- Press Release Distribution

Personalised follow-up care needed to address varying health burdens in breast cancer pts

ESMO Breast Cancer 2021 Virtual Congress, 5-8 May

Personalised follow-up care needed to address varying health burdens in breast cancer pts
( LUGANO, Switzerland, 3 May 2021 - As breast cancer becomes a largely curable disease, with more than 70% of women surviving at least 10 years after diagnosis across most of Europe thanks to early detection and treatment, (1) the quality of life after cancer has become an important aspect of the patient journey - one that may be inadequately addressed with current standards of follow-up. A study presented at the ESMO Breast Cancer 2021 Virtual Congress (2) has shown that breast cancer survivors differ widely in the burden of symptoms they experience after the end of treatment and thereby revealed an unmet need for tailored approaches to follow-up care. (3)

Lead author Kelly de Ligt from the Netherlands Cancer Institute in Amsterdam explained the rationale for the study: "Follow-up programmes are different in each country. In the Netherlands, for instance, breast cancer survivors have an annual visit with their treating physician for a follow-up period of five years, or 10 years if they are young. Previous studies had assessed side-effects experienced after the end of treatment as independent items, but in reality, survivors usually experience multiple symptoms that can add up and weigh heavily on their daily life. We wanted to measure the overall burden on their health-related quality of life and see if any patterns emerged that would better inform us on which individuals require active symptom management."

Women who had been surgically treated with or without adjuvant treatment for breast cancer stages I to III were selected between one and five years after diagnosis from the Netherlands Cancer Registry, which contains comprehensive information about diagnosis and treatment for all cancer patients in the Netherlands. A total of 404 participating survivors were questioned about their experienced burden for fatigue, nausea, pain, shortness of breath, insomnia, appetite, constipation, diarrhoea, as well as emotional and cognitive symptoms.

Analysis of their answers allowed the identification of three main subgroups of breast cancer survivors experiencing low, intermediate and high symptom burdens respectively. "In the low-burden group, to which almost a third of patients belonged, women were less affected compared to the average found among a representative sample of 1,300 women of the general population in the Netherlands, who filled out the same questionnaire," de Ligt elaborated. "I was pleasantly surprised to find that so many survivors were doing as well or even better than the average Dutch woman." A further 55% of study participants were classed in the intermediate-burden subgroup, which had similar results to the general population, though their scores for fatigue, insomnia and cognitive symptoms were slightly worse.

Within the high-burden subgroup, meanwhile, de Ligt was alarmed by the results observed: "This was the smallest group, only 15% of our population, but nonetheless, one in six women in our study had worse scores than the general population for all symptoms - and the differences, ranging between 15 and 20 percentage points, were large enough to be considered not just statistically significant, but clinically relevant as well," she explained. According to de Ligt, these findings confirm the necessity for personalised approaches to the follow-up of cancer patients, some of whom still require special attention as late as five years after diagnosis.

The study results further showed that patients with comorbidities such as heart disease and diabetes were more likely to experience a high symptom burden. "This association was so strong in our analysis that we were not able to link the level of symptom burden patients reported with the type of therapy they had received. However, because we measured symptom burden and comorbidities at the same time in the study, we cannot draw conclusions from these findings alone," de Ligt added. "Future research should attempt to measure patients' health-related quality of life through Patient Reported Outcome Measures (PROMs) before the start of treatment for breast cancer and afterwards to allow us to measure the effect of the therapy."

Nadia Harbeck, LMU University Hospital of Munich, Germany, a breast cancer expert not involved in the study, commented: "As a clinician, I was surprised that the analysis revealed no associations between the treatments patients had received and the burden-related subgroup they belonged to, because I would think that any therapy we administer - for example having just surgery plus radiotherapy versus undergoing an extensive course of systemic treatment both before and after the surgery - does have an impact on the symptom burden patients experience over the five-year follow-up period. Gathering data from a larger group of women could help us to gain more insight, and it would be interesting to see this study reproduced in other countries to ascertain whether there are also cultural and social factors impacting patients' answers."

She added: "In my experience, some patients could do without the quarterly visits to their outpatient practitioner, which are part of the standard follow-up protocol in Germany, while others do need that regular interaction with a physician. It is not always easy to distinguish between them initially, because when I see my patients right after treatment, they are so busy returning to their normal lives that a lot of the physical and emotional burden they feel is not there yet or is suppressed. In addition, some patients are not naturally communicative about their personal experience with the disease. This new data shows that if we specifically assessed women's needs in this respect at different stages in their follow-up journey, we could adapt the care we offer not just to their risk of recurrence, but also to their physical and mental state over time. The gynaecologists, family doctors and nurses who help us in follow-up care should be made aware of these findings."

The important role of outpatient healthcare providers in breast cancer patients' post-treatment journey is confirmed by another study which has revealed that among 621 breast cancer patients treated at Oulu University Hospital in Finland, between 2003 and 2013, only a minority (25%) of cancer relapses were detected during pre-planned control visits. (4) More than half of the 95 cases of recurrence were identified as a result of patients contacting their physician about a new symptom they were experiencing, most commonly pain.

"It is essential to reinforce the message to patients that if they feel anything unusual, they should mention it without delay to a medical professional, along with the information that they are a breast cancer survivor, to ensure that any connection with the cancer is not missed - especially when a lot of time has passed since the initial diagnosis," Harbeck emphasised. "As anticancer therapies have become more effective, the pattern of metastasis has changed over the years and can affect any organ, so there is not just one main symptom or area of the body to be attentive to. Patients therefore need to be well-informed and must be made to feel comfortable about contacting their physician outside of their planned consultations if necessary."


Notes to Editors Please make sure to use the official name of the meeting in your reports: ESMO Breast Cancer Virtual Congress 2021 Official Congress Hashtag: #ESMOBreast21

Disclaimer This press release contains information provided by the author of the highlighted abstract and reflects the content of this abstract. It does not necessarily reflect the views or opinions of the ESMO who cannot be held responsible for the accuracy of the data. Commentators quoted in the press release are required to comply with the ESMO Declaration of Interests policy and the ESMO Code of Conduct.

References 1) F. Cardoso, S. Kyriakides, S. Ohno, F. Penault-Llorca, P. Poortmans, I. T. Rubio, S. Zackrisson and E. Senkus. Early Breast Cancer: ESMO Clinical Practice Guidelines. 2) 3) Abstract 134P 'Towards tailored follow-up care for breast cancer survivors: cluster analyses based on symptom burden' will be presented available as e-Poster from Wednesday 5 May at 09:00 CEST. 4) Abstract 140P 'How breast cancer recurrences are found? - a real-world, prospective cohort study' will be presented available as e-Poster from Wednesday 5 May at 09:00 CEST.

About the European Society for Medical Oncology (ESMO) ESMO is the leading professional organisation for medical oncology. With more than 25,000 members representing oncology professionals from over 160 countries worldwide, ESMO is the society of reference for oncology education and information. ESMO is committed to offer the best care to people with cancer, through fostering integrated cancer care, supporting oncologists in their professional development, and advocating for sustainable cancer care worldwide.

134P_PR - Towards tailored follow-up care for breast cancer survivors: cluster analyses based on symptom burden

K.M. de Ligt1, B.H. de Rooij2, I. Walraven3, M.J. Heins4, S. Siesling2, J.C. Korevaar4, L.V. van de Poll-Franse1 1Psychosocial Oncology and Epidemiolgy, NKI-AVL - Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands, 2Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands, 3Department for Health Evidence, Radboudumc, Nijmegen, Netherlands, 4Department of Primary Care, Netherlands Institute of Health Services Research, Utrecht, Netherlands

Background: Breast cancer survivors may experience multiple co-existing symptoms that affect their health-related quality of life. Insight into symptom clustering can contribute to better targeted follow-up. We aimed to identify subgroups of breast cancer survivors based on clusters of symptom burden, and patient and treatment characteristics associated with these subgroups.

Methods: We selected surgically treated stage I-III breast cancer survivors 1-5 years post-diagnosis from the Netherlands Cancer Registry (N=876). We assessed experienced burden for fatigue, nausea, pain, dyspnea, insomnia, appetite, constipation, diarrhea, financial burden, and emotional and cognitive symptoms through the EORTC-QLQ-C30 on a scale 0-100. We determined subgroups of survivors using?Latent class Cluster Analyses (LCA) based on patterns of co-existing symptom burden. We compared patient and treatment characteristics of the subgroups by multinomial logistic regression and compared their symptom burden to the age and sex matched general?reference population.

Results: From 404 participating survivors (46%), 3 subgroups of survivors were identified: low symptom burden (n=116/404, 28.7%) intermediate symptom burden (n=224/404, 55.4%), and high symptom burden (n=59/404, 14.6%). The low subgroup reported a lower symptom burden compared to the general population. The intermediate subgroup experienced burden similar to the general population, although scores for fatigue, insomnia, and cognitive symptoms were slightly worse (small-medium clinically relevant differences). The high subgroup had worse symptom burden than the general population (medium-large clinically relevant differences). Compared to the intermediate subgroup, one (relative risk ratio (RRR): 2.75; CI: 1.22-6.19; p=0.015) or more (RRR: 9.19; CI: 3.70-22.8; p= END

[Attachments] See images for this press release:
Personalised follow-up care needed to address varying health burdens in breast cancer pts


Team from UHN, CAMH identify unique characteristics of human neurons

TORONTO - Scientists at the Krembil Brain Institute, part of University Health Network (UHN), in collaboration with colleagues at the Centre for Addiction and Mental Health (CAMH), have used precious and rare access to live human cortical tissue to identify functionally important features that make human neurons unique. This experimental work is among the first of its kind on live human neurons and one of the largest studies of the diversity of human cortical pyramidal cells to date. "The goal of this study was to understand what makes human brain cells 'human,' and how human neuron circuitry functions as it does," says Dr. Taufik Valiante, neurosurgeon, scientist at the Krembil Brain Institute at UHN and co-senior author on the paper. "In our study, we wanted ...

Personalised medications possible with 3D printing

Customised medicines could one day be manufactured to patients' individual needs, with University of East Anglia (UEA) researchers investigating technology to 3D 'print' pills. The team, including Dr Andy Gleadall and Prof Richard Bibb at Loughborough University, identified a new additive manufacturing method to allow the 3D printing of medicine in highly porous structures, which can be used to regulate the rate of drug release from the medicine to the body when taken orally. Dr Sheng Qi, a Reader in Pharmaceutics at UEA's School of Pharmacy, led the research. The project findings, 'Effects of porosity on drug release kinetics of swellable and erodible porous pharmaceutical solid dosage forms ...

Same drug can have opposite effects on memory according to sexual differences

Same drug can have opposite effects on memory according to sexual differences
A research team from the Institut de Neurociències at the Universitat Autònoma de Barcelona (INc-UAB) has showed that inhibition through a drug of the Tac2 neuronal circuit, involved in the formation of the memory of fear, has opposite effects on the ability to remember aversive events in mice according to sex: it is reduced in male mice and increased in female mice. Is the first time that a drug has been shown to produce this opposite effect on the memory of male and female mice. The study also evidences that opposing molecular mechanisms and behaviours can occur ...

Oceans' microscopic plants -- diatoms -- capture carbon dioxide via biophysical pathways

Diatoms are tiny unicellular plants -- no bigger than half a millimeter -- which inhabit the surface water of the world's oceans where sunlight penetration is plenty. Despite their modest size, they are one of the world's most powerful resources for removing carbon dioxide (CO2) from the atmosphere. They currently remove, or "fix," 10-20 billion metric tons of CO2 every year by the process of photosynthesis. But not much is known about which biological mechanisms diatoms use, and whether these processes might become less effective with rising ocean acidity, temperatures, and, in particular, CO2 concentrations. A new study in Frontiers in Plant Science shows that diatoms predominantly ...

Planned cesarean births safe for low-risk pregnancies

New research shows that planned cesarean deliveries on maternal request are safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes than planned vaginal deliveries. The study is published in CMAJ (Canadian Medical Association Journal). The study used province-wide data from the Better Outcomes Registry & Network (BORN), Ontario's provincial birth registry. The authors analyzed data on 422,210 low-risk pregnancies over 6 years (2012 to 2018). There were 46,533 cesarean deliveries, of which 1827 (3.9%) were planned at the request of the mother; this proportion was unchanged during the years of study. Mothers who requested cesarean delivery ...

Structural racism contributes to the racial inequities in social determinants of psychosis

The legacy of systemic racism in the U.S impacts psychosis risk at the individual and neighborhood level, according to a definitive review published online today. Researchers examined U.S. based evidence connecting social and environmental factors with outcomes relating to psychotic experiences, including schizophrenia. The review examined potential risk factors and influence of structural racism within three key areas. These included disparities in neighborhoods; trauma and stress experienced at both collective and individual levels; and complications experienced around pregnancy. Disparities in U.S. neighborhoods perpetuate disadvantage for racially minoritized ...

Election campaigns: attacks and smearing backfire and can benefit other candidates

Election campaigns: attacks and smearing backfire and can benefit other candidates
Candidates often give in to temptation to attack opponents in electoral campaigns through negative ads (more than 55% of the ads aired by the Clinton and Trump campaigns in 2016 were negative), even if evidence of this tactic effectiveness is, at least, mixed. A study by Bocconi University professors Vincenzo Galasso, Tommaso Nannicini and Salvatore Nunnari, just published in the American Journal of Political Science, reveals the backlash of electoral smearing and shows that, in a three-candidate race, it's the "idle candidate" (the one neither attacking nor being attacked) to have the upper hand. During a three-candidate mayoral race in a mid-sized Italian town in 2015, the authors ...

Technique to automatically discover simulation configurations for behaviors hard to test

Technique to automatically discover simulation configurations for behaviors hard to test
The research team led by Fuyuki Ishikawa at the National Institute of Informatics (NII, Japan) developed a technique to search automatically for simulation configurations that test various behaviors of automated driving systems. This research was conducted under the ERATO-MMSD project (*1) funded by the Japan Science and Technology Agency (JST, Japan). The proposed technique iterates trials on simulations using an optimization method called evolutionary computation so that it discovers simulation configurations that lead to specific features of driving behaviors such as high acceleration, deceleration, and steering operation. The outcome of this research was presented in ICST 2021 (*2), a flagship conference on software testing ...

Screening healthcare workers could serve as early warning system for future viruses

New research has shown that COVID-19 infections in healthcare workers during the first wave of the pandemic provided an accurate sample of the general population, suggesting that data from healthcare workers could be used to estimate the severity of future viruses more quickly. The study, led by researchers from RCSI University of Medicine and Health Sciences in collaboration with IBM Research, is published in PLOS ONE. The researchers analysed the infection data from healthcare workers and the progression of the first wave of the COVID-19 outbreak using the reported daily infection numbers in Ireland. Using similar data in four other countries (Germany, UK, South Korea and Iceland), computer models showed how the disease progressed in different countries related to ...

Volunteer firefighters have higher levels of 'forever chemicals'

Volunteer firefighters -- who comprise more than 65 percent of the U.S. fire service -- have higher levels of "forever chemicals," per- and polyfluoroalkyl substances (PFAS), in their bodies than the general public, according to a Rutgers study. The study, which was published in the International Journal of Environmental Research and Public Health, compared the levels of nine PFAS chemicals in the blood of volunteer firefighters against levels in the general population. It is the first study to evaluate volunteer firefighters' exposure to PFAS, which are chemicals that accumulate in human bodies and in the environment and ...


Worldwide network develops SARS-CoV-2 protocols for research laboratories

Sharks in protected area attract illegal fishers

Molecular tweezers that attack antibiotic resistant bacteria developed by Ben-Gurion U.

Cricket bats should be made from bamboo not willow, Cambridge study finds

Future-proofing mental health -- Experts set out research roadmap to prioritise key areas

Body mass index during childhood linked with risk of anorexia nervosa and bulimia nervosa in later life

Combining BMI with body shape better predictor of cancer risk, suggests

Higher BMI, body fat, and larger waist and hips pose similar risk for

Higher BMI in childhood may help protect women against breast cancer in later life, both before and after the menopause

Research shows for the first time that protein complexes 'inflammasomes' are linked to obesity-related colon cancer

New Strep A human challenge model paves the way to test vaccines against the deadly bacteria

How proteins control information processing in the brain

Study supports recommendations to avoid pregnancy for at least 12 months after obesity surgery

Most comprehensive studies to date find 'insufficient evidence' to support herbal and dietary supplements for weight loss

Vegetarians have healthier levels of disease markers than meat-eaters

Switch of breast tumors to HER2-low in recurrence may provide greater therapeutic options

Mild COVID-19 infection is very unlikely to cause lasting heart damage

Ice core data show why, despite lower sulfur emissions in US and Western Europe, air pollution is dropping more slowly

The Lancet Rheumatology: Largest study to date confirms non-steroidal anti-inflammatory medications do not result in worse COVID-19 outcomes

The legume family tree

New research sets stage for development of salmonella vaccine

New study examines social network's relation to binge drinking among adults

Archaeologists pinpoint population for the Greater Angkor region

Stop the genetic presses!

Sleep disorders tally $94.9 billion in health care costs each year

Turning a pancreatic cancer cell's addiction into a death sentence

How viruses and bacteria can reach drinking water wells

Latest peer-reviewed research: Immediate global ivermectin use will end COVID-19 pandemic

The structure of DNA is found to be actively involved in genome regulation

New innovation successfully treats neonatal hypothermia

[] Personalised follow-up care needed to address varying health burdens in breast cancer pts
ESMO Breast Cancer 2021 Virtual Congress, 5-8 May