Impact of anthracycline dose on quality of life and rehabilitation in breast cancer treatment.

BACKGROUND: In 2005 the Dutch national guidelines for treatment of breast cancer were updated. From then onwards, patients with operable breast cancer, who formerly received four cycles of adjuvant chemotherapy with doxorubicin/cyclophosphamide (AC), were treated with five cycles of 5-fluorouracil/epirubicin/cyclophosphamide (FEC), based on data suggesting survival benefit. PRIMARY OBJECTIVE: evaluation of the effect on quality-of-life and trainability after four AC versus five FEC cycles of polychemotherapy. SECONDARY OBJECTIVE: evaluation of the effectiveness of an 18-week training programme for breast cancer survivors. METHODS: A prospective cohort study design was used, comparing two chemotherapy regimens historically. The first cohort (group 1) received 4AC (A 60 mg/m2, C 600 mg/m2) (n=25) and the second cohort (group 2) received 5FE C (F 500 mg/m2, E 90 mg/m2, C 500 mg/m2) (n=50) adjuvant polychemotherapy. Both groups completed an 18-week high-intensity strength-training programme. Outcome measures were changes in quality-of-life (EORTC-QLQ-C30, MFI -20), muscular strength (one-repetition maximum; leg press) and cardiopulmonary function (VO2max) between baseline and follow-up. RESULTS: Between March 2002 and February 2006, 75 female subjects with breast cancer participated in this study. Baseline characteristics were similar in both groups. After completing the training programme, both groups showed a significant improvement in all outcome measures. No significant differences in changes of the EORTC-QLQ-C30 and MFI-20, one repetition maximum of the leg press and the VO2max between the two groups were demonstrated. CONCLUSION: After adaptation of the Dutch national breast cancer treatment guidelines, patients received prolonged and increased doses of anthracyclines. This, however, did not result in a difference in the baseline situation before rehabilitation and in training response, nor in quality of life between the two groups.

[Eosinophilic fasciitis; the importance of early detection for optimal outcomes]. / Eosinofiele fasciitis, het belang van een tijdige herkenning voor de genezing.

Eosinophilic fasciitis (EF) is a disease with unknown aetiology, although an immunologic pathogenesis is suspected. The characteristic features of this inflammatory disease include scleroderma-like skin indurations, predominantly on the extremities, and peripheral blood eosinophilia. Internal organs are generally not affected. Initiation of systemic glucocorticoid therapy at an early stage results in a good response and remission of symptoms. This is illustrated in 3 cases of EF to demonstrate the importance of early detection in this disease.

Monofilament assessment of neuropathy in a community diabetes clinic.

OBJECTIVE: To compare the detection of diabetic neuropathy using monofilament, cotton wool, pinprick, vibration sense and symptom evaluation. SETTING: The diabetes clinic of a community hospital. METHODS: Two examiners evaluated 89 women with diabetes mellitus (DM) using a 10 g monofilament, cotton wool, pinprick and a 128 Hz tuning fork after completion of a University of Texas subjective peripheral neuropathy verbal questionnaire. RESULTS: Vibration sense was abnormal in either foot in 8% of subjects. Neuropathy as defined by monofilament, cotton wool and pinprick was present in 26%, 3% and 6% of patients respectively. The respective kappa values (kappa) for the comparison between monofilament neuropathy and cotton wool neuropathy, pinprick neuropathy and symptom-defined neuropathy were 0.18, 0.21 and 0.06. The kappa-value comparing monofilament and tuning fork-defined neuropathy was 0.24. There was fair agreement between 10 versus 3 sites (kappa = 0.60). CONCLUSION: More abnormalities were detected using the monofilament compared with cotton wool or pinprick. There was poor concordance between symptoms and clinically detected neuropathy. The ideal number of sites that need to be evaluated is still contentious.