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Rietjens JAC, Griffioen I, Sierra-Pérez J, Sroczynski G, Siebert U, Buyx A, Peric B, Svane IM, Brands JBP, Steffensen KD, Romero Piqueras C, Hedayati E, Karsten MM, Couespel N, Akoglu C, Pazo-Cid R, Rayson P, Lingsma HF, Schermer MHN, Steyerberg EW, Payne SA, Korfage IJ, Stiggelbout AM. Improving shared decision-making about cancer treatment through design-based data-driven decision-support tools and redesigning care paths: an overview of the 4D PICTURE project. Palliat Care Soc Pract 2024; 18:26323524231225249. [PMID: 38352191 PMCID: PMC10863384 DOI: 10.1177/26323524231225249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
Background Patients with cancer often have to make complex decisions about treatment, with the options varying in risk profiles and effects on survival and quality of life. Moreover, inefficient care paths make it hard for patients to participate in shared decision-making. Data-driven decision-support tools have the potential to empower patients, support personalized care, improve health outcomes and promote health equity. However, decision-support tools currently seldom consider quality of life or individual preferences, and their use in clinical practice remains limited, partly because they are not well integrated in patients' care paths. Aim and objectives The central aim of the 4D PICTURE project is to redesign patients' care paths and develop and integrate evidence-based decision-support tools to improve decision-making processes in cancer care delivery. This article presents an overview of this international, interdisciplinary project. Design methods and analysis In co-creation with patients and other stakeholders, we will develop data-driven decision-support tools for patients with breast cancer, prostate cancer and melanoma. We will support treatment decisions by using large, high-quality datasets with state-of-the-art prognostic algorithms. We will further develop a conversation tool, the Metaphor Menu, using text mining combined with citizen science techniques and linguistics, incorporating large datasets of patient experiences, values and preferences. We will further develop a promising methodology, MetroMapping, to redesign care paths. We will evaluate MetroMapping and these integrated decision-support tools, and ensure their sustainability using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We will explore the generalizability of MetroMapping and the decision-support tools for other types of cancer and across other EU member states. Ethics Through an embedded ethics approach, we will address social and ethical issues. Discussion Improved care paths integrating comprehensive decision-support tools have the potential to empower patients, their significant others and healthcare providers in decision-making and improve outcomes. This project will strengthen health care at the system level by improving its resilience and efficiency.
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Affiliation(s)
| | | | - Jorge Sierra-Pérez
- Department of Engineering Design and Manufacturing, University of Zaragoza, Zaragoza, Spain
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Alena Buyx
- Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
| | - Barbara Peric
- Institute of Oncology Ljubljana, Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Inge Marie Svane
- Department of Oncology, National Center for Cancer Immune Therapy, Herlev, Denmark
| | | | - Karina D. Steffensen
- Center for Shared Decision Making, Vejle/Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Carlos Romero Piqueras
- Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain Fractal Strategy, Zaragoza, Spain
| | - Elham Hedayati
- Department of Oncology–Pathology, Karolinska Institute, Stockholm, Sweden
- Breast Cancer Centre, Cancer Theme, Karolinska University Hospital, Karolinska CCC, Stockholm, Sweden
| | - Maria M. Karsten
- Department of Gynecology with Breast Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Canan Akoglu
- Lab for Social Design, Design School Kolding, Kolding, Denmark
| | - Roberto Pazo-Cid
- Department of Medical Oncology, Instituto de Investigación Sanitaria de Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Paul Rayson
- School of Computing and Communications, University Centre for Computer Corpus Research on Language, Lancaster University, Lancaster, UK
| | - Hester F. Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maartje H. N. Schermer
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Sheila A. Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Hage AM, Gebert P, Blohmer JU, Hedayati E, Speiser D, Karsten MM. Subtype-Specific Survival of Young Women with Breast Cancer and Its Interaction with the Germline BRCA Status. Cancers (Basel) 2024; 16:738. [PMID: 38398129 PMCID: PMC10887122 DOI: 10.3390/cancers16040738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Data are scarce on the role of pathogenic germline variants in BRCA1 and BRCA2 (gBRCAm) in subtype-specific survival in young women who develop breast cancer under the age of 40. This retrospective, real-world cohort study assessed the distant disease-free survival (DDFS) and overall survival (OS) of young women diagnosed with breast cancer between 2008 and 2019 while taking into consideration the interaction of clinical subtypes and the gBRCA status. Among 473 women, HR+/Her2- was the most common subtype (49.0%), followed by TNBC (31.3%), HR+/Her2+ (13.7%), and Her2+/HR- (5.9%). The gBRCA status was known for 319 cases (gBRCAwt (wild-type - without pathogenic variants in BRCA1 or BRCA2): 204, gBRCA1m: 83, gBRCA2m: 31, 1 patient with both). The distribution of clinical subtypes varied depending on the gBRCA status (p < 0.001). In survival analysis with a median follow-up of 43 months, the unadjusted DDFS and OS were worse for gBRCAwt TNBC compared to both HR+ subtypes, but not for gBRCAm TNBC patients. T-stage, nodal involvement, and the gBRCA status were identified as significant for survival in TNBC. In TNBC, gBRCAm was associated with better DDFS and OS than gBRCAwt (5-year DDFS 81.4% vs. 54.3%, p = 0.012 and 5-year OS 96.7% vs. 62.7%, p < 0.001). In contrast, in HR+/Her2- patients, gBRCAm patients showed a tendency for worse survival, though not statistically significant. Subtype-specific survival in young women with breast cancer needs to be evaluated in interaction with the gBRCA status. For TNBC, gBRCAm is of favorable prognostic value for overall survival, while patients with gBRCAwt TNBC need to be considered to have the highest risk for adverse survival outcomes.
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Affiliation(s)
- Anna Maria Hage
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Comprehensive Cancer Centre, 17176 Stockholm, Sweden
| | - Dorothee Speiser
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
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Granberg D, Juhlin CC, Falhammar H, Hedayati E. Lung Carcinoids: A Comprehensive Review for Clinicians. Cancers (Basel) 2023; 15:5440. [PMID: 38001701 PMCID: PMC10670505 DOI: 10.3390/cancers15225440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Lung carcinoids are neuroendocrine tumors, categorized as typical or atypical carcinoids based on their histological appearance. While most of these tumors are slow-growing neoplasms, they still possess malignant potential. Many patients are diagnosed incidentally on chest X-rays or CT scans. Presenting symptoms include cough, hemoptysis, wheezing, dyspnea, and recurrent pneumonia. Endocrine symptoms, such as carcinoid syndrome or ectopic Cushing's syndrome, are rare. Surgery is the primary treatment and should be considered in all patients with localized disease, even when thoracic lymph node metastases are present. Patients with distant metastases may be treated with somatostatin analogues, chemotherapy, preferably temozolomide-based, mTOR inhibitors, or peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE. Most patients have an excellent prognosis. Poor prognostic factors include atypical histology and lymph node metastases at diagnosis. Long-term follow-up is mandatory since metastases may occur late.
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Affiliation(s)
- Dan Granberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden;
- Department of Breast, Endocrine Tumors and Sarcomas, Karolinska University Hospital Solna, 17176 Stockholm, Sweden;
| | - Carl Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Stockholm, Sweden;
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden;
- Department of Endocrinology, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
| | - Elham Hedayati
- Department of Breast, Endocrine Tumors and Sarcomas, Karolinska University Hospital Solna, 17176 Stockholm, Sweden;
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Stockholm, Sweden;
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Hägglund HL, Jonsson M, Hedayati E, Hedman C, Djärv T. Poorer survival after out-of-hospital cardiac arrest among cancer patients: a population-based register study. Eur Heart J Acute Cardiovasc Care 2023; 12:495-503. [PMID: 37210580 PMCID: PMC10449376 DOI: 10.1093/ehjacc/zuad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
AIMS The association between cancer and survival after out-of-hospital cardiac arrest (OHCA) has not been thoroughly investigated. We aimed to address this knowledge gap using national, population-based registries. METHODS AND RESULTS For this study, 30 163 patients with OHCA (≥18 years) were included from the Swedish Register of Cardiopulmonary Resuscitation. Through linkage to the National Patient Registry, 2894 patients (10%) with cancer diagnosed within 5 years prior to OHCA were identified. Differences in 30-day survival between patients with cancer and controls (defined as patients with OHCA without previous cancer diagnosis) were assessed related to cancer stage (locoregional vs. metastasized cancer) and cancer site (e.g. lung cancer, breast cancer, etc.) using logistic regression adjusted for prognostic factors. Long-term survival was presented as a Kaplan-Meier curve. For locoregional cancer, no statistically significant difference in return of spontaneous circulation (ROSC) was seen compared with controls, and metastasized disease was associated with a poorer chance of ROSC. Cancer was associated with a lower 30-day survival for all cancers [adjusted odds ratio (OR) 0.57, confidence interval (CI) 0.49-0.66], locoregional cancer (adjusted OR 0.68, CI 0.57-0.82), and metastasized cancer (adjusted OR 0.24, CI 0.14-0.40) compared with controls. A lower 30-day survival compared with controls was seen for lung, gynaecological and haematological cancers. CONCLUSION Cancer is associated with poorer 30-day survival after OHCA. This study suggests that cancer site and disease stage are more relevant factors than cancer in general with regard to its effect on survival after OHCA.
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Affiliation(s)
- Hanna L Hägglund
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, D1: 04. 171 76 Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
- Breast Cancer Center, Cancer Theme, Karolinska University Hospital, Karolinska CCC, Stockholm, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, D1: 04. 171 76 Stockholm, Sweden
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He W, Zeng E, Sjölander A, Hübbert L, Hedayati E, Czene K. Concomitant Discontinuation of Cardiovascular Therapy and Adjuvant Hormone Therapy Among Patients With Breast Cancer. JAMA Netw Open 2023; 6:e2323752. [PMID: 37459096 DOI: 10.1001/jamanetworkopen.2023.23752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Importance A large proportion of patients with breast cancer concomitantly use adjuvant hormone therapy and cardiovascular therapy. Objective To examine the relative risk of discontinuing cardiovascular therapy during the periods before and after discontinuation of adjuvant hormone therapy. Design, Setting, and Participants This population-based cohort study included all women aged 40 to 74 years in Stockholm, Sweden, who were diagnosed with breast cancer and concomitantly using adjuvant hormone therapy and cardiovascular therapy. Patients were enrolled from July 1, 2005, to August 31, 2020, with a median follow-up of 7.2 years. Data were analyzed from November 3, 2021, to May 12, 2022. Exposure Discontinuation of adjuvant hormone therapy. Main Outcomes and Measures The main outcome was discontinuation of cardiovascular therapy (cardiovascular drugs, statins, or aspirin) within 1 year before and after discontinuation of adjuvant hormone therapy. Incidence rate ratios with 95% CIs were estimated using Poisson regression. Furthermore, hazard ratios (HRs) with 95% CIs for cause-specific mortality were estimated using Cox proportional hazards regression models, comparing those who discontinued and continued adjuvant hormone therapy. Results A total of 5493 patients with breast cancer who concomitantly used cardiovascular therapy were identified; 1811 who discontinued adjuvant hormone therapy were individually matched to 1 patient each who continued therapy by year of breast cancer diagnosis, age at diagnosis, and use of the same cardiovascular therapy. Most patients (4070 [74.1%]) were aged 60 years or older at diagnosis. At the time when patients discontinued adjuvant hormone therapy, 248 (12.2%) concomitantly discontinued their cardiovascular therapy. During follow-up, a higher discontinuation rate of cardiovascular therapy was also observed among those who discontinued adjuvant hormone therapy. Consistently, adjuvant hormone therapy discontinuation was associated with an increased risk of death not only due to breast cancer (HR, 1.43; 95 CI%, 1.01-2.01) but also cardiovascular disease (HR, 1.79; 95 CI%, 1.15-2.81). Stratifying the analyses on baseline type of adjuvant hormone therapy yielded consistent results. Conclusions and Relevance In this cohort study of data from population-based registers in Sweden, patients who discontinued adjuvant hormone therapy were also more likely to discontinue cardiovascular therapy, especially at the time when they discontinued adjuvant hormone therapy. These findings suggest that clinicians should shift from single- to multiple-disease focus to prevent discontinuation of therapies for other diseases among patients with breast cancer.
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Affiliation(s)
- Wei He
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erwei Zeng
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laila Hübbert
- Department of Cardiology, Linköping University, Norrköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Thurell J, Manouchehri N, Fredriksson I, Wilking U, Bergh J, Ryden L, Koppert LB, Karsten MM, Kiani NA, Hedayati E. Risk-adjusted benchmarking of long-term overall survival in patients with HER2-positive early-stage Breast cancer: A Swedish retrospective cohort study. Breast 2023; 70:18-24. [PMID: 37295176 DOI: 10.1016/j.breast.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
AIM The main objective of the current study was to explore the value of risk-adjustment when comparing (i.e. benchmarking) long-term overall survival (OS) in breast cancer (BC) between Swedish regions. We performed risk-adjusted benchmarking of 5- and 10-year OS after HER2-positive early BC diagnosis between Sweden's two largest healthcare regions, constituting approximately a third of the total population in Sweden. METHODS All patients diagnosed with HER2-positive early-stage BC between 01-01-2009 and 31-12-2016 in healthcare regions Stockholm-Gotland and Skane were included in the study. Cox proportional hazards model was used for risk-adjustment. Unadjusted (i.e. crude) and adjusted 5- and 10-year OS was benchmarked between the two regions. RESULTS The crude 5-year OS was 90.3% in the Stockholm-Gotland region and 87.8% in the Skane region. The crude 10-year OS was 81.7% in the Stockholm-Gotland region and 77.3% in the Skane region. However, when adjusted for age, menopausal status and tumour biology, there was no significant OS disparity between the regions, neither at the 5-year nor 10-year follow-up. CONCLUSION This study showed that risk-adjustment is relevant when benchmarking OS in BC, even when comparing regions from the same country that share the same national treatment guidelines. This is, to our knowledge, the first published risk-adjusted benchmarking of OS in HER2-positive BC.
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Affiliation(s)
- Jacob Thurell
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden.
| | - Narges Manouchehri
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Algorithmic Dynamics Lab, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Irma Fredriksson
- Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulla Wilking
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Ryden
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skane University Hospital, Malmö, Sweden
| | - Linetta B Koppert
- Erasmus MC Cancer Institute, Dept of Surgery, Rotterdam, the Netherlands
| | - Maria M Karsten
- Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Narsis A Kiani
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Algorithmic Dynamics Lab, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Cancer Center, Department of Breast, Endocrine Tumours and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
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de Ligt KM, de Rooij BH, Hedayati E, Karsten MM, Smaardijk VR, Velting M, Saunders C, Travado L, Cardoso F, Lopez E, Carney N, Wengström Y, Ives A, Velikova G, Sousa Fialho MDL, Seidler Y, Stamm TA, Koppert LB, van de Poll-Franse LV. International development of a patient-centered core outcome set for assessing health-related quality of life in metastatic breast cancer patients. Breast Cancer Res Treat 2023; 198:265-281. [PMID: 36662394 PMCID: PMC10020292 DOI: 10.1007/s10549-022-06827-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE For patients living with metastatic breast cancer (MBC), achieving best possible health-related quality of life, along with maximizing survival, is vital. Yet, we have no systemic way to determine if we achieve these goals. A Core Outcome Set (COS) that allows standardized measurement of outcomes important to patients, but also promotes discussing these outcomes during clinical encounters, is long overdue. METHODS An international expert group (EG) of patient advocates, researchers, medical specialists, nurse specialists, and pharmaceutical industry representatives (n = 17) reviewed a list of relevant outcomes retrieved from the literature. A broader group (n = 141: patients/patient advocates (n = 45), health care professionals/researchers (n = 64), pharmaceutical industry representatives (n = 28), and health authority representatives (n = 4)) participated in a modified Delphi procedure, scoring the relevance of outcomes in two survey rounds. The EG finalized the COS in a consensus meeting. RESULTS The final MBC COS includes 101 variables about: (1) health-related quality of life (HRQoL, n = 26) and adverse events (n = 24); (2) baseline patient characteristics (n = 9); and (3) clinical variables (n = 42). Many outcome that cover aspects of HRQoL relevant to MBC patients are included, e.g. daily functioning (including ability to work), psychosocial/emotional functioning, sexual functioning, and relationship with the medical team. CONCLUSION The COS developed in this study contains important administrative data, clinical records, and clinician-reported measures that captures the impact of cancer. The COS is important for standardization of clinical research and implementation in daily practice and has received accreditation by the International Consortium for Health Outcomes Measurement (ICHOM).
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Affiliation(s)
- K M de Ligt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - B H de Rooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - E Hedayati
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Solna, Stockholm, Sweden
- Breast Cancer Center, Cancer Theme, Karolinska University Hospital and Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - M M Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - V R Smaardijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - M Velting
- Dutch Breast Cancer Patient Association (Borstkankervereniging Nederland), Utrecht, The Netherlands
| | - C Saunders
- Department of Surgery, Melbourne Medical School, Melbourne, Australia
| | - L Travado
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - E Lopez
- Department of Radiation Oncology, Vithas Hospital La Milagrosa, GenesisCare, Madrid, Spain
| | - N Carney
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Y Wengström
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - A Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, WA, Australia
| | - G Velikova
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | | | - Y Seidler
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - T A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - L V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
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Johnsson A, Kiani NA, Gernaat SAM, Wilking U, Shabo I, Hedayati E. Planning for return to work during the first year after breast cancer metastasis: A Swedish cohort study. Cancer Med 2023; 12:10840-10850. [PMID: 36880198 DOI: 10.1002/cam4.5752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Planning for return to work (RTW) is relevant among sub-groups of metastatic breast cancer (mBC) survivors. RTW and protective factors for RTW in patients with mBC were determined. METHODS Patients with mBC, ages 18-63 years, were identified in Swedish registers, and data were collected starting 1 year before their mBC diagnosis. The prevalence of working net days (WNDs) (>90 and >180) during the year after mBC diagnosis (y1) was determined. Factors associated with RTW were assessed using regression analysis. The impact of contemporary oncological treatment of mBC on RTW and 5-year mBC-specific survival was compared between those diagnosed in 1997-2002 and 2003-2011. RESULTS Of 490 patients, 239 (48.8%) and 189 (36.8%) had >90 and >180 WNDs, respectively, during y1. Adjusted odds ratios (AORs) of WNDs >90 or >180 during y1 were significantly higher for patients with age ≤50 years (AOR180 = 1.54), synchronous metastasis (AOR90 = 1.68, AOR180 = 1.67), metastasis within 24 months (AOR180 = 1.51), soft tissue, visceral, brain as first metastatic site (AOR90 = 1.47) and sickness absence <90 net days in the year before mBC diagnosis, suggesting limited comorbidities (AOR90 = 1.28, AOR180 = 2.00), respectively. Mean (standard deviation) WNDs were 134.9 (140.1) and 161.3 (152.4) for patients diagnosed with mBC in 1997-2002 and 2003-2011, respectively (p = 0.046). Median (standard error) mBC-specific survivals were 41.0 (2.5) and 62.0 (9.6) months for patients diagnosed with mBC in 1997-2002 and 2003-2011, respectively (p < 0.001). CONCLUSIONS RTW of more than 180 WNDs was associated with younger age, early development of metastases and limited comorbidities during the year before the diagnosis of mBC. Patients diagnosed with mBC in 2003 or later had more WNDs and better survival than those diagnosed earlier.
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Affiliation(s)
- Aina Johnsson
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Narsis A Kiani
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Sofie A M Gernaat
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ulla Wilking
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Ivan Shabo
- Breast Cancer Centre, Cancer Theme, Karolinska University Hospital, Karolinska CCC, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Breast Cancer Centre, Cancer Theme, Karolinska University Hospital, Karolinska CCC, Stockholm, Sweden
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9
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Hubbert L, Mallios P, Karlström P, Papakonstantinou A, Bergh J, Hedayati E. Long-term and real-life incidence of cancer therapy-related cardiovascular toxicity in patients with breast cancer: a Swedish cohort study. Front Oncol 2023; 13:1095251. [PMID: 37152049 PMCID: PMC10154463 DOI: 10.3389/fonc.2023.1095251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background The administration of anticancer drugs in females with comorbidity increases the risk for cancer therapy-related cardiovascular toxicity (CTR-CVT), which in turn contributes to cardiovascular disease (CVD). Furthermore, a pathophysiological connection between cancer and cardiovascular disease may exist. Objective To assess the long-term risks and predictors of CTR-CVT, including clinical hypertension (HT), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), as well as all-cause mortality in women diagnosed with early breast cancer (BC) and eligible for adjuvant chemotherapy in Sweden. Methods Data were extracted from Swedish registers and medical records on 433 women, 18-60 years of age, diagnosed 1998-2002 with lymph node-positive BC, and considered for adjuvant chemotherapy. CTR-CVT was defined as HT, CAD, HF, or AF after the diagnosis of BC. Follow-up was from the date of BC diagnosis until November 30, 2021, or death. Prevalence of CTR-CVT and all-cause mortality were calculated. Hazard ratios (HR) were determined for factors associated with CTR-CVT. Results The median age was 50 (interquartile range (IQR) 32) years. 910 CTR-CVT events were diagnosed in 311 women with a median of 19.3 (IQR 15,3) years follow-up. The proportions of CTR-CVT events were: HT 281 (64%); CAD 198 (46%); HF 206 (47%); and AF 225 (51%). The cumulative incidence of CTR-CVT was 71.8%, and 50% of all 433 patients developed CTR-CVT within 11.7 years of BC diagnosis (standard deviation (SD) 0.57, 95% confidence interval (CI) 10.6-12.9). Age was a risk factor for CTR-CVT. Anthracycline increased the risk for HF (p=0,001; HR 2,0; 95%CI 1,4-2,8), CAD (p= 0,002; HR 1,7; 95% CI 1,2-2,4), and AF (p=0,013; HR 1,5; 95% CI 1,0-2,0). At the end of the 24-year study period, 227 of the 433 women were alive, and the total cumulative mortality was 47,6%. Conclusion The prevalence of CTR-CVT and all-cause mortality is high after BC diagnosis and treatment, particularly in older patients and those receiving anthracyclines. These findings and the onset of CTR-CVT support cardio-oncology guidelines recommending initial risk stratification and cardiovascular monitoring during treatment, followed by long-term annual screening for cardiovascular risk factors and CTR-CVT among BC survivors.
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Affiliation(s)
- Laila Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Panagiotis Mallios
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Patric Karlström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Andri Papakonstantinou
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Medical Unit: Breast, Endocrine Tumors, and Sarcoma, Theme Cancer, Karolinska University Hospital and Comprehensive Cancer Center, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Medical Unit: Breast, Endocrine Tumors, and Sarcoma, Theme Cancer, Karolinska University Hospital and Comprehensive Cancer Center, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Medical Unit: Breast, Endocrine Tumors, and Sarcoma, Theme Cancer, Karolinska University Hospital and Comprehensive Cancer Center, Stockholm, Sweden
- *Correspondence: Elham Hedayati,
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10
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Oda H, Hedayati E, Lindström A, Shabo I. GATA-3 expression in breast cancer is related to intratumoral M2 macrophage infiltration and tumor differentiation. PLoS One 2023; 18:e0283003. [PMID: 36996051 PMCID: PMC10062580 DOI: 10.1371/journal.pone.0283003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023] Open
Abstract
Accumulating evidence indicates that tumor-associated macrophages promote tumor progression and that high macrophage infiltration is correlated with advanced tumor stages and poor prognosis in breast cancer. GATA binding protein 3 (GATA-3) is a differentiation marker related to differentiated states in breast cancer. In this study, we explore how the extent of MI relates to GATA-3 expression, hormonal status, and the differentiation grade of breast cancer. To examine breast cancer in early development, we selected 83 patients that were treated with radical breast-conserving surgery (R0), without lymph node metastases (N0) or distant metastases (M0), with and without postoperative radiotherapy. Immunostaining of M2-macrophage-specific antigen CD163 was used to detect tumor-associated macrophages, and macrophage infiltration was estimated semi-quantitatively into no/low, moderate, and high infiltration. The macrophage infiltration was compared to GATA-3, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression in cancer cells. GATA-3 expression is associated with ER and PR expression but inversely correlated to macrophage infiltration and Nottingham histologic grade. High macrophage infiltration in advanced tumor grade was associated with low GATA-3 expression. The disease-free survival is inversely related to Nottingham histologic grade in patients having tumors with no/low macrophage infiltration, a difference that is not found in patients with moderate/high macrophage infiltration. These findings indicate that macrophage infiltration might impact the differentiation, malignant behavior, and prognosis of breast cancer, regardless of the morphological and hormonal states of the cancer cells in the primary tumor.
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Affiliation(s)
- Husam Oda
- Institution of Medical Biosciences, Clinical Pathology, Umeå University, Umeå, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors, and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Annelie Lindström
- Division of Cell Biology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ivan Shabo
- Department of Breast, Endocrine Tumors, and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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11
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Marklund A, Lekberg T, Hedayati E, Liljegren A, Bergh J, Lundberg FE, Rodriguez-Wallberg KA. Relapse Rates and Disease-Specific Mortality Following Procedures for Fertility Preservation at Time of Breast Cancer Diagnosis. JAMA Oncol 2022; 8:1438-1446. [PMID: 36006625 PMCID: PMC9412846 DOI: 10.1001/jamaoncol.2022.3677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Question Is fertility preservation at time of breast cancer diagnosis associated with any increased risk of disease-specific relapse or mortality? Findings In this population-based Swedish nationwide cohort study that included 1275 women with breast cancer, fertility preservation at time of breast cancer diagnosis was not statistically significantly associated with any increased risk of disease-specific mortality or relapse. Meaning Findings of this study support the safety of fertility preservation in women with breast cancer, which is highly relevant for reproductive counseling of women with breast cancer diagnosed at a young age. Importance Breast cancer (BC) is the most common indication for fertility preservation (FP) in women of reproductive age. Procedures for FP often include hormonal stimulation, but current data are scarce regarding whether using hormonal stimulation for FP is associated with any deterioration in BC prognosis. Objective To investigate the risk of disease-specific mortality and relapse in women who underwent FP with or without hormonal stimulation compared with women who did not at time of BC diagnosis. Design, Setting, and Participants This Swedish nationwide prospective cohort study was conducted to assess the safety of hormonal and nonhormonal FP procedures indicated by BC in Sweden from January 1, 1994, through June 30, 2017. Women were identified from any of the regional FP programs located at Swedish university hospitals. A total of 425 women were found to have undergone FP, and 850 population comparators who had not undergone FP were sampled from regional BC registers and matched on age, calendar period of diagnosis, and region. Relapse-free survival was assessed in a subcohort of 241 women who underwent FP and 482 women who had not, with complete data. Nationwide demographic and health care registers provided data on outcome, disease- and treatment-related variables, and socioeconomic characteristics. Data analyses were performed between November 2021 and March 2022 and completed in June 2022. Main Outcomes and Measures Relapse and disease-specific mortality after a diagnosis of BC. Results The final study population included 1275 women (mean [SD] age, 32.9 [3.8] years) at the time of BC diagnosis. After stratification by the matching variables age, calendar period, and region, and adjustment for country of birth, education, parity at diagnosis, tumor size, number of lymph node metastases, and estrogen receptor status, disease-specific mortality was similar in women who underwent hormonal FP (adjusted hazard ratio [aHR], 0.59; 95% CI, 0.32-1.09), women who underwent nonhormonal FP (aHR, 0.51; 95% CI, 0.20-1.29), and women who were not exposed to FP (reference). In a subcohort with detailed data on relapse, adjusted rate of disease-specific mortality and relapse were also similar among the groups who underwent hormonal FP (aHR, 0.81; 95% CI, 0.49-1.37), underwent nonhormonal FP (aHR, 0.75; 95% CI, 0.35-1.62), and were not exposed to FP (reference). Conclusions and Relevance In this cohort study, FP with or without hormonal stimulation was not associated with any increased risk of relapse or disease-specific mortality in women with BC. Results of this study provide much needed additional evidence on the safety of FP procedures in women with BC and may influence current health care practice to the benefit of young women with BC who wish to preserve their fertility.
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Affiliation(s)
- Anna Marklund
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Lekberg
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Breast Cancer Theme Center, Karolinska University Hospital and Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Breast Cancer Theme Center, Karolinska University Hospital and Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - Annelie Liljegren
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Department of Internal Medicine, Southern Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Breast Cancer Theme Center, Karolinska University Hospital and Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - Frida E Lundberg
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, BioClinicum, Karolinska Institutet, Solna, Sweden.,Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Laboratory of Translational Fertility Preservation, BioClinicum, Stockholm, Sweden
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12
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Hägglund H, Jonsson M, Hedayati E, Hedman C, Djärv T. P096 Increased Risk of Death after Out-of-Hospital Cardiac Arrest among Cancer Patients. Resuscitation 2022. [PMCID: PMC9179070 DOI: 10.1016/s0300-9572(22)00506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Altena R, Gernaat SAM, Wilking U, Kiani NA, Johnsson A, Hedayati E. Use of sickness benefits by patients with metastatic breast cancer-A Swedish cohort study. Eur J Cancer Care (Engl) 2022; 31:e13626. [PMID: 35621269 PMCID: PMC9541357 DOI: 10.1111/ecc.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study is to determine the prevalence and predictors of sickness absence (SA) and disability pension (DP) in women with metastatic breast cancer (mBC). METHODS Data were obtained from Swedish registers concerning 1,240 adult women diagnosed 1997-2011 with mBC, from 1 year before (y-1) to 2 (y1) and 2 (y2) years after diagnosis. SA and DP prevalence was calculated. Odds ratios (AOR) were determined for factors associated with using long-term (SA > 180 days or DP > 0 days) sickness benefits. RESULTS Prevalence of SA and DP was 56.0% and 24.8% during y-1, 69.9% and 28.9% during y1, and 64.0% and 34.7% during y2, respectively. Odds of using long-term sickness benefits were higher y1 and y2 in patients using long-term sickness benefits the year before diagnosis (AOR = 3.82, 95% CI 2.91-5.02; AOR = 4.31, 95% CI 2.96-6.29, respectively) and y2 in patients with mBC diagnosis 1997-2000 (AOR = 1.84, 95% CI 1.10-3.08) and using long-term sickness benefits the year after diagnosis (AOR = 22.10, 95% CI 14.33-34.22). CONCLUSIONS The prevalence of sickness benefit utilisation was high and increased after mBC diagnosis, particularly for patients using long-term sickness benefits prior to diagnosis. Additional study is needed to determine factors that might reduce the need for sickness benefits and enhance work ability in these patients.
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Affiliation(s)
- Renske Altena
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Stockholm, Sweden.,Breast Cancer Center, Cancer Theme, Karolinska University Hospital and Karolinska CCC, Stockholm, Sweden
| | - Sofie A M Gernaat
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Ulla Wilking
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Stockholm, Sweden
| | - Narsis A Kiani
- Department of Oncology-Pathology, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Algorithmic Dynamics Lab, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aina Johnsson
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Oncology, South Hospital, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet, Stockholm, Sweden.,Breast Cancer Center, Cancer Theme, Karolinska University Hospital and Karolinska CCC, Stockholm, Sweden
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14
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Bauer A, Eskat A, Ntekim A, Wong C, Eberle D, Hedayati E, Tay F, Yau H, Stockley L, de Medina Redondo M, Şen S, Egert-Schwender S, Üresin Y, Grossmann R. How COVID-19 changed clinical research strategies: a global survey. J Int Med Res 2022; 50:3000605221093179. [PMID: 35469473 PMCID: PMC9087250 DOI: 10.1177/03000605221093179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical research has faced new challenges during the COVID-19 pandemic, leading to excessive operational demands affecting all stakeholders. We evaluated the impact of COVID-19 on clinical research strategies and compared different adaptations by regulatory bodies and academic research institutions in a global context, exploring what can be learned for possible future pandemics. METHODS We conducted a cross-sectional online survey and identified and assessed different COVID-19-specific adaptation strategies used by academic research institutions and regulatory bodies. RESULTS All 19 participating academic research institutions developed and followed similar strategies, including preventive measures, manpower recruitment, and prioritisation of COVID-19 projects. In contrast, measures for centralised management or coordination of COVID-19 projects, project preselection, and funding were handled differently amongst institutions. Regulatory bodies responded similarly to the pandemic by implementing fast-track authorisation procedures for COVID-19 projects and developing guidance documents. Quality and consistency of the information and advice provided was rated differently amongst institutions. CONCLUSION Both academic research institutions and regulatory bodies worldwide were able to cope with challenges during the COVID-19 pandemic by developing similar strategies. We identified some unique approaches to ensure fast and efficient responses to a pandemic. Ethical concerns should be addressed in any new decision-making process.
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Affiliation(s)
- Annina Bauer
- Annina Bauer Clinical Trials Center Zürich, University Hospital
Zurich, Zurich, Switzerland
| | - Anja Eskat
- Anja Eskat Clinical Trials Center Zürich, University Hospital
Zurich, Zurich, Switzerland
| | - Atara Ntekim
- Atara Ntekim University of Ibadan/University College Hospital
Ibadan, Ibadan, Nigeria
| | - Creany Wong
- Creany Wong Clinical Trials Centre, The University of Hong Kong,
Hong Kong
| | - Deborah Eberle
- Deborah Eberle Clinical Trials Center Zürich, University
Hospital Zurich, Zurich, Switzerland
| | - Elham Hedayati
- Elham Hedayat Department of Oncology-Pathology, Cancer Center
Karolinska, Karolinska Institute, Stockholm, Sweden
| | - Fabian Tay
- Fabian Tay Clinical Trials Center Zürich, University Hospital
Zurich, Zurich, Switzerland
| | - Henry Yau
- Henry Yau Clinical Trials Centre, The University of Hong Kong,
Hong Kong
| | - Louise Stockley
- Louise Stockley Cambridge Clinical Trials Unit, Cambridge
University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Selçuk Şen
- Henry Yau Clinical Trials Centre, The University of Hong Kong,
Hong Kong
| | - Silvia Egert-Schwender
- Louise Stockley Cambridge Clinical Trials Unit, Cambridge
University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Yağız Üresin
- María de Medina Redondo Clinical Trials Center Zürich,
University Hospital Zurich, Zurich, Switzerland
| | - Regina Grossmann
- Selçuk Şen Center of Excellence for Clinical Research,
University of Istanbul, Istanbul, Turkey
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15
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Yang H, Bhoo Pathy N, Brand JS, Hedayati E, Grassmann F, Zeng E, Bergh J, Bian W, Ludvigsson JF, Hall P, Czene K. Risk of heart disease following treatment for breast cancer: results from a population-based cohort study. eLife 2022; 11:71562. [PMID: 35293856 PMCID: PMC8940173 DOI: 10.7554/elife.71562] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure and ischemic heart disease in women diagnosed with breast cancer. Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001-2008 in the Stockholm-Gotland region and followed-up until 2017. Time-dependent risks of arrhythmia, heart failure and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR=1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following loco-regional radiotherapy. Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices. Funding: This work was supported by the Swedish Research Council [grant no: 2018-02547]; Swedish Cancer Society [grant no: CAN-19-0266] and FORTE [grant no: 2016-00081].
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Affiliation(s)
- Haomin Yang
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| | - Nirmala Bhoo Pathy
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Judith S Brand
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Felix Grassmann
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erwei Zeng
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Weiwei Bian
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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16
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Altena R, Hubbert L, Kiani NA, Wengström Y, Bergh J, Hedayati E. Evidence-based prediction and prevention of cardiovascular morbidity in adults treated for cancer. Cardiooncology 2021; 7:20. [PMID: 34049593 PMCID: PMC8161987 DOI: 10.1186/s40959-021-00105-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer treatment-related morbidity relevantly compromises health status in cancer survivors, and efforts to optimise health-related outcomes in this population are vital to maximising healthy survivorship. A pre-treatment assessment - and possibly preventive management strategies - of cancer patients at increased risk for cardiovascular disease (CVD) seems a rational approach in this regard. Definitive evidence for such strategies is largely lacking, thereby impeding the formulation of firm recommendations. RESULTS The current scoping review aims to summarise and grade the evidence regarding strategies for prediction and prevention of CVD in adults in relation to oncological treatments. We conducted a scoping literature search for different strategies for primary prevention, such as medical and lifestyle interventions, as well as the use of predictive risk scores. We identified studies with moderate to good strength and up to now limited evidence to recommend primary preventive strategies in unselected patients treated with potentially cardiotoxic oncologic therapies. CONCLUSION Efforts to minimize the CVD burden in cancer survivors are needed to accomplish healthy survivorship. This can be done by means of robust models predictive for CVD events or application of interventions during or after oncological treatments. Up to now there is insufficient evidence to implement preventive strategies in an unselected group of patients treated with potential cardiotoxic oncological treatments. We conclude that randomised controlled trials are needed that evaluate medical and lifestyle interventions in groups at increased risk for complications, in order to be able to influence chronic illness risks, such as cardiovascular complications, for cancer survivors.
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Affiliation(s)
- Renske Altena
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit breast, endocrine tumours and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden.
| | - Laila Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Narsis A Kiani
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
- Medical Unit breast, endocrine tumours and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
| | - Elham Hedayati
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
- Medical Unit breast, endocrine tumours and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
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Clarijs ME, Thurell J, Kühn F, Uyl-de Groot CA, Hedayati E, Karsten MM, Jager A, Koppert LB. Measuring Quality of Life Using Patient-Reported Outcomes in Real-World Metastatic Breast Cancer Patients: The Need for a Standardized Approach. Cancers (Basel) 2021; 13:cancers13102308. [PMID: 34065805 PMCID: PMC8151772 DOI: 10.3390/cancers13102308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Metastatic breast cancer (MBC) remains incurable despite treatment improvements. The health-related quality of life is a multidimensional entity which covers physical, psychological and social dimensions. It is an important outcome particularly in patients with metastatic disease, as the primary goal of therapy is no longer curation, but to provide the best possible quality of life weighted against treatment risks and adverse symptoms. Patient-reported outcomes reflecting the quality of life are usually measured with validated questionnaires to evaluate treatment strategies based on symptom burden and to improve care delivery. This review shares insights into the role of patient-reported outcome measurements in MBC patients and describes the heterogeneity of current questionnaires. We conclude that an up-to-date and standardized outcome set is needed, containing relevant domains referring to individual needs to improve the quality of life assessment among MBC patients. This is a prerequisite to learn about how they could impact the clinical care pathway. Abstract Metastatic breast cancer (MBC) patients are almost always treated to minimize the symptom burden, and to prolong life without a curative intent. Although the prognosis of MBC patients has improved in recent years, the median survival after diagnosis is still only 3 years. Therefore, the health-related quality of life (HRQoL) should play a leading role in making treatment decisions. Heterogeneity in questionnaires used to evaluate the HRQoL in MBC patients complicates the interpretability and comparability of patient-reported outcomes (PROs) globally. In this review, we aimed to provide an overview of PRO instruments used in real-world MBC patients and to discuss important issues in measuring HRQoL. Routinely collecting symptom information using PROs could enhance treatment evaluation and shared decision-making. Standardizing these measures might help to improve the implementation of PROs, and facilitates collecting and sharing data to establish valid comparisons in research. This is a prerequisite to learn about how they could impact the clinical care pathway. In addition, the prognostic value of intensified PRO collection throughout therapy on survival and disease progression is promising. Future perspectives in the field of PROs and MBC are described.
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Affiliation(s)
- Marloes E. Clarijs
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands;
| | - Jacob Thurell
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden; (J.T.); (E.H.)
| | - Friedrich Kühn
- Department of Gynecology with Breast Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (F.K.); (M.M.K.)
| | - Carin A. Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands;
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden; (J.T.); (E.H.)
| | - Maria M. Karsten
- Department of Gynecology with Breast Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (F.K.); (M.M.K.)
| | - Agnes Jager
- Academic Breast Cancer Center, Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands;
| | - Linetta B. Koppert
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands;
- Correspondence: ; Tel.: +31-107-041-161
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Gernaat SAM, von Stedingk H, Hassan M, Nilsson HP, Rodriguez-Wallberg KA, Hedayati E, Rydberg P. Cyclophosphamide exposure assessed with the biomarker phosphoramide mustard-hemoglobin in breast cancer patients: The TailorDose I study. Sci Rep 2021; 11:2707. [PMID: 33526812 PMCID: PMC7851165 DOI: 10.1038/s41598-021-81662-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/30/2020] [Indexed: 11/09/2022] Open
Abstract
Cyclophosphamide (CPA) dosing by body surface area (BSA, m2) has been questioned as a predictor for individual drug exposure. This study investigated phosphoramide mustard-hemoglobin (PAM-Hb, pmol g-1 Hb) as a biomarker of CPA exposure in 135 female breast cancer patients receiving CPA during three courses based on BSA: 500 mg/m2 (C500 group, n = 67) or 600 mg/m2 (C600 group, n = 68). The inter-individual difference was calculated for both groups by dividing the highest through the lowest PAM-Hb value of each course. The inter-occasion difference was calculated in percentage for each individual by dividing their PAM-Hb value through the group mean per course, and subsequently dividing this ratio of the latter through the previous course. A multivariable linear regression (MLR) was performed to identify factors that explained the variation of PAM-Hb. During the three courses, the inter-individual difference changed from 3.5 to 2.1 and the inter-occasion difference ranged between 13.3% and 11.9% in the C500 group. In the C600 group, the inter-individual difference changed from 2.7 to 2.9 and the inter-occasion difference ranged between 14.1% and 11.7%. The MLR including BSA, age, GFR, and albumin explained 17.1% of the variation of PAM-Hb and was significantly better then the model including only BSA. These factors should be considered when calculating the first dose of CPA for breast cancer patients.
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Affiliation(s)
- S A M Gernaat
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | | | - M Hassan
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | | | - K A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Gynecology and Reproduction, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Medical Unit of Breast Cancer, Sarcoma and Endocrine Tumours, Theme Cancer, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Marklund A, Lundberg FE, Eloranta S, Hedayati E, Pettersson K, Rodriguez-Wallberg KA. Reproductive Outcomes After Breast Cancer in Women With vs Without Fertility Preservation. JAMA Oncol 2021; 7:86-91. [PMID: 33211089 PMCID: PMC7677871 DOI: 10.1001/jamaoncol.2020.5957] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Question What are the long-term reproductive outcomes after breast cancer in women with vs without a history of fertility preservation? Findings In this population-based nationwide cohort study of 425 Swedish women with breast cancer who underwent fertility preservation, fertility preservation at the time of breast cancer diagnosis was associated with a significantly higher rate of postdiagnosis live births and assisted reproduction treatments, without any negative association with all-cause survival following fertility preservation. Meaning The findings of this study may be relevant for reproductive counseling of women with breast cancer diagnosed at reproductive age. Importance The practice of fertility preservation (FP) in women with breast cancer (BC) is spreading, but long-term reproductive outcomes after FP are largely unknown. Objective To investigate the long-term reproductive outcomes in women who did or did not undergo FP at the time of BC diagnosis. Design, Setting, and Participants A Swedish nationwide cohort study was conducted to investigate the long-term reproductive outcomes of women with BC receiving FP at 1 of the regional FP programs from 1994 to 2017 (n = 425). Population comparators with BC but without history of FP (n = 850) were sampled from regional BC registers, matched on age, calendar period of diagnosis, and county. Data on live births, assisted reproductive technology (ART) use, and mortality were retrieved from population-based registers. Data analysis was performed from January to September 2020. Exposures History of having received FP compared with no history of FP (unexposed). Main Outcomes and Measures The primary outcome was hazard ratios (HRs) of live births and ART treatments following BC in women with vs without FP and the cumulative incidence of these events in the presence of the competing risk of death. Results Women who had undergone FP (n = 425) had lower parity (302 [71.1%] were nulliparous compared with 171 [20.1%] in the unexposed group), were younger (mean [SD] age, 32.1 [4.0] vs 33.3 [3.6] years), more often had estrogen receptor–positive tumors (289 [68.0%] vs 515 [60.6%]), and were more often scheduled for chemotherapy (399 [93.9%] vs 745 [87.7%]). Of 425 women exposed to FP, 97 (22.8%) had at least 1 post-BC live birth (mean follow-up, 4.6 years), compared with 74 of 850 women (8.7%) unexposed to FP (mean follow-up, 4.8 years). Overall, live birth rates after BC were significantly higher among women with FP (adjusted hazard ratio [aHR], 2.3; 95% CI, 1.6-3.3). The 5-year and 10-year cumulative incidence of post-BC live births was 19.4% and 40.7% among FP-exposed women vs 8.6% and 15.8% among comparators, respectively. Rates of ART use were also higher in the FP group (aHR, 4.8; 95% CI, 2.2-10.7). The all-cause mortality rate was lower in women exposed to FP (aHR, 0.4; 95% CI, 0.3-0.7), with 5-year cumulative incidence of death of 5.3% (95% CI, 3.1%-9.0%) vs 11.1% (95% CI, 8.7%-14.1%) for women with vs without FP. Conclusions and Relevance In this cohort study of Swedish women after a BC diagnosis, successful pregnancy after BC was possible both in women with and without FP at the time of diagnosis, but a significantly higher likelihood of post-BC live births and ART treatments was observed in women who underwent FP, without any negative association with all-cause survival. This information is valuable for health care clinicians responsible for oncologic treatment and reproductive counseling of women diagnosed with breast cancer at reproductive age.
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Affiliation(s)
- Anna Marklund
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Frida E Lundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Pettersson
- Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.,Laboratory of Translational Fertility Preservation, BioClinicum J 5:30, Stockholm, Sweden
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20
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Gernaat SAM, Johnsson A, Altena R, Wilking U, Hedayati E. Sickness absence and disability pension among swedish women prior to breast cancer relapse with a special focus on the roles of treatment and comorbidity. Eur J Cancer Care (Engl) 2021; 30:e13353. [PMID: 33151558 PMCID: PMC7900972 DOI: 10.1111/ecc.13353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We aimed to determine the longitudinal prevalence and the predictors of sickness absence (SA) and disability pension (DP) in breast cancer (BC) women who eventually developed relapse. METHODS A total of 1293 BC women, who were ages 20-63 years, diagnosed between 1996 and 2011 and by 2016 had all developed relapse, were identified in Swedish registers and were followed from two years before to five years after their primary diagnosis, while they were relapse-free. Annual prevalence of SA and DP was calculated. Logistic regression was used to estimate adjusted odds ratios (AOR) for long-term SA (>30 days) at one (y1) and three (y3) years post-diagnosis. RESULTS Prevalence of long-term SA was 68.1% in y1 and 16.3% in y5. Prevalence of DP progressively increased from 16.3% in y1 to 29.0% in y5. Predictors of long-term SA included age <50 years (y1:AOR = 1.79 [1.39-2.29]), TNM stage III (y1:AOR = 1.54 [1.03-2.31]; y3:AOR = 2.21 [1.32-3.72]), metastasis (y1:AOR = 1.64 [1.26-2.12]; y3:AOR = 1.51 [1.05-2.18]), comorbidity (y1:AOR = 2.41 [1.55-3.76]; y3 AOR = 4.62 [2.49-8.57]) and any combination of radiotherapy, chemotherapy and hormonal therapy (y1:AOR = 2.05-5.71). CONCLUSION Among BC women who later developed relapse, those who had higher stages of BC, had comorbidity and received neoadjuvant and/or adjuvant therapy were at significantly higher risk of needing long-term SA after their diagnosis.
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Affiliation(s)
- Sofie A. M. Gernaat
- Department of MedicineClinical Epidemiology DivisionKarolinska InstituteStockholmSweden
| | - Aina Johnsson
- Department of Oncology‐PathologyKarolinska InstituteStockholmSweden
- Neurobiology, Care Science and SocietyDivision of Family MedicineKarolinska InstitutetHuddingeSweden
| | - Renske Altena
- Department of Oncology‐PathologyKarolinska InstituteStockholmSweden
- Medical Unit of Breast CancerSarcoma and Endocrine TumorsTheme CancerKarolinska University HospitalStockholmSweden
| | - Ulla Wilking
- Department of Oncology‐PathologyKarolinska InstituteStockholmSweden
| | - Elham Hedayati
- Department of Oncology‐PathologyKarolinska InstituteStockholmSweden
- Medical Unit of Breast CancerSarcoma and Endocrine TumorsTheme CancerKarolinska University HospitalStockholmSweden
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21
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Hedayati E, Papakonstantinou A, Månsson-Broberg A, Bergh J, Hubbert L, Altena R. Approaches to management of cardiovascular morbidity in adult cancer patients - cross-sectional survey among cardio-oncology experts. Cardiooncology 2020; 6:16. [PMID: 32884837 PMCID: PMC7460793 DOI: 10.1186/s40959-020-00070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
Background In cardio-oncology, a range of clinical dilemmas can be identified where high-quality evidence for management is still lacking. The aim of this project was to study clinical practices and expert approaches to several clinical cardio-oncological dilemmas regarding prediction, prevention and treatment of cardiovascular disease in adult cancer patients. Methods A cross-sectional online survey was sent out to internationally renowned experts in the field of cardio-oncology. Participants were selected based on being first or last authors of papers in the field of cardio-oncology, or principal investigators to trials in this field. Results Topics discussed include, among others, the use of biomarkers for subclinical cardiovascular toxicity, approaches towards primary prevention and follow-up with medication and life-style recommendations, and management of fluoropyrimidine-vasospasm, QTc-prolongation and asymptomatic declines in left ventricular ejection fraction. Conclusion The answers provided in this survey have shed light on expert-based practices in cardio-oncologic dilemmas. Attitudes towards, as well as discrepancies in those dilemmas are presented. Existing discrepancies clearly indicate the need for generation of high-quality data that allows for more evidence-based recommendations in the future.
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Affiliation(s)
- E Hedayati
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Medical unit breast, endocrine tumors and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
| | - A Papakonstantinou
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Medical unit breast, endocrine tumors and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
| | - A Månsson-Broberg
- Cardiology Unit, Theme Heart, Vascular and Neuro, Karolinska University Hospital Stockholm, Solna, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - J Bergh
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Medical unit breast, endocrine tumors and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
| | - L Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Altena
- Department of Oncology and Pathology Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.,Medical unit breast, endocrine tumors and sarcoma, Theme Cancer, Karolinska University Hospital Stockholm, Solna, Sweden
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Hedayati E, Papakonstantinou A, Gernaat SAM, Altena R, Brand JS, Alfredsson J, Bhoo-Pathy N, Herrmann J, Linde C, Dahlstrom U, Bergh J, Hubbert L. Outcome and presentation of heart failure in breast cancer patients: findings from a Swedish register-based study. Eur Heart J Qual Care Clin Outcomes 2020; 6:147-155. [PMID: 31328233 DOI: 10.1093/ehjqcco/qcz039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
AIMS Heart failure (HF) patients diagnosed with breast cancer (BC) may have a higher risk of death, and different HF presentation and treatment than patients without BC. METHODS AND RESULTS A total of 14 998 women with incident HF (iHF) or prevalent HF (pHF) enrolled in the Swedish HF Registry within and after 1 month since HF diagnosis, respectively, between 2008 and 2013. Patients were linked with the National Patient-, Cancer-, and Cause-of-Death Registry. Two hundred and ninety-four iHF and 338 pHF patients with BC were age-matched to 1470 iHF and 1690 pHF patients without BC. Comorbidity and treatment characteristics were compared using the χ2 tests for categories. Cox proportional hazard models assessed the hazard ratio (HR) and 95% confidence intervals (95% CIs) of all-cause and cardiovascular mortality among HF patients with and without BC. In the pHF group, BC patients had less often myocardial infarction (21.6% vs. 28.6%, P < 0.01) and received less often aspirin (47.6% vs. 55.1%, P = 0.01), coronary revascularization (11.8% vs. 16.2%, P < 0.01), or device therapy (0.9% vs. 3.0%, P = 0.03). After median follow-up of 2 years, risk of all-cause mortality (iHF: HR = 1.04, 95% CI = 0.83-1.29 and pHF: HR = 0.94, 95% CI = 0.79-1.12), cardiovascular mortality (iHF: HR = 0.94, 95% CI = 0.71-1.24 and pHF: HR = 0.89, 95% CI = 0.71-1.10), and HF mortality (iHF: HR = 0.80, 95% CI = 0.34-1.90 and pHF: HR = 0.75, 95% CI = 0.43-1.29) were similar for patients with and without BC in the iHF and pHF groups. CONCLUSION Risk of all-cause and cardiovascular mortality in HF patients did not differ by BC status. Differences in pre-existing myocardial infarction and HF treatment among pHF patients with and without BC may suggest differences in pathogenesis of HF.
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Affiliation(s)
- Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, SE-17176 Stockholm, Sweden.,Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumours, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Antroula Papakonstantinou
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, SE-17176 Stockholm, Sweden.,Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumours, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sofie A M Gernaat
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, SE-17176 Stockholm, Sweden
| | - Renske Altena
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, SE-17176 Stockholm, Sweden.,Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumours, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Judit S Brand
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Nirmala Bhoo-Pathy
- Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - Jeorg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ulf Dahlstrom
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, SE-17176 Stockholm, Sweden.,Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumours, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Laila Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Norrkoping, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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Papakonstantinou A, Hedayati E, Hellström M, Johansson H, Gnant M, Steger G, Greil R, Untch M, Moebus V, Loibl S, Foukakis T, Bergh J, Matikas A. Neutropenic complications in the PANTHER phase III study of adjuvant tailored dose-dense chemotherapy in early breast cancer. Acta Oncol 2020; 59:75-81. [PMID: 31583943 DOI: 10.1080/0284186x.2019.1670353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Myelosuppresion is a common side effect of chemotherapy and granulocyte-colony stimulating factor (G-CSF) is often used to reduce the risk of neutropenic events. The purpose of this exploratory analysis was to investigate neutropenic complications in the phase III PANTHER trial of standard 3-weekly chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide plus docetaxel (FEC/D) versus bi-weekly tailored dose-dense EC/D adjuvant chemotherapy in breast cancer.Patients and methods: Febrile neutropenia, neutropenic infection and infection grade 3-4 according to CTC AE 3.0, were explored in relation to G-CSF use. Per cycle analysis was performed concerning dose reduction and dose delays in conjunction with G-CSF administration.Results: In the experimental group, 98.9% of patients received primary G-CSF support during EC and 97.4% during docetaxel, compared with 49.7% during FEC and 63.88% during docetaxel in the standard group. Overall, the use of G-CSF was associated with a lower risk for developing neutropenic events (OR 0.44, 95% CI 0.35-0.55, p < .001). Chemotherapy delays due to neutropenia and leukopenia were significantly decreased among patients that received G-CSF (OR 0.098, 95% CI 0.06-0.15 and OR 0.32, 95% CI 0.18-0.58, respectively).Discussion: In conclusion, G-CSF support reduces neutropenic events and permits increased relative dose intensity, which is essential for improved survival outcomes.
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Affiliation(s)
- Antroula Papakonstantinou
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer, Endocrine Tumours and Sarcoma Section, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer, Endocrine Tumours and Sarcoma Section, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Hellström
- CKC, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- CKC, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Günther Steger
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Department of Medical Oncology, Medical University, Vienna, Austria
- Gaston H. Glock Research Center, Medical University, Vienna, Austria
| | - Richard Greil
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- IIIrd Medical Department, Cancer Cluster Salzburg, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Volker Moebus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Academic Hospital of the Goethe University, Frankfurt, Germany
| | | | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer, Endocrine Tumours and Sarcoma Section, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer, Endocrine Tumours and Sarcoma Section, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer, Endocrine Tumours and Sarcoma Section, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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24
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Papakonstantinou A, Matikas A, Bengtsson NO, Malmström P, Hedayati E, Steger G, Untch M, Hübbert L, Johansson H, Hellström M, Gnant M, Loibl S, Greil R, Moebus V, Foukakis T, Bergh J. Efficacy and safety of tailored and dose-dense adjuvant chemotherapy and trastuzumab for resected HER2-positive breast cancer: Results from the phase 3 PANTHER trial. Cancer 2019; 126:1175-1182. [PMID: 31851385 DOI: 10.1002/cncr.32653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dose-dense (DD) adjuvant chemotherapy improves outcomes in early breast cancer (BC). However, there are no phase 3 randomized data to inform on its combination with trastuzumab for patients with human epidermal growth factor receptor 2 (HER2)-positive disease. METHODS This was a protocol-predefined secondary analysis of the randomized phase 3 Pan-European Tailored Chemotherapy (PANTHER) trial. Women 65 years old or younger with node-positive or high-risk, node-negative BC were randomized 1:1 to either tailored (according to hematologic nadirs) and DD epirubicin and cyclophosphamide followed by docetaxel or standard 5-fluorouracil, epirubicin, and cyclophosphamide plus docetaxel every 3 weeks. Patients with HER2-positive disease received 1 year of adjuvant trastuzumab. The primary endpoint was BC relapse-free survival. In addition, HER2-positive patients and an equal number of HER2-negative patients matched for age, treatment group, and institution who were enrolled at Swedish sites were asked to participate in a predefined study of cardiac safety and underwent echocardiography or multigated acquisition scanning and electrocardiography at the baseline and at 4 and 6 years of follow-up. RESULTS There were 342 HER2-positive patients; 335 received at least 1 dose of trastuzumab, and 29 patients discontinued trastuzumab prematurely. Relapse-free survival was not statistically significantly in favor of the tailored and DD group (hazard ratio, 0.68; 95% confidence interval, 0.37-1.27; P = .231). Cardiac outcomes after 4 and 6 years of follow-up did not differ significantly between HER2-positive and HER2-negative patients or between the 2 treatment groups. CONCLUSIONS The combination of DD chemotherapy and trastuzumab decreased the relative risk for relapse by 32% in comparison with standard treatment, a statistically nonsignificant difference. Its efficacy and safety merit further evaluation as part of both escalation and de-escalation strategies.
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Affiliation(s)
| | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | | | - Per Malmström
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Guenther Steger
- Medical Oncology, Medical University of Vienna, Vienna, Austria.,Gaston H. Glock Research Center, Medical University of Vienna, Vienna, Austria
| | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Laila Hübbert
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linkoping University, Linkoping, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Mats Hellström
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Richard Greil
- Third Medical Department, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
| | - Volker Moebus
- Department of Medicine II, Hematology & Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
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Shabo I, Midtbö K, Hedayati E, Garvin S, Lindström A. Macrophage-cancer cell fusion is mediated by phosphatidylserine-CD36 receptor interaction and induced by ionizing radiation. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Lewinter C, Edfors LR, Nielsen TH, Hedayati E, Kober L, Braunschweig F, Mansson-Broberg A. P3120Prevention of heart failure in treatments with trastuzumab and anthracyclines: a meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Trastuzumab and anthracyclines are conventional chemotherapies used in breast cancer. Unfortunately, they are associated with a decrease in left ventricular function potentially leading to heart failure (HF). In order to prevent this, randomised controlled trials (RCTs) assess the preventive effect of concomitant beta-blocker (BB), angiotensin receptor blocker (ARB) and angiotensin converting enzyme inhibitor (ACEI) therapy during chemotherapy.
Purpose
To assess the preventive effect of BB, ARB or ACEIs on left ventricular ejection fraction (LVEF) during trastuzumab and anthracycline treatment in patients without HF.
Methods
Our primary outcomes were the effect of BBs or ARB/ACEIs during 1) trastuzumab and 2) anthracycline treatment.
Secondary outcomes were the distinct effects of 1) BBs and 2) ARB/ACEIs in either trastuzumab or anthracycline treatments.
Through the search term “(RCTs), prevention, cancer chemotherapy and cardiotoxicity” in PubMed, studies were selected, excluding those without randomising to a BB, ARB/ACEI and a placebo control group during chemotherapy.
Means of the LVEF and the standard deviation (SD) post-chemotherapy were applied.
Meta-analyses estimated the standardised mean difference (SMD) in the LVEF.
Heterogeneity was calculated as the I2.
Results
A total of 7 studies (Table 1) were included in the analysis. Between 93 and 100% were woman. Age varied from 41 to 51 years. Treatment time varied from 12 to 52 weeks.
Concomitant BB or ARB/ACEI therapy during trastuzumab treatment was not associated with the LVEF, significantly (Fig. 1A; p=0.07). Oppositely, in the anthracycline regime the LVEF remained significant higher in the concomitant BB and ARB/ACEI groups as compared to controls (Fig. 1B).
BB and ARB/ACEI separation in the analysis showed both to influence the LVEF positively independent of chemotherapy (P=0.03 & p=0.005).
Table 1 Study reference Year Chemotherapies Preventive drugs Pituskin et al., “Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity.” 2017 Trastuzumab Perindopril. bisoprolol Gulati et al., “Prevention of Cardiac Dysfunction during Adjuvant Breast Cancer Therapy (PRADA).” 2016 Trastuzumab Candesartan, metoprolol Boekhout et al., “Angiotensin II-Receptor Inhibition With Candesartan to Prevent Trastuzumab-Related Cardiotoxic Effects in Patients With Early Breast Cancer: A Randomized Clinical Trial.” 2016 Trastuzumab Candesartan Janbabai et al., “Effect of Enalapril on Preventing Anthracycline-Induced Cardiomyopathy.” 2017 Anthracycline Enalapril Nabati et al., “Cardioprotective Effects of Carvedilol in Inhibiting Doxorubicin-Induced Cardiotoxicity.” 2017 Anthracycline Carvedilol Tashakori Beheshti et al., “Carvedilol Administration Can Prevent Doxorubicin-Induced Cardiotoxicity: A Double-Blind Randomized Trial.” 2016 Anthracycline Carvedilol Kaya et al., “Protective Effects of Nebivolol against Anthracycline-Induced Cardiomyopathy: A Randomized Control Study.” 2013 Anthracycline Nebivolol
Figure 1
Conclusions
Concomitant BB and ARB/ACEI therapy both favoured maintenance of the LVEF during trastuzumab and anthracyclines regimens as compared to controls.
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Affiliation(s)
- C Lewinter
- Karolinska University Hospital, Stockholm, Sweden
| | - L R Edfors
- Karolinska University Hospital, Stockholm, Sweden
| | - T H Nielsen
- Rigshospitalet - Copenhagen University Hospital, Hematology, Copenhagen, Denmark
| | - E Hedayati
- Karolinska University Hospital, Stockholm, Sweden
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark
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Garvin S, Vikhe Patil E, Arnesson LG, Oda H, Hedayati E, Lindström A, Shabo I. Differences in intra-tumoral macrophage infiltration and radiotherapy response among intrinsic subtypes in pT1-T2 breast cancers treated with breast-conserving surgery. Virchows Arch 2019; 475:151-162. [PMID: 30915533 PMCID: PMC6647441 DOI: 10.1007/s00428-019-02563-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023]
Abstract
Breast cancer (BC) intrinsic subtype classification is based on the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and proliferation marker Ki-67. The expression of these markers depends on both the genetic background of the cancer cells and the surrounding tumor microenvironment. In this study, we explore macrophage traits in cancer cells and intra-tumoral M2-macrophage infiltration (MI) in relation to intrinsic subtypes in non-metastatic invasive BC treated with breast conserving surgery, with and without postoperative radiotherapy (RT). Immunostaining of M2-macrophage-specific antigen CD163 in cancer cells and MI were evaluated, together with ER, PR, HER2, and Ki-67-expression in cancer cells. The tumors were classified into intrinsic subtypes according to the ESMO guidelines. The immunostaining of these markers, MI, and clinical data were analyzed in relation to ipsilateral local recurrence (ILR) as well as recurrence-free (RFS) and disease-free specific (DFS) survival. BC intrinsic subtypes are associated with T-stage, Nottingham Histologic Grade (NHG), and MI. Macrophage phenotype in cancer cells is significantly associated with NHG3-tumors. Significant differences in macrophage infiltration were observed among the intrinsic subtypes of pT1-T2 stage BC. Shorter RFS was observed in luminal B HER2neg tumors after RT, suggesting that this phenotype may be more resistant to irradiation. Ki-67-expression was significantly higher in NHG3 and CD163-positive tumors, as well as those with moderate and high MI. Cancer cell ER expression is inversely related to MI and thus might affect the clinical staging and assessment of BC.
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Affiliation(s)
- Stina Garvin
- Division of Pathology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden
| | - Eva Vikhe Patil
- Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden
| | - Lars-Gunnar Arnesson
- Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden
| | - Husam Oda
- Department of Medical Biosciences, Pathology, Umeå University, SE-901 87, Umeå, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, SE 171 76, Stockholm, Sweden
- Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, SE 171 76, Stockholm, Sweden
| | - Annelie Lindström
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden
| | - Ivan Shabo
- Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, SE 171 76, Stockholm, Sweden.
- Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
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Foukakis T, Papakonstantinou A, Matikas A, Bengtsson NO, Malmström P, Hedayati E, Steger GG, Untch M, Hübbert L, Johansson H, Hellstrom M, Gnant M, Loibl S, Greil R, Moebus V, Bergh JCS. Tailored dose-dense chemotherapy in combination with trastuzumab as adjuvant therapy for HER2-positive breast cancer: A secondary analysis of the phase III PANTHER trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
553 Background: Dose-dense (DD) adjuvant chemotherapy improves outcomes in early breast cancer (BC). However, there are no data to inform on the combination of DD chemotherapy with trastuzumab for patients with HER2-positive disease. Methods: This is a protocol predefined secondary analysis of the randomized phase 3 PANTER trial. Women 65 years old or younger with node-positive or high-risk node negative BC were randomized 1:1 to either tailored according to hematologic nadirs and DD epirubicin/cyclophosphamide (4 cycles) followed by 4 cycles of docetaxel (tDD EC/D) or standard 3-weekly 5-fluorouracil/E/C (3 cycles) and D (3 cycles); Patients with HER2-positive disease received 1 year of adjuvant trastuzumab. In addition, HER2-positive and an equal number of matched for age, treatment group and institution, HER2-negative patients that were enrolled in Swedish sites were enrolled in a predefined study of cardiac safety and underwent echocardiography or MUGA and electrocardiography at baseline and at four and six years of follow-up. The primary endpoint was BC relapse-free survival (BCRFS). Results: There were 342 HER2-positive patients; 335 received at least one dose of trastuzumab, while 29 patients discontinued trastuzumab prematurely. BCRFS was not statistically significantly in favor of tDD EC/D (HR = 0.68, 95% CI 0.37 – 1.27, P= 0.231). Cardiac outcomes after four and six years of follow-up did not differ significantly between HER2-positive and HER2-negative patients, nor between tDD and standard treatment. Conclusions: To our knowledge, these are the only data on combining DD adjuvant chemotherapy and trastuzumab in BC. The combination decreased the risk for BC relapse by 32% compared to standard treatment, a statistically non-significant difference. Its efficacy and safety merit further evaluation as part of both escalation and de-escalation strategies. Clinical trial information: NCT00798070.
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Affiliation(s)
| | | | - Alexios Matikas
- Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | | | | | - Guenther G. Steger
- Department of Internal Medicine and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | | | - Laila Hübbert
- Department of Cardiology, Linkoping University, Norrköping, Sweden
| | - Hemming Johansson
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Mats Hellstrom
- Karolinska University Hospital, Clinical Trial Unit Oncology, Stockholm, Sweden
| | | | - Sibylle Loibl
- German Breast Group (GBG) and Centre for Haematology and Oncology Bethanien, Frankfurt, Neu-Isenburg, Germany
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Volker Moebus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Academic Hospital of the Goethe University Frankfurt, Frankfurt, Germany
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29
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Hedayati E, Fracheboud L, Srikant V, Greber D, Wallberg S, Linder Stragliotto C. Economic benefits of subcutaneous trastuzumab administration: A single institutional study from Karolinska University Hospital in Sweden. PLoS One 2019; 14:e0211783. [PMID: 30716137 PMCID: PMC6361452 DOI: 10.1371/journal.pone.0211783] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/22/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction Adjuvant trastuzumab is a standard of care in the treatment of Human Epidermal growth factor Receptor 2 (HER2) positive early breast cancer (eBC). Initially trastuzumab could only be administered intravenously (IV), however since 2013, a subcutaneous (SC) formulation with comparable efficacy and safety profile is available and preferred by patients. Trastuzumab SC does not require pharmacy preparation and has shorter administration time. The objective of this study was to estimate the economic efficiency of the SC formulation of trastuzumab by assessing the economic benefits of actual SC-driven process changes at one single Swedish healthcare institution. Methods This study analyzes changes in trastuzumab administration practice after the SC formulation was introduced at the Karolinska University Hospital. Process changes were identified and introduced in order to capitalize on the inherent work efficiency benefits of the SC formulation. Actual hospital data for 2015 were used to quantitatively estimate the annual economic impact of the changes. It encompassed administrative (i.e. non-medical) data of 178 newly diagnosed HER2-positive eBC patients and a total of 2,769 SC administrations. Realized economic benefits were expressed in hours saved by nurses, direct monetary cost savings and potential infusion fee revenue that could be earned through infrastructural revenue gains. Results In 2015, the replacement of IV infusion to SC administration generated total time savings of more than 1,100 hours, and led to direct monetary cost savings of 603,000 EUR. It unlocked a capacity gain of 1–2 additional administrations daily within the existing facility infrastructure. Given the current remuneration structure per administration, this revenue gain translated into an incremental revenue potential of up to 3 million EUR. Conclusion Data from this study showed that the shift from trastuzumab IV to SC formulation resulted in significant economic effects in terms of departmental resources related to time, direct monetary cost savings, and infrastructural revenue gains.
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Affiliation(s)
- Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | | | | | - David Greber
- The Boston Consulting Group AG, Zurich, Switzerland
| | - Susanne Wallberg
- Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Linder Stragliotto
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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30
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Brand JS, Hedayati E, Humphreys K, Ludvigsson JF, Johansson ALV, Bergh J, Hall P, Czene K. Chemotherapy, Genetic Susceptibility, and Risk of Venous Thromboembolism in Breast Cancer Patients. Clin Cancer Res 2018; 22:5249-5255. [PMID: 27803117 DOI: 10.1158/1078-0432.ccr-16-1110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Venous thromboembolism (VTE) is highly heritable and a serious complication of cancer and its treatment. We examined the individual and joint effects of chemotherapy and genetic susceptibility on VTE risk in patients with breast cancer. EXPERIMENTAL DESIGN A Swedish population-based study including 4,261 women diagnosed with primary invasive breast cancer between 2001 and 2008 in Stockholm, followed until 2012. Risk stratification by chemotherapy and genetic susceptibility [a polygenic risk score (PRS), including nine established VTE loci] was assessed using Kaplan-Meier and flexible parametric survival analyses, adjusting for patient, tumor, and treatment characteristics. RESULTS In total, 276 patients experienced a VTE event during a median follow-up of 7.6 years. Patients receiving chemotherapy [HR (95% CI) = 1.98; 1.40-2.80] and patients in the highest 5% of the PRS [HR (95% CI) = 1.90; 1.24-2.91] were at increased risk of developing VTE. Chemotherapy and PRS acted independently on VTE risk and the 1-year cumulative incidence in patients carrying both risk factors was 9.5% compared with 1.3% in patients not having these risk factors (P < 0.001). Stratified analyses by age showed that the risk-increasing effect of PRS was stronger in older patients (P interaction = 0.04), resulting in an excess risk among genetically susceptible patients receiving chemotherapy aged ≥ 60 years (1-year cumulative incidence = 25.0%). CONCLUSIONS Risk stratification by chemotherapy and genetic susceptibility identifies patients with breast cancer at high VTE risk, who could potentially benefit from thromboprophylaxis. Our results further suggest that genetic testing is more informative in older patients with breast cancer. Clin Cancer Res; 22(21); 5249-55. ©2016 AACR.
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Affiliation(s)
- Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Elham Hedayati
- Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet and Karolinska University Hospital, Cancer Centre Karolinska, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet and Karolinska University Hospital, Cancer Centre Karolinska, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Brand JS, Hedayati E, Bhoo-Pathy N, Bergh J, Hall P, Humphreys K, Ludvigsson JF, Czene K. Time-dependent risk and predictors of venous thromboembolism in breast cancer patients: A population-based cohort study. Cancer 2016; 123:468-475. [PMID: 27727456 DOI: 10.1002/cncr.30364] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/15/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious complication of cancer and its treatment. The current study assessed the risk and clinical predictors of VTE in breast cancer patients by time since diagnosis. METHODS This Swedish population-based study included 8338 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region with complete follow-up until 2012. Their incidence of VTE was compared with the incidence among 39,013 age-matched reference individuals from the general population. Cox and flexible parametric models were used to examine associations with patient, tumor, and treatment characteristics, accounting for time-dependent effects. RESULTS Over a median follow-up of 7.2 years, 426 breast cancer patients experienced a VTE event (cumulative incidence, 5.1%). The VTE incidence was 3-fold increased (hazard ratio [HR], 3.28; 95% confidence interval [CI], 2.87-3.74) in comparison with the incidence in the general population and was highest 6 months after diagnosis (HR, 8.62; 95% CI, 6.56-11.33) with a sustained increase in risk thereafter (HR at 5 years, 2.19; 95% CI, 1.80-2.67). Independent predictors of VTE included the following: older age, being overweight, preexisting VTE, comorbid disease, tumor size > 40 mm, progesterone receptor (PR)-negative status, more than 4 affected lymph nodes, and receipt of chemo- and endocrine therapy. The impact of chemotherapy was limited to early-onset VTE, whereas comorbid disease and PR-negative status were more strongly associated with late-onset events. CONCLUSIONS This study confirms the long-term risk of VTE in breast cancer patients and identifies a comprehensive set of clinical risk predictors. Temporal associations with patient, tumor, and treatment characteristics provide insight into the time-dependent etiology of VTE. Cancer 2017;123:468-475. © 2016 American Cancer Society.
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Affiliation(s)
- Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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32
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Hedayati E, Hazrati M, Momen Nasab M, Shokoohi H, Afkari F. The Relationship Between Spiritual Well-being and Anxiety of Aged People Admitted in Coronary Care Units. Salmand 2016. [DOI: 10.21859/sija-1103432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bühlmann Lerjen E, Hübbert L, Papakonstantinou A, Hedayati E, Linde C, Månsson Broberg A. [Cardiotoxicity relatively common in cancer treatment]. Lakartidningen 2016; 113:DYIE. [PMID: 27299327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Modern cancer therapy has noticeably improved the prognosis for various cancer diseases, but cardiovascular side effects are not uncommon, both in short and long term. The individual patient's cardiovascular risk profile affects the risk of developing side effects. Potential underestimation of this risk can lead to life-long severe cardiac disease for a patient that has been cured from cancer. Overestimation of the risk can lead to withdrawal of life-saving cancer treatment because of potentially reversible or mild cardiac side effects. A multidisciplinary approach will lead to better handling of cardio-oncologic patients.
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Affiliation(s)
- Eva Bühlmann Lerjen
- Triemli Hospital - Cardiology Department Zürich, Switzerland - Stockholm, Sweden
| | - Laila Hübbert
- University Hospital Linköping - Cardiology Department Linköping, Sweden University Hospital Linköping - Cardiology Department Linköping, Sweden
| | - Antroula Papakonstantinou
- Karolinska Universitetssjukhuset - Onkologiska kliniken Stockholm, Sweden Karolinska University Hospital - Oncology Department Stockholm, Sweden
| | - Elham Hedayati
- Karolinska Universitetssjukhuset - Onkologiska kliniken Stockholm, Sweden Karolinska Insitute - Department of Oncology-Pathology Stockholm, Sweden
| | - Cecilia Linde
- Karolinska Universitets Sjukhuset - Hjärtkliniken Stockholm, Sweden Karolinska University Hospital - Cardiology Stockholm, Sweden
| | - Agneta Månsson Broberg
- Karolinska Institutet - Department of Molecular Medicine and Surgery Stockholm, Sweden Karolinska Institutet - Department of Medicine Stockholm, Sweden
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34
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Cortes J, Martinez Janez N, Sablin MP, Perez-Fidalgo JA, Neven P, Hedayati E, Ballester A, Ehrhart MP, Huang DC, Bogenrieder T, Schmid P. Phase 1b/2 trial of BI 836845, an insulin-like growth factor (IGF) ligand-neutralizing antibody, combined with exemestane (Ex) and everolimus (Ev) in hormone receptor-positive (HR+) locally advanced or metastatic breast cancer (BC): primary phase 1b results. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Javier Cortes
- Ramon y Cajal University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | - Elham Hedayati
- Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | - Marie-Paule Ehrhart
- Staburo GmbH, Munich, Germany on behalf of Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Thomas Bogenrieder
- Boehringer Ingelheim RCV, Vienna, Austria, and University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Papakonstantinou A, Hubbert L, Mikiver R, Bergh J, Hedayati E. Abstract P5-21-07: Unexpected low incidence of cardiovascular related events in women with primary breast cancer; population derived retrospective cohort. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-21-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Many studies and even a meta-analysis of the EBCTCG found that, compared to methotrexate containing chemotherapy (non-ACT) or no chemotherapy (no-CT), anthracycline-containing chemotherapy (ACT) decreases overall mortality after breast cancer (BC). However, increased cardiac mortality was observed but did not outweigh improvement in BC survival. The incidence of cardiotoxicity after adjuvant BC treatment is reported with varying frequencies and still remains unknown.
Methods
Women younger than 60 years and diagnosed with lymph node positive BC between 1998 and 2002 were identified through the Cancer Registry of the Regional Cancer Centre in the southeast health region of Sweden. Data on patient, tumor and treatment characteristics were registered from the Cancer Registry and medical records. Information on cardiovascular toxicity (CVT) was collected from the National Patient Registry, the Cause of Death Registry and the Prescribed Drugs Registry. ICD diagnoses for cardiac diseases and hypertension were used. A predefined Kaplan Meier and Cox regression analysis and a post hoc multivariate analysis to investigate confounders were performed. CVT was registered as event only if it occurred prior to BC relapse.
Results
Of 524 eligible women, 329 were analyzed (mean age, 50 years; range, 28 to 60 years) and 195 were excluded due to missing medical records (n=153), primary metastatic disease (n=18), trastuzumab treatment (n=6) and known heart disease at BC diagnosis (n=13). Of those analyzed, 176 received ACT, 64 non-ACT and 89 no-CT. The cumulative CVT was 16 %. CVT was observed in 12 % of those that received ACT, 14 % of those that received non-ACT and 25 % of those that received no-CT. CVT was significantly higher among women that received no-CT (p=0.024) meanwhile BC relapse and BC mortality was significantly higher among women treated with ACT compared to no-CT (p=0.02). According to Kaplan Meier curve, the risk for CVT among women treated with ACT was higher than the rest the first 5 years after diagnosis. 13 out of 85 patients that received epirubicin <450mg/m2 and 5 out of 54 that received epirubicin >450 mg/m2 developed CVT (p=0.302). A multivariate analysis adjusted for age, treated side, obesity, smoking and received chemotherapy showed that age between 51 and 60 year was a significant risk factor for developing CVT (p=0.035).
Conclusion
Clinically overt CVT 10-14 years after adjuvant BC treatment was diagnosed in 16% of women, but the subclinical incidence remains unclear. Women that did not receive chemotherapy showed increased incidence of CVT, probably due to lower risk for BC relapse and better overall survival. Age seems to be an independent risk factor for CVT. The incidence of clinical ACT CVT was unexpected low, however, CVT was observed already in epirubicin < 450 mg/m2. BC relapse still remains the most important risk factor for mortality among women with high risk BC and nowadays high-dose chemotherapy and dose dense treatments are given, increasing the risk of CVT. It is essential to co-operate with cardiologists and investigate methods to identify patients that are at risk of developing chemotherapy-related CVT and find suitable measures to prevent CVT influencing overall survival.
Citation Format: Antroula Papakonstantinou, Laila Hubbert, Rasmus Mikiver, Jonas Bergh, Elham Hedayati. Unexpected low incidence of cardiovascular related events in women with primary breast cancer; population derived retrospective cohort [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-21-07.
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Foukakis T, Lövrot J, Sandqvist P, Xie H, Lindström LS, Giorgetti C, Jacobsson H, Hedayati E, Bergh J. Gene expression profiling of sequential metastatic biopsies for biomarker discovery in breast cancer. Mol Oncol 2015; 9:1384-91. [PMID: 25888067 DOI: 10.1016/j.molonc.2015.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/10/2015] [Accepted: 03/23/2015] [Indexed: 11/17/2022] Open
Abstract
The feasibility of longitudinal metastatic biopsies for gene expression profiling in breast cancer is unexplored. Dynamic changes in gene expression can potentially predict efficacy of targeted cancer drugs. Patients enrolled in a phase III trial of metastatic breast cancer with docetaxel monotherapy versus combination of docetaxel + sunitinib were offered to participate in a translational substudy comprising longitudinal fine needle aspiration biopsies and Positron Emission Tomography imaging before (T1) and two weeks after start of treatment (T2). Aspirated tumor material was used for microarray analysis, and treatment-induced changes (T2 versus T1) in gene expression and standardized uptake values (SUV) were investigated and correlated to clinical outcome measures. Gene expression profiling yielded high-quality data at both time points in 14/18 patients. Unsupervised clustering revealed specific patterns of changes caused by monotherapy vs. combination therapy (p = 0.021, Fisher's exact test). A therapy-induced reduction of known proliferation and hypoxia metagene scores was prominent in the combination arm. Changes in a previously reported hypoxia metagene score were strongly correlated to the objective responses seen by conventional radiology assessments after 6 weeks in the combination arm, Spearman's ρ = 1 (p = 0.017) but not in monotherapy, ρ = -0.029 (p = 1). Similarly, the Predictor Analysis of Microarrays 50 (PAM50) proliferation metagene correlated to tumor changes merely in the combination arm at 6 and 12 weeks (ρ = 0.900, p = 0.083 and ρ = 1, p = 0.017 respectively). Reductions in mean SUV were a reliable early predictor of objective response in monotherapy, ρ = 0.833 (p = 0.008), but not in the combination arm ρ = -0.029 (p = 1). Gene expression profiling of longitudinal metastatic aspiration biopsies was feasible, demonstrated biological validity and provided predictive information.
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.
| | - John Lövrot
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Patricia Sandqvist
- Department of Radiology and Nuclear Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Hanjing Xie
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Linda S Lindström
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, University of California at San Francisco, USA
| | | | - Hans Jacobsson
- Department of Radiology and Nuclear Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Foukakis T, Lovrot J, Sandqvist P, Xie H, Lindström LS, Giorgetti C, Jacobsson H, Hedayati E, Bergh JCS. Sequential metastatic biopsies and functional imaging in breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e22120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - John Lovrot
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | | | - Hanjing Xie
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | | | | | - Hans Jacobsson
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | - Elham Hedayati
- Karolinska Institutet, University Hospital, Stockholm, Sweden
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Hedayati E, Johnsson A, Alinaghizadeh H, Schedin A, Nyman H, Albertsson M. Cognitive, psychosocial, somatic and treatment factors predicting return to work after breast cancer treatment. Scand J Caring Sci 2012; 27:380-7. [DOI: 10.1111/j.1471-6712.2012.01046.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Women with breast cancer (BC) report cognitive impairment. Receiving a BC diagnosis may have a negative psychological impact. We sought to determine whether a diagnosis of BC and subsequent surgical treatment reduced cognitive function. MATERIAL AND METHODS We recruited women, who had a positive radiographic finding, consecutively from the mammography screening program at Stockholm South General Hospital. All subjects completed the Headminder Web-based neuropsychological battery Cognitive Stability Index (CSI) for response speed, processing speed, memory, and attention at enrolment (T1, Baseline). CSI was administered again, after BC was ruled out, or after sector resection or mastectomy, if BC was confirmed by cytology or biopsy (T2, Retest). RESULTS AND CONCLUSION Of the 148 women approached, 146 were enrolled; 69 were healthy and 77 had BC. Comparison between groups at baseline, according to independent t-test, showed significant differences in response speed and processing speed. Cognitive abilities did not decline in either group on any of the measured domains. Our results suggest that a diagnosis of BC and subsequent surgery is not associated with substantial cognitive decline at retest. However, the lack of improvement in attention at retest among BC patients may be suggestive of a decline.
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Affiliation(s)
- Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Hedayati E, Schedin A, Nyman H, Albertsson M, Nilsson BI. The effects of breast cancer treatment on cognitive functions. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
A deep 3-cm liver abscess with resulting exogenous cholecystitis, pericholecystitis and adhesions caused by an adult Ascaris was discovered by laparotomy in a 63-year-old man in northwest Iran. Though Ascaris infection rates are high in most major areas of the country, this apparently is the first case of liver abscess caused by Ascaris to be reported from Iran.
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