Search Results (117)

Breast cancer (BC) is the most prevalent malignancy in women worldwide. Despite most cases being diagnosed in the early stages, patients typically require a multimodal treatment approach. This typically involves a combination of surgery, radiotherapy, systemic treatments (including chemotherapy or immunotherapy), targeted therapy, and endocrine therapy, depending on the disease subtype and the risk of recurrence. Moreover, patients with BC and germline mutations in the breast cancer genes 1 or 2 (BRCA1/BRCA2), (gBRCAm), who are typically young women, often require more aggressive therapeutic interventions. These mutations present unique characteristics that necessitate a distinct treatment approach, potentially influencing the side effect profiles of patients with BC. Regardless of the clear benefit observed with these treatments in terms of reduced recurrence and mortality rates, long-term, treatment-related adverse events occur that negatively affect the health-related quality of life (HRQoL) of BC survivors. Thus, long-term adverse events need to be factored into the treatment decision algorithm of patients with early BC (eBC). Physical, functional, emotional, and psychosocial adverse events can occur and represent a significant concern and a challenge for clinicians, patients, and their families. This review article provides an overview of the various long-term adverse events that patients with eBC may experience, including their associated risk factors, as well as management and prevention strategies. We also explore the evidence of the long-term impact of treatment on the HRQoL of patients with gBRCAm. By providing a comprehensive overview of current evidence and recommendations regarding patients’ HRQoL, we aim to equip clinicians with scientific and clinical knowledge and provide guidance to optimize care and improve long-term outcomes. Full article

Breast-conserving surgery followed by external beam Radiotherapy (RT) is a standard approach for early-stage Breast Cancer (BC). This retrospective study aims to determine the risk of RT-induced lung cancer for both standard and hypofractionated treatments. Fifty-eight Sicilian women treated at Humanitas Istituto Clinico Catanese (Misterbianco, Italy) between 2015 and 2021 with standard fractionated 3D-CRT (50 Gy in 2 Gy/fraction) were included. All treatment plans were designed using a hypofractionated schedule (42.56 Gy in 2.66 Gy/fraction). An Eclipse™ plug-in script was developed using the Eclipse Scripting Application Programming Interface (ESAPI) to extract patient and treatment data from the Treatment Planning System and compute Organ At Risk (OAR) volume, Organ Equivalent Dose (OED), Excess Absolute Risk (EAR), and Lifetime Attributable Risk (LAR) using the Schneider Mechanistic Model and reference data from regional populations, A-bomb survivors, and patients with Hodgkin’s Disease (HD). The OED distributions exhibited a statistically significant shift toward higher values in standard fractionated plans (p < 0.01, one-tailed paired Student’s t-test), leading to increased EAR and LAR. These results indicate that hypofractionated treatment may lower the risk of radiation-induced lung cancer. The feasibility of a priori risk estimation was evaluated by integrating the script into the TPS, allowing rapid comparison of SF and HF plans during planning. Full article

Background: The aim was to explore the association between coping strategies (CSs) and health-related quality of life (HRQoL) in breast cancer (BC) survivors and to analyze the role of relevant sociodemographic and clinical variables. Methods: A cross-sectional study involving 305 women under follow-up for surgically treated BC in Spain. CSs were measured using the Brief Coping Orientation to Problems Experienced Scale and the HRQoL with the Short-Form Health Survey (SF-12). Results: The mean age at BC diagnosis for participants was 57.4 years, with 60.3% of diagnoses at the local stage. Most frequent complementary treatments were radiotherapy (53.4%) and chemotherapy (33.1%). Adaptative CS scores were positively associated both with higher physical HRQoL (adjusted regression coefficient: 2.19; 95% confidence interval: 0.11; 4.27, p-value: 0.039) and mental HRQoL scores (coef.: 2.65: 95%CI: 0.25; 5.04, p-value: 0.030). Maladaptive CS scores were inversely associated with mental HRQoL scores (coef.: −3.92; 95%CI: −6.62; −1.22, p-value: 0.005). The effects were stronger among women with a favorable BC prognosis. Conclusions: Adaptive CSs positively affected the physical and mental HRQoL, while maladaptive CSs negatively affected the mental HRQoL. Therefore, psychosocial interventions that promote adaptive CSs and avoid maladaptive ones could improve the well-being of women with a favorable BC prognosis. Full article

Background: Breast cancer survivors (BCS) experience long-term adverse effects, with breast cancer-related lymphedema (BCRL) being one of the most common complications. Exercise is suggested as a safe strategy to improve functionality in BCS with or at risk of developing BCRL. However, the effects of concurrent training in these patients are poorly understood. The aim of the study was to analyze the effects of a 12-week supervised concurrent training program and a 12-week follow-up period without training on molecular, functional, and clinical outcomes in BCS. Methods: A single-arm study was conducted in 11 BCS with or at risk of BCRL to analyze the effects of a 12-week concurrent training and a 12-week follow-up period on molecular (92 inflammation-related proteins), functional (upper- and lower-body strength, handgrip strength, and cardiorespiratory fitness), and clinical (body mass index, arm volume, subcutaneous and muscle thickness, range of motion, physical activity levels and heart rate variability, pain, and quality of life [QoL]) outcomes. Results: The 12-week concurrent training program significantly improved upper-body muscle strength, handgrip strength, pain, emotional well-being, and total QoL. In addition, after the 12-week follow-up period, the increase in row strength was maintained, and a significant decrease in various inflammation-related proteins was observed. Conclusions: A 12-week concurrent training program improved strength, pain, and QoL in BCS without increasing inflammation. After the follow-up period, inflammation-related protein levels decreased, and row strength gains were maintained, supporting the potential effects of concurrent training. Further larger and controlled studies are needed to confirm the results. Full article

Breast cancer (BC) is the most prevalent malignancy among women worldwide, with a rising incidence in young, premenopausal patients. For those diagnosed with hormone receptor-positive (HR+) BC, tamoxifen is a cornerstone of adjuvant endocrine therapy, significantly reducing recurrence risk and improving long-term survival. However, its prolonged use poses challenges for women desiring pregnancy, prompting interest in temporary treatment interruption as a strategy to achieve reproductive goals while maintaining oncological safety. This systematic review evaluates the impact of tamoxifen on fertility, the feasibility of treatment interruption, and associated reproductive and oncological outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search across major databases, identifying three relevant studies, including one randomized controlled trial (RCT) and two observational cohort studies. The findings suggest that temporary tamoxifen interruption allows for successful pregnancies without significantly increasing short-term recurrence rates. Notably, the POSITIVE trial demonstrated a pregnancy achievement rate of 74% and a live birth rate of 63.8%, with comparable three-year disease-free survival between patients who interrupted tamoxifen and those who continued therapy. However, concerns remain regarding tamoxifen’s teratogenic risks, emphasizing the need for strict contraceptive measures and preconception counseling. Despite emerging evidence supporting this approach, long-term safety data are limited. Further research is warranted to refine clinical recommendations and optimize reproductive counseling for young BC survivors. Full article

Background/Objectives: Endurance exercise increases oxygen demand and, when not balanced by antioxidant defenses, consequently, oxidative stress and inflammatory cytokines increase too. In breast cancer survivors (BCS), post-treatment, physical capacity decreases, lowering life quality. Dragon boat (DB) paddling has shown benefits in reducing lymphedema and improving psychological well-being. This study aimed at non-invasively investigating in BCS, by means of saliva and urine samples, the systemic responses to oxy-inflammation, and appetite hormones after a DB endurance race. Methods: 15 BCS and 15 healthy women (5 (CTR) who performed the DB race too) were studied. BCS and CTR were monitored pre- and post-race. Reactive oxygen species (ROS) production, total antioxidant capacity (TAC), lipid peroxidation (8-iso), DNA oxidation (8-OH-dG), nitric oxide metabolites (NOx), inflammation markers (IL-6-10 and TNFα), appetite hormones, electrolytes concentration, psychometric, and physical scales were assessed. Results: At rest, compared to healthy women, BCS showed a significant increase in oxy-inflammation biomarkers. BCS showed a general increase in oxy-inflammation parameters compared to CTR after the DB race. In BCS, there were the following results: ROS: +80%; lipid peroxidation: +103%; DNA oxidation: +44%; interleukins-6: +179%; IL-10: +55%; TNFα: +9%, NOx: +60% increases and unbalanced appetite hormones: leptin (−32%); and ghrelin (+53%). Moreover, the dragon boat offered a holistic approach to recovery, addressing emotional and social needs supporting belonging, love, and esteem needs, reported to be about 56% of the motivations in this activity, while post-race the following increased: a sense of fatigue (+55%); tiredness (48%); a cold sensation (+15%); and +32% pain. Conclusions: This study provided evidence that, in BCS, a DB endurance race produces an important imbalance in the oxy-inflammation state, at the same time being accompanied by a positive impact on subjective mood and general wellness. Future studies should focus on long-term effects. Full article

Objectives: We aimed to study the efficacy of fractional CO₂ laser for genitourinary syndrome of menopause (GSM) symptoms in breast cancer (BC) survivors through a randomized, sham-controlled study, followed by an open-phase study assessing the impact of additional treatments. Methods: BC survivors with GSM were randomized to receive either three sessions of intravaginal CO₂ laser or sham treatment every 3–4 weeks. The laser’s energy was 45–60 mJ/pixel. Outcomes were compared one month following the last session. Participants initially receiving laser treatment were offered three more sessions, while those receiving sham had six laser sessions in an open-label study. Results: Thirty-four BC survivors were randomized to laser (n = 19) or sham (n = 15) treatments. Dyspareunia and intercourse dryness scores improved in both groups one month post-treatment, without a significant advantage of laser over sham. The laser treatment resulted in a reduction in daily dryness (−1.30 ± 0.55, p = 0.017), an increase in vaginal hydration (3.24 ± 1.13, p = 0.004), and an increase in Vaginal Health Index (VHI) (2.26 ± 0.50, p < 0.001). Most participants (18/19 and 9/15, respectively) opted to continue laser treatments after unblinding, resulting in 27 patients receiving six laser treatments. Increasing the number of laser treatments was associated with a constant improvement in Visual Analogue Score (VAS) scores for dyspareunia, intercourse dryness, daily dryness, burning, discomfort, itch, and average VAS, as well as pH, VHI, and hydration. Conclusions Three fractional CO₂ laser treatments for BC survivors reduced daily dryness but did not improve dyspareunia and sexual dryness when compared to sham in this randomized trial. Increasing the number of treatment sessions seemed to improve outcomes; however, it remained clinically insufficient, even after six treatments. Full article

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all r_s ≤ −0.2, p ≥ 0.05) but was associated with Pain Interference (r_s = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services. Full article

Background/Objectives: Breast cancer-related lymphedema (BCRL) is a significant complication of breast cancer (BC) treatment, characterized by swelling and fluid accumulation. Many risk factors have already been proven to be related to BCRL; meanwhile, many others are still debated and poorly investigated in the literature. This study investigated the potential involvement of commonly prescribed chronic medications in BCRL development. Methods: This observational retrospective cohort study included 162 post-surgical breast cancer survivors attending an oncological rehabilitation outpatient service between January 2021 and April 2023. BCRL was diagnosed by physicians through clinical evaluation and objective measures (≥2 cm increase in circumferential girth measurements). Descriptive statistics summarized patient characteristics, and Cox regression models (univariable and multivariable) were employed to analyze risk factors for BCRL. Results: BCRL was observed in 53% of participants. The univariable model identified BMI (hazard ratio 1.07, 95% CI 1.02–1.11), overweight (BMI ≥ 25) (HR 1.46, 95% CI 0.95–2.25), and breast prosthesis implantation (HR 1.75, 95% CI 1.09–2.80) as potential risk factors for lymphedema. In the multivariable model, overweight (HR 2.90, 95% CI 1.18–7.14), hypertension (HR 5.09, 95% CI 1.88–13.79), radiotherapy (HR 3.67, 95% CI 1.43–9.38), and breast prosthesis implantation (HR 8.93, 95% CI 2.77–28.81) were identified as independent risk factors for BCRL. Conclusions: The findings emphasize the need for further research to understand the role of chronic medications in BCRL risk comprehensively. Full article

Chemotherapy-related cognitive impairment termed «chemobrain» is a prevalent complication in breast cancer survivors that requires early detection for the development of novel therapeutic approaches. Magnetic resonance voxel morphometry (MR morphometry), due to its high sensitivity, might be employed for the evaluation of the early changes in the volumes of brain structures in order to explore the «chemobrain» condition. Methods: The open, prospective, single-center study enrolled 86 breast cancer survivors (43.3 ± 4.4 years) and age-matched 28 healthy female volunteers (44.0 ± 5.68). Conventional MR sequences (T1- and T2-weighted, TIRM, DWI, MPRAGE) were obtained in three mutually perpendicular planes to exclude an organ pathology of the brain. Additionally, the MPRAGE sequence was performed for subsequent MR morphometry of the volume of brain structures using the open VolBrain program. The evaluation was performed at two follow-up visits 6 months and 3 years after the completion of BC treatment. Results: According to the MR morphometry, breast cancer survivors presented with significantly decreased volumes of brain structures (including total brain volume, cerebellum volume, subcortical gray matter, etc.) as compared to healthy volunteers. Evaluation over the follow-up period of 3 years did not show the restoration of brain volume structures. Conclusions: The data obtained employing MR morphometry revealed significant reductions (that were not detected on the conventional MR sequences) in both gray and white matter in breast cancer survivors following chemotherapy. This comprehensive analysis indicated the utility of MR morphometry in detecting subtle yet statistically significant neuroanatomical changes associated with cognitive and motor impairments in patients, which can in turn provide valuable insights into the extent of structural brain alterations, helping to identify specific regions that are most affected by treatment. Full article

Travel to and from distant cancer treatment facilities can place a significant burden on cancer patients, particularly rural and minority survivors. Thus, the purpose of our investigation was to examine the association between patient travel distance and delays in types of treatment for breast cancer (surgery, radiation, chemotherapy, and hormonal therapy) and treatment delays. Using a novel linkage between the state cancer registry and administrative data from Medicaid and a private insurance plan, 2155 BC patients were successfully linked to create the cohort. ArcGIS was used to geocode all case residences and treatment facility addresses and calculate network distance between the residence and each facility. Logistic regression models were used to calculate the adjusted odds of being delayed versus timely by street distance. Odds of late surgery were increased by 1% (95% CI: 1.00, 1.01) for each one-mile increase from the patient’s residence to the treatment facility. In race-stratified models, the odds of late treatment for Black patients increased by 3% per mile (95% CI 1.01, 1.06) for radiation. Increased travel distance appears to significantly increase treatment delays for surgical, radiation, and chemotherapeutic treatments for women with BC, especially among Black women. Full article

Background and Aim: Young women diagnosed with breast cancer (BC) face considerable psychological and emotional distress, impacting their interactions with themselves, their families, and the wider community. This study sought to explore the interaction patterns of young Omani BC survivors following their diagnosis and during treatment. Materials and Methods: Semi-structured individual interviews were conducted with 11 Omani women diagnosed with BC, recruited from the Sultan Qaboos Comprehensive Cancer Care and Research Centre in Muscat, Oman. Participants were selected using purposive sampling to target Omani BC survivors aged under 45 years, with one to five years of survivorship post-diagnosis. Framework analysis was employed to analyse the qualitative data. Results: Six key types of interactions with various groups were identified: self, children, spouses, family, friends, and society. While many BC survivors demonstrated resilience through their strong faith, viewing the illness as part of a divine plan, others experienced diminished confidence and social withdrawal due to body image issues. Interactions with children centred on maintaining normalcy, while spouses typically provided emotional support despite challenges with intimacy. Family and friends offered crucial support, although concerns regarding societal stigma led some women to conceal their diagnosis. Conclusions: Participants in this study demonstrated a strong sense of acceptance of their cancer diagnosis as a result of their faith, viewing it as part of a divine plan. Their belief in divine guidance, paired with optimism about the available treatments, fostered resilience, allowing them to maintain a calm and hopeful outlook during their journey of treatment and recovery. However, some participants experienced a decline in self-confidence, particularly after treatment. This affected their willingness to socialise and interact with others, leading to introversion and a marked withdrawal from social interactions, often related to changed self-perception or fear of judgment following changes in appearance. Full article

Hodgkin lymphoma (HL) treatment has dramatically improved, with high survival rates in early stages. However, long-term survivors face an increased risk of secondary cancers, particularly breast cancer (BC), which emerge as a leading cause of mortality decades after therapy. Background/Objectives: This study explores the risk of BC and the toxic effects of radiation therapy (RT) in long-term HL survivors compared to age-matched high-risk women, including BRCA1 and BRCA2 mutation carriers. A prospective study was conducted on 62 women who had undergone chemotherapy and involved-field RT for HL, with MRI used to assess breast tissue changes. This study’s primary endpoint was to analyze BC incidence in HL survivors, while secondary objectives focused on the analysis of background parenchymal enhancement (BPE) in irradiated areas. Results: The findings revealed a 5% incidence of BC in HL survivors, with 50% showing moderate or marked BPE, similar to that observed in high-risk BC controls. No significant differences in BPE distribution were found between the two groups. Conclusions: The study highlights the long-term risk of BC in HL survivors and suggests that advanced RT techniques and targeted therapies may help reduce the incidence of secondary tumors. Future research should focus on understanding the genetic and biological mechanisms behind treatment-induced cancers Full article

Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p < 0.001), central obesity (p < 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728–131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010–1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment. Full article

Background/Objectives: Dietary factors may significantly influence pain management in cancer survivors. However, a substantial gap exists regarding the relationship between nutrition and chronic pain in this population. This study examined differences in diet quality and dietary intake between breast cancer survivors (BCS) experiencing chronic pain and healthy controls (HC). It also aimed to understand the associations between dietary elements and pain-related outcomes within the BCS group. Methods: A case-control study was conducted with 12 BCS experiencing chronic pain and 12 HC (ages 18–65). Data collection included body composition, experimental pain assessments, pain-related questionnaires, and a 3-day food diary to calculate diet quality using the Healthy Eating Index-2015 (HEI-2015) and Dietary Inflammatory Index (DII). Statistical analyses evaluated group differences and associations between dietary factors and pain within the BCS group. Results: There were no significant differences in HEI-2015 scores between BCS and HC, but BCS had a significantly lower DII score (p = 0.041), indicating a more anti-inflammatory diet. BCS also showed higher intake of omega-3, vitamins B6, B12, A, D, and magnesium (p < 0.05). While total diet quality scores did not correlate with pain outcomes, several HEI-2015 and DII components, such as dairy, sodium, protein, vitamin C, and vitamin D, showed moderate positive or negative correlations with pain measures. Conclusions: Despite no overall differences in diet quality, BCS with chronic pain consumed more anti-inflammatory nutrients than HC. Complex correlations between specific dietary components and pain outcomes emphasise the need for further research to explore these links for chronic pain management in BCS. Full article