1
|
Malcolm FL, Howard P, Klukowska AM, Minhas N, Parks RM, Cheung KL. Factors influencing older women's decision-making related to treatment of operable breast cancer: A qualitative systematic review. Psychooncology 2024; 33:e6294. [PMID: 38282220 DOI: 10.1002/pon.6294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE There is variation in practice in the treatment of older women with breast cancer. International guidelines highlight the importance of patient autonomy in treatment decision-making. The aim of this study is to identify factors which influence decision-making in older women with operable breast cancer, which will enable us to further understand how to support these patients. METHODS Systematic review in accordance with the PRISMA guidelines was performed to identify factors which influence treatment decision-making in older women with operable breast cancer. Medline, Web of Science and SCOPUS were searched. RESULTS The search yielded 5840 results; 13 articles met the inclusion criteria and reported on a total of 1118 women. Thematic analysis identified three key themes in which decision-making factors could be categorised. These were healthcare-related factors, patient-related factors and impact of treatment. Healthcare-related factors included communication with clinicians and provision of information. Patient-related factors were age, pre-existing knowledge, preconceptions of breast cancer and treatment, decision-making style and co-morbidities. The impact of treatment considerations included body image and effect on quality of life. Decision-making style was frequently reported; older women did not demonstrate one preferred style. CONCLUSIONS The findings have highlighted the complex interplay of factors which influence how older women make breast cancer treatment-decisions. Clinicians should have an awareness of the factors highlighted to maximise their ability to provide support and personalised care to older women with breast cancer whilst treatment decisions are made.
Collapse
Affiliation(s)
| | - Penny Howard
- School of Health Science, University of Nottingham, Nottingham, UK
| | | | - Nikita Minhas
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth Mary Parks
- School of Medicine, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
2
|
Aristei C, Tomatis M, Antonio Ponti, Marotti L, Cardoso MJ, Cheung KL, Curigliano G, De Vries J, Santini D, Sardanelli F, Van Dam P, Rubio IT. Treatment and outcomes in breast cancer patients: A cross section study from the EUSOMA breast centre network. Eur J Cancer 2024; 196:113438. [PMID: 37995597 DOI: 10.1016/j.ejca.2023.113438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The present study was designed to describe tumour features and treatments for patients with breast cancer. It also aimed at assessing the risk of distant metastases in relation to biological profiles, disease stages and treatment. METHODS Data were analysed from 81,882 patients in the EUSOMA database (disease stages at diagnosis 0-IV; median age 61 years; range 20-100 years). All patients were treated between January 2016 and December 2021 in 53 Breast Centres within the EUSOMA certification process in 13 European countries. Cases were classified as HR+ /HER2-, HR+ /HER2 + , HR-/HER2 + or HR-/HER2- and data were analysed accordingly. RESULTS Univariable and multivariable analyses for distant metastases were conducted on a subset of 38,119 cases with information on whether or not they had developed them. Potential determinants included sub-group type, Ki67 value, disease stage, adjuvant systemic therapies and post-operative radiation therapy. In multivariable analysis, the HR-/HER2 + and HR-/HER2- sub-groups were associated with a higher risk of distant metastases than HR+ /HER2-. Ki67 > 20 % and advanced stage disease also carried a high risk. Radiation therapy emerged as a protective factor against distant metastases. CONCLUSIONS Present results show a large patient database offers an information stream that can be applied to reduce uncertainties in clinical practice. Database parameters need to be updated dynamically for outcome monitoring. Molecular prognostic factors, gene-expression signatures, tumour-infiltrating lymphocytes and circulating tumoral DNA should be added.
Collapse
Affiliation(s)
- Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital Sant'Andrea delle Fratte Perugia Italy.
| | - Mariano Tomatis
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Antonio Ponti
- CPO Piemonte, Turin and European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Maria Joao Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, and Lisbon University Faculty of Medicine, Lisbon, Portugal
| | - Kwok Leung Cheung
- Academic Unit for Translational Medical Sciences, School of Medicine University of Nottingham, Royal Derby Hospital Centre, United Kingdom
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano
| | | | - Donatella Santini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Peter Van Dam
- Multidisciplinary Oncologic Center, Antwerp University Hospital, Edegem, Belgium
| | - Isabel Teresa Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Universidad de Navarra, Spain
| |
Collapse
|
3
|
Quddus R, Banks J, Morgan JL, Martin C, Reed MW, Walters S, Cheung KL, Todd A, Audisio R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Parmeshwar R, Thompson A, Wyld L. Outcomes of complex oncoplastic breast surgery in older women. Analysis of data from the Age Gap cohort study. Eur J Surg Oncol 2023; 49:107075. [PMID: 37774649 DOI: 10.1016/j.ejso.2023.107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
KEY WORDS Breast cancer, mastectomy, breast conserving surgery, post-mastectomy reconstruction, older women, quality of life.
Collapse
Affiliation(s)
- Ratul Quddus
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jessica Banks
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | | | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kwok Leung Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Riccardo Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345, Göteborg, Sweden
| | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kieran Horgan
- Dept of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Prescott Street, Liverpool, L7 8 XP, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary Ashton Road, Lancaster, Lancashire, LA1 4RP, UK
| | - Alastair Thompson
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| |
Collapse
|
4
|
Chia Z, Lee RXN, Cardoso MJ, Cheung KL, Parks RM. Oncoplastic breast surgery in older women with primary breast cancer: systematic review. Br J Surg 2023; 110:1309-1315. [PMID: 37310128 PMCID: PMC10480033 DOI: 10.1093/bjs/znad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Oncoplastic procedures allow excision of larger breast tumours, or unfavourable tumour/breast ratio lesions while achieving a good cosmetic outcome. This increases the pool of patients eligible for breast conservation over mastectomy, reducing the need for more extensive surgery in older women and potentially improving their quality of life. Nonetheless, studies to date suggest a poor uptake of oncoplastic breast surgery in the older group. This review aimed to establish whether a disparity in uptake of oncoplastic breast surgery exists between older and younger women, and to explore the underlying reasons for this. METHODS A literature search was conducted on 17 January 2022 using MEDLINE and Embase. Eligible studies comprised full-text articles of patients who underwent oncoplastic breast surgery for primary invasive breast cancer, and included those aged at least 65 years. RESULTS Ten published studies were identified. One study was ranked as providing level 2 evidence, and the remainder were level 3. A total of 567 women underwent oncoplastic breast surgery for primary breast cancer, of whom only 61 (10.8 per cent) were aged 65 years or older. None of the studies directly compared younger with older women, or explored the underlying factors contributing to this discrepancy in uptake. CONCLUSION This review has demonstrated a lower uptake of oncoplastic breast surgery in older compared with younger women. Given the increasing number of older women living with breast cancer who may be eligible for breast-conserving surgery, further research into this area is required.
Collapse
Affiliation(s)
- Zoe Chia
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- King’s Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, UK
| | - Rachel X N Lee
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maria J Cardoso
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Breast Unit, Champalimaud Foundation and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Kwok Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
5
|
Chan KS, Chong MTH, Chia CLK, Cheung KL. Revisiting primary endocrine therapy versus surgery in older women with breast cancer: meta-analysis. Br J Surg 2023; 110:420-431. [PMID: 36718056 DOI: 10.1093/bjs/znac435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Old age is associated with increased co-morbidities, resulting in reduced life expectancy. Primary endocrine therapy is an alternative to primary surgical therapy for patients with breast cancer and increased co-morbidities. The aim was to review outcomes of primary endocrine therapy versus primary surgical therapy in older women with breast cancer. METHODS PubMed, Embase (Ovid), Scopus, and the Cochrane Library were searched systematically from January 2000 to May 2022. Single-arm studies were excluded. Primary outcomes were overall survival and breast cancer-specific survival. Secondary outcomes were local and regional failure of primary endocrine therapy, recurrence after primary surgical therapy, and health-related quality of life. RESULTS There were 14 studies including 14 254 patients (primary endocrine therapy 2829, 19.8 per cent; primary surgical therapy 11 425, 80.2 per cent), with the addition of four major studies (9538 patients) compared with the latest review in 2014. Seven studies defined primary surgical therapy as surgery plus adjuvant endocrine therapy, and six studies included patients with oestrogen receptor-positive tumours only. Patients in the primary endocrine therapy group were older than the primary surgical therapy group (mean difference 2.43 (95 per cent c.i. 0.73 to 4.13) years). Primary endocrine therapy led to worse overall survival than primary surgical therapy (HR 1.42, 95 per cent c.i. 1.06 to 1.91). Subgroup analysis of RCTs and prospective studies, however, showed comparable overall survival. Breast cancer-specific survival was also comparable (HR 1.28, 95 per cent c.i. 0.87 to 1.87). At 6 weeks, operated patients had significant arm symptoms and illness burden following major breast surgery compared with patients receiving primary endocrine therapy. Health-related quality of life, measured by the European Organization for Research and Treatment of Cancer QLQ-C30 and EuroQol EQ-5D-5L™, was comparable in the two treatment groups. CONCLUSION Overall survival was worse among older women receiving primary endocrine therapy in an analysis including all studies, but comparable in RCTs and prospective studies. This may be due to confounding by age and co-morbidities in retrospective cohort studies of primary endocrine therapy.
Collapse
Affiliation(s)
- Kai Siang Chan
- Breast Surgical Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Michelle Tian Hui Chong
- Breast Surgical Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Clement Luck Khng Chia
- Breast Surgical Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | | |
Collapse
|
6
|
Lee RXN, Cardoso MJ, Cheung KL, Parks RM. Immediate breast reconstruction uptake in older women with primary breast cancer: systematic review. Br J Surg 2022; 109:1063-1072. [PMID: 35909248 PMCID: PMC10364779 DOI: 10.1093/bjs/znac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Postmastectomy immediate breast reconstruction (PMIBR) may improve the quality of life of patients with breast cancer, of whom older women (aged 65 years or more) are a growing proportion. This study aimed to assess PMIBR in older women with regard to underlying impediments (if any). METHODS MEDLINE, Embase, and PubMed were searched by two independent researchers up to June 2022. Eligible studies compared PMIBR rates between younger and older women with invasive primary breast cancer. RESULTS A total of 10 studies (2012-2020) including 466 134 women were appraised, of whom two-thirds (313 298) were younger and one-third (152 836) older. Only 10.0 per cent of older women underwent PMIBR in contrast to 45.0 per cent of younger women. Two studies explored factors affecting uptake of PMIBR in older women; surgeon-associated (usual practice), patient-associated (socioeconomic status, ethnicity, and co-morbidities), and system-associated (insurance status and hospital location) factors were identified. CONCLUSION Uptake of PMIBR in older women is low with definable (and some correctable) barriers.
Collapse
Affiliation(s)
- Rachel Xue Ning Lee
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maria Joao Cardoso
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Breast Unit, Champalimaud Foundation and Nova Medical School Lisbon, Lisbon, Portugal
| | - Kwok Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Correspondence to: Ruth M. Parks, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK (e-mail: )
| |
Collapse
|
7
|
Wyld L, Reed MWR, Collins K, Ward S, Holmes G, Morgan J, Bradburn M, Walters S, Burton M, Lifford K, Edwards A, Brain K, Ring A, Herbert E, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Richards P, Brennan A, Cheung KL, Todd A, Harder H, Audisio R, Battisti NML, Wright J, Simcock R, Murray C, Thompson AM, Gosney M, Hatton M, Armitage F, Patnick J, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R. Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT. Programme Grants Appl Res 2022. [DOI: 10.3310/xzoe2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to base treatment recommendations.
Aim
We aimed to optimise treatment choice and outcomes for older women (aged ≥ 70 years) with operable breast cancer.
Objectives
Our objectives were to (1) determine the age, comorbidity, frailty, disease stage and biology thresholds for endocrine therapy alone versus surgery plus adjuvant endocrine therapy, or adjuvant chemotherapy versus no chemotherapy, for older women with breast cancer; (2) optimise survival outcomes for older women by improving the quality of treatment decision-making; (3) develop and evaluate a decision support intervention to enhance shared decision-making; and (4) determine the degree and causes of treatment variation between UK breast units.
Design
A prospective cohort study was used to determine age and fitness thresholds for treatment allocation. Mixed-methods research was used to determine the information needs of older women to develop a decision support intervention. A cluster-randomised trial was used to evaluate the impact of this decision support intervention on treatment choices and outcomes. Health economic analysis was used to evaluate the cost–benefit ratio of different treatment strategies according to age and fitness criteria. A mixed-methods study was used to determine the degree and causes of variation in treatment allocation.
Main outcome measures
The main outcome measures were enhanced age- and fitness-specific decision support leading to improved quality-of-life outcomes in older women (aged ≥ 70 years) with early breast cancer.
Results
(1) Cohort study: the study recruited 3416 UK women aged ≥ 70 years (median age 77 years). Follow-up was 52 months. (a) The surgery plus adjuvant endocrine therapy versus endocrine therapy alone comparison: 2854 out of 3416 (88%) women had oestrogen-receptor-positive breast cancer, 2354 of whom received surgery plus adjuvant endocrine therapy and 500 received endocrine therapy alone. Patients treated with endocrine therapy alone were older and frailer than patients treated with surgery plus adjuvant endocrine therapy. Unmatched overall survival and breast-cancer-specific survival were higher in the surgery plus adjuvant endocrine therapy group (overall survival: hazard ratio 0.27, 95% confidence interval 0.23 to 0.33; p < 0.001; breast-cancer-specific survival: hazard ratio 0.41, 95% confidence interval 0.29 to 0.58; p < 0.001) than in the endocrine therapy alone group. In matched analysis, surgery plus adjuvant endocrine therapy was still associated with better overall survival (hazard ratio 0.72, 95% confidence interval 0.53 to 0.98; p = 0.04) than endocrine therapy alone, but not with better breast-cancer-specific survival (hazard ratio 0.74, 95% confidence interval 0.40 to 1.37; p = 0.34) or progression-free-survival (hazard ratio 1.11, 95% confidence interval 0.55 to 2.26; p = 0.78). (b) The adjuvant chemotherapy versus no chemotherapy comparison: 2811 out of 3416 (82%) women received surgery plus adjuvant endocrine therapy, of whom 1520 (54%) had high-recurrence-risk breast cancer [grade 3, node positive, oestrogen receptor negative or human epidermal growth factor receptor-2 positive, or a high Oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA) score of > 25]. In this high-risk population, there were no differences according to adjuvant chemotherapy use in overall survival or breast-cancer-specific survival after propensity matching. Adjuvant chemotherapy was associated with a lower risk of metastatic recurrence than no chemotherapy in the unmatched (adjusted hazard ratio 0.36, 95% confidence interval 0.19 to 0.68; p = 0.002) and propensity-matched patients (adjusted hazard ratio 0.43, 95% confidence interval 0.20 to 0.92; p = 0.03). Adjuvant chemotherapy improved the overall survival and breast-cancer-specific survival of patients with oestrogen-receptor-negative disease. (2) Mixed-methods research to develop a decision support intervention: an iterative process was used to develop two decision support interventions (each comprising a brief decision aid, a booklet and an online tool) specifically for older women facing treatment choices (endocrine therapy alone or surgery plus adjuvant endocrine therapy, and adjuvant chemotherapy or no chemotherapy) using several evidence sources (expert opinion, literature and patient interviews). The online tool was based on models developed using registry data from 23,842 patients and validated on an external data set of 14,526 patients. Mortality rates at 2 and 5 years differed by < 1% between predicted and observed values. (3) Cluster-randomised clinical trial of decision support tools: 46 UK breast units were randomised (intervention, n = 21; usual care, n = 25), recruiting 1339 women (intervention, n = 670; usual care, n = 669). There was no significant difference in global quality of life at 6 months post baseline (difference –0.20, 95% confidence interval –2.7 to 2.3; p = 0.90). In women offered a choice of endocrine therapy alone or surgery plus adjuvant endocrine therapy, knowledge about treatments was greater in the intervention arm than the usual care arm (94% vs. 74%; p = 0.003). Treatment choice was altered, with higher rates of endocrine therapy alone than of surgery in the intervention arm. Similarly, chemotherapy rates were lower in the intervention arm (endocrine therapy alone rate: intervention sites 21% vs. usual-care sites 15%, difference 5.5%, 95% confidence interval 1.1% to 10.0%; p = 0.02; adjuvant chemotherapy rate: intervention sites 10% vs. usual-care site 15%, difference 4.5%, 95% confidence interval 0.0% to 8.0%; p = 0.013). Survival was similar in both arms. (4) Health economic analysis: a probabilistic economic model was developed using registry and cohort study data. For most health and fitness strata, surgery plus adjuvant endocrine therapy had lower costs and returned more quality-adjusted life-years than endocrine therapy alone. However, for some women aged > 90 years, surgery plus adjuvant endocrine therapy was no longer cost-effective and generated fewer quality-adjusted life-years than endocrine therapy alone. The incremental benefit of surgery plus adjuvant endocrine therapy reduced with age and comorbidities. (5) Variation in practice: analysis of rates of surgery plus adjuvant endocrine therapy or endocrine therapy alone between the 56 breast units in the cohort study demonstrated significant variation in rates of endocrine therapy alone that persisted after adjustment for age, fitness and stage. Clinician preference was an important determinant of treatment choice.
Conclusions
This study demonstrates that, for older women with oestrogen-receptor-positive breast cancer, there is a cohort of women with a life expectancy of < 4 years for whom surgery plus adjuvant endocrine therapy may offer little benefit and simply have a negative impact on quality of life. The Age Gap decision tool may help make this shared decision. Similarly, although adjuvant chemotherapy offers little benefit and has a negative impact on quality of life for the majority of older women with oestrogen-receptor-positive breast cancer, for women with oestrogen-receptor-negative breast cancer, adjuvant chemotherapy is beneficial. The negative impacts of adjuvant chemotherapy on quality of life, although significant, are transient. This implies that, for the majority of fitter women aged ≥ 70 years, standard care should be offered.
Limitations
As with any observational study, despite detailed propensity score matching, residual bias cannot be excluded. Follow-up was at median 52 months for the cohort analysis. Longer-term follow-up will be required to validate these findings owing to the slow time course of oestrogen-receptor-positive breast cancer.
Future work
The online algorithm is now available (URL: https://agegap.shef.ac.uk/; accessed May 2022). There are plans to validate the tool and incorprate quality-of-life and 10-year survival outcomes.
Trial registration
This trial is registered as ISRCTN46099296.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Karen Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Collegiate Cresent Campus, Sheffield Hallam University, Sheffield, UK
| | - Sue Ward
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Geoff Holmes
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Burton
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Collegiate Cresent Campus, Sheffield Hallam University, Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Paul Richards
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Riccardo Audisio
- Sahlgrenska Universitetssjukhuset, University of Gothenburg, Göteborg, Sweden
| | | | | | | | | | | | - Margot Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tracy Green
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | - Deirdre Revill
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | - Jacqui Gath
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | | | - Chris Holcombe
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Matt Winter
- Breast Unit, Weston Park Hospital, Sheffield, UK
| | - Jay Naik
- Breast Unit, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Rishi Parmeshwar
- Breast Unit, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| |
Collapse
|
8
|
Ning Lee RX, Parks R, Cardoso MJ, Cheung KL. Post-mastectomy immediate breast reconstruction in older women - A systematic review. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Chan CY, Cheung KL. Exploring the gender difference in relationships between narcissism, competitiveness, and mental health problems among college students. J Am Coll Health 2022; 70:1169-1178. [PMID: 32673180 DOI: 10.1080/07448481.2020.1788565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveThe current research examined the gender difference in relationships in terms of overt and covert narcissism, hypercompetitiveness, personal development competitiveness, and mental health problems, such as anxiety, depression, and stress symptoms among college students. Participants: 195 college students (mean age = 21.55 years) in Hong Kong. Method: Participants were invited to fill in standardized psychological instruments. Results: In all, 125 (62.1%) were females. The results revealed that males had higher levels of narcissism and competitiveness than females. Narcissism was associated with competitiveness in both genders. Covert narcissism was independently and positively related with depression, anxiety, and stress in both males and females. Hypercompetitiveness was independently and positively associated with mental health problems in females, but independent associations were not found in males. Conclusions: For the well-being of college students, those with covert narcissism and females with hypercompetitiveness should be monitored closely as they are more likely to have mental health problems.
Collapse
Affiliation(s)
- Chui Yi Chan
- The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, Hong Kong
| | - Kwok Leung Cheung
- The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, Hong Kong
| |
Collapse
|
10
|
Morgan JL, Shrestha A, Reed MWR, Herbert E, Bradburn M, Walters SJ, Martin C, Collins K, Ward S, Holmes G, Burton M, Lifford K, Edwards A, Ring A, Robinson T, Chater T, Pemberton K, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Thomson AM, Gosney M, Hatton M, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeschwar R, Wyld L. Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes. Br J Surg 2021; 108:315-325. [PMID: 33760065 PMCID: PMC10364859 DOI: 10.1093/bjs/znaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. METHODS This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage. RESULTS The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains. CONCLUSION Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
Collapse
Affiliation(s)
- J L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - E Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - K Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - M Burton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Ring
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - T Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - R Audisio
- Department of Surgery, University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Brighton, UK
| | - A M Thomson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - M Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - M Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - T Green
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - D Revill
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - J Gath
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Department of Breast Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - J Naik
- Department of General Surgery, Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeschwar
- Department of Breast Surgery, University Hospitals of Morecambe Bay, Lancaster, UK
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| |
Collapse
|
11
|
Parks RM, Green AR, Cheung KL. O14 Optimising the management of primary breast cancer in older women. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The risk of breast cancer increases with age and our global population is ageing. By 2040 the number of breast cancer cases diagnosed per year worldwide will double and over 40% of these will be in patients aged 70 or over. Despite this, there are few treatment guidelines specific to breast cancer in older women and none which consider the unique biological differences of this cohort.
Method
Surgical and core needle biopsy (CNB) specimens were obtained from an existing series of 1,785 women over the age of 70 with primary breast cancer, treated in a single institution with long-term (37+ years) follow-up. Of this cohort, 813 had primary surgical treatment. As part of previous work, it was possible to construct good quality tissue microarrays (TMAs) in 575 surgical specimens and 693 CNB specimens. Immunohistochemical staining for 32 biomarkers has been performed in all of the available TMAs. Association between histological score for each biomarker and tumour size, grade, recurrence rate, breast cancer specific and overall survival is currently being investigated in the whole cohort.
Results
Results to date have revealed a unique biological cluster in older women with primary breast cancer that is not seen in a comparative younger cohort. In the future, bioinformatics analysis will determine which biomarkers and in what combination, can predict chance of recurrence/overall survival in this cohort.
Conclusions
This information will be used to create a prognostic tool specific to assist older women with decision making regarding primary treatment of breast cancer.
Collapse
Affiliation(s)
- R M Parks
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - A R Green
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
12
|
Parks RM, Alfarsi LH, Green AR, Cheung KL. Biology of primary breast cancer in older women beyond routine biomarkers. Breast Cancer 2021; 28:991-1001. [PMID: 34165702 PMCID: PMC8354915 DOI: 10.1007/s12282-021-01266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/13/2021] [Indexed: 11/15/2022]
Abstract
Purpose There are numerous biomarkers which may have potential predictive and prognostic significance in breast cancer. This is extremely important in older adults, who may opt for less aggressive therapy. This work outlines the literature on biological assessment outside of standard biomarkers (defined as ER, PgR, HER2, Ki67) in women ≥ 65 years with primary operable invasive breast cancer, to determine which additional biomarkers are relevant to outcome in older women. Methods Medline and Embase databases were searched. Studies were eligible if included ≥ 50 patients aged ≥ 65 years; stratified results by age; measured a biomarker outside of standard assay and reported patient data. Results A total of 12 studies were appraised involving 5000 patients, measuring 28 biomarkers. The studies were extremely varied in methodology and outcome but three themes emerged: 1. Differences in biomarker expression between younger and older women, indicating that breast cancer in older women is generally less aggressive compared to younger women; 2. Relationship of biomarker expression with survival, suggesting biomarkers which may exclusively predict response to primary treatment in older women; 3. Association of biomarker with chemotherapy, suggesting that older patients should not be declined chemotherapy based on age alone. Conclusion There is evidence to support further investigation of B-cell lymphoma (BCL2), liver kinase (LK)B1, epidermal growth factor receptor (EGFR), cytoplasmic cyclin-E, mucin (MUC)1 and cytokeratins (CKs) as potential predictive or prognostic markers in older women with breast cancer undergoing surgery. Studies exploring these biomarkers in larger cohorts and in women undergoing non-operative therapies are required. Supplementary Information The online version contains supplementary material available at 10.1007/s12282-021-01266-5.
Collapse
Affiliation(s)
- R M Parks
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | - L H Alfarsi
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | - A R Green
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK.
| |
Collapse
|
13
|
Battisti NML, Hatton MQ, Reed MWR, Herbert E, Morgan JL, Bradburn M, Simcock R, Walters SJ, Collins KA, Ward SE, Holmes GR, Burton M, Lifford KJ, Edwards A, Robinson TG, Martin C, Chater T, Pemberton KJ, Brennan A, Leung Cheung K, Todd A, Audisio RA, Wright J, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeshwar R, Gosney MA, Thompson AM, Wyld L, Ring A. Observational cohort study in older women with early breast cancer: Use of radiation therapy and impact on health-related quality of life and mortality. Radiother Oncol 2021; 161:166-176. [PMID: 34146616 DOI: 10.1016/j.radonc.2021.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL). METHODS A multicentre, observational study of EBC patients aged ≥ 70 years, undergoing breast-conserving surgery (BCS) or mastectomy, was undertaken. Associations between radiotherapy use, surgery, clinico-pathological parameters, fitness based on geriatric parameters and treatment centre were determined. HRQoL was measured using the European Organisation for the Research and Treatment of Cancer (EORTC) questionnaires. RESULTS In 2013-2018 2811 women in 56 UK study centres underwent surgery with a median follow-up of 52 months. On multivariable analysis, age and tumour risk predicted radiotherapy use. Among healthier patients (based on geriatric assessments) with high-risk tumours, 534/613 (87.1%) having BCS and 185/341 (54.2%) having mastectomy received radiotherapy. In less fit individuals with low-risk tumours undergoing BCS, 149/207 (72.0%) received radiotherapy. Radiotherapy effects on HRQoL domains, including breast symptoms and fatigue were seen, resolving by 18 months. CONCLUSION Radiotherapy use in EBC patients ≥ 70 years is affected by age and recurrence risk, whereas geriatric parameters have limited impact regardless of type of surgery. There was geographical variation in treatment, with some fit older women with high-risk tumours not receiving radiotherapy, and some older, low-risk, EBC patients receiving radiotherapy after BCS despite evidence of limited benefit. The impact on HRQoL is transient.
Collapse
Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Matthew Q Hatton
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Richard Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Karen A Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Sue E Ward
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kirsty J Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humber Consumer Research Panel, Sheffield, UK
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, Sheffield, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Matthew C Winter
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, UK
| | | | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.
| | - Alistair Ring
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | | |
Collapse
|
14
|
Ring A, Battisti NML, Reed MWR, Herbert E, Morgan JL, Bradburn M, Walters SJ, Collins KA, Ward SE, Holmes GR, Burton M, Lifford K, Edwards A, Robinson TG, Martin C, Chater T, Pemberton KJ, Brennan A, Cheung KL, Todd A, Audisio RA, Wright J, Simcock R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeshwar R, Gosney MA, Hatton MQ, Thompson AM, Wyld L. Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer. Br J Cancer 2021; 125:209-219. [PMID: 33972747 PMCID: PMC8292504 DOI: 10.1038/s41416-021-01388-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/20/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy. METHODS A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage. RESULTS Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19-0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20-0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08-0.49];BCSS: HR 0.12 [95% CI 0.03-0.44]).Transient negative quality-of-life impacts were observed. CONCLUSIONS Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient. TRIAL REGISTRATION ISRCTN 46099296.
Collapse
Affiliation(s)
- Alistair Ring
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Karen A Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Sue E Ward
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty J Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
| | | | - Richard Simcock
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - Tracey Green
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Deirdre Revell
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, Lancashire, UK
| | | | | | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.
| | | |
Collapse
|
15
|
Harrison CA, Parks RM, Cheung KL. The impact of breast cancer surgery on functional status in older women - A systematic review of the literature. Eur J Surg Oncol 2021; 47:1891-1899. [PMID: 33875285 DOI: 10.1016/j.ejso.2021.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022] Open
Abstract
Primary endocrine therapy as treatment of breast cancer is only recommended in older women with limited life expectancy. However, many older women opt for endocrine therapy due to concerns regarding frailty and potential decline in function after surgery. A decline in functional status after surgery is documented in some cancer types, such as colorectal, however, the full impact of breast cancer surgery is less understood. A systematic review was performed to examine the evidence for impact of breast cancer surgery on functional status in older women. PubMed and Embase databases were searched. Studies were eligible if performed within the last 10 years; included patients over the age of 65 years undergoing breast cancer surgery; included stratification of results by age; measured functional status pre-operatively and at least six months following surgery. A total of 11 studies including 12 030 women were appraised. Two studies represented level-II and nine level-IV evidence. Overall, physical activity level was negatively impacted by breast cancer surgery and this was compounded by the extent of surgery. Evidence for impact of breast cancer surgery on quality of life, fatigue and cognition, was conflicting. The possibility of decline in functional status after breast cancer surgery should be discussed in all older women considering surgery. A structured exercise program may improve the negative effects of surgery on physical activity. Further work is required in the areas of quality of life, fatigability and cognition.
Collapse
Affiliation(s)
- C A Harrison
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK
| | - R M Parks
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK
| | - K L Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, UK.
| |
Collapse
|
16
|
Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
Collapse
Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
17
|
Morgan JL, Holmes G, Ward S, Martin C, Burton M, Walters SJ, Cheung KL, Audisio RA, Reed MW, Wyld L. Observational cohort study to determine the degree and causes of variation in the rate of surgery or primary endocrine therapy in older women with operable breast cancer. Eur J Surg Oncol 2021; 47:261-268. [PMID: 33046279 PMCID: PMC7526638 DOI: 10.1016/j.ejso.2020.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the UK there is variation in the treatment of older women with breast cancer, with up to 40% receiving primary endocrine therapy (PET), which is associated with inferior survival. Case mix and patient choice may explain some variation in practice but clinician preference may also be important. METHODS A multicentre prospective cohort study of women aged >70 with operable breast cancer. Patient characteristics (health status, age, tumour characteristics, treatment allocation and decision-making preference) were analysed to identify whether treatment variation persisted following case-mix adjustment. Expected case-mix adjusted surgery rates were derived by logistic regression using the variables age, co-morbidity, tumour stage and grade. Concordance between patients' preferred and actual decision-making style was assessed and associations between age, treatment and decision-making style calculated. RESULTS Women (median age 77, range 70-102) were recruited from 56 UK breast units between 2013 and 2018. Of 2854/3369 eligible women with oestrogen receptor positive breast cancer, 2354 were treated with surgery and 500 with PET. Unadjusted surgery rates varied between hospitals, with 23/56 units falling outside the 95% confidence intervals on funnel plots. Adjusting for case mix reduced, but did not eliminate, this variation between hospitals (10/56 units had practice outside the 95% confidence intervals). Patients treated with PET had more patient-centred decisions compared to surgical patients (42.2% vs 28.4%, p < 0.001). CONCLUSIONS This study demonstrates variation in treatment selection thresholds for older women with breast cancer. Health stratified guidelines on thresholds for PET would help reduce variation, although patient preference should still be respected.
Collapse
Affiliation(s)
- Jenna L Morgan
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
| | - Geoff Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Kwok Leung Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345, Göteborg, Sweden
| | | | - Lynda Wyld
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| |
Collapse
|
18
|
Tanner LTA, Cheung KL. Correlation between breast cancer and lifestyle within the Gulf Cooperation Council countries: A systematic review. World J Clin Oncol 2020; 11:217-242. [PMID: 32355643 PMCID: PMC7186238 DOI: 10.5306/wjco.v11.i4.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the six Gulf Cooperation Council countries (GCCCs), Bahrain, Saudi Arabia, Kuwait, Oman, Qatar and the United Arab Emirates, breast cancer (BC) is the greatest cause of cancer incidence and mortality. Obesity and physical inactivity are established risk factors for BC globally and appear to be more of a problem in high income countries like the GCCCs.
AIM To determine whether obesity and physical inactivity are associated with BC incidence in the GCCCs using the United Kingdom as a comparator.
METHODS This systematic review was carried out according to PRISMA guidelines. A cancer registry and a statistical data search was done to identify the BC incidence over the past two decades and the prevalence of obesity and physical inactivity in the GCCCs. Additionally, a systematic search of the databases, MEDLINE, Web of Science, and PubMed between 1999 and 2019 was performed to determine whether obesity and physical inactivity are risk factors for BC in the GCCCs. All papers were critically appraised according to their research methods and were assessed for quality and risk of bias.
RESULTS BC was the top malignancy in each GCC country. Women tended to be diagnosed with BC at a younger age than women in the United Kingdom. The greatest 10-year increase in BC incidence was seen in Saudi Arabia (54.2%), approximately seven times the rate of increase seen in the United Kingdom (7.6%). The prevalence of obesity and physical inactivity was greater in all the GCCCs in comparison to the United Kingdom. A total of 155 full studies were reviewed of which 17 were included. Of those, eight looked at the prevalence of obesity and physical inactivity in the Gulf States and nine looked at these as risk factors for BC. Only one study found an association between BC and obesity (odds ratio = 2.29). No studies looked solely at the link between physical inactivity and BC.
CONCLUSION The prevalence of obesity and physical inactivity was high within the GCCCs, but the majority of the included studies found no positive correlation between obesity or physical inactivity and BC. A high proportion of women in this study were pre-menopausal which could contribute to the negative findings.
Collapse
Affiliation(s)
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Derby DE22 3DT, United Kingdom
| |
Collapse
|
19
|
George J, Morgan J, Martin C, Shrestha A, Sue W, Holmes G, Bradburn M, Burton M, Chater T, Pemberton K, Nettleship A, Walters S, Ring A, Robinson T, Cheung KL, Audisio R, Reed M, Wyld L, Bridging the Age Gap Trial Management Group. Bridging the Age Gap in Breast Cancer - Analysis of the Complication Rates of Surgery in Older Women. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
20
|
Parks RM, Cheung KL. Personalising Care in the Older Woman with Primary Breast Cancer. Ann Acad Med Singap 2019; 48:370-375. [PMID: 31960017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The incidence of breast cancer increases with age. Despite this, most research in the field is targeted at younger patients. Age-specific guidelines are not widely referred to and guidelines which allude to the older woman as an individual are based solely on conventional factors. This creates a problem for older women with primary operable breast cancer who are not fit, too frail or do not wish to have surgery. Preliminary studies have shown that older women with breast cancer have distinct biological features compared to their younger counterparts. This means that they are likely to have less aggressive cancers such as those who are oestrogen receptor-positive. Geriatric assessment (GA) has been used in clinical practice to identify patients that are suitable for certain treatments. More research on this group of patients' unique biological features and GA will help tailor personalised care for them.
Collapse
Affiliation(s)
- Ruth M Parks
- School of Medicine, University of Nottingham, United Kingdom
| | | |
Collapse
|
21
|
Kalaitzi S, Cheung KL, Hiligsmann M, Babich S, Czabanowska K. Exploring Women Healthcare Leaders' Perceptions on Barriers to Leadership in Greek Context. Front Public Health 2019; 7:68. [PMID: 31024874 PMCID: PMC6465948 DOI: 10.3389/fpubh.2019.00068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Gender inequalities have been identified as important derailment factors for health workforce and health system sustainability. Literature holds responsible a list of gendered barriers faced by female health workforce. However, there is a gap in the evidence based research on women leaders' own perceptions of barriers to leading positions advancement. This study aims to explore leadership barriers perceived by women healthcare leaders within country's context; research focused on Greece due to country's poor performance on gender equality index and current economic turbulence. Study supplements survey data and provides orientation for further gender sensitive research in health workforce development through country's specificity lens to better inform education and policy makers. Methods: The best-worst object case survey method was used, applying an online questionnaire designed in Qualtrics. The online questionnaire was sent to 30 purposively invited participants. Respondents were asked to tick the most and the least important barriers to women's leadership in provided choice scenarios. Descriptive data analysis was used to understand and interpret the results. Results: Women leaders perceived stereotypes, work/life balance, lack of equal career advancement, lack of confidence, gender gap and gender bias to be the barriers with the greatest relative importance in constraining opportunities for pursuing leading positions in Greek healthcare setting. Twenty more barriers were identified and ranked lower in relative importance. The results are considered exploratory and not to obtain population based outcomes. Conclusion: This exploratory study reports the perceived barriers of women leaders in pursuing leading positions within Greek healthcare context. The findings point mainly to organizational and socio-cultural related barriers potentially aggravated by country's unfortunate current economic turbulence. Further extensive research is required to establish grounded conclusions and better inform education and policy makers in developing gender sensitive strategies to sustainable health workforce development.
Collapse
Affiliation(s)
- Stavroula Kalaitzi
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - K L Cheung
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, United Kingdom
| | - M Hiligsmann
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - S Babich
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - K Czabanowska
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Health Policy and Management, Faculty of Health Sciences, Institute of Public Health, Jagellonian University, Kraków, Poland
| |
Collapse
|
22
|
Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Abstract P2-12-01: Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-12-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Capivasertib (AZD5363), an AKT1,2,3 inhibitor, significantly improved progression-free and overall survival when added to paclitaxel in triple negative breast cancer (BC) patients (Schmid et al. ASCO 2018). We have previously reported in STAKT, robust target inhibition at 480mg BD versus placebo, including significant decreases in the primary biomarkers (PBs) - Ki67, pPRAS40 & pGSK3β - in primary BCs (Robertson et al. SABCS 2017). We now report the dose- and exposure-response relationship of capivasertib and the correlation between primary and secondary (pAKT, pS6, nuclear FOXO3a) tumor biomarkers.
Design: STAKT was a two-stage, double blind, randomized, placebo controlled 'window-of-opportunity' trial in newly diagnosed ER+ BC patients. Stage 1 assessed capivasertib at a dose of 480mg BD p.o. versus placebo. Stage 2 assessed capivasertib at two lower doses 360mg and 240mg BD. Tumor biopsies were taken prior to 1st dose and after 4.5 days of dosing. Evaluable patients (who required pre-defined minimum baseline PD values for PBs) included placebo (n=11), capivasertib at 480mg (n=17), 360mg (n=5) and 240mg (n=6). Blood samples for pharmacokinetic (PK) studies were scheduled at pre-dose; 2, 4, optional 6 & 8 hrs post first dose on Day 1; ˜2-4 h post last dose on Day 5 (before biopsy). The % change from baseline for PBs were evaluated against the following exposure variables (placebo=0): i) Dose, ii) Observed Cmax Day 1 (˜2h post-dose), iii) Observed plasma concentration on Day 5, iv) Model-predicted plasma concentration Day 5 at time of biopsy, and v) Model-predicted AUC on Day 5. Spearman correlation coefficient measured the strength and direction of association between biomarkers.
Results:
· Significant mean reductions in % change from baseline were observed for the PBs pGSK3β (-39%; p<0.006), pPRAS40 (-50%; p<0.0001) and Ki67 (-23%; p=0.052) at 480mg versus placebo. At 360mg and 240mg, mean % changes from baseline in pGSK3β were -27% and -9%, respectively; in pPRAS40 -45% and -28%, respectively; and in Ki67 0% and +22%, respectively.
· Dose-response relationships for individual % change from baseline could be described by an Emax model for all PBs. Overall, the correlation to PK exposure (observed or predicted) was similar to the correlation to dose.
· Correlation coefficient analyses between biomarkers at capivasertib 480mg BD identified- i) Positive correlations for pGSK3β with Ki67 (ρ = 0.52, p-value < 0.05) & with pS6 (ρ = 0.54, p-value<0.05); ii) Negative correlations between FOXO3a and Ki67 (ρ = -0.75, p-value<0.001) pGSK3β (ρ = -0.71, p-value<0.001) & also pS6 (ρ = -0.61, p-value<0.001).Correlation coefficients for lower doses are not robust due to small sample size in these groups.
Conclusions
· Capivasertib caused dose- and concentration- dependent effects on biomarkers after only 4.5 days.
· Significant changes in the PBs were demonstrated at 480 mg BD. Biomarker changes was observed at 360mg and 240mg BD, but statistical analysis was limited by the small sample size at lower doses.
· Correlation between a number of tumor biomarkers (relative changes) were identified for capivasertib 480mg BD.
Citation Format: Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-12-01.
Collapse
Affiliation(s)
- J Gee
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - RE Coleman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - KL Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Evans
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - C Holcombe
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Skene
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - D Rea
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - S Ahmed
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Jahan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - K Horgan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rauchhaus
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Littleford
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Finlay
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Cullberg
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - E de Bruin
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Foxley
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - L Koulai
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Pass
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - G Schiavon
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rugman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Deb
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - JFR Robertson
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| |
Collapse
|
23
|
Yeo W, Lei YY, Cheng AC, Kwok CC, Cheung KL, Lee R, Lee IC, He YQ, Ho S. Abstract P1-12-07: Prospective 36-month follow-up to determine changes in body mass index and weight among Chinese breast cancer survivors. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Anticancer treatment for breast cancer has been associated with weight gain but such observation has mainly been reported in western patients. More recent data in Asian patients have inconsistent findings. Factors including socio-demographic, clinical and lifestyle may be associated with post-diagnosis weight gain. In this prospective cohort study of women with breast cancer, the objectives were to determine the body mass index (BMI) and weight changes over 36 months after initial diagnosis and the factors associated with such changes.
Methods: Chinese women with newly diagnosed early-stage breast cancer were recruited. Individual woman had her weight measured at breast cancer diagnosis (W0), at study entry (W1) and at 36-month follow-up (W2). Body height was measured at W0. We evaluated change in weight and body mass index (BMI) before and after breast cancer diagnosis.Socio-demographic, clinical and lifestyle factors were assessed to identify potential associated factors with weight changes.
Results: A total of 1133 women with breast cancer had detailed weight measurements at the 3 time-points of assessment. The mean age at diagnosis was 52 years. Fifty-four percent were premenopausal at W1. The proportion of patients with stage 0-I, II and III diseases were 35%, 46% and 19%, respectively.
The proportions of patients who were overweight and obese at the three assessment time-points were 21.2% and 28.5% at W0, 19.7% and 26.6% at W1, and 21.7% and 30.9% at W2 assessment, respectively. When compared to W0, the proportions of women who gained weight within 2-5kg at W1 and W2 were 2.4% and 20.6% respectively, that with weight gain of >5kg at W1 and W2 were 0.5% and 10.0% respectively; 6.1% and 19.6% of women had weight loss >2kg at W1 and W2 respectively.
Compared to W0, the median value of weight change was -0.5 kg (range: -11.4, 18.3) at W1 and 0.6 kg (range: -19.6, 20.5) at W2. On multivariate analysis, only BMI at diagnosis were significantly associated with weight change betweenassessments at diagnosis and W2; the median (range) for weight changes for women who were underweight, normal, overweight and obese were respectively 0.9 (-4.8, 7.6), 0.6 (-13.2, 20.5), 0.5 (-11.5, 13.0) and 0.5 (-19.6, 12.6) kg, p <0.001.
Conclusions: In this prospective study of Chinese women with a history of breast cancer who were followed-up over a 36-months' period, the proportions of women with overweight and obese statuses were relatively stable; weight gain was uncommon among Hong Kong women with breast cancer during the same period. These findings are in contrast with studies conducted in the West, where weight gains were more commonly reported.
Funding: World Cancer Research Fund International (Grant Number WCRF 2010/249 and WCRF 2014/1197)
Citation Format: Yeo W, Lei YY, Cheng AC, Kwok CC, Cheung KL, Lee R, Lee IC, He YQ, Ho S. Prospective 36-month follow-up to determine changes in body mass index and weight among Chinese breast cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-07.
Collapse
Affiliation(s)
- W Yeo
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - YY Lei
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - AC Cheng
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - CC Kwok
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - KL Cheung
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - R Lee
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - IC Lee
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - YQ He
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| | - S Ho
- Chinese University of Hong Kong, Hong Kong, China; Princess Margaret Hospital, Hong Kong, China
| |
Collapse
|
24
|
Cheung KL, Zakai NA, Callas PW, Howard G, Mahmoodi BK, Peralta CA, Judd SE, Kurella Tamura M, Cushman M. Mechanisms and mitigating factors for venous thromboembolism in chronic kidney disease: the REGARDS study. J Thromb Haemost 2018; 16:1743-1752. [PMID: 29984467 PMCID: PMC6123283 DOI: 10.1111/jth.14235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Indexed: 12/26/2022]
Abstract
Essentials Chronic kidney disease (CKD) is associated with procoagulant and inflammatory biomarkers. We studied the association of CKD and venous thromboembolism (VTE) in a case-cohort study. Factor VIII, D-dimer and C-reactive protein appeared to explain the association of CKD and VTE. Statin use was protective against VTE in those with and without CKD. SUMMARY Background Chronic kidney disease (CKD) is associated with venous thromboembolism (VTE) risk via unknown mechanisms. Whether factors associated with reduced VTE risk in the general population might also be associated with reduced VTE risk in CKD patients is unknown. Objectives To determine whether thrombosis biomarkers attenuate VTE risk, and whether factors associated with reduced VTE risk are similarly effective in CKD patients. Methods Baseline biomarkers were measured in a cohort (294 VTE cases; 939 non-cases) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a nationwide prospective cohort study of 30 239 persons aged ≥45 years with 4.3 years of follow-up. The hazard ratio (HR) of VTE per 10 mL min-1 1.73 m-2 decrease in estimated glomerular filtration rate (eGFR), and the percentage attenuation of this HR by each biomarker, were calculated. Associations of protective factors (physical activity, lower body mass index [BMI], and aspirin, warfarin and statin use) with VTE were estimated in those with and without CKD. Results The HR for VTE with lower eGFR was 1.13 (95% confidence interval [CI] 1.02-1.25), and VTE risk was attenuated by 23% (95% CI 5-100) by D-dimer, by 100% (95% CI 50-100) by factor VIII, and by 15% (95% CI 2-84) by C-reactive protein. Normal BMI was associated with lower VTE risk in those without CKD (HR 0.47, 95% CI 0.32-0.70), but not in those with CKD (HR 1.07, 95% CI 0.51-2.22). Statin use, physical activity and warfarin use were associated with lower VTE risk in both groups. Conclusions Procoagulant and inflammatory biomarkers mediated the association of eGFR with VTE. Higher physical activity, statin use and warfarin use mitigated VTE risk in those with CKD and those without CKD, but normal BMI did not mitigate VTE risk in CKD patients.
Collapse
Affiliation(s)
- K L Cheung
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - N A Zakai
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - P W Callas
- University of Vermont, Burlington, VT, USA
| | - G Howard
- University of Alabama Birmingham, Birmingham, AL, USA
| | - B K Mahmoodi
- University of Groningen, Groningen, The Netherlands
| | - C A Peralta
- University of California San Francisco, San Francisco, CA, USA
| | - S E Judd
- University of Alabama Birmingham, Birmingham, AL, USA
| | - M Kurella Tamura
- Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - M Cushman
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| |
Collapse
|
25
|
Trapero-Bertran M, Muñoz C, Coyle K, Coyle D, Lester-George A, Leidl R, Bertalan N, Cheung KL, Pokhrel S, Lopez-Nicolás A. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Trapero-Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak-Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S, EQUIPT Study Group OBOT. Estimating costs for modelling return on investment from smoking cessation interventions. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
27
|
Athanasiou I, Reed M, Shrestha A, Cheung KL, Audisio R, Collins K, Wyld L. Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: Analysis of the age gap trial. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
28
|
Wong KS, Fu SN, Cheung KL, Dao MC, Sy WM. Effect of a financial incentive on the acceptance of a smoking cessation programme with service charge: a cluster-controlled trial. Hong Kong Med J 2018; 24:128-136. [PMID: 29622760 DOI: 10.12809/hkmj176960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Frontline health care professionals in Hong Kong may encounter high refusal rates for the Hospital Authority's Smoking Counselling and Cessation Programme (SCCP) when smokers know it is subject to a service charge. We compared SCCP booking and attendance rates among smokers with or without a financial incentive. METHODS In this multicentre non-randomised cluster-controlled trial, adult smokers who attended one of six general out-patient clinics between November 2015 and April 2016 were invited to join an SCCP. Attendees in the three intervention-group centres but not the three control-group centres received a supermarket coupon to offset the service charge. RESULTS A total of 173 smokers aged 18 years or older (92 in the intervention group and 81 in the control group) were recruited into the study. In the intervention group, 47 smokers (51%) agreed via a questionnaire that they would join the SCCP, compared with only 23 smokers in the control group (28%). The booking rates were 83% (n=39) in the intervention group and 83% (n=19) in the control group. Among those who had booked a place, 19 (49%) intervention-group participants and 11 (58%) control-group participants attended an SCCP session. Multivariable logistic regression revealed that offering a coupon was associated with agreeing to join an SCCP (odds ratio=4.963, 95% confidence interval=2.173-11.334; P<0.001) and booking an SCCP place (odds ratio=4.244, 95% confidence interval=1.838-9.799; P<0.001). CONCLUSION Provision of a financial incentive was positively associated with agreement to join an SCCP and booking an SCCP place. Budget holders should consider providing the SCCP free of charge to increase smokers' access to the service.
Collapse
Affiliation(s)
- K S Wong
- Family Medicine and General Out-patient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong
| | - S N Fu
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - K L Cheung
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - M C Dao
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - W M Sy
- Family Medicine & Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| |
Collapse
|
29
|
Cheung KL, Pinder SE, Paish C, Sadozye AH, Chan SY, Evans AJ, Blamey RW, Robertson JF. The Role of Blood Tumor Marker Measurement (Using a Biochemical Index Score and C-Erbb2) in Directing Chemotherapy in Metastatic Breast Cancer. Int J Biol Markers 2018; 15:203-9. [PMID: 11012094 DOI: 10.1177/172460080001500310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The role of blood tumor markers in monitoring response in advanced breast cancer is established in endocrine therapy and standard chemotherapy. This study examines marker levels in patients receiving new chemotherapy regimens. Thirty patients were recruited into two multicenter trials in which docetaxel-based regimens were used in 15 patients. The other 15 received doxorubicin-based regimens. Biochemical response calculated from a score using CA15.3, CEA and ESR was compared with UICC response. Marker changes at 2, 4 and 5 months correlated with UICC response at 3, 41/2 and 6 months, respectively (p < 0.03). Eleven patients achieved both clinical/radiological and biochemical response at the end of treatment; markers had not yet returned to below cutoffs in seven, suggesting a possible advantage to continue chemotherapy. No patient showed a biochemical response whilst judged clinically/radiologically progressive. Nineteen patients had progressed either clinically/radiologically or biochemically at six months; of these, eight showed progression assessed earlier by markers so that a median of four cycles of chemotherapy could have been saved. Measurements of serum c-erbB2 showed a correlation with tissue c-erbB2 staining in the primary tumor (p < 0.003). Among the patients with positive tissue staining, sequential changes in serum c-erbB2 completely paralleled initial response.
Collapse
Affiliation(s)
- K L Cheung
- Department of Surgery, City Hospital, Nottingham, UK.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Affiliation(s)
- W H Chow
- Department of Medicine, Grantham Hospital, Hong Kong
| | | | | | | |
Collapse
|
31
|
Athanasiou I, Reed M, Shrestha A, Cheung KL, Audisio R, Wyld L. Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: Analysis of the Age Gap Trial. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
32
|
Lei YY, Lee ICK, Cheung KL, Lee R, He Y, Yeo W. Abstract P6-12-04: Quality of life of Chinese breast cancer survivors in association with lifestyle changes before and after cancer diagnosis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Epidemiologic studies in the West have found that lifestyle factors, including maintaining normal body weight, being physically active and eating a healthy diet are individually associated with better quality of life (QOL) among breast cancer survivors. Limited data is available on lifestyle modifications in association with quality of life of breast cancer survivors in Asian region. The objectives of this study were to [1] determine the lifestyle changes among Chinese breast cancer survivors at diagnosis and 18-month post diagnosis; and [2] to assess the association of lifestyle changes with QOL.
Methods: In this prospective cohort study, 1300 Chinese breast cancer patients were assessed at breast cancer diagnosis (baseline; reflecting pre-diagnosis) and at 18-month post-diagnosis. During each assessment, individual patient's lifestyle within the previous 12 months were recorded and included exercise, diet, and body mass index (BMI) data; each patient also underwent self-administered QOL assessment. Assessment of lifestyle modifications were based on World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendation adherence scores (range: 0-6).QOL was evaluated by European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire C-30 (EORTC-QLQ-C30). Paired t-test was performed to compare the overall recommendation adherence score before and after diagnosis.To investigate the association between recommendation adherence score and HRQoL, generalized linear models were used to compare the least-square means by tertiles of adherence score (T1, T2, and T3) and continuous adherence score. In the multivariate models, adjustment were made for age, stage of cancer, education level, marital status, comorbidities, smoking status, current hormonal therapy and energy intake.
Results: The mean recommendation adherence score significantly increased from baseline of 3.2 (SD=1.1) to 3.9 (SD=1.1, p<0.001) at 18-month follow-up. Overall, increasing adherence to WCRF/AICR guideline was associated with higher scores of global health status (P=0.01), physical functioning (P<0.001) and role functioning (P=0.03), and lower scores of fatigue (P=0.001), nausea and vomiting (P=0.003), pain (P<0.001), dyspnea (P=0.006), loss of appetite (P=0.001) and diarrhea (P<0.001).
Conclusions: Positive lifestyle changes were made among Chinese breast cancer survivors after cancer diagnosis. Increased adherence to WCRF/AICR recommendations after cancer diagnosis improves QOL, suggesting that Chinese breast cancer survivors should follow the WCRF/AICR guideline for cancer prevention.
Acknowledgments: This study is funded by the World Cancer Research Fund International (Grant Number WCRF 2010/249and WCRF 2014/1197) and Madam Diana Hon Fun Kong Donation for Cancer Research.
Citation Format: Lei Y-Y, Lee IC-K, Cheung KL, Lee R, He Y, Yeo W. Quality of life of Chinese breast cancer survivors in association with lifestyle changes before and after cancer diagnosis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-04.
Collapse
Affiliation(s)
- Y-Y Lei
- Chinese University of Hong Kong
| | | | | | - R Lee
- Chinese University of Hong Kong
| | - Y He
- Chinese University of Hong Kong
| | - W Yeo
- Chinese University of Hong Kong
| |
Collapse
|
33
|
Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Kelly S, Horgan K, Rauchhaus P, Littleford R, Foxley A, Lindemann JPO, Pass M, Rugman P, Deb R, Finlay P, Gee JMW. Abstract P4-04-06: AZD5363, an AKT inhibitor, significantly inhibits key biomarkers of the AKT pathway and Ki67, in a randomized, placebo, controlled study (STAKT) in human breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-04-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: AKT is an important intracellular control point through which Type 1 growth factors and IGFR signal. Mutations in PIK3CA, AKT and PTEN are prevalent in estrogen receptor positive (ER+) breast cancer (BC) and have been implicated in resistance to endocrine therapies. AZD5363 is an inhibitor of AKT 1, 2 and 3 currently in Phase 2 trials for BC and other solid cancers.
Design: The study examined whether AZD5363 impacts on key biomarkers within the AKT pathway and their subsequent effects on Ki67, a marker of tumor proliferation. STAKT is a multi-center, two-stage, double blind, randomized, placebo controlled, biomarker 'window-of-opportunity' trial in women with newly diagnosed, previously untreated ER+ BC who were deemed would require chemotherapy as part of their primary treatment regimen. Stage 1 assessed AZD5363 at a dose of 480mg bd p.o. versus matching placebo. Up to 30 patients per arm were permitted, to allow 12 subjects per arm with evaluable paired biopsies - obtained at baseline, and after 4.5 days of AZD5363 / placebo. Primary endpoint markers were pPRAS40, pGSK3β and Ki67 assessed by immunohistochemistry. pPRAS40 and pGSK3β were assessed by H-scores and measured separately for cytoplasmic (cyto), nuclear (nuc) and total (cyto+nuc) staining. Ki67 was assessed as % positive staining of 500 tumor nuclei. Laboratory staff were blinded to treatment arm and whether the biopsies were taken before or after AZD5363/placebo. Changes in marker expression (both absolute and %) between biopsies were calculated, and compared between the two groups. An ANOVA test was applied for normally distributed data and Wilcoxon Mann-Whitney used if not normally distributed.
Results: 28/36 patients were evaluable with patient & tumor characteristics as follows: 17 received AZD5363 and 11 placebo; the median ages were 48 & 49 years respectively. 27 patients were Caucasian and 1 African-American. Tumors were all ER+. For HER2 status 8 were positive & 9 negative in the AZD5363 treated group compared to 2 & 9 respectively in the placebo group.
For pPRAS40 and pGSK3β cyto was the predominant staining while for Ki67 staining was nuclear. Changes in each marker with associated p-values are shown in the table.
MarkerType of change vs baselineDegree of change in AZD5363 arm (n=17)p-value versus placebo arm (n=11)pPRAS40 (H-score)TotalAbsolute-83.8<0.0001Total%-50.2<0.0001CytoAbsolute-90.0<0.0001Cyto%-55.8<0.0001NucAbsolute+6.90.42Nuc%+8.90.94pGSK3β (H-score)TotalAbsolute-55.30.006Total%-39.00.006CytoAbsolute-53.60.006Cyto%-39.20.006NucAbsolute-2.80.065Nuc%-36.50.058Ki67 (% cells+)Absolute-9.60.031%-29.40.052
Conclusions• AZD5363 for 4.5 days caused highly significant falls in pGSK3β and pPRAS40, key markers of AKT pathway activation
• AZD53643 also caused a significant decline in Ki67 even after only 4.5 days of drug. This is one of the shortest 'window'-studies to report such an early effect on proliferation.
• Placebo controlled 'window' studies of this short duration can provide important evidence of the therapeutic potential early in a drug's development.
Citation Format: Robertson JFR, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Kelly S, Horgan K, Rauchhaus P, Littleford R, Foxley A, Lindemann JPO, Pass M, Rugman P, Deb R, Finlay P, Gee JMW. AZD5363, an AKT inhibitor, significantly inhibits key biomarkers of the AKT pathway and Ki67, in a randomized, placebo, controlled study (STAKT) in human breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-06.
Collapse
Affiliation(s)
- JFR Robertson
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - RE Coleman
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - KL Cheung
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Evans
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - C Holcombe
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Skene
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - D Rea
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - S Ahmed
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Jahan
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - S Kelly
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - K Horgan
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Rauchhaus
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - R Littleford
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - A Foxley
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - JPO Lindemann
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - M Pass
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Rugman
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - R Deb
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - P Finlay
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| | - JMW Gee
- University of Nottingham, Nottingham; Univeristy of Dundee, Dundee; University of Sheffield, Sheffield; Royal Liverpool University Hospital, Liverpool; King's Mill Hospital, Nottingham; Leeds General Infirmary, Leeds; Weston Park Hospital, Sheffield; Leicester Royal Infirmary, Leicester; Royal Bournemouth & Christchurch NHS Foundation; Poole Hospital NHS Foundation Trust; University of Birmingham; Royal Derby Hospital; Derriford Hospital; AstraZeneca; Cardiff University
| |
Collapse
|
34
|
Syed BM, Morgan D, Setty T, Green AR, Paish EC, Ellis IO, Cheung KL. Oestrogen receptor negative early operable primary breast cancer in older women-Biological characteristics and long-term clinical outcome. PLoS One 2017; 12:e0188528. [PMID: 29284000 PMCID: PMC5746234 DOI: 10.1371/journal.pone.0188528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Older women are at the greatest risk of breast cancer development and a considerable number present with comorbidities. Although the majority of breast cancers in this age group express oestrogen receptor (ER), which makes endocrine therapy (primary or adjuvant) feasible, given the huge size of the elderly population, there remains a significant number of patients, in absolute term, whose tumours do not express ER and their management is challenging. Methods Of a consecutive series of 1,758 older (≥70 years) women with early operable primary breast cancer managed in a dedicated service from 1973–2010, 252(14.3%) had ER-negative (histochemical (H) score ≤50) tumours. Their clinical outcome was retrospectively reviewed and tumour samples collected from diagnostic core biopsies were analysed for progesterone receptor (PgR), HER2 and Ki67 using immunohistochemistry. Results The commonest primary treatment was surgery (N = 194, 77%) followed by primary endocrine therapy (14.3%), primary radiotherapy (5.6%) and supportive treatment only (3.1%). Among the patients undergoing surgery, most of them had grade 3 (78.1%) and node-negative disease (62.2%). Some of them (21.1%) received postoperative radiotherapy. At a median follow-up of 37.5 months, 117 patients had died, out of which 48.6% were due to breast cancer. For those who underwent surgery, the regional and local recurrence rates were 2% and 1.1% per annum respectively. For those who received primary endocrine therapy, 38% progressed at 6 months, however all patients who had primary radiotherapy achieved clinical benefit at 6 months. Regardless of treatment given, the 5-year breast cancer specific and overall survival rates were 70% and 50% respectively. Biological analysis based on good quality needle core biopsy specimensfrom181 patients showed that 26.8% (N = 49), 16.9% (N = 31) and 70.7% (N = 70)expressed positivity for PgR, HER2 and Ki67 respectively. No correlation between these biomarkers and breast cancer specific survival was demonstrated. Conclusion Oestrogen receptor negative early operable primary breast cancer in older women is associated with poor prognostic features in terms of biology and clinical outcome. Surgery appears to produce the best outcome as a primary treatment, however for those where neither surgery nor chemotherapy is appropriate, primary radiotherapy can be beneficial.
Collapse
Affiliation(s)
- Binafsha Manzoor Syed
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Dal Morgan
- Department of Oncology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Tulassi Setty
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Andrew R Green
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Emma C Paish
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Ian O Ellis
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - K L Cheung
- Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| |
Collapse
|
35
|
Alexander A, Karakas C, Chen X, Carey JPW, Yi M, Bondy M, Thompson P, Cheung KL, Ellis IO, Gong Y, Krishnamurthy S, Alvarez RH, Ueno NT, Hunt KK, Keyomarsi K. Cyclin E overexpression as a biomarker for combination treatment strategies in inflammatory breast cancer. Oncotarget 2017; 8:14897-14911. [PMID: 28107181 PMCID: PMC5362453 DOI: 10.18632/oncotarget.14689] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/26/2016] [Indexed: 12/18/2022] Open
Abstract
Inflammatory breast cancer (IBC) is a virulent form of breast cancer, and novel treatment strategies are urgently needed. Immunohistochemical analysis of tumors from women with a clinical diagnosis of IBC (n = 147) and those with non-IBC breast cancer (n = 2510) revealed that, whereas in non-IBC cases cytoplasmic cyclin E was highly correlated with poor prognosis (P < 0.001), in IBC cases both nuclear and cytoplasmic cyclin E were indicative of poor prognosis. These results underscored the utility of the cyclin E/CDK2 complex as a novel target for treatment. Because IBC cell lines were highly sensitive to the CDK2 inhibitors dinaciclib and meriolin 5, we developed a high-throughput survival assay (HTSA) to design novel sequential combination strategies based on the presence of cyclin E and CDK2. Using a 14-cell-line panel, we found that dinaciclib potentiated the activity of DNA-damaging chemotherapies treated in a sequence of dinaciclib followed by chemotherapy, whereas this was not true for paclitaxel. We also identified a signature of DNA repair–related genes that are downregulated by dinaciclib, suggesting that global DNA repair is inhibited and that prolonged DNA damage leads to apoptosis. Taken together, our findings argue that CDK2-targeted combinations may be viable strategies in IBC worthy of future clinical investigation.
Collapse
Affiliation(s)
- Angela Alexander
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA
| | - Cansu Karakas
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xian Chen
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason P W Carey
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Min Yi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Bondy
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Patricia Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, New York, USA
| | | | - Ian O Ellis
- University of Nottingham, School of Medicine, Nottingham, UK
| | - Yun Gong
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA
| | - Ricardo H Alvarez
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Khandan Keyomarsi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
36
|
Collins K, Reed M, Lifford K, Burton M, Edwards A, Ring A, Brain K, Harder H, Robinson T, Cheung KL, Morgan J, Audisio R, Ward S, Richards P, Martin C, Chater T, Pemberton K, Nettleship A, Murray C, Walters S, Bortolami O, Armitage F, Leonard R, Gath J, Revell D, Green T, Wyld L. Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial. BMJ Open 2017; 7:e015133. [PMID: 28760787 PMCID: PMC5642653 DOI: 10.1136/bmjopen-2016-015133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease. METHODS AND ANALYSIS This multicentre, parallel group, pragmatic cluster randomised controlled trial (RCT) (2015-18) reported here is nested within a larger ongoing 'Age Gap Cohort Study' (2012-18RP-PG-1209-10071), aims to evaluate the effectiveness of a complex intervention of decision support interventions to assist in the treatment decision making for early breast cancer in older women. The interventions include two patient decision aids (primary endocrine therapy vs surgery/antioestrogen therapy and chemotherapy vs no chemotherapy) and a clinical treatment outcomes algorithm for clinicians. ETHICS AND DISSEMINATION National and local ethics committee approval was obtained for all UK participating sites. Results from the trial will be submitted for publication in international peer-reviewed scientific journals. IRAS REFERENCE 115550. TRIAL REGISTRATION NUMBER European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2015-004220-61;Pre-results. Sponsor's Protocol Code Number Sheffield Teaching Hospitals STH17086. ISRCTN 32447*.
Collapse
Affiliation(s)
- Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Katherine Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Thompson Robinson
- Department of Cardiovascular Sciences, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Nottingham, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Susan Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anthony Nettleship
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher Murray
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Oscar Bortolami
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Jacqui Gath
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Tracy Green
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
| |
Collapse
|
37
|
Roberston JFR, Cheung KL, Ahmed S, Coleman RE, Evans A, Holcombe C, Rea D, Rauchhaus P, Skene A, Littleford R, Jahan A, Kelly S, Lindermann JPO, Horgan K, Foxley A, Rugman P, Pass M. Abstract P3-06-03: The short term effects of an AKT inhibitor (AZD5363) on biomarkers of the AKT pathway and anti-tumour activity in a breast cancer paired biopsy study (STAKT trial). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-06-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Collapse
Affiliation(s)
- JFR Roberston
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - KL Cheung
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - S Ahmed
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - RE Coleman
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Evans
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - C Holcombe
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - D Rea
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - P Rauchhaus
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Skene
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - R Littleford
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Jahan
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - S Kelly
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - JPO Lindermann
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - K Horgan
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - A Foxley
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - P Rugman
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| | - M Pass
- University of Nottingham, Nottingham, United Kingdom; Univeristy of Dundee, Dundee, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; King's Mill Hospital, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; Royal Bournemouth & Christchurch NHS Foundation, Bournemouth, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Derby Hospital, Derby, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Derriford Hospital, Plymouth, United Kingdom; AstraZeneca, Melbourn, United Kingdom
| |
Collapse
|
38
|
Hunt KK, Karakas C, Ha MJ, Biernacka A, Yi M, Sahin AA, Adjapong O, Hortobagyi GN, Bondy M, Thompson P, Cheung KL, Ellis IO, Bacus S, Symmans WF, Do KA, Keyomarsi K. Cytoplasmic Cyclin E Predicts Recurrence in Patients with Breast Cancer. Clin Cancer Res 2016; 23:2991-3002. [PMID: 27881578 DOI: 10.1158/1078-0432.ccr-16-2217] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/27/2022]
Abstract
Purpose: Low molecular weight cyclin E (LMW-E) detected by Western blot analysis predicts for reduced breast cancer survival; however, it is impractical for clinical use. LMW-E lacks a nuclear localization signal that leads to accumulation in the cytoplasm that can be detected by IHC. We tested the hypothesis that cytoplasmic staining of cyclin E can be used as a predictor of poor outcome in different subtypes of breast cancer using patient cohorts with distinct clinical and pathologic features.Experimental Design: We evaluated the subcellular localization of cyclin E in breast cancer specimens from 2,494 patients from 4 different cohorts: 303 from a prospective study and 2,191 from retrospective cohorts [NCI, MD Anderson Cancer Center (MDA), and the United Kingdom (UK)]. Median follow-up times were 8.0, 10.1, 13.5, and 5.7 years, respectively.Results: Subcellular localization of cyclin E on IHC was associated with full-length (nuclear) and low molecular weight isoforms (cytoplasmic) of cyclin E on Western blot analysis. In multivariable analysis, cytoplasmic cyclin E staining was associated with the greatest risk of recurrence compared with other prognostic factors across all subtypes in three (NCI, MDA, and UK) of the cohorts. In the MDA cohort, cytoplasmic cyclin E staining outperformed Ki67 and all other variables as prognostic factors.Conclusions: Cytoplasmic cyclin E identifies patients with the highest likelihood of recurrence consistently across different patient cohorts and subtypes. These patients may benefit from alternative therapies targeting the oncogenic isoforms of cyclin E. Clin Cancer Res; 23(12); 2991-3002. ©2016 AACR.
Collapse
Affiliation(s)
- Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cansu Karakas
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Min Jin Ha
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna Biernacka
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Min Yi
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Opoku Adjapong
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Bondy
- Department of Pathology Administration, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Patricia Thompson
- Department of Cellular and Molecular Medicine, University of Arizona Cancer Center, Tucson, Arizona, USA
| | | | - Ian O Ellis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Bacus
- Quintiles Transnational Corp, Denver, Colorado, USA
| | - W Fraser Symmans
- Department of Pathology Administration, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Khandan Keyomarsi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
39
|
Hope C, Robertshaw A, Cheung KL, Idris I, English E. Relationship between HbA1c and cancer in people with or without diabetes: a systematic review. Diabet Med 2016; 33:1013-25. [PMID: 26577885 DOI: 10.1111/dme.13031] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/25/2022]
Abstract
AIM To identify the relationship between HbA1c and cancers in people with or without diabetes. BACKGROUND Cancer is a major public health problem, accounting for 8.2 million deaths worldwide in 2012. HbA1c level has been associated with the risk of developing certain cancers, although the existing evidence is conflicting. METHODS EMBASE, MEDLINE, CINAHL and the Cochrane Library were searched. Eligible articles included randomized controlled trials, cohort studies, case-control studies, systematic reviews and meta-analyses. Participants of either sex, with or without Type 1 or 2 diabetes, were included. The studies were assessed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria by two independent assessors. No meta-analysis was performed because of the heterogeneity of results. RESULTS A total of 19 studies from 1006 met the inclusion criteria, of which 14 were cohort studies and five were nested case-control studies. Eight studies investigated outcomes for all cancer sites. Four of these studies reported that higher HbA1c levels were associated with higher incidence and/or mortality risk for all cancers. One study observed a U-shaped relationship between HbA1c and cancer incidence and mortality. Increasing HbA1c levels were associated with increasing risk of developing colorectal, pancreatic, respiratory and female genital tract cancers. No increased risk was observed for breast cancer, gastrointestinal or urological malignancies. CONCLUSION HbA1c appears to be associated with cancer incidence and/or cancer mortality, but further studies are needed to fully understand the complex relationship between HbA1c and cancer.
Collapse
Affiliation(s)
- C Hope
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Robertshaw
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - I Idris
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - E English
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| |
Collapse
|
40
|
Ogunbiyi SO, Lee S, Mathew J, Cheung KL. Primary breast cancer in the elderly: a systematic literature review on histological type and clinical outcome. Future Oncol 2015; 11:259-65. [PMID: 25591838 DOI: 10.2217/fon.14.210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective was to determine whether histological types of breast cancer in elderly women influence clinical outcome. Four major databases were searched. All relevant articles, from January 1990 to December 2013, were screened. After applying inclusion and exclusion criteria, 11 studies were included. Invasive ductal carcinoma was the commonest (68.5-87.1%) histological type, followed by lobular carcinoma (6.9-17.7%). Four studies reported on survival. However, none specifically looked at survival according to different histological types. There are very little data on the influence of histological type on clinical outcome in primary breast cancer in elderly patients. Further studies may elucidate any potential influence and its relationship with tumor biology.
Collapse
|
41
|
Morgan J, Walters S, Collins K, Robinson T, Cheung KL, Audisio R, Reed M, Wyld L. P082. What influences clinicians' treatment preferences for older women with operable breast cancer? An application of the discrete choice experiment. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
42
|
Groeneveld DJ, van Bekkum T, Cheung KL, Dirven RJ, Castaman G, Reitsma PH, van Vlijmen B, Eikenboom J. No evidence for a direct effect of von Willebrand factor's ABH blood group antigens on von Willebrand factor clearance. J Thromb Haemost 2015; 13:592-600. [PMID: 25650553 DOI: 10.1111/jth.12867] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/24/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND One of the major determinants of von Willebrand factor (VWF) plasma levels is ABO blood group status, and individuals with blood group O have ~ 25% lower plasma levels. The exact mechanism behind this relationship remains unknown, although effects on clearance have been postulated. OBJECTIVES To determine whether clearance of VWF is directly dependent on the presence of ABH antigens on VWF. METHODS Three type 3 von Willebrand disease (VWD) patients were infused with Haemate-P, and the relative loading of VWF with ABH antigens at different time points was measured. VWF-deficient mice were injected with purified plasma-derived human VWF obtained from donors with either blood group A, blood group B, or blood group O. RESULTS In mice, we found no difference in clearance rate between plasma-derived blood group A, blood group B and blood group O VWF. Faster clearance of the blood group O VWF present in Haemate-P infused in type 3 VWD patients would have resulted in a relative increase in the loading of VWF with A and B antigens over time. However, we observed a two-fold decrease in the loading with A and B antigens in two out of three patients, and stable loading in the third patient. CONCLUSION There is no direct effect of ABH antigens on VWF in VWF clearance. We demonstrate that, in a direct comparison within one individual, blood group O VWF is not cleared faster than blood group A or blood group B VWF. Clearance differences between blood group O and non-blood group O individuals may therefore be related to the blood group status of the individual rather than the ABH antigen loading on VWF itself.
Collapse
Affiliation(s)
- D J Groeneveld
- Einthoven Laboratory for Experimental Vascular Medicine, Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Mousa R, Chen LC, Cheung KL. An Evidence-Based Model Design to Inform the Cost-Effectiveness Evaluation of Primary Endocrine Therapy And Surgery for Older Women with Primary Breast Cancer. Value Health 2014; 17:A638. [PMID: 27202281 DOI: 10.1016/j.jval.2014.08.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R Mousa
- University of Nottingham, Nottingham, UK
| | - L C Chen
- University of Nottingham, Nottingham, UK
| | | |
Collapse
|
44
|
|
45
|
Fu SN, Luk W, Wong CKH, Cheung KL. Progression from impaired fasting glucose to type 2 diabetes mellitus among Chinese subjects with and without hypertension in a primary care setting. J Diabetes 2014; 6:438-46. [PMID: 24393475 DOI: 10.1111/1753-0407.12120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 12/17/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The progression from impaired fasting glucose (IFG) to type 2 diabetes mellitus (T2DM) in Chinese subjects, with and without hypertension, in a primary care setting was unknown. METHODS The present retrospective multicenter 5-year (2002-2007) cohort study was performed on IFG subjects attending 23 general outpatient clinics who were identified by their elevated fasting blood glucose laboratory results. Development of T2DM was determined by physician diagnosis of T2DM or starting of oral antidiabetic drugs within 5 years. The relationship between the time of T2DM diagnosis and subject characteristics was assessed by adjusted hazard ratios (aHR) from Cox hazards model. RESULTS Of the 9161 IFG subjects, 4080 (45%) were men and 5081 (55%) were women. There were 1998 subjects who developed T2DM. The 5-year cumulative incidence was 0.218, whereas the overall annual incidence rate was 5.981/100 person-years. Subjects were more likely to develop T2DM if they were hypertensive (aHR = 1.44; 95% confidence interval [CI] 1.28-1.62; P < 0.001), aged <60 years (aHR = 1.36, 95% CI 1.24-1.49; P < 0.001), female (aHR = 1.18, 95% CI 1.08-1.29; P < 0.001), and had higher fasting glucose levels (6.39 ± 0.49 vs 6.24 ± 0.43 mmol/L in the group that developed T2DM vs the group without T2DM, respectively; aHR = 2.01, 95% CI 1.83-2.20; P < 0.001). CONCLUSION Overall, more than one-fifth of IFG subjects in the primary care setting developed T2DM within 5 years. Health care professionals can target interventions to patients with risk factors for disease progression.
Collapse
Affiliation(s)
- Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Kowloon
| | | | | | | |
Collapse
|
46
|
Mathew J, Prinsloo P, Agrawal A, Gutteridge E, Marenah C, Robertson JFR, Cheung KL. Pilot randomised study of early intervention based on tumour markers in the follow-up of patients with primary breast cancer. Breast 2014; 23:567-72. [PMID: 24874285 DOI: 10.1016/j.breast.2014.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/02/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND This pilot study aimed to test the possibility of therapeutic benefit imparted by early intervention based on sequential tumour marker (TM) measurements during follow-up of primary breast cancer (PBC) patients. METHODS Patients with oestrogen receptor positive PBC with no clinical and/or radiological evidence of metastases were recruited and followed-up 3-monthly with clinical assessment and TM (CA15.3 and CEA) measurements. The clinical team was blinded to the TM results. Asymptomatic patients who developed raised TMs (based on pre-defined cut-offs) were randomised to either 'treatment change' (either start or change of adjuvant endocrine agent to another agent) or 'no change' (control). Patients who developed symptomatic metastases came off the study. The primary and secondary endpoints were intervals from randomisation to symptomatic metastases and to last follow-up/death respectively. RESULTS Eighty-five patients (median age = 54 years (30-72)) were recruited with a median follow-up of 81 months (1-124). Sixteen patients were randomised as described. There was no significant difference (treatment change versus no change) with regards to interval from randomisation to symptomatic metastases - 23 (2-62) and 22 (1-63) months respectively (p = 0.9), as well as interval from randomisation to last follow-up/death - 36 (7-63) and 37 (10-63) months respectively (p = 0.9). CONCLUSIONS Despite long follow-up (up to 10+ years), this small study has thus far shown no significant difference in outcome. However, we have confirmed the feasibility of this study design but a larger study will be required to show if there is a benefit to this approach.
Collapse
Affiliation(s)
- J Mathew
- School of Medicine, University of Nottingham, UK.
| | - P Prinsloo
- School of Medicine, University of Nottingham, UK; Department of Clinical Pathology, Nottingham University Hospitals, Nottingham, UK
| | - A Agrawal
- School of Medicine, University of Nottingham, UK
| | - E Gutteridge
- School of Medicine, University of Nottingham, UK
| | - C Marenah
- School of Medicine, University of Nottingham, UK; Department of Clinical Pathology, Nottingham University Hospitals, Nottingham, UK
| | | | - K L Cheung
- School of Medicine, University of Nottingham, UK.
| |
Collapse
|
47
|
Syed BM, Green AR, Ellis IO, Cheung KL. Human epidermal growth receptor-2 overexpressing early operable primary breast cancers in older (≥70 years) women: biology and clinical outcome in comparison with younger (<70 years) patients. Ann Oncol 2014; 25:837-842. [PMID: 24667716 DOI: 10.1093/annonc/mdu028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There is dearth of literature reporting the prevalence and biological characteristics as well as the long-term clinical outcome of human epidermal growth factor receptor-2 (HER2) overexpressing tumours in older women. Currently, research involving trastuzumab at large focuses on the younger population. This study aimed to analyse their biological characteristics and to compare them with their younger counterparts from a single centre with a long-term clinical follow-up. METHODS Over 37 years (1973-2010), 1758 older (≥70 years) women with early operable (<5 cm) primary breast cancer were managed in a dedicated clinic and have complete clinical information available. Of these, 813 patients underwent primary surgery and 575 had good quality tumour samples available for tissue microarray analysis using indirect immunohistochemistry. Comparison was made with data from a well-characterised younger (<70 years) series (N = 1711) treated between 1986 and 1998 (before adjuvant trastuzumab became standard) in our institution. Forty five (7.6%) and 140 (8.2%) patients from the older and younger series, respectively, had HER2-positive tumours. RESULTS HER2 overexpression was seen in 45 (7.6%) older women and 140 (8.2%) in younger patients (P = 0.56). HER2 overexpressing tumours in older women when compared with that in their younger counterparts were associated with low Ki67 and high bcl2 expression (P < 0.05). Only 26% of the younger patients and none of the older patients received adjuvant chemotherapy, and no patients at the time received trastuzumab. However, there was no significant difference in the outcome of the two age groups (5-year breast cancer-specific survival rate: <70 years = 65% versus >70 years = 70%, P = 0.51). CONCLUSION HER2 overexpressing tumours in older women showed relatively a less aggressive phenotype and did not show any inferior long-term clinical outcome despite not having received chemotherapy when compared with the younger patients. The precise role of different adjuvant systemic therapies in this population needs to be delineated.
Collapse
Affiliation(s)
- B M Syed
- School of Medicine, University of Nottingham, Nottingham, UK
| | - A R Green
- School of Medicine, University of Nottingham, Nottingham, UK
| | - I O Ellis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Nottingham, UK.
| |
Collapse
|
48
|
Meehan SK, Zabukovec JR, Dao E, Cheung KL, Linsdell MA, Boyd LA. One hertz repetitive transcranial magnetic stimulation over dorsal premotor cortex enhances offline motor memory consolidation for sequence-specific implicit learning. Eur J Neurosci 2013; 38:3071-9. [PMID: 23834742 DOI: 10.1111/ejn.12291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/14/2013] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
Consolidation of motor memories associated with skilled practice can occur both online, concurrent with practice, and offline, after practice has ended. The current study investigated the role of dorsal premotor cortex (PMd) in early offline motor memory consolidation of implicit sequence-specific learning. Thirty-three participants were assigned to one of three groups of repetitive transcranial magnetic stimulation (rTMS) over left PMd (5 Hz, 1 Hz or control) immediately following practice of a novel continuous tracking task. There was no additional practice following rTMS. This procedure was repeated for 4 days. The continuous tracking task contained a repeated sequence that could be learned implicitly and random sequences that could not. On a separate fifth day, a retention test was performed to assess implicit sequence-specific motor learning of the task. Tracking error was decreased for the group who received 1 Hz rTMS over the PMd during the early consolidation period immediately following practice compared with control or 5 Hz rTMS. Enhanced sequence-specific learning with 1 Hz rTMS following practice was due to greater offline consolidation, not differences in online learning between the groups within practice days. A follow-up experiment revealed that stimulation of PMd following practice did not differentially change motor cortical excitability, suggesting that changes in offline consolidation can be largely attributed to stimulation-induced changes in PMd. These findings support a differential role for the PMd in support of online and offline sequence-specific learning of a visuomotor task and offer converging evidence for competing memory systems.
Collapse
Affiliation(s)
- S K Meehan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - J R Zabukovec
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - E Dao
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - K L Cheung
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - M A Linsdell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - L A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Brain Research Centre, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| |
Collapse
|
49
|
Syed BM, Green AR, Paish EC, Soria D, Garibaldi J, Morgan L, Morgan DAL, Ellis IO, Cheung KL. Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts. Br J Cancer 2013; 108:1042-51. [PMID: 23462719 PMCID: PMC3619059 DOI: 10.1038/bjc.2012.601] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: As age advances breast cancer appears to change its biological characteristics, however, very limited data are available to define the precise differences between older and younger patients. Methods: Over 36 years (1973–2009), 1758 older (⩾70 years) women with early operable primary breast cancer were managed in a dedicated clinic. In all, 813 underwent primary surgery and 575 good quality tumour samples were available for biological analysis. The pattern of biomarkers was analysed using indirect immunohistochemistry on tissue microarrays. Comparison was made with a previously characterised series of younger (<70 years) patients. Results: There was high expression of oestrogen receptor (ER), PgR, Bcl2, Muc1, BRCA1 and 2, E-cadherin, luminal cytokeratins, HER3, HER4, MDM2 and 4 and low expression of human epidermal growth factor receptor (HER)-2, Ki67, p53, EGFR and CK17. Oestrogen receptor and axillary stage appeared as independent prognostic factors. Unsupervised partitional clustering showed six biological clusters in older patients, five of which were common in the younger patients, whereas the low ER luminal cluster was distinct in the older series. The luminal phenotype showed better breast cancer-specific survival, whereas basal and HER2-overexpressing tumours were associated with poor outcome. Conclusion: Early operable primary breast cancer in older women appears as a distinct biological entity, with existence of a novel cluster. Overall older women showed less aggressive tumour biology and ER appeared as an independent prognostic factor alongside the time-dependent axillary stage. These biological characteristics may explain the differences in clinical outcome and should be considered in making therapeutic decisions.
Collapse
Affiliation(s)
- B M Syed
- Division of Breast Surgery, University of Nottingham, Derby, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Exemestane, a steroidal aromatase inhibitor, is licensed for postmenopausal patients with estrogen receptor (ER)-positive breast cancer as second-line therapy in metastatic disease following antiestrogen failure and as part of sequential adjuvant therapy following initial tamoxifen. This study is a systematic literature review, evaluating exemestane in different clinical settings. The Ovid Medline (1948-2012), Embase (1980-2012), and Web of Science (1899-2012) databases were searched. Forty-two relevant articles covering randomized controlled trials were reviewed for efficacy and safety, and three for adherence. With regard to efficacy in metastatic disease, exemestane is superior to megestrol acetate after progression on tamoxifen. There is evidence for noninferiority to fulvestrant (following a prior aromatase inhibitor) and to nonsteroidal aromatase inhibitors in the first-line setting. Combined use with everolimus is shown to be more efficacious than exemestane alone following previous aromatase inhibitor use. In the adjuvant setting, a switch to exemestane after 2-3 years of tamoxifen is superior to 5 years of tamoxifen. Exemestane is noninferior to 5 years of tamoxifen as upfront therapy, and may have a role as an extended adjuvant therapy. Used as neoadjuvant therapy, increased breast conservation is achievable. As chemoprevention, exemestane significantly reduces the incidence of breast cancer in "at-risk" postmenopausal women. Exemestane is associated with myalgias and arthralgias, as well as reduced bone mineral density and increased risk of fracture, which do not appear to persist at follow-up, with subsequent return to pretreatment values. Compared with tamoxifen, there is a reduced incidence of endometrial changes, thromboembolic events, and hot flashes. Limited evidence shows nonadherence in 23%-32% of patients. Evidence is growing in support of exemestane in all clinical settings. It is generally more efficacious and has a better safety profile than tamoxifen. How it compares with the nonsteroidal aromatase inhibitors remains to be established. Further studies are required on adherence to ensure that maximum benefit is obtained.
Collapse
Affiliation(s)
- GA Walker
- Clinical Oncology, East Midlands Deanery, University of Nottingham, Nottingham, UK
| | - M Xenophontos
- Breast Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK
| | - LC Chen
- Medicine Use, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - KL Cheung
- Breast Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK
- Correspondence: Kwok-Leung Cheung Division of Breast Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK Tel +44 1332 724 881 Fax +44 1332 724 880 Email
| |
Collapse
|