Impact of two different dose-intensity chemotherapy regimens on psychological distress in early breast cancer patients.

In order to improve outcome, new, often more toxic chemotherapy regimens are continuously investigated in early breast cancer patients. Because the expected survival improvement is small, the possible increase in the negative effects of the new treatments should be carefully evaluated. Negative effects are represented not only by acute and chronic toxicity, but also by the adverse psychological impact of chemotherapy. The aim of this study was to evaluate the effect on patient-reported psychological distress of an increase in the dose-intensity of adjuvant chemotherapy compared with a standard regimen. Psychological distress was evaluated at baseline, during chemotherapy and after 6 and 12 months in breast cancer patients enrolled in a phase III multicentre study comparing the standard adjuvant chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil every 21 days (CEF21) with the same chemotherapy given every 14 days (CEF14). 392 patients were randomised in participating centres, and 363 were evaluable for this study. Overall, 1095 out of 1446 expected questionnaires (75.7%) were collected and evaluable. At baseline, the mean scores of psychological distress were similar in the two arms. During chemotherapy, a significantly higher psychological distress was observed in the CEF14 compared with the CEF21 arm (32.3 +/- 1.3 versus 27.6 +/- 1.3; P=0.009), as well as a higher cumulative incidence of anaemia, mucositis, diarrhoea, alopecia, bone pain and fatigue was observed in the CEF14 arm. In multivariate analyses, mucositis (P=0.01), asthenia (P=0.059), and CEF14 treatment (P=0.054) were independently associated with a higher psychological distress. After 6 months, psychological distress was again similar in the two arms and significantly lower when compared with baseline within each arm. A dose-intensive adjuvant regimen induces a higher, although transient, psychological distress in early breast cancer patients. Final results of the randomised trial will indicate whether such higher adverse effects of the dose-intensive regimen are counterbalanced by a higher efficacy of the experimental treatment in terms of survival.

Pressure available for expiration in chronic airway obstruction.

The pressure generated at 0.1 s after the onset of expiration measures the rate of rise of expiratory pressure potentially available for expiration. P0.1e increased with increasing the frequency of breathing and was higher in chronic obstructive pulmonary disease (COPD) patients than in controls. In normal subjects breathing under resistive load P0.1e became similar to that of patients for a given respiratory frequency. P0.1e consistently increased as the load and/or the frequency of breathing were raised. Expiratory pressure depends on elastic recoil of the respiratory system, nevertheless the action of neurally controlled respiratory muscles influence the rate of rise of expiratory pressure. The decrease of expiratory braking action by inspiratory muscles (-Pmusi) influence the rate of pressure rise in the first part of expiration, whereas the contraction of abdominal muscles (-Pmuse) increases P0.1e later from onset of expiratory occlusion. These compensatory reflexes are vagally mediated and are presumed to originate in stretch receptors. In COPD patients the braking action of inspiratory muscles was smaller and the facilitating action of abdominal muscles was higher than in controls. Both expiratory braking decay and expiratory activity increase with the rise of breathing frequency or with the increase of respiratory airflow resistance.