scholarly journals A Comprehensive Prospective Comparison of Acute Skin Toxicity after Hypofractionated and Normofractionated Radiation Therapy in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5826
Author(s):  
Kai J. Borm ◽  
Johanne Kleine Vennekate ◽  
Jan Vagedes ◽  
Mohammad O. A. Islam ◽  
Marciana N. Duma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Skin Toxicity ◽  
Patient Reported Outcome ◽  
Ultrasound Measurement ◽  
Skin Thickness ◽  
Prospective Comparison ◽  
Significant Difference ◽  
Patient Reported ◽  
Adjuvant Breast Cancer ◽  
Treated Breast

The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of acute radiodermatitis was obtained before radiotherapy, at the end of the treatment (T1), and 6 weeks after the treatment (T2) using CTCAE (v5.0) scores, the Skindex-16 questionnaire, and ultrasound measurement of the skin. CTCAE and Skindex-16 scores in the CF-group were significantly higher compared to the HF group indicating more pronounced side effects at the end of the treatment (CTCAE: CF-RT 1.0 (IQR: 0.0) vs. HF-RT 0.0 (0.25); p = 0.03; Skindex-16: CF: 20.8 (IQR: 25.8); HF: 8.3 (27.1); p = 0.04). At 6 weeks after the treatment, no significant differences between the two fractionation schemes were observed. Ultrasound based assessment showed that the skin thickness in the treated breast was higher compared to the healthy breast at all time-points. However, no significant difference between HF and CF was seen either at T1 or T2. The current study complements and confirms pre-existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF at the end of treatment. This should be considered whenever fractionation of adjuvant breast cancer treatment is being discussed.

312 Retrospective Analysis of Long-Term Scarring Outcomes in Paediatric Burns Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Mistry
Keyword(s):  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Burn Patients ◽  
Burn Scar ◽  
Common Presentation ◽  
Paediatric Burns ◽  
Significant Difference ◽  
Patient Reported

Abstract Introduction Paediatric burns are a common presentation to a plastic surgery unit. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings, in a cohort of paediatric burns patients. Method The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the Brisbane Burn Scar Impact Profile (BBSIP), a patient reported outcome measure specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically versus those treated conservatively. Results A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically versus those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups. Conclusions We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings.

Young, Empowered and Strong: A Web-Based Education and Supportive Care Intervention for Young Women With Breast Cancer Across the Care Continuum

2021 ◽  
pp. 933-943
Author(s):  
Tal Sella ◽  
Craig Snow ◽  
Hannah Freeman ◽  
Philip D. Poorvu ◽  
Shoshana M. Rosenberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Breast Cancer Survivors ◽  
Metastatic Breast ◽  
Patient Reported Outcome ◽  
Self Management ◽  
Semistructured Interview ◽  
Web Based ◽  
Care Continuum ◽  
Patient Reported

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.

scholarly journals Comparison of functional outcomes between teriparatide and vitamin D3 in distal end radius fractures of osteoporotic patients

2021 ◽  
Vol 05 (01) ◽  
pp. 35-40
Author(s):  
Prakash D. Samant ◽  
◽  
Rohit M. Sane ◽  
Rajendraprasad R. Butala ◽  
Aditya M. Sane ◽  
...  
Keyword(s):  
Vitamin D3 ◽  
Functional Outcomes ◽  
Therapeutic Option ◽  
Patient Reported Outcome ◽  
Radius Fractures ◽  
Randomized Clinical Study ◽  
Significant Difference ◽  
Patient Reported ◽  
Vitamin D3 Supplementation ◽  
To Receive

Objectives: The objective of this study was to evaluate and compare the efficacy of teriparatide (osteoanabolic agent) versus vitamin D3 supplementation to improve functional outcomes in osteoporotic patients with distal end radius fractures (DERF). Methods: We conducted a prospective, randomized clinical study to compare the functional outcomes. Sixty osteoporotic DERF patients, treated with either conservative or surgical management were randomized to receive either teriparatide (20 mcg/day) or vitamin D3 (1000 IU/day) for a period of 3 months, along with calcium (500 mg/day) supplementation. The treatment outcomes were evaluated pre and post-management (1-month and 3-months) by Green and O’Brien scale, Patient-rated Wrist Evaluation (PRWE) scale, and Sarmiento scale. Results: There was a significant difference between the two groups at 3-months post-management. Teriparatide showed a significantly greater improvement of functional outcome (P=0.036) and patient-reported outcome (P<0.001) in comparison to vitamin D3 in total Green and O’Brien score and PRWE score, respectively. Conclusion: Teriparatide supplementation was effective and resulted in greater improvement in functional and radiologic outcomes in comparison to vitamin D3. Adjuvant teriparatide therapy may be a therapeutic option to improve the functional outcomes in DERF of osteoporotic patients.

scholarly journals Breast cancer patient-reported outcome of factors influencing cosmetic satisfaction after breast-conserving therapy

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 ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Breast Surgery ◽  
Breast Conserving Therapy ◽  
Patient Reported Outcome ◽  
Breast Size ◽  
Exclusion Criteria ◽  
Non Invasive ◽  
Patient Reported ◽  
Relevant Factors

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.

scholarly journals Short-term serial assessment of electronic patient-reported outcome for depression and anxiety in breast Cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeeyeon Lee ◽  
Jin Hyang Jung ◽  
Wan Wook Kim ◽  
Byeongju Kang ◽  
Jungmin Woo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Period ◽  
Depression Scale ◽  
Patient Reported Outcome ◽  
Depression And Anxiety ◽  
Short Term ◽  
Web Based ◽  
Patient Reported ◽  
Patient Health

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.

scholarly journals Patient-Reported Outcome Measures May Add Value in Breast Cancer Surgery

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 ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Patient Reported

Systemic Therapy

2019 ◽  
pp. 176-193
Author(s):  
Didier Verhoeven ◽  
Etienne Brain ◽  
François Duhoux ◽  
Gilberto Schwartsmann ◽  
Fatima Cardoso
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcome ◽  
World Health ◽  
Key Factors ◽  
Process Indicators ◽  
Funding Model ◽  
Day Clinic ◽  
Patient Reported ◽  
Health Organization ◽  
The Given

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.

scholarly journals Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain

2020 ◽  
Vol 7 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Ryan P McGovern ◽  
RobRoy L Martin ◽  
Amy L Phelps ◽  
Benjamin R Kivlan ◽  
Beth Nickel ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Conservative Management ◽  
Movement Control ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Hip Pain ◽  
Analysis Of Covariance ◽  
Functional Movement ◽  
Significant Difference ◽  
Patient Reported

Abstract Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher’s exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.

scholarly journals Mid-term Prospective Follow-up of Ankle Fracture Fixation Using Patient Reported Outcome Measures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Paul Rai ◽  
Jitendra Mangwani
Keyword(s):  
Outcome Measures ◽  
Ankle Fracture ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ankle Fractures ◽  
Anatomical Reduction ◽  
Clear Space ◽  
Significant Difference ◽  
Patient Reported

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) is a common procedure to stabilise unstable ankle fractures. Anatomical reduction and stable fixation is desirable to achieve good clinical and radiological outcome after this injury. This prospective study examines the correlation between mid-term patient reported outcome measures (PROMs) and quality of fracture reduction of adult patients with ankle fractures treated with ORIF. Methods: A total of 100 patients with unstable ankle fracture who underwent ORIF were prospectively entered into the study between Nov 2013 to Oct 2014. Exclusion criteria were: age <18 years, pathological or open fractures and patients with cognitive impairment. Two independent observers assessed fracture patterns and quality of reduction. Fixations were analysed using Pettrone’s criteria including assessment of fracture displacement, medial clear space and tibiofibular overlap. Patients were followed up at two years post-operatively with postal questionnaires. Validated PROMs, Olerud-Molander Score (OMAS) and the Lower Extremity Functional Scale (LEFS) were used. For both scores a higher number indicated a better result. Co-morbidities and infection data were collated from Hospital records. Results: At 2 years post-op there were 5 deceased patients,17 did not have accessible radiographs and there was a 65% response rate to questionnaires. 46 patients were included in the final study group with a mean age of 45 (16-90). There was 1 Weber A fracture, 26 Weber B, 16 Weber C and 3 Medial malleolus fractures. 7% had Diabetes Mellitus, 22% were smokers. The mean OMAS score was 71.4(SD26.9) and LEFS score 56.7(SD25.9). There was no significant difference in PROM scores when fracture fragment reduction was optimised. There was a significant improvement in PROMs with low medial clear space and high tibiofibular overlap. Conclusion: This study reports a good correlation between quality of reduction and favourable PROMs at 2 years post ORIF ankle fracture. Reduced medial clear space and increased tibiofibular overlap were most associated with good outcome scores. Anatomical reduction of fracture fragments did not appear to affect PROMs on its own. There was very little infection in this cohort to confound the results. We would advise careful consideration of medial clear space and tibiofibular overlap in particular at time of fixation of unstable ankle fractures.

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