Function In Breast Cancer Patients Research Articles

Impact of Adjuvant Anthracycline-Based and Taxane-Based Chemotherapy on Plasma VEGF Levels and Cognitive Function in Breast Cancer Patients: A Longitudinal Study

BackgroundVascular endothelial growth factor (VEGF) has been shown to induce neurogenesis in the brain and yield neuroprotective effects. It is hypothesized that chemotherapy reduces circulating VEGF levels and leads to cognitive decline among patients. This multicenter longitudinal study aimed to evaluate the impact of chemotherapy on VEGF levels and the association between VEGF levels and cognitive function. Patients and MethodsA total of 145 early-stage breast cancer patients were recruited and assessed before chemotherapy (T1), during chemotherapy (T2), and at the end of chemotherapy (T3). At each time point, plasma VEGF levels were assessed using a multiplex immunoassay. Cognitive function was assessed using both Functional Assessment of Cancer Therapy–Cognitive Function, Version 3 (FACT-Cog), and Headminder (a computerized, web-based neuropsychologic battery). ResultsGenerally, we observed higher-than-baseline plasma VEGF levels after the start of chemotherapy (P < .001). Among patients receiving anthracycline-based chemotherapy, the median plasma VEGF levels were significantly higher at T2 (T2: 37.3 pg/mL vs. T1: 21.3 pg/mL; P < .001) and T3 (T3: 35.5 pg/mL vs. T1: 21.3 pg/mL; P < .001) than at baseline. Plasma VEGF levels were not associated with chemotherapy-associated cognitive impairment. ConclusionBreast cancer patients experience an increasing trend in plasma VEGF levels during chemotherapy, and the regimen types may have a differential effect on circulating VEGF levels. Furthermore, changes in plasma VEGF levels during chemotherapy were not associated with cognitive impairment. VEGF may play a minor role in mediating the occurrence of chemotherapy-associated cognitive impairment.

Relationship between social support and social function in patients with breast cancer after mastectomy

Objective To explore the current situation and the relationship of social support with social function in breast cancer patients after mastectomy. Methods A questionnaire survey was conducted in 100 patients with breast cancer from July 2015 to November 2016 using the Social Support Rating Scale (SSRS) and the Social Function Deficiency Screening Scale (SFDSS) . Pearson correlation test was used to investigate the relationship between social support and social function. Results The total score of SSRS and the average score of SFDSS was (33.46±5.28) and (1.86±0.67) , respectively. The overall score of SSRS, subjective support and the availability of support showed a negative relationship with social functional deficiency (P<0.05) . Conclusions It is beneficial to help understand and take advantage of social support in patients with breast cancer after breast mastectomy so that to improve their social function and quality of life. Key words: Breast neoplasms; Social support; Social function; Correlation analysis

Abstract P5-07-08: Survival relevance of tamoxifen sensitivity-related microRNAs, miR-342 and miR-221/222, in breast cancer patients

Abstract BACKGROUND: MicroRNAs (miRNAs) are small noncoding RNAs, which regulate the expression of target genes post-transcriptionally by RNA interference. They have emerged as one of the crucial regulators of cancer progression. Some miRNAs are reported to be related to the response of breast cancer to tamoxifen (TAM). In this study, we investigated whether the levels of TAM-resistant miRNA (miR-221/222) and TAM-sensitive miRNA (miR-342) translate to breast cancer patient survival, using multiple large databases. MATERIALS AND METHODS: The Cancer Genome Atlas (TCGA; n=1049), Gene Expression Omnibus (GEO; GSE19536 n=96, GSE22220 n=210), and Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=2509) datasets were used and Gene Set Enrichment Analysis (GSEA) was performed. RESULTS: MiR-342 was identified as a TAM-sensitive miRNA, and miR-221/222 were identified as TAM-resistant miRNAs by literature search. Patients with high expression of miR-342 were shown to have better survival in TCGA (OS, p=0.02; DFS, p=0.03, respectively) and in two other independent GEO cohorts (OS, p=0.02 and p=0.0007, respectively) as well as in the METABRIC cohort (OS, miR-342-3p, p=0.006; miR-342-5p, p=0.00009). By subtype analyses, high expression of miR-342 was significantly associated with better survival in ER-positive patients (p=0.04), but not in ER-negative or triple negative patients in the TCGA cohort. This association was not observed in the METABRIC cohort. Within TCGA cohort, expression of TAM-resistant miR-221/222 did not significantly impact survival. Unexpectedly, increased expression of miR-221 was shown to have increased overall survival in all patients (p=0.00904) as well as in ER-negative patients (p=0.0479) and non-triple negative patients (p=0.0106) within the METABRIC cohort. On the other hand, low expression of miR-222 was associated with increased survival of all patients (p=0.00802) as well as in non-triple negative patients (p=0.041). Lastly, GSEA demonstrated that lower miR-342 expression was significantly seen in TAM-resistant gene sets, and higher miR-342 expression was seen TAM-sensitive gene sets, but miR-221/222 did not show any significant enrichment with TAM-resistant or TAM-sensitive gene sets. Taken together with survival data, expression levels of miR-342 reflect its TAM-sensitivity related function, however, that of miR-221/222 reflect other functions in breast cancer patients. CONCLUSION: For the first time, we used “big data” from the TCGA, GEO and METABRIC cohorts to analyze multiple miRNAs with respect to TAM sensitivities and its survival impact. We demonstrated that expression of miR-342 reflected the sensitivity of the cancer cells to TAM sensitivity, however, that of miR-221/222 reflected other functions in breast cancer patients. Citation Format: Young JS, Kawaguchi T, Yan L, Qi Q, Liu S, Takabe K. Survival relevance of tamoxifen sensitivity-related microRNAs, miR-342 and miR-221/222, in breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-07-08.

Research of acupuncture for the perioperative analgesia and immune function of the breast cancer patients

Objective To research of acupuncture for the perioperative analgesia and immune function of the breast cancer patients. Methods A total of 40 breast cancer patients who were carried out the radical operation was randomly (random number table method) divided into acupuncture combined drugs group and control group in our hospital during from 2015.1 to 2016.12. The patients in acupuncture combined drugs group was carried out acupuncture combined TCI anesthesia, and the patients in control group was carried out TCI anesthesia. The analgesic effect was evaluated by Visual analogue scales(VAS) in 2h, 6h, 12h, 24h and 48h after operation. The percentage of peripheral blood subgroups of T-lymphocytes (CD3+, CD4+, CD8+), natural killer cell (CD16+CD56+) and the ratio of CD4+/CD8+ was detected in 30 min before anesthesia, 2h after beginning of operation, 1d , 2d and 5d after operation. Results he VAS scores at 2 h (2.30 ± 1.12 vs. 3.75 ± 1.06, t=2.378), 6 h (2.64 ± 1.23 vs. 5.56 ± 1.41, t=3.289) and 12 h (3.49 ± 1.46 vs. 4.99 ± 1.27, t=2.040) after operation of acupuncture combined drugs group wwere significantly lower than those of control group (P<0.05). The CD3+ (52.35% ± 4.20% vs. 48.01% ± 4.42%, t=2.127), CD4+ (27.81% ± 2.72% vs. 24.96% ± 2.60%, t=2.250), CD4+/CD8+ (1.12 ± 0.15 vs. 1.01 ± 0.13, t=2.136) in acupuncture combined drugs group were significantly higher than those of the control group in 1d after operation (P<0.05). The CD16+ CD56+ 2 h (14.79% ± 2.04% vs. 13.58% ± 1.50%, t=2.852), 1 d (14.43% ± 2.27% vs. 13.11% ± 1.82%, t=2.933) in acupuncture combined drugs group were significantly higher han those of control group in 2h after beginning of operation and 1d after operation (P<0.05). Conclusions The analgesic effect of acupuncture could be applied to radical operation of breast cancer under general anesthesia. This method could protect the subgroups of T-lymphocytes and natural killer cell, and improve the immune function of breast cancer patients. Key words: Breast neoplasms; Perioperative period; Acupuncture analgesia; Immunity; T-lymphocyte subsets; Natural killer cell

Associations between inflammatory markers and cognitive function in breast cancer patients receiving chemotherapy

BackgroundCancer-related cognitive impairment (CRCI) is often related to chemotherapy. Increased chronic inflammation is believed to play a key role in the development of CRCI related to chemotherapy but studies assessing this hypothesis specifically in patients receiving chemotherapy are rare. MethodsWe assessed several cognitive domains using the Cambridge Neuropsychological Test Automated Battery (CANTAB) in twenty-two breast cancer patients currently receiving chemotherapy. We also measured inflammatory cytokine and receptor (MCP-1, TNF-α, sTNFRI, sTNFRII) concentrations in patient sera using Luminex assays. These concentrations were log-transformed to obtain a normal distribution. Associations between log-transformed cytokines and cognition were evaluated using Pearson correlations and linear regression, taking into account relevant covariates. ResultsIncreased concentrations of sTNFRI and sTNFRII were associated with poorer performance on the CANTAB Delayed Matching to Sample (DMS, tests visual memory). Increasing sTNFRI levels were negatively correlated with DMS percent correct (r=−0.47, p=0.029) and DMS percent correct after a 12 second (s) delay (r=−0.65, p=0.001). Increasing levels of sTNFRII negatively correlated with DMS percent correct after 12s delay (r=−0.57, p=0.006). After controlling for relevant demographic (i.e. age, education) and clinical variables (i.e. disease stage, regimen type), we found that increased sTNFRI remained significantly related to decline on the DMS at the 12s delay (p=0.018). ConclusionThis preliminary study shows a significant association between higher sTNFRI and lower scores on the short-term visual memory delayed match to sample test in breast cancer patients receiving chemotherapy, supporting the hypothesis that sTNFRI is involved in CRCI.

Differences in immune response to anesthetics used for day surgery versus hospitalization surgery for breast cancer patients

BackgroundSurgery/anesthetic technique-stimulated immunosuppression may be associated with outcome for cancer patients. Here, the immune responses of patients undergoing day surgery versus hospitalization surgery for breast cancer were compared in a prospective study.MethodsBetween February 2012 and August 2014, 21 breast cancer patients underwent day surgery and 16 breast cancer patients underwent hospitalization surgery. The former group received lidocaine/propofol/pethidine, while propofol/systemic opioid- and sevoflurane/propofol/systemic opioid-based anesthesia were administered to the latter group. Surgical stress response was evaluated based on time of operation and amount of bleeding during operation. Immune function was assessed based on natural killer (NK) cell activity, CD4/8 T cell ratio, and cytokine levels of IL-6 and IL-10 that were detected before surgery, after surgery, and on the first postoperative day.ResultsOperation time did not differ between the two groups. Blood loss was significantly less for the hospitalization surgery group. No change in NK cell activity was observed for either group, although the CD4/8 T cell ratio increased transiently following day surgery. Levels of IL-6 increased significantly in both groups following surgery, and these levels tended to be higher in the hospitalization surgery group. One patient who underwent hospitalization surgery had higher levels of IL-10.ConclusionsThere were few differences in immune response between the two groups, potentially since a majority of the hospitalization surgery patients received propofol-based anesthesia. We hypothesize that the use of volatile anesthetic/opioid analgesia in hospitalization surgery has a greater influence on immune function in breast cancer patients than local anesthetic/propofol-based anesthesia in day surgery.

Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT

BackgroundPreclinical studies have reported that a single treadmill session performed 24h prior to doxorubicin provides cardio-protection. We aimed to characterize the acute change in cardiac function following an initial doxorubicin treatment in humans and determine whether an exercise session performed 24h prior to treatment changes this response. MethodsBreast cancer patients were randomized to either 30min of vigorous-intensity exercise 24h prior to the first doxorubicin treatment (n=13), or no vigorous exercise for 72h prior to treatment (control, n=11). Echocardiographically-derived left ventricular volumes, longitudinal strain, twist, E/A ratio, and circulating NT-proBNP, a marker of later cardiotoxicity, were measured before and 24–48h after the treatment. ResultsFollowing treatment in the control group, NT-proBNP, end-diastolic and stroke volumes, cardiac output, E/A ratio, strain, diastolic strain rate, twist, and untwist velocity significantly increased (all p≤0.01). Whereas systemic vascular resistance (p<0.01) decreased, and ejection fraction (p=0.02) and systolic strain rate (p<0.01) increased in the exercise group only. Relative to control, the exercise group had a significantly lower NT-proBNP (p<0.01) and a 46% risk reduction of exceeding the cut-point used to exclude acute heart failure. ConclusionThe first doxorubicin treatment is associated with acutely increased NT-proBNP, echocardiographic parameters of myocardial relaxation, left ventricular volume overload, and changes in longitudinal strain and twist opposite in direction to documented longer-term changes. An exercise session performed 24h prior to treatment attenuated NT-proBNP release and increased systolic function. Future investigations should verify these findings in a larger cohort and across multiple courses of doxorubicin.

Symptoms of depression and anxiety as predictors of physical functioning in breast cancer patients. A prospective study using path analysis

Background: Although symptoms of depression and anxiety are linked to health-related quality of life (HRQoL), the nature of this relationship remained unclear. We therefore aimed to examine, in a prospective study, both possible directions of impact in this relationship. To avoid conceptual and measurement overlap between depressive and anxiety symptoms, on the one hand, and HRQoL, on the other hand, we focused on the physical functioning component of HRQoL.Material and methods: We conducted a secondary analysis of a prospective cohort study with 436 female breast cancer patients (mean age 51 years). Both at baseline and after 12 months, we measured symptoms of depression and anxiety with the four-item Patient Heath Questionnaire (PHQ-4) and physical functioning with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Using path analysis, we estimated (1) the predictive value of symptoms of depression/anxiety for subsequent physical functioning and (2) the predictive value of physical functioning for subsequent symptoms of depression/anxiety, in the same model.Results: Baseline symptoms of depression/anxiety predicted 1-year levels of physical functioning (depression: standardized β = −.09, p = .024; anxiety: standardized β = −.10, p = .009), while the reciprocal paths linking baseline physical functioning to subsequent depressive and anxiety symptoms were not significant, adjusting for the baseline scores of all outcome variables.Conclusions: Depressive and anxiety symptoms were predictors of the physical functioning component of HRQoL. Thus, if this relation is causal, treating breast cancer patients’ depressive and anxiety symptoms may have a favorable impact on their self-reported physical functioning.

The relationship between statins and breast cancer prognosis varies by statin type and exposure time: A meta-analysis.

e21606 Background:Breast cancer is the most common cancer in females. The effects of statins on breast cancer prognosis have long been controversial, so it is important to investigate the relationship between statin type, exposure time, and breast cancer prognosis. This study sought to explore the effect of statins on breast cancer prognosis. Methods:We searched the MEDLINE, EMBASE, Cochrane Library between October 15, 2016 and January 20, 2017. Searches combined the terms “breast neoplasms[MeSH]”, “statins”, “prognosis” or “survival” or “mortality” with no limit on publication date. Data were analyzed using Stata/SE 11.0. Results: 7 studies finally met the selection criteria and 197,048 included women. Overall statin use was associated with lower cancer-specific mortality and all-cause mortality (HR 0.73, 95% CI 0.59-0.92, P = 0.000 and HR 0.72, 95% CI 0.58-0.89, P = 0.000). Lipophilic statins were associated with decreased breast cancer-specific and all-cause mortality (HR 0.57, 95% CI 0.46-0.70, P = 0.000 and HR 0.57, 95% CI 0.48-0.69, P = 0.000); however, hydrophilic statins were weakly protective against only all-cause mortality (HR 0.79, 95% CI 0.65-0.97, P = 0.132) and not breast cancer-specific mortality (HR 0.94, 95% CI 0.76-1.17, P = 0.174). Of note, more than four years of follow-up did not show a significant correlation between statin use and cancer-specific mortality or all-cause mortality (HR 0.84, 95% CI 0.71-1.00, P = 0.616 and HR 0.95, 95% CI 0.75-1.19, P = 0.181), while groups with less than four years of follow-up still showed the protective effect of statins against cancer-specific mortality and all-cause mortality (HR 0.62, 95% CI 0.44-0.87, P = 0.000 and HR 0.61, 95% CI 0.45-0.80, P = 0.000). Conclusions:Although statins can reduce breast cancer patient mortality, the benefit appears to be constrained by statin type and follow-up time. Lipophilic statins showed a strong protective function in breast cancer patients, while hydrophilic statins only slightly improved all-cause mortality. Finally, the protective effect of statins could only be observed in groups with less than four years of follow-up.

TUmor-volume to breast-volume RAtio for improving COSmetic results in breast cancer patients (TURACOS); a randomized controlled trial

BackgroundCosmetic result following breast conserving surgery (BCS) for cancer influences quality of life and psychosocial functioning in breast cancer patients. A preoperative prediction of expected cosmetic result following BCS is not (yet) standard clinical practice and therefore the choice for either mastectomy or BCS is still subjective. Recently, we showed that tumour volume to breast volume ratio as well as tumour location in the breast are independent predictors of superior cosmetic result following BCS. Implementation of a prediction model including both factors, has not been studied in a prospective manner. This study aims to improve cosmetic outcome by implementation of a prediction model in the treatment decision making for breast cancer patients opting for BCS.Methods/designMulticentre, single-blinded, randomized controlled trial comparing standard preoperative work-up to a preoperative work-up with addition of the prediction model. Tumour volume to breast volume ratio and tumour location in the breast will be used to predict cosmetic outcome in invasive breast cancer patients opting for BCS. Three dimensional (3D)-ultrasonography will be used to measure the tumour volume to breast volume ratio needed for the prediction model. Sample size was estimated based on a 14% improvement in incidence of superior cosmetic result one year after BCS (71% in the control group versus 85% in the intervention group). Primarily cosmetic outcome will be evaluated by a 6-member independent panel. Secondary endpoints include; (1) patient reported outcome measured by BREAST-Q, EORTC-QLQ-C30/BR23 and EQ-5D-5 L (2) cosmetic outcome as assessed through the BCCT.core software, (3) radiation-induced reaction (4) surgical treatment performed, (5) pathological result and (6) cost-effectiveness. Follow-up data will be collected for 3 years after surgery or finishing radiotherapy.DiscussionThis randomized controlled trial examines the value of a preoperative prediction model for the treatment-decision making. It aims for a superior cosmetic result in breast cancer patients opting for BCS. We expect improvement of patients’ quality of life and psychosocial functioning in a cost-effective way.Trial registrationProspectively registered, February 17th 2015, at ‘Nederlands Trialregister - NTR4997’.

Anthracycline Chemotherapy and Cardiovascular Function and Fitness in Breast Cancer Patients

Chemotherapy using anthracyclines is among the most effective pharmacological therapy available in the treatment of cancer. However, they are often accompanied by profound adverse complications of cardiovascular system called cardiotoxicity. Some of these side effects can lead to progressive cardiovascular diseases. Currently, it is not known if anthracycline chemotherapy is associated with vascular dysfunction and cardiovascular fitness impairment in breast cancer patients. PURPOSE: To investigate the association between anthracycline chemotherapy and cardiovascular functions in breast cancer patients. METHODS: Fifteen breast cancer patients aged 45±3 years were compared with fourteen age-, sex-, and body composition-matched healthy females. The anthracycline chemotherapy treatment consisted of 4 cycles of doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) repeated every 3 weeks. Breast cancer patients had been undergoing second or third cycle of chemotherapy treatments. RESULTS: There were no significant group differences in height, body fat, resting heart rate, systolic and diastolic blood pressure. Maximal oxygen consumption was not different between cancer patients and healthy controls (26.7±1.4 vs. 26.6±0.9 ml/kg/min). Ankle-brachial index was not different but carotid artery intima-media thickness was higher (p<0.05) in cancer patients than in healthy controls (0.50±0.02 vs 0.45±0.01 mm). Brachial-ankle pulse wave velocity, an index of arterial stiffness, was greater (p<0.05) in cancer patients than in healthy controls (1325±48 vs. 1158±38 cm/sec). CONCLUSIONS: These results suggest that anthracycline chemotherapy is associated with vascular stiffening in breast cancer patients. Prospective intervention studies are needed to confirm the findings from this cross-sectional study. Supported by Government research budget Chulalongkorn University 2016 and The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship.

Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study.

Aims2 dimensional (2D) strain analysis detects subclinical left ventricular (LV) systolic dysfunction. Our aim was to evaluate changes in LV systolic and diastolic function in breast cancer patients early after anthracycline chemotherapy, and to identify predisposing factors.Methods and results140 patients were assessed by detailed echocardiography before and within seven days post treatment. LV ejection fraction (LVEF), global longitudinal strain (GLS), strain rate and radial and circumferential strain were assessed. Additionally, left atrial volumes and LV diastolic parameters were evaluated. LVEF although reduced after treatment, remained within the normal range (60±3% vs. 59±3%, p = 0.04). Triplane GLS was significantly reduced after treatment (-20.0±1.6% vs. -19.1±1.8%, p<0.001). Subclinical LV dysfunction (>11% reduction in GLS compared to before therapy) occurred in 22% (29/135). Impaired diastolic function grade significantly increased from 46% to 57% (p<0.001) after treatment. Furthermore, diastolic dysfunction was more common in the subgroup group with reduced systolic GLS compared to those without changes in GLS (30% vs. 11%; p = 0.04). No risk factors or clinical parameters were associated with the development of subclinical LV dysfunction; however the percentage change in early diastolic strain rate and the E velocity were independent predictors of >11% reduction in GLS.ConclusionTwenty two percent of patients had subclinical LV dysfunction by GLS, whilst none had cardiotoxicity defined by LVEF, demonstrating that GLS is more sensitive for detection of subclinical LV systolic dysfunction immediately after anthracycline therapy. Diastolic dysfunction increased, particularly in the group with reduced GLS, demonstrating the close pathophysiological relationship between systolic and diastolic function.

Higher antral follicle count associated with earlier return of ovarian function in breast cancer patients with temporary amenorrhea after chemotherapy

Higher antral follicle count associated with earlier return of ovarian function in breast cancer patients with temporary amenorrhea after chemotherapy

Effects of exercise interventions and physical activity behavior on cancer-related cognitive impairments: an update.

The purpose of this review is to give an update on studies investigating the influence of physical activity behavior and exercise interventions on cancer-related cognitive impairments. Cross-sectional and observational studies underline previous findings, revealing an association of cancer patients' fitness and their cognitive functions. Results from interventional studies are sparse. Only one study investigated self-perceived cognitive function in breast cancer patients as a secondary outcome, indicating no effects. Recent research on physical activity and exercise interventions is still restricted by methodological limitations, including the wide variation in assessments and the lack of adequate control groups.

Effects of compensatory cognitive training intervention for breast cancer patients undergoing chemotherapy: a pilot study.

Numerous breast cancer patients experience cognitive changes during and after chemotherapy. Chemotherapy-related cognitive impairment can significantly affect quality of life. This pilot study attempted to determine the effects of a compensatory cognitive training on the objective and subjective cognitive functioning of breast cancer patients receiving adjuvant chemotherapy. Fifty-four patients were assigned to either a compensatory cognitive training or waitlist condition. They were assessed at baseline (T1), the completion of the 12-week intervention (T2), and 6months after intervention completion (T3). Outcomes were assessed using the standardized neuropsychological tests and the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), version 3. Raw data were converted to T-scores based on baseline scores, and a repeated-measures ANCOVA, adjusting for age, intelligence, depression, and treatment, was used for analysis. The effect sizes for differences in means were calculated. The intervention group improved significantly over time compared to the waitlist group on objective cognitive function. Among ten individual neuropsychological measures, immediate memory, delayed memory, verbal fluency in category, and verbal fluency in letter showed significant group × time interaction. In subjective cognitive function, scores of the waitlist group significantly decrease over time on perceived cognitive impairments, in contrast to those of the intervention group. The 12-week compensatory cognitive training significantly improved the objective and subjective cognitive functioning of breast cancer patients. Because this was a pilot study, further research using a larger sample and longer follow-up durations is necessary.

Development of the Cognitive Function Scale for Breast Cancer Patients

Purpose: This is the methodological study to develop the cognitive function scale for breast cancer patients. Methods: Study was consisted with 1st and 2nd items developing and testify for reliability and validity of them. 94 breast cancer patients in 2 university hospitals and 1 general hospitals responded to a questionnaire that assessed cognitive function scale. Collected data were analysed using the program SPSS/PC Win 21.0. Structural validity was determined factor analysis and convergent validity. This method yielded Cronbach’s α value as an internal consistency for the reliability. Results: Factor analysis resulted in six factors and 24 items accounted for 76.31% of the variance. Cronbach’s α of scale developed was high as a .95. Conclusion: The developed cognitive function scale in breast cancer patients scale has reliability and validity as linear analogue scale witch quantitatively measure the subjectivity. Over these results, providing the way on an assessment in cognitive function in effect for breast cancer patients, it is supposed to contribute the development of nursing knowledge about the cognitive function in breast cancer patients.

Longitudinal assessment of right ventricular structure and function by cardiovascular magnetic resonance in breast cancer patients treated with trastuzumab: a prospective observational study

BackgroundThere are limited data on the effects of trastuzumab on the right ventricle (RV). Therefore, we sought to evaluate the temporal changes in right ventricular (RV) structure and function as measured by cardiovascular magnetic resonance (CMR), and their relationship with left ventricular (LV) structure and function in breast cancer patients treated with trastuzumab.MethodsProspective, longitudinal, observational study involving 41 women with HER2+ breast cancer who underwent serial CMR at baseline, 6, 12, and 18 months after initiation of trastuzumab. A single blinded observer measured RV parameters on de-identified CMRs in a random order. Linear mixed models were used to investigate temporal changes in RV parameters.ResultsOf the 41 women (age 52 ± 11 years), only one patient experienced trastuzumab-induced cardiotoxicity. Compared to baseline, there were small but significant increases in the RV end-diastolic volume at 6 months (p = 0.002) and RV end-systolic volume at 6 and 12 months (p < 0.001 for both), but not at 18 months (p = 0.82 and 0.13 respectively). RV ejection fraction (RVEF), when compared to baseline (58.3%, 95% CI 57.1–59.5%), showed corresponding decreases at 6 months (53.9%, 95% CI 52.5–55.4%, p < 0.001) and 12 months (55%, 95% CI 53.8–56.2%, p < 0.001) that recovered at 18 months (56.6%, 95% CI 55.1–58.0%, p = 0.08). Although the temporal pattern of changes in LVEF and RVEF were similar, there was no significant correlation between RVEF and LVEF at baseline (r = 0.29, p = 0.07) or between their changes at 6 months (r = 0.24, p = 0.17).ConclusionIn patients receiving trastuzumab without overt cardiotoxicity, there is a subtle but significant deleterious effect on RV structure and function that recover at 18 months, which can be detected by CMR. Furthermore, monitoring of LVEF alone may not be sufficient in detecting early RV injury. These novel findings provide further support for CMR in monitoring early cardiotoxicity.Trial registrationClinicalTrials.gov Identifier: NCT01022086. Date of registration: November 27, 2009.

Long-term tolerance and cardiac function in breast cancer patients receiving trastuzumab therapy.

We examined the long-term clinical tolerance and cardiac safety of trastuzumab treatment in ninety-four female patients diagnosed with breast cancer with human epidermal growth factor receptor 2 (HER-2) overexpression. Electrocardiography (ECG) was monitored throughout trastuzumab treatment, and left ventricular ejection fractions (LVEFs) were estimated using echocardiography prior to treatment with trastuzumab and every 3 months after its first application. The duration of trastuzumab treatments ranged from 3 to 60 months. Declines in LVEF ≥ 15% were seen mainly after 3-15 months of trastuzumab treatment, and LVEF was lowest at 15 months, which coincided with the largest decline in LVEF from baseline. Spearman correlation coefficients indicated that accumulation of anthracycline, the use of cyto/cardioprotective drugs (CPD) and the duration of trastuzumab treatment were all associated with the change of LVEF, and there was a strong correlation between these factors and the change of LVEF (ρ=0.81, ρ=0.734 and ρ=0.777 respectively). These results indicate that significant decreases of LVEF may be seen after 3-15 months of trastuzumab treatment, but that there is a favorable benefit-risk ratio for patients undergoing long-term trastuzumab treatment.

Impairment of the executive function in breast cancer patients receiving chemotherapy treatment: a functional MRI study

The aim of this study is to investigate chemotherapy-induced alterations in the functional framework of the brain, and probe the relationship between these changes and executive function impairments in breast cancer patients. Thirty-three breast cancer patients (BC) after receiving chemotherapy and 31 matched healthy controls (HC) were enrolled in this study. All participants received resting-state functional connectivity magnetic resonance imaging (rs-fcMRI) and neuropsychological background tests. The lower functional connectivity of the posterior cingulate cortex (PCC) was found in the left postcentral gyrus, left precentral gyrus, right superior temporal gyrus, right cingulate gyrus and right middle frontal gyrus. A significant negative correlation was found between the response time on the Trail Making Tests and the functional connectivity strength between the PCC and right middle frontal and right cingulate gyri in breast cancer patients. In addition, the strength of the functional connectivity between the PCC and right middle frontal gyrus had a negative correlation with the response times on the Stroop Interference Test in breast cancer patients. This study demonstrated that BC patients after receiving chemotherapy have abnormal functional connectivity. These findings suggest that functional connectivity changes might play an important role in chemotherapy-induced executive function impairments in breast cancer patients.

The Effect Of Exercise 24-hours Before Chemotherapy On Cardiac Function And Symptoms In Breast Cancer

Rodent studies have demonstrated that a single submaximal exercise bout can attenuate markers of cardiac damage caused by adriamycin chemotherapy injection 24 hr later. However, it is unclear whether this finding extends to humans. PURPOSE: To determine the effects of exercise 24 hr prior to the first chemotherapy treatment on cardiac function in breast cancer patients (BCP). METHODS: Patients were randomized to either: 1) no vigorous exercise for 72 hr prior to first treatment (n = 8), or 2) no vigorous exercise for 48 hrs, then 30 min of vigorous exercise (70% age-predicted heart rate reserve) 24 hr prior to first treatment (n = 9). Chemotherapy treatment included 60 mg/m2 adriamycin and 600 mg/m2 cyclophosphamide. Two-dimensional echocardiography and blood pressure were assessed pre- and 24-48 hr post-treatment. Key cardiac measures included speckle tracking-derived global longitudinal strain (GLS) and standard volumetric measures (e.g., end-diastolic volume (EDV)). Rotterdam Symptom Checklists were administered prior to the first and second treatments. Standardized physical and psychological distress scores were tabulated. Analysis included mixed methods ANOVA with p≤0.05. RESULTS: There were no significant interactions or group differences for GLS, EDV, systolic blood pressure, or resting heart rate. There were significant (p≤0.05) main effects for time (pre vs. post treatment) for GLS (-19.3 ± 1.5 to -21.2 ± 1.8 %), systolic blood pressure (107 ± 14 to 102 ± 14 mmHg) and a trend for EDV (80 ± 13 to 88 ± 16 mL, p=0.06). There was no significant change in heart rate (70 ± 10 to 68 ± 11 bpm). Physical distress increased post-treatment (14 ± 8 to 26 ± 11, p<0.01), while there was a trend toward a decrease in psychological distress (26 ± 13 to 18 ± 17, p=0.07). CONCLUSIONS: Within this initial small sample of BCP, there does not seem to be an effect of aerobic exercise 24 hr prior to receipt of the first adriamyacin chemotherapy treatment on the cardiac function parameters or symptoms measured. The acute effect of chemotherapy is an increase in GLS; and the trend in EDV may be suggestive of an increase in blood volume, but this requires further investigation. Receipt of the first treatment significantly increases physical symptoms, but may decrease the psychological distress associated with anticipation of the first treatment.