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1.
Nurs Open ; 8(3): 1030-1037, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482659

RESUMO

AIM: This study aimed to examine the sleep pattern of breast cancer survivors and anxiety and depression associated with sleep quality to provide evidence-based information for the development of interventions to improve sleep disorders in these survivors. DESIGN: A cross-sectional study. METHODS: The subjects were 266 breast cancer survivors in South Korea. Structured questionnaires regarding sleep quality, anxiety and depression were used. The data were analysed using t test, ANOVA and multiple regression analysis. RESULTS: Sleep duration and sleep disturbance were found to affect anxiety, whereas sleep latency and subjective sleep quality were found to affect depression. These results suggest that various factors affecting sleep quality should be considered when providing care for anxiety and depression in breast cancer survivors.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Ansiedade/epidemiologia , Neoplasias da Mama/complicações , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , República da Coreia/epidemiologia , Sono , Sobreviventes
2.
BMJ Open ; 11(8): e048115, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408044

RESUMO

INTRODUCTION: The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is one of the most common and debilitating side effects in patients with breast cancer (BC) throughout their treatment trajectory. Tai chi has been supported as a promising non-pharmacological intervention for the individual symptom relief of cancer-related fatigue, sleep disturbance and depression. However, relevant evidence of using tai chi for FSDSC management in patients with BC has been lacking. METHODS: This study will be a two-arm, single-blinded pilot randomised controlled trial involving an 8-week intervention and a 4-week follow-up. Seventy-two patients with BC experiencing the FSDSC will be recruited from two tertiary medical centres in China. The participants will be randomised to either a tai chi group (n=36) or a control group (n=36). The participants in the tai chi group will receive an 8-week tai chi intervention in addition to standard care, while the participants in the control group will receive standard care only consisting of a booklet on the self-management of cancer symptoms. The primary outcomes will include a series of feasibility assessments of the study protocol in relation to the study's methodological procedures, including subject recruitment and follow-up process, completion of study questionnaires and the feasibility, acceptability and safety of the intervention. The secondary outcomes will be the clinical outcomes regarding the effects of tai chi on the FSDSC and quality of life, which will be evaluated by the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale and the Functional Assessment of Cancer Therapy-Breast questionnaires. ETHICS AND DISSEMINATION: Ethics approval was obtained from relevant sites (H19094, KY2019133, 201932). The findings of the study will be published in peer-reviewed scientific journals and at conferences. TRAIL REGISTRATION NUMBER: NCT04190342; Pre-results.


Assuntos
Neoplasias da Mama , Tai Ji , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Depressão/terapia , Fadiga/etiologia , Fadiga/terapia , Estudos de Viabilidade , Feminino , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Síndrome
3.
Ann Surg Oncol ; 28(10): 5742-5751, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34333706

RESUMO

BACKGROUND: In 2017, the American Society of Breast Surgeons (ASBrS) published expert panel recommendations for patients at risk for breast cancer-related lymphedema (BCRL) and those affected by BCRL. This study sought to determine BCRL practice patterns. METHODS: A survey was sent to 2975 ASBrS members. Questions evaluated members' clinical practice type, practice duration, and familiarity with BCRL recommendations. Descriptive statistics, the chi-square test, and Fisher's exact test were used. RESULTS: Of the ASBrS members surveyed, 390 (13.1%) responded. Most of the breast surgeons (58.5%, 228/390) indicated unfamiliarity with recommendations. Nearly all respondents (98.7%, 385/390) educate at-risk patients. Most (60.2%, 234/389) instruct patients to avoid venipuncture, injection or blood pressure measurements in the at-risk arm, and 35.6% (138/388) recommend prophylactic compression sleeve use during air travel. Nearly all (97.7%, 380/389) encourage those at-risk to exercise, including resistance exercise (86.2%, 331/384). Most do not perform axillary reverse mapping (ARM) (67.9%, 264/389) or a lymphatic preventive healing approach (LYMPHA) (84.9%, 331/390). Most (76.1%, 296/389) screen at-risk patients for BCRL. The most frequently used screening tools include self-reported symptoms (81%, 255/315), circumferential tape measure (54%, 170/315) and bioimpedance spectroscopy (27.3%, 86/315). After a BCRL diagnosis, most (90%, 351/390) refer management to a lymphedema-certified physical therapist. For affected patients, nearly all encourage exercise (98.7%, 384/389). Many (49%, 191/390) refer affected patients for consideration of lymphovenous bypass or lymph node transfer. CONCLUSION: Most respondents were unfamiliar with the ASBrS expert panel recommendations for patients at risk for BCRL and those affected by BCRL. Opportunities exist to increase awareness of best practices and to acquire ARM and LYMPHA technical expertise.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Cirurgiões , Linfedema Relacionado a Câncer de Mama/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos , Linfedema/etiologia , Linfedema/prevenção & controle , Estados Unidos
4.
Medicine (Baltimore) ; 100(31): e26745, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397816

RESUMO

BACKGROUND: To assess the prognostic capability of the maximum standardized uptake values (SUVmax) measured in the primary tumor and axillary lymph nodes (ALNs) by pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography and analyze outcomes according to the molecular breast cancer subtypes. METHODS: The databases were systematically searched using keywords for breast cancer, positron emission tomography/computed tomography, and SUVmax; the extracted studies reported at least 1 form of survival data, event-free survival (EFS) and overall survival. Comparative analyses of the pooled hazard ratios (HRs) for EFS and overall survival were performed to assess their correlations with SUVmax. The pooled HR was estimated using random-effects model according to the results of heterogeneity. RESULTS: Thirteen eligible studies comprising 3040 patients with breast cancer were included. The pooled HRs of high SUVmax in the primary tumor and ALN were 3.01 (95% CI 1.83-4.97, P < .00001; I2 = 82%) and 3.72 (95% CI 1.15-12.01; I2 = 92%; P = .03), respectively. Patients with higher SUVmax demonstrated a poorer survival prognosis. Furthermore, comparative analyses according to the molecular subtypes demonstrated that the SUVmax in the primary tumor or ALN can be a predictive parameter in patients with the luminal subtype disease. Subtype analysis results indicated a significant association of the luminal group, with a HR of 2.65 (95% CI 1.31-5.37; I2 = 27%; P = .007). CONCLUSIONS: SUVmax from pretreatment is a significant prognostic factor for EFS in patients with breast cancer. Despite several limitations, correlation with molecular subtype (luminal type) was demonstrated. Further large-scale studies are required to investigate the precise prognostic capability of SUVmax.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/genética , Valor Preditivo dos Testes , Neoplasias da Mama/mortalidade , Feminino , Humanos , Imunofenotipagem
5.
J Bodyw Mov Ther ; 27: 307-313, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391250

RESUMO

INTRODUCTION: Breast cancer affects women of different ages, and comorbidities resulting from treatment can affect postural stability. The study aimed to evaluate the influence of age and lymphedema on the postural balance of women undergoing breast cancer treatment. METHODS: The study included 77 women undergoing breast cancer treatment, divided into different groups: 37 young adult women divided into 17 with lymphedema (GYL) and 20 young adults without lymphedema (GY); 40 elderly women, 20 elderly women with lymphedema (GEL) and 20 elderly women without lymphedema (GE). Mini Balance Evaluation Systems Test (Mini BESTest) and Falls Efficacy Scale - International (FES-I) were used. RESULTS: Mini BESTest and FES-I between the groups showed that GE and GEL had a significant difference to GY. Mini BESTest Total and Time Up and Go TUG-Double Task showed that GE has a significant difference to GYL, with GE and GEL having lower scores. Moderate negative correlation in the GEL between FES-I and Mini BESTest. In the age correlation between the Mini BESTest, FES-I, TUG, and double task TUG, a moderate positive correlation was observed for TUG. GEL showed a moderate positive correlation for FES-I and double-task TUG, strong for TUG, and moderate negative correlation with Mini BESTest. Correlation of the volume difference between the limb affected and not affected by lymphedema and the FES-I, Mini BESTest, TUG, and TUG double task, GYL showed moderate negative correlation for TUG. CONCLUSION: Age and lymphedema influenced the dynamic postural balance of women undergoing breast cancer treatment.


Assuntos
Neoplasias da Mama , Linfedema , Acidentes por Quedas , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Avaliação da Deficiência , Feminino , Humanos , Equilíbrio Postural , Psicometria , Reprodutibilidade dos Testes
6.
Medicine (Baltimore) ; 100(33): e27018, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414995

RESUMO

ABSTRACT: Breast cancer is the leading type of cancer among women worldwide, and a high number of breast cancer patients are suffering from psychological and cognitive disorders. This cross-sectional study used resting-state functional magnetic resonance imaging (rs-fMRI) and clinical neuropsychological tests to evaluate the possible underlying mechanisms.We enrolled 32 breast cancer patients without chemotherapy (BC), 32 breast cancer patients within 6 to 12 months after the completion of chemotherapy (BC_CTx) and 46 healthy controls. Participants underwent neuropsychological tests and rs-fMRI with mean fractional amplitude of low-frequency fluctuation and mean regional homogeneity analyses. Between groups whole-brain voxel-wise rs-fMRI comparisons were calculated using two-sample t test. rs-fMRI and neuropsychological tests correlation analyses were calculated using multiple regression. Age and years of education were used as covariates. A false discovery rate-corrected P-value of less than .05 was considered statistically significant.We found significantly alteration of mean fractional amplitude of low-frequency fluctuation and mean regional homogeneity in the frontoparietal lobe and occipital lobe in the BC group compared with the other 2 groups, indicating alteration of functional dorsal attention network (DAN). Furthermore, we found the DAN alteration was correlated with neuropsychological impairment.The majority of potential underlying mechanisms of DAN alteration in BC patients may due to insufficient frontoparietal lobe neural activity to drive DAN and may be related to the effects of neuropsychological distress. Further longitudinal studies with comprehensive images and neuropsychological tests correlations are recommended.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Neoplasias da Mama/tratamento farmacológico , Tratamento Farmacológico/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Neoplasias da Mama/complicações , Estudos Transversais , Depressão/etiologia , Depressão/psicologia , Tratamento Farmacológico/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Taiwan
7.
Health Qual Life Outcomes ; 19(1): 179, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247645

RESUMO

BACKGROUND: Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS: This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS: Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION: This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Fadiga/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Neoplasias da Mama/complicações , Estudos Transversais , Análise Fatorial , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , República da Coreia
8.
Int J Mol Sci ; 22(12)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207220

RESUMO

COVID-19 is a pandemic respiratory disease caused by the SARS-CoV-2 coronavirus. The worldwide epidemiologic data showed higher mortality in males compared to females, suggesting a hypothesis about the protective effect of estrogens against severe disease progression with the ultimate end being patient's death. This article summarizes the current knowledge regarding the potential effect of estrogens and other modulators of estrogen receptors on COVID-19. While estrogen receptor activation shows complex effects on the patient's organism, such as an influence on the cardiovascular/pulmonary/immune system which includes lower production of cytokines responsible for the cytokine storm, the receptor-independent effects directly inhibits viral replication. Furthermore, it inhibits the interaction of IL-6 with its receptor complex. Interestingly, in addition to natural hormones, phytestrogens and even synthetic molecules are able to interact with the estrogen receptor and exhibit some anti-COVID-19 activity. From this point of view, estrogen receptor modulators have the potential to be included in the anti-COVID-19 therapeutic arsenal.


Assuntos
COVID-19/patologia , Moduladores de Receptor Estrogênico/farmacologia , SARS-CoV-2/efeitos dos fármacos , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , COVID-19/complicações , COVID-19/virologia , Moduladores de Receptor Estrogênico/metabolismo , Moduladores de Receptor Estrogênico/uso terapêutico , Feminino , Humanos , Receptores de Estrogênio/química , Receptores de Estrogênio/metabolismo , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/fisiologia , Proteínas da Matriz Viral/antagonistas & inibidores , Proteínas da Matriz Viral/metabolismo , Internalização do Vírus/efeitos dos fármacos , Replicação Viral/efeitos dos fármacos
9.
BMJ Case Rep ; 14(7)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34290001

RESUMO

Metastatic cancer to the oesophagus is rare. Most cases are diagnosed at autopsy or surgery. The breast is the most common organ bearing a primary tumour. Metastatic oesophageal tumours are nearly always located in the submucosal layer with normal benign-looking mucosa, rendering tissue diagnosis difficult. In the absence of breast-related symptoms, the diagnosis of oesophageal metastasis from breast primary would be very challenging. We report a case of a 50 year-old woman, who was referred to our centre for a second opinion after she was offered an esophagectomy for a suspected oesophageal carcinoma. She presented solely with dysphagia and weight loss. Multiple investigations were performed to investigate her dysphagia which eventually led to the diagnosis of metastatic breast cancer with oesophageal involvement. She underwent excision of right breast invasive lobular carcinoma with axillary dissection. She completed her adjuvant chemoradiotherapy and currently on daily dose of tamoxifen, whereby her dysphagia has dramatically improved.


Assuntos
Neoplasias da Mama , Transtornos de Deglutição , Neoplasias Esofágicas , Mama , Neoplasias da Mama/complicações , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirurgia , Esofagectomia , Feminino , Humanos , Pessoa de Meia-Idade
10.
Breast Cancer Res Treat ; 189(1): 145-154, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34089422

RESUMO

PURPOSE: Obesity increases the risk of cancer recurrence and death in survivors of breast cancer. This study tested the hypothesis that exercise alone, diet alone, and the combination of exercise plus diet reduce body weight and improve body composition in survivors of breast cancer. METHODS: In this 2 × 2 factorial trial, 351 survivors of breast cancer with overweight or obesity were randomized to one of four treatment groups for 52 weeks: control, exercise alone, diet alone, or exercise plus diet. Endpoints included body weight and body composition measured by dual-energy x-ray absorptiometry. RESULTS: After 52 weeks, compared with control, diet alone [- 5.39 kg (95% CI - 7.24, - 3.55);- 6.0% (95% CI - 8.0, - 3.9)] and exercise plus diet [- 6.68 kg (95% CI - 8.46, - 4.90);- 7.4% (95% CI - 9.4, - 5.4)] reduced body weight; exercise alone did not change body weight. Compared with control, diet alone [- 3.59 kg (95% CI - 5.00, - 2.17)] and exercise plus diet [- 4.28 kg (95% CI - 5.71, - 2.84)] reduced fat mass; exercise alone did not change fat mass. Compared with control, diet alone [- 0.82 kg (95% CI - 1.50, - 0.15)] and exercise plus diet [- 1.24 kg (95% CI - 1.92, - 0.56)] reduced lean mass; exercise alone did not change lean mass. Compared with control, exercise alone, diet alone, and exercise plus diet did not change bone mineral density. CONCLUSION: In survivors of breast cancer with overweight or obesity, diet alone or diet plus exercise produced clinically meaningful weight loss at week 52. The majority of weight loss was fat mass.


Assuntos
Neoplasias da Mama , Composição Corporal , Índice de Massa Corporal , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Dieta , Feminino , Humanos , Recidiva Local de Neoplasia , Obesidade/complicações , Obesidade/terapia , Sobrepeso/complicações , Sobrepeso/terapia , Sobreviventes
11.
Breast Cancer Res Treat ; 189(1): 257-267, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34081259

RESUMO

PURPOSE: Obesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer. METHODS: This retrospective case-control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion. RESULTS: A strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics. CONCLUSION: Fat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.


Assuntos
Neoplasias da Mama , Axila , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Obesidade/complicações , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela
12.
Breast Cancer Res Treat ; 189(2): 521-532, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34191201

RESUMO

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect of taxane and platinum chemotherapy for breast cancer. Clinicians cannot accurately predict CIPN severity partly because its pathophysiology is poorly understood. Although inflammation may play a role in CIPN, there are limited human studies. Here, we identified the strongest predictors of CIPN using variables measured before taxane- or platinum-based chemotherapy, including serum inflammatory markers. METHODS: 116 sedentary women with breast cancer (mean age 55 years) rated (1) numbness and tingling and (2) hot/coldness in hands/feet on 0-10 scales before and after 6 weeks of taxane- or platinum-based chemotherapy. A sub-study was added to collect cytokine data in the final 55 patients. We examined all linear models to predict CIPN severity at 6 weeks using pre-chemotherapy assessments of inflammatory, behavioral, clinical, and psychosocial factors. The final model was selected via goodness of fit. RESULTS: The strongest pre-chemotherapy predictors of numbness and tingling were worse fatigue/anxiety/depression (explaining 27% of variance), older age (9%), and baseline neuropathy (5%). The strongest predictors of hot/coldness in hands/feet were worse baseline neuropathy (11%) and fatigue/anxiety/depression (6%). Inflammation was a risk for CIPN, per more pro-inflammatory IFN-γ (12%) and IL-1ß (6%) and less anti-inflammatory IL-10 (6%) predicting numbness/tingling and more IFN-γ (17%) and less IL-10 (9%) predicting hot/coldness in hands/feet. CONCLUSIONS: The strongest pre-chemotherapy predictors of CIPN included worse fatigue/anxiety/depression and baseline neuropathy. A pro-inflammatory state also predicted CIPN. Because this is an exploratory study, these results suggest specific outcomes (e.g., IL-1ß) and effect size estimates for designing replication and extension studies. CLINICAL TRIAL REGISTRATION: NCT00924651.


Assuntos
Antineoplásicos , Neoplasias da Mama , Doenças do Sistema Nervoso Periférico , Idoso , Antineoplásicos/efeitos adversos , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/epidemiologia , Fatores de Risco
13.
In Vivo ; 35(4): 2253-2260, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34182504

RESUMO

BACKGROUND/AIM: The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic. PATIENTS AND METHODS: Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders. RESULTS: Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38). CONCLUSION: Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.


Assuntos
Neoplasias da Mama , COVID-19 , Transtornos do Sono-Vigília , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , SARS-CoV-2 , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
14.
Nat Commun ; 12(1): 3528, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112795

RESUMO

Breast tumors generally consist of a diverse population of cells with varying gene expression profiles. Breast tumor heterogeneity is a major factor contributing to drug resistance, recurrence, and metastasis after chemotherapy. Antibody-drug conjugates (ADCs) are emerging chemotherapeutic agents with striking clinical success, including T-DM1 for HER2-positive breast cancer. However, these ADCs often suffer from issues associated with intratumor heterogeneity. Here, we show that homogeneous ADCs containing two distinct payloads are a promising drug class for addressing this clinical challenge. Our conjugates show HER2-specific cell killing potency, desirable pharmacokinetic profiles, minimal inflammatory response, and marginal toxicity at therapeutic doses. Notably, a dual-drug ADC exerts greater treatment effect and survival benefit than does co-administration of two single-drug variants in xenograft mouse models representing intratumor HER2 heterogeneity and elevated drug resistance. Our findings highlight the therapeutic potential of the dual-drug ADC format for treating refractory breast cancer and perhaps other cancers.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias da Mama/tratamento farmacológico , Imunoconjugados/farmacologia , Receptor ErbB-2/imunologia , Animais , Antineoplásicos/farmacologia , Neoplasias da Mama/complicações , Linhagem Celular Tumoral , Feminino , Humanos , Imunoconjugados/farmacocinética , Imunoconjugados/uso terapêutico , Imunoconjugados/toxicidade , Imuno-Histoquímica , Inflamação/complicações , Camundongos , Oligopeptídeos/farmacologia , Oligopeptídeos/uso terapêutico , Receptor ErbB-2/metabolismo , Trastuzumab/farmacologia , Trastuzumab/uso terapêutico , Ensaios Antitumorais Modelo de Xenoenxerto
15.
J Cancer Res Ther ; 17(2): 547-550, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34121706

RESUMO

Purpose: Health emergency due to COVID-19 started in Uruguay on March 13, 2020; our mastology unit tried to ensure adequate oncological care, and protect patients from the virus infection and complications. Objective: To assess the health care activities in the "peak" of the pandemic during 3 months. Materials and Methods: we collected data from the electronic health record. Results: There were a total of 293 medical appointments from 131 patients (221 face-to-face), that decreased by 16.7% compared to the same period in 2019 (352 appointments). The medical appointments were scheduled to evaluate the continuity of systemic treatment or modifications (95 patients; 72.5%), follow-up (17; 12.9%), first-time consultation (12; 9.1%), and assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). New twenty treatments were initiated. Of the 14 patients that were on adjuvant/neoadjuvant CT, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte-colony-stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. Of the seven patients that were on palliative CT, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one and due to progression of the disease in the other patient). The ninety patients who were receiving adjuvant, neoadjuvant, or palliative criteria hormone therapy and/or anti-HER2 therapies, continued the treatment with no changes. Conclusions: The evidence suggests that, although medical appointments decreased by approximately 17%, we could maintain healthcare activities, continued most of the treatments while the most modified was CT with G-CSF to avoid myelosuppression.


Assuntos
Neoplasias da Mama/tratamento farmacológico , COVID-19/epidemiologia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Medula Óssea/efeitos dos fármacos , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/imunologia , COVID-19/imunologia , COVID-19/prevenção & controle , COVID-19/transmissão , Controle de Doenças Transmissíveis/normas , Continuidade da Assistência ao Paciente/organização & administração , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Hematopoese/efeitos dos fármacos , Hematopoese/imunologia , Humanos , Oncologia/organização & administração , Oncologia/normas , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Telemedicina/organização & administração , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Triagem/organização & administração , Triagem/normas , Uruguai/epidemiologia
16.
Res Nurs Health ; 44(4): 598-607, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33963594

RESUMO

A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments.


Assuntos
Neoplasias da Mama , Quimioterapia Adjuvante/efeitos adversos , Terapia por Exercício , Doenças do Sistema Nervoso Periférico/prevenção & controle , Qualidade de Vida/psicologia , Adulto , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade
17.
Neurology ; 97(1): e13-e22, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34011575

RESUMO

OBJECTIVE: To test the hypotheses that overall survival and cancer-specific survival after breast cancer diagnosis would be lower in persons with multiple sclerosis (MS) as compared to persons without MS using a retrospective matched cohort design. METHODS: We applied a validated case definition to population-based administrative data in Manitoba and Ontario, Canada, to identify women with MS. We linked the MS cohorts to cancer registries to identify women with breast cancer. Then we selected 4 breast cancer controls without MS matched on birth year, cancer diagnosis year, and region. We compared all-cause survival between cohorts using Cox proportional hazards regression adjusting for age at cancer diagnosis, cancer diagnosis period, income quintile, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a multivariable cause-specific hazards model. We pooled findings between provinces using meta-analysis. RESULTS: We included 779 patients with MS and 3,116 controls with breast cancer. Most patients with stage data (1,976/2,822 [70.0%]) were diagnosed with stage I or II breast cancer and the mean (SD) age at diagnosis was 57.8 (10.7) years. After adjustment for covariates, MS was associated with a 28% increased hazard for all-cause mortality (hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.08-1.53), but was not associated with altered cancer-specific survival (HR 0.98; 95% CI 0.65-1.46). CONCLUSION: Women with MS have lower all-cause survival after breast cancer diagnosis than women without MS. Future studies should confirm these findings in other populations and identify MS-specific factors associated with worse prognosis.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/mortalidade , Esclerose Múltipla/complicações , Esclerose Múltipla/mortalidade , Adolescente , Adulto , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Renda , Manitoba/epidemiologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
18.
J Bodyw Mov Ther ; 26: 43-48, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33992279

RESUMO

BACKGROUND: Analyze the effects of a 12-week dance intervention on the sleep quality and the level of pain among women with breast cancer. METHODS: Non-randomized clinical trial including 21 breast cancer survivors allocated in intervention group (n = 11) or control group (n = 10). Intervention group received a 12-week mix dance intervention and the control group maintained their routine activities. Data collection was realized through the application of a questionnaire before and after 12 weeks, involving pain (VAS) and sleep quality (Pittsburgh Sleep Quality Index). The Two-way ANOVA with repeated measures and Sidák correction, and multiple linear regression was used. RESULTS: No significant effects were found on sleep quality and pain after the 12-week intervention with a mix dance protocol. Also, no significant difference was found between intervention and control group during post-intervention. The multiple linear regression analysis, controlled by stage of treatment, did not present a significant relationship between sleep quality and pain. Additionally, some spontaneous reports provided by the participants demonstrated a subjective improvement in their social life and general well-being. CONCLUSION: The 12-week mix dance intervention did not seem to directly influence the sleep quality and pain of breast cancer survivors in this study; however, no adverse events were reported. Perhaps, a dance protocol focusing only in one modality of dance may be more effective for breast cancer survivors on sleep quality and pain.


Assuntos
Neoplasias da Mama , Dança , Neoplasias da Mama/complicações , Feminino , Humanos , Dor , Projetos Piloto , Qualidade de Vida , Sono
19.
Bull Cancer ; 108(7-8): 730-739, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34052032

RESUMO

Thrombotic Microangiopathies (TM) have been described since the 1960s. They are characterized by presence of mechanical haemolytic anemia associated with peripheral thrombocytopenia. TM in cancer can be related to several causes, whose cancer himself: cancer-related microangiopathic haemolytic anaemia (MAHA). Incidence of cancer related MAHA remains unknown. Cancer-related MAHA are mainly observed in mucin-producer adenocarcinomas, such as gastric (half of reported cases) and breast cancer. We conducted a review of all original published cases of TM reported in breast cancer, and we specifically investigated BC-MAHA cases. A Medline search identified 158 MAHA cases including 118 BC-MAHA, and 40 drug-related MAHA. Most of BC-MAHA occur in disseminated cancers, mainly with medullar involvement, and/or bone metastasis. Patients typically suffer from poor general state, bone pain, and/or dyspnea. Laboratory abnormalities such as myelemia or erythromyelemia in peripheral blood are frequently observed. Incidence of coagulation disorders is increased, compared to other MAHA causes. BC-MAHA prognosis is dramatically poor. Treatments classically used in other MAHA causes, such as plasmapheresis or immunoglobulins, are inefficient. Urgent anti-neoplastic therapy may be the only effective treatment, associated to symptomatic therapies (transfusions, blood pressure control).


Assuntos
Anemia Hemolítica/complicações , Neoplasias da Mama/complicações , Microangiopatias Trombóticas/etiologia , Adenocarcinoma/metabolismo , Anemia Hemolítica/epidemiologia , Anemia Hemolítica/mortalidade , Anemia Hemolítica/terapia , Transtornos da Coagulação Sanguínea/epidemiologia , Neoplasias Ósseas/secundário , Neoplasias da Mama/metabolismo , Feminino , Humanos , Incidência , Mucinas/biossíntese , Trombocitopenia/complicações , Microangiopatias Trombóticas/terapia
20.
Medicine (Baltimore) ; 100(20): e25705, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011028

RESUMO

RATIONALE: One repetition maximum (1-RM) testing is a standard strength assessment procedure in clinical exercise intervention trials. Because no adverse events (AEs) are published, expert panels usually consider it safe for patient populations. However, we here report a vertebral fracture during 1-RM testing. PATIENT CONCERNS: A 69-year-old breast cancer survivor (body-mass-index 31.6 kg/m2), 3 months after primary therapy, underwent 1-RM testing within an exercise intervention trial. At the leg press, she experienced pain accompanied by a soft crackling. DIAGNOSIS: Imaging revealed a partially unstable cover plate compression fracture of the fourth lumbar vertebra (L4) with a vertical fracture line to the base plate, an extended bone marrow edema and a relative stenosis of the spinal canal. INTERVENTIONS: It was treated with an orthosis and vitamin D supplementation. Another imaging to exclude bone metastases revealed previously unknown osteoporosis. OUTCOMES: The patient was symptom-free 6.5 weeks after the event but did not return to exercise. CONCLUSION: This case challenges safety of 1-RM testing in elderly clinical populations. LESSONS: Pre-exercise osteoporosis risk assessment might help reducing fracture risk. However, changing the standard procedure from 1-RM to multiple repetition maximum (x-RM) testing in studies with elderly or clinical populations would be the safest solution.


Assuntos
Neoplasias da Mama/complicações , Teste de Esforço/efeitos adversos , Fraturas por Osteoporose/etiologia , Treinamento de Força/efeitos adversos , Fraturas da Coluna Vertebral/etiologia , Idoso , Sobreviventes de Câncer , Ensaios Clínicos como Assunto , Teste de Esforço/métodos , Feminino , Humanos , Vértebras Lombares/lesões , Aparelhos Ortopédicos , Fraturas por Osteoporose/terapia , Treinamento de Força/métodos , Fraturas da Coluna Vertebral/terapia , Vitamina D/administração & dosagem
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