1
|
Izawa T, Kobayashi A, Kawashima M, Kawaguchi-Sakita N, Nakakura A, Kataoka Y, Shide K, Mori Y, Yamazaki K, Toi M, Arao H. Quantitative analysis of the effect of docetaxel-induced edema on quality of life in patients with breast cancer and related factors: a prospective cohort study. BMC Womens Health 2024; 24:165. [PMID: 38454375 PMCID: PMC10921572 DOI: 10.1186/s12905-024-03003-4] [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: 09/06/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Systemic edema is an adverse effect of docetaxel chemotherapy and causes distress to patients, including those receiving this agent for breast cancer. However, its characteristics and factors related to its effect on quality of life (QoL) have not been adequately investigated. In this study, we assessed systemic edema quantitatively, explored related factors, and evaluated QoL in patients receiving docetaxel for breast cancer. METHODS The study had a prospective cohort design and included 37 patients with no known history of swelling who were treated with docetaxel between September 2019 and April 2022. Patients were examined at the start, middle, and end of their course of treatment and 1 and 2 months later. Body water content, body mass, fat mass, and muscle mass were quantified using bioelectrical impedance analysis. Systemic edema was evaluated with reference to the Common Terminology Criteria for Adverse Events. The timing of development of systemic edema at any anatomical site that was grade 2 or worse was recorded. QoL was assessed using the Quality of Life-Anti Cancer Drug scale. Nutrition was evaluated using the Brief-type self-administered diet history questionnaire. Multivariable logistic regression analysis was performed to identify related factors. QoL was also compared between patients with edema and those without edema. RESULTS Systemic edema developed in 67% of the study participants and was most prevalent at the end of treatment. Body fat mass (adjusted odds ratio [aOR] 0.802, 95% confidence interval [CI] 0.651-0.988, p = 0.038), disease stage (aOR 3.279, 95% CI 0.493-21.793, p = 0.219), and history of alcohol consumption (aOR 0.141, 95% CI 0.013-1.521, p = 0.106) were identified as risk factors for docetaxel-induced edema. Participants who developed systemic edema experienced more physical, vital, and emotional distress 1 month after treatment than those who did not. There was no association between systemic edema and nutrition. CONCLUSIONS Systemic edema may develop after treatment with docetaxel and increase distress in patients with a high body fat mass. Patients at risk of systemic edema should be informed in advance about the potential frequency, location, and timing of its onset and encouraged to self-manage this condition.
Collapse
Affiliation(s)
- Tomoko Izawa
- Department of Nursing, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Ami Kobayashi
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuko Kawaguchi-Sakita
- Department of Clinical Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Scientific Research Works Peer Support Group, Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kenichiro Shide
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yukiko Mori
- Department of Medical Informatics, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Japan.54 Shogoin-Kawahara-Cho, Sakyo-Ku, KyotoKyoto, 606-8507, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Harue Arao
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka Suita, Osaka, 565-0871, Japan
| |
Collapse
|
2
|
Hertz DL. Incidence, description, predictors, and consequences of persistent taxane-induced peripheral neuropathy. Curr Opin Support Palliat Care 2024; 18:30-38. [PMID: 38126251 PMCID: PMC10872673 DOI: 10.1097/spc.0000000000000684] [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] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide insights into persistent taxane-induced peripheral neuropathy (TIPN). The primary objective is to describe the incidence, predictors, and consequences of TIPN lasting at least 1 year after the end of taxane treatment. RECENT FINDINGS Studies show varying rates of TIPN persistence, with an estimated 30-40% and 40-60% resolving by 1- and 3-year post-treatment. TIPN in the feet and motor symptoms show less resolution post-treatment. Patients who are older or have higher body weight may experience less TIPN resolution, but results may be confounded by TIPN development during treatment. Persistent TIPN negatively impacts long-term functional ability, including gait, balance, and the ability to work. It also reduces overall quality of life (QOL), particularly affecting physical and social aspects. SUMMARY Clinicians should be aware of the potential for persistent TIPN and its impact on patients' function and QOL. Future research should focus on large prospective studies with systematic TIPN assessments during and after treatment to better understand which symptoms and patient characteristics predict resolution. This information can guide treatment decisions, balancing the need for effective chemotherapy with minimizing long-term impairments in function and QOL.
Collapse
Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy , Ann Arbor , Michigan , USA
| |
Collapse
|
3
|
Andersen C, Adamsen L, Damhus CS, Piil K, Missel M, Jarden M, Larsen A, Larsen HB, Møller T. Qualitative exploration of the perceptions of exercise in patients with cancer initiated during chemotherapy: a meta-synthesis. BMJ Open 2023; 13:e074266. [PMID: 38086582 PMCID: PMC10729187 DOI: 10.1136/bmjopen-2023-074266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To synthesise qualitative literature on (1) the perceptions of patients with cancer of participating in an exercise intervention while undergoing chemotherapy and (2) to inform and guide professionals in oncology and haematology practice. DESIGN A qualitative meta-synthesis based on Noblit and Hare's seven-step meta-ethnography. DATA SOURCES Six electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, PubMed, SCI-Expanded-SSCI and Scopus (final search June 2022) were used to identify qualitative literature containing individual or focus group interviews. The transparency of reporting for each study was assessed using the Consolidated criteria for Reporting Qualitative research checklist. RESULTS The search identified 5002 articles, 107 of which were selected for full-text review. Seventeen articles from five countries with patients undergoing chemotherapy during exercise interventions were included. Eleven articles were included in the meta-synthesis, which comprised 193 patients with various cancer diagnoses, disease stages, sexes and ages. Four main themes were identified: chemotherapy overpowers the body; exercise in battle with side effects; a break from gloomy thoughts; and a question of survivorship. CONCLUSIONS AND IMPLICATIONS The meta-synthesis emphasised that patients with cancer undergoing chemotherapy and simultaneously participating in exercise interventions may experience momentary relief from overwhelming side effects, even though full bodily recovery may be perceived as a distant prospect. The synthesis offers a sparse empirical basis for gaining insight into what patients experience existentially following exercise interventions. It is up to patients to independently apply the transfer value of exercise to their own existential circumstances.
Collapse
Affiliation(s)
- Christina Andersen
- Center for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lis Adamsen
- Center for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christina Sadolin Damhus
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Karin Piil
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mary Jarden
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Heamatology, Centre for Cancer and Organ Diseases, University of Copenhagen, Copenhagen, Denmark
| | - Anders Larsen
- Center for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Peadiatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tom Møller
- Center for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| |
Collapse
|
4
|
Salati SA, Alsulaim L, Alharbi MH, Alharbi NH, Alsenaid TM, Alaodah SA, Alsuhaibani AS, Albaqami KA. Postmastectomy Pain Syndrome: A Narrative Review. Cureus 2023; 15:e47384. [PMID: 38021812 PMCID: PMC10657609 DOI: 10.7759/cureus.47384] [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] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Postmastectomy pain syndrome is a very common disorder in breast cancer survivors. The impact on the quality of patients' lives is significantly adverse. The precise pathophysiology has not been determined as yet though various risk factors have been identified that make the patient vulnerable. Required preoperative work includes the identification and possible elimination of risk factors. Treatment is multidisciplinary involving surgical and non-surgical modalities. There is a great scope of research in this field.
Collapse
Affiliation(s)
- Sajad Ahmad Salati
- General Surgery, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Lamees Alsulaim
- Surgery, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Mariyyah H Alharbi
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Norah H Alharbi
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Thana M Alsenaid
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Shoug A Alaodah
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Abdulsalam S Alsuhaibani
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Khalid A Albaqami
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| |
Collapse
|
5
|
Azizoddin DR, Soens MA, Beck MR, Flowers KM, Edwards RR, Schreiber KL. Perioperative Sleep Disturbance Following Mastectomy: A Longitudinal Investigation of the Relationship to Pain, Opioid Use, Treatment, and Psychosocial Symptoms. Clin J Pain 2023; 39:76-84. [PMID: 36650603 PMCID: PMC9968504 DOI: 10.1097/ajp.0000000000001090] [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: 06/02/2021] [Accepted: 10/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Sleep disturbance negatively impacts the quality of life and recovery. Our objective was to evaluate the relationship between the individual patient and surgical factors with greater sleep disturbance following breast surgery. METHODS In this prospective longitudinal study, patients completed validated measures regarding sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Univariable and multivariable generalized estimating equations evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after breast surgery. RESULTS Female patients (n=259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain and psychosocial factors (eg, anxiety, depression, and affect). Independent preoperative predictors of worse sleep disturbance included younger age (B=-0.09, P =0.006), opioid use (B=3.09, P =0.02), and higher pain (B=0.19, P =<0.001) and anxiety (B=0.45, P =<0.001) at baseline. In addition, higher baseline positive affect (B=-0.14, P =<0.012) and the surgical category total mastectomy without reconstruction (B=-2.81, P =<0.006) were independently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks postsurgery was associated with disturbed sleep. DISCUSSION Certain patient characteristics, including younger age and baseline anxiety, positive affect, pain, and opioid use, were associated with greater sleep disturbance in the first year after breast surgery. Sleep disturbance was also associated with the greater perioperative and postoperative opioid requirements. Preoperative interventions (eg, anxiety management, cultivating positive affect, and multimodal pain management) in high-risk individuals may enhance sleep and recovery postoperatively, and allow more moderate and less prolonged opioid use.
Collapse
Affiliation(s)
- Desiree R Azizoddin
- Department of Emergency Medicine
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Mieke A Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | | | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| |
Collapse
|
6
|
Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery. Pain Rep 2021; 6:e976. [PMID: 34841183 PMCID: PMC8613357 DOI: 10.1097/pr9.0000000000000976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Examining the divergence of prevalence and predictors of postsurgical numbness vs positive neuropathic symptoms gives insights into variation in clinical postoperative pain experienced by patients. Introduction: Both positive (burning, stabbing, and allodynia) and negative (numbness) neuropathic symptoms may arise after surgery but likely contribute differently to patients' postoperative pain experience. Numbness has been identified as divergent from positive neuropathic symptoms and therefore excluded from some neuropathic assessment tools (Neuropathic Pain Scale for PostSurgical patients [NeuPPS]). Objectives: In this prospective longitudinal study of patients undergoing breast surgery, we aimed to delineate the time course of numbness and its coincidence with NeuPPS and to contrast the association of surgical, psychosocial, and psychophysical predictors with the development of negative vs positive neuropathic symptoms. Methods: Patients reported surgical area sensory disturbances at 2 weeks and 3, 6, and 12 months postoperatively. Association of baseline demographic, surgical, psychosocial, and psychophysical factors with NeuPPS and numbness across time was investigated using generalized estimating equation linear and logistic regression. Results: Numbness was consistently reported by 65% of patients; positive neuropathic symptoms were less common, often decreasing over time. Neuropathic Pain scale for PostSurgical patients and numbness co-occurred in half of patients and were both associated with greater clinical pain severity and impact, younger age, axillary surgery, and psychosocial factors. More extensive surgery and chemotherapy were only associated with numbness. Conversely, other chronic pain, lower physical activity, perioperative opioid use, negative affect, and lower baseline pressure pain threshold and tolerance were only associated with NeuPPS. Patients reporting numbness alone did not endorse substantial clinical pain. Conclusions: Differentiation of predictors, prevalence, and time course of numbness vs NeuPPS in breast surgical patients revealed important distinctions, suggesting that their independent assessment is worthwhile in future studies of postsurgical pain.
Collapse
|
7
|
Schreiber KL, Zinboonyahgoon N, Flowers KM, Hruschak V, Fields KG, Patton ME, Schwartz E, Azizoddin D, Soens M, King T, Partridge A, Pusic A, Golshan M, Edwards RR. Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive Preoperative Assessment of Biopsychosocial Pain Modulators. Ann Surg Oncol 2021; 28:5015-5038. [PMID: 33452600 DOI: 10.1245/s10434-020-09479-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Persistent post-mastectomy pain (PPMP) is a significant negative outcome occurring after breast surgery, and understanding which individual women are most at risk is essential to targeting of preventive efforts. The biopsychosocial model of pain suggests that factors from many domains may importantly modulate pain processing and predict the progression to pain persistence. METHODS This prospective longitudinal observational cohort study used detailed and comprehensive psychosocial and psychophysical assessment to characterize individual pain-processing phenotypes in 259 women preoperatively. Pain severity and functional impact then were longitudinally assessed using both validated surgery-specific and general pain questionnaires to survey patients who underwent lumpectomy, mastectomy, or mastectomy with reconstruction in the first postsurgical year. An agnostic, multivariable modeling strategy identified consistent predictors of several pain outcomes at 12 months. RESULTS The preoperative characteristics most consistently associated with PPMP outcomes were preexisting surgical area pain, less education, increased somatization, and baseline sleep disturbance, with axillary dissection emerging as the only consistent surgical variable to predict worse pain. Greater pain catastrophizing, negative affect, younger age, higher body mass index (BMI), and chemotherapy also were independently predictive of pain impact, but not severity. Sensory disturbance in the surgical area was predicted by a slightly different subset of factors, including higher preoperative temporal summation of pain. CONCLUSIONS This comprehensive approach assessing consistent predictors of pain severity, functional impact, and sensory disturbance may inform personalized prevention of PPMP and also may allow stratification and enrichment in future preventive studies of women at higher risk of this outcome, including pharmacologic and behavioral interventions and regional anesthesia.
Collapse
Affiliation(s)
- Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valerie Hruschak
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan E Patton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Schwartz
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Desiree Azizoddin
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mieke Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Pusic
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mehra Golshan
- Department of Surgery, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Rob R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Divella M, Vetrugno L, Bertozzi S, Seriau L, Cedolini C, Bove T. Patient-reported pain and other symptoms among breast cancer survivors: prevalence and risk factors. TUMORI JOURNAL 2020; 106:480-490. [PMID: 32162594 DOI: 10.1177/0300891620908930] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the prevalence and risk factors associated with chronic pain and other symptoms related to breast cancer 6 months after surgery. METHODS In an observational study of 261 female breast cancer survivors treated between January 2017 and January 2018, patients were asked about their pain symptoms using a questionnaire that utilized the Numeric Rating Score (NRS) and the Douleur Neuropathique Score (DN4) for neuropathic pain; it also addressed phantom sensations and functional disorders on the ipsilateral shoulder. A total of 218 women completed the survey. RESULTS A total of 105 patients (48.17%) reported chronic pain. Of these, 64% rated the pain with an NRS of 1-3 and 35% with an NRS >3. Neuropathic pain was reported in 65% of the sample, phantom sensations in 12%, disorders of shoulder function in 16%, and web syndrome in 2%. Multivariable analyses showed that chronic pain (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.094-5.942; p < 0.05) and neuropathic pain (OR, 2.988; 95% CI, 1.366-6.537; p < 0.05) were positively associated with surgical adverse events; phantom sensations were statistically associated with the weight of removed breast tissue (OR, 1.003; 95% CI, 1.001-1.005; p < 0.05). CONCLUSIONS Our study highlights the need to employ specific tools capable of detecting different kinds of chronic pain after breast cancer surgery to improve pain prevention and treatment. Surgical complications and the weight of removed breast tissue emerged as 2 of the risk factors for chronic and neuropathic pain development in breast cancer survivors.
Collapse
Affiliation(s)
- Michele Divella
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University Hospital of Udine, Udine, Italy
| | - Serena Bertozzi
- Breast Unit, Clinic of Surgery, University Hospital of Udine, Udine, Italy
| | - Luca Seriau
- Breast Unit, Clinic of Surgery, University Hospital of Udine, Udine, Italy
| | - Carla Cedolini
- Breast Unit, Clinic of Surgery, University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University Hospital of Udine, Udine, Italy
| |
Collapse
|
9
|
Marschner N, Trarbach T, Rauh J, Meyer D, Müller-Hagen S, Harde J, Dille S, Kruggel L, Jänicke M. Quality of life in pre- and postmenopausal patients with early breast cancer: a comprehensive analysis from the prospective MaLife project. Breast Cancer Res Treat 2019; 175:701-712. [PMID: 30868393 PMCID: PMC6534521 DOI: 10.1007/s10549-019-05197-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022]
Abstract
Purpose Quality of life (QoL) plays an important role in recovery—especially after an incisive diagnosis such as breast cancer. Here, we present a comprehensive assessment of QoL for pre- and postmenopausal patients, starting from initial systemic treatment of early breast cancer until 3 years later, in patients from a so-called “real-world” setting. Methods 251 premenopausal and 478 postmenopausal patients with early breast cancer have been recruited into the longitudinal MaLife project within the prospective, multicentre, German Tumour Registry Breast Cancer between 2011 and 2015. The questionnaires FACT-G, FACT-Taxane, FACT-ES, EORTC QLQ-BR23, BFI and HADS were filled in at start of treatment (T0), 6, 12, 24 and 36 months later. The proportion of patients with clinically meaningful changes at 36 months was determined. Results This first interim analysis shows that the FACT-G global QoL improved over time regardless of the menopausal status. However, clinically meaningful decrease of social/family well-being (48–51%), arm symptoms (44–49%) and symptoms of neurotoxicity (55–56%) was frequently reported 3 years after start of treatment. Many premenopausal patients also reported a clinically meaningful worsening of endocrine symptoms (64%), emotional well-being (36%) and fatigue intensity (37%). Additionally, 3 years after start of treatment, 15% of the patients were classified as doubtful cases and 18% as definite cases of anxiety. Conclusions Despite improvements in global QoL, breast cancer survivors report worsened ailments 3 years after start of therapy. Follow-up care should distinguish between premenopausal patients needing special attention for emotional/menopausal issues, and postmenopausal patients needing particular care regarding physical concerns. Electronic supplementary material The online version of this article (10.1007/s10549-019-05197-whttps://doi.org/10.1007/s10549-019-05197-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Norbert Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Wirthstrasse 11c, 79110, Freiburg, Germany.
| | - Tanja Trarbach
- MVZ des Klinikums Wilhelmshaven, Zentrum für Tumorbiologie, Wilhelmshaven, Germany
| | | | | | | | - Johanna Harde
- Department of Biostatistics, iOMEDICO, Freiburg, Germany
| | | | - Lisa Kruggel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | |
Collapse
|
10
|
Marschner N, Salat C, Söling U, Hansen R, Grebhardt S, Harde J, Nusch A, Potthoff K. Final Effectiveness and Safety Results of NABUCCO: Real-World Data From a Noninterventional, Prospective, Multicenter Study in 697 Patients With Metastatic Breast Cancer Treated With nab-Paclitaxel. Clin Breast Cancer 2018; 18:e1323-e1337. [PMID: 30100104 DOI: 10.1016/j.clbc.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/30/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND One of the most effective chemotherapies for metastatic breast cancer (MBC) is nab-paclitaxel (nab-P), which is approved for treatment of MBC after failure of first-line therapy and when anthracyclines are not indicated. Randomized clinical trials have shown high efficacy and acceptable toxicity. Real-world data of nab-P in MBC, however, are still limited. PATIENTS AND METHODS The prospective multicenter noninterventional study NABUCCO collected data on the routine treatment of patients with MBC receiving nab-P in 128 sites across Germany. The primary objective was time to progression. Secondary objectives were overall response rate, overall survival, safety, and quality of life. RESULTS Between April 2012 and April 2015, a total of 705 patients with MBC at 128 active sites had been enrolled. A total of 697 patients had evaluable data with a median follow-up of 17.7 months. Median time to progression was 5.9 months (95% confidence interval, 5.6-6.4), overall response rate was 37.2%, and median overall survival was 15.6 months (95% confidence interval, 14.2-17.2). The results were similar in patients aged < 65 versus ≥ 65 years as well as in patients who received nab-P on a weekly or a triweekly schedule. The most frequently reported grade 3/4 adverse events were leukopenia (55, 7.9%), peripheral sensory neuropathy (30, 4.3%), and infections (29, 4.2%). Patients reported no apparent treatment-related impact on global quality of life. CONCLUSION The results of the NABUCCO study confirm the clinical trial outcomes and the favorable safety profile of nab-P in patients with metastatic breast cancer in a real-world setting.
Collapse
Affiliation(s)
- Norbert Marschner
- Outpatient Center for Interdisciplinary Oncology and Hematology, Freiburg i.Br., Germany.
| | - Christoph Salat
- Joint Practice for Internal Medicine, Hematology, and Internal Oncology, Munich, Germany
| | - Ulrike Söling
- Joint Practice for Oncology Dres. Söling/Siehl, Kassel, Germany
| | - Richard Hansen
- Oncological Practice Dres. Hansen & Reeb, Kaiserslautern, Germany
| | | | | | - Arnd Nusch
- Practice for Hematology and Internal Oncology, Ratingen, Germany
| | | |
Collapse
|
11
|
de la Rosa-Díaz I, Torres-Lacomba M, Acosta-Ramírez P, Orive IGD, Nee RJ, de la Villa-Polo P, Andrés-Esteban EM, Sánchez-Sánchez B. Protective myoelectric activity at performing upper limb neurodynamic test 1 in breast cancer survivors. A cross-sectional observational study. Musculoskelet Sci Pract 2018; 36:68-80. [PMID: 29860136 DOI: 10.1016/j.msksp.2018.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/11/2018] [Accepted: 05/21/2018] [Indexed: 11/25/2022]
Abstract
Myoelectric activity and range of motion during ULNT1 were recorded in 62 breast cancer (BC) survivors who had axillary lymph node dissection (n = 30) or sentinel lymph node biopsy (n = 32) within the previous 18 months, and 63 age-matched healthy women. BC survivors' symptoms were reproduced by ULNT1 and exhibited greater myoelectric activity in the biceps brachii than healthy women (MD (95% CI): 21,26 (10,83-31,70)). No differences between the axillary lymph node dissection and sentinel lymph node biopsy groups (MD (95% CI): 8,47 (-7,84-24,79)) were found. Myoelectric activity in the triceps brachii was greater in the sentinel lymph node biopsy group (MD (95% CI): 2,70 (-2,06-7,60)). BC survivors exhibited less shoulder and elbow range of motion during ULNT1 than healthy women. Increased upper limb nerve mechanosensitivity in BC survivors was associated with a greater protective muscle response during ULNT1.
Collapse
Affiliation(s)
- Irene de la Rosa-Díaz
- Physical Therapist in Women´s Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Torres-Lacomba
- Physical Therapist in Women´s Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain.
| | - Paz Acosta-Ramírez
- Physical Therapist in Torrejón Hospital, Rehabilitation Department, Torrejón de Ardoz, Madrid, Spain
| | - Itxaso García-de Orive
- Physical Therapist in Torrejón Hospital, Rehabilitation Department, Torrejón de Ardoz, Madrid, Spain
| | - Robert J Nee
- Physical Therapist in School of Physical Therapy, Pacific University, Hillsboro, OR, USA
| | - Pedro de la Villa-Polo
- Medical Doctor in the Neurophysiology Research Group, Department of Systems Biology, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Eva M Andrés-Esteban
- Biostatistician, Department of Preventive Medicine, Universtiy of Jaume I, Castellón, Spain
| | - Beatriz Sánchez-Sánchez
- Physical Therapist in Women´s Health Research Group, Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| |
Collapse
|
12
|
Adjuvant chemotherapeutic treatment of 1650 patients with early breast cancer in routine care in Germany: data from the prospective TMK cohort study. Breast Cancer 2017; 25:275-283. [PMID: 29204847 PMCID: PMC5906523 DOI: 10.1007/s12282-017-0823-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/24/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Several regimens for which efficacy was established in randomized controlled trials are recommended in current treatment guidelines for early breast cancer. However, knowledge on use and effectiveness of commonly administered chemotherapeutic agents in real-life care and across all breast cancer subtypes is limited. METHODS The prospective, multicentre German TMK cohort study (Tumour Registry Breast Cancer) recruited patients in 148 oncology outpatient-centres. Data from 1650 patients who completed adjuvant chemotherapy were analysed regarding treatment regimens and taxane use from 2007 to 2014. The association of patient characteristics with application of taxane-free regimens was examined with a multivariate regression model. RESULTS The preferred adjuvant treatment shifted from fluorouracil, anthracycline and cyclophosphamide containing regimens to anthracycline/taxane combinations. Taxane use increased for all subtypes, and the greatest rise was among node-negative patients. Older age, node-negativity, lower grading, HR-positive/HER2-negative subtype and earlier start year of therapy were significantly associated with taxane-free therapy. CONCLUSIONS Treatment with anthracycline/taxane-based chemotherapy in Germany has been rising for every subtype. The increased taxane use reflects updated guideline recommendations over the past decade. Cohort studies like the TMK provide insight into real-life treatment of patients outside of clinical trials.
Collapse
|
13
|
Hidding JT, Beurskens CHG, van der Wees PJ, Bos WCAM, Nijhuis-van der Sanden MWG, van Laarhoven HWM. Changes in volume and incidence of lymphedema during and after treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) in patients with breast cancer. Support Care Cancer 2017; 26:1383-1392. [PMID: 29127528 PMCID: PMC5876252 DOI: 10.1007/s00520-017-3907-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/25/2017] [Indexed: 01/18/2023]
Abstract
Purposes The purposes of this study were to investigate the incidence of lymphedema in patients with breast cancer during and after adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC), to identify predictors for development of lymphedema, and to describe consequences in daily life in relation to lymphedema. Methods This is a prospective study with measurements before chemotherapy (T0), during chemotherapy before cycle 2 (T1), cycle 4 (T2), and 1 month after completion of treatment (T3). Volume change was monitored using tape measurements. Lymphedema was defined as ≥ 10% volume difference. Linear mixed-effect models were estimated to analyze differences in arm volume and consequences in daily life (total score and domain scores of the Lymph-International Classification of Functioning (ICF) questionnaire) over time and to identify treatment and patient characteristics as predictors for changes in volume. Results Forty-eight patients completed all measurements. Volume did not change during TAC treatment. One month after treatment, volume was significantly increased compared to T0-T2, and 12 patients (25%) had developed lymphedema. Axillary lymph node dissection was associated with lymphedema (ES 2.9, 95% CI 0.02–5.7; p < 0.05). In patients with and without lymphedema, 1 month after completion (T3), the Lymph-ICF questionnaire showed significant limitations in physical function compared to T0-T2. In patients with lymphedema at T3, a significant association between volume and total score on the Lymph-ICF questionnaire on physical function and mobility activities was observed. Conclusions One month after treatment in 12 patients (25%), volume difference increased over 10%. Axillary lymph node dissection was predictive for development of lymphedema. All patients, but more patients with lymphedema, perceived difficulties in activities in daily life after treatment.
Collapse
Affiliation(s)
- Janine T Hidding
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands. .,Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, The Netherlands.
| | - Carien H G Beurskens
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, The Netherlands
| | - Wilmy C A M Bos
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Geert Grooteplein Noord 21, 6525 EZ, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,Academic Medical Center, Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Mustafa Ali M, Moeller M, Rybicki L, Moore HCF. Long-term peripheral neuropathy symptoms in breast cancer survivors. Breast Cancer Res Treat 2017; 166:519-526. [PMID: 28791499 DOI: 10.1007/s10549-017-4437-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Peripheral neuropathy (PN) is a common and distressing complication from chemotherapy. Symptoms often, but not always, improve with time. The prevalence of long-term PN symptoms in breast cancer survivors is not well known. We sought to explore PN symptoms and associated risk factors among breast cancer survivors at least 2 years out from diagnosis. METHODS We performed a cross-sectional retrospective study investigating the prevalence of patient-reported numbness, tingling, and anesthesia symptoms as a surrogate for PN in breast cancer survivors. We included patients with stage 0-III breast cancer who completed a clinical questionnaire at a survivorship visit that occurred 2 or more years after diagnosis. We estimated the prevalence of PN and identified risk factors for PN. RESULTS Six hundred and five patients assessed between April 2009 and October 2016 met eligibility for analysis. Median age was 60 years. Median number of years from diagnosis to assessment was 6.3. All patients had surgery and 62% had chemotherapy. Twenty-seven percent reported PN. On univariable analysis, obesity, stage II and III, mastectomy, PN before diagnosis, and receipt of taxane chemotherapy were associated with higher risk of PN (all p < 0.05); older age, exercise, ER-positive disease, and endocrine therapy were associated with lower risk of PN (all p < 0.05). On multivariable analysis, only receipt of docetaxel (OR 2.18, CI 1.22-3.88) or paclitaxel (OR 4.07, CI 2.54-6.50) and reporting PN symptoms before diagnosis (OR 3.28, CI 1.49-7.21) were associated with higher risk of PN. Overall, 17, 20, 31, and 44% reported long-term PN symptoms after no chemotherapy, non-taxane chemotherapy, docetaxel chemotherapy, and paclitaxel chemotherapy, respectively. CONCLUSION Long-term peripheral neuropathy symptoms are reported by a significant minority of breast cancer survivors, particularly following paclitaxel or docetaxel chemotherapy. These study findings can help inform patients and clinicians regarding long-term PN risk following chemotherapy.
Collapse
Affiliation(s)
| | - Machelle Moeller
- Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, 10201 Carnegie Ave, CA-60, Cleveland, OH, 44195, USA
| | - Lisa Rybicki
- Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Halle C F Moore
- Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, 10201 Carnegie Ave, CA-60, Cleveland, OH, 44195, USA.
| |
Collapse
|
15
|
Huang K, Bian D, Jiang B, Zhai Q, Gao N, Wang R. TRPA1 contributed to the neuropathic pain induced by docetaxel treatment. Cell Biochem Funct 2017; 35:141-143. [PMID: 28370084 DOI: 10.1002/cbf.3258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/07/2022]
Abstract
Peripheral mechanical neuropathic pain is a serious side effect of docetaxel chemotherapy for cancer. However, the underlying mechanism for this side effect is unknown. In the present study, we found that docetaxel treatment induced mechanical allodynia in rats. We further revealed that the transient receptor potential ankyrin subtype 1 protein (TRPA1) protein level is upregulated and the TRPA1 activator allyl isothiocyanate induced larger ion currents in the dorsal root ganglion neurons from the docetaxel treated rats. In addition, application the TRPA1 blocker Ap18 reversed the docetaxel-induced mechanical hypersensitivity. We suggest that the docetaxel-induced mechanical allodynia is mediated by upregulation of TRPA1 in dorsal root ganglion neurons.
Collapse
Affiliation(s)
- Kun Huang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Donglin Bian
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bin Jiang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qixi Zhai
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ningning Gao
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ruiying Wang
- Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
16
|
Aromolaran KA, Goldstein PA. Ion channels and neuronal hyperexcitability in chemotherapy-induced peripheral neuropathy; cause and effect? Mol Pain 2017; 13:1744806917714693. [PMID: 28580836 PMCID: PMC5480635 DOI: 10.1177/1744806917714693] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 12/18/2022] Open
Abstract
Abstract Cancer is the second leading cause of death worldwide and is a major global health burden. Significant improvements in survival have been achieved, due in part to advances in adjuvant antineoplastic chemotherapy. The most commonly used antineoplastics belong to the taxane, platinum, and vinca alkaloid families. While beneficial, these agents are frequently accompanied by severe side effects, including chemotherapy-induced peripheral neuropathy (CPIN). While CPIN affects both motor and sensory systems, the majority of symptoms are sensory, with pain, tingling, and numbness being the predominant complaints. CPIN not only decreases the quality of life of cancer survivors but also can lead to discontinuation of treatment, thereby adversely affecting survival. Consequently, minimizing the incidence or severity of CPIN is highly desirable, but strategies to prevent and/or treat CIPN have proven elusive. One difficulty in achieving this goal arises from the fact that the molecular and cellular mechanisms that produce CPIN are not fully known; however, one common mechanism appears to be changes in ion channel expression in primary afferent sensory neurons. The processes that underlie chemotherapy-induced changes in ion channel expression and function are poorly understood. Not all antineoplastic agents directly affect ion channel function, suggesting additional pathways may contribute to the development of CPIN Indeed, there are indications that these drugs may mediate their effects through cellular signaling pathways including second messengers and inflammatory cytokines. Here, we focus on ion channelopathies as causal mechanisms for CPIN and review the data from both pre-clinical animal models and from human studies with the aim of facilitating the development of appropriate strategies to prevent and/or treat CPIN.
Collapse
Affiliation(s)
- Kelly A Aromolaran
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Peter A Goldstein
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
17
|
Chemotherapy-induced pain and neuropathy: a prospective study in patients treated with adjuvant oxaliplatin or docetaxel. Pain 2016; 157:560-568. [PMID: 26529271 DOI: 10.1097/j.pain.0000000000000404] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer therapy. This study evaluates symptoms of CIPN and CIPN-related pain and its influence on psychological functioning and potential predictors of chronic CIPN and pain. In this large prospective questionnaire study, 174 patients receiving adjuvant oxaliplatin or docetaxel were consecutively included. Patients were asked to complete a questionnaire with validated questions on peripheral neuropathy, pain, anxiety and depression, and quality of life at baseline, after the first cycle, halfway through therapy, and 1 year after baseline. Chronic CIPN symptoms (tingling and/or numbness) in the feet at 1-year follow-up were present in 63.6% of patients without preexisting neuropathy in the oxaliplatin group and in 44.8% in the docetaxel group, whereas pain in hands and feet was found in 31.3% and 35.1%, respectively. Both groups had significantly different pain profiles, and persistent pain in the docetaxel group was found to have effect on psychological function. Cumulative dose predicted oxaliplatin-induced neuropathy (P = 0.004), whereas endocrine therapy predicted peripheral pain in the docetaxel group (P = 0.04). There are important differences in acute neuropathic symptoms and chronic pain profiles in patients after oxaliplatin and docetaxel treatment. It is, however, important to recognize that chronic peripheral pain may be unrelated to neuropathy and can be caused by concomitant treatments. Future studies should focus on characterizing and distinguishing CIPN-related pain from other types of pain to determine the best outcome measures for trials on prevention or relief.
Collapse
|
18
|
Paice JA, Mulvey M, Bennett M, Dougherty PM, Farrar JT, Mantyh PW, Miaskowski C, Schmidt B, Smith TJ. AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions. THE JOURNAL OF PAIN 2016; 18:233-246. [PMID: 27884691 PMCID: PMC5439220 DOI: 10.1016/j.jpain.2016.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022]
Abstract
Chronic cancer pain is a serious complication of malignancy or its treatment. Currently, no comprehensive, universally accepted cancer pain classification system exists. Clarity in classification of common cancer pain syndromes would improve clinical assessment and management. Moreover, an evidence-based taxonomy would enhance cancer pain research efforts by providing consistent diagnostic criteria, ensuring comparability across clinical trials. As part of a collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) and the American Pain Society (APS), the ACTTION-APS Pain Taxonomy initiative worked to develop the characteristics of an optimal diagnostic system. After the establishment of these characteristics, a working group consisting of clinicians and clinical and basic scientists with expertise in cancer and cancer-related pain was convened to generate core diagnostic criteria for an illustrative sample of 3 chronic pain syndromes associated with cancer (ie, bone pain and pancreatic cancer pain as models of pain related to a tumor) or its treatment (ie, chemotherapy-induced peripheral neuropathy). A systematic review and synthesis was conducted to provide evidence for the dimensions that comprise this cancer pain taxonomy. Future efforts will subject these diagnostic categories and criteria to systematic empirical evaluation of their feasibility, reliability, and validity and extension to other cancer-related pain syndromes.
Collapse
Affiliation(s)
- Judith A Paice
- Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Matt Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Michael Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Patrick M Dougherty
- The Division of Anesthesia and Critical Care Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - John T Farrar
- Department of Epidemiology, Neurology, and Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick W Mantyh
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California
| | - Brian Schmidt
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York
| | - Thomas J Smith
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
19
|
Wang L, Guyatt GH, Kennedy SA, Romerosa B, Kwon HY, Kaushal A, Chang Y, Craigie S, de Almeida CPB, Couban RJ, Parascandalo SR, Izhar Z, Reid S, Khan JS, McGillion M, Busse JW. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ 2016; 188:E352-E361. [PMID: 27402075 DOI: 10.1503/cmaj.151276] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. METHODS We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case-control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase. RESULTS Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24-1.48), radiotherapy (OR 1.35, 95% CI 1.16-1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73-3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03-1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01-1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy. INTERPRETATION Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.
Collapse
Affiliation(s)
- Li Wang
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Gordon H Guyatt
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Sean A Kennedy
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Beatriz Romerosa
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Henry Y Kwon
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Alka Kaushal
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Yaping Chang
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Samantha Craigie
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Carlos P B de Almeida
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Rachel J Couban
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Shawn R Parascandalo
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Zain Izhar
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Susan Reid
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - James S Khan
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Michael McGillion
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| | - Jason W Busse
- Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland
| |
Collapse
|
20
|
Caro-Morán E, Fernández-Lao C, Díaz-Rodríguez L, Cantarero-Villanueva I, Madeleine P, Arroyo-Morales M. Pressure Pain Sensitivity Maps of the Neck-Shoulder Region in Breast Cancer Survivors. PAIN MEDICINE 2016; 17:1942-1952. [PMID: 27113218 DOI: 10.1093/pm/pnw064] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of the present study was to report pressure pain sensitivity topographical maps of the frontal and dorsal parts of the shoulder region, and locate the pressure pain sensitive areas in breast cancer survivors compared with matched healthy control subjects. METHODS Twenty-two breast cancer survivors (BCS) and 22 matched control subjects participated. A numeric pain rating scale of the neck-shoulder area and pressure pain thresholds (PPTs) was assessed bilaterally over 28 points in the frontal and dorsal neck-shoulder area. Topographical pain sensitivity maps of the upper trapezius, pectoral, and anterior deltoid areas were computed. RESULTS A three-way analysis of variance was carried out to evaluate the differences in PPTs. The BCS reported spontaneous neck pain (mean ± SD 3.6 ± 2.8), pain in the affected shoulder (4.3 ± 2.7), and pain in the non-affected shoulder (0.9 ± 1.8). Additionally, the BCS exhibited bilaterally lower PPTs in all the measurement points as compared with the control subjects (P < 0.05). The PPTs were lower at the superior part of the trapezius muscle (P < 0.001), the musculotendinous insertion, the anterior part of the deltoid muscle (P < 0.001), and the tendon of the pectoral muscle (P < 0.001) as compared with the control subjects. CONCLUSIONS The results suggest the sensitization processes in the BCS and give preliminary evidence to most sensitive areas in the superior part of the upper trapezius and musculotendinous insertion of the pectoral muscle.
Collapse
Affiliation(s)
- Elena Caro-Morán
- *Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada, Granada, Spain
| | - Lourdes Díaz-Rodríguez
- Department of Nursing, Instituto Biosanitario Granada (IBS. Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada, Granada, Spain
| | - Pascal Madeleine
- Physical Activity and Human Performance group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Manuel Arroyo-Morales
- Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada, Granada, Spain
| |
Collapse
|
21
|
Alkan A, Guc ZG, Senler FC, Yavuzsen T, Onur H, Dogan M, Karci E, Yasar A, Koksoy EB, Tanriverdi O, Turhal S, Urun Y, Ozkan A, Mizrak D, Akbulut H. Breast cancer survivors suffer from persistent postmastectomy pain syndrome and posttraumatic stress disorder (ORTHUS study): a study of the palliative care working committee of the Turkish Oncology Group (TOG). Support Care Cancer 2016; 24:3747-55. [PMID: 27039206 DOI: 10.1007/s00520-016-3202-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/28/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized by reactions to reminders of the trauma that has been experienced. The purpose of this study is to evaluate the predictors of PMPS and PTSD in Turkish breast cancer survivors and the correlation between PMPS and PTSD. METHOD The study is designed as a multicenter survey study. Breast cancer patients in remission were evaluated. Patients were evaluated with structured questionnaires to assess the PMPS and clinical parameters associated with it. The Turkish version of the posttraumatic stress disorder checklist-civilian version (PCL-C) was used. RESULTS Between February 2015 and October 2015, 614 breast cancer survivors in outpatient clinics were evaluated. The incidence of PMPS documented is 45.1 %. In the multivariate analysis low income, presence of PTSD and <46 months after surgery were associated with increased risk of PMPS. PTSD was documented in 75 %, and the mean PCL-C score was 32.4 ± 11.1. PMPS and being married at the time of the evaluation were linked with PTSD. CONCLUSIONS It is the first data about the association between PMPS and PTSD. The clinicians should be aware of PMPS and PTSD in breast cancer survivors.
Collapse
Affiliation(s)
- Ali Alkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey. .,Medical Oncology, Ankara University School of Medicine, Ankara Üniversitesi Tıp fakültesi hastanesi, Cebeci hastanesi, Tıbbi onkoloji bilim dalı, Mamak/Ankara, TR 06890, Turkey.
| | - Zeynep Gulsum Guc
- Department of Medical Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Filiz Cay Senler
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Tugba Yavuzsen
- Department of Medical Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Handan Onur
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Numune Training and Research Hospital, Ankara, Turkey
| | - Ebru Karci
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Arzu Yasar
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Berna Koksoy
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Ozgur Tanriverdi
- Department of Medical Oncology, Mugla Sitki Kocman University, Muğla, Turkey
| | - Serdar Turhal
- Department of Medical Oncology, Marmara University School of Medicine, İstanbul, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Asiye Ozkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Dilsa Mizrak
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Akbulut
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
22
|
Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience. Stem Cells Int 2015; 2016:2527349. [PMID: 26858758 PMCID: PMC4709779 DOI: 10.1155/2016/2527349] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/07/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of “Postmastectomy Pain Syndrome” (PMPS) and had undergone mastectomy with axillary dissection (113 patients) or quadrantectomy (96 patients). Both procedures were followed by radiotherapy. We performed fat grafting following Coleman's procedure. Mean amount of adipose tissue injected was 52 cc (±8.9 cc) per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7–13.5 months). In 120 treated patients we detected pain decrease (mean ± SD point reduction, 3.19 ± 2.86). Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ± SD decrease of pain of 1.14 ± 2.72. Results showed that pain decreased significantly in patients treated (p < 0.005, Wilcoxon rank-sum test). Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.
Collapse
|
23
|
Abstract
Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients' quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available.
Collapse
Affiliation(s)
- Matthew Rd Brown
- Pain Management Department, The Royal Marsden Hospital, London, UK ; Institute of Cancer Research, London, UK
| | - Juan D Ramirez
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
24
|
General anaesthetic agents do not influence persistent pain after breast cancer surgery. Eur J Anaesthesiol 2015; 32:697-704. [DOI: 10.1097/eja.0000000000000215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Shamley D, Robb K. An early warning surveillance programme for detecting upper limb deterioration after treatment for breast cancer: A novel technology supported system. BMC Cancer 2015. [PMID: 26370571 DOI: 10.1186/s12885‐015‐1636‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Upper limb morbidity is a well-recognised consequence of treatment for breast cancer that can develop for up to 6 years after treatment. However, the capacity to fully integrate evidence-based rehabilitation pathways into routine care for all patients is questionable due to limited resources. A long term surveillance programme must therefore be accessible to all patients, should identify those at risk of developing morbidity and target the interventions at the high risk population of patients. The proposed model uses a surrogate marker for assessing risk of morbidity, incorporated into an Early Warning System (EWS), to produce a technology-lead, prospective surveillance programme.
Collapse
Affiliation(s)
- Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory, 7925, Cape Town, South Africa.
| | - Karen Robb
- Macmillan Cancer Care, Consequences of Cancer Treatment Collaborative, England, UK.
| |
Collapse
|
26
|
Shamley D, Robb K. An early warning surveillance programme for detecting upper limb deterioration after treatment for breast cancer: A novel technology supported system. BMC Cancer 2015; 15:635. [PMID: 26370571 PMCID: PMC4570230 DOI: 10.1186/s12885-015-1636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/01/2015] [Indexed: 11/17/2022] Open
Abstract
Upper limb morbidity is a well-recognised consequence of treatment for breast cancer that can develop for up to 6 years after treatment. However, the capacity to fully integrate evidence-based rehabilitation pathways into routine care for all patients is questionable due to limited resources. A long term surveillance programme must therefore be accessible to all patients, should identify those at risk of developing morbidity and target the interventions at the high risk population of patients. The proposed model uses a surrogate marker for assessing risk of morbidity, incorporated into an Early Warning System (EWS), to produce a technology-lead, prospective surveillance programme.
Collapse
Affiliation(s)
- Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory, 7925, Cape Town, South Africa.
| | - Karen Robb
- Macmillan Cancer Care, Consequences of Cancer Treatment Collaborative, England, UK.
| |
Collapse
|
27
|
|
28
|
Ewertz M, Qvortrup C, Eckhoff L. Chemotherapy-induced peripheral neuropathy in patients treated with taxanes and platinum derivatives. Acta Oncol 2015; 54:587-91. [PMID: 25751757 DOI: 10.3109/0284186x.2014.995775] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemotherapy with taxanes and platinum compounds has resulted in substantial survival benefits both in adjuvant and metastatic settings. However, as a side effect, such chemotherapy may cause peripheral neuropathy (CIPN) which may result in discontinuation of treatment, and if it persists after treatment completion, has a negative impact on quality of life (QoL). RESULTS Symptoms of CIPN are sensory, like pain, numbness, and tingling, typically located in the hands and feet. For oxaliplatin, there is an acute form of CIPN, resulting in paraesthesias in the mouth and throat during or shortly after the infusion triggered by exposure to cold. Risks factors for CIPN include preexisting neuropathy, either from treatment with other neurotoxic agents, or from comorbid conditions. The incidence of CIPN is related to dose per cycle, cumulative dose, and duration of infusion. While cisplatin-induced neuropathy is irreversible, CIPN induced by taxanes may persist for several years in about 30% of patients. Evidence from the literature is suggestive that CIPN is likely to be negatively associated with QoL. No agents have been identified to be recommended for the prevention of CIPN. For treatment of CIPN, the best available data supports a moderate recommendation for treatment with duloxetine and evidence is inconclusive regarding the use of tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine. CONCLUSION Research is still needed to predict which patients are at high risk of developing CIPN during treatment and in whom CIPN will persist after completion of chemotherapy.
Collapse
Affiliation(s)
- Marianne Ewertz
- Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Denmark
| | | | | |
Collapse
|
29
|
Eckhoff L, Knoop AS, Jensen MB, Ewertz M. Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors. Eur J Cancer 2015; 51:292-300. [DOI: 10.1016/j.ejca.2014.11.024] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/15/2014] [Accepted: 11/27/2014] [Indexed: 01/17/2023]
|
30
|
Hidding JT, Beurskens CHG, van der Wees PJ, van Laarhoven HWM, Nijhuis-van der Sanden MWG. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One 2014; 9:e96748. [PMID: 24816774 PMCID: PMC4016041 DOI: 10.1371/journal.pone.0096748] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined. METHODS AND FINDINGS We conducted a systematic literature search using the databases of PubMed, Embase, CINAHL and Cochrane from 2000 to October 2012, according to the PRISMA guidelines. Included were studies with patients with stage I-III breast cancer, treated with surgery and additional treatments (radiotherapy, chemotherapy and hormonal therapy). The following health outcomes were extracted: reduced joint mobility, reduced muscle strength, pain, lymphedema and limitations in daily activities. Outcomes were divided in within the first 12 months and >12 months post-operatively. Patients treated with ALND are at the highest risk of developing impairments of the arm and shoulder. Reduced ROM and muscle strength, pain, lymphedema and decreased degree of activities in daily living were reported most frequently in relation to ALND. Lumpectomy was related to a decline in the level of activities of daily living. Radiotherapy and hormonal therapy were the main risk factors for pain. CONCLUSIONS Patients treated with ALND require special attention to detect and consequently address impairments in the arm and shoulder. Patients with pain should be monitored carefully, because pain limits the degree of daily activities. Future research has to describe a complete overview of the medical treatment and analyze outcome in relation to the treatment. Utilization of uniform validated measurement instruments has to be encouraged.
Collapse
Affiliation(s)
- Janine T. Hidding
- Radboud university medical center, Department of Orthopedics, Section of Physical Therapy, Nijmegen, The Netherlands
- Radboud university medical center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
- * E-mail:
| | - Carien H. G. Beurskens
- Radboud university medical center, Department of Orthopedics, Section of Physical Therapy, Nijmegen, The Netherlands
| | - Philip J. van der Wees
- Radboud university medical center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Academic Medical Center, Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
31
|
Smoot B, Boyd BS, Byl N, Dodd M. Mechanosensitivity in the upper extremity following breast cancer treatment. J Hand Ther 2014; 27:4-11. [PMID: 24084387 PMCID: PMC3903181 DOI: 10.1016/j.jht.2013.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 06/19/2013] [Accepted: 08/12/2013] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Descriptive, cross-sectional. INTRODUCTION Breast cancer (BC) treatments place the nervous system at risk, which may contribute to upper extremity (UE) mechanosensitivity. PURPOSE OF THE STUDY To evaluate elbow extension range of motion (EE-ROM) during upper limb neurodynamic testing (ULNT) post-BC treatment. METHODS ULNT EE-ROM was measured for 145 women post-BC treatment. Women were sub-grouped by presence/absence of pain and lymphedema. RESULTS Mean EE-ROM during ULNT1 was -22.3° (SD 11.9°) on the unaffected limb and -25.99° (SD 13.1°) on the affected limb. The women with pain and lymphedema had the greatest limitation in EE-ROM during ULNT1 testing, particularly of their affected limb (-33.8°, SD 12.9). Symptoms were reported more frequently in the affected chest, shoulder, arm, elbow, and hand. The intensity of symptoms was greater at the affected chest (p = 0.046), shoulder (p = 0.033) and arm (p = 0.039). CONCLUSIONS Women with lymphedema and pain after BC treatment may present with altered neural mechanosensitivity. LEVEL OF EVIDENCE 3a.
Collapse
Affiliation(s)
- Betty Smoot
- Department of Physical Therapy and Rehabilitation Science,
University of California San Francisco, Box 0736, San Francisco, CA
94143-0736., Corresponding author Phone: 707 494-8262.
Fax: 415 514-6778.
| | - Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University,
450 30th Street, Oakland, CA, 94609. Phone: (510) 869-6511 x4913. Fax:
(510) 869-6282.
| | - Nancy Byl
- Department of Physical Therapy and Rehabilitation Science,
University of California San Francisco, Box 0736, San Francisco, CA 94143-0736.
Phone:. Fax: 415 514-6776.
| | - Marylin Dodd
- Department of Physiological Nursing, University of
California San Francisco
| |
Collapse
|
32
|
Upper Body Pain and Functional Disorders in Patients With Breast Cancer. PM R 2013; 6:170-83. [DOI: 10.1016/j.pmrj.2013.08.605] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/22/2022]
|
33
|
A retrospective study of postmastectomy pain syndrome: incidence, characteristics, risk factors, and influence on quality of life. ScientificWorldJournal 2013; 2013:159732. [PMID: 24379736 PMCID: PMC3863453 DOI: 10.1155/2013/159732] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/05/2013] [Indexed: 12/23/2022] Open
Abstract
Objective. The underlying cause for postmastectomy pain syndrome (PMPS) and its impact on quality of life remain unclear. The objective of this study aims to determine retrospectively the prevalence of PMPS, its predicting risk factors, and its impact on quality of life. Method. In this survey, 225 women completed a battery of questionnaires. The questionnaires comprised the short form of the McGill Pain Questionnaire (SF-MPQ) exploring the characteristics and the description of the pain, and a Short Form-36 (SF-36) Health Survey evaluating quality of life. Logistic regression analyses were subsequently performed to identify risk factors for PMPS. Results. 62 women (27.6%) reported PMPS as a consequence of surgery, and the pain was generally mild, mostly localized in breast area and intermittent. The pain was mainly described as aching (62.9%). 144 women reported sensory disturbance. We found that only the younger age is the predictive factor for PMPS (P < 0.05). Compared to the patients who did not experience PMPS, those who suffered from PMPS had significantly worse scores in role limitations due to physical problems (role physical, RP), body pain (BP), general health (GH), vitality (VT), role limitations due to emotional problems (role emotional, RE), and mental health (MH) (P < 0.05). Conclusion. PMPS is a significant problem, and the possible risk factors should be further explored. Patients with PMPS have significant worse quality of life, suggesting that patients should be well informed about the likelihood of experiencing the pain, and they may be afforded greater predictability and higher perceived control to enhance their quality of life.
Collapse
|
34
|
Møller T, Lillelund C, Andersen C, Ejlertsen B, Nørgaard L, Christensen KB, Vadstrup E, Diderichsen F, Hendriksen C, Bloomquist K, Adamsen L. At cancer diagnosis: a 'window of opportunity' for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer. BMJ Open 2013; 3:e003556. [PMID: 24189081 PMCID: PMC3822303 DOI: 10.1136/bmjopen-2013-003556] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Challenges exist in identifying, recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels. We hypothesise that the onset period of adjuvant chemotherapy can be 'the open window of opportunity' to identify and motivate sedentary patients with breast and colon cancers, at risk for developing coronary heart disease, to initiate and sustain lifestyle changes. AIMS To investigate the feasibility of oncologists/nurses screening for physical inactivity, in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy. Furthermore, the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks; (1) hospital-based, high intensity, group exercise intervention (2) home-based, low intensity, individual, pedometer intervention. Both arms will be compared with a control group. METHODS AND ANALYSES All newly referred patients will be screened for sedentary behaviour, using national recommendations. Testing at baseline, 6, 12 and 39 weeks will include; (1) physiological testing (VO2-peak, one repetition maximum muscle strength and lung function (2) fasting full body dual-energy X-ray absorptiometry scan (3) fasting blood glucose, insulin, lipids and cholesterols, (4) psychometric questionnaires (general well-being, quality of life, anxiety and depression, motivational readiness). The randomised controlled trial feasibility design is selected in order to examine barriers for recruitment, programme adherence, safety aspects and potential efficacy to the interventions during adjuvant chemotherapy. ETHICS AND DISSEMINATION The Scientific Committee of the Capital Region (case No. H-1-2011-131) and the Danish Data Protection Agency (j. No. 2011-41-6349) approved the study. Data will be entered and locked into a database hosted by the Copenhagen Trial Unit, Rigshosptialet. Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test. Results will be published in peer-reviewed scientific journals. TRIAL REGISTRATION Current Controlled Trials ISRCTN24901641.
Collapse
Affiliation(s)
- Tom Møller
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Lillelund
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Nørgaard
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Karl Bang Christensen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Eva Vadstrup
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Finn Diderichsen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hendriksen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Kira Bloomquist
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
35
|
Andersen K, Jensen M, Tvedskov T, Kehlet H, Gärtner R, Kroman N. Persistent pain, sensory disturbances and functional impairment after immediate or delayed axillary lymph node dissection. Eur J Surg Oncol 2013; 39:31-5. [DOI: 10.1016/j.ejso.2012.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/17/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022] Open
|