We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance two years after diagnosis of breast cancer building on clinical and behavioral factors and integrating ...pre-treatment markers of systemic inflammation.BACKGROUNDWe aimed to generate a model of cancer-related fatigue (CRF) of clinical importance two years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation.Women with stage I-III HR+/HER2- breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance (EORTC QLQ-C30≥40/100) two years after diagnosis (year-2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers (interleukin IL-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, interferon gamma, IL-1 receptor antagonist, TNF-α, and C-reactive protein), and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling.METHODSWomen with stage I-III HR+/HER2- breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance (EORTC QLQ-C30≥40/100) two years after diagnosis (year-2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers (interleukin IL-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, interferon gamma, IL-1 receptor antagonist, TNF-α, and C-reactive protein), and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling.Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year-2. High pre-treatment levels of IL-6 (Quartile 4 vs.1) were associated with global CRF at year-2 (adjusted Odds Ratio aOR: 2.06 95% Confidence Interval 1.40-3.03; p=0.0002; AUC=0.74). Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese (62.4%; mean BMI 28.0 SD 6.3 Kg/m2) and physically inactive (53.5% did not meet WHO recommendations). Clinical and behavioral associations with CRF at year-2 included pre-treatment CRF (aOR vs no: 3.99 2.81-5.66), younger age (per 1-year decrement: 1.02 1.01-1.03), current smoking (vs never: 1.81 1.26-2.58), and worse insomnia or pain (per 10-unit increment: 1.08 1.04-1.13, and 1.12 1.04-1.21, respectively). Secondary analyses indicated additional associations of IL-2 (aOR per log-unit increment:1.32 CI 1.03-1.70) and IL-10 (0.73 0.57-0.93) with global CRF and of C-reactive protein (1.42 1.13-1.78) with cognitive CRF at year-2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF.RESULTSAmong 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year-2. High pre-treatment levels of IL-6 (Quartile 4 vs.1) were associated with global CRF at year-2 (adjusted Odds Ratio aOR: 2.06 95% Confidence Interval 1.40-3.03; p=0.0002; AUC=0.74). Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese (62.4%; mean BMI 28.0 SD 6.3 Kg/m2) and physically inactive (53.5% did not meet WHO recommendations). Clinical and behavioral associations with CRF at year-2 included pre-treatment CRF (aOR vs no: 3.99 2.81-5.66), younger age (per 1-year decrement: 1.02 1.01-1.03), current smoking (vs never: 1.81 1.26-2.58), and worse insomnia or pain (per 10-unit increment: 1.08 1.04-1.13, and 1.12 1.04-1.21, respectively). Secondary analyses indicated additional associations of IL-2 (aOR per log-unit increment:1.32 CI 1.03-1.70) and IL-10 (0.73 0.57-0.93) with global CRF and of C-reactive protein (1.42 1.13-1.78) with cognitive CRF at year-2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF.This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance two years later among a large prospective sample of survivors of breast cancer.CONCLUSIONSThis study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance two years later among a large prospective sample of survivors of breast cancer.
Background and aims
Little is known about the long‐term economic consequences of smoking during pregnancy. We estimated the association between smoking in pregnancy and the costs of delivering ...health‐care to infants and children in England, and investigated which aspects of care are the key drivers of these costs.
Methods
We used Hospital Episode Statistics (HES) linked with Clinical Practice Research Datalink (CPRD) data in England from January 2003 to January 2015 in children with longitudinal data for at least 1, 5 and 10 years after birth. Poisson regression provided rate ratios (RR) and 95% confidence intervals (CIs) comparing health‐care episode rates between those exposed and not exposed to smoking during pregnancy. Linear regression was used to compare estimated costs between groups (£ sterling, 2015 prices) and generalized linear multivariable (GLM) models adjusted for potentially moderating factors.
Results
A total of 93 152 singleton pregnancies with the required data were identified. Maternal smoking in pregnancy was associated with higher primary care, prescription and hospital in‐patient episode rates, but lower out‐patient visit and diagnostic test rates. Adjusting for year of birth, socio‐economic deprivation, parity, sex of child and delivery method showed that maternal smoking in pregnancy was associated with increased child health‐care costs at 1 year average cost difference for children of smokers, β = £91.18, 95% confidence interval (CI) = £47.52–134.83 and 5 years of age (β = £221.80, 95% CI = £17.78–425.83, but not at 10 years of age (β = £365.94, 95% CI = –£192.72 to £924.60).
Conclusion
In England, maternal smoking in pregnancy is associated with increased child health‐care costs over the first 5 years of life; these costs are driven primarily by greater hospital in‐patient care.
This study evaluated the variation of surface and intra-pulpal temperature, during bleaching protocol, using LED/laser. The 35% (HP35), 15% (HP15) and 6% (HP6) gels were used associated with ...LED/laser applied every 1 min for 30 min in a human canine. The evaluation of surface temperature variation (∆Ts) was performed using a pHmeter and the intra-pulpal temperature variation (∆Ti) was performed using a digital thermometer, at times of 1-, 5-, 10- 15- and 30-min. Statistical analysis was performed using the two-way repeated measures ANOVA test and Bonferroni post-hoc test was used at a significance level of 5%. HP35 and HP15 showed greater temperature variation than HP6 up to 10 min of surface evaluation, showing no differences between them. In the intra-pulpal evaluation, no group showed differences throughout the procedure.
The objective of the study was to evaluate the effects of dentin deproteinization protocols for post space using different formulations containing sodium hypochlorite before fiber post cementation ...with self-adhesive resinous cement. The groups were divided according to the irrigation protocol (DWC, SHS, SHT and SHG). The residue cleanliness, bond strength, adhesive failure pattern, and tag formation at the adhesive interface between the self-adhesive cement and the dentin were evaluated. For this, analysis in scanning electron microscope, push-out test and confocal laser scanning microscopy were performed. The SHT protocol showed the highest residue cleanliness on the dentin surface of the post space (p<0.05). In addition, SHT protocol showed highest bond strength and tag formation in the cervical and middle thirds (p<0.05). Dentin deproteinization with sodium hypochlorite with surfactant provided the best dentin cleaning of residues, bond strength and tag formation after cementation of the fiber post with self-adhesive cement.
Nicotine replacement therapy (NRT) helps nonpregnant smokers quit, but there is no evidence that standard dose NRT is effective in pregnancy. As nicotine metabolism increases in pregnancy, this could ...reduce NRT efficacy. Using the ratio of trans-3'-hydroxycotinine to cotinine, the nicotine metabolite ratio (NMR), we investigated relationships between the rate of nicotine metabolism, maternal characteristics and smoking cessation in pregnant women recruited to a randomized controlled trial of NRT.
Data from 1,050 pregnant smokers in the Smoking, Nicotine and Pregnancy trial who were of 12-24 weeks gestation had exhaled carbon monoxide readings of ≥8 ppm at recruitment and who were randomized to NRT or placebo patches were used. Linear and logistic regression investigated associations between maternal characteristics and NMR and also between NMR and subsequent validated cessation from smoking.
Six hundred and sixty-two women (63%) provided blood samples for NMR estimation. Higher NMR was associated with increased cigarette consumption prior to pregnancy. At 1 month (odds ratio OR = 0.87; 95% CI = 0.76-0.99; p = .043) and delivery (OR = 0.79; 95% CI = 0.66-0.95; p = .010), there was a significant negative association between a 0.1 unit increase in NMR and odds of achieving cessation after adjusting for possible confounders. There was no evidence for an interaction between a 0.1 unit increase in NMR and treatment assignment on the odds of cessation at 1 month post-quit date (p = .556).
Pregnant women who metabolize nicotine more rapidly are less likely to achieve cessation when they try to quit smoking. There is no evidence that NRT is more effective in women who metabolize nicotine more slowly.
Purpose
A substantial proportion of cancer survivors experience fatigue after diagnosis. Physical activity (PA) can impact fatigue after cancer. In this study, we evaluated the prevalence and ...association of fatigue and the practice of PA in a population with early cancer.
Methods
Using the national population‐based French cross‐sectional study Vie après le cancer 2, we included 1984 patients with early breast (61.1%), prostate (21.5%), and colorectal (17.4%) cancer. Severe fatigue at 2 years postdiagnosis was defined by a score ≥40 in the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ C30) fatigue subscale. PA was defined as (a) self‐reported PA before diagnosis (active/inactive) and (b) change in PA since diagnosis (increased/maintained exposure vs decreased exposure/remaining inactive). Multivariate regression examined associations of severe fatigue with PA, adjusting for baseline clinical and treatment variables.
Results
Median age was 52 years. 51.5% of patients experienced severe fatigue 2 years post‐diagnosis. 87.7% reported to be physically active before cancer diagnosis; 53.3% of patients either decreased PA or remained inactive at 2 years postdiagnosis. At 2 years postdiagnosis, severe fatigue was associated with a change in PA since diagnosis: patients with decreasing PA/remaining inactive from pre‐ to postdiagnosis had a higher risk of severe fatigue vs those with increasing/maintaining PA (adjusted odds ratio 95% confidence interval 2.32 1.85‐2.90).
Conclusion
Fatigue continues to be a substantial problem for cancer survivors 2 years after cancer diagnosis and is associated with PA decreasing/remaining inactive since diagnosis. Interventions to maintain or increase PA for cancer survivors should be tested to mitigate long‐term fatigue after cancer.
Fatigue continues to be a substantial problem for cancer survivors 2 years after cancer diagnosis and is associated with PA decreasing /remaining inactive since diagnosis. Interventions to maintain or increase PA for cancer survivors should be tested to mitigate long‐term fatigue after cancer.
Return to work (RTW) after breast cancer is associated with improved quality of life. The link between household characteristics and RTW remains largely unknown. The aim of this study was to examine ...the effect of the family situation on women’s RTW two years after breast cancer. We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Among women employed at diagnosis and under 57 years old, we assessed the association between household characteristics (living with a partner, marital status, number and age of economically dependent children, support by the partner) and RTW. Logistic regression models were adjusted for age, household income, stage, comorbidities, treatments and their side effects. Analyzes stratified by age and household income were performed to assess the association between household characteristics and RTW in specific subgroups. Among the 3004 patients included, women living with a partner returned less to work (OR = 0.63 0.47–0.86) and decreased their working time after RTW. Among the 2305 women living with a partner, being married was associated with decreased RTW among women aged over 50 (OR = 0.57 0.34–0.95). Having three or more children (vs. none) was associated with lower RTW among women with low household income (OR = 0.28 0.10–0.80). Household characteristics should be considered in addition to clinical information to identify vulnerable women, reduce the social consequence of cancer and improve their quality of life.
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