Effect of ribociclib on productivity losses due to breast cancer in young women in Brazil

ABSTRACT OBJETIVE To evaluate the effect of ribociclib versus endocrine therapy on productivity losses due to advanced breast cancer. METHODS Productivity data from the MONALEESA-7 trial, obtained from the results of the application of the Work Productivity and Activity Impairment (WPAI) questionnaire on progression-free survival state (43-month follow-up), were extrapolated to the 10,936 Brazilian prevalent cases of premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer. Productivity loss was determined by quantifying the economic costs of workforce dropout over time in both treatment arms and by discounting the economic costs of absenteeism and presenteeism from workforce retention. A human capital approach was used. RESULTS Net productivity gains in the ribociclib arm were estimated at USD 4,285,525.00, representing 316,609 added work hours over 43 months and a mean of 2,009 added work weeks per year. CONCLUSIONS The phase III MONALEESA-7 trial productivity results applied to the Brazilian premenopausal prevalent cases of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer showed that treatment with ribociclib + endocrine therapy improves workforce participation compared with endocrine therapy alone in premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer, with potential economic gains for the Brazilian society.

Clinical pathways of breast cancer patients treated in the Federal District, Brazil / Itinerário terapêutico de mulheres com câncer de mama tratadas no Distrito Federal, Brasil

ABSTRACT OBJECTIVE: To identify the clinical pathways of women with breast cancer treated in public hospitals, and to analyze the factors that influence the time interval between the first appointment and the start of therapy. METHODS: A cross-sectional study was conducted with 600 women with breast cancer treated in nine public hospitals in the Brazilian Federal District. Patients were interviewed between September 2012 and September 2014. Simple and multiple logistic regression models were adjusted to evaluate the variables associated with the time interval studied. The most frequent pathway was the one that started in primary care with following care in the therapy service (28.9%). In the multiple adjustment, factors associated to a longer time interval between the first appointment and therapy were: lower family income (OR = 1.89; 95%CI 1.32-2.68), the first appointment in public services (OR = 1.78; 95%CI 1.20-2.64), care in more than two health services in the clinical pathway (OR = 1.71; 95%CI 1.19-2.44); and obtaining the anatomopathological analysis of the biopsy in public services instead of private health services (OR = 1.87; 95%CI 1.29-2.71). Independently, the implementation of specialist appointment scheduling, with care regulation, was associated with a shorter time interval between first appointment and therapy (OR = 0.33; 95%CI 0.16-0.65). CONCLUSIONS: We observed that multiple pathways were covered by women with breast cancer treated in public services of the Federal District. Socioeconomic iniquities and several aspectos of the pathways covered were associated with a longer time interval between the first appointment and the start of breast cancer therapy.

RESUMO OBJETIVO: Conhecer os itinerários terapêuticos de mulheres com câncer de mama tratadas em hospitais públicos, assim como analisar os fatores que influenciam o intervalo de tempo entre a primeira consulta e o início do tratamento. MÉTODOS: Realizou-se um estudo transversal com 600 mulheres com câncer de mama tratadas em nove hospitais públicos do Distrito Federal, Brasil. As pacientes foram entrevistadas entre setembro de 2012 e setembro de 2014. Foram ajustados modelos de regressão logística simples e múltipla para avaliar as variáveis associadas ao intervalo de tempo estudado. O itinerário mais frequente foi aquele iniciado na atenção primária com atendimento subsequente no serviço de tratamento (28,9%). No ajuste múltiplo, foram associados a um maior tempo entre a primeira consulta e o tratamento: menor renda familiar (OR = 1,89; IC95% 1,32-2,68), realização da primeira consulta em serviços públicos (OR = 1,78; I IC95% 1,20-2,64), atendimento em mais de dois serviços de saúde no itinerário terapêutico (OR = 1,71; IC95% 1,19-2,44); e obtenção da análise anatomopatológica da biópsia em serviços públicos ao invés de serviços de saúde privados (OR = 1,87; IC95% 1,29-2,71). De forma independente, a implementação do agendamento de consulta com especialista, por meio da regulação assistencial, foi associada a um menor intervalo de tempo entre primeira consulta e tratamento (OR = 0,33; IC95% 0,16-0,65). CONCLUSÕES: Observou-se que múltiplos itinerários foram percorridos pelas mulheres com câncer de mama tratadas em serviços públicos do Distrito Federal. Iniquidades socioeconômicas e diversos aspectos dos itinerários percorridos foram associados a um maior intervalo de tempo entre a primeira consulta e início do tratamento do câncer de mama.

Tuberculosis axillary lymph node coexistent breast cancer in adjuvant treatment: case report / Tuberculose linfonodal axilar coexistente com carcinoma mamário em tratamento adjuvante: relato de caso

Coexistence of breast cancer and tuberculosis is rare. In most cases, involvement by tuberculosis occurs in axillary lymph nodes. We report a case of a 43-years-old patient who had undergone adenomastectomy and left sentinel lymph node biopsy due to a triple negative ductal carcinoma. At the end of adjuvant treatment, the patient had an atypical lymph node in the left axilla. Lymph node was excised, and after laboratory analysis, the diagnosis was ganglion tuberculosis. The patient underwent treatment for primary tuberculosis. The development of these two pathologies can lead to problems in diagnosis and treatment. An accurate diagnosis is important to avoid unnecessary surgical procedures.

A coexistência de câncer de mama e tuberculose é rara. Na maioria das vezes, o acometimento pela tuberculose ocorre nos linfonodos axilares. Relatamos caso clínico de paciente de 43 anos submetida à adenomastectomia e à biópsia de linfonodo sentinela à esquerda devido a um carcinoma ductal triplo negativo. Ao final do tratamento adjuvante, a paciente apresentou linfonodomegalia atípica em axila esquerda. Foi realizado exérese do linfonodo e, após análises laboratoriais, diagnosticou-se tuberculose ganglionar. A paciente foi submetida a tratamento para tuberculose primária. O desenvolvimento dessas duas patologias pode acarretar problemas quanto ao diagnóstico e ao tratamento. O diagnóstico acurado é importante para evitar procedimentos cirúrgicos desnecessários.

Study on adherecce to capecitabine among patiens with colorectal cancer and meetastatic breast cancer / Estudo de aderência a capecitabina em pacientes com câncer colorretal e câncer de mama metastático

Context Capecitabine, an oral drug, is as effective as traditional chemotherapy drugs. Objectives To investigate the adhesion to treatment with oral capecitabine in breast and colorectal cancer, and to determine any correlation with changes in patient’s quality of life. Methods Patients with colorectal cancer or breast cancer using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. The QLQ-C30 questionnaire was applied at the first visit and 8-12 weeks after treatment. Results Thirty patients were evaluated. Adherence was 88.3% for metastatic colon cancer, 90.4% for non-metastatic colon cancer, 94.3% for rectal cancer and 96.2% for metastatic breast cancer. No strong correlation between adherence and European Organisation for Research and Treatment of Cancer QLQ-C30 functional or symptom scale rates had been found. There was no statistically significant correlation between compliance and the functional and symptom scales of the questionnaire before and after chemotherapy, with the exception of dyspnea. Conclusions Although no absolute adherence to oral capecitabine treatment had been observed, the level of adherence was good. Health professionals therefore need a greater focus in the monitoring the involvement of patients with oral treatment regimens. Patients with lesser degrees of dyspnea had greater compliance. .

Contexto A capecitabina, uma droga oral, é tão eficaz quanto as drogas quimioterápicas tradicionais. Objetivos Investigar a adesão ao tratamento oral com capecitabina para câncer de mama e colorretal e determinar qualquer correlação com as mudanças na qualidade de vida do paciente. Métodos Pacientes com câncer colorretal ou de mama em uso de capecitabina foram incluídos. A cada consulta os pacientes trouxeram a medicação restante. O questionário de qualidade de vida QLQ- C30 foi aplicado na primeira visita e 8-12 semanas após o tratamento. Resultados Trinta pacientes foram avaliados. A adesão foi de 88,3% para o câncer de cólon metastático, 90,4% para o de cólon não-metastático, 94,3% para o de reto e 96,2% para o de mama metastático. Com exceção da dispnéia, não houve forte correlação entre adesão e as taxas European Organisation for Research and Treatment of Cancer QLQ-C30 em relação a escala funcional ou de sintomas no início ou após quimioterapia. Conclusões O nível de adesão foi bom, embora não houvesse adesão absoluta ao tratamento com capecitabina oral. Os profissionais de saúde, portanto, precisam dar maior atenção a pacientes em regimes de tratamento oral. Os pacientes com menor grau de dispneia tiveram maior adesão. Neoplasias colorretais, terapia .

Tempo para acesso ao tratamento do câncer de mama no Distrito Federal, Brasil Central / Interval for access to treatment for breast cancer in the Federal District, Brazil

OBJETIVO: Analisar o tempo desde o primeiro sintoma até o tratamento de pacientes tratadas para o câncer de mama em hospitais públicos do Distrito Federal, no Brasil Central. MÉTODOS: Trata-se de um estudo transversal analítico. Foram entrevistadas 250 mulheres com diagnóstico de câncer de mama tratadas em 6 hospitais da Secretaria de Estado de Saúde do Distrito Federal (Brasil) no período de novembro de 2009 a janeiro de 2011. Os intervalos de tempo estudados foram o período entre a detecção do sintoma e o tratamento, subdividido nos intervalos até a primeira consulta e após. As outras variáveis analisadas foram: a idade, o estado menopausal, a cor, o nível de escolaridade, a renda familiar média mensal, a procedência, o motivo da primeira consulta, o estadiamento, o tamanho do tumor, a lateralidade, a metástase para linfonodos axilares, a realização de quimioterapia neoadjuvante e o tipo de cirurgia. Para verificar a associação das variáveis com os intervalos de tempo até o tratamento, foi utilizado o teste de Mann-Whitney. RESULTADOS: A média de idade foi de 52 anos, predominando mulheres brancas (57,6%), residentes no Distrito Federal (62,4%), com renda familiar de até dois salários mínimos (78%), que estudaram por até 4 anos (52,4%). O estadiamento da doença em 78,8% das mulheres variou de II a IV. O tempo entre o primeiro sintoma e o tratamento foi de 229 dias (mediana). Após a detecção do primeiro sintoma, 52,9% das mulheres compareceram a uma consulta em até 30 dias e 88,8% tiveram demora de mais de 90 dias para iniciar o tratamento. As mulheres com nível primário de escolaridade apresentaram maior atraso para início do tratamento (p=0,04). CONCLUSÕES: Houve um importante atraso para iniciar o tratamento das mulheres com câncer de mama em hospitais públicos do Distrito Federal sugerindo que esforços devem ser feitos para a redução dos tempos necessários para agendar a consulta médica, diagnosticar e tratar essas pacientes.

PURPOSE: To analyze the time between the first symptom and treatment in patients treated for breast cancer in public hospitals in the Federal District. METHODS: This was a cross-sectional analysis. We interviewed 250 women diagnosed with breast cancer treated in six hospitals of the State Department of Health of the Federal District from November 2009 to January 2011. The time intervals studied were the time between the detection of the symptoms and treatment subdivided into intervals until and after the first medical appointment. The variables were: age, menopausal status, color, educational level, average monthly household income, origin, reason for the initial consultation, staging, tumor size, laterality, metastasis to axillary lymph nodes, neoadjuvant chemotherapy, and type of surgery. The Mann-Whtney test was used to assess the association of these variables with the time intervals until treatment. RESULTS: The mean age was 52 years, with a predominance of white women (57.6%), from the Federal District (62.4%), with a family income of up to 2 minimum wages (78%), and up to four years of schooling (52.4%). The staging of the disease ranged from II to IV in 78.8% of the women. The time between the first symptom and treatment was 229 days (median). After detection of the first symptom, 52.9% of the women attended a consultation within 30 days and 88.8% took more than 90 days to start treatment. Women with elementary school education had a greater delay to the start of treatment (p=0.049). CONCLUSIONS: There was a significant delay to start treatment of women with breast cancer in public hospitals of the Federal District, suggesting that efforts should be made to reduce the time needed to schedule medical appointments and to diagnose and treat these patients.

Survival effects of cyclooxygenase-2 and 12-lipooxygenase in Egyptian women with operable breast cancer.

BACKGROUND: Breast cancer (BC) is the commonest among women in Egypt as well as in many other countries. Cyclo-oxygenase-2 (COX-2) and 12-lipo-oxygenase (12-LOX) are over-expressed in 30-40% of patients and carry a poor prognosis. The objectives of this study were to correlate COX-2 and 12-LOX expression with various clinico-pathologic patients' characteristics and their impact on overall survival (OS) and disease free survival (DFS) in Egyptian women with operable BC. MATERIALS AND METHODS: This prospective study included 57 consecutive BC cases presenting to the Egyptian National Cancer Institute. Sections from BC and nearby normal tissues were examined for expression of COX-2 and 12-LOX using reverse transcriptase polymerase chain reaction. RESULTS: The patients' median age was 45 years. Fifty-three percent were premenopausal. Stage II and III disease represented 25 and 75% respectively. Adjuvant chemotherapy, radiotherapy and tamoxifen were used in 90, 75 and 60% respectively. Sixty percent had hormone-receptor positive tumors and 28% over-expressed HER2/neu. Forty-nine and sixty-five percent showed over-expression of COX-2 and 12-LOX respectively. Patients with higher TNM stage or who developed visceral metastases had significantly higher COX-2 expression. For the whole group of patients, the median DFS was 37 months, while the median OS was not reached. OS or DFS did not differ significantly between patients with normal and over-expression of COX-2. DFS but not OS was significantly higher in 12-LOX over-expression compared to normal expression. CONCLUSION: COX-2 over-expression was associated with poor prognostic criteria in BC, but did not affect DFS or OS. 12-LOX over-expression was associated with better DFS, but not OS.

Mammographic Changes in Breast Cancer Patients Treated with Tamoxifen

PURPOSE: To evaluate the efficacy of tamoxifen, as shown by mammographic changes. MATERIALS AND METHODS: We studied the mammograms of 20 breast cancer patients treated with tamoxifen (20mg/day) and 20 patients treated with tamoxifen (20mg/day) in combination with chemothrapy. Control groups consisted of 20 breast cancer patients treated with chemotherapy and 20 healthy women; the patterns of age distribution and menstrual cycle among these participants were similar to these of the study groups. Two radiologists determined parenchymal changes as seen on follow-up mammogram, of the contralateral breast in patients with breast cancer, and of the left breast in healthy women. RESULTS: Follow-up mammogram showed decreased breast parenchyma in 75% of patients treated with tamoxifen, and in 70% of patients treated with tamoxifen and chemotherapy. Mammographic changes were not noted in 85% of patients treated with chemotherapy and in 90% of healthy women. CONCLUSION: On follow-up mammogram, breast parenchyma was seen to have been decreased by tamoxifen, used to prevent the recurrence of breast cancer and forits antiproliferative effect. Mammography might be a suitable method for determining the effect of tamoxifen.