Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Violence against Women with Breast Neoplasms

The aim of this study is to assess the occurrence and type of violence suffered by women with breast cancer in the High Complexity Care Unit of a municipality in the South of Minas and patients in a support group of the University of the South of Minas Gerais. For that aim, a descriptive-exploratory methodology was applied through the quantitative method. Data were collected through a semi-structured form applied in individual interviews over a period of three months. We interviewed 57 patients and among those, 20 women （35.08%） reported having experienced some form of violence at some stage of their life, and the most frequently mentioned was the psychological violence followed by physical aggression. Although it was possible to identify that violence against affected these women, complaints against the aggressor were not affected.

The accuracy of magnetic resonance imaging and ultrasound in evaluating the size of early-stage breast neoplasms

Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Both overestimation and underestimation have important adverse effects on patient care. This study aimed to evaluate the accuracy of breast magnetic resonance imaging(MRI) and ultrasound(US) examination for measuring the size and extent of early-stage breast neoplasms.Methods The longest diameter of breast tumors in patients with T_(1–2)N_(0–1)M_0 invasive breast cancer preparing for breast-conserving surgery(BCS) was measured preoperatively by using both MRI and US and their accuracy was compared with that of postoperative pathologic examination. If the diameter difference was within 2 mm, it was considered to be consistent with pathologic examination.Results A total of 36 patients were imaged using both MRI and US. The mean longest diameter of the tumors on MRI, US, and postoperative pathologic examination was 20.86 mm ± 4.09 mm(range: 11–27 mm), 16.14 mm ± 4.91 mm(range: 6–26 mm), and 18.36 mm ± 3.88 mm(range: 9–24 mm). US examination underestimated the size of the tumor compared to that determined using pathologic examination(t = 3.49, P < 0.01), while MRI overestimated it(t =-6.35, P < 0.01). The linear correlation coefficients between the image measurements and pathologic tumor size were r = 0.826(P < 0.01) for MRI and r = 0.645(P < 0.01) for US. The rate of consistency of MRI and US compared to that with pathologic examination was 88.89% and 80.65%, respectively, and there was no statistically significant difference between them(χ~2 = 0.80, P > 0.05).Conclusion MRI and US are both effective methods to assess the size of breast tumors, and they maintain good consistency with pathologic examination. MRI has a better correlation with pathology. However, we should be careful about the risk of inaccurate size estimation.

Clinical Trial of Letrozole (femara) versus Aminoglutethimide in Postmenopausal Women with Advanced Breast Cancer

Objective： To compare the response and adverse reactions of aminoglutethimide with that of femara, an oral aromatase inhibitor, in postmenopausal women with advanced breast cancer. Methods： Fifty patients were randomly assigned to femara 2.5 mg once daily （n=26） or aminoglutethimide （n=24） 125 mg twice daily in the first week, 250 mg twice daily in the second week, 250 mg three times daily in the third week and 250 mg four times daily in the fourth week, 30 days for one cycle for both groups. Results： Overall objective response rate （complete＋partial） of 26.9% for femara was 12.5% higher than that of aminoglutethimide, but there was no significant difference （P=0.294）. The percentages of stable disease were 53.8% and 50.0% respectively in both treatment groups and that of progressive disease of two groups were 19.2% and 37.5%. There was no significant difference between two arms in the receptor status, disease-free intervals, sites of disease and stages of treatment. Femara-related adverse events were fatigue （15.4%）, anorexia （11.5%）, dizziness （7.7%）, nausea （3.8%） and somnolence （3.8%）. However, incidence of nausea （25.0%） and vomiting （16.7%） in aminoglutethimide group was obviously higher and severer than that in femara group （P=0.045 and P=0.046）. Compared to femara group, frequency in dizziness （25.0%）, fatigue （20.8%）, anorexia （16.7%）, somnolence （12.5%） and cutaneous pruritus （12.5%） was higher in aminoglutethimide group. Allergic rash occurred in aminoglutethimide group. Conclusion： Femara was more effective and well tolerated than aminoglutethimide with respect to side effects in the treatment of postmenopausal women with advanced breast cancer.

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

Objective： Early assessment of response to neoadjuvant chemotherapy （NAC） for breast cancer allows therapy to be individualized. The optimal assessment method has not been established. We investigated the accuracy of automated breast ultrasound （ABUS） to predict pathological outcomes after NAC. Methods： A total of 290 breast cancer patients were eligible for this study. Tumor response after 2 cycles of chemotherapy was assessed using the product change of two largest perpendicular diameters （PC） or the longest diameter change （LDC）. PC and LDC were analyzed on the axial and the coronal planes respectively. Receiver operating characteristic （ROC） curves were used to evaluate overall performance of the prediction methods. Youden＇s indexes were calculated to select the optimal cut-off value for each method. Sensitivity, specificity, positive and negative predictive values （PPV and NPV） and the area under the ROC curve （AUC） were calculated accordingly.Results： ypT0/is was achieved in 42 patients （14.5%） while ypT0 was achieved in 30 patients （10.3%） after NAC. All four prediction methods （PC on axial planes, LDC on axial planes, PC on coronal planes and LDC on coronal planes） displayed high AUCs （all〉0.82）, with the highest of 0.89 [95% confidence interval （95% CI）, 0.83-0.95] when mid-treatment ＆BUS was used to predict final pathological complete remission （pCR）. High sensitivities （85.7%-88.1%） were observed across all four prediction methods while high specificities （81.5%-85.1%） were observed in two methods used PC. The optimal cut-off values defined by our data replicate the WHO and the RECIST criteria. Lower AUCs were observed when mid-treatment ABUS was used to predict poor pathological outcomes. Conclusions：ABUS is a useful tool in early evaluation of pCR after NAC while less reliable when predicting poor pathological outcomes.

Trans-arterial chemoperfusion for the treatment of liver metastases of breast cancer and colorectal cancer: Clinical results in palliative care patients

AIM To evaluate the clinical value and efficiency of transarterial chemoperfusion(TACP) in patients with liver metastases from breast cancer(BC) and colorectal cancer(CRC).METHODS We treated 36 patients with liver metastases of BC(n = 19, 19 females) and CRC(n = 17; 8 females, 9 males) with repeated TACP. The treatment interval was 4 wk. TACP was performed with gemcitabine(1000 mg/m2) and mitomycin(10 mg/m2), administered within 1 h after positioning the catheter tip in the hepatic artery. Before treatment, the size, location, tumour volume, vascularization and number of liver tumours were evaluated using magnetic resonance imaging(MRI). Tumour response was evaluated according to the Response Evaluation Criteria in Solid Tumors guidelines.RESULTS TACP using gemcitabine and mitomycin for metastases from CRC and BC was performed without any serious side effects. The follow-up MRI showed a therapeutic response in 84.2% of the BC patients-stable disease 47.4% and partial response 36.8%. A progression was seen in 15.8%.CRC patients showed a therapeutic response in 52.9% of cases. A progression of the disease was documented in 47.1% of the patients with CRC. These data show that TACP in patients with liver metastases of BC leads to a significantly better therapeutic response compared with CRC patients(P = 0.042). The median survival time was 13.2 mo for the BC patients, which is significantly longer than for CRC patients at 9.3 mo(P = 0.001).CONCLUSION TACP for liver metastases of BC appears to be a safe and effective palliative treatment with improved outcomes in comparison to patients with CRC.

Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea

Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.

Tim-3 promotes cell aggressiveness and paclitaxel resistance through NF-κB/STAT3 signalling pathway in breast cancer cells

Objective:Although T-cell immunoglobulin and mucin-domain containing molecule-3(Tim-3)has been recognized as a promising target for cancer immunotherapy,its exact role in breast cancer has not been fully elucidated.Methods:Tim-3 gene expression in breast cancer and its prognostic significance were analyzed.Associated mechanisms were then explored in vitro by establishing Tim-3-overexpressing breast cancer cells.Results:In a pooled analysis of The Cancer Genome Atlas(TCGA)database,Tim-3 gene expression levels were significantly higher(P<0.001)in breast cancer tissue,compared with normal tissues.Tim-3 was a prognosis indicator in breast cancer patients[relapse-free survival(RFS),P=0.004;overall survival(OS),P=0.099].Tim-3 overexpression in Tim-3 low breast cancer cells promoted aggressiveness of breast cancer cells,as evidenced by enhanced proliferation,migration,invasion,tight junction deterioration and tumor-associated tubal formation.Tim-3 also enhanced cellular resistance to paclitaxel.Furthermore,Tim-3 exerted its function by activating the NF-κB/STAT3 signalling pathway and by regulating gene expression[cyclin D1(CCND1),C-Myc,matrix metalloproteinase-1(MMP1),TWIST,vascular endothelial growth factor(VEGF)upregulation,concomitant with Ecadherin downregulation).Lastly,Tim-3 downregulated tight junction-associated molecules zona occludens(ZO)-2,ZO-1 and occludin,which may further facilitate tumor progression.Conclusions:Tim-3 plays an oncogenic role in breast cancer and may represent a potential target for antitumor therapy.

Serological Diagnosis of Liver Metastasis in Patients with Breast Cancer

Objective To diagnose and explore the serological diagnostic factors for liver metastasis in patients with breast cancer before symptoms occur. Methods A total of 430 female in-patients with breast cancer of stages 0 to IIIC who came to Tianjin Medical University Cancer Institute and Hospital from January 2003 to January 2004 were studied and followed up until May 2011. Serum levels of biochemical markers for tumor and liver were measured at the time of diagnosis. Results Liver metastasis was more likely to occur in patients with stage Ill cancer or c-erbB-2-positive expression. Alanine aminotransferase, aspartate aminotransferase, ~/-glutamyltransferase （GGT）, alkaline phosphatase, lactate dehvdrogenase （LDH）, and carbohydrate antigen 1153 （CA153） levels were significantly higher in patients with liver metastasis than those without liver metastasis. Diagnostic indices of LDH, GGT, and CA153 were 174 U/L, 32 U/L, and 26.48 Dg/L, respectively. The areas under the curves of LDH, GGT, and CEA were 0.795, 0.784, and 0.661, respectively, and sensitivities of parallel tests for LDH and CA153 and for GGT and CA153 were 88.6% and 85.7 %, respectively. The specificity of serial tests for both pairs of enzymes was 97.7%. Conclusions Tile sensitivity and specificity of combined tumor and biochemical markers could be used as indicators during screening for breast-liver metastasis.

Exploring the employment readiness and return to work status of breast cancer patients and related factors

Objective:To investigate the employment status,employment readiness,and other factors affecting the ease or difficulty with which breast cancer patients effect their return to work(RTW).Methods:This study adopted a mixed-method design,recruiting participants from among breast cancer patients in a cancer hospital in Hunan from December 2018 to June 2019.We approached 300 individuals,192 of whom ultimately participated in this study.The quantitative part of the study involved several scales:the Patient Health Questionnaire-9(PHQ-9),the Brief Fatigue Inventory(BFI),the Work Ability Index(WAI),and the Lam Assessment of Employment Readiness(LASER).The qualitative part involved a set of open-ended questions and written responses collected from 41 participants who had already returned to work at the time of data collection.Their written responses mainly concerned factors influencing RTW.Results:Forty-one breast cancer patients had returned to work.The results reported a median total Cognitive Symptom Checklist score of 9.00(6.00,15.25),a median WAI score of 5.00(3.50,9.75),a median BFI score of 26.00(14.75,42.00),a median total PHQ-9 score of 8.00(5.25,17.00),and a LASER score of 50.35±11.90.Multiple regression analysis showed that the participants’cancer stage,cognitive limitations,depression,fatigue,and work ability were significant predictors of employment readiness(P<0.05).Exploring the qualitative data,we found that higher skill levels,better social support,and a flexible work schedule facilitated RTW;stress,lack of confidence in one’s work skills,depression,and fatigue are all possible barriers to RTW.Conclusion:The findings indicate that breast cancer patients have a low level of employment readiness.Nurses and other healthcare providers can develop relevant interventions to promote employment readiness and ultimately achieve RTW in this study population.

Exercise for fatigue in breast cancer patients: An umbrella review of systematic reviews

Objective:To evaluate evidence from published systematic reviews about the effectiveness of exercise interventions on fatigue management in breast cancer patients.Methods:PubMed,Web of Science,the Cochrane Library,the Cumulative Index of Nursing and Allied Health(CINAHL),Embase databases,the China National Knowledge Infrastructure(CNKI),the Wanfang database,the China Biomedical Literature Database(CBM),and the VIP database were searched to identify relevant systematic reviews.The reviews which assessed exercise interventions on cancer-related fatigue(CRF)in breast cancer patients were included.Quality of evidence was evaluated by the Grade of Recommendation,Assessment,Development,and Evaluation(GRADE)tool.The Assessment of Multiple Systematic Reviews(AMSTAR)appraisal tool was used to evaluate the methodological quality of included systematic reviews.Results:Twenty-four systematic reviews met all the inclusion criteria.The overall mean score for AMSATR is 7.38 and ranged from 4 to 10 points.In addition,21 reviews arrived at positive conclusions,which exercises could reduce CRF,and 3 obtained that exercise does not affect fatigue.As for GRADE,8 of the reviews were graded as'moderate',2 of the studies were'very low',and the others were'low'.Conclusions:Aerobic and resistance exercise can be regarded as beneficial to CRF in breast cancer patients,and limited evidence exists that yoga had an effect on reducing fatigue.The quality of the current systematic review is still far from satisfactory.

Relationship between sex hormone receptors and ultrastructural cellular differentiation in breast cancer:an observation in 40 patients

Estrogen and progesterone receptor (ER and PR) contents of 40 breastcancer patients were determined with immunofluorescent staining.Thedifferentiation of cancer cells was evaluated on the basis of histological andultrastructural changes.It was found that there was a positive correlation of ERand PR contents with the cellular differentiation of breast cancer,and the lattercould be used to estimate the status of hormone receptors.Breast cancer is a malignant disease with heteropathological characteristics.In handling a breast cancerpatient,both the status of hormone receptors and the cellular differentiationshould be considered and the treatment varied with each pa(?)ent.For those witha well-differentiated cancer and rich hormone receptors,endocrine therapy shouldmainly be administered,while for those with a poorly-differentiated cancer and afew hormone receptors,chemotherapy would be of choice.

Symptom Cluster Research in Women with Breast Cancer: A Comparison of Three Subgrouping Techniques

Aims: To examine how symptom cluster subgroups defined by extreme discordant composite scores, cut-off scores, or a median split influence statistical associations with peripheral cytokine levels in women with breast cancer. Background: Systemic cytokine dysregulation has been posited as a potential biological mechanism underlying symptom clusters in women with breast cancer. Symptom characteristics may play an important role in identifying cytokines of significant etiological importance, however, there is no consensus regarding to the ideal subgrouping technique to use. Design: A secondary analysis of data collected from a cross-sectional descriptive study of women with stage I-II breast cancer was used to examine and compare the relationships between peripheral cytokine levels and symptom subgroups defined by extreme discordant composite scores, cut-off scores, or a median split. Methods: Participant symptom scores were transformed into a composite score to account for variability in symptom intensity, frequency and interference. Cytokine levels in subgroups defined by composite scores within the highest and lowest 20% were contrasted with those composed from cut-off scores and a median split. Results: Subgroups defined by the composite score or cut-off scores resulted in similar statistical relationships with cytokine levels in contrast to the median split technique. The use of a median split for evaluating relationships between symptoms clusters and cytokine levels may increase the risk of a type I error. Conclusion: Composite and cut-off scores represent best techniques for defining symptom cluster subgroups in women with breast cancer. Using a consistent approach to define symptom clusters across studies may assist in identifying relevant biological mechanisms.

PACLITAXEL PLUS CARBOPLATIN FOR WOMEN WITH ADVANCED BREAST CANCER

Objective To evaluate the efficacy and safety of combination chemotherapy with paclitaxel and carboplatin for advanced breast cancer (ABC). Methods From January 2001 to March 2006, 45 patients with ABC were treated with combination chemotherapy of paclitaxel and carboplatin. Patients received infusion of paclitaxel 175 mg/m2 on day 1 every 3 weeks or 75 mg/m2 on day 1, 8, 15 every 4 weeks. Carboplatin was administrated on day 2 with a dose of area under the time-concentration curve (AUC) being 5. Results The median number of cycles was 3 (range, 2-6). The overall response rate was 62.2%. Median time to progression was 7.0 months (95%CI:5.1-8.9). Median overall survival was 29.0 months (95%CI: 20.1-37.9). One year survival rate was 73.3%. Response rate for first line and second line treatment were 62.1% and 62.5%, respectively. No significant difference in response existed between visceral metastasis and soft tissue metastasis. The main side effects included nausea/vomiting, neurotoxicity, and hematologic toxicities. Grade Ⅲ to Ⅳ adverse events included nausea/vomiting in 2 cases (4.4%), leukopenia in 17 cases (37.8%), and alopecia in 6 cases (13.3%). Conclusion Combination of paclitaxel and carboplatin is active in treatment of ABC with an acceptable toxicity profile.

The evaluation of Tracp5b as a marker for monitoring treatment results of bone metastasis in breast cancer patients

Objective ：To evaluate the sensitivity of serum tartrate-resistant acid phosphatase 5b（Tracp5b） activity in monitoring bisphosphonate treatment results of bone metastasis in breast cancer（BC） patients. Methods：The serum activities of Tracp5b, CEA, CA153 were measured in 58 BC patients, including 26 without bone metastasis, 32 with bone metastasis. The serum activities of TracpSb, CEA, CA153 were also measured in 19 patients with bone metastasis after 3 months of bisphosphonate treatment. Eighteen healthy women with age from 34 to 70 served as control. Results：Serum TracpSb was significantly elevated in patients with bone metastasis compared with that in all any other groups（P〈 0.05）. The sensitivity of TracpSb was 78.13% and the specificity was 86.36%. The sensitivity of CA153 was 37.50% and the specificity was 77.27%. The sensitivity of CEA was 21.88% and the specificity was 84.09%. The serum activity of TracpSb decreased significantly（P 〈 0.05） after 3 months of bisphosphonate treatment, while the levels of CA153 and CEA were unchanged. Conclusion：Serum Tracp5b activity is a useful diagnostic marker for bone metastasis in BC patients and can be used to evaluate the treatment results of bisphosphonate.

Histopathological Features of Invasion of Breast Invasive Ductal Carcinoma and Safety of Breast-conserving Surgery

In order to investigate the relationship between the extent of tumor invasion and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery, the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed. The correlation analysis on invasive extent, which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre, and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and his- tologic grading was processed. There was a significant correlation between invasive extent and tumor size （r=-0.766, P〈0.01）, and lymph nodes metastases 0=0.574, P〈0.01）, but there was no significant correlation between invasive extent and Her-2 expression （r=-0.106, P〉0.05）, and histologic grading （r=-0.228, P〉0.05）. The 100% negative rate of infiltration in patients without nipple discharge with tumor size 〈2, 2-3 and 〉3 cm was obtained at 1.5, 2.0 and 2.5 cm away from the tumor respectively. It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

Paclitaxel-induced stress granules increase LINE-1 mRNA stability to promote drug resistance in breast cancer cells

Abnormal expression of long interspersed element-1(LINE-1)has been implicated in drug resistance,while our previous study showed that chemotherapy drug paclitaxel(PTX)increased LINE-1 level with unknown mechanism.Bioinformatics analysis suggested the regulation of LINE-1 mRNA by drug-induced stress granules(SGs).This study aimed to explore whether and how SGs are involved in drug-induced LINE-1 increase and thereby promotes drug resistance of triple negative breast cancer(TNBC)cells.We demonstrated that SGs increased LINE-1 expression by recruiting and stabilizing LINE-1 mRNA under drug stress,thereby adapting TNBC cells to chemotherapy drugs.Moreover,LINE-1 inhibitor efavirenz(EFV)could inhibit drug-induced SG to destabilize LINE-1.Our study provides the first evidence of the regulation of LINE-1 by SGs that could be an important survival mechanism for cancer cells exposed to chemotherapy drugs.The findings provide a useful clue for developing new chemotherapeutic strategies against TNBCs.

Developing an Evidence-Based Exercise Guideline on Improving Shoulder Motion and Lessening the Severity of Lymphedema for Breast Cancer Patients after Axillary Lymph-Node Dissection

Exercise is proven to be effective, safe and the preferred intervention for improving the range of shoulder motion of breast cancer patients who have undergone surgery for axillary lymph-node dissection. The application of evidence-based guidelines to clinical practice can help healthcare professionals to provide good quality care to patients and, in turn, produce better patient outcomes. The purpose of the present paper is to describe the development process of an evidenced-based guideline. Challenges in the implementation of evidence-based practice are identi.ed and strategies for tackling them discussed.

Clinical features and prognosis of obese breast cancer patients: a retrospective study

Objective:The aim of our study was to investigate the prognosis of obese breast cancer patients.Methods:This study was conducted on a total of 317 breast cancer patients who were histopathologically and clinically diagnosed at the General Hospital of Shenyang Military Region(China)from 2004 to 2006.Clinical data including height,weight,age at diagnosis,tumor size,lymph node status,menopausal status,family history of cancer and hormone receptor status were collected.Log-rank test was performed to compare the disease free survival(DFS)and overall survival(OS).Cox proportional hazards regression analysis was conducted to make multivariate analysis.The Chi square test was used to compare the clinical features among normal weight group,overweight group,and obese group.Results:Obesity was an independent prognostic factor for DFS(P=0.022)and OS(P=0.032)in breast cancer patients.In the stratified analysis based on the hormone receptor status,obesity was independently associated with OS in patients with negative ER/PR(P=0.002),but such association was not observed in patients with positive hormone receptors.Obesity was also associated with lymph node status(P=0.001)and smoking(P=0.009).Conclusion:Obesity is associated with poor DFS and OS in patients with breast cancer.Therefore,maintaining normal weight may benefit breast cancer patients.

Subcutaneous Trastuzumab (Herceptin^®): A UK Time and Motion Study in Comparison with Intravenous Formulation for the Treatment of Patients with HER2-Positive Early Breast Cancer

Aim: Firstly, to quantify active healthcare professional (HCP) time and costs associated with subcutaneous (SC) administration of trastuzumab (Herceptin?) compared with the standard intravenous infusion (IV) in the treatment of patients with HER2-positive early breast cancer within the adjuvant PrefHer trial setting;secondly, to measure patient time in the care unit and patient infusion chair time for both routes of administration. Methods: A UK multi-centre prospective, observational Time and Motion study was conducted alongside the PrefHer trial (ClinicalTrials.gov id: NCT01401166). Trained observers measured the duration of each SC and IV related task that HCPs undertook and recorded patient time in the chemotherapy unit and infusion chair. The type and quantity of medical consumables used with each route of administration were also collected. Twenty-four patient episodes were recorded (12 SC, 12 IV). Mean total administration time was calculated as the mean sum of task times, both for IV and SC formulations. The mean cost of each route of administration was calculated as the mean cost of HCP time plus the mean cost of consumables used. HCP time was costed using Personal Social Services Research Unit. Consumables were costed using hospital pharmacy data and online sources. Results: Mean active HCP time for IV administration was 92.6 minutes compared with 24.6 minutes for SC administration. The mean cost for IV preparation and administration was ￡144.96 (￡132.05 of HCP time and ￡12.92 of consumables) versus ￡33.15 (￡31.99 of HCP time and ￡1.17 of consumables) for SC administration. Mean time spent in the care unit and in the infusion chair was 94.5 minutes and 75 minutes respectively for IV, and 30.3 minutes and 19.8 minutes for SC. SC administration of trastuzumab could translate to a time saving of 68 minutes (versus IV) with a total cost saving of ￡111.81 per patient episode. This equates to a potential saving of ￡2012.58 over a full course of adjuvant treatment (18 cycles). Conclusion: Substituting IV infusion with SC administration of trastuzumab may lead to a substantial reduction in active HCP time, patient chair and unit time, consumable use and overall costs. The reduced patient chair and unit time could provide increased capacity within existing resources.