The impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation.

Objective: To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis. Methods: We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil. Results: Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 - 3.72, p = 0.0366) than those who underwent breast-conserving surgery. Conclusion: Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.

The impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation

Abstract Objective To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis. Methods We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil. Results Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 - 3.72, p = 0.0366) than those who underwent breast-conserving surgery. Conclusion Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.

Multicenter Database of Patients with Germ-Cell Tumors: A Latin American Cooperative Oncology Group Registry (LACOG 0515).

INTRODUCTION: Germ-cell tumors (GCTs) are the most common malignancy in young men. There is a paucity of data on GCTs in developing countries. LACOG 0515 study aimed to evaluate clinical characteristics and treatment outcomes in patients with GCTs from Brazilian cancer centers. MATERIALS AND METHODS: This is a retrospective cohort study evaluating male patients diagnosed with GCTs from 2000 to 2018 in 13 Brazilian hospitals. We described baseline characteristics, progression-free survival (PFS), and overall survival (OS). RESULTS: A total of 1232 patients were included, with a median age of 30 years. Histology was seminoma in 47.1% and non-seminoma GCT (NSGCT) in 52.9%. The primary tumor site was testis in 96.5%. At diagnosis, clinical stage I was present in 68.1% and 34.7% and clinical stages IS/II/III in 31.9% and 65.2% of patients with seminoma and NSCGT, respectively. Following orchiectomy, 55.2% of patients with clinical stage I were managed with surveillance. The 5-year disease-free survival rates among patients with stage I were 98.0% in seminoma and 92.3% in NSGCT, with 5-year OS of 99.6% and 97.6%, respectively. Among patients with advanced disease (IS, II, and III), the 5-year PFS were 88.7% in seminoma and 68.7% in NSGCT, with 5y-OS of 97.6% and 82.8%, respectively. CONCLUSION: This is the largest Brazilian cohort of GCTs. Our results show a high rate of adjuvant chemotherapy in patients with clinical stage I. Although our data demonstrate slightly inferior PFS compared with the International Germ Cell Cancer Collaborative Group and other contemporary series, the OS rates were similar.

The relationship between sleep and physical activity in nonagenarians and centenarians / Relação entre sono e atividade física em nonagenários e centenários

OBJECTIVE: Since the relationship between physical activity and sleep quality has been poorly studied in nonagenarians and centenarians, this study sought to relate the sleep quality and physical activity in this age group. METHODS: This is a secondary analysis of the initial assessment of a longitudinal study involving nonagenarians and centenarians in Porto Alegre, Brazil, which included physical activity (yes or no) and sleep quality (altered or normal). The chi-square test, adjusted by logistic regression, was used to investigate the relationship between sleep quality, physical activity, and sociodemographic and clinical characteristics. RESULTS: Among the 233 participants, 26% were physically active and 53% reported altered sleep. Higher frequencies of physical activity and normal sleep occurred in men (36%, p = 0.02 and 54%, p = 0.18), in those living with a caregiver (42%, p = 0.09 and 58, p = 0.51), in those with high school or higher education (33%, p = 0.44 and 58%, p = 0.07), and in those with excellent or good self-perceived health (31%, p = 0.03 and 51%, p = 0.16). Physical activity was lower among those who reported apathy and drowsiness (83%, p = 0.03) and in those who had difficulty falling asleep (66%, p = 0.05). In the adjusted analysis, only education remained significant (p = 0.02, when comparing high school or higher with illiteracy; odds ratio: 3.91 confidence interval 1.18-12.90, p = 0.02). CONCLUSIONS: We observed a low frequency of physical activity and a high prevalence of altered sleep patterns in nonagenarians and centenarians. Factors related greater physical activity were also associated with better sleep quality. High school or higher education was a significant and independent predictor of good sleep quality in nonagenarians and centenarians.

OBJETIVOS: A relação entre atividade física e qualidade do sono é pouco estudada em nonagenários e centenários. Portanto, o presente trabalho busca relacionar a qualidade do sono com a atividade física nessas faixas etárias. METODOLOGIA: Estudo transversal na linha de base de uma coorte longitudinal envolvendo nonagenários e centenários em Porto Alegre (RS), que incluiu atividade física (realiza ou não) e qualidade de sono (alterado e normal). A relação entre qualidade do sono e atividade física e características sociodemográficas e clínicas foi testada pelo χ2 , com análise ajustada pela regressão logística. RESULTADOS: Entre os 233 participantes, 26% realizavam atividade física e 53% referiam sono alterado. Maiores frequências de atividade física e de sono normal foram vistas em homens (36%, p = 0,02 e 54%, p = 0,18), residindo com cuidador (42%, p = 0,09 e 58%, p = 0,51), com ensino médio ou superior (33%, p = 0,44 e 58%, p = 0,07) e ótima ou boa autopercepção de saúde (31%, p = 0,03 e 51%, p = 0,16). A prática de atividade física foi menor entre os apáticos e sonolentos (83%, p = 0,03) e aqueles com dificuldade de iniciar o sono (66%, p = 0,05). Na análise ajustada, apenas a escolaridade se manteve significativa (razão de chance de 3,91 com intervalo de confiança de 1,18 ­ 12,90, p = 0,02). CONCLUSÕES: Os nonagenários e centenários apresentaram baixa frequência de atividade física e alta prevalência de sono alterado. Fatores relacionados à maior frequência de atividade física também apresentavam melhor qualidade do sono. Ter nível de escolaridade secundário ou superior foi um fator preditivo de boa qualidade do sono em nonagenários e centenários