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Halpern MT, Liu B, Lowy DR, Gupta S, Croswell JM, Doria-Rose VP. The Annual Cost of Cancer Screening in the United States. Ann Intern Med 2024; 177:1170-1178. [PMID: 39102723 DOI: 10.7326/m24-0375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. OBJECTIVE To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. DESIGN Model using national health care survey and cost resources data. SETTING U.S. health care systems and institutions. PARTICIPANTS People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. MEASUREMENTS The number of people screened and associated health care system costs by insurance status in 2021 dollars. RESULTS Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. LIMITATIONS All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. CONCLUSION The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - Benmei Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - Douglas R Lowy
- Office of the Director, National Cancer Institute, Bethesda, Maryland (D.R.L.)
| | - Samir Gupta
- VA San Diego Healthcare System, San Diego, California, and UC San Diego Division of Gastroenterology and Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California (S.G.)
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
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Ionescu Miron AI, Anghel AV, Antone-Iordache IL, Atasiei DI, Anghel CA, Barnonschi AA, Bobolocu AM, Verga C, Șandru F, Lișcu HD. Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania. J Pers Med 2024; 14:214. [PMID: 38392647 PMCID: PMC10889928 DOI: 10.3390/jpm14020214] [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: 02/01/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up.
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Affiliation(s)
- Andreea-Iuliana Ionescu Miron
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Alexandra-Valentina Anghel
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ionuț-Lucian Antone-Iordache
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dimitrie-Ionuț Atasiei
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin-Alexandru Anghel
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andrei-Alexandru Barnonschi
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandra-Maria Bobolocu
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catinca Verga
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatovenerology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Dermatology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Horia-Dan Lișcu
- Department of Oncological Radiotherapy and Medical Imaging, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Chan PW, Yu H, Hsu CH, Liu CY. Characteristics of early short-term traditional Chinese medicine in breast cancer patients: A population-based cohort study. J Chin Med Assoc 2024; 87:70-78. [PMID: 37962411 DOI: 10.1097/jcma.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Traditional Chinese medicine (TCM) is frequently utilized as a complementary therapy for breast cancer patients. TCM primarily involves the use of Chinese herbal products (CHPs), which consist of single or multiherb formulas with diverse therapeutic effects documented in medical classics. The study aims to investigate the association between medication possession ratios to CHPs within 2-year post breast cancer diagnosis and 5-year survival, to explore the potential beneficial class effect of TCM. METHODS This retrospective population-based cohort study included newly diagnosed breast cancer patients between 2003 and 2006, identified from the National Health Insurance Research Database of Taiwan. Logistic regression and Cox proportional hazards analysis were utilized to assess the likelihood of medication possession ratios (MPRs) for CHPs and to examine the association of variables with 5-year survival. RESULTS A total of 3472 patients with breast cancer were included. Patients who had MPR of 1% to 9% and 10% to 19% for CHPs within 2 years after breast cancer diagnosis exhibited better 5-year survival rates compared with those who did not use CHPs (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.55-0.86, p = 0.001; aHR 0.50, 95% CI 0.28-0.88, p = 0.016). Furthermore, the use of TCM formulations specifically targeting insomnia, such as Tian-wang-bu-xin-dan and Suan-zao-ren-tang, demonstrated a significantly positive association with survival (aHR 0.71, 95% CI 0.52-0.98, p = 0.035) among patients who were short-term users of CHPs (MPR of 1% to 19%). CONCLUSION Short-term use of TCM (ie, MPR to CHPs 1~19%) within 2-year post breast cancer diagnosis present positive association with survival outcome. Tian-wang-bu-xin-dan and Suan-zao-ren-tang may have benefits to 5-year survival, but their causality still need further investigation.
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Affiliation(s)
- Pi-Wei Chan
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Hung Yu
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Branch of Linsen, Chinese Medicine, and Kunming, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Chun-Yu Liu
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Cardoso F, Rihani J, Harmer V, Harbeck N, Casas A, Rugo HS, Fasching PA, Moore A, de Courcy J, Pathak P, Haftchenary S, Aubel D, Schumacher-Wulf E. Quality of Life and Treatment-Related Side Effects in Patients With HR+/HER2- Advanced Breast Cancer: Findings From a Multicountry Survey. Oncologist 2023; 28:856-865. [PMID: 37523663 PMCID: PMC10546820 DOI: 10.1093/oncolo/oyad207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Quality of life (QOL) is a critical factor in decision-making for advanced breast cancer (ABC). There is a need to improve how QOL and treatment-related side effects (SEs) that impact it are clinically assessed. We examined healthcare professionals' (HCPs') and patients' perspectives on the importance of QOL discussions and the impact of SEs on QOL in clinical settings. PATIENTS AND METHODS A cross-sectional online survey was conducted (7/2020-5/2021) among oncologists, nurses, and patients with HR+/HER2- ABC in 7 countries. RESULTS The survey was completed by 502 HCPs and 467 patients. Overall, 88% of oncologists and 49% of patients recalled QOL discussions at follow-up. In the first- through fourth-line (1L, 2L, 3L, and 4L) settings, respectively, 48%, 57%, 79%, and 85% of oncologists reported QOL was very important; 73% and 45% of patients receiving 1L and 2L treatment and 40% receiving 3L+ treatment indicated QOL was important. Patients reported that insomnia, anxiety, back pain, fatigue, diarrhea, hot flashes, low sexual interest, and loss of appetite had a moderate/severe impact on QOL. Of patients experiencing certain SEs, ≥64% did not discuss them with HCPs until there was a moderate/severe impact on QOL. In patients receiving a CDK4/6 inhibitor, SEs, including insomnia, diarrhea, back pain, and fatigue, had a moderate/severe impact on QOL. CONCLUSIONS This survey discovered disconnects between HCPs and patients with ABC on the importance of QOL discussions and the impact of SEs on QOL. These data support the use of ABC-specific QOL questionnaires that closely monitor SEs impacting QOL.
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Affiliation(s)
- Fatima Cardoso
- Department of Oncology, Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - Julie Rihani
- Department of Oncology, Independent Patient Advocate, Amman, Jordan
| | - Victoria Harmer
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, LMU University Hospital Munich, Munich, Germany
| | - Ana Casas
- Department of Oncology, University Hospital Virgen del Rocio, Sevilla, Spain
| | - Hope S Rugo
- Department of Oncology, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Peter A Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen–European Metropolitan Region of Nuremberg and Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Adam Moore
- Department of Oncology, Adelphi Real World, Cheshire, UK
| | | | - Purnima Pathak
- Department of Oncology, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Sina Haftchenary
- Department of Oncology, Novartis Pharmaceuticals, Montreal, QC, Canada
| | - Dawn Aubel
- Department of Oncology, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Eva Schumacher-Wulf
- Department of Oncology, Mamma Mia! Breast Cancer Magazine, Kronberg, Germany
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Su M, Yao N, Shang M, Shen Y, Qin T, Wang J, Sun X. Frailty and its association with health-related quality of life among older cancer patients: an evidence-based study from China. Health Qual Life Outcomes 2022; 20:124. [PMID: 35986354 PMCID: PMC9389706 DOI: 10.1186/s12955-022-02032-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is limited information about the population characteristics and adverse health outcomes of older cancer patients in China. This study aimed to describe the prevalence of frailty and examine the association between frailty and health-related quality of life (HRQoL) among older cancer patients. METHODS This was a cross-sectional study involving older patients diagnosed with cancer in two tertiary hospitals in Shandong Province, China. Frailty was assessed using Geriatric 8 (G-8). HRQoL was measured using the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire. The Tobit regression model and logistic regression model was used to identify the relationship between frailty and HRQoL. RESULTS Of the 229 older patients, 175 (76.4%) were frail. Frail patients had lower EQ-5D-5L utility scores than those who were non-frail (0.830 vs. 0.889; P = 0.004). After adjustments for sociodemographic and cancer-related variables, frailty was statistically associated with worse health-related quality of life (OR = 6.024; P = 0.001). CONCLUSION Frailty was associated with deteriorated HRQoL in older patients with cancer. Early frailty screening and preventive interventions are essential for improving quality of life through decision-making or pretreatment optimization in geriatric oncology.
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Affiliation(s)
- Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Nengliang Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, Shandong, China
| | - Meimei Shang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Yuzhen Shen
- Taian City Center Hospital, Taian, 271099, Shangdong, China
| | - Tingting Qin
- School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Jialin Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, Shandong, China.
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Tripathy D, Curteis T, Hurvitz S, Yardley D, Franke F, Babu KG, Wheatley-Price P, Im YH, Pencheva R, Eddowes LA, Dionne PA, Chandiwana D, Pathak P, Lanoue B, Harbeck N. Correlation between work productivity loss and EORTC QLQ-C30 and -BR23 domains from the MONALEESA-7 trial of premenopausal women with HR+/HER2− advanced breast cancer. Ther Adv Med Oncol 2022; 14:17588359221081203. [PMID: 35251320 PMCID: PMC8891884 DOI: 10.1177/17588359221081203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 01/05/2023] Open
Abstract
Background: The phase III MONALEESA-7 trial (NCT02278120) assessed ribociclib + endocrine therapy (ET) versus ET in premenopausal women with HR+/HER2− advanced breast cancer (ABC). The relationship between work productivity loss (WPL) and domains of European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and the breast cancer (BC)-specific module (QLQ-BR23) has not been explored in ABC. In this post hoc analysis (data cutoff, November 30, 2018), we assessed the correlation between the WPL component of the Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire and EORTC QLQ-C30/BR23 domains. Methods: We analyzed EORTC and WPAI:GH data from 329 patients in both treatment arms of MONALEESA-7 who were employed during the trial. Separate univariable mixed-model repeated measures (MMRM) regression models were fitted for each domain, with WPL as dependent variable and each EORTC domain score as a single fixed-effect covariate. Linear and quadratic relationships were considered based on the Akaike information criterion. Next, two separate multivariable MMRM regression models were fitted with WPL a dependent variable and all QLQ-C30/BR23 domain scores as fixed-effect covariates. The strength of correlation between WPL and EORTC domains was assessed in terms of minimally important differences for the QLQ-C30/BR23 modules. Results: Our univariable analysis showed that greater WPL was statistically significantly associated with lower levels of overall quality of life (QoL) and other functional domains and with higher levels of all symptomatic domains of the QLQ-C30/BR23 modules. Our multivariable analysis determined that this correlation was primarily driven by changes in QoL; physical, role, social, and future perspective domains; and BC-specific symptomatic domains. Conclusion: This analysis determined the QoL domains that correlate with WPL in premenopausal patients with HR+/HER2− ABC. These results may inform prognostic tools to identify and characterize patients with greater risk for WPL and help design interventional strategies to minimize WPL.
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Affiliation(s)
| | | | - Sara Hurvitz
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Denise Yardley
- Sarah Cannon Research Institute, Nashville, TN, USA; Tennessee Oncology, PLLC, Nashville, TN, USA
| | - Fabio Franke
- Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil
| | - K. Govind Babu
- HCG Curie Centre of Oncology and Kidwai Memorial Institute of Oncology, Bangalore, India
| | | | - Young-Hyuck Im
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | - Purnima Pathak
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Brad Lanoue
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Nadia Harbeck
- Breast Center, Department OB&GYN, LMU University Hospital, Munich, Germany
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Liu YH, Jin J, Liu YJ. Machine learning-based random forest for predicting decreased quality of life in thyroid cancer patients after thyroidectomy. Support Care Cancer 2021; 30:2507-2513. [PMID: 34782918 DOI: 10.1007/s00520-021-06657-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Decreased quality of life (QoL) in thyroid cancer patients after thyroidectomy is a common, but there is a lack of predictive methods for decreased QoL. This study aimed to construct a machine learning-based random forest for predicting decreased QoL in thyroid cancer patients 3 months after thyroidectomy. MATERIALS AND METHODS Two hundred and eighty-six thyroid cancer patients after thyroidectomy were enrolled in this prospective cross-sectional study from November 2018 to June 2019, and were randomly assigned to training and validation cohorts at a ratio of 7:3. The European Organization for Research and Treatment of Cancer quality of life questionnaire version 3 (EORTC QLQ-C30) questionnaire was used to assess the QoL 3 months after thyroidectomy, and decreased QoL was defined as EORTC QLQ-C30 < 60 points. The random forest model was constructed for predicting decreased QoL in thyroid cancer patients after thyroidectomy. RESULTS The mean QoL 3 months after thyroidectomy was 65.93 ± 9.00 with 21.33% (61/286) decreased QoL. The main manifestation is fatigue in symptom scales and social functioning dysfunction in functional scales. The top seven most important indices affecting QoL were clinical stage, marital status, histological type, age, nerve injury symptom, economic income and surgery type. For random forest prediction model, the areas under the curve in the training and validation courts were 0.834 and 0.897, respectively. CONCLUSION The present study demonstrated that random forest model for predicting decreased QoL in thyroid cancer patients 3 months after thyroidectomy displayed relatively high accuracy. These findings should be applied clinically to optimise health care.
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Affiliation(s)
- Yong Hong Liu
- Department of Breast Surgery, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Street, Shijiazhuang City, 050011, China
- Thyroid and Breast Surgery, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China
| | - Jian Jin
- Thyroid and Breast Surgery, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China
| | - Yun Jiang Liu
- Department of Breast Surgery, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Street, Shijiazhuang City, 050011, China.
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Law E, Gavanji R, Walsh S, Haltner A, McTavish R, Cameron C. Palbociclib versus abemaciclib in HR+/HER2- advanced breast cancer: an indirect comparison of patient-reported end points. J Comp Eff Res 2021; 11:109-120. [PMID: 34751591 DOI: 10.2217/cer-2021-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the relative impact of palbociclib plus fulvestrant (PAL + FUL) and abemaciclib plus fulvestrant (ABEM + FUL) on patient-reported outcomes in patients with hormone receptor-positive, HER2-negative (HR+/HER2-) advanced breast cancer. Patients & methods: Anchored matching-adjusted indirect comparisons were conducted using individual patient data from PALOMA-3 (PAL + FUL) and summary-level data from MONARCH-2 (ABEM + FUL). Outcomes included the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30) and its breast cancer-specific module (QLQ-BR23). Results: Significantly different changes from baseline favoring PAL + FUL compared with ABEM + FUL were observed in global quality of life (6.95 [95% CI: 2.19-11.71]; p = 0.004) and several functional/symptom scales, including emotional functioning, nausea/vomiting, appetite loss, diarrhea and systemic therapy side effects. Conclusion: PAL + FUL was associated with more favorable patient-reported outcomes than ABEM + FUL in patients with HR+/HER2- advanced breast cancer.
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Affiliation(s)
| | | | - Sarah Walsh
- EVERSANA, Sydney, Nova Scotia B1P 1C6, Canada
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9
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Comparison of the performance of four staging systems in determining the prognosis of breast cancer among women undergoing neoadjuvant chemotherapy. Breast Cancer Res Treat 2021; 187:547-555. [PMID: 33417086 DOI: 10.1007/s10549-020-06077-4] [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: 11/05/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Different tumor-related factors have been proposed to assess the risk of disease progression and death in women undergoing neoadjuvant breast cancer chemotherapy. Recently, besides the classical pre-treatment clinical stage (CS) and post-treatment pathologic stage (PS), estrogen receptor status and histologic grade (CPS + EG score) and HER2 results (Neo-Bioscore) have also been added to this suite of staging systems, generating new scores. The present study aims to compare the performance of these four staging systems, namely CS, PS, CPS + EG and Neo-Bioscore, in the prognosis of breast cancer in women undergoing neoadjuvant chemotherapy. METHODS This study comprises a retrospective cohort study of female breast cancer patients diagnosed at the Brazilian National Cancer Institute, Brazil from January 2013 to December 2015. A descriptive analysis of patient characteristics was conducted, and Kaplan-Meier curves, a Cox proportional hazard analysis and Receiver Operating Characteristic (ROC) curves were developed according to the assessed staging system scores. RESULTS A total of 803 patients were eligible for this study. Most were under 65 years old (88.0%), presented advanced tumors (clinical stage ≥ IIB 77.1%), with positive estrogen receptor (71.2%) and negative HER2 (75.7%) results. During the follow-up, 172 patients (21.4%) evolved to death. A statistical difference (p < 0.001) was observed between 5 year disease-free survival and 5 year overall survival rates according to the PS, CPS + EG and Neo-Bioscore staging systems. CONCLUSION The PS, CPS + EG and Neo-Bioscore staging systems were proven to be equivalent to predict the prognosis of patients undergoing neoadjuvant chemotherapy.
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10
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Fasching PA, Beck JT, Chan A, De Laurentiis M, Esteva FJ, Jerusalem G, Neven P, Pivot X, Bianchi GV, Martin M, Chandiwana D, Lanoue B, Ridolfi A, Wang Y, Rodriguez Lorenc K, Nusch A. Ribociclib plus fulvestrant for advanced breast cancer: Health-related quality-of-life analyses from the MONALEESA-3 study. Breast 2020; 54:148-154. [PMID: 33065342 PMCID: PMC7567051 DOI: 10.1016/j.breast.2020.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose In the MONALEESA-3 Phase III trial of patients with hormone receptor–positive human epidermal growth factor receptor–negative advanced breast cancer, ribociclib plus fulvestrant significantly improved progression-free survival (PFS) and overall survival (OS). Here, we present patient-reported outcomes from the trial, including health-related quality of life (HRQOL). Methods Patients were randomized (2:1) to receive ribociclib plus fulvestrant or placebo plus fulvestrant. Time to definitive 10% deterioration (TTD) from baseline in HRQOL (global health status [GHS] from the EORTC QLQ-C30 questionnaire) and pain (BPI-SF questionnaire) were assessed using Kaplan-Meier estimates; a stratified Cox regression model was used to estimate the hazard ratio (HR) and 95% CIs. Results Deterioration ≥10% in the EORTC-QLQ-C30 GHS was observed in 33% of patients in the ribociclib group vs 34% of patients in the placebo (reference) group (HR for TTD ≥ 10% = 0.81 [95% CI, 0.62–1.1]). Similar findings were noted for TTD ≥5% (HR = 0.79 [95% CI, 0.61–1.0]) and TTD ≥15% (HR = 0.81 [95% CI, 0.60–1.08]). TTD ≥10% in emotional functioning (HR = 0.76 [95% CI, 0.57–1.01]) trended in favor of the ribociclib group, whereas results for fatigue and pain were similar between arms. TTD ≥10% in BPI-SF pain severity index score (HR = 0.77 [95% CI, 0.57–1.05]) and worst pain item score (HR = 0.81 [95% CI, 0.58–1.12]) trended in favor of ribociclib vs placebo. Conclusions In addition to significantly prolonging PFS and OS compared with placebo plus fulvestrant, adding ribociclib to fulvestrant maintains HRQOL. Ribociclib + fulvestrant allowed maintenance of global health status (GHS). Time to deterioration (TTD) by 10% can convey duration until worsening of QOL. TTD ≥10% was delayed with ribociclib in GHS and emotional functioning. Ribociclib also demonstrated trends toward delayed TTD vs placebo in pain outcomes.
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Affiliation(s)
- Peter A Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | | | - Arlene Chan
- Breast Cancer Research Centre-Western Australia, Nedlands, WA, Australia
| | | | | | | | - Patrick Neven
- Multidisciplinary Breast Centre, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc Geicam, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Brad Lanoue
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Arnd Nusch
- Practice for Haematology and Internal Oncology, Velbert, Germany
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11
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Harbeck N, Franke F, Villanueva-Vazquez R, Lu YS, Tripathy D, Chow L, Babu GK, Im YH, Chandiwana D, Gaur A, Lanoue B, Rodriguez-Lorenc K, Bardia A. Health-related quality of life in premenopausal women with hormone-receptor-positive, HER2-negative advanced breast cancer treated with ribociclib plus endocrine therapy: results from a phase III randomized clinical trial (MONALEESA-7). Ther Adv Med Oncol 2020; 12:1758835920943065. [PMID: 32782490 PMCID: PMC7385843 DOI: 10.1177/1758835920943065] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background: This analysis evaluated patient-reported outcomes (PROs) to assess health-related quality of life (HRQoL) in the phase III MONALEESA-7 trial, which previously demonstrated improvements in progression-free survival (PFS) and overall survival (OS) with ribociclib (cyclin-dependent kinase 4/6 inhibitor) + endocrine therapy (ET) compared with placebo + ET in pre- and perimenopausal patients with hormone-receptor-positive, HER2-negative (HR+/HER2−) advanced breast cancer (ABC). Methods: The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life questionnaire C30 (QLQ-C30) and the EQ-5D-5L were used to evaluate HRQoL. Results: EORTC QLQ-C30 assessments were evaluable for 335 patients in the ribociclib arm and 337 patients in the placebo arm. Adherence rates at baseline and ⩾1 postbaseline time point were 90% and 83%, respectively. Patients treated with ribociclib + ET had a longer time to deterioration (TTD) ⩾ 10% in global HRQoL {hazard ratio (HR), 0.67 [95% confidence interval (CI), 0.52–0.86]}. TTD ⩾ 10% in global HRQoL was delayed in ribociclib-treated patients without versus with disease progression [HR, 0.31 (95% CI, 0.21–0.48)]. TTD ⩾ 10% in pain was longer with ribociclib + ET than with placebo + ET [HR, 0.65 (95% CI, 0.45–0.92)]. Patients who received a nonsteroidal aromatase inhibitor experienced similar benefits with ribociclib versus placebo in global HRQoL and pain. Conclusion: HRQoL was maintained longer in patients who received ribociclib + ET versus placebo + ET. These data, combined with previously reported improvements in PFS and OS, support a strong clinical benefit-to-risk ratio with ribociclib-based treatment in pre- and perimenopausal patients with HR+/HER2− ABC.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCCLMU, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, München, 81377, Germany
| | - Fabio Franke
- Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil
| | | | | | - Debu Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Louis Chow
- Organisation for Oncology and Translational Research, Hong Kong
| | - Govind K Babu
- HCG Curie Centre of Oncology and Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Young-Hyuck Im
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Anil Gaur
- Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - Brad Lanoue
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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12
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Li M, Roder D, D'Onise K, Walters D, Farshid G, Buckley E, Karapetis C, Joshi R, Price T, Townsend A, Miller CL, Currow D, Powell K, Buranyi-Trevarton D, Olver I. Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study. BMJ Open 2020; 10:e037069. [PMID: 32595164 PMCID: PMC7322288 DOI: 10.1136/bmjopen-2020-037069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN Population-based registry cohort. SETTING AND PARTICIPANTS 14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES Stage and survival. RESULTS At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a population level.
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Affiliation(s)
- Ming Li
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Katina D'Onise
- Prevention and Population Health, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - David Walters
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Gelareh Farshid
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, SA Pathology, Rundle Mall, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Chris Karapetis
- Medical Oncology, Flinders University, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Cancer Research and Clinical Trials, Adelaide Oncology and Haematology, North Adelaide, South Australia, Australia
| | - Timothy Price
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Amanda Townsend
- Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Solid Tumour Group, Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
| | - Caroline Louise Miller
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Currow
- Chief Executive Officer, Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Kate Powell
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- SA Clinical Cancer Registry, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Dianne Buranyi-Trevarton
- SA Clinical Cancer Registry, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Ian Olver
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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13
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Li M, Holliday L, Roder D, Tervonen H, Anazodo A, Dallapozza L, Hesketh E, Currow D. Degree of Cancer Spread at Presentation and Survival Among Adolescents and Young Adults in New South Wales, Australia. J Adolesc Young Adult Oncol 2020; 10:156-163. [PMID: 32456575 DOI: 10.1089/jayao.2020.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Five-year relative cancer survival increased from 80% to 89% among adolescent and young adult (AYA) Australians between 1985-1989 and 2011-2015. New South Wales (NSW), with a third of the Australian population, has long recorded degree of spread (localized, regional, or distant) at diagnosis. This study complements national data by investigating survival increases after adjusting for differences in degree of spread, cancer type, and sociodemographic characteristics. Methods: Population-based NSW Cancer Registry data, for malignant solid cancers where degree of spread was applicable, were analyzed for ages 15-24 years in 1980-2015. Subhazard ratios (SHRs) from competing risk regression indicated risk of death from the primary cancer as opposed to other causes. Multiple logistic regression was used to model odds ratios for more extensive compared with localized spread at diagnosis. Results: Approximately 72% of cancers had a localized degree of spread. Adjusted SHRs for cancer-specific mortality decreased from 1980-1989 to 2010-2015 (SHR: 0.73, 95% confidence interval: 0.55-0.95). Adjusted odds ratios (aORs) for more advanced versus localized spread were lowest for melanoma and lip, oral cavity, and pharyngeal carcinoma, and highest for breast carcinoma, Ewing tumor, and colorectal carcinoma. The aOR for more advanced versus localized cancer was higher for men than women. Conclusions: Cancer survival increased to a statistically significantly in AYAs during 1980-2015, after adjusting for degree of spread, cancer type, and sociodemographic characteristics. We attribute this mostly to treatment gains. Linked data should be used to explore treatment contributions.
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Affiliation(s)
- Ming Li
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia.,Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Laura Holliday
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia
| | - David Roder
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia.,Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Hanna Tervonen
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Luciano Dallapozza
- Cancer Centre for Children, Royal Alexandra Hospital for Children, Westmead Hospital, Westmead, Australia
| | - Elizabeth Hesketh
- Hunter and Northern New South Wales Youth Cancer Service, Calvary Mater Newcastle, Australia
| | - David Currow
- Cancer Information & Analysis, Cancer Institute NSW, Alexandria, Sydney, Australia
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14
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Si Y, Yuan P, Hu N, Wang X, Ju J, Wang J, Ma F, Luo Y, Zhang P, Li Q, Xu B. Primary Tumor Surgery for Patients with De Novo Stage IV Breast Cancer can Decrease Local Symptoms and Improve Quality of Life. Ann Surg Oncol 2020; 27:1025-1033. [PMID: 31970572 PMCID: PMC7060161 DOI: 10.1245/s10434-019-08092-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND It was unknown whether surgery for primary tumor would affect the occurrence of local symptoms caused by tumor progression in patients with de novo stage IV breast cancer (BC). Our work attempted to probe the effect of local resection on controlling local symptoms and improving the quality of life in de novo stage IV BC patients. METHODS Our study included patients presenting with de novo stage IV BC at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2008 to December 2014. In this study, we defined a new term called "local progress/recurrence of symptoms" (LPRS) to refer to the local problems caused by tumor progression/recurrence. All the patients were grouped into surgery and non-surgery groups. The characteristics of the two groups were analyzed by Chi square and Fisher's test. Univariate and multivariate Cox regression models were designed to evaluate independent prognostic factors. RESULTS This study contained 177 patients. The follow-up deadline was April 1, 2019. The median follow-up time was 33 months (range 1-135 months). In included patients, 77 (43.5%) underwent surgery for primary tumors. Primary tumor surgery could reduce the occurrence of LPRS (relative risk/risk ratio (RR = 0.440; 95% CI 0.227-0.852; p = 0.015)) and patients without LPRS had longer OS (45 months vs 29 months, p < 0.001). In addition, patients who had only one symptom had better OS than those who had two or three symptoms (p = 0.0175). CONCLUSIONS The quality of life in patients with de novo stage IV breast cancer can be improved by reducing the incidence of local symptoms through primary tumor surgery.
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Affiliation(s)
- Yiran Si
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Peng Yuan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Nanlin Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xue Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Ju
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiayu Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fei Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yang Luo
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Pin Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qing Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Binghe Xu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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15
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Si Y, Yuan P. ASO Author Reflections: Effect of Primary Surgery on Quality of Life in De Novo Stage IV Breast Cancer Patients. Ann Surg Oncol 2020; 27:1034-1035. [PMID: 32034576 DOI: 10.1245/s10434-019-08130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Yiran Si
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Yuan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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16
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Lin YS, Shen YC, Wu CY, Tsai YY, Yang YH, Lin YY, Kuan FC, Lu CN, Chang GH, Tsai MS, Hsu CM, Yeh RA, Yang PR, Lee IY, Shu LH, Cheng YC, Liu HT, Wu YH, Wu YH, Chang DC. Danshen Improves Survival of Patients With Breast Cancer and Dihydroisotanshinone I Induces Ferroptosis and Apoptosis of Breast Cancer Cells. Front Pharmacol 2019; 10:1226. [PMID: 31736748 PMCID: PMC6836808 DOI: 10.3389/fphar.2019.01226] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
Danshen (salvia miltiorrhiza Bunge) is widely used in traditional Chinese medicine. However, it is definite clinical effort and mechanism on breast cancer is unclear. In our study, we used the real-world database to investigate in vivo protective effort of danshen in the breast cancer patients through using population-based data from the Taiwan National Health Insurance Research Database (NHIRD). In vitro, human breast cancer cells (MCF-7 cells and MDA-MB-231 cells) were used to investigate the effect and the underlying mechanism through XTT assay, flow cytometry, glutathione peroxidase (GPX) activity assay, GSH (reduced glutathione)/GSSG (oxidized glutathione), malondialdehyde (MDA), and western blot analysis. The in vivo effect was investigated through a xenograft nude mouse model. We found that dihydroisotanshinone I (DT), a pure compound present in danshen, can inhibit the growth of breast carcinoma cells, including MCF-7 cells and MDA-MB-231 cells. Moreover, DT induced apoptosis and ferroptosis in these breast cancer cells. DT also repressed the protein expression of GPX4 (Glutathione peroxidase 4). For in vivo study, DT treatment also significantly inhibited the final tumor volume without adverse effects in a xenograft nude mouse model. In conclusion, danshen has protective efforts in breast cancer patients, which could be attributed to DT through inducing apoptosis and ferroptosis of breast cancer cells.
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Affiliation(s)
- Yu-Shih Lin
- Department of Pharmacy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Institute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan
| | - Yi-Chia Shen
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Yuan Wu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ying-Ying Tsai
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yin-Yin Lin
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Feng-Che Kuan
- Department of Hematology and Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Nan Lu
- Division of Acupuncture and Chinese Traumatology, Department of TCM, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Reming-Albert Yeh
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Rung Yang
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - I-Yun Lee
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Hsin Shu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Ching Cheng
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hung-Te Liu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Huei Wu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Heng Wu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - De-Ching Chang
- Institute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan
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