No abstract

Purpose Understanding the etiology of cancer-related fatigue (CRF) is critical to identify targets to develop therapies to reduce CRF burden. The goal of this systematic review was to expand on the initial work by the National Cancer Institute CRF Working Group to understand the state of the science of the biology of CRF. Specifically, to evaluate studies that examined the relationships between biomarkers and CRF, and to develop an etiologic model of CRF to guide researchers on pathways to explore or therapeutic targets to investigate. Methods This review was completed by the Multinational Association of Supportive Care in Cancer Fatigue Study Group – Biomarker Working Group. The initial search used three terms (biomarkers, fatigue, cancer), which yielded 11,129 articles. After removing duplicates, 7,175 articles remained. Titles were assessed for the keywords, “cancer” and “fatigue” resulting in 3,811 articles. Articles published before 2010 and those with samples <50 were excluded, leaving 75 articles for full-text review. Of the 75 articles, 25 were further excluded for not investigating the associations of biomarkers and CRF. Results Of the 47 articles reviewed, 25 were cross-sectional and 22 were longitudinal studies. Less than half (44%) were published recently (2010-2013). Almost half (46%) enrolled breast cancer participants. A majority of studies assessed fatigue using self-report questionnaires, and only two studies used clinical parameters to measure fatigue. Conclusions The findings from this review suggest that CRF is linked to immune/inflammatory, metabolic, neuroendocrine, and genetic biomarkers. We also identified gaps in knowledge and made recommendations for future research.

Burnout syndrome is typified by three dimensions: emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PS), and is prevalent among cancer care providers. The objective is to conduct a systematic review and meta-analysis of studies that evaluated the presence of burnout syndrome in professionals dedicated to the care of cancer patients. A search was conducted of the MEDLINE, LILACS and COCHRANE databases. Articles were selected that had used the Maslach questionnaire to assess burnout syndrome prevalence, had evaluated at least 35 subjects (including physicians), had at least a 20% questionnaire response rate, and that were published in English, Spanish or Portuguese. Ten studies (2375 participants) were included in this analysis. Severe involvement by any one of the three dimensions ranged from 8% to 51%. The overall prevalence of EE was found to be 36% [95% confidence interval (CI) (31-41)], while for DP this was 34% [95% CI (30-39)] and for PS 25% [95% CI (0.16-34)], demonstrating considerable heterogeneity across studies. The prevalence of burnout syndrome is elevated among cancer professionals throughout the world but varies substantially among studies. Further research is needed to better understand and prevent this syndrome.

Fatigue is an exceedingly common often treatable problem in cancer patients that profoundly affects all aspects of quality of life. Prevalence estimates have ranged from 50% to 90% of cancer patients overall. After addressing reversible or treatable contributing factors, such as hypothyroidism, anemia, sleep disturbance, pain, emotional distress, climacterium, medication adverse events, metabolic disturbances, or organ dysfunction such as heart failure, myopathy, and pulmonary fibrosis, patients may be screened with a brief fatigue self-assessment tool. All cancer patients should be screened regularly for fatigue. Those with moderate or severe fatigue may benefit from both pharmacologic and nonpharmacologic interventions, while mild fatigue that does not interfere with quality of life can be treated with nonpharmacologic measures alone. Physicians often have insufficient knowledge about fatigue and its treatments or underestimate the impact of fatigue on quality of life, while patients may consider it an unavoidable and untreatable side-effect and fear that reporting it may incite a change toward less aggressive cancer treatment. A practical review may therefore be useful to health care professionals in order to avoid the common barriers to its treatment that exist on the sides of both physicians and patients.

PurposeSorafenib is a multikinase inhibitor with antiangiogenic/antiproliferative activity. A randomized, double-blind, placebo-controlled phase IIB trial assessed sorafenib with capecitabine for locally advanced or metastatic human epidermal growth factor receptor 2 (HER2) –negative breast cancer.Patients and MethodsPatients were randomly assigned to first- or second-line capecitabine 1,000 mg/m2orally twice a day for days 1 to 14 of every 21-day cycle with sorafenib 400 mg orally twice a day or placebo. The primary end point was progression-free survival (PFS).ResultsIn total, 229 patients were enrolled. The addition of sorafenib to capecitabine resulted in a significant improvement in PFS versus placebo (median, 6.4 v 4.1 months; hazard ratio [HR], 0.58; 95% CI, 0.41 to 0.81; P = .001) with sorafenib favored across subgroups, including first-line (HR, 0.50; 95% CI, 0.30 to 0.82) and second-line (HR, 0.65; 95% CI, 0.41 to 1.04) treatment. There was no significant improvement for overall survival (median, 22.2 v 20.9 months; HR, 0.86; 95% CI, 0.61 to 1.23; P = .42) and overall response (38% v 31%; P = .25). Toxicities (sorafenib v placebo) of any grade included rash (22% v 8%), diarrhea (58% v 30%), mucosal inflammation (33% v 21%), neutropenia (13% v 4%), hypertension (18% v 12%), and hand-foot skin reaction/hand- foot syndrome (HFSR/HFS; 90% v 66%); grade 3 to 4 toxicities were comparable between treatment arms except HFSR/HFS (44% v 14%). Reasons for discontinuation in the sorafenib and placebo arms included disease progression (63% v 82%, respectively), adverse events (20% v 9%, respectively), and death (0% v 1%, respectively).ConclusionAddition of sorafenib to capecitabine improved PFS in patients with HER2-negative advanced breast cancer. The dose of sorafenib used in this trial resulted in unacceptable toxicity for many patients. A phase III confirmatory trial has been initiated with a reduced sorafenib dose.

Drug interactions comprise an important issue in oncology, with approximately one-third of ambulatory cancer patients being at risk of DDIs. Data are limited on the clinical consequences of drug interactions among cancer patients.

RESUMOOBJETIVO. Identificar as possíveis fases de atraso na condução de pacientes com câncer de mama atendidas em um hospital público, desde a suspeita até o diagnóstico e o início do tratamento. MÉTODOS. Estudo retrospectivo, no qual foram analisados em pacientes com câncer de mama atendidas consecutivamente no Serviço de Oncologia do Hospital Estadual Mário Covas, durante o ano de 2006, os dados relativos aos intervalos de tempo transcorrido entre a suspeita, o diagnóstico e o início do tratamento adjuvante sistêmico. RESULTADOS. Sessenta e oito mulheres foram incluídas. A média de idade foi de 56,3 anos (desvio padrão: 12,2 anos). Entre os intervalos analisados, o maior atraso ocorreu entre a suspeita mamográfica de câncer e a realização da biópsia (mediana de 72 dias, variação de 4 a 1095 dias), sendo este significativamente maior (p<0,001) quando comparado aos demais intervalos analisados. Além disso, considerando particularmente este intervalo, verifica-se que foi significativamente maior nas pacientes com câncer de mama de estadio avançado, comparativamente àquelas de estadio inicial (p=0,014). CONCLUSÃO. Pacientes com câncer de mama tratadas em serviço público sofrem atrasos importantes, principalmente no período de diagnóstico de sua doença. Com base em nossos dados, otimizar o intervalo entre a mamografia e a obtenção da biópsia de lesões suspeitas parece ser a estratégia mais profícua. O tamanho do tumor, a presença ou ausência de receptores hormonais e a presença de linfonodos axilares e metástases são os mais consistentes indicadores prognósticos para mulheres com carcinoma mamário de estadio inicial 3 . O câncer de mama pode ser detectado pelo auto-exame das mamas e/ou pela realização de mamografia e/ou ultra-sonografia, devendo ser confirmado por meio da biópsia da lesão 3 . A biópsia deve conter todos os elementos necessários para o adequado manejo clínico da paciente sob o ponto de vista prognóstico e terapêutico 4 . Com este objetivo, realiza-se na avaliação pela imunoistoquímica a pesquisa da presença de receptores hormonais (estrógeno e progesterona) e do marcador c-erb-2 4 . O estadiamento da doença no momento da instituição do tratamento é um dos fatores mais importantes (se não o mais importante) na determinação prognóstica do paciente. Deste modo, atrasos que levem à demora diagnóstica e/ou terapêutica permitem o crescimento tumoral com potencial detrimento para as chances de cura dos pacientes. UNITERMOSO acesso e o tempo para o diagnóstico e tratamento do câncer de mama variam nas diversas regiões do país, dependendo de fatores geográficos e socioeconômicos. Estudo preliminar, realizado nos três serviços de oncologia clínica ligados à Faculdade de Medicina do ABC, em Santo André, mostrou que o atraso no diagnóstico do câncer de mama está, em grande parte, relacionado ao tempo que a paciente demora a procurar os serviços de saúde a partir da detecção do primeiro sintoma ou sinal (por exemplo, a palpação de nódulo ou outra alteração na mama) 5 . A partir do primeiro sintoma, a mediana de ...

Background: Recombinant granulocyte colony-stimulating factors (G-CSFs) such as Filgrastim are used to treat chemotherapy-induced neutropenia. We investigated a new G-CSF, XM02, and compared it to Neupogen™ after myelotoxic chemotherapy in breast cancer (BC) patients.