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Aneed IK, Luaibi NM, Abdulqader SN. Investigating the clinical significance of immune and thyroid biomarkers in women with breast cancer and Hashimoto's thyroiditis. Reprod Biol 2025; 25:101011. [PMID: 40222067 DOI: 10.1016/j.repbio.2025.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 02/15/2025] [Accepted: 03/19/2025] [Indexed: 04/15/2025]
Abstract
Breast cancer with Hashimoto's thyroiditis (BC-HT) presents a unique immuno-thyroid interplay that remains poorly understood. This study investigates the relationships between thyroid function markers (TSH, T3, T4), immune markers (CD33, CD44), and thyroid autoantibodies (Anti-TPO, Anti-Tg) in BC-HT patients and healthy controls. Normality testing confirmed non-parametric data distribution, necessitating Mann-Whitney U tests for group comparisons. BC-HT patients exhibited significantly elevated TSH, CD33, Anti-TPO, and Anti-Tg levels, alongside reduced T3 and T4, compared to controls, indicating thyroid dysfunction. Spearman's correlation analysis revealed strong negative correlations between TSH and T3/T4 in controls, which were lost in BC-HT, suggesting disruption of normal thyroid feedback mechanisms. Additionally, CD33 and CD44 correlations with thyroid hormones were evident in controls but absent in BC-HT, highlighting altered immune-thyroid interactions. ROC analysis demonstrated high diagnostic performance for TSH, Anti-Tg, and Anti-TPO, with sensitivities exceeding 0.75, whereas CD33 and CD44 showed limited diagnostic utility. These findings suggest a distinct immuno-thyroid dysregulation in BC-HT patients and highlight the potential of thyroid-specific markers for disease stratification. Future research should focus on longitudinal studies and mechanistic investigations to further delineate the role of immune markers in breast cancer pathophysiology within the context of thyroid autoimmunity.
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Affiliation(s)
- Israa Khalaf Aneed
- Department of Biology, Mustansiriyah University, College of Science, Baghdad, Iraq.
| | | | - Sajid Nader Abdulqader
- National center for medical laboratories, Medical City, Ministry of Health, Baghdad, Iraq
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Álvarez-Salvago F, Medina-Luque J, Pujol-Fuentes C, Atienzar-Aroca S, Molina-García C, Gutiérrez-García P, Estornut C, Jiménez-García JD, Martínez-Amat A, De-Diego-Moreno M. Relationship of different levels of physical activity on the health status of long-term breast cancer survivors: a cross-sectional study. Disabil Rehabil 2025:1-12. [PMID: 40219722 DOI: 10.1080/09638288.2025.2489063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 03/30/2025] [Accepted: 04/01/2025] [Indexed: 04/14/2025]
Abstract
PURPOSE The first objective of this study is to examine the relationship between different levels of physical activity (PA) and the health status of long-term breast cancer survivors (LTBCSs) who have survived ≥5 years beyond diagnosis. The second aim is to identify potential predictors of long-term PA levels in this population. METHODS An 80-participant cross-sectional study categorized LTBCSs by PA levels: insufficiently active (very low ≤3 metabolic equivalent task (MET), low 3.1-7.4 MET) and sufficiently active (≥7.5 MET). Variables assessed included PA, pain, self-perceived physical fitness, cancer-related fatigue (CRF), comorbidities, mood, and health-related quality of life (HRQoL). ANOVA, Mann-Whitney U, and Chi-square tests were performed, along with Spearman's correlation and multiple regression analysis. Cohen's d and Cramér's V were used to calculate effect sizes. RESULTS 66.25% of LTBCSs were insufficiently active, with 17.25% classified as sedentary (≤1.5 MET). In the first objective, and compared to sufficiently active survivors, insufficiently active LTBCSs reported higher levels of pain, breast symptoms, dyspnea, moderate-to-severe CRF, sadness/depression, and anger, along with lower levels of happiness, general fitness, speed/agility, role functioning, and HRQoL (p < 0.05). In the second objective, the regression analysis found "future perspective" (β = 0.314; p < 0.01) and "insomnia" (β = -0.288; p = 0.02) to be significant predictors of higher PA levels (r2 = 0.224). CONCLUSION Insufficiently active LTBCSs had higher pain, symptoms, CRF, and mood disturbances, with decreased happiness, self-perceived physical fitness, and HRQoL. Future research should focus on interventions that target improving PA levels and managing factors such as "future perspective" and "insomnia," as they are significant predictors of PA adherence. These findings underscore the importance of incorporating PA into rehabilitation programs to enhance overall well-being and HRQoL in LTBCSs.
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Affiliation(s)
- Francisco Álvarez-Salvago
- FIBIO Research Group, Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Jose Medina-Luque
- FIBIO Research Group, Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | - Clara Pujol-Fuentes
- FIBIO Research Group, Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | - Sandra Atienzar-Aroca
- FIBIO Research Group, Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Department of Dentistry, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | | | - Palmira Gutiérrez-García
- FIBIO Research Group, Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | - Cristina Estornut
- FIBIO Research Group, Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Department of Dentistry, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | | | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Manuel De-Diego-Moreno
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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Sawant-Basak A, Urva S, Mukker JK, Haertter S, Mariano D, Parasrampuria DA, Goteti K, Singh RSP, Chiney M, Liao MZ, Chang SS, Mehta R. Role of Clinical Pharmacology in Diversity and Inclusion in Global Drug Development: Current Practices and Industry Perspectives: White Paper. Clin Pharmacol Ther 2024; 116:902-913. [PMID: 38973127 DOI: 10.1002/cpt.3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/24/2024] [Indexed: 07/09/2024]
Abstract
The 2022 United States Food and Drug Administration (US FDA) draft guidance on diversity plan (DP), which will be implemented through the Diversity Action Plans by December 2025, under the 21st Century Cures Act, marks a pivotal effort by the FDA to ensure that registrational studies adequately reflect the target patient populations based on diversity in demographics and baseline characteristics. This white paper represents the culminated efforts of the International Consortium of Quality and Innovation (IQ) Diversity and Inclusion (D&I) Working Group (WG) to assess the implementation of the draft FDA guidance by members of the IQ consortium in the discipline of clinical pharmacology (CP). This article describes current practices in the industry and emphasizes the tools and techniques of quantitative pharmacology that can be applied to support the inclusion of a diverse population during global drug development, to support diversity and inclusion of underrepresented patient populations, in multiregional clinical trials (MRCTs). It outlines strategic and technical recommendations to integrate demographics, including age, sex/gender, race/ethnicity, and comorbidities, in multiregional phase III registrational studies, through the application of quantitative pharmacology. Finally, this article discusses the challenges faced during global drug development, which may otherwise limit the enrollment of a broader, potentially diverse population in registrational trials. Based on the outcomes of the IQ survey that provided the current awareness of diversity planning, it is envisioned that in the future, industry efforts in the inclusion of previously underrepresented populations during global drug development will culminate in drug labels that apply to the intended patient populations at the time of new drug application or biologics license application rather than through post-marketing requirements.
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Affiliation(s)
- Aarti Sawant-Basak
- Clinical Pharmacology and Pharmacometrics, AstraZeneca, Waltham, MA, USA
| | - Shweta Urva
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Jatinder Kaur Mukker
- EMD Serono Research and Development Institute, Inc., affiliated with Merck KGaA, Darmstadt, Germany., Billerica, Massachusetts, USA
| | | | - Dean Mariano
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - Kosalaram Goteti
- EMD Serono Research and Development Institute, Inc., affiliated with Merck KGaA, Darmstadt, Germany., Billerica, Massachusetts, USA
| | | | | | | | | | - Rashmi Mehta
- Clinical Pharmacology Modeling and Simulation, GSK PLC, Durham, North Carolina, USA
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Álvarez-Salvago F, Gutiérrez-García P, Molina-García C, Atienzar-Aroca S, Jiménez-García JD, Aibar-Almazán A, Martínez-Amat A, Pujol-Fuentes C. Is it really over when it is over? physical, mental and emotional health status of long-term breast cancer survivors compared to healthy matched controls. Support Care Cancer 2024; 32:641. [PMID: 39242365 DOI: 10.1007/s00520-024-08830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE This study aimed to assess pain, fitness condition, physical activity (PA) level, comorbidities, cancer-related fatigue (CRF), mood state and health-related quality of life (HRQoL) in long-term breast cancer survivors (LTBCS) compared to women without cancer history, matched by age, weight, height, and educational level. METHODS A cross-sectional study conducted in Granada between April 2018 and July 2023 involved 80 LTBCS and 80 matched controls. Pain, fitness condition, PA level, comorbidities, CRF, mood state, and HRQoL were evaluated ≥ 5 years post-diagnosis using validated instruments. RESULTS LTBCS, compared to the controls, reported significantly higher levels of "pain intensity and interference", CRF (in all domains and > 40% exhibited moderate-to-severe fatigue levels), "sadness-depression", "anxiety", "anger/hostility", and "symptom scales" (All: P = .000 to .027). Moreover, 66.25% of LTBCS not only did not reach recommended PA levels (P = .035), but also presented significantly lower levels of "general physical fitness", "muscular strength", "happiness", "functioning scales" (except "emotional functioning"), and "global health status" (All: P = .000 to .048). CONCLUSION LTBCS still suffer from physical (pain, fitness condition, and CRF), both mental and emotional (sadness-depression, anxiety and anger/hostility) long-term side effects as well as multiple HRQoL issues (including lower levels of physical functioning and higher levels of symptoms). These findings highlight the chronic nature of this disease and the importance of continuing long- term follow-up care for survivors many years after the diagnosis of breast cancer.
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Affiliation(s)
- Francisco Álvarez-Salvago
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Palmira Gutiérrez-García
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | | | - Sandra Atienzar-Aroca
- Department of Dentistry, Faculty of Health Sciences, European University of Valencia, Paseo de La Alameda 7, 46010, Valencia, Spain.
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Clara Pujol-Fuentes
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
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Yeganeh L, Willey S, Wan CS, Bahri Khomami M, Chehrazi M, Cook O, Webber K. The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors: A systematic review and network meta-analysis. Maturitas 2024; 185:107977. [PMID: 38574414 DOI: 10.1016/j.maturitas.2024.107977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
Lifestyle/behavioural interventions may improve breast cancer outcomes and quality of life (QoL); however, uncertainty remains about the most effective interventions due to limited evidence. This study aimed to assess and compare the effects of lifestyle/behavioural interventions on cancer recurrence, survival and QoL in breast cancer survivors. Electronic databases including Medline, EMBASE, PsycINFO, CINAHL and EBM Reviews were searched for relevant literature. Randomized controlled trials (RCTs) and quasi-RCTs comparing a lifestyle/behavioural intervention with a control condition in breast cancer survivors were included. Outcomes included cancer recurrence, overall survival and QoL. A network meta-analysis synthesized intervention effect. Studies not included in the analysis were reported narratively. Of 6251 identified articles, 38 studies met the selection criteria. Limited evidence exists on the impacts of lifestyle/behavioural interventions on breast cancer recurrence/survival. Exercise was identified as the most effective intervention in improving overall survival (HR 0.50, 95 % CI 0.36, 0.68). Lifestyle/behavioural interventions may improve QoL; psychosocial interventions (SMD 1.28, 95 % CI 0.80, 1.77) and aerobic-resistance exercise (SMD 0.33, 95 % CI -0.03, 0.69) were the most effective interventions to enhance QoL. This review highlights potential post-breast cancer benefits from lifestyle/behavioural interventions, notably exercise and psychosocial support for QoL and exercise for overall survival. Thus, encouraging active lifestyle, stress management and coping skills programs during and after cancer treatment may enhance physical wellbeing and QoL. However, the findings should be interpreted with caution due to the small number and sample sizes of studies. Future longer-term RCTs are required for conclusive recommendations.
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Affiliation(s)
- Ladan Yeganeh
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia; Monash Centre for Health Research and Implementation, Monash University, VIC, Australia.
| | - Suzanne Willey
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, VIC, Australia
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, Monash University, VIC, Australia
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Olivia Cook
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia; McGrath Foundation, North Sydney, NSW, Australia
| | - Kate Webber
- Oncology Department, Monash Health, Clayton, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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Vainshelboim B, Sardesai SD, Bhammar D. Potential Therapeutic Role of Respiratory Muscle Training in Dyspnea Management of Cancer Survivors: A Narrative Review. World J Oncol 2024; 15:337-347. [PMID: 38751708 PMCID: PMC11092410 DOI: 10.14740/wjon1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024] Open
Abstract
Dyspnea is a disabling symptom presented in approximately half of all cancer survivors. From a clinical perspective, despite the availability of pharmacotherapies, evidence-based effective treatments are limited for relieving dyspnea in cancer survivors. Preliminary evidence supports the potential of respiratory muscle training to reduce dyspnea in cancer survivors, although large randomized controlled studies are warranted. The aims of this article were to review the relevant scientific literature on the potential therapeutic role of respiratory muscle training in dyspnea management of cancer survivor, and to identify possible mechanisms, strengths and limitations of the evidence as well as important gaps for future research directions.
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Affiliation(s)
- Baruch Vainshelboim
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43214, USA
| | - Sagar D. Sardesai
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43214, USA
| | - Dharini Bhammar
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43214, USA
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Dumas E, Grandal Rejo B, Gougis P, Houzard S, Abécassis J, Jochum F, Marande B, Ballesta A, Del Nery E, Dubois T, Alsafadi S, Asselain B, Latouche A, Espie M, Laas E, Coussy F, Bouchez C, Pierga JY, Le Bihan-Benjamin C, Bousquet PJ, Hotton J, Azencott CA, Reyal F, Hamy AS. Concomitant medication, comorbidity and survival in patients with breast cancer. Nat Commun 2024; 15:2966. [PMID: 38580683 PMCID: PMC10997660 DOI: 10.1038/s41467-024-47002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Between 30% and 70% of patients with breast cancer have pre-existing chronic conditions, and more than half are on long-term non-cancer medication at the time of diagnosis. Preliminary epidemiological evidence suggests that some non-cancer medications may affect breast cancer risk, recurrence, and survival. In this nationwide cohort study, we assessed the association between medication use at breast cancer diagnosis and survival. We included 235,368 French women with newly diagnosed non-metastatic breast cancer. In analyzes of 288 medications, we identified eight medications positively associated with either overall survival or disease-free survival: rabeprazole, alverine, atenolol, simvastatin, rosuvastatin, estriol (vaginal or transmucosal), nomegestrol, and hypromellose; and eight medications negatively associated with overall survival or disease-free survival: ferrous fumarate, prednisolone, carbimazole, pristinamycin, oxazepam, alprazolam, hydroxyzine, and mianserin. Full results are available online from an interactive platform ( https://adrenaline.curie.fr ). This resource provides hypotheses for drugs that may naturally influence breast cancer evolution.
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Affiliation(s)
- Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- INSERM, U900, 75005, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006, Paris, France
| | - Beatriz Grandal Rejo
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Sophie Houzard
- Health Data and Assessment, Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | - Judith Abécassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- INRIA, Paris-Saclay University, CEA, Palaiseau, 91120, France
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marande
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Annabelle Ballesta
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210, Saint-Cloud, France
| | - Elaine Del Nery
- Département de Recherche Translationnelle - Plateforme Biophenics, PICT-IBISA, PSL Research University, Paris, France
| | - Thierry Dubois
- Institut Curie - PSL Research University Translational Research Department Breast Cancer Biology Group 26 rue d'Ulm, 75005, Paris, France
| | - Samar Alsafadi
- Institut Curie, PSL Research University, Uveal Melanoma Group, Translational Research Department, Paris, France
| | | | - Aurélien Latouche
- INSERM, U900, 75005, Paris, France
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210, Saint-Cloud, France
- Conservatoire National des Arts et Métiers, Paris, France
| | - Marc Espie
- Breast diseases Center Hôpital saint Louis APHP, Université Paris Cité, Paris, France
| | - Enora Laas
- Department of Surgical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Clémentine Bouchez
- Breast diseases Center Hôpital saint Louis APHP, Université Paris Cité, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Christine Le Bihan-Benjamin
- Health Data and Assessment, Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | - Philippe-Jean Bousquet
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Équipe Labellisée Ligue Contre le Cancer, 13005, Marseille, France
- Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | | | - Chloé-Agathe Azencott
- INSERM, U900, 75005, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006, Paris, France
- Institut Curie, PSL Research University, Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France.
- Department of Surgical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France.
- Department of Surgery, Institut Jean Godinot, Reims, France.
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
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Park YI, Cho MS, Chang JS, Kim JS, Kim YB, Lee IJ, Hong CS, Choi SH. Normal tissue complication probability models of hypothyroidism after radiotherapy for breast cancer. Clin Transl Radiat Oncol 2024; 45:100734. [PMID: 38317677 PMCID: PMC10839258 DOI: 10.1016/j.ctro.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose We aimed to develop Lyman-Kutcher-Burman (LKB) and multivariable normal tissue complication probability (NTCP) models to predict the risk of radiation-induced hypothyroidism (RIHT) in breast cancer patients. Materials and methods A total of 1,063 breast cancer patients who underwent whole breast irradiation between 2009 and 2016 were analyzed. Individual dose-volume histograms were used to generate LKB and multivariable logistic regression models. LKB model was fit using the thyroid radiation dose-volume parameters. A multivariable model was constructed to identify potential dosimetric and clinical parameters associated with RIHT. Internal validation was conducted using bootstrapping techniques, and model performance was evaluated using the area under the curve (AUC) and Hosmer-Lemeshow (HL) goodness-of-fit test. Results RIHT developed in 4 % of patients with a median follow-up of 77.7 months. LKB and multivariable NTCP models exhibited significant agreement between the predicted and observed results (HL P values > 0.05). The multivariable NTCP model outperformed the LKB model in predicting RIHT (AUC 0.62 vs. 0.54). In the multivariable model, systemic therapy, age, and percentage of thyroid volume receiving ≥ 10 Gy (V10) were significant prognostic factors for RIHT. The cumulative incidence of RIHT was significantly higher in patients who exceeded the cut-off values for all three risk predictors (systemic therapy, age ≥ 40 years, and thyroid V10 ≥ 26 %, P < 0.005). Conclusions Systemic therapy, age, and V10 of the thyroid were identified as strong risk factors for the development of RIHT. Our NTCP models provide valuable insights to clinicians for predicting and preventing hypothyroidism by identifying high-risk patients.
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Affiliation(s)
- Ye-In Park
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Seok Cho
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi do, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- BC Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
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9
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Baguley BJ, Benna-Doyle S, Drake S, Curtis A, Stewart J, Loeliger J. Access to nutrition services and information after active cancer treatment: a mixed methods study. J Cancer Surviv 2024; 18:176-185. [PMID: 36823493 PMCID: PMC10866769 DOI: 10.1007/s11764-023-01352-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Evidence-based guidelines for cancer strongly support nutrition and dietetic services for people with cancer and carers in order to improve patient-centred and health service outcomes. Access to nutrition services and information after completing active cancer treatment is relatively unknown in Australia. This study aimed to determine the availability, accessibility, barriers, and preferences to nutrition services and information after cancer treatment in Australia. METHODS Utilising mixed methods, people with cancer and carers completed a cross-sectional survey, and a sub-group of participants completed a semi-structured interview. The survey evaluated the availability of nutrition services, nutrition information searched, barriers, and preferences for nutrition information. Semi-structured interviews explored participant experience with nutrition services and information. RESULTS The 149 participants (including 10 carers) were predominately male and with a diagnosis of prostate cancer (63%). Overall, 23% of participants received nutrition information from a dietitian after cancer treatment. Participants (78%) indicated that accessing a nutrition specialist is the main barrier to receiving nutrition care after treatment. Most searched nutrition information on the internet (55%) and found the information easy to understand (89%), but conflicting (52%). Thematic analysis of interviews in fourteen cancer patients revealed three key themes pertaining to (1) preferred referral and timing of nutrition services, (2) lack of confidence in publicly available nutrition information, and (3) streamlining nutrition services for greater access. CONCLUSION Access to a dietitian and evidence-based information after cancer treatment is limited for people with cancer and carers in Australia, despite the high interest and need for ongoing nutrition care. IMPLICATIONS FOR CANCER SURVIVORS Models of care evaluating the provision of appropriate nutrition care and information provision after cancer treatment are needed to address this unmet survivorship need.
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Affiliation(s)
- Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, VIC, 3220, Geelong, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia.
| | - Sarah Benna-Doyle
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia
| | - Shani Drake
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Annie Curtis
- Institute for Physical Activity and Nutrition, Deakin University, VIC, 3220, Geelong, Australia
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia
| | - Jane Stewart
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Jenelle Loeliger
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
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10
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Scott L, Truong LL, Houlden RL, Wijeratne DT. Screening and Management Recommendations for Type 2 Diabetes in Women With Breast Cancer. Can J Diabetes 2024; 48:66-72. [PMID: 37474100 DOI: 10.1016/j.jcjd.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
Breast cancer increases the risk of type 2 diabetes 1.07- to 4.27-fold, depending on patient and treatment characteristics, such as postmenopausal status, hormone therapy, and treatment with adjuvant chemotherapy. We evaluated the current evidence and considered the role of increased screening for type 2 diabetes in this at-risk population. This narrative review was conducted using Embase and MEDLINE databases. Keywords including diabetes and breast cancer were used. Articles were limited to those published in English between 2000 and 2022. It appears that the increased risk of diabetes begins at or just after breast cancer diagnosis, and remains elevated for at least 10 to 15 years, with greatest risk in the first 2 years after diagnosis. Subsets of patients with breast cancer appear to be at higher risk of developing type 2 diabetes, including those who were treated with adjuvant chemotherapy or hormone therapy. Further investigation is needed to develop specific screening recommendations for this population. If screening is performed with a glycated hemoglobin test during breast cancer treatment, then hemoglobin should be measured at the same time given the association of breast cancer therapy with anemia. Presence of breast cancer should not be a major factor when choosing among available antihyperglycemic agents. Overall, patients with breast cancer appear to be at an increased risk of developing type 2 diabetes. This increased risk suggests the need for further investigation to develop specific screening recommendations for this at-risk population.
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Affiliation(s)
- Laura Scott
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lan-Linh Truong
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Robyn L Houlden
- Division of Endocrinology, Kingston General Hospital, Kingston, Ontario, Canada
| | - Don Thiwanka Wijeratne
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
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11
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Galimzhanov A, Istanbuly S, Tun HN, Ozbay B, Alasnag M, Ky B, Lyon AR, Kayikcioglu M, Tenekecioglu E, Panagioti M, Kontopantelis E, Abdel-Qadir H, Mamas MA. Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:2018-2031. [PMID: 37499186 DOI: 10.1093/eurjpc/zwad243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
AIMS It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc. METHODS AND RESULTS We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. CONCLUSION Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. REGISTRATION CRD42022298741.
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Affiliation(s)
- Akhmetzhan Galimzhanov
- Department of Propedeutics of Internal Disease, Semey Medical University, Semey, Kazakhstan
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
| | - Sedralmontaha Istanbuly
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Han Naung Tun
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Benay Ozbay
- Basaksehir Cam and Sakura State Hospital Department of Cardiology, Istanbul, Turkey
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Meral Kayikcioglu
- Department of Cardiology, Faculty of Medicine, 60521 Ege University, Izmir, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
- Department of Cardiology, Erasmus MC, Thorax Center, Erasmus University, Rotterdam, The Netherlands
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Husam Abdel-Qadir
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
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12
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Liu YS, Liu Y, Park C. Association of cardiovascular disease with health-related quality of life among older women with early-stage breast cancer undergoing adjuvant endocrine therapy. J Geriatr Oncol 2023; 14:101598. [PMID: 37549476 DOI: 10.1016/j.jgo.2023.101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Due to the improved overall survival and life expectancy of older women with breast cancer, cardiovascular disease (CVD) arose as the primary cause of non-cancer-related deaths in this population. Therefore, assessing the health-related quality of life (HRQoL) of breast cancer patients with comorbid CVD is becoming increasingly vital. Our study aimed to evaluate the association between comorbid CVD and HRQoL among older women with early-stage breast cancer who are receiving adjuvant endocrine therapy (AET) in the United States. MATERIALS AND METHODS We conducted a retrospective cohort study using the 2006-2017 Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data. We identified female patients over the age of 65 who were diagnosed with stage I-III hormone receptor-positive breast cancer and treated with AET. HRQoL was assessed by the physical and mental component summary (PCS & MCS) in the health survey. CVD was defined as a history of acute myocardial infarction (AMI), congestive heart failure (CHF), angina, stroke, or other heart-related conditions. We performed multivariate linear regression models while controlling for covariates. RESULTS Among 3,904 older women, a history of CHF [β = -1.97, p = 0.025], stroke [β = -3.00, p < 0.010], or other heart-related condition [β = -1.10, p = 0.046] was significantly associated with lower PCS. However, no significant differences in PCS scores were found between women with a history of AMI or angina and those without these conditions. Having a history of CHF [β = -1.72, p = 0.033] or stroke [β = -1.48, p = 0.038] was significantly associated with lower MCS, whereas a history of angina, AMI, or other heart conditions was not associated with significant differences in MCS. Our study did not observe any significant differences in PCS and MCS between the two types AETs. DISCUSSION The study found that older women with early-stage breast cancer who were being treated with AETs had a lower HRQoL if they had a history of CHF or stroke. These comorbidities were identified as strong predictors for decreased HRQoL. The findings highlight the significance of managing cardiovascular diseases in such patients for better HRQoL while they receive AET treatment.
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Affiliation(s)
- Yi-Shao Liu
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Yan Liu
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
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13
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Sharon CE, Wang M, Tortorello GN, Perry NJ, Ma KL, Tchou JC, Fayanju OM, Mahmoud NN, Miura JT, Karakousis GC. Impact of Patient Comorbidities on Presentation Stage of Breast and Colon Cancers. Ann Surg Oncol 2023; 30:4617-4626. [PMID: 37208570 PMCID: PMC10788153 DOI: 10.1245/s10434-023-13596-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND While patients with multiple comorbidities may have frequent contact with medical providers, it is unclear whether their healthcare visits translate into earlier detection of cancers, specifically breast and colon cancers. METHODS Patients diagnosed with stage I-IV breast ductal carcinoma and colon adenocarcinoma were identified from the National Cancer Database and stratified by comorbidity burden, dichotomized as a Charlson Comorbidity Index (CCI) Score of <2 or ≥2. Characteristics associated with comorbidities were analyzed by univariate and multivariate logistic regression. Propensity-score matching was performed to determine the impact of CCI on stage at cancer diagnosis, dichotomized as early (I-II) or late (III-IV). RESULTS A total of 672,032 patients with colon adenocarcinoma and 2,132,889 with breast ductal carcinoma were included. Patients with colon adenocarcinoma who had a CCI ≥ 2 (11%, n = 72,620) were more likely to be diagnosed with early-stage disease (53% vs. 47%; odds ratio [OR] 1.02, p = 0.017), and this finding persisted after propensity matching (CCI ≥ 2 55% vs. CCI < 2 53%, p < 0.001). Patients with breast ductal carcinoma who had a CCI ≥ 2 (4%, n = 85,069) were more likely to be diagnosed with late-stage disease (15% vs. 12%; OR 1.35, p < 0.001). This finding also persisted after propensity matching (CCI ≥ 2 14% vs. CCI < 2 10%, p < 0.001). CONCLUSIONS Patients with more comorbidities are more likely to present with early-stage colon cancers but late-stage breast cancers. This finding may reflect differences in practice patterns for routine screening in these patients. Providers should continue guideline directed screenings to detect cancers at an earlier stage and optimize outcomes.
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Affiliation(s)
- Cimarron E Sharon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Michael Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gabriella N Tortorello
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhita J Perry
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin L Ma
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julia C Tchou
- Division of Breast Surgery, Department of surgery, The University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Philadelphia, PA, USA
| | - Oluwadamilola M Fayanju
- Division of Breast Surgery, Department of surgery, The University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Philadelphia, PA, USA
| | - Najjia N Mahmoud
- Abramson Cancer Center, Philadelphia, PA, USA
- Division of Colon and Rectal Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA
| | - John T Miura
- Abramson Cancer Center, Philadelphia, PA, USA
- Division of Endocrine and Oncologic Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Abramson Cancer Center, Philadelphia, PA, USA
- Division of Endocrine and Oncologic Surgery, Department of Surgery, The University of Pennsylvania, Philadelphia, PA, USA
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14
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Szlezinger K, Pogoda K, Jagiełło-Gruszfeld A, Kłosowska D, Górski A, Borysowski J. Eligibility criteria in clinical trials in breast cancer: a cohort study. BMC Med 2023; 21:240. [PMID: 37400830 DOI: 10.1186/s12916-023-02947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer type in women. The purpose of this study was to assess the eligibility criteria in recent clinical trials in BC, especially those that can limit the enrollment of older patients as well as those with comorbidities and poor performance status. METHODS Data on clinical trials in BC were extracted from ClinicalTrials.gov. Co-primary outcomes were proportions of trials with different types of the eligibility criteria. Associations between trial characteristics and the presence of certain types of these criteria (binary variable) were determined with univariate and multivariate logistic regression. RESULTS Our analysis included 522 trials of systemic anticancer treatments started between 2020 and 2022. Upper age limits, strict exclusion criteria pertaining to comorbidities, and those referring to inadequate performance status of the patient were used in 204 (39%), 404 (77%), and 360 (69%) trials, respectively. Overall, 493 trials (94%) had at least one of these criteria. The odds of the presence of each type of the exclusion criteria were significantly associated with investigational site location and trial phase. We also showed that the odds of the upper age limits and the exclusion criteria involving the performance status were significantly higher in the cohort of recent trials compared with cohort of 309 trials started between 2010 and 2012 (39% vs 19% and 69% vs 46%, respectively; p < 0.001 for univariate and multivariate analysis in both comparisons). The proportion of trials with strict exclusion criteria was comparable between the two cohorts (p > 0.05). Only three of recent trials (1%) enrolled solely patients aged 65 or 70 and older. CONCLUSIONS Many recent clinical trials in BC exclude large groups of patients, especially older adults, individuals with different comorbidities, and those with poor performance status. Careful modification of some of the eligibility criteria in these trials should be considered to allow investigators to assess the benefits and harms of investigational treatments in participants with characteristics typically encountered in clinical practice.
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Affiliation(s)
- Katarzyna Szlezinger
- Pharmacovigilance Department, Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, Aleje Jerozolimskie 181C, 02-222, Warsaw, Poland
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstruction Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Agnieszka Jagiełło-Gruszfeld
- Department of Breast Cancer and Reconstruction Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Danuta Kłosowska
- Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Andrzej Górski
- Bacteriophage Laboratory, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfe Weigla 12, 53-114, Wrocław, Poland
| | - Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland.
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15
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Omosule M, De Silva-Minor S, Coombs N. Case Report: Intraoperative radiotherapy as the new standard of care for breast cancer patients with disabling health conditions or impairments. Front Oncol 2023; 13:1156619. [PMID: 37274260 PMCID: PMC10233125 DOI: 10.3389/fonc.2023.1156619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
In selected patients, intraoperative radiotherapy (IORT) offers an alternative to standard external beam radiotherapy (EBRT) while providing equivalent breast cancer control outcomes. After IORT, most patients do not require external beam radiotherapy and thus avoid the need to travel to and from a radiotherapy centre in the weeks after surgery. EBRT is associated with an increased risk of non-breast cancer mortality and poorer cosmetic outcomes while increasing patient travel time, emissions associated with travel and time spent in the hospital. Consequently, EBRT is associated with an overall reduction in quality of life compared to IORT. Patients with other on-going health conditions or clinical impairments are likely to be affected by the daily radiotherapy requirement. Should these patients be consulted during their pre-operative assessment as to options to undergo IORT? This paper describes a case of IORT and follow up in a functionally blind patient. Quality of life effects are elucidated and further support the use of IORT in selected breast cancer patients with health conditions or impairments.
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Affiliation(s)
- Michael Omosule
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Shiroma De Silva-Minor
- Department of Clinical Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Nathan Coombs
- Department of Breast Surgery, Great Western Hospitals NHS Foundation Trust, Great Western Hospital, Swindon, United Kingdom
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16
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Pakiet A, Jędrzejewska A, Duzowska K, Wacławska A, Jabłońska P, Zieliński J, Mika A, Śledziński T, Słomińska E. Serum fatty acid profiles in breast cancer patients following treatment. BMC Cancer 2023; 23:433. [PMID: 37173619 PMCID: PMC10176817 DOI: 10.1186/s12885-023-10914-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Breast cancer is associated with alterations in lipid metabolism. The treatment of breast cancer can also affect serum lipid composition. The purpose of this study was the examination of serum fatty acids (FAs) profiles in breast cancer survivors to assess if the FA levels normalize. METHODS Serum levels of FAs were determined by gas chromatography-mass spectrometry in a group of breast cancer patients at baseline (before treatment, n = 28), at two follow-up visits at 12 months (n = 27) and 24 months (n = 19) after the breast cancer resection, and in the group of healthy controls (n = 25). Multivariate analysis was performed to assess how FA serum profile changes following treatment. RESULTS Breast cancer patients' serum FA profiles at follow-ups did not normalize to the levels of control group. The greatest differences were found for levels of branched-chain (BCFA), odd-chain (OCFA) and polyunsaturated (PUFAs) FAs, all of which were significantly increased 12 months after the surgery. CONCLUSIONS After treatment for breast cancer, the patients' serum FA profile differs from the profile before treatment and from controls, especially 12 months after treatment. Some changes may be beneficial - increased BCFA and OCFA levels, and improved n-6/n-3 PUFA ratio. This may reflect lifestyle changes in breast cancer survivors and have an impact on the risk of recurrence.
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Affiliation(s)
- Alicja Pakiet
- Department of Environmental Analysis, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-308, Gdańsk, Poland
| | - Agata Jędrzejewska
- Department of Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdańsk, Poland
| | - Katarzyna Duzowska
- Department of Pharmaceutical Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdansk, Poland
| | - Alina Wacławska
- Department of Pharmaceutical Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdansk, Poland
| | - Patrycja Jabłońska
- Department of Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdańsk, Poland
| | - Jacek Zieliński
- Department of Surgical Oncology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Adriana Mika
- Department of Pharmaceutical Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdansk, Poland.
| | - Tomasz Śledziński
- Department of Pharmaceutical Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdansk, Poland
| | - Ewa Słomińska
- Department of Biochemistry, Medical University of Gdańsk, Dębinki 1, 80-211, Gdańsk, Poland
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17
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Solmunde E, Falstie-Jensen AM, Lorenzen EL, Ewertz M, Reinertsen KV, Dekkers OM, Cronin-Fenton DP. Breast cancer, breast cancer-directed radiation therapy and risk of hypothyroidism: A systematic review and meta-analysis. Breast 2023; 68:216-224. [PMID: 36868138 PMCID: PMC9996441 DOI: 10.1016/j.breast.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/21/2023] Open
Abstract
OBJECTIVE Breast cancer and breast cancer-directed radiation therapy (RT) may increase the risk of late effects, such as hypothyroidism. We conducted a systematic review and meta-analysis to investigate the association between breast cancer, RT, and risk of hypothyroidism in breast cancer survivors. METHODS Through February 2022, we searched PubMed, EMBASE, and references of relevant articles, to identify papers on breast cancer and breast cancer-directed RT and subsequent risk of hypothyroidism. Articles were screened by title and abstract and reviewed for eligibility. We used a pre-formed data extraction sheet and identified key design elements that could potentially introduce bias. The main outcome was the confounder-adjusted relative risk (RR) of hypothyroidism in breast cancer survivors versus women without breast cancer, and in breast cancer survivors according to the receipt of RT to the supraclavicular lymph nodes. We used a random-effects model to calculate pooled RRs and associated 95% confidence intervals (95% CI). RESULTS From 951 papers screened by title and abstract, 34 full-text papers were reviewed for eligibility. We included 20 studies published between 1985 and 2021-19 were cohort studies. Compared with women without breast cancer, the pooled RR of hypothyroidism in breast cancer survivors was 1.48 (95% CI: 1.17, 1.87), with highest risk associated with RT to the supraclavicular region (RR = 1.69, 95% CI: 1.16, 2.46). The most important limitations of the studies were small sample size yielding estimates with low precision, and lack of data on potential confounders. CONCLUSION Breast cancer and radiation therapy to the supraclavicular lymph nodes is associated with an increased risk of hypothyroidism.
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Affiliation(s)
- Elisabeth Solmunde
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark
| | - Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark
| | - Ebbe L Lorenzen
- Department of Oncology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Kristin V Reinertsen
- National Advisory Unit on Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, Norway
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark; Department of Epidemiology, Leiden University Medical Center, Netherlands
| | - Deirdre P Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark.
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18
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Koczwara B, Meng R, Battersby M, Mangoni AA, Spence D, Lawn S. Comorbidities and their management in women with breast cancer-an Australian survey of breast cancer survivors. Support Care Cancer 2023; 31:212. [PMID: 36917330 PMCID: PMC10014784 DOI: 10.1007/s00520-023-07678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Breast cancer survivors experience significant burden from comorbid chronic conditions, but little is known about how well these conditions are managed. We conducted a national survey of Australian breast cancer survivors to examine the burden of chronic conditions, their impact and care alignment with the principles of chronic condition management. METHODS A study-specific survey incorporated questions about chronic conditions using the Charlson Comorbidity Index (CCI), functional status using the Vulnerable Elders Survey (VES) and perceived quality of care for cancer and non-cancer conditions using the Patient Assessment of Care for Chronic Conditions Survey (PACIC). Members of Breast Cancer Network Australia (BCNA) were invited via email to complete the survey either online or through direct mail. RESULTS The survey was sent to 2198 BCNA members and 177 responses were received (8.1%). Respondents were women aged 32-88 years (median 60.1 years). The majority were married (116; 67.7%) and had private insurance (137; 80.0%) and reported good to excellent health (119; 73.5%). Other health conditions were reported by 157 (88.7%), the most common being chronic pain (27.1%) and fatigue (22.0%). When asked about management of comorbidities or cancer, less than 20% were routinely asked about management goals, helped to set goals or asked about health habits. CONCLUSIONS In this population of survivors with good health status and high rates of private insurance, comorbidities were common and their management, as well as management of breast cancer, was poorly aligned with chronic condition management principles.
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Affiliation(s)
- Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rosie Meng
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Arduino A. Mangoni
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Dynamic Biobanking for Advancing Breast Cancer Research. J Pers Med 2023; 13:jpm13020360. [PMID: 36836597 PMCID: PMC9959444 DOI: 10.3390/jpm13020360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Longitudinal patient biospecimens and data advance breast cancer research through enabling precision medicine approaches for identifying risk, early diagnosis, improved disease management and targeted therapy. Cancer biobanks must evolve to provide not only access to high-quality annotated biospecimens and rich associated data, but also the tools required to harness these data. We present the Breast Cancer Now Tissue Bank centre at the Barts Cancer Institute as an exemplar of a dynamic biobanking ecosystem that hosts and links longitudinal biospecimens and multimodal data including electronic health records, genomic and imaging data, offered alongside integrated data sharing and analytics tools. We demonstrate how such an ecosystem can inform precision medicine efforts in breast cancer research.
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20
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Becerra‐Tomás N, Balducci K, Abar L, Aune D, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Vieira R, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK, Chan DSM. Postdiagnosis dietary factors, supplement use and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:616-634. [PMID: 36279902 PMCID: PMC10092903 DOI: 10.1002/ijc.34321] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
Little is known about how diet might influence breast cancer prognosis. The current systematic reviews and meta-analyses summarise the evidence on postdiagnosis dietary factors and breast cancer outcomes from randomised controlled trials and longitudinal observational studies. PubMed and Embase were searched through 31st October 2021. Random-effects linear dose-response meta-analysis was conducted when at least three studies with sufficient information were available. The quality of the evidence was evaluated by an independent Expert Panel. We identified 108 publications. No meta-analysis was conducted for dietary patterns, vegetables, wholegrains, fish, meat, and supplements due to few studies, often with insufficient data. Meta-analysis was only possible for all-cause mortality with dairy, isoflavone, carbohydrate, dietary fibre, alcohol intake and serum 25-hydroxyvitamin D (25(OH)D), and for breast cancer-specific mortality with fruit, dairy, carbohydrate, protein, dietary fat, fibre, alcohol intake and serum 25(OH)D. The results, with few exceptions, were generally null. There was limited-suggestive evidence that predefined dietary patterns may reduce the risk of all-cause and other causes of death; that isoflavone intake reduces the risk of all-cause mortality (relative risk (RR) per 2 mg/day: 0.96, 95% confidence interval (CI): 0.92-1.02), breast cancer-specific mortality (RR for high vs low: 0.83, 95% CI: 0.64-1.07), and recurrence (RR for high vs low: 0.75, 95% CI: 0.61-0.92); that dietary fibre intake decreases all-cause mortality (RR per 10 g/day: 0.87, 95% CI: 0.80-0.94); and that serum 25(OH)D is inversely associated with all-cause and breast cancer-specific mortality (RR per 10 nmol/L: 0.93, 95% CI: 0.89-0.97 and 0.94, 95% CI: 0.90-0.99, respectively). The remaining associations were graded as limited-no conclusion.
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Affiliation(s)
- Nerea Becerra‐Tomás
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism SectionInternational Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Doris S. M. Chan
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
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21
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Heidary Z, Ghaemi M, Hossein Rashidi B, Kohandel Gargari O, Montazeri A. Quality of Life in Breast Cancer Patients: A Systematic Review of the Qualitative Studies. Cancer Control 2023; 30:10732748231168318. [PMID: 37082898 DOI: 10.1177/10732748231168318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Quality of life (QoL) in breast cancer patients is still an important topic. Despite numerous quantitative scales, qualitative studies can help to in-depth understand the QoL of breast cancer patients. The purpose of this systematic review was to integrate qualitative studies on the QoL of women with breast cancer. METHODS A literature search was performed in electronic databases including PubMed, Scopus, and Web of Science from January 1, 2010 until June 28, 2022 to find out qualitative studies assessing breast cancer patient's QoL. Two authors independently evaluated methodological quality according to the consolidated criteria for reporting qualitative research (COREQ) checklist. Data were extracted and reported by themes for cancer-free women and patients with metastatic cancer separately. RESULTS In all, 1565 citations were retrieved. After removing 1387 duplicate and irrelevant papers, the full texts of 27 articles were reviewed and finally, 9 were eligible for evaluation. In quality checking of the citations, all articles gained the required quality score. After examining and merging similar topics, nine major themes were extracted. Physical, spiritual, and psychological aspects of QoL were the common issues in cancer-free women (before and after the COVID-19 pandemic) and patients with metastatic cancer. Perception of cancer and social life were the other main concerns in cancer-free women, whereas, in metastatic patients' overall survival and planning for the future and their children's life was the focus of interest. Women with metastatic disease showed more vulnerability in coping compared to cancer-free women. CONCLUSION This review provides an opportunity to have a closer look into the several domains of QoL in women with breast cancer. In-depth information provided by this review might help to develop interventions for patients and their families to support women to cope much better with their life challenges.
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Affiliation(s)
- Zohreh Heidary
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Batool Hossein Rashidi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Montazeri
- Health Metric Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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22
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Zunica ERM, Axelrod CL, Kirwan JP. Phytochemical Targeting of Mitochondria for Breast Cancer Chemoprevention, Therapy, and Sensitization. Int J Mol Sci 2022; 23:ijms232214152. [PMID: 36430632 PMCID: PMC9692881 DOI: 10.3390/ijms232214152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Breast cancer is a common and deadly disease that causes tremendous physical, emotional, and financial burden on patients and society. Early-stage breast cancer and less aggressive subtypes have promising prognosis for patients, but in aggressive subtypes, and as cancers progress, treatment options and responses diminish, dramatically decreasing survival. Plants are nutritionally rich and biologically diverse organisms containing thousands of metabolites, some of which have chemopreventive, therapeutic, and sensitizing properties, providing a rich source for drug discovery. In this study we review the current landscape of breast cancer with a central focus on the potential role of phytochemicals for treatment, management, and disease prevention. We discuss the relevance of phytochemical targeting of mitochondria for improved anti-breast cancer efficacy. We highlight current applications of phytochemicals and derivative structures that display anti-cancer properties and modulate cancer mitochondria, while describing future applicability and identifying areas of promise.
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23
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McVicker L, Cardwell CR, McIntosh SA, McMenamin ÚC. Cancer-specific mortality in breast cancer patients with hypothyroidism: a UK population-based study. Breast Cancer Res Treat 2022; 195:209-221. [PMID: 35908274 PMCID: PMC9374643 DOI: 10.1007/s10549-022-06674-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/04/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Epidemiological studies have indicated a higher prevalence of hypothyroidism in breast cancer patients, possibly related to shared risk factors and breast cancer treatments. However, few studies have evaluated how hypothyroidism impacts survival outcomes in breast cancer patients. We aimed to determine the association between hypothyroidism and breast cancer-specific and all-cause mortality. METHODS We conducted a population-based study using the Scottish Cancer Registry to identify women diagnosed with breast cancer between 2010 and 2017. A matched comparison cohort of breast cancer-free women was also identified. Using hospital diagnoses and dispensed prescriptions for levothyroxine, we identified hypothyroidism diagnosed before and after breast cancer diagnosis and determined associations with breast cancer-specific and all-cause mortality. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for potential confounders. RESULTS A total of 33,500 breast cancer patients were identified, of which 3,802 had hypothyroidism before breast cancer diagnosis and 565 patients went on to develop hypothyroidism after. Breast cancer patients had higher rates of hypothyroidism compared with cancer-free controls (HR 1.14, 95% CI 1.01-1.30). Among breast cancer patients, we found no association between hypothyroidism (diagnosed before or after) and cancer-specific mortality (before: HR 0.99, 95% CI 0.88-1.12, after: HR 0.97, 95% CI 0.63-1.49). Similar associations were seen for all-cause mortality. CONCLUSION In a large contemporary breast cancer cohort, there was little evidence that hypothyroidism, either at diagnosis or diagnosed after breast cancer, was associated with cancer-specific or all-cause mortality.
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Affiliation(s)
- Lauren McVicker
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | | | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
- Breast Surgery Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Úna C McMenamin
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
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24
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Hamid A, Anker MS, Ruckdeschel JC, Khan MS, Tharwani A, Oshunbade AA, Kipchumba RK, Thigpen SC, Anker SD, Fonarow GC, Hall ME, Butler J. Cardiovascular Safety Reporting in Contemporary Breast Cancer Clinical Trials. J Am Heart Assoc 2022; 11:e025206. [PMID: 35876414 PMCID: PMC9375478 DOI: 10.1161/jaha.121.025206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Several cancer therapies have been associated with cardiovascular harm in early‐phase clinical trials. However, some cardiovascular harms do not manifest until later‐phase trials. To limit interdisease variability, we focused on breast cancer. Thus, we assessed the reporting of cardiovascular safety monitoring and outcomes in phase 2 and 3 contemporary breast cancer clinical trials. Methods and Results We searched Embase and Medline records for phase 2 and 3 breast cancer pharmacotherapy trials. We examined exclusion criterion as a result of cardiovascular conditions, adverse cardiovascular event reporting, and cardiovascular safety assessment through cardiovascular imaging, ECG, troponin, or natriuretic peptides. Fisher's exact test was utilized to compare reporting. Fifty clinical trials were included in our study. Patients were excluded because of cardiovascular conditions in 42 (84%) trials. Heart failure was a frequent exclusion criterion (n=31; 62% trials). Adverse cardiovascular events were reported in 43 (86%) trials. Cardiovascular safety assessments were not reported in 23 (46%) trials, whereas natriuretic peptide and troponin assessments were not reported in any trial. Cardiovascular safety assessments were more frequently reported in industry‐funded trials (69.2% versus 0.0%; P<0.001), and in trials administering targeted/immunotherapy agents compared with only hormonal/conventional chemotherapy (78.6% versus 22.7%, P<0.001). Conclusions Our findings demonstrate significant under‐representation of patients with cardiovascular conditions or prevalent cardiovascular disease in contemporary later‐phase breast cancer trials. Additionally, cardiovascular safety is not routinely monitored in these trials. Therefore, contemporary breast cancer clinical trials may possibly underestimate the cardiovascular risks of cancer pharmacotherapy agents for use in clinical practice.
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Affiliation(s)
- Arsalan Hamid
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Markus S Anker
- Department of Cardiology (CBF), Charité University Medicine Berlin Berlin Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT) Berlin Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
| | - John C Ruckdeschel
- Division of Hematology/Oncology, Department of Medicine, Cancer Center and Research Institute University of Mississippi Medical Center Jackson MS
| | | | - Arsal Tharwani
- Department of Medicine Cleveland Clinic Foundation Cleveland OH
| | - Adebamike A Oshunbade
- Division of Cardiology, Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Rodney K Kipchumba
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Samuel C Thigpen
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies (BCRT) Berlin Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany.,Department of Cardiology (CVK) Charité Universitätsmedizin Berlin Berlin Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT) Charité Universitätsmedizin Berlin Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin Charité Universitätsmedizin Berlin Germany
| | - Gregg C Fonarow
- Division of Cardiology David Geffen School of Medicine at UCLA Los Angeles CA
| | - Michael E Hall
- Division of Cardiology, Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Javed Butler
- Department of Medicine University of Mississippi Medical Center Jackson MS
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25
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Park J, Kim C, Ki Y, Kim W, Nam J, Kim D, Park D, Jeon H, Kim DW, Joo JH. Incidence of hypothyroidism after treatment for breast cancer: A Korean population-based study. PLoS One 2022; 17:e0269893. [PMID: 35709221 PMCID: PMC9202953 DOI: 10.1371/journal.pone.0269893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
This Korean population-based study aimed to describe the patterns of hypothyroidism after adjuvant radiation therapy (RT) in patients with breast cancer. The Korean Health Insurance Review and Assessment Service database was searched for patients with invasive breast carcinomas. We calculated the cumulative incidence and incidence rates per 1,000 person-years of subsequent hypothyroidism and compared them using the log-rank test and the Cox proportional hazards model. Between 2007 and 2018, 117,135 women diagnosed with breast cancer with a median follow-up time of 4.6 years were identified. The 8-year incidence of hypothyroidism was 9.3% in patients treated with radiation and 8.6% in those treated without radiation (p = 0.002). The incidence rates per 1,000 person-years in the corresponding treatment groups were 6.2 and 5.7 cases, respectively. The hazard ratio (HR) in patients receiving RT was 1.081 (95% confidence interval [CI], 1.013–1.134; p = 0.002). After mastectomy, RT showed a trend toward a higher risk of hypothyroidism (HR = 1.248; 95% CI, 0.977–1.595; p = 0.076). Our study provides one of the largest population-based data analyses regarding the risk of hypothyroidism among Korean patients with breast cancer. The adjusted risk for patients treated with RT exceeded that for patients with breast cancer treated without RT. The effect was evident immediately after treatment and lasted up to approximately 9 years.
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Affiliation(s)
- Jongmoo Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Choongrak Kim
- Department of Statistics, Pusan National University, Busan, Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Wontaek Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Jiho Nam
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Donghyun Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Dahl Park
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Hosang Jeon
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Woon Kim
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Hyeon Joo
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Korea
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
- * E-mail:
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26
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Higher Incidence of Diabetes in Cancer Patients Compared to Cancer-Free Population Controls: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14071808. [PMID: 35406580 PMCID: PMC8997959 DOI: 10.3390/cancers14071808] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/21/2022] Open
Abstract
Background: Diabetes increases the risk of certain types of cancer. However, the literature regarding the incidence of diabetes after cancer diagnosis is inconsistent. We aimed to assess whether there was a higher incidence of diabetes among cancer patients by performing a systematic review and meta-analysis of results from cohort studies. Methods: A systematic electronic literature search was carried out from cohort studies regarding the incidence of diabetes in cancer patients, using the databases PubMed (MEDLINE), Embase, Web of Science, and the Cochrane Library. Random-effects meta-analyses were conducted to pool the estimates. Results: A total of 34 articles involving 360,971 cancer patients and 1,819,451 cancer-free controls were included in the meta-analysis. An increased pooled relative risk (RR) of 1.42 (95% confidence interval (CI): 1.30−1.54, I2 = 95, τ2 = 0.0551, p < 0.01) for diabetes in cancer patients was found compared with the cancer-free population. The highest relative risk was observed in the first year after cancer diagnosis (RR = 2.06; 95% CI 1.63−2.60). Conclusions: New-onset diabetes is positively associated with cancer, but this association varies according to cancer type. More prospective studies with large sample sizes and longer follow-up times are advocated to further examine the association and the underlying mechanisms.
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27
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Kwan ML, Cheng RK, Iribarren C, Neugebauer R, Rana JS, Nguyen-Huynh M, Shi Z, Laurent CA, Lee VS, Roh JM, Shen H, Rillamas-Sun E, Santiago-Torres M, Hershman DL, Kushi LH, Greenlee H. Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study. J Clin Oncol 2022; 40:1635-1646. [PMID: 35025627 PMCID: PMC9113213 DOI: 10.1200/jco.21.01738] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The incidence of cardiometabolic risk factors in breast cancer (BC) survivors has not been well described. Thus, we compared risk of hypertension, diabetes, and dyslipidemia in women with and without BC. METHODS Women with invasive BC diagnosed from 2005 to 2013 at Kaiser Permanente Northern California (KPNC) were identified and matched 1:5 to noncancer controls on birth year, race, and ethnicity. Cumulative incidence rates of hypertension, diabetes, and dyslipidemia were estimated with competing risk of overall death. Subdistribution hazard ratios (sHRs) were estimated by Fine and Gray regression, adjusted for cardiovascular disease-related risk factors, and stratified by treatment and body mass index (BMI). RESULTS A total of 14,942 BC cases and 74,702 matched controls were identified with mean age 61.2 years and 65% non-Hispanic White. Compared with controls, BC cases had higher cumulative incidence rates of hypertension (10.9% v 8.9%) and diabetes (2.1% v 1.7%) after 2 years, with higher diabetes incidence persisting after 10 years (9.3% v 8.8%). In multivariable models, cases had higher risk of diabetes (sHR, 1.16; 95% CI, 1.07 to 1.26) versus controls. Cases treated with chemotherapy (sHR, 1.23; 95% CI, 1.11 to 1.38), left-sided radiation (sHR, 1.29; 95% CI, 1.13 to 1.48), or endocrine therapy (sHR, 1.23; 95% CI, 1.12 to 1.34) continued to have higher diabetes risk. Hypertension risk was higher for cases receiving left-sided radiation (sHR, 1.11; 95% CI, 1.02 to 1.21) or endocrine therapy (sHR, 1.10; 95% CI, 1.03 to 1.16). Normal-weight (BMI < 24.9 kg/m2) cases had higher risks overall and within treatment subgroups versus controls. CONCLUSION BC survivors at KPNC experienced elevated risks of diabetes and hypertension compared with women without BC depending on treatments received and BMI. Future studies should examine strategies for cardiometabolic risk factor prevention in BC survivors.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA, US
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Mai Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, CA
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Hanjie Shen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Heather Greenlee
- University of Washington School of Medicine, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA, US.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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28
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Dai D, Coetzer H, Zion SR, Malecki MJ. Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population. Cancer Control 2022; 29:10732748221140691. [PMID: 36382426 PMCID: PMC9669700 DOI: 10.1177/10732748221140691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND Multimorbidity is common in patients with breast cancer, thus increasing the complexity of cancer care and economic burden, worsening their prognosis and quality of life. The prevalence of multimorbidity and its influence on psychological distress among patients with breast cancer have not been well characterized. OBJECTIVES To examine the prevalence of multimorbidity and its associations with anxiety and depression among newly diagnosed patients with breast cancer. METHODS We conducted a retrospective observational cohort study using a large administrative claims database. Patients with breast cancer (ICD-10-CM: C50.x) were identified during the study period (1/1/2017-12/31/2020). The index date was defined as the diagnosis date of breast cancer. Demographics and comorbid conditions were assessed using data within 12 months prior to the index date. Multimorbidity was defined as the presence of ≥2 comorbid conditions. Anxiety and depression were examined using data within 12 months after the index date. Multivariable logistic regressions were performed to examine the associations between multimorbidity and anxiety and depression, adjusting for sociodemographic factors. RESULTS Of the 6392 patients with newly diagnosed breast cancer, 86.9% had multimorbidity at the time of breast cancer diagnosis. The median number of comorbid conditions was 5. Overall, 27.7% experienced anxiety, and 21.9% experienced depression in the first year following breast cancer diagnosis. An increased number of comorbid conditions was associated with elevated prevalence of both anxiety and depression. After adjusting for possible confounding factors, number of comorbid conditions was significantly associated with risk of anxiety (adjusted odds ratio [95% confidence interval (CI)]: 1.17 [1.15-1.19]), and depression (1.24 [1.21-1.26]); all P < .0001. CONCLUSIONS Multimorbidity was highly prevalent among patients with breast cancer and was strongly associated with increased risk of anxiety and depression in the first year following breast cancer diagnosis. The presence of multimorbidity, anxiety, and depression should be considered in the context of clinical decision making to optimize cancer care and improve mental health and quality of life.
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Affiliation(s)
- Dingwei Dai
- CVS Health Clinical Trial Services, LLC, Woonsocket, RI, USA
| | | | - Sean R. Zion
- Blue Note Therapeutics,
Inc., San Francisco, CA, USA
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29
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Jansana A, Poblador-Plou B, Gimeno-Miguel A, Lanzuela M, Prados-Torres A, Domingo L, Comas M, Sanz-Cuesta T, Del Cura-Gonzalez I, Ibañez B, Abizanda M, Duarte-Salles T, Padilla-Ruiz M, Redondo M, Castells X, Sala M. Multimorbidity clusters among long-term breast cancer survivors in Spain: Results of the SURBCAN study. Int J Cancer 2021; 149:1755-1767. [PMID: 34255861 DOI: 10.1002/ijc.33736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022]
Abstract
The disease management of long-term breast cancer survivors (BCS) is hampered by the scarce knowledge of multimorbidity patterns. The aim of our study was to identify multimorbidity clusters among long-term BCS and assess their impact on mortality and health services use. We conducted a retrospective study using electronic health records of 6512 BCS from Spain surviving at least 5 years. Hierarchical cluster analysis was used to identify groups of similar patients based on their chronic diagnoses, which were assessed using the Clinical Classifications Software. As a result, multimorbidity clusters were obtained, clinically defined and named according to the comorbidities with higher observed/expected prevalence ratios. Multivariable Cox and negative binomial regression models were fitted to estimate overall mortality risk and probability of contacting health services according to the clusters identified. 83.7% of BCS presented multimorbidity, essential hypertension (34.5%) and obesity and other metabolic disorders (27.4%) being the most prevalent chronic diseases at the beginning of follow-up. Five multimorbidity clusters were identified: C1-unspecific (29.9%), C2-metabolic and neurodegenerative (28.3%), C3-anxiety and fractures (9.7%), C4-musculoskeletal and cardiovascular (9.6%) and C5-thyroid disorders (5.3%). All clusters except C5-thyroid disorders were associated with higher mortality compared to BCS without comorbidities. The risk of mortality in C4 was increased by 64% (adjusted hazard ratio 1.64, 95% confidence interval 1.52-2.07). Stratified analysis showed an increased risk of death among BCS with 5 to 10 years of survival in all clusters. These results help to identify subgroups of long-term BCS with specific needs and mortality risks and to guide BCS clinical practice regarding multimorbidity.
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Affiliation(s)
- Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Poblador-Plou
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Manuela Lanzuela
- Radiotherapy Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Sanz-Cuesta
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, Madrid, Spain
| | - Isabel Del Cura-Gonzalez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, Madrid, Spain
| | - Berta Ibañez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Mercè Abizanda
- Department of Organization and Communication, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Padilla-Ruiz
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
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30
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Paek MS, Wong SS, Hsu FC, Avis NE, Fino NF, Clark CJ. Depressive Symptoms and Associated Health-Related Variables in Older Adult Breast Cancer Survivors and Non-Cancer Controls. Oncol Nurs Forum 2021; 48:412-422. [PMID: 34143000 DOI: 10.1188/21.onf.412-422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the prevalence of depressive symptoms and associated risk factors in older adult breast cancer survivors (BCS) and age-matched non-cancer controls. SAMPLE & SETTING Using the Surveillance, Epidemiology, and End Results-Medicare Health Outcome Survey linked dataset from 1998 to 2012, BCS and non-cancer controls aged 65 years or older were identified. METHODS & VARIABLES Depressive symptoms, comorbidities, functional limitations, socio-demographics, and health-related information were examined. Univariate and multivariable logistic regression and marginal models were performed. RESULTS 5,421 BCS and 21,684 controls were identified. BCS and non-cancer controls had similar prevalence of depressive symptoms. Having two or more comorbidities and functional limitations were strongly associated with elevated risk of depressive symptoms in BCS and non-cancer controls. IMPLICATIONS FOR NURSING Having multiple comorbidities and multiple functional status are key factors associated with depressive symptoms in older adult BCS and non-cancer controls. Nurses are in an ideal position to screen older adult BCS and non-cancer controls at risk for depressive symptoms.
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31
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Boér K, Rubovszky G, Rokszin G, Abonyi-Tóth Z, Földesi C, Dank M. Demographic Characteristics and Treatment Patterns Among Patients Receiving Palbociclib for HR+/HER2- Advanced Breast Cancer: A Nationwide Real-World Experience. Onco Targets Ther 2021; 14:3971-3981. [PMID: 34234466 PMCID: PMC8257075 DOI: 10.2147/ott.s309862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background This nationwide retrospective study reports data on the real-world use of the selective cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor palbociclib in a large population of advanced breast cancer (ABC) patients during a 2-year period in Hungary. Methods All patients with ABC who received palbociclib between May 1, 2017 and June 30, 2019 were included in the analysis. Patient demographic and clinical characteristics, disease-related factors and treatment patterns were examined during the early access program and in the regular reimbursement period. Results Altogether, 962 patients were included (mean age: 60.6 years). A total of 399 patients (41%) were treated with palbociclib plus aromatase inhibitors (P+AI), and 563 patients (59%) received palbociclib and fulvestrant (P+F). The most commonly prescribed AI was letrozole (n=359; 90%). Of those with metastatic disease (n=733; 76%), 241 patients (33%) had visceral metastases and 449 (61%) had bone-only disease. The majority of patients (79%) received palbociclib as first- or second-line therapy for ABC. The starting dose of palbociclib was 125 mg in 98% of patients; dose reductions were required in 32% of patients receiving P+AI and 31% of those treated with P+F. At the time of data collection, palbociclib therapy was ongoing in 270 patients (68%) in the P+AI group and 245 patients (44%) in the P+F group. Conclusions This nationwide analysis is the first to provide insights into the real-world use of palbociclib in a large patient population from a Central-Eastern European country. The findings confirm the good tolerability of palbociclib with similar dose reduction rates to those reported from registration trials.
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Affiliation(s)
- Katalin Boér
- Department of Medical Oncology, Szent Margit Hospital, Budapest, Hungary
| | - Gábor Rubovszky
- Chemotherapy Department B, National Institute of Oncology, Budapest, Hungary.,Department of Internal Medicine and Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary.,University of Veterinary Medicine, Budapest, Hungary
| | | | - Magdolna Dank
- Department of Internal Medicine and Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
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32
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Foster M, Niedzwiedz CL. Associations between multimorbidity and depression among breast cancer survivors within the UK Biobank cohort: a cross-sectional study. BMC Cancer 2021; 21:650. [PMID: 34058985 PMCID: PMC8167936 DOI: 10.1186/s12885-021-08409-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Advances in the early detection of cancer and its treatment have resulted in an increasing number of people living with and beyond breast cancer. Multimorbidity is also becoming more common in this population as more people live longer with breast cancer and experience late effects of cancer treatment. Breast cancer survivors have heightened risk of depression, but to what extent multimorbidity affects the mental health of this population is less clear. This study aims to investigate the association between multimorbidity and depression among women living with and beyond breast cancer in the UK Biobank cohort. METHODS Data from UK Biobank (recruitment during 2006 to 2010, aged 40-70 years) were used to identify 8438 women with a previous diagnosis of breast cancer via linked cancer registries in England, Scotland and Wales. The lifetime number of chronic conditions was self-reported and multimorbidity defined as 0, 1, 2, 3, 4 or 5+. The Patient Health Questionnaire (PHQ-2) was used to define participants that were likely to have depression based on their symptom reporting at baseline. Logistic regression models were used to analyse the associations between multimorbidity and depression, accounting for a number of potential sociodemographic confounding variables (including age, ethnicity, socioeconomic deprivation, education level and marital status) and characteristics related to the cancer (number of years since diagnosis and recurrence/secondary cancer). RESULTS Multimorbidity was common among breast cancer survivors, with 32.9% of women experiencing one and 30.1% experiencing two or more chronic health conditions. Hypertension (25.8%), painful conditions (18.3%), and asthma (11.6%) were the three most common co-morbid conditions. 5.3% of participants had current depression. A strong, dose-response relationship was found between multimorbidity and the likelihood of depression (OR = 2.09, 95% CI: 1.56-2.79 for two conditions and OR = 6.06, 95% CI: 3.63-10.14 for five or more conditions). CONCLUSIONS Multimorbidity and depression were strongly associated among female UK Biobank participants with a previous breast cancer diagnosis. This association became increasingly pronounced as the number of chronic comorbid conditions increased. As more people survive cancer for longer, increasing recognition and support for multimorbidity and its impact on mental health is needed.
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Affiliation(s)
- Murray Foster
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Claire L Niedzwiedz
- College of Medical, Veterinary and Life Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
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33
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Walsh RL, Lofters AK, Moineddin R, Krzyzanowska MK, Grunfeld E. The effect of comorbidity on primary care use during breast cancer chemotherapy: a population-based retrospective cohort study using CanIMPACT data. CMAJ Open 2021; 9:E331-E341. [PMID: 33795223 PMCID: PMC8034254 DOI: 10.9778/cmajo.20200166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with breast cancer visit their primary care physicians (PCPs) more often during chemotherapy than before diagnosis, but the reasons are unclear. We assessed the association between physical comorbidities and mental health history (MHH) and the change in PCP use during adjuvant breast cancer chemotherapy. METHODS We conducted a population-based, retrospective cohort study using data from the Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) project. Participants were women 18 years of age and older, who had received a diagnosis of stage I-III breast cancer in Ontario between 2007 and 2011 and had received surgery and adjuvant chemotherapy. We used difference-in-difference analysis using negative binomial modelling to quantify the differences in the 6-month rate of PCP visits at baseline (the 24-month period between 6 and 30 months before diagnosis) and during treatment (the 6 months from start of chemotherapy) between physical comorbidity and MHH groups. RESULTS Among 12 781 participants, the 6-month PCP visit rate increased during chemotherapy (mean 2.3 visits at baseline, 3.4 visits during chemotherapy). Patients with higher physical comorbidity levels or MHH visited their PCPs 4.2 or 1.7 more times, respectively, over 6 months compared to those with low physical comorbidity or no MHH at baseline and 2.5 or 1.1 more times, respectively, over 6 months during treatment. During treatment, the adjusted 6-month rate of PCP visits more than doubled in the group with the fewest physical comorbidities or no MHH compared with baseline (rate ratio 2.52, 95% confidence interval [CI] 2.43-2.61). This increase was lower in those with MHH (rate ratio 1.81, 95% CI 1.68-1.96) and in the highest physical comorbidity group (rate ratio 1.16, 95% CI 1.07-1.28). INTERPRETATION Patients with breast cancer who have more physical comorbidities and MHH have a higher frequency of PCP visits during adjuvant chemotherapy but lower absolute and relative increases in visits compared with baseline. Therefore, PCPs can expect to see their patients with fewer physical comorbidities and no MHH more often during chemotherapy. Primary care physicians can plan for their patients with high physical comorbidity levels and MHH to continue having frequent appointments while they undergo chemotherapy, and they can expect their patients with low physical comorbidity levels and no MHH to increase the frequency of their visits during chemotherapy, and should be prepared to provide breast cancer-related care to these patients.
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Affiliation(s)
- Rachel L Walsh
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.
| | - Aisha K Lofters
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Rahim Moineddin
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Monika K Krzyzanowska
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
| | - Eva Grunfeld
- Department of Family and Community Medicine (Walsh), Sunnybrook Health Sciences Centre; Department of Family & Community Medicine (Walsh, Lofters, Grunfeld), University of Toronto; Department of Family & Community Medicine (Lofters), Women's College Hospital; Dalla Lana School of Public Health (Moineddin), University of Toronto; ICES Central (Moineddin); Department of Medical Oncology & Hematology (Krzyzanowska), Princess Margaret Cancer Centre, University Health Network; Institute of Health Policy, Management and Evaluation (Krzyzanowska), University of Toronto; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont
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34
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Davey MG, Ryan ÉJ, McAnena PF, Boland MR, Barry MK, Sweeney KJ, Malone CM, McLaughlin RJ, Lowery AJ, Kerin MJ. Disease recurrence and oncological outcome of patients treated surgically with curative intent for estrogen receptor positive, lymph node negative breast cancer. Surg Oncol 2021; 37:101531. [PMID: 33545657 DOI: 10.1016/j.suronc.2021.101531] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/10/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The molecular era has identified four breast cancer subtypes. Luminal A breast cancer (LABC) is defined by estrogen-receptor positive (ER+), progesterone-receptor positive (PgR+) and human epidermal growth factor receptor-2 negative (HER2-) tumours; these cancers are the most common and carry favourable prognoses. AIMS To describe clinicopathologic features, oncological outcome and relapse patterns in LABC. METHODS Consecutive female patients diagnosed with ER/PgR+/HER2-, lymph node negative (LN-) breast cancer between 2005 and 2015 were included. Clinicopathological and recurrence data was recorded using descriptive statistics. Oncological outcome was determined using Kaplan-Meier and Cox-regression analyses. RESULTS Analysis was performed for 849 patients with median follow-up of 102.1 months. Mean disease-free (DFS) and overall survival (OS) were 85.8% and 91.8%. Seventy patients died during this study (8.2%), while 58 patients had recurrence; 7 had local recurrence (0.8%) and 51 had distant recurrence (DDR) (6.0%). Patients developing DDR were likely to be postmenopausal (P = 0.028), present symptomatically (P < 0.001) and have larger tumours (P < 0.001). The mean time to DDR was 65.7 months, with fatal recurrence occurring in 66.6% of patients with DDR (34/51). Systemic chemotherapy prescription did not influence DDR (P = 0.053). Age >65 (hazards ratio (HR):1.66, 95% Confidence Interval (CI):1.07-2.55, P = 0.022), presenting symptomatically (HR:2.28, 95%CI:1.21-4.29, P = 0.011) and tumour size >20 mm (HR:1.81, 95%CI:1.25-2.62, P = 0.002) predicted DFS, while age>65 (HR:2.60, 95%CI:1.49-4.53, P = 0.001) and being postmenopausal at diagnosis (HR:3.13, 95%CI:1.19-8.22, P = 0.020) predicted OS. CONCLUSION Our series demonstrated excellent survival outcomes for patients diagnosed with LN- LABC after almost a decade of follow-up. However, following DDR, fatal progression is often imminent.
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Affiliation(s)
- M G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland.
| | - É J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - P F McAnena
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M R Boland
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - K J Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - C M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - R J McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - A J Lowery
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M J Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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35
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Kudesia P, Salimarouny B, Stanley M, Fortin M, Stewart M, Terry A, Ryan BL. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211032880. [PMID: 34350127 PMCID: PMC8287424 DOI: 10.1177/26335565211032880] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
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Affiliation(s)
- Prtha Kudesia
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Banafsheh Salimarouny
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, University of Western
Ontario, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Amanda Terry
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
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36
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Carreira H, Williams R, Funston G, Stanway S, Bhaskaran K. Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom. PLoS Med 2021; 18:e1003504. [PMID: 33411711 PMCID: PMC7822529 DOI: 10.1371/journal.pmed.1003504] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/22/2021] [Accepted: 12/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health-related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer. METHODS AND FINDINGS We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health-related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health-related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29-1.36; p < 0.001), depression (1.35; 1.32-1.38; p < 0.001), sexual dysfunction (1.27; 1.17-1.38; p < 0.001), and sleep disorder (1.68; 1.63-1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97-1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25-1.31; p < 0.001), pain (1.22; 1.20-1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83-1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97-1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact. CONCLUSIONS In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5-10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.
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Affiliation(s)
- Helena Carreira
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - Garth Funston
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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37
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Sampsell K, Hao D, Reimer RA. The Gut Microbiota: A Potential Gateway to Improved Health Outcomes in Breast Cancer Treatment and Survivorship. Int J Mol Sci 2020; 21:E9239. [PMID: 33287442 PMCID: PMC7731103 DOI: 10.3390/ijms21239239] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is the most frequently diagnosed cancer in women worldwide. The disease and its treatments exert profound effects on an individual's physical and mental health. There are many factors that impact an individual's risk of developing breast cancer, their response to treatments, and their risk of recurrence. The community of microorganisms inhabiting the gastrointestinal tract, the gut microbiota, affects human health through metabolic, neural, and endocrine signaling, and immune activity. It is through these mechanisms that the gut microbiota appears to influence breast cancer risk, response to treatment, and recurrence. A disrupted gut microbiota or state of 'dysbiosis' can contribute to a biological environment associated with higher risk for cancer development as well as contribute to negative treatment side-effects. Many cancer treatments have been shown to shift the gut microbiota toward dysbiosis; however, the microbiota can also be positively manipulated through diet, prebiotic and probiotic supplementation, and exercise. The objective of this review is to provide an overview of the current understanding of the relationship between the gut microbiota and breast cancer and to highlight potential strategies for modulation of the gut microbiota that could lead to improved clinical outcomes and overall health in this population.
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Affiliation(s)
- Kara Sampsell
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Desirée Hao
- Department of Medical Oncology, Tom Baker Cancer Centre and Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada;
| | - Raylene A. Reimer
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
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38
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Möhl A, Orban E, Jung AY, Behrens S, Obi N, Chang-Claude J, Becher H. Comorbidity burden in long-term breast cancer survivors compared with a cohort of population-based controls from the MARIE study. Cancer 2020; 127:1154-1160. [PMID: 33259052 DOI: 10.1002/cncr.33363] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The number of elderly cancer survivors is growing because of increasing survival rates. A high comorbidity burden in the elderly can affect their quality of life and survival. The aim of this study was to examine whether breast cancer survivors and population-based controls have a different comorbidity burden after long-term follow-up. METHODS This study used data from a German breast cancer case-control study, which initially comprised 3813 breast cancer cases aged 50 to 74 years who were diagnosed between 2002 and 2005 and 7341 population-based controls. Participants were followed up in 2014/2016. A modified Charlson Comorbidity Index (mCCI) was calculated to quantify severe comorbidities. Negative binomial regression was performed to estimate rate ratios (RRs) with 95% confidence intervals (CIs) for the association between case-control status and mCCI (dependent variable) for the baseline population and for those who participated at follow-up, with adjustments made for relevant lifestyle factors. RESULTS In total, 1925 cases and 3674 controls participated in the follow-up 12 years after recruitment. In the baseline population 35% had at least 1 comorbid condition.In long-term survivors this proportion was 52%. No difference was found in the mCCI between breast cancer cases and controls at baseline (RR, 1.05; 95% CI, 0.98-1.11) or between long-term survivors of the 2 groups at baseline (RR, 1.07; 95% CI, 0.97-1.18) or at follow-up (RR, 1.00; 95% CI, 0.91-1.10). CONCLUSIONS The comorbidity burden of long-term breast cancer survivors and controls increased over time; however, it remained similar in both groups after 12 years of follow-up.
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Affiliation(s)
- Annika Möhl
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ester Orban
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Audrey Y Jung
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jenny Chang-Claude
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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39
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Falstie-Jensen AM, Esen BÖ, Kjærsgaard A, Lorenzen EL, Jensen JD, Reinertsen KV, Dekkers OM, Ewertz M, Cronin-Fenton DP. Incidence of hypothyroidism after treatment for breast cancer-a Danish matched cohort study. Breast Cancer Res 2020; 22:106. [PMID: 33050919 PMCID: PMC7556927 DOI: 10.1186/s13058-020-01337-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Breast cancer survivors (BCS) may have increased risk of hypothyroidism, but risk according to treatment modality is unclear. We estimated the incidence of hypothyroidism in women with breast cancer, and according to cancer treatment. Methods Using nationwide registries, we identified all Danish women aged ≥ 35 years diagnosed with non-metastatic breast cancer (1996–2009). We matched up to five cancer-free women (controls) for each BCS. We excluded women with prevalent thyroid disease. Cancer treatment was chemotherapy with or without radiotherapy (RT) targeting the breast/chest wall only, or also the lymph nodes (RTn). We identified hypothyroidism using diagnostic codes, and/or levothyroxine prescriptions. We calculated the cumulative incidence, incidence rates (IR) per 1000 person-years, and used Cox regression to estimate hazard ratios (HR) and associated 95% confidence intervals (CIs) of hypothyroidism, adjusting for comorbidities. Results We included 44,574 BCS and 203,306 matched controls with 2,631,488 person-years of follow-up. BCS had a slightly higher incidence of hypothyroidism than controls [5-year cumulative incidence, 1.8% (95%CI = 1.7–1.9) and 1.6% (95%CI = 1.5–1.6), respectively]. The overall IR was 4.45 (95%CI = 4.25–4.67) and 3.81 (95%CI = 3.73–3.90), corresponding to an adjusted HR = 1.17 (95%CI = 1.11–1.24). BCS who received RTn with chemotherapy (HR = 1.74, 95%CI = 1.50–2.02) or without chemotherapy (HR = 1.31, 95%CI = 1.14–1.51) had an elevated risk of hypothyroidism compared with matched controls and compared with BCS who underwent surgery alone [HR = 1.71, 95%CI = 1.45–2.01 and HR = 1.36, 95%CI = 1.17–1.58, respectively]. Conclusions BCS have an excess risk of hypothyroidism compared with age-matched controls. BCS and those working in cancer survivorship settings ought to be aware that this risk is highest in women treated with radiation therapy to the lymph nodes and chemotherapy.
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Affiliation(s)
- Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
| | - Buket Ö Esen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
| | - Ebbe L Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jeanette D Jensen
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristin V Reinertsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.,Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Deirdre P Cronin-Fenton
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.
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40
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Haque R, Hsu JW, Avila C, Olmstead R, Carroll JE, Irwin MR. Insomnia and Susceptibility to Depressive Symptoms and Fatigue in Diverse Breast Cancer Survivors. J Womens Health (Larchmt) 2020; 30:1604-1615. [PMID: 33035108 PMCID: PMC8917892 DOI: 10.1089/jwh.2019.8135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Nearly 40% of breast cancer survivors have insomnia, yet, information how this condition affects their quality of life is lacking. We examined the association between insomnia and depressive symptoms and fatigue in breast cancer survivors. Methods: Participants were recruited from a community health plan. We conducted a cross-sectional analysis to examine the association between current insomnia (using Insomnia Severity Index [ISI]) and current depressive symptoms (using Inventory of Depressive Symptomology [IDS]) and fatigue (using Fatigue Symptom Inventory [FSI]) in 315 breast cancer survivors who did not have major depressive disorder. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression. Results: The cohort included 30% minority women whose median time since breast cancer diagnosis was 6 years. Survivors with current insomnia symptoms (ISI ≥8) had a sixfold greater odds of current depressive symptoms (IDS >14, OR = 5.98, 95% CI: 3.04–11.76), after adjusting for lifetime insomnia history (OR = 2.01, 95% CI: 1.03–3.94) and perceived stress (OR = 6.37, 95% CI: 2.48–16.32). Insomnia symptoms were markedly associated with moderate fatigue (FSI >3, OR = 5.02, 95% CI: 2.66–9.44). Ever use of antidepressants or sleep medications post-breast cancer diagnosis was not associated with lower odds of current depressive symptoms or feeling fatigued in those with insomnia symptoms. Conclusion: Current insomnia symptoms were strongly correlated with current depressive symptoms and fatigue. Survivorship care plans should consider incorporating insomnia screening to that may potentially enhance quality of life domains.
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Affiliation(s)
- Reina Haque
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Jin Wen Hsu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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41
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Bortolozo HI, Derchain S, Vechin FC, Maginador GF, Santos IS, Torresan R, de Nazaré Silva Dos Santos P, Sarian LO, Conceição MS. Aerobic Fitness is a Predictor of Body Composition in Women With Breast Cancer at Diagnosis. Clin Breast Cancer 2020; 21:e245-e251. [PMID: 34159902 DOI: 10.1016/j.clbc.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to investigate the relationship of aerobic fitness (AF) at diagnosis, before treatment and its relationship with body composition, physical function, lipidic profile, comorbidities, tumor characteristics, and quality of life of women with breast cancer (BC) PATIENTS AND METHODS: This cross-sectional cohort study included 78 women with BC that were assessed before treatment. A 6-minute walk test was used to evaluate the subjects' AF, estimating the maximum oxygen consumption (VO2max) to classify the women with BC into 2 groups: good/excellent AF or fair/weak/very weak AF. Dual-energy x-ray absorptiometry was performed to assess body composition. The International Global Physical Activity Questionnaire and the Functional Assessment of Cancer Therapy - Fatigue questionnaires were applied to assess the level of physical activity and the quality of life, respectively. RESULTS Among the women included, the majority (81%) had the luminal subtype of BC. Most of the women were diagnosed with T1/T2 tumors and with negative axillary lymph nodes. We found that women with BC with good/excellent AF (VO2max = 32.9 ± 6.0 mL/kg/min-1) presented significantly lower weight, body mass index, abdominal circumference, percentual and total body fat, and bone mineral density compared with women with fair/weak/very weak AF (VO2max = 21.8 ± 6.9 mL/kg/min-1). Also, women with BC with good/excellent AF showed better performance on physical functional tests. No relationship between estimated VO2max and comorbidities, tumor characteristics, or quality of life was found. CONCLUSION AF is a predictor of body composition and physical function in women with BC. These data suggest that women with BC with higher AF can decrease the chance of adverse effects during BC treatment.
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Affiliation(s)
- Henrique Ims Bortolozo
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Felipe C Vechin
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Guilherme F Maginador
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Izabella Silva Santos
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Renato Torresan
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Miguel S Conceição
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; Faculty of Physical Education, University of Campinas, Campinas, São Paulo, Brazil.
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