Treatment guidelines for systemic adjuvant therapy of breast cancer

The rapidly growing body of knowledge provided by an efficient clinical trials process requires periodic revisions of clinical practice guidelines. These guidelines are prepared by experts whose delicate task is to digest the evidence provided by the clinical trials which may indicate a weak or a strong average treatment effect for a patient population and to translate this evidence into implications for individual patient care. Guidelines are thought to enhance the quality of care by reducing under-treatment, over-treatment and wrong treatment. At least one study has shown an adverse impact on overall mortality if treatment guidelines are not followed. Guidelines that have authority in the adjuvant treatment of breast cancer are the NIH and NCCN guidelines, those developed in St. Gallen and those by Japan Breast Cancer Society.     

Systemic adjuvant therapy in women with resected node-negative breast cancer

Currently, the role of adjuvant systemic therapy in women with node-negative breast cancer is being determined. Several studies of adjuvant hormonal therapy and adjuvant chemotherapy have demonstrated a moderate reduction in the risk of recurrence in the treated patients. With relatively limited follow-up, however, overall survival has not improved with use of adjuvant therapy. The use of prognostic factors to select those patients at highest risk for relapse is an active area of oncologic research. The decision to recommend adjuvant therapy necessitates assessment of the probability of recurrence, the expected reduction of risk with adjuvant therapy, the toxic effects of therapy, and the influence of treatment on the patient's overall quality of life.     

乳腺癌病人的术后护理

乳腺癌是威胁妇女生命的常见恶性肿瘤之一。因根治手术切除组织多,伤口创面大,胸部明显畸形,影响妇女的外观形象,所以有计划地做好心理、生理及康复功能的护理尤为重要[1]。术后的早期护理决定预后,所以应重视术后48h内的早期护理。1一般资料选择2008年1月—2010年10月在我院行乳癌根治术的     

Improving quality of life: adjuvant psychological therapy for patients with cancer

The present paper describes a psychological treatment programme — Adjuvant Psychological Therapy (APT) — that has been developed specifically for patients with cancer-related psychosocial disorders. APT is brief (average six sessions), directed at current problems and conducted with individual patients together with their partners or spouses, if possible. Therapy focuses on the personal meaning of cancer to the patient and his or her coping strategies. An outline of APT together with a clinical ilustration is given. A randomised trial has demonstrated that APT produces significant improvement in psychological distress and thus in the quality of life of patients with cancer.Presented at the Symposium Psychotherapeutic Interventions in Cancer Patients, Flims, Switzerland, 12–14 January 1995     

Influence of adjuvant chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil on plasma melatonin and chosen hormones in breast cancer premenopausal patients

OBJECTIVE: To investigate the effect of chemotherapy on levels of melatonin in patients with breast cancer. BACKGROUND: In light of reports on the possible oncostatic role of melatonin in breast cancer patients, it is essential to know the influence of adjuvant chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) on plasma melatonin concentration as well as on its contributing factors, e.g. current hormonal state of the organism. The combination therapy is one of the oldest, safest and most commonly prescribed adjuvant treatments. METHOD: Twenty-four breast cancer patients on CMF chemotherapy were studied along with a control group of 16 healthy pre-menopausal women. RESULTS: Plasma melatonin concentration (determined by RIA method) in breast cancer patients prior to treatment did not differ significantly from that of healthy women, but it was significantly increased after the initial cycle of CMF, and significantly increased as compared to a group of healthy women. We did not notice any significant interactions between plasma melatonin and growth hormone, prolactin, estradiol, progesterone, cortisol and met-enkephalin concentrations in all studied groups. CONCLUSION: The possible oncostatic action of melatonin warrants further investigation to elucidate whether the induced increase of blood melatonin concentration is essential to successful CMF chemotherapy.     

Self-reported cognitive problems in women receiving adjuvant therapy for breast cancer.

Self-reported cognitive problems are common among women receiving adjuvant therapy for breast cancer but are unrelated to actual cognitive impairment. To date, no studies have objectively measured impairment and asked patients to speak about the type and extent of problems they encounter. We report interview data from 142 breast cancer patients receiving adjuvant therapy. We aimed to identify the types of problems and the extent to which they interfered with everyday life. We investigated the relationship between self-reported and objective cognitive impairment, quality of life and psychological distress. The majority of participants reported problems with their memory (71% overall at 6 months, 60% at 18 months) and concentration (64% and 42%, respectively). This was unrelated to objective cognitive decline; rather, it was associated with psychological distress and quality of life. For the vast majority, the problems reported were everyday slips and lapses. The neuropsychological measures routinely used may lack the sensitivity to detect these subtle changes experienced by this group. In addition, the effects of mood on cognition may be more important in everyday life than in the highly structured neuropsychological test situation. Future research should focus on developing cognitive assessments that tap everyday functioning.     

Dose-dense adjuvant chemotherapy for breast cancer

Dose intensity, the amount of drug delivered per unit of time, is an important predictor of outcome in adjuvant chemotherapy for breast cancer. It can be increased by using higher doses of chemotherapy (dose escalation) or by shortening the interval between cycles (dose density). Dose-escalation strategies (adjuvant high-dose chemotherapy with bone marrow or peripheral blood progenitor cell support) have shown no benefit in patients with breast cancer. In contrast, dose-dense regimens (given every 2 weeks) are associated with greater disease-free and overall survival than are conventional, 3-week regimens. Toxicity with dose-dense regimens should be managed as it is with conventional regimens, but the timing of interventions may differ, and supportive care, such as providing granulocyte colony-stimulating factor support in all cycles of chemotherapy to reduce the incidence and duration of neutropenia, can help facilitate the safe delivery of dose-dense regimens. Oncology nurses should be involved in developing and implementing educational plans that help patients become aware of the potential advantages of dose-dense therapy and the potentially greater risk of toxicity. With conventional and dose-dense regimens alike, maintaining dose intensity through the optimal management of adverse events can help ensure better outcomes.     

Antibody therapy for early-stage breast cancer: trastuzumab adjuvant and neoadjuvant trials

The HER2/neu gene is amplified in ～ 25% of breast cancers; amplification is associated with an aggressive course. Her2/neu activation initiates signalling cascades that result in proliferation, angiogenesis and survival of breast cancer cells. Trastuzumab is a monoclonal antibody against Her2. Binding of the antibody activates an immune response and decreases Her2 phosphorylation, phosphatidylinositol 3-kinase (PI3K)/Akt activity and vascular endothelial growth factor levels. When trastuzumab is used preoperatively, apoptosis is seen in resected tumours. In the adjuvant setting, large, randomised trials demonstrate improved outcome for trastuzumab with chemotherapy followed by a year of trastuzumab. In a combined analysis of two such studies, overall survival was improved (hazard ratio for death 0.67, p = 0.015). The agent has associated cardiotoxicity. Trastuzumab is a highly active agent in Her2-overexpressing breast cancer.     

Antibody therapy for early-stage breast cancer: trastuzumab adjuvant and neoadjuvant trials

The HER2/neu gene is amplified in approximately 25% of breast cancers; amplification is associated with an aggressive course. Her2/neu activation initiates signalling cascades that result in proliferation, angiogenesis and survival of breast cancer cells. Trastuzumab is a monoclonal antibody against Her2. Binding of the antibody activates an immune response and decreases Her2 phosphorylation, phosphatidylinositol 3-kinase (PI3K)/Akt activity and vascular endothelial growth factor levels. When trastuzumab is used preoperatively, apoptosis is seen in resected tumours. In the adjuvant setting, large, randomised trials demonstrate improved outcome for trastuzumab with chemotherapy followed by a year of trastuzumab. In a combined analysis of two such studies, overall survival was improved (hazard ratio for death 0.67, p = 0.015). The agent has associated cardiotoxicity. Trastuzumab is a highly active agent in Her2-overexpressing breast cancer.     

Patients' reactions to completion of adjuvant breast cancer therapy.

Thirty-eight women with breast cancer were studied to determine the psychological distress they experienced at the completion of adjuvant treatment. Measures were completed at the start of adjuvant chemotherapy, one week after chemotherapy was completed, and following completion of radiotherapy. Approximately 30% of the women reported the termination of treatment was upsetting. For the group as a whole, depression scores decreased significantly from the first to the last measurement. Those who were most upset by termination of treatment had been more depressed since the onset of treatment, tended to view their illness as chronic rather than acute, and had more side effects during their last cycle of chemotherapy. Some women stated they were upset by the termination of treatment per se, but many other problems were reported including side effects that had continued after treatment ended.