Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life

Sleep duration among breast cancer survivors correlates with fatigue, depression, and health-related quality of life (HRQOL); however, this has not been studied longitudinally. This study investigated patterns of sleep duration change across the early breast cancer survivorship period, their demographic and clinical predictors, and their relationships with subsequent cancer-related symptoms and HRQOL. Breast cancer survivors (n = 572), were assessed 6 months post-diagnosis (current sleep & retrospective reports of pre-diagnosis sleep), 30 months post-diagnosis (sleep), and 39 months post-diagnosis (symptoms, HRQOL). Sleep duration change was determined by examining sleep at each time point in relation to published norms. Analysis of variance and logistic regression models tested demographic and clinical differences between the sleep change groups; linear regression models tested differences in symptoms and HRQOL. Half of the survivors reported no sleep duration change over time; however, 25% reported sleep changes indicating a temporary (5.6%), late-occurring (14%), or sustained (5.9%) change. Survivors reporting sustained or temporary sleep changes were more likely to have been treated with chemotherapy (OR = 2.62, P < 0.001) or gained weight after diagnosis (OR = 1.82, P = 0.04) than those with no sleep change. Sustained sleep changes were related to greater subsequent severity, affective, and sensory aspects of fatigue (βs = 2.0, 2.3, 1.8; all P < 0.0001) and lower vitality (β = −10.8, P = 0.005). Survivors treated with chemotherapy and those who gain weight after diagnosis may have increased risk for sustained sleep duration changes, which may increase their fatigue. These results point to the need for routine assessment of sleep as part of survivorship care.     

Sources of meaning in cancer patients – influences on global meaning,anxiety and depression in a longitudinal study

Although existential needs are highly prevalent in patients with cancer, specific sources of meaning have been little explored. We investigated whether specific sources of meaning predict global meaning and psychological distress. N = 258 patients with breast (45%), lung (39%) and gynaecological cancer (16%) completed a battery of validated questionnaires at T1. Six months later (T2), n = 183 (78%) patients participated again. The primary outcomes – sources of meaning, global meaning and psychosocial distress – were measured with the Sources of Meaning Profile‐Revised (SOMP‐R), Life Attitude Profile‐Revised (LAP‐R) and modules for depression and anxiety of the Patient Health Questionnaire (PHQ‐9, GAD‐7). Most important sources of meaning were ‘engaging in personal relationships’, ‘preserving human values and ideals’ and ‘feeling financially secure’. Stepwise multivariate regression analyses controlling for demographic and medical factors revealed that ‘engaging in personal relationships’, ‘preservation of culture and tradition’ and ‘interest in social and/or political causes’ predicted lower depression. ‘Leaving a legacy for the next generation’ and ‘feeling financially secure’ predicted both higher depression and anxiety. The findings highlight the relevance of sources of meaning for the psychological well‐being of cancer patients and point towards specific sources of meaning that should be focused in psychosocial interventions.     

Correlates of quality of life-related outcomes in breast cancer patients participating in the Pathfinders pilot study

Objective: In a pilot study, participation in the Pathfinders program was associated with reductions in distress and despair and improvements in quality of life (QOL) among advanced breast cancer patients. This study explores the relationship between psychosocial resources invoked through the Pathfinders intervention and outcomes. Methods: Advanced breast cancer patients were enrolled in a prospective, single‐arm, pilot study of the Pathfinders psychosocial program. Participants met at least monthly with a licensed clinical social worker who administered the Pathfinders intervention, which focused on strengthening adaptive coping skills, identifying inner strengths, and developing a self‐care plan. Longitudinal assessments over 6 months used validated instruments to assess changes in Pathfinders targets (coping, social support, self‐efficacy, spirituality, and optimism) and outcomes (distress, despair, QOL, and fatigue). Multiple linear regression models examined the joint effect of average changes in target subscales on average outcome changes, adjusted for baseline outcome scores and patient characteristics. Results: Participants (n=44) were: mean age 51 (SD, 12), 20% non‐Caucasian, 50% college degree, and 75% married. Improvements in active coping skills, self‐efficacy, and spiritual meaning/peace significantly correlated with an improvement in despair after adjustment for demographic characteristics (all P<0.05). Improvements in social support significantly correlated with positive changes in distress (P<0.05). Gains in learned optimism independently correlated with an increase in overall QOL (P<0.01). Conclusions: In this pilot assessment, changes in pre‐defined Pathfinders targets such as coping skills, social support, self‐efficacy, spirituality, and optimism correlated with improvements in patient‐reported outcomes. Copyright © 2010 John Wiley & Sons, Ltd.     

Phase II study of a new vinca alkaloid derivative,S12363, in advanced breast cancer

Vinca alkaloids are widely used in the medical treatment of breast cancer. Our study aimed to evaluate the therapeutic activity of a new vinca alkaloid derivative, S12363 (vinfosiltine), which is 36 and 72 times more cytotoxic in vitro than vincristine and vinblastine, respectively. Because phase I studies did not allow a choice of the best treatment schedule, a randomization was performed between two schedules with the same dose intensity, that is, 0.3 mg/m² given weekly or 0.6 mg/m² given every 2 weeks. A total of 16 patients with advanced breast cancer who had failed a first-line treatment without any vinca alkaloid were entered in the study. Additionally, 6 women received the bimonthly regimen as first-line treatment of advanced breast cancer. Altogether, 17 patients received, prior to vinfosiltine, an anthracycline-based regimen given either as adjuvant (n=4) or as first-line palliative treatment (n=13). All 22 patients were evaluable for both toxicity and response. Neutropenia was the main toxic event (maximal toxicity per patient) with grade 3 (WHO) toxicity developing in 7/22 patients and grade 4, in 8/22. Other severe toxicities included leukopenia (n=9), anemia (n=1), diarrhea (n=1), constipation (n=1), and fatigue (n=1). No patient achieved a complete or partial response. Vinfosiltine does not appear to have significant single-agent activity in advanced breast cancer at the doses and the schedules used in our study.     

Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy

Purpose Exercise during breast cancer chemotherapy is beneficial but it needs to be maintained into survivorship to optimize long-term benefits. Here, we report the predictors of follow-up exercise behavior 6 months after a randomized exercise trial in breast cancer patients. Methods Breast cancer patients (N = 242) initiating adjuvant chemotherapy were randomly assigned to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy. At baseline and postintervention, data were collected on demographic, medical, behavioral, fitness, psychosocial, and motivational variables. At 6-month follow-up, participants were mailed a questionnaire that assessed exercise behavior over the past 6 months and were categorized as either meeting both aerobic and resistance exercise guidelines, either exercise guideline, or neither exercise guideline. Results Two hundred one (83.1%) participants provided 6-month follow-up data with 85 (42.3%) meeting neither exercise guideline, 74 (36.8%) meeting either exercise guideline, and 42 (20.9%) meeting both exercise guidelines. In multivariate regression analysis, seven variables independently predicted the likelihood of meeting exercise guidelines at follow-up including higher pretrial exercise (β = 0.23; P = 0.002), younger age (β = −0.15; P = 0.028), breast conserving surgery (β = 0.15; P = 0.033), strength improvements (β = 0.15; P = 0.028), lower postintervention fatigue (β = 0.13; P = 0.067), a more positive attitude (β = 0.12; P = 0.086), and lower postintervention body mass index (β = −0.11; P = 0.105). Conclusion Exercise behavior 6 months after a randomized trial was predicted by a wide range of demographic, medical, behavioral, fitness, psychosocial, and motivational variables. These findings may help facilitate the uptake of exercise behavior during the transition from breast cancer patient to survivor.     

Psychological effects of a cosmetic education programme in patients with breast cancer

Treatments for breast cancer often include interventions related to psychosocial issues such as negative body image, loss of femininity, and low self‐esteem. We identified the psychological effects of a cosmetics education programme in patients with breast cancer. Cosmetic programme is a specific care designed to help patients handle appearance‐related side effects. Thirty‐one women with breast cancer at a university hospital in South Korea who received a cosmetics education programme were compared with 29 subjects in a control group who received the treatment as usual. Psychological factors including distress, self‐esteem, and sexual functioning were assessed three times (before and after the programme, and at the 1‐month follow‐up). After the programme, patients in the treatment group were significantly less likely than those in the control group to rely on distress (P = 0.038) and avoidance coping (P < 0.001) but not on self‐esteem. The mean scores in the treatment group for sexual functioning were higher than those in the control group after the treatment. Our results suggest the potential usefulness of a brief cosmetics education programme for reducing distress and reliance on negative coping strategies. Implementing a cosmetics programme for patients with breast cancer may encourage patients to control negative psychological factors.     

Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors

BACKGROUND:

Health‐related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may explain partially the higher mortality for breast cancer in certain racial/ethnic subgroups. In this study, associations between PA, BMI, and HRQOL by race were examined in a sample of breast cancer survivors.

METHODS:

Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N = 3013, 13% nonwhite) who participated in the Women's Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were 2‐sided.

RESULTS:

African American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < .05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P < .05) and vitality (point differences ranged from 9.9 to 16.5 points, all P < .05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian American and African American women and stronger associations for whites.

CONCLUSIONS:

Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL. Cancer 2012. © 2012 American Cancer Society.     

A polymorphism in the G protein β3-subunit gene is associated with bone metastasis risk in breast cancer patients

Breast cancer is the most frequently diagnosed cancer among women in western countries and bone metastases of breast cancer cause significant morbidity. G proteins are important components of a multitude of transmembrane receptors and are involved in the regulation of intracellular signaling pathways such as parathormone receptors 1 and 2 (PTH1 and 2), extracellular calcium-sensing receptor, the calcitonin receptor and the OPG/RANKL-system. A common polymorphism in the gene encoding the G protein β3-subunit, GNB3 825C > T, has been linked to increased G protein activation. To analyse the role of this polymorphism in bone metastasis of breast cancer, we determined GNB3 825C > T genotypes in 500 female breast cancer patients. According to breast cancer staging, patients were divided in three groups, representing patients without metastases (n = 250), those with metastases other than bone (n = 117), and those with bone metastasis (n = 133). Frequency of the GNB3 825 TT genotype was significantly lower among patients with bone metastases (3.1%) than among those with other metastases (12.8%; P = 0.004) or no metastases (13.3%; P < 0.001). In a Cox regression analysis, relative risk of the GNB3 TT genotype for bone metastasis was 0.22 (95% CI 0.08–0.61; P = 0.004) for bone metastasis. We conclude that the homozygous GNB3 825 TT genotype may be protective against development of bone metastasis in breast cancer patients. The precise mechanism for this remains to be determined, but could be due to a direct involvement of G protein-coupled receptors in bone metabolism.     

Risk factors for local recurrence after breast-conserving therapy

Background. Breast-conserving therapy has been widely accepted as a standard treatment for early breast cancer both in Western countries and in Japan. In Western countries, many studies have investigated the risk factors for local recurrence after breast-conserving therapy (BCT), but few such studies have been done in Japan. Methods. To determine the risk factors for local recurrence in 399 breast cancer patients (stage I and II, n = 396; stage III, n = 3) who had undergone BCT with or without postoperative radiation therapy, we evaluated their clinicopathological features by univariate and multivariate analyses. The patients were treated at Osaka National Hospital between February 1988 and December 1997. Results. Univariate analysis showed that a young age (≤45 years; P = 0.0005) was a significant risk factor for local recurrence, while radiation therapy (P = 0.0058) and adjuvant endocrine therapy (P = 0.0041) significantly reduced the risk of local recurrence. In patients with BCT, without radiation therapy a positive surgical margin significantly increased the risk of local recurrence (P = 0.0470). Multivariate analysis showed that a young age (P = 0.0285) was a significant independent risk factor for local recurrence, while radiation therapy (P = 0.0457) significantly decreased recurrence. In patients with a negative surgical margin, radiation therapy (P = 0.0158) and adjuvant endocrine therapy (P = 0.0421) significantly reduced the relative risk of local recurrence, to 0.160 and 0.366, respectively. In patients with a positive surgical margin, radiation therapy marginally significantly (P = 0.0756) reduced the relative risk of local recurrence, to 0.181, and adjuvant endocrine therapy significantly (P = 0.0119) reduced the risk, to 0.076. Conclusions. Young age and lack of radiation therapy or adjuvant endocrine therapy were risk factors for local recurrence in breast cancer patients treated with breast-conserving therapy, with surgical margin status also being a possible risk factor. Received: November 9, 1998 / Accepted: March 11, 1999     

Vitamin E concentration in breast adipose tissue of breast cancer patients (Kuopio, Finland)

Previous data on animals and humans suggest that vitamin E may be a protective factor against cancer. A low dietary vitamin E intake has been suggested to increase the risk of breast cancer. We examined the dietary intake and the concentration of vitamin E in breast adipose tissue of women in Kuopio, Finland, diagnosed between 1990 and 1992 with benign breast disease (n=34) and with breast cancer (n=32). In postmenopausal women, lower dietary intake (P=0.006) and a smaller concentration of vitamin E in breast adipose tissue (P=0.024) were observed in breast cancer patients than in subjects with benign breast disease. Partial correlation showed that the vitamin E concentration in the breast adipose tissue correlated positively with the dietary intake of vitamin E (r=0.25, P=0.023), indicating that the vitamin E concentration in breast adipose tissue reflects the dietary intake of vitamin E.Drs Zhu and Uusitupa are with the Department of Clinical Nutrition, University of Kuopio, Finland, Dr Parviainen is with the Laboratory of Helsinki University, Central Hospital, Helsinki, Finland. Drs Männistö and Pietinen are with the Department of Nutrition, National Public Health Institute, Helsinki, Finland Dr Eskelinen is with the Department of Surgery, and Dr Syrjänen is with the Department of Pathology, University of Kuopio. Address correspondence to Professor Uusitupa, Department of Clinical Nutrition, University of Kuopio, P.O. Box 1627, FIN-70211 Kuopio, Finland. This study was supported by research grants from the Finnish Cancer Society, and by EVO funding for the Breast Cancer Project of Kuopio Cancer Research Center from the Kuopio University Hospital, Finland.     

Significance of survivin and Bcl-2 homologous antagonist/killer mRNA in detection of bone metastasis in patients with breast cancer

Aim The relation of anxiety and depression levels with characteristics of coping with the disease and quality of life were evaluated in women under follow-up for breast cancer. Materials and Methods Patients who had presented to the breast cancer polyclinics for follow-up were evaluated. The Beck Depression and the State-Trait Anxiety inventories were used in the evaluation of depression and anxiety levels. In order to evaluate their power to cope with cancer, the patients were questioned for a social support network. EORTC QLQ-C30 and QLQ-BR23 questionnaires were applied for quality of life evaluations. Results There were 23 (19%) patients with depression; 3 (2.5%) with grade I anxiety, 94 (77%) grade II, and 23 (19%) grade III anxiety, respectively. Depression and anxiety levels were affected by the following parameters: being unaccompanied by spouse for hospital follow-ups (P < 0.0001); request to get help by a psychologist (P = 0.02); presence of a person to share their problems (P < 0.0001); and using an alternative treatment (P = 0.04). In the quality of life evaluations, difficulty in sleeping, emotional status, fatigue, and body appearance were related with both depression and anxiety (P < 0.05 for all), whereas physical function (P = 0.002), role performance (P = 0.005), cognitive condition (P < 0.0001), social position (P < 0.0001), pain (P < 0.0001), general health (P < 0.0001), treatment methods (P = 0.001), future anxiety (P < 0.0001), and arm symptoms (P = 0.001) were negatively affected in patients with depression. Conclusion High depression and anxiety levels in patients under follow-up for breast cancer influence the coping with cancer and quality of life adversely.     

Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors

Background Leptomeningeal metastasis (LM) occurs in 4–15% of patients with solid tumors. Although the clinical outcomes in cancer patients have been improving recently, no standard treatment for LM has been established as yet. The purpose of this study was to identify the prognostic factors in patients with solid tumors with cytologically proven LM. Methods We retrospectively analyzed a series of 85 consecutive patients with cytologically proven LM who were treated between 1997 and 2005. Results The primary diseases were as follows; lung cancer (n = 36), breast cancer (n = 33), gastric cancer (n = 8), and others (n = 8). Forty-nine patients had brain metastasis at the time of diagnosis of the LM, and in 51 patients, MRI revealed meningeal dissemination in the brain or spine. The performance status (PS) was 0–1 in 26 patients and 2–4 in 59 patients. Thirty-one patients, including 19 with breast cancer, four with lung cancer, five with gastric cancer and three with other cancers, were treated by intrathecal (IT) chemotherapy. The response rate to the IT was 52% (95% confidence interval (CI): 41.4–62.6%). The median survival was 51 days (range, 3–759 days). A univariate analysis identified breast cancer, good PS (0–1), time to development of the LM (>1 year), and treatment by IT chemotherapy as being associated with a good prognosis, and multivariate analysis identified poor PS (HR: 1.72 (95% CI, 1.04–2.86) P = 0.04) and MRI-proven LM (HR: 1.82 (95% CI, 1.11–2.98) P = 0.02) as being associated with a poor prognosis. Conclusion In patients with poor prognostic factors, such as poor PS or MRI-proven LM, palliative therapy might be the most suitable treatment strategy.     

Incidence of anemia,leukocytosis, and thrombocytosis in patients with solid tumors in China

Despite the fact that malignancies are associated with hematological abnormalities, some clinical studies have been unable to detect such a relation. The aim of our study was to detect the prevalence of pretreatment hematologic abnormalities in patients with common solid tumors and to determine if such a profile could be used for prognostic evaluations. We identified all patients in Cancer Center of Sun Yat-sen University who were diagnosed as solid tumors (breast carcinoma, hepatocellular carcinoma, nasopharyngeal carcinoma, esophageal carcinoma, gastric cancer, cervical carcinoma, endometrial cancer, renal cell carcinoma, and non-small cell lung cancer) between January 2000 and August 2009. All subjects were investigated regarding levels of white blood cells, platelets, and hemoglobin concentration. We identified 3,180 patients with solid tumors and 285 patients with benign diseases for the final analysis. The percentages of leukocytosis, anemia, and thrombocytosis in patients with solid tumors ranged from 4.0% to 25.6%, 3.3% to 29.2%, and 2.1% to 9.7%, respectively. The multivariate Cox analysis revealed that anemia was an independent prognostic factor in patients with breast cancer (P = 0.006), hepatocellular carcinoma (P = 0.002), nasopharyngeal carcinoma (P = 0.008), and esophageal carcinoma (P = 0.001). Leukocytosis was an independent prognostic factor in patients with cervical cancer (P = 0.007). The incidence of hematological abnormalities in Chinese patients with solid tumors was relatively lower than that of the counterparts in the Western countries. A pretreatment anemia or leukocytosis can serve as a useful marker to predict outcome of patients in some of the solid tumors.     

Health‐related quality of life of patients with advanced breast cancer treated with everolimus plus exemestane versus placebo plus exemestane in the phase 3, randomized,controlled, BOLERO‐2 trial

BACKGROUND:

The randomized, controlled BOLERO‐2 (Breast Cancer Trials of Oral Everolimus) trial demonstrated significantly improved progression‐free survival with the use of everolimus plus exemestane (EVE + EXE) versus placebo plus exemestane (PBO + EXE) in patients with advanced breast cancer who developed disease progression after treatment with nonsteroidal aromatase inhibitors. This analysis investigated the treatment effects on health‐related quality of life (HRQOL).

METHODS:

Using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire‐Core 30 (EORTC QLQ‐C30) questionnaire, HRQOL was assessed at baseline and every 6 weeks thereafter until disease progression and/or treatment discontinuation. The 30 items in 15 subscales of the QLQ‐C30 include global health status wherein higher scores (range, 0‐100) indicate better HRQOL. This analysis included a protocol‐specified time to definitive deterioration (TDD) analysis at a 5% decrease in HRQOL versus baseline, with no subsequent increase above this threshold. The authors report additional sensitivity analyses using 10‐point minimal important difference decreases in the global health status score versus baseline. Treatment arms were compared using the stratified log‐rank test and Cox proportional hazards model adjusted for trial stratum (visceral metastases, previous hormone sensitivity), age, sex, race, baseline global health status score and Eastern Cooperative Oncology Group performance status, prognostic risk factors, and treatment history.

RESULTS:

Baseline global health status scores were found to be similar between treatment groups (64.7 vs 65.3). The median TDD in HRQOL was 8.3 months with EVE + EXE versus 5.8 months with PBO + EXE (hazard ratio, 0.74; P = .0084). At the 10‐point minimal important difference, the median TDD with EVE + EXE was 11.7 months versus 8.4 months with PBO + EXE (hazard ratio, 0.80; P = .1017).

CONCLUSIONS:

In patients with advanced breast cancer who develop disease progression after treatment with nonsteroidal aromatase inhibitors, EVE + EXE was associated with a longer TDD in global HRQOL versus PBO + EXE. Cancer 2013. © 2013 American Cancer Society.     

SerpinB3, a new prognostic tool in breast cancer patients treated with neoadjuvant chemotherapy

It is unclear which patients with breast cancer benefit from anthracycline-based neoadjuvant chemotherapy and whether taxanes increase survival. Hsp70 and serpinB3 inhibit a lysosomal cell death pathway induced in anthracycline and taxane treated cells, which may be critical for breast cancer cell survival. Thus we evaluated serpinB3 and Hsp70 as putative prognostic biomarkers in breast cancer patients treated with neoadjuvant chemotherapy. SerpinB3 and Hsp70 were measured by immunohistochemistry in residual breast tumours of patients without a complete pathological response [pCR] (n = 250), from a retrospective cohort of 296 patients treated with anthracycline-based chemotherapy with or without sequential docetaxel prior to surgical resection. SerpinB3 (P = 0.02) and Hsp70 (P = 0.008) positivity in residual tumour were associated with a poor pathological response and serpinB3 was an independent prognostic biomarker (HR 2.1 (95% CI 1.2–3.8), P = 0.02). Docetaxel significantly improved overall survival of breast cancer patients treated with neoadjuvant chemotherapy. Furthermore, serpinB3 positivity predicted poor survival in patients treated with anthracycline-based chemotherapy alone (P = 0.02), but those with serpinB3 negative tumours had as equally good survival as those also treated with docetaxel (P = 0.7). Survival was independent of serpinB3 expression in patients who received sequential docetaxel. The Nottingham prognostic index (NPI), calculated at surgical resection, predicted overall survival in these neoadjuvantly treated patients (P < 0.001) and serpinB3 status segregated patients with a moderate NPI into distinct prognostic subgroups. The use of clinical (NPI) and molecular (serpinB3) biomarkers measured at surgical resection to provide accurate prognostication in patients who do not achieve a pCR following neoadjuvant chemotherapy could facilitate optimal post-operative clinical management of these patients and is of significant clinical value. Furthermore, serpinB3 status in residual tumour is a biomarker of neoadjuvant docetaxel benefit in patients not achieving a pCR and use of serpinB3 molecular subtyping for adjuvant docetaxel treatment planning warrants further investigation.     

Incidence of contralateral breast cancer in Japanese patients with unilateral minimum-risk primary breast cancer,and the benefits of endocrine therapy and radiotherapy

Background:

Tamoxifen is recommended as adjuvant endocrine therapy for patients with minimum-risk breast cancer. It is primarily effective at prevention of contralateral and ipsilateral breast cancer recurrence after breast-conserving surgery. The incidence of contralateral breast cancer and the absolute benefit of endocrine therapy among patients with unilateral minimum-risk breast cancer in Japan, where the incidence of breast cancer is low, are unknown.

Patients and methods

We retrospectively studied the incidence of contralateral breast cancer, and the efficacy of endocrine therapy, in a cohort of 2074 Japanese women with unilateral breast cancer whose primary tumor was pTis (n = 1905) or pT1mic (n = 169) (unknown for endocrine therapy, n = 4; unknown for radiotherapy, n = 2). We also assessed the efficacy of endocrine therapy and radiotherapy for prevention of ipsilateral and contralateral breast cancer recurrence in 1205 patients who underwent breast-conserving surgery (unknown for endocrine therapy, n = 2; unknown for radiotherapy, n = 2).

Results

The incidence of contralateral breast cancer per 1000 person-years was 5.1 (95 % confidence interval (CI), 3.7–7.1) among patients without endocrine therapy (n = 1364) and 3.6 (95 % CI 2.1–6.1) among those with endocrine therapy (n = 706). The incidence of ipsilateral breast cancer recurrence after breast-conserving surgery per 1000 person-years was 9.2 (95 % CI 6.5–13) among patients without endocrine therapy (n = 753) and 4.2 (95 % CI 2.2–8.1) among those with endocrine therapy (n = 450). The incidence of ipsilateral breast cancer recurrence after breast-conserving surgery per 1000 person-years was 9.9 (95 % CI 6.3–15.6) among patients without radiotherapy (n = 380) and 5.9 (95 % CI 3.9–9.0) among those with radiotherapy (n = 823).

Conclusion

The incidence of contralateral breast cancer among minimum-risk breast cancer patients in Japan, where the incidence of breast cancer is low, was similar to that in Western countries. Endocrine therapy is indicated for this population.     

Assessment of Health-Related Quality of Life and Distress in an Asian Community-Based Cancer Rehabilitation Program

Cancer survivors have reduced health-related quality of life (HRQOL) and high levels of distress during and after active treatment, due to physical, psychological, and social problems. Understanding the prevalence and associations of HRQOL and distress in a patient population in the community is important when designing rehabilitation programs. This was a cross-sectional observational study conducted at a community-based cancer rehabilitation center, with the aim of investigating the prevalence and associations of HRQOL and distress in cancer patients. There were 304 patients who were recruited. We found low levels of HRQOL and high levels of distress in patients, with a mean FACT-G7 total score of 11.68, and a mean distress thermometer score of 3.51. In the multivariate regression model, significant factors for low HRQOL were metastatic disease (p = 0.025) and Malay ethnicity (p < 0.001). Regression analyses also found that significant distress was associated with family health issues (p = 0.003), depression (p = 0.001), worry (p = 0.005), breathing (p = 0.007), getting around (p = 0.012) and indigestion (p = 0.039). A high prevalence of impaired HRQOL and distress was reported in cancer survivors even in a community rehabilitation setting. The physical and psychosocial well-being of cancer survivors should be monitored and managed as part of community-based cancer rehabilitation.     

Acute myeloid leukemia and myelodysplastic syndrome following breast cancer: increased frequency of other cancers and of cancers in multiple family members

Adjuvant chemotherapy and radiation therapy for breast cancer are associated with therapy-related acute myeloid leukemia (AML)/myelodysplastic syndromes (MDS), but little is known about additional risk factors. Thirty-four patients with AML (n = 26)/MDS (n = 8) following breast cancer (cases) were compared with 2029 breast cancer patients without AML/MDS (controls). Cases were older at breast cancer diagnosis (mean 60.2 years versus 54.5 years; p = 0.01) and more commonly had additional cancers (29% versus 4.9%; p < 0.0001) and ≥4 first-degree relatives with any type of cancer (OR: 5.37, CI: 1.44–19.9). Thus risk factors for AML/MDS following breast cancer include older age, other cancers and multiple first-degree relatives with cancer.