Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis.

PURPOSE: Patients with early breast cancer and coexistent comorbidities generally experience worse prognosis which may be in part related to inferior treatment. Randomised data on chemotherapy use and tolerance in comorbid patients are limited. We aimed to review the available literature regarding the use of chemotherapy in such patients. METHODS: A systematic search of databases was performed for English-language articles evaluating the impact of comorbidity on chemotherapy use for early breast cancer. Comorbidity was assessed as a specific condition, summary count or index. Outcomes of interest were receipt of chemotherapy, change in chemotherapy delivery and occurrence of toxicity. RESULTS: Sixty studies met inclusion criteria for systematic review. Thirty-three studies evaluated receipt of chemotherapy, with 19 reporting reduced treatment, particularly with higher levels of comorbidity. Meta-analysis of 10 eligible studies returned odds ratios (OR's) of 0.88 [95% confidence interval (CI) 0.80-0.96] and 0.63 (95% CI 0.49-0.80) for receipt of chemotherapy by patients with comorbidity scores of 1 and ≥2, respectively, compared with no comorbidity. Comorbidity had a generally adverse impact on the quality of chemotherapy delivery, although outcomes were heterogeneous. Toxicity was greater in patients with comorbidity, with 10 out of 13 studies reporting greater odds of toxicity or hospitalisation during chemotherapy. Meta-analysis of three studies addressing chemotherapy-associated hospitalisation produced OR's of 1.42 (95% CI 1.20-1.67) and 2.23 (95% CI 1.46-3.39) for comorbidity scores of 1 and ≥2, respectively. CONCLUSIONS: Compared with their non-comorbid counterparts, comorbid patients with early breast cancer receive less quality adjuvant chemotherapy and experience greater toxicity.

The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial.

BACKGROUND: Laparoscopic gastric bypass has become the standard surgical treatment for severe obesity in the United States. Less clear is what diet should be followed by these patients after surgery to maximize their weight loss. METHODS: Patients undergoing laparoscopic gastric bypass procedures for morbid obesity were randomly assigned to either a low-fat control diet based on American Heart Association recommendations or a low-carbohydrate, high-protein diet based on the South Beach Diet. One-on-one diet counseling with a bariatric nutritionist was provided preoperatively, postoperatively while in the hospital, and at postoperative clinic visits during the 12-month follow-up period. Investigators were blinded to diet assignment. Body composition including Body Mass Index (BMI) was recorded preoperatively and during postoperative visits at 3, 6, and 12 months. RESULTS: Thirty-two patients were included in the analysis with 13 control and 19 low-carbohydrate, high-protein subjects. No demographic or clinical preoperative variables, including preoperative BMI, showed statistical differences between the two groups. Both groups demonstrated significant yet similar weight loss both by reduction in BMI (at 12 months, low fat diet, -14.0 +/- 5.5% versus low carbohydrate, -17.0 +/- 4.5%; P = 0.15) and excess body weight lost (at 12 months, low-fat diet, -60.3 +/- 15.3% versus low carbohydrate, -59.6 +/- 13.0%; P = 0.96). CONCLUSIONS: Based on this limited prospective study, no weight loss advantage is observed in substituting a low-carbohydrate, high-protein diet in place of a standard low-fat diet in patients who have undergone laparoscopic gastric bypass surgery.