A Feasibility Study on the Identification of Postlumpectomy Seromas by a Radiation Therapist Compared with That by Radiation Oncologists in Radiation Therapy Planning for Early Stage Breast Cancer

IntroductionComputed tomography (CT) simulation is currently used to identify the tumour bed in patients with early stage breast cancer requiring whole-breast and boost radiation therapy. Postlumpectomy breast seromas as visible on CT data have been identified as a proxy for the tumour bed. This study aims to quantify the incidence of postsurgical tumour bed seromas identified at CT simulation and report how well a radiation therapist (RT) is able to identify these seromas compared with those contoured by radiation oncologists (ROs).Methods and MaterialsA study was undertaken on electronic patient records and the CT-simulation datasets of early stage breast cancer patients treated in 2013 at the Calvary Mater Newcastle to identify the presence of seromas. Patient and tumour characteristics were reviewed. Data analysed included seroma volumes, as contoured by the ROs, as part of the standard voluming procedure. One RT rated seroma visibility based on the level of difficulty when viewing the seroma.ResultsOut of 108 CT datasets, an RT was able to identify the presence of a seroma in 102 cases vs. 104 as contoured by ROs. The number of observed agreements was 106 (98.15% of the observations), and the number of agreements expected by chance was 98.4 (91.15% of the observations). The Kappa statistics equalled 0.791 (SE of kappa = 0.143). The strength of agreement is considered to be “substantial.”ConclusionRTs play an integral role in contouring during the planning process, and there is scope to expand this role. This research introduced the first step by confirming that a radiation therapist is able to identify seromas on CT-simulation data when compared those contoured by an RO.     

Impact of Self-Reported Exercise on Recounted Levels of Fatigue and Anxiety in Early-Stage Breast Cancer Radiation Therapy Patients

PurposeExercise may be an alternative strategy to helping early-stage breast cancer (ESBC) patients manage their cancer-related fatigue and anxiety during radiation therapy. This observational study aims to investigate the impact of self-reported exercise on fatigue and anxiety levels pre (T0), mid (T1), and post (T2) radiation therapy in patients with ESBC.MethodsFollowing informed consent, subjects completed three standardized questionnaires measuring physical activity, fatigue/quality of life, and anxiety at T0, T1, and T2.ResultsA total of 58 female patients (57 ± 9 years) completed this study. Mean activity level at T0 was 2548 (3292) metabolic equivalent units (METs), T1 was 3072 (3974) METs, and T2 was 2963 (2442) METs. There was no significant change between the three time points with measures of physical activity. Many patients moved from the moderately active group at T0 to the active group at T1. The mean T0 score using the quality of life questionnaire was 38.97 (11.30), T1 was 36.93 (11.69), and T2 was 35.36 (11.18). There was no significant change between the three time points with measures of quality of life (P = .211). There was statistical significance at P = .025 at T1 for lower quality of life compared to T0 across all exercise types. There was also statistical significance at P = .026 at T1 for the active group with higher quality of life compared to the inactive one. All three physical activity categories showed a decline in quality of life scores over time. Anxiety decreased between the three time point measurements. Mean T0 score for anxiety was 47.33 (5.95), T1 was 43.16 (6.49), and T2 was 38.48 (8.46). The interaction of exercise level and time is not significant for anxiety (P = .91). There was statistical significance (P = .015) for anxiety at T2 compared to T1 across exercise types.DiscussionThis study demonstrated that ESBC patients showed signs of fatigue and anxiety while undergoing radiation therapy regardless of self-reported exercise measured by a physical activity questionnaire. Several trends were observed that showed improved outcomes for patients consistent with previously published studies. The present study highlights a nonsignificant change in fatigue. As fatigue is one of the main side effects from radiation, it may be difficult to demonstrate significance. There are some studies in the field that demonstrate significance between fatigue and exercise with larger sample sizes. The results also highlight a decrease in anxiety from the baseline to the end of treatment. It is postulated that patients become less anxious as treatment progresses due to familiarity of a routine. The present study is limited by several factors including sample size and the study not being a randomized controlled one.ConclusionsExercise may reduce anxiety during radiation treatment for ESBC patients. Further investigation is required to assess the impact of fatigue.     

Needs as Expressed by Women after Breast Cancer Surgery in the Setting of a Short Hospital Stay

The aim of this study was to describe needs as expressed by a group of women after surgery for breast cancer in the setting of a short hospital stay. Ten days after surgery, 97 women answered an open-ended question about their perception of the care given. A content analysis inspired by the method of Grounded Theory was used. Satisfaction with the personal treatment and feelings of abandonment were identified as the two main themes. Expressed needs (n = 113) were classified in five categories: Trust, Information, Practical Assistance, Personal Treatment and Emotional Support, of which Trust appeared to be the core concept. In addition, time and space emerged as two dimensions that were interwoven with the categories of needs. The patients' perception of trust in the staff was interpreted as depending on whether the needs in the other categories were satisfied or not. It is hypothesized that, to fulfil the patients' need of trust, the patients have to be satisfied at least with information, practical assistance, personal treatment and emotional support. We consider that, in an organization with a high degree of continuity, when the patients are aware of the physician and nurse responsible, the possibilities for trust are increased, especially in short hospital stays.     

Gait Speed vs. VES-13: A Pilot Study Comparing Screening Tools to Determine the Need for a Comprehensive Geriatric Assessment in Senior Women with Breast Cancer

Background/ObjectivesPatients aged 70 years and older may be suboptimally treated with cancer therapy because of the lack of clinical trial data in this population. The Comprehensive Geriatric Assessment can be time consuming, and access to geriatricians is limited. This study aims to determine whether gait speed (GS) analysis is equivalent to the widely accepted Vulnerable Elders Survey 13 (VES-13) in identifying vulnerable or frail patients in need of a Comprehensive Geriatric Assessment.MethodsA pilot prospective cohort study was carried out at a tertiary cancer centre in Toronto, Canada, in a radiation oncology breast follow-up clinic. GS analysis and VES-13 were completed by each patient at the same clinic visit. GS of <1 meter/second (m/s) and VES-13 score ≥3 were considered abnormal. Sensitivity, specificity, positive and negative predictive values, and Kappa characteristic were calculated for GS compared with VES-13.Results and DiscussionTwenty-nine participants aged 70 years and older with any stage of breast cancer were included. The GS was 67% sensitive and 95% specific for abnormal VES-13 scores. The GS had an 86% positive predictive value and 86% negative predictive value for abnormal scores on VES-13. Overall, the GS showed a substantial strength of agreement with the VES-13 (kappa 0.66, P < .0001).ConclusionThe GS analysis compared very well with VES-13 scores, and this may be a reasonable alternative to VES-13 screening. This pilot data warrant further study in a larger group of patients.