A bio-behavioral model of systemic inflammation at breast cancer diagnosis and fatigue of clinical importance 2 years later.

BACKGROUND: We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance 2 years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation. PATIENTS AND METHODS: Women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance [European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 ≥40/100] 2 years after diagnosis (year 2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers [interleukin (IL)-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, interferon γ, IL-1 receptor antagonist, tumor necrosis factor-α, and C-reactive protein], and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling. RESULTS: Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year 2. High pre-treatment levels of IL-6 (quartile 4 versus 1) were associated with global CRF at year 2 [adjusted odds ratio (aOR): 2.06 (95% confidence interval [CI] 1.40-3.03); P = 0.0002; area under the receiver operating characteristic curve = 0.74]. Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese [62.4%; mean body mass index 28.0 (standard deviation 6.3 kg/m2)] and physically inactive (53.5% did not meet World Health Organization recommendations). Clinical and behavioral associations with CRF at year 2 included pre-treatment CRF [aOR versus no pre-treatment CRF: 3.99 (95% CI 2.81-5.66)], younger age [aOR per 1-year decrement: 1.02 (95% CI 1.01-1.03)], current tobacco smoking [aOR versus never: 1.81 (95% CI 1.26-2.58)], and worse insomnia or pain [aOR per 10-unit increment: 1.08 (95% CI 1.04-1.13), and 1.12 (95% CI 1.04-1.21), respectively]. Secondary analyses indicated additional associations of IL-2 [aOR per log-unit increment: 1.32 (95% CI 1.03-1.70)] and IL-10 [0.73 (95% CI 0.57-0.93)] with global CRF and of C-reactive protein [1.42 (95% CI 1.13-1.78)] with cognitive CRF at year 2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF. CONCLUSIONS: This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance 2 years later among a large prospective sample of survivors of breast cancer.

Comparison of chemical composition of organic and conventional Italian cheeses from parallel production.

Although there are several studies comparing organic and conventional milk characteristics, very few focused on dairy processed products such as cheese. Thus, this study aimed for a detailed controlled examination of gross composition, minerals, and the fatty acid profile of organic (ORG) and conventional (CON) Italian cheeses from parallel production. Four Italian cheese types were analyzed: Latteria (ORG, n = 9; CON, n = 10); Asiago Protected Designation of Origin (PDO) fresco (ORG, n = 9; CON, n = 9); Caciotta (ORG, n = 8; CON, n = 8); and Mozzarella Traditional Specialty Guaranteed (TSG; ORG, n = 14; CON, n = 14). Cheese samples were collected from September 2020 to August 2021. Gross composition, minerals, and fatty acids were determined using infrared spectroscopy. Within each cheese type, paired ORG and CON samples were compared using a nonparametric Wilcoxon signed-rank test. Latteria showed lower PUFA, n-3, and n-6 content, and greater Fe, K, C10:0, C12:0, and C16:0 content in ORG than in CON. Asiago PDO fresco showed lower protein and Zn content and greater salt, ash, and Na content in ORG than in CON. Caciotta showed lower ash, n-3, and n-6 content and greater K, C4:0, C8:0, C10:0, C14:0, and C16:0 content in ORG than in CON. Mozzarella TSG showed lower fat and, therefore, fatty acid content, and greater moisture, ash, and Mg content in ORG than in CON. In conclusion, few significant differences in chemical composition were observed between ORG and CON cheeses, regardless of the type considered. Moreover, Asiago PDO fresco showed fewer significant differences between ORG and CON compared with Latteria, Caciotta, and Mozzarella TSG.

Effectiveness of mid-infrared spectroscopy for the prediction of cow milk metabolites.

Proton nuclear magnetic resonance (1H NMR) spectroscopy is acknowledged as one of the most powerful analytical methods with cross-cutting applications in dairy foods. To date, the use of 1H NMR spectroscopy for the collection of milk metabolic profile is hindered by costly and time-consuming sample preparation and analysis. The present study aimed at evaluating the accuracy of mid-infrared spectroscopy (MIRS) as a rapid method for the prediction of cow milk metabolites determined through 1H NMR spectroscopy. Bulk milk (n = 72) and individual milk samples (n = 482) were analyzed through one-dimensional 1H NMR spectroscopy and MIRS. Nuclear magnetic resonance spectroscopy identified 35 milk metabolites, which were quantified in terms of relative abundance, and MIRS prediction models were developed on the same 35 milk metabolites, using partial least squares regression analysis. The best MIRS prediction models were developed for galactose-1-phosphate, glycerophosphocholine, orotate, choline, galactose, lecithin, glutamate, and lactose, with coefficient of determination in external validation from 0.58 to 0.85, and ratio of performance to deviation in external validation from 1.50 to 2.64. The remaining 27 metabolites were poorly predicted. This study represents a first attempt to predict milk metabolome. Further research is needed to specifically address whether developed prediction models may find practical application in the dairy sector, with particular regard to the screening of dairy cows' metabolic status, the quality control of dairy foods, and the identification of processed milk or incorrectly stored milk.

Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification.

BACKGROUND: The landscape of clinical trials testing risk-adapted modulations of cancer treatments is complex. Multiple trial designs, endpoints, and thresholds for non-inferiority have been used; however, no consensus or convention has ever been agreed to categorise biomarkers useful to inform the treatment intensity modulation of cancer treatments. METHODS: An expert subgroup under the European Society for Medical Oncology (ESMO) Precision Medicine Working Group shaped an international collaborative project to develop a classification system for biomarkers used in the cancer treatment de-intensification, based on a tiered approach. A group of disease-oriented clinical, translational, methodology and public health experts, and patients' representatives provided an analysis of the status quo, and scanned the horizon of ongoing clinical trials. The classification was developed through multiple rounds of expert revisions and inputs. RESULTS: The working group agreed on a univocal definition of treatment de-intensification. Evidence of reduction in the dose-density, intensity, or cumulative dose, including intermittent schedules or shorter treatment duration or deletion of segment(s) of the standard regimens, compound(s), or treatment modality must be demonstrated, to define a treatment de-intensification. De-intensified regimens must also portend a positive impact on toxicity, quality of life, health system burden, or financial toxicity. ESMO classification categorises the biomarkers for treatment modulation in three tiers, based on the level of evidence. Tier A includes biomarkers validated in prospective, randomised, non-inferiority clinical trials. The working group agreed that in non-inferiority clinical trials, boundaries are highly dependent upon the disease scenario and endpoint being studied and that the absolute differences in the outcomes are the most relevant measures, rather than relative differences. Biomarkers tested in single-arm studies with a threshold of non-inferiority are classified as Tier B. Tier C is when the validation occurs in prospective-retrospective quality cohort investigations. CONCLUSIONS: ESMO classification for the risk-guided intensity modulation of cancer treatments provides a set of evidence-based criteria to categorise biomarkers deemed to inform de-intensification of cancer treatments, in risk-defined patients. The classification aims at harmonising definitions on this matter, therefore offering a common language for all the relevant stakeholders, including clinicians, patients, decision-makers, and for clinical trials.

Characterization of the genetic polymorphism linked to the ß-casein A1/A2 alleles using different molecular and biochemical methods.

The 2 major subvariants of ß-casein (A1 and A2), coded by CSN2 gene, have received great interest in the last decade both from the scientific community and the dairy sector due to their influence on milk quality. The consumption of the A1 variant, compared with the A2 variant, has a potential negative effect on human health after its digestion but, at the same time, its presence improves the milk technological properties. The aim of the present study was to compare the best method in terms of time required, costs, and technical engagement for the identification of ß-casein A1 and A2 variants (homozygous and heterozygous animals) in milk to offer a reliable service for large-scale screening studies. Two allele-specific PCR procedures, namely RFLP-PCR and amplification refractory mutation system (ARMS-PCR), and one biochemical technique (HPLC) were evaluated and validated through sequencing. Manual and automated DNA extraction protocols from milk somatic cells were also compared. Automated DNA extraction provided better yield and purity. Chromatographic analysis was the most informative and the cheapest method but unsuitable for large-scale studies due to lengthy procedures (45 min per sample). Both allele-specific PCR techniques proved to be fast and reliable for differentiating between A1 and A2 variants but more expensive than HPLC analysis. Specifically, RFLP-PCR was the most expensive and labor-demanding among the evaluated techniques, whereas ARMS-PCR was the fastest while also requiring less technical expertise. Overall, automated extraction of DNA from milk matrix combined with ARMS-PCR is the most suitable technique to provide genetic characterization of the CSN2 gene on a large scale.

Immunotherapy for early breast cancer: too soon, too superficial, or just right?

Immunotherapy emerged as a new treatment modality for breast cancer, and its use is approved in combination with chemotherapy for first-line therapy in metastatic triple-negative breast cancer overexpressing PD-L1. As immune checkpoint inhibitors alone have modest clinical activity in advanced breast cancer, there is a growing interest in combinatorial modalities, and particularly for their rapid development in the early disease setting. The plethora of ongoing immunotherapy trials in early breast cancer comes at a time when solid data in advanced disease are still imperfect. This review offers a perspective on the efforts to establish the efficacy and safety of immunotherapeutic agents in early breast cancer.

Mineral equilibrium in commercial curd and predictive ability of near-infrared spectroscopy.

Curd samples (n = 83) from 3 European dairy companies were analyzed for micellar and soluble mineral fractions content using inductively coupled plasma optical emission spectrometry as a gold standard method. The same curd samples were analyzed through 3 different near-infrared (NIR) instruments, and NIR spectra were merged with reference data. Prediction equations were developed using modified partial least squares analysis, and the accuracy of prediction was evaluated through leave-one-out cross validation. Overall, NIR spectroscopy was capable of predicting micellar and soluble mineral fractions in curd, but with differences among instruments. Fitting statistics showed that the visible NIR instrument in reflectance mode outperformed the NIR instrument in transmittance mode as well as the portable NIR instrument in reflectance mode. Prediction accuracies for most of the analyzed mineral fractions can be used for curd quality control in dairy companies and to aid in decision-making during the cheesemaking process.

Short communication: Iodine content in bovine milk is lowly heritable and shows limited genetic variation.

Milk and dairy products are considered important sources of iodine in several countries. Despite this, there is a paucity of studies that have investigated sources of variation of milk iodine, especially on a large scale. So far, it is not clear if milk iodine content could be increased through breeding in dairy cattle. Recently, a mid-infrared spectroscopy prediction model has been developed for an indirect quantification of iodine content in cow milk, as it is a faster and less expensive method that allows the prediction at population level. The model has coefficient of determination and ratio of performance to deviation in external validation of 0.57 and 1.44, respectively, and it was used in the present study to predict the iodine content from historical milk spectral data to investigate phenotypic and genetic aspects in the Italian Holstein cattle. Based on the accuracy of the model, the prediction was interpreted as proxy for the real milk iodine concentration (IODP). The data set comprised 33,776 test-day records with IODP from 4,072 cows. Data of IODP were transformed through natural logarithm to achieve a normal distribution. The effect of parity, lactation stage, and month of sampling were investigated, and genetic parameters were estimated using a test-day repeatability animal model. Milk IODP decreased with parities and was the lowest in early lactation. Heritability of IODP was low (0.025) and it was positively genetically correlated with milk yield and negatively with fat content. Results suggested that it would be challenging to directly improve this trait through breeding strategies in dairy cattle, because IODP is mainly affected by temporary environmental factors and thus, cannot be easily improved through genetics. Although preliminary, findings of this study suggest that it would be more convenient to develop feeding and management strategies to drive milk iodine level than to put efforts and resources into breeding strategies. Further studies should validate IODP as an indicator trait of milk iodine content by improving reference data and estimating genetic correlation between predicted and measured values.

Effects of somatic cell score on milk yield and mid-infrared predicted composition and technological traits of Brown Swiss, Holstein Friesian, and Simmental cattle breeds.

High milk somatic cell count (SCC) influences milk production and quality; however, very little is known about the effect of low SCC on milk quality, especially in terms of mineral content and coagulation properties. Thus, the present study aimed to investigate the effects of somatic cell score (SCS), calculated as log2(SCC/100) + 3, on milk yield, composition (fat, crude protein, casein, lactose, milk urea nitrogen, protein fractions, and mineral contents), and coagulation properties of Brown Swiss, Holstein Friesian, and Simmental cows from multibreed herds. Milk composition and coagulation traits were predicted using mid-infrared spectroscopy. The data set comprised 95,591 observations of 6,940 cows in 313 multibreed herds, collected from January 2011 to December 2017. Observations were divided into 8 classes based on SCS. Statistical analysis was performed using a linear mixed model, which included breed, parity, stage of lactation, SCS class, and their interactions as fixed effects, and herd test day, cow, and residual as random effects. The probability that cows experienced SCS > 4.00 at 30 ± 5, 60 ± 5, or 90 ± 5 d after the observation test day was calculated for each SCS class, and odds ratios to the reference class (-1.00 < SCS ≤ 0.00) were reported. Results showed that the relationship between SCS and milk traits followed a third-order polynomial regression. The average loss of milk, fat, and crude protein yields were 0.43, 0.01, and 0.01 kg/d, respectively, for each SCS unit higher than 1.00. Very low SCS (<-1.00) had detrimental effects on milk yield and quality traits similar to or even stronger than high SCS (>4.00). Moreover, cows with SCS lower than -1.00 on a test day were about 7 times more likely to present high SCS within the following 90 ± 5 d than cows with SCS between -1.00 and 0.00. Breeds responded similarly to the increase of SCS, but the overall loss of fat and crude protein yields, and several minerals among Holstein Friesian were lower with increasing SCS. The best milk yield and quality were observed between SCS 0.00 and 1.00, but milk quality of Holstein Friesians started to decrease at lower SCS compared with milk quality of Brown Swiss and Simmental cows. Results suggest a breed-dependent optimum of SCS, and highlighted that very low SCS can be an indicator of udder health problems and, thus, may be used for early detection of mastitis.

Technical note: Repeatability and reproducibility of curd yield and composition in a miniaturized coagulation model.

Miniaturized coagulation (MC) models have been proposed for the evaluation of curd yield (CY) in individual milk samples of different dairy species and breeds, and for the analysis of cheese microstructure and texture. It is still unclear if MC using less than 50 mL of milk is suitable to evaluate CY and chemical composition, and if preservative added to raw milk may interfere with MC process. Therefore, this study aimed at evaluating repeatability and reproducibility of CY, curd moisture, and fat and protein content on curd dry matter (DM) from MC trials using 40 g of milk. Miniaturized coagulations were performed by 3 different operators on 3 consecutive days, using raw milk (RM) and raw milk added with preservative (RMP). Repeatability of CY, calculated as relative standard deviation on 6 miniaturized curds obtained within a day by the same operator, was below 5% for MC carried out with both RM and RMP. The Horwitz ratio, which is the ratio between measured and expected reproducibility, highlighted good reproducibility for CY from RM and fair reproducibility for CY from RMP. The same ratio highlighted lower accuracies for curd moisture and fat and protein content on curd DM, especially for MC trials carried out with RMP. The z-test was performed to evaluate the similarity between curds manufactured with RM and RMP in terms of average yield and chemical composition; z-scores did not highlight significant differences between values obtained from MC carried out with RM and RMP. It can be concluded that preservative had negligible effects on MC, giving the opportunity to extend milk physical and chemical stability, to schedule laboratory trials on longer time span, and to broaden the sample size within a batch of analyses.

Prediction of blood metabolites from milk mid-infrared spectra in early-lactation cows.

Dairy cows commonly experience an unbalanced energy status in early lactation, and this condition can lead to the onset of several metabolic disorders. Blood metabolic profile testing is a valid tool to monitor and detect the most common early lactation disorders, but blood sampling and analysis are time-consuming and expensive, and the procedure is invasive and stressful for the cows. Mid-infrared (MIR) spectroscopy is routinely used to analyze milk composition, being a cost-effective and nondestructive method. The present study aimed to assess the feasibility of using routine milk MIR spectra for the prediction of main blood metabolites in dairy cows, and to investigate associations between measured blood metabolites and milk traits. Twenty herds of Holstein Friesian, Brown Swiss, or Simmental cows located in Northeast Italy were visited 1 to 4 times between December 2017 and June 2018, and blood and milk samples were collected from all lactating cows within 35 d in milk. Concentrations of main blood metabolites and milk MIR spectra were recorded from 295 blood and milk samples and used to develop prediction models for blood metabolic traits through backward interval partial least squares analysis. Blood ß-hydroxybutyrate (BHB), urea, and nonesterified fatty acids were the most predictable traits, with coefficients of determination of 0.63, 0.58, and 0.52, respectively. On the contrary, predictive performance for blood glucose, triglycerides, cholesterol, glutamic oxaloacetic transaminase, and glutamic pyruvic transaminase were not accurate. Associations of blood BHB and urea with their respective contents in milk were moderate to strong, whereas all other correlations were weak. Predicted blood BHB showed an improved performance in detecting cows with hyperketonemia (blood BHB ≥ 1.2 mmol/L), compared with commercial calibration equation for milk BHB. Results highlighted the opportunity of using milk MIR spectra to predict blood metabolites and thus to collect routine information on the metabolic status of early-lactation cows at a population level.

Validation of a gold standard method for iodine quantification in raw and processed milk, and its variation in different dairy species.

Adequate milk consumption significantly contributes to meeting the human iodine recommended daily intake, which ranges from 70 µg/d for infants to 200 µg/d for lactating women. The fulfilment of iodine recommended daily intake is fundamental to prevent serious clinical diseases such as cretinism in infants and goiter in adults. In the present study iodine content was measured in raw and processed commercial cow milk, as well as in raw buffalo, goat, sheep, and donkey milk. Iodine extraction was based on 0.6% (vol/vol) ammonia, whereas iodine detection and quantification were carried out through an inductively coupled plasma mass spectrometer analyzer. Among processed commercial cow milk, partially skimmed pasteurized milk had the greatest iodine content (359.42 µg/kg) and raw milk the lowest (166.92 µg/kg). With regard to the other dairy species, the greatest iodine content was found in raw goat milk (575.42 µg/kg), followed by raw buffalo (229.82 µg/kg), sheep (192.64 µg/kg), and donkey milk (7.06 µg/kg). Repeatability of milk iodine content, calculated as relative standard deviation of 5 measurements within a day or operator, ranged from 0.96 to 1.84% and 0.72 to 1.16%, respectively. The overall reproducibility of milk iodine content, calculated as relative standard deviation of 45 measurements across 3 d of analyses and 3 operators, was 4.01%. These results underline the precision of the proposed analytical method for the determination of iodine content in milk.

Invited review: Milk lactose-Current status and future challenges in dairy cattle.

Lactose is the main carbohydrate in mammals' milk, and it is responsible for the osmotic equilibrium between blood and alveolar lumen in the mammary gland. It is the major bovine milk solid, and its synthesis and concentration in milk are affected mainly by udder health and the cow's energy balance and metabolism. Because this milk compound is related to several biological and physiological factors, information on milk lactose in the literature varies from chemical properties to heritability and genetic associations with health traits that may be exploited for breeding purposes. Moreover, lactose contributes to the energy value of milk and is an important ingredient for the food and pharmaceutical industries. Despite this, lactose has seldom been included in milk payment systems, and it has never been used as an indicator trait in selection indices. The interest in lactose has increased in recent years, and a summary of existing information about lactose in the dairy sector would be beneficial for the scientific community and the dairy industry. The present review collects and summarizes knowledge about lactose by covering and linking several aspects of this trait in bovine milk. Finally, perspectives on the use of milk lactose in dairy cattle, especially for selection purposes, are outlined.

Technical note: Development and validation of a new method for the quantification of soluble and micellar calcium, magnesium, and potassium in milk.

Milk mineral content is a key trait for its role in dairy processes such as cheese-making, its use as source of minerals for newborns, and for all traits involving salt-protein interactions. This study investigated a new method for measuring mineral partition between soluble and micellar fractions in bovine milk after rennet coagulation. A new whey dilution step was added to correct the quantification bias due to whey trapped in curd and excluded volume. Moreover, the proposed method allowed the quantification of the diffusible volume after milk coagulation. Milk mineral content and concentration in whey, and diluted whey were quantified by acid digestion and inductively coupled plasma optical emission spectrometry. The repeatability of the method for micellar Ca, Mg, and K was between 2.07 and 8.96%, whereas reproducibility ranged from 4.01 to 9.44%. Recovery of total milk minerals over 3 spiking levels ranged from 92 to 97%. The proposed method provided an accurate estimation of micellar and soluble minerals in milk, and curd diffusible volume.

Effects of restricted vs. step up dietary adaptation for 6 or 9 days on feedlot performance, feeding behaviour, ruminal and blood variables of Nellore cattle.

This study was designed to determine effects of quantitatively restricted intake of the final finishing diet as a means of dietary adaptation compared with diets increasing in concentrate (step up) over periods of 6 and 9 days on feedlot performance, carcass characteristics, feeding behaviour, blood gas profile and rumen morphometrics of Nellore cattle. One hundred twenty 22-month-old Nellore bulls (352 ± 20 kg) were randomly allocated in 24 pens and fed for 84 days. The experimental design was a completely randomized block with 2 × 2 factorial arrangement of treatments: adaptation using either step up protocol for 6 days or 9 days or restriction protocol for 6 days or 9 days, where the pen (five bullocks/pen; six pens/treatment) was considered the experimental unit. Cattle adapted by step up protocol had significantly greater average daily gain throughout the study when compared to those adapted by restriction protocol, regardless of adaptation length. During the adaptation period, a greater dry matter intake fluctuation was observed for animals maintained on restriction programme when compared to those adapted to the finishing diets using step up protocol. In addition, a protocol × length interaction for rumenitis scores was observed, where the level of injuries to the ruminal wall was significantly higher for the cattle adapted by restriction protocol for 9 days and lower for animals submitted for 9 days to the step up programme. Likewise, a protocol × length interaction for mitotic index was observed, in which cattle adapted by step up protocol for 9 days had lower numbers of cells in mitosis. Thus, the step up protocol led to better feedlot performance, and based on this fact, the length of 9 days promoted better rumen epithelium adaptation of Nellore cattle to high-concentrate diets.

Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes.

BACKGROUND: Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes. METHODS: Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics. RESULTS: Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified. CONCLUSIONS: Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.

A 1-year follow-up study on checkpoint inhibitor-induced colitis: results from a European consortium.

BACKGROUND: Data regarding the clinical outcome of patients with immune checkpoint inhibitor (ICI)-induced colitis are scant. We aimed to describe the 12-month clinical outcome of patients with ICI-induced colitis. MATERIALS AND METHODS: This was a retrospective, European, multicentre study. Endoscopy/histology-proven ICI-induced colitis patients were enrolled. The 12-month clinical remission rate, defined as a Common Terminology Criteria for Adverse Events diarrhoea grade of 0-1, and the correlates of 12-month remission were assessed. RESULTS: Ninety-six patients [male:female ratio 1.5:1; median age 65 years, interquartile range (IQR) 55.5-71.5 years] were included. Lung cancer (41, 42.7%) and melanoma (30, 31.2%) were the most common cancers. ICI-related gastrointestinal symptoms occurred at a median time of 4 months (IQR 2-7 months). An inflammatory bowel disease (IBD)-like pattern was present in 74 patients (77.1%) [35 (47.3%) ulcerative colitis (UC)-like, 11 (14.9%) Crohn's disease (CD)-like, 28 (37.8%) IBD-like unclassified], while microscopic colitis was present in 19 patients (19.8%). As a first line, systemic steroids were the most prescribed drugs (65, 67.7%). The 12-month clinical remission rate was 47.7 per 100 person-years [95% confidence interval (CI) 33.5-67.8). ICI was discontinued due to colitis in 66 patients (79.5%). A CD-like pattern was associated with remission failure (hazard ratio 3.84, 95% CI 1.16-12.69). Having histopathological signs of microscopic colitis (P = 0.049) and microscopic versus UC-/CD-like colitis (P = 0.014) were associated with a better outcome. Discontinuing the ICI was not related to the 12-month remission (P = 0.483). Four patients (3.1%) died from ICI-induced colitis. CONCLUSIONS: Patients with IBD-like colitis may need an early and more aggressive treatment. Future studies should focus on how to improve long-term clinical outcomes.

The Future of Breast Cancer Research in the Survivorship Field.

Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.