乳腺癌患者化疗相关心脏毒性非药物干预研究进展

化疗导致的心脏毒性是乳腺癌患者死亡率升高的重要原因,而非药物干预作为预防的新型策略,能有效弥补药物干预的不足。本文将从运动干预、营养干预、调整治疗剂量和方式及给药途径、控制心血管危险因素以及心理干预对乳腺癌患者化疗相关心脏毒性的非药物干预进行综述,旨在为临床上管理乳腺癌患者化疗相关心脏毒性提供参考。     

基于CiteSpace的“三阴性乳腺癌脑转移”研究可视化分析

目的 分析全球三阴性乳腺癌脑转移文献的分布规律和研究前沿，对三阴性乳腺癌脑转移的研究进行整体文献计量评价，为此后的相关研究提供方向。方法 研究数据均来自WOS核心数据库，使用CiteSpace文献计量软件，对三阴性乳腺癌脑转移研究的作者、机构及国家分布、研究热点与演进趋势等进行数据可视化处理以及相关分析。结果 共分析了2007年到2021年12月31日期间发表的文献共计393篇，出版物发表数量呈波动性上升的趋势，发表数量最多的一年为2021年，全球共计发表相关文献60篇。主要研究机构有丹娜·法伯癌症研究院(Dana-Farber Cancer Institute)、北卡罗来纳大学(The University of North Carolina System)等。关键词分析得到350个关键词、20簇主要关键词聚类和14个突现关键词，研究热点主要集中在治疗、肿瘤分型、生存期等方面。突变点分析显示，三阴性乳腺癌脑转移的趋势集中在信号通路以及细胞增殖研究上。结论 本研究成果为三阴性乳腺癌脑转移提供了研究重点以及未来发展方向，可以进一步准确地指导学者的研究。     

乳腺癌照顾者研究的文献计量学及可视化分析

目的 对乳腺癌照顾者相关文献进行文献计量及可视化分析,了解乳腺癌照顾者研究的发展态势,为以后的研究提供参考。方法 通过检索Embase数据库,获取乳腺癌照顾者研究文献的相关信息,采用Excel 2016软件对不同作者、机构、国家及关键词出现频次制作发表柱状图,生成高产作者、高产机构、高产国家及高频关键词表格,利用VOSviewer1.6.15软件对纳入研究的作者、国家、机构和关键词进行提取,并生成高产作者、机构合作网络图和高频关键词的聚类网络图。结果 共检索出符合要求的文献698篇,研究数量整体呈年度上升趋势,作者共来自63个国家,1 350个机构,发文量最多的国家为美国,发文量最多的机构以加利福尼亚大学最为突出,主要作者形成5个合作团体,不同团体之间合作较少。乳腺癌照顾者研究主题较为集中,其中生活质量、照顾者负担、缓和治疗是研究者关注的焦点。结论 乳腺癌照顾者负担逐渐被关注,但缺乏长期从事该领域研究的科研人员和团体,研究的广度和深度需进一步加强,同时需加强不同团体的交流与合作,共同产出高质量研究,为改善乳腺癌患者及其照顾者生活质量提供指导。     

乳腺癌化疗相关心脏毒性的机制及其评估

乳腺癌是威胁女性生命健康的主要肿瘤,在中国城乡女性中发病率高。多种治疗方式大大提高了乳腺癌患者的生存率,化疗成为乳腺癌治疗中的一种重要手段。随着乳腺癌化疗药物的大量使用,药物不良反应的问题逐渐凸显,其中心脏毒性严重影响患者的生活质量。影像学评估因为其无创、便捷的特点已经成为心脏功能评估的重要手段。利用影像学检查早期发现乳腺癌化疗相关心脏损伤,为早期干预提供依据,成为影像科医师亟待解决的重要课题。笔者就乳腺癌化疗心脏毒性的相关研究及心脏损伤的评估方式进行总结,以期为乳腺科及影像科医师提供参考。     

基于文献计量学的国内外肿瘤心脏病学研究现状与热点分析

背景与目的：肿瘤心脏病学作为一门新兴的交叉学科,主要关注与肿瘤治疗相关的心血管毒性的管理,在过去十年取得了长足的发展。本研究利用文献计量学方法分析国内外肿瘤心脏病学领域热点和趋势,为相关研究提供参考。方法：基于Web of Science核心数据库和中国知网即中国知识基础设施工程（China National Knowledge Infrastructure,CNKI）,使用CiteSpace软件对2012—2022年国内外肿瘤心脏病学领域研究的发文量、国家、机构、作者、高被引文献、关键词进行分析。结果：筛选后共纳入4 287篇英文文献,1 165篇中文文献。目前国外肿瘤心脏病学领域的文献数量呈快速增长趋势,而中国以2016年为界,产生了“缓慢发展期”和“快速发展期”。美国是Web of Science中发文量最多的国家,约占总数的34.21%,其次是中国、意大利等。国内外发文量最多的机构分别是得克萨斯大学MD安德森癌症中心（The University of Texas MD Anderson Cancer Center）和大连医科大学附属第一医院。国外以Bonnie KY、Ana Barac、Paaladinesh Thavendiranathan等为主要贡献者,国内以夏云龙、张宇辉、程蕾蕾等为主要贡献者。Web of Science被引频次最高的文献是来自欧洲心脏病学会的关于癌症治疗和心血管毒性的立场声明,反映了专业协会的指南和共识常作为一个学科中被广泛引用的文献可直接影响临床实践。国外出现频次最高的关键词是“heart failure”、“breast cancer”、“cardiotoxicity”等,国内出现频次最高的关键词是“心脏毒性”、“心脏肿瘤”、“阿霉素”等。“immune checkpoint inhibitors”、“免疫检查点抑制剂相关心肌炎”是近3年的突现词,从分析结果可以看出,国外主要关注肿瘤心脏病的发生机制、肿瘤心脏病的防治,国内则更多地关注抗肿瘤治疗引起的心脏毒性,如“化疗”、“阿霉素”、“多柔比星”、“蒽环类”等。 结论：研究热点主要集中于抗肿瘤治疗引起的心脏毒性、肿瘤心脏病的防治、肿瘤心脏病的筛查与诊断等;建立多学科参与的诊疗模式,关注免疫检查点抑制剂相关心肌炎及肿瘤心脏病的全程管理是未来关注的方向。     

lncRNA在肝细胞癌组织中表达及生物学作用的文献计量分析

目的:通过对长链非编码RNA(lncRNA)在肝细胞癌组织中表达及生物学作用的相关文献进行计量分析,探索该领域近10年的研究现状、热点及趋势。方法:以Web of Science核心合集数据库为数据来源,利用Excel、VOSviewer、Citespace、Carrot 2软件分别进行年度发文情况、期刊分布情况、国家/机构分布情况、作者分布情况及关键词分析,并绘制相关可视化图谱。结果:纳入1 673篇SCI文献,载文量最多的期刊是Oncotarget,引文量最高的作者是Sun Shuhan,中国为该领域研究的主要国家,南京医科大学、第二军医大学是该领域研究的重要机构,主要的研究热点是基因表达、lncRNAs的生物学作用。蛋白激酶B、凋亡、自噬是研究的前沿。结论:研究结果为科研工作者今后开展相关课题提供了新的视角,为研究人员寻找潜在合作者与研究合作机构、研究热点及趋势提供了有价值的信息。     

中国乳腺癌相关心脏病诊疗共识（2022年版）

乳腺癌和心血管疾病是现代社会的两大“杀手”,严重威胁着中国女性的健康,目前两个学科之间关联共性尚未引起临床医师足够的重视,为相关的跨学科合作实践带来一定困难。因此,对于那些已存在心血管系统疾病或心血管疾病风险的乳腺癌患者,临床医师在进行相关抗肿瘤诊疗时,应用类似乳腺癌干预策略的方法来综合评估相关风险,进行相关心脏毒性的预防及治疗干预。目前不少发达国家,已经建立了肿瘤心脏病专科门诊、病房和对应的多学科治疗团队（multidisciplinary treatment teams,MDT）。而在国内,相关学科发展才刚刚开始。可以预见的是,随着乳腺癌检测和治疗手段的不断进步,会有越来越多的乳腺癌患者获得长期的生存,这意味着其中部分患者必然要面临抗肿瘤治疗相关心脏毒性所带来的并发症的风险。因此,一份具有强有力循证医学证据支持的相关指南和临床共识能够为临床医师提供针对性的随访、监测、治疗流程和有效的管理手段,具有十分重要的临床指导意义。本共识旨在指导临床医师对乳腺癌患者进行相关抗肿瘤治疗（化疗、靶向治疗、手术、内分泌治疗、免疫治疗及放疗）的前提下,将心脏保护作为一个整体进行评估和监测,根据监测的结果决定后续干预手段,并决定是否及何时由心脏科医师进行专业会诊,避免因对乳腺癌相关心脏毒性认识不够,导致治疗不及时产生相关不良后果,为中国乳腺癌心脏病诊疗防治提供一份切实可行的临床实践操作流程,最终为改善中国乳腺癌患者的预后作出贡献。     

基于CiteSpace对肝癌铁死亡研究现状的可视化分析

目的:通过对肝癌铁死亡相关研究进行文献计量学统计及可视化分析,探讨近9年该领域的研究热点和发展趋势。方法:基于Web of Science核心数据库,利用CiteSpace分析软件对2013年至2022年发表文章进行文献计量学统计及可视化分析,通过对发表文章的年度分布、被引情况、国家、机构、基金和关键词等进行可视化分析,并对关键词进行共现分析和聚类分析。结果:通过对300篇肝癌铁死亡领域文献进行可视化分析显示,该领域发文量呈逐年上涨趋势,中国是发文量最多的国家,中心性居于第三位,发文量最多的机构为上海交通大学,资助该领域最多的基金资助机构是中国国家自然科学基金委员会,关键词聚类分析提示肝癌铁死亡信号通路,相关蛋白、关键酶、基因及转录因子的表达是肝癌铁死亡研究的热点。结论:靶向肝癌铁死亡相关蛋白、关键酶、基因及转录因子等是肝癌治疗的新靶点,可为肝癌的临床疗法提供更多见解,为制定开发肝癌药物提供新策略。     

基于卷积神经网络的肿瘤影像诊断文献计量研究

目的 通过分析十年来国内外发表的关于卷积神经网络的肿瘤影像诊断领域的文献特征,了解该领域的研究热点及发展趋势。方法 以SCI-E数据库为数据源,检索2012年—2022年十年间发表的有关卷积神经网络的肿瘤影像诊断领域的文献,利用CiteSpace软件分析文献的国家、机构、期刊、作者共被引和关键词的分布特征。结果 最终共有1088篇文献纳入研究;文献主要来自中国、美国和印度等国家;中山大学发文39篇,是发文量最多的研究机构;Radiology Nuclear Medicine MedicalImaging是发文量最多的期刊;共得到25个高频关键词和15个突发性关键词;形成了image segmentation、lung nodule等12个作者共被引聚类和automatic segmentation、breast cancer等11个关键词聚类。结论 当前卷积神经网络的肿瘤影像诊断的研究主要集中在肿瘤分割、肺结节识别、乳腺癌的辅助诊断以及其他高频肿瘤的研究。     

乳腺癌治疗相关心血管不良事件的诊治进展

乳腺癌是全球女性最常见的恶性肿瘤，是女性癌症死亡的主要原因，在过去的40年中，随着诊疗手段不断提升，早期乳腺癌的死亡率下降近40%，人们越来越关注乳腺癌患者早期治疗的心脏毒性及长期的预后水平。与治疗相关的心血管不良事件已成为癌症患者死亡的常见原因，且心血管疾病（cardiovascular disease，CVD）是50岁以上乳腺癌患者死亡的主要原因，临床上乳腺癌患者心血管不良事件风险的早期筛查和管理，对提高患者生存率及生活质量尤为重要。本文对乳腺癌治疗相关心血管不良事件的早期诊断及治疗进展作一综述。     

Assessment of Practice and Outcome of Exercise on Quality of Life of Women with Breast Cancer in Delta State

Objectives: This study evaluated the effect of exercise on the quality of life of women with breast cancer. It determined the pre and post-intervention functional, symptoms, and global quality of life of women with breast cancer in the control and intervention groups. Methods: The quasi-experimental design study adopted a purposive sampling technique in selecting the women with breast cancer in the intervention (47) and control (47) groups. Data on  QOL was measured using standardized instruments, namely the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-version 3 (EORTC QLQ-C30. Results: The results show the pre-intervention overall functional quality of life domain score was 59.2±21.98 for the intervention and 67.0± 20.13 for the control, an overall score for the symptom domain was 31.8±10.89 for the intervention and 29.8±10.24 for the control. The post-intervention overall generic functional domain score was 89.0±11.1 for the intervention and 51.2±17.8 for the control and for symptoms domain; their overall score was 16.4±10.2 for the intervention and 35.4±12.4 for the control. A significant difference existed  in all post-intervention  functional domain scores of the generic function and symptoms quality of life as the functional domains (p < 0.001) and global health status (p < 0.001). Conclusion: As the numbers of women who survive breast cancer continue to increase, there is a need for lifestyle modification like exercise to improve and maintain their overall QOL to live a fulfilled life devoid of post-treatment complications.     

The effects of exercise on cardiovascular outcomes before, during, and after treatment for breast cancer

Asymptomatic cardiotoxicity following breast cancer treatment is a significant issue for many patients, as these patients typically face an increased risk of cardiovascular disease (CVD). Exercise has well established benefits to improve and maintain cardiovascular function across patients with and without CVD. However, there is a dearth of information on the effects of exercise on cardiovascular outcomes in breast cancer patients. While pre-clinical studies support the use of exercise in mitigating cardiotoxicity, only one human study has specifically investigated cardiac function following an exercise intervention during chemotherapy treatment. No significant differences were observed between groups, which highlights the unidentified role of exercise in altering the risk of cardiotoxicity in breast cancer patients. Issues such as establishing the optimal timing, type, and intensity of an exercise program before, during, or after oncologic treatment for breast cancer are unclear. CVD risk and incidence increase in breast cancer survivors post therapy, and CVD is the number one killer of women in the United States. Thus, there is an increasing need to define the efficacy of exercise as a non-pharmacologic intervention in this growing population.     

The Potential Role of Aerobic Exercise to Modulate Cardiotoxicity of Molecularly Targeted Cancer Therapeutics

Molecularly targeted therapeutics (MTT) are the future of cancer systemic therapy. They have already moved from palliative therapy for advanced solid malignancies into the setting of curative‐intent treatment for early‐stage disease. Cardiotoxicity is a frequent and potentially serious adverse complication of some targeted therapies, leading to a broad range of potentially life‐threatening complications, therapy discontinuation, and poor quality of life. Low‐cost pleiotropic interventions are therefore urgently required to effectively prevent and/or treat MTT‐induced cardiotoxicity. Aerobic exercise therapy has the unique capacity to modulate, without toxicity, multiple gene expression pathways in several organ systems, including a plethora of cardiac‐specific molecular and cell‐signaling pathways implicated in MTT‐induced cardiac toxicity. In this review, we examine the molecular signaling of antiangiogenic and HER2‐directed therapies that may underpin cardiac toxicity and the hypothesized molecular mechanisms underlying the cardioprotective properties of aerobic exercise. It is hoped that this knowledge can be used to maximize the benefits of small molecule inhibitors, while minimizing cardiac damage in patients with solid malignancies.     

Effect of a Pedometer-based Exercise Program on Cancer Related Fatigue and Quality of Life amongst Patients with Breast Cancer Receiving Chemotherapy

Background: Breast cancer is the most common cancer amongst Indian women. Cancer treatments leads to various side effects out of which Cancer-Related fatigue (CRF) is one of the most under-addressed side-effects. It is experienced the most in patients receiving chemotherapy. Exercise has been proven to be a beneficial intervention to manage CRF but the benefits of pedometer-based exercise programs is under-studied in patients with breast cancer. Hence, we set out to investigate the effects of a pedometer-based exercise program for patients with breast receiving chemotherapy. Methods: The current study was a non-randomized controlled trial with 22 patients each in exercise and control group. The exercise group received a pedometer-based walking program, whereas the control group received standard physical activity advice. Fatigue, quality of life, functional capacity and body composition were assessed at baseline, 3rd week and 7th week. Results: At the end of 7 weeks intervention, functional capacity, quality of life and skeletal mass were found to have improved with statistical significance, while the fatigue and changes in total fat did improve but were not statistically significant. Conclusion: A 7-week pedometer-based exercise program improved functional capacity, quality of life and percentage of skeletal mass and also shows to have prevented deterioration in fatigue levels in patients with breast cancer receiving chemotherapy.     

Clinicians Should Actively Promote Exercise in Survivors of Breast Cancer

Breast cancer is the most common cancer affecting women, causing 29% of all female cancers and afflicting 14% of all female cancer-related deaths worldwide. It remains a significant clinical, psychological, and financial burden. Exercise has been suggested to reduce cancer recurrence and cancer-related mortality from research in the past decade. Recent American and European guidelines advise on exercise for breast cancer survivors, not only to improve quality of life and decrease fatigue, but also to aid in decreasing recurrence and improve breast cancer related mortality. Nonetheless, adherence to guidelines remains low, with lack of awareness and fatigue related to chemotherapy as the most common barriers. It remains to be elucidated whether a particular type of exercise, or whether group or individualized activity is most effective. The importance of exercise in avoiding recurrence and improving quality of life needs to be recognized and taken into account in the management of breast cancer survivors. Further patient awareness and education is essential towards this goal, and the role of group exercise should be further explored.     

Exercise despite pain – breast cancer patient experiences of muscle and joint pain during adjuvant chemotherapy and concurrent participation in an exercise intervention

Chemotherapy‐related pain is a well‐known side effect in cancer patient receiving chemotherapy. However, limited knowledge exists describing whether exercise exacerbates existing pain. Aim of the research was to explore muscle and joint pain experienced by women with breast cancer receiving adjuvant chemotherapy with epirubicin and cyclophosphamide followed by docetaxel and factor support and concurrently participating in an exercise intervention. The study used individual semi‐structured interviews (pre‐ and post‐intervention). Fifteen women were interviewed. The multimodal group intervention comprised supervised training: high‐intensity cardiovascular, heavy resistance and relaxation, massage and body‐awareness (9 h weekly, 6 weeks). The analysis revealed five categories: Abrupt pain – a predominant side effect, cogitated pain management, the adapted training, non‐immediate exacerbation of pain and summarised into the essence of chemotherapy related muscle and joint pain in exercise breast cancer patients; exercise despite pain. Findings indicate that the patients' perception of sudden onset of chemotherapy‐related muscle and joint pain was not aggravated by training. Pain intensity peaked between 2 and 9 days after chemotherapy and is described to be stabbing pain with a feeling of restlessness in the body. The patients demonstrated a high adherence rate to the exercise intervention caused by their own willpower and camaraderie of the group.     

Exercise in patients coping with breast cancer: An overview

Breast cancer is the most common type of cancer in women, but fortunately has high survival rates. Many studies have been performed to investigate the effects of exercise in patients diagnosed with breast cancer. There is evidence that exercise after the diagnosis of breast cancer improves mortality, morbidity, health related quality of life, fatigue, physical functioning, muscle strength, and emotional wellbeing. Based on scientific data, breast cancer patients should be recommended to participate in rehabilitation programs including aerobic and strength training. The aim of this article is to review the recently published data on the effect of exercise in patients with breast cancer in order to present the current perspective on the topic.     

Progressive resistance training in breast cancer: a systematic review of clinical trials

Background Progressive resistance training (PRT) may be effective for targeting the sequelae of breast cancer and its treatment given the unique anabolic nature of this exercise modality. Therefore, our objectives were: (1) to systematically review studies that have prescribed PRT after breast cancer surgery, (2) to summarize the efficacy of PRT in this cohort, and (3) to delineate areas for future investigations. Method A systematic review using computerized databases was performed. Results The systematic review located 10 trials: Four uncontrolled trials, one controlled trial and five randomized controlled trials (RCTs). PRT was prescribed with aerobic training in 8/10 trials reviewed, and in isolation in 2/10 trials reviewed. Upper body PRT was prescribed in 7/10 trials, including 4/5 RCTs. No exacerbation of objectively measured or subjectively reported lymphedema symptoms was reported in any of these trials. Adverse events were rare, generally musculoskeletal in nature, and were managed effectively by conservative means. Overall, the studies we reviewed suggest that women surgically treated for breast cancer can derive health-related and clinical benefits by performing PRT after breast cancer surgery. Further research may be required to stimulate greater advocacy for PRT among oncologists, and in community care settings. Conclusions Robustly designed RCTs prescribing targeted PRT regimens throughout various phases of breast cancer treatment are warranted. RCTs with thorough, standardized reporting of interventions and adverse events are required to establish the efficacy of this intervention for the post-treatment management of breast cancer patients and survivors as a means to improve health status and quality of life.