Systemic Therapy

Author(s):  
Didier Verhoeven ◽  
Etienne Brain ◽  
François Duhoux ◽  
Gilberto Schwartsmann ◽  
Fatima Cardoso

Abstract: Quality management of systemic treatment of breast cancer is a high priority, but few quality indicators have been identified so far. As structure indicators, education, day clinic facilities, and a dedicated pharmacy are proposed. As process indicators, access to appropriate experts, equity, and report of the given treatment in accordance to the guidelines are suggested. Overuse can burden the patients with unnecessary toxicity and society with unnecessary costs. Overall survival is the reference standard of outcome, but this is difficult to compare. Just as important are quality of life, patient-reported outcome, and safety. The essential antineoplastic agents for breast cancer are regularly updated by the World Health Organization. Tailored therapy, optimal patient selection, and clinical benefit are becoming key factors for all patients. In the future, a new funding model, precision medicine, and the molecular revolution will require sufficient human resources and networks to organize the best strategies.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Svetlana Orlova ◽  
Galina Dikke ◽  
Gisele Pickering ◽  
Eliso Djobava ◽  
Sofya Konchits ◽  
...  

AbstractThis study was aimed to assess the effectiveness of magnesium (Mg)-vitamin B 6 replenishment and its correlation with clinical status in pregnant women (PW), and quality of life in women with hormone-related conditions (HRCW) and hypomagnesemia (HME). Data collected in four observational studies were pooled and analysed. All women received Mg supplementation for 4 weeks. The proportion of women with normalized Mg level, and the correlation between serum Mg dynamics and number of symptoms/complaints (PW) or changes in World Health Organization quality of life questionnaire scores (WHOQOL; HRCW) were evaluated. 869 PW and 957 HRCW were included in the study. Normalization of serum Mg level to ≥ 0.66 mmol/L occurred in 92.1% of PW and 78.4% of HRCW, and to ≥ 0.8 mmol/L in 73.8% and 58.9%, respectively. Mg normalization was accompanied by a median decrease of 1 symptom and 1 complaint in PW. Serum Mg level increase by 0.1 mmol/L was associated to significant changes in the WHOQOL scores in HRCW. Treatment of HME with the Mg for approximately 4 weeks provided a high response rate of Mg serum level, was associated with an improvement in symptom severity and complaints in PW, and WHOQOL score in HRCW. A 0.8 mmol/L cut-off appeared to be more relevant in terms of patient-reported outcomes.


2021 ◽  
pp. 933-943
Author(s):  
Tal Sella ◽  
Craig Snow ◽  
Hannah Freeman ◽  
Philip D. Poorvu ◽  
Shoshana M. Rosenberg ◽  
...  

PURPOSE Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic. METHODS Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome–based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview. RESULTS Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms. CONCLUSION YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.


Breast Cancer ◽  
2021 ◽  
Author(s):  
A. T. P. M. Brands-Appeldoorn ◽  
A. J. G. Maaskant-Braat ◽  
L. Janssen ◽  
L. A. D. M. van Osch ◽  
V. C. G. Tjan-Heijnen ◽  
...  

Abstract Background The aim of this study was to investigate which factors patients considered to be important for determining the degree of cosmetic satisfaction with regards to perceived body image after previous breast-conserving therapy (BCT). Methods Outcomes considered relevant by the patients were first identified using interviews. A questionnaire based on this group input was then devised and added to the physician-based Sneeuw questionnaire. Next, a quantitative study using this questionnaire was conducted in Dutch patients treated at least 6 months earlier for (non-) invasive breast cancer by BCT. Exclusion criteria were: previous mastectomy or BCT of the contralateral breast, BCT with nipple resection, metastatic disease, local recurrence or (previous) plastic breast surgery. Descriptive statistics were used throughout. Results A total of 149 patients (aged 36–87 years) completed the questionnaire. From this focus group input, the top three factors in overall importance (important or very important) for satisfaction were: ‘wearability of bra’ (67%), ‘breast sensitivity’ (59%) and ‘asymmetry’ (51%). Younger patients (< 55 years) considered ‘breast size’ to be most important, whereas ‘wearability of bra’ was most frequently reported by older patients (> 55 years). Time since BCT did not significantly influence the rating of relevant factors. Conclusion Patients consider ‘wearability of bra’, ‘breast sensitivity’ and ‘asymmetry’ as the most important factors when assessing their satisfaction with regards to cosmetic outcome and body image. These factors should be addressed in routine clinical practice during (pre) counseling.


2018 ◽  
Vol 9 (2) ◽  
pp. 165-170
Author(s):  
Husni Husni

One of the effects is not maintaining hygiene during menstruation is able to hitkankes Rahim neck (cervical). Based on data from the World Health Organization (WHO),cervical cancer is the second most cancer in women aged 15-45 years after breast cancer. Noless than 500,000 new cases with 280,000 patient deaths occur each year worldwide.Indonesia was ranked first by the victims died at least 555 women per day and 200,000women annually. This study aims to determine the correlation between knowledge andattitude towards personal hygiene during menstruation action at SMAN 2 Bengkulu City. Thisresearch is descriptive analytic. The number of respondents 84 people with a samplingtechnique that stratified random sampling. Presentation of data is done by using a frequencydistribution table. The collection of data taken using a questionnaire. The data were analyzedusing univariate and bivariate analysis with Chi-Square.The results showed that therespondents are classified as good knowledge of (54.8%), attitude unfavorabel or does notsupport (53.6%), and the biggest acts (52.4%) is good. From the bivariate analysis were foundno correlation between knowledge against acts of personal hygiene during menstruation (p =0.794), and no relation attitude towards personal hygiene actions during menstruation (p =0.975).Required role of schools, educators, parents to be more proactive in enhancingknowledge and useful information about the process of menstruation and how to maintainhygiene during menstruation.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeeyeon Lee ◽  
Jin Hyang Jung ◽  
Wan Wook Kim ◽  
Byeongju Kang ◽  
Jungmin Woo ◽  
...  

Abstract Purpose The incidence of depression and anxiety is higher in patients with breast cancer than in the general population. We evaluated the degree of depression and anxiety and investigated the changes in patients with breast cancer during the treatment period and short-term follow-up period. Methods Overall, 137 patients with breast cancer were evaluated using the Patient Health Questionnaire 9-item depression scale (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). The scales were developed as a web-based electronic patient-reported outcome measure, and serial results were assessed before the operation, after the operation, in the post-treatment period, and in the 6-month follow-up period after surgery. Results The degree of depression and anxiety increased during treatment and decreased at 6-month follow-up, even if there were no statistical differences among the four periods (PHQ-9: p = 0.128; GAD-7: p = 0.786). However, daily fatigue (PHQ-9 Q4) and insomnia (PHQ-9 Q3) were the most serious problems encountered during treatment and at 6-month follow-up, respectively. In the GAD-7, worrying too much (Q3) consistently showed the highest scores during the treatment and follow-up periods. Of the patients, 7 (5.11%) and 11 (8.03%) patients had a worsened state of depression and anxiety, respectively, after treatment compared with before treatment. Conclusion Most factors associated with depression and anxiety improved after treatment. However, factors such as insomnia and worrying too much still disturbed patients with breast cancer, even at 6-month follow-up. Therefore, serial assessment of depression and anxiety is necessary for such patients.


2018 ◽  
Vol 25 (12) ◽  
pp. 3563-3571 ◽  
Author(s):  
M. Lagendijk ◽  
L. S. E. van Egdom ◽  
F. E. E. van Veen ◽  
E. L. Vos ◽  
M. A. M. Mureau ◽  
...  

2015 ◽  
Vol 51 (3) ◽  
pp. 551-559
Author(s):  
Leandro Cabral Pereira ◽  
Thaísa Amorim Nogueira ◽  
Leandro Augusto de Oliveira Barbosa ◽  
Sabrina Calil-Elias ◽  
Selma Rodrigues de Castilho

The rates of breast cancer mortality remain high in Brazil. Docetaxel is a semi-synthetic taxane used to treat various tumors, particularly tumors of the breast, lung and prostate. In this study ADR that occurred in 45 docetaxel users with breast cancer were surveyed. They were identified by type, causality (Naranjo algorithm and World Health Organization categories) and, if considered probable or defined, rated for severity according to SOBRAFO proposal (2007). A total of 325 ADR were observed: 165 in the first, 137 in the second and 23 in the third cycle. Fifty seven ADR were immediate and the others, late. Fatigue and exhaustion for more than five days, classified as Grade 3 by SOBRAFO (2007), were reported as the primary late RAM. There was no significant difference in the occurrence of immediate and late ADR between cycles (p=1 and p=0.3577, respectively). The presence of a pharmacist gave the patients a better understanding of the occurrence of RAM, especially those that occur outside the hospital, between chemotherapy cycles and are often not reported to the healthcare team, creating institutional demands and reaching the goal to track, observe and correlate the RAM for each user.


Cancers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2018 ◽  
Author(s):  
Francesca Salamanna ◽  
Veronica Borsari ◽  
Deyanira Contartese ◽  
Viviana Costa ◽  
Gianluca Giavaresi ◽  
...  

Breast cancer cells produce stimulators of bone resorption known as interleukins (ILs). However, data on the functional roles of ILs in the homing of metastatic breast cancer to bone are still fragmented. A systematic search was carried out in three databases (PubMed, Scopus, Web of Science Core Collection) to identify preclinical reports, and in three clinical registers (ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform, European Union (EU) Clinical Trials Register) to identify clinical trials, from 2008 to 2019. Sixty-seven preclinical studies and 11 clinical trials were recognized as eligible. Although preclinical studies identified specific key ILs which promote breast cancer bone metastases, which have pro-metastatic effects (e.g., IL-6, IL-8, IL-1β, IL-11), and whose inhibition also shows potential preclinical therapeutic effects, the clinical trials focused principally on ILs (IL-2 and IL-12), which have an anti-metastatic effect and a potential to generate a localized and systemic antitumor response. However, these clinical trials are yet to post any results or conclusions. This inconsistency indicates that further studies are necessary to further develop the understanding of cellular and molecular relations, as well as signaling pathways, both up- and downstream of ILs, which could represent a novel strategy to treat tumors that are resistant to standard care therapies for patients affected by breast cancer bone disease.


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