Side Effects Of Adjuvant Chemotherapy Research Articles

The use of adjuvant chemotherapy in resected stage IB-IIIA non–small cell lung cancer (NSCLC) and comparison to the TriNetX database.

29 Background: Adjuvant cisplatin-based chemotherapy (AC) is the standard of care for completely resected stage IB (tumor size > 4cm), II, and IIIA non small cell lung cancer (NSCLC) patients. Several randomized clinical trials have shown varying levels of survival benefit for patients treated with AC compared to surgery alone. Methods: A retrospective study was performed regarding the use of adjuvant chemotherapy comparing Charleston Area Medical Center (CAMC) patients to those in the TriNetX database in the years 1998-2017. Inclusion criteria were patients > 18 years of age, completely resected (R0), stage IB (tumor size > 4 cm) through stage IIIA (R0) NSCLC. SAS 9.3 was used for data analysis. Results: The populations included two hundred and thirty-six (CAMC) and 4,364 (TriNetX) patients. The CAMC population was 98% Caucasian, 63% male with an average age of 65±10 years. The TriNetX population was 66% Caucasian, 57% male with an average age of 67±10 years. The 5-year overall survival (OS) in the CAMC database between chemotherapy and non-chemotherapy groups was not statistically significant (49.5% vs 49.8%, p = 0.8, respectively). In the TriNetX database, the 5-year OS for the chemotherapy group was significantly higher compared to the non-chemotherapy groups (61.2% vs 54.0%, p < 0.05, respectively). Cox proportional hazards model was used to determine the factors influencing 5-year OS in the CAMC population. Results showed that patients >65 years of age were 2.2 times (95% CI: 1.53-3.2) more likely to be dead in 5-years. With each increase in stage patients were 1.3 times (95% CI: 1.0-1.8) more likely to be dead in 5-years. Moreover, patients without coronary artery disease were 1.7 times (95% CI: 1.2-2.4) more likely to be dead in 5-years. Conclusions: Regardless of treatment, about half of CAMC patients were alive at 5 years, while a higher OS was seen in the TriNetX chemotherapy group. Regression analysis of the CAMC population showed that chemotherapy was not a significant variable in 5-year OS. Differences in survival between CAMC and TriNetX could be due to the large number of comorbidities in the CAMC population, patient refusal to chemotherapy, particularly those >65 years, and incomplete planned dose due to side effects of adjuvant chemotherapy. We conclude that several barriers may impact the use of adjuvant chemotherapy in non-trial settings in the CAMC population.

Early and late readmissions after enhanced recovery thoracoscopiclobectomy.

The purpose of this study was to describe the incidence of and reasons for early (0-30 days) and late (31-90 days) readmissions after enhanced recovery video-assisted thoracoscopic surgery lobectomy. We performed a retrospective analysis of prospectively collected consecutive VATS lobectomy data in an institutional database from January 2019 through December 2020. All reasons for readmission with complete follow-up were individually evaluated. Univariable and multivariable analyses were used to assess predictors. In total, 508 patients were included; the median length of stay after the operation was 3 days. There were 77 (15%) early and 54 (11%) late readmissions, respectively. There were 33 (7%) multiple readmissions during postoperative days 0-90 ; pneumonia (19.8%) and pneumothorax (18.3%) were the dominant reasons for early readmissions, and the side effects of adjuvant chemotherapy (22.0%), for late readmissions. In multivariable analyses, current smoking (P = 0.001), alcohol abuse (P = 0.024) and chronic obstructive pulmonary disease (P = 0.019) were predictors of early readmissions, whereas Clavien-Dindo I-II grade gastrointestinal complications predicted late readmissions (P = 0.006) and multiple readmissions (P = 0.007). Early discharge (< 3 days) was not a predictor of readmissions. Early readmission did not increase late readmission. Early and late readmissions after video-assisted thoracoscopic lobectomy are frequent even when enhanced recovery programmes are followed. Pulmonary complications and adjuvant chemotherapy are the most predominant reasons for early and late readmissions.

Days alive and out of hospital after enhanced recovery video-assisted thoracoscopic surgery lobectomy.

Days alive and out of hospital (DAOH) integrates overall information of hospitalization, readmissions, and mortality that have been applied as a new outcome measure. However, DAOH after video-assisted thoracoscopic surgery (VATS) in an established enhanced recovery after surgery (ERAS) programme has not been reported. Patients aged ≥18 years with non-small-cell lung cancer undergoing VATS lobectomy in an established ERAS programme were eligible. The primary and secondary outcomes were DAOH during the first postoperative 365 days and reasons for reduced DAOH. A total of 316 consecutive patients with well-defined inclusion criteria and complete follow-up were assessed retrospectively. The median length of stay was 3 days (IQR 2-6). The medians (IQR) of postoperative 30, 60, 90, 180 and 365 DAOH were 27 (22-28), 57 (51-58), 86 (80-88), 176 (169-178) and 359 (349-363) days, respectively. Air leak was the dominant factor for reduced DAOH from postoperative day (POD) 0-30 (47.2%) and 0-365 (38.3%). Side effects of adjuvant chemotherapy were dominant from POD 31-60 and 61-90 (23.5% and 47.1%) and recurrence/metastases from POD 91-180 and 181-365 (25.6% and 50.0%). A low diffusing capacity for carbon monoxide (odds ratios 1.28, 95% confidence interval 1.07-1.53; P=0.007) and prior surgical history (odds ratios 1.80, 95% confidence interval 1.08-2.99; P=0.023) were predictors for low DAOH. DAOH after 1 year with an established VATS lobectomy ERAS programme was only reduced with a median of 6 days. The main factors reducing DAOH were air leak, adjuvant chemotherapy and recurrence. DAOH may be an important patient-centred outcome to define future improvement strategies.

Reduction of Chemotherapy–Induced Side Effects by Complementary Medicine in Breast Cancer Patients

This clinical investigation was performed to evaluate the benefit of Complementary Medicine (CM) in breast cancer patients undergoing adjuvant Chemotherapy (ChT). Patients and Methods: The patients (n=668) were treated according to international guidelines with adjuvant ChT. As to reduce the side effects, the patients were complementarily treated with a combination of sodium selenite, proteolytic plant enzymes (bromelaine and papain) and Lens culinaris lectin. On Case Report Formulas (CRFs) assessment of side effects of ChT was documented at defined times during adjuvant ChT and additional complementary treatment. Validation was carried out by scoring from 1 (no side-effects/optimal tolerability) to 6 (extreme side-effects/extremely bad tolerability), however, only patients suffering from severe side effects (symptom scores 4 and higher) were enrolled into this investigation. Results: The severity of side-effects of ChT was significantly reduced by complementary treatment. Mean scores of symptoms declined for sleep disorder, fatigue, lack of drive (p&lt;0.05) and for arthralgia, hot flushes, mucosal dryness, nausea, vomiting, diarrhea, loss of appetite, pain of tumour (p&lt;0.001). Conclusion: This investigation confirms benefits of indication-based complementary treatment with the combination of sodium selenite, proteolytic enzymes and Lens culinaris lectin in breast cancer patients, e.g. reduction of side-effects of adjuvant ChT.

Side effects of adjuvant chemotherapy and their impact on outcome in elderly breast cancer patients: a cohort study.

Aim:Breast cancer patients over the age of 65 are more likely to suffer chemotherapy side effects, with premature discontinuation, which negatively affects survival.Methods:We conducted a retrospective cohort study enrolling breast cancer patients; dose reductions or interruptions of chemotherapy have been collected, as well as side effects. Progression-free survival was determined by Kaplan–Meier and evaluated for its association with reduction/suspension. The study included 128 women (median age: 71).Results:Nineteen patients experienced cardiotoxicity, while dosage of chemotherapy was reduced in 23 patients (18.0%), and 14 (10.9%) had premature interruptions. Dose reduction/interruptions were associated with numerically worse progression-free survival (78.2 vs 94.8 months; p = 0.10).Conclusion:Reduction/discontinuation of chemotherapy due to side effects affected nearly 30% of our population, potentially worsening outcomes.

Ozone therapy can be considered as an integrative therapy in oncology? [abstract

BACKGROUND: Our group in Policlinic Umberto I - University Hospital of Sapienza Rome - has decided to further investigate if Ozone therapy can be of support in oncology.&#x0D; In literature it has been reported that ozone applications in oncology or in cancer cells is associated with: high efficiency in preventing chemotherapy complications (nausea, vomiting, opportunistic infections, asthenia) as well as confining or restricting the expansion of tumours.(1-5)&#x0D; &#x0D; PURPOSE: The aim of our study in to evaluate and eventually confirm the validity of ozone treatments in order to consider such procedures as a possible and concrete support therapy for oncology patients undertaking chemotherapy. A statistical significance and clinical evaluation of our work would finally give a scientifically validation, still missing, to officially consider ozone therapy as one of the many possible integrative therapy in oncology.&#x0D; &#x0D; DESIGN: It is a pilot study designed and approved by the Ethical Committee of the University of Rome, La Sapienza (March 2017) to evaluate quality of life and reduction of side effects of adjuvant chemotherapy in 20 breast cancer patients.&#x0D; &#x0D; METHODS: The selected patients will be treated with systemic ozone treatment: Ozonated autohemotherapy will be performed according to the following method: 200 ml venous blood will be exposed an equal amount of O2 /O3 (200 ml) The ozone concentration will be gradually increased as follows: 20-30-40 mcrg/mL with a specific schedule until each patient will receive 15 applications overall. The sessions will be scheduled according to a specific timetable during the administration of adjuvant chemotherapy by means of Epirubicin and Cyclophsphamide (EC) every 3 weeks for 4 cycles followed by Paclitaxel for 12 consecutive weeks.&#x0D; &#x0D; Ozone therapy will not be applied on days of chemotherapy in order to avoid interaction between chemotherapeutics and ozonides. Biochemical blood analysis and stress oxidative blood test will be used as parameters for activity of antioxidant defence system. Quality of life will be evaluated with Fact G Test.&#x0D; &#x0D; It is the first study to have been evaluated and approved by an official university ethical committee and we will be glad to publish our result as soon as possible. On this behalf it would be great if any other centre could be interested in cooperating with us so to transform this pilot study into a multicentre study with larger numbers and therefore, with a greater impact on the international community.&#x0D; &#x0D; Our aim is to give cancer patients a better life quality in general and especially help them overcome all the side effects during the chemotherapy. This could open a new scenario in the alternative complementary treatments in oncology.

Non-Hodgkin’s lymphoma: unexpected cause of shoulder pain. A systematic review of the literature

The non-Hodgkin lymphoma (NHL) is one of the most common shoulder neoplasms, especially the diffuse large B cell lymphoma (DLBCL). We report a rare case of shoulder pain in a 80-year-old man presenting with a six-month history of continuous severe pain to the right shoulder. Routine laboratory studies were normal. Shoulder MRI showed an in-growing inhomogeneous lesion in the anteromedial aspect of the right humeral head extended within the cortical bone of the humerus (osteolitic lesion), next to the surrounding soft tissues. He also underwent shoulder arthroscopy: the intra-articular involvement of the shoulder was therefore excluded. A percutaneous bone biopsy performed on the same day was diagnostic for lymphoma. Three days later, the patient underwent surgical excision of the mass; a reverse shoulder prosthesis was then implanted (Aequalis reversed prosthesis). The patient started chemiotherapy according with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen, but did not tolerate it because of the sudden onset of herpes zoster. At 9-month follow-up, the patient is doing well, with fair range of motion, due to the delay of rehabilitation, but no shoulder pain and no evidence of local or systemic recurrence. A painful shoulder may be due to lymphoma even in the absence of classical symptoms. In suspected patients, plain radiographs should be followed by magnetic resonance imaging and bone biopsy. Tumor removal and shoulder arthroplasty can be an effective therapy. Given the devastating side effects of adjuvant chemotherapy, we do not recommend it in elderly patients.

The effect of pregabalin and duloxetine treatment on quality of life of breast cancer patients with taxane-induced sensory neuropathy: A randomized clinical trial

Background:The primary side effect of adjuvant chemotherapy with taxanes is the taxane-induced peripheral neuropathy (TIPN), which may have substantial negative impacts on patients’ quality of life (QOL). We investigated the effect of pregabalin and duloxetine on QOL of breast cancer patients who experienced TIPN.Materials and Methods:This was a randomized, double-blind clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences, Sari, Iran. Breast cancer patients 18 or more years old were included if they received paclitaxel or docetaxel and experienced neuropathy grade one or higher; and neuropathic pain score of four or more. Patients were treated with pregabalin or duloxetine until 6 weeks. Assessment of sensory neuropathy and QOL was performed at baseline, and 6 weeks after the initiation of the treatment.Results:At baseline, the mean score of global health status/QOL scale for pregabalin and duloxetine groups were 61 (standard deviation [SD]; 5.11) and 60.28 (SD; 5.44), respectively (P = 0.54). After 6 weeks, both interventions were associated with improvement of global QOL compared to baseline. The global health status/QOL score was not different between two groups after 6 weeks. While the emotional functioning was improved more favorably with duloxetine (P < 0.001); pregabalin was associated with more improvement in insomnia and pain scores (P = 0.05 and P < 0.001, respectively).Conclusion:Pregabalin as well as duloxetine improve the global QOL of breast cancer patients with TIPN. Different effects of treatments on subscale of QLQ-C30 could help clinicians to select the appropriate agent individually.

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients.

Background/AimsAdjuvant chemotherapy (AC) has been reported to improve the prognosis for patients with Stage III colorectal cancer (CRC). However, some patients experience severe side effects and must stop AC. The C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammation-based score that could reflect the patient’s general condition. The aim of this study was to evaluate the predictive value of the CAR for side effects of AC in CRC.MethodsA total of 136 CRC patients who received AC were retrospectively analyzed. The patients were subdivided into two groups by the CAR level (CAR ≥0.1, n = 30; CD < 0.1, n = 106).ResultsThe presence of lymphatic invasion, severe side effects, and discontinuation of AC were associated with high CAR levels (p = 0.02, <0.01, and 0.02; respectively). High levels of the Glasgow Prognostic Score (GPS) and the neutrophil to lymphocyte ratio (NLR) appeared to be associated with the CAR (p = 0.04, p<0.01; respectively). Multivariate analysis identified CAR≥0.1 (HR: 7.06, 95% CI: 2.51–19.88, p<0.01) as a significant determinant of severe side effects of AC. CAR had the highest area under the curve (0.79) among several inflammation-based scores.ConclusionThe present study showed that the CAR is a novel and promising inflammation-based score for ≥ grade 3 side effects of AC in node-positive CRC.

Long term side effects of adjuvant chemotherapy in patients with early breast cancer

Adjuvant systemic therapy along with screening has been key to the observed improvements in disease-free and overall survival (DFS/OS) in breast cancer. Improvements in overall survival already take into account therapy related toxicities that can result in death. However, this measure alone does not adequately capture the impact on health-related quality of life. Therefore, it is important to examine the prevalence, frequency and short/long-term impact of therapy-related toxicities, identify patients who might be at greatest risk. Ultimately decisions regarding expected therapy benefits (relative and absolute percentage improvements in DFS/OS) must be made against a background of known potential harms. For many patients with early breast cancer (EBC), their risk of recurrence is not zero but is small. At the same time, for many therapies for early stage breast cancer, the risk of serious side effects is small but is not zero. As we better understand the long-term side effects of adjuvant chemotherapy and targeted therapy, it becomes critical to integrate our growing understanding of breast cancer biology with standard high-quality histopathologic measures to better identify the patients most likely to benefit from the various options for combined multimodality therapy. Hence, we must strive against the notion of recommending adjuvant systemic chemotherapy “just in case.” This article focuses on the long-term side effects of adjuvant chemotherapy in patients with EBC.

Abstract P3-12-05: Reduction of ovarian reserve in young early breast cancer patients: 24 months follow up of a prospective cohort trial

Abstract Background: Sideeffects of adjuvant chemotherapy on ovarian function are inadequately studied by now. Premenopausal women undergoing chemotherapy are at risk for sexual hormone deficiency and impaired fertility. This prospective cohort study searches for predictive parameters of ovarian reserve after chemotherapy. Methods: 51 premenopausal patients (average 38 years; 28-46 years) with primary breast cancer have been included. They all received neo- or adjuvant chemotherapy: anthracycline based "A"(FEC)(n= 18); anthracycline/taxane based "T"( TAC or FEC/Doc or EC/Pac)(n=30) or anthracycline- free "AF"(n=3). After chemotherapy patients received endocrine therapy (ET) for hormone receptor (HR) positive disease (tamoxifen (n=34) or goserelin/tamoxifen (n=7)). For HR negative disease (n=20) no ET was given. Before (visit 1) and 6, 12 and 24 months after initiation of chemotherapy (visit 2-4) age and chemotherapy related changes in hormone (LH, FSH, E2 and Anti-Muellerian hormone (AMH)) levels, antral follicle count and amenorrhea as parameters of endocrine function and fertility were assessed. Also quality of life (QL) and additional impact of parity, BMI and nicotine use on ovarian reserve were evaluated. Results: Antral follicle count is decreasing dramatically after chemotherapy and is not fully recovering after 2 years. Antral follicle count before and 1 year after chemotherapy are significantly correlated (p=0.012). Follicle count and age before chemotherapy are negatively correlated (p=0.004). At visit 4 the type of chemotherapy (A, T, AF) has no influence on antral follicle count or AMH levels. Tamoxifen is correlated with a significant decrease in follicle count (vs. no endocrine therapy) (p=0.039). Smoking is significantly detrimental on antral follicle count after 24 months (p=0.001). AMH levels at visits 2-4 are significantly correlated with levels at the 1 visit and are negatively correlated with age (p=0.032). Tamoxifen therapy has no impact on AMH levels. LH and FSH are increasing between visit 1 and 2 and decreasing at visits 3 and 4 (but stay above basic levels). At visit 4 LH is not and FSH is correlated with visit 1 levels (p=0.005). LH and FSH are correlated with age (p=0.0001) and are not influenced by type of chemotherapy or tamoxifen .E2 levels at visit 4 are not influenced by type of chemotherapy, but significantly decreased (p=0.003) by continued smoking. At visit 4 31/51 patients have stayed amenorrheic, 19 resumed their menstruation. This was not influenced by type of chemotherapy or age. Non- smokers are 13 times more likely to resume their menstruation (vs. smokers). Tamoxifen is correlated with a higher probability of permanent amenorrhea (p=0.058, n.s.). BMI, nicotine abuse, age, type of chemotherapy and tamoxifen have no influence on duration of amenorrhea. QL is significantly lower at visit 2, but recovers to basic values at visits 3 and 4. Conclusions: Our study contributes to a better prediction of ovarian reserve before chemotherapy. We suggest personalized counselling on fertility preserving measures before chemotherapy especially at higher age, with low AMH levels or low antral follicle counts. To stop smoking could enhance chances for ovarian preservation. Citation Format: Christoph Mundhenke, Antonia S Wenners, Jana Grambach, Juliane Koss, Ulrike von Hehn, Walter Jonat, Andreas G Schmutzler. Reduction of ovarian reserve in young early breast cancer patients: 24 months follow up of a prospective cohort trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-12-05.

PG 12.04 Long term side effects of adjuvant chemotherapy in patients with early breast cancer

PG 12.04 Long term side effects of adjuvant chemotherapy in patients with early breast cancer

Differences in attitude toward adjuvant chemotherapy between colorectal cancer survivors and the medical staff of Japanese hospitals.

Adding oxaliplatin to fluorouracil-based chemotherapy can improve the survival of patients with stage III colorectal cancer by approximately 20 %. Reportedly, cancer patients are much more likely to prefer chemotherapy than medical professionals, although there is only a very small chance of achieving benefits from treatment. However, chronic neurotoxicity may be long lasting after the administration of oxaliplatin-based chemotherapy. This study aimed to evaluate potential side effects and differences in attitude between colorectal cancer patients and medical staff regarding the risk-benefit trade-offs of chemotherapy. Relapse-free colorectal cancer patients who received adjuvant chemotherapy, doctors, and nurses were surveyed using a questionnaire regarding the side effects of chemotherapy and hypothetical clinical scenarios to quantify gains in the risk of relapse that were deemed necessary to make chemotherapy worthwhile. Responses were obtained from 147 patients, 54 doctors, and 84 nurses. Of these, 39 % of patients and 85 % of doctors replied that moderate side effects of adjuvant chemotherapy were worthwhile to achieve an absolute gain in the risk of relapse of 10 % from a baseline of 40 %. More severe side effects, as reported by colorectal cancer patients, were not associated with the larger gains necessary to make treatment worthwhile. Seven percent of patients treated with oxaliplatin, 40 % of doctors, and 43 % of nurses replied that side effects associated with oxaliplatin-based chemotherapy were severe. Doctors should consider potential heterogeneity in side effects and attitudes regarding the risk-benefit balance of adjuvant chemotherapy, and that patient perspectives should enhance shared decision-making.

Chemotherapy-related cognitive dysfunction: current animal studies and future directions

Cognitive impairment is a potential long-term side effect of adjuvant chemotherapy that can have a major impact on the quality of life of cancer survivors. There is a growing number of preclinical studies addressing this issue, thereby extending our knowledge of the mechanisms underlying chemotherapy-induced neurotoxicity. In this review, we will summarize the recent advances and important findings presented in these studies. Emerging challenges, such as the development of neuroprotective strategies, and the role of the blood-brain barrier on cognitive impairment will be described and future directions in this field of investigation will be outlined.

Diabetes alone should not be a reason for withholding adjuvant chemotherapy for stage III colon cancer.

With increasing prevalence of diabetes mellitus and colon cancer, the number of patients suffering from both diseases is growing, and physicians are being faced with complicated treatment decisions. To investigate the association between diabetes and treatment/course of stage III colon cancer and the association between colon cancer and course of diabetes. Additional information was collected from the medical records of all patients with both stage III colon cancer and diabetes (n=201) and a random sample of stage III colon cancer patients without diabetes (n=206) in the area of the population-based Eindhoven Cancer Registry (1998-2007). Colon cancer patients without diabetes were more likely to receive adjuvant chemotherapy compared with diabetic colon cancer patients (OR 1.8; 95% CI 1.2-2.7). After adjustment for age, this difference was borderline significant (OR 1.6; 95% CI 1.0-2.6). Diabetic patients did not have: significantly more side-effects from surgery or adjuvant chemotherapy; more recurrence from colon cancer; significantly shorter time interval until recurrence; or a poorer disease-free survival or overall survival. Age and withholding of adjuvant chemotherapy were most predictive of all-cause mortality. After colon cancer diagnosis, the dose of antiglycaemic medications was increased in 22% of diabetic patients, resulting in significantly lower glycaemic indexes than before colon cancer diagnosis. Since diabetic patients did not have more side-effects of adjuvant chemotherapy, and adjuvant chemotherapy had a positive effect on survival for both patients with and without diabetes, diabetes alone should not be a reason for withholding adjuvant chemotherapy. Journal of Comorbidity 2011;1:19-27.

Weight change during adjuvant chemotherapy regimens for breast cancer.

599 Background: Weight gain and obesity are associated with increased risk for many health conditions threatening mortality, including recurrence of breast cancer. Weight gain is an observed side effect of adjuvant chemotherapy, however little is known about the amount of weight increase associated with specific regimens and risk factors. We sought to characterize weight change with commonly-administered adjuvant therapy regimens and to determine characteristics associated with weight change during treatment. Methods: Retrospective electronic medical record abstraction was performed on patients prescribed adjuvant chemotherapy from April 2008-December 2009, at the Rena Rowan Breast Center at the University of Pennsylvania. Women with previous cancer or gastric bypass surgery were excluded. Chemotherapy regimen (dose and schedule), demographics, height, weight at chemotherapy initiation and completion, and alterations in treatment were abstracted. Two sample t-tests compared the mean weight change of regimens by age (< 50 vs. ≥ 50). Results: 125 women with mean age 51 years (range 26-76) and BMI 26.2 (range 16.6-54.7) were analyzed. The most common regimens were docetaxel/cyclophosphamide (TC, 4 cycles, q3 weeks) and doxorubicin/cyclophosphamide × 4 followed by paclitaxel × 4 (dose-dense AC-T), (33.9% and 37.2%, respectively). Absolute and percent weight change observed during treatment differed significantly between regimens. Women receiving TC gained an average of 2.8 lbs (95% CI 1.2-4.3), those on dose dense AC-T lost 1.2 lbs (95% CI -3.6-1.1) (p = 0.007). Among younger women (<50), those on TC gained an average of 2.3% body weight (95% CI = 0.9-3.8); those on dose dense AC-T had no significant gain (0.004%; 95% CI = -1.7-1.7) (p = 0.04). Pretreatment BMI was not associated with a change in weight for either regimen when considered as a continuous or categorical variable (< 25, 25-29.9, ≥ 30; normal, overweight, and obese, respectively). Conclusions: Weight gain is not generalizable to all adjuvant chemotherapy regimens. There is a significant difference in the amount of weight change in women receiving TC vs. dose dense AC-T. Increased awareness of weight gain during treatment and interventions to minimize this effect are needed. No significant financial relationships to disclose.

Growth fraction as a predictor of response to chemotherapy in node‐negative breast cancer

Accurate predictive markers of chemotherapeutic response in early breast cancer are still lacking. The role of tumour growth fraction as a predictor of response to chemotherapy was assessed in early breast cancer. In this study, immunohistochemical expression of MIB1 was studied in a well-characterised series of early (Stages I and II) node-negative breast carcinoma cases (n = 100) with long-term follow-up that have received adjuvant chemotherapy (cyclophosphamide/methotrexate/5-fluorouracil regimen). In addition, 728 cases who did not receive adjuvant chemotherapy were used as a control group. Increased tumour growth fraction was associated with a better response to adjuvant chemotherapy in terms of longer breast cancer specific survival and disease-free interval [hazard ratio (HR) = 0.354, 95% CI = 0.177-0.688, p = 0.003 and HR = 0.396, 95% CI = 0.205-0.768, p = 0.006, respectively]. In contrast to the control group, patients with high growth fraction tumour (>70%) showed an excellent outcome with infrequently reported events during the period of follow-up. Importantly, patients with a low growth fraction (< or =10%) showed frequent recurrences and shorter survival time with outcome comparable to those of high growth fraction who did not receive chemotherapy. Therefore, tumour growth fraction can be used to assign patients into distinct groups showing differential response to adjuvant chemotherapy. Patients with a high growth fraction appear to be ideal candidates for adjuvant chemotherapy while those with low growth fraction are less likely to benefit and are prone to the potential serious side effects of adjuvant chemotherapy.

Effects of Specific Neuropsychological Training Programs for Breast Cancer Patients After Adjuvant Chemotherapy

Neuropsychological deficits are among the negative side effects of adjuvant chemotherapy for breast cancer. We compared the effects of two types of neuropsychological interventions against a control group with no specific training in a total of 96 female in-patients undergoing oncological rehabilitation. Most results of a comprehensive neuropsychological test battery improved significantly during the patients’ oncological rehabilitation in all three groups; we identified no specific intervention effects. We observed little overall correlation between the neuropsychological test results and the patients’ own appraisals of their mental capacity. Clinically relevant neuropsychological deficits were still evident 6 months later in a small subgroup of patients.

Risk of subsequent dementia diagnoses does not vary by types of adjuvant chemotherapy in older women with breast cancer

Little is known about long-term cognitive side effects of adjuvant chemotherapy for breast cancer. We thus examined incidence of dementia diagnoses in older women diagnosed with breast cancer, stratified by types of chemotherapy regimen. We identified patients with incident dementia diagnoses through Medicare claims linked to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry data. The study population (n = 6,932) consisted of women at least 68 years of age, who were diagnosed with early-stage breast cancer from 1994 through 2002 in one of the SEER areas and received chemotherapy as part of their cancer treatment. Excluded were women with a diagnosis of dementia within the 3 years prior to their cancer diagnosis. Our sample comprised mostly white women. The mean age was 74. Fifty-seven percent were estrogen receptor positive. Over 70% had no comorbidity. The use of taxol and anthracycline-based treatments increased from mid-1990s to early 2000. Increasing age at cancer diagnosis, Black ethnicity, living in a census tract with lower level of education, and increasing number of comorbidities were associated with new claims of dementia diagnoses after chemotherapy. There was no significant association between types of chemotherapy agents and risk of subsequent dementia diagnoses. No association was found between types of adjuvant chemotherapy agents for breast cancer and risk of new dementia diagnoses. Our findings suggest that concerns about post-chemotherapy dementia should not be a major factor in determining type of adjuvant chemotherapy regimen to prescribe for older women with breast cancer.

Resting Energy Expenditure and Body Mass Changes in Women During Adjuvant Chemotherapy for Breast Cancer

Weight gain is a commonly reported side effect of adjuvant chemotherapy. A change in resting energy expenditure during treatment has been a suggested mechanism for weight gain. We prospectively measured resting energy expenditure, weight change, and body composition (dual-energy x-ray absorptiometry) in 10 women undergoing adjuvant chemotherapy for breast cancer. There was no change in resting energy expenditure across cycles of chemotherapy (P =.78) or from baseline to the end of treatment (1,189.68 +/- 80.27 vs 1,205.76 +/- 56.71 kcal/d; P =.74). Overall, participants did not gain weight across treatment. However, there was an overall trend toward weight gain (66.3 +/- 5.1 vs 68.2 +/- 5.0 kg; P =.09), and participants did show an increase in total fat mass (24.2 +/- 3.8 vs 26.5 +/- 3.2 kg; P =.04), whereas muscle mass remained the same. Although no change in resting energy expenditure was seen, the observed increase in total fat mass is consistent with a decrease in physical activity level commonly reported with adjuvant chemotherapy treatment of breast cancer, and these body composition changes may have important health implications for survivors.