Abstract P5-19-03: Factors that influence posttraumatic growth in patients with breast cancer: A longitudinal trial

Objectives:

The main focus of previous research into coping with breast cancer, have been mostly with regards to the negative impacts such as emotional stress, anxiety, depression or cognitive dysfunction. However, patients also report positive changes that have come about as a result of their struggle with cancer. This is referred to as posttraumatic growth (PTG). The aim of this study was to assess the presence of PTG in breast cancer patients at two measurements and to explore the association between personality traits (resilience, optimism, self-efficacy) and positive emotions on PTG.

Patients and Methods:

The study group comprised of 80 women (with a mean age of 53.6 years, SD=10.2) recently diagnosed with stage I to III breast cancer. They completed self-report measures of PTG, resilience, optimism, self-efficacy and positive emotions up to three weeks after diagnose (t1) and then following by an update six months later (t2). Sociodemographic characteristics, emotional distress, anxiety and depression were also recorded.

Results:

Planned comparison: Breast cancer patients showed an increase of PTG from t1 to t2 (p=.00035). Resilience, optimism, self-efficacy and positive emotions did not change in the total sample from t1 to t2. Emotional distress, anxiety and depression have significantly declined from t1 to t2 (anxiety p=.015, depression p=.029, emotional distress p=.000065). Moreover, we found a significant positive correlation between positive emotions to PTG (r=-.386, p=.0004) and optimism to PTG (r=.334, p=.002) at t2, respectively. Depression t2 correlated negatively to PTG at t2 (r=-.264 p=.018).

Explorative results: We also calculated the difference between PTG t2 and t1. We found 67.5% (n=54) of the patients with an increase of PTG and 32.5% (n=26) without or with negative change. In a subgroup analysis we noticed that patients without benefit of PTG showed a decline of resilience (p=.015), self-efficacy (p=.028) and positive emotions (p=.045) between t1 and t2. Furthermore, anxiety and depression did not improve from t1 to t2 in this group.

Conclusions: Positive emotions and optimism represent indicators of PTG in breast cancer patients. A decline of anxiety and depression is associated with a higher rate of PTG. Psycho-oncological strategies related to these factors may support PTG in breast cancer patients. Future studies are needed to search for effective interventions to support patients in PTG.

Citation Format: Berndt U, Gottschlik Y, Leplow B, Thomssen C. Factors that influence posttraumatic growth in patients with breast cancer: A longitudinal trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-03.

[Aspiration in a specialised weaning unit--an underestimated problem]

This retrospective case series shows that 45 % of patients aspirated straight after removal of the tracheal cannula. The present case series includes 82 patients with long-term mechanical ventilation (LTMV) admitted to a specialised weaning unit. Aspiration was proven after patients sipped water coloured with patent blue V. Colour was detected with a bronchoscope after passing through the tracheostoma and directed toward the VC. The aspiration rate in this study is in good agreement with other reports in the literature.We could find no significant statistical differences concerning age (p = 0.97), gender (47 % vs. 49), number of bronchoscopies (p = 0.91) and comorbidities (p = 0.326) between patients with and without aspiration. The duration of the stay at the ward and the duration of ventilation as well as the parameter Hb at the time of admission (p = 0.566), CO2(p = 0.288/p = 0.716), HCO3 (p = 0.915/p = 0.612) and CRP (p = 0.402/p = 0.523) at the time of admission and discharge also showed no significant differences.The Kaplan Meier curves show a considerable divergence between patients with and without aspiration. However, the Log Rank Test (p = 0.348) and the univariate Cox Regression (HR 1.4, 95 % CI 0.689 - 2.849) were not significant. We believe that this can be attributed to the event rate, which was too low in our collective. This trend to a higher mortality of patients with aspiration might be due to weakness of the respiratory muscles when there is reduced coughing. Proof of aspiration in these patients is only one aspect of a multidimensional problem. Larger, prospective cohort studies are needed to show whether aspiration can serve as a prognostic marker.

Abstract P5-11-16: Cognitive Effects of Endocrine Therapy in Patients with Breast Cancer

Background: Adjuvant endocrine therapy is the mainstay in the therapy of primary breast cancer. However, the impact of endocrine therapy on cognitive function in patients with breast cancer is still unclear. Numerous studies suggest a protective effect of estrogens on neurons. From these findings it has been derived that the almost complete estrogen deprivation by aromatase suppression would modify cognitive performances. The primary aim of our study was to ascertain, whether neurocognitive functioning is altered in breast cancer patients receiving various endocrine therapies.

Patients and Methods: In a cross sectional study we investigated 80 post-menopausal women with breast cancer. Memory, spatial cognition, processing speed and attention were evaluated. Patients who ever received chemotherapy were not included. To compare cognitive task performance we constituted four treatment groups (see tab. 1).

Tab. 1 Groups and Medication

Patient characteristics were equally distributed, however, “switch” patients had received significantly more hormone replacement therapy before the onset of breast cancer than all other groups. We also evaluated mood, depression, anxiety, pre-morbid intelligence and self-perception of memory in order to receive homogenous groups. All participants were interviewed about their compliance to their medication. In this study, we used univariate statistical analyses of variance (ANOVA) and we calculated the effect-sizes of significant values. In case of lacking normal distribution we applied non-parametric statistics.

Results: Women who solely received aromatase inhibitor treatment showed a significant impairment of general memory (p=0.01, d=1.15) and verbal memory (p=0.026, d=0.97) in comparison to the control group. In more than 50% of the aromatase inhibitor patients we found below-average performance concerning verbal memory compared to normative data. The aromatase inhibitor group performed significantly worse than the tamoxifen-(p=0.035, d=0.64) and the “switch-group” (p=0.03, d=0.91) with regard to attention. With respect to their spatial abilities, no significant differences in navigation and in mental rotation were noted. With regard to path integration we solely ascertained significant lower results of the aromatase inhibitor patients compared with the tamoxifen group (p=0.04). Overall, no differences were observed between the “switch”- and the tamoxifen patients. Surprisingly, most patients perceived their own memory performance as averaged. Self-perception of memory correlated with anxiety and depression but not with test scores.

Conclusion: Treatment with tamoxifen alone seems to be less harmful for cognitive abilities than treatment with aromatase inhibitors alone. Patient may benefit from prior tamoxifen therapy when sequentially treated with aromatase inhibitors however this observation must be confirmed in further studies as well as the potential role of prior hormone replacement therapy and the objective adherence to therapy assessed by serum drug levels measurements.

Prognostic relevance of the novel TNM-classification system for neuroendocrine tumors of foregut origin

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Background: Until recently no TNM-classification existed for neuroendocrine tumors (NET) of the gastroenteropancreatic system. In 2006 Rindi et al. proposed a new TNM-classification system for foregut-NET of gastric, duodenal and pancreatic origin. The present study validates prognostic significance of the new TNM-classification in a cohort from a German referral center. Methods: The case files of 193 patients with histologically proven foregut NET were analyzed retrospectively. Patients were classified according to Capella (1995) and the WHO (2000) and to the new TNM-classification. Uni- and multivariate analysis was performed using log-rank and Cox regression methods. Results: Primary tumors localization was gastric (n=48), duodenal (23) and pancreatic (122); 35 patients (18%) died during the observation period. Overall 5- and 10-year survival rates (YSR) were 76% and 65% resp., while 5- and 10-YSR according to NET-related deaths (74% of all deaths, 26/35) were 83% and 74% resp.. The classifications by Capella and the WHO significantly discriminated between low and high grade malignant NET (p<0,001 and 0,002 resp.), but did not allow further prognostic differentiation. In contrast, the newly proposed TNM-classification system was able to significantly differentiate stage IV NET from all other stages (I vs. IV p=0,001; II vs. IV p=0,001; III vs. IV p=0,008) as well as stage III from stage I NET (p=0,038). Furthermore, the new classification system which includes a grading system according to the mitotic index (Ki67-index; G1 <3%, G2 3–20%, G3 >20%) was also able to significantly distinguish all three groups from each other (G1 vs. G3 p<0,001; G2 vs. G3 p<0,001). On multivariate analysis stage I and II as well as stage III-NET had a decreased hazard ratio (HR) when compared to stage IV-NET (I/II: HR 0,094, p=0,003; III: HR 0,38, p=0,096). In the same model G1 and G2-NET were associated with an decreased HR as compared to G3-NET (G1: HR 0,05, p=0,01; G2: HR 0,20, p=0,002). Conclusions: Here we demonstrate prognostic relevance of the newly proposed TNM-classification system for foregut-NET with statistical significance which therefore provides a new and powerful tool for future classification of NET.

No significant financial relationships to disclose.

The Cologne Carbon Cluster experiment: ro-vibrational spectroscopy on C8 and other small carbon clusters

We report on our ongoing efforts in obtaining the IR-spectra of the linear carbon cluster molecules Cn with n=8-13. So far C8, C9, C10, and C13 have been recorded at Cologne. With the exception of C8 all assignments have been secured. For C8 a tentative assignment could be derived with the bandcenter of the sigmau antisymmetric stretching mode located at nu0=2067.9779 cm(-1) and a preliminary rotational constant in the vibrational ground state of B"=0.02068 cm(-1). The measured signal to noise ratio of the ro-vibrational band is fairly weak and thus the lower J ro-vibrational transitions can not be assigned with certainty. As a consequence the band center remains uncertain by 4 J or 0.17 cm(-1). For a more reliable assignment the sensitivity of the system has to be increased by at least one order of magnitude. The envisaged sensitivity increase of our experiment will be discussed along with the intention to perform terahertz observations of the low energetic bending ro-vibrational spectra. These sub-mm wave measurements will be carried out simultaneously with the IR measurements.

Hand eczema in metalworker trainees--an analysis of risk factors

The present study, as part of PROMETES (Swiss Prospective Metal Worker Eczema Study), was performed to examine risk factors for the development of occupational hand dermatitis in metal-worker trainees. Since this disease is very common, a high standard of preventive measures is necessary, especially for persons with an endogenous disposition for the development of eczema, e.g., atopics. Within the cohort of 201 healthy young men, 47 (23%) showed at least mild signs of hand eczema at 1 point of the 2.5 year observation period. Various occupational and domestic exposures, skin protection behaviour, regeneration time, and smoking habits, as well as atopic disposition, were studied with regard to their influence on the skin condition of the metalworker trainees. By multivariate analysis, we determined 3 important risk factors for the development of hand eczema in the cohort. (i) We showed once more the important influence of an atopic disposition as a major risk factor for occupational contact dermatitis. (ii) Furthermore, the results suggest that, apart from chemical irritants, mechanical factors should not be underestimated in their role as irritants to the epidermal barrier. (iii) Additionally, an insufficient amount of skin recovery time seems to support a cumulative sub-irritant effect on the skin, which may lead to irritant contact dermatitis.

Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis

The actual advantage of barrier creams over bland emollients for skin protection is still hotly debated. In a randomized, double-blinded study, a newly-introduced barrier cream and its moisturizing vehicle were compared regarding their skin compatibility, efficacy and resulting acceptance. Thus, 2 panels of 25 hospital nurses with mild signs of skin irritation were asked to use 1 of the test products provided (verum or vehicle) over a period of 4 weeks. Effects of both types of preparations were studied weekly by clinical examination and the instrumental assessment of bioengineering parameters. Results showed no significant differences between barrier cream and vehicle. In both groups, clinical skin status improved and stratum corneum hydration increased significantly during the study period. Both preparations were tolerated and accepted well, thus showing both skin protection and skin care. These results contribute to the debate as to whether a strict distinction between "skin care" and "skin protection" products is justified. The vehicle alone is capable of positively influencing skin status. Emphasis must be laid on regular, frequent, and correct application of a product for it to be effective.

Is occupational irritant contact dermatitis predictable by cutaneous bioengineering methods? Results of the Swiss Metalworkers' Eczema Study (PROMETES)

BACKGROUND

Since identification of subjects with high eczema risk by screening tests is desirable, different skin bioengineering methods were studied for their validity as predictive measures for the development of hand eczema.

METHODS

205 metalworker trainees were followed up over 2.5 years from the beginning of their apprenticeship to observe the occurrence of hand eczema. Within the first weeks of their training they underwent a number of noninvasive biophysical tests. Transepidermal water loss, skin moisture and skin roughness were measured, and irritation tests with dimethyl sulfoxide (DMSO), sodium hydroxide (NaOH) and sodium lauryl sulfate were conducted. Sensitivity, specificity and predictive values of the performed tests and test combinations were calculated.

RESULTS

None of the observed single biophysical methods can be considered a valid screening test.

CONCLUSION

A combination of short irritation tests (DMSO and NaOH tests) and the measurement of skin moisture, however, allows to identify individuals at high risk for hand dermatitis with a high sensitivity, though low specificity.

Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metal workers

This study was performed as part of PROMETES (Swiss Prospective Metal Worker Eczema Study) to examine the role of atopy as a possible risk factor for the development of hand eczema in trainee metal workers. In a cohort of 201 young men without any skin problems at the start of their apprenticeship, 9.5% developed signs of dermatitis on their hands within a period of 6 months. The 2. 5-year incidence was 23%. We did not find a significantly increased risk for hand eczema in those participants with an atopic skin diathesis according to the atopy score of Diepgen et al. (Dermatosen 1991; 39: 79-83) Analysis of individual atopic signs and symptoms showed reported metal reactivity to have a significant influence on the onset of early skin damage within 6 months, whereas a history of flexural eczema appeared to be significantly related to the overall incidence over 2.5 years.

Cephalometric investigations concerning the geometry of the viscerocranium of human anencephalic fetuses

Cephalometric investigations were carried out on 16 macerated skulls of anencephalic fetuses aged around 6 months and compared with the values obtained from a group of 18 normally developed specimens. The skull geometry of the anencephalic fetuses was different from normal proportions: anencephalic fetuses showed a clear mandibular prognathism, and a maxilla tilted in anterior direction. The values describing length of maxilla and length of the anterior cranial base, and NS-Ba angle were found to be within the normal range. From the results it can be concluded that the defective development of the forebrain seems to have no effects on the length development of the anterior cranial base although it does influence the form of the surrounding bony structures. The formation of the mandibular prognathism cannot be brought into direct connection with the defective brain development.

[Metatarsal osteotomies for the correction of hallux valgus and metatarsus primus varus congenitus]

It is reported about the combined use of different methods for metatarsal osteotomy and in conclusion we recommend a differentiation of these corrective techniques and their indications. The differentiation is based on the consideration of the valgus angle, the grade of secondary arthrosis and the functional load of the joints.