Effects of weight reduction on the breast cancer-related lymphedema: A systematic review and meta-analysis

Effects of weight reduction on the breast cancer-related lymphedema: A systematic review and meta-analysis

by Chi-Lin Tsai, Chih-Yang Hsu, Wei-Wen Chang, Yen-Nung Lin 

The Breast: VOLUME 52, P116-121, AUGUST 01, 2020

Highlights

•Weight reduction decreases the volume of both arms in patients with BCRL.

•Weight reduction does not reduce the severity of BCRL measured objectively.

•Effects of weight reduction on preventing BCRL are yet unknown.

Abstract

Background:

Obesity has long been considered a risk factor for breast cancer–related lymphedema (BCRL), but the benefits of weight reduction in managing BCRL have not been clearly established.

Objective:

To evaluate the beneficial effects of weight loss interventions (WLIs) on the reduction and prevention of BCRL.

Methods:

We conducted a systematic review and meta-analysis by searching the PubMed, Scopus, and Embase databases from their earliest record to October 1st, 2019. We included randomized and non-randomized controlled trials involving adult patients with a history of breast cancer, that compared WLI groups with no-WLI groups, and provided quantitative measurements of lymphedema.

Results:

Initial literature search yielded 461 nonduplicate records. After exclusion based on title, abstract, and full-text review, four randomized controlled trials involving 460 participants were included for quantitative analysis. Our meta-analysis revealed a significant between-group mean difference (MD) regarding the volume of affected arm (MD = 244.7 mL, 95% confidence interval [CI]: 145.3–344.0) and volume of unaffected arm (MD = 234.5 mL, 95% CI: 146.9–322.1). However, a nonsignificant between-group MD of −0.07% (95% CI: 1.22–1.08) was observed regarding the interlimb volume difference at the end of the WLIs.

Conclusions:

In patients with BCRL, WLIs are associated with decreased volume of the affected and unaffected arms but not with decreased severity of BCRL measured by interlimb difference in arm volume.

Changes in breast cancer management during the Corona Virus Disease 19 pandemic: An international survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST)

Changes in breast cancer management during the Corona Virus Disease 19 pandemic: An international survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST)

by Maria Luisa Gasparri, Oreste Davide Gentilini, Diana Lueftner, Thorsten Kuehn, Orit Kaidar-Person, Philip Poortmans

The Breast: VOLUME 52, P110-115, AUGUST 01, 2020

Highlights

•Management of breast cancer patients was modified during the pandemic.

•Waiting time increased during the pandemic in 20% of the institutions.

•A workload reduction of ≥50% was reported in 1/3 and relocation of the centres in 13%.

•It is unknown whether these changes will affect outcome of breast cancer patients.

Abstract

Background

Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic.

Methods

A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested.

Results

In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2-positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases.

Conclusions

Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.

Clinical outcome of adjuvant radiotherapy for squamous cell carcinoma of the breast; a multicenter retrospective cohort study

Clinical outcome of adjuvant radiotherapy for squamous cell carcinoma of the breast; a multicenter retrospective cohort study

by Mami Ogita, Kenshiro Shiraishi, Katsuyuki Karasawa, Kenji Tokumasu, Naomi Nakajima, Tachen Chang, Jiro Kawamori, Hideomi Yamashita, Keiichi Nakagawa

The Breast: VOLUME 52, P88-94, AUGUST 01, 2020

Highlights

•Clinical outcome of adjuvant radiotherapy for SCC of the breast was evaluated.

•Breast SCC had poor prognosis and a high incidence of locoregional recurrence.

•In-field recurrence following radiotherapy occurred frequently.

•Age and lymphatic invasion were significantly associated with increased risk of recurrence.

Abstract

Background:

Because primary squamous cell carcinoma (SCC) of the breast is a rare disease, the standard therapy has not been established. We examined the clinical outcomes of postoperative adjuvant radiotherapy for breast SCC.

Material and methods:

We conducted a multicenter retrospective cohort study. Patients diagnosed with primary breast SCC who received adjuvant radiotherapy as part of their primary definitive treatment were included. Overall survival (OS), breast cancer-specific survival (BCSS), and recurrence-free interval (RFi) were evaluated.

Results:

Between January 2002 and December 2017, 25 breast SCC patients received adjuvant radiotherapy as a primary treatment were included. Median follow-up time was 43.5 months. Three (12%), fifteen (60%) and seven (28%) patients had clinical stage I, II and III disease, respectively. Fourteen patients underwent breast-conserving surgery and subsequent adjuvant radiotherapy. Eleven patients underwent mastectomy and post-mastectomy radiotherapy. Ten patients received regional lymph node irradiation. Nine (36%) patients had disease recurrence. The first site of recurrence was locoregional in five, but distant metastasis arose in one. Concurrent local and distant metastasis were seen in two. Six cases of local recurrence occurred within the irradiated site. Seven patients died, and six of the deaths were due to breast cancer. Five-year OS, BCSS, and Rfi were 69%, 70%, and 63%, respectively. In multivariate analysis, age and lymphatic invasion were associated with increased risk of recurrence.

Conclusion:

Breast SCC has a high incidence of locoregional recurrence and poor prognosis. Age and lymphatic invasion are significant risk factors for recurrence.

Hospital-based or home-based administration of oncology drugs? A micro-costing study comparing healthcare and societal costs of hospital-based and home-based subcutaneous administration of trastuzumab

Hospital-based or home-based administration of oncology drugs? A micro-costing study comparing healthcare and societal costs of hospital-based and home-based subcutaneous administration of trastuzumab

by Margreet Franken, Tim Kanters, Jules Coenen, Paul de Jong, Agnes Jager, Carin Uyl-de Groot 

The Breast: VOLUME 52, P71-77, AUGUST 01, 2020

Highlights

• Home-based administration of SC trastuzumab almost triples the time of healthcare professionals.
• Healthcare costs are almost twice as much for home-based than for hospital-based administration.
• Patient and family costs are almost five times lower for home-based than for hospital-based administration.

Abstract

Objective

To investigate resource use and time investments of healthcare professionals, patients and their family and to compare healthcare and societal costs of one single hospital-based and one single home-based subcutaneous administration of trastuzumab in The Netherlands.

Method

We conducted a bottom-up micro-costing study. Patients diagnosed with HER2+ early or metastatic breast cancer were recruited in four Dutch hospitals. For healthcare costs, data were collected on drug use, consumables, use of healthcare facilities, time of healthcare professionals, and travelling distance of the nurse. For societal costs, data were collected on patient and family costs (including travelling expenses and time of informal caregivers) and productivity losses of paid and unpaid work.

Results

Societal costs of one single administration of SC trastuzumab were €1753 within the home-based and €1724 within the hospital-based setting. Drug costs of trastuzumab were identical in both settings (€1651). Healthcare costs were higher for home-based administration (€91 versus €47) mainly because of more time of healthcare professionals (110 versus 38 minutes). Costs for patient and family were, however, lower for home-based administration due to travelling expenses (€7 versus €0) and time of informal caregivers (€14 versus €4). Costs for productivity losses were similar for both settings.

Conclusions

Home-based subcutaneous administration of trastuzumab is more time consuming for healthcare professionals and therefore more costly than hospital-based administration. The total budget impact can be large considering that a large number of patients receive a large number of cycles of oncology treatments. If home-based administration is the way forward, novel approaches are crucial for ensuring efficiency of home-based care.

Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life ESME metastatic breast cancer cohort

Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life ESME metastatic breast cancer cohort

by Sophie Frank, Matthieu Carton, Coraline Dubot, Mario Campone, Barbara Pistilli, Florence Dalenc, Audrey Mailliez, Christelle Levy, Véronique D’Hondt, Marc Debled, Thomas Vermeulin, Bruno Coudert, Christophe Perrin, Anthony Gonçalves, Lionel Uwer, Jean-Marc Ferrero, Jean-Christophe Eymard, Thierry Petit, Marie-Ange Mouret-Reynier, Anne Patsouris, Tahar Guesmia, Thomas Bachelot, Mathieu Robain, Paul Cottu

The Breast:  VOLUME 52, P50-57, AUGUST 01, 2020

Highlights

•Young age is a poor prognosis factor in early stage breast cancer.

•Young age is associated with an aggressive presentation in metastatic breast cancer.

•Young age had no impact on overall survivall in metastatic breast cancer.

•Oppositely, older women (>60y) had a stightly poorer prognosis at the metastatic stage.

Abstract

Background

Young age is a poor prognostic factor in early stage breast cancer (BC) but its value is less established in metastatic BC (MBC). We evaluated the impact of age at MBC diagnosis on overall survival (OS) across three age groups (<40 40="" 60="" and="" nbsp="" to=""> 60 years(y)).

Methods

ESME MBC database is a national cohort, collecting retrospective data from 18 participating French cancer centers between January 01, 2008 and December 31, 2014.

Results

Among 14 403 women included, 1077 (7.5%), 6436 (44.7%) and 6890 (47.8%) pts were <40 40="" and="" nbsp=""> 60 y respectively. Pts <40 15.3="" age="" aggressive="" frequent="" groups:="" had="" her2="" in="" more="" other="" presentations="" significantly="" than="" vs="">60y) and triple negative subtypes (27.4 vs 14.6% in >60y), and more frequent visceral involvement (36.3 vs 29.8% in >60y). At a median follow-up of 48 months, median OS differed across age groups: 38.8, 38.4 and 35.6 months for pts <40 40="" and="" nbsp=""> 60y, respectively (p < 0.0001). Compared to pts <40y 40="" 74.9="" 81.9="" 86.6="" 95="" a="" all="" although="" and="" anti-her2="" as="" better="" causes="" clinical="" death="" diseases.="" explanation="" first-line="" for="" greater="" had="" her2="" higher="" ic="" in="" included="" is="" limited="" luminal="" nbsp="" of="" older="" os="" possible="" pts="" risk="" significant="" statistically="" therapies="" there="" treatments:="" trend="" use="" value="" was="" with="" y=""> 60y, respectively (p < 0.0001).

Conclusion

Although young age seems associated with more aggressive presentations at diagnosis of MBC, it has no deleterious effect on OS in this large series.

Changes in weight, physical and psychosocial patient-reported outcomes among obese women receiving treatment for early-stage breast cancer: A nationwide clinical study

Changes in weight, physical and psychosocial patient-reported outcomes among obese women receiving treatment for early-stage breast cancer: A nationwide clinical study

by Antonio Di Meglio, Stefan Michiels, Lee W. Jones, Mayssam El-Mouhebb, Arlindo R. Ferreira, Elise Martin, Margarida Matias, Ana Elisa Lohmann, Florence Joly, Laurence Vanlemmens, Sibille Everhard, Anne-Laure Martin, Jerome Lemonnier, Patrick Arveux, Paul H. Cottu, Charles Coutant, Lucia Del Mastro, Ann H. Partridge, Fabrice André, Jennifer A. Ligibel, Ines Vaz-Luis

The Breast: VOLUME 52, P23-32, AUGUST 01, 2020

Background

Evidence on how weight loss correlates to health-related quality-of-life (HRQOL) among obese breast cancer (BC) patients is limited. We aimed to evaluate associations between weight changes and HRQOL.

Methods

We included 993 obese women with stage I-II-III BC from CANTO, a multicenter, prospective cohort collecting longitudinal, objectively-assessed anthropometric measures and HRQOL data (NCT01993498). Associations between weight changes (±5% between diagnosis and post-treatment [shortly after completion of surgery, adjuvant chemo- or radiation-therapy]) and patient-reported HRQOL (EORTC QLQ-C30/B23) were comprehensively evaluated. Changes in HRQOL and odds of severely impaired HRQOL were assessed using multivariable generalized estimating equations and logistic regression, respectively.

Results

14.1% women gained weight, 67.3% remained stable and 18.6% lost weight. Significant decreases in functional status and exacerbation of symptoms were observed overall post-treatment. Compared to gaining weight or remaining stable, obese women who lost weight experienced less of a decline in HRQOL, reporting better physical function (mean change [95%CI] for gain, stability and loss: −12.9 [-16.5,-9.3], −6.9 [-8.2,-5.5] and −6.2 [-8.7,-3.7]; pinteraction[weight-change-by-time] = 0.006), less dyspnea (+18.9 [+12.3,+25.6], +9.2 [+6.5,+11.9] and +3.2 [-1.0,+7.3]; pinteraction = 0.0003), and fewer breast symptoms (+22.1 [+16.8,+27.3], +18.0 [+15.7,+20.3] and +13.4 [+9.0,+17.2]; pinteraction = 0.044). Weight loss was also significantly associated with reduced odds of severe pain compared with weight gain (OR [95%CI] = 0.51 [0.31–0.86], p = 0.011) or stability (OR [95%CI] = 0.62 [0.41–0.95], p = 0.029). No associations between weight loss and worsening of other physical or psychosocial parameters were found.

Conclusions

This large contemporary study suggests that weight loss among obese BC patients during early survivorship was associated with better patient-reported outcomes, without evidence of worsened functionality or symptomatology in any domain of HRQOL.

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

by Giuseppe Curigliano, Maria Joao Cardoso, Philip Poortmans, Oreste Gentilini, Gabriella Pravettoni, Ketti Mazzocco, Nehmat Houssami, Olivia Pagani, Elzbieta Senkus, Fatima Cardoso, on behalf of the editorial board of The Breast

The Breast: VOLUME  52, P8-16, AUGUST  01, 2020

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) associated disease (COVID-19) outbreak seriously challenges globally all health care systems and professionals. Expert projections estimate that despite social distancing and lockdown being practiced, we have yet to feel the full impact of COVID-19. In this manuscript we provide guidance to prepare for the impact of COVID-19 pandemic on breast cancer patients and advise on how to triage, prioritize and organize diagnostic procedures, surgical, radiation and medical treatments.