Purpose
Cancer-related fatigue (CRF) is a common side effect of cancer and cancer treatment that significantly impairs the quality of life and can persist for years after treatment completion. ...Although fatigue is often associated with cancer treatment, it is also a result of the disease itself, even before intervention. CRF at the time of diagnosis may affect treatment timing or completion and is a consistent predictor of post-treatment fatigue at any time. The mechanisms underlying CRF are multidimensional and not well understood, particularly at the time of diagnosis.
Methods
Sixty-five breast cancer patients at the time of diagnosis were included. The participants completed self-assessment questionnaires about CRF, sleep disturbances, and emotional symptoms and wore an accelerometer to assess levels of spontaneous physical activity and sleep quality. During the experimental session, the participants underwent cognitive, neuromuscular, and exercise metabolism evaluations.
Results
Using augmented backward elimination regression, this study found that emotional symptoms and perceived sleep disturbances were the strongest predictors of CRF (adjusted
r
2
= 0.51). Neuromuscular fatigability and sleep disturbance were also associated with physical dimensions, whereas cognitive performance was associated with cognitive dimensions.
Conclusion
At the time of diagnosis, emotional and cognitive dimensions are over-represented compared to the general population, and specific subdimensions have specific predictors that support the idea of distinct mechanisms. Evaluating CRF subdimensions and their potential mechanisms at the time of diagnosis would be particularly relevant for identifying high-risk patients and offering them appropriate interventions.
Trial registration
This study was registered at ClinicalTrials.gov (NCT04391543) in May, 2020.
Cancer-related fatigue (CRF) is the most common side effect of cancer and cancer treatment. CRF prevalence is up to 50% in breast cancer patients and can continue several years after cancer ...remission. This persistent subjective sense of exhaustion is multifactorial. Numerous parameters have been evidenced to be related to CRF across biological, physical, psychological, social and/or behavioral dimensions. Although CRF has been studied for many years, the majority of previous studies focused on only one dimension, i.e., physical function. Moreover, few studies investigated CRF longitudinally with repeated measures. These are the two main obstacles that limit the understanding of CRF mechanisms. The purpose of this study is to create a biopsychosocial model of CRF with simultaneous and longitudinal anthropometric, clinical, biological, physical, psychological and sociological parameters.
BIOCARE FActory is a multicentric prospective study that will consist of an 18-month follow-up of 200 women diagnosed with breast cancer. Four visits will be scheduled at diagnosis, after treatments, and 12 and 18 months after diagnosis. The same procedure will be followed for each visit. Each session will be composed of anthropometric data collection, a semi-structured interview, cognitive tests, postural control tests, neuromuscular fatigability tests and a cardiorespiratory fitness test. Clinical and biological data will be collected during medical follow-ups. Participants will also complete questionnaires to assess psychological aspects and quality of life and wear an actigraphy device. Using a structural equation modeling analysis (SEM), collected data will build a biopsychosocial model of CRF, including the physiological, biological, psychological, behavioral and social dimensions of CRF.
This study aims to highlight the dynamics of CRF and its correlates from diagnosis to post treatment. SEM analysis could examine some relations between potential mechanisms and CRF. Thus, the biopsychosocial model will contribute to a better understanding of CRF and its underlying mechanisms from diagnosis to the aftermaths of cancer and its treatments.
This study is registered at ClinicalTrials.gov ( NCT04391543 ), May 2020.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In 2008, a study of the characteristics of hospitalised patients led to the development of a prognostic tool that distinguished three populations with significantly different 2-month survival rates. ...The goal of our study aimed at validating prospectively this prognostic tool in outpatients treated for cancer in terminal stage, based on four factors: performance status (ECOG) (PS), number of metastatic sites, serum albumin and lactate dehydrogenase.
PRONOPALL is a multicentre study of current care. About 302 adult patients who met one or more of the following criteria: life expectancy under 6months, performance status≥2 and disease progression during the previous chemotherapy regimen were included across 16 institutions between October 2009 and October 2010. Afterwards, in order to validate the prognostic tool, the score was ciphered and correlated to patient survival.
Totally 262 patients (87%) were evaluable (27 patients excluded and 13 unknown score). Median age was 66 years 37–88, and women accounted for 59%. ECOG PS 0–1 (46%), PS 2 (37%) and PS 3–4 (17%). The primary tumours were: breast (29%), colorectal (28%), lung (13%), pancreas (12%), ovary (11%) and other (8%). About 32% of patients presented one metastatic site, 35% had two and 31% had more than two. The median lactate dehydrogenase level was 398IU/l 118–4314; median serum albumin was 35g/l 13–54. According to the PRONOPALL prognostic tool, the 2-month survival rate was 92% and the median survival rate was 301 days 209–348 for the 130 patients in population C, 66% and 79 days 71–114 for the 111 patients in population B, and 24% and 35 days for 14–56 the 21 patients in population A. These three populations survival were statistically different (P<0.0001).
PRONOPALL study confirms the three prognostic profiles defined by the combination of four factors. This PRONOPALL score is a useful decision-making tool in daily practice.
In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer.
A study on a homogenous series of 111 ...patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks.
Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.
Résumé
En 2006, bevacizumab-FOLFIRI représente la thérapie ciblée administrable dès la première ligne chez les patients porteurs d’un cancer colorectal métastatique non opérable. Une série homogène ...de 111 patients colligés en région Bretagne et Pays de la Loire ayant reçu du bevacizumab- FOLFIRI en première ligne en 2006 révèle les résultats suivants: 51 réponses, 29 stabilités, 21 progressions et 10 toxicités avant évaluation. La médiane de survie globale (OS) est de 25,1 mois et la médiane de survie sans progression (PFS) de 10,2 mois. Dans le cas d’une chirurgie secondaire, l’OS médian triple de 18,8 mois chez les patients non réséqués versus 59,2 mois ceux réséqués. En comparant les sujets âgés de plus et de moins de 70 ans, aucune différence n’a été mise en évidence en termes de bénéfice ou de risque. Bevacizumab-FOLFIRI pourrait être administré en pratique courante chez les personnes âgées sous couvert d’une évaluation gériatrique et d’une approche multidisciplinaire.
Metastatic colorectal cancer (mCRC) management has been clearly improved by targeted therapies such as anti-HER1 drugs (panitumumab and cetuximab). As evaluation of their use sequentially after ...progression in the real world is strategic to assess health poliltics, no series of patients is currently available. The Observatory of cancer Bretagne-Pays de la Loire is a network of 50 private and public cancer centers particularly focused on good practise for cancer drugs use.
The aim of the study is to evaluate the use of Panitumumab Monotherapy (PM) after previous treatment with Cetuximab-Based Regimen (CBR) in an homogeneous series of kras wild type unresectable mCRC according to EMA approval. Sex, age, localization of the tumor, successive chemotherapeutic regimens, toxicities, response rate, progression free survival (PFS) and overall survival (OS) have been studied.
106 patients (73 men, median age 64.4 years 36-86) previously treated with CBR received PM at progression. The primary tumor site was colon (62%), rectum (35%) and both of them (3%). Patients received successively 1 to 9 lines of treatment for mCRC. Objective responses (OR) were observed in 46% of the patients under CBR and 17% responded again to PM. Disease stabilization was achieved in 17% of the patients treated with CBR and in 13% of the patients treated with PM. Amongst the patients who had an OR with CBR, 31% also had an OR with PM and 16% were stabilized with PM (clinical benefit 47%). In case of cetuximab resistance, only 14% of the patients had a clinical benefit with PM. The median PFS under CBR was 6.6 months IC95% 5.3-7.7 and 3.2 months IC95% 2.8 -3.5 under PM after CBR. The median OS for the patients who achieved a response with both targeted therapies was 25.4 months IC 95% 22.4-42.6 vs 15.0 months IC 95% 12.9-18.3 for the patients who did not (p < 0.0001).
Our study clearly showed that patients with progression after response to cetuximab regimen had a potential opportunity of clinical benefit (47%) with panitumumab monotherapy with a good response rate. OS was potentially increased in responders to the successive use of both targeted therapies.
J. Metges: conference for Amgen, MerckSerono and Amgen.
O. Dupuis: participation in a scientific evening as moderator account for MerckSerono.
M. Ferec: participation paid to a board VIFOR invitations congress by Roche, Amgen.
J. Douillard: AMGEN : participation in advisory boards and steering committees, speaker in symposia, compensated MERCKSERONO: Research Funding, participation in advisory boards and steering committees, speaker in symposia, compensated.
All other authors have declared no conflicts of interest.
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