Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results

PURPOSE

To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway.

METHODS

Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary).

RESULTS

99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician.

CONCLUSION

The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.

Lipomodelling for the management of symptomatic peristomal contour abnormalities: a pilot and feasibility study

AIM

Lipomodelling has been successfully used in reconstructive breast surgery but not yet in patients with permanent stomas.

METHOD

A feasibility study of six patients with permanent stomas was undertaken. Patients underwent lipomodelling of the peristomal area. The number of leakages and quality of life were measured before and for 6 months after the procedure.

RESULTS

All patients reported an improvement in their stoma-related quality of life and a reduction in the number of leakages experienced (mean: 2.25 leakages/24 h before lipomodelling and 0.5 leakages/24 h after lipomodelling).

CONCLUSION

Lipomodelling appears to be an effective method to reduce stoma leakages caused by peristomal skin contour abnormalities.

Postprandial decrease in splenic volume demonstrated by magnetic resonance imaging and stereology

The aim of this study was to determine if the volume of the spleen changes after food intake. We applied an unbiased and efficient method for splenic volume estimation using magnetic resonance imaging (MRI) in combination with modern design stereology. MR images of the spleen were obtained for 10 healthy volunteers (five men and five women; mean age 28.9 years [range 23-35 years]) without a history of splenomegaly. The initial scans were performed in the morning after overnight fasting. Each volunteer then consumed a standard balanced meal weighing 500 g [2,460 kJ (627 kcal) energy] with 500 ml of still mineral water. Second identical MR scans were performed approximately 1 hr later. Postprandially, splenic volume decreased by an average of 6.6% (P = 0.005), probably due to increased splanchnic blood flow after food intake.

Segmentation and numerical analysis of microcalcifications on mammograms using mathematical morphology

The top-hat and watershed algorithms of mathematical morphology have been applied to detect automatically and segment microcalcifications on mammograms digitized to a pixel resolution of 40 microns using a CCD camera. The database comprised 38 cases from the breast assessment clinic in Liverpool. For all cases, both craniocaudal (CC) and lateral oblique (LO) views were available. 19 cases were proven to be benign and 19 malignant based on cytology and histology. Malignant clusters contained more microcalcifications (14 malignant, 10 benign), occupied a larger area (37 mm2, 9 mm2) and had longer cluster perimeters than benign clusters (33.2 mm, 15.5 mm). Malignant microcalcifications exhibited a wider variety of shapes and were more heterogeneous in terms of image signal intensity than benign microcalcifications. Further mathematical morphology algorithms were applied to describe microcalcification shape in terms of the presence or absence of infoldings, elongation, narrow irregularities and wide irregularities. The three largest microcalcifications were selected for each case and, using a "leave-one-out" approach, each microcalcification was classified in respect of its five nearest neighbours as either malignant or benign. The area under the curve of a receiver operating characteristic (ROC) analysis of the proportion of the three microcalcifications which agreed with the true diagnosis increased from 0.73 (CC) and 0.63 (LO) to 0.79 when both views were considered. Next, each cluster in turn was ranked according to its agreement with the database as a whole over 21 features. An ROC analysis was performed to investigate the effect on sensitivity and specificity of the proportion of the nine nearest neighbours that agreed with the true classification. The largest area under the ROC curve was 0.84 produced by the four features of proportion of irregular microcalcifications, proportion of round microcalcifications, number of microcalcifications in the cluster and the interquartile range of microcalcification area. The shape of microcalcifications is confirmed as being of overriding importance in classifying cases as either malignant or benign. This observation motivates a further study enhanced by using magnified views digitized to a higher resolution by a laser scanner. This will enable the reliable assessment of the shape of a greater number of microcalcifications in each cluster, which is likely to increase further the discriminating power of the image analysis routines and lead to the development of an expert system for automatic mammographic screening.

Objective quantification of muscle and fat in human dystrophic muscle by magnetic resonance image analysis

Information about changes in muscle composition has to date been primarily restricted to histological examination of biopsy samples or qualitative assessment of images obtained using a variety of techniques (e.g., ultrasound, CT, and MRI). We describe the development of a quantitative method for the analysis of muscle composition using MR T2 relaxation time mapping and image analysis. This approach provides an objective means of studying muscle and, when used in conjunction with force production measurements, may provide an accurate measure of response to muscle therapy.