Purpose
BRCA
mutation carriers have an increased risk of developing breast or ovarian cancer. Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is associated with a decrease in risk for tubal and ...ovarian cancer. Hormone replacement therapy (HRT) may increase breast, ovarian, and endometrial cancer risk in the general population. This review analyses the published data on HRT and risk of cancer in
BRCA
mutation carriers with and without RRBSO.
Methods
We included all relevant articles published in English from 1995 to October 2020. Sources were identified through a search on PubMed and Cochrane Library.
Results
We included one case–control and one retrospective cohort study on ovarian and one case–control study on endometrial cancer risk and HRT in
BRCA
mutation carriers. Regarding breast cancer risk, one case–control study on
BRCA
mutation carriers with and without RRBSO and one case–control study, one Markov chain decision model, two prospective cohort studies, and one metaanalysis on carriers after RRBSO were included. For ovarian cancer, results were ambiguous. For breast cancer, most studies did not find an adverse effect associated with HRT. However, some of the studies found a risk modification associated with different formulations and duration of use.
Conclusion
Although data are limited, HRT does not seem to have a relevant effect on cancer risk in
BRCA
mutation carriers. RRBSO should not be postponed to avoid subsequent HRT in this population. Adequate HRT after RRBSO should be offered to avoid chronic diseases resulting from low estrogen levels. However, further data on the safety of different formulations are needed.
Purpose
BRCA
mutation carriers have an increased risk of developing breast or ovarian cancer. Oral contraception (OC) is known to increase breast cancer and reduce ovarian cancer risk in the general ...population. This review analyses the published data on OC and risk of cancer in
BRCA
mutation carriers.
Methods
We included all relevant articles published in English from 1995 to 2018. Literature was identified through a search on PubMed and Cochrane Library.
Results
We included four meta-analyses, one review, one case–control study and one retrospective cohort study on the association between ovarian cancer and OC in
BRCA
mutation carriers. All report a risk reduction for the OC users and several also describe an inverse correlation with duration of use. Regarding breast cancer, we included four meta-analyses, one review, one case–control study, two case-only studies, one prospective and one retrospective cohort study. Some studies report a risk elevation, while others did not find an association between OC use and breast cancer in
BRCA
mutation carriers. In other studies, the association was limited to early-onset breast cancer and/or associated with young age at first start of OC.
Conclusion
Oral contraception leads to a risk reduction of ovarian cancer also in
BRCA
mutation carriers. An increase in breast cancer risk due to OC cannot be excluded. Women with BRCA mutation who consider OC use have to be informed about possible increase in breast cancer risk and alternative contraceptive methods. OC should not be used for the prevention of ovarian cancer in this population.
Even though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is ...available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities.
Fifty-three children and adolescents (5-19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity.
Children and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants.
Children and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions.
Background and purpose
Aneurysmal subarachnoid hemorrhage (SAH) survivors often complain of fatigue, which is disabling. Fatigue is also a common symptom of pituitary dysfunction (PD), in particular ...in patients with growth hormone deficiency (GHD). A possible association between fatigue after SAH and long‐term pituitary deficiency in SAH survivors has not yet been established.
Methods
A single center observational study was conducted amongst 84 aneurysmal SAH survivors to study the relationship between PD and fatigue over time after SAH, using mixed model analysis. Fatigue was measured with the Fatigue Severity Scale and its relationships with other clinical variables were studied.
Results
Three‐quarters of respondents (76%) have pathological fatigue directly after SAH and almost two‐thirds (60%) of patients still have pathological levels of fatigue after 14 months. The severity of SAH measured with a World Federation of Neurosurgical Societies (WFNS) score higher than 1 (P = 0.008) was associated with long‐term fatigue. There is no statistically significant effect of PD (P = 0.8) or GHD (P = 0.23) on fatigue in SAH survivors over time.
Conclusions
Fatigue is a common symptom amongst SAH survivors. WFNS is a usable clinical determinant of fatigue in SAH survivors. Neither PD nor GHD has a significant effect on long‐term fatigue after SAH.
Purpose
Mutations in the genes
BRCA1
and
BRCA2
represent a significant risk factor for ovarian and breast cancer. With increasing number and success rates, fertility protection and treatment are ...gaining importance also for
BRCA1/2
mutation carriers. However, the effect on primary cancer risk and risk for recurrence remains unclear. This review analyses the published data on fertility treatment and risk of ovarian and breast cancer in
BRCA1/2
mutation carriers.
Methods
In this review, we included all relevant articles published in English from 1995 to 2018. Literature was identified through a search on PubMed and Cochrane Library.
Results
We identified one retrospective cohort and one case–control study regarding the association of fertility treatments and ovarian cancer risk in
BRCA
mutation carriers. The studies show no increase in ovarian cancer risk. Furthermore, one case–control study on the association between fertility treatment and breast cancer risk in
BRCA
mutation carriers and one prospective cohort study on the long-term safety of medication used for fertility preservation in women with a history of breast cancer were identified. One of the studies shows a possible adverse effect for gonadotropin-containing medication.
Conclusion
Possible increases in cancer risk associated with fertility treatments in
BRCA1/2
mutation carriers cannot be excluded at this time. Based on the existing studies,
BRCA1/2
mutation carriers should not be generally excluded from fertility treatments. However, they have to be informed about limited data and possible increases in cancer risk.
Zusammenfassung
Hintergrund
Hormonelle Kontrazeptiva („oral contraceptives“, OC) sind die am häufigsten verordneten Medikamente bei Frauen im reproduktiven Alter. Auch geringfügige Modifikationen des ...Risikos für bestimmte Karzinome durch OC könnten zu relevanten Änderungen ihrer Inzidenzen führen.
Fragestellung
Beeinflussung der Risiken für das Auftreten relevanter Malignome durch Anwendung hormoneller Kontrazeptiva.
Methode
Narrativer Review der Literatur (Pubmed einschließlich 2014); Suchbegriffe: hormonal contraception, cancer.
Ergebnisse
Orale Kontrazeptiva reduzieren deutlich das Risiko für Ovarial- und Endometriumkarzinome. Das Mammakarzinomrisiko wird vorübergehend leicht erhöht, insbesondere bei Einnahmebeginn vor dem 20. Lebensjahr bzw. vor der ersten Schwangerschaft. Bei BRCA-Mutationsträgerinnen sind die Effekte vergleichbar. Die Daten zur Risikomodifikation von Zervix- und kolorektalen Karzinomen sind nicht eindeutig. In der Summe führt die Einnahme oraler Kontrazeptiva nicht zu einem erhöhten Krebsrisiko.
Zusammenfassung
Hintergrund
Das Endometriumkarzinom (EC) ist in Deutschland die vierthäufigste maligne Erkrankung der Frau.
Fragestellung
Epidemiologie, Ätiologie, Diagnostik und Therapie des EC.
...Methode
Systematische Auswertung der Literatur in Pubmed bis Dezember 2014 (Suchbegriff: „endometrial cancer“).
Ergebnisse
In Deutschland erkranken pro Jahr 11.550 Frauen neu an einem EC. Das EC zählt zu den prognostisch günstigen Malignomen, da es meist in einem frühen Stadium diagnostiziert wird. Hierfür sind Blutungen in der Postmenopause und im Senium sowie atypische Blutungen bei prämenopausalen Frauen sorgfältig abzuklären. Durch eine Hysterektomie mit beidseitiger Adnexexstirpation kann die Mehrzahl der EC-Patientinnen geheilt werden. Bei Tumoren mit hohem Rückfallrisiko wird die systematische Lymphonodektomie (pelvin und paraaortal), eine adjuvante Chemotherapie, eine vaginale Brachytherapie und ggf. eine perkutane Strahlentherapie empfohlen. Bei EC mit niedrigem Rezidivrisiko ist eine minimal-invasive Operation onkologisch sicher. Aussagekräftige Studien zur onkologischen Sicherheit minimal-invasiver Operationsmethoden bei EC mit hohem Rezidivrisiko liegen nicht vor.
First studies indicate that up to 6 months after hospital discharge, coronavirus disease 2019 (COVID-19) causes severe physical, cognitive, and psychological impairments, which may affect ...participation and health-related quality of life (HRQoL). After hospitalization for COVID-19, a number of patients are referred to medical rehabilitation centers or skilled nursing facilities for further treatment, while others go home with or without aftercare. The aftercare paths include 1 community-based rehabilitation; 2 in- and outpatient medical rehabilitation; 3 inpatient rehabilitation in skilled nursing facilities; and 4 sheltered care (inpatient). These aftercare paths and the trajectories of recovery after COVID-19 urgently need long-term in-depth evaluation to optimize and personalize treatment. CO-FLOW aims, by following the outcomes and aftercare paths of all COVID-19 patients after hospital discharge, to systematically study over a 2-year period: 1 trajectories of physical, cognitive, and psychological recovery; 2 patient flows, healthcare utilization, patient satisfaction with aftercare, and barriers/facilitators regarding aftercare as experienced by healthcare professionals; 3 effects of physical, cognitive, and psychological outcomes on participation and HRQoL; and 4 predictors for long-term recovery, health care utilization, and patient satisfaction with aftercare.
CO-FLOW is a multicenter prospective cohort study in the mid-west of the Netherlands with a 2-year follow-up period. Measurements comprise non-invasive clinical tests and patient reported outcome measures from a combined rehabilitation, pulmonary, and intensive care perspective. Measurements are performed at 3, 6, 12, and 24 months after hospital discharge and, if applicable, at rehabilitation discharge. CO-FLOW aims to include at least 500 patients who survived hospitalization for COVID-19, aged ≥18 years.
CO-FLOW will provide in-depth knowledge on the long-term sequelae of COVID-19 and the quality of current aftercare paths for patients who survived hospitalization. This knowledge is a prerequisite to facilitate the right care in the right place for COVID-19 and comparable future infectious diseases.
The Netherlands Trial Register (NTR), https://www.trialregister.nl . Registered: 12-06-2020, CO-FLOW trialregister no. NL8710.
PDF
