scholarly journals An Underestimated Toxicity Radiation-Induced Hypothyroidism in Patients Multimodally Treated for Breast Cancer

2021 ◽  
Vol 10 (23) ◽  
pp. 5503
Author(s):  
Camil Ciprian Mireștean ◽  
Roxana Irina Iancu ◽  
Dragoș Petru Teodor Iancu
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Radiation Therapy ◽  
Thyroid Gland ◽  
Radical Mastectomy ◽  
Primary Hypothyroidism ◽  
Cervical Region ◽  
Breast Cancers ◽  
Free T4

Radiation therapy is part of the therapeutic arsenal for breast cancer, whether it is adjuvant treatment after lumpectomy or radical mastectomy, or it is used as a palliative option in the case of metastatic or recurrent disease. Significant advances in diagnostic and therapeutic stratification of breast cancers have significantly prolonged survival, even in the metastatic stage. Exposure of patients during the course of the disease in a multidisciplinary therapeutic approach including chemotherapy, hormone therapy, targeted anti-HER therapies or CDK4/6 inhibitors had led to improved survival but with the price of additional toxicity. Among them, hypothyroidism is a well-known consequence of external radiation therapy, especially in the case of cervical region irradiation, including supraclavicular and infra-clavicular nodal levels. In this situation, the thyroid gland is considered as an organ at risk (OAR) and receives a significant dose of radiation. Subclinical hypothyroidism is a common endocrine disorder characterized by elevated TSH levels with normal levels of FT4 (free T4) and FT3 (free T3), and as a late effect, primary hypothyroidism is one of the late effects that significantly affects the quality of life for patients with breast cancer receiving multimodal treatment. Hypothyroidism has a significant impact on quality of life, most often occurring as late clinical toxicity, secondary to thyroid irradiation at doses between 30 and 70 Gy. Dose-volume parameters of irradiation, gland function at the beginning of the treatment and associated systemic therapies may be factors that alter thyroid radio-sensitivity and affect thyroid gland tolerance. In the case of head and neck tumor pathology, in which doses of >50 Gy are routinely used, the thyroid gland is generally considered as an OAR, the rate of radio-induced hypothyroidism being estimated at rates of between 20% and 52%. For breast cancer, the thyroid is often neglected in terms of dosimetry protection, the rate of late dysfunction being 6–21%.

scholarly journals EVALUATION OF POSTURE AND QUALITY OF LIFE IN FEMALES UNDERGONE MODIFIED RADICAL MASTECTOMY

2021 ◽  
Vol 10 (4) ◽  
pp. 3233-32337
Author(s):  
Shruti Deshpande
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Social Life ◽  
Radical Mastectomy ◽  
Improve Quality ◽  
Modified Radical Mastectomy ◽  
Social Domain ◽  
Common Cancer ◽  
Environment Domain

Breast cancer is most common cancer in females. Modified radical mastectomy is operation in female which affects social life and physical life. There is also slightly moderate in quality of life in female undergone modified radical mastectomy. The aim of the study was to find “Evaluation of Posture and Quality Of Life in Females undergone Modified Radical Mastectomy’’ This study was carried out in Physiotherapy OPD, Ravi Nair Physiotherapy College and AVBRH, Sawangi (Meghe), Wardha. The objectives included to evaluate posture in female’s undergone Modified radical mastectomy and to evaluate Quality of life. The present study titled “Evaluation of Posture and Quality of Life in females undergone Modified Radical Mastectomy” which comprised of 35 females. The present study showed that slight changes in posture in females undergone modified radical mastectomy and moderately hampered in social domain of quality of life. From the present study we concluded that there is slight changes in posture in female patients undergone MRM and there is good quality of life in physical , psychological , environment domain and moderate quality of life in social domain. This study will helps in evaluating posture and QOL after Modified radical mastectomy. Hence after every modified radical mastectomy conditions, therapists always follow ergonomics to prevent bad posture and improve quality of life. Hence, the evaluation of posture and QOL should be include in all assessment proformas related MRM conditions.

Considerations on the Use of Aromatase Inhibitors in Postmenopausal Women With Breast Cancer

2020 ◽  
pp. 385-400
Author(s):  
Jeffrey D. Blaustein
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cognitive Function ◽  
Adverse Effects ◽  
Develop Breast Cancer ◽  
Laboratory Animals ◽  
Breast Cancers ◽  
The Brain

About 1 of every 8 women will develop breast cancer during her lifetime, and approximately 250,000 new cancer cases are expected annually as of 2017. Of those breast cancers, approximately 60% to 75% will express estrogen receptors, suggesting that estrogens are likely to promote growth of those tumors. Because the use of inhibitors of the synthesis of estrogens is the adjuvant treatment of choice for many women, it is essential that we understand the potential adverse effects on quality of life of those treatments. This review addresses the role of estrogens locally synthesized in the brain in laboratory animals and women, the effects of estrogens on cognitive function, the effects of synthesis blockers on cognitive function, and the limitations in performing experiments that will give us strong confidence in the results and conclusions.

scholarly journals Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India

2019 ◽  
Vol 29 (3) ◽  
pp. 683-692
Author(s):  
K. V. Deepa ◽  
A. Gadgil ◽  
Jenny Löfgren ◽  
S. Mehare ◽  
Prashant Bhandarkar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Breast Conservation ◽  
Radical Mastectomy ◽  
Breast Conservation Surgery ◽  
Breast Cancer Surgery ◽  
Significant Difference ◽  
Domain Scores

Abstract Purpose Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India. Methods We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed. Results We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores. Conclusion QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

scholarly journals Acceptance of the illness and the quality of life of patients with breast cancer

2014 ◽  
Vol 124 (1) ◽  
pp. 5-9
Author(s):  
Marzena Kamińska ◽  
Tomasz Ciszewski ◽  
Agnieszka Bronikowska ◽  
Maria Ferańska ◽  
Agnieszka Pawlak-Warszawska ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Hormone Therapy ◽  
Endocrine Therapy ◽  
Negative Impact ◽  
Combined Therapy ◽  
Radical Mastectomy ◽  
Well Being ◽  
Breast Cancer Patients

Abstract Introduction. Breast cancer is the most frequent cancer diagnosed in women. Its treatment is a combined therapy and the sequence and time are established according to the accepted standards in Poland. Consequences posed by this disease include disorder in the physical, mental and social spheres in women. Adapting to cancer is very important for the process of treatment, and the acceptance of the disease is the determinant. Aim. The aim of the study was to determine and compare the degree of acceptance of the illness and the assessment of quality of life among breast cancer patients during cancer treatment. Material and methods. The survey included 85 ill people treated in a conserving way and 94 ill people treated by breast amputation. Patients after the surgical procedure were subjected to adjuvant treatment involving chemotherapy (90 women) and/or endocrine therapy (87 women). The study used standardized questionnaires EORTC (European Organisation for Research and Treatment of Cancer): QLQC-30 and the scale (AIS Approval IIIness Scale). Results. The highest level of acceptance of the disease, so the best ability to adapt to cancer have those women who have undergone radical mastectomy and adjuvant hormone therapy during the treatment. The lowest level of acceptance of the illness, expressed as a negative assessment was observed in women after BCT and during chemotherapy treatment. The use of the EORTC QLQC-30 to assess the overall health and quality of life of patients allowed us to capture statistically significant differences in the percentages stating good health, with the relatively highest negative response rates which were observed in the subgroups treated with chemotherapy and hormone therapy. With regard to the highest quality of life, the percentage of negative responses was observed in subgroups treated with the use of hormone therapy and after mastectomy. Conclusions. Good acceptance of the disease was obtained by women treated for breast cancer who have undergone mastectomy in the course of adjuvant endocrine therapy. The assessment of general health and quality of life was influenced by oncological treatment. Patients during chemotherapy and hormone therapy showed a negative impact of this form of treatment on overall well-being and functioning.Patients after mastectomy and during hormone therapy treatment showed a comparatively lower quality of life compared to a group of patients after BCT and during treatment with chemotherapy

B-TREUH: A single-arm phase II pilot study of euthyroid hypothyroxinemia in metastatic breast carcinoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS1115-TPS1115
Author(s):  
Shruti Trehan ◽  
Suzan S. Cheng ◽  
Aleck Hercbergs
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Breast Carcinoma ◽  
Radiation Effects ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Free T4 ◽  
Metastatic Breast Carcinoma ◽  
The Us

TPS1115 Background: It is estimated that there are approximately 155,000 people living with metastatic breast cancer in the US. Studies exploring the connection between hypothyroidism or hyperthyroidism and breast cancer have yielded varying results with up to 33% prevalence of thyroid disease in these patients. L-thyroxine (T4) is the most commonly prescribed agent in the US to manage hypothyroidism. However, there are data suggesting that T4 is a pro-oncogenic agent with proposed mechanisms such as stimulation of mitogenesis, angiogenesis, resistance to apoptosis. In addition, T4 May counter anti-PDL-1 and radiation effects. Triiodothyronine (T3), which is deiodinated form of T4 and also commercially available, is felt to be less oncogenic and less mitogenic. Therefore, exogenous supplementation of T3 would decrease the T4 levels creating the desired state of EUTHYROID HYPOTHYROXINEMIA. The study hypothesizes that replacing L-thyroxine (T4) with Triiodothyronine (T3) in hypothyroid patients with metastatic breast carcinoma, while they simultaneously continue to receive standard systemic therapy, with titrating T3 dose to achieve a state of Euthyroid Hypothyroxinemia would result in improved disease outcomes. Methods: Eligible participants are adults with metastatic breast carcinoma with estimated life expectancy of > 3months, hypothyroidism, and with normal TSH on L-thyroxine (T4). Following consent, participants will discontinue L-thyroixne (T4) and initiate Triiodothyronine (T3) dose based on current T4 dose after an appropriate washout period. Drug titration will be in accordance with thyroid function testing to maintain levels of free T4 at < 50% normal range. The treatment period will continue for 9 months with periodic assessment of disease status, quality of life (FACT-B) and laboratory measures. The primary endpoint is the progression free survival at 12 months while the secondary endpoints are prevalence of hypothyroidism in the cohort, overall survival, quality of life, and duration of time to achieve the Euthyroid Hypothyroxinemia state. Given many uncertainties to calculate power precisely, the sample size is estimated to be approximately 30 patients. Clinical trial information: NCT03787303 .

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