Five-year survival rate and prognostic factors in women with breast cancer treated at a reference hospital in the Brazilian Amazon

The Effects of a Web Application for Reducing the Risk of Breast Cancer-Related Lymphedema on Health Literacy and Self-Efficacy in Managing Symptoms Among Patients With Breast Cancer

AIMS

This study aimed to examine the effectiveness of a web application on health literacy and self-efficacy in managing arm oedema symptoms among patients with breast cancer.

METHODS

The research was carried out in four phases as follows: Phase 1, using a qualitative approach to explore problems and information needs in educating breast cancer patients through in-depth interviews with 10 professional nurses who had experiences in caring for breast cancer patients and 20 breast cancer patients. Data were analysed by content analysis; Phase 2, designing and developing a web application and confirming its quality by five experts with experience caring for breast cancer patients; Phase 3, testing the web application with five breast cancer patients; and Phase 4, examining the effectiveness of a web application in breast cancer patients using a quasiexperimental research method. Patients were divided into 15 persons in control and 15 in intervention groups, a total of 30 persons. The tools used in the study consisted of (1) a web application on practices for reducing risk for arm oedema after breast cancer treatment, (2) a health literacy assessment tool, (3) a self-efficacy for managing symptoms questionnaire and (4) a web application satisfaction questionnaire. Data were analysed using descriptive statistics, chi-square and t test.

RESULTS

Qualitative findings: The web application should cover patients' and nurses' views on arm oedema causes, assessment, prevention and self-care for managing swelling after breast cancer treatment. Characteristics of a web application required: large text, bright colours, clear visibility, accompanying pictures or videos, using simple language without official terminology, easy to access, convenient to use, concise, interesting content and shareable to others. Quantitative findings: The intervention group had significantly higher health literacy and self-efficacy in managing symptom scores than before the trial (p < 0.001). Sample groups were satisfied with the developed web application at a high level. When considering each item, it was found that all items were rated at high levels. Two items with the same highest score were ease of use and the attractiveness of the presentation style.

CONCLUSION

This web application, aimed at reducing the risk of arm oedema after breast cancer treatment, is an effective tool for educating all hospitalized patients. In addition, further research should be conducted to monitor the sustainability of long-term and clinical outcomes.

Factors delaying non-metastatic breast cancer adjuvant therapy and impact on prognosis in a cohort of Brazilian women

OBJECTIVE

To identify factors associated with delays in beginning adjuvant therapy and prognosis impacts on non-metastatic breast cancer patients.

METHODS

This assessment comprised a prospective cohort study concerning breast cancer patients treated at a public oncology centre. A time interval of ≥60 days between surgery and the beginning of the first adjuvant treatment was categorised as a delay. Factors associated with delays were evaluated through logistic regression analysis and the prognosis effects were assessed by a Cox regression analysis.

RESULTS

The median time interval between surgery and the first adjuvant treatment for the 401 women included in this study was of 57.0 days (37.0-93.0). Independent factors associated with delays comprised not presenting an overexpression of the HER-2 protein, not having undergone neoadjuvant chemotherapy, and having undergone chemotherapy or other therapeutic modalities other than hormone therapy and chemotherapy as the first adjuvant treatment. Delays did not affect recurrence, distant metastasis, or death risks. Factors associated with recurrence and distant metastasis risks comprised a clinical staging ≥2B, having undergone neoadjuvant chemotherapy, presenting the luminal molecular subtype B and triple-negative tumours, and having children. Factors associated with death comprised triple-negative molecular tumours and neoadjuvant chemotherapy.

CONCLUSION

Delays in beginning adjuvant treatment did not affect the prognosis of non-metastatic breast cancer patients. Clinical and treatment-related factors, on the other hand, were associated with delays, and recurrence, distant metastasis, and death risks.

Performance of the Wisconsin Card Sorting Test in Oncopediatric Patients in an Oncology Unit in Cali, Colombia: A Cross-Sectional Observational Study

BACKGROUND

In 2020, the prevalence of cancer rose to 844,778 cases among the population aged 0-19 years. Approximately 90% of individuals under 18 years of age reside in low- and middle-income countries, where cancer survivors report adverse outcomes that negatively impact their general health, emotional state, and external factors such as academic performance due to the effect of these outcomes on executive functions. The Wisconsin Cart Sorting Test (WCST) is the gold standard for evaluating executive functioning. Therefore, this article (1) reports the performance of the Wisconsin Card Sorting Test (WCST) in oncopediatric patients from Cali, Colombia; (2) indicates the reliability of the WCST; (3) describes the association between cancer type and executive functioning in patients; (4) describes the differences between patients with various executive deficits and their executive total scores; and (5) describes the association between cancer type and the presence of brain deficits based on the WCST.

METHODS

In this cross-sectional observational study, 24 oncopediatric patients were interviewed and evaluated via the WCST.

RESULTS

The mean age was 12.08 years (SD 3.98); 20.8% of the patients were women, 70.8% had a primary diagnosis of leukemia, 8% exhibited acquired brain deficits, and more than 75% displayed adequate functional indicators of executive functions. Robust statistics were employed to explore the differences between the types of diagnosis and performance in executive functions, and no statistically significant differences were found (p = 0.156). We found that the WCST has a reliable Cronbach's α of 0.804. Oncopediatric patients without brain deficits presented strong results in terms of executive functions (p = 0.002), with a moderate effect size (0.727).

CONCLUSIONS

The WCST is reliable for discriminating executive functioning among pediatric cancer patients. The evidence suggests that there were no differences in the executive functioning of the participants based on the types of cancer being evaluated.

Value of inversion imaging to diagnosis in differentiating malignant from benign breast masses

BACKGROUND

We aimed to evaluate the added value of inversion imaging in differentiating between benign and malignant breast masses when combined with the Breast Imaging Reporting and Data System (BI-RADS).

METHODS

A total of 364 patients with 367 breast masses (151 benign and 216 malignant) who underwent conventional ultrasound and inversion imaging prior to breast surgery were included. A 5-point inversion score (IS) scale was proposed based on the masses' internal echogenicity and distribution characteristics in the inversion images. The combination of IS and BI-RADS was compared with BI-RADS alone to evaluate the value of inversion imaging for breast mass diagnosis. The diagnostic performance of the BI-RADS and its combination with IS for breast masses were analyzed using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

The IS for malignant breast masses (3.96 ± 0.77) was significantly higher than benign masses (2.58 ± 0.98) (P < 0.001). The sensitivity, specificity, accuracy, PPV, and NPV of BI-RADS were 86.1%, 81.5%, 84.2%, 86.9%, and 80.4%, respectively, and an AUC was 0.909. By compared with BI-RADS, 72 breast masses were downgraded from suspected malignancy to benign, and 6 masses were upgraded from benign to suspected malignancy. Thus, the specificity was increased from 81.5 to 84.8%, it allows 72 benign masses avoid biopsy.

CONCLUSION

The combination of inversion imaging with BI-RADS can effectively improve the diagnostic efficacy of breast masses, and inversion imaging could help benign masses avoid biopsy.

Codelivery of resveratrol melatonin utilizing pH responsive sericin based nanocarriers inhibits the proliferation of breast cancer cell line at the different pH

Protein-based nanocarriers have demonstrated good potential for cancer drug delivery. Silk sericin nano-particle is arguably one of the best in this field. In this study, we developed a surface charge reversal sericin-based nanocarrier to co-deliver resveratrol and melatonin (MR-SNC) to MCF-7 breast cancer cells as combination therapy. MR-SNC was fabricated with various sericin concentrations via flash-nanoprecipitation as a simple and reproducible method without complicated equipment. The nanoparticles were subsequently characterized for their size, charge, morphology and shape by dynamic light scattering (DLS) and scanning electron microscope (SEM). Nanocarriers chemical and conformational analysis were done by fourier transform infrared spectroscopy (FT-IR) and circular dichroism (CD) respectively. In vitro drug release was determined at different pH values (7.45, 6.5 and 6). The cellular uptake and cytotoxicity were studies using breast cancer MCF-7 cells. MR-SNC fabricated with the lowest sericin concentration (0.1%), showed a desirable 127 nm size, with a net negative charge at physiological pH. Sericin structure was preserved entirely in the form of nano-particles. Among the three pH values we applied, the maximum in vitro drug release was at pH 6, 6.5, and 7.4, respectively. This pH dependency showed the charge reversal property of our smart nanocarrier via changing the surface charge from negative to positive in mildly acidic pH, destructing the electrostatic interactions between sericin surface amino acids. Cell viability studies demonstrated the significant toxicity of MR-SNC in MCF-7 cells at all pH values after 48 h, suggesting a synergistic effect of combination therapy with the two antioxidants. The efficient cellular uptake of MR-SNC, DNA fragmentation and chromatin condensation was found at pH 6. Nutshell, our result indicated proficient release of the entrapped drug combination from MR-SNC in an acidic environment leading to cell apoptosis. This work introduces a smart pH-responsive nano-platform for anti-breast cancer drug delivery.