Patient-reported predictors of early treatment discontinuation: treatment-related symptoms and health-related quality of life among postmenopausal women with primary breast cancer randomized to anastrozole or exemestane on NCIC Clinical Trials Group (CCTG) MA.27 (E1Z03)

PURPOSE

Aromatase inhibitors are the most commonly prescribed adjuvant endocrine therapy for hormone-dependent early breast cancer in postmenopausal women. Among Canadian Cancer Trials Group MA.27 participants, anastrozole and exemestane had comparable 5-year event-free survival. This companion study examined differences in patient-reported treatment-related symptoms (TRS) and health-related quality of life (HRQL) among postmenopausal women randomized to anastrozole or exemestane.

METHODS

MA.27 participants (N = 686, of 7576) randomized to 5 years of anastrozole (1 mg/day, n = 371, Arm A) or exemestane (25 mg/day, n = 315, Arm E) completed the 56-item Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES) questionnaire to assess TRS and HRQL. The FACT-ES was completed at baseline, 3, 6, 12, and 24 months.

RESULTS

No significant differences in FACT-ES median scores measuring TRS and HRQL were observed between treatment arms at any time point. Change in TRS from baseline was statistically significant at 3, 6, 12, and 24 months. HRQL was stable over time in both arms. Greater TRS burden was associated with poorer HRQL (coefficient = 0.57, p < 0.001). Twenty percent of patients discontinued AI therapy by month 24 and 32% discontinued AIs at 4 years. In both arms, patients reporting more side effect bother prior to initiating study treatment had a higher risk of discontinuing treatment before completing protocol therapy (hazard ratio [HR] 1.29, 95% CI 1.08-1.55, p = 0.01).

CONCLUSIONS

TRS and HRQL were comparable between anastrozole and exemestane. TRS negatively affect HRQL. Women who report being bothered by treatment side effects prior to initiating an AI are at increased risk for early treatment discontinuation.

Supporting tool suite for production proteomics

SUMMARY

The large amount of data produced by proteomics experiments requires effective bioinformatics tools for the integration of data management and data analysis. Here we introduce a suite of tools developed at Vanderbilt University to support production proteomics. We present the Backup Utility Service tool for automated instrument file backup and the ScanSifter tool for data conversion. We also describe a queuing system to coordinate identification pipelines and the File Collector tool for batch copying analytical results. These tools are individually useful but collectively reinforce each other. They are particularly valuable for proteomics core facilities or research institutions that need to manage multiple mass spectrometers. With minor changes, they could support other types of biomolecular resource facilities.

Sexual problems as a matter of course

The two most fundamental aspects of sexual relationships, passion and intimacy, are complex concepts, with at least partly paradoxical contents. Intimacy, for example, stands for unity and security, but also for shifting boundaries and exposure. Passion in its turn, stands for enthusiasm and energy, but also for surrender and dependency. It is this 'two sides of the coin' phenomenon that makes sexual relationships as interesting as they are dangerous. In terms of development, a relationship often starts with 'setting each other on fire' and ends with 'sexual burn-out'. In this paper, an analysis is made of the way patients, but also health care providers such as gynecologists and sexologists, cope with these unavoidable phenomena in sexual relationships.

Orgasm after radical prostatectomy

OBJECTIVE

To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy.

PATIENTS AND METHODS

The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56-76) using a semi-structured interview and a self-administered questionnaire. In addition, the patients were asked to write a brief statement about their experiences and sensations during orgasm before and after the operation.

RESULTS

Eighteen patients returned the questionnaire and 17 completed a statement indicating what their orgasm was like before and after radical prostatectomy. After the operation, no patient was able to maintain a completely rigid erection, but for five patients the erection was sufficient for sexual intercourse. Nine patients used a vacuum device or intracavernosal self-injection. Half the patients reported diminished sexual desire (libido) and arousal after the operation and reported the same to occur in their partners. During their "dry' orgasm post-operatively, none of the patients experienced the exquisite sensation of inevitability, the so-called "point of no return'. Seven of the 14 patients experiencing orgasm complained that their orgasmic sensation was weakened. Four patients reported normal pleasure and sensation compared to that experienced pre-operatively. Surprisingly, nine of the 14 patients had involuntary loss of urine at orgasm; for five of them this was sufficient reason to avoid any sexual contact with their partner.

CONCLUSION

Radical prostatectomy may have serious consequences on libido and erectile function but sometimes other important factors, such as the absence of prostate and seminal vesicle contractions, the loss of ejaculation and involuntary loss of urine, may also compromise the orgasm.