Use of a Case Definition Approach to Identify Cancer-Related Fatigue in Women Undergoing Adjuvant Therapy for Breast Cancer

Purpose Use a proposed case-definition approach to identify the prevalence of cancer-related fatigue (CRF), demographic, clinical and psychosocial predictors of subsequent CRF, and psychosocial factors associated with concurrent CRF. Patients and Methods Women (n = 288) undergoing adjuvant therapy for early-stage breast cancer were recruited from two outpatient clinics. Women completed a baseline assessment before adjuvant therapy and a post-treatment assessment at the conclusion of an initial course of adjuvant chemotherapy or radiotherapy. At both assessments, women completed a clinical interview and measures of fatigue, distress, coping, and quality of life (QOL). The clinical interview consisted of modules from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) and a diagnostic interview to identify cases of CRF. Results CRF prevalence at the baseline and post-treatment assessments was 10% and 26%, respectively. Multivariate analyses identified factors prospectively associated with greater risk for CRF at the post-treatment assessment, including receipt of adjuvant chemotherapy and a tendency to catastrophize in response to fatigue. Patients with and without CRF differed on a host of concurrent measures of fatigue, depression, functioning, and QOL with mean effect sizes in the range of 1.0 standard deviation. Conclusion CRF is a clinical syndrome experienced before and during adjuvant therapy for breast cancer. Results suggest CRF has a multifactorial etiology and support use of the proposed case definition approach to defining CRF. Future research is necessary to determine the scientific value of these criteria for understanding the etiology and management of fatigue in the oncology setting.

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A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study

Journal of Medical Internet Research ◽

10.2196/27576 ◽

2021 ◽

Vol 23 (9) ◽

pp. e27576

Author(s):

Jing Yu ◽

Jiayi Wu ◽

Ou Huang ◽

Xiaosong Chen ◽

Kunwei Shen

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Endocrine Therapy ◽

Adjuvant Treatment ◽

Early Stage ◽

Compliance Rate ◽

Multidisciplinary Treatment ◽

Significant Difference ◽

Noncompliance Rate

Background Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.

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Clinical and laboratory criteria used for patient selection for adjuvant chemotherapy in post-operative breast cancer

Mastology ◽

10.29289/259453942020v30s1059 ◽

2020 ◽

Vol 30 (Suppl 1) ◽

Author(s):

Bianca Pamela Soares ◽

Grasiela Benini dos Santos Cardoso ◽

Marcia Fernanda Roque da Silva ◽

Roberto Odebrecht Rocha

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Hormone Receptors ◽

Early Stage ◽

Effective Means ◽

Breast Cancer Incidence ◽

Neoadjuvant Treatment ◽

Disease Free Survival ◽

Cross Sectional

Introduction: Breast cancer remains the second most common type of cancer in the world and the first among women, with breast cancer incidence rates doubling in the last thirty years. In 2013, the St Gallen Consensus recommended the use of a study of the multigene profile and phenotyping to indicate adjuvance by use of the MammaPrint and Oncotype4 applications; however, as they are not available in the Unified Health System (Sistema Único de Saúde–SUS), clinical predictive criteria and laboratory tests are used for indication of adjuvant therapy. Objective: Evaluation of clinical and laboratory criteria in the selection of patients with breast cancer after surgery for adjuvant chemotherapy and quantification of the factors used in the selected patients and their results. Method: This is a retrospective, cross-sectional observational study with patients over 18 years of age, without gender and race restriction, diagnosed with breast cancer at a public hospital in São Paulo, from 09/10/18 to 10/12/18, who underwent surgical treatment and discussed adjuvant therapy. Patients with metastatic neoplasia and/or undergoing neoadjuvant treatment were excluded. Data collected were: TNM staging, histological type and hormone receptors, age and comorbidities in all medical records collected. Results: 1,390 consultations were carried out, with 42 patients selected, according to the study criteria. Since 40% of the patients were outside the recommended range for breast cancer screening, regarding TNM, late diagnoses were evidenced, with 69% presenting ≥T2 and 36% with lymph node involvement. Of the 42 patients, 98% received adjuvant therapy. Conclusion: It was evidenced by Paik et al., that 92.1% of the 668 patients enrolled in the NSABP B-14 study were considered of intermediate or high risk according to the NCCN and St. Gallen criteria, and by Oncotype DX, 50.6% of the patients were classified as at low risk of recurrence. However, as these are not available in SUS, the present study shows the need to use clinical and laboratory factors to indicate adjuvant therapy, and with these, of the 42 patients, 98% had indication, showing that they are not such effective means in the use of genetic tests, and patients treated by SUS initiate their treatments late, which impacts disease-free survival, since less than 10% of patients received care with early stage neoplasia.

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A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study (Preprint)

10.2196/preprints.27576 ◽

2021 ◽

Author(s):

Jing Yu ◽

Jiayi Wu ◽

Ou Huang ◽

Xiaosong Chen ◽

Kunwei Shen

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Endocrine Therapy ◽

Adjuvant Treatment ◽

Early Stage ◽

Compliance Rate ◽

Multidisciplinary Treatment ◽

Significant Difference ◽

Noncompliance Rate

BACKGROUND Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. OBJECTIVE This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. METHODS Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. RESULTS A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). CONCLUSIONS This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.

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Disparities in multigene signature testing and its impact on adjuvant therapy in early stage breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.550 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 550-550

Author(s):

Maris S. Jones ◽

Melanie Goldfarb ◽

Mansen Wang ◽

Emily Ho

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Early Stage ◽

Ethnic Disparities ◽

Early Stage Breast Cancer ◽

Patients Âgés ◽

Inappropriate Use ◽

Almost All ◽

To Receive

550 Background: Commercially available prognostic multigene signature tests (PMT) have been available for over a decade to guide adjuvant therapy in early stage breast cancer. This study explores persistent disparities in the availability of PMT and how results influence the use of adjuvant therapy. Methods: Females > 18 years of age with newly diagnosed, primary, Stage I-III, ER positive, HER2-neu negative breast cancer that did not receive neoadjuvant therapy between 2006-2014 were captured from the National Cancer Database (NCDB) participant user file. Univariate and multivariate analyses identified factors associated with utilization of PMT as well as receipt of adjuvant chemotherapy for patients with PMT risk stratification. Results: Of 574,921 eligible females, 130,297 (22.66%) received PMT. Almost all patients that had PMT had pathologically negative (pN0 = 83%) or 1-3 positive LNs (pN1 = 16%). Controlling for tumor features, patients least likely to have PMT were of lower socioeconomic status, uninsured, not White non-Hispanic, < 40 or > 70 years of age, and treated at community hospitals or in the Western region (all p < 0.001). Very few patients with PMT results actually received adjuvant chemotherapy (0.64% of 92,235). Of this small group, younger patients (ages 18-49) those with less education (OR = 1.37, 95%CI:1.07-1.76), positive lymph nodes, and larger tumors (OR = 1.62, 95%CI:1.37-1.91) were more likely to receive adjuvant chemotherapy whereas patients with PR positive tumors (OR = 0.33, 95%CI:0.18-0.60) and those treated at academic facilities (OR = 0.81, 95%CI:0.68-0.96) were less likely to receive adjuvant chemotherapy after controlling for competing factors. Intermediate (OR = 5.34, 95%CI: 4.42-6.45) or high risk (OR = 32.65, 95%CI: 25.74-41.43) PMT scores had the greatest impact on receipt of adjuvant chemotherapy regardless of nodal status. Conclusions: Common socioeconomic and racial/ethnic disparities exist for PMT testing, though inappropriate use (high T or N stage) was minimal. Since PMT results strongly influenced recommendation of adjuvant therapy, decreasing disparities and making PMT available to all patients that are deciding on adjuvant therapy should be a priority.

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Systematic review of adjuvant therapy for early stage (epithelial) ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200307000-00001 ◽

2003 ◽

Vol 13 (4) ◽

pp. 395-404 ◽

Cited By ~ 7

Author(s):

B. Winter-Roach ◽

L. Hooper ◽

H. Kitchener

Keyword(s):

Systematic Review ◽

Ovarian Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Early Stage ◽

Meta Analysis ◽

Disease Free Survival ◽

Significant Difference ◽

Well Differentiated ◽

Platinum Chemotherapy

A systematic review and meta analysis has been undertaken in order to evaluate the effectiveness of adjuvant therapy following surgery for early ovarian cancer. Trials reported since 1990 have been of a higher quality enabling a meta analysis of adjuvant chemotherapy vs adjuvant radiotherapy and a meta analysis of adjuvant chemotherapy vs observation. There was no significant difference between radiotherapy and chemotherapy, though these comprised studies which demonstrated considerable heterogeneity. Chemotherapy did confer significant benefit over observation in terms of both overall and disease free survival. Except for women in whom adequate surgical staging has revealed well differentiated disease confined to one or both ovaries with intact capsule, platinum chemotherapy should be offered to reduce risk of recurrence.

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