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Ribeiro FE, Tebar WR, Ferrari G, Palma MR, Fregonesi CE, Caldeira DT, Silva GCR, Vanderlei LCM, Beretta VS, Christofaro DGD. Comparison of Quality of Life in Breast Cancer Survivors with and without Persistent Depressive Symptoms: A 12-Month Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3663. [PMID: 36834358 PMCID: PMC9966205 DOI: 10.3390/ijerph20043663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Although breast cancer treatments reduce mortality, their adverse effects can increase depression which impacts one's quality of life (QoL). Physical activity (PA) seems to improve the QoL of breast cancer survivors (BCS). However, an unanswered question is the influence of PA on the QoL in BCS with depressive symptoms. Thus, we analyzed the influence of PA on the QoL in BCS with persistent depressive symptoms during 12 months of follow-up. The sample included 70 female BCS. Depression and QoL domains (i.e., functional capacity, physical limitations, body pain, general health status, vitality, social and emotional aspects, and mental health) were assessed at baseline and follow-up periods by the Hospital Anxiety and Depression Scale and SF-36, respectively. Habitual PA was assessed by Baecke's questionnaire. Our results indicate a prevalence of 17.1% of depressive symptoms. Non-depressives BCS improved their physical limitations and general health status domains over time, but there were no observed differences in depressive BCS. BCS with persistent depressive symptoms (baseline and follow-up) showed worse QoL scores than non-depressives in all domains, regardless of confounding factors. When adjusted for PA, the difference between BCS depressives and non-depressives lost its significance in the functional capacity domain. In conclusion, habitual PA practice positively influenced the functional capacity domain of the QoL in BCS.
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Affiliation(s)
- Fernanda Elisa Ribeiro
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - William Rodrigues Tebar
- Center of Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, São Paulo 05403-000, Brazil
| | - Gerson Ferrari
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia 7500912, Chile
| | - Mariana Romanholi Palma
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - Cristina Elena Fregonesi
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - Daniela Tanajura Caldeira
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - Gabriela Caroline Rodrigues Silva
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - Luiz Carlos Marques Vanderlei
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - Victor Spiandor Beretta
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
| | - Diego Giulliano Destro Christofaro
- Physical Education Department, Graduate Program in Movement Sciences, School of Technology and Sciences, São Paulo State University (Unesp), São Paulo 19060-900, Brazil
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Rosa DD, Magliano CADS, Simon SD, Amorim G, Reinert T, Landeiro L, Gagliato DDM, Exman P, Argolo D, Guilgen G, Mano M, Testa L, Liedke P, Barroso R, Sasse M, Buehler AM. Cost-effectiveness of ribociclib for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a Brazilian public health care system perspective. Ther Adv Med Oncol 2022; 14:17588359221100865. [PMID: 36339925 PMCID: PMC9634995 DOI: 10.1177/17588359221100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: The MONALEESA-7 trial compared ribociclib plus endocrine therapy (ET) with
placebo as first-line treatment of advanced luminal/HER2-negative breast
cancer (ABC) in premenopausal and perimenopausal women (age <50 years)
and showed significant benefits to progression-free survival and overall
survival. This study aimed to compare the cost-effectiveness of
ribociclib + ET versus ET alone in patients with ABC from
the perspective of the Brazilian public national health system. Methods: We calculated the incremental cost-effectiveness ratio (ICER) using a Markov
model with progression-free survival, post-progression survival, and death
states. We expressed ICER as incremental costs per progression-free
life-year (PFLY) and quality-adjusted life-year (QALY) gained in a 10-year
time horizon. We used parametric survival distributions fit to MONALEESA-7
data to generate survival distributions for progression-free and
post-progression survival. The largest British preference study in breast
cancer served as the basis to estimate health-state utilities. We estimated
direct costs (ABC treatment, follow-up, monitoring, and adverse events)
using Brazilian-specific values from public sources. An expert consensus
panel determined the resource patterns required. We applied annual discounts
of 5% to costs and QALYs. Results: Ribociclib + ET resulted in an incremental gain of 1.03 PFLYs and 0.80 QALYs
at a cost of $37,319.31. The ICER of ribociclib + ET versus
ET was $36,379.41 per PFLY gained and $46,590.79 per QALY gained. In
deterministic sensitivity analysis, results were primarily affected by the
annual discount rate, followed by the cost of ribociclib. In probabilistic
sensitivity analysis, simulations agreed with the base-case. Conclusion: Ribociclib increased PFLYs and QALYs in patients with HR+/HER2− ABC when
added to ET. Because Brazil does not have a formally defined
cost-effectiveness threshold, other domains need to be considered for
incorporation decisions, such as disease burden and humanistic impact on
this young, economically active population. These findings may be useful in
discussions for incorporation of ribociclib into the Brazilian public health
system.
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Affiliation(s)
- Daniela Dornelles Rosa
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, BrazilOncology, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | - Sergio D. Simon
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Grupo Oncoclinicas, São Paulo, BrazilOncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gilberto Amorim
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Tomás Reinert
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias do Sul, Brazil
| | - Luciana Landeiro
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Grupo Oncoclínicas Bahia, Salvador, Brazil
| | - Débora de Melo Gagliato
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Beneficência Portuguesa, São Paulo, Brazil
| | - Pedro Exman
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Daniel Argolo
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Clion/Grupo CAM, Salvador, Brazil
| | - Gisah Guilgen
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Instituto do Câncer e Transplante de Curitiba, Curitiba, Brazil
| | - Max Mano
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Grupo Oncoclínicas, São Paulo, BrazilOncology, Centro Paulista de Oncologia, São Paulo, Brazil
| | - Laura Testa
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Instituto D’Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
- Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Pedro Liedke
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Hospital das Clínicas de Porto Alegre (HCPA), Porto Alegre, BrazilOncology, Grupo Oncoclínicas Porto Alegre, Porto Alegre, Brazil
| | - Romualdo Barroso
- Oncology, Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brazil
- Oncology, Hospital Sírio Libanês, Brasília, Brazil
| | - Mariana Sasse
- Oncology, Novartis Biociências S.A., São Paulo, Brazil
| | - Anna Maria Buehler
- Oncology, Novartis Biociências S.A., Professor Vicente Rao Avenue, 90, 04636-000 São Paulo, SP, Brazil
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Barrios C, Freitas-Junior R, Martins S, Bines J, Del Pilar Estevez-Diz M, Caleffi M. Challenge of Incorporating New Drugs for Breast Cancer in Brazil: A Proposed Framework for Improving Access to Innovative Therapies. JCO Glob Oncol 2021; 7:474-485. [PMID: 33822641 PMCID: PMC8081546 DOI: 10.1200/go.20.00566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The objective of this review is to address the barriers limiting access to treatment of advanced metastatic breast cancer (mBC) in Brazil, specifically for patients in the public health care system, arguably those with the least access to innovation. MATERIALS AND METHODS A selected panel of Brazilian experts in BC were provided with a series of relevant questions to address in a multiday conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for implementing access to new drugs in cancer care in Brazil. Moreover, in creating these recommendations and framework, the authors strive to address the most important barriers and impediments for technology incorporation. A feasible and specific multidisciplinary process is proposed, which is based on the collective participation of all involved stakeholders. CONCLUSION Given the current benefits and likely future developments, there is a great need to expand treatments for mBC not only in Brazil but also in most other countries in the world where access issues remain an unresolved demand. Adapting the current framework is essential for accomplishing this goal. The recommendations in this review can serve as a framework for adoption of new technologies in countries with limited resources.
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Affiliation(s)
- Carlos Barrios
- Grupo Oncoclínicas, Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Ruffo Freitas-Junior
- CORA, Advanced Center for Diagnosis of Breast Diseases, Federal University of Goias, Goiânia, Brazil
- Araujo Jorge Hospital of Associação de Combate ao Câncer em Goiás, Goiânia, Brazil
| | - Sandro Martins
- Medical Oncology Unit, University Hospital of Brasília/EBSERH, Brasília, Brazil
| | - Jose Bines
- Clínica São Vicente, Rio de Janeiro, Brazil
| | - Maria Del Pilar Estevez-Diz
- Instituto do Câncer do Estado de São Paulo/Faculdade de Medicina da Universidade de São Paulo, Onco Star Rede D'Or, São Paulo, Brazil
| | - Maira Caleffi
- Hospital Moinhos de Vento, Femama, Porto Alegre, Brazil
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Reinert T, Pellegrini R, Barrios CH. Lack of access to CDK4/6 inhibitors for premenopausal patients with metastatic breast cancer in Brazil: estimation of the number of premature deaths. Ecancermedicalscience 2020; 14:1081. [PMID: 32863875 PMCID: PMC7434502 DOI: 10.3332/ecancer.2020.1081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose A CDK4/6 inhibitor (CDK4/6i) combined with endocrine therapy is the standard of care for patients with hormone receptor-positive (HR+) and HER2-negative (HER2-) metastatic breast cancer (MBC). However, the incorporation of these agents into clinical practice remains challenging. This study aims to estimate the impact of the lack of access to ribociclib on mortality of premenopausal patients with MBC in Brazil. Methods Based on published epidemiological studies and national cancer registries, we estimated the number of premenopausal patients with potential indication of ribociclib as first-line treatment for MBC. Efficacy estimates were based on results from the Monaleesa-7 trial. Our analysis is made under the unrealistic assumption that all premenopausal MBC patients would be candidates for the treatment. To estimate the number of yearly premature deaths that could be prevented, we considered the largest absolute effect on mortality when sequentially applying the observed hazard ratio. Results We estimated an annual incidence of 4,294 premenopausal HR+, HER2- MBC patients in Brazil. Considering these patients, at 12, 24 and 60 months, the number of surviving subjects would be 3,504, 2,859 and 1,553 for endocrine therapy (ET) alone; and 3,717, 3,217 and 2,086 for ET plus ribociclib. The largest difference between both groups was observed at the end of the sixth year when the use of ribociclib would prevent 538 premature deaths (survival of 1,805 versus 1,267 patients by the 72nd month). Conclusion We estimate that lack of access to CDK4/6i for patients with HR+, HER2-, MBC will cause the premature death of a significant number of premenopausal women with MBC. The unavailability of effective therapies has measurable consequences. Progress in this area demands a concerted effort to prevent further loss of lives.
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Affiliation(s)
- Tomás Reinert
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, 90619-900, Brazil.,Oncoclinicas, Porto Alegre, 90570-020, Brazil
| | - Rodrigo Pellegrini
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) School of Medicine, Porto Alegre, 90619-900, Brazil
| | - Carlos Henrique Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, 90619-900, Brazil.,Oncoclinicas, Porto Alegre, 90570-020, Brazil
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