Objectives. This meta-analysis was conducted to compare the complication rates between arm and chest ports in patients with breast cancer. Design and Data Sources. PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang database were used to perform a systematic review and meta-analysis of publications published from the inception of the database to 11, October 2019. Our search generated a total of 22 articles published from 2011 to 2019, including 6 comparative studies and 16 single-arm articles, involving 4131 cases and 5272 controls. Single-arm studies combined with comparative studies were also pooled and analyzed. Finally, subgroup analysis was performed to compare the rates of infection and thrombosis between these two ports. Eligibility Criteria. Included articles were research studies comparing complication rates of arm ports with chest ports in patients with breast cancer. Any review or meta-analysis article would be removed. Data Extraction and Synthesis. Demographic data and information for the following analysis were extracted. DerSimonian and Laird random effect meta-analysis was conducted to analyze comparative studies while Begg’s and Egger’s tests were used for assessment of publication bias. Meta-regression analysis was performed to explain the sources of heterogeneity. Results. There was no difference in the risk of overall complications between arm and chest ports for comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (RR = 2.23, P=0.041) as well as pooled comparative and single-arm studies (RR = 1.21, P=0.029). Conclusions. This study indicated that the arm port might increase the risk of overall complication risks as well as the risk of catheter-related thrombosis compared with the chest port. However, these reported findings still need to be verified by large randomized clinical trials.
BACKGROUND Breast cancer remains the most common neoplasm diagnosed amongst women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate the disease or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research need. Prevalence of individual smartphones and social apps provide a potential electronic approach to administrating questionnaire; however, the reliability of NFBSI-16 in electronic format has not been assessed. OBJECTIVE This study aimed to assess the reliability of web-based measurement of NFBSI-16 in the Chinese language in breast cancer patients undergoing systematic treatment. METHODS We recruited patients with breast cancer under systematic treatment to complete both paper- and web-based questionnaires. Patients were randomly assigned to group A (paper- based first and web-based second) or group B (web- based first and paper-based second). A total of 354 patients included in the analysis successfully completed both versions of the NFBSI-16 questionnaire in Chinese language. Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscale, and total score were analyzed using Wilcoxon test. Lin’s concordance correlation coefficient (CCC), Spearman and Kendall tau rank correlation were used to assess test-retest reliability. RESULTS Test-retest reliability was excellent with CCCs 0.94 for the total NFBSI-16 score. Highly significant correlations were documented for all 4 subscales, 16 individual items, and total NFBSI-16 score. Mean differences of the test and re-test were all close to zero (≤0.06). A majority of the participants in this study preferred the web-based (72%, n=255) over the paper-based version. CONCLUSIONS The web-based version of the NFBSI-16 questionnaire is reliable for patients with breast cancer and demonstrated highly significant correlations with the paper-based version in all items, subscales and the total score. The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, also as a majority of participants preferred it over paper-based version.
Background Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy–Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall τ rank correlations were used to assess test-retest reliability. Results Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ρ) were documented for all 4 subscales—Disease-Related Symptoms Subscale–Physical (ρ=0.93), Disease-Related Symptoms Subscale–Emotional (ρ=0.85), Treatment Side Effects Subscale (ρ=0.95), and Function and Well-Being Subscale (ρ=0.91)—and total NFBSI-16 score (ρ=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version.
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