Function In Breast Cancer Patients Research Articles

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

Cognitive impairments in breast cancer survivors treated with chemotherapy: a study based on event-related potentials.

Chemotherapy-related cognitive impairments in breast cancer patients were usually reported through cognitive questionnaires or scales which may be subjective and insensitive. This study is to assess the effect of chemotherapy on cognitive function in breast cancer patients stratified by age using objective electrophysiological measure, the P300 component of event-related potentials (ERPs) with a large sample size. Totally, 529 primary breast cancer patients, including 178 cases at initial diagnosis stage and before chemotherapy (Group1), 167 cases during chemotherapy (Group2), and 184 cases post chemotherapy and during follow-up period (Group3), were examined with ERPs (P300 component) to assess the effect of chemotherapy on their cognitive function. There were significant differences of P300 latency in Group2 (364.74 ± 15.73ms) and Group3 (364.02 ± 17.12ms, mean follow-up period of 2.42years) compared with Group1 (355.13 ± 19.47ms, P < 0.001), respectively. With further age stratification: in patients of < 50years, P300 latency was significantly prolonged in Group2 and Group3 compared with Group1 (P < 0.001), respectively; in patients of 50-59years, P300 latency was significantly prolonged in Group2 compared with Group1 (P < 0.05), but without difference in Group1 and Group3 (P>0.05); In patients of ≥ 60years, there were no differences of P300 latency among three the groups (P>0.05). It is first suggested by our objective detection data that the side effect of chemotherapy on cognitive functions in breast cancer patients may decrease with age. Electrophysiological cognitive impairments mainly occur in younger breast cancer patients undergoing chemotherapy and would last for years after chemotherapy, which highlights the importance of early intervention for those patients, especially in younger patients.

Evaluation of left ventricular function in breast cancer with targeted therapy by gated equilibration ventriculography

Objective To observe the evaluation function of gated equilibration ventriculography for the changes of left ventricular function in breast cancer with targeted therapy. Methods From February 2016 to December 2017, a total of 60 female breast cancer patients (age: 28-65 (48.7±9.4) years) were included prospectively. Patients were divided into 2 groups: lapatinib combined with taxeme-based chemotherapy group (group A; n=25, age: 29-65 (47.8±11.3) years) and lapatinib monotherapy group (group B; n=35, age: 31-62 (51.1±8.5) years). All patients underwent gated equilibration ventriculography before treatment and 6/12 months after treatment. The parameters of left ventricular function including left ventricle ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), 1/3 ejection fraction (EF), 1/3 filling fraction (FF), time to peak ejection rate (TPER) and time of peak filling rate (TPFR) were observed. Repeated measurement analysis of variance, independent-samples t test and Wilcoxon rank sum test were performed. Results In group A, the PER at 12 months after treatment ((3.11±0.48) end-diastolic volume (EDV)/s) was lower than that before treatment ((3.60±0.62) EDV/s; F=3.447, t=0.60, P 0.05); the PFR at 6 months ((3.07±0.71) EDV/s) and 12 months after treatment ((2.84±0.54) EDV/s) declined significantly compared with that before treatment ((3.57±0.81) EDV/s; F=5.345, t=0.82 and 0.75, both P<0.05). In group B, the PFR at 12 months after treatment ((2.86±0.55) EDV/s) declined significantly compared with that before treatment ((3.23±0.87) EDV/s; F=3.214, t=0.84, P<0.05). The decrease of PFR at 6 months and 12 months after treatment in group A was greater than that in group B (-0.37(-0.78, 0.15) vs -0.13(-0.44, 0.17) EDV/s; z=-1.569, P<0.05). Conclusions The gated equilibration ventriculography can effectively monitor the left ventricular function of breast cancer patients after targeted therapy. PER and PFR may be more sensitive than other parameters to assess heart function changes. The lapatinib combined with taxeme-based chemotherapy can affect diastolic function more and earlier than lapatinib monotherapy. Key words: Breast neoplasms; Molecular targeted therapy; Cardiotoxicity; Ventricular function, left; Gated blood-pool imaging

434P - Is radiation therapy influencing alzheimer’s in brain and head and neck cancers?

BackgroundAlzheimer’s disease showed different connections with various types of cancers and, even, both are protecting from each other. Some studies attributed it to shared genetic backgrounds. One of the shared mutations is located on APOE4 gene, a risk factor in Alzheimer’s, and was connected to chemotherapy-related deterioration of cognitive functions in breast cancer patients. Our aim is to examine the addon effect of radiation therapy on the risk of death from Alzheimer’s disease. MethodsWe collected data from 13 USA cancer registries enrolled in Surveillance Epidemiology and End Results program using SEER*stat software. We enrolled patients diagnosed with head and neck cancers or brain cancers between 1992 and 2016. The event was defined as death due to Alzheimer’s disease following the cancer diagnosis. Moreover, we have calculated Multiple Primary Standardized Incidence Ratios and excess risk per 10,000 person-years, to estimate the change of risk following the diagnosis when compared to the general population. Besides, we calculated the effect of gender, age, and receiving radiation for cancer. ResultsOut of 142,541 patients (59,630 patients with brain malignancies, and 82,911 with head and neck malignancies), 151 died due to Alzheimer’s after more than 10 years following a cancer diagnosis; 20 had brain malignancies, and 131 had other head and neck malignancies. The risk of Alzheimer’s death increased significantly after more than 10 years of a cancer diagnosis with an O/E ratio of 1.35 and an excess risk of 2.72 per 10,000. The risk increased significantly among females (81 females and O/E was 1.4) and males (70 and O/E was 1.29). Alzheimer’s was the cause of death in 52 patients who received Radiation therapy, and 13 patients who received chemotherapy with O/Es of 1.45 and 1.59 respectively. The risk of disease-related mortality was high in patients older than 70 years, while patients who were diagnosed with cancer earlier did not show a significant increase in their risk of Alzheimer’s death than the general population. ConclusionsRisk of Alzehimer’s-related mortality increases significantly among survivors of head and neck cancers and brain cancers. Further studies shall address the biological risk-modifying effects of aging, gender, and treatment. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Myeloid-Derived Suppressor Cell Function in Breast Cancer Patients

Myeloid-Derived Suppressor Cell Function in Breast Cancer Patients

The Effect of Mini-Latissimus Dorsi Flap (MLDF) Reconstruction on Shoulder Function in Breast Cancer Patients.

The aim of this study is to investigate the effect of mini latissimus dorsi flap (MLDF) reconstruction on ipsilateral shoulder functions. Those included in the study are the patients aged between 23 and 73, who were operated with the diagnosis of early breast cancer (cT1-3)N0). The first group includes the patients who had sentinel lymph node biopsy (SLNB) with partial mastectomy. The second group consists of the patients who had axillary lymph nodule dissection (ALND) with partial mastectomy. The third group includes the patients who had SLNB and MLDF with partial mastectomy. The fourth group includes the patients who had ALND and MLDF with partial mastectomy. Patients' Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score work model point were recorded. 174 patients were included in this study. According to Q-DASH score, no functional change was detected in 69.5% of the patients, whereas slight functional loss was identified in 23.6%, moderate functional loss in 5.7%, severe functional loss 1.1%. In the comparison of Q-DASH scores in surgery groups, while these four groups were being analyzed, a significant difference was determined (p=0.007). When dual analyses were made, it was also established that the difference resulted from the group to which ALND and MLDF were applied together. We conclude that MLDF application for reconstruction purposes after breast surgery has a negative impact on shoulder functions of the patients who had both of partial mastectomy and ALND.

Abstract 4061: Investigating the Indoleamine 2,3-dioxygenase 1 (IDO1) responsive gene expression panel in predicting outcome in stage matched colorectal cancer patients

Abstract Colorectal cancer has emerged as a third most commonly diagnosed cancer in males and second in females. There is need for new tools in the form of prognostic biomarkers which could assist in tailoring of individualized treatment. Indoleamine 2,3-dioxygenase (IDO), a single chain oxido-reductase that serves as a catalyst for the degradation of tryptophan into kynurenine, has merged as a key player in T-cell suppression and in the induction of immune tolerance to tumors. IDO inhibitors have entered the clinical arena with a promise to restore immune functions in breast cancer patients. We identified through extensive literature search a list of IDO1-responsive genes. These gene along with IDO1 interferes with cancer control pathways and leads to cancer progression. The expression of following genes was quantified on Nanostring platform - IDO1, CTLA4, IL4R, PDL1, CTLA4, IL4R, HIF and IL6. Under an approved IRB protocol we identified 750 colon cancer patients at the Georgia Cancer Center with a 5 year follow-up. These patients were then divided into different experimental groups based on tumor stage (AJCC stages 1-4), survival (more or less than 3 years), tumor grade (AJCC grades 1-3), and age (older or younger than 68). A total of 88 patients fitted in our inclusion criteria on the basis of survival duration after diagnosis. The FFPE blocks were acquired from Medical College of Georgia, Augusta. Total RNA was isolated and quantified through Nanodrop method. The statistical analysis of data was performed using student t-test and Pearson correlation. IDO1 had significantly expressed at higher levels in stage IV patients (p = 0.01*). CTLA4 and IL4R were significantly expressed in stage IV patients with higher survival (p = 0.03*) and (p = 0.04*) respectively. PDL1 expression was higher in stage III patients with higher survival (p = 0.04*). CTLA4 was expressed at higher levels in patients with higher survival (&amp;gt;5 years). IDO1 was expressed at higher levels in males (p = 0.23*). In smokers, HIF and IL6 expression was higher as compared to non-smokers, (p = 0.02*). Preclinical data have shown that IDO1 inhibitors such as 1-Methyl-D-Tryptophan (1-MT) can synergize with chemotherapy in killing tumors. Therefore the inhibition of IDO as an approach to immunotherapy has a high amount of potential. Combining this new agent with current therapies may boost their efficacy and improve survival in TNBC patients. Furthermore, despite the rapid progress made in cancer immunotherapy, very few biomarkers are available for predicting the responsiveness and effectiveness of immunotherapy agents. Therefore, there is an urgent need to identify and develop such predictive biomarkers. These findings points to the clinical significance of IDO responsive genes and tested its importance in a gene expression based prognostic biomarker panel in CRC patients. Citation Format: Ravindra Kolhe, Chance Bloomer, Pankaj Ahluwalia, Chetan Pundkar, Saleh Heneidi, Ashis Mondal. Investigating the Indoleamine 2,3-dioxygenase 1 (IDO1) responsive gene expression panel in predicting outcome in stage matched colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4061.

The Impact of Taxane-based Chemotherapy on the Lymphatic System.

Breast cancer-related lymphedema affects 700,000 breast cancer survivors in the United States. Although taxane-based chemotherapy regimens are commonly used in the treatment of breast cancer, the impact of taxanes on the lymphatic system remains poorly understood. This study aims to examine the influence of taxane-based chemotherapy on lymphatic function in breast cancer patients. A retrospective review of a prospectively-maintained database was performed. Consecutive patients with node positive breast cancer who underwent preoperative indocyanine green (ICG) lymphangiograms were identified. Information including patient demographics, baseline measurements, cancer characteristics, and treatment information were retrieved. Preoperative ICG lymphangiography videos were analyzed and lymphatic contractility was quantified for each subject. Multiple regions of interest were selected on each lymphatic channel and signal intensity was recorded for 3 minutes to generate contractility curves. Each lymphatic contraction was identified using a novel, systematic, and algorithmic approach. Twenty-nine consecutive patients with unilateral node-positive breast cancer were included for analysis. Average patient age was 54.5 (13) years and mean BMI was 26.8 kg/m (4). The mean lymphatic contractility of patients who received taxane-based neoadjuvant chemotherapy was 0.7 contractions/minute (c/m) (n = 19) compared to 1.1 c/m in those who received no neoadjuvant therapy (n = 10), (P = 0.11). In subgroup analysis, patients who reported taxane induced neuropathy demonstrated significantly lower lymphatic contractility values than those who were asymptomatic or did not receive any chemotherapy (P = 0.018). In this study, we used a novel method for quantifying and evaluating lymphatic contractility rates in routine ICG lymphangiograms. Diminished lymphatic contractility was noted in patients who received taxane-based neoadjuvant chemotherapy compared with those who did not. Taxane-based neoadjuvant chemotherapy may adversely affect the lymphatic system in the breast cancer population. A larger patient cohort with longer follow-up time is needed to validate this finding and evaluate any potential association with breast cancer-related lymphedema development.

Change of upper limb function in breast cancer patients after lymph node dissection and mastectomy

Change of upper limb function in breast cancer patients after lymph node dissection and mastectomy