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Appelgren M, Wengström Y, de Boniface J, Sackey H. 'Balancing Challenges and Personal Resources': A Qualitative Study of Women's Experiences of Arm Impairment After Axillary Surgery for Breast Cancer. J Adv Nurs 2025; 81:3156-3165. [PMID: 39373540 PMCID: PMC12080084 DOI: 10.1111/jan.16517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/27/2024] [Accepted: 09/23/2024] [Indexed: 10/08/2024]
Abstract
AIM To explore how women previously treated for breast cancer experience living with arm impairment after axillary surgery. DESIGN Descriptive qualitative study. The inductive starting point for the analysis was followed by a deductive approach as the categories were related to the components of the sense of coherence framework. METHODS Twenty-eight relapse-free Swedish-speaking females participated in six focus group discussions conducted between September and December 2022. All participants had undergone sentinel lymph node biopsy with or without completion axillary dissection 4 years earlier. Data were analysed using qualitative content analysis. RESULTS Three categories and an overall theme were identified. The categories 'Sense-making', 'Daily life' and 'Driving force' reflect actions to understand and prevent arm symptoms, adaptations made in daily life and the empowering resources adopted to meet challenges. The overall theme, 'Balancing challenges and personal resources', comprised a process that began at diagnosis and remained ongoing for some participants. Most participants considered their new life situations manageable. However, those with more pronounced arm impairment reported that they did not always receive adequate aid, and that their daily lives were negatively affected. CONCLUSION Returning to everyday life after axillary surgery for breast cancer is associated with varying degrees of challenges. Individuals with persistent arm impairment find returning to normal life more challenging. Therefore, further improvements in person-centred care are of utmost importance. PATIENT AND PUBLIC CONTRIBUTION Members of the Swedish Breast Cancer Association were involved in the creation of the interview guide. IMPACT This study emphasises the requirement for providing further individualised support to those living with more severe arm impairment after axillary surgery. REPORTING METHOD This study was reported in accordance with the Standards for Reporting Qualitative Research.
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Affiliation(s)
- Matilda Appelgren
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of SurgeryCapio St Göran's HospitalStockholmSweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of NursingKarolinska InstitutetStockholmSweden
- Karolinska Comprehensive Cancer CenterKarolinska University HospitalStockholmSweden
- Department of Breast, Endocrine Tumors and SarcomaKarolinska University HospitalStockholmSweden
| | - Jana de Boniface
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of SurgeryCapio St Göran's HospitalStockholmSweden
| | - Helena Sackey
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Karolinska Comprehensive Cancer CenterKarolinska University HospitalStockholmSweden
- Department of Breast, Endocrine Tumors and SarcomaKarolinska University HospitalStockholmSweden
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Yang B, Sun Z, Ouyang Q, Tong Z, Wang S, Li H, Niu Z, Chen Y, Ma LX, Wang H, Tang M, Hu Z, Gao X, Wang X, Xie F, Cheng Q, Shen Y, Geng C, Wang H, Wu J. Safety and quality of life of CDK4/6 inhibitors therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: a multicenter cross-sectional survey in China. BMC Cancer 2025; 25:951. [PMID: 40426093 DOI: 10.1186/s12885-025-14223-8] [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] [Received: 11/08/2024] [Accepted: 04/24/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND To investigate the treatment pattern, adverse events, and quality of life of Chinese patients treated with CDK4/6 inhibitors (CDK4/6i) for hormone receptor (HR)+/HER2- advanced breast cancer. METHODS This multicenter cross-sectional survey enrolled patients with HR+/HER2- advanced breast cancer currently treated with CDK4/6i. The patients reported adverse events and quality of life during CDK4/6i treatment with a questionnaire and EORTC QLQ-BR23. Meanwhile, the oncologists collected the treatment information, adverse events and patient characteristics from medical record. RESULTS The analysis included 1254 patients. Most patients received only one CDK4/6i, of which 38.92% received dalpiciclib, 35.81% received abemaciclib, 15.07% received palbociclib, and 0.47% received ribociclib, while 9.73% patients were treated with two CDK4/6i sequentially. The oncologists reported adverse events occurred in > 81.17% of patients, and most common AEs were leukopenia (63.30%) and neutropenia (58.73%). The most common symptomatic adverse events reported by the patients were fatigue (34.13%), alopecia (14.02%) and weakness (11.30%). The incidence of alopecia in patients receiving dalpiciclib was lower than in those receiving palbociclib (8.81% vs. 16.40%, P < 0.001) and abemaciclib (8.81% vs. 19.82%, P = 0.027). Regard to quality of life, breast symptom scores were lower in the palbociclib group than in the abemaciclib group (3.84 ± 8.57 vs. 5.70 ± 9.81, P = 0.047). Patient reported alopecia was associated with body image, systemic therapy side effects, breast symptoms, arm symptoms, and upset by hair loss (all P < 0.001). CONCLUSIONS The safety profile of different CDK4/6i varies and has different impacts on patients' quality of life, which needs more attention in clinical practice.
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Affiliation(s)
- Benlong Yang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Xuhui District, Shanghai, China
| | - Zhengkui Sun
- Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Nanchang, Jiangxi, China
| | - Quchang Ouyang
- Department of Breast Cancer Medical Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Zhongsheng Tong
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Shu Wang
- Peking University People's Hospital, Beijing, China
| | - Hongyuan Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaofeng Niu
- Yuncheng Women and Children Health Care Family Planning Service Center (Yuncheng Maternal and Child Health Hospital, Yuncheng Children's Hospital), Yuncheng, Shanxi, China
| | - Yiding Chen
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lin-Xiaoxi Ma
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Xuhui District, Shanghai, China
| | - Haoqi Wang
- Breast Center, Fourth Hospital of Hebei Medical University, No. 169 Tianshan Street, East Development Zone, Shijiazhuang, Hebei, China
| | - Mu Tang
- Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Nanchang, Jiangxi, China
| | - Zheyu Hu
- Department of Breast Cancer Medical Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Xueqiang Gao
- The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Laoshan District, Qingdao, Shandong, China
| | - Xu Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Fei Xie
- Peking University People's Hospital, Beijing, China
| | - Qiao Cheng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Shen
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Cuizhi Geng
- Breast Center, Fourth Hospital of Hebei Medical University, No. 169 Tianshan Street, East Development Zone, Shijiazhuang, Hebei, China.
| | - Haibo Wang
- The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Laoshan District, Qingdao, Shandong, China.
| | - Jiong Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'an Road, Xuhui District, Shanghai, China.
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Vaca-Cartagena BF, Mesa-Chavez F, Guajardo ASF, Azim HA, Rotolo F, Platas A, Fonseca A, Cruz-Ramos M, Rodriguez A, Mohar A, Villarreal-Garza C. Evaluating changes in the breast cancer-related quality of life of young women with breast cancer: long-term results from a multicenter prospective cohort. Ther Adv Med Oncol 2025; 17:17588359251337493. [PMID: 40386468 PMCID: PMC12084701 DOI: 10.1177/17588359251337493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 04/08/2025] [Indexed: 05/20/2025] Open
Abstract
Background Young women with breast cancer (YWBC) typically undergo intensive treatment that negatively impacts their quality of life (QoL). However, limited information is available on how their QoL changes, as most research has focused on older patients. Objectives To assess changes in QoL among YWBC, identify the most affected QoL domains, and identify the factors associated with these changes. Design Joven & Fuerte is a multicenter cohort of women aged ⩽40 in Mexico with newly diagnosed BC from 2014 to 2020. Methods Participants completed the European Organization for Research and Treatment of Cancer Breast Cancer module QLQ-BR23 questionnaire at five different time points from enrollment until year 5 postdiagnosis. Clinical and treatment data were also collected. Group-based multivariate trajectory modeling was used to analyze longitudinal changes across QoL domains and classify patients into appropriate groups. Logistic models were then employed to identify associations between variables and group classification. Results A total of 477 women (median age: 36 years; interquartile range 32-38) were included. Most had public health insurance (87%) and were diagnosed with stage II (49%) or III (39%) BC. Two trajectory groups, namely, "good" and "poor," were identified based on QLQ-BR23 scores. Most patients (n = 294, 62%) were in the poor group. In the good group, sexual enjoyment scores remained stable from baseline to year 5 (51.4), whereas those in the poor group decreased (51.0-37.3). Distress related to hair loss over time declined, with scores decreasing from 36.3 to 27.0 in the good trajectory group and from 43.4 to 31.2 in the poor trajectory group. For future perspective, the good group improved from 56.4 to 79.0, while the poor group increased from 39.3 to 57.2. Patients with human epidermal growth factor receptor 2-positive BC (adjusted odds ratio (aOR) = 0.57, 95% confidence interval (CI) 0.35-0.94, p = 0.028) and those with public health insurance (aOR = 0.41, 95% CI 0.16-0.90, p = 0.035) were less likely to belong to the poor trajectory group. Conclusion A high proportion of YWBC experience a poor QoL trajectory over time, particularly in areas related to sexual health, future perspective, and hair loss.
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Affiliation(s)
- Bryan F. Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Fernanda Mesa-Chavez
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico
| | | | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico
| | | | - Alejandra Platas
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Ciudad de México, Mexico
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama, Ciudad de México, Mexico
| | - Alan Fonseca
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Ciudad de México, Mexico
| | - Marlid Cruz-Ramos
- Investigadora por México del Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT), Instituto Nacional de Cancerologia, Ciudad de México, Mexico
| | - Ana Rodriguez
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama, Ciudad de México, Mexico
| | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología e Instituto de Investigaciones Biomédicas, UNAM, Ciudad de México, Mexico
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Batallón de San Patricio 112, Real San Agustín, 66260 San Pedro Garza García, Mexico
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama, Ciudad de México, Mexico
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Mac A, Kalia M, Reel E, Amir E, Isenberg A, Kim RH, Kennedy E, Koch CA, Li M, McCready D, Metcalfe K, Okrainec A, Papadakos J, Rotstein S, Rodin G, Xu W, Zhong T, Cil TD. At-home Breast Oncology care Delivered with EHealth solutions (ABODE) study protocol: a randomised controlled trial. BMJ Open 2025; 15:e091579. [PMID: 40345693 PMCID: PMC12067776 DOI: 10.1136/bmjopen-2024-091579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 04/17/2025] [Indexed: 05/11/2025] Open
Abstract
INTRODUCTION The COVID-19 pandemic disrupted healthcare delivery for patients with breast cancer. eHealth solutions enable remote care and may improve patient activation, which is defined as having the knowledge, skills and confidence to manage one's health. Thus, we developed the Breast Cancer Treatment Application (app) for patients and practitioners to use throughout the cancer care continuum. The app facilitates virtual assistance, delivers educational resources, collects patient-reported outcome measures and provides individualised support via volunteer e-coaches. Among newly diagnosed patients with breast cancer, we will compare changes in patient activation, other patient-reported outcomes and health service outcomes over 1 year between those using the app and Fitbit, and those receiving standard care and Fitbit only. METHODS AND ANALYSIS This randomised controlled trial will include 200 patients with breast cancer seen at a tertiary care cancer centre in Ontario, Canada. The intervention group (n=100) will use the app in addition to standard care and Fitbit for 13 months following diagnosis. The control group (n=100) will receive standard care and Fitbit only. Patients will complete questionnaires at enrolment, 6 and 12 months post-diagnosis to measure patient activation (Patient Activation Measure-13 score), distress, anxiety, quality of life and experiences with their care and information received. All patients will also receive Fitbits to measure activity and heart rate. We will also measure wait times and number of visits to ambulatory care services to understand the impact of the app on the use of in-person services. ETHICS AND DISSEMINATION Ethics approval was obtained on 6 January 2023. Protocol version 2.0 was approved on 6 January 2023. The trial is registered with ClinicalTrials.gov. Study findings will be disseminated via publication in a peer-reviewed journal and shared with participants, patient programmes and cancer awareness groups. The app has also been approved as a secure communication method at our trial institution, thus we are well-positioned to support future integration of the app into standard care through collaboration with our hospital network. TRIAL REGISTRATION NUMBER NCT05989477.
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Affiliation(s)
- Amanda Mac
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohini Kalia
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Emma Reel
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | | | - Raymond H Kim
- Medical Genetics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Erin Kennedy
- Division of General Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - C Anne Koch
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David McCready
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Kelly Metcalfe
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Allan Okrainec
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Institute for Education Research, University Health Network, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Rotstein
- Department of Nursing, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Wei Xu
- Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Tulin D Cil
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
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Wilson OWA, Wojcik KM, Jayasekera J, Rogers LQ, Demark-Wahnefried W, Farrell D, Butera G, Matthews CE, Street RL. Exercise Communication for Breast Cancer Survivors: A Systematic Scoping Review. JAMA Netw Open 2025; 8:e258862. [PMID: 40377942 DOI: 10.1001/jamanetworkopen.2025.8862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2025] Open
Abstract
Importance Exercise may offer various clinical benefits to breast cancer survivors. However, exercise participation among survivors is low. Discussions about exercise can increase participation, but details regarding implementation of exercise communication for breast cancer survivors are unclear. Objective To examine the development and implementation of explicitly reported exercise communication for breast cancer survivors. Evidence Review The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews was used. Six databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Communication and Mass Media Complete, and PsycINFO) were searched for articles describing exercise communication for female breast cancer survivors in any geographical location or setting published up to April 2024. Information about study and participant characteristics, exercise communication, and intervention components and effects were extracted. Findings Thirty-nine studies were included. Information consistent with exercise guidelines was communicated in 32 studies for aerobic exercise (82.1%) and 7 studies for muscle-strengthening exercise (17.9%). More studies communicated information about exercise benefits (20 [51.3%]) compared with exercise safety (3 [7.7%]). Studies included breast cancer survivors who were predominantly White (median [range], 85.5% [47.4%-98.7%]). Most included breast cancer survivors were educated (median percentage, 50.7% were college graduates) and had completed primary treatment (eg, median percentage, 66.7% had completed chemotherapy). Seventeen individualized (ie, tailored) information based on demographic or clinical characteristics (43.6%), and 5 considered contextual factors, such as the environment (12.8%). Most interventions reported an increase in exercise (19 of 21 [90.4%]). Heterogeneity in intervention design (eg, dietary advice or exercise trackers in addition to exercise information) and evaluation (eg, intervention length and outcomes) prevented quantitative synthesis of intervention effects. Conclusions and Relevance In this systematic scoping review of exercise communication for breast cancer survivors, interventions including exercise communication appeared to show a favorable effect. However, data were limited about the development and implementation of these interventions among underrepresented breast cancer survivors. Interest in research involving exercise communication for breast cancer survivors in clinical settings remains strong.
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Affiliation(s)
- Oliver W A Wilson
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Laura Q Rogers
- Division of Preventive Medicine, Department of Medicine at University of Alabama at Birmingham
| | | | | | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, Maryland
| | - Charles E Matthews
- Metabolic Epidemiology Branch at the National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard L Street
- Department of Communication and Journalism at Texas A & M University, College Station
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Fasching PA, Slamon D, Nowecki Z, Kukielka-Budny B, Stroyakovskiy D, Yardley DA, Huang CS, Chan A, Chia S, Martín M, Rugo HS, Loi S, Hurvitz S, Untch M, Afenjar K, Fresco R, Danyliv A, Ferrusi I, Li Z, Hortobagyi G. Health-Related Quality of Life in Patients with HR+/HER2- Early Breast Cancer Treated with Ribociclib Plus a Nonsteroidal Aromatase Inhibitor: Results from the NATALEE Trial. Clin Cancer Res 2025; 31:1625-1635. [PMID: 40019493 PMCID: PMC12010963 DOI: 10.1158/1078-0432.ccr-24-1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 10/29/2024] [Accepted: 02/26/2025] [Indexed: 03/01/2025]
Abstract
PURPOSE The phase III NATALEE trial reported a statistically significant invasive disease-free survival benefit with ribociclib plus nonsteroidal aromatase inhibitor (NSAI) versus an NSAI alone in stage II/III hormone receptor-positive, HER2-negative (HR+/HER2-) early breast cancer. In this study, we report health-related quality of life (HRQOL) data from NATALEE. PATIENTS AND METHODS Patients were randomized to receive ribociclib plus NSAI or NSAI alone. Patient-reported outcome scores [European Organisation for Research and Treatment of Cancer core quality of life questionnaire global health status and physical, social, and emotional functioning domains; the supplementary European Organisation for Research and Treatment of Cancer breast cancer-specific QOL questionnaire breast symptoms scale; health on a visual analog scale of the generic EuroQOL 5-level instrument; and the Hospital Anxiety and Depression Scale] were assessed. The prespecified primary HRQOL endpoint was physical functioning. Mean scores and time-categorical and prespecified linear-time repeated-measure models were used to evaluate HRQOL changes during treatment. RESULTS HRQOL was evaluated in all patients in the ribociclib plus NSAI (n = 2,549) and NSAI alone (n = 2,552) arms. Compliance was high in both arms (≈93%-97%). Mean scores did not differ meaningfully from baseline for any analyzed domain. Likewise, neither a meaningful change from baseline (in either treatment arm) nor a difference between arms was observed during treatment in the time-categorical, model-adjusted mean scores for any HRQOL domains-using published thresholds for interpreting longitudinal and between-group differences, with all values being within 0.5 SD of their baseline values. Linear-time regression analysis confirmed these findings. CONCLUSIONS These analyses of NATALEE show that adding adjuvant ribociclib to an NSAI does not negatively affect HRQOL in patients with HR+/HER2- early breast cancer.
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Affiliation(s)
- Peter A. Fasching
- University Hospital Erlangen Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Dennis Slamon
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Daniil Stroyakovskiy
- Moscow City Oncology Hospital No. 62 of Moscow Healthcare Department, Moscow Oblast, Russia
| | | | - Chiun-Sheng Huang
- National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Arlene Chan
- Breast Cancer Research Centre Western Australia and School of Medicine, Curtin University, Perth, Australia
| | - Stephen Chia
- British Columbia Cancer Agency, Vancouver, Canada
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañon, Centro de Investigación Biomédica en Red de Cáncer, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid, Spain
| | - Hope S. Rugo
- UCSF Comprehensive Cancer Center, San Francisco, California
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sara Hurvitz
- Los Angeles Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Michael Untch
- Interdisciplinary Breast Cancer Center, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Karen Afenjar
- TRIO - Translational Research in Oncology, Paris, France
| | - Rodrigo Fresco
- TRIO - Translational Research in Oncology, Montevideo, Uruguay
| | | | - Ilia Ferrusi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Zheng Li
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Gabriel Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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7
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Morgan JL, Shrestha A, Martin C, Walters S, Bradburn M, Reed M, Robinson TG, Cheung KL, Audisio R, Gath J, Revell D, Green T, Ring A, Lifford KJ, Brain K, Edwards A, Wyld L. Preferences for quality of life versus length of life in older women deciding about treatment for early breast cancer: A cross-sectional sub-analysis of the Bridging the Age Gap study. J Geriatr Oncol 2025; 16:102226. [PMID: 40138983 DOI: 10.1016/j.jgo.2025.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 02/22/2025] [Accepted: 03/17/2025] [Indexed: 03/29/2025]
Abstract
INTRODUCTION Prioritising quality of life (QoL) or length of life is often necessary in the decision-making process for cancer care. This may be complicated in patients with limited life expectancy due to age and comorbidities. Older women with early breast cancer often receive non-standard care (primary endocrine therapy [PET] or omission of chemotherapy or radiotherapy) to reduce treatment morbidity and maintain QoL. We aimed to determine the perceived relative influence of QoL versus length of life in treatment decision making by older women with early (potentially curable) breast cancer. MATERIALS AND METHODS This was a sub-study of the Age Gap multi-centre, cohort study, which prospectively recruited women >70 yrs. with early breast cancer. Baseline demographics, health characteristics, and QoL scores were analysed alongside a bespoke questionnaire to assess QoL and length of life preferences, including a modified version of the validated quality/quantity questionnaire, in a subset of the main study. RESULTS The questionnaire was sent to 308 patients and 194 (63 %) were returned by participants with a median age of 75 years (range 70-93). Of these, 14 had PET and 180 had standard treatment (ST) (surgery +/- adjuvant therapy) including 37 who had chemotherapy. The PET group was older (median age 83.5 versus 76 years) and in poorer health (9/14; 64.3 % patients had one or more comorbidities versus 69/144; 47.9 %) with inferior baseline physical domain QoL scores. Patients who received PET valued QoL and length of life equally (Q score 0.87, L score 0.91), and patients who received chemotherapy favoured length of life over QoL (Q score 0.67, L score 0.86). Subgroup analysis showed a small correlation between increasing age and QoL preferences (Spearman's r = 0.2, P < 0.009). There was no correlation between co-morbidities, frailty, or global QoL and length of life/QoL preferences. DISCUSSION Older women with early breast cancer valued length of life and QoL highly, with an association between preference for QoL and less aggressive treatment choices. Relative QoL preference increased with advancing age. More research is needed to define QoL determinants and outcomes following treatment to help patients make decisions that reflect their priorities. TRIAL REGISTRATION NUMBER ISRCTN: 46099296.
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Affiliation(s)
- Jenna L Morgan
- Division of Clinical Medicine, Faculty of Health, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
| | - Anne Shrestha
- Division of Clinical Medicine, Faculty of Health, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Charlene Martin
- Division of Clinical Medicine, Faculty of Health, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Riccardo Audisio
- Department of Surgery, University of Gothenburg, Sahlgrenska, Universitetssjukhuset, 41345 Göteborg, Sweden
| | - Jacqui Gath
- North Trent Cancer Network Consumer Research Panel, UK
| | | | - Tracy Green
- North Trent Cancer Network Consumer Research Panel, UK
| | - Alistair Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kate J Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Katherine Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Lynda Wyld
- Division of Clinical Medicine, Faculty of Health, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
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8
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Wintraecken VM, van Roozendaal LM, Simons JM, de Vries J, van Kuijk SMJ, Vane MLG, van Dalen T, Sackey H, van der Hage JA, Strobbe LJA, Linn SC, Lobbes MBI, Poortmans PMP, Tjan-Heijnen VCG, van de Vijver KKBT, Westenberg HH, Dirksen CD, de Wilt JHW, Boersma LJ, Smidt ML. Three-year patient-reported outcomes of the BOOG 2013-08 RCT evaluating omission of sentinel lymph node biopsy in early-stage breast cancer patients treated with breast conserving surgery: Impact of personality traits on health-related quality of life. Br J Surg 2025; 112:znaf031. [PMID: 40365927 PMCID: PMC12076147 DOI: 10.1093/bjs/znaf031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 11/04/2024] [Accepted: 01/15/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND The non-inferiority randomized controlled trial BOOG 2013-08 investigates the oncological safety and impact on health-related quality of life (HRQoL) of sentinel lymph node biopsy (SNLB) omission in cT1-2 N0 breast cancer. The primary aim of the present study was to compare patient-reported arm function and HRQoL up to 3 years after study inclusion in cT1-2 N0 patients with breast cancer undergoing breast-conserving surgery (BCS) with or without SLNB. The secondary aim was to explore the association between personality traits 'trait anxiety' and 'neuroticism', and perceived arm function and HRQoL. METHODS A total of 1733 women with unilateral cT1-2 N0 invasive breast cancer treated with BCS with or without SLNB were included. The primary outcomes of arm function (assessed using the Lymphoedema Functioning, Disability, and Health Questionnaire) and HRQoL (assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR-23 questionnaires) were analysed. RESULTS Analyses included 821 patients (383 with SLNB and 438 without SLNB). Those in the SLNB group experienced a slight, temporary decline in arm function (P < 0.025) and reported more HRQoL arm and breast symptoms (P < 0.049). High trait anxiety or neuroticism was associated with significant poorer arm function and lower HRQoL. CONCLUSION SLNB slightly reduced arm function, temporarily affecting HRQoL arm and breast symptoms. Neuroticism significantly negatively impacted arm function and HRQoL. Measuring and stratifying for personality traits is crucial for interpreting patient-reported outcomes and to identify patients needing additional support after surgery. REGISTRATION NUMBER NCT02271828 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Veerle M Wintraecken
- GROW—Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lori M van Roozendaal
- Department of Surgical Oncology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Janine M Simons
- GROW—Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Board member Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marissa L G Vane
- GROW—Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Thijs van Dalen
- Division of Surgical Oncology, Diakonessenhuis Hospital, Utrecht, The Netherlands
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Helena Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast- Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Jos A van der Hage
- Division of Surgical Oncology, Leids University Medical Centre, Leiden, The Netherlands
| | - Luc J A Strobbe
- Division of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Sabine C Linn
- Division of Medical Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Philip M P Poortmans
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vivianne C G Tjan-Heijnen
- GROW—Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Koen K B T van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Centre for Gynaecological Oncology Amsterdam (CGOA), Department of Gynaecology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Helen H Westenberg
- Radiation Oncology, Radiotherapiegroep location Arnhem, Arnhem, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Johan H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW—Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marjolein L Smidt
- GROW—Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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9
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van Vliet C, Tetar S, van den Bongard HJGD, Fraikin T, Jeulink M, Palacios MA, van den Tol MP, Slotman BJ, Bruynzeel AME. Partial breast radiotherapy in low-risk breast cancer using a MRI-guided adaptive approach; results of the phase II PARLOB study. Pract Radiat Oncol 2025:S1879-8500(25)00098-0. [PMID: 40280483 DOI: 10.1016/j.prro.2025.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 03/05/2025] [Accepted: 03/24/2025] [Indexed: 04/29/2025]
Abstract
PURPOSE The majority of breast cancer patients are treated with breast-conserving surgery followed by postoperative whole (WBI) or partial breast irradiation (PBI). Previous studies on PBI demonstrated similar ipsilateral breast tumor recurrences (IBTR) compared to WBI, however conflicting data on toxicity and cosmetic outcomes were reported. This study investigates the feasibility of stereotactic MRI-guided adaptive radiotherapy (SMART) for PBI, with emphasis on toxicity and cosmetic outcomes. METHODS AND MATERIALS Patients with low-risk breast cancer suitable for PBI as defined by ESTRO guidelines were included. SMART was delivered in supine position in a two-week course of 5 fractions of 6 Gy, or 6.5 Gy in case of high risk characteristics. Patient- and physician-reported toxicity and cosmetic outcomes were scored at 3, 9, 18 and 36 months postoperatively. RESULTS Between 2017-2020, 50 patients were included and 45 patients were treated with SMART. Median age was 66 years, median tumor size was 1.2 cm. Most tumors were Bloom Richardson Grade 1 (55.6%) and estrogen receptor positive (95.6%). The majority did not receive adjuvant systemic therapy (80%). The highest grade acute toxicity was grade 2 in 20%, mostly fatigue. At 18 months, four patients (9%) reported grade 2 toxicity, consisting of fibrosis and fatigue. No grade 3 or higher toxicity was recorded. At 9 and 18 months, 86.4% of patients were (very) satisfied with the cosmetic outcome. The cosmetic outcome was good-excellent compared to the contralateral breast at 18 months in 90.9% and 73.8% as scored by patients and physicians, respectively. CONCLUSION Stereotactic MRI-guided adaptive PBI for patients with low-risk breast cancer was feasible and resulted in low rates of toxicity. Good cosmetic outcomes were reported by patients after a follow-up of 18 months.
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Affiliation(s)
- C van Vliet
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands.
| | - S Tetar
- Department of Radiation Oncology, Catharinaziekenhuis, Eindhoven, Netherlands
| | - H J G D van den Bongard
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - T Fraikin
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - M Jeulink
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - M A Palacios
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - M P van den Tol
- Department of Surgery, Medisch centrum Leeuwarden, Leeuwarden, Netherlands
| | - B J Slotman
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - A M E Bruynzeel
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
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10
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Pang Y, He H, Ng RP, Lee NKL, Htein MMW, Zhao XX, Li YH, Chan EJ, Zhu L, Liu GY, Pikkarainen M, Lim SH. Effectiveness of an Innovative Mobile-Based Perioperative Care Program for Women Undergoing Breast Cancer Surgery (iCareBreast): Randomized Controlled Trial. J Med Internet Res 2025; 27:e71684. [PMID: 40258266 PMCID: PMC12053255 DOI: 10.2196/71684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 02/21/2025] [Accepted: 03/07/2025] [Indexed: 04/23/2025] Open
Abstract
BACKGROUND Breast cancer is one of the most prevalent cancers among women and significantly impacts psychological well-being and health-related quality of life (HR-QoL) during the perioperative period. Mobile health interventions offer a promising approach to providing education and psychosocial support, yet their effectiveness in this context remains underexplored. OBJECTIVE This study aimed to develop and evaluate the effectiveness of an innovative, mobile-based, perioperative care program for women undergoing breast cancer surgery (iCareBreast). The assessment focused on perioperative self-efficacy, anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. METHODS A two-group randomized control trial was conducted at a tertiary hospital in Singapore. The intervention group used the iCareBreast app, offering four main resources: perioperative care guidance, breast cancer and surgery education, psychological support, and social support. The control group received standard hospital care. Participants in the intervention group engaged with the fully automated app daily for 29 days (two weeks before surgery, on the day of surgery, and two weeks after surgery). Data were collected face-to-face or on the web at three time points: baseline, immediately after the intervention (T1; two weeks after surgery), and at a 2.5-month follow-up (T2; three months after surgery). The primary outcome was perioperative care self-efficacy, while secondary outcomes included anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. RESULTS A total of 123 patients with early-stage breast cancer scheduled for breast surgery were enrolled in the study, with 62 patients assigned to the iCareBreast group and 61 patients to the control group. The results showed no significant differences between the groups in the primary outcome-perioperative self-efficacy-at any time point. Baseline scores were similar (P=.80), and while the iCareBreast group showed slightly lower scores at T1 (mean difference [MD] -1.63, 95% CI -3.43 to 0.18; P=.08) and T2 (MD -1.90, 95% CI -4.06 to 0.26; P=.09), the differences were not statistically significant. Similarly, secondary outcomes, including anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction, showed no significant changes between groups (all P>.05). However, the iCareBreast group reported higher perioperative care satisfaction during the postintervention assessment. Satisfaction scores were comparable at T1 (P=.68), while at T2, the iCareBreast group showed a slight increase compared to the control group (MD 0.35, 95% CI 0.04-0.73; P=.08), though the difference was not statistically significant. CONCLUSIONS The mobile-based psychosocial intervention, although satisfied by users, did not demonstrate significant benefits compared to standard care. This highlights the need to refine the iCareBreast app in future iterations to enhance its effectiveness in addressing the targeted health outcomes. Future mobile health research should prioritize optimizing user engagement strategies and incorporating personalized approaches to better address the perioperative care needs of patients with breast cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT04172350; https://clinicaltrials.gov/study/NCT04172350.
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Affiliation(s)
- Yan Pang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Honggu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Ruey-Pyng Ng
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | - Xiao-Xin Zhao
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ying-Hong Li
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Lixia Zhu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Guang Yu Liu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Minna Pikkarainen
- Digitalization of Healthcare Services, Oslomet, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, University of Oulu, Oulu, Finland
| | - Swee-Ho Lim
- KK Women's and Children's Hospital, Singapore, Singapore
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11
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Jansen BAM, Bargon CA, Bouman MA, van der Molen DRM, Postma EL, van der Leij F, Zonnevylle E, Ruhe Q, Bruekers SE, Maarse W, Siesling S, Young-Afat DA, Doeksen A, Verkooijen HM. Patient-reported outcomes after immediate and delayed DIEP-flap breast reconstruction in the setting of post-mastectomy radiation therapy-results of the multicenter UMBRELLA breast cancer cohort. Breast Cancer Res Treat 2025; 210:759-769. [PMID: 39899162 PMCID: PMC11953195 DOI: 10.1007/s10549-025-07613-w] [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: 08/06/2024] [Accepted: 01/09/2025] [Indexed: 02/04/2025]
Abstract
PURPOSE Timing of Deep Inferior Epigastric artery Perforator (DIEP)-flap breast reconstruction in the context of post-mastectomy radiotherapy for breast cancer patients is topic of debate. We compared the impact of immediate (before radiotherapy) versus delayed (after radiotherapy) DIEP-flap breast reconstruction (IBR versus DBR) on short- and long-term patient-reported outcomes (PROs). METHODS Within the prospective, multicenter breast cancer cohort (UMBRELLA), we identified 88 women who underwent immediate or delayed DIEP-flap breast reconstruction and received PMRT. At 6 and 12 months post-mastectomy, as well as on long-term (≥ 12 months post-reconstruction) body image, breast symptoms, physical functioning, and pain were measured by EORTC-QLQ-30/BR23. Additionally, long-term evaluation included satisfaction with breast(s), physical well-being and self-reported adverse effects of radiation as measured by BREAST-Q, and late treatment toxicity. PROs were compared between groups using independent sample T-test. RESULTS IBR was performed in 56 patients (64%) and DBR in 32 patients (36%), with 15 months of median time to reconstruction. At 6 and 12 months post-mastectomy, better body image and physical functioning were observed after IBR. No statistically nor clinically relevant differences were observed in long-term EORTC and BREAST-Q outcomes (median follow-up 37-41 months for IBR vs. 42-46 months for DBR). Patients with IBR reported more fibrosis and movement restriction (median follow-up 29 vs. 61 months, resp.). CONCLUSION Long-term PROs were comparable for patients with IBR and DBR, despite more patient-reported fibrosis and movement restriction after IBR. Therefore, both treatment pathways can be considered when opting for autologous breast reconstruction in the setting of PMRT.
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Affiliation(s)
- Britt A M Jansen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands.
- Department of Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands.
| | - Claudia A Bargon
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
- Department of Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Maria A Bouman
- Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | | | - Emily L Postma
- Department of Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Erik Zonnevylle
- Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Quinten Ruhe
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Sven E Bruekers
- Department of Plastic Surgery, Diakonessenhuis, Zeist, The Netherlands
| | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
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12
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Menvielle G, Sandoval JL. [Increasing social inequalities in quality of life after early breast cancer]. Med Sci (Paris) 2025; 41:380-383. [PMID: 40294297 DOI: 10.1051/medsci/2025041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Abstract
Using data from the French CANTO cohort (n=5,915), we assessed the socioeconomic inequalities in quality of life after breast cancer and their time trends over two years after diagnosis. Socioeconomic position was measured using self-reported financial difficulties. Quality of life was assessed with the QLQ-C30 summary score. Social inequalities were quantified using the slope index of inequality (SII). Social inequalities in QLQ-C30 summary score at baseline were observed after adjustment for age at diagnosis, Charlson Comorbidity Index, disease stage, and treatment. These inequalities significantly increased in year 1 and year 2 postdiagnosis.
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Affiliation(s)
- Gwenn Menvielle
- Inserm U981 - Université Paris Saclay - Gustave Roussy, Paris
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13
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Bjelic-Radisic V, Cardoso F, Weis J, Pogoda K, Arraras JI, Greimel E, Bottomley A, Cameron D, Brain E, Hartup S, da Costa Vieira RA, Hoefnagels N, Huang CC, Shamieh O, Pinto M, Belay YB, Serpentini S, Bleiker E, Nookala Krishnamurthy M, Shimomura A, Sturm-Inwald EC, Getu MA, Bliem B, Astrup G, Morag O, Kikawa Y, Kuljanic K, Nevries N, Sprangers M, Aaronson NK, Sinai P, Tomaszewski K, Galalae R, Conroy T, Duhoux F, Chie WC, Velikova G. An international Phase IV field study - psychometric properties of the updated module on assessing quality of life of patients with breast cancer EORTC QLQ-BR42. Breast 2025; 80:103890. [PMID: 39947087 PMCID: PMC11867226 DOI: 10.1016/j.breast.2025.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 01/21/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND The EORTC QLQ-BR23, published in 1996, was one of the first disease-specific questionnaires to assess health-related quality of life (HRQoL) in patients with breast cancer (BC). In the last decades, major changes in BC treatment have occurred, requiring an update of this module. The results of the Phase 1-3 of the study were published in 2019. The aim of study was to examine the psychometric properties of the provisional EORTC-QLQ-BR45.questionnaire. METHODS Patients with a diagnosis of BC, age ≥18 years, and cognitive able to fill the questionnaire were included in the study and completed the provisional questionnaire during a visit at each participating centre. Psychometric analyses included the evaluation of the scale structure, internal consistency, test-retest reliability, convergent, discriminant, and clinical validity, and responsiveness to change. RESULTS Between May 2019 and September 2021, 576 patients from 22 centers (17 countries, 16 languages) were enrolled in the study. The psychometric analyses resulted in a final questionnaire containing 42 items divided into 10 scales: Breast Symptoms, Body Image, Sexual Functioning, Arm Symptoms, Systemic Chemotherapy Side Effects, Hand/Feet Symptoms/Neuropathy, Skeletal Symptoms, Endocrine Symptoms, Breast Satisfaction, Vaginal Symptoms, and 3 single items: Weight Gain, Sexual Enjoyment and Future Perspective. CONCLUSION The revised EORTC QLQ-BR42 questionnaire incorporates the EORTC-QLQ-BR23 original items, combined with 19 new items that address the new therapies developed over the past 20 years. This comprehensive module is a valid instrument to assess the HRQoL of BC patients and can be used in place of the BR23 in future trials.
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Affiliation(s)
| | - Fatima Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - Joachim Weis
- Comprehensive Cancer Center, Medical Faculty, University Medical Center Freiburg, Freiburg, Germany
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Elfriede Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | | | - David Cameron
- Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Sue Hartup
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - Nicolette Hoefnagels
- Tumor- and Breast Center of Eastern Switzerland, (TBZO, St. Gallen site), Switzerland
| | - Chi-Cheng Huang
- Taipei Veterans General Hospital, Comprehensive Breast Health Center and Division of Breast Surgery, Taipei, Taiwan; National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | - Omar Shamieh
- King Hussein Cancer Center, Department of Palliative Medicine, Amman, Jordan
| | - Monica Pinto
- Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Yared Belete Belay
- Mekelle University, School of Pharmacy, Mekelle, Ethiopia; School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - Samantha Serpentini
- Unit for Psychooncology, Veneto Institute of Oncology IOV e IRCCS, Padua, Italy
| | - Eveline Bleiker
- Netherlands Cancer Institute, Psychosocial Research and Epidemiology, Amsterdam, the Netherlands
| | - Manjunath Nookala Krishnamurthy
- Dept. of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Maharashtra, India
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Elisabeth C Sturm-Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | | | - Brigitte Bliem
- Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | - Guro Astrup
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Ofir Morag
- Cancer Pain Service, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Yuichiro Kikawa
- Kansai Medical University, Dept. of Breast Surgery, Osaka, Japan
| | - Karin Kuljanic
- Department of Obstetrics and Gynecology, Clinical Center Rijeka, Rijeka, Croatia
| | - Nora Nevries
- Breast Unit, Helios University Clinic Wuppertal, Germany
| | - Mirjam Sprangers
- Netherlands Cancer Institute, Psychosocial Research and Epidemiology, Amsterdam, the Netherlands
| | - Neil K Aaronson
- Netherlands Cancer Institute, Psychosocial Research and Epidemiology, Amsterdam, the Netherlands
| | - Parisa Sinai
- Southmead Hospital, University of Bristol, Bristol, UK
| | - Krzysztof Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | - Thierry Conroy
- Département d'oncologie médicale, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Francois Duhoux
- Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc (UCLouvain), Brussels, Belgium
| | - Wei-Chu Chie
- National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, St James's University Hospital, Leeds, UK
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14
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Özdemir H, Demir A, Bardakçı M, Uncu D. The effect of an interactive nurse support program developed with a mobile application on patient outcomes in breast cancer patients who received outpatient chemotherapy: A randomized controlled trial. Eur J Oncol Nurs 2025; 76:102882. [PMID: 40185060 DOI: 10.1016/j.ejon.2025.102882] [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: 02/04/2025] [Revised: 03/20/2025] [Accepted: 03/22/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE To determine the effect of the interactive nurse support program developed with a mobile application on patient outcomes (symptom management, quality of life, perception of social support, anxiety) in breast cancer patients who received outpatient chemotherapy. METHODS The randomized controlled study was conducted in the outpatient chemotherapy unit of a public hospital between 2021 and 2023. The study sample consisted of 100 breast cancer patients receiving anthracycline-cyclophoshamide chemotherapy. Patients in the control group received standard care, and patients in the intervention group were applied an interactive nurse support program developed with a mobile application throughout four chemotherapy cycles. Memorial Symptom Assessment Scale (MSAS), EORTC QLQ-C30, EORTC QLQ-BR23 Scales, Multidimensional Perceived Social Support Scale (MPSSS), Beck Anxiety Scale (BAS) were used in data collection. Data were collected five times, including before chemotherapy (t0) and at the end of the first week after each chemotherapy (t1, t2, t3, t4). RESULTS MSAS, BAS total scores, EORTC QLQ-C30 and EORTC QLQ-BR23 Scales "Symptom Dimension" scores of the patients in the intervention group were found to be significantly lower than the control group at t1, t2, t3, t4 (p˂0.05). EORTC QLQ-C30 Scale "General Well-Being", "Functional Status", EORTC QLQ-BR23 "Functional Status" scores, MPSSS total scores of the patients in the intervention group were found to be significantly higher than the control group at t1, t2, t3, t4 measurements (p˂0.05). CONCLUSIONS The interactive nurse support program developed with the mobile application is effective on patient outcomes in breast cancer patients who received outpatient chemotherapy. TRIAL REGISTRATION www. CLINICALTRIALS gov, NCT05739175.
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Affiliation(s)
- Handan Özdemir
- Ankara University Institute of Health Sciences, Department of Nursing, Ankara, Turkey.
| | - Ayten Demir
- Ankara University Faculty of Nursing, Department of Nursing, Ankara, Turkey
| | - Murat Bardakçı
- Ankara City Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Doğan Uncu
- Ankara City Hospital, Department of Medical Oncology, Ankara, Turkey
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15
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Ramírez-Parada K, Sánchez C, Cantarero-Villanueva I, Reyes Á, Pinto MP, Bravo ML, Montt-Blanchard D, Acevedo F, Walbaum B, Alfaro-Barra M, Barra-Navarro M, Muñoz-Flores S, Pinto C, Muñiz S, Contreras-Briceño F, Merino T, Merino G. Randomized Trial Assessing Prospective Surveillance and Exercise for Preventing Breast Cancer-Related Lymphedema in High-Risk Patients. Arch Phys Med Rehabil 2025:S0003-9993(25)00546-5. [PMID: 40081785 DOI: 10.1016/j.apmr.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/19/2024] [Accepted: 03/05/2025] [Indexed: 03/16/2025]
Abstract
OBJECTIVE To evaluate if combining a prospective surveillance model (PSM) with a supervised multimodal exercise program prevents breast cancer-related lymphedema (BCRL) and its effect on the functional capacity and quality of life (QoL) of high-risk breast cancer (BC) patients undergoing treatment. DESIGN Two-arm parallel superiority randomized controlled trial. SETTING Outpatient physical therapy service in a public hospital. PARTICIPANTS 116 adult women (N=116; age ≥18y) diagnosed with stage I-III BC were enrolled. Inclusion criteria included recent surgery and indication for adjuvant chemotherapy. Exclusion criteria were significant arm volume difference, previous cancer, exercise contraindications, and extreme body mass index values. INTERVENTIONS Participants were randomized into experimental (n=61) or control groups (n=55) in a 1:1 ratio. The experimental group received PSM with a supervised multimodal exercise program for 12 weeks. The control group received PSM alone. MAIN OUTCOME MEASURES Arm volume, grip strength, 6-minute walk test, and QoL were blindly assessed at baseline, 3, 6, and 9 months. RESULTS The combination of PSM with a supervised multimodal exercise program significantly reduced arm volume and body weight and improved grip strength, functional capacity, and the QoL of patients. CONCLUSIONS Combining PSM and physical exercise reduces arm volume, prevents BCRL, and improves physical performance and QoL in high-risk patients. The combination of PSM and STRONG-B was superior to PSM alone, validating the study's superiority design.
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Affiliation(s)
- Karol Ramírez-Parada
- Departamento de Kinesiología, Escuela Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro para la prevención y el control del cáncer, CECAN, Santiago, Chile.
| | - Cesar Sánchez
- Centro para la prevención y el control del cáncer, CECAN, Santiago, Chile; Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain
| | - Álvaro Reyes
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Mauricio P Pinto
- Support team for Oncological Research and Medicine (STORM), Santiago, Chile
| | - M Loreto Bravo
- Support team for Oncological Research and Medicine (STORM), Santiago, Chile
| | - Denise Montt-Blanchard
- Centro para la prevención y el control del cáncer, CECAN, Santiago, Chile; School of Design, Faculty of Architecture, Design and Urban Studies. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Acevedo
- Centro para la prevención y el control del cáncer, CECAN, Santiago, Chile; Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Benjamín Walbaum
- Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Margarita Barra-Navarro
- Departamento de Kinesiología, Escuela Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Scarlet Muñoz-Flores
- Departamento de Kinesiología, Escuela Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza Pinto
- Unidad de patología mamaria, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Sabrina Muñiz
- Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Contreras-Briceño
- Departamento de Kinesiología, Escuela Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratory of Exercise Physiology, Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Merino
- Department of Hematology-Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gina Merino
- Departamento Agencia Nacional de Prevención y Control del Cáncer, Subsecretaria de Salud Pública, Ministerio de Salud de Chile, Santiago, Chile
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Åsberg E, Giskeødegård GF, Karlsen J, Kiserud CE, Aune G, Nilsen M, Reidunsdatter RJ. Sexual health in female and male cancer survivors - compared with age-matched cancer-free controls in Norway. Acta Oncol 2025; 64:380-390. [PMID: 40052251 PMCID: PMC11905150 DOI: 10.2340/1651-226x.2025.42451] [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: 11/07/2024] [Accepted: 02/06/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND AND PURPOSE Sexual dysfunction is a common late effect of cancer reducing quality of life. This study investigated sexual health in cancer survivors shortly after diagnosis and at long-term follow-up compared to the general population. METHODS A nationwide survey stratified by sex and age was distributed to a representative sample of the Norwegian population. Of the 5,135 respondents (33% response rate), 453 were cancer survivors, and 4,682 were cancer-free controls. Time since cancer diagnosis was divided into two categories: 2 years or less (short-term) and over 2 years (long-term). Sexual health was evaluated using the EORTC questionnaires SHQ-22 and the sexual domains of the QLQ-BR23/QLQ-BR45. Multivariable linear regression analyses compared sexual health between cancer survivors and cancer-free controls, and between short- and long-term cancer survivors. RESULTS Cancer survivors reported significantly poorer sexual health outcomes than cancer-free controls, except for the importance of maintaining a sexually active life, rated equally important. There were minimal differences in sexual health between short-term and long-term cancer survivors. Interestingly, male cancer survivors appeared to be more affected by sexual health challenges than females, when compared to their cancer-free controls. INTERPRETATION This study is the first to utilize the EORTC SHQ-22 questionnaire to assess sexual health in cancer survivors and controls. Sexual health was found to be significantly worse in cancer survivors compared to age-matched controls. It is imperative to address this overlooked health issue in the follow-up programs for cancer survivors.
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Affiliation(s)
- Emilie Åsberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.
| | - Guro F Giskeødegård
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Jarle Karlsen
- Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Guro Aune
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Nilsen
- Department of Social Work, Faculty of Social and Educational Sciences, NTNU, Trondheim, Norway
| | - Randi J Reidunsdatter
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Pappot H, Jørgensen A, Bjørum AH, Jakobsen CB, Jørgensen CU, Høeg BL, Bidstrup P, Knop A, Bentsen L. Understanding quality of life in Danish women with metastatic breast cancer undergoing multiple treatments. Acta Oncol 2025; 64:292-302. [PMID: 39988768 PMCID: PMC11871412 DOI: 10.2340/1651-226x.2025.42446] [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: 11/07/2024] [Accepted: 02/07/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND Women with metastatic breast cancer (mBC) may experience several symptoms exacerbated by successive treatments. There is however, a lack of knowledge of the most important symptoms and how these may affect daily life function. This study aims to elucidate the quality of life (QoL), including both symptoms and daily life functions, among mBC women undergoing varied treatments. METHODOLOGY We conducted a cross-sectional electronic questionnaire study enrolling mBC women (≥ stage III) receiving medical cancer treatment through September-December 2023. QoL, symptoms, and daily life function were measured using the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and the breast cancer module (BR45). Health-related quality of life (HRQoL), defined by the EORTC, covers the subjective perceptions of the positive and negative aspects of cancer patients' symptoms, including physical, emotional, social, and cognitive functions. We examined associations between QoL, treatment line and therapy types, and estimated odds ratios (ORs) and confidence intervals (CIs). RESULTS Of 359 eligible participants, 111 responded (30.9%). At study commencement, 90.9% of the participants received at least one type of systemic treatment, with 16.2% undergoing chemotherapy, 61.3% anti-hormonal treatment, and 66.6% targeted cancer treatment. QLQ-C30 sum scores were highest in women receiving anti-hormonal treatment (80.7, interquartile range [IQR]: 17.6), followed by targeted cancer treatment (78.8, IQR: 18.4), and lowest with chemotherapy (77.1, IQR: 24.8). Quality of life decreased with subsequent treatment lines (first line: 80.3, IQR: 20.7, fourth line: 67.4, IQR: 11.3). No significant differences were found in the functions or in the individual symptoms according to monotherapy type. INTERPRETATION Women with mBC experience a substantial symptom burden and reduced functioning, and their QoL differs with successive lines of treatment. This underlines that women living with mBC need support and effective symptom management to maintain QoL.
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Affiliation(s)
- Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Annasofie Jørgensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Hincheli Bjørum
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Camilla Uhre Jørgensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Ann Knop
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Bentsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Belani P, Wadasadawala T, Sarin R, Pathak R, Krishnamurthy R, Syeda N, Chavan S. Translation and Linguistic Validation of BIS (Body Image Scale) for Breast Cancer Patients in India. Indian J Surg Oncol 2025; 16:203-210. [PMID: 40114862 PMCID: PMC11920465 DOI: 10.1007/s13193-024-02037-2] [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: 10/08/2023] [Accepted: 06/28/2024] [Indexed: 03/22/2025] Open
Abstract
A number of PROMs (patient-reported outcome measures) have been developed and validated for English-speaking populations but with limited utility in non-English-speaking countries. Body image scale (BIS) is a type of PROM which assesses the changes in the body image of a patient diagnosed with cancer. The current study was carried out to translate the BIS in Hindi and Marathi. Out of the 10 questions in the BIS questionnaire, Hindi and Marathi translations were already available for 4 questions (Questions no. 2, 4, 5, and 9) from the EORTC BR23 questionnaire. Remaining questions were translated using the EORTC translation manual, which includes forward translation, reconciliation, backward translation, proofreading, and pilot testing. Pilot testing done on 10 patients each for Hindi and Marathi showed at least 80% acceptability for all the questions for both Hindi and Marathi translations. Both the translated versions will be used for validation in a large cohort of breast cancer patients. The Hindi and Marathi versions of the BIS have very good acceptability and can be utilized for clinical trials once validated in cancer patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-024-02037-2.
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Affiliation(s)
- Preeti Belani
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
| | - Rajiv Sarin
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
| | - Rima Pathak
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
| | - Revathy Krishnamurthy
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
| | - Naseera Syeda
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
| | - Sonal Chavan
- Department of Radiation Oncology, Breast DMG (Disease Management Group), Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Navi Mumbai 400012 India
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Kim N, Park W, Kim H, Cho WK, Ahn SJ, Kim MY, Park SH, Lee IJ, Ha I, Kim JH, Kim TH, Lee KC, Lee HS, Kim TG, Shin KH, Lee JH, Jung J, Cho O, Kim YB, Kim ES, Jo IY, Koo T, Kim K, Park HJ, Shin YJ, Ha B, Kwon J, Lee JH, Moon S. Patient-Reported Outcomes Between Whole-Breast Plus Regional Irradiation and Whole-Breast Irradiation Only in pN1 Breast Cancer After Breast-Conserving Surgery and Taxane-Based Chemotherapy: A Randomized Phase 3 Clinical Trial (KROG 17-01). Int J Radiat Oncol Biol Phys 2025; 121:341-351. [PMID: 39326505 DOI: 10.1016/j.ijrobp.2024.09.017] [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: 05/30/2024] [Revised: 08/01/2024] [Accepted: 09/04/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE The role of regional node irradiation (RNI) with whole-breast irradiation (WBI) in patients with pN1 breast cancer receiving taxane-based adjuvant chemotherapy is not well defined. The KROG 1701 trial, a phase 3, multicenter, noninferiority study, aimed to compare the disease-free survival between WBI+RNI and WBI alone in this patient cohort. Comprehensive patient-reported outcomes (PROs) collected at multiple timepoints are reported. METHODS AND MATERIALS The trial (NCT03269981) enrolled patients with pN1 breast cancer after breast-conserving surgery and taxane-based adjuvant chemotherapy, allocating them to receive either WBI+RNI or WBI only. PROs were assessed using European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaires Core 30and breast cancer-specific module 23 modules at baseline, during radiation therapy, and at subsequent follow-up intervals of 3 to 6 months, and annually up to 4 years. RESULTS From April 2017 to December 2021, 840 patients were enrolled; 777 received intervention as assigned, and 750 completed baseline PRO questionnaires (387 in WBI+RNI, 363 in WBI only). All PRO domains showed improvements over time (P < .001). During radiation therapy, the WBI+RNI group reported greater fatigue and nausea. Higher arm symptom scores were observed in the WBI+RNI group 3 months post-treatment (P = .030). No other significant PRO domain differences, including arm/breast symptoms, were observed between the 2 groups. CONCLUSIONS In patients with pN1 breast cancer treated with taxane-based chemotherapy, adding RNI to WBI resulted in minor, temporary declines in specific PRO domains, but these differences were not clinically significant. This indicates that overall patient experience between WBI+RNI and WBI is comparable, supporting the safety and patient tolerability of both treatments.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Sung Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju
| | - Mi Young Kim
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu
| | - Shin-Hyung Park
- Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - Inbong Ha
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu
| | - Tae Hyun Kim
- National Cancer Center, Research Institute and Hospital, Center for Proton Therapy, Goyang
| | - Kyu Chan Lee
- Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Hyung-Sik Lee
- Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University Hospital, Seoul
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, Suwon
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - Eun Seog Kim
- Department of Radiation Oncology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Cheonan
| | - In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Cheonan
| | - Taeryool Koo
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul
| | - Young-Joo Shin
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul
| | - Boram Ha
- Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University Hospital, Daejeon
| | - Ju Hye Lee
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan
| | - Sunrock Moon
- Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Álvarez-Salvago F, Figueroa-Mayordomo M, Molina-García C, Pujol-Fuentes C, Atienzar-Aroca S, de Diego-Moreno M, Medina-Luque J. Assessing the Relationship of Different Levels of Pain to the Health Status of Long-Term Breast Cancer Survivors: A Cross-Sectional Study. Life (Basel) 2025; 15:177. [PMID: 40003586 PMCID: PMC11856788 DOI: 10.3390/life15020177] [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: 12/12/2024] [Revised: 01/15/2025] [Accepted: 01/23/2025] [Indexed: 02/27/2025] Open
Abstract
Purpose: This study investigated the relationship between different pain levels in the affected arm and health status in long-term breast cancer survivors (LTBCSs) and identified predictors of pain at this stage of long-term survivorship. Methods: A cross-sectional study of 80 participants categorized LTBCSs by pain levels in the affected arm into three groups: no pain (0-0.99), mild pain (1-3.99), and moderate to severe pain (4-10). Variables assessed at least 5 years since diagnosis include pain in the non-affected arm, pain interference, cancer-related fatigue (CRF), physical activity (PA) level, fitness condition, mood state, and health-related quality of life (HRQoL). Results: A total of 36.25% of LTBCSs have no pain, 30% have mild pain, and 33.75% have moderate to severe pain. Furthermore, pain presence was associated with increased pain in the non-affected arm, pain interference, CRF, mood disturbances, and physical inactivity, as well as a decreased HRQoL (all p < 0.05). Regression analysis found "upset by hair loss", CRF "affective domain", "dyspnea", and "alcohol consumption" as significant predictors of higher levels of pain in the affected arm (r2 adjusted = 0.646). Conclusions: A total of 63.75% of LTBCSs continue to experience mild to moderate to severe pain in the affected arm, negatively impacting their physical, mental, and emotional health status, with increased pain severity ≥5 years beyond cancer diagnosis. "Upset by hair loss", CRF "affective domain", "dyspnea", and alcohol consumption collectively explain 64.6% of the affected-arm pain level in LTBCSs.
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Affiliation(s)
- Francisco Álvarez-Salvago
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, 46010 Valencia, Spain; (F.Á.-S.); (C.P.-F.)
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - Maria Figueroa-Mayordomo
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, 46010 Valencia, Spain; (F.Á.-S.); (C.P.-F.)
| | - Cristina Molina-García
- Faculty of Physiotherapy, Podiatry and Occupational Therapy, Catholic University San Antonio-UCAM, 30107 Murcia, Spain;
| | - Clara Pujol-Fuentes
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, 46010 Valencia, Spain; (F.Á.-S.); (C.P.-F.)
| | - Sandra Atienzar-Aroca
- Department of Dentistry, Faculty of Health Sciences, European University of Valencia, 46010 Valencia, Spain;
| | - Manuel de Diego-Moreno
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - Jose Medina-Luque
- Translational Brain Research, German Center for Neurodegenerative Diseases DZNE, 37075 Munich, Germany;
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21
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Dupoiron D, Bienfait F, Seegers V, Piloquet FX, Pluchon YM, Pechard M, Mezaib K, Chvetzoff G, Diaz J, Ahmeidi A, Mauriès-Saffon V, Lebrec N, Jubier-Hamon S. Evaluating Treatment Preferences and the Efficacy of Capsaicin 179 mg Patch vs. Pregabalin in a Randomized Trial for Postsurgical Neuropathic Pain in Breast Cancer: CAPTRANE. Cancers (Basel) 2025; 17:313. [PMID: 39858095 PMCID: PMC11763653 DOI: 10.3390/cancers17020313] [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: 12/04/2024] [Revised: 01/13/2025] [Accepted: 01/17/2025] [Indexed: 01/27/2025] Open
Abstract
Background/Objectives: CAPTRANE evaluated the efficacy and tolerability of high-concentration capsaicin patch (HCCP) vs. oral pregabalin for the treatment of postsurgical neuropathic pain (PSNP) following breast cancer surgery. The study was designed with the aim of demonstrating noninferiority of one HCCP against daily pregabalin. Methods: This was a multicenter, randomized, parallel-arm, open-label study conducted across nine centers in France. The primary endpoint was a change from baseline in the Numeric Pain Rating Scale (NPRS) score after 2 months. Results: Recruitment challenges resulted in the randomization of 140 patients (versus 644 planned); the per-protocol population comprised 107 patients (HCCP: n = 65; pregabalin: n = 42). Baseline characteristics were similar between the two groups. In the per-protocol analysis, the mean (standard deviation) change versus baseline in NPRS score was -1.926 (2.554) with HCCP and -1.634 (2.498) with pregabalin. The prespecified analysis showed that HCCP was not inferior to pregabalin: the lower bound of the 90% confidence interval for the between-arm difference was -0.889 and the upper bound was +0.260 (i.e., below the predefined clinical threshold of +0.4). Patient-reported outcomes showed no statistically significant differences between treatments. The painful area size decreased significantly more with HCCP. Tolerability profiles differed, with HCCP mostly causing application-site reactions. While >50% of patients switched from pregabalin to HCCP, none switched from HCCP to pregabalin. Conclusions: This comparative study in PSNP post breast cancer surgery, evaluating a single treatment of HCCP, shows a noninferior reduction in pain intensity, a superior reduction in painful area size, and a patient preference for HCCP compared with pregabalin. Despite limitations, it contributes valuable initial data for PSNP management in breast cancer care.
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Affiliation(s)
- Denis Dupoiron
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49055 Angers, France; (F.B.); (N.L.); (S.J.-H.)
| | - Florent Bienfait
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49055 Angers, France; (F.B.); (N.L.); (S.J.-H.)
| | - Valérie Seegers
- Biometrics Department, Institut de Cancérologie de l’Ouest, 49055 Angers, France;
| | - François-Xavier Piloquet
- Oncology and Medical Specialties Department, Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France;
| | - Yves-Marie Pluchon
- Pain Management Consultation Center, Centre Hospitalier Départemental Vendée, 85000 La Roche-sur-Yon, France;
| | - Marie Pechard
- Institut Curie Hôpital de Saint-Cloud, 92210 Saint-Cloud, France;
| | - Karima Mezaib
- Gustave Roussy Cancer Campus, 94805 Villejuif, France;
| | | | - Jésus Diaz
- Anaesthesiology and Pain Department, Institut du Cancer de Montpellier, 34090 Montpellier, France;
| | - Abesse Ahmeidi
- Department of Anesthesiology, Intensive Care, Centre Oscar Lambret, 59000 Lille, France;
| | | | - Nathalie Lebrec
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49055 Angers, France; (F.B.); (N.L.); (S.J.-H.)
| | - Sabrina Jubier-Hamon
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49055 Angers, France; (F.B.); (N.L.); (S.J.-H.)
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22
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Burkon P, Selingerova I, Vrzal M, Holanek M, Coufal O, Polachova K, Andraskova V, Jhawar SR, Slampa P, Kazda T, Slavik M. Quality of life in early breast cancer patients after adjuvant accelerated partial-breast irradiation (APBI) in randomized trial. Sci Rep 2025; 15:1387. [PMID: 39779797 PMCID: PMC11711455 DOI: 10.1038/s41598-025-85342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 01/02/2025] [Indexed: 01/11/2025] Open
Abstract
Accelerated partial breast irradiation (APBI) represents a valid option for adjuvant therapy of selected early breast cancer (BC). This single-institution prospective randomized study compares the health-related quality of life (HRQoL) between women treated with the highly conformal-external beam APBI technique and those with the more commonly used moderately hypofractionated whole breast irradiation (hypo-WBI). Eligible patients were women over 50 years with early BC (G1/2 DCIS ≤ 25 mm or G1/2 invasive non-lobular luminal-like HER2 negative carcinoma ≤ 20 mm) after breast-conserving surgery with negative margins. APBI arm consisted of 30 Gy in 5 consecutive daily fractions and WBI arm of 40 Gy in 15 fractions plus 10 Gy in 5 fractions boost to the tumor bed. Patients were requested to complete the official Czech translation of the EORTC QoL questionnaires, including QLQ-C30 and QLQ-BR45, before radiation (baseline), at the end of radiation (M0) and 1 (M1), 3 (M3), 6 (M6), 12 (M12), and 24 (M24) months after radiation. Linear regression models were used to analyze differences in HRQoL between the arms. The 85 enrolled patients exhibited no differences in HRQoL scores between the two arms at baseline. Patients in the APBI arm reported more favorable global health status at M6 (p = 0.055). Other functional scales showed a decrease in the WBI arm at M0 (p = 0.027 for physical functioning). During radiation, symptoms scores increased. Significant between-group differences were observed for the pain (p = 0.002), systemic therapy side effects (p = 0.004), and breast symptoms (p < 0.001) scales at M0, with higher scores in the WBI arm. During follow-up, scores on symptoms scales returned to at least the baseline values. Early BC patients treated with APBI showed non-inferior short-term and late HRQoL outcomes compared to hypo-WBI. In addition to previous findings regarding toxicity, promising pain and breast symptoms results, suggest that APBI should be strongly considered as a treatment option for selected low-risk patients.Trial registration NCT06007118, August 23, 2023 (retrospectively registered).
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Affiliation(s)
- Petr Burkon
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Iveta Selingerova
- Research Centre for Applied Molecular Oncology (RECAMO), Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic.
- Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic.
| | - Miroslav Vrzal
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic
| | - Milos Holanek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Oldrich Coufal
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Katerina Polachova
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vera Andraskova
- Clinical Nutrition Unit, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Sachin R Jhawar
- Radiation Oncology Department, Arthur James Cancer Center, The Ohio State University, Columbus, USA
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Research Centre for Applied Molecular Oncology (RECAMO), Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic
| | - Marek Slavik
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 656 53, Czech Republic.
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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23
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Irzaldy A, Otten JDM, Kregting LM, van der Molen DRM, Verkooijen HM, van Ravesteyn NT, Heijnsdijk EAM, Doeksen A, van der Pol CC, Evers DJ, Ernst MF, Korfage IJ, de Koning HJ, Broeders MJM. Quality of life of women with a screen-detected versus clinically detected breast cancer in the Netherlands: a prospective cohort study. Qual Life Res 2025; 34:161-171. [PMID: 39287764 PMCID: PMC11802699 DOI: 10.1007/s11136-024-03783-0] [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] [Accepted: 09/01/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE Breast cancer (BC) screening enables early detection of BC, which may lead to improved quality of life (QoL). We aim to compare QoL between women with a screen-detected and clinically detected BC in the Netherlands. METHODS We used data from the 'Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaluation' (UMBRELLA) between October 2013 and March 2022. Patients were categorized as screen-detected or clinically detected. We analysed three questionnaires, namely EORTC QLQ C-30, BR23, and HADS (Hospital Anxiety and Depression Scale) completed by BC patients shortly after diagnosis (T1) and one-year after treatment (T2). Independent t-tests were performed to compare QoL average differences between the two groups. Bonferroni-corrected p-value significance threshold of 0.00057 was used. The magnitude of differences was calculated using Cohen's d. The clinical relevance of QLQ-C30 differences was assessed based on interpretation guideline of EORTC-QLQ-C30 results. RESULTS After applying inclusion and exclusion criteria, there were 691 women with screen-detected BC and 480 with clinically detected BC. Generally, screen-detected BC patients reported a better QoL. At T1, their average QLQ-C30 summary score was higher (86.1) than clinically detected BC patients (83.0) (p < 0.0001). Cohen's d for all items ranged between 0.00 and 0.39. A few QLQ-C30 score differences were clinically relevant, indicating better outcomes in emotional functioning, general health, constipation, and fatigue for women with screen-detected BC. CONCLUSIONS In the Netherlands, women with screen-detected BC reported statistically significant and better QoL than women with clinically detected BC. However, clinical relevance of the differences is limited.
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Affiliation(s)
- Abyan Irzaldy
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40 NA-24, Rotterdam, 3015 GD, The Netherlands.
| | - Johannes D M Otten
- IQ Health Science Department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40 NA-24, Rotterdam, 3015 GD, The Netherlands
- IQ Health Science Department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Helena M Verkooijen
- Division of Imaging & Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40 NA-24, Rotterdam, 3015 GD, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40 NA-24, Rotterdam, 3015 GD, The Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | | | - Daniel J Evers
- Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands
| | - Miranda F Ernst
- Department of Surgery, Alexander Monro Hospital, Bilthoven, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40 NA-24, Rotterdam, 3015 GD, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40 NA-24, Rotterdam, 3015 GD, The Netherlands
| | - Mireille J M Broeders
- IQ Health Science Department, Radboud University Medical Centre, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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24
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Chan WL, Wong YL, Tai YL, Liu M, Yun B, Zhang Y, Hou HLY, Kwong D, Lee VHF, Lam WWT. Digital Rehabilitation Program for Breast Cancer Survivors on Adjuvant Hormonal Therapy: A Feasibility Study. Cancers (Basel) 2024; 16:4084. [PMID: 39682269 DOI: 10.3390/cancers16234084] [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: 09/28/2024] [Revised: 11/28/2024] [Accepted: 12/01/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Breast cancer survivors often face physical and psychological challenges, including weight gain, metabolic syndrome, and reduced quality of life. To address these concerns, a mobile app-based rehabilitation program called "THRIVE" was developed to improve physical activity, medication adherence, and health-related quality of life (HRQoL) in this population. Methods: This prospective, single-arm study assessed the feasibility and effectiveness of the "THRIVE" app among breast cancer survivors undergoing hormonal therapy. Participants were recruited from Queen Mary Hospital in Hong Kong between December 2022 and June 2023. Eligible survivors had completed treatment within the last five years or had stable advanced disease on hormonal therapy. Participants monitored their exercise, medication adherence, and self-care via the app and a Fitbit activity tracker for 16 weeks. Primary outcomes included recruitment, dropout, adherence rates, and safety. Secondary outcomes, measured at baseline and week 16, included physical activity intensity, HRQoL, psychological stress, body composition, and app satisfaction. Results: A total of 50 participants, with a median age of 53 years, completed the study. The recruitment rate was 70.4% with no dropouts. The adherence rate, measured by completing exercises recommended in the mobile app at least three times per week, was 74%. No severe adverse events were reported. While physical activity intensity showed no significant changes from baseline to week 16 (p = 0.24), cognitive function (p = 0.021), future perspective (p = 0.044), arm symptoms (p = 0.042), depression (p = 0.01), and anxiety (p = 0.004) improved. All participants reported perfect medication compliance (100%). Satisfaction with the app was high. Conclusions: This mobile app-based rehabilitation program demonstrated good feasibility, with satisfactory recruitment, adherence, and safety, providing valuable insights into future definitive studies.
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Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yat-Lam Wong
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Yin-Ling Tai
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michelle Liu
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bryan Yun
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yuning Zhang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Holly Li-Yu Hou
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Dora Kwong
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wendy Wing-Tak Lam
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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25
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Wang AJ, Hircock C, Sferrazza D, Goonaratne E, Cella D, Bottomley A, Lee SF, Chan A, Chow E, Wong HCY. The EORTC QLQ breast modules and the FACT-B for assessing quality of life in breast cancer patients - an updated literature review. Curr Opin Support Palliat Care 2024; 18:249-259. [PMID: 39269251 DOI: 10.1097/spc.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
PURPOSE OF REVIEW Two commonly used quality of life questionnaires in breast cancer are EORTC QLQ-BR23, the FACT-B, and the extended FACT-B + 4. More recently, the EORTC EORTC QLQ-BR42 was developed. This systematic review compares the various versions of the EORTC QLQ and FACT tools for breast cancer in terms of their content, validity, and psychometric properties. RECENT FINDINGS Thirty-six studies met the inclusion criteria. All questionnaires have been proven to be valid, reliable and responsive. The provisional EORTC QLQ-BR45 transitioned to the EORTC QLQ-BR42 in Phase IV of its development, which encompasses the side effects associated with the latest breast cancer treatments. Both the EORTC and FACT measures assess physical and mental dimensions of quality of life, with the EORTC measure placing relatively more emphasis on physical content and FACT placing relatively more emphasis on mental (social and emotional) content. The four additional items in the FACT-B + 4 were developed to address arm lymphoedema following axillary surgery. SUMMARY The development and uptake of quality of life tools are essential in the evaluation of breast cancer treatments. The EORTC QLQ-BR42 and FACT-B are both valid, reliable, and responsive QoL questionnaires.
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Affiliation(s)
- Alyssa J Wang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Caroline Hircock
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | | | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Adrian Chan
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hong Kong, SAR, China
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26
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Orellana-Jaén J, Mora-Fernández M, Carrasco-Páez L. Effects of a motor and cognitive training program on executive function and different biomarkers related to muscle-brain crosstalk in breast cancer survivors: 3-arm randomised controlled BRAINonFIT study protocol. Contemp Clin Trials 2024; 146:107672. [PMID: 39265784 DOI: 10.1016/j.cct.2024.107672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/21/2024] [Accepted: 08/27/2024] [Indexed: 09/14/2024]
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) is a significant but often neglected issue for breast cancer survivors that reduces their quality of life. Physical exercise and cognitive training have emerged as promising strategies for CRCI; however, evidence regarding its effectiveness is still unknown. A recently developed motor-cognitive training (dual-tasks) is proposed to examine its efficacy on executive function, physical fitness, emotional symptomatology, and important muscle-brain crosstalk biomarkers. METHODS The BRAINonFIT study is a randomised, controlled, longitudinal (20 weeks), three-arm, parallel study with a follow-up phase (12 weeks). Breast cancer survivors (stage I-IIIA) with completed chemotherapy are recruited from QuirónSalud Hospital in Seville. Principal outcomes are executive functions, measured by the Trail Making Test, Stroop and Digit Span Backwards; physical fitness, assessed by muscle strength, cardiorespiratory fitness, and body composition; and several muscle-brain biomarkers analysed by immunoenzymatic assay (ELISA). Secondary endpoints are memory function, intelligence, learning ability, self-reported cognitive function, and emotional symptomatology. Assessments take place after the enrolment (baseline; T1), after completing the interventions (5 months after baseline; T2), and after completing the follow-up period (8 months after baseline; T3). DISCUSSION Given the importance of improving care for breast cancer survivors, this study will provide preliminary evidence for the effectiveness of cognitive-motor training (dual task) as a therapeutic strategy to improve CRCI. Moreover, addressing muscle-brain crosstalk by representative biomarkers will help to elucidate the underlying mechanisms by which this intervention may beneficially impact CRCI. CLINICALTRIALS gov: NCT06073717.
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Affiliation(s)
| | - Matilde Mora-Fernández
- Depatment of Human Motricity and Sport Performance, University of Seville, Pirotecnia St. E-41013 Seville, Spain.
| | - Luis Carrasco-Páez
- Department of Physical Education and Sport, University of Seville, Pirotecnia St. E-41013 Seville, Spain
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27
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Spyrou A, Martin AG, Hannoun-Lévi JM, Stewart A. Measuring patient reported outcomes in brachytherapy: Why we should do it and more importantly how. Clin Transl Radiat Oncol 2024; 49:100870. [PMID: 39885895 PMCID: PMC11780381 DOI: 10.1016/j.ctro.2024.100870] [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: 06/25/2024] [Revised: 09/26/2024] [Accepted: 09/30/2024] [Indexed: 02/01/2025] Open
Abstract
As the treatment for cancer improves and advances are made, the clinical focus is often on treatment response and survival. However, these are not the only factors which are important to patients. More patients are living longer after cancer treatment and therefore it is important that we can describe not only the treatment to patients but also what their life will be like during and after treatment. Patient reported outcomes (PROs) allow us to describe these. Although there are a range of patient reported outcome measures (PROMs) available to the clinician to assess these, the use of them in many areas of brachytherapy lags behind ideal levels. Brachytherapy has many features that differ to external beam radiotherapy (EBRT) yet the assessment of quality of life during and after treatment is much more scarce than EBRT. Brachytherapy is often used in the setting of organ preservation or in place of radical surgery, yet there is a paucity of quality of life data comparing the different treatment modalities. This review article will aim to elaborate on the evidence that exists in the use of specific PROMs within prostate, breast and gynaecologic cancers and describe the development of a novel PROMs approach in rectal brachytherapy which aims to identify and resolve symptoms at an early stage.
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Affiliation(s)
| | - André-Guy Martin
- Centre Intégré de Cancérologie, CHU de Québec – Université Laval, Quebec, Canada
| | | | - Alexandra Stewart
- Royal Surrey Hospital, Guildford, UK
- University of Surrey, Guildford, UK
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28
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Velickovic K, Olsson Möller U, Ryden L, Bendahl PO, Malmström M. Model of Health-Related Quality of Life in Breast Cancer Patients Using Cross-Sectional Data: The Role of Resilience. Cancer Manag Res 2024; 16:1545-1555. [PMID: 39493320 PMCID: PMC11531721 DOI: 10.2147/cmar.s467542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 09/25/2024] [Indexed: 11/05/2024] Open
Abstract
Purpose Resilience has been suggested as an important predictor of both physical and mental health-related quality of life in breast cancer patients. However, it is unclear why resilient women handle their diagnosis better, not only mentally, but also physically. The aim of this study was to investigate paths between resilience, physical activity, and mental, physical, and global health-related quality of life in breast cancer patients. Patients and Methods Structural equation modeling was conducted to evaluate the proposed structural paths using a sample of 638 women with newly diagnosed breast cancer patients from Sweden. Results Resilience was directly associated with physical activity and mental health-related quality of life. It was indirectly associated with physical functioning, through mental health-related quality of life and physical activity. Resilience was also indirectly associated with global quality of life, through mental health-related quality of life. Conclusion Mental health support and encouraging physical activity may be especially relevant to enhance all aspects of health-related quality of life early in the breast cancer process. Results should be replicated longitudinally.
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Affiliation(s)
| | - Ulrika Olsson Möller
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Lisa Ryden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Marlene Malmström
- Department of Health Sciences, Lund University, Lund, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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Luque Suárez S, Olivares Crespo ME, Brenes Sánchez JM, Herrera de la Muela M. Immediate Psychological Implications of Risk-Reducing Mastectomies in Women With Increased Risk of Breast Cancer: A Comparative Study. Clin Breast Cancer 2024; 24:620-629. [PMID: 39117504 DOI: 10.1016/j.clbc.2024.07.005] [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: 05/29/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Risk-reducing mastectomy is recommended for high-risk patients but may have significant psychological consequences. This study aimed to determine the differences in anxiety, depressive symptomatology, body image and quality of life in women with an increased risk of breast cancer immediately before and after undergoing risk-reducing mastectomy. METHODS Eighty-eight women with an increased risk of breast cancer due to BRCA1/2 mutations or a previous cancer diagnosis participated in this study. Instruments used were the Hospital Anxiety and Depression Scale, Body Image Scale and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and Breast 23, administered 15-30 days before and after surgery. RESULTS Following surgery, there was an immediate and significant worsening in anxiety, depressive symptomatology and body image. There was a significant deterioration in global, physical, role, and social functioning, as well as in body image and sexual enjoyment scales. Additionally, there were increases in fatigue, nausea and vomiting, constipation, dyspnoea, insomnia, appetite loss, perceived financial difficulties, pain, systemic therapy side effects, and breast and arm symptoms. However, there was an improvement in future perspective. These changes occurred independently of whether participants had a cancer diagnosis or BRCA1/2 mutation. CONCLUSION Risk-reducing mastectomies have immediate psychological consequences. While these procedures improve future health perspective, they increase anxiety and depressive symptomatology and decrease body image and quality of life, regardless of cancer diagnosis or BRCA1/2 mutation. These findings highlight the psychological consequences of such surgical procedures, emphasizing the need for comprehensive psychological interventions both before and after surgery.
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Affiliation(s)
- Sofía Luque Suárez
- Department of Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Universidad Complutense of Madrid, Madrid, Spain.
| | - María Eugenia Olivares Crespo
- Department of Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Universidad Complutense of Madrid, Madrid, Spain; Breast Pathology Unit, José Botella Llusia Women's Health Institute, Hospital Clínico San Carlos, Madrid, España
| | - Juana María Brenes Sánchez
- Breast Pathology Unit, José Botella Llusia Women's Health Institute, Hospital Clínico San Carlos, Madrid, España
| | - María Herrera de la Muela
- Breast Pathology Unit, José Botella Llusia Women's Health Institute, Hospital Clínico San Carlos, Madrid, España
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30
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Caminiti C, Maglietta G, Arenare L, Di Liello R, Migliaccio G, Barberio D, De Laurentiis M, Di Rella F, Nuzzo F, Pacilio C, Iodice G, Orditura M, Ciardiello F, Di Bella S, Cavanna L, Porta C, Giovanardi F, Ripamonti CI, Bilancia D, Aprile G, Ruelle T, Diodati F, Piccirillo MC, Iannelli E, Pinto C, Perrone F. Psychometric properties of patient-reported outcomes Common Terminology Criteria for adverse events (PRO-CTCAE®) in breast cancer patients: The prospective observational multicenter VIP study. Breast 2024; 77:103781. [PMID: 39059033 PMCID: PMC11332192 DOI: 10.1016/j.breast.2024.103781] [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: 02/27/2024] [Revised: 06/19/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Patients' self-reporting is increasingly considered essential to measure quality-of-life and treatment-related side-effects. However, if multiple patient-reported instruments are used, redundancy may represent an overload for patients. Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) are a tool allowing direct patients' reporting of side-effects. We tested psychometric properties of a selected list of PRO-CTCAE items, in a cohort of 303 breast cancer patients, using validated instruments for quality of life assessment as anchors. The analysis of convergent validity with HADS (Hospital Anxiety and Depression Scale) and EORTC BR-23 sub-scales, and the analysis of responsiveness with the PGIC (Patients Global Impression of Change) score supported that a selected list of PRO-CTCAE symptoms might represent a standardized, agile tool for both research and practice settings to reduce patient burden without missing relevant information on patient perceptions. Among patients using digital devices, those with a higher education levels required shorter time to fulfil questionnaires. In conclusion, a selected list of PRO-CTCAE items can be considered as a standardized, agile tool for capturing crucial domains of side-effects and quality of life in patients with breast cancer. The study is registered on clinicaltrials.gov (NCT04416672).
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Affiliation(s)
- Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital, Parma, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital, Parma, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy
| | | | - Gessica Migliaccio
- Departmental Structure of Clinical Psycho-oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Daniela Barberio
- Departmental Structure of Clinical Psycho-oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Michelino De Laurentiis
- Experimental and Clinical Senologic Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy
| | - Francesca Di Rella
- Experimental and Clinical Senologic Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy
| | - Francesco Nuzzo
- Experimental and Clinical Senologic Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy
| | - Carmen Pacilio
- Experimental and Clinical Senologic Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy
| | - Giovanni Iodice
- Experimental and Clinical Senologic Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy
| | - Michele Orditura
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | | | - Luigi Cavanna
- Medical Oncology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Camillo Porta
- Interdisciplinary Department of Medicine, Università degli Studi 'A. Moro', Bari, Italy; Polyclinic Consortium University Hospital, Bari, Italy
| | | | | | | | - Giuseppe Aprile
- Medical Oncology, Azienda ULSS 8 Nerica, Ospedale S.Bortolo, Vicenza, Italy
| | - Tommaso Ruelle
- Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genova, Italy
| | - Francesca Diodati
- Clinical and Epidemiological Research Unit, University Hospital, Parma, Italy
| | | | - Elisabetta Iannelli
- FAVO - Federazione Italiana delle Associazioni di Volontariato in Oncologia, Roma, Italy
| | | | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS Fondazione G.Pascale, Napoli, Italy.
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31
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Dent R, Cortés J, Pusztai L, McArthur H, Kümmel S, Bergh J, Denkert C, Park YH, Hui R, Harbeck N, Takahashi M, Untch M, Fasching PA, Cardoso F, Haiderali A, Jia L, Nguyen AM, Pan W, O’Shaughnessy J, Schmid P. Neoadjuvant pembrolizumab plus chemotherapy/adjuvant pembrolizumab for early-stage triple-negative breast cancer: quality-of-life results from the randomized KEYNOTE-522 study. J Natl Cancer Inst 2024; 116:1654-1663. [PMID: 38913881 PMCID: PMC11461162 DOI: 10.1093/jnci/djae129] [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: 03/20/2024] [Revised: 05/14/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In KEYNOTE-522 (NCT03036488), neoadjuvant pembrolizumab plus chemotherapy and then adjuvant pembrolizumab significantly improved pathological complete response and event-free survival vs neoadjuvant chemotherapy in early-stage triple-negative breast cancer (TNBC). We report patient-reported outcomes (PROs) from KEYNOTE-522. METHODS Patients were randomized 2:1 to neoadjuvant pembrolizumab 200 mg or placebo every 3 weeks, plus 4 cycles of paclitaxel plus carboplatin and then 4 cycles of doxorubicin (or epirubicin) plus cyclophosphamide. After surgery, patients received adjuvant pembrolizumab or placebo for up to 9 cycles. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and EORTC Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23) were prespecified secondary objectives. Between-group differences in least squares (LS) mean change from baseline (day 1 of cycle 1 in both neoadjuvant and adjuvant phases) to the prespecified latest time point with at least 60% completion and at least 80% compliance were assessed using a longitudinal model (no alpha error assigned). RESULTS Week 21 (neoadjuvant phase) and week 24 (adjuvant phase) were the latest time points at which completion/compliance rates were ≥60%/80%. In the neoadjuvant phase, between-group differences (pembrolizumab plus chemotherapy [n = 762] vs placebo plus chemotherapy [n = 383]) in LS mean change from baseline to week 21 in QLQ-C30 global health status/quality of life (GHS/QoL), emotional functioning, and physical functioning were -1.04 (95% confidence interval = -3.46 to 1.38), -0.69 (95% CI = -3.13 to 1.75), and -2.85 (95% CI = -5.11 to -0.60), respectively. In the adjuvant phase, between-group differences (pembrolizumab [n = 539] vs placebo [n = 308]) in LS mean change from baseline to week 24 were -0.41 (95% CI = -2.60 to 1.77), -0.60 (95% CI = -2.99 to 1.79), and -1.57 (95% CI = -3.36 to 0.21). CONCLUSIONS No substantial differences in PRO assessments were observed between neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab vs neoadjuvant placebo plus chemotherapy in early-stage TNBC. TRIAL REGISTRATION ClinicalTrials.gov, NCT03036488.
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Affiliation(s)
- Rebecca Dent
- National Cancer Center Singapore and Duke-National University of Singapore (NUS) Medical School, Division of Medical Oncology, Singapore, Singapore
| | - Javier Cortés
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Group, Barcelona, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
- IOB Madrid, Institute of Oncology, Hospital Beata Maria Ana, Madrid, Spain
| | - Lajos Pusztai
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sherko Kümmel
- Breast Unit, Kliniken Essen-Mitte Evang, Huyssens-Stiftung, Essen, Germany
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet and Breast Cancer Centre, Cancer theme, Karolinska Comprehensive Cancer & University Hospital, Karolinska CCC and Cancer Core Europe, Solna, Sweden
| | - Carsten Denkert
- Institute of Pathology, Philipps University Marburg, Marburg, Germany
| | - Yeon Hee Park
- Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Rina Hui
- Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
- Centre of Cancer Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong
| | - Nadia Harbeck
- Breast Center, Department of OB&GYN and CCC Munich, LMU University Hospital, Munich, Germany
| | - Masato Takahashi
- Department of Breast Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Michael Untch
- Breast Cancer Center, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Peter A Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Amin Haiderali
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
| | - Liyi Jia
- Biostatistics and Research Division Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Allison Martin Nguyen
- Biostatistics and Research Decision Sciences—Epidemiology, Patient-Centered Endpoints & Strategy, Merck & Co., Inc., Rahway, NJ, USA
| | - Wilbur Pan
- Global Clinical Development, Merck & Co., Inc., Rahway, NJ, USA
| | - Joyce O’Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
| | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
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Rose MM, Bilimale AS, Krishnappa R. Assessing the Impact of Mastectomy on the Quality of Life among Cancer Survivors: A Hospital-based Cross-sectional Study in Mysuru. J Midlife Health 2024; 15:258-263. [PMID: 39959733 PMCID: PMC11824943 DOI: 10.4103/jmh.jmh_60_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/27/2024] [Accepted: 09/23/2024] [Indexed: 02/18/2025] Open
Abstract
Introduction While mastectomy a crucial procedure in preventing and treating breast cancer is essential, it significantly impacts the emotional well-being, dignity, and overall quality of life (QoL) of survivors. Dealing with the physical challenges of mastectomy is emotionally demanding as it requires adapting to the changes in one's body following breast cancer. Objective The objective of this study was to assess the impact of mastectomy on the QoL among cancer survivors. Subjects and Methods A hospital-based cross-sectional study was carried out in the outpatient departments of oncology at two tertiary care hospitals in Mysuru. Women diagnosed with breast cancer in the year 2021-2022 and who have undergone mastectomy of at least one breast were chosen for the study. The QoL was measured by the European Organisation for Research and Treatment of Cancer - C-30 and BR (breast specific) - 23 modules. Results Emotional, physical, social, and cognitive functioning scores assigned a maximum number of participants in the average to good QoL category. The survivors scored lower in sexual enjoyment (10.758 ± 29.73), sexual functioning (32.024 ± 45.35), future perspective (57.419 ± 38.773), and body image (57.309 ± 32.51) and reported lower QoL which was also related to their menstruation status and age. However, a small group of participants had a positive body image despite their transformed bodies. Symptoms such as fatigue (80.43 ± 24.84), nausea/vomiting (116.39 ± 64.7), insomnia (73.43 ± 38.85), and financial difficulties (65.28 ± 45.46) negatively affected the QoL. The study also highlighted that poor QoL was associated with hair loss (85.48 ± 34.60), side effects of systemic therapy (42.08 ± 22.28), arm symptoms (83.16 ± 23.67), and breast symptoms (20.71 ± 30.45). Conclusion Survivors face physical and psychological changes that significantly impact their QoL. QoL assessments offer insights into the impact of the disease during and after treatment.
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Affiliation(s)
- Minu Maria Rose
- School of Public Health, JSS Medical College, JSS AHER, Mysuru, Karnataka, India
| | - Anil S. Bilimale
- School of Public Health, JSS Medical College, JSS AHER, Mysuru, Karnataka, India
| | - Ravi Krishnappa
- Department of Surgical Oncology, JSS Hospital, JSS AHER, Mysuru, Karnataka, India
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Macdonald ER, Amorim NML, Hagstrom AD, Markovic K, Simar D, Ward RE, Clifford BK. Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis. J Cancer Surviv 2024; 18:1517-1547. [PMID: 37199900 PMCID: PMC11424680 DOI: 10.1007/s11764-023-01395-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment. METHODS The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire. RESULTS Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = - 0.99; 95%CI = - 1.26, - 0.71; p < 0.00001), psychological (SMD = - 0.43; 95%CI = - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD = - 0.62; 95%CI = - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains. CONCLUSIONS Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains. IMPLICATIONS FOR CANCER SURVIVORS Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.
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Affiliation(s)
- Eliza R Macdonald
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia.
| | - Nadia M L Amorim
- Centre for Inflammation, Faculty of Science, School of Life Sciences, Centenary Institute and University of Technology Sydney, Sydney, NSW, Australia
| | - Amanda D Hagstrom
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - Katarina Markovic
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - David Simar
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - Rachel E Ward
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
| | - Briana K Clifford
- School of Health Sciences, Department of Exercise Physiology, UNSW, Sydney, Sydney, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane, Australia
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Álvarez-Salvago F, Gutiérrez-García P, Molina-García C, Atienzar-Aroca S, Jiménez-García JD, Aibar-Almazán A, Martínez-Amat A, Pujol-Fuentes C. Is it really over when it is over? physical, mental and emotional health status of long-term breast cancer survivors compared to healthy matched controls. Support Care Cancer 2024; 32:641. [PMID: 39242365 DOI: 10.1007/s00520-024-08830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE This study aimed to assess pain, fitness condition, physical activity (PA) level, comorbidities, cancer-related fatigue (CRF), mood state and health-related quality of life (HRQoL) in long-term breast cancer survivors (LTBCS) compared to women without cancer history, matched by age, weight, height, and educational level. METHODS A cross-sectional study conducted in Granada between April 2018 and July 2023 involved 80 LTBCS and 80 matched controls. Pain, fitness condition, PA level, comorbidities, CRF, mood state, and HRQoL were evaluated ≥ 5 years post-diagnosis using validated instruments. RESULTS LTBCS, compared to the controls, reported significantly higher levels of "pain intensity and interference", CRF (in all domains and > 40% exhibited moderate-to-severe fatigue levels), "sadness-depression", "anxiety", "anger/hostility", and "symptom scales" (All: P = .000 to .027). Moreover, 66.25% of LTBCS not only did not reach recommended PA levels (P = .035), but also presented significantly lower levels of "general physical fitness", "muscular strength", "happiness", "functioning scales" (except "emotional functioning"), and "global health status" (All: P = .000 to .048). CONCLUSION LTBCS still suffer from physical (pain, fitness condition, and CRF), both mental and emotional (sadness-depression, anxiety and anger/hostility) long-term side effects as well as multiple HRQoL issues (including lower levels of physical functioning and higher levels of symptoms). These findings highlight the chronic nature of this disease and the importance of continuing long- term follow-up care for survivors many years after the diagnosis of breast cancer.
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Affiliation(s)
- Francisco Álvarez-Salvago
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Palmira Gutiérrez-García
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
| | | | - Sandra Atienzar-Aroca
- Department of Dentistry, Faculty of Health Sciences, European University of Valencia, Paseo de La Alameda 7, 46010, Valencia, Spain.
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Clara Pujol-Fuentes
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
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35
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Li H, Zhao W, Chang C, Xuan T, Wang C, Zhang R, Yang C, Wang J, Yi C, Wang X, Yu S, Li J. Efficacy and patient-reported outcomes in advanced non-small cell lung cancer patients receiving aumolertinib as first-line therapy: a real-world study. Front Pharmacol 2024; 15:1444707. [PMID: 39323634 PMCID: PMC11422657 DOI: 10.3389/fphar.2024.1444707] [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: 06/06/2024] [Accepted: 08/12/2024] [Indexed: 09/27/2024] Open
Abstract
Background Aumolertinib demonstrated superior progression-free survival (PFS) and a well-tolerated toxicity profile compared to gefitinib in front-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) in the AENEAS trial. However, patient-reported outcomes (PROs) of aumolertinib have not been published. Methods In this real-world study, the efficacy was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0. PROs were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (QLQ-C30) and the EORTC Quality of Life lung cancer-specific module (QLQ-LC13) in advanced NSCLC patients receiving aumolertinib as initial therapy. Pre-specified key symptoms were cough, hemoptysis, dyspnea, sore mouth or tongue, dysphagia, hair loss, tingling in hands or feet, chest pain, arm or shoulder pain, and pain at other sites. Results A total of 33 patients were included, 23 of whom had efficacy information up to January 2024. The median follow-up time was 264 days (interval: 36-491 days). The objective response rate and disease control rate were 65.2% and 91.3%, respectively. The EORTC QLQ-LC30 general health status scale showed that functional scales increased and symptom scales decreased during aumolertinib treatment. Symptom scales assessed by the EORTC QLQ-LC13 showed that improvements in cough, sore mouth or tongue, tingling in hands or feet, chest pain, arm or shoulder pain, and other pain sites were both clinically and statistically significant after 6 months of aumolertinib treatment (p < 0.05). Conclusion In this real-world study, aumolertinib showed comparable disease control and objective response rates as reported in the AENEAS trial for advanced NSCLC patients with EGFR-sensitizing mutations. Aumolertinib treatment improved PROs, further supporting it in first-line clinical practice.
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Affiliation(s)
- Hongxin Li
- School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wen Zhao
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Caiyun Chang
- Department for Infectious Disease Control and Prevention, Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Tiantian Xuan
- Department of Medical Oncology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
| | - Chengjun Wang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Rongyu Zhang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chuang Yang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jian Wang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Cuihua Yi
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuwen Wang
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shuwen Yu
- School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Pharmacy, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Clinical Trial Center, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drugs, Shandong University, Jinan, Shandong, China
| | - Jisheng Li
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Fassier JB, Guittard L, Fervers B, Rouat S, Sarnin P, Carretier J, Broc G, Letrilliart L, Péron J, Lamort-Bouché M. Using intervention mapping to facilitate and sustain return-to work after breast cancer: protocol for the FASTRACS multicentre randomized controlled trial. BMC Cancer 2024; 24:1107. [PMID: 39237867 PMCID: PMC11378548 DOI: 10.1186/s12885-024-12796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/12/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Women with breast cancer face many barriers to return to work (RTW) after their cancer. The main objective of the FASTRACS-RCT is to evaluate the impact of the FASTRACS (Facilitate and Sustain Return to Work after Breast Cancer) intervention on the sustainable RTW of breast cancer patients, 12 months after the end of active treatment. METHODS FASTRACS-RCT is a prospective, national, multicentre, randomized, controlled and open-label study. A total of 420 patients with early breast cancer scheduled for surgery and (neo)adjuvant chemotherapy, will be randomly assigned (1:1 ratio) to: (i) the intervention arm comprising four steps over 6 months : Handing over the intervention tools; transitional medical consultation with the general practitioner (GP); pre-RTW visit with the company's occupational physician (OP); catch-up visit with a hospital-based RTW expert (if sick leave > 10 months) (ii) the control arm to receive usual care. The design of the FASTRACS intervention was informed by intervention mapping for complex interventions in health promotion planning, and involved patients and representatives of relevant stakeholders. Specific tools were developed to bridge the gap between the hospital, the GP, the OP and the workplace: a toolkit for breast cancer patients comprising a theory-based guide; specific checklists for the GP and the OP, respectively; and a theory-based guide for workplace actors (employer, manager, colleagues). The primary endpoint will associate sustainable RTW (full-time or part-time work at 50% or more of working time, for at least 28 consecutive days) and days off work. It will be assessed at 4, 8 and 12 months after the end of active oncological treatment. Secondary endpoints will include quality of life, anxiety, depression, RTW self-efficacy, physical activity, social support, job accommodations, work productivity, job status, and the usefulness and acceptability of the intervention's tools. DISCUSSION FASTRACS-RCT will be supplemented by a realist evaluation approach aimed at understanding the influence of context in activating the intervention's mechanisms and effects. If the expected impact of the intervention is confirmed, the intervention will be adapted and scaled-up for other cancers and chronic diseases to better integrate healthcare and work disability prevention. TRIAL REGISTRATION NCT04846972 ; April 15, 2021.
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Grants
- INCa Amorçage, RISP no 2016-003 Institut National Du Cancer
- AAP ONCOSTARTER 2016 Cancéropôle Auvergne Rhône Alpes (CLARA)
- Délibération 2016-1445 projets structurants 2016 2017 Métropole du Grand Lyon
- 2017-2018 Direction Régionale de l'économie, de l'emploi, du travail, et des solidarités (DREETS) Auvergne Rhône Alpes
- INCa, RISP no 2018-025 Institut National du Cancer
- Appel à initiatives 2020 Association nationale de GEstion du Fonds pour l'Insertion Professionnelle des personnes Handicapées (Agefiph) et Direction Régionale des Entreprises, de la Concurrence, de la Consommation, du Travail et de l'Emploi (DIRECCTE, nouvellement DREETS )
- Direction Régionale de l’économie, de l’emploi, du travail, et des solidarités (DREETS) Auvergne Rhône Alpes
- Financement mixte avec la Caisse de Retraite et de Prévoyance des Clercs et Employés de Notaires
- Association nationale de GEstion du Fonds pour l’Insertion Professionnelle des personnes Handicapées (Agefiph) et Direction Régionale des Entreprises, de la Concurrence, de la Consommation, du Travail et de l’Emploi (DIRECCTE, nouvellement DREETS )
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Affiliation(s)
- Jean-Baptiste Fassier
- Université Claude Bernard Lyon 1, Université Gustave Eiffel, UMRESTTE UMR T9405, 8 Avenue Rockefeller, Lyon, France.
- Hospices Civils de Lyon, Service de Médecine et Santé au Travail, Pôle de Santé Publique, Lyon, France.
| | - Laure Guittard
- Hospices Civils de Lyon, Service Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Lyon, France
- Research on Healthcare Performance RESHAPE, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Béatrice Fervers
- Centre Léon Bérard (CLB), Départment Cancer et Environment, Lyon, France
- Radiations: Defense, Health & Environment, INSERM U1296, Lyon, France
| | - Sabrina Rouat
- Université Lumière Lyon 2, GREPS EA 4163, Lyon, France
| | | | - Julien Carretier
- Université Claude Bernard Lyon 1, P2S, UR4129, Lyon, France
- Centre National des Soins Palliatifs et de La Fin de Vie, Paris, France
| | - Guillaume Broc
- Université Paul-Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
| | - Laurent Letrilliart
- Research on Healthcare Performance RESHAPE, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, University General Practice Department (CUMG), Lyon, France
| | - Julien Péron
- Research on Healthcare Performance RESHAPE, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Service D'oncologie médicale, Hospices Civils de Lyon, Institut de Cancérologie, Lyon, France
| | - Marion Lamort-Bouché
- Research on Healthcare Performance RESHAPE, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, University General Practice Department (CUMG), Lyon, France
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Hahn EA, Pugh SL, Lu HL, Vela AM, Gillespie EF, Nichols EM, Wright JL, MacDonald SM, Cahlon O, Baas C, Braunstein LZ, Fang LC, Freedman GM, Jimenez RB, Kesslering CM, Mishra MV, Mutter RW, Ohri N, Rosen LR, Urbanic JJ, Jagsi R, Mitchell SA, Bekelman JE, Cella D. Validation of Patient-Reported Outcomes in Patients With Nonmetastatic Breast Cancer Receiving Comprehensive Nodal Irradiation in the RadComp Trial. Int J Radiat Oncol Biol Phys 2024; 120:149-161. [PMID: 38739047 PMCID: PMC11329347 DOI: 10.1016/j.ijrobp.2024.03.020] [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: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Our purpose was to evaluate the measurement properties of patient-reported outcome (PRO) measures used in the ongoing RadComp pragmatic randomized clinical trial (PRCT). METHODS AND MATERIALS The deidentified and blinded data set included 774 English-speaking female participants who completed their 6-month posttreatment assessment. Eleven PRO measures were evaluated, including the Trial Outcome Index from the Functional Assessment of Cancer Therapy-Breast (FACT-B), Satisfaction with Breast Cosmetic Outcomes, the BREAST-Q, and selected Patient-Reported Outcomes Measurement Information System (PROMIS) measures. PROs were measured at 3 timepoints: baseline, completion of radiation therapy (RT), and 6 months post-RT. Ten variables were used as validity anchors. Pearson or Spearman correlations were calculated between PROs and convergent validity indicators. Mean PRO differences between clinically distinct categories were compared with analysis of variance methods (known-groups validity). PRO change scores were mapped to change in other variables (sensitivity to change). RESULTS Most correlations between PROs and validity indicators were large (≥0.5). Mean score for Satisfaction with Breast Cosmetic Outcomes was higher (better) for those with a lumpectomy compared with those with a mastectomy (P < .001). Mean scores for the FACT-B Trial Outcome Index and for PROMIS Fatigue and Ability to Participate in Social Roles and Activities were better for those with good baseline performance status compared with those with poorer baseline performance status (P < .05). At completion of RT and post-RT, mean scores for Satisfaction with Breast Cosmetic Outcomes and BREAST-Q Radiation were significantly different (P < .001) across categories for all Functional Assessment of Chronic Illness Therapy -Treatment Satisfaction - General items. There were medium-sized correlations between change scores for FACT-B Trial Outcome Index, Fatigue, Anxiety, and Ability to Participate in Social Roles and change scores in the Visual Analog Scale. CONCLUSIONS For patients with nonmetastatic breast cancer receiving radiation in the RadComp PRCT, our findings demonstrate high reliability and validity for important PRO measures, supporting their psychometric strength and usefulness to reflect the effect of RT on health-related quality of life.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hien L Lu
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alyssa M Vela
- Department of Cardiac Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oren Cahlon
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - Carole Baas
- Alamo Breast Cancer Foundation, San Antonio, Texas
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Gary M Freedman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert W Mutter
- Department of Radiation Oncology and Pharmacology, Mayo Clinic Axis School of Medicine, Rochester, Minnesota
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Lane R Rosen
- Department of Radiation Oncology, Willis-Knighton Health System, Shreveport, Louisiana
| | - James J Urbanic
- Department of Radiation Oncology, UC San Diego School of Medicine, San Diego, California
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Institutes of Health, Bethesda, Maryland
| | - Justin E Bekelman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Oliveira M, Rugo HS, Howell SJ, Dalenc F, Cortes J, Gomez HL, Hu X, Toi M, Jhaveri K, Krivorotko P, Loibl S, Morales Murillo S, Okera M, Nowecki Z, Park YH, Sohn JH, Tokunaga E, Yousef S, Zhukova L, Fulford M, Andrews H, Wadsworth I, D'Cruz C, Turner NC. Capivasertib and fulvestrant for patients with hormone receptor-positive, HER2-negative advanced breast cancer (CAPItello-291): patient-reported outcomes from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol 2024; 25:1231-1244. [PMID: 39214106 DOI: 10.1016/s1470-2045(24)00373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND CAPItello-291 is an ongoing phase 3 trial in which capivasertib-fulvestrant significantly improved progression-free survival versus placebo-fulvestrant in patients with hormone receptor-positive, HER2-negative advanced breast cancer who had relapse or disease progression during or after aromatase inhibitor treatment, in both the overall population and in patients with PIK3CA, AKT1, or PTEN-altered tumours. This study further explored patient-reported health-related quality of life (HRQOL), functioning, symptoms, and symptom tolerability in CAPItello-291. METHODS This phase 3, randomised, double-blind, placebo-controlled trial, which was conducted across 193 hospitals and cancer centres in 19 countries, enrolled women with any menopausal status or men, aged ≥18 years (≥20 years in Japan), with hormone receptor-positive, HER2-negative locally advanced or metastatic breast cancer who had relapse or disease progression during or after treatment with an aromatase inhibitor, with or without previous cyclin-dependent kinase (CDK) 4 or 6 inhibitor therapy. Patients had an Eastern Cooperative Oncology Group/WHO performance score of 0 or 1 and could have received up to two previous lines of endocrine therapy and up to one previous line of chemotherapy for advanced disease. Patients were randomly assigned (1:1) using block randomisation (stratified according to the presence or absence of liver metastases, previous use of a CDK4/6 inhibitor [yes vs no], and geographical region) to receive oral capivasertib 400 mg (twice daily for 4 days, followed by 3 days off) plus intramuscular fulvestrant 500 mg (every 14 days for the first three injections, then every 28 days) or placebo with matching fulvestrant dosing. The dual primary endpoint of the trial was investigator-assessed progression-free survival assessed both in the overall population and among patients with PIK3CA, AKT1, or PTEN-altered tumours. The EORTC Quality of Life Questionnaire 30-item core module (QLQ-C30) and breast module (QLQ-BR23), Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), and Patient Global Impression of Treatment Tolerability (PGI-TT) questionnaires were used to assess patient-reported outcomes. Evaluation of EORTC QLQ-C30 and EORTC QLQ-BR23 were secondary endpoints and evaluation of PRO-CTCAE and PGI-TT were pre-defined exploratory endpoints, and these endpoints are the subject of analysis in this Article. Data were collected at baseline and prespecified timepoints. Patient-reported outcomes were analysed in all randomly assigned patients with an evaluable baseline assessment and at least one evaluable post-baseline assessment. Change from baseline was assessed using mixed model with repeated measures for EORTC QLQ-C30 and summarised for QLQ-BR23. Time to deterioration was described using the Kaplan-Meier method. PGI-TT and PRO-CTCAE responses were summarised at each treatment cycle. Patient-reported outcomes were not prospectively powered for statistical comparison. The trial is registered with ClinicalTrials.gov, NCT04305496. FINDINGS Between June 2, 2020, and Oct 13, 2021, 901 patients were enrolled, of whom 708 patients were randomly assigned to receive capivasertib-fulvestrant (n=355) or placebo-fulvestrant (n=353). The median age of the patients was 59 years (IQR 51-67) in the capivasertib-fulvestrant group and 58 years (IQR 49-66) in the placebo-fulvestrant group. At data cutoff (Aug 15, 2022), the median duration of follow-up for progression-free survival in censored patients was 13·0 months (IQR 9·1-16·7) for capivasertib-fulvestrant and 12·7 months (IQR 2·0-16·4) for placebo-fulvestrant in the overall population. EORTC QLQ-C30 global health status/quality of life (GHS/QOL) scores were maintained from baseline and were similar between treatment groups throughout the study period (difference in mean change from baseline of -2·5 [95% CI -4·5 to -0·6] with capivasertib-fulvestrant vs -5·6 [-7·9 to -3·4] with placebo-fulvestrant; treatment difference 3·1 [95% CI 0·2 to 6·0]). Median time to deterioration in EORTC QLQ-C30 GHS/QOL was 24·9 months (95% CI 13·8 to not reached) in the capivasertib-fulvestrant group and 12·0 months (10·2 to 15·7) in the placebo-fulvestrant group (hazard ratio [HR] 0·70, 95% CI 0·53 to 0·92). Time to deterioration HRs for all EORTC QLQ-C30 and QLQ-BR23 subscale scores showed little difference between the treatment groups, except for diarrhoea, which was worse in the capivasertib-fulvestrant group than in the placebo-fulvestrant group (HR 2·75, 95% CI 2·01-3·81). In PRO-CTCAE symptom assessment, the proportion of patients reporting loose and watery stools "frequently" or "almost constantly" was 29% higher at cycle 1, day 15 in the capivasertib-fulvestrant group than in the placebo-fulvestrant group, decreasing at subsequent cycles. Other PRO-CTCAE-reported symptoms (rash, mouth or throat sores, itchy skin, and numbness or tingling in hands or feet) were absent or mild in most patients in both groups throughout treatment. According to the PGI-TT, most patients in both groups reported "not at all" or "a little bit" of bother from treatment side-effects. INTERPRETATION Patient-reported outcomes from CAPItello-291 demonstrated that capivasertib-fulvestrant delayed time to deterioration of GHS/QOL and maintained other dimensions of HRQOL (except symptoms of diarrhoea) similarly to fulvestrant. With the clinical efficacy and manageable safety profile, these exploratory results further support the positive benefit-risk profile of capivasertib-fulvestrant in this population. FUNDING AstraZeneca.
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Affiliation(s)
- Mafalda Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital, and Breast Cancer Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | - Florence Dalenc
- Oncopole Claudius Regaud, Institut Universitaire du Cancer-Toulouse, Toulouse, France
| | - Javier Cortes
- Oncology Department, International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Group, Medica Scientia Innovation Research (MedSIR), Barcelona, Spain; Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Henry L Gomez
- Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas (INEN) and Universidad Ricardo Palma, Lima, Peru
| | - Xichun Hu
- Shanghai Cancer Center, Fudan University, Shanghai, China
| | | | - Komal Jhaveri
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Petr Krivorotko
- Petrov Research Institute of Oncology, St Petersburg, Russia
| | - Sibylle Loibl
- GBG Forschungs GmbH, Neu-Isenburg and Centre for Haematology and Oncology, Frankfurt, Germany
| | | | | | - Zbigniew Nowecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Yeon Hee Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Joo Hyuk Sohn
- Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, South Korea
| | | | | | | | | | | | - Ian Wadsworth
- Oncology R&D, AstraZeneca, Cambridge, UK; PHASTAR, London, UK
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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.
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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
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Muñoz-Lerma A, Sánchez-Sánchez R, Ruiz-Vozmediano J, Yebras Cano T, González-Jiménez A, Jurado-Fasoli L. Effect of a multimodal intervention in breast Cancer patients undergoing neoadjuvant therapy: A study protocol of the multimodal project. Contemp Clin Trials 2024; 143:107598. [PMID: 38838986 DOI: 10.1016/j.cct.2024.107598] [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: 02/12/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND AIMS To determine the effect of a multimodal intervention (nutritional behavior change and physical exercise) on quality of life, chemotherapy response rate and tolerance, histopathological level of the tumor, body composition, and biochemical parameters, in patients diagnosed with breast cancer during neoadjuvant chemotherapy treatment, and to compare them with the control group. METHODS Anticipated 80 patients diagnosed with breast cancer aged 18-70 years will be recruited for this randomized, unblinded clinical trial based on a nutritional behavior change and physical exercise in patients during the approximately 6 months in which the patient receives neoadjuvant treatment. Participants will be randomly allocated (1:1) to one of two groups (intervention or control). Primary and secondary outcomes will be assessed before the beginning and after the neoadjuvant treatment (before surgery). The primary outcome is quality of life, whereas secondary outcomes include chemotherapy response rate and tolerance, histopathological level of the tumor and body composition (i.e., visceral adipose tissue activity, bone, lean and fat masses). We will analyze blood parameters (i.e., biochemical, inflammatory, and tumor markers) as exploratory outcomes. CONCLUSION This study will address the influence of a practical and viable multimodal intervention (i.e., nutritional behavior change and physical exercise) on breast cancer patients undergoing neoadjuvant chemotherapy. Given the practical viability of the intervention in real-world settings, our study holds promise for significant scientific and clinical implications.
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Affiliation(s)
- Amelia Muñoz-Lerma
- Servicio de Oncología Médica, Hospital Universitario Virgen de las Nieves, 18004 Granada, Spain.
| | - Rocío Sánchez-Sánchez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, 18004 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Julia Ruiz-Vozmediano
- Servicio de Oncología Médica, Hospital Universitario Virgen de las Nieves, 18004 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain; Centro de Oncología Integrativa Onconature, 18418 Granada, Spain
| | | | | | - Lucas Jurado-Fasoli
- Department of Physiology, Faculty of Medicine, University of Granada, 18071 Granada, Andalucía, Spain; Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Carretera de Alfacar s/n, 18071 Granada, Spain
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Robins VR, Gelcich S, Absolom K, Velikova G. The impact of age on physical functioning after treatment for breast cancer, as measured by patient-reported outcome measures: A systematic review. Breast 2024; 76:103734. [PMID: 38691921 PMCID: PMC11070762 DOI: 10.1016/j.breast.2024.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE This systematic review aims to explore the impact of age on physical functioning post-treatment for early-stage, locally advanced, or locally recurrent breast cancer, as measured by patient-reported outcome measures (PROMs), identify PROMs used and variations in physical functioning terms/labels. METHODS MEDLINE, EmBase, PsycINFO, CINAHL and AMED were searched, along with relevant key journals and reference lists. Risk of bias (quality) assessment was conducted using a Critical Appraisal Skills Programme checklist. Data was synthesised through tables and narrative. RESULTS 28,207 titles were extracted from electronic databases, resulting in 44 studies with age sub-groups, and 120 without age sub-groups. Of those with findings on the impact of age, there was variability in the way findings were reported and 21 % found that age did not have a significant impact. However, 66 % of the studies found that with older age, physical functioning declined post-treatment. Comorbidities were associated with physical functioning declines. However, findings from sub-groups (breast cancer stage, treatment type and time post-treatment) lacked concordance. Twenty-eight types of PROM were used: the EORTC QLQ-C30 was most common (50.6 %), followed by the SF-36 (32.3 %). There were 145 terms/labels for physical functioning: 'physical functioning/function' was used most often (82.3 %). CONCLUSIONS Findings point towards an older age and comorbidities being associated with more physical functioning declines. However, it was not possible to determine if stage, treatment type and time since treatment had any influence. More consistent use of the terminology 'physical functioning/function' would aid future comparisons of study results.
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Affiliation(s)
- V R Robins
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - S Gelcich
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - K Absolom
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK.
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Ren JH, Wang Y, Zhang X, Cheng Q, Wang K, Liu Q, Tang R, Yang L, Gong J, Xu J, Li H. A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study. Aesthetic Plast Surg 2024; 48:3109-3119. [PMID: 37821554 DOI: 10.1007/s00266-023-03631-5] [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: 06/01/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Approximately 25-30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate. METHODS A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire. RESULTS The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6-69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13). CONCLUSION Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- J H Ren
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiang Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qiao Cheng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kang Wang
- Department of Oncology-Pathology, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Qiang Liu
- The People's Hospital of Dazu, Chongqing, China
| | - Renxi Tang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ling Yang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junge Gong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jiawei Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongyuan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Cao S, Wei Y, Huang J, Yue Y, Deng A, Zeng H, Wei W. A bibliometric worldview of breast-conserving surgery for breast cancer from 2013 to 2023. Front Oncol 2024; 14:1405351. [PMID: 39099692 PMCID: PMC11294094 DOI: 10.3389/fonc.2024.1405351] [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: 03/22/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Over the last decade, significant advancements have been made in breast-conserving surgery (BCS) for breast cancer. However, there is a lack of analytical and descriptive investigations on the trajectory, essential research directions, current research scenario, pivotal investigative focuses, and forthcoming perspectives. The objective of this research is to provide a thorough update on the progress made in BCS for breast cancer over the preceding decade. Retrieved from the Web of Science database, the data span from January 1, 2013, to November 30, 2023. Utilizing a set of advanced analytical instruments, we conducted comprehensive bibliometric and visual analyses. The findings underscore the predominant influence of the USA, representing 35.77% of the overall publications and playing a pivotal role in shaping research within this field. Notable productivity was evident at various institutions, including the Memorial Sloan Kettering Cancer Center, the University of Texas MD Anderson Cancer Center, and the University of Toronto. Annals of Surgical Oncology contributed the most publications in this field. An examination of keywords indicated a change in the concentration of research attention, transitioning from molecular subtype, ultrasonography, and intraoperative aspects to SEER, male breast cancer, and adjuvant measures. By offering a comprehensive bibliometric assessment, this study enhances our understanding of BCS for breast cancer. Consequently, this benefits both experienced researchers and newcomers alike, providing prompt access to essential information and fostering the extraction of innovative concepts within this specific field.
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Affiliation(s)
- Siyang Cao
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Orthopaedic Diseases and Biomaterials Research, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yihao Wei
- National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Orthopaedic Diseases and Biomaterials Research, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jing Huang
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yaohang Yue
- National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Orthopaedic Diseases and Biomaterials Research, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Aishi Deng
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Hui Zeng
- National & Local Joint Engineering Research Centre of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Orthopaedic Diseases and Biomaterials Research, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Wei Wei
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Stafford L, Sinclair M, Butow P, Hughes J, Park A, Gilham L, Rose A, Mann GB. Quality of Life Outcomes Associated With Optimization of Treatment by Omitting Radiotherapy in Early Breast Cancer. Clin Breast Cancer 2024; 24:447-456.e2. [PMID: 38548516 DOI: 10.1016/j.clbc.2024.03.002] [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: 12/08/2023] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE Improved prognosis of early breast cancer (EBC) has created opportunities for treatment optimization but reducing morbidity should not inadvertently compromise quality of life (QoL). PROSPECT1 used pre-operative MRI and pathology findings to identify women suitable for radiotherapy (RT) omission following breast conserving surgery. We retrospectively explored the association between de-escalation by omission of RT and QoL in women with EBC. MATERIALS AND METHODS Three groups were recruited: PROSPECT participants who omitted RT following preoperative MRI (A); participants who received RT following preoperative MRI (B); and women who received usual care - No MRI, received RT (C). Measures included the EORTC QLQ-C30 and BR23, BCTOS, DASS-21 and a measure of decision regret. Between group differences were assessed using ANOVA or nonparametric equivalents. Semi-structured interviews were analyzed with qualitative description (n = 44). RESULTS Data from 400 women were analyzed (125A, 102B, 173C). Group A had fewer symptoms and better body image (breast symptoms: A-B P = .003, A-C P = <.001; arm symptoms: A-B P = .004, A-C P = .011; body image: A-C P = .041) and fewer differences between the treated and untreated breasts (cosmetic: A-B P < .001, A-C P < .001; functional: A-C P = .011; breast specific pain: A-B P < .001, A-C P < .001). Two qualitative themes were found: Treatment with the biggest impact on QoL, and Specific impact of RT on QoL. CONCLUSIONS Omission of RT was associated with better QoL and functional and cosmetic outcomes. It was highly acceptable to patients. Clinicians should consider the potential for preserved QoL associated with treatment optimization via omission of RT in treatment planning for patients with EBC.
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Affiliation(s)
- Lesley Stafford
- Familial Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | | | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Janemary Hughes
- The Breast Service, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia
| | - Allan Park
- The Breast Service, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia
| | - Leslie Gilham
- Breast Cancer Trials, Newcastle, New South Wales, Australia
| | - Allison Rose
- The Breast Service, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia; Northwestern Breast Screen, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Victoria, Australia; The Breast Service, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia; Breast Cancer Trials, Newcastle, New South Wales, Australia
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Kregting LM, Vrancken Peeters NJMC, Clarijs ME, Koppert LB, Korfage IJ, van Ravesteyn NT. Health utility values of breast cancer treatments and the impact of varying quality of life assumptions on cost-effectiveness. Int J Cancer 2024; 155:117-127. [PMID: 38478916 DOI: 10.1002/ijc.34899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/01/2023] [Accepted: 02/06/2024] [Indexed: 05/04/2024]
Abstract
In breast cancer research, utility assumptions are outdated and inconsistent which may affect the results of quality adjusted life year (QALY) calculations and thereby cost-effectiveness analyses (CEAs). Four hundred sixty four female patients with breast cancer treated at Erasmus MC, the Netherlands, completed EQ-5D-5L questionnaires from diagnosis throughout their treatment. Average utilities were calculated stratified by age and treatment. These utilities were applied in CEAs analysing 920 breast cancer screening policies differing in eligible ages and screening interval simulated by the MISCAN-Breast microsimulation model, using a willingness-to-pay threshold of €20,000. The CEAs included varying sets on normative, breast cancer treatment and screening and follow-up utilities. Efficiency frontiers were compared to assess the impact of the utility sets. The calculated average patient utilities were reduced at breast cancer diagnosis and 6 months after surgery and increased toward normative utilities 12 months after surgery. When using normative utility values of 1 in CEAs, QALYs were overestimated compared to using average gender and age-specific values. Only small differences in QALYs gained were seen when varying treatment utilities in CEAs. The CEAs varying screening and follow-up utilities showed only small changes in QALYs gained and the efficiency frontier. Throughout all variations in utility sets, the optimal strategy remained robust; biennial for ages 40-76 years and occasionally biennial 40-74 years. In sum, we recommend to use gender and age stratified normative utilities in CEAs, and patient-based breast cancer utilities stratified by age and treatment or disease stage. Furthermore, despite varying utilities, the optimal screening scenario seems very robust.
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Affiliation(s)
- Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marloes E Clarijs
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Academic Breast Cancer Center, Department of Oncologic and Gastro-intestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Tiberio P, Balordi M, Castaldo M, Viganò A, Jacobs F, Benvenuti C, Torrisi R, Zambelli A, Santoro A, De Sanctis R. Empowerment, Pain Control, and Quality of Life Improvement in Early Triple-Negative Breast Cancer Patients through Pain Neuroscience Education: A Prospective Cohort Pilot Study Protocol (EMPOWER Trial). J Pers Med 2024; 14:711. [PMID: 39063964 PMCID: PMC11278336 DOI: 10.3390/jpm14070711] [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: 05/30/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
The treatment of early triple-negative breast cancer (eTNBC) has improved patients' prognosis but often leads to adverse events and sequelae affecting quality of life (QoL). Pain Neuroscience Education (PNE) is a promising non-pharmacological intervention in this field. Preliminary data have shown the beneficial effect of PNE in BC survivors. However, there are still gaps in knowledge regarding its optimal use in eTNBC. To address this issue, a prospective pilot study will enroll 30 consecutive patients diagnosed with eTNBC at IRCCS Humanitas Research Hospital. The PNE program will consist of 10 weekly sessions to be started within 4 weeks of the onset or worsening of a pain syndrome (PS). QoL, pain, and disability will be assessed before, during, at the end of, and 6 months after PNE using validated questionnaires. Peripheral venous blood samples will be taken before and at the end of PNE to evaluate inflammatory serum biomarker levels. The primary objective is to evaluate whether PNE leads to clinical improvement in QoL and pain. If successful, it will be validated in a larger multi-centric cohort, potentially leading to its widespread implementation as a standard pain management tool for eTNBC patients.
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Affiliation(s)
- Paola Tiberio
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
| | - Marco Balordi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
| | - Matteo Castaldo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, Sensory Motor Interaction (SMI), Aalborg University, 9220 Aalborg, Denmark
- Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Labs, Parma University, 43126 Parma, Italy
| | | | - Flavia Jacobs
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
| | - Chiara Benvenuti
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
| | - Rosalba Torrisi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
| | - Alberto Zambelli
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
| | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
| | - Rita De Sanctis
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.T.); (F.J.); (C.B.); (R.T.); (A.Z.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (M.B.); (M.C.)
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Contreras Sánchez SE, Doubova SV, Martinez Vega IP, Grajales Álvarez R, Villalobos Valencia R, Dip Borunda AK, Lio Mondragón L, Martínez Pineda WJ, Nuñez Cerrillo JG, Huerta López AD, Zalapa Velázquez R, Mendoza Ortiz V, Vázquez Zamora VJ, Montiel Jarquín ÁJ, García Galicia A, Talamantes Gómez EI, Sánchez Reyes R, Aguirre Gómez J, Ayala Anzures ME, Zapata Tarrés M, Monroy A, Leslie HH. Addressing the unmet needs of women with breast cancer in Mexico: a non-randomised pilot study of the digital ePRO intervention. BMJ Open 2024; 14:e087240. [PMID: 38908841 PMCID: PMC11328655 DOI: 10.1136/bmjopen-2024-087240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024] Open
Abstract
OBJECTIVES This study aimed to explore the acceptability, feasibility, usability, and preliminary effect of an electronic patient-reported outcome (ePRO) intervention for patients with breast cancer in Mexico. DESIGN We conducted a multimethod non-randomised pilot study. We used a pre-test/post-test design for quantitative assessment of the intervention's effect on patients' supportive care needs and quality of life. We conducted in-depth interviews (IDIs) with participants and healthcare workers to explore the intervention's benefits and barriers and understand its feasibility. PARTICIPANTS 50 women aged 20-75 diagnosed with stage I-III breast cancer were enrolled within 2 weeks of starting neoadjuvant or adjuvant treatment with chemotherapy or radiotherapy. We excluded illiterate women and those with visual impairment, cognitive disability or severe depression. IDIs were conducted with 18 participants and 10 healthcare providers. SETTING Oncology services in three public hospitals of the Mexican Social Security Institute. INTERVENTION The ePRO intervention consisted of a responsive web application for weekly symptom reporting combined with proactive follow-up by nurses guided by predefined clinical algorithms for 6 weeks. RESULTS 50 women were enrolled out of 66 eligible patients approached (75.8%). All 50 completed the 4-week follow-up assessment (100% retention). Completion of the symptom registry declined from 100% in week 1 to 66% in week 6. Participants experienced decreases in supportive care needs and increased quality of life. The ePRO application was rated highly usable. Participants and health professionals both perceived intervention benefits. Drawbacks included poor fit for women receiving radiotherapy and challenges using the application for women with low digital literacy or experiencing severe symptoms. CONCLUSIONS This pilot study provided evidence of the high usability and potential efficacy of a web-based ePRO intervention. We revised recruitment during the pilot to include multiple facilities, and we will further revise for the randomised trial to address barriers to successful ePRO implementation. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT05925257.
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Affiliation(s)
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Ingrid Patricia Martinez Vega
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Rocío Grajales Álvarez
- Department of Oncology, Oncology Hospital CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Ricardo Villalobos Valencia
- Department of Oncology, Oncology Hospital CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Abdel Karim Dip Borunda
- Department of Oncology, Oncology Hospital CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Lorena Lio Mondragón
- Department of Radiation Oncology, Oncology Hospital CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Wendy Jazmín Martínez Pineda
- Department of Radiation Oncology, Oncology Hospital CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Jose Gustavo Nuñez Cerrillo
- Department of Oncology, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Alma Diana Huerta López
- Department of Oncology, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Rita Zalapa Velázquez
- Department of Oncology, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Valeria Mendoza Ortiz
- Department of Oncology, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Víctor Javier Vázquez Zamora
- Department of Oncology, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Álvaro José Montiel Jarquín
- Department of Education and Research, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Arturo García Galicia
- Department of Education and Research, Speciality Hospital CMN Manuel Ávila Camacho, Mexican Institute of Social Security, Mexico City, Mexico
| | - Enrique Isay Talamantes Gómez
- Department of Oncology, Obstetrics and Gynecology Hospital CMN La Raza, Mexican Institute of Social Security, Mexico City, Mexico
| | - Roberto Sánchez Reyes
- Department of Oncology, Obstetrics and Gynecology Hospital CMN La Raza, Mexican Institute of Social Security, Mexico City, Mexico
| | - Jaqueline Aguirre Gómez
- Department of Oncology, Obstetrics and Gynecology Hospital CMN La Raza, Mexican Institute of Social Security, Mexico City, Mexico
| | - María Eugenia Ayala Anzures
- Department of Oncology, Obstetrics and Gynecology Hospital CMN La Raza, Mexican Institute of Social Security, Mexico City, Mexico
| | - Marta Zapata Tarrés
- Research Coordination, IMSS Foundation, Mexican Institute of Social Security, Mexico City, Mexico
| | - Adriana Monroy
- Department of Oncology, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
| | - Hannah H. Leslie
- Division of Prevention Science, University of California, San Francisco, San Francisco, California, USA
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Ueberroth BE, Kosiorek HE, Nafissi NN, Ertz-Archambault N, Howland A, Haddad T, Northfelt DW. Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer. Support Care Cancer 2024; 32:412. [PMID: 38842732 DOI: 10.1007/s00520-024-08611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Automated scalp cooling (ASC) is available to patients undergoing chemotherapy for breast cancer to decrease chemotherapy-induced alopecia. This study sought to elucidate patient and chemotherapy nursing perspectives on the ASC experience. METHODS This is a survey-based study of chemotherapy nursing staff and patients with breast cancer regarding perceived efficacy, side effects, administration, support, and overall opinions of ASC. Chemotherapy nurses across a large, multi-regional tertiary healthcare system completed a one-time survey regarding their experiences in administering ASC. Breast cancer patients who utilized ASC were surveyed along with a control group who underwent alopecia-inducing chemotherapy without ASC use for comparison. RESULTS The majority of nursing responses reported inadequate technical support, an increased burden of administering ASC compared to other clinical duties, and that they would not recommend ASC to a family member or friend. Patients who underwent ASC reported significantly less hair loss and were significantly less likely to shave their heads or wear a wig, but this did not translate into significant differences in body image or psychosocial wellbeing responses. Time investment was the most significant burden related to ASC. CONCLUSION Patients using ASC reported significantly less hair loss compared to those not using ASC during alopecia-inducing breast cancer chemotherapy, but this did not translate to improved body image. The majority of chemotherapy nurses reported they lacked adequate support in administering ASC and would not recommend it. Enhanced nursing support may provide a means for improving the ASC experience for both nursing staff and patients.
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Affiliation(s)
- Benjamin E Ueberroth
- Department of Hematology/Oncology, University of Colorado Anschutz School of Medicine, 12801 E 17thAve, MS, Aurora, CO, 8117, USA.
| | - Heidi E Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Nellie N Nafissi
- Department of Hematology/Oncology, University of CA-Irvine, Irvine, CA, USA
| | | | | | - Tufia Haddad
- Mayo Clinic Comprehensive Cancer Center, Rochester, MN, USA
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Joaquim A, Amarelo A, Antunes P, Garcia C, Leão I, Vilela E, Teixeira M, Duarte B, Vieira M, Afreixo V, Capela A, Viamonte S, Costa H, Helguero LA, Alves A. Effects of a Physical Exercise Program on Quality of Life and Physical Fitness of Breast Cancer Survivors: the MAMA_MOVE Gaia After Treatment Trial. PSYCHOL HEALTH MED 2024; 29:964-987. [PMID: 37644639 DOI: 10.1080/13548506.2023.2240074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
To assess the effects of a group class physical exercise program on health-related quality of life (HRQOL), physical fitness and activity, and safety in early breast cancer women after treatment, a double-phase trial [16-week control phase (CP) followed by a 16-week intervention phase (IP)] was designed. Outcomes were evaluated at baseline (T1), 8 (T2) and 16 (T3) weeks (CP), and 24 (T4) and 32 (T5) weeks (IP). The primary endpoint was global health status. Out of 82 enrolled patients, 37 completed the IP. Global health status decreased (-10,1; 95% CI -19.8 to -0.4; p = 0.040) during the CP and stabilized during the IP. Physical and sexual functioning increased during the IP (p = 0.008; p = 0.017), while cardiorespiratory fitness increased in the CP (p = 0.004). Upper limb strength and lower limb functionality increased during both phases [CP: p < 0.0001, p = 0.001 (surgical and nonsurgical arm), p = 0.028; IP: p < 0.0001, p = 0.002, p = 0.009]. Body mass index decreased in the IP (p = 0.026). Waist circumference increased in the CP (p = 0.001) and decreased in the IP (p = 0.010); sedentary behaviours and moderate and vigorous physical activity did not change. Adherence to 70% of the sessions was reported in 54% of patients. No serious adverse events related to the intervention were reported. In conclusion, the physical exercise program was able to prevent the decline in global health status and to improve other domains of HRQOL and physical fitness. As physical exercise is not the standard of care in many countries, the implementation of group class programs might be an option.
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Affiliation(s)
- Ana Joaquim
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Anabela Amarelo
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Pedro Antunes
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Beira Interior, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Catarina Garcia
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Maia, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Inês Leão
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Eduardo Vilela
- Cardiology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Madalena Teixeira
- Cardiology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Bárbara Duarte
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Micael Vieira
- Solinca Classic, SA, SC Fitness, SA, Lisbon, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Vera Afreixo
- Department of Mathematics; University of Aveiro, Center for Research & Development in Mathematics and Applications (CIDMA), University of Aveiro
| | - Andreia Capela
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Sofia Viamonte
- Department of Medical Sciences, University of Aveiro Centro de Reabilitação Do Norte, Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Portugal
| | - Horácio Costa
- Department of Plastic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Department of Medical Sciences, University of Aveiro, Portugal
| | - Luisa A Helguero
- Department of Medical Sciences, University of Aveiro, Institute of Biomedicine of Aveiro (IBIMED), University of Aveiro, Aveiro, Portugal
| | - Alberto Alves
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Maia, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
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Schunn FA, El Shafie RA, Kronsteiner D, Sauer LD, Kudak A, Bougatf N, Oetzel D, Krämer A, Regnery S, Machmer T, Debus J, Nicolay NH. Oncologic treatment support via a dedicated mobile app: a prospective feasibility evaluation (OPTIMISE-1). Strahlenther Onkol 2024; 200:475-486. [PMID: 37947806 PMCID: PMC11111550 DOI: 10.1007/s00066-023-02166-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Mobile health (mhealth) is gaining interest, with mobile devices and apps being ever more available among medical facilities and patients. However, in the field of radiation oncology, the medical benefits of mhealth apps are still underexplored. As an additional approach to patient care during radiotherapy, we designed a mobile treatment surveillance app based on patient-reported outcomes. OBJECTIVE We aimed to examine the feasibility of app-based treatment surveillance in patients undergoing radiotherapy (RT). Alongside technical practicability and acceptance, we assessed patient satisfaction and quality of life during treatment. METHODS This prospective single-center study was performed at Heidelberg University Hospital between August 2018 and January 2020. During RT we measured patients' quality of life, symptoms, and treatment satisfaction. Respective questionnaires (EORTC QLQ-C30 with diagnosis-specific modules, RAND PSQ-18) were presented to patients via a mobile app running on a designated tablet device. The primary endpoint was determined by the fraction of patients who completed at least 80% of the items. Secondary endpoints were disease-related quality of life and patient satisfaction. RESULTS A total of 49 cancer patients (14 breast, 13 pelvic, 12 lung, 10 prostate) were eligible for analysis. 79.6% (95% confidence interval: 66.4-88.5%; n = 39) of all patients completed at least 80% of the items received by the mobile app. A mean of 227.5 ± 48.25 questions were answered per patient. Breast cancer patients showed the highest rate of answered questions, with 92.9% (n = 13) completing at least 80% of the items. CONCLUSION Patients showed high acceptance, with 79.6% (n = 39) completing at least 80% of the given items. The use of a mobile app for reporting symptoms and quality of life during RT is feasible and well accepted by patients. It may allow for resource-efficient, detailed feedback to the medical staff and assist in the assessment of side effects over time.
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Affiliation(s)
- Fabian A Schunn
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Radiation Oncology, Göttingen University Hospital, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Dorothea Kronsteiner
- Institute for Medical Biometry (IMBI), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Lukas D Sauer
- Institute for Medical Biometry (IMBI), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Andreas Kudak
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Dieter Oetzel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Anna Krämer
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | | | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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