A prospective interventional study investigating sleep disorders prior to and during adjuvant radiotherapy for breast cancer

Abstract Background Most breast cancer patients with non-metastatic disease receive adjuvant local or loco-regional radiotherapy. To be scheduled for irradiation may cause distress and fears that can lead to sleep disorders. Few reports focused on sleep problems in patients assigned to radiotherapy. This study evaluates the course of sleep disorders during adjuvant radiotherapy for primary breast cancer and potential risk factors including the use of smartphones or tablets at bedtime. Methods The main goal is the evaluation of sleep disorders prior to radiotherapy and after 15 fractions of radiotherapy. A potential effect of habituation to the procedure of radiotherapy can be assumed that will likely lead to improvement (decrease) of sleep disorders. Improvement of sleep disorders (compared to baseline before radiotherapy) is defined as decrease of the severity of sleep disorders by ≥2 points on a patient self-rating scale (0 = no problems; 10 = maximum problems) or decrease of distress caused by sleep disorders by ≥2 points on a self-rating scale (0 = no distress; 10 = maximum distress) or reduction of the dose of sleeping drugs by ≥25%. Additional endpoints include sleep disorders after 5 fractions and at the end of radiotherapy. Moreover, potential risk factors including the use of smartphones or tablets at bedtime are evaluated. Fifty-one patients (48 plus potential drop-outs) are required. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with improvement of sleep disorders is 25% (rate under the alternative hypothesis) and assuming that a decrease of ≤10% has to be judged as a random, non-causal change in this uncontrolled study setting (null hypothesis). Discussion If a decrease of sleep disorders during the course of radiotherapy is shown, this aspect should be included in the pre-radiotherapy consent discussion with the patients. Moreover, identification of additional risk factors will likely lead to earlier psychological support. If the use of smartphones or tablets at bedtime is a risk factor, patients should be advised to change this behavior. Trial registration clinicaltrials.gov (NCT04879264; URL: https://clinicaltrials.gov/show/NCT04879264); registered on 7th of May, 2021.

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Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

Diagnostics ◽

10.3390/diagnostics11081303 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1303

Author(s):

Khairunnisa’ Md Yusof ◽

Kelly A. Avery-Kiejda ◽

Shafinah Ahmad Suhaimi ◽

Najwa Ahmad Zamri ◽

Muhammad Ehsan Fitri Rusli ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Survivors ◽

Potential Risk ◽

Breast Cancer Survivors ◽

Ultrasound Examination ◽

Arm Circumference ◽

Potential Risk Factors ◽

Breast Cancer Related Lymphedema

Breast cancer has been reported to have the highest survival rate among various cancers. However, breast cancer survivors face several challenges following breast cancer treatment including breast cancer-related lymphedema (BCRL), sexual dysfunction, and psychological distress. This study aimed to investigate the potential risk factors of BCRL in long term breast cancer survivors. A total of 160 female breast cancer subjects were recruited on a voluntary basis and arm lymphedema was assessed through self-reporting of diagnosis, arm circumference measurement, and ultrasound examination. A total of 33/160 or 20.5% of the women developed BCRL with significantly higher scores for upper extremity disability (37.14 ± 18.90 vs. 20.08 ± 15.29, p < 0.001) and a lower score for quality of life (103.91 ± 21.80 vs. 115.49 ± 16.80, p = 0.009) as compared to non-lymphedema cases. Univariate analysis revealed that multiple surgeries (OR = 5.70, 95% CI: 1.21–26.8, p < 0.001), axillary lymph nodes excision (>10) (OR = 2.83, 95% CI: 0.94–8.11, p = 0.047), being overweight (≥25 kg/m2) (OR = 2.57, 95% CI: 1.04 – 6.38, p = 0.036), received fewer post-surgery rehabilitation treatment (OR = 2.37, 95% CI: 1.05–5.39, p = 0.036) and hypertension (OR = 2.38, 95% CI: 1.01–5.62, p = 0.043) were associated with an increased risk of BCRL. Meanwhile, multivariate analysis showed that multiple surgeries remained significant and elevated the likelihood of BCRL (OR = 5.83, 95% CI: 1.14–29.78, p = 0.034). Arm swelling was more prominent in the forearm area demonstrated by the highest difference of arm circumference measurement when compared to the upper arm (2.07 ± 2.48 vs. 1.34 ± 1.91 cm, p < 0.001). The total of skinfold thickness of the affected forearm was also significantly higher than the unaffected arms (p < 0.05) as evidenced by the ultrasound examination. The continuous search for risk factors in specific populations may facilitate the development of a standardized method to reduce the occurrence of BCRL and provide better management for breast cancer patients.

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Time-Course of Arm Lymphedema and Potential Risk Factors for Progression of Lymphedema After Breast Conservation Treatment for Early Stage Breast Cancer

The Breast Journal ◽

10.1111/j.1524-4741.2012.01229.x ◽

2012 ◽

Vol 18 (3) ◽

pp. 219-225 ◽

Cited By ~ 20

Author(s):

Voichita Bar Ad ◽

Pinaki R. Dutta ◽

Lawrence J. Solin ◽

Wei-Ting Hwang ◽

Kay See Tan ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Potential Risk ◽

Time Course ◽

Early Stage ◽

Breast Conservation ◽

Conservation Treatment ◽

Breast Conservation Treatment ◽

Arm Lymphedema ◽

Potential Risk Factors

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A Clinicopathological Study of Early-Stage Synchronous Bilateral Breast Cancer: A Retrospective Evaluation and Prospective Validation of Potential Risk Factors

PLoS ONE ◽

10.1371/journal.pone.0095185 ◽

2014 ◽

Vol 9 (4) ◽

pp. e95185 ◽

Cited By ~ 9

Author(s):

Jia-jian Chen ◽

Yan Wang ◽

Jing-yan Xue ◽

Ying Chen ◽

Ya-ling Chen ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Potential Risk ◽

Early Stage ◽

Bilateral Breast Cancer ◽

Retrospective Evaluation ◽

Synchronous Bilateral Breast Cancer ◽

Clinicopathological Study ◽

Potential Risk Factors

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Time-Course of Arm Lymphedema and Potential Risk Factors for Progression of Lymphedema After Breast Conservation Treatment for Early Stage Breast Cancer

Breast Diseases A Year Book Quarterly ◽

10.1016/j.breastdis.2013.01.039 ◽

2013 ◽

Vol 24 (1) ◽

pp. 92-93

Author(s):

S.F. Shaitelman ◽

J.L. Wagner

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Potential Risk ◽

Time Course ◽

Early Stage ◽

Breast Conservation ◽

Conservation Treatment ◽

Breast Conservation Treatment ◽

Arm Lymphedema ◽

Potential Risk Factors

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Ado-Trastuzumab Emtansine-Induced Pulmonary Toxicity: A Single-Institution Retrospective Review

Case Reports in Oncology ◽

10.1159/000491574 ◽

2018 ◽

Vol 11 (2) ◽

pp. 527-533 ◽

Cited By ~ 4

Author(s):

Heidi Egloff ◽

Kelley M. Kidwell ◽

Anne Schott

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Lung Disease ◽

Potential Risk ◽

Pulmonary Toxicity ◽

Clinical Symptoms ◽

Pulmonary Metastases ◽

Sample Population ◽

Potential Risk Factors ◽

History Of

Purpose: T-DM1 is an antibody drug conjugate with proven efficacy in metastatic breast cancer for progressive disease refractory to trastuzumab. Drug-induced pneumonitis is a rare serious potential adverse effect. The purpose of this review was to estimate the incidence of pulmonary toxicity at our institution. Methods: A retrospective analysis of electronic medical record data inclusive of all women and men aged 18 years and older treated with T-DM1 at out institution was undertaken. The records were reviewed for clinical symptoms and/or radiographic evidence concerning for pneumonitis. We identified variables of interest with regard to potential risk factors for toxicity. Results: A total of 50 patients were included, 6 (12%) of whom had radiographic and/or clinical symptoms concerning for T-DM1-induced pneumonitis. All 6 patients had metastatic or unresectable breast cancer. Of the 6 patients, 5 (83%) had suspected pulmonary metastases, 1 (17%) had a history of underlying lung disease, and 5 (83%) had a history of prior taxane therapy. Pulmonary metastases (p = 0.38), the median number of treatment cycles (p = 0.29), prior taxane therapy (p = 0.99), underlying lung disease (p = 0.99), and hormone receptor positivity (p = 0.66) did not have any statistical significance for an association with pneumonitis. Conclusion: Pneumonitis is a recognized toxic effect of T-DM1. While our sample size was small, the number of events was higher than described in the literature, which may be an artifact of referral bias. Future studies with a larger sample population may detect potential risk factors for toxicity.

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A case control study on risk factors of lymphedema after axillary lymph node dissection for breast cancer in Hong Kong

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.9048 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 9048-9048 ◽

Cited By ~ 1

Author(s):

S. Mak ◽

W. Yeo ◽

K. F. Mo ◽

K. Y. Tse ◽

Y. M. Lee ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Potential Risk ◽

Axillary Dissection ◽

Case Control Study ◽

Case Control ◽

Axillary Lymph ◽

Potential Risk Factors ◽

One Year ◽

Control Study

9048 Background: Lymphedema is a relatively common occurrence after treatment for breast cancer. Some of the causes are well known such as axillary surgery and axillary radiation therapy. However, many of the potential modifiable factors such as weight-bearing exercises and airline travel have been inadequately studied. Methods: A matched case-control study was designed to evaluate potential factors associated with lymphedema for breast cancer patients. Subjects were 202 women undergoing a unilateral axillary dissection for breast cancer, consisting of 101 cases with lymphedema and 101 controls without lymphedema who were matched cases in terms of surgery date, having received axillary radiotherapy or not and stage of cancer. Potential risk factors were collected by using clinical data and questionnaire. Two-arm circumferences were measured to determine presence and severity of lymphedema. A multiple logistic regression was used to obtain the adjust odds ratios for potential risk factors. Results: Adjusted odds ratio (OR) for lymphedema were separately 3.80 (95% CI 1.84- 7.87) for previous inflammation-infection, and 1.06 (95% CI 1.02–1.10) for an increase in one year of age at axillary dissection. Adjusted ORs for moderate to severe degree of lymphedema were separately 4.49 (95% CI 2.16–9.30) for previous inflammation-infection, 2.97 (95% CI 1.46- 6.03) for operation on dominant arm, 1.11 (95% CI 1.01–1.21) for an increase in 1kg/m2 body mass index at recruitment, and 1.05 (95% CI 1.01–1.10) for an increase in one year of age at recruitment time. Leisure activities requiring walking once a week to twice a week was a protective factor with adjusted ORs of 0.23 (95% CI 0.08–0.66) for developing lymphedema and 0.19 (95% CI 0.05–0.69) for developing moderate to severe lymphedema. Hypertension and tumor location at upper-outer or outer quadrant in breast were not important factors. Conclusions: Previous inflammation-infection and older age at axillary dissection are risk factors for initiating lymphedema. Previous inflammation-infection, operation on the side of dominant hand, obesity and aging are risk factors for aggravating lymphedema. No significant financial relationships to disclose.

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Risk factors associated with ifosfamide (IFOS)-induced encephalopathy in patients (pts) with metastatic (Met) sarcoma (Sarc).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22518 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22518-e22518

Author(s):

Adebayo Ogunniyi ◽

Anjali Varma Desai ◽

Troy Z Horvat ◽

Li-Xuan Qin ◽

Ping Chi ◽

...

Keyword(s):

Risk Factors ◽

Serum Albumin ◽

Retrospective Analysis ◽

Potential Risk ◽

Odds Ratio ◽

Serum Alkaline Phosphatase ◽

Statistical Significance ◽

Univariate Analysis ◽

Potential Risk Factors ◽

Low Serum

e22518 Background: IFOS is commonly used in the treatment of met sarc. IFOS has been reported to cause encephalopathy in 5 - 30% of pts. Potential risk factors for IFOS-induced encephalopathy (IIE) include female gender, older age, route of administration of IFOS, low serum albumin, existence of pelvic disease and renal failure. Unfortunately, the majority of the data surrounding potential risk factors is from heterogeneous cohorts. Methods: The purpose of this single-center retrospective analysis was to identify risk factors for developing IIE in a homogenous cohort of met sarc pts treated at MSKCC between 1/2010 and 5/2015. Logistic regression was used to examine the univariate effect of baseline and treatment variables. Variables significant at the 0.05 level were entered into a multivariate model. Results: A total of 328 met sarc pts with a median age of 51 years were analyzed. Thirty-four pts (10%) developed IIE. Of those 34 pts, 88% developed encephalopathy with the first or second cycle of IFOS. Age at the time of treatment (p = 0.0037), low serum albumin (p < 0.0001), increased serum alkaline phosphatase (p = 0.0022), liver met disease (p = 0.0011) and more than 3 met sites at time of IFOS dose (p = 0.0008) were all identified as risk factors by univariate analysis. Only low serum albumin (p < 0.0001, odds ratio = 0.33) and more than 3 met sites at time of IFOS dose (p = 0.0068, odds ratio = 2.47) maintained statistical significance after multivariate analysis. Conclusions: To our knowledge, this is the largest retrospective analysis of risk factors for IIE in the met sarc population. This analysis identified low serum albumin and more than 3 met sites at time of IFOS as predictors of IIE. Our data would suggest that clinicians considering the option of IFOS in met sarc pts should give particular attention to these predictive risk factors when making their treatment decisions.

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