Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature

BackgroundAn increasing number of young women are delaying childbearing; hence, more are diagnosed with breast cancer (bca) before having a family. No clear recommendations are currently available for counselling such a population on the safety of carrying a pregnancy during bca or becoming pregnant after treatment for bca.MethodsUsing a Web-based search of PubMed we reviewed the recent literature about bca and pregnancy. Our objective was to report outcomes for patients diagnosed with bca during pregnancy, comparing them with outcomes for non-pregnant women, and to evaluate prognosis in women diagnosed with and treated for bca who subsequently became pregnant.Results“Pregnancy and bca” should be divided into two entities. Pregnancy-associated bca tends to be more aggressive and advanced in stage at diagnosis than bca in control groups; hence, it has a poorer prognosis. With respect to pregnancy after bca, there is, despite the bias in reported studies and meta-analyses, no clear evidence for a different or worse disease outcome in bca patients who become pregnant after treatment compared with those who do not.ConclusionsPregnancy-associated bca should be treated as aggressively as and according to the standards applicable in nonpregnant women; pregnancy after bca does not jeopardize outcome. The guidelines addressing risks connected to pregnancy and bca lack a high level of evidence for better counselling young women about pregnancy considerations and preventing unnecessary abortions. Ideally, evidence from large prospective randomized trials would set better guidelines, and yet the complexity of such studies limits their feasibility.

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Abstract PD12-08: Young, empowered & strong (YES): A web-based education and supportive care intervention for young women with breast cancer across the care continuum

10.1158/1538-7445.sabcs20-pd12-08 ◽

2021 ◽

Author(s):

Tal Sella ◽

Craig Snow ◽

Hannah Freeman ◽

Phillip D Poorvu ◽

Shoshana M Rosenberg ◽

...

Keyword(s):

Breast Cancer ◽

Supportive Care ◽

Young Women ◽

Web Based ◽

Care Continuum ◽

Care Intervention ◽

Supportive Care Intervention ◽

Web Based Education

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

JCO Clinical Cancer Informatics ◽

10.1200/cci.21.00067 ◽

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.

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Does Locoregional Radiation Therapy Improve Survival in Breast Cancer? A Meta-Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.6.1220 ◽

2000 ◽

Vol 18 (6) ◽

pp. 1220-1229 ◽

Cited By ~ 381

Author(s):

Timothy J. Whelan ◽

Jim Julian ◽

Jim Wright ◽

Alejandro R. Jadad ◽

Mark L. Levine

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Systemic Therapy ◽

Odds Ratio ◽

Randomized Trials ◽

Meta Analysis ◽

Radical Mastectomy ◽

Node Positive ◽

Meta Analyses ◽

Positive Breast Cancer

PURPOSE: Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS: Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS: Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.

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Interventions for Adolescents With ADHD to Improve Peer Social Functioning: A Systematic Review and Meta-Analysis

Journal of Attention Disorders ◽

10.1177/1087054720906514 ◽

2020 ◽

pp. 108705472090651 ◽

Cited By ~ 1

Author(s):

Sarah Morris ◽

Jade Sheen ◽

Mathew Ling ◽

Denise Foley ◽

Emma Sciberras

Keyword(s):

Social Functioning ◽

Randomized Trials ◽

Meta Analysis ◽

Parent Report ◽

Self Report ◽

Age Group ◽

Control Groups ◽

Social Interventions ◽

Meta Analyses ◽

And Control

Objective: Peer social functioning difficulties characteristic of ADHD persist into adolescence, but the efficacy of interventions for this age group remains unclear. Method: A systematic search of nonpharmacological interventions for adolescents with ADHD (10–18 years) identified 11 trials addressing social functioning, of which eight were included in meta-analyses. Results: Random effects meta-analyses of four randomized trials found no differences in social functioning between treatment and control groups by parent- ( g = −0.08 [−0.34, 0.19], k = 4, N = 354) or teacher-report ( g = 0.17 [−0.06, 0.40], k = 3, N = 301). Meta-analyses of nonrandomized studies indicated participants’ social functioning improved from baseline to postintervention by parent-report, but not teacher- or self-report. All trials had a high risk of bias. Conclusion: These results highlight the paucity of research in this age group. There is little evidence that current interventions improve peer social functioning. Clearer conceptualizations of developmentally relevant targets for remediation may yield more efficacious social interventions.

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Aromatase inhibitors versus tamoxifen as adjuvant therapy for postmenopausal women with estrogen receptor positive breast cancer: meta-analyses of randomized trials of monotherapy and switching strategies.

10.1158/0008-5472.sabcs-12 ◽

2009 ◽

Cited By ~ 17

Author(s):

JN Ingle ◽

M Dowsett ◽

J Cuzick ◽

C Davies

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Adjuvant Therapy ◽

Postmenopausal Women ◽

Aromatase Inhibitors ◽

Randomized Trials ◽

Estrogen Receptor Positive ◽

Meta Analyses ◽

Switching Strategies ◽

Positive Breast Cancer

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The experience of conducting a Cochrane systematic review of the impact of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs

International Journal of Care Pathways ◽

10.1258/jicp.2009.009009 ◽

2009 ◽

Vol 13 (2) ◽

pp. 62-66 ◽

Cited By ~ 2

Author(s):

Thomas Rotter ◽

Leigh Kinsman ◽

Erica James ◽

Andreas Machotta ◽

Holger Gothe ◽

...

Keyword(s):

Systematic Review ◽

Clinical Pathways ◽

Hospital Costs ◽

Evidence Base ◽

Care Group ◽

Level Of Evidence ◽

Organisation Of Care ◽

High Level ◽

Meta Analyses ◽

The Impact

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of an agreed definition of a CPW make the relevance of individual studies difficult to apply to clinical settings. It was timely to catalogue and analyse the existing evidence base for CPWs via a rigorous systematic review. Systematic reviews and meta-analyses provide a high level of evidence for the effectiveness of interventions and are commonly employed reviewing strategies for addressing scientific questions in health-related research. This method is especially useful when research results are known to be inconsistent. Instead of conducting another primary evaluation, a detailed review is needed that reflects a summation of available research. This paper reports and discusses methodological and technical issues of a systematic review of the effectiveness of CPWs in hospitals, based on our experience with the Cochrane Effective Practice and Organisation of Care Group.

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Genetic testing in young women with breast cancer: Results from a web-based survey

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.21093 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 21093-21093

Author(s):

J. A. Shin ◽

S. Gelber ◽

J. Garber ◽

R. Rosenberg ◽

M. Przypyszny ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Genetic Testing ◽

Family History ◽

High Risk ◽

Young Women ◽

College Education ◽

Web Based ◽

Increased Risk ◽

History Of

21093 Background: Young women with breast cancer have an increased risk of harboring a BRCA1/2 mutation. The frequency of genetic testing in this population is not well described. We evaluated the reported frequency and factors associated with genetic testing among young breast cancer survivors identified through the Young Survival Coalition (YSC), an international advocacy group for young women with breast cancer. Methods: Items regarding family history and genetic testing were included in a large web-based survey addressing quality of life and fertility issues for young women with breast cancer. All YSC members were invited by email in March 2003 (N= 1,703 women) to participate in this cross-sectional survey. Results: 657 women completed the on-line survey; 622 were eligible for this analysis (age <40, no metastatic or recurrent disease). Mean age at breast cancer diagnosis was 33 years; mean age when surveyed 35.5 years. Stages included: 0 (10%), I (27%), II (49%), III (12%), missing (3%). 90% of women were white; 64% married; 49% with children; 78% had at least a college education; 42% of women reported a 1st or 2nd degree relative with breast or ovarian cancer, and 13% considered themselves high-risk for harboring a genetic mutation at the time of diagnosis. At the time of the survey, 23% of women had undergone genetic testing, and 26% of those tested reported that a mutation was found. In a multivariate model, women who were younger (age 36–40 vs. age =30, O.R. 2.26, p=0.004), more educated (< college vs. > college education, O.R. 2.62, p=0.0009), had a family history of breast or ovarian cancer (O.R. 3.15, p<0.0001), and had had a mastectomy (O.R. 1.99, p=0.001) were more likely to have undergone genetic testing. Non-significant covariates included: age at survey, stage, time since diagnosis, race, marital status, employment, finances, insurance, number of children, comorbidities, baseline anxiety and depression, and fear of recurrence. Conclusion: The majority of women diagnosed with breast cancer age 40 and younger do not undergo genetic testing. Younger, more educated women with a family history of breast or ovarian cancer are more likely to get tested. Further research to define the appropriateness of genetic testing in this relatively high-risk population is warranted. No significant financial relationships to disclose.

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Genetic testing in young women with breast cancer: results from a Web-based survey

Annals of Oncology ◽

10.1093/annonc/mdp355 ◽

2010 ◽

Vol 21 (4) ◽

pp. 741-747 ◽

Cited By ~ 15

Author(s):

K.J. Ruddy ◽

S. Gelber ◽

J. Shin ◽

J.E. Garber ◽

R. Rosenberg ◽

...

Keyword(s):

Breast Cancer ◽

Genetic Testing ◽

Young Women ◽

Web Based

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Salvage of the Failed Total Wrist Arthroplasty: A Systematic Review

Journal of Wrist Surgery ◽

10.1055/s-0040-1713728 ◽

2020 ◽

Vol 09 (05) ◽

pp. 446-456

Author(s):

Onur Berber ◽

Sam Gidwani ◽

Lorenzo Garagnani ◽

Michelle Spiteri ◽

Nicholas Riley ◽

...

Keyword(s):

Systematic Review ◽

Revision Surgery ◽

Revision Arthroplasty ◽

Postoperative Outcome ◽

Secondary Outcome ◽

Level Of Evidence ◽

Total Wrist Arthroplasty ◽

High Level ◽

Meta Analyses ◽

Wrist Arthroplasty

Abstract Background Although the performance of total wrist arthroplasty systems has improved, failure is encountered and is a major challenge to manage. Questions Does physical function improve with surgical management of the failed wrist arthroplasty? Is there an improvement in secondary outcome measures including pain, grip strength, and range of motion? What are the reasons for failure in primary total wrist arthroplasty? What are the complications associated with revision of the failed total wrist arthroplasty? What are the survival profiles of the different revision strategies? Methods A systematic review of available literature was performed. Studies were systematically assessed, and data extracted from suitable studies for review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were adhered to. The study protocol was modified from a previous protocol published on the PROSPERO database. Results Fourteen studies were identified considering 218 patients/214 index operations with a follow-up duration following revision surgery of 2 months to 21 years (silicone wrist arthroplasty—42 cases; nonsilicone wrist arthroplasty—172 cases). The functional outcome of revision surgery was infrequently recorded and documented with only short-term assessments undertaken. Complications were seen in 1:2 revision procedures, with re-revision surgeries required in 21.6% of revised primary nonsilicone arthroplasties. Re-revision rate following a revision arthrodesis was 21.4% (15/70 cases) compared with revision arthroplasty of 34.8% (32/92 cases). Revision arthrodesis nonunion rate was 17.5% (22 cases). Conclusion This review has confirmed the high level of surgical complexity and the likelihood of a complicated postoperative outcome when salvaging a failed wrist replacement. Level of Evidence This is a Level 3, systematic review study.

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