1
|
Soldato D, Michiels S, Havas J, Di Meglio A, Pagliuca M, Franzoi MA, Pistilli B, Iyengar NM, Cottu P, Lerebours F, Coutant C, Bertaut A, Tredan O, Vanlemmens L, Jouannaud C, Hrab I, Everhard S, Martin AL, André F, Vaz-Luis I, Jones LW. Dose/Exposure Relationship of Exercise and Distant Recurrence in Primary Breast Cancer. J Clin Oncol 2024; 42:3022-3032. [PMID: 38838281 PMCID: PMC11361355 DOI: 10.1200/jco.23.01959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE Postdiagnosis exercise is associated with lower breast cancer (BC) mortality but its link with risk of recurrence is less clear. We investigated the impact and dose-response relationship of exercise and recurrence in patients with primary BC. METHODS Multicenter prospective cohort analysis among 10,359 patients with primary BC from 26 centers in France between 2012 and 2018 enrolled in the CANcer TOxicities study, with follow-up through October 2021. Exercise exposure was assessed using the Global Physical Activity Questionnaire-16, quantified in standardized metabolic equivalent of task-hours per week (MET-h/wk). We examined the dose/exposure response of pretreatment exercise on distant recurrence-free interval (DRFI) for all patients and stratified by clinical subtype and menopausal status using inverse probability treatment weighted multivariable Cox models to estimate hazard ratios (HRs). RESULTS For the overall cohort, the relationship between exercise and DRFI was nonlinear: increasing exercise ≥ 5 MET-h/wk was associated with an inverse linear reduction in DRFI events up to approximately 25 MET-h/wk; increasing exercise over this threshold did not provide any additional DRFI benefit. Compared with <5 MET-h/wk, the adjusted HR for DRFI was 0.82 (95% CI, 0.61 to 1.00) for ≥ 5 MET-h/wk. Stratification by subtype revealed the hormone receptor-/human epidermal growth factor receptor 2- (HR-/HER2-; HR, 0.59 [95% CI, 0.38 to 0.92]) and HR-/HER2+ (HR, 0.37 [95% CI, 0.14 to 0.96]) subtypes were preferentially responsive to exercise. The benefit of exercise was observed especially in the premenopausal population. CONCLUSION Postdiagnosis/pretreatment exercise is associated with lower risk of DRFI events in a nonlinear fashion in primary BC; exercise has different impact on DRFI as a function of subtype and menopausal status.
Collapse
Affiliation(s)
- Davide Soldato
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- INSERM U1018 CESP, Service de Biostatistique et d’Epidemiologie, Institut Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | - Martina Pagliuca
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
- Division of Breast Medical Oncology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Maria Alice Franzoi
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | | | - Neil M. Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Iona Hrab
- Centre François Baclesse, Caen, France
| | | | | | - Fabrice André
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
- Medical Oncology Department, Gustave Roussy, Villejuif, France
- Supportive Care and Pathways Department (DIOPP), Gustave Roussy, Villejuif, France
| | - Lee W. Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| |
Collapse
|
2
|
Sandoval JL, Franzoi MA, di Meglio A, Ferreira AR, Viansone A, André F, Martin AL, Everhard S, Jouannaud C, Fournier M, Rouanet P, Vanlemmens L, Dhaini-Merimeche A, Sauterey B, Cottu P, Levy C, Stringhini S, Guessous I, Vaz-Luis I, Menvielle G. Magnitude and Temporal Variations of Socioeconomic Inequalities in the Quality of Life After Early Breast Cancer: Results From the Multicentric French CANTO Cohort. J Clin Oncol 2024; 42:2908-2917. [PMID: 38889372 PMCID: PMC11328924 DOI: 10.1200/jco.23.02099] [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: 09/27/2023] [Revised: 02/12/2024] [Accepted: 04/11/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE Socioeconomic status (SES) influences the survival outcomes of patients with early breast cancer (EBC). However, limited research investigates social inequalities in their quality of life (QoL). This study examines the socioeconomic inequalities in QoL after an EBC diagnosis and their time trends. PATIENTS AND METHODS We used data from the French prospective multicentric CANTO cohort (ClinicalTrials.gov identifier: NCT01993498), including women with EBC enrolled between 2012 and 2018. QoL was assessed using the European Organisation for Research and Treatment of Cancer QoL Core 30 questionnaire (QLQ-C30). summary score at diagnosis and 1 and 2 years postdiagnosis. We considered three indicators of SES separately: self-reported financial difficulties, household income, and educational level. We first analyzed the trajectories of the QLQ-C30 summary score by SES group. Then, social inequalities in QLQ-C30 summary score and their time trends were quantified using the regression-based slope index of inequality (SII), representing the absolute change in the outcome along socioeconomic gradient extremes. The analyses were adjusted for age at diagnosis, Charlson Comorbidity Index, disease stage, and type of local and systemic treatment. RESULTS Among the 5,915 included patients with data on QoL at diagnosis and at the 2-year follow-up, social inequalities in QLQ-C30 summary score at baseline were statistically significant for all SES indicators (SIIfinancial difficulties = -7.6 [-8.9; -6.2], SIIincome = -4.0 [-5.2; -2.8]), SIIeducation = -1.9 [-3.1; -0.7]). These inequalities significantly increased (interaction P < .05) in year 1 and year 2 postdiagnosis, irrespective of prediagnosis health, tumor characteristics, and treatment. Similar results were observed in subgroups defined by menopausal status and type of adjuvant systemic treatment. CONCLUSION The magnitude of preexisting inequalities in QoL increased over time after EBC diagnosis, emphasizing the importance of considering social determinants of health during comprehensive cancer care planning.
Collapse
Affiliation(s)
- José Luis Sandoval
- Unit of Population Epidemiology, Division of Primary Care, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Maria Alice Franzoi
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antonio di Meglio
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | | | | | - Fabrice André
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Anne-Laure Martin
- UNICANCER, Direction des Data et des Partenariats, Le Kremlin-Bicêtre, France
| | - Sibille Everhard
- UNICANCER, Direction des Data et des Partenariats, Le Kremlin-Bicêtre, France
| | | | | | - Philippe Rouanet
- Institut régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France
| | | | | | | | | | | | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ines Vaz-Luis
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
- Interdisciplinary department for the Organization of Patient Pathways (DIOPP), Gustave Roussy Institute, Villejuif, France
| | - Gwenn Menvielle
- Unit of Molecular Predictors and New Targets in Oncology, INSERM, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| |
Collapse
|
3
|
Chen H, Moriceau S, Joseph A, Mailliet F, Li S, Tolle V, Duriez P, Dardennes R, Durand S, Carbonnier V, Stoll G, Sauvat A, Lachkar S, Aprahamian F, Alves Costa Silva C, Pan H, Montégut L, Anagnostopoulos G, Lambertucci F, Motiño O, Nogueira-Recalde U, Bourgin M, Mao M, Pan Y, Cerone A, Boedec E, Gouveia ZL, Marmorino F, Cremolini C, Derosa L, Zitvogel L, Kepp O, López-Otín C, Maiuri MC, Perez F, Gorwood P, Ramoz N, Oury F, Martins I, Kroemer G. Acyl-CoA binding protein for the experimental treatment of anorexia. Sci Transl Med 2024; 16:eadl0715. [PMID: 39141698 DOI: 10.1126/scitranslmed.adl0715] [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: 09/27/2023] [Revised: 03/25/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024]
Abstract
Extracellular acyl-coenzyme A binding protein [ACBP encoded by diazepam binding inhibitor (DBI)] is a phylogenetically ancient appetite stimulator that is secreted in a nonconventional, autophagy-dependent fashion. Here, we show that low ACBP/DBI plasma concentrations are associated with poor prognosis in patients with anorexia nervosa, a frequent and often intractable eating disorder. In mice, anorexia induced by chronic restraint stress (CRS) is accompanied by a reduction in circulating ACBP/DBI concentrations. We engineered a chemical-genetic system for the secretion of ACBP/DBI through a biotin-activatable, autophagy-independent pathway. In transgenic mice expressing this system in hepatocytes, biotin-induced elevations in plasma ACBP/DBI concentrations prevented anorexia induced by CRS or chemotherapeutic agents including cisplatin, doxorubicin, and paclitaxel. ACBP/DBI reversed the CRS or cisplatin-induced increase in plasma lipocalin-2 concentrations and the hypothalamic activation of anorexigenic melanocortin 4 receptors, for which lipocalin-2 is an agonist. Daily intravenous injections of recombinant ACBP/DBI protein or subcutaneous implantation of osmotic pumps releasing recombinant ACBP/DBI mimicked the orexigenic effects of the chemical-genetic system. In conclusion, the supplementation of extracellular and peripheral ACBP/DBI might constitute a viable strategy for treating anorexia.
Collapse
Affiliation(s)
- Hui Chen
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, 91400 Paris, France
| | - Stéphanie Moriceau
- Institut Imagine, Platform for Neurobehavioral and Metabolism, Structure Fédérative de Recherche Necker, 26 INSERM US24/CNRS UAR, 3633, 75015 Paris, France
| | - Adrien Joseph
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Service de Réanimation Médicale, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, 75010 Paris, France
| | - Francois Mailliet
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, Team 8, F-75015 Paris, France
| | - Sijing Li
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, 91400 Paris, France
| | - Virginie Tolle
- Université de Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Genetic Vulnerability to Addictive and Psychiatric Disorders Team, 75015 Paris, France
| | - Philibert Duriez
- Université de Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Genetic Vulnerability to Addictive and Psychiatric Disorders Team, 75015 Paris, France
- Université Paris Cité and GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 75014 Paris, France
| | - Roland Dardennes
- Université Paris Cité and GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 75014 Paris, France
| | - Sylvère Durand
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Vincent Carbonnier
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Gautier Stoll
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Allan Sauvat
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Sylvie Lachkar
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Fanny Aprahamian
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Carolina Alves Costa Silva
- Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
- Université Paris-Saclay, Faculté de Médecine, 94800 Le Kremlin-Bicêtre, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Équipe Labellisée-Ligue Nationale contre le Cancer, 94805 Villejuif, France
| | - Hui Pan
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, 91400 Paris, France
| | - Léa Montégut
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, 91400 Paris, France
| | - Gerasimos Anagnostopoulos
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Flavia Lambertucci
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Omar Motiño
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Uxía Nogueira-Recalde
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Rheumatology Research Group (GIR), Biomedical Research Institute of A Coruña (INIBIC), Professor Novoa Santos Foundation, 15006 A Coruña, Spain
| | - Mélanie Bourgin
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Misha Mao
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, 91400 Paris, France
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, 310016 Hangzhou, Zhejiang, China
| | - Yuhong Pan
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, 91400 Paris, France
| | - Alexandra Cerone
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Erwan Boedec
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Biochemistry and Biophysics (B&B) Core Facility, 75014 Paris, France
| | - Zelia L Gouveia
- Cell Biology and Cancer Unit, Institut Curie, PSL Research University, CNRS, 75005 Paris, France
| | - Federica Marmorino
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Lisa Derosa
- Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
- Université Paris-Saclay, Faculté de Médecine, 94800 Le Kremlin-Bicêtre, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Équipe Labellisée-Ligue Nationale contre le Cancer, 94805 Villejuif, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
- Université Paris-Saclay, Faculté de Médecine, 94800 Le Kremlin-Bicêtre, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Équipe Labellisée-Ligue Nationale contre le Cancer, 94805 Villejuif, France
| | - Oliver Kepp
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Carlos López-Otín
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Facultad de Ciencias de la Vida y la Naturaleza, Universidad Nebrija, 28248 Madrid, Spain
- Departamento de Bioquímica y Biología Molecular, Instituto Universitario de Oncología (IUOPA), Universidad de Oviedo, 33006 Oviedo, Spain
| | - Maria Chiara Maiuri
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
| | - Franck Perez
- Cell Biology and Cancer Unit, Institut Curie, PSL Research University, CNRS, 75005 Paris, France
| | - Philip Gorwood
- Université de Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Genetic Vulnerability to Addictive and Psychiatric Disorders Team, 75015 Paris, France
- Université Paris Cité and GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 75014 Paris, France
| | - Nicolas Ramoz
- Université de Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Genetic Vulnerability to Addictive and Psychiatric Disorders Team, 75015 Paris, France
- Université Paris Cité and GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, 75014 Paris, France
| | - Franck Oury
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, Team 8, F-75015 Paris, France
| | - Isabelle Martins
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université Paris Cité, Sorbonne Université, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Institut, 94805 Villejuif, France
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| |
Collapse
|
4
|
Di Meglio A, Havas J, Pagliuca M, Franzoi MA, Soldato D, Chiodi CK, Gillanders E, Dubuisson F, Camara-Clayette V, Pistilli B, Ribeiro J, Joly F, Cottu PH, Tredan O, Bertaut A, Ganz PA, Bower J, Partridge AH, Martin AL, Everhard S, Boyault S, Brutin S, André F, Michiels S, Pradon C, Vaz-Luis I. A bio-behavioral model of systemic inflammation at breast cancer diagnosis and fatigue of clinical importance 2 years later. Ann Oncol 2024:S0923-7534(24)01517-5. [PMID: 39098454 DOI: 10.1016/j.annonc.2024.07.728] [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: 12/03/2023] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance 2 years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation. PATIENTS AND METHODS Women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance [European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 ≥40/100] 2 years after diagnosis (year 2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers [interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon γ, IL-1 receptor antagonist, tumor necrosis factor-α, and C-reactive protein], and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling. RESULTS Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year 2. High pre-treatment levels of IL-6 (quartile 4 versus 1) were associated with global CRF at year 2 [adjusted odds ratio (aOR): 2.06 (95% confidence interval [CI] 1.40-3.03); P = 0.0002; area under the receiver operating characteristic curve = 0.74]. Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese [62.4%; mean body mass index 28.0 (standard deviation 6.3 kg/m2)] and physically inactive (53.5% did not meet World Health Organization recommendations). Clinical and behavioral associations with CRF at year 2 included pre-treatment CRF [aOR versus no pre-treatment CRF: 3.99 (95% CI 2.81-5.66)], younger age [aOR per 1-year decrement: 1.02 (95% CI 1.01-1.03)], current tobacco smoking [aOR versus never: 1.81 (95% CI 1.26-2.58)], and worse insomnia or pain [aOR per 10-unit increment: 1.08 (95% CI 1.04-1.13), and 1.12 (95% CI 1.04-1.21), respectively]. Secondary analyses indicated additional associations of IL-2 [aOR per log-unit increment: 1.32 (95% CI 1.03-1.70)] and IL-10 [0.73 (95% CI 0.57-0.93)] with global CRF and of C-reactive protein [1.42 (95% CI 1.13-1.78)] with cognitive CRF at year 2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF. CONCLUSIONS This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance 2 years later among a large prospective sample of survivors of breast cancer.
Collapse
Affiliation(s)
- A Di Meglio
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France.
| | - J Havas
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France
| | - M Pagliuca
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France; Division of Breast Medical Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - M A Franzoi
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France
| | - D Soldato
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France
| | - C K Chiodi
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France
| | - E Gillanders
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France
| | - F Dubuisson
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif
| | - V Camara-Clayette
- Biological Resource Center, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif
| | - B Pistilli
- Medical Oncology Department, INSERM U981, Gustave Roussy, Villejuif
| | - J Ribeiro
- Medical Oncology Department, INSERM U981, Gustave Roussy, Villejuif
| | - F Joly
- Centre Francois Baclesse, University UniCaen, Anticipe U1086 Inserm, Caen
| | | | | | - A Bertaut
- Centre Georges François Leclerc, Dijon, France
| | - P A Ganz
- University of California, Los Angeles
| | - J Bower
- University of California, Los Angeles
| | | | | | | | - S Boyault
- Centre Georges François Leclerc, Dijon, France
| | - S Brutin
- Biological Resource Center, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif
| | - F André
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France
| | - S Michiels
- Oncostat U1018, Inserm, Université Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif; Service de Biostatistique et Epidémiologie, Gustave Roussy, Villejuif
| | - C Pradon
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif; Biological Resource Center, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif
| | - I Vaz-Luis
- Cancer Survivorship Program, INSERM U981, Gustave Roussy, Villejuif, France; Interdisciplinary Department for the Organization of Patient Pathways (DIOPP), Gustave Roussy, Villejuif, France. https://twitter.com/ines_vazluis
| |
Collapse
|
5
|
Lange M, Lequesne J, Dumas A, Clin B, Vaz-Luis I, Pistilli B, Rigal O, Lévy C, Lerebours F, Martin AL, Everhard S, Menvielle G, Joly F. Cognition and Return to Work Status 2 Years After Breast Cancer Diagnosis. JAMA Netw Open 2024; 7:e2427576. [PMID: 39158915 PMCID: PMC11333979 DOI: 10.1001/jamanetworkopen.2024.27576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024] Open
Abstract
Importance Return to work after breast cancer (BC) treatment depends on several factors, including treatment-related adverse effects. While cancer-related cognitive impairment is frequently reported by patients with BC, to date, no longitudinal studies have assessed its association with return to work. Objective To examine whether cognition, assessed using objective and subjective scores, was associated with return to work 2 years after BC diagnosis. Design, Setting, and Participants In a case series of the French Cancer Toxicities (CANTO) cohort, a study of patients with stage I to III BC investigated cognition from April 2014 to December 2018 (2 years' follow-up). Participants included women aged 58 years or younger at BC diagnosis who were employed or looking for a job. Main Outcomes and Measures The outcome was return to work assessed 2 years after BC diagnosis. Objective cognitive functioning (tests), cognitive symptoms, anxiety, depression, and fatigue were prospectively assessed at diagnosis (baseline), 1 year after treatment completion, and 2 years after diagnosis. Multivariable logistic regression models were used to explain return to work status at year 2 according to each cognitive measure separately, adjusted for age, occupational class, stage at diagnosis, and chemotherapy. Results The final sample included 178 women with BC (median age: 48.7 [range, 28-58] years), including 37 (20.8%) who did not return to work at year 2. Patients who returned to work had a higher (ie, professional) occupational class and were less likely to have had a mastectomy (24.1% vs 54.1%; P < .001). Return to work at year 2 was associated with lower overall cognitive impairment (1-point unit of increased odds ratio [1-pt OR], 0.32; 95% CI, 0.13-0.79; P = .01), higher working memory (1-pt OR, 2.06; 95% CI, 1.23-3.59; P = .008), higher processing speed (1-pt OR, 1.97; 95% CI, 1.20-3.36; P = .01) and higher attention performance (1-pt OR, 1.63; 95% CI, 1.04-2.64; P = .04), higher perceived cognitive abilities (1-pt OR, 1.12; 95% CI, 1.03-1.21; P = .007), and lower depression (1-pt OR, 0.83; 95% CI, 0.74-0.93; P = .001) at year 2 assessment. Return to work at year 2 was associated with several measures assessed at baseline and year 1: higher processing speed (1-pt OR, 2.38; 95% CI, 1.37-4.31; P = .003 and 1.95; 95% CI, 1.14-3.50; P = .02), higher executive performance (1-pt OR, 2.61; 95% CI, 1.28-5.75; P = .01, and 2.88; 95% CI, 1.36-6.28; P = .006), and lower physical fatigue (10-pt OR, 0.81; 95% CI, 0.69-0.95; P = .009 and 0.84; 95% CI, 0.71-0.98; P = .02). Conclusions and Relevance In this case series study of patients with BC, return to work 2 years after diagnosis was associated with higher cognitive speed performance before and after BC treatment. Cognitive difficulties should be assessed before return to work to propose suitable management.
Collapse
Affiliation(s)
- Marie Lange
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, Caen, France
| | - Justine Lequesne
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, Caen, France
| | - Agnes Dumas
- Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM (Economic and Social Sciences of Health and Medical Information Processing), Marseille, France
| | - Bénédicte Clin
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, Caen, France
- CHU de Caen, Service de santé au travail et pathologie professionnelle, F-14000 Caen, France
| | - Ines Vaz-Luis
- INSERM, Gustave Roussy Institute, University Paris Saclay, Unit Molecular Predictors and New Targets in Oncology, Villejuif, France
| | | | - Olivier Rigal
- Care Support Department, Centre Henri Becquerel, Rouen, France
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France
| | - Christelle Lévy
- Institut Normand du Sein, Centre François Baclesse, Caen, France
| | | | | | | | - Gwenn Menvielle
- INSERM, Gustave Roussy Institute, University Paris Saclay, Unit Molecular Predictors and New Targets in Oncology, Villejuif, France
| | - Florence Joly
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, Caen, France
- Medical Oncology Department, CHU de Caen, Caen, France
| |
Collapse
|
6
|
Kok M, Gielen RJ, Adams S, Lennerz JK, Sharma P, Loibl S, Reardon E, Sonke G, Linn S, Delaloge S, Lacombe D, Robinson T, Badve S, Martin M, Balko JM, Ignatiadis M, Curigliano G, Wolff AC, Mittendorf EA, Loi S, Pusztai L, Tolaney SM, Salgado R. Academic Uphill Battle to Personalize Treatment for Patients With Stage II/III Triple-Negative Breast Cancer. J Clin Oncol 2024:JCO2400372. [PMID: 39038259 DOI: 10.1200/jco.24.00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/17/2024] [Accepted: 05/08/2024] [Indexed: 07/24/2024] Open
Affiliation(s)
- Marleen Kok
- Departments of Medical Oncology and Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Robbert-Jan Gielen
- Departments of Medical Oncology and Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sylvia Adams
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY
| | | | | | - Sibylle Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
- Centre for Haematology and Oncology, Bethanien, and Goethe University, Frankfurt, Germany
| | | | - Gabe Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sabine Linn
- Departments of Medical Oncology and Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Tim Robinson
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Winship Cancer Institute, Atlanta, GA
| | - Miguel Martin
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sherene Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Lajos Pusztai
- Department of Medicine, Yale Cancer Center, Yale University, New Haven, CT
| | | | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
- Division of Research, PeterMacCallum Cancer Centre, Melbourne, VIC, Australia
| |
Collapse
|
7
|
Duivon M, Lequesne J, Di Meglio A, Pradon C, Vaz-Luis I, Martin AL, Everhard S, Broutin S, Rigal O, Bousrih C, Lévy C, Lerebours F, Lange M, Joly F. Inflammation at diagnosis and cognitive impairment two years later in breast cancer patients from the Canto-Cog study. Breast Cancer Res 2024; 26:93. [PMID: 38840166 PMCID: PMC11151649 DOI: 10.1186/s13058-024-01850-5] [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: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Inflammation could be related to cancer-related cognitive impairment (CRCI) and might be used as a predictive marker of long-term CRCI. We evaluated associations between inflammatory markers assessed at diagnosis of breast cancer and CRCI two years afterwards. METHODS Newly diagnosed stage I-III patients with breast cancer from the French CANTO-Cog (Cognitive sub-study of CANTO, NCT01993498) were included at diagnosis (baseline). Serum inflammatory markers (IL-2, IL-4, IL-6, IL-8, IL-10, TNFα, CRP) were assessed at baseline. Outcomes at year 2 post-baseline included overall cognitive impairment (≥ 2 impaired domains) and the following domains: episodic memory, working memory, attention, processing speed, and executive functions. Multivariable logistic regression models evaluated associations between markers and outcomes, controlling for age, education, and baseline cognitive impairment. RESULTS Among 200 patients, the mean age was 54 ± 11 years, with 127 (64%) receiving chemotherapy. Fifty-three (27%) patients had overall cognitive impairment at both timepoints. Overall cognitive impairment at year 2 was associated with high (> 3 mg/L) baseline CRP (OR = 2.84, 95%CI: 1.06-7.64, p = 0.037). In addition, associations were found between high CRP and processing speed impairment (OR = 2.47, 95%CI:1.05-5.87, p = 0.039), and between high IL-6 and episodic memory impairment (OR = 5.50, 95%CI:1.43-36.6, p = 0.010). CONCLUSIONS In this cohort, high levels of CRP and IL-6 assessed at diagnosis were associated with overall CRCI, processing speed and episodic memory impairments two years later. These findings suggest a potential inflammatory basis for long-term CRCI. CRP may represent an easily measurable marker in clinical settings and be potentially used to screen patients at greater risk of persistent CRCI.
Collapse
Affiliation(s)
- Mylène Duivon
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
| | - Justine Lequesne
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif, France
| | - Caroline Pradon
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif, France
- DIOPP, Gustave Roussy, Villejuif, France
| | | | | | - Sophie Broutin
- Biological Resource Center, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Olivier Rigal
- Care Support Department, Centre Henri Becquerel, 76000, Rouen, France
- Medical Oncology Department, Centre Henri Becquerel, 76000, Rouen, France
| | | | - Christelle Lévy
- Institut Normand du Sein, Centre François Baclesse, 14000, Caen, France
| | | | - Marie Lange
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France.
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France.
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France.
| | - Florence Joly
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France
| |
Collapse
|
8
|
Berger ML, Ganz PA, Zou KH, Greenfield S. When Will Real-World Data Fulfill Its Promise to Provide Timely Insights in Oncology? JCO Clin Cancer Inform 2024; 8:e2400039. [PMID: 38950323 DOI: 10.1200/cci.24.00039] [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: 02/22/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 07/03/2024] Open
Abstract
Randomized trials provide high-quality, internally consistent data on selected clinical questions, but lack generalizability for the aging population who are most often diagnosed with cancer and have comorbid conditions that may affect the interpretation of treatment benefit. The need for high-quality, relevant, and timely data is greater than ever. Promising solutions lie in the collection and analysis of real-world data (RWD), which can potentially provide timely insights about the patient's course during and after initial treatment and the outcomes of important subgroups such as the elderly, rural populations, children, and patients with greater social health needs. However, to inform practice and policy, real-world evidence must be created from trustworthy and comprehensive sources of RWD; these may include pragmatic clinical trials, registries, prospective observational studies, electronic health records (EHRs), administrative claims, and digital technologies. There are unique challenges in oncology since key parameters (eg, cancer stage, biomarker status, genomic assays, imaging response, side effects, quality of life) are not recorded, siloed in inaccessible documents, or available only as free text or unstructured reports in the EHR. Advances in analytics, such as artificial intelligence, may greatly enhance the ability to obtain more granular information from EHRs and support integrated diagnostics; however, they will need to be validated purpose by purpose. We recommend a commitment to standardizing data across sources and building infrastructures that can produce fit-for-purpose RWD that will provide timely understanding of the effectiveness of individual interventions.
Collapse
Affiliation(s)
| | - Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center, UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kelly H Zou
- Global Medical Analytics, Real World Evidence, and Health Economics & Outcomes Research, Viatris Inc, Canonsburg, PA
| | | |
Collapse
|
9
|
Gédor M, Desandes E, Chesnel M, Merlin JL, Marchal F, Lambert A, Baudin A. [Development of an artificial intelligence system to improve cancer clinical trial eligibility screening]. Bull Cancer 2024; 111:473-482. [PMID: 38503584 DOI: 10.1016/j.bulcan.2024.01.010] [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: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION The recruitment step of all clinical trials is time consuming, harsh and generate extra costs. Artificial intelligence tools could improve recruitment in order to shorten inclusion phase. The objective was to assess the performance of an artificial intelligence driven tool (text mining, machine learning, classification…) for the screening and detection of patients, potentially eligible for recruitment in one of the clinical trials open at the "Institut de Cancérologie de Lorraine". METHODS Computerized clinical data during the first medical consultation among patients managed in an anticancer center over the 2019-2023 period were used to study the performances of an artificial intelligence tool (SAS® Viya). Recall, precision and F1-score were used to determine the artificial intelligence algorithm effectiveness. Time saved on screening was determined by the difference between the time taken using the artificial intelligence-assisted method and that taken using the standard method in clinical trial participant screening. RESULTS Out of 9876 patients included in the study, the artificial intelligence algorithm obtained the following scores: precision of 96 %, recall of 94 % and a 0.95 F1-score to detect patients with breast cancer (n=2039) and potentially eligible for inclusion in a clinical trial. The screening of 258 potentially eligible patient's files took 20s per file vs. 5min and 6s with standard method. DISCUSSION This study suggests that artificial intelligence could yield sizable improvements over standard practices in several aspects of the patient screening process, as well as in approaches to feasibility, site selection, and trial selection.
Collapse
Affiliation(s)
- Maud Gédor
- Service en charge des données de santé, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Emmanuel Desandes
- Service en charge des données de santé, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; EA 4360 APEMAC, université de Lorraine, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-lès-Nancy, France
| | - Mélanie Chesnel
- Direction de la santé numérique, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Jean-Louis Merlin
- Service de biologie moléculaire des tumeurs, institut de cancérologie de Lorraine, CNRS UMR 7039 CRAN-université de Lorraine, 6, avenue de Bourgogne CS 30519, 54519 Vandœuvre-lès-Nancy, France
| | - Frédéric Marchal
- Département de chirurgie, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; Centre de recherche en automatique de Nancy, Centre national de la recherche scientifique, UMR 7039, université de Lorraine, faculté des sciences et technologies-Campus Aiguillettes, 54506 Vandœuvre-lès-Nancy, France
| | - Aurélien Lambert
- EA 4360 APEMAC, université de Lorraine, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-lès-Nancy, France; Département d'oncologie médicale, institut de cancérologie de Lorraine, 6 avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Arnaud Baudin
- Service en charge des données de santé, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.
| |
Collapse
|
10
|
Chiodi C, Epstein J, Arvis J, Martin E, Barbier A, Di Meglio A, Gillanders E, Jacob G, Menvielle G, Everhard S, Guillemin F, Luis IV, Franzoi MA. An effort to improve the collection of patient-generated data: readability and understandability of patient-reported outcomes measures in a survivorship cohort. Qual Life Res 2024; 33:1267-1274. [PMID: 38441716 DOI: 10.1007/s11136-024-03600-8] [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] [Accepted: 01/01/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE In this study, we evaluated readability and understandability of nine French-language Patient-Reported Outcome Measures (PROMs) that are currently used in a contemporary longitudinal cohort of breast cancer survivors as part of an effort to improve equity in cancer care and research. METHODS Readability of PROMs was assessed using the Flesh Reading Ease Score (FRES), the Gunning's Fog Index (FOG), and the FRY graphics. Readability was considered ideal if mean score ≤ 6th-grade level and acceptable if between 6th and 8th grade. Understandability was evaluated using the Patient Education Materials Assessment Tool and defined as ideal if PEMAT ≥ 80%. The Evaluative Linguistic Framework for Questionnaires (ELF-Q) provided additional qualitative elements to assess understandability. Plain-language best practice was met if both readability and understandability were ideal. RESULTS None of the 9 PROMs evaluated had ideal readability scores and only 1 had an acceptable score. Understandability ranged from 55% to 91%, and only 3 PROMs had ideal scores. ELF-Q identified points for improvement in several understandability dimensions of the PROMs. None of the instruments met the definition of plain-language best practice. CONCLUSION None of the studied PROMs met the standards of readability and understandability. Future development and translation of PROMs should follow comprehensive linguistic and cultural frameworks to ensure plain-language standards and enhance equitable patient-centered care and research.
Collapse
Affiliation(s)
- Camila Chiodi
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France.
| | - Jonathan Epstein
- Université de Lorraine, APEMAC, Nancy, France
- REFLIS, Paris, France
- French National Platform Quality of Life and Cancer, Paris, France
| | - Johanna Arvis
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| | - Elise Martin
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| | - Aude Barbier
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| | - Emma Gillanders
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| | | | - Gwenn Menvielle
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| | | | - Francis Guillemin
- Université de Lorraine, APEMAC, Nancy, France
- REFLIS, Paris, France
- French National Platform Quality of Life and Cancer, Paris, France
| | - Ines Vaz Luis
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
- Department for the Organization of Patient Pathways (DIOPP), Inserm Unit 981 Gustave Roussy, Villejuif, France
| | - Maria Alice Franzoi
- Cancer Survivorship Group, Inserm Unit 981 Gustave Roussy, Villejuif, France
| |
Collapse
|
11
|
Franzoi MA, Di Meglio A, Michiels S, Gillanders E, Gaudin C, Martin AL, Vaz-Luis I. Patient-Reported Quality of Life 6 Years After Breast Cancer. JAMA Netw Open 2024; 7:e240688. [PMID: 38421653 PMCID: PMC10905303 DOI: 10.1001/jamanetworkopen.2024.0688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
This cohort study assesses quality-of-life trajectories up to 6 years after breast cancer diagnosis among individuals in France.
Collapse
Affiliation(s)
- Maria Alice Franzoi
- Cancer Survivorship Group, INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Department for the Organization of Patient Pathways, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d’Epidémiologie, Oncostat Inserm U1018, Université Paris–Saclay, Equipe Labellisée Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Emma Gillanders
- Cancer Survivorship Group, INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Ines Vaz-Luis
- Cancer Survivorship Group, INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Department for the Organization of Patient Pathways, Gustave Roussy, Villejuif, France
| |
Collapse
|
12
|
Franzoi MA, Aupomerol M, Havas J, Soldato D, Lambertini M, Massarotti C, Hang H, Pistilli B, Fasse L, Tredan O, Gillanders E, Joly F, Cottu P, Mouret-Reynier MA, Tarpin C, Arnaud A, Everhard S, Martin AL, Di Meglio A, Vaz-Luis I. Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes. ESMO Open 2024; 9:102236. [PMID: 38350335 PMCID: PMC10937197 DOI: 10.1016/j.esmoop.2024.102236] [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: 08/07/2023] [Revised: 11/28/2023] [Accepted: 01/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes. METHODS Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics. RESULTS Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified. CONCLUSIONS Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.
Collapse
Affiliation(s)
- M A Franzoi
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif.
| | - M Aupomerol
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - J Havas
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - D Soldato
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Gynecology Department, Policlinico San Martino, University of Genova, Genova; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - C Massarotti
- Physiopatology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Health (DiNOGMI department), School of Medicine, University of Genova, Genova, Italy
| | - H Hang
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - B Pistilli
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Fasse
- Interdisciplinary and Patient Pathway Department, Institut Gustave Roussy, Villejuif
| | | | - E Gillanders
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - F Joly
- Centre François Baclesse, Caen
| | | | | | - C Tarpin
- Institut Paoli Calmettes, Marseille
| | | | | | | | - A Di Meglio
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - I Vaz-Luis
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| |
Collapse
|
13
|
Allali S, Carton M, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, De La Lande B, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, André F, Kirova Y. CANTO skin: Evaluation of skin toxicity risk factors in patients treated for breast cancer. Int J Cancer 2023; 153:1797-1808. [PMID: 37572223 DOI: 10.1002/ijc.34664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, Lille, France
- Université de Lille, CHU Lille, CNRS, Centrale Lille, Lille, France
| | | | | | | | | | | |
Collapse
|
14
|
Kabirian R, Franzoi MA, Havas J, Coutant C, Tredan O, Levy C, Cottu P, Dhaini Mérimèche A, Guillermet S, Ferrero JM, Giacchetti S, Petit T, Dalenc F, Rouanet P, Everhard S, Martin AL, Pistilli B, Lambertini M, Vaz-Luis I, Di Meglio A. Chemotherapy-Related Amenorrhea and Quality of Life Among Premenopausal Women With Breast Cancer. JAMA Netw Open 2023; 6:e2343910. [PMID: 37971739 PMCID: PMC10654794 DOI: 10.1001/jamanetworkopen.2023.43910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Younger survivors of breast cancer frequently report more treatment-related symptoms, mostly related to the menopausal transition. Objective To assess factors associated with chemotherapy-related amenorrhea (CRA) and to evaluate its association with long-term quality of life (QOL). Design, Setting, and Participants The prospective, longitudinal Cancer Toxicities Study, a multicenter French cohort study, includes women with a diagnosis of stage I to III breast cancer and collects data approximately yearly after diagnosis. The current study reports outcomes up to 4 years after diagnosis for participants enrolled from 2012 to 2017. Participants included premenopausal women younger than 50 years treated with chemotherapy and not receiving adjuvant ovarian function suppression. Data analysis was performed from September 2021 to June 2023. Exposures Clinical, socioeconomic, tumor, and treatment characteristics assessed at diagnosis (for the analysis of factors associated with CRA) and persistent CRA (for the QOL analysis). Main Outcomes and Measures The main outcome of interest was CRA at year 1 (Y1), year 2 (Y2), and year 4 (Y4) after diagnosis. Generalized estimating equations assessed associations of exposure variables with CRA. In the QOL analysis, QOL at Y4 (assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23) was the outcome of interest. Multivariable random-effect mixed models assessed the association of persistent CRA (ie, never recovering menses after treatment) with QOL. Results Among 1636 women, the mean (SD) age at diagnosis was 42.2 (5.6) years. Overall, 1242 of 1497 women (83.0%) reported CRA at Y1, 959 of 1323 women (72.5%) reported it at Y2, and 599 of 906 women (66.1%) reported it at Y4. Older age vs 18 to 34 years (adjusted odds ratio [OR] for 35 to 39 years, 1.84 [95% CI, 1.32 to 2.56]; adjusted OR for 40 to 44 years, 5.90 [95% CI, 4.23 to 8.24]; and adjusted OR for ≥45 years, 21.29 [95% CI, 14.34 to 31.61]) and receipt of adjuvant tamoxifen (adjusted OR, 1.97 [95% CI, 1.53 to 2.53]) were associated with higher likelihood of CRA. In the QOL analysis, 416 of 729 women (57.1%) had persistent CRA. However, late menses recovery among women aged 18 to 34 years with no menses at Y2 were reported by 11 of 21 women (52.4%) between Y2 and Y4. Persistent CRA was associated with worse insomnia (mean difference vs recovery at any time, 9.9 points [95% CI, 3.2 to 16.5 points]; P = .004), systemic therapy-related adverse effects (mean difference, 3.0 points [95% CI, 0.2 to 5.8 points]; P = .04), and sexual functioning (mean difference, -9.2 points [95% CI, -14.3 to -4.1 points]; P < .001) at Y4. Conclusions and Relevance In this cohort study of premenopausal women with breast cancer, persistent CRA was common, although some women recovered menses late, and was associated with worse long-term QOL. This study can help inform risk communication, personalized counseling, and early supportive care referrals for such patients.
Collapse
Affiliation(s)
- Rayan Kabirian
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Sorbonne Université, Paris, France
| | - Maria Alice Franzoi
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Asma Dhaini Mérimèche
- Institut de Cancérologie de Lorraine–Alexis Vautrin, Vandœuvre-lès-Nancy, France
- Now with Centre Hospitalier de Lunéville-Ghemm, Pôle Mère-Enfant, Lunéville, France
| | | | | | | | - Thierry Petit
- Centre Paul Strauss Centre de Lutte Contre le Cancer, Strasbourg, France
| | | | | | | | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine University of Genova, Genova, Italy
- Department of Medical Oncology, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Département Interdisciplinaire d’Organisation des Parcours Patients, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| |
Collapse
|
15
|
Bailleux C, Chardin D, Guigonis JM, Ferrero JM, Chateau Y, Humbert O, Pourcher T, Gal J. Survival analysis of patient groups defined by unsupervised machine learning clustering methods based on patient metabolomic data. Comput Struct Biotechnol J 2023; 21:5136-5143. [PMID: 37920813 PMCID: PMC10618114 DOI: 10.1016/j.csbj.2023.10.033] [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: 04/30/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Purpose Meta-analyses failed to accurately identify patients with non-metastatic breast cancer who are likely to benefit from chemotherapy, and metabolomics could provide new answers. In our previous published work, patients were clustered using five different unsupervised machine learning (ML) methods resulting in the identification of three clusters with distinct clinical and simulated survival data. The objective of this study was to evaluate the survival outcomes, with extended follow-up, using the same 5 different methods of unsupervised machine learning. Experimental design Forty-nine patients, diagnosed between 2013 and 2016, with non-metastatic BC were included retrospectively. Median follow-up was extended to 85.8 months. 449 metabolites were extracted from tumor resection samples by combined Liquid chromatography-mass spectrometry (LC-MS). Survival analyses were reported grouping together Cluster 1 and 2 versus cluster 3. Bootstrap optimization was applied. Results PCA k-means, K-sparse and Spectral clustering were the most effective methods to predict 2-year progression-free survival with bootstrap optimization (PFSb); as bootstrap example, with PCA k-means method, PFSb were 94% for cluster 1&2 versus 82% for cluster 3 (p = 0.01). PCA k-means method performed best, with higher reproducibility (mean HR=2 (95%CI [1.4-2.7]); probability of p ≤ 0.05 85%). Cancer-specific survival (CSS) and overall survival (OS) analyses highlighted a discrepancy between the 5 ML unsupervised methods. Conclusion Our study is a proof-of-principle that it is possible to use unsupervised ML methods on metabolomic data to predict PFS survival outcomes, with the best performance for PCA k-means. A larger population study is needed to draw conclusions from CSS and OS analyses.
Collapse
Affiliation(s)
- Caroline Bailleux
- University Côte d′Azur, Centre Antoine Lacassagne, Medical Oncology Department, Nice F-06189, France
- University Côte d′Azur, Commissariat à l′Energie Atomique et aux énergies alternatives, Institut Frédéric Joliot, Service Hospitalier Frédéric Joliot, laboratory Transporters in Oncology and Radiotherapy in Oncology (TIRO), School of medicine, Nice F-06100, France
| | - David Chardin
- University Côte d′Azur, Commissariat à l′Energie Atomique et aux énergies alternatives, Institut Frédéric Joliot, Service Hospitalier Frédéric Joliot, laboratory Transporters in Oncology and Radiotherapy in Oncology (TIRO), School of medicine, Nice F-06100, France
- University Côte d′Azur, Centre Antoine Lacassagne, Nuclear medicine Department, Nice F-06189, France
| | - Jean-Marie Guigonis
- University Côte d′Azur, Commissariat à l′Energie Atomique et aux énergies alternatives, Institut Frédéric Joliot, Service Hospitalier Frédéric Joliot, laboratory Transporters in Oncology and Radiotherapy in Oncology (TIRO), School of medicine, Nice F-06100, France
| | - Jean-Marc Ferrero
- University Côte d′Azur, Centre Antoine Lacassagne, Medical Oncology Department, Nice F-06189, France
| | - Yann Chateau
- University Côte d′Azur, Centre Antoine Lacassagne, Epidemiology and Biostatistics Department, Nice F-06189, France
| | - Olivier Humbert
- University Côte d′Azur, Commissariat à l′Energie Atomique et aux énergies alternatives, Institut Frédéric Joliot, Service Hospitalier Frédéric Joliot, laboratory Transporters in Oncology and Radiotherapy in Oncology (TIRO), School of medicine, Nice F-06100, France
- University Côte d′Azur, Centre Antoine Lacassagne, Nuclear medicine Department, Nice F-06189, France
| | - Thierry Pourcher
- University Côte d′Azur, Commissariat à l′Energie Atomique et aux énergies alternatives, Institut Frédéric Joliot, Service Hospitalier Frédéric Joliot, laboratory Transporters in Oncology and Radiotherapy in Oncology (TIRO), School of medicine, Nice F-06100, France
| | - Jocelyn Gal
- University Côte d′Azur, Centre Antoine Lacassagne, Epidemiology and Biostatistics Department, Nice F-06189, France
| |
Collapse
|
16
|
Giudici F, Pistilli B, Vaz-Luis I, Karimi M, Delaloge S, Bachelot T, Michiels S, Bardet A. Insights adjusting for non-adherence in randomized clinical trials: a reanalysis of an adjuvant trial of tamoxifen duration in early breast cancer. Br J Cancer 2023; 129:1516-1523. [PMID: 37697030 PMCID: PMC10628101 DOI: 10.1038/s41416-023-02420-w] [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: 02/14/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Several randomized clinical trials provide evidence of the survival benefit of extended adjuvant tamoxifen in women with estrogen receptor (ER)-positive early breast cancer (BC). However, non-adherence may lead to underestimate treatment effects using intention to treat (ITT) methods. We reanalyzed a randomized trial using contemporary statistical methods adjusting for non-adherence. METHODS The TAM01 study was a phase 3 trial including women with early BC, who had completed 2-3 years of adjuvant tamoxifen between 1986 and 1995. Participants were randomly assigned to continue tamoxifen up to 10 years or to discontinue the treatment at randomization. Invasive disease-free survival (iDFS) and overall survival (OS) were estimated using marginal structural models (MSM) and rank preserving structural failure time model (RPSFTM). RESULTS Of 3830 patients enrolled, 2485 were randomized to extended tamoxifen, and 1345 to treatment discontinuation. The 10-year non-adherence rate in the extended group was 27.2%. Among women with ER-positive BC (n = 2402), extended tamoxifen was associated with a 45% and 21% relative improvement in iDFS by MSM and RPSFTM, respectively (Hazard Ratio (HR), 0.55; 95% Confidence Interval (CI), 0.48-0.64 and HR, 0.79; 95%CI, 0.67-0.95, respectively), a considerable greater benefit than in the ITT analysis (HR, 0.90; 95%CI, 0.81-0.99). The OS reanalysis revealed a substantial benefit of extended tamoxifen (MSM: HR, 0.70; 95%CI, 0.59-0.83; RPSFTM: HR, 0.85; 95%CI, 0.67-1.04), compared to the ITT analyses (HR, 0.94; 95%CI, 0.84-1.07). CONCLUSION This analysis emphasizes both the importance of adherence to hormonotherapy in hormone-receptor positive early BC and the usefulness of more complex statistical analyses.
Collapse
Affiliation(s)
- Fabiola Giudici
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Ines Vaz-Luis
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, 114 Rue Edouard Vaillant, Villejuif, France
| | - Maryam Karimi
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laënnec, Lyon, France
| | - Stefan Michiels
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France.
| | - Aurelie Bardet
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| |
Collapse
|
17
|
Balazard F, Bertaut A, Bordet É, Mulard S, Blanc J, Briot N, Paux G, Dhaini Merimeche A, Rigal O, Coutant C, Fournier M, Jouannaud C, Soulie P, Lerebours F, Cottu PH, Tredan O, Vanlemmens L, Levy C, Mouret-Reynier MA, Campone M, Brady KJS, Sasane M, Rice M, Coulouvrat C, Martin AL, Jacquet A, Vaz-Luis I, Herold C, Pistilli B. Adjuvant endocrine therapy uptake, toxicity, quality of life, and prediction of early discontinuation. J Natl Cancer Inst 2023; 115:1099-1108. [PMID: 37434306 PMCID: PMC10483331 DOI: 10.1093/jnci/djad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Many patients receiving adjuvant endocrine therapy (ET) for breast cancer experience side effects and reduced quality of life (QoL) and discontinue ET. We sought to describe these issues and develop a prediction model of early discontinuation of ET. METHODS Among patients with hormone receptor-positive and HER2-negative stage I-III breast cancer of the Cancer Toxicities cohort (NCT01993498) who were prescribed adjuvant ET between 2012 and 2017, upon stratification by menopausal status, we evaluated adjuvant ET patterns including treatment change and patient-reported discontinuation and ET-associated toxicities and impact on QoL. Independent variables included clinical and demographic features, toxicities, and patient-reported outcomes. A machine-learning model to predict time to early discontinuation was trained and evaluated on a held-out validation set. RESULTS Patient-reported discontinuation rate of the first prescribed ET at 4 years was 30% and 35% in 4122 postmenopausal and 2087 premenopausal patients, respectively. Switching to a new ET was associated with higher symptom burden, poorer QoL, and higher discontinuation rate. Early discontinuation rate of adjuvant ET before treatment completion was 13% in postmenopausal and 15% in premenopausal patients. The early discontinuation model obtained a C index of 0.62 in the held-out validation set. Many aspects of QoL, most importantly fatigue and insomnia (European Organization for Research and Treatment of Cancer QoL questionnaire 30), were associated with early discontinuation. CONCLUSION Tolerability and adherence to ET remains a challenge for patients who switch to a second ET. An early discontinuation model using patient-reported outcomes identifies patients likely to discontinue their adjuvant ET. Improved management of toxicities and novel more tolerable adjuvant ETs are needed for maintaining patients on treatment.
Collapse
Affiliation(s)
| | | | - Élise Bordet
- Sanofi Research and Development, Chilly-Mazarin, France
| | | | - Julie Blanc
- Centre George François Leclerc, Dijon, France
| | | | - Gautier Paux
- Sanofi Research and Development, Cambridge, MA, USA
| | | | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de L’Ouest—Centre Paul Papin, Angers, France
| | | | | | | | | | | | | | - Mario Campone
- Institut de Cancérologie de l’Ouest—Centre René Gauducheau, Nantes Saint Herblain, France
| | | | - Medha Sasane
- Sanofi Research and Development, Cambridge, MA, USA
| | - Megan Rice
- Sanofi Research and Development, Cambridge, MA, USA
| | | | | | | | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Department of Supportive care and pathways (DIOPP) Oncology, Gustave Roussy, Villejuif, France
- INSERM 981, Gustave Roussy, Villejuif, France
| |
Collapse
|
18
|
Ruiz de Azua G, Kousignian I, Vaz‐Luis I, Di Meglio A, Caumette E, Havas J, Martin E, Martin A, Querel O, Vanlemmens L, Pistilli B, Coutant C, Cottu PH, Merimeche AD, Lerebours F, Tredan O, Jouannaud C, Levy C, Dumas A, Menvielle G. Sustainable return to work among breast cancer survivors. Cancer Med 2023; 12:19091-19101. [PMID: 37602836 PMCID: PMC10557874 DOI: 10.1002/cam4.6467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
PURPOSE This study assessed sustainable return to work (SRTW) of breast cancer survivors (BCS). METHODS We used data from the prospective French cohort, CANTO. We included 1811 stage I-III BCS who were <57 years old and employed at the moment of diagnosis and working 2 years after diagnosis. Using logistic regression, we investigated the role of clinical, health and socio-economic factors, and the work environment on SRTW 3 years after diagnosis. We compared having any sick leave with having worked continuously and being unemployed to having worked continuously between 2 and 3 years after diagnosis. RESULTS Overall, 77% (n = 1395) worked continuously after return to work (RTW). Out of the other 416 BCS, 66% had any sick leave period, 33% had been unemployed, 4% had an early retirement, 2% a disability and 1% another status (multiple situations possible). Being on sick leave was associated with age > 50 (OR = 0.59; 95%CI = 0.43-0.82), stage III (2.56; 1.70-3.85), tumour subtype HR+/HER2+ (0.61; 0.39-0.95), severe fatigue (1.45; 1.06-1.98), workplace accommodations (1.63; 1.14-2.33) and life priorities (0.71; 0.53-0.95). Unemployment was associated with age > 50 (0.45; 0.29-0.72), working in the public sector (0.31; 0.19-0.51), for a small company (3.00; 1.74-5.20) and having a fixed-term contract (7.50; 4.74-11.86). CONCLUSIONS A high number of BCS have periods of sick leave or unemployment after RTW. The determinants differ between sick leave and unemployment. IMPLICATIONS FOR CANCER SURVIVORS BCS need to be supported even after RTW, which should be regarded as a process.
Collapse
Affiliation(s)
- Garazi Ruiz de Azua
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie SocialeParisFrance
| | - Isabelle Kousignian
- Université Paris Cité, Unité de Recherche «Biostatistique, Traitement et Modélisation des données bio‐logiques» BioSTM, UR 7537ParisFrance
| | - Ines Vaz‐Luis
- Medical Oncology DepartmentGustave RoussyVillejuifFrance
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | - Antonio Di Meglio
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | - Elsa Caumette
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie SocialeParisFrance
- Department of MaieuticsUniversité de MontpellierMontpellierFrance
| | - Julie Havas
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | - Elise Martin
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | | | | | | | | | - Charles Coutant
- Department of Medical OncologyCentre Georges‐François LeclercDijonFrance
| | | | | | | | | | | | | | - Agnes Dumas
- Université Paris Cité ECEVE, UMR 1123, InsermParisFrance
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie SocialeParisFrance
| |
Collapse
|
19
|
Gueiderikh A, Sarrade T, Kirova Y, De La Lande B, De Vathaire F, Auzac G, Martin AL, Everhard S, Meillan N, Bourgier C, Benyoucef A, Lacornerie T, Pasquier D, Racadot S, Moignier A, Paris F, André F, Deutsch E, Duchemann B, Allodji RS, Rivera S. Radiation-induced lung injury after breast cancer treatment: incidence in the CANTO-RT cohort and associated clinical and dosimetric risk factors. Front Oncol 2023; 13:1199043. [PMID: 37456251 PMCID: PMC10342531 DOI: 10.3389/fonc.2023.1199043] [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: 04/02/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Radiation-induced lung injury (RILI) is strongly associated with various clinical conditions and dosimetric parameters. Former studies have led to reducing radiotherapy (RT) doses to the lung and have favored the discontinuation of tamoxifen during RT. However, the monocentric design and variability of dosimetric parameters chosen have limited further improvement. The aim of our study was to assess the incidence of RILI in current practice and to determine clinical and dosimetric risk factors associated with RILI occurrence. Material and methods Data from 3 out of the 10 top recruiting centers in CANTO-RT, a subset of the CANTO prospective longitudinal cohort (NCT01993498), were retrospectively analyzed for RILI occurrence. This cohort, which recruited invasive cT0-3 cN0-3 M0 breast cancer patients from 2012 to 2018, prospectively recorded the occurrence of adverse events by questionnaires and medical visits at the end of, and up to 60 months after treatment. RILI adverse events were defined in all patients by the association of clinical symptoms and compatible medical imaging. Results RILI was found in 38/1565 (2.4%) patients. Grade II RILI represented 15/38 events (39%) and grade III or IV 2/38 events (6%). There were no grade V events. The most frequently used technique for treatment was 3D conformational RT (96%). In univariable analyses, we confirmed the association of RILI occurrence with pulmonary medical history, absence of cardiovascular disease medical history, high pT and pN, chemotherapy use, nodal RT. All dosimetric parameters were highly correlated and had close predictive value. In the multivariable analysis adjusted for chemotherapy use and nodal involvement, pulmonary medical history (OR=3.05, p<0.01) and high V30 Gy (OR=1.06, p=0.04) remained statistically significant risk factors for RILI occurrence. V30 Gy >15% was significantly associated with RILI occurrence in a multivariable analysis (OR=3.07, p=0.03). Conclusion Our study confirms the pulmonary safety of breast 3D RT in CANTO-RT. Further analyses with modern radiation therapy techniques such as IMRT are needed. Our results argue in favor of a dose constraint to the ipsilateral lung using V30 Gy not exceeding 15%, especially in patients presenting pulmonary medical history. Pulmonary disease records should be taken into account for RT planning.
Collapse
Affiliation(s)
- Anna Gueiderikh
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
| | | | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
- University Versailles, St. Quentin, France
| | | | - Florent De Vathaire
- Gustave Roussy, Comprehensive Cancer Research Center, Villejuif, France
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Unité Mixte de Recherche (UMR) 1018, Villejuif, France
| | - Guillaume Auzac
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
| | | | | | - Nicolas Meillan
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
- Radiation Therapy Department, CH Victor Dupouy, Argenteuil, France
| | - Celine Bourgier
- Montpellier University, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1194, Montpellier, France
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Ahmed Benyoucef
- Radiation Therapy Department, Henri Becquerel Center, Rouen, France
| | - Thomas Lacornerie
- Centre Oscar Lambret, Academic Department of Radiation Oncology, 3 rue Combemale, Lille, France
| | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, 3 rue Combemale, Lille, France
- Univ. Lille, &, Centre National de la Recherche Scientifique (CNRS), Centrale Lille, Unité Mixte de Recherche (UMR) 9189 – Centre de Recherche en Informatique, Signal et Automatique de Lille (CRIStAL), Lille, France
| | | | - Alexandra Moignier
- Radiotherapy Department, Institut de Cancérologie de l’Ouest, Nantes, France
| | - François Paris
- Radiotherapy Department, Institut de Cancérologie de l’Ouest, Nantes, France
- Nantes Université, Nantes - Angers Cancer and Immunology Research Center (CRCI2NA), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Nantes, France
| | - Fabrice André
- Gustave Roussy, Medical Oncology Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) U981, Villejuif, France
| | - Eric Deutsch
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
| | | | - Rodrigue Setcheou Allodji
- Gustave Roussy, Comprehensive Cancer Research Center, Villejuif, France
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Unité Mixte de Recherche (UMR) 1018, Villejuif, France
| | - Sofia Rivera
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
| |
Collapse
|
20
|
Curtit E, Bellanger MM, Nerich V, Hequet D, Frenel JS, Cristeau O, Rouzier R. Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis. Front Oncol 2023; 13:1191943. [PMID: 37427133 PMCID: PMC10327821 DOI: 10.3389/fonc.2023.1191943] [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: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Chemotherapy (CT) is commonly used as an adjuvant treatment for women with early breast cancer (BC). However, not all patients benefit from CT, while all are exposed to its short- and long-term toxicity. The Oncotype DX® test assesses cancer-related gene expression to estimate the risk of BC recurrence and predict the benefit of chemotherapy. The aim of this study was to estimate, from the French National Health Insurance (NHI) perspective, the cost-effectiveness of the Oncotype DX® test compared to standard of care (SoC; involving clinicopathological risk assessment only) among women with early, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC considered at high clinicopathological risk of recurrence. Methods Clinical outcomes and costs were estimated over a lifetime horizon based on a two-component model that comprised a short-term decision tree representing the adjuvant treatment choice guided by the therapeutic decision support strategy (Oncotype DX® test or SoC) and a Markov model to capture long-term outcomes. Results In the base case, the Oncotype DX® test reduced CT use by 55.2% and resulted in 0.337 incremental quality-adjusted life-years gained and cost savings of €3,412 per patient, compared with SoC. Being more effective and less costly than SoC, Oncotype DX® testing was the dominant strategy. Discussion Widespread implementation of Oncotype DX® testing would improve patient care, provide equitable access to more personalized medicine, and bring cost savings to the health system.
Collapse
Affiliation(s)
- Elsa Curtit
- University of Franche-Comté, University Hospital of Besançon J. Minjoz, INSERM, EFS UMR 1098, Besançon, France
| | - Martine Marie Bellanger
- UMR CNRS6051, Ecole des Hautes Etudes en Santé Publique - School of Public Health (EHESP), University of Rennes, Rennes, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, France; INSERM, EFS-BFC, UMR 1098, University of Franche-Comté, Besançon, France
| | - Delphine Hequet
- Institut Bourdonnais, Clinique Saint Jean de Dieu, Paris, France
| | | | | | | |
Collapse
|
21
|
Harris CS, Pozzar RA, Conley Y, Eicher M, Hammer MJ, Kober KM, Miaskowski C, Colomer-Lahiguera S. Big Data in Oncology Nursing Research: State of the Science. Semin Oncol Nurs 2023; 39:151428. [PMID: 37085404 PMCID: PMC11225574 DOI: 10.1016/j.soncn.2023.151428] [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: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To review the state of oncology nursing science as it pertains to big data. The authors aim to define and characterize big data, describe key considerations for accessing and analyzing big data, provide examples of analyses of big data in oncology nursing science, and highlight ethical considerations related to the collection and analysis of big data. DATA SOURCES Peer-reviewed articles published by investigators specializing in oncology, nursing, and related disciplines. CONCLUSION Big data is defined as data that are high in volume, velocity, and variety. To date, oncology nurse scientists have used big data to predict patient outcomes from clinician notes, identify distinct symptom phenotypes, and identify predictors of chemotherapy toxicity, among other applications. Although the emergence of big data and advances in computational methods provide new and exciting opportunities to advance oncology nursing science, several challenges are associated with accessing and using big data. Data security, research participant privacy, and the underrepresentation of minoritized individuals in big data are important concerns. IMPLICATIONS FOR NURSING PRACTICE With their unique focus on the interplay between the whole person, the environment, and health, nurses bring an indispensable perspective to the interpretation and application of big data research findings. Given the increasing ubiquity of passive data collection, all nurses should be taught the definition, characteristics, applications, and limitations of big data. Nurses who are trained in big data and advanced computational methods will be poised to contribute to guidelines and policies that preserve the rights of human research participants.
Collapse
Affiliation(s)
- Carolyn S Harris
- Postdoctoral Scholar, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel A Pozzar
- Nurse Scientist at Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA and Instructor at Harvard Medical School, Boston, Massachusetts, USA
| | - Yvette Conley
- Professor, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Manuela Eicher
- Associate Professor and Director of the Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, and Lausanne University Hospital, Lausanne, Switzerland
| | - Marilyn J Hammer
- Director, The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA and Lecturer at Harvard Medical School, Boston, Massachusetts, USA
| | - Kord M Kober
- Associate Professor, School of Nursing, University of California, San Francisco, California, USA
| | - Christine Miaskowski
- Professor, Schools of Medicine and Nursing, University of California, San Francisco, California, USA
| | - Sara Colomer-Lahiguera
- Senior Nurse Scientist and Junior Lecturer, Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, and Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
22
|
Soldato D, Arecco L, Agostinetto E, Franzoi MA, Mariamidze E, Begijanashvili S, Brunetti N, Spinaci S, Solinas C, Vaz-Luis I, Di Meglio A, Lambertini M. The Future of Breast Cancer Research in the Survivorship Field. Oncol Ther 2023:10.1007/s40487-023-00225-8. [PMID: 37005952 DOI: 10.1007/s40487-023-00225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.
Collapse
Affiliation(s)
- D Soldato
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - E Agostinetto
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M A Franzoi
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital Tbilisi, Tbilisi, Georgia
| | - N Brunetti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - S Spinaci
- Division of Breast Surgery, Villa Scassi Hospital, Genoa, Italy
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico Duilio Casula, Monserrato, Italy
| | - I Vaz-Luis
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| |
Collapse
|
23
|
Courtinard C, Gourgou S, Jacot W, Carton M, Guérin O, Vacher L, Bertaut A, Le Deley MC, Pérol D, Marino P, Levy C, Uwer L, Perrocheau G, Schiappa R, Bachelot F, Parent D, Breton M, Petit T, Filleron T, Loeb A, Mathoulin-Pélissier S, Robain M, Delaloge S, Bellera C. Association between progression-free survival and overall survival in women receiving first-line treatment for metastatic breast cancer: evidence from the ESME real-world database. BMC Med 2023; 21:87. [PMID: 36882736 PMCID: PMC9993797 DOI: 10.1186/s12916-023-02754-5] [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: 07/04/2022] [Accepted: 01/25/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Overall survival (OS) is the gold standard endpoint to assess treatment efficacy in cancer clinical trials. In metastatic breast cancer (mBC), progression-free survival (PFS) is commonly used as an intermediate endpoint. Evidence remains scarce regarding the degree of association between PFS and OS. Our study aimed to describe the individual-level association between real-world PFS (rwPFS) and OS according to first-line treatment in female patients with mBC managed in real-world setting for each BC subtype (defined by status for both hormone-receptor [HR] expression and HER2 protein expression/gene amplification). METHODS We extracted data from the ESME mBC database (NCT03275311) which gathers deidentified data from consecutive patients managed in 18 French Comprehensive Cancer Centers. Adult women diagnosed with mBC between 2008 and 2017 were included. Endpoints (PFS, OS) were described using the Kaplan-Meier method. Individual-level associations between rwPFS and OS were estimated using the Spearman's correlation coefficient. Analyses were conducted by tumor subtype. RESULTS 20,033 women were eligible. Median age was 60.0 years. Median follow-up duration was 62.3 months. Median rwPFS ranged from 6.0 months (95% CI 5.8-6.2) for HR-/HER2 - subtype to 13.3 months (36% CI 12.7-14.3) for HR + /HER2 + subtype. Correlation coefficients were highly variable across subtypes and first-line (L1) treatments. Among patients with HR - /HER2 - mBC, correlation coefficients ranged from 0.73 to 0.81, suggesting a strong rwPFS/OS association. For HR + /HER2 + mBC patients, the individual-level associations were weak to strong with coefficients ranging from 0.33 to 0.43 for monotherapy and from 0.67 to 0.78 for combined therapies. CONCLUSIONS Our study provides comprehensive information on individual-level association between rwPFS and OS for L1 treatments in mBC women managed in real-life practice. Our results could be used as a basis for future research dedicated to surrogate endpoint candidates.
Collapse
Affiliation(s)
- Coralie Courtinard
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, 33000, Bordeaux, France
- Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Sophie Gourgou
- Biometrics Unit, Institut du Cancer de Montpellier, 208 Rue Des Apothicaires, 34298, Montpellier, France
- University of Montpellier, 163 Rue Auguste Broussonnet, 34090, Montpellier, France
| | - William Jacot
- University of Montpellier, 163 Rue Auguste Broussonnet, 34090, Montpellier, France
- Department of Medical Oncology, Institut du Cancer de Montpellier, 208 Rue Des Apothicaires, 34298, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM) INSERM U1194, 208 Rue Des Apothicaires, 34298, Montpellier, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 35 Rue Dailly, 92210, Saint-Cloud, France
| | - Olivier Guérin
- Department of Medical Information, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, 49055, Angers, France
| | - Laure Vacher
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Aurélie Bertaut
- Department of Biometry, Institut de Cancérologie de Bourgogne, 21079, Dijon, France
| | | | - David Pérol
- Department of Biometry, Centre Léon Bérard, 28 Prom. Léa Et Napoléon Bullukian, Lyon, 69008, France
| | - Patricia Marino
- Institut Paoli-Calmettes, SESSTIM UMR912, 232, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Aix-Marseille Université, Inserm, IRD, SESSTIM Sciences Économiques Et Sociales de La Santé Et Traitement de L'information Médicale, 13009, Marseille, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Geneviève Perrocheau
- Department of Pharmacy, Institut de Cancérologie de L'Ouest Nantes, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Renaud Schiappa
- Department of Biometry, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Florence Bachelot
- Department of Medical Information, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Damien Parent
- Department of Pharmacy, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100, Reims, France
| | - Mathias Breton
- Department of Medical Information, Centre Eugène Marquis, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Thierry Petit
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, 67200, Strasbourg, France
| | - Thomas Filleron
- Department of Biometry, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Agnès Loeb
- Department of Medical Information, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - Simone Mathoulin-Pélissier
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, 33000, Bordeaux, France
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Carine Bellera
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, 33000, Bordeaux, France.
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France.
| |
Collapse
|
24
|
Sarrade T, Allodji R, Ghannam Y, Auzac G, Everhard S, Kirova Y, Peignaux K, Guilbert P, Pasquier D, Racadot S, Bourgier C, Ducornet S, André F, De Vathaire F, Rivera S. CANTO-RT: One of the Largest Prospective Multicenter Cohort of Early Breast Cancer Patients Treated with Radiotherapy including Full DICOM RT Data. Cancers (Basel) 2023; 15:cancers15030751. [PMID: 36765709 PMCID: PMC9913384 DOI: 10.3390/cancers15030751] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
This article describes the methodology used and provides a characterization of the study population in CANTO-RT (CANcer TOxicities RadioTherapy). CANTO (NCT01993498) is a prospective clinical cohort study including patients with stage I-III BC from 26 French cancer centers. Patients matching all CANTO inclusion and exclusion criteria who received RT in one of the 10 top recruiting CANTO centers were selected. Individual full DICOM RT files were collected, pseudo-anonymized, structured and analyzed on the CANTO-RT/UNITRAD web platform. CANTO-RT included 3875 BC patients with a median follow-up of 64 months. Among the 3797 patients with unilateral RT, 3065 (80.4%) had breast-conserving surgery, and 2712 (71.5%) had sentinel node surgery. Tumor bed boost was delivered in 2658 patients (68.5%) and lymph node RT in 1356 patients (35%), including internal mammary chain in 844 patients (21.8%). Most patients (3691 (95.3%)) were treated with 3D conformal RT. Target volumes, organs at risk contours and dose/volume histograms were extracted after quality-control procedures. CANTO-RT is one of the largest early BC prospective cohorts with full individual clinical, biological, imaging and DICOM RT data available. It is a valuable resource for the identification and validation of clinical and dosimetric predictive factors of RT and multimodal treatment-related toxicities.
Collapse
Affiliation(s)
- Thomas Sarrade
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
- Department of Radiation Oncology, Tenon Hospital, Paris Sorbonne University, 75020 Paris, France
| | | | - Youssef Ghannam
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
| | - Guillaume Auzac
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | - Sofia Rivera
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
- Inserm UMR 1030, Molecular Radiotherapy and Therapeutic Innovation, Paris-Saclay University, 94805 Villejuif, France
- Correspondence: ; Tel.: +33-(0)14-211-5106
| |
Collapse
|
25
|
Impact of radiation therapy on fatigue at 1 year in breast cancer survivors in the prospective multicentre CANcer TOxicity cohort. Eur J Cancer 2022; 177:143-153. [PMID: 36356418 DOI: 10.1016/j.ejca.2022.09.026] [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: 06/27/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fatigue is a common and disabling symptom after breast cancer (BC) treatment, significantly impacting patients' quality of life. We aimed to assess the impact of radiation therapy (RT) modalities on fatigue one year after treatment among patients with early-stage BC. METHODS We used CANTO-RT, a subcohort of CANcer TOxicity (CANTO; NCT01993498), a multicentric nationwide prospective cohort of stages I-III BC treated from 2012 to 2017. Our primary outcome was severe global fatigue 1 year after RT completion (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 score ≥40/100). The secondary outcomes included severe physical, emotional and cognitive fatigue (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-FA12). RT-related variables were used as independent variables. Multivariable logistic regression models assessed associations between RT-related variables and fatigue. RESULTS The final analytic cohort included 3295 patients. The prevalence of severe global fatigue 1 year after treatment was 33.3%. Internal mammary chain RT (adjusted odds ratio [OR] 1.48 [95% confidence interval [CI] 1.03-2.13; p = 0.0355]) and normofractionated RT (adjusted OR 1.88 [95% CI 1.06-3.31; p = 0.0298]) were associated with increased odds of severe global fatigue. In addition, there was a significant association between normofractionated RT (adjusted OR 1.849 [95% CI 1.04-3.3; p = 0.0354]) and an increased likelihood of severe physical fatigue. CONCLUSION We found a significant association between internal mammary chain RT (versus No), normofractionated RT (versus hypofractionated RT) and increased likelihood of persistent severe global fatigue. Our data add to the current understanding of treatment-related factors affecting fatigue after BC and could lead to personalised interventions to improve the prevention and management of this disabling symptom.
Collapse
|
26
|
Csendes D, Gutlapalli SD, Prakash K, Swarnakari KM, Bai M, Manoharan MP, Raja R, Jamil A, Desai A, Desai DM, Khan S. Gastrointestinal Microbiota and Breast Cancer Chemotherapy Interactions: A Systematic Review. Cureus 2022; 14:e31648. [PMID: 36540440 PMCID: PMC9760128 DOI: 10.7759/cureus.31648] [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: 08/26/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is the most common type of cancer in women besides basal cell and squamous cell skin cancer. The current systemic therapy guidelines for this heterogeneous disease are mainly based on the molecular subtypes. However, more research is required to improve rates of therapy resistance and prevent side effects. Previous studies have shown that the human gut microbiota may have an important role in carcinogenesis as well as therapy outcomes, but this factor has not yet been integrated into therapy protocols. This systematic review aims to analyze how response rates and side effect profiles of breast cancer systemic therapies may be affected by the gastrointestinal microbiota. A literature search was performed using multiple databases and keywords related to gastrointestinal microbiota, breast cancer, and anticancer drugs. Studies were excluded if they primarily focused on diseases other than breast cancer. Abstracts, reviews, meta-analyses, and animal experiments were also excluded. After screening, nine studies met all selection criteria and included a total of 566 participants. Most studies described the impact of the gut microbiota on therapy response, but a few additionally discussed chemotherapy side effects, probiotics, or antibiotics. In general, diversity and specific microbiota were linked to chemotherapy response as well as prognosis. Microbiota diversity was also predictive of side effects such as neurological symptoms, weight gain, and constipation. The diversity and composition of gastrointestinal microbiota may serve as biomarkers and provide pathways for the optimization of chemotherapy in breast cancer patients.
Collapse
Affiliation(s)
- Denise Csendes
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Keerthana Prakash
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kiran Maee Swarnakari
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Meena Bai
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohana Priya Manoharan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rabab Raja
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneeque Jamil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aditya Desai
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Darshi M Desai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
27
|
Vaz-Luis I, Masiero M, Cavaletti G, Cervantes A, Chlebowski RT, Curigliano G, Felip E, Ferreira AR, Ganz PA, Hegarty J, Jeon J, Johansen C, Joly F, Jordan K, Koczwara B, Lagergren P, Lambertini M, Lenihan D, Linardou H, Loprinzi C, Partridge AH, Rauh S, Steindorf K, van der Graaf W, van de Poll-Franse L, Pentheroudakis G, Peters S, Pravettoni G. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol 2022; 33:1119-1133. [PMID: 35963481 DOI: 10.1016/j.annonc.2022.07.1941] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. DESIGN AND METHODS Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. RESULTS We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. CONCLUSIONS The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
Collapse
Affiliation(s)
- I Vaz-Luis
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif; UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy-Cancer Campus, Villejuif, France.
| | - M Masiero
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - A Cervantes
- Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon; Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - P A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
| | - J Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - J Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - C Johansen
- Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Joly
- Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
| | - K Jordan
- Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - B Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - P Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Lenihan
- International Cardio-Oncology Society, Tampa, USA
| | - H Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
| | | | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Rauh
- Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - W van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
| | - L van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Peters
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| |
Collapse
|
28
|
Ruiz De Azua G, Vaz-Luis I, Bovagnet T, Di Meglio A, Havas J, Caumette E, Martin E, Pistilli B, Coutant C, Cottu P, Rouanet P, Arnaud A, Arsene O, Ibrahim M, Wassermann J, Rouzier R, Martin AL, Everhard S, Dumas A, Menvielle G. Perceived discrimination at work: examining social, health and work-related factors as determinants among breast cancer survivors – evidence from the prospective CANTO cohort. J Epidemiol Community Health 2022. [DOI: 10.1136/jech-2021-218331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundWe assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors.MethodsWe used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models.ResultsOverall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination.ConclusionsOne in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination.Trial registration numberNCT01993498.
Collapse
|
29
|
Lambertini M, Massarotti C, Havas J, Pistilli B, Martin AL, Jacquet A, Coutant C, Coussy F, Mérimèche AD, Lerebours F, Rousset-Jablonski C, Jouannaud C, Rigal O, Fournier M, Soulie P, Franzoi MA, Del Mastro L, Partridge AH, André F, Vaz-Luis I, Di Meglio A. Contraceptive Use in Premenopausal Women With Early Breast Cancer. JAMA Netw Open 2022; 5:e2233137. [PMID: 36149651 PMCID: PMC9508662 DOI: 10.1001/jamanetworkopen.2022.33137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE As life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant. OBJECTIVE To examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer. DESIGN, SETTING, AND PARTICIPANTS The Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022. EXPOSURES Contraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2). MAIN OUTCOMES AND MEASURES Contraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis. RESULTS A total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P < .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44). CONCLUSIONS AND RELEVANCE Findings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.
Collapse
Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, School of Medicine, University of Genova, Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Julie Havas
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | - Charles Coutant
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | | | | | | | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Marion Fournier
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Patrick Soulie
- Department of Medical Oncology, Institut de Cancérologie de L’ouest-Paul Papin, Angers, France
| | - Maria Alice Franzoi
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fabrice André
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| |
Collapse
|
30
|
Soldato D, Havas J, Crane TE, Presti D, Lapidari P, Rassy N, Pistilli B, Martin E, Del Mastro L, Martin AL, Jacquet A, Coutant C, Cottu P, Merimeche A, Lerebours F, Tredan O, Vanlemmens L, André F, Vaz-Luis I, Di Meglio A. Coffee and tea consumption, patient-reported, and clinical outcomes in a longitudinal study of patients with breast cancer. Cancer 2022; 128:3552-3563. [PMID: 35913436 PMCID: PMC9541449 DOI: 10.1002/cncr.34401] [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: 12/10/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022]
Abstract
Background Higher consumption of coffee and tea has been associated with improved health outcomes in the general population and improved breast cancer (BC) prognosis. This study investigated patterns of coffee and tea consumption and association with patient‐reported outcomes (PROs) and clinical outcomes among survivors of BC. Methods The authors included survivors of stage I–III BC enrolled in the CANTO cohort (NCT01993498) that provided post‐treatment assessment of coffee and tea consumption from years 1 to 4 after diagnosis. Group‐based trajectory modeling clustered patients according to daily consumption of coffee and tea. Multivariable mixed models and Cox models examined associations between consumption, PROs and clinical outcomes. Results Among 3788 patients, the authors identified four stable patterns of consumption: “Low” (25.8%), “Moderate” (37.6%), “High” (25.3%), and “Very high” (11.3%), corresponding to <1, 2, 3, and ≥ 4 cups of coffee and/or tea per day. Patients in the “Very high” group (vs. “Low”), were more likely to be younger, smokers, with higher monthly income and education. PROs and survival outcomes were similar across the four groups. Conclusions Over one in three survivors of BC reported high or very high consumption of coffee and/or tea. The authors found no association between higher consumption of coffee and/or tea, worse PROs and clinical outcomes. More than 30% of survivors of breast cancer report high post‐diagnostic consumption of coffee and tea. In this study, the authors did not find any detrimental association between higher consumption of coffee and tea and patient‐reported or clinical outcomes.
Collapse
Affiliation(s)
- Davide Soldato
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy
| | - Julie Havas
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Tracy E Crane
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Daniele Presti
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Pietro Lapidari
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | | | | | - Elise Martin
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy.,Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Charles Coutant
- Medical Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Paul Cottu
- Medical Oncology, Institut Curie, Paris, France
| | - Asma Merimeche
- Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France
| | | | | | | | - Fabrice André
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Medical Oncology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Medical Oncology, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Medical Oncology, Gustave Roussy, Villejuif, France
| |
Collapse
|
31
|
Vaz-Luis I, Di Meglio A, Havas J, El-Mouhebb M, Lapidari P, Presti D, Soldato D, Pistilli B, Dumas A, Menvielle G, Charles C, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Dauchy S, Delaloge S, Lin NU, Ganz PA, Partridge AH, André F, Michiels S. Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis. J Clin Oncol 2022; 40:2148-2162. [PMID: 35290073 PMCID: PMC9242405 DOI: 10.1200/jco.21.01958] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Fatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors. METHODS We performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models. RESULTS Three trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors. CONCLUSION Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.
Collapse
Affiliation(s)
- Ines Vaz-Luis
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Antonio Di Meglio
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Pietro Lapidari
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Daniele Presti
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Davide Soldato
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Agnes Dumas
- Universite de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | | | | | | | | | - Sarah Dauchy
- Gustave Roussy, Supportive Care, IPLESP, Paris, France
| | | | | | | | | | - Fabrice André
- Gustave Roussy, Medical Oncology, Villejuif, France
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, INSERM, University Paris-Saclay, Villejuif, France
- Equipe labellisée Ligue Contre le Cancer, Villejuif, France
| |
Collapse
|
32
|
Baker JL, Di Meglio A, Gbenou AS, El Mouhebb M, Iyengar NM, Michiels S, Cottu P, Lerebours F, Coutant C, Lesur A, Tredan O, Vanlemmens L, Jouannaud C, Hrab I, Everhard S, Martin AL, Arveux P, Fabrice A, Vaz-Luis I, Jones LW. Association between physical activity and neoadjuvant chemotherapy completion and pathologic complete response in primary breast cancer: the CANTO study. Br J Cancer 2022; 127:886-891. [PMID: 35715631 DOI: 10.1038/s41416-022-01870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Regular physical activity is associated with improved symptom control in patients with breast cancer but its association with chemotherapy completion or response is unclear. METHODS Using a prospective design, 1075 breast cancer patients receiving neoadjuvant chemotherapy between March 2012 and February 2017 were studied. Physical activity was assessed using the Global Physical Activity Questionnaire [GPAQ-16], quantified in standardised MET-h/wk. Chemotherapy completion was defined as the proportion of patients completing planned treatment course, requiring dose reduction, or requiring dose delay. Response was evaluated by pathologic complete response (pCR). Associations between physical activity and primary outcomes were assessed using multivariable logistic regression models. RESULTS There was no differences between any chemotherapy completion outcome on the basis of physical activity classification. The percent of patients not completing planned treatment was 5.7% for ≦0.33 MET-h/wk, compared with 6.8% for 0.34-16.65 MET-h/wk, and 4.6% for ≥16.6 MET-h/wk (p = 0.52). No significant relationships were observed between physical activity dose classification and pCR for the overall cohort or upon stratification by clinical subtype. CONCLUSION Future studies are required to further investigate the relationship between pre-treatment levels of physical activity and function on treatment completion and response in breast and other cancer populations. CLINICAL TRIAL REGISTRATION NCT01993498.
Collapse
Affiliation(s)
| | - Antonio Di Meglio
- INSERM U 981 - Prédicteurs moléculaires et nouvelles cibles en oncologie, Institut Gustave Roussy, Villejuif, France
| | - Arnauld S Gbenou
- INSERM U 981 - Prédicteurs moléculaires et nouvelles cibles en oncologie, Institut Gustave Roussy, Villejuif, France
| | - Mayssam El Mouhebb
- INSERM U 981 - Prédicteurs moléculaires et nouvelles cibles en oncologie, Institut Gustave Roussy, Villejuif, France
| | - Neil M Iyengar
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Stefan Michiels
- INSERM U1018 CESP, Service de Biostatistique et d'Epidemiologie, Institut Gustave Roussy, Villejuif, France
| | | | | | | | - Anne Lesur
- Insitut de cancerlogie de Lorraine, Nancy, France
| | | | | | | | - Iona Hrab
- Centre François Baclesse, Caen, France
| | | | | | | | - Andre Fabrice
- INSERM U 981 - Prédicteurs moléculaires et nouvelles cibles en oncologie, Institut Gustave Roussy, Villejuif, France.,Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- INSERM U 981 - Prédicteurs moléculaires et nouvelles cibles en oncologie, Institut Gustave Roussy, Villejuif, France. .,Medical Oncology Department, Institut Gustave Roussy, Villejuif, France.
| | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA. .,Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
33
|
Presti D, Havas J, Soldato D, Lapidari P, Martin E, Pistilli B, Jouannaud C, Emile G, Rigal O, Fournier M, Soulie P, Mouret-Reynier MA, Tarpin C, Campone M, Guillermet S, Martin AL, Everhard S, Di Meglio A. Factors associated with enrolment in clinical trials among women with early-stage breast cancer. ESMO Open 2022; 7:100513. [PMID: 35724624 PMCID: PMC9271499 DOI: 10.1016/j.esmoop.2022.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Clinical trials allow development of innovative treatments and ameliorate the quality of clinical care in oncology. Data show that only a minority of patients are enrolled in clinical trials. We assessed enrolment in clinical trials and its correlates among women with early breast cancer. Methods We included 9516 patients with stage I-III breast cancer from the multicenter, prospective CANTO study (NCT01993498), followed-up until year 4 (Y4) post-diagnosis. We assessed factors associated with enrolment using multivariable logistic regression. In exploratory, propensity score matched analyses, we used multiple linear regression to evaluate the relationship of enrolment in clinical trials with the European Organisation for Research and Treatment of Cancer Quality Of Life (QoL) questionnaire (EORTC QLQ-C30) Summary Score and described clinical outcomes (distant disease event, invasive disease event, and death by any cause) according to enrolment. Results Overall, 1716 patients (18%) were enrolled in a clinical trial until Y4 post-diagnosis of breast cancer. Socioeconomic factors were not associated with enrolment. Centres of intermediate volume were most likely to enrol patients in clinical trials [versus low volume, odds ratio 1.45 (95% confidence interval (CI) 1.08-1.95), P = 0.0124]. Among 2118 propensity score matched patients, enrolment was associated with better QoL at Y4 (adjusted mean difference versus not enrolled 1.37, 95% CI 0.03-2.71, P = 0.0458), and clinical outcomes (enrolled versus not enrolled, distant disease event 7.3% versus 10.1%, P = 0.0206; invasive disease event 8.2% versus 10.5%, P = 0.0732; death by any cause 2.8% versus 3.7%, P = 0.2707). Conclusions In this large study, one in five patients enrolled on a clinical trial until Y4 after diagnosis of early breast cancer. Geographical and centre-related factors were significantly associated with enrolment in clinical trials. Inclusion in clinical trials seemed associated with improved QoL and clinical outcomes. Access to innovation for early-stage breast cancer patients should be encouraged and facilitated by overcoming organizational and geographical barriers to recruitment. The proportion of patients who access innovation through participation in clinical trials is generally limited. Rate of enrolment in clinical trials among women with early breast cancer exceeded what previously found in other settings. Clinical and geographical factors were associated to access to innovation in clinical trials. Enrolment in clinical trials is associated with better quality of life and clinical outcomes.
Collapse
Affiliation(s)
- D Presti
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - J Havas
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - D Soldato
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - P Lapidari
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - E Martin
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - G Emile
- Centre François Baclesse, Caen, France
| | - O Rigal
- Centre Henri Becquerel, Rouen, France
| | | | - P Soulie
- Institut de Cancérologie de L'ouest -Paul Papin, Angers, France
| | | | - C Tarpin
- Institut Paoli Calmettes, Marseille, France
| | - M Campone
- Institut de Cancérologie de l'Ouest - Site de Nantes - Centre René Gauducheau, Nantes, France
| | | | | | | | - A Di Meglio
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France.
| |
Collapse
|
34
|
Dumas A, Menvielle G. [Socio-professional life after cancer]. REVUE DE L'INFIRMIERE 2022; 71:29-30. [PMID: 35843639 DOI: 10.1016/j.revinf.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The occurrence of cancer can create or increase social inequalities, particularly because of its consequences on employment. The first results of a large French prospective cohort on the return to work of women after breast cancer show the importance of the support of these patients by health professionals, and in particular by nurses.
Collapse
Affiliation(s)
- Agnès Dumas
- Eceve, UMR 1123, Inserm, faculté de médecine, université Paris Cité, 10 avenue de Verdun, 75010 Paris, France.
| | - Gwenn Menvielle
- UMR-S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Inserm, faculté de médecine, Sorbonne Université, 27 rue Chaligny, 75012 Paris, France
| |
Collapse
|
35
|
Allali S, Carton M, Sarrade T, Querel O, Jacquet A, Rivera S, Ghannam Y, Peignaux K, Guilbert P, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Labib A, Geffrelot J, Benyoucef A, Paris F, Cottu P, André F, Kirova Y. CANTO-RT: Skin toxicities evaluation of a multicenter large prospective cohort of irradiated patients for early-stage breast cancer. Int J Cancer 2022; 151:1098-1108. [PMID: 35489021 DOI: 10.1002/ijc.34057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
Skin damage is the most common and most important toxicity during and after radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer CANTO is a prospective clinical cohort study of 10 150 patients with stage I-III BC treated from 2012-2017 in 26 cancer centers. In this study, we used CANTO-RT, a sub-cohort of CANTO, including 3480 patients who received RT. We are focus on specifical skin toxicities: Erythema, fibrosis, telangiectasia, and cutaneous pigmentation The prevalence of toxicities of interest varied over time, so at M3-6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased respectively while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M3-6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane-based CT and the 3DvsIMRT irradiation technique. Regarding fibrosis, an association is found, at M3-6, with age at diagnosis, obesity, tobacco, and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In this study we identified several risk factors for acute and late skin. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT-type technique decreased the occurrence of skin erythema.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - François Paris
- Centre de Recherche en Cancérologie Immunologie Nantes Angers (CRCINA) UMR Inserm 1232, Université de Nantes, Nantes
| | | | | | | |
Collapse
|
36
|
Di Meglio A, Havas J, Gbenou AS, Martin E, El-Mouhebb M, Pistilli B, Menvielle G, Dumas A, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Joly F, Delaloge S, Ganz PA, André F, Partridge AH, Jones LW, Michiels S, Vaz-Luis I. Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy. J Clin Oncol 2022; 40:3190-3204. [PMID: 35446677 PMCID: PMC9509127 DOI: 10.1200/jco.21.00277] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.
Collapse
Affiliation(s)
- Antonio Di Meglio
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Arnauld S Gbenou
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Elise Martin
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Agnes Dumas
- Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | | | | | | | | | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | - Fabrice André
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Oncostat Inserm U1018, Université Paris- Saclay, Equipe labellisée Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| |
Collapse
|
37
|
Charles C, Bardet A, Larive A, Gorwood P, Ramoz N, Thomas E, Viari A, Rousseau-Tsangaris M, Dumas A, Menvielle G, Everhard S, Martin AL, Gbenou SYA, Havas J, El-Mouhebb M, Di Meglio A, André F, Pistilli B, Coutant C, Cottu P, Mérimèche A, Lerebours F, Tredan O, Vanlemmens L, Jouannaud C, Levy C, Vaz-Luis I, Michiels S, Dauchy S. Characterization of Depressive Symptoms Trajectories After Breast Cancer Diagnosis in Women in France. JAMA Netw Open 2022; 5:e225118. [PMID: 35420663 PMCID: PMC9011125 DOI: 10.1001/jamanetworkopen.2022.5118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/21/2022] [Indexed: 12/15/2022] Open
Abstract
Importance Breast cancer (BC) diagnosis and treatment expose patients to a 5-fold higher risk of depression compared with the general population, with an estimated prevalence of 10% to 25%. A depressive episode in patients with BC has implications for the tolerance of and adherence to treatment, impairing quality of life and reducing life expectancy. Objective To identify and characterize distinct longitudinal patterns of depressive symptoms in patients with BC from diagnosis to 3 years after treatment. Design, Settings, and Participants The CANTO-DEePRESS (Deeper in the Understanding and Prevention of Depression in Breast Cancer Patients) cohort study included women in the French multicenter CANTO (CANcer TOxicities) cohort study (conducted between March 20, 2012 and December 11, 2018), who were 18 years or older with invasive stage I to III BC and no previous BC treatment. The study aimed to characterize toxicities over a 5-year period following stage I to III primary BC treatment. Assessments of depressive symptoms were performed on a subset of patients with available data at diagnosis and at least 2 other time points. All data were extracted from the CANTO database on October 1, 2020. Main Outcomes and Measures The primary outcome was the level of depressive symptoms at each assessment time point measured with the Hospital Anxiety and Depression Scale and depression subscale at BC diagnosis and at 3 to 6, 12, and 36 months after the end of treatment. The group-based trajectory modeling was used to identify trajectory groups, and multinomial logistic regression models were used to characterize the following factors associated with trajectory group affiliation: demographic, socioeconomic, clinical, lifestyle, and quality-of-life data. Results A total of 4803 women (mean [SD] age, 56.2 [11.2] years; 2441 patients [50.8%] with stage I BC) were included in the study. Six trajectory groups that described the heterogeneity in the expression of depressive symptoms were identified: noncases with no expression of symptoms (n = 2634 [54.8%]), intermediate worsening (1076 [22.4%]), intermediate improvement (480 [10.0%]), remission (261 [5.4%]), delayed occurrence (200 [4.2%]), and stable depression (152 [3.2%]). HADS-D scores at diagnosis were consistently associated with the 5 depressive trajectory group affiliations, with an estimated higher probability per point increase of experiencing subthreshold or clinically significant depressive symptoms between diagnosis and the 3 years after the end of BC treatment. The higher probabilities ranged from 1.49 (95% CI, 1.43-1.54) for the intermediate worsening group to 10.53 (95% CI, 8.84-12.55) for the stable depression group. Trajectory groups with depressive symptoms differed from the noncases group without symptoms by demographic and clinical factors, such as having dependent children, lower household income, cancer stage, family history of BC, previous psychiatric hospitalizations, obesity, smoking status, higher levels of fatigue, and depression at diagnosis. Conclusions and Relevance In this cohort study, nearly a third of patients with BC experienced temporary or lasting significant depressive symptoms during and after treatment. Improving early identification of women at risk of developing long-term or delayed depression is therefore critical to increase quality of life and overall survival. Subjected to validation, this study is an important first step toward personalized care of patients with BC at risk of depression.
Collapse
Affiliation(s)
- Cécile Charles
- Department of Prevention-Public Health, Institut Bergonié, Bordeaux, France
- Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale (INSERM) U1219, Université de Bordeaux, Bordeaux, France
| | - Aurélie Bardet
- Gustave Roussy, Université Paris-Saclay, Biostatistics and Epidemiology Office, Villejuif, France
- Oncostat U1018 INSERM, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Alicia Larive
- Gustave Roussy, Université Paris-Saclay, Biostatistics and Epidemiology Office, Villejuif, France
- Oncostat U1018 INSERM, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France
- La Clinique des Maladies Mentales et de l'Encéphale, Le Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, Paris, France
| | - Emilie Thomas
- Fondation Synergie Lyon Cancer Plateforme Bioinformatique Gilles Thomas, Lyon, France
| | - Alain Viari
- Fondation Synergie Lyon Cancer Plateforme Bioinformatique Gilles Thomas, Lyon, France
| | | | - Agnès Dumas
- Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Unité Mixte de Recherche 1123 INSERM, Université de Paris, Paris, France
| | - Gwenn Menvielle
- Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Unité Mixte de Recherche 1123 INSERM, Université de Paris, Paris, France
| | | | | | | | - Julie Havas
- Gustave Roussy, INSERM U981, Université Paris-Saclay, Villejuif, France
| | | | - Antonio Di Meglio
- Gustave Roussy, INSERM U981, Université Paris-Saclay, Villejuif, France
| | | | - Barbara Pistilli
- Gustave Roussy, INSERM U981, Université Paris-Saclay, Villejuif, France
| | | | | | - Asma Mérimèche
- Centre Alexis Vautrin, Vandoeuvre les Nancy, Nancy, France
| | | | | | | | | | | | - Ines Vaz-Luis
- Gustave Roussy, INSERM U981, Université Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Gustave Roussy, Université Paris-Saclay, Biostatistics and Epidemiology Office, Villejuif, France
- Oncostat U1018 INSERM, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Sarah Dauchy
- Department of Prevention-Public Health, Institut Bergonié, Bordeaux, France
| |
Collapse
|
38
|
Di Meglio A, Havas J, Soldato D, Presti D, Martin E, Pistilli B, Menvielle G, Dumas A, Charles C, Everhard S, Martin AL, Coutant C, Tarpin C, Vanlemmens L, Levy C, Rigal O, Delaloge S, Lin NU, Ganz PA, Partridge AH, André F, Michiels S, Vaz-Luis I. Development and Validation of a Predictive Model of Severe Fatigue After Breast Cancer Diagnosis: Toward a Personalized Framework in Survivorship Care. J Clin Oncol 2022; 40:1111-1123. [PMID: 35061509 PMCID: PMC8966972 DOI: 10.1200/jco.21.01252] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Fatigue is common and troublesome among breast cancer survivors; however, limited tools exist to predict its risk. PATIENTS AND METHODS Participants with stage I-III breast cancer were prospectively included from CANTO (ClinicalTrials.gov identifier: NCT01993498), collecting longitudinal data at diagnosis (before the initiation of any cancer treatment) and 1 (T1), 2 (T2), and 4 (T3) years after diagnosis. The main outcome was severe global fatigue at T2 (score ≥ 40/100, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30). Analyses at T3 were exploratory. Secondary outcomes included physical, emotional, and cognitive fatigue (EORTC Quality of Life Questionnaire-FA12). Multivariable logistic regression models retained associations with severe fatigue by bootstrapped Augmented Backward Elimination. Validation methods included 10-fold internal cross-validation, overoptimism-corrected area under the receiver operating characteristic curves, and external validation. RESULTS Among 5,640, 5,000, and 3,400 patients at T1, T2, and T3, respectively, the prevalence of post-treatment severe global fatigue was 35.6%, 34.0%, and 31.5% in the development cohort. Retained risk factors for severe global fatigue at T2 were severe pretreatment fatigue (adjusted odds ratio v no 3.191 [95% CI, 2.704 to 3.767]); younger age (for 1-year decrement 1.015 [1.009 to 1.022]), higher body mass index (for unit increment 1.025 [1.012 to 1.038]), current smoking behavior (v never 1.552 [1.291 to 1.866]), worse anxiety (v noncase 1.265 [1.073 to 1.492]), insomnia (for unit increment 1.005 [1.003 to 1.007]), and pain at diagnosis (for unit increment 1.014 [1.010 to 1.017]), with an area under the receiver operating characteristic curve of 0.73 (95% CI, 0.72 to 0.75). Receipt of hormonal therapy was a risk factor for severe fatigue at T3 (v no 1.448 [1.165 to 1.799]). Dimension-specific risk factors included body mass index for physical fatigue and emotional distress for emotional and cognitive fatigue. CONCLUSION We propose a predictive model to assess fatigue among breast cancer survivors, within a personalized survivorship care framework. This may help clinicians to provide early management interventions or to correct modifiable risk factors and offer more tailored monitoring and education to patients at risk of severe post-treatment fatigue.
Collapse
Affiliation(s)
- Antonio Di Meglio
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
| | - Davide Soldato
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy
| | - Daniele Presti
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Elise Martin
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
| | - Barbara Pistilli
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Gwenn Menvielle
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Agnes Dumas
- Universite de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | - Cecile Charles
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
| | | | | | | | | | | | | | | | - Suzette Delaloge
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | - Fabrice André
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Ines Vaz-Luis
- INSERM Unit 981–Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France; University Paris-Saclay
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| |
Collapse
|
39
|
Change in the value of work after breast cancer: evidence from a prospective cohort. J Cancer Surviv 2022; 17:694-705. [PMID: 35267143 DOI: 10.1007/s11764-022-01197-w] [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: 01/20/2022] [Accepted: 02/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Return to work (RTW) after cancer can be modulated by psychosocial factors, including a reordering of one's life values, with more emphasis on private life than work-life. This change in patients' outlook on work-life is however poorly understood. METHODS We used data from a French cohort (CANTO, NCT01993498) of women diagnosed with stage I-III primary breast cancer (BC) prospectively assessing life priorities between work and private life at diagnosis and 2 years after diagnosis. We identified women who reported a shift in life values toward private life, and we investigated the clinical, demographic, work-related, and psychosocial determinants of this change using logistic regressions. RESULTS Overall, 46% (N = 1097) of the women had reordered their life priorities toward private life 2 years after diagnosis. The factors positively associated with this shift included being diagnosed with stage III BC, perceiving one's job as not very interesting, being an employee/clerk (vs. executive occupation), perceiving no support from the supervisor at baseline, perceiving negative interferences of cancer in daily life, and perceiving a positive impact from experiencing cancer. Depressive symptoms were negatively associated with this shift. CONCLUSION After BC, there seems to be an important reordering of life values, with more emphasis on private life. This change is influenced by clinical determinants, but also by work-related and psychosocial factors. IMPLICATIONS FOR CANCER SURVIVORS Stakeholders should consider this change in a patient's outlook on work-life as much as the classical physical late effects when designing post-BC programs to support RTW.
Collapse
|
40
|
Di Meglio A, Charles C, Martin E, Havas J, Gbenou A, Flaysakier JD, Martin AL, Everhard S, Laas E, Chopin N, Vanlemmens L, Jouannaud C, Levy C, Rigal O, Fournier M, Soulie P, Scotte F, Pistilli B, Dumas A, Menvielle G, André F, Michiels S, Dauchy S, Vaz-Luis I. Uptake of Recommendations for Posttreatment Cancer-Related Fatigue Among Breast Cancer Survivors. J Natl Compr Canc Netw 2022; 20:jnccn20441. [PMID: 35130491 DOI: 10.6004/jnccn.2021.7051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Physical activity (PA) and psychosocial interventions are recommended management strategies for cancer-related fatigue (CRF). Randomized trials support the use of mind-body techniques, whereas no data show benefit for homeopathy or naturopathy. METHODS We used data from CANTO (ClinicalTrials.gov identifier: NCT01993498), a multicenter, prospective study of stage I-III breast cancer (BC). CRF, evaluated after primary treatment completion using the EORTC QLQ-C30 (global CRF) and QLQ-FA12 (physical, emotional, and cognitive dimensions), served as the independent variable (severe [score of ≥40/100] vs nonsevere). Outcomes of interest were adherence to PA recommendations (≥10 metabolic equivalent of task [MET] h/week [GPAQ-16]) and participation in consultations with a psychologist, psychiatrist, acupuncturist, or other complementary and alternative medicine (CAM) practitioner (homeopath and/or naturopath) after CRF assessment. Multivariable logistic regression examined associations between CRF and outcomes, adjusting for sociodemographic, psychologic, tumor, and treatment characteristics. RESULTS Among 7,902 women diagnosed from 2012 through 2017, 36.4% reported severe global CRF, and 35.8%, 22.6%, and 14.1% reported severe physical, emotional, and cognitive CRF, respectively. Patients reporting severe global CRF were less likely to adhere to PA recommendations (60.4% vs 66.7%; adjusted odds ratio [aOR], 0.82; 95% CI, 0.71-0.94; P=.004), and slightly more likely to see a psychologist (13.8% vs 7.5%; aOR, 1.29; 95% CI, 1.05-1.58; P=.014), psychiatrist (10.4% vs 5.0%; aOR, 1.39; 95% CI, 1.10-1.76; P=.0064), acupuncturist (9.8% vs 6.5%; aOR, 1.46; 95% CI, 1.17-1.82; P=.0008), or CAM practitioner (12.5% vs 8.2%; aOR, 1.49; 95% CI, 1.23-1.82; P<.0001). There were differences in recommendation uptake by CRF dimension, including that severe physical CRF was associated with lower adherence to PA (aOR, 0.74; 95% CI, 0.63-0.86; P=.0001) and severe emotional CRF was associated with higher likelihood of psychologic consultations (aOR, 1.37; 95% CI, 1.06-1.79; P=.017). CONCLUSIONS Uptake of recommendations to improve CRF, including adequate PA and use of psychosocial services, seemed suboptimal among patients with early-stage BC, whereas there was a nonnegligible interest in homeopathy and naturopathy. Findings of this large study indicate the need to implement recommendations for managing CRF in clinical practice.
Collapse
Affiliation(s)
- Antonio Di Meglio
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Cecile Charles
- 2Département de Soins de Support, Gustave Roussy, Villejuif.,3Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes-Sorbonne Paris Cité, Boulogne-Billancourt
| | - Elise Martin
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Julie Havas
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Arnauld Gbenou
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Jean-Daniel Flaysakier
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | | | | | - Enora Laas
- 5Medical Oncology, Institut Curie, Paris
| | | | | | | | | | | | | | - Patrick Soulie
- 12Medical Oncology, Institut de Cancérologie de L'ouest-Paul Papin, Angers
| | - Florian Scotte
- 2Département de Soins de Support, Gustave Roussy, Villejuif
| | - Barbara Pistilli
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Agnes Dumas
- 13Universite de Paris, ECEVE UMR 1123 INSERM, Paris; and
| | - Gwenn Menvielle
- 14Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - Fabrice André
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Stefan Michiels
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| | - Sarah Dauchy
- 2Département de Soins de Support, Gustave Roussy, Villejuif
| | - Ines Vaz-Luis
- 1INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif
| |
Collapse
|
41
|
Scotte F, Mir O, Di Palma M, Minvielle E. Essential digital health. Ann Oncol 2021; 32:1468-1469. [PMID: 34699931 PMCID: PMC8605799 DOI: 10.1016/j.annonc.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- F Scotte
- Interdisciplinary Patient Pathway Department (DIOPP), Gustave Roussy, Villejuif, France.
| | - O Mir
- Interdisciplinary Patient Pathway Department (DIOPP), Gustave Roussy, Villejuif, France
| | - M Di Palma
- Interdisciplinary Patient Pathway Department (DIOPP), Gustave Roussy, Villejuif, France
| | - E Minvielle
- Interdisciplinary Patient Pathway Department (DIOPP), Gustave Roussy, Villejuif, France; École polytechnique, I3-CRG, CNRS, Institut Polytechnique, Palaiseau cedex, France
| |
Collapse
|
42
|
Benoit L, Cambra C, Rouzier R, Cottu P, Rodrigues M, Reyal F, Research Network S, Bonneau C. Quality of Life in an e-Cohort of Women Treated by Endocrine Therapy for Early Breast Cancer. Clin Breast Cancer 2021; 22:e352-e361. [PMID: 34756686 DOI: 10.1016/j.clbc.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of our study was to analyze quality of life (QOL) in an e-cohort of patients treated for breast cancer (BC) by endocrine therapy (ET), by means of validated quality of life questionnaires. STUDY DESIGN AND SETTING A retrospective, observational, e-cohort study was conducted (Seintinelles platform). Female patients treated for nonmetastatic and nonrecurrent BC, treated in France after 2005, filled in online questionnaires concerning: QOL (QLQ-C30 and QLQ-BR23), tolerability of treatment and demographic characteristics. A multivariate analysis including variables significant on univariate analysis (P < .05) to select QOL predictors was performed. RESULTS We included 1,198 patients, 1140 of whom declared that they were taking ET (37.7% tamoxifen, 17.1% aromatase inhibitor (AI), 5.6% LHRH-agonist and 39.6% sequential tamoxifen and AI). Different tolerability profiles were observed when comparing the tamoxifen and AI groups. Treatment adherence was similar in the 2 groups. QOL varied slightly according to the type of ET. On multivariate analysis, ET had no impact on QOL. However, individual patient characteristics (socioeconomic, education and age) were significantly associated with QOL CONCLUSION: Using a real-life study questionnaire on a large e-cohort, individual patient characteristics were strongly associated with deterioration of QOL. The use of e-cohorts must be encouraged to modulate the conclusions of randomized trials.
Collapse
Affiliation(s)
- Louise Benoit
- Institut Curie, Saint Cloud, Surgical Oncology Department, 35, rue Dailly, 92210 Saint-Cloud, France.
| | - Carine Cambra
- Institut Curie, Saint Cloud, Surgical Oncology Department, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Roman Rouzier
- Institut Curie, Saint Cloud, Surgical Oncology Department, 35, rue Dailly, 92210 Saint-Cloud, France; Versailles St Quentin University, Paris-Saclay University, 78180 Montigny-le-Bretonneux, France
| | - Paul Cottu
- Institut Curie, Paris, Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - Manuel Rodrigues
- Institut Curie, Paris, Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - Fabien Reyal
- Institut Curie Paris, Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France; Residual Tumor and Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Paris, France
| | | | - Claire Bonneau
- Institut Curie, Saint Cloud, Surgical Oncology Department, 35, rue Dailly, 92210 Saint-Cloud, France; Versailles St Quentin University, Paris-Saclay University, 78180 Montigny-le-Bretonneux, France
| |
Collapse
|
43
|
Lapidari P, Djehal N, Havas J, Gbenou A, Martin E, Charles C, Dauchy S, Pistilli B, Cadeau C, Bertaut A, Everhard S, Martin AL, Coutant C, Cottu P, Menvielle G, Dumas A, Andre F, Michiels S, Vaz-Luis I, Di Meglio A. Determinants of use of oral complementary-alternative medicine among women with early breast cancer: a focus on cancer-related fatigue. Breast Cancer Res Treat 2021; 190:517-529. [PMID: 34559354 DOI: 10.1007/s10549-021-06394-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/11/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Despite the questionable effectiveness of oral complementary and alternative medicine (OCAM) in relieving cancer-related symptoms, including fatigue (CRF), many patients use it aiming to improve their quality of life. We assessed factors associated with OCAM use, focusing on CRF. METHODS Women with stage I-III breast cancer (BC) were included from CANTO (NCT01993498). OCAM use was defined as taking homeopathy, vitamins/minerals, or herbal/dietary supplements. Multivariable multinomial logistic regressions evaluated associations of CRF (EORTC QLQ-C30), patient, and treatment characteristics with OCAM use. RESULTS Among 5237 women, 23.0% reported OCAM use overall (49.3% at diagnosis, 50.7% starting post-diagnosis), mostly homeopathy (65.4%). Mean (SD) CRF score was 27.6 (24.0) at diagnosis and 35.1 (25.3) at post-diagnosis. More intense CRF was consistently associated with OCAM use at diagnosis and post-diagnosis [adjusted odds ratio (aOR) for 10-point increase 1.05 (95% Confidence interval 1.01-1.09) and 1.04 (1.01-1.09) vs. never use, respectively]. Odds of using OCAM at diagnosis were higher among older [for 5-year increase, 1.09 (1.04-1.14)] and more educated patients [college vs. primary 1.80 (1.27-2.55)]. Women with income > 3000 [vs. < 1500 euros/month, 1.44 (1.02-2.03)], anxiety [vs. not, 1.25 (1.01-1.54)], and those receiving chemotherapy [vs. not, 1.32 (1.04-1.68)] had higher odds of using OCAM post-diagnosis. CONCLUSION One-in-four patients reported use of OCAM. More severe CRF was consistently associated with its use. Moreover, older, better educated, wealthier, more anxious women, and those receiving chemotherapy seemed more prone to use OCAM. Characterizing profiles of BC patients more frequently resorting to OCAM may help deliver targeted information about its benefits and potential risks.
Collapse
Affiliation(s)
- Pietro Lapidari
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Univesità Degli Studi di Pavia, Pavia, Italy
| | | | - Julie Havas
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Arnauld Gbenou
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Elise Martin
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Cecile Charles
- Bordeaux Public Health, Université de Bordeaux, U1219, Bordeaux, France
| | - Sarah Dauchy
- Département Interdisciplinaire de Soins de Support aux Patients en Onco-hématologie, Gustave Roussy, Villejuif, France
| | | | | | - Aurélie Bertaut
- Centre Georges-François Leclerc, Methodology and Biostatistic Unit, Dijon, France
| | | | | | - Charles Coutant
- Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Paul Cottu
- Medical Oncology, Institut Curie, Paris, France
| | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Agnes Dumas
- ECEVE UMR 1123, Université de Paris, Paris, France
| | - Fabrice Andre
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France.,Inserm, University Paris-Saclay, Labeled «Ligue Contre le Cancer», Oncostat U1018, Villejuif, France
| | - Ines Vaz-Luis
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.
| |
Collapse
|
44
|
Joseph A, Chen H, Anagnostopoulos G, Montégut L, Lafarge A, Motiño O, Castedo M, Maiuri MC, Clément K, Terrisse S, Martin AL, Vaz-Luis I, Andre F, Grundler F, de Toledo FW, Madeo F, Zitvogel L, Goldwasser F, Blanchet B, Fumeron F, Roussel R, Martins I, Kroemer G. Effects of acyl-coenzyme A binding protein (ACBP)/diazepam-binding inhibitor (DBI) on body mass index. Cell Death Dis 2021; 12:599. [PMID: 34108446 PMCID: PMC8190068 DOI: 10.1038/s41419-021-03864-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022]
Abstract
In mice, the plasma concentrations of the appetite-stimulatory and autophagy-inhibitory factor acyl-coenzyme A binding protein (ACBP, also called diazepam-binding inhibitor, DBI) acutely increase in response to starvation, but also do so upon chronic overnutrition leading to obesity. Here, we show that knockout of Acbp/Dbi in adipose tissue is sufficient to prevent high-fat diet-induced weight gain in mice. We investigated ACBP/DBI plasma concentrations in several patient cohorts to discover a similar dual pattern of regulation. In relatively healthy subjects, ACBP/DBI concentrations independently correlated with body mass index (BMI) and age. The association between ACBP/DBI and BMI was lost in subjects that underwent major weight gain in the subsequent 3-9 years, as well as in advanced cancer patients. Voluntary fasting, undernutrition in the context of advanced cancer, as well as chemotherapy were associated with an increase in circulating ACBP/DBI levels. Altogether, these results support the conclusion that ACBP/DBI may play an important role in body mass homeostasis as well as in its failure.
Collapse
Affiliation(s)
- Adrien Joseph
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, Paris, France
| | - Hui Chen
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, Paris, France
| | - Gerasimos Anagnostopoulos
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, Paris, France
| | - Léa Montégut
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, Paris, France
| | - Antoine Lafarge
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, Paris, France
| | - Omar Motiño
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
| | - Maria Castedo
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
| | - Maria Chiara Maiuri
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
| | - Karine Clément
- INSERM, NutriOmics Research Unit, Sorbonne Université, Paris, France
- Assistance Publique Hôpitaux de Paris, Nutrition Departement, Pitié-Salpêtrière Hospital, Sorbonne Université, 47-83 bd de l'Hôpital, 75013, Paris, France
| | - Safae Terrisse
- Department of Medical Oncology, Saint-Louis Hospital, Paris Descartes University, AP-HP, Paris, France
| | | | - Ines Vaz-Luis
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
- Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - Fabrice Andre
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
- Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | | | | | - Frank Madeo
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, Graz, Austria
- Field of Excellence BioHealth, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Laurence Zitvogel
- Faculté de Médecine, Université de Paris Saclay, Kremlin Bicêtre, Paris, France
- INSERM U1015, Gustave Roussy, Cancer Campus, 94800, Villejuif, France
- INSERM CICBT1428, Centre d'Investigation Clinique-Biothérapie, 94800, Villejuif, France
| | - François Goldwasser
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
- URP4466, Paris University, Paris, France
| | - Benoit Blanchet
- Pharmacokinetics and Pharmacochemistry Unit, Cochin Hospital, Paris Descartes University, CARPEM, AP-HP, Paris, France
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University of Paris, PRES Sorbonne Paris Cité, CARPEM, 75006, Paris, France
| | - Frédéric Fumeron
- Centre de Recherche des Cordeliers, UMR-S 1138, INSERM, Université de Paris, Paris, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, UMR-S 1138, INSERM, Université de Paris, Paris, France
- Department of Diabetology, Endocrinology, Nutrition, AP-HP, Bichat Hospital, Paris, France
| | - Isabelle Martins
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France.
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France.
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Inserm U1138, Université de Paris, Sorbonne Université, Paris, France.
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France.
- Institut Universitaire de France, Paris, France.
- Department of Physiology, University Complutense of Madrid, Madrid, Spain.
- Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
- Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China.
- Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
45
|
Lapidari P, Gbenou A, Havas J, Martin E, Pistilli B, Martin AL, Everhard S, Coutant C, Cottu P, Lesur A, Lerebours F, Tredan O, Vanlemmens L, Jouannaud C, Levy C, Rigal O, Fournier M, Andre F, Vaz-Luis I, Di Meglio A. Long-term patient reported outcomes and hematologic toxicity among patients who received Granulocyte-Colony Stimulating Factors during chemotherapy for early breast cancer. Breast 2021; 57:43-48. [PMID: 33711699 PMCID: PMC7970125 DOI: 10.1016/j.breast.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/12/2022] Open
Abstract
We assessed long-term associations of Granulocyte-Colony Stimulating Factors (G-CSF) use with patient-reported outcomes (PROs) and hematologic toxicity among chemotherapy-treated, early-stage breast cancer patients in CANTO (NCT01993498). Among 2920 patients longitudinally followed-up until year-4 after diagnosis, 49% used G-CSF. In multivariable-adjusted mixed-models, EORTC QLQ-C30 pain and summary score were not substantially different between groups (overall adjusted mean difference, use vs no-use [95%CI]: +1.27 [-0.33 to +2.87] and -1.01 [-1.98 to -0.04], respectively). PROs were slightly worse at year-4 among patients receiving G-CSF, although differences were of trivial clinical significance. No major differences were observed in leukocyte or platelet count over time.
Collapse
Affiliation(s)
- Pietro Lapidari
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France; Univesità Degli Studi di Pavia, Pavia, Italy
| | - Arnauld Gbenou
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Elise Martin
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Anne Lesur
- Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | | | | | | | | | | | | | | | - Fabrice Andre
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France.
| |
Collapse
|
46
|
Di Meglio A, Gbenou AS, Martin E, Pistilli B, Ligibel JA, Crane TE, Flaysakier JD, Minvielle E, Vanlemmens L, Guenancia C, Rigal O, Fournier M, Soulie P, Mouret-Reynier MA, Tarpin C, Boiffard F, Guillermet S, Everhard S, Martin AL, Giacchetti S, Petit T, Dalenc F, Rouanet P, Arnaud A, Andre F, Vaz-Luis I. Unhealthy behaviors after breast cancer: Capitalizing on a teachable moment to promote lifestyle improvements. Cancer 2021; 127:2774-2787. [PMID: 33887074 DOI: 10.1002/cncr.33565] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study assessed the prevalence and risk factors of unhealthy behaviors among survivors of early-stage breast cancer. METHODS Women (n = 9556) from the CANcer TOxicity cohort (NCT01993498) were included. Physical activity (PA), tobacco and alcohol consumption, and body mass index were assessed at diagnosis and at years 1 and 2 after diagnosis. A behavior was defined as unhealthy if patients failed to meet PA recommendations (≥10 metabolic equivalent task hours per week), reduce/quit tobacco, or decrease alcohol consumption to less than daily, or if they gained substantial weight over time. Multivariable-adjusted generalized estimating equations explored associations with unhealthy behaviors. RESULTS At diagnosis, 41.7% of patients were inactive, 18.2% currently used tobacco, 14.6% consumed alcohol daily, and 48.9% were overweight or obese. At years 1 and 2, unhealthy PA behavior was reported among 37.0% and 35.6% of patients, respectively, unhealthy tobacco use behavior was reported among 11.4% and 9.5%, respectively, and unhealthy alcohol behavior was reported among 13.1% and 12.6%, respectively. In comparison with the previous assessment, 9.4% and 5.9% of underweight and normal-weight patients had transitioned to the overweight or obese category at years 1 and 2, respectively, and 15.4% and 16.2% of overweight and obese patients had gained ≥5% of their weight at years 1 and 2, respectively. One in 3 current tobacco smokers and 1 in 10 daily alcohol users reported improved behaviors after diagnosis. Older women (5-year increment) were more likely to be inactive (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 1.01-1.05) and report unhealthy alcohol behavior (aOR, 1.28; 95% CI, 1.23-1.33) but were less likely to engage in unhealthy tobacco use (aOR, 0.81; 95% CI, 0.78-0.85). Being at risk for depression (vs not being at risk for depression) was associated with reduced odds of unhealthy tobacco use (aOR, 0.67; 95% CI, 0.46-0.97) and with a higher likelihood of unhealthy alcohol behavior (aOR, 1.58; 95% CI, 1.14-2.19). Women with a college education (vs a primary school education) less frequently reported an unhealthy PA behavior (aOR, 0.61; 95% CI, 0.51-0.73) and were more likely to report unhealthy alcohol behavior (aOR, 1.85; 95% CI, 1.37-2.49). Receipt of chemotherapy (vs not receiving chemotherapy) was associated with higher odds of gaining weight (aOR, 1.51; 95% CI, 1.23-1.87) among those who were overweight or obese at diagnosis. CONCLUSIONS The majority of women were adherent to healthy lifestyle behaviors at the time of their breast cancer diagnosis, but a significant subset was nonadherent. Unhealthy behaviors tended to persist after the breast cancer diagnosis, having varying clinical, psychological, sociodemographic, and treatment-related determinants. This study will inform more targeted interventions to promote optimal health.
Collapse
Affiliation(s)
- Antonio Di Meglio
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Arnauld S Gbenou
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Elise Martin
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | | | | | - Jean-Daniel Flaysakier
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Etienne Minvielle
- Division of Interdisciplinary Patient Care Pathways (DIOPP), Gustave Roussy, Villejuif, France.,I3-CRG, Ecole polytechnique-CNRS, Palaiseau, France
| | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de l'Ouest-Paul Papin, Angers, France
| | | | | | | | | | | | | | | | | | - Florence Dalenc
- Institut Claudius Regaud and Institut Universitaire du Cancer-Oncopole, Toulouse, France
| | | | | | - Fabrice Andre
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- INSERM Unit 981 - Molecular predictors and new targets in oncology, Gustave Roussy, Villejuif, France
| |
Collapse
|
47
|
Hequet D, Harrissart G, Krief D, Maumy L, Lerebours F, Menet E, Callens C, Rouzier R. Prosigna test in breast cancer: real-life experience. Breast Cancer Res Treat 2021; 188:141-147. [PMID: 33860387 DOI: 10.1007/s10549-021-06191-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/10/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Genomic tests can guide the decision to administer adjuvant chemotherapy in women with hormone receptor (HR)-positive, Human Epidermal growth Factor 2 (HER2)-negative breast cancer (BC) at intermediate risk of recurrence. We assessed the decision-making and economic impact of the Prosigna test in a real-life setting. METHODS Retrospective cohort study of HR + , HER2- BC patients managed from 2016 to 2020, potential candidates for adjuvant chemotherapy, at intermediate risk of recurrence, in whom a Prosigna test was performed according to contemporary guidelines. The additional cost of chemotherapy over one year in terms of direct medical and non-medical costs was estimated in this study to be €9,737 (derived from a previous study, NCT02813317). The cost of the Prosigna test, as defined by the reimbursement system, was €1,849. RESULTS Among the 809 patients included in this study, 2.3 Prosigna tests had to be performed to avoid adjuvant chemotherapy for one patient. The number of tests that had to be performed to avoid chemotherapy for one patient was higher for patients with grade 3 tumors and pN1mic axillary node involvement and lower for grade 1 tumors or in the absence of axillary node involvement (pN0), but did not vary according to the 10-year overall survival gain predicted by the Predict online test. The cost saving related to withholding of adjuvant chemotherapy for one patient on the basis of the Prosigna test results was €5,485. CONCLUSION We present one of the largest cohorts of HR + , HER2- BC patients at intermediate risk of recurrence, in whom a Prosigna test was used to guide the adjuvant therapy decision in a real-life setting, resulting in a 44% decrease in the indication for chemotherapy.
Collapse
Affiliation(s)
- D Hequet
- Department of Surgical Oncology, Institut Curie, St Cloud, France.
- INSERM U900, Institut Curie, St Cloud, France.
| | - G Harrissart
- Department of Surgical Oncology, Institut Curie, St Cloud, France
| | - D Krief
- Department of Surgical Oncology, Institut Curie, St Cloud, France
| | - L Maumy
- Department of Surgical Oncology, Institut Curie, St Cloud, France
| | - F Lerebours
- Department of Medical Oncology, Institut Curie, St Cloud, France
| | - E Menet
- Department of Pathology, Institut Curie, St Cloud, France
| | - C Callens
- Pharmacogenomics Unit, Department of Genetics, Institut Curie, Paris, France
| | - R Rouzier
- Department of Surgical Oncology, Institut Curie, St Cloud, France
- INSERM U900, Institut Curie, St Cloud, France
| |
Collapse
|
48
|
Saleh K, Carton M, Dieras V, Heudel PE, Brain E, D'Hondt V, Mailliez A, Patsouris A, Mouret-Reynier MA, Goncalves A, Ferrero JM, Petit T, Emile G, Uwer L, Debled M, Dalenc F, Jouannaud C, Ladoire S, Leheurteur M, Cottu P, Veron L, Savignoni A, Courtinard C, Robain M, Delaloge S, Deluche E. Impact of body mass index on overall survival in patients with metastatic breast cancer. Breast 2020; 55:16-24. [PMID: 33307392 PMCID: PMC7725947 DOI: 10.1016/j.breast.2020.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High Body mass index (BMI) is a risk factor for breast cancer among postmenopausal women and an adverse prognostic factor in early-stage. Little is known about its impact on clinical outcomes in patients with metastatic breast cancer (MBC). METHODS The National ESME-MBC observational cohort includes all consecutive patients newly diagnosed with MBC between Jan 2008 and Dec 2016 in the 18 French comprehensive cancer centers. RESULTS Of 22 463 patients in ESME-MBC, 12 999 women had BMI data available at MBC diagnosis. Median BMI was 24.9 kg/m2 (range 12.1-66.5); 20% of women were obese and 5% underweight. Obesity was associated with more de novo MBC, while underweight patients had more aggressive cancer features. Median overall survival (OS) of the BMI cohort was 47.4 months (95% CI [46.2-48.5]) (median follow-up: 48.6 months). Underweight was independently associated with a worse OS (median OS 33 months; HR 1.14, 95%CI, 1.02-1.27) and first line progression-free survival (HR, 1.11; 95%CI, 1.01; 1.22), while overweight or obesity had no effect. CONCLUSION Overweight and obesity are not associated with poorer outcomes in women with metastatic disease, while underweight appears as an independent adverse prognostic factor.
Collapse
Affiliation(s)
- Khalil Saleh
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, INSERM U1194, University of Montpellier, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, 49055, Angers, France
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, 67000, Strasbourg, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de L'Argonne, F-33000, Bordeaux, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, 51100, Reims, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, 1 Rue Professeur Marion, 21079, Dijon, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, 76000, Rouen, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Lucie Veron
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Alexia Savignoni
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France; Department of Medical Oncology, CHU de Limoges, 2 Avenue Martin Luther King, Limoges, France
| |
Collapse
|
49
|
Cottu P, Coudert B, Perol D, Doly A, Manson J, Aujoulat O, Barletta H, Chalabi N, Samelson L, Pivot X. Evolution in the real-world therapeutic strategies in more than 20,000 women with breast cancer having received human epidermal growth factor receptor 2–targeted treatments: Results from the french personalized reimbursement model database (2011–2018). Eur J Cancer 2020; 141:209-217. [DOI: 10.1016/j.ejca.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
|
50
|
Martin E, Zingarello A, Di Meglio A, Baciarello G, Matias M, Charles C, Arvis J, Dumas A, Menvielle G, Vaz-Luis I. A qualitative evaluation of the use of interventions to treat fatigue among cancer survivors: A healthcare provider's view. Eur J Cancer Care (Engl) 2020; 30:e13370. [PMID: 33191520 DOI: 10.1111/ecc.13370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is among the most common and distressing side effects of cancer treatment. Different types of interventions, including physical activity (PA), psychosocial and mind-body interventions, have been shown to reduce CRF. We aimed to explore HCPs' practices and barriers to refer patients towards interventions to reduce CRF. METHODS We performed a qualitative study using key informant interviews among a sample of 20 HCPs including medical, surgical and radiation oncologists, pain specialists, nurses, psychologists, psychiatrists and physiotherapists recruited from breast, prostate and colorectal cancer disease groups from a comprehensive cancer centre. RESULTS Most interviewees reported not to address CRF spontaneously during consultations. When the topic of CRF was brought up by patients, all interviewees acknowledged to recommend PA, whereas few would recommend psychosocial or mind-body interventions. Barriers to recommend interventions to manage CRF included: lack of knowledge about CRF and its treatment, lack of time and complexity of the referral due to their accessibility and cost. CONCLUSION In a diverse sample of HCPs, most acknowledged not to address CRF proactively with their patients, but identified several actionable barriers. Specific training on screening and management of CRF and improving the referral network dedicated to interventions need to be implemented.
Collapse
Affiliation(s)
- Elise Martin
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Anna Zingarello
- Hôpital Saint-Camille, Unité de Soins Médicaux en Oncologie (USMO), Bry-sur-Marne, France
| | - Antonio Di Meglio
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Giulia Baciarello
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Margarida Matias
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Cécile Charles
- Psycho-Oncology Unit, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Dumas
- Inserm Unit 1123, Unité ECEVE, Université de Paris, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Paris, France
| | - Ines Vaz-Luis
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France.,Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| |
Collapse
|