Risk stratification based on results provided by a 21-gene assay (Oncotype DX(®)) in early stage breast cancer can help optimize hormone therapy (HT) and/or chemotherapy (CT) decisions. We performed a systematic review and meta-analysis of decision impact (DI) and net change in CT use before and after assay results, both in the whole studies' population and by recurrence risk score (RS) strata. A systematic search of studies with prospective data collection reported physician's decision on treatment allocation in early stage node-negative breast cancer was performed. DI reflects the proportion of patients whose management was changed, and net change focuses on CT change. A random-effects model is reported. Fifteen studies (N = 2229) met our inclusion criteria: 50.09, 37.35, and 13.38 % of patients with low, intermediate, and high RS. Treatment decision changed in 29.5 % (95 % CI 26.29-32.86). Net reduction of CT use was 12 % (8-17 %). It was 16 % (12.00-19.00) in the low RS group, 0 % (-3.00 to 3.00) in the intermediate RS group, and increased by 2 % (-1.00 to 3.00) in the high RS group. Use of a 21-gene assay showed a significant impact on treatment decisions. From 100 women tested, 30 could have their treatment optimized, and 12 could avoid CT. Its main effects consist of sparing chemotherapy in low risk patients and slightly increasing it in the high risk category. DI could be higher in selected patient populations with greater uncertainty regarding initial treatment decisions.
Background and Objectives. Breast cancer (BC) is the most common cancer in women. It imposes a huge disease burden and a significant impact on health-related quality of life (HRQoL). Our study focused on HRQoL of patients with BC in Latin America and the Caribbean (LAC). We conducted a systematic review to identify relevant articles published between 2008 and August 2018. We conducted several meta-analyses and subgroup analyses by country, disease stage, and instrument used (Prospective Register Of Systematic Reviews registration number: CRD42018106835). Results. From 2,265 initial references, we finally included 75 articles (8,806 participants) that assessed HRQoL. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 and B23 modules (34 studies; 8 countries; 4,866 participants) were the most used instruments, followed by the Short Form 36-item, the abbreviated version of the World Health Organization Quality of Life instrument, and the Functional Assessment of Cancer Therapy-Breast instrument. Only four studies reported specific HRQoL data of patients with metastatic disease. Half the studies were rated as having moderate quality (38/75), and 38% (29/75) as high quality. We identified substantial heterogeneity. As expected, the metaanalyses revealed that patients with metastatic disease reported lower HRQoL values and high symptom burden compared with patients at earlier stages. Similar results can be observed when we compared patients with early breast cancer in active treatment phases versus those in follow-up. Conclusion. This study provides a synthesis of breast cancer HRQoL reported in LAC and exposes existing evidence gaps. Patients with BC in active treatment or with metastatic disease had worse HRQoL compared with survivors during the follow-up period. The Oncologist 2021;9999:• • Implications for Practice: This systematic review study provides an exhaustive synthesis of breast cancer health-related quality of life in women in the Latin American and Caribbean region. Patients with breast cancer in active treatment or with metastatic disease had worse health-related quality of life compared with survivors during the different follow-up periods. This study also shows important evidence and methods gaps that can help inform future research.
BackgroundColorectal cancer (CRC) is the third most common neoplasm and the fourth cause of cancer death worldwide. In Argentina, more than 16,000 cases are diagnosed and 8,700 people die each year. The Immunochemical Faecal Occult Blood Test (iFOBT) is recommended for the prevention and early detection of CRC in people of both sexes, between 50 and 75 years old with average-risk. The worksite setting has great potential to improve adherence to preventive interventions. We aimed to design and evaluate the feasibility, acceptability, and effectiveness of a strategy implemented in the workplace to improve the rate of adherence to the IFOBT screening in employees of the government’s Revenue Agency of the Province of Buenos Aires (ARBA). MethodsWe used a quasi-experimental research design, a controlled interrupted time-series (ITS). The study period was divided into two-time segments: (1) a 51- month pre-intervention period (July 2015 through September 2018); (2) a 5-month post-intervention period (October 2018 through February 2019). We performed an initial formative research using qualitative research methods (semi-structured interviews, focus groups) in order to inform the design of the intervention and adapt it, to ensure that it is both feasible and implementable by the target population. We fitted segmented linear regression models to evaluate changes in the monthly rates per 10,000 of tests done in ARBA employees, and controlling for the proportion of tests done in non-ARBA workers. ResultsA total of 1552 ARBA employees aged 50 or more participated. Overall, iFOBT mean uptake rates were 16 times higher in the intervened during the five-month intervention period, remaining statistically significant after adjusting by the proportion of tests done in the control group (p <0.001). This observed effect was higher in women aged 50 to 59 years. Activities were suspended due to the Covid-19 pandemic lockdown in the country in 2020.ConclusionsA multifaceted workplace-based intervention helped increase the uptake of CRC screening in public sector employees of the province of Buenos Aires, Argentina. Achieving high implementation rates requires building a healthy relationship with the partner organization, adding their values and views, and establishing agreed upon mechanisms and realistic timelines.
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