Impact of reducing day 1 dexamethasone dose in anthracycline-containing regimens on acute gastrointestinal symptoms associated with breast cancer treatment

AbstractThe potential of steroid sparing from day 2 onward is reported in anthracycline-containing regimens for breast cancer treatment. We evaluated whether the reduction of dexamethasone (DEX) dose from 9.9 to 6.6 mg on day 1 is possible in anthracycline-containing treatments. Patients receiving anthracycline-containing regimens were divided into control (9.9 mg DEX on day 1) and reduced (6.6 mg DEX on day 1) groups, and retrospectively evaluated. The complete response (CR) rate and the incidence and severity of nausea, vomiting, anorexia, and fatigue were evaluated. The CR rate in the acute phase (day 1) was 63.1% and 38.1% in the control and reduced groups, respectively, with significant difference (P = 0.01) between the groups. However, no difference was found in the delayed phase (days 2–7). The incidence of anorexia and vomiting during treatment was not statistically different. Severity of nausea tended to, but not statistically, worsen while anorexia significantly worsened in the reduced group. Multivariate analysis suggested that patients < 55 years, with non- or less-alcohol drinking habit (< 5 days/week), and administered reduced-DEX dosage on day 1, have a higher risk of acute nausea development. Thus, reducing day 1 DEX dose in anthracycline-containing regimens is not suitable for acute nausea management.

Download Full-text

The Impact of Facility Volume/Size on Breast Cancer Treatment and Outcome

The American Surgeon ◽

10.1177/000313481007601216 ◽

2010 ◽

Vol 76 (12) ◽

pp. 1333-1337 ◽

Cited By ~ 3

Author(s):

Jack Sariego

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Treatment ◽

Breast Cancer Treatment ◽

Definitive Treatment ◽

Treatment Facility ◽

Cancer Data ◽

Stage Distribution ◽

Significant Difference ◽

The Impact

Recent studies have suggested that outcomes and survival from breast cancer are improved when definitive treatment is rendered at high-volume and/or teaching centers. Consolidation of such cases in tertiary centers, however, is often impractical and impossible. Patients often desire primary treatment of their breast cancer in their own communities. The current study was undertaken to examine the impact of treatment facility type on the treatment performed as well as on overall survival. Breast cancer treatment and survival data were available from the American College of Surgeons National Cancer Data Base. Only patients in whom no previous treatment had been rendered were included in the analysis. Data were stratified with regard to type and size of treatment facility/hospital; stage distribution; initial treatment performed; and 1-, 2-, and 5-year survival. A total of 665,409 patients were included in the current analysis. There were no significant differences in stage distribution between facility types nor was there a significant difference in the treatment performed (although there was a slight trend toward breast conservation at the larger centers). This was true overall and for each stage of cohort. There were also no significant differences in 1-, 2-, and 5-year survival rates overall and at any stage (although again, there was a slight trend toward a minimal survival advantage at the larger centers). There was no significant impact of facility size or type on either breast cancer treatment performed or overall survival. There was no evidence that more “advanced” treatments were offered at larger centers nor was there evidence of improved outcome/survival at larger centers. Care can be rendered safely, efficiently, and effectively in the community setting.

Download Full-text

P1361Impact of radiation/chemotherapy for breast cancer on the electroanatomic features in patients receiving catheter ablation for left atrial arrhythmia

EP Europace ◽

10.1093/europace/euaa162.177 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

N Schenker ◽

N Hashiguchi ◽

T Maurer ◽

C Lemes ◽

L Rottner ◽

...

Keyword(s):

Breast Cancer ◽

Catheter Ablation ◽

Cancer Treatment ◽

Left Atrial ◽

Independent Predictor ◽

Breast Cancer Treatment ◽

Control Group ◽

Study Cohort ◽

Scar Area ◽

Significant Difference

Abstract Background Atrial fibrillation (AF) is a common cardiac arrhythmia and catheter ablation a viable treatment option for patients with AF. Extensive left atrial (LA) scars, frequently seen in patients with persistent AF, can limit its efficacy. Radiation for breast cancer treatment is known to have serious long-term effects (e.g. fibrosis) on the targeted tissue. At the same time, chemotherapy often leads to organ dysfunction. We sought to examine the effects of radiation and chemotherapy on the electroanatomic features of the LA in patients who received catheter ablation for left atrial arrhythmias with prior breast cancer treatment. Methods and Results We compared 38 patients (mean age 68.4 ± 7.1 years) who underwent catheter ablation for LA arrhythmia and had a previous diagnosis of breast cancer with 38 patients (mean age 65.4 ± 7.3 years) without breast cancer who formed our control group. LA scar area, as well as its distribution was measured during the electrophysiology (EP) study and graded according to the Utah classification. The existence of LA scarring did not differ significantly between both groups (71.1% vs. 76.3%, p = 0.602). LA scar area (excluding PVs) was 107.5cm2 ± 19.0cm2 in the breast cancer group compared to 110.1cm2 ± 18.5cm2 in the control group (p = 0.536). The distribution of the scar area revealed no significant difference between both groups, however an involvement of the anterior wall was common (65.8% vs. 73.7%; p = 0.454). We further investigated whether the location of breast cancer had an impact on the LA scar development of the patients in our study cohort. Here, we found no significant difference in the amount of LA scarring when comparing patients with left-sided breast cancer to patients with right-sided breast cancer (66.7% vs. 73.9%). In a sub-analysis patients with breast cancer and persistent AF showed a non-significant trend towards greater LA scar areas (17.4cm2 vs. 6.8cm2) in comparison to patients of the control group with similar LA volumes. The patient’s age (>65 years) was the only independent predictor for greater LA scarring we could identify. Neither former radiotherapy, nor chemotherapy showed a positive correlation with greater LA scarring. Conclusion There is no change in the distribution as well as an increase of the extent of LA scars after thoracic irradiation and/or chemotherapy. A trend towards greater LA scar areas was seen in patients with breast cancer and persistent AF. The patient’s age was identified as an independent predictor for LA scar development.

Download Full-text