Recent advances in breast cancer treatment.

Breast cancer treatment is determined by the molecular subtype both in the early stage and the advanced disease. While there is clear benefit from adjuvant systemic treatment for patients with early-stage triple negative and HER2 positive breast cancer, it was unclear in the past which patient with luminal breast cancer needs adjuvant chemotherapy. As a result, we used to overtreat or undertreat patients. In the era of personalized treatment, genomic panels have become as or more important than the anatomic extent of disease to define prognosis in luminal breast cancer. Several gene expression assays are available for consideration of adjuvant systemic therapy categorizing patients according to genomic risk for recurrence (e.g., Oncotype, Mammaprint, etc). Except for the high and low risk signature, more recently Mammaprint announced that patients with ultra-low risk signature have excellent prognosis, distinctive from low risk with 8-year BCSS above 99%, regardless of age, clinical risk or treatment received. Very few patients developed distant metastasis, allowing physicians to de-escalate treatment plans.

A Smart Digital Health Platform to Enable Monitoring of Quality of Life and Frailty in Older Patients with Cancer: A Mixed-Methods, Feasibility Study Protocol.

OBJECTIVES: LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. DATA SOURCES: This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. CONCLUSION: The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. IMPLICATIONS FOR NURSING PRACTICE: LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate "big data" sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care.