Objective
Cancer‐related fatigue (CRF) is among the most common and distressing side effects of cancer treatment. Different types of interventions, including physical activity (PA), psychosocial and ...mind–body interventions, have been shown to reduce CRF. We aimed to explore HCPs’ practices and barriers to refer patients towards interventions to reduce CRF.
Methods
We performed a qualitative study using key informant interviews among a sample of 20 HCPs including medical, surgical and radiation oncologists, pain specialists, nurses, psychologists, psychiatrists and physiotherapists recruited from breast, prostate and colorectal cancer disease groups from a comprehensive cancer centre.
Results
Most interviewees reported not to address CRF spontaneously during consultations. When the topic of CRF was brought up by patients, all interviewees acknowledged to recommend PA, whereas few would recommend psychosocial or mind–body interventions. Barriers to recommend interventions to manage CRF included: lack of knowledge about CRF and its treatment, lack of time and complexity of the referral due to their accessibility and cost.
Conclusion
In a diverse sample of HCPs, most acknowledged not to address CRF proactively with their patients, but identified several actionable barriers. Specific training on screening and management of CRF and improving the referral network dedicated to interventions need to be implemented.
Background
Higher consumption of coffee and tea has been associated with improved health outcomes in the general population and improved breast cancer (BC) prognosis. This study investigated patterns ...of coffee and tea consumption and association with patient‐reported outcomes (PROs) and clinical outcomes among survivors of BC.
Methods
The authors included survivors of stage I–III BC enrolled in the CANTO cohort (NCT01993498) that provided post‐treatment assessment of coffee and tea consumption from years 1 to 4 after diagnosis. Group‐based trajectory modeling clustered patients according to daily consumption of coffee and tea. Multivariable mixed models and Cox models examined associations between consumption, PROs and clinical outcomes.
Results
Among 3788 patients, the authors identified four stable patterns of consumption: “Low” (25.8%), “Moderate” (37.6%), “High” (25.3%), and “Very high” (11.3%), corresponding to <1, 2, 3, and ≥ 4 cups of coffee and/or tea per day. Patients in the “Very high” group (vs. “Low”), were more likely to be younger, smokers, with higher monthly income and education. PROs and survival outcomes were similar across the four groups.
Conclusions
Over one in three survivors of BC reported high or very high consumption of coffee and/or tea. The authors found no association between higher consumption of coffee and/or tea, worse PROs and clinical outcomes.
More than 30% of survivors of breast cancer report high post‐diagnostic consumption of coffee and tea. In this study, the authors did not find any detrimental association between higher consumption of coffee and tea and patient‐reported or clinical outcomes.
Background
This study assessed the prevalence and risk factors of unhealthy behaviors among survivors of early‐stage breast cancer.
Methods
Women (n = 9556) from the CANcer TOxicity cohort ...(NCT01993498) were included. Physical activity (PA), tobacco and alcohol consumption, and body mass index were assessed at diagnosis and at years 1 and 2 after diagnosis. A behavior was defined as unhealthy if patients failed to meet PA recommendations (≥10 metabolic equivalent task hours per week), reduce/quit tobacco, or decrease alcohol consumption to less than daily, or if they gained substantial weight over time. Multivariable‐adjusted generalized estimating equations explored associations with unhealthy behaviors.
Results
At diagnosis, 41.7% of patients were inactive, 18.2% currently used tobacco, 14.6% consumed alcohol daily, and 48.9% were overweight or obese. At years 1 and 2, unhealthy PA behavior was reported among 37.0% and 35.6% of patients, respectively, unhealthy tobacco use behavior was reported among 11.4% and 9.5%, respectively, and unhealthy alcohol behavior was reported among 13.1% and 12.6%, respectively. In comparison with the previous assessment, 9.4% and 5.9% of underweight and normal‐weight patients had transitioned to the overweight or obese category at years 1 and 2, respectively, and 15.4% and 16.2% of overweight and obese patients had gained ≥5% of their weight at years 1 and 2, respectively. One in 3 current tobacco smokers and 1 in 10 daily alcohol users reported improved behaviors after diagnosis. Older women (5‐year increment) were more likely to be inactive (adjusted odds ratio aOR, 1.03; 95% confidence interval CI, 1.01‐1.05) and report unhealthy alcohol behavior (aOR, 1.28; 95% CI, 1.23‐1.33) but were less likely to engage in unhealthy tobacco use (aOR, 0.81; 95% CI, 0.78‐0.85). Being at risk for depression (vs not being at risk for depression) was associated with reduced odds of unhealthy tobacco use (aOR, 0.67; 95% CI, 0.46‐0.97) and with a higher likelihood of unhealthy alcohol behavior (aOR, 1.58; 95% CI, 1.14‐2.19). Women with a college education (vs a primary school education) less frequently reported an unhealthy PA behavior (aOR, 0.61; 95% CI, 0.51‐0.73) and were more likely to report unhealthy alcohol behavior (aOR, 1.85; 95% CI, 1.37‐2.49). Receipt of chemotherapy (vs not receiving chemotherapy) was associated with higher odds of gaining weight (aOR, 1.51; 95% CI, 1.23‐1.87) among those who were overweight or obese at diagnosis.
Conclusions
The majority of women were adherent to healthy lifestyle behaviors at the time of their breast cancer diagnosis, but a significant subset was nonadherent. Unhealthy behaviors tended to persist after the breast cancer diagnosis, having varying clinical, psychological, sociodemographic, and treatment‐related determinants. This study will inform more targeted interventions to promote optimal health.
Unhealthy behaviors are common at the diagnosis of breast cancer and tend to persist afterward with varying clinical, psychological, sociodemographic, and treatment‐related determinants. Targeted behavioral interventions are needed to promote optimal health for breast cancer survivors and capitalize on a teachable moment.
Pre-heating mitigates composite degradation Silva, Jessika Calixto da; Rogério Vieira, Reges; Rege, Inara Carneiro Costa ...
Journal of applied oral science,
11/2015, Letnik:
23, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Dental composites cured at high temperatures show improved properties and higher degrees of conversion; however, there is no information available about the effect of pre-heating on material ...degradation. Objectives This study evaluated the effect of pre-heating on the degradation of composites, based on the analysis of radiopacity and silver penetration using scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS). Material and Methods Thirty specimens were fabricated using a metallic matrix (2x8 mm) and the composites Durafill VS (Heraeus Kulzer), Z-250 (3M/ESPE), and Z-350 (3M/ESPE), cured at 25°C (no pre-heating) or 60°C (pre-heating). Specimens were stored sequentially in the following solutions: 1) water for 7 days (60°C), plus 0.1 N sodium hydroxide (NaOH) for 14 days (60°C); 2) 50% silver nitrate (AgNO3) for 10 days (60°C). Specimens were radiographed at baseline and after each storage time, and the images were evaluated in gray scale. After the storage protocol, samples were analyzed using SEM/EDS to check the depth of silver penetration. Radiopacity and silver penetration data were analyzed using ANOVA and Tukey's tests (α=5%). Results Radiopacity levels were as follows: Durafill VS<Z-350<Z-250 (p<0.05). The depth of silver penetration into the composites ranked as follows: Durafill VS>Z-350>Z-250 (p<0.05). After storage in water/NaOH, pre-heated specimens presented higher radiopacity values than non-pre-heated specimens (p<0.05). There was a lower penetration of silver in pre-heated specimens (p<0.05). Conclusions Pre-heating at 60°C mitigated the degradation of composites based on analysis of radiopacity and silver penetration depth.
Fatigue is common and troublesome among breast cancer survivors; however, limited tools exist to predict its risk.
Participants with stage I-III breast cancer were prospectively included from CANTO ...(ClinicalTrials.gov identifier: NCT01993498), collecting longitudinal data at diagnosis (before the initiation of any cancer treatment) and 1 (T1), 2 (T2), and 4 (T3) years after diagnosis. The main outcome was severe global fatigue at T2 (score ≥ 40/100, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30). Analyses at T3 were exploratory. Secondary outcomes included physical, emotional, and cognitive fatigue (EORTC Quality of Life Questionnaire-FA12). Multivariable logistic regression models retained associations with severe fatigue by bootstrapped Augmented Backward Elimination. Validation methods included 10-fold internal cross-validation, overoptimism-corrected area under the receiver operating characteristic curves, and external validation.
Among 5,640, 5,000, and 3,400 patients at T1, T2, and T3, respectively, the prevalence of post-treatment severe global fatigue was 35.6%, 34.0%, and 31.5% in the development cohort. Retained risk factors for severe global fatigue at T2 were severe pretreatment fatigue (adjusted odds ratio
no 3.191 95% CI, 2.704 to 3.767); younger age (for 1-year decrement 1.015 1.009 to 1.022), higher body mass index (for unit increment 1.025 1.012 to 1.038), current smoking behavior (
never 1.552 1.291 to 1.866), worse anxiety (
noncase 1.265 1.073 to 1.492), insomnia (for unit increment 1.005 1.003 to 1.007), and pain at diagnosis (for unit increment 1.014 1.010 to 1.017), with an area under the receiver operating characteristic curve of 0.73 (95% CI, 0.72 to 0.75). Receipt of hormonal therapy was a risk factor for severe fatigue at T3 (
no 1.448 1.165 to 1.799). Dimension-specific risk factors included body mass index for physical fatigue and emotional distress for emotional and cognitive fatigue.
We propose a predictive model to assess fatigue among breast cancer survivors, within a personalized survivorship care framework. This may help clinicians to provide early management interventions or to correct modifiable risk factors and offer more tailored monitoring and education to patients at risk of severe post-treatment fatigue.
This study aimed to describe the influence of four different small-sided games with 15-min duration on physical and physiological demands in rugby union players. Fourteen rugby union players (22.4 ± ...3.2 years) participated in the study that was conducted during the competitive period of final-four first Division of 2012–2013 qualifying competition. Time-motion and body impact data were collected using global positional systems technology with heart rate monitored continuously across training sessions. The present study found that interaction between speed zones, impacts zones and small-sided game formats was significant. No differences were found in the distance covered per minute or the interaction of heart rate values; however, players spent the majority of time above 90% of the HRmax. The SSG 1 presents significant lower values in body impacts per minute compared with the other small-sided games. The results of this study demonstrate that small-sided games with evasion skills showed different levels of physical performance, and skill qualities of rugby union players. Although HR responses were similar between all small-sided game formats, the high levels of individual variability may explain the obtained results. Future use of this technology may help practitioners in design and implementation of individual position-specific training programs with appropriate management of player exercise load.
BEROSE is a single-center observational study, which aimed to determine the proportion of women with breast cancer who received information on sexual health from health professionals throughout their ...whole care pathway. A total of 318 women with all stages of breast cancer (30% metastatic) and at different time interval from diagnosis (up to 7 years) participated to the survey. Sixty-five percent of women reported that they had not received any information about sexual health over the whole care. Increased awareness among the healthcare professionals and particularly the oncology community is needed to discuss sexual health in women with breast cancer.
The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of ...cancer survivorship.
Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research.
We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care.
The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
•Patients’ challenges from cancer diagnosis to treatment and beyond led to the discipline of cancer survivorship.•Despite the progress made in cancer survivorship, the need for high-quality care, education and research remains.•We attempted to define the principles for promotion of high-quality survivorship, suggesting areas for ESMO’s contribution.
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