The Impact of Chemotherapy on Complications Associated with Mastectomy and Immediate Autologous Tissue Reconstruction

2016 ◽  
Vol 82 (8) ◽  
pp. 713-717 ◽  
Author(s):  
Shoichiro Tanaka ◽  
Genevieve Hayek ◽  
Pravitha Jayapratap ◽  
Sita Yerrasetti ◽  
Hugo St. Hilaire ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Preoperative Chemotherapy ◽  
Wound Complications ◽  
Breast Cancer Patients ◽  
Autologous Tissue ◽  
Increased Risk ◽  
Tissue Reconstruction ◽  
Group 2 ◽  
The Impact ◽  
Group 1

We performed this study to evaluate the impact of chemotherapy on the outcomes associated with immediate autologous tissue reconstruction (IATR) in the treatment of breast cancer. Patients were divided into two groups: Group 1 received chemotherapy before surgery and Group 2 did not receive chemotherapy. Records were reviewed to identify demographics, comorbidities, histology, and wound healing complications. Groups were compared using Kruskal-Wallis and Fisher exact tests as appropriate. A total of 128 patients were identified: 29 received chemotherapy before surgery (Group 1) and 99 did not receive chemotherapy (Group 2). Group 1 patients were more likely to have diabetes 27 per cent versus 6 per cent ( P = 0.005) despite both groups having a mean body mass index of 30. Group 2 patients had less advanced stage disease as expected because they did not receive chemotherapy; 37 per cent of Group 2 patients had stage 0 breast cancer ( P < 0.001). The incidence of wound complications was 17 per cent in Group 1 and 12 per cent in Group 2 ( P = NS). Preoperative chemotherapy for breast cancer followed by IATR was associated with no increased risk of healing complications. IATR can be offered to patients who require preoperative chemotherapy, and their healing will not be impaired as a result of the chemotherapy.

scholarly journals The Role of the Psychooncology Team in the Multidisciplinary Team Management of Breast Cancer Patients - From Diagnosis to After Treatment: A Qualitative Study at MISR Cancer Center

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 114s-114s
Author(s):  
I. Sallam ◽  
G. Amira ◽  
A. Youssri
Keyword(s):  
Breast Cancer ◽  
Qualitative Study ◽  
Cancer Center ◽  
Team Management ◽  
Breast Cancer Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: According to the cultural and socioeconomic factors, breast cancer patients (BCP) experienced a relatively low health-related quality of life (Qol) during the journey of breast cancer treatment, that influence patient adaptation to the situation from diagnosis to after treatment. And the further effect on either starting the treatment or its continuation. This merited conducting a qualitative study to explore the importance of the psychooncological approach to BCP and the impact on commencing and continuation of treatment and follow-up. Aim: To describe the impact and importance of the psychooncology team in the cancer center and the effect of their approach on the BCP's Qol. Methods: The study involved 114 interviewed participants, excluding patients with wide variety of chronic illnesses, only 91 patients are the focused study group. Of which 11 patients group (1) refused to join the psychooncological approach due to cultural, and socioeconomic issues, and 80 patients group (2) joined and followed up by the team. Both groups are regularly surveyed. Qualitative and quantitative measurements were used. Data were collected as follows, at time of diagnosis, after surgery and after chemo-radiation therapies from group (1) and for group (2) after the psychooncology team management and care. Developing the psychooncology team for the cancer center. 2 psychooncologists, 5 psychoeducating nurses and a group therapy sessions at a world standard levels of care with ethics committee approvals, and caring for patients' privacy. Close follow-up and evaluation of the performance and Qol of our BCP, raising the awareness about psychoeducation and psychological approach importance for BCP that would help them cope with daily life challenges to improve Qol. Results: Category Group N. Diagnosis related depression N. Surgery related depression N. Treatment related depression Free of depression Group (1) No= 11 3 (27%) 2 (18%) 5 (45%) 1 (10%) Group (2) No= 80 12 (15%) 9 (11.3%) 23 (28.7%) 36 (45%) Conclusion: Results indicate that the most critical depressing points is at time of diagnosis and chemo-radiation therapy. Group (2) has positive indication and alternation on the level of Qol and a significant improvement on level of depression when compared with group (1). This study highlighted the importance of psychooncology team in BCPs' survivorship. It also brings to attention the important role of the government, health policy makers and health plans toward enriching all cancer centers with the psychooncology team. To maximize health and health care for BCP.

Association of baseline cardiovascular risk factors and health care utilization and costs in elderly breast cancer patients enrolled in SWOG clinical trials.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11508-11508
Author(s):  
Dawn L. Hershman ◽  
Cathee Till ◽  
Jason Dennis Wright ◽  
Melissa Kate Accordino ◽  
Riha Vaidya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Healthcare Costs ◽  
Disease Risk ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Clinical Records ◽  
The Impact

11508 Background: Cardiovascular-disease risk factors (CVD-RFs) increase the risk of cardiac events in women undergoing chemotherapy. Less is known about the impact of CVD-RFs on healthcare utilization and costs. Methods: We examined breast cancer patients treated uniformly on SWOG clinical trials from 1999-2011. We identified baseline diabetes, hypertension, hypercholesterolemia, and coronary artery disease (CAD) by linking trial records to Medicare claims; obesity was identified using clinical records. The outcomes were emergency room visits (ER), hospitalizations and costs. Multivariable logistic and linear regression were used. Results: Among the 708 patients included in the analysis, 160 (22.6%) experienced 234 separate hospitalizations, and 193 (27.3%) experienced 311 separate ER visits. Diabetes, hypertension, hypercholesterolemia, and CAD were all associated with increased risk of hospitalizations and ER visit. Hypertension had the strongest association, with more than a threefold risk of hospitalization for those with hypertension compared to those without (OR [95% CI], 3.16 [1.85-5.40], p<0.001). For those with ≥3 CVD-RFs, the risk of hospitalization was greater compared to 0 or 1 CVD-RFs (OR [95% CI], 2.74 [1.71-4.38], p<0.001). Similar results were seen for ER visits. In the first 12 months after trial registration, patients with diabetes ($38,324 vs $30,923, 23.9% increase, p=0.05), hypercholesterolemia ($34,168 vs $30,661, 11.4% increase, p=0.02), and CAD ($37,781 vs $31,698, 19.2% increase, p=0.04) had statistically significantly higher total healthcare costs. Additionally, those with 2 significant CVD-RFs ($35,353 vs. $28,899, 22.3% increase, p=.005) had higher total healthcare costs. Conclusions: Our study demonstrates that the presence of both CVD-RFs and ER visits and hospitalizations are frequent among elderly BC patients. The risk of ER visits and hospitalizations is higher among patients with CVD-RFs, and increases with the number of RFs. Better management of CVD-RFs and more aggressive symptom management may be required to reduce both physical and financial toxicities to elderly patients undergoing BC therapy.

scholarly journals Expression level of serum circulating miRNA-21, miRNA-10b and miRNA-200c in breast cancer patients with sentinel lymph node metastasis*

2019 ◽  
Vol 73 ◽  
pp. 325-332
Author(s):  
Sebastian Niedźwiecki ◽  
Janusz Piekarski ◽  
Bożena Szymańska ◽  
Zofia Pawłowska ◽  
Arkadiusz Jeziorski
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Sentinel Lymph Node Metastasis ◽  
Breast Cancer Patients ◽  
Node Metastasis ◽  
Group 2 ◽  
Group 1

MicroRNAs (miRNAs) act a role in regulation numerous processes crucial for oncogenesis. The aim of the study was to compare the blood serum concentrations of selected microRNAs (miRNA-21, miRNA-10b and miRNA-200c) between breast cancer patients without sentinel lymph node metastasis (Group 1) and those with metastasis (Group 2). The serum levels of miRNA-21, miRNA-10b and miRNA-200c were measured with using TaqMan PCR assays performed on a 7900HT Fast Real-Time PCR System in two groups of breast cancer patients: Group 1 – without sentinel lymph node metastasis (32 patients) and Group 2 – with sentinel lymph node metastasis (14 patients). The mean level of miRNA-200c was noticeably lower in Group 2 than in Group 1. The mean fold change of miRNA-200c level in the metastatic group (Group 2) was approximately 1.3 times lower than that in non-metastatic group (Group 1). However, this result just approached the arbitrary threshold for significance (p = 0.05). Breast cancer patients with sentinel lymph node metastasis demonstrate diminished levels of circulating miR-200c compared to non-metastatic patients.

Primary outcome results of NSABP B-32, a randomized phase III clinical trial to compare sentinel node resection (SNR) to conventional axillary dissection (AD) in clinically node-negative breast cancer patients.

2010 ◽  
Vol 28 (18_suppl) ◽  
pp. LBA505-LBA505 ◽  
Author(s):  
D. N. Krag ◽  
S. J. Anderson ◽  
T. B. Julian ◽  
A. Brown ◽  
S. P. Harlow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Phase Iii ◽  
Breast Cancer Patients ◽  
Regional Control ◽  
Kaplan Meier ◽  
Regional Node ◽  
Group 2 ◽  
Group 1

LBA505 Background: NSABP B-32 is the largest prospective randomized phase III trial designed to determine in SN negative patients that SNR alone results in the same survival and regional control as SNR + AD while reducing morbidity. It was designed to detect a survival difference of 2% between the 2 groups at 5 years. Methods: 5,611 women with operable, clinically N0, invasive breast cancer were randomized to SNR + AD (Group 1) or to SNR alone with AD only if SNs were positive (Group 2). 3,989 (71.1%) of the 5,611 patients were SN negative and followed for events. 99.9% of these SN negative patients had follow-up information: 1,975 in Group 1 and 2,011 in Group 2. Median time on study was 95.3 months. Patients were well balanced across clinical strata. Log-rank tests for unadjusted analyses and Cox proportional hazard models adjusting for study stratification variables were used to compare overall survival (OS) and disease-free survival (DFS) between the two groups. Two-sided p-values were used. HR values > 1 indicate a more favorable outcome in Group 1 (SNR + AD). Results: Comparisons of OS (Group 1 vs. Group 2) yielded an unadjusted HR of 1.20 (p = 0.12) and an adjusted HR of 1.19 (p=0.13). Five-year Kaplan-Meier estimates for OS are 96.4% in Group 1 and 95.0% in Group 2 and the 8-year estimates are 91.8% and 90.3%, respectively. Comparisons of DFS (Group 1 vs. Group 2) yielded an unadjusted HR of 1.05 (p=0.54) and an adjusted HR of1.07 (p=0.57). No substantial differences could be seen across sites for first treatment failure. Five-year Kaplan-Meier estimates for DFS are 89.0% in Group 1, and 88.6% in Group 2 and the 8-year estimates are 82.4% and 81.5%, respectively. Local and Regional Recurrences: There were 54 local recurrences in Group 1 and 49 in Group 2 (p=0.55). There were 8 regional node recurrences as first events in Group 1 and 14 in Group 2 (p=0.22). Conclusions: No significant differences were observed in OS, DFS, or regional control between the trial groups. Within the limits of this trial, SNR without AD is validated as a safe and effective method for regional node treatment of SN negative breast cancer patients. [Table: see text]

scholarly journals The impact of obesity to antioxidant defense parameters in adolescents with increased cardiovascular risk

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Emina Čolak ◽  
Dragana Pap ◽  
Ljubinka Nikolić ◽  
Sanja Vicković
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Inflammatory Markers ◽  
Antioxidant Defense ◽  
Hdl Cholesterol ◽  
Increased Risk ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Summary Background The goal of this study was to assess the oxidative stress status through the values of antioxidant defense parameters: superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR) and total antioxidant status (TAS), as well as cardiovascular risk factors (total cholesterol, LDL-cholesterol, VLDL-cholesterol, non-HDL-cholesterol and triglycerides), anthropometric parameters (Body mass index-BMI, waist circumference-WC, hipp circumferemce-HC, waist-to-hipp ratio-WHR and inflammatory markers (high sensitive C-reactive protein) in a group of obese adolescents. Methods A total of 238 students of both sexes, age of 22.32 ± 1.85 yr. were included in the study. According to the values of BMI lower and higher than 25 kg/m2 and WC higher and lower than 94 cm (males)/80 cm (females) the tested group of students was divided into 2 subgroups: Group 1 (increased risk for CVD) and Group 2 (lower risk for CVD). Results Significantly reduced SOD and GPx with increased GR, TAS, inflammatory and lipoprotein parameters were obtained in Group 1 compared to Group 2. Significant positive association of hsCRP (OR:1.41; 95%CI 1.08–1.83; P=0.007), TAS (OR:827.2; 95%CI 19.27–35498; P=0.007) and GR (OR:1.13; 95%CI 1.05–1.21; P=0.002) and negative association of GPx (OR:0.97; 95%CI 0.94–1.003; P=0.043) and HDL-cholesterol (OR:0.41; 95%CI 0.176– 0.963; P=0.0014) with cardiovascular risk factors were found in obese students. According to the ROC analysis GR>44.8 U/L, TAS>1.35 mmol/L, hsCRP>1.71 mg/L and HDL-cholesterol <1.13 mmol/L have sufficient predictive ability for cardiovascular disease in obese students. Conclusions Significant association of antioxidant defense parameters with anthropometric, lipid and inflammatory markers in obese students with increased cardiovascular risk suggest that screening of these parameters is necessary and highly recommended.

scholarly journals Increased Risk of Cardiovascular Death in Breast Cancer Patients Without Chemotherapy or (and) Radiotherapy: A Large Population-Based Study

2021 ◽  
Vol 10 ◽  
Author(s):  
Tianwang Guan ◽  
Hanbin Zhang ◽  
Jinming Yang ◽  
Wenrui Lin ◽  
Kenie Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Tumor Resection ◽  
Cardiovascular Death ◽  
Female Breast Cancer ◽  
Breast Cancer Patients ◽  
Cvd Risk ◽  
Female Breast ◽  
Increased Risk ◽  
The Impact

BackgroundCardiovascular death (CVD) in breast cancer patients without chemotherapy (CT) or (and) radiotherapy (RT) has not been studied yet. This study evaluates the correlation between breast cancer and CVD risk independent of chemotherapy or (and) radiotherapy.MethodsData of female breast cancer patients without receiving CT or RT were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database (2004–2015). Data were divided into two cohorts: tumor resection cohort and no resection cohort. The CVD risk in patients was expressed as standardized mortality ratios (SMRs). A 1:1 propensity score matching (PSM) was applied to balance inter-group bias, and competing risk regressions were utilized to evaluate the impact of tumor resection on CVD.ResultsThe CVD risk was significantly higher (SMR = 2.196, 95% CI: 2.148–2.245, P&lt;0.001) in breast cancer patients who did not receive CT or RT compared to the general population. Breast cancer patients without tumor resection showed higher CVD risk than patients who underwent tumour resection (tumor resection SMR = 2.031, 95% CI: 1.983–2.079, P&lt;0.001; no resection SMR = 5.425, 95% CI: 5.087–5.781, P&lt;0.001). After PSM, the CVD risk among patients without tumor resection indicated an increase of 1.165-fold compared to patients with tumor resection (HR=1.165, 95% CI: 1.039–1.306, P=0.009).ConclusionsFemale breast cancer patients are at higher risk of CVD despite unexposure to cardio-toxic CT or RT. However, female breast cancer patients subjected to tumor resection have decreased CVD risk. These results indicated that monitoring female breast cancer patients not receiving RT or CT might serve as a preventative measure against CVD.

How did the COVID crisis affect use of neoadjuvant therapy for patients with breast cancer?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18708-e18708
Author(s):  
Anees B. Chagpar ◽  
Donald R. Lannin ◽  
Sarah Schellhorn Mougalian ◽  
Elizabeth Rapp Berger ◽  
Cary Philip Gross ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Metastatic Breast ◽  
Practice Setting ◽  
Cancer Management ◽  
Group 3 ◽  
Group 2 ◽  
One Year ◽  
The Impact ◽  
Group 1

e18708 Background: The COVID-19 pandemic has caused shifts in terms of cancer management, but the impact of this has not been well-elucidated in a contemporary cohort of patients in clinical practice in the US. We hypothesized that closure of operating rooms would increase the use of neoadjuvant therapy (NT) during the early pandemic period. Methods: The nationwide Flatiron Health database is a longitudinal electronic health record (EHR)-derived database, comprising de-identified, patient-level structured and unstructured data, curated via technology-enabled abstraction. These data originated from approximately 280 cancer clinics. We compared patients diagnosed with non-metastatic breast cancer during the early pandemic period (March 1 – June 30, 2020; group 1) with those diagnosed in the four month period prior (November 1, 2019 – February 29, 2020; group 2) and those diagnosed during the same period one year earlier (March 1 – June 30, 2019; group 3). Results: There were 174 patients in group 1, 277 in group 2, and 348 in group 3. Overall, 591 (74.1%) were ER/PR+HER2-, 100 (12.6%) were HER2+, and 106 (13.3%) were triple negative (TN). Patients in the three groups were equally likely to be ER/PR+HER2- (75.3% vs. 72.2% vs. 74.9%, p = 0.68), HER2+ (12.1% vs. 14.9% vs. 11%, p = 0.33), TN (12.6% vs. 12.7% vs. 14.2%, p = 0.83) and to be high risk by genomic testing (either Oncotype Dx or Mammaprint; p = 0.72). While there was no difference in the clinical stage (p = 0.36) nor patient age at diagnosis (p = 0.76) across the three groups, patients diagnosed during the early pandemic (group 1) were more likely to receive NT compared to those diagnosed one year earlier (group 3); 28.7% vs 16.4%, p < 0.01 (see table). The use of NT differed between the three groups in the ER/PR+her2- (p < 0.01) and her2+ patients (p = 0.05), but not in the TN patients (p = 0.61). There was no difference in the use of NT overall during the pandemic by geographic state (p = 0.32) nor practice setting (p = 0.23); NT was also similar by geographic state and practice setting when considering the ER/PR+HER2-, HER2+, and TNBC subsets. Conclusions: Despite similar clinicopathologic features as earlier time periods, there was an increased use of NT during the early pandemic when compared to the same period in the prior year. This was seen particularly in the ER/PR+HER2- group, suggesting an increased use of neoadjuvant endocrine therapy.[Table: see text]

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