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Madison AA, Andridge R, Renna ME, Sheridan JF, Lustberg M, Ramaswamy B, Wesolowski R, Williams NO, Sardesai SD, Noonan AM, Reinbolt RE, Cherian MA, Malarkey WB, Kiecolt-Glaser JK. Inflamed but not impulsive: Acute inflammatory cytokine response does not impact prepotent response inhibition. J Affect Disord 2023; 342:1-9. [PMID: 37683942 PMCID: PMC10591975 DOI: 10.1016/j.jad.2023.09.008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Prior evidence has linked inflammation with impulsivity, but most of this evidence is cross-sectional. In this study, we provoked an acute inflammatory cytokine response to see whether it lowered prepotent response inhibition on three cognitive tasks. METHOD This study features secondary analyses from a randomized crossover trial in which 171 postmenopausal breast cancer survivors (Stage I-IIIA) each received a typhoid capsular polysaccharide vaccination and a saline placebo injection in a random sequence at two separate visits at least one month apart. Participants completed the Stroop Color-Discrepant Task, the 2-back, and the Conners Continuous Performance Test (CPT) on the computer between 5 and 7 h after the injections. They had their blood drawn once before and repeatedly after the injection to measure interleukin-1 receptor antagonist and interleukin-6 responses. RESULTS Women committed marginally fewer errors on the Stroop color-discrepant trials after the typhoid vaccine (M = 0.36, SE = 0.08), compared to placebo (M = 0.54, SE = 0.09, p = .076). Injection type did not predict 2-back accuracy (p = .80) or CPT commission errors (p = .47). Inflammatory cytokine responses were also unrelated to the outcomes of interest (ps>.16). CONCLUSION We found no evidence that an acute inflammatory cytokine response provokes response disinhibition - an important facet of impulsivity. In fact, our only marginally non-significant result suggested that women were better able to inhibit their prepotent responses on the Stroop after receiving the typhoid vaccine, compared to placebo. Further experimental tests of the acute inflammatory cytokine response's effect on other aspects of impulsivity are warranted. LIMITATIONS The sample was female, primarily White, highly educated cancer survivors, and recruitment was not premised on impulsive traits or diagnosis with an impulsive-related disorder. Also, there are many facets of impulsivity, and this study only measured response inhibition.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Psychology, The Ohio State University, Columbus, OH, United States of America.
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America; Division of Biostatistics, The Ohio State University, Columbus, OH, United States of America
| | - Megan E Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States of America
| | - John F Sheridan
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America; Division of Biosciences, The Ohio State University College of Dentistry, Columbus, OH, United States of America
| | - Maryam Lustberg
- Yale School of Medicine, New Haven, CT, United States of America
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Robert Wesolowski
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Nicole O Williams
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Sagar D Sardesai
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Anne M Noonan
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Raquel E Reinbolt
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Mathew A Cherian
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Renna ME, Madison AA, Peng J, Rosie Shrout M, Lustberg M, Ramaswamy B, Wesolowski R, VanDeusen JB, Williams NO, Sardesai SD, Noonan AM, Reinbolt RE, Stover DG, Cherian M, Malarkey WB, Andridge R, Kiecolt-Glaser JK. Worry and Mindfulness Differentially Impact Symptom Burden Following Treatment Among Breast Cancer Survivors: Findings From a Randomized Crossover Trial. Ann Behav Med 2023; 57:888-898. [PMID: 37335884 PMCID: PMC10498820 DOI: 10.1093/abm/kaad032] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Breast cancer survivors often experience many somatic and cognitive side effects resulting from their cancer diagnosis and treatment, including higher rates of pain, fatigue, and memory/concentration problems. Emotion regulation offers opportunities to either enhance or dampen physical health. PURPOSE In a secondary analysis of a double-blind randomized controlled trial (RCT) using a typhoid vaccine to assess factors associated with breast cancer survivors' inflammatory responses, we assessed how two specific aspects of emotion regulation, mindfulness, and worry, corresponded to acute changes in focus problems, memory problems, and fatigue along with performance on pain sensitivity and cognitive tasks across two visits among breast cancer survivors. METHODS Breast cancer survivors (N = 149) completed two 8.5-hr visits at a clinical research center. Survivors were randomized to either the vaccine/saline placebo or a placebo/vaccine sequence. Worry and mindfulness questionnaires provided data on trait-level emotion regulation abilities. Fatigue, memory problems, and focus difficulties were assessed via Likert scales six times-once before the injections and then every 90 min for 7.5 hr thereafter. Women also completed a pain sensitivity task and several cognitive tasks at each visit. RESULTS Findings from this study showed that breast cancer survivors who worried more and were less mindful experienced subjective memory problems, focus problems, and cold pain sensitivity across two visits and irrespective of injection type. Lower mindfulness also corresponded to higher subjective fatigue and hot pain sensitivity and objective ratings. Emotion regulation skills did not predict objective pain sensitivity or cognitive problems. CONCLUSION Results from this study highlight the benefits of adaptive emotion regulation in helping mitigate symptoms associated with breast cancer survivorship.
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Affiliation(s)
- Megan E Renna
- School of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Juan Peng
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marcella Rosie Shrout
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| | - Maryam Lustberg
- Yale Cancer Hospital, Yale School of Medicine, New Haven, CT, USA
| | | | - Robert Wesolowski
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey B VanDeusen
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nicole O Williams
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sagar D Sardesai
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne M Noonan
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Raquel E Reinbolt
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel G Stover
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mathew Cherian
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William B Malarkey
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rebecca Andridge
- Department of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
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Madison AA, Andridge R, Kantaras AH, Renna ME, Bennett JM, Alfano CM, Povoski SP, Agnese DM, Lustberg M, Wesolowski R, Carson WE, Williams NO, Reinbolt RE, Sardesai SD, Noonan AM, Stover DG, Cherian MA, Malarkey WB, Kiecolt-Glaser JK. Depression, Inflammation, and Intestinal Permeability: Associations with Subjective and Objective Cognitive Functioning throughout Breast Cancer Survivorship. Cancers (Basel) 2023; 15:4414. [PMID: 37686689 PMCID: PMC10487080 DOI: 10.3390/cancers15174414] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
About one-in-three breast cancer survivors have lingering cognitive complaints and objective cognitive impairment. Chronic inflammation and intestinal permeability (i.e., leaky gut), two risk factors for cognitive decline, can also fuel depression-another vulnerability for cognitive decline. The current study tested whether depression accompanied by high levels of inflammation or intestinal permeability predicted lower subjective and objective cognitive function in breast cancer survivors. We combined data from four breast cancer survivor studies (n = 613); some had repeated measurements for a total of 1015 study visits. All participants had a blood draw to obtain baseline measures of lipopolysaccharide binding protein-a measure of intestinal permeability, as well as three inflammatory markers that were incorporated into an inflammatory index: C-reactive protein, interleukin-6, and tumor necrosis factor-α. They reported depressive symptoms on the Center for Epidemiological Studies depression scale (CES-D), and a binary variable indicated clinically significant depressive symptoms (CES-D ≥ 16). The Kohli (749 observations) and the Breast Cancer Prevention Trial (591 observations) scales assessed subjective cognitive function. Objective cognitive function tests included the trail-making test, Hopkins verbal learning test, Conners continuous performance test, n-back test, FAS test, and animal-naming test (239-246 observations). Adjusting for education, age, BMI, cancer treatment type, time since treatment, study visit, and fatigue, women who had clinically elevated depressive symptoms accompanied by heightened inflammation or intestinal permeability reported poorer focus and marginally poorer memory. However, poorer performance across objective cognitive measures was not specific to inflammation-associated depression. Rather, there was some evidence of lower verbal fluency; poorer attention, verbal learning and memory, and working memory; and difficulties with visuospatial search among depressed survivors, regardless of inflammation. By themselves, inflammation and intestinal permeability less consistently predicted subjective or objective cognitive function. Breast cancer survivors with clinically significant depressive symptoms accompanied by either elevated inflammation or intestinal permeability may perceive greater cognitive difficulty, even though depression-related objective cognitive deficits may not be specific to inflammation- or leaky-gut-associated depression.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Biostatistics, The Ohio State University, Columbus, OH 43210, USA
| | - Anthony H Kantaras
- Department of Neuroscience, The Ohio State University, Columbus, OH 43210, USA
| | - Megan E Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Jeanette M Bennett
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC 28213, USA
| | | | - Stephen P Povoski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Doreen M Agnese
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Maryam Lustberg
- Center for Breast Cancer, Yale Cancer Center, Yale University, New Haven, CT 06519, USA
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - William E Carson
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Nicole O Williams
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Sagar D Sardesai
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Anne M Noonan
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Daniel G Stover
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Mathew A Cherian
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Madison AA, Renna M, Andridge R, Peng J, Shrout MR, Sheridan J, Lustberg M, Ramaswamy B, Wesolowski R, Williams NO, Noonan AM, Reinbolt RE, Stover DG, Cherian MA, Malarkey WB, Kiecolt-Glaser JK. Conflicts hurt: social stress predicts elevated pain and sadness after mild inflammatory increases. Pain 2023; 164:1985-1994. [PMID: 36943254 PMCID: PMC10440304 DOI: 10.1097/j.pain.0000000000002894] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023]
Abstract
ABSTRACT Individuals respond differently to inflammation. Pain, sadness, and fatigue are common correlates of inflammation among breast cancer survivors. Stress may predict response intensity. This study tested whether breast cancer survivors with greater exposure to acute or chronic social or nonsocial stress had larger increases in pain, sadness, and fatigue during an acute inflammatory response. In total, 156 postmenopausal breast cancer survivors (ages 36-78 years, stage I-IIIA, 1-9 years posttreatment) were randomized to either a typhoid vaccine/saline placebo or the placebo/vaccine sequence, which they received at 2 separate visits at least 1 month apart. Survivors had their blood drawn every 90 minutes for the next 8 hours postinjection to assess levels of interleukin-6 and interleukin-1 receptor antagonist (IL-1Ra). Shortly after each blood draw, they rated their current levels of pain, sadness, and fatigue. Women also completed the Test of Negative Social Exchange to assess chronic social stress and the Trier Inventory of Chronic Stressors screen to index chronic general stress. At each visit, a trained experimenter administered the Daily Inventory of Stressful Events to assess social and nonsocial stress exposure within the past 24 hours. After statistical adjustment for relevant demographic and behavioral covariates, the most consistent results were that survivors who reported more chronic social stress reported more pain and sadness in response to IL-1Ra increases. Frequent and ongoing social stress may sensitize the nervous system to the effects of inflammation, with potential implications for chronic pain and depression risk among breast cancer survivors.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, The Ohio State University, Columbus, OH, United States
| | - Megan Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Rebecca Andridge
- Division of Biostatistics, The Ohio State University, Columbus, OH, United States
| | - Juan Peng
- Division of Biostatistics, The Ohio State University, Columbus, OH, United States
| | - M Rosie Shrout
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - John Sheridan
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States
- Division of Biosciences, The Ohio State University College of Dentistry, Columbus, OH, United States
| | | | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert Wesolowski
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Nicole O Williams
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Anne M Noonan
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Raquel E Reinbolt
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Mathew A Cherian
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, United States
| | - William B Malarkey
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
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5
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Renna ME, Shrout MR, Madison AA, Lustberg M, Povoski SP, Agnese DM, Reinbolt RE, Wesolowski R, Williams NO, Ramaswamy B, Sardesai SD, Noonan AM, VanDeusen JB, Stover DG, Cherian M, Malarkey WB, Di Gregorio M, Kiecolt-Glaser JK. Distress Disorder Histories Relate to Greater Physical Symptoms Among Breast Cancer Patients and Survivors: Findings Across the Cancer Trajectory. Int J Behav Med 2023; 30:463-472. [PMID: 35831698 PMCID: PMC10278051 DOI: 10.1007/s12529-022-10115-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychological disorders can substantially worsen physical symptoms associated with breast cancer diagnosis and treatment, reducing survivors' quality of life and increasing recurrence risk. Distress disorders may be particularly detrimental given their physical correlates. Across two studies, we examined the relationship between a distress disorder history and physical symptoms pre- and post-adjuvant treatment - two important periods of the cancer trajectory. METHODS Breast cancer patients awaiting adjuvant treatment (n = 147; mean age = 52.54) in study 1 and survivors 1-10 years post-treatment (n = 183; mean age = 56.11) in study 2 completed a diagnostic interview assessing lifetime presence of psychological disorders. They also rated their pain, fatigue, physical functioning, and self-rated health. Covariates included body mass index, age, cancer stage, menopause status, and physical comorbidities. RESULTS Results from both studies indicated that a distress disorder history was associated with higher pain, fatigue, and sleep difficulties as well as lower self-rated health compared to those without such a history. CONCLUSIONS These findings suggest that breast cancer survivors with a distress disorder may be particularly at risk for more physical symptoms, poorer sleep, and worse self-rated health both prior to and following adjuvant treatment.
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Affiliation(s)
- Megan E Renna
- School of Psychology, University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS, 39406, USA.
| | | | | | | | | | - Doreen M Agnese
- The Ohio State University College of Medicine, Columbus, USA
| | | | | | | | | | | | - Anne M Noonan
- The Ohio State University College of Medicine, Columbus, USA
| | | | - Daniel G Stover
- The Ohio State University College of Medicine, Columbus, USA
| | - Mathew Cherian
- The Ohio State University College of Medicine, Columbus, USA
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6
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Delamare Fauvel A, Bischof JJ, Reinbolt RE, Weihing VK, Boyer EW, Caterino JM, Wang HE. Diagnosis of cancer in the Emergency Department: A scoping review. Cancer Med 2023; 12:8710-8728. [PMID: 36622062 PMCID: PMC10134283 DOI: 10.1002/cam4.5600] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Emergency Department (ED) plays a key role in the identification and care of acute medical conditions, including cancer. In this scoping review, we aimed to determine the role of the ED in the acute diagnosis of cancer. METHODS We conducted a scoping review of articles according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) using PubMed and Google Scholar. We screened studies of adults with a new diagnosis of cancer in the ED. We included randomized control trials, prospective, retrospective, and cross-sectional observational studies, and case reports published in English since 2000. We grouped the articles into categories based on their objectives and findings. RESULTS Of the 4459 articles, we included 47 in the review. The identified studies fell into three major categories: (1) studies describing the incidental diagnosis of cancer in the ED (n = 11, 23%), (2) studies characterizing the acute initial presentation of cancer in the ED (n = 19, 41%), and (3) studies describing the ED as a pathway to cancer diagnosis in the healthcare system (n = 17, 36%). Across the studies, cancer diagnoses in the ED were more likely in patients with higher comorbidities, occurred at later stages, and resulted in worse survival rates. CONCLUSIONS The ED plays a prominent role in the initial diagnosis of cancer. Efforts must be made to integrate the ED within the cancer care continuum.
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Affiliation(s)
- Alix Delamare Fauvel
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.,Emergency Department, Rouen University Hospital, Rouen, France
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Raquel E Reinbolt
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Veronica K Weihing
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Edward W Boyer
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
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7
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Madison AA, Filatov M, Andridge R, Haas G, Povoski SP, Agnese DM, Lustberg M, Reinbolt RE, Wesolowski R, Williams NO, Malarkey WB, Kiecolt-Glaser JK. A troubled heart: Mood disorder history longitudinally predicts faster cardiopulmonary aging in breast cancer survivorship. PLoS One 2023; 18:e0283849. [PMID: 37000800 PMCID: PMC10065250 DOI: 10.1371/journal.pone.0283849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Breast cancer survivors live longer due to more advanced cancer treatments; however, cardiovascular disease (CVD) is the leading non-cancer cause of death in breast cancer survivors. Previous studies have shown that depression is associated with an increased risk of CVD development. This study investigated whether depressive symptoms or mood disorder history, either independently or in combination with cardiotoxic treatments, predicted older cardiopulmonary age using a novel index-the Age Based on Exercise Stress Test (ABEST)-among breast cancer survivors. METHODS Breast cancer survivors (N = 80, ages 26-72, stage I-IIIA) were assessed an average of 53 days (SD = 26) post-surgery, but before adjuvant treatment, and again an average of 32 (SD = 6) months thereafter. At both visits, they reported depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D), completed the Structured Clinical Interview for DSM-V, and engaged in an exercise stress test to obtain ABEST scores. RESULTS Controlling for treatment type, age, education, trunk fat, antidepressant use, and time between visits, longitudinal analyses showed that breast cancer survivors with a mood disorder history had worsening ABEST scores over time, compared to their peers without this history (p = .046). Change in physical activity between Visits 1 and 2 did not mediate this relationship (95% CI: -0.16-0.51). Ancillary analyses provided some additional support for the primary finding, such that those with a mood disorder history trended toward greater decreases in Vo2max, although results were marginally non-significant (p = .095). There were no cross-sectional relationships between depressive symptoms or mood disorder history and ABEST scores (ps>.20). Treatment type did not modulate observed relationships (ps>.22). CONCLUSIONS Breast cancer survivors with a mood disorder history may experience faster cardiopulmonary aging compared to their peers without such a history, raising risk for CVD.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Psychology, The Ohio State University, Columbus, OH, United States of America
| | - Marie Filatov
- Department of Psychology, The Ohio State University, Columbus, OH, United States of America
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Division of Biostatistics, The Ohio State University, Columbus, OH, United States of America
| | - Garrie Haas
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Stephen P Povoski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Doreen M Agnese
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Maryam Lustberg
- Center for Breast Cancer, Yale Cancer Center, New Haven, CT, United States of America
| | - Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Nicole O Williams
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
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8
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Mitin N, Nyrop KA, Strum SL, Knecht A, Carey LA, Reeder-Hayes KE, Claire Dees E, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, O'Hare EA, Muss HB. A biomarker of aging, p16, predicts peripheral neuropathy in women receiving adjuvant taxanes for breast cancer. NPJ Breast Cancer 2022; 8:103. [PMID: 36075910 PMCID: PMC9458644 DOI: 10.1038/s41523-022-00473-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/09/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Identifying patients at higher risk of chemotherapy-induced peripheral neuropathy (CIPN) is a major unmet need given its high incidence, persistence, and detrimental effect on quality of life. We determined if the expression of p16, a biomarker of aging and cellular senescence, predicts CIPN in a prospective, multi-center study of 152 participants enrolled between 2014 and 2018. Any women with newly diagnosed Stage I–III breast cancer scheduled to receive taxane-containing chemotherapy was eligible. The primary outcome was development of grade 2 or higher CIPN during chemotherapy graded by the clinician before each chemotherapy cycle (NCI-CTCAE v5 criteria). We measured p16 expression in peripheral blood T cells by qPCR before and at the end of chemotherapy. A multivariate model identified risk factors for CIPN and included taxane regimen type, p16Age Gap, a measure of discordance between chronological age and p16 expression, and p16 expression before chemotherapy. Participants with higher p16Age Gap—higher chronological age but lower p16 expression prior to chemotherapy - were at the highest risk. In addition, higher levels of p16 before treatment, regardless of patient age, conferred an increased risk of CIPN. Incidence of CIPN positively correlated with chemotherapy-induced increase in p16 expression, with the largest increase seen in participants with the lowest p16 expression before treatment. We have shown that p16 expression levels before treatment can identify patients at high risk for taxane-induced CIPN. If confirmed, p16 might help guide chemotherapy selection in early breast cancer.
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Affiliation(s)
| | - Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Claire Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Raquel E Reinbolt
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin A O'Hare
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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9
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Kiecolt-Glaser JK, Renna M, Peng J, Sheridan J, Lustberg M, Ramaswamy B, Wesolowski R, VanDeusen JB, Williams NO, Sardesai SD, Noonan AM, Reinbolt RE, Stover DG, Cherian MA, Malarkey WB, Andridge R. Breast cancer survivors' typhoid vaccine responses: Chemotherapy, obesity, and fitness make a difference. Brain Behav Immun 2022; 103:1-9. [PMID: 35378230 PMCID: PMC9149127 DOI: 10.1016/j.bbi.2022.03.019] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate breast cancer survivors' inflammatory responses to typhoid vaccine as a window into their innate immune response to novel pathogens. METHODS This double-blind crossover trial randomized 158 breast cancer survivors to either the vaccine/saline placebo or the placebo/vaccine sequence. The relative contributions of age, cardiorespiratory fitness (VO2peak), type of cancer treatment, central obesity, and depression to interleukin (IL)-6, IL-1 receptor antagonist (IL-1Ra), and WBC vaccine responses were assessed pre-injection and 1.5, 3, 4.5, 6, and 7.5 h post-injection. RESULTS The vaccine produced larger IL-6, IL-1Ra, and WBC responses than placebo, ps < 0.0001. Prior chemotherapy, higher central obesity, and lower VO2peak were associated with smaller vaccine responses after controlling for baseline inflammation. Vaccine response was summarized by the percent increase in area under the curve (IL-6, WBC) or average post-injection mean (IL-1Ra) for vaccine relative to placebo. Women who received chemotherapy had smaller vaccine responses than women who did not for both IL-6 (44% vs 78%, p <.001) and WBC (26% vs 40%, p <.001); IL-1ra response was not significantly moderated by chemotherapy. Women whose central adiposity was one standard deviation above the mean had smaller vaccine responses than women with average adiposity for IL-6 (33% vs 54%, p <.001), WBC (20% vs 30%, p <.001), and IL-1Ra (2.0% vs 3.2%, p <.001). Women with an average level of VO2peak had smaller vaccine responses than women whose VO2peak was one standard deviation above the mean for IL-6 (54% vs 73%, p <.001), WBC (30% vs 40%, p <.001), and IL-1Ra (3.2% vs. 4.1%, p = 0.01). Age and depression did not significantly moderate vaccine responses. CONCLUSIONS This study provided novel data on chemotherapy's longer-term adverse immune consequences. The data also have an important public health message: even relatively low levels of fitness can benefit the innate immune response to a vaccine.
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Affiliation(s)
- Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH
| | - Megan Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS
| | - Juan Peng
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, College of Medicine, Columbus, OH
| | - John Sheridan
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH,Division of Biosciences, The Ohio State University College of Dentistry, Columbus, OH
| | | | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Robert Wesolowski
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Jeffrey B. VanDeusen
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Nicole O. Williams
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Sagar D. Sardesai
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Anne M. Noonan
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Raquel E. Reinbolt
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Daniel G. Stover
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - Mathew A. Cherian
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH
| | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
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10
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Reinbolt RE, Moline T, Rader J, Nilsson R, Garnett D, Liebner N, Graham L. Readmission risk identification: Implementation of a patient-centered interview. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6564] [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: 11/20/2022] Open
Abstract
6564 Background: Unplanned 30-day readmissions in the cancer population are common. There are few large studies describing cancer patients’ readmission perspective. To better define predisposing factors associated with readmission, our Nurse Case Manager team implemented a patient-focused survey. Methods: Cancer patients readmitted to The James Cancer Hospital from May 2020-December 2021 were included. Readmission events were defined as an inpatient hospital readmission within 30 days of the patient’s prior hospitalization. Team members conducted a 16-question survey immediately following readmission to evaluate the patients’ perspective on factors that may have contributed to their readmission; results were recorded. Results: A total of 3,333 readmissions were unplanned, 109 planned, 22 listed as other; 3,464 patients completed interviews (Table). During their index admission, most patients reported receiving (90%) and understanding (89%) discharge education/instructions. Upon index discharge, most patients (62%) were discharged on a new medication; the majority reported filling their prescription (95%) and taking it as instructed (98%). Nearly all patients had a post-index hospitalization follow up appointment scheduled, but only 58% reported attending. The primary reason reported for not attending was readmission prior to the appointment. Just over 50% of patients received a post-index hospital stay phone call. Some patients (6% yes; 58% unanswered) felt services at discharge would have been helpful. Most patients (51%) contacted their provider regarding worrisome symptoms experienced prior to being readmitted. Pain (18%), fever (11%), and shortness of breath (10%) were the most commonly reported symptoms that prompted returning to the hospital. Conclusions: To our knowledge, this is the largest study to date of cancer patients’ own perspective of their 30-day readmission. More immediate post-hospitalization follow up and increased deployment of tailored discharge services represent areas of opportunity identified to decrease readmission rates. Symptom-specific interventions may also be impactful. Due to the negative downstream effects readmissions have on the healthcare system, it is critical to develop risk mitigation strategies incorporating patient-reported experience. [Table: see text]
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Affiliation(s)
- Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Taylor Moline
- The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
| | - Julie Rader
- The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
| | - Rhonda Nilsson
- The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
| | - Doris Garnett
- The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
| | - Nicole Liebner
- The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
| | - Lisa Graham
- The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH
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11
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Quick AM, Hundley A, Evans C, Stephens JA, Ramaswamy B, Reinbolt RE, Noonan AM, Van Deusen JB, Wesolowski R, Stover DG, Williams NO, Sardesai SD, Faubion SS, Loprinzi CL, Lustberg MB. Long-Term Follow-Up of Fractional CO 2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors. J Clin Med 2022; 11:jcm11030774. [PMID: 35160226 PMCID: PMC8836519 DOI: 10.3390/jcm11030774] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The objective of this study was to determine the long-term efficacy of fractional CO2 laser therapy in breast cancer survivors. (2) Methods: This was a single-arm study of breast cancer survivors. Participants received three treatments of fractional CO2 laser therapy and returned for a 4 week follow-up. Participants were contacted for follow-up at annual intervals. The Vaginal Assessment Scale (VAS), the Female Sexual Function Index (FSFI), the Female Sexual Distress Scare Revised (FSDS-R), the Urinary Distress Inventory (UDI), and adverse events were collected and reported for the two-year follow-up. The changes in scores were compared between the four-week and two-year and the one-year and two-year follow-ups using paired t-tests. (3) Results: In total, 67 BC survivors were enrolled, 59 completed treatments and the four week follow-up, 39 participated in the one-year follow-up, and 33 participated in the two-year follow-up. After initial improvement in the VAS from baseline to the four week follow-up, there was no statistically significant difference in the VAS score (mean Δ 0.23; 95% CI [−0.05, 0.51], p = 0.150) between the four week follow-up and the two-year follow-up. At the two-year follow-up, the FSFI and FSDS-R scores remained improved from baseline and there was no statistically significant change in the FSFI score (mean Δ −0.83; 95% CI [−3.07, 2.38] p = 0.794) or the FSDS-R score (mean Δ −2.85; 95% CI [−1.88, 7.59] p = 0.227) from the one to two-year follow-up. The UDI scores approached baseline at the two-year follow-up; however, the change between the one- and two-year follow-ups was not statistically significant (mean Δ 4.76; 95% CI [−1.89, 11.41], p = 0.15). (4) Conclusions: Breast cancer survivors treated with fractional CO2 laser therapy have sustained improvement in sexual function two years after treatment completion, suggesting potential long-term benefit.
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Affiliation(s)
- Allison M. Quick
- Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Andrew Hundley
- Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (A.H.); (C.E.)
| | - Cynthia Evans
- Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (A.H.); (C.E.)
| | - Julie A. Stephens
- The Ohio State University Center for Biostatistics, Columbus, OH 43210, USA;
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Raquel E. Reinbolt
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Anne M. Noonan
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Jeffrey Bryan Van Deusen
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Robert Wesolowski
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Daniel G. Stover
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Nicole Olivia Williams
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Sagar D. Sardesai
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | | | | | - Maryam B. Lustberg
- Division of Medical Oncology Yale Cancer Center, New Haven, CT 06520, USA;
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12
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Nyrop KA, Damone EM, Deal AM, Wheeler SB, Charlot M, Reeve BB, Basch E, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Wood WA, Muss HB. Patient-reported treatment toxicity and adverse events in Black and White women receiving chemotherapy for early breast cancer. Breast Cancer Res Treat 2021; 191:409-422. [PMID: 34739658 DOI: 10.1007/s10549-021-06439-6] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE It is not known whether chemotherapy-related symptom experiences differ between Black and White women with early breast cancer (Stage I-III) receiving current chemotherapy regimens and, in turn, influences dose delay, dose reduction, early treatment discontinuation, or hospitalization. METHODS Patients self-reported their race and provided symptom reports for 17 major side effects throughout chemotherapy. Toxicity and adverse events were analyzed separately for anthracycline and non-anthracycline regimens. Fisher's exact tests and two-sample t-tests compared baseline patient characteristics. Modified Poisson regression estimated relative risks of moderate, severe, or very severe (MSVS) symptom severity, and chemotherapy-related adverse events.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.no changes RESULTS: In 294 patients accrued between 2014 and 2020, mean age was 58 (SD13) and 23% were Black. For anthracycline-based regimens, the only significant difference in MSVS symptoms was in lymphedema (41% Black vs 20% White, p = .04) after controlling for axillary surgery. For non-anthracycline regimens, the only significant difference was MSVS peripheral neuropathy (41% Blacks vs. 23% White) after controlling for taxane type (p = .05) and diabetes (p = .05). For all other symptoms, severity scores were similar. Dose reduction differed significantly for non-anthracycline regimens (49% Black vs. 25% White, p = .01), but not for anthracycline regimens or in dose delay, early treatment discontinuation, or hospitalization for either regimen. CONCLUSION Except for lymphedema and peripheral neuropathy, Black and White patients reported similar symptom severity during adjuvant chemotherapy. Dose reductions in Black patients were more common for non-anthracycline regimens. In this sample, there were minimal differences in patient-reported symptoms and other adverse outcomes in Black versus White patients.
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Affiliation(s)
- K A Nyrop
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - E M Damone
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Charlot
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B B Reeve
- Duke University School of Medicine, Durham, NC, USA
| | - E Basch
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S S Shachar
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L A Carey
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Reeder-Hayes
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E C Dees
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Jolly
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G G Kimmick
- Duke University School of Medicine, Durham, NC, USA
| | - M S Karuturi
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - R E Reinbolt
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J C Speca
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - W A Wood
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H B Muss
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Quick AM, Zvinovski F, Hudson C, Hundley A, Evans C, Stephens JA, Arthur E, Ramaswamy B, Reinbolt RE, Noonan AM, VanDeusen JB, Wesolowski R, Stover DG, Williams NO, Sardesai SD, Faubion SS, Loprinzi CL, Lustberg MB. Patient-reported sexual function of breast cancer survivors with genitourinary syndrome of menopause after fractional CO2 laser therapy. Menopause 2021; 28:642-649. [PMID: 33534429 DOI: 10.1097/gme.0000000000001738] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/19/2022]
Abstract
OBJECTIVE The objective of this pilot study was to evaluate the change in sexual function following treatment with fractional CO2 laser therapy in breast cancer (BC) survivors with genitourinary syndrome of menopause (GSM). METHODS A single-arm feasibility study of BC survivors with symptoms of GSM, including dyspareunia and/or vaginal dryness, was conducted. Participants who received three treatments with fractional CO2 laser and 4-week follow-up were contacted for patient-reported outcomes and adverse events at 12 months. Sexual function was measured using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale Revised (FSDS-R). Descriptive statistics were calculated for patient demographics and disease characteristics for the set of participants who agreed to long-term follow-up and those who were lost to follow-up. FSFI and FSDS-R scores were summarized at baseline, 4 weeks and 12 months, as well as the change from baseline, and were compared using a Wilcoxon signed rank test. RESULTS A total of 67 BC survivors enrolled, 59 completed treatments and 4-week follow-up; 39 participated in the 12 month follow-up. The overall FSFI score improved from baseline to 4-week follow-up (median Δ 8.8 [Q1, Q3] (QS) (2.2, 16.7)], P < 0.001). There were improvements at 4 weeks in all domains of the FSFI (P < 0.001 for each) including desire (median Δ 1.2; QS [0.6, 1.8]), arousal (median Δ 1.2; QS [0.3, 2.7]), lubrication (median Δ 1.8 (0, 3.3), orgasm (median Δ 1.2; QS [0, 3.6]), satisfaction (median Δ 1.6 (0.4, 3.2)), and pain (median Δ 1.6 (0, 3.6). The FSDS-R score also improved from baseline to 4-week follow-up (median Δ -10.0; QS [-16, -5] P < 0.001) indicating less sexually related distress. The scores of the FSFI and FSDS-R remained improved at 12 months and there were no serious adverse events reported. CONCLUSIONS In BC survivors with GSM, the total and individual domain scores of the FSFI and the FSDS-R improved after fractional CO2 laser therapy.
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Affiliation(s)
| | | | | | | | - Cynthia Evans
- The Ohio State University Medical Center, Columbus, OH
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH
| | | | | | | | - Anne M Noonan
- The Ohio State University Medical Center, Columbus, OH
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14
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Shachar SS, Deal AM, Reeder-Hayes KE, Nyrop KA, Mitin N, Anders CK, Carey LA, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Muss HB. Effects of Breast Cancer Adjuvant Chemotherapy Regimens on Expression of the Aging Biomarker, p16INK4a. JNCI Cancer Spectr 2020; 4:pkaa082. [PMID: 33409457 PMCID: PMC7771421 DOI: 10.1093/jncics/pkaa082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/29/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although chemotherapy saves lives, increasing evidence shows that chemotherapy accelerates aging. We previously demonstrated that mRNA expression of p16INK4a , a biomarker of senescence and molecular aging, increased early and dramatically after beginning adjuvant anthracycline-based regimens in early stage breast cancer patients. Here, we determined if changes in p16INK4a expression vary by chemotherapy regimen among early stage breast cancer patients. METHODS We conducted a study of stage I-III breast cancer patients receiving adjuvant or neoadjuvant chemotherapy. p16INK4a expression was analyzed prechemotherapy and postchemotherapy (median 6.2 months after the last chemotherapy) in peripheral blood T lymphocytes. Chemotherapy-induced change in p16INK4a expression was compared among regimens. All statistical tests were 2-sided. RESULTS In 146 women, chemotherapy was associated with a statistically significant increase in p16INK4a expression (accelerated aging of 17 years; P < .001). Anthracycline-based regimens were associated with the largest increases (accelerated aging of 23 to 26 years; P ≤ .008). Nonanthracycline-based regimens demonstrated a much smaller increase (accelerated aging of 9 to 11 years; P ≤ .15). In addition to the type of chemotherapy regimen, baseline p16INK4a levels, but not chronologic age or race, were also associated with the magnitude of increases in p16INK4a . Patients with lower p16INK4a levels at baseline were more likely to experience larger increases. CONCLUSIONS Our findings suggest that the aging effects of chemotherapy may be influenced by both chemotherapy type and the patient's baseline p16INK4a level. Measurement of p16INK4a expression is not currently available in the clinic, but nonanthracycline regimens offering similar efficacy as anthracycline regimens might be favored.
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Affiliation(s)
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Claire Dees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor A Jolly
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Raquel E Reinbolt
- Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | | | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Nyrop KA, Deal AM, Chen YT, Reeve BB, Basch EM, Wood WA, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Lee JT, Brenizer A, Muss HB. Patient-reported symptom severity, interference with daily activities, and adverse events in older and younger women receiving chemotherapy for early breast cancer. Cancer 2020; 127:957-967. [PMID: 33216355 DOI: 10.1002/cncr.33329] [Citation(s) in RCA: 4] [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] [Received: 08/24/2020] [Revised: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND To the authors' knowledge, it is unknown whether patient-reported symptom severity and symptom interference with daily activities differ between younger (aged <65 years) and older (aged ≥65 years) women receiving similar chemotherapy regimens for early breast cancer (EBC). METHODS Study participants rated 17 side effects of chemotherapy regimens currently in use in clinical practice (2014-2019). RESULTS Of 284 women with EBC (stage I-III), approximately 57% were aged <65 years and 43% were aged ≥65 years. For anthracycline-based regimens, a higher percentage of younger women reported moderate, severe, or very severe (MSVS) hot flashes (49% vs 18%) (P < .001). For nonanthracycline regimens, a higher percentage of younger women reported MSVS hot flashes (38% vs 19%) (P = .009) and a lower percentage reported MSVS arthralgia (28% vs 49%) (P = .005). With regard to symptom interference with daily activities, a higher percentage of younger women being treated with anthracycline-based regimens reported MSVS hot flashes (32% vs 7%) (P = .001) and myalgia (38% vs 18%) (P = .02). For nonanthracycline chemotherapy, a higher percentage of younger women reported MSVS interference for hot flashes (26% vs 9%) (P = .006) and lower percentages reported abdominal pain (13% vs 28%) (P = .02). Overall, there were no significant differences noted among younger versus older patients with regard to hospitalizations (19% vs 12%; P = .19), dose reductions (34% vs 31%; P = .50), dose delays (22% vs 25%; P = .59), or early treatment discontinuation (16% vs 16%; P = .9546). CONCLUSIONS Older and younger women with EBC who were treated with identical chemotherapy regimens generally experienced similar levels of symptom severity, symptom-related interference with daily activities, and adverse events. LAY SUMMARY In this study, women receiving chemotherapy for early breast cancer rated the severity of 17 symptoms and symptom interference with their activities of daily living. Older (aged ≥65 years) and younger (aged <65 years) women who received identical chemotherapy regimens generally experienced similar levels of symptom severity, symptom-related interference with daily activities, and adverse events.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi Tang Chen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina
| | - Ethan M Basch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William A Wood
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E Claire Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Addison Brenizer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Nyrop KA, Deal AM, Reeve BB, Basch E, Chen YT, Park JH, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Lee JT, Wood WA, Muss HB. Congruence of patient- and clinician-reported toxicity in women receiving chemotherapy for early breast cancer. Cancer 2020; 126:3084-3093. [PMID: 32315091 DOI: 10.1002/cncr.32898] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/08/2020] [Revised: 02/14/2020] [Accepted: 03/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, collected alongside the clinician-reported Common Terminology Criteria for Adverse Events, enables comparisons of patient and clinician reports on treatment toxicity. METHODS In a multisite study of women receiving chemotherapy for early-stage breast cancer, symptom reports were collected on the same day from patients and their clinicians for 17 symptoms; their data were not shared with each other. The proportions of moderate, severe, or very severe patient-reported symptom severity were compared with the proportions of clinician-rated grade 2, 3, or 4 toxicity. Patient-clinician agreement was assessed via κ statistics. Chi-square tests investigated whether patient characteristics were associated with patient-clinician agreement. RESULTS Among 267 women, the median age was 58 years (range, 24-83 years), and 26% were nonwhite. There was moderate scoring agreement (κ = 0.413-0.570) for 53% of symptoms, fair agreement for 41% (κ = 0.220-0.378), and slight agreement for 6% (κ = 0.188). For example, patient-reported and clinician-rated percentages were 22% and 8% for severe or very severe fatigue, 41% and 46% for moderate fatigue, 32% and 39% for mild fatigue, and 6% and 7% for none. Clinician severity scores were lower for nonwhite patients in comparison with white patients for peripheral neuropathy, nausea, arthralgia, and dyspnea. CONCLUSIONS Although clinician reporting of symptoms is common practice in oncology, there is suboptimal agreement with the gold standard of patient self-reporting. These data provide further evidence supporting the integration of patient-reported outcomes into oncological clinical research and clinical practice to improve monitoring of symptoms as well as timely interventions for symptoms.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina
| | - Ethan Basch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi Tang Chen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ji Hye Park
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth C Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Meghan S Karuturi
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | | | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William A Wood
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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17
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Adams EJ, Asad S, Abdel-Rasoul M, Reinbolt RE, Wesolowski R, Tolliver K, Gillespie S, Collier KA, Noonan A, Sardesai S, VanDeusen J, Williams N, Shapiro CL, Macre ER, Ramaswamy B, Lee CN, Lustberg MB, Stover DG. Abstract P5-10-03: Perceptions of somatic genomic testing in patients with metastatic breast cancer: Psychosocial factors, emotional well-being, and genetic comprehension. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-10-03] [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
Background: Little is known regarding the effect of somatic tumor genomic testing on patient perceptions and psychological well-being. We previously demonstrated that patient perceptions of care can be negatively affected if their next cancer treatment is not supported by the genomic test. To further understand this, we investigated psychological effects of genomic testing, as well as sociodemographic and genomic comprehension factors that may attenuate these effects. Methods: In a prospective, single institution, single-arm trial, patients with metastatic breast cancer underwent next-generation sequencing (NGS) using Foundation Medicine at study entry, with sequencing results released to providers at time of next disease progression. We evaluated patient survey data before and after NGS, including questions about psychosocial characteristics, genetic comprehension, and perceived risks and expectations of the genomic testing. We evaluated psychosocial characteristics using 4 validated psychology measures: the Center for Epidemiologic Studies Depression Scale (CES-D), the Beck Anxiety Inventory (BAI), the Trust in Physician Scale (TPS), and the Communication and Attitudinal Self-Efficacy scale for Cancer (CASE-cancer). CASE-cancer measures self-efficacy, how confident patients are in their ability to navigate their cancer care. Genetic comprehension was assessed with a 7-question objective measure and a 6-question subjective measure. No formal genetic education was provided, but the informed consent process included an introduction to NGS. We included exploratory questions on perceived risks and expectations of NGS. Results: Among the 58 patients who completed the pre-NGS survey, we found high rates of depression (38%) and anxiety (47%) using validated metrics. Depression and anxiety were positively correlated (Pearson’s r=0.61; p<0.0001) but both were negatively correlated with self-efficacy (Pearson’s r=-0.43 and -0.42 for depression and anxiety, respectively; p=0.001 for both). Baseline genetic knowledge was significantly lower for non-white and lower income status patients (p=0.04 and 0.001, respectively). Genetic knowledge was not associated with any of the 4 validated psychological measures. The validated psychological measures were not associated with demographic characteristics, treatment decisions, or number of treatment options offered by the NGS test. The average time between pre-test and post-test surveys was 7.6 months. Additionally, the validated psychology measures did not significantly change from pre- to post-study (n=40 patients). However, there was a strong trend of self-efficacy decreasing from pre- to post-NGS testing (p=0.05). Subjectively, patients gained confidence in their ability to teach others about genetics from the start (33% “confident”) to the end of study (46%). Yet, objective comprehension of genetics remained modest throughout the study, with an average score of 72% in both the pre- and post-NGS surveys. The exploratory patient perception questions revealed that 33% of patients felt learning their cancer had a high chance of progressing would be too much to cope with emotionally. Conclusions: This is the first study, to our knowledge, to longitudinally evaluate multiple validated psychological metrics in MBC. NGS did not have a significant effect on depression, anxiety, or trust, but there was a trend towards decreased self-efficacy. This may be influenced by the already high rates of depression, anxiety, and trust in this population. In this study, patient genetic knowledge was limited and associated with race and income. These findings raise important questions about how to support MBC patient emotional well-being and how to improve comprehension of somatic genomic testing in future studies.
Citation Format: Elizabeth J Adams, Sarah Asad, Mahmoud Abdel-Rasoul, Raquel E Reinbolt, Robert Wesolowski, Kaitlyn Tolliver, Susan Gillespie, Katherine A Collier, Anne Noonan, Sargar Sardesai, Jeffrey VanDeusen, Nicole Williams, Charles L Shapiro, Erin R Macre, Bhuvaneswari Ramaswamy, Clara N Lee, Maryam B Lustberg, Daniel G Stover. Perceptions of somatic genomic testing in patients with metastatic breast cancer: Psychosocial factors, emotional well-being, and genetic comprehension [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-10-03.
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Affiliation(s)
| | - Sarah Asad
- 1The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | - Susan Gillespie
- 1The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Anne Noonan
- 1The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sargar Sardesai
- 1The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Nicole Williams
- 1The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | - Clara N Lee
- 1The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Daniel G Stover
- 1The Ohio State University Wexner Medical Center, Columbus, OH
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18
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Stover DG, Reinbolt RE, Adams EJ, Asad S, Tolliver K, Abdel-Rasoul M, Timmers CD, Gillespie S, Chen JL, Ali SM, Collier KA, Cherian MA, Noonan AM, Sardesai S, VanDeusen J, Wesolowski R, Williams N, Lee CN, Shapiro CL, Macrae ER, Ramaswamy B, Lustberg MB. Prospective Decision Analysis Study of Clinical Genomic Testing in Metastatic Breast Cancer: Impact on Outcomes and Patient Perceptions. JCO Precis Oncol 2019; 3:1900090. [PMID: 32923860 DOI: 10.1200/po.19.00090] [Citation(s) in RCA: 5] [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] [Accepted: 10/26/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To evaluate the impact of targeted DNA sequencing on selection of cancer therapy for patients with metastatic breast cancer (MBC). PATIENTS AND METHODS In this prospective, single-center, single-arm trial, patients with MBC were enrolled within 10 weeks of starting a new therapy. At enrollment, tumor samples underwent next-generation sequencing for any of 315 cancer-related genes to high depth (> 500×) using FoundationOne CDx. Sequencing results were released to providers at the time of disease progression, and physician treatment recommendations were assessed via questionnaire. We evaluated three prespecified questions to assess patients' perceptions of genomic testing. RESULTS In all, 100 patients underwent genomic testing, with a median of five mutations (range, 0 to 13 mutations) detected per patient. Genomic testing revealed one or more potential therapies in 98% of patients (98 of 100), and 60% of patients (60 of 100) had one or more recommended treatments with level I/II evidence for actionability. Among the 94 genomic text reports that were released, there was physician questionnaire data for 87 patients (response rate, 92.6%) and 31.0% of patients (27 of 87) had treatment change recommended by their physician. Of these, 37.0% (10 of 27) received the treatment supported by genomic testing. We did not detect a statistically significant difference in time-to-treatment failure (log-rank P = .87) or overall survival (P = .71) among patients who had treatment change supported by genomic testing versus those who had no treatment change. For patients who completed surveys before and after genomic testing, there was a significant decrease in confidence of treatment success, specifically among patients who did not have treatment change supported by genomic testing (McNemar's test of agreement P = .001). CONCLUSION In this prospective study, genomic profiling of tumors in patients with MBC frequently identified potential treatments and resulted in treatment change in a minority of patients. Patients whose therapy was not changed on the basis of genomic testing seemed to have a decrease in confidence of treatment success.
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Affiliation(s)
- Daniel G Stover
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Raquel E Reinbolt
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | | | - Sarah Asad
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Katlyn Tolliver
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | | | - Cynthia D Timmers
- The Ohio State University College of Medicine, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Susan Gillespie
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - James L Chen
- The Ohio State University College of Medicine, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Katharine A Collier
- The Ohio State University College of Medicine, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mathew A Cherian
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Anne M Noonan
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Sagar Sardesai
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Jeffrey VanDeusen
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Nicole Williams
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Clara N Lee
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.,The Ohio State University College of Public Health, Columbus, OH
| | | | | | - Bhuvaneswari Ramaswamy
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Maryam B Lustberg
- The Ohio State University College of Medicine, Columbus, OH.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH
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19
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Nyrop KA, Deal AM, Reeder-Hayes KE, Shachar SS, Reeve BB, Basch E, Choi SK, Lee JT, Wood WA, Anders CK, Carey LA, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Muss HB. Patient-reported and clinician-reported chemotherapy-induced peripheral neuropathy in patients with early breast cancer: Current clinical practice. Cancer 2019; 125:2945-2954. [PMID: 31090930 DOI: 10.1002/cncr.32175] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 01/15/2019] [Revised: 04/01/2019] [Accepted: 04/11/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the current study, the authors investigated the incidence of moderate to severe chemotherapy-induced peripheral neuropathy (CIPN) for chemotherapy regimens commonly used in current clinical practice for the treatment of patients with early breast cancer. Patient-reported and clinician-assessed CIPN severity scores were compared, and risk factors for CIPN severity were identified. METHODS Patients completed a Patient-Reported Symptom Monitoring form and oncologists completed a Common Terminology Criteria for Adverse Events form. CIPN reports were collected prospectively during regularly scheduled infusion visits throughout the duration of chemotherapy. RESULTS The sample included 184 women with a mean age of 55 years; approximately 73% were white. The 4 chemotherapy regimens used were doxorubicin and cyclophosphamide plus paclitaxel (60 patients); docetaxel and cyclophosphamide (50 patients); docetaxel, carboplatin, and anti-human epidermal growth factor receptor 2 (HER2) (24 patients); and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin (18 patients). All patients treated with doxorubicin and cyclophosphamide plus paclitaxel and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin received paclitaxel; all patients treated with docetaxel and cyclophosphamide and docetaxel, carboplatin, and anti-HER2 received docetaxel. The chemotherapy dose was reduced in 52 patients (28%); in 15 patients (29%), this reduction was due to CIPN. Chemotherapy was discontinued in 26 patients (14%), 8 because of CIPN. Agreement between patient-reported and clinician-assessed CIPN severity scores was minimal (weighted Cohen kappa, P = .34). Patient-reported moderate to severe CIPN was higher for paclitaxel (50%) compared with docetaxel (17.7%) (P < .001). Pretreatment arthritis and/or rheumatism (relative risk [RR], 1.58; 95% CI, 1.06-2.35 [P = .023]) and regimens containing paclitaxel (RR, 2.88; 95% CI, 1.72-4.83 [P < .0001]) were associated with higher CIPN severity. Being married (RR, 0.57; 95% CI, 0.37-0.887 [P = .01]) was found to be associated with lower CIPN severity. CONCLUSIONS The discrepancy between patient-reported and clinician-assessed CIPN underscores the need for both patient and clinician perspectives regarding this common, dose-limiting, and potentially disabling side effect of chemotherapy.
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Affiliation(s)
- Kirsten A Nyrop
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn E Reeder-Hayes
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ethan Basch
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Seul Ki Choi
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - William A Wood
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carey K Anders
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A Carey
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth C Dees
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor A Jolly
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gretchen G Kimmick
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Meghan S Karuturi
- Department of Breast Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Raquel E Reinbolt
- Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - JoEllen C Speca
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Hyman B Muss
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Nyrop KA, Deal AM, Shachar SS, Basch E, Reeve BB, Choi SK, Lee JT, Wood WA, Anders CK, Carey LA, Dees EC, Jolly TA, Reeder-Hayes KE, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Muss HB. Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer. Oncologist 2018; 24:762-771. [PMID: 30552158 DOI: 10.1634/theoncologist.2018-0590] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 09/11/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study explores the incidence of patient-reported major toxicity-symptoms rated "moderate," "severe," or "very severe"-for chemotherapy regimens commonly used in early breast cancer. PATIENTS AND METHODS Female patients aged 21 years or older completed a validated Patient-Reported Symptom Monitoring instrument and rated 17 symptoms throughout adjuvant or neoadjuvant chemotherapy. Fisher's exact tests compared differences in percentages in symptom ratings, and general linear regression was used to model the incidence of patient-reported major toxicity. RESULTS In 152 patients, the mean age was 54 years (range, 24-77), and 112 (74%) were white; 51% received an anthracycline-based regimen. The proportion of patients rating fatigue, constipation, myalgia, diarrhea, nausea, peripheral neuropathy, and swelling of arms or legs as a major toxicity at any time during chemotherapy varied significantly among four chemotherapy regimens (p < .05). The mean (SD) number of symptoms rated major toxicities was 6.3 (3.6) for anthracycline-based and 4.4 (3.5) for non-anthracycline-based regimens (p = .001; possible range, 0-17 symptoms). Baseline higher body mass index (p = .03), patient-reported Karnofsky performance status ≤80 (p = .0003), and anthracycline-based regimens (p = .0003) were associated with greater total number of symptoms rated major toxicities (alternative model: chemotherapy duration, p < .0001). Twenty-six percent of dose reductions (26 of 40), 75% of hospitalizations (15 of 20), and 94% of treatment discontinuations (15 of 16) were in anthracycline-based regimens. CONCLUSION Capturing multiple toxicity outcomes throughout chemotherapy enables oncologists and patients to understand the range of side effects as they discuss treatment efficacies. Continuous symptom monitoring may aid in the timely development of interventions that minimize toxicity and improve outcomes. IMPLICATIONS FOR PRACTICE: This study investigated patient-reported toxicities for 17 symptoms recorded prospectively during adjuvant and neoadjuvant chemotherapy regimens for early breast cancer. An analysis of four commonly used chemotherapy regimens identified significant differences among regimens in both individual symptoms and total number of symptoms rated moderate, severe, or very severe. Longer chemotherapy regimens, such as anthracycline-based regimens followed by paclitaxel, had higher proportions of symptoms rated major toxicities. The inclusion of patient perspectives on multiple toxicity outcomes at the same time at multiple time points during chemotherapy has the potential for improving patient-provider communication regarding symptom management, patient satisfaction, and long-term clinical outcomes.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Ethan Basch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Seul Ki Choi
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Wood
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carey K Anders
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth C Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Raquel E Reinbolt
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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21
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Quick AM, Zvinovski F, Hudson C, Hundley A, Evans C, Suresh A, Stephens J, Carpenter K, Ramaswamy B, Reinbolt RE, Noonan AM, VanDeusen JB, Wesolowski R, Stover DG, Williams NO, Sardesai SD, Smith KL, Faubion SS, Loprinzi CL, Lustberg MB. Fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) in survivors of breast cancer (BC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.202] [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: 11/20/2022] Open
Abstract
202 Background: Fractional CO2 laser therapy is an emerging treatment for GSM. The objective of this study was to determine the feasibility, tolerability and preliminary efficacy of fractional CO2 laser therapy in BC survivors. Methods: This was a single arm feasibility study of BC survivors with dyspareunia and/or vaginal dryness. Participants received three treatments with office-based fractional CO2 laser on at least 30 day intervals and returned for a one-month follow-up. Feasibility was defined as treatment completion without serious adverse events (SAE) in a minimum of 80% of patients. Primary efficacy was evaluated using the mean change (∆) in the score on the Vaginal Assessment Scale (VAS). Secondary efficacy endpoints included mean ∆ in scores on the Female Sexual Function Index (FSFI) and Urogenital Distress Inventory (UDI). Descriptive statistics (means and 95% confidence intervals (CI) for continuous variables and proportions for categorical variables) were used. Results: The study is ongoing with 65 patients enrolled. To date, 37 patients have completed all study treatments and follow-up. Median age for those who have completed treatment was 57 years (range 34-72). Most were ER/PR positive (78%) and Her 2 negative (81%) with stage I (43%) or II (41%) BC. Ninety-five percent were receiving endocrine therapy, most commonly aromatase inhibitors (73%). No SAEs were reported in the 37 patients who have completed study treatments and their outcomes are as follows. Based on the VAS, 78% reported moderate-severe dyspareunia and 89% reported moderate-severe vaginal dryness at baseline. At follow up, 28% reported moderate-severe dyspareunia and 28% reported moderate-severe vaginal dryness. The VAS score improved from baseline to follow up (mean ∆ 4.1; 95% CI [3.1, 5.1]). Similarly, the FSFI score improved (mean ∆ -10.0; 95% CI [-13.2, -6.9]) and the UDI score improved (mean ∆ -5.7; 95% CI [-10.1, -1.3]). Final efficacy analysis will be reported once all patients have completed all time points. Conclusions: Fractional CO2 laser treatment is feasible and tolerable in BC survivors and may reduce symptom burden from GSM. A randomized controlled trial with sham laser is currently in development. Clinical trial information: NCT03307044.
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Affiliation(s)
| | | | | | | | - Cynthia Evans
- The Ohio State University Medical Center, Columbus, OH
| | - Anupama Suresh
- Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Julie Stephens
- Center for Biostatistics in the Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Kristen Carpenter
- Ohio State University Wexner Medical Center, Dept. of Psychiatry, Columbus, OH
| | | | - Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | | | | | - Karen L. Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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22
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Nyrop KA, Deal AM, Shachar SS, Basch EM, Reeve BB, Lee JT, Choi SK, Wood WA, Anders CK, Carey LA, Dees EC, Jolly TA, Reeder-Hayes KE, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Muss HB. Patient(Pt)-reported toxicities during breast cancer (BC) chemotherapy (CRx): Associations with pre-treatment (Tx) measures of quality of life (QOL) and Tx discontinuation. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Allison Mary Deal
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Ethan M. Basch
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jordan T Lee
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Seul Ki Choi
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - William Allen Wood
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | | | | | | | - Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - Hyman B. Muss
- University of North Carolina School of Medicine, Chapel Hill, NC
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23
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Nyrop KA, Deal AM, Shachar SS, Basch EM, Reeve BB, Lee JT, Choi SK, Wood WA, Anders CK, Carey LA, Dees EC, Jolly TA, Reeder-Hayes KE, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Muss HB. Patient(Pt)-reported toxicities by chemotherapy regimen for early breast cancer (BC) (LCCC1334/1440). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Allison Mary Deal
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Ethan M. Basch
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jordan T Lee
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Seul Ki Choi
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - William Allen Wood
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | | | | | | | - Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - Hyman B. Muss
- University of North Carolina School of Medicine, Chapel Hill, NC
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24
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Leblanc AF, Sprowl JA, Alberti P, Chiorazzi A, Arnold WD, Gibson AA, Hong KW, Pioso MS, Chen M, Huang KM, Chodisetty V, Costa O, Florea T, de Bruijn P, Mathijssen RH, Reinbolt RE, Lustberg MB, Sucheston-Campbell LE, Cavaletti G, Sparreboom A, Hu S. OATP1B2 deficiency protects against paclitaxel-induced neurotoxicity. J Clin Invest 2018; 128:816-825. [PMID: 29337310 DOI: 10.1172/jci96160] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/28/2017] [Indexed: 01/11/2023] Open
Abstract
Paclitaxel is among the most widely used anticancer drugs and is known to cause a dose-limiting peripheral neurotoxicity, the initiating mechanisms of which remain unknown. Here, we identified the murine solute carrier organic anion-transporting polypeptide B2 (OATP1B2) as a mediator of paclitaxel-induced neurotoxicity. Additionally, using established tests to assess acute and chronic paclitaxel-induced neurotoxicity, we found that genetic or pharmacologic knockout of OATP1B2 protected mice from mechanically induced allodynia, thermal hyperalgesia, and changes in digital maximal action potential amplitudes. The function of this transport system was inhibited by the tyrosine kinase inhibitor nilotinib through a noncompetitive mechanism, without compromising the anticancer properties of paclitaxel. Collectively, our findings reveal a pathway that explains the fundamental basis of paclitaxel-induced neurotoxicity, with potential implications for its therapeutic management.
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Affiliation(s)
- Alix F Leblanc
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Jason A Sprowl
- Department of Pharmaceutical, Social and Administrative Sciences, School of Pharmacy, D'Youville College, Buffalo, New York, USA
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessia Chiorazzi
- Experimental Neurology Unit and Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - W David Arnold
- Division of Neuromuscular Disorders, Department of Neurology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Alice A Gibson
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Kristen W Hong
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Marissa S Pioso
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Mingqing Chen
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Kevin M Huang
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Vamsi Chodisetty
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Olivia Costa
- Department of Pharmaceutical, Social and Administrative Sciences, School of Pharmacy, D'Youville College, Buffalo, New York, USA
| | - Tatiana Florea
- Department of Pharmaceutical, Social and Administrative Sciences, School of Pharmacy, D'Youville College, Buffalo, New York, USA
| | - Peter de Bruijn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Ron H Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Lara E Sucheston-Campbell
- Division of Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Guido Cavaletti
- Experimental Neurology Unit and Milan Center for Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alex Sparreboom
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Shuiying Hu
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
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25
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Reinbolt RE, Sonis S, Timmers CD, Fernández-Martínez JL, Cernea A, de Andrés-Galiana EJ, Hashemi S, Miller K, Pilarski R, Lustberg MB. Genomic risk prediction of aromatase inhibitor-related arthralgia in patients with breast cancer using a novel machine-learning algorithm. Cancer Med 2017; 7:240-253. [PMID: 29168353 PMCID: PMC5773952 DOI: 10.1002/cam4.1256] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 08/11/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 02/06/2023] Open
Abstract
Many breast cancer (BC) patients treated with aromatase inhibitors (AIs) develop aromatase inhibitor‐related arthralgia (AIA). Candidate gene studies to identify AIA risk are limited in scope. We evaluated the potential of a novel analytic algorithm (NAA) to predict AIA using germline single nucleotide polymorphisms (SNP) data obtained before treatment initiation. Systematic chart review of 700 AI‐treated patients with stage I‐III BC identified asymptomatic patients (n = 39) and those with clinically significant AIA resulting in AI termination or therapy switch (n = 123). Germline DNA was obtained and SNP genotyping performed using the Affymetrix UK BioBank Axiom Array to yield 695,277 SNPs. SNP clusters that most closely defined AIA risk were discovered using an NAA that sequentially combined statistical filtering and a machine‐learning algorithm. NCBI PhenGenI and Ensemble databases defined gene attribution of the most discriminating SNPs. Phenotype, pathway, and ontologic analyses assessed functional and mechanistic validity. Demographics were similar in cases and controls. A cluster of 70 SNPs, correlating to 57 genes, was identified. This SNP group predicted AIA occurrence with a maximum accuracy of 75.93%. Strong associations with arthralgia, breast cancer, and estrogen phenotypes were seen in 19/57 genes (33%) and were functionally consistent. Using a NAA, we identified a 70 SNP cluster that predicted AIA risk with fair accuracy. Phenotype, functional, and pathway analysis of attributed genes was consistent with clinical phenotypes. This study is the first to link a specific SNP/gene cluster to AIA risk independent of candidate gene bias.
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Affiliation(s)
- Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Stephen Sonis
- Primary Endpoint Solutions, Watertown, Massachusetts.,Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cynthia D Timmers
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Ana Cernea
- Primary Endpoint Solutions, Watertown, Massachusetts.,University of Oviedo, Oviedo, Spain
| | | | - Sepehr Hashemi
- Primary Endpoint Solutions, Watertown, Massachusetts.,Harvard School of Dental Medicine, Boston, Massachusetts
| | - Karin Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Robert Pilarski
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Maryam B Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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26
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Wesolowski R, Duggan MC, Stiff A, Markowitz J, Trikha P, Levine KM, Schoenfield L, Abdel-Rasoul M, Layman R, Ramaswamy B, Macrae ER, Lustberg MB, Reinbolt RE, Mrozek E, Byrd JC, Caligiuri MA, Mace TA, Carson WE. Circulating myeloid-derived suppressor cells increase in patients undergoing neo-adjuvant chemotherapy for breast cancer. Cancer Immunol Immunother 2017; 66:1437-1447. [PMID: 28688082 DOI: 10.1007/s00262-017-2038-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/29/2017] [Indexed: 12/22/2022]
Abstract
This study sought to evaluate whether myeloid-derived suppressor cells (MDSC) could be affected by chemotherapy and correlate with pathologic complete response (pCR) in breast cancer patients receiving neo-adjuvant chemotherapy. Peripheral blood levels of granulocytic (G-MDSC) and monocytic (M-MDSC) MDSC were measured by flow cytometry prior to cycle 1 and 2 of doxorubicin and cyclophosphamide and 1st and last administration of paclitaxel or paclitaxel/anti-HER2 therapy. Of 24 patients, 11, 6 and 7 patients were triple negative, HER2+ and hormone receptor+, respectively. 45.8% had pCR. Mean M-MDSC% were <1. Mean G-MDSC% and 95% confidence intervals were 0.88 (0.23-1.54), 5.07 (2.45-7.69), 9.32 (4.02-14.61) and 1.97 (0.53-3.41) at draws 1-4. The increase in G-MDSC by draw 3 was significant (p < 0.0001) in all breast cancer types. G-MDSC levels at the last draw were numerically lower in patients with pCR (1.15; 95% CI 0.14-2.16) versus patients with no pCR (2.71; 95% CI 0-5.47). There was no significant rise in G-MDSC from draw 1 to 3 in African American patients, and at draw 3 G-MDSC levels were significantly lower in African Americans versus Caucasians (p < 0.05). It was concluded that G-MDSC% increased during doxorubicin and cyclophosphamide therapy, but did not significantly differ between patients based on pathologic complete response.
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Affiliation(s)
- Robert Wesolowski
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Megan C Duggan
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Andrew Stiff
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Joseph Markowitz
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Prashant Trikha
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Kala M Levine
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Lynn Schoenfield
- Department of Pathology, The Ohio State University, 410 W 10th Ave, N337B Doan Hall, Columbus, OH, 43210-1267, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd, Columbus, OH, 43221, USA
| | - Rachel Layman
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA.,Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Erin R Macrae
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Maryam B Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Raquel E Reinbolt
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Ewa Mrozek
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Michael A Caligiuri
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Thomas A Mace
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, 410 W 10th Ave, N911 Doan Hall, Columbus, OH, 43210-1267, USA.
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27
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Stiff A, McQuinn C, Wesolowski R, Lustberg MB, Reinbolt RE, VanDeusen JB, Sardesai SD, Williams NO, Noonan AM, Dewani SJ, Ramaswamy B, Carson WE. Effect of neoadjuvant chemotherapy on immune checkpoint expression in breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12126] [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: 11/20/2022] Open
Abstract
e12126 Background: Even with neo-adjuvant chemotherapy (NAC) many breast cancer (BC) patients (pts) relapse, especially triple negative pts. The incorporation of checkpoint inhibitors into NAC for BC is being tested in clinical trials. How NAC affects checkpoint receptor expression is not known. Such information could aid in the rational selection of checkpoints to target during NAC. We sought to characterize changes in the frequency of circulating CD4 and CD8 T cells expressing PD1, CTLA4, LAG3, TIM3, and OX40 over the course of NAC. Methods: In this prospective trial, expression of PD-1, CTLA-4, Lag3, Tim3 and Ox40 on circulating CD4 and CD8 T cells were measured by FACS analysis in pts with operable breast cancer (BC) prior and at the end of NAC. The primary objective was to explore the association between NAC and expression levels of the immune checkpoints. Results: 1, 20 and 3 pts had clinical stage I, II, IIIA, respectively. Median age was 48. 11, 6 and 7 pts were triple negative (TN), HER2+ and hormone receptor (HR)+, respectively. Complete pathologic response rate was 45.8%. Globally CD4 T cells expressing CTLA4, Lag3, Ox40 and PD1 decreased following NAC (all p < 0.01). Conversely, CD8 T cells expressing CTLA4, Lag3 and Ox40 significantly increased (all p < 0.01). More CD8 T cells from HER2+ pts expressed Lag3 prior to therapy compared to HR+ pts (p < 0.05) with a similar trend compared to TN pts. Prior to therapy more CD8 T cells from HER2+ and TN pts expressed Tim3 compared to HR+ pts (p < 0.05 for each). Post therapy more CD4 T cells from HER2+ pts expressed PD1 compared to HR+ and TN pts (p = 0.027 and 0.018 respectively). Clinical response did not predict change in checkpoint expression. An interaction analysis revealed that HER2+ disease predicted a drop in CTLA4 CD4 T cells and a drop in Lag3 CD4 and CD8 T cells over NAC (p < 0.05). Conclusions: This analysis identified changes in checkpoint receptor expression by CD4 and CD8 T cells in BC pts after NAC. Differences in checkpoint receptor expression were found between BC subgroups. This data provides a starting point for understanding checkpoint receptor expression changes with NAC, and could help guide the selection and timing of incorporating checkpoint inhibitors in BC.
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Affiliation(s)
- Andrew Stiff
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Maryam B. Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | | | | | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
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28
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Reinbolt RE, Sonis ST, Timmers CD, Fernández-Martínez JL, deAndrés-Galiana EJ, Hashemi S, Miller K, Ramaswamy B, Wesolowski R, Noonan AM, Dewani SJ, Williams NO, Sardesai SD, Pilarski R, Lustberg MB. Genomic risk prediction of aromatase inhibitor-related arthralgias (AIA) in breast cancer (BC) patients using a novel analytical algorithm (NAA). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10102] [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: 11/20/2022] Open
Abstract
10102 Background: Many BC patients treated with aromatase inhibitors (AIs) develop AIA; 20% have symptoms severe enough to effect treatment compliance. Results of candidate gene studies to identify AIA risk are limited in scope. In this case-controlled study, we evaluated the potential of a NAA to predict AIA using germline single nucleotide polymorphism (SNP) data obtained prior to treatment initiation. Methods: Systematic chart review of 700 AI-treated patients with stage I-III BC between 2003-2012 identified asymptomatic patients (n = 39) and those with clinically significant AIA resulting in AI termination or therapy switch (n = 123). Germline DNA was obtained from peripheral blood cells and SNP genotyping performed using the Affymetrix UK BioBank Axiom Array to yield 695,277 SNPs. The identity of the cluster of SNPs that most closely defined AIA risk was discovered using an NAA that sequentially combined statistical filtering and a machine learning algorithm. NCBI PhenGenI and Ensemble databases were used to define gene attribution of the 200 most discriminating SNPs. Phenotype, pathway, and ontologic analyses assessed functional and mechanistic validity. Results: Cases and controls were similar in demographic characteristics. A cluster of 70 SNPs, correlated to 57 genes (accounting for linkage disequilibrium), was identified. This SNP group predicted AIA occurrence with a maximum accuracy of 75.93%. Strong associations with arthralgia, breast cancer, and estrogen phenotypes were seen in 19/57 genes (33%) and were functionally and ontologically consistent. Conclusions: Using a NAA, we identified a 70 SNP cluster that predicted AIA risk with fair accuracy. Phenotype, functional, and pathway analysis of attributed genes was consistent with clinical phenotypes. This study is the first to link a specific SNP/gene cluster to AIA risk independent of candidate gene bias. An ongoing prospective companion study will be used to validate and to expand upon results.
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Affiliation(s)
- Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | | | | | | | | | - Karin Miller
- Johns Hopkins University Department of Pathology, Baltimore, MD
| | | | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | | | | | - Robert Pilarski
- Division of Human Genetics and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Maryam B. Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
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Wesolowski R, Lustberg MB, Reinbolt RE, VanDeusen JB, Sardesai SD, Williams NO, Noonan AM, Dewani SJ, Poi M, Wilson D, Grever MR, Stephens J, Puhalla S, Mathew A, Carson WE, Ramaswamy B. Phase Ib study of heat shock protein 90 inhibitor, onalespib in combination with paclitaxel in patients with advanced, triple-negative breast cancer (NCT02474173). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps1127] [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: 11/20/2022] Open
Abstract
TPS1127 Background: Heat shock protein 90 (HSP90) is a molecular chaperone which is necessary for proper folding and stabilization of proteins. Client proteins of HSP90 include many oncogenic proteins known to be over-activated in triple negative breast cancer such as AKT, EGFR, members of RAS/MAPK signaling pathway and androgen receptor. High expression of HSP90 in breast cancer has been associated with poor outcome. In addition, over-expression of HSP90 client proteins such as AKT and c-RAF has been implicated in paclitaxel resistance. Onalespib (AT13387) is a synthetic non-ansamycin small molecule that acts as an inhibitor of HSP90 by binding to the amino terminal of the protein and has dissociation constant (Kd) of 0.71 nM. Methods: Patients with inoperable or metastatic, triple negative or < 10% hormone receptor positive breast cancer are treated with onalespib and paclitaxel on days 1, 8, 15 every 28 days. Paclitaxel is given at a standard dose of 80 mg/m2 while the dose of onalespib is gradually increased using standard 3+3 design (see table). In order to assess the effect of each drug on pharmacokinetics of the other drug, onalespib is given on day -7 prior to cycle 1 and skipped on day 1 of cycle 1 during which paclitaxel is administered alone. The primary objective of the study is to determine recommended phase II dose and assess the toxicity profile of the combination. The secondary objectives include pharmacokinetic of each agent. Overall response rate, response duration and progression-free survival will also be assessed. The study is currently enrolling patients to dose level 2. Clinical trial information: NCT02474173. [Table: see text]
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Affiliation(s)
- Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Maryam B. Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | - Raquel E. Reinbolt
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | | | | | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - Ming Poi
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Julie Stephens
- Center for Biostatistics in the Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | | | - Aju Mathew
- University of Kentucky Markey Cancer Center, Lexington, KY
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Monfort SM, Pan XJ, Patrick R, Singaravelu J, Layman RM, Mrozek E, Ramaswamy B, Reinbolt RE, Wesolowski R, Naughton MJ, Shapiro CL, Loprinzi CL, Chaudhari AM, Lustberg MB. Longitudinal changes in patient-reported symptoms and physical function during taxane-based chemotherapy in breast cancer patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10098] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Scott M. Monfort
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH
| | - Xueliang Jeff Pan
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Robyn Patrick
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University, Columbus, OH
| | | | - Rachel M. Layman
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Ewa Mrozek
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Bhuvaneswari Ramaswamy
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Raquel E. Reinbolt
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Ajit M.W. Chaudhari
- School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Maryam B. Lustberg
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
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Lustberg MB, Luff A, Young GS, Layman RM, Mrozek E, Reinbolt RE, Wesolowski R, Ramaswamy B. Metaplastic progression free survival compared to triple negative breast cancer, a retrospective analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12552] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Maryam B. Lustberg
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Amanda Luff
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Gregory S. Young
- The Ohio State University Center for Biostatistics, Columbus, OH
| | - Rachel M. Layman
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Ewa Mrozek
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Raquel E. Reinbolt
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Bhuvaneswari Ramaswamy
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
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Reinbolt RE, Tolliver K, Abdel-Rasoul M, Timmers CD, Ramaswamy B, Layman RM, Wesolowski R, Mrozek E, Gillespie S, Chen JL, Ali SM, Balasubramanian S, Shapiro CL, Ostrowski MC, Leone GW, Macrae EM, Lustberg MB. Decision impact analysis of comprehensive genomic profiling (CGP) in advanced breast cancer: A prospective study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11578] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Raquel E. Reinbolt
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Katlyn Tolliver
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mahmoud Abdel-Rasoul
- The Ohio State University Comprehensive Cancer Center, Center for Biostatistics, Columbus, OH
| | | | - Bhuvaneswari Ramaswamy
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Rachel M. Layman
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Ewa Mrozek
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
| | - Susan Gillespie
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James Lin Chen
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | - Gustavo W. Leone
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Maryam B. Lustberg
- The Ohio State University Medical Center James Comprehensive Cancer Center, Columbus, OH
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Reinbolt RE, Patel R, Pan X, Timmers CD, Pilarski R, Shapiro CL, Lustberg MB. Risk factors for anthracycline-associated cardiotoxicity. Support Care Cancer 2015; 24:2173-2180. [PMID: 26563179 DOI: 10.1007/s00520-015-3008-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 04/10/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Carbonyl reductase (CBR) catalyzes anthracycline metabolism, and single nucleotide polymorphisms (SNPs) in CBR impact metabolic efficiency. In pediatric patients, homozygosity for the major allele (G) in the CBR3 gene was associated with increased risk of anthracycline cardiotoxicity. We hypothesized that CBR SNPs contribute to cardiotoxicity in adults. METHODS We retrospectively identified female breast cancer patients in the Columbus Breast Tissue Bank Registry treated with adriamycin and cytoxan (AC) from 2003 to 2012. We selected patients who developed cardiomyopathy, defined as a drop in ejection fraction to <50 % or >15 % decrease from pre-therapy. Univariate and multivariate logistic regressions were performed to identify cardiotoxicity risk factors. SNPs were genotyped, and frequency of the major allele (G)/minor allele (A) of the CBR3 and CBR1 genes was calculated. RESULTS We identified 52 cases of cardiotoxicity after AC and 110 controls. Multivariate analysis showed that trastuzumab (p = 0.009), diabetes (p = 0.05), and consumption of >8 alcoholic drinks/week (p = 0.024) were associated with higher cardiotoxicity risk. Moderate alcohol consumption (<8 drinks/week) was associated with lower risk (p = 0.009). No association was identified between CBR SNPs and cardiotoxicity (CBR1 p = 0.261; CBR3 p = 0.556). CONCLUSIONS This is the first study to evaluate SNPs in the CBR pathway as predictors of AC cardiotoxicity in adults. We did not observe any significant correlation between cardiotoxicity and SNPs within the CBR pathway. Further investigation into CBR SNPs in a larger adult sample is needed. Additional exploration into genomic predictors of anthracycline cardiotoxicity may allow for the development of preventative and therapeutic strategies for those at risk.
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Affiliation(s)
- Raquel E Reinbolt
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, B421 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH, 43210, USA.
| | - Roshan Patel
- The Ohio State University College of Medicine, 1470, Highland St., Columbus, OH, 43210, USA
| | - Xueliang Pan
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, 2012, Kenny Road, Columbus, OH, 43221, USA
| | | | - Robert Pilarski
- Division of Human Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Charles L Shapiro
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, B421 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH, 43210, USA
| | - Maryam B Lustberg
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, B421 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH, 43210, USA
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Reinbolt RE, Pan XJ, Wandell KK, Pilarski R, Layman RM, Mrozek E, Ramaswamy B, Wesolowski R, Lustberg MB. Impact of breast cancer treatment on body mass index (BMI) over time. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.28_suppl.94] [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: 11/20/2022] Open
Abstract
94 Background: Weight gain concerns breast cancer patients, can impact quality of life, may lead to therapy non-adherence, and is associated with increased recurrence risk and mortality. Early placebo-controlled trials did not identify a clear correlation between Tamoxifen (TAM) and weight gain; gain due to aromatase inhibitors (AIs) is not well characterized. We hypothesized that weight gain occurs more frequently than previously reported in breast cancer patients receiving endocrine therapy. Methods: This is a retrospective chart review investigating body mass index (BMI) change in women after breast cancer therapy. Patients with early stage breast cancer and whom had BMI and treatment data (at least 90 days) from 2003-2012 were identified in The Columbus Breast Cancer Tissue Bank. Patients were separated by treatment received: chemotherapy with and without endocrine therapy vs. endocrine therapy alone (including both TAM and AIs) vs. no other treatment. Results: A total of 970 subjects were included in the analysis. At diagnosis and/or treatment initiation, patients’ mean BMI was 29.2 ± 7.0 kg/m2; mean age 53.7± 11.6 years; and average length of therapy/follow up per patient, 1833 days (range 90-3,990). Patients who received an AI alone had significantly decreased BMIs during therapy (-0.65± 0.29 kg/m2, p = 0.025), whereas patients receiving chemotherapy alone, chemotherapy with TAM, or TAM followed by AI therapy, had significantly increased BMIs (0.51 ± 0.25, 0.73 ± 0.26, 1.01 ± 0.51 kg/m2; p = 0.039, 0.005, 0.045, respectively). Both older age and a higher BMI at diagnosis were associated with a significantly greater decline in BMI over treatment time (p < 0.001 and p < 0.001, respectively). In a multivariate regression model, after adjusting for age and initial BMI effect, the BMI change noted among different treatment groups was no longer significantly different (p = 0.43). BMI change was not statistically associated with treatment length (p = 0.26). Conclusions: Our review of a large, early stage breast cancer patient cohort showed no association between weight gain and endocrine therapy after adjusting for the effect of initial BMI and age at diagnosis. Additional study is needed to identify other factors impacting weight in this population.
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Affiliation(s)
| | - Xueliang Jeff Pan
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center – The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | | | - Robert Pilarski
- Division of Human Genetics and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Rachel M. Layman
- The Ohio State University Medical Center James CCC, Columbus, OH
| | - Ewa Mrozek
- The Ohio State University Medical Center James CCC, Columbus, OH
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Wandell KK, Lustberg MB, Reinbolt RE, Orchard T, Andridge R, Wandell H, Schade C, Moran T, Yang N, Conlan T. Effects of chemotherapy on quality of life in breast cancer survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.28_suppl.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
112 Background: Women undergoing chemotherapy for breast cancer often experience side effects that can impact quality of life and tolerance of planned therapy. This can lead to poor outcomes. By understanding these changes, we can intervene and improve the treatment for women. We hypothesized that chemotherapy would be associated with changes in functional status and nutrition related symptoms in breast cancer survivors. Methods: Patients were prospectively recruited prior to initiation of their neo-adjuvant or adjuvant therapy. Body mass index (BMI) was abstracted from records. The patient’s functional status was assessed using the Duke Activity Status Index (DASI), and the Patient Generated Subjective Global Assessment (PG-SGA) characterized nutrition-related symptoms of patients. Participants completed these questionnaires prior to initiating the first cycle chemotherapy (time point 1), during the second cycle (time point 2), and during the last cycle of chemotherapy, 12-20 weeks after initiation of treatment (time point 3). Changes in BMI, functional status, and symptomatology were analyzed using linear mixed effects models. Results: Twenty-five women enrolled; 19 women with a median age of 51 (range 33-66) completed the study. There was no significant change in BMI (p = 0.18) over the duration of chemotherapy. Analysis of DASI data indicated that there was a significant decline in peak oxygen uptake (p = 0.005), showing a decrease in functional capacity from before the first cycle to both the second and the last cycles. This suggests that functional capacity dropped significantly once chemotherapy began and stayed below baseline. There was also a significant change in PG-SGA (p = 0.005), indicating significant reported nutrition-related symptoms. PG-SGA scores were significantly higher during the second cycle compared to the other two time points, indicating that patient’s showed the highest degree of symptoms shortly after initiation of treatment and then improved. Conclusions: Chemotherapy is associated with symptomatology and a decrease in functional capabilities. Improved understanding of symptom burden during chemotherapy will allow more specific interventions to be designed that can help improve quality of life.
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Affiliation(s)
| | | | | | - Tonya Orchard
- The Ohio State University College of Education and Human Ecology, Columbus, OH
| | - Rebecca Andridge
- The Ohio State University College of Public Health, Columbus, OH
| | | | | | - Tim Moran
- The Ohio State University, Columbus, OH
| | - Nan Yang
- The Ohio State University, Columbus, OH
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Lustberg MB, Monfort S, Singaravelu J, Reinbolt RE, Pan X, Ramaswamy B, Layman RM, Wesolowski R, Mrozek E, Macrae E, Shapiro C, Patrick R, Loprinzi CL, Chaudhari A. Abstract P1-09-04: Longitudinal evaluation of taxane-induced neuropathy in early stage breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-09-04] [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
Introduction
Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several chemotherapy drug classes, including taxanes. Peripheral neuropathies have been shown to lead to pain, falls, and difficulty in walking and performing activities of daily living in a variety of patient populations. Although the prevalence of CIPN has been noted in cancer patients, the development of self-reported symptoms, gait changes and balance changes during treatment have not been well explored to date. We hypothesized that the use of taxane-based chemotherapy will result in significant changes in spatiotemporal gait and balance parameters, as well as self-reported quality of life and function.
Methods
We characterized the alterations in gait and balance that occur in non-metastatic breast cancer patients during taxane chemotherapy. We evaluated (1) spatiotemporal gait parameters, including cadence and step length, and (2) balance parameters, including time-to-contact and 95% ellipse area, using each patient as her own control. Laboratory assessment of gait and balance was conducted at baseline and at completion of therapy in selected patients. We compared the natural history of changes in gait and balance parameters with changes in CIPN status as measured by validated patient reported outcomes, including EORTC QLQ-C30, CIPN-20, and Brief Pain Inventory Short Form (BPI-SF), and the Duke Activity Status Index (DASI). Time points included pre-chemotherapy, after each cycle of chemotherapy, and one month after the end of therapy to collect information on neuropathy, pain and functional capacity. The preliminary data were illustrated using individual plots; trend lines (changing over time) were based on least square means at each time point, which were estimated using the linear mixed models for repeated measures.
Results
To date, 15 patients with localized breast cancer have been enrolled; patient recruitment is ongoing. The median age is 42 years (range 25-67). Ten patients (67%) received weekly paclitaxel, 1 patient (7%) received paclitaxel every 2 weeks, and 4 patients (27%) received docetaxel every 3 weeks. Preliminary results with these 15 patients, based on least square means at each timepoint, showed trends in several parameters. As treatments progressed, patients tended to develop more difficulty in quiet balance and in their ability to actively shift weight in the sagittal and frontal planes. From the CIPN-20, they also tended to develop increased difficulty with sensory and motor systems. From the QLQ-C30, their global health status also tended to worsen. For most of these parameters, the largest changes were observed between the 2nd and 3rd treatments, though some changes were not observed until the 4th treatment. From the BPI-SF, no trends in pain symptoms or pain interference were observed within this preliminary cohort.
Conclusions
Gait and balance testing is feasible in the clinical setting. Preliminary observations suggest that balance, function and quality of life may all be affected by taxane therapy, even without pain symptoms. The findings of this study will enable us to better characterize the neurotoxic effect of taxanes and to ultimately test the effectiveness of preventative measures and interventions.
Funding by NCI R03CA182165-01.
Citation Format: Maryam B Lustberg, Scott Monfort, Janani Singaravelu, Raquel E Reinbolt, Xueliang Pan, Bhuvaneswari Ramaswamy, Rachel M Layman, Robert Wesolowski, Ewa Mrozek, Erin Macrae, Charles Shapiro, Robyn Patrick, Charles L Loprinzi, Ajit Chaudhari. Longitudinal evaluation of taxane-induced neuropathy in early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-04.
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Affiliation(s)
- Maryam B Lustberg
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | | | | | - Raquel E Reinbolt
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | | | - Bhuvaneswari Ramaswamy
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Rachel M Layman
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Robert Wesolowski
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Ewa Mrozek
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Erin Macrae
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Charles Shapiro
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
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Reinbolt RE, Mangini N, Hill JL, Levine LB, Dempsey JL, Singaravelu J, Koehler KA, Talley A, Lustberg MB. Endocrine therapy in breast cancer: the neoadjuvant, adjuvant, and metastatic approach. Semin Oncol Nurs 2015; 31:146-55. [PMID: 25951743 DOI: 10.1016/j.soncn.2015.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the rationale for endocrine therapy in the neoadjuvant, adjuvant, and metastatic breast cancer setting and to highlight clinical considerations unique to this treatment. DATA SOURCES Contemporary literature, clinical guidelines, and national statistics. CONCLUSION Endocrine therapy represents an important strategy in the management of both early and advanced hormone positive breast cancer. Additional research is required to better define the role of neoadjuvant therapy and the optimal duration of treatment. IMPLICATIONS FOR NURSING PRACTICE Nurses play a pivotal role in the identification and management of endocrine therapy-associated symptoms. Prompt symptom intervention may improve therapy adherence and ultimately, may improve long-term disease outcomes.
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Oostra DR, Lustberg MB, Reinbolt RE, Pan X, Wesolowski R, Shapiro CL. Association of osteoprotegerin and bone loss after adjuvant chemotherapy in early-stage breast cancer. Mol Cell Endocrinol 2015; 402:51-6. [PMID: 25575458 PMCID: PMC4316829 DOI: 10.1016/j.mce.2014.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/05/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Chemotherapy induced ovarian failure (CIOF) results in rapid bone loss. Receptor Activator of Nuclear Factor Kappa-B (RANK)-RANK ligand (RANK-L) signaling balances bone resorption and formation. Osteoprotegerin (OPG) acts as a decoy receptor for RANK, interrupting osteoclast activation and bone resorption. This study examined the relationship between OPG and bone loss in women with CIOF. METHODS Premenopausal women with stage I/II breast cancers receiving adjuvant chemotherapy were evaluated at chemotherapy initiation, 6 and 12 months. Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN), follicle stimulating hormone (FSH), ionized calcium, osteocalcin, and OPG were serially measured. CIOF was defined as a negative pregnancy test, FSH levels >30 MIU/mL, and ≥3 months of amenorrhea. RESULTS Forty women were enrolled; 31 (77.5%) met CIOF criteria. BMD significantly decreased (p < 0.001) in the CIOF group at both time points: LS BMD decreased from a median of 0.993 g/cm(2) to 0.976 g/cm(2) and 0.937 g/cm(2) at 6 and 12 months, respectively. OPG was significantly elevated at 6 months (median increase 0.30 pmol/L, p = 0.015) and then decreased at 12 months to levels still above baseline (median difference 0.2 pmol/L, p = 0.70). CONCLUSIONS In what was likely a compensatory response to rapid bone loss, CIOF patients' OPG levels increased at 6 months and then decreased at 12 months to values greater than baseline assessments. This phenomenon is described in other diseases, but never before in CIOF.
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Affiliation(s)
- Drew R Oostra
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Maryam B Lustberg
- The Breast Program, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA; Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA.
| | - Raquel E Reinbolt
- The Breast Program, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA; Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
| | - Xueliang Pan
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Robert Wesolowski
- The Breast Program, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA; Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
| | - Charles L Shapiro
- The Breast Program, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA; Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
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39
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Affiliation(s)
- Raquel E. Reinbolt
- The Stefanie Spielman Comprehensive Breast Center, Ohio State University Wexner Medical Center, Columbus, OH
| | - Roshan Patel
- The Ohio State University College of Medicine, Columbus, OH
| | - Xueliang Jeff Pan
- Center for Biostatisics, The Ohio State University Comprehensive Cancer Center – The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | | | - Robert Pilarski
- Division of Human Genetics and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Charles L. Shapiro
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Maryam B. Lustberg
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
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Abstract
Gynecologic malignancies annually account for over 91,000 new cancer cases and approximately 28,000 deaths in the United States. Although there have been advancements in cytotoxic chemotherapies, there has not been significant improvement in overall survival in these patients. While targeted therapies have shown some benefit in many solid tumors, further development of these agents is needed for the treatment of gynecologic malignancies. Poly(ADP-ribose) polymerase (PARP) catalyzes the polyADP-ribosylation of proteins involved in DNA repair. Inhibitors of PARP were originally developed for cancers with homologous recombination deficiencies, such as those harboring mutations in BRCA1 or BRCA2 genes. However, pre-clinical research and clinical trials have suggested that the activity of PARP inhibitors is not limited to those with BRCA mutations. PARP inhibitors may have activity in cancers deficient in other DNA repair genes, signaling pathways that mitigate DNA repair, or in combination with DNA-damaging agents independent of DNA repair dysfunction. Currently there are seven different PARP inhibitors in clinical development for cancer. While there has been promising clinical activity for some of these agents, there are still significant unanswered questions regarding their use. Going forward, specific questions that must be answered include timing of therapy, use in combination with cytotoxic agents or as single-agent maintenance therapy, and whether there is a predictive biomarker that can be used with PARP inhibition. Even with large strides in the treatment of many gynecologic malignancies in recent years, it is imperative that we develop newer agents and methods to identify patients that may benefit from these compounds. The focus of this review will be on pre-clinical data, current clinical trials, and the future of PARP inhibitors in the treatment of ovarian, endometrial, and cervical cancer.
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Affiliation(s)
- Raquel E Reinbolt
- Division of Medical Oncology, Department of Internal Medicine, The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Reinbolt RE, Shapiro CL, Garrett J, Basinger H, Lester JL, Muscari N, Ries K, Lustberg MB. Integrative model for breast cancer survivorship. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.132] [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: 11/20/2022] Open
Abstract
132 Background: Efforts to better address needs of survivors, summative care plans, and point of delivery are ongoing at academic, research, and community institutions. Lacking are empiric data to support one method over another. Methods: A quasi-experimental approach was used to measure a multidisciplinary integrative care model that involved the primary nurse, nurse practitioner, and medical oncologist to determine the best time, method, and application of cancer survivorship care planning. A concomitant cross-sectional study was ongoing in which patients completed the Distress Thermometer (0-10 analog score) plus a problem list (34 items) in early survivorship (e.g. during treatment, at its end, at 3- and 6-months later). Results: As a result of our teamwork, data from the electronic medical record (EMR) was integrated into end-of-treatment summaries and care plans; ‘smart-phrases’ provided links to personalized patient data which resulted in individualized care plans. The average self-reported distress level in early survivorship was 4.8, indicating a moderate to severe level of distress. Patients stated practical problems (e.g. finances, work) were of highest concern, followed by physical symptoms (e.g. fatigue, aches/pains), then emotional and family issues were prime distressors. The integrative model allowed our work teams to provide personalized services with a greater understanding of each individual patient. Data is presently being collected to quantify these services. Through this multidisciplinary approach, team-driven initiatives, and EMR integration, the preparation, delivery and follow up required for survivorship encounters was greatly streamlined. Conclusions: An integrative care model that is linked to the electronic medical record provides personalized care in a timely manner that is neither time nor resource intensive. We ‘listened’ to our patients and have diligently worked to increase and expand resources. Future initiatives include group educational sessions, earlier discussion of survivorship goals, and treatment summary generation at diagnosis. We believe this model will serve as the foundation for survivorship care expansion in our breast program, and can potentially be generalized to other institutions.
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Affiliation(s)
| | - Charles L. Shapiro
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Julia Garrett
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Heidi Basinger
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Joanne L. Lester
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nicole Muscari
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Kathleen Ries
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
| | - Maryam B. Lustberg
- The Breast Program, The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center, Columbus, OH
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42
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Abstract
Optimizing health outcomes, including prevention of osteoporotic fractures, is essential for promoting the well-being of the growing number of cancer survivors. Medical providers who participate in the care of cancer survivors should be aware that various cancer treatments may cause bone loss, which can increase the risk of subsequent of osteoporosis. Healthy bone remodeling is a balanced and dynamic equation between new bone formation and bone resorption. Aging, natural menopause, and cancer treatments such as surgical oophorectomy, gonadotropin-releasing hormone agonists, chemotherapy-induced ovarian failure, androgen deprivation therapy, and aromatase inhibitors can all promote bone loss. The WHO Fracture Assessment Tool can be used as a clinical aid to assess an individual's osteoporotic fracture risk, with or without bone mineral density measurements obtained from dual-energy x-ray absorptiometry. Preventative strategies include adequate calcium and vitamin D supplementation and modifying risk factors such as alcohol intake, tobacco use, and lack of exercise. Bisphosphonate therapy and rank-ligand monoclonal antibody therapy are the most commonly used agents for management of bone loss resulting from cancer treatment. This review will summarize the mechanisms by which cancer treatments cause bone loss as well provide screening and treatment recommendations for the management of bone loss.
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Reinbolt RE, Alam S, Layman R, Shapiro C, Lustberg M. Pneumocystis jiroveci Pneumonia in an Atypical Host. Clin Breast Cancer 2012; 12:138-41. [PMID: 22133356 PMCID: PMC3498486 DOI: 10.1016/j.clbc.2011.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Raquel E Reinbolt
- Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA.
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Abstract
Symptom control is one of the primary goals of hospice care. We prospectively followed patients with advanced cancer receiving outpatient hospice care to determine if the use of antimicrobials for a clinically suspected infection improved infection-related symptoms. During a 24-month period, 1,731 patients with a cancer diagnosis were admitted to a community-based outpatient hospice program. Over 89% of the patients had a Karnofsky performance of < or =60%. Six hundred twenty-three of 1,598 study patients were diagnosed with a total of 685 infections. Six hundred thirty-three of the infections were treated with antimicrobials for a clinically suspected infection. Symptoms were recorded, clinically indicated cultures were obtained, and antimicrobials were instituted at the discretion of the attending physician. Patients were subsequently monitored to determine the effects of antimicrobials on infection-related symptoms. A complete or a partial response of infection-related symptoms was observed in 79% of 265 patients with urinary tract infections, 43% of 221 patients with respiratory tract infections, 46% of 63 patients with oral cavity infections, 41% of 59 patients with skin or subcutaneous infections, and none of 25 patients with bacteremia. Fifty-two of the infections were not evaluable due to refusal of antimicrobials or receipt of less than 72 hours of antimicrobials. Patient survival in this study was not affected by the presence of infection or the use of antimicrobials. Although the use of antimicrobials improved symptoms in the majority of patients with urinary tract infections, symptom control was less successful in infections of the respiratory tract, mouth/pharynx, skin/subcutaneous tissue, or blood. Physicians should be aware of the limitations of the use of antimicrobials in patients with advanced cancer receiving hospice care. Treatment guidelines are proposed emphasizing the importance of patient preferences and the use of symptom control as the major indication for the use of antimicrobials in this patient population.
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Affiliation(s)
- Raquel E Reinbolt
- Walther Cancer Research Center, University of Notre Dame, Notre Dame, Indiana 46556, USA
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