Function In Breast Cancer Patients Research Articles

Effect of intravenous lidocaine infusion on perioperative cellular immunity and the quality of postoperative recovery in breast cancer patients: a randomized controlled trial.

Breast cancer has become the most common malignancy worldwide. Experimental and, retrospective, clinical data indicate that anaesthetic technique might influence the risk of metastasis after cancer surgery by modulating the immune system. The purpose of this study is to investigate the effect of perioperative lidocaine injection on immune cells such as T lymphocytes and natural killer cells (NK cells) and the quality of postoperative recovery in breast cancer patients and to propose new ideas and relevant theoretical evidence for the selection of anesthetic protocols for perioperative tumor patients. Women (n=68) undergoing primary breast tumour resection were randomly assigned to received 2% lidocaine (n=34; group L) or placebo (normal saline; n=34; group S). Venous blood was collected thirty minutes before surgery (T0), after tumor removal (T1), immediately after surgery (T2), 24 h after surgery (T3), and 48 h after surgery (T4). The percentages of NK cells and T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) in peripheral blood were detected by flow cytometry. Patients' quality of recovery-15 (QoR-15) scores were recorded by questionnaire before and 24 h after the operation, as well as intraoperative propofol and remifentanil dosages, the frequency of 24 h postoperative remedial analgesia, and the incidence of nausea and vomiting, dizziness, and chest tightness. There were 62 patients included in the study, and 60 patients were finally analyzed. The difference in the changing trend of NK cell levels in the 2 groups over time was statistically significant (F=7.675, P=0.008). The intraoperative changing trends of CD3+ T cells, CD4+ T cells, and the CD4+/CD8+ ratio over time differed significantly between the 2 groups of patients (P<0.05), whereas the trends of CD8+ T cells did not differ significantly (P>0.05). The QoR-15 score at 24 h after surgery was higher in Group L (128.50±20.25) than in Group S (117.50±19.50), and the difference was statistically significant (P=0.005). No adverse events such as cardiac arrhythmia and lidocaine toxicity occurred in both groups during the perioperative period. Continuous intravenous pumping of lidocaine during the perioperative period has little effect on immune function in breast cancer patients and promotes postoperative recovery. Chinese Clinical Trial Registry ChiCTR2100050445.

Abstract P4-09-08: Examining neurocognitive function in breast-cancer patients after chemotherapy

Abstract Background Chemotherapy induces neurocognitive impairment ranging from mild subjective symptoms to functional limitations of daily living. Common subjective symptoms patients report after chemotherapy include memory and concentration difficulties that are not always captured by standard neurocognitive testing (P.A. Ganz, 2012 and 2013). The goal of this retrospective study was to examine the result of a detailed neurocognitive testing battery in women with breast cancer (BC) who were self-reporting cognitive concerns. Methods This was a retrospective single center study on BC patients who had undergone treatment with surgical resection, chemotherapy, endocrine therapy, and/or radiation therapy and completed outpatient neuropsychological evaluation. Neurocognitive tests included the Mini-Mental State Examination (MMSE), the Trails Making test, and the Wisconsin Card Sorting Test (WCST). Descriptive statistics were used to summarize patient demographics, clinical characteristics and neurocognitive test scores. Comparisons of neurocognitive scores between patients receiving chemotherapy, radiation, chemotherapy and radiation, or no chemotherapy or radiation were assessed using Wilcoxon sign tests. Results Fifty-three women with BC were included. The average age was 55 (STD 11) years; 39 (74%) patients underwent chemotherapy. Of the patients who underwent chemotherapy, 24 (62%) underwent anthracycline-based therapy, and 10 (26%) underwent non-anthracycline based therapy. Thirty-six (68%) patients had invasive ductal carcinoma, and 8 (15%) had invasive lobular carcinoma. Most patients were either stage 1 or 2, 17 (32%) and 20 (38%), respectively. Additionally, 68% (36 patients) were ER positive, 25% (13) were ER negative, and 49% (26) were PR positive with 42% (22) PR negative. Twelve (22%) patients were HER2 positive, and 31 (59%) were HER2 negative. Results from the neurocognitive tests evaluated are included in Table 1. Results showed that the longest times to complete the Trails tests were in patients who underwent both chemotherapy and radiation (three times more errors in this group than the group who did not undergo any treatment), and the increase in errors in the WCST in patients receiving chemotherapy was two and a half times greater than the no treatment group, although results were not statistically significant. Conclusions This study highlights the challenges of finding reliable assessment tools for measuring cognitive concerns in BC survivors. On a highly selected group of patients with self-reported cognitive concerns, we did not find statistically significant differences in neurocognitive testing across different treatment arms. The Trails tests and WCST both examine the same domain of executive functioning and are a detailed way of examining this aspect of neurocognitive functioning. Although no difference was detected between treatment groups for the Trails tests and the WCST, the changes in the number of errors in the WCST and the Trails B sorting time, which is influenced by the Trails A test, suggest that there are likely quantifiable changes experienced by BC patients undergoing chemotherapy compared to those who do not undergo chemotherapy. Future work will expand on these results by examining a larger sample of BC patients and by comparing them to their age-matched peers without cancer. Table 1.Neurocognitive test results listed as Median [Interquartile Range].VariableNo chemotherapy, no radiation (n=6)Chemotherapy, no radiation (n=15)No chemotherapy, radiation (n=8)Chemotherapy and radiation (n=24)P-valueMMSE t-score48 [29, 50]47 [42, 50]46.5 [34, 54]47 [43, 57]0.850Trials A time (seconds)33 [31, 38]32.5 [25, 42]37 [23, 55]32 [27, 44]0.940Trails B time (seconds)86 [47, 87]90 [69, 124]82 [48, 109]99 [80, 137]0.460WCST-128 total errors raw score14 [14, 53]36 [13, 47]20 [10, 53]48 [22, 68]0.175 Citation Format: Jessica Sharpe, Marilly Palettas, Michael Grimm, Mahmoud Kassem, Bhuvaneswari Ramaswamy, Robert Wesolowski, Nicole Williams, Sagar Sardesai, Daniel Stover, Jeffrey VanDeusen, Mathew Cherian, Ashley Pariser, Margaret Gatti-Mays, Maryam Lustberg, Laura Boxley. Examining neurocognitive function in breast-cancer patients after chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-08.

Association between cardiovascular risk factors and cancer therapy-related cardiac dysfunction in patients with breast cancer

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in breast cancer (BC) patients. The clinical relevance of CTRCD and its cardiovascular risk factors (CVRF) remains unclear. Purpose Our aim was to investigate the impact of baseline CVRF on ventricular systolic function in BC patients. Methods Retrospective study of patients with BC treated with anthracyclines (A) and/or trastuzumab between Jan 2017 and Dec 2018 who underwent a transthoracic echocardiography (TTE) before, during, and after chemotherapy. CTRCD is defined as a reduction of LVEF &amp;gt;10% to a value &amp;lt;50% or as a relative reduction of GLS &amp;gt;15%. Results We included 128 females with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%). LVEF at baseline was 64,7 ± 5,7%. At baseline, hypertension was present in 34,4% (44), dyslipidaemia in 29,9% (38), overweight (BMI: 25-30kg/m2) in 33,6% (43), obesity (BMI: &amp;gt;30kg/m2) in 28,1% (36), diabetes in 13 (10,2%) and smoker status in 11 (8,6%). No one had ischemic heart disease. During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD from which 9 (7%) suffered clinical heart failure. After multivariate analysis, in the group treated with T (with or without A), the BMI &amp;gt;25 kg/m2 was the only CVRF associated to the development of CTRCD (p &amp;lt; 0,01). In the group treated with A, no CVRF was associated with CTRCD. During follow-up, BMI &amp;gt;25kg/m2 was not associated to a lower survival (log-rank p test = 0.627). In the baseline TTE did not occur statistically significant differences between the groups according to the absence or presence of CVRF. Nonetheless, some statistically significant differences occurred during follow-up. In hypertensive patients, treated with T, the TTE at 2 years of follow-up had a significant decrease in LVEF (5,9 ±2,8; p = 0,047) compared to non-hypertensive patients. In diabetic patients, treated with A, there was a significant decrease in tricuspid annular systolic velocity (S") in the TTE after chemotherapy (2,8 ±1,4; P = 0,049) compared to non-diabetic. The group of patients with dyslipidaemia treated with A had a significant decrease in GLS in the TTE after chemotherapy (1,5 ± 0,7; p = 0,037) compared to patients without dyslipidaemia; The same group treated with T (without A) revealed a significant decrease in S’ in the TTE during T therapy (5,2 ± 1,6; p = 0,034). The group of patients with BMI &amp;gt;25 kg/m2 treated with T (without A) showed a significant decrease in the GLS during T therapy (5,1 ± 1,6; p = 0,021) and in the LVEF at 2 years of follow-up (15,3 ± 5,7; p = 0,036) compared to patients with BMI &amp;lt;25 kg/m2. Conclusions In our cohort, a high BMI was an independent risk factor for CTRCD among patients treated with T. This finding is in agreement with literature data. These results should encourage further research into the mechanisms linking overweight/obesity to CTRCD.

Early Detection and Pelvic Floor Rehabilitation for Sexual Dysfunction with or Without Incontinence in the Breast Cancer

Introduction: Sexual health is an important aspect of human life, and cancer should not change that. Data suggested that issues related to sexual function are quite common among women treated for cancer ranged from 30% to 100% [1]. However, clinicians often spend little to no time on the topic. However, the treatment options are available. The literature also supports the use of pelvic floor exercises and dilators to improve sexual function and urinary incontinence in women and specially those presenting with orgasm problems [2]. Objective: To explore the effectiveness of the pelvic floor rehabilitation on sexual dysfunction or sexual dysfunction combined with incontinence in the Saudi breast cancer survivors during, or post chemotherapy intervention. Methods: Thirty breast cancer women who had either sexual dysfunction, or sexual dysfunction combined with incontinence, during or post chemotherapy were evaluated using the Oxford scale for muscle power assessment before and after the intervention. Additionally, FSFI &amp; UDI-6 questionnaire responses were received and analyzed before and after the pelvic floor rehabilitation. The supervised pelvic floor rehabilitation (which included the pelvic floor muscle training (seven Yoga poses: Mountain pose, Tree pose, standing forward bend pose, worrier pose, bridge pose, bound angle pose, and seated twist pose), manual therapy, and dilator) were conducted for 45 minutes once a week for eight weeks (a total of 8 sessions). Main Outcome Measures: The domain scores of the Female Sexual Function Index-Breast cancer (FSDI-BC) which included desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. Furthermore, the domain of the Urinary Distress Inventory (UDI-6) which included frequent urination, urgency leakage, activity leakage, leakage with coughing or sneezing, difficulty emptying the bladder, and pain or discomfort in the lower abdominal or genital area were also analyzed. Muscle power (Oxford scale) was measured before and after the treatment. Results: All subjects successfully completed the study with no adverse events. Significant improvement in sexual function as assessed by the FSFI-BC indicated that sex desire improved by 86%, sexual arousal improved by 83%, lubrication improved by 76.3%, orgasm improved by 70%, general satisfaction improved by 44-54%, 73.3% felt pain minor, and 23% free of pain during intercourse. Muscle power as measured by the Oxford scale improved from grade 1 or 2 out of 5 to3 or 3+ out of 5. Significant improvement in UDI-6 were also observed in all participants by 80%. Conclusion: In this study, we observed the influence of chemotherapy side effects for breast cancer on women’s quality of life, sexual function and continence. The study confirmed that Pelvic floor muscle training, manual therapy and dilator use showed significant improvement in the symptoms of continence and sexual function in breast cancer patients.

Effects of Radiation Dose on Liver After Free-breathing Volumetric Modulated Arc Therapy for Breast Cancer.

To evaluate the early effect of radiation dose on liver function in breast cancer patients undergoing free-breathing volumetric modulated arc therapy (FB-VMAT). Medical records of 125 patients with breast cancer who underwent curative surgery followed by postoperative radiotherapy using FB-VMAT during 2018-2021 were reviewed. Results of the liver function test (LFT), performed within 1-week before and 6-months after radiotherapy, were collected and compared. The LFTs analyzed albumin, total and direct bilirubin, aspartate transaminase, alanine transferase, and alkaline phosphatase levels. The mean dose and relative liver volume receiving at least 10 Gy, 20 Gy, or 30 Gy were calculated. Median follow-up time was 21.4 months. One patient experienced locoregional and distant failures. The mean liver irradiation dose was 325.9 centigray (cGy) for all patients. The liver irradiation dose was higher in patients with right breast cancer than in those with left breast cancer (mean, 434.1 cGy vs. 260.6 cGy, p<0.001). Direct bilirubin and aspartate transaminase levels showed significant differences after FB-VMAT. LFT results outside normal limits were noted in 31 patients at follow-up, but nobody met the criteria of radiation-induced liver disease. Underlying liver disease, breast laterality, systemic treatment, or dose-volume histogram parameters were not associated with abnormal LFT results. FB-VMAT can deliver radiation doses safely without adversely affecting the liver. The mean dose ≤4 Gy could be a useful dose criterium of the liver for FB-VMAT plans.

Comparison of impedance cardiography and cardiac magnetic resonance imaging for the evaluation of cardiac function in early-stage breast cancer patients

Objective. Breast cancer treatment can negatively impact cardiac function in some breast cancer patients. Current methods (MUGA, echocardiography) used in clinical practice to detect abnormal cardiac changes as a result of treatment suffer from important limitations. Use of alternative techniques that would offer safe, inexpensive and non-invasive cardiac function assessment in this population would be highly advantageous. The aim of this study was to examine the agreement between impedance cardiography (ICG) and cardiac magnetic resonance imaging (CMR) in quantifying stroke volume (SV), cardiac output (CO) and end-diastolic volume (EDV) in this population. Approach. Sixteen breast cancer patients underwent ICG and CMR assessments at three time-points (before treatment, immediately after chemotherapy, and four months after chemotherapy). Bland–Altman analysis was used to quantify the accuracy and precision of ICG (relative to CMR) in estimating absolute values of SV, CO and EDV. Four methods (concordance rate, polar concordance rate, clinical concordance rate and trend interchangeability rate) were also used to assess ICG performance in tracking changes in these variables. Main results. Bland–Altman analysis showed that the accuracy of ICG relative to CMR was −3.1 ml (SV), 0.2 l·min−1 (CO) and −26.0 ml (EDV) and precision was 13.2 ml (SV), 1.1 l·min−1 (CO) and 20.1 ml (EDV), respectively. Trending ability assessment showed that (1) the concordance rate was 87% (SV), 73% (CO) and 73% (EDV), (2) the polar concordance rate was 67% (SV), 53% (CO) and 33% (EDV), (3) the clinical concordance rate was 33% (SV), 40% (CO) and 20% (EDV) and (4) the trend interchangeability rate was 29% (SV), 43% (CO) and 17% (EDV), respectively. Significance. Our findings show that, although ICG showed good accuracy for absolute SV and CO measurements and for CO and EDV changes, precision was poor for all variables in terms of both absolute measurements and trend tracking performance. This suggests that ICG cannot be used interchangeably with CMR in breast cancer patients.

수중 운동 후 유방암 환자의 허파 기능 변화

본 연구는 유방암 환자를 대상으로 수술치료와 보존치료 후 환자의 허파 기능을 알아보기 위해 실시했다. 45세 이상 유방암 환자를 대상으로 유방암 1~2기 진단 받은 후 수술치료와 보존치료 중이거나 종료된 자로 재활치료를 위해 입원한 유방암 환자 59명을 대상으로 하였다. 연구를 위해 수중 운동을 적용한 29명(실험군)과 지상 운동을 적용한 30명(대조군)으로 구분했다. 허파 기능 평가를 위해 폐활량계를 이용했다. 본 연구는 8주간 수중 운동과 지상 운동을 동일 조건하에 실시하여 유방암 치료 후 수중 운동의 허파 기능 향상 여부를 비교 조사했다. 집단 간 운동 중재 기간이 증가함에 따라 노력성폐활량은 수중 운동군(p=.030)이 지상 운동군(p<.001)보다 증가를 보였다. 효과 검증 결과 중재 기간(p<.001), 기간 · 집단(p<.001), 개체 간(p=.019) 유의한 차이를 보였다. 또한 수중운동군이 1초간 노력성 날숨량이 증가했지만, 효과 검증은 유의한 차이가 없었다. 수중 운동 맞춤 프로그램을 시행 한다면, 호흡근 강화에 의해 허파 기능이 향상되고, 삶의 질 향상에 기여할 수 있다. 따라서, 수중운동 프로그램은 유방암 환자의 신체활동을 향상시키기 위한 재활 프로그램으로 활용할 수 있을 것이다.

Predictive value of lncRNA LOC100505851 in breast cancer in the neoadjuvant setting.

The expression and function of long noncoding RNA (lncRNA) LOC100505851 in breast cancer are still unknown. We aimed to examine the expression of lncRNA LOC100505851 in breast cancer and adjacent tissues and preliminarily explore its predictive value and function in breast cancer patients receiving neoadjuvant therapy (NAT). The expression of lncRNA LOC100505851 was tested by qRT-PCR. The correlation between LOC100505851 expression and clinicopathological factors as well as pathological complete response (pCR) was analyzed by chi-squared test and logistic regression, respectively. The online database Kaplan-Meier plotter (KM plotter) was used to compare relapse-free survival (RFS) and overall survival (OS) between groups with different LOC100505851 expression levels. Subcellular localization of LOC100505851 was determined by nuclear and cytoplasmic extraction. A bioinformatics tool was used to predict RNA-binding proteins (RBPs) and interaction among these proteins. LncRNA LOC100505851 was significantly expressed at lower levels in cancer tissues than in adjacent tissues (P<0.001). Its expression was related to human epidermal growth factor receptor 2 (HER2) expression (P=0.003) and molecular subtype based on immunohistochemistry (P=0.001). Patients with high LOC100505851 expression were prone to pCR (OR =3.077, 95% CI: 1.042-9.086, P=0.042) and better RFS (HR =0.68, 95% CI: 0.59-0.79, P<0.001) and OS (HR =0.60, 95% CI: 0.43-0.84, P=0.0026) according to the online database KM plotter. The subcellular localization of LOC100505851 was in the nucleus, and its binding proteins were predicted by bioinformatics tools. LncRNA LOC100505851 was located mainly in the nucleus and was significantly downregulated in breast cancers. Its expression was related to a higher pCR rate and better RFS and OS, indicating its potential value as a novel predictive and prognostic biomarker in breast cancer.

Effects of Cancer, Chemotherapy, and Cytokines on Subjective and Objective Cognitive Functioning Among Patients with Breast Cancer.

Simple SummaryAlthough cognitive impairments have been complained about in patients with breast cancer who underwent chemotherapy, recent research has described possible neurocognitive decline prior to the start of chemotherapy and suggested that inflammatory cytokines may also have been involved. However, inconsistencies have been found in correlations of cognitive impairments with cancer, chemotherapy, and peridiagnostic cytokine levels. This cross-sectional study aimed to examine associations of cognitive functions and levels of cytokines in patients with newly- diagnosed breast cancer before chemotherapy, those that were 3 to 9 months after completing chemotherapy, and non-cancer controls, adjusting for baseline intelligence quotient, mood, and fatigue. We found that the performance in semantic association of verbal fluency in patients post chemotherapy might be affected by the status of cancer, IL-13, and anxiety. Our results indicated that verbal fluency and anxiety may be important when considering relevant psychosocial managements or prophylactic interventions for cognitive preservation associated with regulations in cytokines.Background: We aimed to investigate the associations of breast cancer (BC) and cancer-related chemotherapies with cytokine levels, and cognitive function. Methods: We evaluated subjective and objective cognitive function in BC patients before chemotherapy and 3~9 months after the completion of chemotherapy. Healthy volunteers without cancer were also compared as control group. Interleukins (IL) 2, 4, 5, 6, 10, 12p70, 13, 17A, 1β, IFNγ, and TNFα were measured. Associations of cancer status, chemotherapy and cytokine levels with subjective and objective cognitive impairments were analyzed using a regression model, adjusting for covariates, including IQ and psychological distress. Results: After adjustment, poorer performance in semantic verbal fluency was found in the post-chemotherapy subgroup compared to controls (p = 0.011, η2 = 0.070); whereas pre-chemotherapy patients scored higher in subjective cognitive perception. Higher IL-13 was associated with lower semantic verbal fluency in the post-chemotherapy subgroup. Higher IL-10 was associated with better perceived cognitive abilities in the pre-chemotherapy and control groups; while IL-5 and IL-13 were associated with lower perceived cognitive abilities in pre-chemotherapy and control groups. Our findings from mediation analysis further suggest that verbal fluency might be affected by cancer status, although mediated by anxiety. Conclusions: Our findings suggest that verbal fluency might be affected by cancer status, although mediated by anxiety. Different cytokines and their interactions may have different roles of neuroinflammation or neuroprotection that need further research.

Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy.

The purpose of this study was to determine the effects of an 8-week HIIT intervention on patient-reported outcomes and physical function in breast cancer patients undergoing anthracycline-based chemotherapy. Thirty breast cancer patients were recruited prior to initiating treatment and randomized into the HIIT group (n = 15) or control (CON) group (n = 15). The HIIT group attended HIIT sessions three days per week for eight weeks. The CON group was asked to maintain their current level of physical activity. Patient-reported outcomes were assessed by the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), Multidimensional Fatigue Inventory with 20 questions (MFI-20), and the 15-item Five-Facet Mindfulness Questionnaire (FFMQ-15). Physical function was assessed using the timed up and go (TUG), 30-s sit-to-stand (30STS), Margaria-Kalamen stair climb test, and 6-min walk test (6MWT). Repeated measures ANCOVA and paired t-tests were performed to assess group differences. All patients completed the 8-week study with 82.3% adherence to the intervention among the HIIT group. Post-intervention, significant improvements were found for the Margaria-Kalamen stair climb test (- 3.39%; P = 0.013) and 6MWT (+ 11.6%; P = 0.008) in the HIIT group compared to baseline and CON group. No changes in patient-reported outcomes, TUG, and 30STS were observed following the 8-week study period in both groups (P > 0.05). HIIT may be an effective strategy to improve physical function and possibly maintain QOL in breast cancer patients undergoing the anthracycline-based chemotherapy. ClinicalTrials.gov: NCT02454777.

Anti‐Cancer Therapy Provokes Human Microvascular Endothelial Dysfunction via Circulating Mitochondrial DNA and TLR9 Activation

Rationale The detrimental impact of anti-cancer therapy (CTx) on endothelial function has emerged as a novel putative contributor to cardiovascular toxicity in cancer patients and survivors. Ongoing work in our laboratory has established impaired microvascular endothelial function in breast cancer patients following CTx, yet the causative mechanisms have not been identified. Mitochondrial DNA (mtDNA) is susceptible to damage from CTx, which stimulates release of cell-free mtDNA (cf-mtDNA) fragments that are recognized by toll-like receptor 9 (TLR9) on endothelial cells. We sought to determine whether elevated plasma cf-mtDNA and TLR9 activation following CTx are sufficient to induce endothelial dysfunction in healthy arterioles. Methods cf­-mtDNA levels were assessed (via PCR) in plasma obtained from breast cancer patients ~1 mo following CTx (doxorubicin and/or anti-HER2 therapy) and in plasma from CTx-naïve breast cancer patients (n = 7-9). HEK-Blue™-hTLR9 reporter cells (Invivogen) were treated with plasma to assess TLR9 activation (n = 4-5). We then exposed healthy human adipose arterioles to plasma from either CTx patients or healthy controls (CTRL). Freshly isolated resistance vessels were cannulated and filled with 10% plasma. Following overnight incubation, endothelium-dependent dilation was assessed as the percent change in internal diameter (videomicroscopy) in response to flow (FMD; n = 3-4) or acetylcholine (ACh; n = 2). Smooth muscle vasodilatory function was assessed in response to papaverine (n = 3-4). Vessels transfected with siRNA targeted to TLR9 were used to determine specificity of the response. Data are shown as mean ± SE. Dilation is expressed relative to maximal diameter. Results cf-mtDNA levels were 50 ± 26% higher in plasma from CTx patients relative to CTx-naïve patients (Fig. 1A) and elicited 70 ± 31% greater TLR9 activation (P < 0.05). Endothelium-dependent dilation was diminished in arterioles treated with plasma from CTx patients compared to healthy controls (Fig. 1B, FMD: 64 ± 5% vs. 86 ± 3%; ACh: 34 ± 3% vs. 90 ± 1%, P < 0.05). Maximal smooth muscle-dependent dilation to papaverine was not affected (CTx plasma: 92 ± 7% vs. CTRL plasma: 96 ± 2%; P = 0.62). In an initial observation, targeted knockdown of TLR9 prevented the detrimental effect of CTx plasma on endothelial function (FMD: 91%, n = 1). Conclusions These results demonstrate that plasma obtained from breast cancer patients 1 mo following CTx induces endothelial dysfunction in healthy human arterioles. Our preliminary findings suggest that circulating cf-mtDNA and activation of TLR9 may contribute to microvascular endothelial dysfunction in cancer patients following treatment.

Exercise Protocol With Limited Shoulder Range of Motion for 15 or 30 Days After Conservative Surgery for Breast Cancer With Oncoplastic Technique: A Randomized Clinical Trial.

The objective is to evaluate the effect of limiting shoulder range of motion (ROM) for 15 or 30 days on surgical complications and on shoulder ROM, pain, and upper limb function of breast cancer patients following conservative oncoplastic surgery. A randomized clinical trial was conducted with 60 women with breast cancer who underwent conservative oncoplastic surgery. The day after surgery, all patients started an exercise protocol with shoulder exercises limited to 90 degrees. Two weeks after surgery they were randomized into Free ROM Group (n=30) or Limited ROM Group (n=30). The Free ROM Group was allowed to perform shoulder exercises with unlimited ROM; the Limited ROM Group continued with shoulder movement restricted at 90 degrees until 30 days after surgery, at which time they were also allowed free ROM. The primary outcome was the incidence of postoperative complications (dehiscence, seroma, infection, and necrosis) and secondary outcomes were shoulder ROM, pain, and upper limb function. No difference in the incidence of postoperative scar complications between groups was noted. There was no difference between the groups in shoulder joint amplitude, pain, or upper limb function. The free ROM exercise protocol 15 days post surgery was safe concerning cicatricial complications.

Real-time exercise reduces impaired cardiac function in breast cancer patients undergoing chemotherapy: A randomized controlled trial.

Previous studies have reported that chemotherapy results in substantial long-term risk of heart failure. Exercise ameliorates exercise responses and exercise tolerance in patients receiving chemotherapy. The cardioprotective effect of real-time exercise in breast cancer is still unclear. The aim of the present study was to determine the effect of real-time moderate-to-high-intensity exercise training in women with breast cancer undergoing chemotherapy and to follow up on parameters of cardiac function and exercise capacity at different times. We hypothesized that early moderate-to-high-intensity exercise training has beneficial effects on cardiac function in women with breast cancer undergoing chemotherapy. This was a randomized controlled study that included 32 women randomly allocated into the control or exercise group. Exercise began with the first cycle of chemotherapy, and the training program was maintained during chemotherapy with 2 to 3 sessions per week for 3 months. Patients were instructed to perform moderate-to-high-intensity training with aerobic and resistance training. Outcome measurements were echocardiography and cardiopulmonary exercise test. The primary outcome was the change in left ventricle ejection fraction (LVEF). The secondary outcome was peak oxygen consumption (peak VO2). The control group showed lower cardiac systolic function than the exercise group [mean (SD) LVEF 62% (2) and 70% (5), P<0.05], reduced cardiac diastolic function, and cardiac hypertrophy at 3, 6 and 12 months after chemotherapy. At 6 months after chemotherapy, the exercise group exhibited relatively higher exercise capacity than controls [mean (SD) VO2 12.1 (2.2) and 13.6 (2.2) mL/kg/min, P<0.05]. The main effect size of the study based on echocardiography outcomes was 0.25 (95% confidence interval 0.23 to 0.27), a medium effect size. Moderate-to-high-intensity exercise training in breast cancer patients undergoing chemotherapy may prevent impaired cardiac function. https://www. in.th (Identifier TCTR20190330002).

The Effect of Psychological Status and Family Function in Breast Cancer Patients on Their Children’s Quality of Life (Effect of Family Function in Breast Cancer Patients on Children)

The Effect of Psychological Status and Family Function in Breast Cancer Patients on Their Children’s Quality of Life (Effect of Family Function in Breast Cancer Patients on Children)

Association between clinical risk factors and left ventricular function in patients with breast cancer following chemotherapy

Abstract Background The sequential or concurrent use of two different types of agents such as anthracyclines and trastuzumab may increase myocardial injury and cancer therapeutics-related cardiac dysfunction (CTRCD), which is often the result of the combined detrimental effect of the two therapies for breast cancer patients. For risk stratification to detect the development of CTRCD, the current position paper from the European Society of Cardiology (ESC) lists several factors associated with risk of cardiotoxicity following treatment with chemotherapy. However, the association between clinical risk factors and left ventricular (LV) function in breast cancer patients is currently unclear. Purpose Our purpose was to investigate the impact of baseline risk factors on LV function in patients with preserved LV ejection fraction (LVEF) who have undergone anthracycline or trastuzumab chemotherapy for breast cancer. Methods We studied 86 breast cancer patients treated with anthracyclines, trastuzumab, or both. Mean age was 59±13 years and LVEF was 67±5%. In accordance with the current definition, CTRCD was defined as a decline in LVEF of &amp;gt;10% to an absolute value of &amp;lt;53% after chemotherapy. Based on the 2016 ESC position paper, clinical risk factors for CTRCD were defined as: (1) a cumulative total doxorubicin dose of ≥240 mg/m2, (2) age ≥65-year-old, (3) body mass index ≥30 kg/m2, (4) a previous history of radiation therapy to chest or mediastinum, (5) B-type natriuretic peptide ≥100pg/mL, (6) a previous history of cardiovascular disease, (7) atrial fibrillation, (8) hypertension, (9) diabetes mellitus, (10) current or ex-smoker. Results The relative decrease in LVEF after chemotherapy for patients with more than four risk factors was significantly greater than that for patients without (−9.3±10.8% vs. −2.2±10.2%; p=0.02). However, this finding did not apply to patients with more than one, two or three risk factors. Patients with more than four risk factors also tended to show a higher prevalence of CTRCD than those without (14.3% vs. 2.8%, p=0.12). Moreover, patients with more than four risk factors were more likely to have higher LV mass index (109.3±29.0 g/m2 vs. 83.2±21.0g /m2, p&amp;lt;0.001), lower global longitudinal strain (18.4±2.8% vs. 20.0±2.6%, p=0.06) and higher E/e' (10.4 (8.9–13.0) vs. 9.0 (7.4–10.9), p=0.06) compared to those without. Conclusions Association between clinical risk factors and LV dysfunction following chemotherapy became stronger with an increase in the number of risk factors in breast cancer patients, and was especially strong for patients treated with chemotherapy who had more than four risk factors. Our findings can thus be expected to have clinical implications for better management of patients with breast cancer referred for chemotherapy. Funding Acknowledgement Type of funding source: None

Physical Function in Breast Cancer Patients Receiving Radiotherapy: A Pilot Study

Physical Function in Breast Cancer Patients Receiving Radiotherapy: A Pilot Study

The effect of prophylactic carvedilol on subclinical left ventricular dysfunction after 1 cycle FAC chemotherapy in breast cancer patients.

BackgroundDespite its efficacy, FAC regimen may cause fatal cardiotoxicity. Carvedilol may also exert additional antioxidant effects. This study aimed to assess the effect of carvedilol in preventing decline of left ventricular function in breast cancer patients receiving FAC regimen chemotherapy.MethodsThe study was a quasi-experimental study. The study subjects were consisted of breast cancer patients currently receiving post-first cycle FAC chemotherapy regimen in period of March – May 2019. The study subjects were divided into 2 groups: control and intervention group. In intervention groups, the patients consumed up titrated carvedilol with initial dose of 2 × 6.25 mg daily, follow-up echocardiography was performed for the patients in order to assess GLS score of left ventricle.ResultEighty patients were enrolled to the study, with each group consisted of 40 patients. Patient baseline characteristics were not significantly different between both groups. Left ventricular function was assessed using speckle tracking echocardiography and assessing the change of GLS score. Decrease of GLS score was higher in the intervention group compared to the control group, although the decrease was not statistically significant (0.767 ± 0.355 vs. 0.897 ± 0.526; p = 0.838). Percentage wise, similar findings were reported, albeit no significant (3.34 ± 1.65 vs. 3.46 vs. 2.58; p = 0.968).ConclusionsCarvedilol was not able to prevent the decline of subclinical left ventricular function after such chemotherapy cycle. However, it maybe more likely that the benefits appear in patients whose given larger cumulative dose of anthracycline and have multiple risk factors.

Effects Of High Intensity Interval Training On Patient-reported Outcomes And Physical Function During Anthracycline Chemotherapy

PURPOSE: Breast cancer patients treated with anthracycline chemotherapy experience negative anthracycline-related side effects, including poor quality of life and impaired physical function. However, it is unclear whether high intensity interval training (HIIT) improves quality of life and physical function in breast cancer patients undergoing anthracycline-based chemotherapy. The purpose of this study was to examine the effects of HIIT on patient-reported outcomes and physical function in breast cancer patients with anthracycline-based chemotherapy. METHODS: Thirty breast cancer patients were recruited prior to initiating anthracycline-based chemotherapy and randomized into the HIIT group (n=15) or control (CON) group (n=15). The HIIT group attended the HIIT session for 3 days per week for 8 weeks. The CON group was asked to maintain their current level of physical activity and offered the same HIIT intervention after the 8-week study period. Patient-reported outcomes were assessed by the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), Multidimensional Fatigue Inventory with 20 questions (MFI-20), andthe 15-item Five-Facet Mindfulness Questionnaire (FFMQ-15). Physical function was assessed using the timed up and go (TUG), 30-second sit-to-stand (30STS), Margaria-Kalamen stair climb test, and 6-minute walk test (6MWT). Repeated measures ANCOVA and paired t-tests were performed to assess changes in the outcome measures. RESULTS: Thirty breast cancer patients completed the 8-week study with 82.3% adherence to the intervention among the HIIT group. Post-intervention, significant improvements were found for the functional Margaria-Kalamen Power Test (-3.39%; P=0.013) and 6MWT (+11.6%; P=0.008) in the HIIT group compared baseline and to the CON group. No changes in patient-reported outcomes, TUG, and 30STS were found following the 8-week study period in both groups (P>0.05). CONCLUSIONS: HIIT may be an effective strategy to improve physical function and possibly maintain quality of life in breast cancer patients undergoing the anthracycline-based chemotherapy.

Cardiopulmonary function in breast cancer patients versus healthy control women

IntroductionThe study investigated cardiopulmonary function in breast cancer patients versus healthy control women.MethodsOverall, 115 women after breast cancer surgery and 50 healthy controls were included. The outcome measures were spirographic and hemodynamic parameters.ResultsMost of the investigated parameters in breast cancer patients were significantly lower than in healthy women. The actual vital capacity (VC) was significantly lower by 0.34 l (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), forced vital capacity (FVC) by 0.25 l (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), forced expiratory volume in 1 second (FEV1) by 0.26 l (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), peak expiratory flow (PEF) by 0.95 l/s (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), maximum expiratory flow25 (MEF25) by 0.98 l/s (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), maximum expiratory flow50 (MEF50) by 0.65 l/s (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), expiratory reserve volume by 0.48 l (p &lt; 0.001), maximal voluntary ventilation by 22.73 l/min (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The percentage of predicted values of VC, FVC, FEV1, PEF, MEF25, and MEF50 was lower by 9.93% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), 7.39% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), 8.87% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), 15.7% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), 18.09% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and 15.96% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), respectively. As for the cardiovascular system, the actual stroke volume was higher in the control group compared with the main group by 12.20 ml/beat (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), stroke index by 8.85 ml/beat/m2 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), cardiac output by 0.87 l/min (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), left ventricular work by 0.96 g · m/beat (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), LVP by 0.26 W (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).ConclusionsCancer treatment negatively affected most cardiorespiratory parameters. The results support the need for physiotherapy intervention in breast cancer patients after treatment.

A Comparison between Breast-Conserving Surgery and Modified Radical Mastectomy Concerning the Female Sexual Function in Breast Cancer Patients under 50 Years of Age

A Comparison between Breast-Conserving Surgery and Modified Radical Mastectomy Concerning the Female Sexual Function in Breast Cancer Patients under 50 Years of Age