HOPE (SOLTI-1903) breast cancer study: real-world, patient-centric, clinical practice study to assess the impact of genomic data on next treatment decision-choice in patients with locally advanced or metastatic breast cancer

Background

Metastatic breast cancer (mBC) causes nearly all BC-related deaths. Next-generation sequencing (NGS) technologies allow for the application of personalized medicine using targeted therapies that could improve patients' outcomes. However, NGS is not routinely used in the clinical practice and its cost induces access-inequity among patients. We hypothesized that promoting active patient participation in the management of their disease offering access to NGS testing and to the subsequent medical interpretation and recommendations provided by a multidisciplinary molecular advisory board (MAB) could contribute to progressively overcome this challenge. We designed HOPE (SOLTI-1903) breast cancer trial, a study where patients voluntarily lead their inclusion through a digital tool (DT). The main objectives of HOPE study are to empower mBC patients, gather real-world data on the use of molecular information in the management of mBC and to generate evidence to assess the clinical utility for healthcare systems.

Trial design

After self-registration through the DT, the study team validates eligibility criteria and assists patients with mBC in the subsequent steps. Patients get access to the information sheet and sign the informed consent form through an advanced digital signature. Afterwards, they provide the most recent (preferably) metastatic archival tumor sample for DNA-sequencing and a blood sample obtained at the time of disease progression for ctDNA analysis. Paired results are reviewed by the MAB, considering patient's medical history. The MAB provides a further interpretation of molecular results and potential treatment recommendations, including ongoing clinical trials and further (germline) genetic testing. Participants self-document their treatment and disease evolution for the next 2 years. Patients are encouraged to involve their physicians in the study. HOPE also includes a patient empowerment program with educational workshops and videos about mBC and precision medicine in oncology. The primary endpoint of the study was to describe the feasibility of a patient-centric precision oncology program in mBC patients when a comprehensive genomic profile is available to decide on a subsequent line of treatment.

Clinical trial registration

www.soltihope.com, identifier NCT04497285.

Ecological momentary assessment of contextual variables, satisfaction, and emotional and behavioral states of adolescents by level of victimization

The harmful effects of victimization on mental health have been demonstrated in several age groups, cultures, and populations, but there is wide variability in the resulting psychopathology. Ecological momentary assessment (EMA) allows the expression of an emotional state to be recorded at any given time and linked to a situation or context. This study aimed to analyze the contextual variables (where, with whom, and what), momentary satisfaction, and perception of momentary emotional and behavioral symptoms in a cohort of adolescents by the level of victimization, using EMA. We explored the everyday symptom profiles and the contexts in which events took place among 100 adolescents over a one-week period. Sociodemographic data were collected and assessment was done using the EMA (as a smartphone application) and the Juvenile Victimization Questionnaire (to assess childhood and adolescent victimization). In this study, regarding contextual variables, the group with the highest level of victimization (top 10%) showed a significant relationship with being away from home and being with friends other than classmates, and not being with parents or relatives. There was also an unexpectedly higher frequency of sporting engagement in this group. A relationship existed between emotional and behavioral problems and higher levels of victimization. In conclusion, the different groups of victimized subjects present a relatively high level of satisfaction in relation to the daily contexts and show low levels of emotional and behavioral symptomatology.

Coping Victimization among Peers in Spain

Background

Bullying at school and victimization problems in adolescence have a negative impact in personal identity development specifically in mental health field.

Objective

To analyze coping profiles used in a communitarian adolescents sample in relation to victimization among peers and controlling the other victimization subtypes.

Method

From Barcelona Metropolitan area, 1031 adolescents between 12 and 20 years old participated (37.5% boys; 15.7% foreigners). The different coping strategies were assessed with adolescent coping orientation for problem experiences test and the victimization types with juvenile victimization questionnaire.

Results

A 46.2% of adolescents suffered a victimization event by peers in the last year. As victimization level by peers advance, it presents an increase of unproductive coping strategies (P < .001; d-Cohen = 0.92). Regularly women score higher than men in low and moderate victimization groups (P < .05). However, when it reaches the highest expression (higher risk profile), unproductive strategies use in both genders is very similar and significant differences disappear. The results show that avoidant coping type is associated with a higher rate of victimization by peers. Positive relationship between previous victimization in other areas and peer victimization rate was found.

Conclusions

It is of high importance to develop and strengthen coping psychoeducation programs centered in solving this problem and struggling against victimization consequences by peers in adolescence. Due to that, increase of this victimization type is very related to the use of unproductive strategies use and therefore a coping by avoiding the problem.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Internationally adopted children's psychosocial adjustment in internationally adopted children: personal and parental perceptions]

OBJECTIVE

To assess psychosocial adjustment in middle childhood in internationally adopted children in Spain.

MATERIAL AND METHODS

One hundred and one internationally adopted children (67% girls), aged 8 to 12, and their adoptive parents (97 mothers and 67 fathers) completed the Behaviour Assessment System for Children (BASC). Descriptive analyses and mean comparisons (Student's t test and ANOVA) were conducted to test for gender, age at adoption, current age and area of origin differences for each informant on the scales and composite-scales of the BASC. Multiple linear regression analyses were then performed. Agreement between mothers and fathers was calculated using intra-class correlation coefficients (ICC). Percentages of children in the normal and symptomatic range in composite-scales were compared to the theoretical ones using chi square tests.

RESULTS

The results showed that children were generally well-adjusted, regardless of the informant. Differences were found in children's adjustment by area of origin, gender and current age, although values remained within the normal range. The ICC ranged from 0.46 (satisfactory) to 0.84 (excellent). Compared to the normal-group, more children showed difficulties in adapting to school (24.8%; as reported by children), externalising problems, (27.8% and 28.3%; as reported by mothers and fathers, respectively), and behavioural and adaptive difficulties (28.4% and 29.9%, respectively; as reported by fathers).

CONCLUSIONS

About 25% of the internationally adopted children showed adaptive difficulties in basic areas, clearly identified using the BASC, which need psychological and paedological support.

[Implication of the anxiety and depression in eating disorders of young obese]

OBJECTIVES

the goals of the present study were: 1) to compare the levels of anxiety, depression, and eating disorders in young patients assisted at a children's hospital for obesity; 2) to determine whether anxiety and depression explain the symptoms of the eating disorders; and 3) to know which of these symptoms better discriminate the young people with different degrees of obesity.

MATERIALS AND METHOD

Descriptive, cross-sectional study with a sample comprised by 281 youngsters (56% girls) aged 11-17 years. The BMI percentiles were calculated by using the WHO growth tables. Two study groups were created: severe obesity and overweight/light-moderate obesity. The following questionnaires were used: Eating Disorders Inventory-2 (EDI-2), depression questionnaire (DQ), and Status-Trait Anxiety Questionnaire (STAI).

RESULTS

The youngsters with obesity showed more psychological problems than youngsters with overweight/light-moderate obesity, 12% had anxiety, and 11% depression. In both groups, the behaviours related with eating disorders were partially explained by the presence of symptoms of anxiety and depression. Dissatisfaction with the body and high anxiety trait increased the risk for perpetuating the obesity and were the two symptoms that better discriminated the patients with or without severe obesity.

CONCLUSION

Obesity prevention programmes should include body dissatisfaction and the anxiety trait into the assessment and management protocols, and prevent anxiety getting fixed as a personality trait.

Use of the Kidcope to identify socio-economically diverse Spanish school-age children's stressors and coping strategies

BACKGROUND

The process by which children cope with stressful events is a very relevant topic. However, few systematic efforts have been made to design age-specific measures.

METHODS

This study examined problems commonly experienced by children, ages between 7 and 12 years, from two different sources: a primary school mainly enrolling families of medium socio-economic status, and an after-school social care centre from a socially and economically deprived neighbourhood. Data were obtained using the younger version of the Kidcope.

RESULTS

Almost 55% of the sample reported a problem related to others with no differences observed in age, gender or school group. The strategies that children considered the most effective were 'social support' (35%), 'emotional regulation' (33%) and 'wishful thinking' (32%). The children from disadvantaged backgrounds reported different problems mainly related with 'victimization and violence', 'moving house' and conflicts with 'norms and rules' and tended to use avoidant strategies to face them, which could be related to the perception of uncontrollability of these stressors.

CONCLUSIONS

This study reported the first descriptive results in the type of problems and coping strategies of two different social groups of Spanish children using the Kidcope. The Kidcope can be useful to screen children for coping abilities at an early age living under stressful conditions in underprivileged sectors of society.

Comparison of dexketoprofen trometamol and ketoprofen in the treatment of osteoarthritis of the knee

Dexketoprofen, the active enantiomer of the racemic compound ketoprofen, is a new nonsteroidal antiinflammatory drug (NSAID) of the arylpropionate family. The efficacy and safety of dexketoprofen trometamol were compared with the equivalent enantiomeric dose of ketoprofen in a multicenter, randomized, double-blind 3-week trial of adult outpatients with pain due to osteoarthritis of the knee. After a washout period of 7-15 days, patients were randomly assigned to receive either dexketoprofen trometamol 25 mg tid (N = 89) or ketoprofen 50 mg tid (N = 94). Of the 183 patients enrolled, two were lost to follow-up. At the end of treatment (3 weeks), the main efficacy outcome measures were significantly better in the dexketoprofen trometamol group than in the ketoprofen group. In addition, overall physician assessment indicated that 75% of the dexketoprofen group had improved compared with 50% of the ketoprofen patients. There were fewer adverse events in the dexketoprofen treatment group, but the difference did not reach statistical significance. These results demonstrate that dexketoprofen trometamol 25 mg tid is more effective than ketoprofen 50 mg tid in short-term symptomatic treatment of knee osteoarthritis and suggest that the tolerability of dexketoprofen trometamol is more favorable than ketoprofen. Therefore, the substitution of dexketoprofen for racemic ketoprofen may be advantageous in clinical practice.

Clinical comparison of dexketoprofen trometamol and dipyrone in postoperative dental pain

A total of 125 outpatients with moderate to severe pain after surgical removal of one impacted third molar were randomly assigned to receive dexketoprofen trometamol 12.5 or 25 mg or dipyrone 575 mg. For first-dose assessments, patients rated their pain intensity and its relief at regular intervals. From 60 min post dose to the end of the 6-h observation period, both doses of dexketoprofen trometamol had higher pain relief scores than dipyrone: Between 3 and 6 h the differences were statistically significant. In addition, peak measures (PIDmax and PARmax) were statistically superior after both doses of dexketoprofen trometamol compared to dipyrone. The overall efficacy assessed at the end of the first-dose phase was rated as good or excellent by 90%, 83.3%, and 70% of patients receiving dexketoprofen trometamol 25 mg, dexketoprofen trometamol 12.5 mg, and dipyrone, respectively. The number of patients who required remedication during the 6-h period was significantly lower in both dexketoprofen groups. Repeated-dose data were also obtained. No significant differences were found in the efficacy after repeated doses, the number of doses taken, or the mean time elapsed between doses. The overall efficacy at the end of the repeated-dose phase was rated as good or excellent by 84.2%, 66.7%, and 70% of patients receiving dexketoprofen trometamol 25 mg, dexketoprofen trometamol 12.5 mg, and dipyrone, respectively. The frequency of adverse events was similar for all treatments and no serious adverse events were reported during the study.