BACKGROUND Cancer patients are considered a priority group for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination given their high risk of contracting severe coronavirus disease 2019 (COVID-19). However, limited data exists regarding the efficacy of immunization in this population. In this study we assess the immunologic response after COVID-19 vaccination of cancer versus non-cancer population. METHODS PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were searched from March 01, 2020, through August 12, 2021. Primary endpoints were anti-SARS-CoV-2 spike protein (S) immunoglobulin G (IgG) seroconversion rates, T-cell response, and documented SARS-CoV-2 infection after COVID-19 immunization. Data was extracted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Overall effects were pooled using random effects models. RESULTS This systematic review and meta-analysis included 35 original studies. Overall, 51% (95% confidence interval [CI], 41-62) and 73% (95%CI, 64-81) of cancer patients developed anti-S IgG above the threshold level after partial and complete immunization, respectively. Patients with hematologic malignancies had a significantly lower seroconversion rate than those with solid tumors after complete immunization (65% vs 94%; P <0.0001). Compared to non-cancer controls, oncological patients were less likely to attain seroconversion after incomplete (RR 0.45 [95%CI 0.35-0.58]) and complete (RR 0.69 [95%CI 0.56-0.84]) COVID-19 immunization schemes. Cancer patients had a higher likelihood of having a documented SARS-CoV-2 infection after partial (RR 3.21; 95%CI 0.35-29.04) and complete (RR 2.04; 95%CI 0.38-11.10) immunization. CONCLUSIONS Cancer patients have an impaired immune response to COVID-19 vaccination compared to controls. Strategies that endorse the completion of vaccination schemes are warranted. Future studies should aim to evaluate different approaches that enhance oncological patients’ immune response.
The COVID-19 pandemic has had a substantial effect on cancer care. 1 The recent widespread availability of vaccines against SARS-CoV-2 is a promising strategy to prevent COVID-19associated mortality. However, previous reports have shown a high hesitancy rate to receive a COVID-19 vaccine among oncologic patients. 2,3 Because breast cancer is the most commonly diagnosed malignant neoplasm, 4 it is imperative to evaluate the specific concerns regarding COVID-19 vaccination among patients with this disease.Methods | From March 12 to March 26, 2021, any woman with breast cancer residing in Mexico who visited the social media channels of nongovernmental organizations dedicated to improving breast cancer care were invited to complete a webbased survey. To assess COVID-19 vaccine hesitancy rates, participants were dichotomized into a vaccine-acceptant group (ie, willing to be vaccinated immediately) and a vaccinehesitant group (ie, prefer to wait, only if vaccine is mandatory, or refuse). Respondents who previously had been vaccinated against COVID-19 were excluded from the statistical analysis.Data analyses were performed using SPSS, version 27 (IBM Inc). Significance was defined as 2-tailed P < .05. The
Lambert-Eaton syndrome is a rare paraneoplastic disorder of the neuromuscular junction, characterized by impaired release of acetylcholine, which causes proximal muscle weakness, depressed tendon reflexes, and autonomic changes. Most cases of Lambert-Eaton syndrome present in small-cell lung carcinoma, and only a few cases have been reported in other lung subtypes. Herein, we report a case of 69 years old male patient with Lambert-Eaton syndrome as a rare association with a pulmonary large-cell neuroendocrine carcinoma, which presented 5 months before neoplasm diagnosis. A lobectomy was auspiciously performed. A review of the literature is also presented.
PURPOSE In response to the worldwide shortage of oncologists, ASCO established Oncology Student Interest Groups (OSIGs) to increase oncology exposure at medical schools. However, there is limited guidance on the activities they should undergo. The main purposes of this study were (1) to assess the preferences and perceptions of OSIG members about their group events and (2) to describe the difficulties faced by leaders to carry out OSIGs' tasks. METHODS In this multicenter, cross-sectional study, group members and leaders from five active Latin American OSIGs were invited to answer anonymous web-based surveys exploring members' attitudes toward group activities and leaders' challenges when carrying them out. Data collection was conducted from March to June 2021. RESULTS Responses from 142 medical students and four OSIGs leaders were analyzed. In total, 83% of student members considered that lectures with an oncology-related expert was very useful for increasing their overall interest in oncology. For increasing interest in cancer research, 87% deemed that participating in oncology research projects was very useful. Shadowing oncology professionals was very useful for at least 70% of members to increase their oncology knowledge and their interest in following an oncology-related career. Moreover, leaders' main challenges were having a high academic load, little response from members, lack of interesting ideas and protected time for OSIGs' events, and limited support from their school. CONCLUSION OSIGs' leaders, medical schools, and international oncology organizations should work together to design activities that increase medical students' exposure to oncology-related professionals and encourage their participation in international oncological events. These schools and organizations should actively support OSIG leaders when facing difficulties to prevent members' disengagement and groups' discontinuation.
e12560 Background: Young women with breast cancer (YWBC) have worse survival outcomes compared to their older counterparts. Even though a higher recurrence rate has been previously documented in this population, there is still limited information regarding the timing, prevalence and type of disease recurrence. This study aims to describe the patterns of early recurrence in Mexican YWBC. Methods: Women aged ≤40 years at diagnosis, accrued in the Joven & Fuerte prospective cohort, with stage I-III BC and having at least a 2-year follow-up were analyzed. Recurrence-free survival (RFS) and overall survival (OS) at 2 years were evaluated using the Kaplan-Meier estimate. Log-rank and Fisher’s exact tests were employed for group comparisons; the Cox regression method was used to identify factors associated with RFS and OS. Results: A total of 210 patients with a median age at diagnosis of 36 years (range: 21-40) were analyzed. Most patients were diagnosed with stage II (50%) and III (39%). Distribution according to molecular subtype was: 50% HR+/HER2-, 26% TNBC, 17% HR+/HER2+, and 7% HR-/HER2+. In total, 31 (15%) patients experienced early disease recurrence. The two BC subtypes with the highest recurrence rate were TNBC (12/54; 22%) and HR+/HER2+ (6/35; 17%), followed by HR+/HER2- (12/106; 11%) and HR-/HER2+ (1/15; 7%). Stage at diagnosis was associated with a higher risk of recurrence (stage III: 21/82 (68%); stage II: 10/94 (32%); p= 0.003). Of the total recurrences, 23% were locorregional and the remaining 77% were distant metastases. The most common sites of distant metastases were lung (46%), bone (38%) and central nervous system (33%). Notably, 50% of distant recurrences affected multiple organs. Overall, RFS at 2 years was 85.2% (95%CI 79.7-89.4). In the univariate analysis, age ( < 35 v ≥35), type of surgery (conservative v mastectomy) and BMI ( < 25 v ≥25 kg/m²) were not significantly associated with RFS. In a multivariate model, node involvement (HR = 2.76; p= 0.044), not receiving chemotherapy (HR = 3.86; p= 0.024) and TNBC (HR = 2.47; p= 0.035) were independently associated with worse RFS. The OS found in this cohort was 92.9% (95%CI 88.4-95.6). In a multivariate model, TNBC (HR = 3.71; p= 0.029) and stage III at diagnosis (HR = 5.55; p= 0.008) were associated with worse OS. Conclusions: This cohort of YWBC experienced a low RFS at 2 years. As previously reported, patients with node involvement and TNBC faced a greater risk of early recurrence. Noteworthy, a high prevalence of distant metastases was observed, with half of them involving > 1 site. Future studies are warranted to elucidate the factors associated with early recurrence in YWBC. In addition, the incorporation of new treatment strategies is urgently needed to improve disease outcomes in this group.
10562 Background: Breast cancer (BC) is the most common cause of cancer-related death and morbidity among young women in Latin America. This group has a higher prevalence of advanced disease stages at diagnosis compared to their older counterparts. Thus, strategies aimed at detecting BC at early stages are imperative. Breast self-examination (BSE) remains a useful strategy for BC detection, especially in women who do not routinely undergo screening with imaging studies. This study aims to evaluate factors related with BSE practice in Mexican young women with BC and assess its association with earlier disease stages. Methods: Women aged ≤40 newly diagnosed with BC from 2014 to 2020 at three cancer referral centers in Mexico accrued in the Joven & Fuerte cohort were included and asked to complete a socio-demographic survey. Fisher’s exact and Mann-Whitney U tests were used to evaluate associations between BSE and socio-demographic characteristics, as well as disease stages. Results: A total of 554 patients with a median age at diagnosis of 36 years (range: 19-40) were analyzed. Most patients (65%) were married or in a domestic partnership, and the majority were housewives (63%). Regarding educational background, 64% had completed at least high school, and up to 84% had a monthly income < 11,600 Mexican pesos (US$ 581). Overall, 85% of patients had public insurance, 6% had private insurance, and 9% were uninsured. The distribution of clinical stages at diagnosis was: 0 (2%), I (11%), II (45%), III (32%), and IV (10%). BC detection methods were: 85% by self/partner exam, 11% by an imaging study, and 4% by a healthcare professional. A total of 443 (80%) patients practiced BSE, of which 50% did it on a monthly basis, 18% every 2-3 months, and the remaining 12% every 4-12 months. Notably, a higher educational level (≥ high school v ≤ middle school) was positively associated with BSE practice (RR: 1.28; 95%CI 1.06-1.54; p= 0.005). No significant association was found between BSE and age (≤35 v > 35), marital status (in a relationship v no), occupation (housewive v other), monthly income ( < 11,600 v ≥11,600) or medical coverage (public/uninsured v private). Patients that performed BSE were more likely to be diagnosed with early BC (stages 0-II) compared to those that did not (61% v 45%; p= 0.003). No association was found between BSE frequency and stage at diagnosis. Noteworthy, patients with private insurance were more likely to be diagnosed with stages 0-II compared to those with public or no insurance (80% v 56%; p= 0.007). Conclusions: The significant association between BSE and earlier stages at diagnosis found in this study highlights the need to raise awareness and promote this practice among young women with the objective of downstaging BC diagnoses. Public health interventions such as educational and social media campaigns that aim to improve the correct practice of BSE might be particularly useful in settings with inadequate screening programs.
Background: Breast cancer (BC) is the most common malignancy and the leading cause of cancer-related deaths among young women worldwide. This population usually presents with more advanced stages at diagnosis compared to their older counterparts, exposing them to more intensive treatments which compromise their quality of life (QOL). This study aims to determine the change in QOL in young women with locally-advanced BC over time. Methods: Women aged ≤40, newly diagnosed with locally-advanced BC from 2016 to 2020 at three cancer referral centers in Mexico and accrued in the Joven & Fuerte cohort were included and asked to complete the EORTC QLQ-C30 and QLQ-BR23 questionnaires at diagnosis, six months, and one year follow-up. Differences in mean values were analyzed using repeated measures ANOVA tests. The Mauchly's test was employed to assess the assumption of sphericity and if violated the Huynh-Feldt correction was used. Adjustment of multiple comparisons was performed with the Bonferroni correction. Results: A total of 195 patients with a median age at diagnosis of 35 years (IQR: 32-38) were analyzed. Most patients (59%) were married or in a domestic partnership and the majority (60%) were housewives or unemployed. The distribution of clinical stages at diagnosis was: IIB (41%), IIIA (39%), IIIB (11%), and IIIC (10%). Regarding treatment modalities, most patients underwent mastectomy (n=111, 57%), neoadjuvant (n=103, 53%) or adjuvant chemotherapy (n=79, 41%), and adjuvant endocrine therapy (n=106, 54%). QLQ changes over time are shown in the Table. Most functional scales worsened significantly at six months. Although most of them improved at one year of follow-up, they did not reach baseline levels. Certain symptoms such as fatigue, insomnia, financial difficulties, and arm symptoms worsened from baseline. When analyzing QLQ changes according to the different treatment modalities (mastectomy vs lumpectomy), (neoadjuvant vs neoadjuvant/adjuvant vs adjuvant chemotherapy) and (receiving hormone therapy vs not) no significant differences were found in functional scales or BC symptoms over time. Conclusion: Young women with BC experience physical and psychological distress that negatively impacts their QOL. Several BC specific domains worsened from baseline, such as body imaging, sexual satisfaction, and arm symptoms. Thus, strategies aimed at addressing these specific areas are warranted. QLQ-C30 and QLQ-BR23 at baseline, six months and one yearMean (SEM)NumberBaselineSix monthsOne yearp valueQLQ-C30Global health status14277.76 (1.65)73.53 (1.81)78.46 (1.59)0.047Physical Functioning14290.09 (0.93)86.62 (1.16)89.20 (1.02)0.026Role Functioning14286.97 (1.53)80.16 (1.86)87.68 (1.37)<0.001Emotional Functioning14275.12 (1.72)75.47 (1.81)73.01 (1.89)0.419Cognitive Functioning14282.75 (1.75)76.88 (1.75)77.93 (1.78)0.012Social Functioning14284.04 (1.83)77.70 (1.98)80.40 (1.82)0.015Fatigue14223.79 (1.53)29.89 (1.61)26.21 (1.50)0.002Nausea and vomiting1428.22 (1.23)11.39 (1.49)5.87 (1.22)0.012Pain14222.18 (1.87)21.95 (1.92)21.13 (1.67)0.876Dyspnea14210.80 (1.81)14.55 (1.68)10.09 (1.37)0.085Insomnia14226.29 (2.33)30.75 (2.43)27.23 (2.28)0.278Appetite Loss1429.39 (1.35)11.50 (1.45)8.45 (1.27)0.203Constipation14216.67 (2.28)20.42 (2.23)16.43 (1.94)0.259Diarrhea1428.45 (1.39)8.45 (1.35)5.87 (1.22)0.233Financial Difficulties14232.86 (2.56)38.73 (2.55)35.92 (2.60)0.161QLQ-BR23Body Imaging14280.69 (2.05)74.77 (2.15)76.64 (2.12)0.029Sexual Functioning14231.81 (2.33)24.77 (1.97)30.16 (1.99)0.009Sexual Enjoyment6162.84 (3.90)50.82 (4.45)50.27 (3.71)0.012Future Perspective14252.35 (2.67)49.30 (2.76)54.23 (2.46)0.245Systemic Therapy Side Effects14222.64 (1.46)29.21 (1.45)17.00 (1.01)<0.001Breast Symptoms14223.65 (1.95)17.96 (1.58)22.52 (1.47)0.022Arm Symptoms14217.14 (1.52)16.12 (1.56)20.27 (1.54)0.063Upset by hair loss12922.48 (3.07)24.55 (3.10)5.17 (1.62)<0.001 Citation Format: Cynthia Villarreal-Garza, Bryan F Vaca-Cartagena, Andrea Becerril-Gaitan, Alejandra Platas, Melina Miaja, Fernanda Mesa-Chavez, Ana S Ferrigno, Alan Fonseca, Marlid Cruz-Ramos, Lucero Labra, Enrique Bargallo-Rocha, Alejandro Mohar. Quality of life in Mexican young women with locally-advanced breast cancer: A cohort study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-20.
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