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Moreno-Palacios E, Martí C, Frías L, Meléndez M, Loayza A, Roca MJ, Córdoba V, Oliver JM, Hernández A, Sánchez-Méndez JI. Breast-Conserving Surgery Guided with Magnetic Seeds vs. Wires: A Single-Institution Experience. Cancers (Basel) 2024; 16:566. [PMID: 38339317 PMCID: PMC10854709 DOI: 10.3390/cancers16030566] [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: 12/16/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The aim of this study is to describe our initial experience using magnetic seeds (Magseed®) to guide breast-conserving surgery in non-palpable breast lesions and compare the use of magnetic seed with wires to guide breast-conserving surgery in terms of clinical and pathological characteristics. METHODS We performed a retrospective study including all breast-conserving surgeries for non-palpable breast lesions under 16 mm from June 2018 to May 2021. We compared breast-conserving surgeries guided with magnetic seeds (Magseed®) to those guided with wires, analyzing tumor and patient characteristics, surgical time, and pathological results of the surgical specimens. RESULTS Data from 225 cases were collected, including 149 cases guided by magnetic seeds and 76 cases guided by wires. The breast lesion was localized in every case. Both cohorts were similar regarding clinical and pathological characteristics. We found significant statistical differences (p < 0.02) in terms of the median volume (cm3) of the excised specimen, which was lower (29.3%) in the magnetic seed group compared with the wire group (32.5 [20.5-60.0]/46.0 [20.3-118.7]). We did not find significant differences regarding surgical time (min) or the affected or close margins. CONCLUSION In our experience, the use of magnetic seed (Magseed®) is a feasible option to guide breast-conserving surgery of non-palpable lesions and enabled us to resect less breast tissue.
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Affiliation(s)
- Elisa Moreno-Palacios
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Covadonga Martí
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Laura Frías
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Marcos Meléndez
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Adolfo Loayza
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - María José Roca
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - Vicenta Córdoba
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - José María Oliver
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - Alicia Hernández
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - José Ignacio Sánchez-Méndez
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
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Sánchez-Méndez JI, Horstmann M, Méndez N, Frías L, Moreno E, Yébenes L, Roca MJ, Hernández A, Martí C. Surgical Interest of an Accurate Real-World Prediction of Primary Systemic Therapy Response in HER2 Breast Cancers. Cancers (Basel) 2023; 15:2757. [PMID: 37345094 DOI: 10.3390/cancers15102757] [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: 04/16/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-enriched breast cancers (BC) present the highest rates of pathological response to primary systemic therapy (PST), but they are also the ones that tend to be larger at diagnosis, with microcalcifications and, often, with axillary involvement. If we do not have a reliable method to predict the degree of response, we may not be able to transfer the benefits of PST to surgery. The post-PST surgery planning is guided by the findings in the magnetic resonance imaging (MRI), whose predictive capacity, although high, is far from optimal. Thus, it seems interesting to find other variables to improve it. A retrospective observational study including women with HER2 BC treated with PST and further surgery was conducted. Information regarding clinical, radiological, and histopathological variables was gathered from a total of 132 patients included. Radiological complete response (rCR) was achieved in 65.9% of the sample, and pathological complete response (pCR), according to Miller and Payne criteria, in 58.3% of cases. A higher Ki67 value, the absence of Hormonal Receptors expression, and an rCR was significantly related to a pCR finding. This information impacts directly in surgery planning, as it permits adjustment of the breast resection volume.
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Affiliation(s)
- Jose Ignacio Sánchez-Méndez
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
| | - Mónica Horstmann
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Obstetrics & Gynecology Department, Hospital Clínico Universitario Valladolid, 47003 Valladolid, Spain
| | - Nieves Méndez
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Laura Frías
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Elisa Moreno
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Laura Yébenes
- Hospital La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Breast Unit, Pathology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Mᵃ José Roca
- Breast Unit, Radiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Alicia Hernández
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
| | - Covadonga Martí
- Breast Unit, Obstetrics & Gynecology Department, University Hospital La Paz, 28046 Madrid, Spain
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Martí C, Yébenes L, Oliver JM, Moreno E, Frías L, Berjón A, Loayza A, Meléndez M, Roca MJ, Córdoba V, Hardisson D, Rodríguez MÁ, Sánchez-Méndez JI. The Clinical Impact of Neoadjuvant Endocrine Treatment on Luminal-like Breast Cancers and Its Prognostic Significance: Results from a Single-Institution Prospective Cohort Study. Curr Oncol 2022; 29:2199-2210. [PMID: 35448153 PMCID: PMC9026529 DOI: 10.3390/curroncol29040179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 01/02/2023] Open
Abstract
Purpose: Neoadjuvant endocrine treatment (NET) has become a useful tool for the downstaging of luminal-like breast cancers in postmenopausal patients. It enables us to increase breast- conserving surgery (BCS) rates, provides an opportunity for us to assess in vivo NET effectiveness, and allows us to study any biological changes that may act as valid biomarkers. The purpose of this study was to evaluate the safety and effectiveness of NET, and to assess the role of Ki67 proliferation rate changes as an indicator of endocrine responsiveness. Methods: From 2016 to 2020, a single-institution cohort of patients, treated with NET and further surgery, was evaluated. In patients with Ki67 ≥ 10%, a second core biopsy was performed after four weeks. Information regarding histopathological and clinical changes was gathered. Results: A total of 115 estrogen receptor-positive (ER+)/HER2-negative patients were included. The median treatment duration was 5.0 months (IQR: 2.0−6.0). The median maximum size in the surgical sample was 40% smaller than the pretreatment size measured by ultrasound (p < 0.0001). The median pretreatment Ki67 expression was 20.0% (IQR: 12.0−30.0), and was reduced to 5.0% (IQR: 1.8−10.0) after four weeks, and to 2.0% (IQR: 1.0−8.0) in the surgical sample (p < 0.0001). BCS was performed on 98 patients (85.2%). No pathological complete responses were recorded. A larger Ki67 fold change after four weeks was significantly related to a PEPI score of zero (p < 0.002). No differences were observed between luminal A- and B-like tumors, with regard to fold change and PEPI score. Conclusions: In our cohort, NET was proven to be effective for tumor size and Ki67 downstaging. This resulted in a higher rate of conservative surgery, aided in therapeutic decision making, provided prognostic information, and constituted a safe and well-tolerated approach.
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Affiliation(s)
- Covadonga Martí
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
- Correspondence:
| | - Laura Yébenes
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
| | - José María Oliver
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Radiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Elisa Moreno
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Laura Frías
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Alberto Berjón
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
| | - Adolfo Loayza
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Marcos Meléndez
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - María José Roca
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Radiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Vicenta Córdoba
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Radiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - David Hardisson
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
- Center for Biomedical Research in the Cancer Network (CIBERONC), 28029 Madrid, Spain
| | - María Ángeles Rodríguez
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
| | - José Ignacio Sánchez-Méndez
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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Palacios EM, Carbonell M, Frías L, Martí C, Meléndez M, Loayza A, García-Ortiz V, Roca MJ, Córdoba V, Garrido D, Navarro Y, Oliver JM, Hernández A, Sánchez Méndez JI. Advantages of magnetic seeds compared with wires in the excision of non-palpable breast cancer. A single institution experience. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.085] [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: 10/19/2022] Open
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Morales Cerchiaro Á, Velasco C, Frías L, Carrascal M, Arhip L, Serrano C, Motilla M, Bretón I, Camblor M, Cuerda C. Fulfilment of the phenotypic and etiological criteria when diagnosing malnutrition according to the glim criteria. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.187] [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: 11/29/2022]
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Morales Cerchiaro Á, Velasco C, Frías L, Carrascal M, Arhip L, Motilla M, Serrano C, Bretón I, Camblor M, Cuerda C. Our experience implementing glim criteria to diagnose malnutrition at hospital. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.188] [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: 12/01/2022]
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Arhip L, Camblor M, Bretón I, Motilla M, Serrano-Moreno C, Frías L, Velasco C, Carrascal ML, Morales Á, Cuerda C. Social and economic costs of home parenteral nutrition. Clin Nutr ESPEN 2020; 40:103-109. [PMID: 33183521 DOI: 10.1016/j.clnesp.2020.10.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure. Although HPN has been studied from an economic point of view, the categories of costs usually included direct costs, frequently excluding personal costs and productivity costs. The purpose of the present paper was to study the total costs of HPN from a societal perspective. METHODS Observational, retrospective, transverse study of all adult patients who were on HPN for more than 3 months and were treated at Gregorio Marañón University Hospital (Madrid, Spain), from June 2018-2019. Data on personal costs and productivity costs were collected from questionnaires completed by patients receiving HPN. We also updated the direct healthcare and non-healthcare costs studied by our group previously to Euros (€) for the year 2019. RESULTS Twenty-two patients were included. Personal costs were €729.49 per patient (€3.45 per patient per day) and productivity costs were €256.39 per patient (€1.21 per patient per day). Total HPN costs amounted to €14,460.87 per patient (€131.58 per patient per day). The direct healthcare and non-healthcare costs accounted for 96.46% of overall costs, the personal costs for the patients receiving HPN accounted for 2.62% and productivity costs for 0.92%. CONCLUSIONS From a societal perspective, the direct healthcare and non-healthcare costs accounted for the majority of HPN expenditure, followed by personal costs and productivity costs.
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Affiliation(s)
- Loredana Arhip
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Miguel Camblor
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Irene Bretón
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marta Motilla
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Clara Serrano-Moreno
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Laura Frías
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Velasco
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Luisa Carrascal
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ángela Morales
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Martínez N, Herrera M, Frías L, Provencio M, Pérez-Carrión R, Díaz V, Morse M, Crespo MC. A combination of hydroxytyrosol, omega-3 fatty acids and curcumin improves pain and inflammation among early stage breast cancer patients receiving adjuvant hormonal therapy: results of a pilot study. Clin Transl Oncol 2018; 21:489-498. [PMID: 30293230 DOI: 10.1007/s12094-018-1950-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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: 07/01/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Breast cancer patients receiving hormonal therapies face risks of relapse, increased rates of cardiovascular events, and toxicities of therapy such as aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS). C-reactive protein (CRP), a marker for inflammation, is associated with breast cancer outcomes. We evaluated whether the olive-derived polyphenol hydroxytyrosol combined with omega-3 fatty acids and curcumin would reduce CRP and musculoskeletal symptoms in breast cancer patients receiving adjuvant hormonal therapies. EXPERIMENTAL DESIGN This prospective, multicenter, open-label, single arm, clinical trial enrolled post-menopausal breast cancer patients (n = 45) with elevated C-reactive protein (CRP) taking predominantly aromatase inhibitors to receive a combination of hydroxytyrosol, omega-3 fatty acids, and curcumin for 1 month. CRP, other inflammation-associated cytokines, and pain scores on the Brief Pain Inventory were measured before therapy, at the end of therapy and 1 month after completion of therapy. RESULTS CRP levels declined during the therapy [from 8.2 ± 6.4 mg/L at baseline to 5.3 ± 3.2 mg/L (p = 0.014) at 30 days of treatment], and remained decreased during the additional 1 month off therapy. Subjects with the highest baseline CRP levels had the greatest decrease with the therapy. Pain scores also decreased during the therapy. There were no significant adverse events. CONCLUSIONS The combination of hydroxytyrosol, omega-3 fatty acids, and curcumin reduced inflammation as indicated by a reduction in CRP and reduced pain in patients with aromatase-induced musculoskeletal symptoms. Longer studies comparing this combination to other anti-inflammatories in larger groups of patients with clinical outcome endpoints are warranted.
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Affiliation(s)
- N Martínez
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Herrera
- Hospital Clínico San Carlos, Madrid, Spain
| | - L Frías
- Hospital Universitario La Paz, Madrid, Spain
| | - M Provencio
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - V Díaz
- Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - M C Crespo
- IMDEA-Food, CEI UAM + CSIC, Madrid, Spain
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Arhip L, García-Peris P, Romero R, Frías L, Bretón I, Camblor M, Motilla M, Velasco C, Morales Á, Carrascal M, Herranz A, Sanjurjo M, Cuerda C. Economic appraisal of a home parenteral nutrition programme. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1510] [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: 11/25/2022]
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10
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Arhip L, García-Peris P, Romero RM, Frías L, Bretón I, Camblor M, Motilla M, Velasco C, Morales A, Carrascal ML, Herranz A, Sanjurjo M, Cuerda C. Direct costs of a home parenteral nutrition programme. Clin Nutr 2018; 38:1945-1951. [PMID: 30005903 DOI: 10.1016/j.clnu.2018.06.972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/26/2018] [Revised: 05/06/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital. METHODS Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists. RESULTS Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%). CONCLUSIONS The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.
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Affiliation(s)
- L Arhip
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - P García-Peris
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - R M Romero
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Frías
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I Bretón
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Camblor
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Motilla
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Velasco
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Morales
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M L Carrascal
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Herranz
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Sanjurjo
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Cuerda
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Arribas L, Frías L, Creus G, Parejo J, Urzola C, Ashbaugh R, Pérez-Portabella C, Cuerda C. Document of standardization of enteral nutrition access in adults. NUTR HOSP 2014; 30:1-14. [PMID: 25137256 DOI: 10.3305/nh.2014.30.1.7446] [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] [Indexed: 12/01/2022] Open
Abstract
The group of standardization and protocols of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) published in 2011 a consensus document SENPE/SEGHNP/ANECIPN/SECP on enteral access for paediatric nutritional support. Along the lines of this document, we have developed another document on adult patients to homogenize the clinical practice and improve the quality of care in enteral access in this age group. The working group included health professionals (nurses, dietitians and doctor) with extensive experience in enteral nutrition and access. We tried to find scientific evidence through a literature review and we used the criteria of the Agency for Health-care Research and Quality (AHRQ) to classify the evidence (Grade of Recommendation A, B or C). Later the document was reviewed by external experts to the group and requested the endorsement of the Scientific and Educational Committee (CCE) and the group of home artificial nutrition (NADYA) of the SENPE. The full text will be published as a monograph number in this journal.
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Affiliation(s)
- Lorena Arribas
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad Funcional de Nutrición Clínica. Institut Català d'Oncologia. L'Hospitalet de Llobregat. Barcelona. España..
| | - Laura Frías
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad de Nutrición. Hospital General Universitario Gregorio Marañón. Madrid. España
| | - Gloria Creus
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad de Dietética y Nutrición Clínica. Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Juana Parejo
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad de Nutrición Clínica y Dietética. Hospital Virgen del Rocío. Sevilla. España
| | - Carmen Urzola
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad de Nutrición Clínica y Dietética. Hospital San Jorge. Huesca. España
| | - Rosana Ashbaugh
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Servicio de Endocrinología y Nutrición. Hospital Príncipe de Asturias. Alcalá de Henares. Madrid. España
| | - Cleofé Pérez-Portabella
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad de Soporte Nutricional. Hospital Vall d'Hebrón. Barcelona. España
| | - Cristina Cuerda
- Grupo de estandarización y protocolos. Sociedad Española de Nutrición Parenteral y Enteral (SENPE). Unidad de Nutrición. Hospital General Universitario Gregorio Marañón. Madrid. España..
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Frías L, Cuerda C. [Not Available]. NUTR HOSP 2014; 29 Suppl 3:5-20. [PMID: 25453144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Cuerda C, Higuera I, Velasco C, Bretón I, Camblor M, Frías L, Carrascal M, Romero R, García-Peris P. PP126-MON HOME PARENTERAL NUTRITION (HPN) IN A GENERAL HOSPITAL: DESCRIPTIVE STUDY OF 26 YEARS OF ACTIVITY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60437-9] [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: 10/26/2022]
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14
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Frías L, Puiggròs C, Calañas A, Cuerda C, García-Luna PP, Camarero E, Rabassa-Soler A, Irles JA, Martínez-Olmos MA, Romero A, Wanden-Berghe C, Laborda L, Vidal A, Gómez-Candela C, Penacho MA, Pérez de la Cruz A, Lecha M, Luengo LM, Suárez P, de Luis D, García Y, Parés RM, Garde C. [Home enteral nutrition in Spain: NADYA registry in 2010]. NUTR HOSP 2012; 27:266-9. [PMID: 22566332 DOI: 10.1590/s0212-16112012000100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 11/02/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. MATERIAL AND METHODS We retrieved the data of the patients recorded from January 1st to December 31st 2010. RESULTS We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and 16% of the cases, respectively. CONCLUSIONS The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes.
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Affiliation(s)
- L Frías
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España
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Cuerda C, Chicharro ML, Frías L, García Luna PP, Cardona D, Camarero E, Penacho MA, Calañas A, Parés RM, Martínez Olmos MA, Zapata A, Rabassa Soler A, Gómez Candela C, Pérez de la Cruz A, Lecha M, Luis DD, Luengo LM, Wanden-Berghe C, Laborda L, Matía P, Cantón A, Martí E, Irles JA. [Registry of home-based enteral nutrition in Spain for the year 2006 (NADYA-SENPE Group)]. NUTR HOSP 2008; 23:95-99. [PMID: 18449443] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 01/10/2008] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006. MATERIAL AND METHODS Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006. RESULTS During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients. CONCLUSIONS Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.
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Affiliation(s)
- C Cuerda
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España.
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