The patient experience

Are previous episodes of bacterial vaginosis a predictor for vaginal symptoms in breast cancer patients treated with aromatase inhibitors?

Objective To estimate the prevalence of vaginal symptoms in postmenopausal women with breast cancer exposed to aromatase inhibitors, and to investigate if the risk of vaginal symptoms is associated with previous episodes of bacterial vaginosis. Methods Patients from Rigshospitalet and Herlev University Hospital, Denmark, were identified through the register of Danish Breast Cancer Cooperation Group and 78 patients participated in the study. Semiquantitave questionnaires and telephone interview were used to assess the prevalence of vaginal symptoms and previous episode(s) of bacterial vaginosis. Multivariable logistic regression models were used to assess the association between vaginal symptoms and previous episodes of bacterial vaginosis. Results Moderate to severe symptoms due to vaginal itching/irritation were experienced by 6.4% (95% CI: 2.8-14.1%), vaginal dryness by 28.4% (95% CI: 19.4-39.5%), and dyspareunia by 23.1% (95% CI: 11.0-42.1%). Patients with earlier episodes of bacterial vaginosis had an increased risk of vaginal dryness when exposed to a treatment with an aromatase inhibitor, adjusted OR 5.5 (95% CI 1.3-21.6). Conclusion A considerable number of patients exposed to aromatase inhibitor have vaginal symptoms and the risk is highest among patients with earlier episodes of bacterial vaginosis.

Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cancer survivors: a pragmatic controlled trial

OBJECTIVE

To investigate the impact of aquatic exercise on pressure pain threshold in breast cancer survivors with hormone therapy-associated arthralgia.

DESIGN

Single-blind, controlled trial.

SETTING

Two major metropolitan hospitals and a Sport and Spa Club in Granada, Spain.

SUBJECTS

Forty women aged 29-71 years with stage I-III breast cancer who reported arthralgia.

INTERVENTION

Patients were allocated alternately to either aquatic exercise in a chest-high pool or usual care while on the waiting list; control patients received treatment later. The two-month hydrotherapy intervention consisted of 24 sessions 3 days per week. Each session included 5 minutes of warm-up, 15-20 minutes of aerobic exercise, 15 minutes of mobility exercise and 20 minutes of recovery techniques.

MAIN MEASURES

Pressure pain threshold at neck, shoulder, hand and leg were evaluated as primary outcomes. Cancer-related fatigue, as measured by the Piper Fatigue Scale, body mass index and waist circumference were secondary outcomes. A 2 × 2 repeated-measure ANCOVA was used in this study.

RESULTS

No adverse events or development of worsening of pain was observed. Almost all the participants in the intervention group (89%) adhered to the hydrotherapy programme. Participants experienced a decrease in pressure pain threshold measured in neck, hand, shoulder and leg, as measured by algometry pressure, and waist circumference; all P < 0.05. Cancer-related fatigue (P = 0.06) and body mass index (P = 0.42) did not show significant improvement.

CONCLUSIONS

These data suggest that hydrotherapy in a chest-high pool may reduce the pain threshold and waist circumference in breast cancer survivors with hormone therapy-associated arthralgia.

Patient and physician perceptions on continuing aromatase inhibitors beyond the 5-year mark

Aromatase inhibitors (AIs) have been shown to improve disease-free survival and in certain cases, overall survival in the treatment of postmenopausal women with hormone receptor positive early breast cancer. Trials are ongoing to determine if AI therapy should be continued for patients who have already completed 5 years of AI treatment. The objective of this study was to assess the minimum disease-free and overall survival benefit acceptable to physicians and to women undergoing AI therapy to continue treatment beyond 5 years. A self-administered survey was completed by women with stage I-III breast cancer, who were undergoing adjuvant AI therapy for at least 1 year. The survey assessed relevant cancer-related, treatment, social and comorbid factors, and FACT-ES (V4). Minimum acceptable treatment benefit was denoted as a percentage decrease in cancer recurrence risk, and percentage increase in survival at 5 years. Medical oncologists (MOs) treating breast cancer across Canada were also surveyed. A total of 153 patients were surveyed; median age was 60, 51% had node-negative disease, 89% had prior radiation therapy, 61% had prior chemotherapy, and 59% had prior tamoxifen therapy. Mean duration of AI therapy was 31 months. Approximately 30% of women required a 5-year survival benefit of less than 1%, and 27.5% needed a decrease in risk of recurrence of less than 1% to continue an AI beyond the initial 5 years. In contrast, 45% of the 40 surveyed MOs required a 5-year survival benefit of at least 1-2%, and 37.5% preferred a decrease in recurrence risk of 2-5% to prescribe an AI for an additional 5 years. There was a significant correlation between severity of endocrine symptoms experienced on AIs and an increased minimum survival benefit required for women to continue therapy (r = 0.18, p = 0.036). Patients were willing to continue on AIs for smaller treatment benefits than physicians would prefer to prescribe them beyond 5 years. Patient preference to continue on AIs correlated somewhat to the severity of AI-related side effects.

Integrating Palliative Medicine into Comprehensive Breast Cancer Therapy - a Pilot Project

BACKGROUND: To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach. METHODS: A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation. RESULTS: Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues. CONCLUSIONS: A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.

Topical preparations for pain relief: efficacy and patient adherence

There has been an increasing focus on development of new routes of drug administration to provide tailored treatments for patients, without decreasing efficacy of analgesia, in proportion to the progression of the knowledge of pain mechanisms. While acute pain acts as an alarm, chronic pain is a syndrome requiring meticulous selection of analgesic drugs of high bioavailability for long-term use. Such criteria are challenges that topical medications aim to overcome, allowing progressive delivery of active component, maintaining stable plasma levels, with a good safety profile. This review presents recent findings regarding topical formulations of the most widely used drugs for pain treatment, such as nonsteroidal anti-inflammatory agents, anesthetics, and capsaicin, and the role of physical agents as delivery enhancers (phonophoresis and iontophoresis). Although the number of topical agents is limited for use in peripheral conditions, increasing evidence supports the efficacy of these preparations in blocking nociceptive and neuropathic pain. Patient adherence to medical treatment is also a challenge, especially in chronic painful conditions. It is known that reduction of treatment complexity and pill burden are good strategies to increase patient compliance, as discussed here. However, the role of topical presentations, when compared to traditional routes, has not yet been fully explored and thus remains unclear.