLC). This study examined the factors associated with delayed initiation of ALK inhibitor (ALKi) treatment and its impact on overall survival (OS) as well as the impact of initiating chemotherapy before biomarker test results. MATERIALS AND METHODS Advanced NSCLC (aNSCLC) patients selected from the deidentified Flatiron Health electronic health record-derived database were stratified into early- and delayed-use cohorts based on initiation of ALKi treatment relative to time since receiving ALK+ biomarker test results; cohorts were further stratified by timing of chemotherapy initiation relative to availability of ALK+ test results. Prescription-time matching (PTM) was used to examine the effect of delayed ALKi treatment and chemotherapy on survival; Cox proportional hazards models adjusting for baseline characteristics before and after PTM were used to examine factors associated with delayed ALKi treatment and the effects of delayed ALKi treatment and chemotherapy on OS, respectively. RESULTS Comparison of OS between early- and delayed-use cohorts (N = 442 ALK + aNSCLC patients) demonstrated that a >3-week delay in the initiation of ALKi treatment was associated with a >2-fold higher risk of death (adjusted hazard ratio [HR] [95 % CI] 2.05 [1.13, 3.71]. The number of office visits, age factors, and use of chemotherapy were associated with an increased risk of being untreated >3 weeks after ALK+ test results. There were no significant differences in survival outcomes regardless of whether patients received chemotherapy before the ALK+ test result or ALKi treatment (adjusted HR [95 % CI] 1.02 [0.64, 1.63]). Completing the chemotherapy regimen after receiving ALK+ test results did not appear to improve survival (adjusted HR [95 % CI] 0.84 [0.38, 1.9]). CONCLUSION Initiating ALKi treatment for aNSCLC patients in a timely manner may have a positive impact on survival outcomes.
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Affiliation(s)
| | | | - Ning Wu
- Genentech, South San Francisco, CA, United States
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14
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Soliman H, Shah V, Srkalovic G, Mahtani R, Levine E, Mavromatis B, Srinivasiah J, Kassar M, Gabordi R, Qamar R, Untch S, Kling HM, Treece T, Audeh W. MammaPrint guides treatment decisions in breast Cancer: results of the IMPACt trial. BMC Cancer 2020; 20:81. [PMID: 32005181 PMCID: PMC6995096 DOI: 10.1186/s12885-020-6534-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/13/2020] [Indexed: 01/06/2023] Open
Abstract
Background Increased usage of genomic risk assessment assays suggests increased reliance on data provided by these assays to guide therapy decisions. The current study aimed to assess the change in treatment decision and physician confidence based on the 70-gene risk of recurrence signature (70-GS, MammaPrint) and the 80-gene molecular subtype signature (80-GS, BluePrint) in early stage breast cancer patients. Methods IMPACt, a prospective, case-only study, enrolled 452 patients between November 2015 and August 2017. The primary objective population included 358 patients with stage I-II, hormone receptor-positive, HER2-negative breast cancer. The recommended treatment plan and physician confidence were captured before and after receiving results for 70-GS and 80-GS. Treatment was started after obtaining results. The distribution of 70-GS High Risk (HR) and Low Risk (LR) patients was evaluated, in addition to the distribution of 80-GS compared to IHC status. Results The 70-GS classified 62.5% (n = 224/358) of patients as LR and 37.5% (n = 134/358) as HR. Treatment decisions were changed for 24.0% (n = 86/358) of patients after receiving 70-GS and 80-GS results. Of the LR patients initially prescribed CT, 71.0% (44/62) had CT removed from their treatment recommendation. Of the HR patients not initially prescribed CT, 65.1% (41/63) had CT added. After receiving 70-GS results, CT was included in 83.6% (n = 112/134) of 70-GS HR patient treatment plans, and 91.5% (n = 205/224) of 70-GS LR patient treatment plans did not include CT. For patients who disagreed with the treatment recommended by their physicians, most (94.1%, n = 16/17) elected not to receive CT when it was recommended. For patients whose physician-recommended treatment plan was discordant with 70-GS results, discordance was significantly associated with age and lymph node status. Conclusions The IMPACt trial showed that treatment plans were 88.5% (n = 317/358) in agreement with 70-GS results, indicating that physicians make treatment decisions in clinical practice based on the 70-GS result. In clinically high risk, 70-GS Low Risk patients, there was a 60.0% reduction in treatment recommendations that include CT. Additionally, physicians reported having greater confidence in treatment decisions for their patients in 72% (n = 258/358) of cases after receiving 70-GS results. Trial registration “Measuring the Impact of MammaPrint on Adjuvant and Neoadjuvant Treatment in Breast Cancer Patients: A Prospective Registry” (NCT02670577) retrospectively registered on Jan 27, 2016.
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Affiliation(s)
| | - Varsha Shah
- Ascension Columbia St. Mary's Hospital, Milwaukee, WI, USA
| | - Gordan Srkalovic
- Herbert-Herman Cancer Center, Sparrow Hospital, Lansing, MI, USA
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15
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Social support and quality of life in Greek women with breast cancer during chemotherapy and two years later. HEALTH PSYCHOLOGY REPORT 2020. [DOI: 10.5114/hpr.2020.93757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Shapiro CL. De-escalation yes, but not at the expense of efficacy: in defense of better treatment. NPJ Breast Cancer 2019; 5:25. [PMID: 31428678 PMCID: PMC6690937 DOI: 10.1038/s41523-019-0120-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Charles L Shapiro
- Department of Medicine, Director of Translational Breast Cancer Research, Director of Cancer Survivorship, Icahn School of Medicine, Mount Sinai, NY 10029 USA
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17
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Ou H, Chung W, Su P, Lin T, Lin J, Wen Y, Fang W. Health‐related quality of life associated with different cancer treatments in Chinese breast cancer survivors in Taiwan. Eur J Cancer Care (Engl) 2019; 28:e13069. [DOI: 10.1111/ecc.13069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Huang‐Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
- Department of Pharmacy, College of Medicine National Cheng Kung University Tainan Taiwan
- Department of Pharmacy National Cheng Kung University Hospital Tainan Taiwan
| | - Wei‐Pang Chung
- Division of Hemato‐Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Pei‐Fang Su
- Department of Statistics National Cheng Kung University Tainan Taiwan
| | - Tzu‐Hsuan Lin
- Department of Statistics National Cheng Kung University Tainan Taiwan
| | - Ji‐Ying Lin
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
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18
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Roopchand-Martin S, Rajkumar F, Creary-Yan S. Quality of life of cancer patients living in Trinidad and Tobago. Qual Life Res 2019; 28:1863-1872. [PMID: 30826980 DOI: 10.1007/s11136-019-02151-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine quality of life (QoL) of cancer patients in The Republic of Trinidad and Tobago using the European Organization for Research and Treatment of Cancer Care Quality of Life Instrument (EORTC QLQ-C30) and examine relationships between QoL and socioeconomic and medical variables. METHOD A cross-sectional study, consisting of 480 cancer patients being managed at the National Radiotherapy Centre, was conducted. One-way, multiple analysis of variance (MANOVA) with post hoc testing was used to analyze relationships between socioeconomic and medical variables and scales on the EORTC QLQ-C30. Stepwise linear regression was used to evaluate which independent variables contributed to the global QoL and function scores. RESULTS Participants were of mean age 64.1 ± 12.1 years (males) and 56.7 ± 16.6 years (females). Mean values for global QoL and function scales were below 75. Persons in younger age groups had significantly better physical and cognitive function scores (p < 0.05). Males had higher emotional function scores than females (p < 0.05). Persons with higher income and education had better scores on all function scales, except social, and less symptoms (p < 0.05). Persons receiving chemotherapy had more nausea/vomiting, appetite loss, and constipation (p < 0.05). CONCLUSION Age, income, education, and cancer treatment were factors most associated with scores on the EORTC QLQ-C30. Further research is required in this population to examine these variables in more depth and explore methods to improve QoL of cancer patients in this population.
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Affiliation(s)
- S Roopchand-Martin
- Faculty of Sport, Mona Academy of Sport, The University of the West Indies-Mona, Mona Campus, Kingston 7, Jamaica.
| | - F Rajkumar
- Physiotherapy Department, Eric Williams Medical Sciences Complex, Uriah Buttler Highway, Champs Fleurs, Trinidad
| | - S Creary-Yan
- Faculty of Sport, Mona Academy of Sport, The University of the West Indies-Mona, Mona Campus, Kingston 7, Jamaica
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19
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Porro B, Michel A, Zinzindohoué C, Bertrand P, Monrigal E, Trentini F, Baussard L, Cousson-Gélie F. Quality of life, fatigue and changes therein as predictors of return to work during breast cancer treatment. Scand J Caring Sci 2019; 33:467-477. [PMID: 30664270 DOI: 10.1111/scs.12646] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To our knowledge, only one study has assessed Quality of Life (QOL) as a predictor of return to work (RTW) during breast cancer treatment and one has evaluated multidimensional cancer-related fatigue (CRF) as a determinant of RTW. However, no study has assessed the impact of changes in these variables on RTW. The objective of this study was to evaluate QOL, multidimensional CRF and changes in these variables as determinants of RTW during breast cancer treatment. METHODS We performed a longitudinal study of 68 patients with a mean age of 46.97 years (SD = 6.92), who were employed at the time of diagnosis. Women were assessed at the beginning of adjuvant treatments (T0) and followed up with by telephone at three (T1) and 6 months later (T2), using questionnaires (QLQ-C30; MFI-20). RESULTS Global QOL, OR = 1.12 [1.01-1.25], sleep disturbance, OR = 1.04 [1.002-1.08], fatigue (QLQ-C30), OR = 0.93 [0.88-0.99], nausea-vomiting, OR = 0.84 [0.73-0.97], reduced motivation, OR = 1.49 [1.05-2.11] and general fatigue, OR = 0.79 [0.63-0.99] at T0 were associated with RTW at T1. At T2 global QOL, OR = 1.09 [1.01-1.17], cognitive functioning, OR = 1.10 [1.03-1.17], general fatigue, OR = 1.82 [1.04-3.17] and mental fatigue, OR = 0.29 [0.11-0.81] were associated with RTW. Furthermore, changes in mental fatigue were associated with RTW at T2, OR = 0.02 [0.001-0.29]. CONCLUSIONS Quality of life, fatigue and their changes in them, especially cognitive functioning and mental fatigue, can play an important role in predicting the RTW of women with breast cancer. This confirms the importance of multidisciplinary care for cancer and the emergence of a theoretical psychological model of RTW.
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Affiliation(s)
- Bertrand Porro
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Aude Michel
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France.,Montpellier Breast Institute (MIS), Montpellier, France
| | | | | | | | | | - Louise Baussard
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France.,Epidaure Prevention Department of the Regional Institute of Cancer of Montpellier (ICM)-Val d'Aurelle, Montpellier, France
| | - Florence Cousson-Gélie
- University Paul Valéry Montpellier 3, University Montpellier, EPSYLON EA 4556, Montpellier, France.,Epidaure Prevention Department of the Regional Institute of Cancer of Montpellier (ICM)-Val d'Aurelle, Montpellier, France
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20
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Knoerl R, Hong F, Blonquist T, Berry D. Impact of Electronic Self-Assessment and Self-Care Technology on Adherence to Clinician Recommendations and Self-Management Activity for Cancer Treatment-Related Symptoms: Secondary Analysis of a Randomized Controlled Trial. JMIR Cancer 2019; 5:e11395. [PMID: 30622093 PMCID: PMC6329427 DOI: 10.2196/11395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing cancer treatment experience symptoms that negatively affect their quality of life and adherence to treatment. The early identification and management of treatment-related symptoms are critical to prevent symptom distress due to unmanaged symptoms. However, the early identification and management of treatment-related symptoms are complex as most cancer treatments are delivered on an outpatient basis where patients are granted less face-to-face time with clinicians. The Electronic Symptom Assessment and Self-Care (ESRA-C) promotes participant self-management of treatment-related symptoms by providing participants with communication coaching and symptom self-report, education, and tracking features. While the ESRA-C intervention has been demonstrated to improve symptom distress significantly, little is known as to how the ESRA-C influenced participants' self-management practices and adherence to clinician recommendations for symptom/quality of life issues (SQIs). OBJECTIVE To compare participant adherence to clinician recommendations and additional self-management strategy use for SQIs between ESRA-C intervention and control (electronic symptom assessment and participant symptom reports alone) group participants. Secondarily, we explored the impact of participant adherence to clinician recommendations and additional self-management strategy use for SQIs on symptom control, symptom management satisfaction, and symptom distress. Lastly, we examined baseline predictors of participant adherence to clinician recommendations and additional self-management strategy use for SQIs. METHODS This study presents an analysis of a randomized controlled trial. Participants beginning a new chemotherapy or radiotherapy regimen were recruited from oncology outpatient centers and were randomized to receive the ESRA-C intervention or control during treatment. Patients were included in this analysis if they remained on study through the duration of treatment and self-reported at least one bothersome SQI three-to-six weeks after beginning treatment. The Symptom Distress Scale-15 and Self-Management of SQIs Questionnaire were completed two weeks later. Based on Self-Management of SQIs Questionnaire ratings, participants were placed into adherence to clinician recommendations (adhered/did not adhere/did not receive recommendations) and additional self-management strategy use (yes/no) categories. RESULTS Most participants were adherent to clinician recommendations (273/370, 73.8%), while fewer used additional self-management strategies for SQIs (182/370, 49.2%). There were no differences in the frequency of participant adherence to clinician recommendations (chi-square test, P=.99) or self-management strategy use (chi-square test, P=.80) between intervention (n=182) and control treatment groups (n=188). Participants who received clinician recommendations reported the highest treatment satisfaction (n=355, P<.001 by analysis of variance; ANOVA), although lowest distress was reported by participants who did not follow clinician recommendations (n=322, P=.04 by ANOVA) for top 2 SQIs. Women (n=188) reported greater additional self-management strategy use than men (n=182, P=0.03 by chi-square test). CONCLUSIONS ESRA-C intervention use did not improve participants' adherence to clinician recommendations or additional self-management strategy use for SQIs in comparison to the control. Future research is needed to determine which factors are important in improving patients' self-management practices and symptom distress following ESRA-C use. TRIAL REGISTRATION ClinicalTrials.gov NCT00852852; https://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/73rEhNWkU).
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Fangxin Hong
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Traci Blonquist
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Donna Berry
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
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21
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Padilla-Ruiz M, Ruiz-Román C, Pérez-Ruiz E, Rueda A, Redondo M, Rivas-Ruiz F. Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: cross-sectional study. Support Care Cancer 2019; 27:1279-1286. [PMID: 30607680 DOI: 10.1007/s00520-018-4612-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Breast cancer is one of the most common diseases, affecting many thousands of women. Although more than 80% of women survive the experience, very few studies have been conducted to examine the question of resilience among long-term survivors of breast cancer. The aim of this study is to describe the clinical and sociodemographic factors that correlate with greater resilience in women survivors of breast cancer, in the Costa del Sol Health Area (Spain). METHODS Accordingly, a descriptive cross-sectional study was conducted, with respect to 59 survivors of breast cancer, who each completed a questionnaire for analysis according to the Connor-Davidson Resilience Scale (CD-RISC). RESULTS The median resilience score was 77 (interquartile range 70-80). The group of patients who had survived for six or more years since the diagnosis had a higher score for total resilience (90: IR 76-92) than those diagnosed more recently (74: IR 65.7-83.7) (p = 0.012). Regarding the patients' education background, the group with no formal qualifications or only primary studies had a score of 72 (IR 64-84), versus 79 (IR 74-89.7) for the group with higher levels of education (p = 0.016). Of the clinical variables, only the administration of chemotherapy was significantly associated with the score obtained on the CD-RISC scale (p = 0.012). CONCLUSIONS The results obtained in this study lead us to conclude that sociodemographic and clinical factors have a positive impact on the level of resilience among women resident in the Costa del Sol Health Area and who are long-term survivors of breast cancer.
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Affiliation(s)
- María Padilla-Ruiz
- Research Unit, Hospital Costa del Sol, Marbella, Spain. .,School of Education Science, University of Málaga, Málaga, Spain. .,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain. .,Agencia Sanitaria Costa del Sol, Unidad de Investigación, Autovía A-7, Km.187, 29603, Marbella, Málaga, Spain.
| | | | - Elisabet Pérez-Ruiz
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Oncology Service, Hospital Costa del Sol, Marbella, Spain
| | - Antonio Rueda
- Research Unit, Hospital Costa del Sol, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Oncology Service, Hospital Costa del Sol, Marbella, Spain
| | - Maximino Redondo
- Research Unit, Hospital Costa del Sol, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
| | - Francisco Rivas-Ruiz
- Research Unit, Hospital Costa del Sol, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
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22
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Zhang L, Hall M, Bastola D. Utilizing Twitter data for analysis of chemotherapy. Int J Med Inform 2018; 120:92-100. [DOI: 10.1016/j.ijmedinf.2018.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/24/2018] [Accepted: 10/07/2018] [Indexed: 01/05/2023]
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23
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Wang TQ, Samuel JN, Brown MC, Vennettilli A, Solomon H, Eng L, Liang M, Gill G, Merali Z, Tian C, Cheng NYH, Campbell M, Patel D, Liu AX, Liu G, Howell D. Routine Surveillance of Chemotherapy Toxicities in Cancer Patients Using the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Oncol Ther 2018; 6:189-201. [PMID: 32700029 PMCID: PMC7360011 DOI: 10.1007/s40487-018-0065-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Systematic documentation of chemotoxicities in outpatient clinics is challenging. Incorporating patient-reported outcome (PRO) measures in clinical workflows can be an efficient strategy to strengthen the assessment of symptomatic treatment toxicities in oncology clinical practice. We compared the adequateness, feasibility, and acceptability of toxicity documentation using systematic, prospective, application of the PRO Common Toxicity Criteria for Adverse Events (PRO-CTCAE) tool. Methods At a comprehensive cancer center, data abstraction of electronic health record reviews elucidated current methods and degree of chemotoxicity documentation. Web-based 32-item PRO-CTCAE questionnaires, administered in ambulatory clinics of patients receiving chemotherapy, captured chemotoxicities and respective severities. Patient telephone surveys assessed whether healthcare providers had addressed chemotoxicities to the patients’ satisfaction. Results Over a broad demographic of 497 patients receiving chemotherapy, 90% (95% CI 84–96%) with significant chemotoxicities (n = 107) reported that their providers had discussed toxicities with them; of these, 70% received a therapy management change, while among the rest, 17% desired a change in management. Of patients surveyed, 91% (95% CI 82–99%) were satisfied with their current chemotoxicity management. Clinician chart documentation varied greatly; descriptors rather than numerical grading scales were typically used. Although 93% of patients were willing to complete the PRO survey, only 50% thought that it would be acceptable to complete this survey at routine clinic visits. Conclusion Use of PRO-CTCAE in routine clinical practice promotes systematic evaluation of symptomatic toxicities and improves the clarity, consistency, and efficiency of clinician documentation; however, methods to improve patient willingness to complete this tool routinely are needed.
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Affiliation(s)
- Tian Qi Wang
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | | | | | | | - Lawson Eng
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Mindy Liang
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Zahra Merali
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Chenchen Tian
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Matthew Campbell
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ai Xin Liu
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Center, Toronto, ON, Canada.
| | - Doris Howell
- Princess Margaret Cancer Center, Toronto, ON, Canada
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24
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Akhtari-Zavare M, Mohd-Sidik S, Periasamy U, Rampal L, Fadhilah SI, Mahmud R. Determinants of quality of life among Malaysian cancer patients: a cross-sectional study. Health Qual Life Outcomes 2018; 16:163. [PMID: 30103759 PMCID: PMC6090648 DOI: 10.1186/s12955-018-0989-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 07/30/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cancer is a serious public health problem not only in Malaysia, also worldwide. The aim of this study was to determine the determinants of quality of life (QOL) among cancer patients in Peninsular Malaysia. METHODS A cross sectional study was conducted among 2120 cancer patients in Peninsular Malaysia, between April 2016 to January 2017. All cancer patients aged 18 years old and above, Malaysian citizens and undergoing cancer treatment at government hospitals were approached to participate in this study and requested to complete a set of validated questionnaires. Inferential statistical tests such as t-test and one-way ANOVA were used to determine the differences between demographic variables, physical effects, clinical factors, psychological effects and self-esteem with the quality of life of cancer patients. Predictor(s) of quality of life were determined by using Multivariate linear regression models. RESULT A total 1620 out of 2120 cancer patients participated in this study, giving a response rate of 92%. The majority of cancer patients were female 922 (56.9%), Malays 1031 (63.6%), Muslim 1031 (63.6%), received chemotherapy treatment 1483 (91.5%). Overall, 1138 (70.2%) of the patients had depression and 1500 (92.6%) had anxiety. Statistically significant associations were found between QOL and clinical factors, physical side effects of cancer, psychological effects and self-esteem (p < 0.05). However, among socio-demographics only age, race, religion, working status were significantly associated with QOL. Based on the multivariate regression analysis, the main predictors of QOL among cancer patients in Malaysia were age, self-esteem as positive predictors, and Indian race, nausea, fatigue, hair loss, bleeding as negative predictors. CONCLUSION The findings of this study provide a scientific basis to develop a comprehensive program for improving quality of life of cancer patients in Malaysia.
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Affiliation(s)
- Mehrnoosh Akhtari-Zavare
- Department of Public Health, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
- Cancer Resource & Education Center, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Sherina Mohd-Sidik
- Cancer Resource & Education Center, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | | | - Lekhraj Rampal
- Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Siti Irma Fadhilah
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Rozi Mahmud
- Cancer Resource & Education Center, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
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25
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Subramaniam S, Kong YC, Chinna K, Kimman M, Ho YZ, Saat N, Malik RA, Taib NA, Abdullah MM, Lim GCC, Tamin NSI, Woo YL, Chang KM, Goh PP, Yip CH, Bhoo-Pathy N. Health-related quality of life and psychological distress among cancer survivors in a middle-income country. Psychooncology 2018; 27:2172-2179. [PMID: 29856903 DOI: 10.1002/pon.4787] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Quality of life and psychological well-being are important patient-centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low-income and middle-income countries remains scarce. We assessed health-related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle-income setting. METHODS Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed-up in Malaysia for 1 year. Health-related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EuroQol-5 (EQ-5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses. RESULTS One year after diagnosis, the mean EORTC QLQ-C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty-four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high-income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type. CONCLUSION Cancer survivors in this middle-income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well-being is urgently needed in our settings.
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Affiliation(s)
- Shridevi Subramaniam
- National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Yek-Ching Kong
- National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, AZ Maastricht, The Netherlands
| | - Yan-Zheng Ho
- Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - Nadiah Saat
- National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Gerard Chin-Chye Lim
- Department of Radiotherapy & Oncology, National Cancer Institute, Putrajaya, Malaysia
| | | | - Yin-Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kian-Meng Chang
- Department of Haematology, Ampang Hospital, Ampang, Selangor, Malaysia
| | - Pik-Pin Goh
- National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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26
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Nathoo D, Willis S, Tran WT. Distress Among Locally Advanced Breast Cancer Patients from Diagnosis to Follow-Up: A Critical Review of Literature. J Med Imaging Radiat Sci 2018; 49:325-336. [PMID: 32074060 DOI: 10.1016/j.jmir.2018.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This critical review used a systematic approach to explore the prevalence of distress among locally advanced breast cancer (LABC) patients along their treatment journey. This review explored the domains of distress (psychosocial, physical and/or practical) that are significant to this patient population and determined indications for psychosocial support throughout the patients' treatment. METHODS Electronic databases including CINAHL, EmBase, Medline PsycInfo, and gray literature were searched from the year 2000 to 2016, to produce relevant literature. A critical review was conducted on 73 articles meeting the inclusion and exclusion criteria. A narrative synopsis was used to summarize the findings under key themes. RESULTS The results indicate that 16/73 studies assessed for distress in all three domains of distress throughout the treatment course. A meta-analysis was not possible due to the methodological heterogeneity of the articles, the variation of assessment tools used, timing in which the assessments were done, and the different treatment modalities. Distress was prevalent from the time of diagnosis, through treatment, and into survivorship. Sexuality, body image, age, financial difficulty, family/social support, and informational needs were common themes that emerged among the LABC population in these studies. CONCLUSIONS Comprehensive assessments incorporating all three domains of distress with the appropriate tools will assist health care professionals throughout the complicated treatment trajectory of LABC patients in taking a more proactive approach in assisting patients' concerns and preventing undue or increase in psychological distress during or after active treatment. This will encourage effective patient-centered communication and supportive care referrals for a better patient experience.
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Affiliation(s)
- Dilshad Nathoo
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.
| | | | - William T Tran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario
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27
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Alamdarsaravi M, Ghajar A, Noorbala AA, Arbabi M, Emami A, Shahei F, Mirzania M, Jafarinia M, Afarideh M, Akhondzadeh S. Efficacy and safety of celecoxib monotherapy for mild to moderate depression in patients with colorectal cancer: A randomized double-blind, placebo controlled trial. Psychiatry Res 2017; 255:59-65. [PMID: 28528242 DOI: 10.1016/j.psychres.2017.05.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/31/2017] [Accepted: 05/15/2017] [Indexed: 12/17/2022]
Abstract
Cancer-related inflammation is an essential process in malignancies. Celecoxib, a nonsteroidal anti-inflammatory drug that acts via the selective inhibition of cyclooxygenase (COX)-2, has shown favorable effects in several psychiatric disorders. The present study aimed to assess the safety and efficacy of celecoxib single therapy on depressive symptoms of patients with colorectal cancer who underwent chemotherapy. The study was conducted as a 6-week, parallel-group, randomized, double-blind, placebo-controlled trial. Forty participants randomly received either 400mg/day celecoxib or placebo. Treatment effect was assessed using the Hamilton Depression Rating Scale (HDRS) and Visual Analogue Scale (VAS) score at baseline and at week 2, 4 and 6 of the trial. Over 6 weeks, patients who received celecoxib showed significant improvement in scores of the Hamilton Depression rating Scale (P=0.003). When comparing the Mean Difference (95% CI) between the two groups of therapy, the celecoxib group demonstrated greater reduction in HDRS score during the study period at weeks 4 (1.95, 95% CI 0.27-3.63, P value =0.024) and 6 (2.60, 95% CI 0.96-4.23, P=0.003). This study indicates celecoxib as a potential monotherapy treatment strategy for mild to moderate depression in patients with colorectal cancer who underwent chemotherapy.
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Affiliation(s)
- Maryam Alamdarsaravi
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghajar
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran 13337, Iran
| | - Ahmad-Ali Noorbala
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arbabi
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Emami
- Hematology and Medical Oncology Ward, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahei
- Hematology and Medical Oncology Ward, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad Mirzania
- Hematology and Medical Oncology Ward, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Jafarinia
- Psychosomatic Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran 13337, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran 13337, Iran.
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Abstract
BACKGROUND The diagnosis and treatment of breast cancer may negatively affect the quality of life (QOL) of women. OBJECTIVES The aim of this study is to assess QOL in women with breast cancer who were treated with or without chemotherapy and to identify factors associated with improved or worsening QOL in these women. METHODS This cross-sectional study enrolled 112 women who were treated with chemotherapy (CTX group, with 85 [75.9%] women) or without chemotherapy (non-CTX group, with 27 [24.1%] women) for breast cancer. The Short-Form Health Survey (SF-36) assessed QOL and the Hospital Anxiety and Depression scale assessed anxiety and depression. RESULTS The overall mean SF-36 score was below 50 in all domains. Relative to CTX women, non-CTX women were significantly older (P = .001) and more likely to engage in physical exercise (P = .002). The non-CTX group had higher scores in the Physical Functioning (P = .001) and Role-Physical (P = .0009) domains of the SF-36 relative to the CTX group, and the fluoruracil + epirubicin + cyclophosphamide group had significantly lower scores in the SF-36 domains Physical Functioning (P = .009) and Role-Physical (P = .02). CONCLUSION Chemotherapy treatment for breast cancer worsens QOL in the Physical Functioning and the Role-Physical domains of the SF-36 relative to women treated without chemotherapy. IMPLICATIONS FOR PRACTICE Nurses should assess Physical Functioning and the Role-Physical before treatment, as a woman who was not physically active before breast cancer is not likely to become physically active after treatment. Establishing support groups and providing educational sessions about the disease and its management, supportive care can improve the QOL of this population.
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29
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Wood R, Mitra D, de Courcy J, Iyer S. Patient-reported pain severity, pain interference and health status in HR+/HER2- advanced/metastatic breast cancer. ESMO Open 2017; 2:e000227. [PMID: 29209529 PMCID: PMC5703387 DOI: 10.1136/esmoopen-2017-000227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 01/22/2023] Open
Abstract
Introduction Patient-reported pain severity and related impact in advanced/metastatic breast cancer (ABC/MBC) are not well documented. The objective of this study was to assess pain and general health status in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) ABC/MBC. Methods Data were collected in the USA and Europe in a real-world, cross-sectional study. Patients were recruited at oncology practices and completed validated questionnaires; pain severity and interference were assessed using the Brief Pain Inventory (BPI) and general health status using the EuroQoL-5D (EQ-5D-3L). Descriptive statistics were generated for the overall cohort, and stratified by type of therapy and sites of metastases. Differences between patient groups were assessed via the Mann-Whitney Wilcoxon test. The relationship between pain scores and general health status was assessed using Kruskal-Wallis tests. Results Overall, 173 oncologists and 739 patients participated. The majority of patients rated their worst pain, average pain and pain interference as mild (59%, 77% and 70%, respectively). Most patients (>90%) reported no problems or moderate problems for all items of the EQ-5D-3L. Current treatment had no significant associations with pain severity or interference. Patients on chemotherapy reported significantly higher proportions of moderate/extreme levels of anxiety/depression (66.7%) and significantly lower general health status (60.7) compared with those on endocrine therapy (53.1% and 64.4, respectively). Pain severity and interference, all EQ-5D-3L items except self-care and the EQ-5D-3L health utility index were also significantly associated with sites of metastases, with greater impact in patients with visceral and bone metastases than those with bone only or visceral only metastases. Significant associations were observed between pain and health status, with increased pain severity and pain interference associated with worse health utility and general health status. Conclusion There is a clear unmet need for treatments that can reduce pain and preserve health status in patients with HR+/HER2− ABC/MBC.
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Affiliation(s)
- Robert Wood
- Real World Evidence, Adelphi Real World, Manchester, UK
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30
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Wilhelmsson A, Roos M, Hagberg L, Wengström Y, Blomberg K. Motivation to uphold physical activity in women with breast cancer during adjuvant chemotherapy treatment. Eur J Oncol Nurs 2017; 29:17-22. [PMID: 28720261 DOI: 10.1016/j.ejon.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Physical activity (PA) is important for recovery after a breast cancer diagnosis; however, women's motivation to engage in PA can be impacted by disease and/or treatment, and can therefore be a challenge. This study explored factors associated with PA levels during chemotherapy among women with breast cancer. METHOD The study had a cross-sectional descriptive and comparative design using a study-specific questionnaire. One hundred women with breast cancer receiving adjuvant chemotherapy were included. Data were analysed by Pearson's correlation coefficient and linear regression. The open question was subjected to manifest content analysis. RESULTS Identified factors associated with engaging in PA during chemotherapy treatment were: being physically active before diagnosis, and the information given by the oncology nurse before the treatment start. The physically active women experienced higher psychological wellbeing, less fatigue, and faster recovery after treatment. They also experienced an overall feeling of fitness. CONCLUSION It seems that PA is associated with less fatigue, better recovery between chemotherapy treatments, and a better mental condition leading to wellbeing. Information given by the oncology nurse may be an important factor for being physically active. Women with breast cancer need to get specific advice about and support in engaging in PA to feel better during chemotherapy treatment. Further research is required to develop guidelines for advice about and support regarding PA during chemotherapy treatment.
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Affiliation(s)
- Anna Wilhelmsson
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Maria Roos
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Lars Hagberg
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yvonne Wengström
- Neurobiology Care Science and Society, Nursing, Karolinska Institute, & Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
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Abstract
The introduction of targeted therapies in cancer treatment was accompanied with promising results including tumor control and patients survival benefits. However, these drugs just like their predecessors were associated with systemic side effects, including frequent and various cutaneous effects. Targeted therapies such as epidermal growth factor receptor, vascular endothelial growth factor receptor, kit, platelet-derived growth factor receptor, and BCR-ABL inhibitors as well as mammalian target of rapamycin inhibitors can induce cutaneous toxicities of varying severity. There are scarce studies on the actual impact of these toxicities on the patients' lives including the physical, social, and psychological aspects and overall quality of life. Patient's perspective in living with and beyond these toxicities remains largely uncharted but essential in optimizing care provided to those receiving treatment with targeted therapies.
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Affiliation(s)
- Andreas Charalambous
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus, Finland.,Department of Nursing, University of Turku, Turku, Finland
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Doss J, Ghani W, Razak I, Yang Y, Rogers S, Zain R. Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country. Int J Oral Maxillofac Surg 2017; 46:687-698. [DOI: 10.1016/j.ijom.2017.02.1269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/22/2017] [Indexed: 11/26/2022]
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Maj MA, Ma J, Krukowski KN, Kavelaars A, Heijnen CJ. Inhibition of Mitochondrial p53 Accumulation by PFT-μ Prevents Cisplatin-Induced Peripheral Neuropathy. Front Mol Neurosci 2017; 10:108. [PMID: 28458631 PMCID: PMC5394177 DOI: 10.3389/fnmol.2017.00108] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/30/2017] [Indexed: 02/03/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN), a debilitating major side effect of cancer treatment, is characterized by pain and sensory loss in hand and feet. Platinum-based chemotherapeutics like cisplatin frequently induce CIPN. The molecular mechanism underlying these neurotoxic symptoms is incompletely understood and there are no preventive or curative interventions. We hypothesized that cisplatin acts as a cellular stressor that triggers p53 accumulation at mitochondria, leading to mitochondrial dysfunction and CIPN. To test this hypothesis, we examined the effect of the small molecule pifithrin-μ (PFT-μ), an inhibitor of p53 mitochondrial association on CIPN and the associated mitochondrial dysfunction. We show here for the first time that in vivo cisplatin rapidly increases mitochondrial accumulation of p53 in dorsal root ganglia (DRG), spinal cord, and peripheral nerve without evidence for apoptosis. Cisplatin-treatment also reduced mitochondrial membrane potential and lead to abnormal mitochondrial morphology and impaired mitochondrial function in DRG neurons. Pre-treatment with PFT-μ prevented the early cisplatin-induced increase in mitochondrial p53 and the reduction in mitochondrial membrane potential. Inhibition of the early mitochondrial p53 accumulation by PFT-μ also prevented the abnormalities in mitochondrial morphology and mitochondrial bioenergetics (reduced oxygen consumption rate, maximum respiratory capacity, and adenosine triphosphate synthesis) that develop in DRG and peripheral nerve after cisplatin-treatment. Functionally, inhibition of mitochondrial p53 accumulation prevented the hallmarks of CIPN including mechanical allodynia, peripheral sensory loss (numbness) as quantified by an adhesive-removal task, and loss of intra-epidermal nerve fibers. In conclusion, PFT-μ is a potential neuroprotective agent that prevents cisplatin-induced mitochondrial dysfunction in DRG and peripheral nerves thereby protecting against CIPN through blockade of the early cisplatin-induced increase in mitochondrial p53. Notably, there is accumulating evidence that PFT-μ has anti-tumor activities and could therefore be an attractive candidate to prevent CIPN while promoting tumor cell death.
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Lorusso D, Bria E, Costantini A, Di Maio M, Rosti G, Mancuso A. Patients' perception of chemotherapy side effects: Expectations, doctor-patient communication and impact on quality of life - An Italian survey. Eur J Cancer Care (Engl) 2016; 26. [PMID: 28004440 DOI: 10.1111/ecc.12618] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 12/30/2022]
Abstract
Chemotherapy side effects (CSE) have a strong impact on patients' quality of life (QOL). To assess patient perceptions of CSE, their impact on QOL and doctor-patient communication regarding these aspects, a survey was conducted among Italian cancer patients. Patients at least 18 years of age, who received chemotherapy, were administered a dedicated questionnaire to assess their point of view on five domains: expectations about CSE and impact on QOL; doctor-patient communication about CSE; treatments to reduce the impact of CSE; sexual life; family relationships/activities and employment. A total of 761 patients participated. CSE had a considerable impact on patient QOL. Nausea/vomiting was the most feared adverse effect before initiating chemotherapy and the one most commonly experienced during treatment. Patients generally reported good doctor-patient communication regarding information about CSE. In almost all cases, the oncologists prescribed an antiemetic treatment, but the incidence of nausea/vomiting was high. Cancer and CSE severely affected sexual life, daily activities and employment. CSE had a strong negative impact on QOL. Good doctor-patient communication is essential. Improving antiemetic strategies may improve QOL. Doctors' ability to inform patients about delicate issues, such as the impact of CSE on sexual life, needs to be improved.
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Affiliation(s)
| | - Emilio Bria
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Costantini
- Psycho-Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, and Italian Society of Psycho-Oncology (SIPO), Rome, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, and Medical Oncology, Mauriziano Hospital, Turin, Italy
| | | | - Annamaria Mancuso
- Salute Donna (Association for the Prevention and Fight Against Female Cancers), Milan, Italy
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Kool M, van der Sijp JRM, Kroep JR, Liefers GJ, Jannink I, Guicherit OR, Vree R, Bastiaannet E, van de Velde CJH, Marang-van de Mheen PJ. Importance of patient reported outcome measures versus clinical outcomes for breast cancer patients evaluation on quality of care. Breast 2016; 27:62-8. [PMID: 27026219 DOI: 10.1016/j.breast.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Given increasing numbers of breast cancer survivors, there is an increased focus on quality of life and quality of care. This study aims to investigate whether clinical or patient reported outcomes are most important for perceived quality of care by breast cancer patients. METHODS Overall, 606 patients aged 18 years or older, who underwent breast cancer surgery 9-18 months ago in five hospitals in the Netherlands, were invited to complete an internet-based questionnaire. Patients were asked to judge a random selection of 24 patient profiles and choose which of 2 presented patients had received the best quality of care, using conjoint analysis. The individual relative importance (RI) for each outcome was estimated using Hierarchical Bayes Estimation, and averaged over all patients to assess which outcomes were most important. RESULTS Complete data were available for 350 patients (58%). Avoiding severe breast symptoms was most important for good quality of care according to patients (RI 23.22 [95% Confidence Interval (95% CI) 22.32-24.12]), followed by a 2 year longer disease free survival (18.30 [17.38-19.22]). However, the importance differed by age: younger patients (<50 years) assigned higher importance to longer disease free survival (21.99 [19.52-24.46]) than older patients (65 + years) (15.03 [13.88-16.18]). CONCLUSION Avoiding severe breast symptoms rather than 2 year longer disease free survival is considered most important in our population of breast cancer patients for evaluation of quality of care. These data should thus be included in both information provision prior to treatment choices and post treatment quality of care evaluation.
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Affiliation(s)
- Melissa Kool
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Judith R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilse Jannink
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Bronovo Hospital, The Hague, The Netherlands
| | - Robbert Vree
- Department of Surgery, Diaconessenhuis, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Ho MY, McBride ML, Gotay C, Grunfeld E, Earle CC, Relova S, Tsonis M, Ruan JY, Chang JT, Cheung WY. A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer. Psychooncology 2015; 25:1470-1476. [DOI: 10.1002/pon.3988] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/22/2015] [Accepted: 08/21/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Maria Y. Ho
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Mary L. McBride
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Carolyn Gotay
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Eva Grunfeld
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Craig C. Earle
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Sharon Relova
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Miranda Tsonis
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Jenny Y. Ruan
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Jennifer T. Chang
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Winson Y. Cheung
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
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Adjuvant treatments of breast cancer increase the risk of depressive disorders: A population-based study. J Affect Disord 2015; 182:44-9. [PMID: 25973782 DOI: 10.1016/j.jad.2015.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies have posited conflicting results regarding depressive disorders among breast cancer survivors who received adjuvant therapies including chemotherapy, radiotherapy, selective estrogen receptor modulator (e.g. tamoxifen), third-generation aromatase inhibitors (AIs; e.g. anastrozole, letrozole or exemestane), and monoclonal antibody (e.g. trastuzumab). We therefore performed a population-based study with a defined breast cancer cohort to investigate the risk of depressive disorders in breast cancer patients who received adjuvant therapies. METHODS We conducted a retrospective study of a breast cancer cohort of 36,586 participants who were selected from the National Health Insurance Research Database(NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidences of newly onset depressive disorders. Kaplan-Meier and Cox regression analyses were used to identify the risk factors associated with depressive disorders in breast cancer patients who underwent adjuvant therapies RESULTS Of the total 36,586 patients, 1342 (3.7%) were ascertained with depressive disorders. The Cox multivariate proportional hazards analysis showed that age of 40-59 (adjusted hazard ratio (aHR) 1.327, 95% CI 1.123-1.567, p=0.001), chemotherapy (aHR 1.555, 95% CI 1.387-1.743, p<0.001), radiotherapy (aHR 1.385 95% CI 1.220-1.571, p<0.001), tamoxifen (aHR 1.458, 95% CI 1.110-1.914, p=0.007), AIs (aHR 1.360, 95% CI 1.193-1.550, p<0.001), and trastuzumab (aHR 1.458, 95% CI 1.110-1.914, p=0.007) were independent risk factors for developing depressive disorders. LIMITATIONS The dosage effect of adjuvant treatments, cancer staging, genetic or environmental confounders associated with the risk of depressive disorders were not comprehensively evaluated. CONCLUSION Developing depressive disorders are at higher risk in breast cancer survivors aged 40-59 who received adjuvant treatments including chemotherapy, radiotherapy, tamoxifen, AIs or trastuzumab. Psychological evaluation and support are necessarily needed in breast cancer survivors who received adjuvant therapies.
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A study of donepezil in female breast cancer survivors with self-reported cognitive dysfunction 1 to 5 years following adjuvant chemotherapy. J Cancer Surviv 2015; 10:176-84. [PMID: 26130292 DOI: 10.1007/s11764-015-0463-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/07/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Some breast cancer survivors report cognitive difficulties greater than 1 year after chemotherapy. Acetylcholinesterase inhibitors (AChEI) may improve cognitive impairment. We conducted a randomized, placebo-controlled, pilot study to assess the feasibility of using the AChEI, donepezil, to improve subjective and objective measures of cognitive function in breast cancer survivors. METHODS Women who received adjuvant chemotherapy 1-5 years prior with current cognitive dysfunction symptoms were randomized to 5 mg of donepezil/day vs placebo for 6 weeks and if tolerated 10 mg/day for 18 weeks for a total of 24 weeks. A battery of validated measures of attention, memory, language, visuomotor skills, processing speed, executive function, and motor dexterity and speed was administered at baseline and at 24 and 36 weeks. Subjective cognitive function, fatigue, sleep, mood, and health-related quality of life were evaluated at baseline and at 12, 24, and 36 weeks. RESULTS Sixty-two patients were enrolled, 76 % completed the study, self-reported compliance was 98 %, and toxicities were minimal. At the end of treatment, the donepezil group performed significantly better than the control group on two parameters of memory-the Hopkins Verbal Learning Test -Revised (HVLT-R) Total Recall (p = 0.033) and HVLT-R Discrimination (p = 0.036). There were no significant differences on other cognitive variables or in subjective cognitive function or quality of life. CONCLUSION Accrual to this feasibility trial was robust, retention was good, compliance was excellent, and toxicities were minimal. IMPLICATIONS FOR CANCER SURVIVORS Randomized clinical trials in breast cancer survivors to improve cognitive dysfunction are feasible. A phase III trial testing the efficacy of donepezil is warranted given these pilot results.
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Harder H, Langridge C, Solis-Trapala I, Zammit C, Grant M, Rees D, Burkinshaw L, Jenkins V. Post-operative exercises after breast cancer surgery: Results of a RCT evaluating standard care versus standard care plus additional yoga exercise. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boswell EN, Dizon DS. Breast cancer and sexual function. Transl Androl Urol 2015; 4:160-8. [PMID: 26816822 PMCID: PMC4708123 DOI: 10.3978/j.issn.2223-4683.2014.12.04] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/12/2014] [Indexed: 01/13/2023] Open
Abstract
As the most common malignancy affecting women within the United States, breast cancer can bring about multiple physical and psychological challenges. Among the greatest challenges are those associated with female sexual function. Chemotherapy, endocrine therapy, surgeries and radiation can all have a large effect in altering a woman's sexual health and function. Sexual concerns result in significant emotional distress, including sadness/depression, issues related to personal appearance, stigma, and negative impacts on personal relationships. In this article, we discuss some of the specific challenges that present with each type of treatment and the socio-physical impact they have on survivorship. Among the most detrimental to sexual function, are the use of chemotherapy and endocrine therapy. Additionally, anatomical changes that transpire in patients who have undergone surgery or radiation therapy (RT), disrupt perceptions of body image. Here we will discuss and also review the contemporary literature to determine effective management and treatment of sexual dysfunction.
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Pud D. The psychometric properties of the Hebrew version of the Memorial Symptom Assessment scale (MSAS-Heb) in patients with breast cancer. J Pain Symptom Manage 2015; 49:790-5. [PMID: 25261638 DOI: 10.1016/j.jpainsymman.2014.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/27/2014] [Accepted: 09/08/2014] [Indexed: 11/21/2022]
Abstract
CONTEXT To date, no report of the psychometric properties of the Hebrew version of the Memorial Symptom Assessment Scale (MSAS-Heb) has been available, which may be a barrier to comprehensively assessing symptom frequency, severity, and distress in Israeli patients with cancer. OBJECTIVES This study aimed to translate the MSAS into Hebrew and to evaluate the psychometric properties in Israeli patients with cancer. METHODS The original 32-item MSAS was translated into Hebrew using the forward and backward procedure, and administered to female patients with early stage breast cancer (stages I-IIIA) who had received adjuvant chemotherapy. In addition, patients completed a demographic questionnaire, the Lee Fatigue Scale, the Center for Epidemiological Studies-Depression Scale, the General Sleep Disturbance Scale, a numeric rating scale for pain intensity, the Multidimensional Quality of Life Scale-Cancer and the Karnofsky Performance Status Scale. RESULTS A sample of 110 patients was recruited (mean age 45.5 ± 10.1 years). The most frequent symptoms were hair loss (96.4%), lack of energy (88.2%) and "I do not look like myself" (80.9%), and the most infrequent were vomiting (7.3%), problems with urination (10.9%), and shortness of breath (20.9%). Cronbach alpha coefficients for the MSAS-Heb subscales (i.e., physical, psychological and global distress index) ranged from 0.78 to 0.90. All MSAS-Heb subscales and all the other questionnaires used in this study were significantly correlated (P < 0.0001), with expected directions. CONCLUSION The MSAS-Heb is a valid and a reliable measure and should be a useful tool in the clinical arena and in future studies for evaluation of multiple symptoms in Israeli patients with cancer.
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Affiliation(s)
- Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Lindkær-Jensen S, Larsen S, Habib-Lindkær-Jensen N, Fagertun HE. Positive effects on hematological and biochemical imbalances in patients with metastatic breast cancer stage IV, of BP-C1, a new anticancer substance. Drug Des Devel Ther 2015; 9:1481-90. [PMID: 25792808 PMCID: PMC4364592 DOI: 10.2147/dddt.s80451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED A benzene-poly-carboxylic acid complex with cis-diammineplatinum(II) dihydrocholride, BP-C1 is currently used in clinical trials in treating metastatic breast cancer. BP-C1 controls tumor growth with a few mild side-effects, improving quality of life. METHODS The data consisted of prospectively collected laboratory results from 47 patients in two controlled clinical trials of daily intramuscular injections of BP-C1 for 32 days. Study I was performed as an open, nonrandomized, Phase I dose-response, multicenter study with a three-level, between-patient, response surface pathway design. The second study was a randomized, double-blind, and placebo-controlled, multicenter study with a stratified semi-crossover design. RESULTS Hemoglobin (Hb) and hematocrit (Hct) increased significantly (P<0.01) during BP-C1 treatment, while red blood cell (RBC) count increased but not significantly. The most pronounced increase in Hb, RBC, Hct, and white blood cell (WBC) was in anemic patients (P≤0.01). WBC count and neutrophils increased significantly (P=0.01) in the overall data. WBCs and neutrophils (P<0.01), eosinophils (P=0.05) and monocytes (P<0.01) increased significantly and markedly in patients with lowest baseline levels. Additionally, low levels of thrombocytes significantly increased. No changes in liver parameters, amylase, glucose, creatinine, or albumin, were detected except for albumin in the subgroup with low baseline levels, where levels increased significantly (P=0.04). An increase in K(+), Ca(2+), and PO4 (3-) was most pronounced in patients with low baseline levels (P≤0.02). A similar pattern detected for Mg(2+), prothrombin time (PT), coagulation factors II, VII, X (KFNT), and C-reactive protein (CRP), which increased significantly (P≤0.05) in the groups with the lowest values. CONCLUSION Our findings support the safety profile of BP-C1 use in cancer patients. BP-C1 did not induce anemia, infection, bleeding, hepatic insufficiency or electrolyte imbalances. In contrast, BP-C1 corrected abnormalities. No hematological and biochemical toxicity was observed.
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Affiliation(s)
- Steen Lindkær-Jensen
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College, London, UK
| | - Stig Larsen
- Center of Epidemiology and Biostatistics, Faculty of Veterinary Medicine, University of Life Science, Oslo, Norway
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Braybrooke JP, Mimoun S, Zarca D, Elia D, Pinder B, Lloyd AJ, Breheny K, Lomazzi M, Borisch B. Patients' experiences following breast cancer treatment: an exploratory survey of personal and work experiences of breast cancer patients from three European countries. Eur J Cancer Care (Engl) 2014; 24:650-61. [PMID: 25053521 DOI: 10.1111/ecc.12222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
Abstract
Improved treatments for early breast cancer have led to a significant increase in overall survival. While evidence regarding potential long-term sequelae of adjuvant treatments exists, relatively little research reports patients' own perceptions of change before and after adjuvant chemotherapy (AC). This study aimed to identify key ongoing issues associated with AC in daily life. An online survey developed for this study was completed by 198 women (mean age 49.7 years) in the UK, France and Germany who had AC 1-5 years previously for oestrogen receptor positive, HER2 negative early breast cancer. Women without AC and endocrine therapy, those treated with Trastuzumab or who had recurrent disease were excluded. A third of women who responded were currently unable to perform their former family role. The majority had needed support, particularly with child care, during treatment. While 54% were in full-time employment before diagnosis this had reduced to 32% following AC. Of those women still working, over half reported difficulties with tiredness or concentration. Most (85.8%) were satisfied with healthcare professionals' treatment information, but only 29.7% received information about returning to work. This exploratory survey highlights areas of women's lives affected 1-5 years following AC for early breast cancer. The impact on returning to work and issues surrounding childcare particularly, require further study.
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Affiliation(s)
| | | | | | | | - B Pinder
- ICON Patient Reported Outcomes, Oxford, UK
| | - A J Lloyd
- ICON Patient Reported Outcomes, Oxford, UK
| | - K Breheny
- Health Economics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M Lomazzi
- Institute of Global Health, University of Geneva, Genève, Switzerland
| | - B Borisch
- Institute of Global Health, University of Geneva, Genève, Switzerland
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Hansen RN, Ramsey SD, Lalla D, Masaquel A, Kamath T, Brammer M, Hurvitz SA, Sullivan SD. Identification and cost of adverse events in metastatic breast cancer in taxane and capecitabine based regimens. SPRINGERPLUS 2014; 3:259. [PMID: 24926422 PMCID: PMC4047276 DOI: 10.1186/2193-1801-3-259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE We sought to compare the economic impact of treatment-related adverse events (AEs) in patients with metastatic breast cancer (mBC) using taxane- or capecitabine-based treatment regimens as either first- or second-line (FL or SL) therapy in the US. METHODS We used healthcare claims data from the Truven Health Analytics MarketScan® Commercial Databases to conduct a retrospective cohort study comparing the economic impact of AEs amongst taxane- and capecitabine-treated mBC patients in the US. We selected women diagnosed with mBC between 2008-2010 who received a taxane or capecitabine as first- or second-line (FL or SL) chemotherapy. Costs related to hospitalization, outpatient services, emergency department visits, chemotherapy and other medications were tabulated and combined to determine total healthcare costs. The incremental monthly costs associated with the presence of AEs compared to no AEs were estimated using generalized linear models, controlling for age and Charlson Comorbidity Index. RESULTS We identified 15,443 mBC patients meeting inclusion criteria. Adjusted total monthly costs were significantly higher in those who experienced AEs than in those without AEs in both lines of treatment (FL incremental cost: taxanes $1,142, capecitabine $1,817; SL incremental cost: taxanes $1,448, capecitabine $4,437). Total costs increased with the number of AEs and were primarily driven by increased hospitalization amongst those with AEs. CONCLUSIONS Adverse events in taxane- or capecitabine-treated mBC patients are associated with significant increases in costs. Selecting treatment options associated with fewer AEs may reduce costs and improve outcomes in these patients.
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Affiliation(s)
- Ryan N Hansen
- University of Washington, Seattle, WA USA ; Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, 1959 NE Pacific Ave, H-375Q, Box 357630, Seattle, WA 98195-7630 USA
| | - Scott D Ramsey
- University of Washington, Seattle, WA USA ; Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | | | | | | | | | - Sara A Hurvitz
- UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, CA USA
| | - Sean D Sullivan
- University of Washington, Seattle, WA USA ; Fred Hutchinson Cancer Research Center, Seattle, WA USA
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Pud D, Har-Zahav G, Laitman Y, Rubinek T, Yeheskel A, Ben-Ami S, Kaufman B, Friedman E, Symon Z, Wolf I. Association between variants of 5-hydroxytryptamine receptor 3C (HTR3C) and chemotherapy-induced symptoms in women receiving adjuvant treatment for breast cancer. Breast Cancer Res Treat 2014; 144:123-31. [PMID: 24477975 DOI: 10.1007/s10549-014-2832-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Administration of chemotherapy is associated with a wide array of symptoms affecting quality of life. Genetic risk factors for severity of chemotherapy-induced symptoms have not been determined. The present study aimed to explore the associations between polymorphisms in candidate genes and chemotherapy-induced symptoms. Women treated with at least two cycles of adjuvant doxorubicin and cyclophosphamide, with or without paclitaxel for early breast cancer (n = 105) completed the memorial symptom assessment scale and provided blood for genotyping. DNA was extracted from peripheral blood leukocytes and assayed for single nucleotide polymorphisms (SNPs) in GTP cyclohydrolase 1 (GCH1, rs10483639, rs3783641, and rs8007267), catecholamine-o-methyltransferase (COMT, rs4818), and 5-hydroxytryptamine (serotonin) receptor 3C (HTR3C, rs6766410, and rs6807362). Genotyping of HTR3C revealed a significant association between the presence of rs6766410 and rs6807362 SNPs (K163 and G405 variants) and increased severity of symptoms (p = 0.0001 and p = 0.007, respectively). Multiple regressions revealed that rs6766410 and rs6807362, but not age or stage at diagnosis, predicted severity of symptoms (p = 0.001 and p = 0.006, respectively) and explained 12 % of the variance in each regression model. No association was found between the genetic variants of CGH1 or COMT and symptom score. Our study indicates, for the first time, an association between variants of HTR3C and severity of chemotherapy-induced symptoms. Analyzing these genetic variants may identify patients at increased risk for the development of chemotherapy-induced symptoms and targeting the serotonin pathway may serve as a novel treatment strategy for these patients.
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Affiliation(s)
- Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Bordonaro S, Romano F, Lanteri E, Cappuccio F, Indorato R, Butera A, D’Angelo A, Ferraù F, Tralongo P. Effect of a structured, active, home-based cancer-treatment program for the management of patients on oral chemotherapy. Patient Prefer Adherence 2014; 8:917-23. [PMID: 25028540 PMCID: PMC4077854 DOI: 10.2147/ppa.s62666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes. PATIENTS AND METHODS In this multicenter observational study, we assessed the effect of the "Active Home Care" initiative - a structured, active, home-based cancer-treatment program - on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients' compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits. RESULTS A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen. CONCLUSION The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.
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Affiliation(s)
- S Bordonaro
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Romano
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - E Lanteri
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - F Cappuccio
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
| | - R Indorato
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A Butera
- Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, Italy
| | - A D’Angelo
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - F Ferraù
- Medical Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - P Tralongo
- Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, Italy
- Correspondence: Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, RAO, Siracusa, Italy, Tel +39 9 3172 4542, Email
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