Compressive taping to prevent postmastectomy seroma: patient adherence and satisfaction.

OBJECTIVE: Evaluate patient adherence and satisfaction concerning postmastectomy compressive taping. METHODS: This comprises a preintervention and postintervention study carried out with women ≥18 years old who underwent taping during the first 7 postoperative days at the Cancer Hospital III/National Cancer Institute. Good adherence was considered as taping maintenance for 7 days. Satisfaction levels were classified as satisfied and dissatisfied. RESULTS: A total of 124 women with a mean age of 56.54 (±11.24) were included in the study. Most lived without a partner (58.1%), had more than 8 years of study (59.7%), referred to themselves as white (68.5%) and considered their health status to be good or very good (69.4%). Regarding treatment adherence, 90.3% patients displayed adherence. Patients with no bullous lesions were more likely to adhere to taping (OR 7.00; 95% CI 1.98 to 24.74; p=0.003). Regarding satisfaction, 78.2% of the patients felt satisfied. The absence of local discomfort (OR 4.51; 95% CI 1.73 to 11.74; p=0.002) and non-existence of self-reported oedema (OR 5.81; 95% CI 1.81 to 18, 66; p=0.003) were associated with greater patient satisfaction. CONCLUSION: Patients exhibited good adherence and felt very satisfied with the use of postmastectomy compressive taping. TRIAL REGISTRATION NUMBER: NCT04471142.

Prevalence and factors associated with the occurrence of pathological fractures and their impact on the overall survival of patients with bone metastases under palliative care.

OBJECTIVES: To assess the prevalence and factors associated with the occurrence of pathological fractures and their impact on the overall survival of patients with bone metastases under palliative care. METHODS: An observational retrospective cohort assessment concerning both male and female patients with cancer presenting with bone metastases referred to a palliative care unit. Sociodemographic and clinical data were obtained before and after care unit referral. Patients were followed up until death or the last follow-up (4 years after referral). Logistic regression models and survival curves employing a log-rank test were applied. RESULTS: A total of 348 patients were included in the study. Most were <65 years (65%) and female (62%), and the most frequent primary tumour site was the breast (40%). The prevalence of pathological fractures was 28%, more frequent in the axial skeleton (49%), with no association with overall patient survival (p=0.348). Patients with breast cancer exhibited a 2.96-fold higher chance (95% CI: 1.80 to 4.86) of developing a fracture compared with other tumours, and not receiving previous radiotherapy increased the chances of fracture occurrence by 5.60-fold (95% CI: 2.46 to 12.77). CONCLUSION: A high prevalence of pathological fractures was observed. Presenting with breast cancer and not having undergone previous radiotherapy increase the chances of fracture occurrence, although this is not associated with overall survival in patients under palliative care.

Complex physical therapy employing self-adjusting garment (ReadyWrap®) in breast cancer-related lymphedema cases in Brazilian women: a protocol for a randomized controlled trial.

BACKGROUND: Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema. METHODS: This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant. DISCUSSION: This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis. TRIAL REGISTRATION: NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021.

Impacto de Marcadores Inflamatórios no Prognóstico de Pacientes Oncológicos Internados no Instituto Nacional de Câncer com SARS-CoV-2 na Primeira Onda da Pandemia no Brasil / Impact of Inflammatory Markers on the Prognosis of Patients with Cancer Admitted to the National Cancer Institute with SARS-CoV-2 in the First Wave of the Pandemic in Brazil / Impacto de los Marcadores Inflamatorios en el Pronóstico de Pacientes con Cáncer Ingresados en el Instituto Nacional del Cáncer con SARS-CoV-2 en la Primera Ola de la Pandemia en el Brasil

Introdução: O intenso processo inflamatório desencadeado pela covid-19 tem sido apontado por diversos autores. Objetivo: Avaliar o impacto de marcadores inflamatórios no prognóstico de pacientes com tumores sólidos internados com SARS-CoV-2/covid-19 na primeira onda da pandemia no Brasil. Método: Estudo de coorte com pacientes maiores de 18 anos com câncer, internados em um centro público de referência no tratamento oncológico, com SARS-CoV-2/covid-19, no período de março a setembro de 2020. Os seguintes marcadores inflamatórios foram analisados: razão neutrófilo-linfócito (RNL), derivação da razão neutrófilo-linfócito (dRNL) e razão plaqueta-linfócito (RPL). Foi considerado desfecho deste estudo a ocorrência de óbito durante a internação hospitalar. A associação entre as variáveis independentes e o desfecho foi analisada por meio de regressão logística univariada e múltipla. Resultados: Dos 185 pacientes, a maioria apresentava idade < 65 anos (61,1%), performance status (PS) ≥ 2 (82,4%) e estavam em tratamento oncológico (80,0%). O câncer de mama foi o tumor mais frequente (26,5%). Para a maior parte dos casos, o tempo de internação foi ≥ 5 dias (59,5%) e ocorreu em unidade de tratamento intensivo (84,3%). Durante a internação, 86 (46,5%) pacientes evoluíram para óbito. Na análise ajustada, apenas a RNL elevada (≥ 4,44) esteve associada ao risco de morrer (OR 3,54; IC 95%; 1,68 - 7,46; p = 0,001). Conclusão: A RNL se mostrou um importante marcador prognóstico, e níveis acima do seu valor mediano estiveram relacionados ao aumento do risco de morte durante a internação hospitalar

Introduction: The intense inflammatory process triggered by COVID-19 has been pointed out by several authors. Objective: To evaluate the impact of inflammatory markers on the prognosis of patients with solid tumors hospitalized with SARS-CoV-2/COVID-19 in the first wave of the pandemic in Brazil. Method: A cohort study of patients >18 years old with cancer, hospitalized at a public cancer treatment reference center, with SARS-CoV-2/COVID-19 from March to September 2020. The following inflammatory markers were analyzed: neutrophil-lymphocyte ratio (NLR), derivation of the neutrophil-lymphocyte ratio (dNLR) and platelet-lymphocyte ratio (PLR). The outcome of this study was death during hospitalization. The association between the independent variables and the outcome was analyzed using univariate and multiple logistic regression. Results: Of the 185 patients, most were aged < 65 years (61.1%), had performance status (PS) ≥ 2 (82.4%) and were in cancer treatment (80.0%). Breast cancer was the most frequent tumor (26.5%). For the majority of the cases, the length of hospital stay was ≥ 5 days (59.5%) and occurred in the intensive treatment unit (84.3%). During hospitalization, 86 (46.5%) patients progressed to death. In the adjusted analysis only high NLR (≥ 4.44) was associated with the risk of death (OR 3.54; 95% CI; 1.68 - 7.46; p = 0.001). Conclusion: NLR proved to be an important prognostic marker, and levels above its median value were related to an increased risk of death during hospitalization

Introducción: El papel de la inflamación desencadenada por la COVID-19 ha sido señalado por varios autores. Objetivo: Evaluar el impacto de los marcadores inflamatorios en el pronóstico de pacientes con tumores sólidos hospitalizados por SARS-CoV-2/COVID-19 en la primera ola de la pandemia en el Brasil. Método: Estudio de cohorte con pacientes >18 años con cáncer, ingresados en un centro público de referencia en el tratamiento del cáncer, con SARS-CoV-2/COVID-19 de marzo a septiembre de 2020. Se evaluaron los siguientes marcadores inflamatorios: relación neutrófilos-linfocitos (RNL), derivación de la relación neutrófilos-linfocitos (dRNL) y relación plaquetas-linfocitos (RPL). Se consideró como desenlace de este estudio la ocurrencia de muerte durante la hospitalización. La asociación entre las variables independientes y el desenlace se analizó mediante regresión logística univariada y múltiple. Resultados: De los 185 pacientes hospitalizados, la mayoría tenía una edad < 65 años (61,1%), un performance status (PS) ≥ 2 (82,4%) y estaban en tratamiento oncológico (80,0 %). El cáncer de mama fue el tumor más frecuente (26,5%). Para la mayoría de los casos, el tiempo de hospitalización fue ≥ 5 días (59,5%) y ocurrió en la unidad de tratamiento intensivo (84,3%). Durante la hospitalización, 86 (46,5%) pacientes terminaron falleciendo. En el análisis ajustado, solo una RNL alta (≥ 4,44) se asoció con el riesgo de muerte (OR 3,54; IC 95%; 1,68 - 7,46; p = 0,001). Conclusión: La RNL demostró ser un importante marcador pronóstico, y los niveles por encima de su valor medio se relacionaron con un mayor riesgo de muerte durante la hospitalización

Influence of Age on Health-Related Quality of Life of Women Diagnosed with Breast Cancer / Influência da Idade na Qualidade de Vida Relacionada à Saúde de Mulheres Diagnosticadas com Câncer de Mama / Influencia de la Edad en la Calidad de Vida Relacionada con la Salud de Mujeres Diagnosticadas con Cáncer de Mama

Introduction: Women with breast cancer may have differences in health-related quality of life (HRQoL) at diagnosis by age. Objective: To analyze the influence of age on the HRQoL of women diagnosed with breast cancer. Method: Cross-sectional study was carried out with women diagnosed with breast cancer. HRQoL assessment was performed before starting cancer treatment, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its specific breast cancer module (BR-23). Association between age group and HRQoL was determined through multiple linear regression. Results: 961 women were included in the study, with a mean age of 54 (SD±11.7). Women aged ≥50 years displayed better emotional functioning (+7.6 points; p<0.001), and less fatigue (-4.4 points; p=0.014), pain (-4.7 points; p=0.033), nausea and vomiting (-2.3 points; p=0.030) and financial difficulties (-10.3 points; p<0.001) compared to younger women. Concerning the BR-23 module, these women displayed better body image scores (+3.6 points; p=0.029) and future perspective (+12.4 points; p<0.001), and worse sexual functioning (-19.9 points; p<0.001) and sexual enjoyment (-8.9 points; p=0.001), and on the symptom scale, less breast symptoms (-11.6 points; p<0.001) and arm symptoms (-3.5 points; p=0.047). Conclusion: Patients aged ≥50 years exhibited better HRQoL in all QLQ C-30 and BR-23 functioning scales and symptom scales, except for sexual functioning and sexual enjoyment

Introdução: Mulheres com câncer de mama podem apresentar diferenças na qualidade de vida relacionada à saúde (QVRS) ao diagnóstico de acordo com a idade. Objetivo: Analisar a influência da idade na QVRS de mulheres com diagnóstico de câncer de mama. Método: Estudo transversal com mulheres diagnosticadas com câncer de mama. A avaliação da QVRS foi realizada antes do início do tratamento oncológico por meio do questionário European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) e seu módulo específico para o câncer de mama (BR-23). A associação entre faixa etária e QVRS foi determinada por meio da regressão linear múltipla. Resultados: Foram incluídas 961 mulheres com média de idade de 54 anos (DP±11,7). Mulheres com idade ≥50 anos apresentaram melhor função emocional (+7,6 pontos; p<0,001), menos fadiga (-4,4 pontos; p=0,014), dor (-4,7 pontos; p=0,033), náuseas e vômitos (-2,3 pontos; p=0,030) e dificuldade financeira (-10,3 pontos; p<0,001) comparadas às mulheres jovens. Em relação ao BR-23, essas mulheres apresentaram melhor escores de imagem corporal (+3,6 pontos; p=0,029) e de perspectiva futura (+12,4 pontos; p<0,001), e piores função sexual (-19,9 pontos; p<0,001) e satisfação sexual (-8,9 pontos; p=0,001); e, na escala de sintomas, menos sintomas na mama (-11,6 pontos; p<0,001) e sintomas no braço (-3,5 pontos; p=0,047). Conclusão: As pacientes com idade ≥50 anos apresentaram melhor QVRS em todos os domínios das escalas de função e escalas de sintomas do QLQ C-30 e BR-23, exceto no que diz respeito à função sexual e à satisfação sexual

Introducción: Las mujeres con cáncer de mama pueden tener diferencias en la calidad de vida relacionada con la salud (CVRS) al momento del diagnóstico según la edad. Objetivo: Analizar la influencia de la edad en la CVRS de mujeres con diagnóstico de cáncer de mama. Método: Estudio transversal con mujeres diagnosticadas con cáncer de mama. La evaluación de la CVRS se realizó antes de iniciar el tratamiento oncológico mediante el Cuestionario European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) y su módulo específico para el cáncer de mama (BR-23). La asociación entre el grupo de edad y la CVRS se determinó mediante regresión lineal múltiple. Resultados: Se incluyeron 961 mujeres con una edad media de 54 años (DE±11,7). Las mujeres ≥50 años tuvieron mejor funcionamiento emocional (+7,6 puntos; p<0,001), y menos fatiga (-4,4 puntos; p=0,014), dolor (-4,7 puntos; p=0,033), náuseas y vómitos (-2,3 puntos; p=0,030) y dificultades financieras (-10,31 puntos; p<0,001) en comparación con las mujeres jóvenes. Con respecto al BR-23, estas mujeres presentaron mejores puntajes de imagen corporal (+3,6 puntos; p=0,029) y perspectiva de futuro (+12,4 puntos; p<0,001) y peor función sexual (-19,9 puntos; p<0,001) y satisfacción sexual (-8,9 puntos; p=0,001), y en la escala de síntomas, menos síntomas mamarios (-11,6 puntos; p<0,001) y brazos (-3,5 puntos; p=0,047). Conclusión: Las pacientes con edad ≥50 años tuvieron mejor CVRS en todos los dominios de las escalas de función y síntomas del QLQ C-30 y BR-23, excepto función sexual y satisfacción sexual

Guidelines for the prevention of secondary lymphedema following breast cancer treatment: adhesion and associated factors

Introduction: Lymphedema is the most feared complication that may take place after breast cancer treatment. With treatment progression, doubts have arisen regarding the real benefits of lymphedema prevention care, as well as of patient adherence to guidelines. Objective: In this context, the aim of this study was to assess patient adherence to preventive lymphedema guidelines and the distribution of sociodemographic, clinical, and treatment variables according to adherence to treatment. Methods: A cross­sectional study conducted at the Cancer Hospital III/INCA, Rio de Janeiro, Brazil, concerning patients with breast cancer undergoing surgical treatment with an axillary approach. Participants were questioned about assistance care performance, exercise-related care, and limb ipsilateral to surgery care. A descriptive analysis of patient demographic, clinical, treatments, postoperative complications variables, and main outcomes (adherence to the guidelines) was performed through a central tendency measure and data dispersion and frequency measures analyses. Differences between means were assessed using the Student's t-test, while differences between proportions were evaluated using the chi-square test. A significance level of 5% was considered for all assessments. Results: Of the 103 women included in this study, 89.3% adhered to assistance care, 61.2% adhered to limb care, and 42.7% performed exercise-related care. Women undergoing chemotherapy (p = 0.030) and axillary lymphadenectomy (AL) (p = 0.017) exhibited greater adherence to care. Non-white patients (p = 0.048) and those who underwent AL (p = 0.025) adhered to limb care more frequently. Finally, patients displaying lower education levels (p = 0.013) and those who underwent AL (p = 0.009) adhered more frequently to limb exercises. Conclusion: Patients adhered the most to assistance care and limb care compared to exercise practice. Patients undergoing chemotherapy displayed greater adherence to care and non-white patients adhered the most to limb care. Women who underwent AL displayed greater adherence to all types of care and those presenting lower education levels adhered more frequently to exercise guidelines.

Shoulder amplitude movement does not influence postoperative wound complications after breast cancer surgery: a randomized clinical trial.

PURPOSE: The goal of this study is to evaluate the influence of shoulder exercises with restricted amplitude movement (RAM) or free amplitude movement (FAM) performed from the first postoperative day (1st POD) on the incidence of surgical wound complications (SWC) in breast cancer. METHODS: This study comprises a randomized clinical trial with an intention-to-treat analysis including 465 women aged 18 to 79, who underwent curative surgery for breast cancer. Participants were submitted to perform free amplitude movement (FAM) or restricted amplitude movement (RAM) shoulder exercises, until the 30th postoperative day. The outcome measures were the SWC: seroma, dehiscence, necrosis, infection, hematoma and bruise. RESULTS: 461 participants completed the follow-up. Thirty days after surgery, 63.8% of the women presented some surgical wound complication, with necrosis (39.3%) and seroma (30.8%) as the most frequent. No statistically significant differences in SWC according to postoperative amplitude shoulder exercise (FAM vs RAM), even after a stratified analysis by type of surgery (segmentectomy vs mastectomy) or axillary approach (axillary lymphadenectomy versus sentinel lymph node biopsy) were observed. CONCLUSION: FAM exercises do not increase the incidence of postoperative wound complications compared to RAM exercises. TRIAL REGISTRATION: NCT03796845.

Fatores Associados ao Atraso entre o Diagnóstico e o Início do Tratamento de Câncer de Mama: um Estudo de Coorte com 204130 Casos no Brasil / Factors Associated with Delay between Diagnosis and Initiation of Breast Cancer Treatment: a Cohort Study with 204130 Cases in Brazil / Factores Asociados con el Retardo entre el Diagnóstico y el Inicio del Tratamiento del Cáncer de Mama: un Estudio de Cohorte con 204130 Casos en Brasil

Introdução: O câncer de mama é considerado um problema de saúde pública, tendo crescente incidência mundial. Diversos fatores contribuem para o diagnóstico tardio e dificultam o início do tratamento, repercutindo em um pior prognóstico. Objetivos: Analisar o intervalo de tempo entre o diagnóstico e o início do primeiro tratamento oncológico na população brasileira, além de avaliar os fatores associados aos maiores intervalos. Método: Trata-se de um estudo de coorte retrospectivo com 540.529 pacientes cadastrados no Sistema de Registros Hospitalares de Câncer (SisRHC)no período de 2000 a 2017. Utilizou-se como desfecho o intervalo de tempo entre o diagnóstico e o início do primeiro tratamento oncológico, considerando-se como atraso o intervalo maior do que 60 dias. Para análise das variáveis, foram realizadas análise descritiva e regressão logística simples (IC95%; p<0,05). Resultados: Foram analisados 204.130 casos que apresentaram média de idade de 55,8 anos (±13,24), sendo predominantemente do sexo feminino (99,1%), 55,1% eram da Região Sudeste e 71,4% residiam em cidades não capitais. A mediana do intervalo de tempo entre o diagnóstico e o início do primeiro tratamento oncológico foi de 63 dias (variação interquartil = 36-109). As variáveis sociodemográficas, clínicas e relacionadas ao tratamento mostraram impacto no intervalo de tempo, com exceção da variável sexo. Conclusão: O tempo entre o diagnóstico e o início do primeiro tratamento oncológico foi elevado. Fatores sociodemográficos, clínicos e relacionados ao tratamento influenciam nos intervalos de tempo. Identificá-los precocemente pode contribuir para o direcionamento de ações a esses grupos mais vulneráveis ao atraso.

Breast cancer is considered a public health problem with an increasing incidence worldwide. Several factors contribute to late diagnosis and hinder the initiation of the treatment, resulting in a worse prognosis. Objectives:To analyze the time interval between diagnosis and the beginning of the first oncologic treatment in the Brazilian population, in addition to assessing the factors associated with the longest time intervals. Method: Retrospective cohort study with 540,529 patients registered in the Hospital Cancer Registry System (SisRHC) from 2000 to 2017. The outcome was the time between diagnosis and the beginning of the first oncologic treatment, considering the interval greater than 60 days as delay. Descriptive analysis and simple logistic regression were performed (95% CI; p <0.05) to analyze the variables. Results: 204,130 cases were analyzed, mean age of 55.8 years (± 13.24), predominantly females (99.1%), 55.1% were from the southeast region and 71% lived in non-capital cities. The median of the time interval between diagnosis and the beginning of the first oncologic treatment was 63 days (interquartile range = 36-109). Sociodemographic, clinical and treatment-related variables affect the time interval, except the gender variable. Conclusion: The time between diagnosis and the beginning of the first oncologic treatment was high. Sociodemographic, clinical and treatment-related factors influence time intervals. Their early identification can contribute to guide the actions toward these most vulnerable groups to delay.

Introducción: El cáncer de mama se considera un problema de salud pública con una incidencia mundial creciente. Varios factores contribuyen al diagnóstico tardío y dificultan el inicio del tratamiento, resultando en un peor pronóstico. Objetivos:Analizar el intervalo de tiempo entre el diagnóstico y el comienzo del primer tratamiento oncologico en la población brasileña, además de evaluar los factores asociados con los intervalos de tiempo más largos. Método: Este es un estudio de cohorte retrospectivo con 540.529 pacientes registrados en el Hospital Cancer Registry System (SisRHC) desde 2000 hasta 2017. El resultado fue el intervalo de tiempo entre el diagnóstico y el comienzo del primer tratamiento oncologico, considerando como retraso el intervalo superior a 60 días. Para el análisis de las variables, se realizó un análisis descriptivo y una regresión logística simple (IC 95%; p <0,05). Resultados: Se analizaron 204,130 casos, con una edad media de 55,8 años (±13,24), predominantemente mujeres (99,1%), 55,1% de la región sureste y 71,4% residentes en ciudades no capitales.La mediana del intervalo de tiempo entre el diagnóstico y el comienzo del primer tratamiento contra el cáncer fue de 63 días (rango intercuartil = 36-109). Las variables sociodemográficas, clínicas y relacionadas con el tratamiento tuvieron un impacto en el intervalo de tiempo, con la excepción de la variable de género. Conclusión: El intervalo de tiempo promedio entre el diagnóstico y el comienzo del primer tratamiento oncologico fue alto. Además, se observó que los factores sociodemográficos, clínicos y relacionados con el tratamiento influyen en los intervalos de tiempo, por lo que identificarlos temprano puede contribuir a acciones directas para estos grupos más vulnerables al retraso.

Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer.

OBJECTIVE: This study aimed to evaluate the association of axillary lymph node ratio (LNR) and number of positive lymph nodes (pN) with the risk of breast cancer recurrence and death. MATERIALS AND METHODS: A retrospective cohort study of node-positive stage II and III breast cancer patients diagnosed and treated between 2008 and 2009 at the Brazilian National Cancer Institute (INCA), Brazil. Overall and disease-free survival curves for number of positive lymph nodes (pN) and lymph node ratio (LNR) risk groups were constructed using the Kaplan-Meier method and compared by the log-rank test. Multivariate analysis was performed using stepwise forward Cox regression models. RESULTS: In total, 628 women with node-positive breast cancer were included. Most patients (69.5%) had advanced clinical stage tumors (≥IIB). The median follow-up was 58 months (range: 3-92 months). The adjusted recurrence hazard of pN2 and pN3 patients was 2.47 (95% Confidence Interval [CI] 1.72-3.56) and 2.42 (1.62-3.60), respectively, compared to pN1 patients (p<0.001), while the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR was 2.11 (1.49-3.00) and 3.19 (2.12-4.80), respectively, compared to low-risk LNR (≤0.20) patients (p<0.001). On the other hand, the hazard of death of pN2 and pN3 patients was 2.17 (1.42-3.30) and 2.41 (1.53-3.78), respectively (p<0.001), and the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR patients was 1.70 (1.13-2.56) and 2.74 (1.75-4.28), respectively (p≤0.001). CONCLUSION: Higher pN and LNR were associated with shorter disease-free survival and overall survival times.

Health-related quality of life in women with cervical cancer / Qualidade de vida relacionada à saúde em mulheres com câncer do colo do útero

Abstract Objective To analyze the factors associated with health-related quality of life (HRQoL) in women with cervical cancer (CC) in a single center in Rio de Janeiro, state of Rio de Janeiro, Brazil. Methods A cross-sectional study in women with a diagnosis of CC followed-up in the gynecology outpatient clinic of the Hospital do Câncer II (HCII, in the Portuguese acronym) of the Instituto Nacional de Câncer (INCA, in the Portuguese acronym). The data were collected from March to August 2015. Women with palliative care, communication/cognition difficulty, undergoing simultaneous treatment for other types of cancer, or undergoing chemotherapy and/or radiation therapy were excluded. For the evaluation of the HRQoL, a specific questionnaire for women with CC was used (Functional Assessment of Cancer Therapy - Cervix Cancer [FACT-Cx]). The total score of the questionnaire ranges from 0 to 168, with higher scores indicating a better HRQoL. Results A total of 115 women were included in the present study, with a mean age of 52.64 years old (standard deviation [SD] = 12.13). The domains of emotional (16.61; SD = 4.55) and functional well-being (17.63; SD = 6.15) were those which presented the worst scores. The factors that had an association with better HRQoL in women with CC were having a current occupation, a longer time since the treatment and diagnosis, and women who had undergone hysterectomy. Conclusion Considering the domains of HRQoL of the women treated for cervical cancer, a better score was observed in the domains of physical and social/family wellbeing. For most domains, better scores were found between those with a current occupation, with a longer time after the diagnosis and treatment, and among those who had undergone a hysterectomy.

Resumo Objetivo Analisar os fatores associados à qualidade de vida em mulheres com câncer de colo do útero tratadas em um hospital de referência no Rio de Janeiro, RJ, Brasil. Métodos Estudo transversal em mulheres com diagnóstico de câncer do colo do útero emseguimento ambulatorial no Hospital de Câncer II (HCII) do Instituto Nacional de Câncer (INCA). Os dados foram coletados no período de março a agosto de 2015. Foram excluídas as mulheres em cuidados paliativos, comdificuldade de comunicação/cognição, que estavam em tratamento simultâneo para outros tipos de câncer, ou em quimioterapia e/ou radioterapia. Para a avaliação da qualidade de vida relacionada à saúde, foi utilizado um questionário específico para mulheres com câncer de colo do útero (Avaliação Funcional da Terapia do Câncer - Câncer Cervical (FACT-Cx, na sigla em inglês). O escore total do questionário varia de 0 a 168, com escores mais altos indicando melhor qualidade de vida relacionada à saúde. Resultados Foram incluídas 115 mulheres com uma média de idade de 52,64 anos (desvio padrão [DP] = 12,13). Os domínios de questões emocionais (16,61; DP = 4,55) e de bem-estar funcional (17,63; DP = 6,15) foram os que apresentaram os piores escores. Os fatores que tiveram associação com melhor qualidade de vida relacionada à saúde em mulheres com câncer de colo do útero foram ocupação atual, maior tempo após o tratamento e diagnóstico, e mulheres que haviamsido submetidas a histerectomia. Conclusão Considerando os domínios da qualidade de vida relacionada à saúde de mulheres tratadas para câncer do colo do útero, foi observado melhor escore nos domínios de bem-estar físico e social. Para amaioria dos domínios, osmelhores escores foram observados entre aquelas com ocupação atual, com mais tempo após o diagnóstico e tratamento, além daquelas que se submeteram a histerectomia.

Advanced Clinical Stage at Diagnosis of Breast Cancer Is Associated with Poorer Health-Related Quality of Life: A Cross-Sectional Study.

OBJECTIVE: To describe the clinical stage in women diagnosed with breast cancer and the association between clinical stage and Health-related quality of life (HRQoL). MATERIALS AND METHODS: This was a cross-sectional study involving women diagnosed with breast cancer. HRQoL was assessed with European Organization for Research and Treatment of Cancer 30-Item Quality of Life Questionnaire and the Quality of Life Questionnaire Breast Cancer 23. The principal exposure was clinical stage (

Health-related Quality of Life in Women with Cervical Cancer.

OBJECTIVE: To analyze the factors associated with health-related quality of life (HRQoL) in women with cervical cancer (CC) in a single center in Rio de Janeiro, state of Rio de Janeiro, Brazil. METHODS: A cross-sectional study in women with a diagnosis of CC followed-up in the gynecology outpatient clinic of the Hospital do Câncer II (HCII, in the Portuguese acronym) of the Instituto Nacional de Câncer (INCA, in the Portuguese acronym). The data were collected from March to August 2015. Women with palliative care, communication/cognition difficulty, undergoing simultaneous treatment for other types of cancer, or undergoing chemotherapy and/or radiation therapy were excluded. For the evaluation of the HRQoL, a specific questionnaire for women with CC was used (Functional Assessment of Cancer Therapy - Cervix Cancer [FACT-Cx]). The total score of the questionnaire ranges from 0 to 168, with higher scores indicating a better HRQoL. RESULTS: A total of 115 women were included in the present study, with a mean age of 52.64 years old (standard deviation [SD] = 12.13). The domains of emotional (16.61; SD = 4.55) and functional well-being (17.63; SD = 6.15) were those which presented the worst scores. The factors that had an association with better HRQoL in women with CC were having a current occupation, a longer time since the treatment and diagnosis, and women who had undergone hysterectomy. CONCLUSION: Considering the domains of HRQoL of the women treated for cervical cancer, a better score was observed in the domains of physical and social/family well-being. For most domains, better scores were found between those with a current occupation, with a longer time after the diagnosis and treatment, and among those who had undergone a hysterectomy.

OBJETIVO: Analisar os fatores associados à qualidade de vida em mulheres com câncer de colo do útero tratadas em um hospital de referência no Rio de Janeiro, RJ, Brasil. MéTODOS: Estudo transversal em mulheres com diagnóstico de câncer do colo do útero em seguimento ambulatorial no Hospital de Câncer II (HCII) do Instituto Nacional de Câncer (INCA). Os dados foram coletados no período de março a agosto de 2015. Foram excluídas as mulheres em cuidados paliativos, com dificuldade de comunicação/cognição, que estavam em tratamento simultâneo para outros tipos de câncer, ou em quimioterapia e/ou radioterapia. Para a avaliação da qualidade de vida relacionada à saúde, foi utilizado um questionário específico para mulheres com câncer de colo do útero (Avaliação Funcional da Terapia do Câncer ­ Câncer Cervical (FACT-Cx, na sigla em inglês). O escore total do questionário varia de 0 a 168, com escores mais altos indicando melhor qualidade de vida relacionada à saúde. RESULTADOS: Foram incluídas 115 mulheres com uma média de idade de 52,64 anos (desvio padrão [DP] = 12,13). Os domínios de questões emocionais (16,61; DP = 4,55) e de bem-estar funcional (17,63; DP = 6,15) foram os que apresentaram os piores escores. Os fatores que tiveram associação com melhor qualidade de vida relacionada à saúde em mulheres com câncer de colo do útero foram ocupação atual, maior tempo após o tratamento e diagnóstico, e mulheres que haviam sido submetidas a histerectomia. CONCLUSãO: Considerando os domínios da qualidade de vida relacionada à saúde de mulheres tratadas para câncer do colo do útero, foi observado melhor escore nos domínios de bem-estar físico e social. Para a maioria dos domínios, os melhores escores foram observados entre aquelas com ocupação atual, com mais tempo após o diagnóstico e tratamento, além daquelas que se submeteram a histerectomia.

Qualidade de Vida Relacionada à Saúde e Risco de Comorbidade Cardiovascular ao Diagnóstico de Câncer de Mama / Health-Related Quality of Life and Cardiovascular Comorbidity Risk for Breast Cancer Diagnosis / Calidad de Vida Relacionada con la Salud y Riesgo de Comorbilidad Cardiovascular al Diagnóstico de Cáncer de Mama

INTRODUÇÃO: A literatura sugere que mulheres com doenças cardiovasculares apresentam pior qualidade de vida ao diagnóstico de câncer de mama. OBJETIVO: Avaliar a associação entre a qualidade de vida relacionada à saúde (QVRS) e as doenças cardiovasculares ao diagnóstico de câncer de mama. MÉTODO: Estudo transversal com mulheres diagnosticadas com câncer de mama. A QVRS foi avaliada pelos questionários European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Câncer Module (QLQ-BR23) e a comorbidade por meio da Cumulative Illness Rating Scale Geriatric (CIRS-G). Foram calculadas as diferenças entre as médias dos escores de QVRS e comorbidade. A associação foi avaliada por regressão logística múltipla. RESULTADOS: Foram incluídas 953 mulheres com média de idade de 54 anos (DP±11,7). Apresentavam alguma comorbidade ao diagnóstico de câncer de mama 84,1% das mulheres. O sistema coração foi afetado em 10,8% e o sistema vascular em 48,2%. Após ajuste, observou-se associação entre os escores das funções física e sexual e problemas nos sistemas coração e vascular. Foi ainda observada associação entre os piores escores de dor e dispneia e o sistema coração. Em relação à presença de doenças no sistema vascular, este esteve associado à melhor satisfação sexual, melhor perspectiva futura e piores sintomas na mama. CONCLUSÃO: A QVRS se mostrou associada a doenças cardiovasculares em pacientes com câncer de mama em relação à função física, sexual, satisfação sexual, a perspectivas futuras e às escalas de sintomas (dor, dispneia e sintomas na mama).

INTRODUCTION: The literature suggests that women with cardiovascular diseases have worse quality of life when diagnosed with breast cancer. OBJECTIVE: To evaluate the association between health-related quality of life (HRQoL) and cardiovascular disease at diagnosis of breast cancer. METHOD: Cross-sectional study with women diagnosed with breast cancer. HRQoL was assessed by the questionnaires of the European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Cancer Module (QLQ-BR23) and comorbidity was assessed by the Cumulative Illness Rating Scale Geriatric (CIRS-G). It were calculated the differences between mean HRQoL values and comorbidity. Logistic multiple regression was used to evaluate the association. RESULTS: 953 women with a mean age of 54 years (SD±11.7) were included. Comorbidity was presented at diagnosis of breast cancer in 84.1% of the women. The heart system was affected in 10.8% and the vascular system in 48.2%. After adjustment, an association between physical and sexual function scores and heart and vascular system problems was observed. An association between worse pain and dyspnea scores and the heart system was also noticed. Regarding the presence of diseases in the vascular system, this was associated with better sexual satisfaction, better future outcome and worse breast symptoms. CONCLUSION: HRQoL was associated with cardiovascular disease in breast cancer patients, in relation to physical and sexual function, sexual satisfaction, future perspectives and symptom scales (pain, dyspnea and breast symptoms).

INTRODUCCIÓN: La literatura sugiere que las mujeres con enfermedad cardiovascular tienen una peor calidad de vida cuando se les diagnostica cáncer de la mama. OBJETIVO: Evaluar la asociación entre la calidad de vida relacionada con la salud (CVRS) y la enfermedad cardiovascular en el diagnóstico de cáncer de mama. MÉTODO: Estudio transversal con mujeres diagnosticadas con cáncer de mama. La CVRS se evaluó mediante los cuestionarios European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Câncer Module (QLQ-BR23) y la comorbilidad se evaluó mediante Cumulative Illness Rating Scale Geriatric (CIRS-G). Se calcularon las diferencias entre las puntuaciones medias de CVRS y la comorbilidad. La asociación se evaluó mediante regresión logística múltiple. RESULTADOS: Se incluyeron 953 mujeres con una edad media de 54 años (DP±11,7). Algunas tenían comorbilidad en el diagnóstico de cáncer de mama 84,1% de las mujeres. El sistema cardíaco se vio afectado en 10,8% y el sistema vascular en 48,2%. Después del ajuste, se observó una asociación entre las puntuaciones de la función física y sexual y los problemas del corazón y del sistema vascular. También se observó una asociación entre puntajes de dolor y disnea peores y el sistema cardíaco. Con respecto a la presencia de enfermedades en el sistema vascular, esto se asoció con una mejor satisfacción sexual, una mejor perspectiva futura y peores síntomas mamarios. CONCLUSIÓN: La CVRS se asoció con la enfermedad cardiovascular en pacientes con cáncer de mama, con respecto a la función física, la función sexual, la satisfacción sexual, las perspectivas futuras y las escalas de síntomas (dolor, disnea y síntomas de mama).

Men Have a Higher Incidence of Seroma after Breast Cancer Surgery

Background and Objectives: Male breast cancer (MBC) is rare. While surgical treatment may result in several complications in women, little is known about how it affects men. The objective of this study was to compare the incidence of postoperative wound complications between men and women after breast cancer surgery. Methods: This cohort study included all male patients enrolled for breast cancer surgical treatment at the Brazilian National Cancer Institute, between 1999 and 2013. Each was matched with three female breast cancer patients. Parameters analyzed were necrosis, seroma and infection. Odds ratios (OR) were generated and statistical significance was considered at p<0.05. Results: We included in this study 71 men and 213 women with an average age of 63.5 (±12.0). The incidences of complications in men and women were: necrosis, 32.8% and 37.8% (p=0.477); seroma, 80.6% and 59.4% (p=0.003); and surgical site infection, 14.8% and 18.2% (p=0.54). After adjustment, men had a 3 times greater risk of developing seroma compared to women (OR=3.0; IC95%=1.4-6.4; p=0.004). No statistically significant differences was detected in the incidences of wound infection and necrosis. Conclusion: Men have a greater risk of developing seroma after surgery for breast cancer than women, whereas infection and necrosis occur at similar frequencies in both genders.

Effectiveness of four inflammatory markers in predicting prognosis in 2374 women with breast cancer.

OBJECTIVE: To analyze the association between four biomarkers and overall survival in patients with breast cancer (BC). METHODOLOGY: This cohort study had a sample of 2374 women over the age of 18, diagnosed and treated in a single reference center for BC in Brazil, during the year 2008-2009. The following pretreatment indices were analyzed: neutrophil-lymphocyte ratio (NLR), a derived neutrophil-lymphocyte ratio (dNLR), absolute neutrophil count (ANC) and platelet-lymphocyte ratio (PLR). A descriptive analysis was performed using median (range) and absolute and relative frequency as categorical variables. Exploratory survival evaluation was performed using the Kaplan-Meier method and the log-rank test for comparison between survival curves, with a statistical significance level of 5%. The variables with p<0.20 were selected for inclusion in a multivariate Cox regression model, considering as statistically significant p<0.05. RESULTS: After adjusting for clinical variables, the biomarkers associated with worse overall survival were NLR >5 (HR=1.66 95%CI 1.08-2.55; p=0.021) and PLR >300 (HR=1.82 95%CI 1.10-2.99; p=0.019). When stratified by molecular subtype, the independent markers related to death were PLR >300 for triple negative (HR 3.27 95%CI 1.38-7.76; p=0.007); NLR >5 (HR 2.47 95%CI 1.16-5.28; p=0.019), ANC >7500 (HR 1.84 95%CI 1.17-2.90; p=0.008) and dNLR >3 (HR 2.45 95%CI 1.29-4.66; p=0.006) for luminal. CONCLUSION: NLR and PLR are independent markers of prognosis in BC. Further studies are needed in patients with overexpression of HER 2.

Men and women show similar survival rates after breast cancer.

PURPOSE: To compare the disease-free survival (DFS) and overall survival (OS) rates of men and women undergoing treatment for breast cancer. METHODS: A retrospective cohort study of patients with breast cancer diagnosed and treated at the Cancer Hospital III of the National Cancer Institute of Brazil, Rio de Janeiro, Brazil, between 1999 and 2013. Male breast cancer cases were matched for age, year of diagnosis, and clinical staging to three female cases (1:3). Patient characteristics were abstracted from hospital records and medical charts. Cases were analyzed using descriptive statistics, and comparisons between the genders were performed using Kaplan-Meier curves and Cox regression analysis with 95% confidence intervals. RESULTS: The study population comprised 98 men and 294 women. There were significant differences (p < 0.05) between the genders for marital status, alcohol consumption, smoking, presence of hypertension and other comorbidities, histological type of tumor, expression of estrogen receptors, progesterone receptors, human epidermal growth factor receptor-type 2, type of breast surgery, neoadjuvant chemotherapy, adjuvant radiotherapy, and use of palliative bisphosphonate therapy. Five- and 10-year DFS rates were, respectively, 80.0 and 51.4% for men and 71.4 and 63.5% for women (p = 0.245), and 5- and 10-year OS rates were, respectively, 65.0 and 47.5% for men and 56.5 and 41.4% for women (p = 0.221). CONCLUSION: There was no significant difference in prognosis (DFS and OS rates) between the genders, but significant differences in sociodemographic and clinical characteristics were detected between male and female breast cancer cases.

Impact of Treatment Type on Overall Survival in ElderlyBrazilian Women with Breast Cancer

Objective: To analyze the survival of elderly patients with breast cancer according to the type of treatment used. Methods: A cohort study of women aged 80 or over with breast cancer registered with the Brazilian National Cancer Institute (Instituto Nacional do Câncer - INCA) between 2008 and 2009 was conducted. Prognosis was analyzed according to the cancer treatment performed: surgery, radiotherapy, or hormone therapy. Analysis of the overall 5-year survival rate was performed using the Kaplan - Meier method, and comparisons of curves were undertaken using the log-rank test. For multiple regression analysis, Cox regression was used, adjusting for age and clinical stage, considering values of p < 0.05 as significant. Data were all analyzed using the statistical package SPSS version 20. Results: 70 women with a mean age of 84.0 ± 3.7 years at diagnosis participated in the study. The median follow-up time was 37.1 months (range 0.5­75.5), and 31 deaths (44.3%) occurred during this time. The median survival time was 51.2 months (95% CI, 44.9­57.4), higher in those who underwent surgery (p = 0.012) and those who had hormone therapy (p=0.001). Treatment with surgery reduced the risk of death by 61.7% (HR 0.3; 95% CI, 0.1­0.6; p = 0.001) when adjusted for clinical stage and age at diagnosis. However, there was no significant benefit from radiotherapy (HR 1.2; 95% CI, 0.5­2.5; p = 0.694). Conclusion: Treatment with surgery and hormone therapy increased the survival of our Brazilian patients with breast cancer aged 80 or over.