The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis

Persistent pain after breast cancer treatment is prevalent, and not all patients respond sufficiently to pharmacological treatment. Pain is recognized as a multi-dimensional phenomenon, which includes psychological and social components, and several clinical trials have investigated the efficacy of psychosocial interventions on pain in cancer patients and survivors. Our aim was to systematically review and quantify the existing research on the effect of psychosocial interventions on pain in breast cancer patients and survivors. Two independent raters reviewed 474 abstracts for eligibility, leading to the identification of 26 independent and eligible studies published between 1983 and 2012, which were assessed for their methodological quality and subjected to meta-analytic evaluation. A total of 1786 participants were included in the analyses. A statistically significant and robust overall effect size was found across all included studies (Hedges g = 0.37, 95 % CI: 0.20–0.40; p < 0.001). However, the effect size was considerably smaller (0.21), when adjusted for possible publication bias. Furthermore, the results were heterogeneous, and when exploring the sources of heterogeneity, studies of higher methodological quality were found to yield a more conservative effect size (g = 0.21, 95 % CI: 0.02–0.41) than studies of poorer quality (g = 0.65, 95 % CI: 0.25–1.04). The results also indicated that patient educational approaches yielded a larger effect size (g = 0.64) than relaxation-based interventions (g = 0.31, 95 % CI: ?0.05–0.67) and supportive group therapy (g = 0.17, 95 % CI: 0.02–0.32). Taken together, while suggestive of psychosocial intervention as an effective tool in the management of pain among breast cancer patients and survivors, the results should be interpreted as preliminary. The methodological quality of the existing research varied considerably, and only few studies had selected patients on the basis of the presence of pain and included pain as the primary outcome.     

Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health‐related quality of life in breast cancer patients and survivors—a meta‐analysis

Objective: To evaluate the effect of behavioral techniques and physical exercise on psychosocial functioning and health‐related quality of life (HRQoL) outcomes in breast cancer patients and survivors. Methods: A meta‐analysis was carried out to quantify the effects of behavioral and exercise interventions on fatigue, depression, anxiety, body‐image, stress and HRQoL. Summary effect sizes and standard errors were calculated. The presence of publication bias was explored and sensitivity analyses were performed to identify possible sources of heterogeneity. Results: In total, 56 studies were included. Statistically significant results were found for the effect of behavioral techniques on fatigue (ES ?0.158; 95% CI ?0.233 to ?0.082, p<0.001), depression (ES ?0.336; 95% CI ?0.482 to ?0.190, p<0.001), anxiety (ES ?0.346; 95% CI ?0.538 to ?0.154, p<0.001) and stress (ES ?0.159; 95% CI ?0.310 to ?0.009, p=0.038). For the effect of physical exercise interventions, statistically significant results were found on fatigue (ES ?0.315; 95% CI ?0.532 to ?0.098, p=0.004), depression (ES ?0.262; 95% CI ?0.476 to ?0.049, p=0.016), body‐image (ES 0.280; 95% CI 0.077 to 0.482, p=0.007) and HRQoL (ES 0.298; 95% CI 0.117 to 0.479, p=0.001). Conclusions: The results indicate that behavioral techniques and physical exercise improve psychosocial functioning and HRQoL in breast cancer patients and survivors. Future research is needed on the effect of physical exercise on stress and the effect of the combined intervention in breast cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Posttraumatic stress,depression and anxiety among adult long-term survivors of cancer in adolescence

BackgroundTo determine the prevalence of posttraumatic stress, depression and anxiety in adults who have survived cancer (?5 years) diagnosed in adolescence, as compared to healthy controls.Patients and methodsSurvivors (n = 820) of cancer during adolescence (age M = 30.4 ± 6.0 years; M = 13.7 ± 6.0 years since diagnosis) and 1027 matched controls without history of cancer (age M = 31.5 ± 6.9 years) completed standardised questionnaires measuring posttraumatic stress, depression and anxiety. Additionally, sub-groups of 202 survivors and 140 controls with elevated scores received structured interviews to ascertain DSM-IV-diagnoses.ResultsA total of 22.4% of the survivors reported clinically relevant symptoms of posttraumatic stress, anxiety and/or depression compared to 14.0% of the controls (odds ratios [ORs] 1.77; 95% confidence interval [CI] 1.39–2.26). The odds of posttraumatic stress symptoms in male (OR 3.92, 95% CI 1.80–8.51) and female (OR 3.83, 95% CI 2.54–5.76) survivors were more than three times those in the controls. However, only female survivors reported symptoms of depression and anxiety significantly more often (respectively: OR 2.12, 95% CI 1.16–3.85; and OR 1.86, 95% CI 1.33–2.59) than the controls. A relevant subgroup of 24.3% of the survivors met DSM-IV criteria for at least one mental disorder compared to 15.3% of the controls.ConclusionSurvivors of cancer during adolescence show an elevated risk of presenting symptoms of posttraumatic stress, anxiety and/or depression during adulthood which is also reflected in a greater number of DSM-IV diagnoses when compared to controls. Comprehensive follow-up assessments should include the examination of possible psychological late effects of a cancer diagnosis in adolescence in order to identify survivors needing psychosocial interventions even years after the completion of successful medical treatment.     

Effectiveness of telephone‐based interventions on health‐related quality of life and prognostic outcomes in breast cancer patients and survivors—A meta‐analysis

The aim of this meta‐analysis was to evaluate the effect of telephone‐based interventions on prognostic outcomes and health‐related quality of life (HRQoL) in breast cancer patients and survivors. A systematic search of the Cochrane Library, Web of science, Medline, EMBASE, CNKI and CBM database was carried out. Randomised, controlled trials (RCTs) examining the effects of telephone‐based intervention versus a control group receiving no telephone intervention, on prognostic outcomes and HRQoL with breast cancer were included. A meta‐analysis was conducted to quantify the effects of telephone‐based interventions on anxiety, depression, fatigue, self‐efficiency, physiological function, social‐domestic function and quality of life. In total, 14 studies involving 2002 participants were included. Due to the effect of telephone‐based interventions, statistically significant results were found on anxiety (standard mean difference [SMD] = ?0.16, 95% confidence intervals [CI] [0.01, 0.30], p = .04), self‐efficiency (SMD = 0.22, 95% CI [?0.34, ?0.10], p = .0004), social‐domestic function (SMD = 0.19, 95% CI [?0.35, ?0.03], p = .02) and quality of life (SMD = 0.54, 95% CI [?1.00, ?0.08], p = .02). Although the effects on depression, fatigue and physiological function were in the expected direction, these effects were not statistically significant (p > .05) based on the insufficient evidence.     

Survival outcomes of metastatic breast cancer patients by germline BRCA1/2 status in a large multicenter real-world database

The outcomes and best treatment strategies for germline BRCA1/2 mutation (gBRCAm) carriers with metastatic breast cancer (MBC) remain uncertain. We compared the overall survival and the first line progression free survival (PFS1) of patients with a gBRCAm identified at initiation of first-line treatment with those of BRCA wild-type (WT) and not-tested (NT) individuals in the ESME real-world database of MBC patients between 2008 and 2016 (NCT03275311). Among the 20 624 eligible patients, 325 had a gBRCAm, 1138 were WT and 19 161 NT. Compared with WT, gBRCAm carriers were younger, and had more aggressive diseases. At a median follow-up of 50.5 months, median OS was 30.6 (95%CI: 21.9-34.3), 35.8 (95%CI: 32.2-37.8) and 39.3 months (95% CI: 38.3-40.3) in the gBRCAm, WT and NT subgroups, respectively. Median PFS1 was 7.9 (95%CI: 6.6-9.3), 7.8 (95%CI: 7.3-8.5) and 9.7 months (95%CI, 9.5-10.0). In the multivariable analysis conducted in the whole cohort, gBRCAm status had however no independent prognostic impact on OS and PFS1. Though, in the triple-negative subgroup, gBRCAm patients had better OS and PFS1 (HR vs WT = 0.76; 95%CI: 0.60-0.97; P = .027 and 0.69; 95% CI: 0.55-0.86; P = .001, respectively). In contrast, in patients with HR+/HER2 negative cancers, PFS1 appeared significantly and OS non significantly lower for gBRCAm carriers (PFS1: HR vs WT = 1.23; 95%CI: 1.03-1.46; P = .024; OS:HR = 1.22, 95% CI: 0.97-1.52, P = .089). In conclusion, gBRCA1/2 status appears to have divergent survival effects in MBC according to IHC subtype.     

Tai chi for breast cancer patients: a systematic review

The objective of this review was to assess the effectiveness of tai chi for supportive breast cancer care. Eleven databases were searched from inception through December 2009. Controlled trials testing tai chi in patients with breast cancer that assessed clinical outcome measures were considered. The selection of studies, data extraction, and validations were performed independently by two reviewers. Risk of bias was assessed using Cochrane criteria. Three randomized clinical trials (RCTs) and four non-randomized controlled clinical trials (CCTs) met our inclusion criteria. The three RCTs tested the effects of tai chi on breast cancer care compared with walking exercise, psychological support therapy, or spiritual growth or standard health care and showed no significant differences between tai chi and these control procedures in quality of life and psychological and physical outcome measures. The meta-analysis also failed to demonstrate significant effects of tai chi compared with control interventions (n = 38, SMD, 0.45, 95% CI −0.25 to 1.14, P = 0.21; heterogeneity: χ² = 0.23, P = 0.63; I ² = 0%). All of the four CCTs showed favorable effects of tai chi. Three trials suggested effectiveness in psychological and physical outcome measures, whereas one study was too poorly reported to be evaluated in detail. All of the CCTs had a high risk of bias. Collectively, the existing trial evidence does not show convincingly that tai chi is effective for supportive breast cancer care. Future studies should be of high methodological quality, with a particular emphasis on including an adequate control intervention.     

Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies

Published data have shown that physical activity (PA) has a positive role on the primary prevention of breast cancer risk. However, the role of PA on breast cancer outcome has been controversial with inconsistent data. The lack of a meta-analysis that addresses that issue prompted the current report. A comprehensive literature search identified eight studies, of which two studies were excluded. The remaining six studies (12,108 patients with breast cancer) were included in this meta-analysis. Pre-diagnosis PA reduced all causes mortality by 18% but had no effect on breast cancer deaths. Post-diagnosis PA reduced breast cancer deaths by 34% (HR = 0.66, 95% CI, 0.57–0.77, P < 0.00001), all causes mortality by 41% (HR = 0.59, 95% CI, 0.53–0.65, P < 0.00001), and disease recurrence by 24% (HR = 0.76, 95% CI, 0.66–0.87, P = 0.00001). Breast cancer mortality was reduced by pre-diagnosis PA in women with body mass index (BMI) < 25 kg/m2, while post-diagnosis PA reduced that risk among those with BMI ≥ 25 kg/m2. On the other hand, post-diagnosis PA reduced all causes mortality regardless of the BMI. The analysis showed that post-diagnosis PA reduced breast cancer deaths (HR = 0.50, 95% CI, 0.34–0.74, P = 0.0005), and all causes mortality (HR = 0.36, 95% CI, 0.12–1.03, P = 0.06) among patients with estrogen receptor (ER)-positive tumor, while women with ER-negative disease showed no gain. The current meta-analysis provides evidence for an inverse relationship between PA and mortality in patients with breast cancer and supports the notion that appropriate PA should be embraced by breast cancer survivors.     

Relationship between survivorship care plans and unmet information needs,quality of life,satisfaction with care,and propensity to engage with,and attend,follow-up care

Background

The impact of survivorship care plans (SCPs) on the proximal and distal outcomes of adult and childhood cancer survivors, and parent proxies, is unclear. This study aimed to determine the relationship between SCP receipt and these outcomes.

Methods

A cross-sectional survey of adult and childhood cancer survivors (and parent proxies for survivors aged younger than 16 years) across Australia and New Zealand was conducted. Multivariate regression models were fitted to measure the impact of SCP receipt on proximal (unmet information needs and propensity to engage with, and attend, cancer-related follow-up care) and distal outcomes (quality of life and satisfaction with cancer-related follow-up care) with control for cancer history and sociodemographic factors.

Results

Of 1123 respondents, 499 were adult cancer survivors and 624 were childhood cancer survivors (including 222 parent proxies). We found that SCP receipt was predictive of greater attendance at, and awareness of, cancer-related follow-up care (adult: odds ratio [OR], 2.46; 95% CI, 1.18–5.12; OR, 2.38; 95% CI, 1.07–5.29; child/parent: OR, 2.61; 95% CI, 1.63–4.17; OR, 1.63; 95% CI, 1.06–2.50; respectively). SCP receipt also predicted fewer unmet information needs related to “follow-up care required” and “possible late effects” (adult: OR, 0.44; 95% CI, 0.20–0.96; OR, 0.29; 95% CI, 0.13–0.64; child/parent: OR, 0.46; 95% CI, 0.30–0.72; OR, 0.57; 95% CI, 0.38–0.85; respectively). In terms of distal outcomes, SCP receipt predicted a better global quality of life for adult cancer survivors (β, 0.08; 95% CI, −0.01–7.93), proxy-reported health-related quality of life (β, 0.15; 95% CI, 0.44–7.12), and satisfaction with follow-up care for childhood cancer survivors (OR, 2.93; 95% CI, 1.64–5.23).

Conclusions

Previous studies have shown little impact of SCPs on distal end points. Results suggest that SCPs may be beneficial to cancer survivors’ proximal and distal outcomes.     

Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study

Soy isoflavones, structurally similar to endogenous estrogens, may affect breast cancer through both hormonally mediated and non-hormonally related mechanisms. Although the effects of soy are not well understood, some breast cancer survivors increase their soy intake post-diagnosis in attempt to improve their prognosis. Therefore, we examined the role of soy isoflavone intake and the risk of breast cancer recurrence by hormone receptor status, menopausal status, and tamoxifen therapy. A cohort of 1,954 female breast cancer survivors, diagnosed during 1997–2000, was prospectively followed for 6.31 years and 282 breast cancer recurrences were ascertained. Isoflavone intake was assessed by mailing modified Block and supplemental soy food frequency questionnaires to participants, on average 23 months post-diagnosis. Risk of breast cancer recurrence, measured by hazard ratios (HR) and 95% confidence intervals (CI), was estimated using multivariable delayed entry Cox proportional hazards models. Suggestive trends for a reduced risk of cancer recurrence were observed with increasing quintiles of daidzein and glycetin intake compared to no intake among postmenopausal women (P for trend: P = 0.08 for daidzein, P = 0.06 for glycetin) and among tamoxifen users (P = 0.10 for daidzein, P = 0.05 for glycetin). Among postmenopausal women treated with tamoxifen, there was an approximately 60% reduction in breast cancer recurrence comparing the highest to the lowest daidzein intakes (>1,453 vs. <7.7 μg/day; HR, 0.48; 95% CI, 0.21–0.79, P = 0.008). Soy isoflavones consumed at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and moreover, appears not to interfere with tamoxifen efficacy. Further confirmation is required in other large prospective studies before recommendations regarding soy intake can be issued to breast cancer survivors.     

Relative mortality rates from incident chronic diseases among breast cancer survivors – A 14 year follow-up of five-year survivors diagnosed in Denmark between 1994 and 2007

BackgroundIt remains unknown whether incident chronic diseases are more often fatal among breast cancer survivors than among women free of breast cancer.MethodsWe conducted a nationwide matched cohort study of all Danish breast cancer patients diagnosed between 1994 and 2007, who survived for five years. We compared their long-term mortality with five times as many women from the general population without breast cancer, matched on age. We used time-varying methods to compute mortality rate ratios (MRRs) for incident diseases included in the Charlson Comorbidity Index (CCI).ResultsOne third of five-year breast cancer survivors developed incident diseases during 14 years of follow-up, with about the same incidence as women without breast cancer. Mortality associated with any incident disease was similar among breast cancer survivors (MRR = 7.1, 95% confidence interval (CI): 6.7, 7.4) and comparison women (MRR = 7.5, 95% CI: 7.3, 7.7). Among breast cancer patients, relative mortality associated with incident diseases was higher among patients treated with chemotherapy (MRR = 10, 95% CI: 8.7, 12) and radiotherapy (MRR = 9.8, 95% CI: 8.8, 11) than among patients who received surgery (MRR = 7.0, 95% CI: 6.7, 7.4) or hormonal therapy (MRR = 6.3, 95% CI: 5.8, 6.9).ConclusionThere were no marked differences in mortality of diseases among breast cancer survivors and women from the general population. Among breast cancer patients, new diseases were more often fatal in patients treated with chemotherapy and radiotherapy. Five-year breast cancer survivors have similar risk of dying from new chronic medical conditions as women from the general population without breast cancer.     

Clinical effectiveness of neoadjuvant chemotherapy in advanced gastric cancer: An updated meta-analysis of randomized controlled trials

Aims

To assess the efficacy and safety of neoadjuvant chemotherapy (NAC) for advanced gastric cancer (AGC).

Methods

By searching electronic databases (PubMed, Embase, Cochrane Library) and ASCO proceedings from 1990 to 2012, all randomized controlled trials (RCTs) which compared the effect of NAC-combined surgery versus surgery alone in AGC were included. All calculations and statistical tests were performed using RevMan 5.0 software.

Results

12 RCTs with a total of 1820 patients were included. All patients had locally advanced but resectable gastric cancer and received NAC. NAC can slightly improve the survival rate (OR = 1.32, 95% confidence interval (CI): 1.07–1.64, P = 0.01), with little or no significant benefits in subgroup analyses between either different population or regimens. NAC can significantly improve the 3-year progression-free survival (PFS) (OR: 1.85, 95% CI: 1.39–2.46, p < 0.0001), tumor down-staging rate (OR: 1.71, 95% CI: 1.26, 2.33, p = 0.0006) and R0 resection rate (OR: 1.38, 95% CI: 1.08–1.78, P = 0.01) of patients with AGC. There was no difference between the two arms, in terms of relapse rates (OR: 1.03, 95% CI: 0.60–1.78, p = 0.92), operative complications (OR: 1.20, 95% CI: 0.90–1.58, p = 0.21), perioperative mortality (OR: 1.14, 95% CI: 0.64–2.05, p = 0.65) and grade 3/4 adverse effects: gastrointestinal problem (OR: 0.57, 95% CI: 0.25–1.30, p = 0.18), leukopenia (OR: 0.88, 95% CI: 0.41–1.91, p = 0.75), thrombocytopenia (OR: 1.27, 95% CI: 0.27–5.93, p = 0.76).

Conclusion

NAC is effective and safe. However, further prospective multi-national and multi-center RCTs are still needed in order to investigate the long-term oncological and functional outcomes to define the clinical benefits of NAC and the most effective strategies for AGC.     

Prophylaxis with itraconazole is more effective than prophylaxis with fluconazole in neutropenic patients with hematological malignancies: a meta-analysis of randomized-controlled trials

Antifungal prophylaxis using fluconazole or itraconazole has been studied for many years but still no consensus has been reached regarding their safety and effectiveness. We performed a systematic meta-analysis to assess the efficacy of fluconazole compared to itraconazole in neutropenic patients with hematological malignancies. We gathered the data for our analysis from MEDLINE, EMBASE, Cochrane-controlled trials register, Cochrane Library, and Science Citation Index (1/1990 to 1/2009) searches. Risk ratio (RR) and 95% confidence intervals (CIs) were calculated using the random effect model. Nine RCTs were identified that were published in full text. Significantly, fewer patients were withdrawn from the studies due to the development of adverse effects with fluconazole prophylaxis when compared with itraconazole (RR 0.45, 95% CI 0.27–0.75, P = 0.002). There were statistically significant differences regarding fungal infections (RR 1.34, 95% CI 1.08–1.67, P = 0.009) and invasive fungal infections (RR 1.33, 95% CI 1.02–1.73, P = 0.03) between the two educations. There were no statistically significant differences regarding overall mortality (RR 0.95, 95% CI 0.77–1.17, P = 0.64), fungal-related mortality (RR 1.28, 95% CI 0.80–2.07, P = 0.31), and proven fungal infections (RR 1.38, 95% CI 0.75–2.53, P = 0.30). The analysis of published evidence reveals that itraconazole administration resulted in significantly fewer episodes of fungal infections and invasive fungal infections compared with fluconazole.     

Survival benefit from S‐1 as compared to Fluorouracil in Asian patients with advanced gastrointestinal cancer: A meta‐analysis

Whether S‐1 could replace 5‐Fluorouracil (5‐Fu) or not in the treatment of advanced gastrointestinal (GI) cancer (including advanced gastric cancer [AGS] and metastatic colorectal cancer [mCRC]) in Asian patients has been controversial. This meta‐analysis was performed to compare the activity, efficacy and toxicity of S‐1‐based versus 5‐Fu‐based chemotherapy in those Asian patients. Randomized controlled trials (RCTs) were identified by electronic search of Pubmed. Relevant abstracts were manually searched to identify relevant trials. A total of 2182 patients from eight RCTs were included, and our results demonstrated that S‐1‐based chemotherapy significantly improved overall survival (OS) (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.77–1.00) and overall response rate (ORR) (odds ratio [OR], 1.72; 95% CI, 1.09–2.70), but no significant progression‐free survival (PFS) benefit was found between arms (HR, 0.87; 95% CI, 0.72–1.06). Subgroup analyses revealed that S‐1‐based chemotherapy significantly improved OS and ORR in subgroups of patients with non‐platinum containing regimens (P = 0.041; P = 0.034) and patients with no prior chemotherapy history (P = 0.025; P = 0.016). Statistically significant improvements of PFS and ORR in the S‐1‐based chemotherapy were observed in the subgroup of patients with AGC (P < 0.001; P = 0.005). S‐1‐based chemotherapy was characterized by significantly higher incidences of diarrhea, fatigue and thrombocytopenia, and a lower incidence of nausea. This analysis provided strong evidence for survival benefits of S‐1, and S‐1‐based chemotherapy could be considered to replace 5‐Fu‐based therapy for the treatment of advanced GI cancer in Asian patients.     

Genetic variations in transcription factor 7-like 2 (<Emphasis Type="Italic">TCF7L2)</Emphasis> gene: association of <Emphasis Type="Italic">TCF7L2</Emphasis> rs12255372(G/T) or rs7903146(C/T) with breast cancer risk and clinico-pathological parameters

The purpose of the present study was to evaluate the association between TCF7L2 rs12255372(G/T) or rs7903146(C/T) polymorphism and breast cancer risk, and clinico-pathologic characteristics of the patients. Genotyping of these polymorphisms was performed on 387 breast cancer patients and 252 normal and healthy women who had no history of any malignancy using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) method in a hospital-based Malaysian population. The allele (P = 0.033) frequency of rs7903146 (T) polymorphism was significantly higher in the cancer patients than normal individuals. No significant association was demonstrated between CT (OR^adj = 1.386; 95% CI, 0.985–1.949) or TT (OR^adj = 1.579; 95% CI, 0.869–2.870) genotype and breast cancer risk. However, women who were carriers of T allele (OR^adj = 1.316; 95% CI, 1.022–1.695) or T allele genotype (OR^adj = 1.419; 95% CI, 1.027–1.960) showed significant increased risk of breast cancer. Women who were GT heterozygotes (OR^adj = 1.329; 95% CI, 0.948–1.862) or TT homozygotes (OR^adj = 1.574; 95% CI, 0.829–2.987), and carriers of T allele genotype (OR^adj = 1.365; 95% CI, 0.989–1.883) or T allele (OR^adj = 1.284; 95% CI, 0.995–1.657) were not associated with breast cancer risk. The rs7903146(T) allele genotype was significantly associated with nodal involvement (P = 0.003) but rs12255372 (T) allele genotype was not associated with the clinico-pathologic characteristics. In conclusion, our findings suggest that rs7903146 (T) variant may elevate the risk of breast cancer, thus could be a potential candidate for breast cancer susceptibility. The variant may also increase the metastatic potential of the tumor.     

Targeted therapies in patients with newly diagnosed glioblastoma—A systematic meta-analysis of randomized clinical trials

Glioblastoma (GB) is the most common malignant primary brain tumor in adults. The standard of care for newly diagnosed GB involves surgical resection followed by radiochemotherapy with temozolomide, with or without tumor-treating fields. In recent years, various efforts have been made to identify suitable molecularly targeted treatment options for malignant brain tumors. This meta-analysis provides an overview of recently published randomized controlled trials (RCTs) with and without molecular stratification, analyzing targeted agents in patients with newly diagnosed GB. The Cochrane Library, MEDLINE (Ovid), ClinicalTrials.gov , WHO's International Clinical Trials Registry Platform, and Google Scholar were searched for RCTs on targeted therapies in patients with newly diagnosed glioblastoma. Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were extracted and pooled in a random-effects meta-analysis. Twelve RCTs (n = 3941 patients) involving protein kinase inhibitors, proteasome and histone deacetylase inhibitors, anti-angiogenic approaches and poly (ADP-ribose) polymerase (PARP) inhibitors were included in the meta-analysis. None of the targeted agents achieved a significant benefit with regard to OS (HR = 0.98 [95% confidence interval (CI) 0.86-1.11, P = .7731]). By comparison, targeted therapy showed a benefit for PFS (HR = 0.83 [95% CI 0.74-0.94, P = .0037]), especially for patients with an unmethylated O6-methylguanine-DNA-methyltransferase (MGMT) promoter (0.75 [95% CI 0.56-0.99, P = .0440]). Prolongation of PFS was largely driven by VEGF inhibition with bevacizumab (HR = 0.70 [95% CI 0.61-0.80, P = .0000]). VEGF inhibition with bevacizumab prolonged PFS in patients with newly diagnosed glioblastoma compared to standard care. However, no improvement in OS was observed with any of the targeted agents.     

Associations between XPD polymorphisms and risk of breast cancer: a meta-analysis

Studies on polymorphisms of Xeroderma Pigmentosum Group D Protein (XPD) and breast cancer risk are inconclusive. To elucidate the role of XPD genotypes, all available studies were considered in this meta-analysis. The study provided 11,362/10,622 cases/controls for XPD K751Q and 9010/9873 cases/controls for XPD D312N, respectively. Overall, no apparent effects of 751Q allele compared to 751K on breast cancer risk was found in all subjects [RE OR = 1.04, 95% confidence interval (CI) (0.97–1.10), P = 0.28]. Insignificant effects were also found under other genetic contrasts (homologous contrast, dominant model, and recessive model). However, the 751Q allele showed significantly increased risk in Caucasians [FE OR = 1.05, 95% CI (1.00–1.11), P = 0.035]. In addition, insignificant risk effects of D312N polymorphism on breast cancer susceptibility were observed in all subjects under any genetic contrast, but protective effects of 312NN genotype were observed under recessive model [P = 0.02, OR = 0.53, 95% CI (0.32, 0.90)] and homozygote contrast [P = 0.03, OR = 0.55; 95% CI (0.32, 0.96)] in Asians. In summary, our meta-analysis suggested 312N allele might act as a recessive allele in its association with breast cancer and the 751Q allele may play a plausible role in breast cancer development whereas the ethnic background should be carefully concerned in further studies.     

Obstructive sleep apnoea and the incidence and mortality of cancer: a meta‐analysis

As there are conflicting reports regarding the association between obstructive sleep apnoea (OSA) and cancer incidence and mortality, a meta‐analysis was performed to evaluate whether OSA is independently associated with cancer incidence and mortality. Pubmed, EMBASE and Web of Science were searched up until November 2014. Studies that assessed OSA and the future risk of cancer incidence or mortality were included. Pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) were calculated. Subgroup analysis was conducted based on the polysomnographic variable, apnoea–hypopnoea index. Six studies, which involved 114 105 participants, were pooled in this meta‐analysis. Fixed‐effects analysis showed the pooled adjusted HR of cancer incidence as 0.91 (95% CI, 0.74–1.13; P = 0.408) for mild OSA, 1.07 (95% CI, 0.86–1.33; P = 0.552) for moderate OSA and 1.03 (95% CI, 0.85–1.26; P = 0.743) for severe OSA. Random‐effects analysis demonstrated neither mild OSA (adjusted HR, 0.79; 95% CI, 0.46–1.34; P = 0.381), moderate OSA (adjusted HR, 1.92; 95% CI, 0.63–5.88; P = 0.251) nor severe OSA (adjusted HR, 2.09; 95% CI, 0.45–9.81; P = 0.349) correlated with cancer mortality. This meta‐analysis indicates that OSA is not independently associated with cancer incidence and mortality according to currently available data. Additional experimental and human research is required to determine the exact association between OSA and cancer.     

Acupuncture for treating hot flashes in breast cancer patients: a systematic review

The objective of this review was to assess the effectiveness of acupuncture as a treatment option for hot flashes in patients with breast cancer. We searched the literature using 14 databases from their inceptions to August 2008, without language restrictions. We included randomised clinical trials (RCTs) comparing real with sham acupuncture or another active treatment or no treatment. Their methodological quality was assessed using the modified Jadad score. Three RCTs compared the effects of manual acupuncture with sham acupuncture. One RCT showed favourable effects of acupuncture in reducing hot flash frequency, while other two RCTs failed to do so. The meta-analysis show significant effects of acupuncture compared with sham acupuncture (n = 189, weight mean difference, 3.09, 95% confidence intervals −0.04 to 6.23, P = 0.05) but marked heterogeneity was observed in this model (χ ² = 8.32, P = 0.02, I ² = 76%). One RCT compared the effects of electroacupuncture (EA) with hormone replacement therapy. Hormone therapy was more effective than EA. Another RCT compared acupuncture with venlafaxine and reported no significant intergroup difference. A further RCT compared acupuncture with applied relaxation and failed to show a significant intergroup difference. In conclusion, the evidence is not convincing to suggest acupuncture is an effective treatment of hot flash in patients with breast cancer. Further research is required to investigate whether there are specific effects of acupuncture for treating hot flash in patients with breast cancer.