RESUMEN
This systematic review provides an overview of the effects of menopausal symptom treatment options on palpitations, defined as feelings of missed or exaggerated heart beats, reported by perimenopausal and postmenopausal women. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searches were conducted in PubMed, CINAHL and PsycINFO to identify articles meeting pre-specified inclusion criteria. Of 670 unique articles identified, 37 were included in the review. Treatments included drug therapies and non-drug therapies. Palpitations were studied as an outcome in 89% of articles and as an adverse effect in 11%. Articles provided mostly level II/III evidence due to their design and/or small sample sizes. Based on available evidence, no therapies can be fully recommended for clinical practice. Only some hormonal agents (e.g. estradiol) can be recommended with caution based on some positive evidence for reducing palpitation prevalence or severity. However, other drug therapies (e.g. moxonidine, atenolol), dietary supplementary treatments (e.g. isoflavones, Rheum rhaponticum, sage), cognitive-behavioral intervention and auricular acupressure cannot be recommended given the existing evidence. Additional well-designed randomized controlled treatment trials focusing on palpitations during the menopause transition as an inclusion criteria and outcome are needed to advance the field.
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Terapia Cognitivo-Conductual , Isoflavonas , Femenino , Humanos , MenopausiaRESUMEN
The blood-brain barrier (BBB) is a major anatomical and physiological barrier limiting the passage of drugs into brain. Central nervous system tumors can impair the BBB by changing the tumor microenvironment leading to the formation of a leaky barrier, known as the blood-tumor barrier (BTB). Despite the change in integrity, the BTB remains effective in preventing delivery of chemotherapy into brain tumors. Focused ultrasound is a unique noninvasive technique that can transiently disrupt the BBB and increase accumulation of drugs within targeted areas of the brain. Herein, we summarize the current understanding of different types of targeted ultrasound mediated BBB/BTB disruption techniques. We also discuss influence of the tumor microenvironment on BBB opening, as well as the role of immunological response following disruption. Lastly, we highlight the gaps between evaluation of the parameters governing opening of the BBB/BTB. A deeper understanding of physical opening of the BBB/BTB and the biological effects following disruption can potentially enhance treatment strategies for patients with brain tumors.
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Barrera Hematoencefálica/metabolismo , Barrera Hematoencefálica/efectos de la radiación , Neoplasias Encefálicas/metabolismo , Sistemas de Liberación de Medicamentos , Microambiente Tumoral/efectos de la radiación , Ondas Ultrasónicas , Animales , Transporte Biológico/efectos de la radiación , Variación Biológica Poblacional , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/etiología , Neoplasias Encefálicas/patología , Modelos Animales de Enfermedad , Ultrasonido Enfocado de Alta Intensidad de Ablación/efectos adversos , Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Humanos , Metástasis de la Neoplasia , Permeabilidad/efectos de la radiación , Resultado del Tratamiento , Microambiente Tumoral/efectos de los fármacos , Microambiente Tumoral/inmunología , Terapia por UltrasonidoRESUMEN
BACKGROUND AND PURPOSE: The impact of increased aneurysm packing density on angiographic outcomes has not been studied in a randomized trial. We sought to determine the potential for larger caliber coils to achieve higher packing densities and to improve the angiographic results of embolization of intracranial aneurysms at 1 year. MATERIALS AND METHODS: Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, parallel, randomized, controlled clinical trial. Patients had 4- to 12-mm unruptured aneurysms. Treatment allocation to either 15- (experimental) or 10-caliber coils (control group) was randomized 1:1 using a Web-based platform. The primary efficacy outcome was a major recurrence or a residual aneurysm at follow-up angiography at 12 ± 2 months adjudicated by an independent core lab blinded to the treatment allocation. Secondary outcomes included indices of treatment success and standard safety outcomes. Recruitment of 564 patients was judged necessary to show a decrease in poor outcomes from 33% to 20% with 15-caliber coils. RESULTS: Funding was interrupted and the trial was stopped after 210 patients were recruited between November 2013 and June 2017. On an intent-to-treat analysis, the primary outcome was reached in 37 patients allocated to 15-caliber coils and 36 patients allocated to 10-caliber coils (OR = 0.931; 95% CI, 0.528-1.644; P = .885). Safety and other clinical outcomes were similar. The 15-caliber coil group had a higher mean packing density (37.0% versus 26.9%, P = .0001). Packing density had no effect on the primary outcome when adjusted for initial angiographic results (OR = 1.001; 95% CI, 0.981-1.022; P = .879). CONCLUSIONS: Coiling of aneurysms randomized to 15-caliber coils achieved higher packing densities compared with 10-caliber coils, but this had no impact on the angiographic outcomes at 1 year, which were primarily driven by aneurysm size and initial angiographic results.
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Prótesis Vascular , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/terapia , Adulto , Anciano , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Hospital systems increasingly utilize pharmacogenomic testing to inform clinical prescribing. Successful implementation efforts have been modeled at many academic centers. In contrast, this report provides insights into the formation of a pharmacogenomics consultation service at a safety-net hospital, which predominantly serves low-income, uninsured, and vulnerable populations. The report describes the INdiana GENomics Implementation: an Opportunity for the UnderServed (INGENIOUS) trial and addresses concerns of adjudication, credentialing, and funding.
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Farmacogenética/organización & administración , Proveedores de Redes de Seguridad/organización & administración , Poblaciones Vulnerables , Centros Médicos Académicos/organización & administración , Humanos , Pacientes no Asegurados , PobrezaRESUMEN
OBJECTIVE: Diurnal salivary cortisol patterns in healthy adults are well established but have not been studied in midlife women with hot flashes. We hypothesized that frequent hot flashes are associated with aberrant cortisol patterns similar to sleep-deficient individuals. DESIGN: Cross-sectional. PARTICIPANTS: A total of 306 women, ages 40-62, randomized to a behavioural intervention for hot flashes. MEASUREMENTS: Baseline comparisons of cortisol geometric means (nmol/l) from four daily time points averaged over two consecutive days plus other calculated cortisol measures were made between groups defined by baseline: (i) mean daily hot flash frequency tertile (≤5·5, N = 103; >5·5-8·8, N = 103; >8·8, N = 100) and (ii) selected characteristics. Repeated-measures linear regression models of log-transformed cortisol evaluated group differences, adjusting for covariates. RESULTS: Women were 67% White and 24% African American, with 7·6 (SD 3·9) hot flashes per day. Salivary cortisol geometric means (nmol/l) among all women were as follows: 75·0 (SD 44·8) total, 8·6 (SD 5·6) wake, 10·0 (SD 7·5) wake +30 min, 3·7 (SD 3·3) early afternoon and 1·6 (SD 1·8) bedtime. Wake + 30-minute values showed an 18% median rise from wake values (interquartile range -24 to 96%), and means varied by hot flash frequency tertile, from lowest to highest: 11·4(SD 7·3), 10·3 (SD 6·5) and 8·6 (SD 7·8), respectively, P = 0·003. Beside the early afternoon value (P = 0·02), cortisol values did not vary by hot flash frequency. CONCLUSION: Taken together, these findings suggest that high frequency of moderate-to-severe hot flashes may be associated with subtle abnormalities in cortisol concentrations - a pattern consistent with chronic sleep disturbance.
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Ejercicio Físico/fisiología , Ácidos Grasos Omega-3/uso terapéutico , Sofocos/prevención & control , Hidrocortisona/análisis , Saliva/química , Adulto , Ritmo Circadiano , Estudios Transversales , Femenino , Sofocos/metabolismo , Sofocos/fisiopatología , Humanos , Modelos Lineales , Modelos Logísticos , Menopausia/fisiología , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricosRESUMEN
OBJECTIVE: To describe self-reported menopausal symptom priorities and their association with demographics and other symptoms among participants in an intervention trial for vasomotor symptoms (VMS). METHODS: Cross-sectional study embedded in the MsFLASH 02 trial, a three-by-two factorial design of yoga vs. exercise vs. usual activity and omega-3-fatty acid vs. placebo. At baseline, women (n = 354) completed hot flush diaries, a card sort task to prioritize symptoms they would most like to alleviate, and standardized questionnaires. RESULTS: The most common symptom priorities were: VMS (n = 322), sleep (n = 191), concentration (n = 140), and fatigue (n = 116). In multivariate models, women who chose VMS as their top priority symptom (n = 210) reported significantly greater VMS severity (p = 0.004) and never smoking (p = 0.012), and women who chose sleep as their top priority symptom (n = 100) were more educated (p ≤ 0.001) and had worse sleep quality (p < 0.001). ROC curves identified sleep scale scores that were highly predictive of ranking sleep as a top priority symptom. CONCLUSIONS: Among women entering an intervention trial for VMS and with relatively low prevalence of depression and anxiety, VMS was the priority symptom for treatment. A card sort may be a valid tool for quickly assessing symptom priorities in clinical practice and research.
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Trastornos del Conocimiento/terapia , Fatiga/terapia , Sofocos/terapia , Menopausia , Prioridad del Paciente , Trastornos del Sueño-Vigilia/terapia , Adulto , Área Bajo la Curva , Atención , Estudios Transversales , Ejercicio Físico/fisiología , Ácidos Grasos Omega-3/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Curva ROC , Encuestas y Cuestionarios , YogaRESUMEN
Pharmacogenomics (PGx) technology is advancing rapidly; however, clinical adoption is lagging. The Indiana Institute of Personalized Medicine (IIPM) places a strong focus on translating PGx research into clinical practice. We describe what have been found to be the key requirements that must be delivered in order to ensure a successful and enduring PGx implementation within a large health-care system.
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Atención a la Salud/organización & administración , Farmacogenética/organización & administración , Medicina de Precisión , Conducta Cooperativa , Difusión de Innovaciones , Humanos , Comunicación Interdisciplinaria , Objetivos Organizacionales , Desarrollo de Programa , Investigación Biomédica TraslacionalRESUMEN
OBJECTIVES: To evaluate the relationships among measures of hot flushes, perceived hot flush interference, sleep disturbance, and measures of quality of life while controlling for potential covariates (patient and treatment variables). METHODS: Breast cancer survivors (n = 395) due to receive aromatase inhibitor therapy provided demographic information, physiological hot flush data via sternal skin conductance monitoring, hot flush frequency via written diary and electronic event marker, hot flush severity and bother via written diary, and questionnaire data via the Hot Flash Related Daily Interference Scale, Pittsburgh Sleep Quality Index, the EuroQOL, Hospital Anxiety and Depression Scale and the Center for Epidemiologic Studies Depression Scale. RESULTS: Confirmatory factor analysis supported a two-factor model for hot flush symptoms (frequency and severity). Although there was strong convergence among self-reported hot flush measures, there was a high degree of unexplained variance associated with physiological measures. This suggests that self-report and physiological measures do not overlap substantially. The structural model showed that greater hot flush frequency and severity were directly related to greater perceived interference with daily life activities. Greater perceived interference, in turn, directly predicted greater sleep disruption, which predicted lower perceived health state and more symptoms of anxiety and depression. CONCLUSIONS: Findings suggest hot flush interference may be the most appropriate single measure to include in clinical trials of vasomotor symptom therapies. Measuring and ameliorating patients' perceptions of hot flush interference with life activities and subjective sleep quality may be the most direct routes to improving quality of life.
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Neoplasias de la Mama/psicología , Análisis Factorial , Sofocos/psicología , Modelos Biológicos , Calidad de Vida , Ansiedad/psicología , Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Depresión/psicología , Femenino , Respuesta Galvánica de la Piel , Estado de Salud , Humanos , Persona de Mediana Edad , Monitoreo Ambulatorio , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/psicología , Encuestas y Cuestionarios , SobrevivientesRESUMEN
Rhinocerebral mucormycosis is a rare angioinvasive fungal infection that has a strong predilection for patients with poorly controlled diabetes and immunosuppression. Initial presenting symptoms are nonspecific and frequently are attributed to more mundane sinonasal and orbital pathologies. Early diagnosis and treatment are essential for survival and minimizing neurologic sequelae. CT and MR imaging are often used in the diagnostic work-up; however, CT findings are nonspecific.
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Imagen de Difusión por Resonancia Magnética , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Mucormicosis/diagnóstico , Enfermedades Nasales/diagnóstico , Infecciones Oportunistas/diagnóstico , Enfermedades Orbitales/diagnóstico , Enfermedades de los Senos Paranasales/diagnóstico , Cornetes Nasales/patología , Anciano , Niño , Endoscopía , Femenino , Humanos , Masculino , Mucormicosis/patología , Mucormicosis/cirugía , Enfermedades Nasales/patología , Enfermedades Nasales/cirugía , Infecciones Oportunistas/patología , Infecciones Oportunistas/cirugía , Evisceración Orbitaria , Enfermedades Orbitales/patología , Enfermedades Orbitales/cirugía , Enfermedades de los Senos Paranasales/patología , Enfermedades de los Senos Paranasales/cirugía , Cornetes Nasales/cirugíaRESUMEN
A 36-year-old woman presented with lower extremity paralysis. Her past medical history included gout. Conventional radiography and MR imaging revealed bone erosion and soft tissue lesions of the thoracic spine. Fluorodeoxyglucose-positron-emission tomographic (FDG-PET) images revealed hypermetabolic lesions of the thoracic spine. A CT-guided biopsy was diagnostic for inflammatory tophaceous gout. This case describes the CT, MR, and FDG-PET imaging characteristics of acute inflammatory gout. FDG-PET imaging characteristics of this disorder have not been previously described.
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Fluorodesoxiglucosa F18 , Gota/complicaciones , Imagen por Resonancia Magnética , Radiofármacos , Compresión de la Médula Espinal/etiología , Estenosis Espinal/etiología , Tomografía Computarizada de Emisión , Adulto , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/diagnóstico por imagen , Estenosis Espinal/diagnóstico , Estenosis Espinal/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Tomografía Computarizada por Rayos XRESUMEN
To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.
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Neoplasias de la Mama/psicología , Sofocos/psicología , Calidad de Vida/psicología , Femenino , Humanos , Psicometría , Reproducibilidad de los ResultadosRESUMEN
One of the strongest advantages of CT angiography (CTA) lies in its unique ability to display simultaneously the anatomy of the vascular system and the topographic relationships existing between the vessels and the neighboring structures. The case we report, a 76-year-old man who underwent an intraventricular shunt placement complicated by a stroke, shows how this topographic assessment also provides important diagnostic information when vascular lesions resulting from an extrinsic compression mechanism are suspected.
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Arteriopatías Oclusivas/etiología , Angiografía Cerebral , Arterias Cerebrales , Tomografía Computarizada por Rayos X , Derivación Ventriculoperitoneal/efectos adversos , Anciano , Arteriopatías Oclusivas/diagnóstico por imagen , Angiografía Cerebral/métodos , Humanos , Masculino , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: Similar to the circadian rhythm of core body temperature, hot flashes have been found to exhibit a circadian rhythm in healthy, naturally postmenopausal women, with a peak in frequency at 18:25 h. However, to date, no studies have evaluated whether this same pattern is found among breast cancer survivors reporting hot flashes. DESIGN: Daily hot flash frequencies were measured among 21 postmenopausal breast cancer survivors using validated 24-h sternal skin conductance monitoring. RESULTS: Hot flashes were noted in all women, ranging in frequency from 1 to 30 per 24-h period. A majority of the sample (86%) experienced > or = 1 nighttime hot flash, with 48% exhibiting > or = 3 but < or = 7 nighttime hot flashes. For the total sample, a modest circadian rhythm was noted with a peak in hot flash frequency occurring at 16:10 h. However, significant variability was observed across individual women, and, as a whole, breast cancer survivors demonstrated distorted to obliterated rhythms. CONCLUSIONS: Data suggest that hot flashes in postmenopausal breast cancer survivors do not follow the same circadian pattern as previously seen in healthy, naturally postmenopausal women. Findings have implications for (1) understanding the potential for sleep disturbances and fatigue in breast cancer survivors experiencing hot flashes, and (2) future research examining circadian rhythms of core body temperature and hot flashes in breast cancer survivors.
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Neoplasias de la Mama , Sofocos , Posmenopausia , Sobrevivientes , Temperatura Corporal , Ritmo Circadiano , Femenino , Humanos , Persona de Mediana Edad , Proyectos PilotoRESUMEN
PURPOSE: Women who undergo a benign breast biopsy are at elevated risk for the subsequent development of breast cancer (BC). Therefore, appropriate clinical follow-up of a benign breast biopsy is important. The present study examines the extent and correlates of nonadherence with follow-up recommendations after a benign breast biopsy. METHODS: Women (n = 114) who had undergone a benign breast biopsy completed an initial telephone interview within 50 days of their biopsy (mean = 21 days). Additional telephone interviews were completed at 4 and 8 months post-biopsy. Measures of BC risk perception, general and BC-specific distress, BC-related attitudes and beliefs, social support, optimism, and informational coping style were completed. Specific recommendations for clinical follow-up and evidence of actual follow-up were obtained from medical records. RESULTS: Of 103 women given a specific recommendation for clinical follow-up, 34% were classified as nonadherent with follow-up recommendations. Logistic regression analyses indicated that nonadherent women were characterized by younger age, recommendations for follow-up by clinical breast examination alone, greater confidence in their ability to perform breast self-examination properly, higher perceived personal risk for BC, and greater BC-specific distress. CONCLUSION: Despite the importance of appropriate clinical follow-up of a benign breast biopsy, about one-third of women did not adhere to recommended follow-up. Risk factors for nonadherence suggest potential avenues for interventions to enhance participation in appropriate clinical follow-up.
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Adaptación Psicológica , Actitud Frente a la Salud , Enfermedades de la Mama/patología , Neoplasias de la Mama/patología , Adhesión a Directriz , Cooperación del Paciente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Biopsia , Enfermedades de la Mama/diagnóstico , Neoplasias de la Mama/diagnóstico , Autoexamen de Mamas , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Percepción , Análisis de Regresión , Factores de Riesgo , Estrés PsicológicoRESUMEN
OBJECTIVES: To review literature relevant to defining and managing hot flashes in women with breast cancer. DATA SOURCES: Published literature on hot flashes in women with breast cancer and in healthy women. CONCLUSIONS: The etiology of hot flashes is influenced by several breast cancer treatment-related factors. Hot flashes are a prevalent, severe problem that can negatively impact quality of life. Certain women are at higher risk for hot flashes following breast cancer treatment. Little research supports the safety or effectiveness of treatments in women with breast cancer. IMPLICATIONS FOR NURSING PRACTICE: Implications include the need to improve patient education, perform comprehensive symptom assessments, and counsel women about various treatment alternatives.
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Antineoplásicos Hormonales/efectos adversos , Neoplasias de la Mama , Sofocos , Tamoxifeno/efectos adversos , Adulto , Envejecimiento/fisiología , Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Sofocos/inducido químicamente , Sofocos/etiología , Sofocos/terapia , Humanos , Persona de Mediana Edad , Educación del Paciente como Asunto , Calidad de Vida , Factores de Riesgo , Tamoxifeno/uso terapéuticoRESUMEN
OBJECTIVE: To assess the feasibility and psychometric properties of a lightweight, automated, ambulatory sternal skin conductance monitor to measure frequency of hot flashes (HFs) among breast cancer survivors (BCSs). DESIGN: A total of 19 postmenopausal BCSs and 5 premenopausal healthy comparison women participated by wearing the monitor for 24 h during their normal daily activities, including sleep. HFs were assessed using subjective (diaries, event markers) and objective (skin conductance) methods. RESULTS: Problems with subjective reporting of HFs were reported by 35% of BCSs. Technological problems and discomfort related to wearing the monitor were minimal. A total of 243 HFs were recorded using the skin conductance monitor by 17 BCSs and 5 premenopausal women (BCS group M = 13.4; range, 1-30). Subjective reporting of HFs was associated with a 31-33% false-positive rate. Skin conductance monitoring during waking hours was associated with a 30% false-negative rate. CONCLUSIONS: The monitor is a feasible method for objectively assessing HFs in BCSs. Data support continued use of sternal skin conductance as an objective measure of HF frequency. This technology should prove useful as an objective measure of HFs in future intervention research aimed at alleviating the symptom and improving quality of life among BCSs.
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Neoplasias de la Mama/fisiopatología , Sofocos/diagnóstico , Monitoreo Fisiológico/instrumentación , Posmenopausia/fisiología , Adulto , Anciano , Atención Ambulatoria/métodos , Diseño de Equipo , Estudios de Factibilidad , Femenino , Sofocos/fisiopatología , Humanos , Persona de Mediana Edad , Psicometría , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Although interviews are commonly used to gather research data, the integrity of interview data can be threatened by discrepancies between interviewers and respondents on such characteristics as race, gender, or age. OBJECTIVES: To determine if participants' reports of the prevalence and severity of 30 symptoms varied as a function of interviewer gender. Symptoms that were assessed included general physical symptoms (diarrhea, headaches), psychological symptoms (feel blue and depressed, worry about nervous breakdown), and menopausal symptoms (hot flashes, vaginal dryness). METHOD: Structured telephone interviews were completed by 137 women who were a mean of 56.5 years old (SD = 11.1, range 36-83) and a mean of 38.8 months (SD = 23.6) postdiagnosis of breast cancer. Interviewers included two women and two men. RESULTS: Symptom prevalence and severity did not vary as a function of interviewer gender. CONCLUSIONS: Findings suggest that both male and female interviewers can be used successfully to assess participants' reports of physical, psychological, or menopausal symptoms.
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Actitud Frente a la Salud , Neoplasias de la Mama/enfermería , Neoplasias de la Mama/psicología , Entrevistas como Asunto , Prejuicio , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The prevalence of rheumatoid symptoms following breast cancer (BC) treatment was examined. Breast cancer patients (n = 111) who were a mean of 27.6 months postcompletion of BC treatment and 99 otherwise healthy women with benign breast problems (BBP) completed a self-report measure that assessed current joint pain, swelling, and stiffness, as well as measures of quality of life. Results supported a hypothesized link between BC and rheumatoid symptoms: (1) the BC group was more likely to report joint stiffness lasting more than 60 min following morning waking; (2) the prevalence of unilateral or bilateral joint point or swelling was greater (P < 0.10) in the BC group for four of 10 joint-symptom combinations examined, with differences between the BC and BBP groups in upper extremity joint swelling particularly pronounced; and (3) 41% of the BC group reported that current rheumatoid symptoms exceeded those experienced prior to diagnosis. Within the BC group, the data did not support postchemotherapy rheumatism as an explanation for rheumatoid symptoms. Rather, data suggested that symptoms were associated with surgical management of BC. Finally, among women in the BC group with the most severe joint pain, only a minority were receiving medication for these symptoms. Given the relationship between rheumatoid symptoms and quality of life, more systematic research examining potential contributing factors such as menopausal status, concurrent lymphedema, and weight gain is warranted.