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Impact of breast cancer treatments on sleep disturbances - A systematic review

Sleep disturbances are highly prevalent in women with breast cancer; side effects of cancer treatment may worsen pre-existing sleep problems and have been pointed to as important determinants of their incidence. Therefore, we aimed to assess the association between different types of breast cancer treatment and sleep disturbances, through a systematic review. Medline (using PubMed), CINAHL Plus with full text, PsycINFO and Cochrane Central Register of Controlled Trials (Central) were searched from inception to January 2014. Studies that evaluated samples of women with breast cancer, assessed sleep disturbances with standardized sleep-specific measures, and provided data for different cancer treatments were eligible. A total of 12 studies met the inclusion criteria. Three studies evaluated insomnia, five studies assessed sleep quality, two provide data on general sleep disturbances and two analysed specific sleep parameters. Women submitted to chemotherapy, or radiotherapy, tended to report higher levels of sleep disturbances. More heterogeneous findings were observed regarding the effect of surgical treatment and hormonal therapy. However, a sound assessment of the impact of these treatments was hampered by differences across studies regarding the outcomes assessed, reporting bias and the fact that most studies did not control for the effect of potential confounders. The present review highlights the potential relation between breast cancer treatments and sleep disturbances, particularly of chemotherapy, though more robust evidence is needed for a proper understanding of these associations.

Trends in cardiovascular diseases and cancer mortality in 45 countries from five continents (1980-2010)

Background Cardiovascular diseases (CVD) and cancer are worldwide main causes of death with mortality trends varying across countries with different levels of economic development. Design and methods We analysed trends in CVD and cancer mortality for 37 European countries, five high-income non-European countries and four leading emerging economies (BRICS) using data from the World Health Organization database for the period 1980–2010. Results In high-income countries, CVD mortality trends are characterized by steep declines over the last decades, while a downward trend in cancer mortality started more recently and was less pronounced. This resulted in the gradual convergence of the CVD and cancer mortality rates, and the latter are already higher in some countries. The absolute number of CVD deaths decreased in most settings, while cancer deaths increased in nearly all countries. Among the BRICS, China and South Africa share a similar pattern of no meaningful variation in both CVD and cancer age-standardized mortality rates and an increase in the overall number of deaths by these causes. Brazil presents trends similar to those of high-income countries, except for the still increasing number of CVD deaths. Conclusions The substantial decreases in CVD mortality over the last decades have overcome the impact of the growth and ageing of populations in the overall number of deaths, while stabilization in the number of cancer deaths was observed only in some of the high-income countries.

Patterns of breast cancer mortality trends in Europe.

OBJECTIVES To identify patterns of variation in breast cancer mortality in Europe (1980-2010), using a model-based approach. METHODS Mortality data were obtained from the World Health Organization database and mixed models were used to describe the time trends in the age-standardized mortality rates (ASMR). Model-based clustering was used to identify clusters of countries with homogeneous variation in ASMR. RESULTS Three patterns were identified. Patterns 1 and 2 are characterized by stable or slightly increasing trends in ASMR in the first half of the period analysed, and a clear decline is observed thereafter; in pattern 1 the median of the ASMR is higher, and the highest rates were achieved sooner. Pattern 3 is characterised by a rapid increase in mortality until 1999, declining slowly thereafter. CONCLUSION This study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.

Neurological complications of breast cancer: A prospective cohort study

OBJECTIVES Neurological complications secondary to breast cancer treatment may be an important contributor to these patients morbidity. We aimed to quantify the incidence of neurological complications of breast cancer treatment during the first year after diagnosis. MATERIALS AND METHODS We performed a prospective cohort study with 506 patients recruited at the Portuguese Institute of Oncology of Porto, among those newly diagnosed. Participants underwent a neurological examination before treatment, after surgery, after chemotherapy (whenever applicable) and at one year after enrollment. The Montreal Cognitive Assessment was used to assess cognitive function, at baseline and at one year. We computed one-year cumulative incidence estimates and the corresponding 95% confidence intervals (95%CI) for each of the neurological complications. RESULTS Just over half of women had breast cancer stage 0 or I. A total of 6.9% were submitted to neoadjuvant chemotherapy but most of them completed adjuvant treatment - endocrine therapy, radiotherapy or chemotherapy (83.9%, 73.0% and 52.5%, respectively). The cumulative incidence of at least one oncological-related neurological complication during the first year after diagnosis was 48.4% (95%CI: 44.1-52.8); the most frequent were neuropathic pain (30.8%, 95%CI: 27.0-35.0), chemotherapy-induced peripheral neuropathy (16.8%, 95%CI: 13.8-20.3), phantom breast pain/syndrome (16.6%, 95%CI: 13.6-20.1) and cognitive decline (8.1%, 95%CI: 5.8-11.1). CONCLUSIONS Neurological complications were a frequent side-effect of breast cancer management in the first year after diagnosis, especially neuropathic pain and chemotherapy-induced peripheral neuropathy. Accurate diagnosis and treatment of these complications are important to minimize the burden associated with breast cancer treatment in breast cancer survivors.

Neurological complications of breast cancer: study protocol of a prospective cohort study

Introduction The improvement in breast cancer survival rates, along with the expected overdiagnosis and overtreatment associated with breast cancer screening, requires a comprehensive assessment of its burden. Neurological complications can have a devastating impact on these patients; neuropathic pain and chemotherapy-induced peripheral neuropathy are among the most frequently reported. This project aims to understand the burden of neurological complications of breast cancer treatment in Northern Portugal, and their role as mediator of the impact of the treatment in different dimensions of the patients’ quality of life. Methods and analysis A prospective cohort study was designed to include 500 patients with breast cancer, to be followed for 3 years. The patients were recruited at the Portuguese Oncology Institute of Porto and evaluations were planned at different stages: pretreatment, after surgery, after chemotherapy (whenever applicable) and at 1 and 3 years after enrolment. Patients diagnosed with neuropathic pain or chemotherapy-induced peripheral neuropathy (subcohorts), were also evaluated at the moment of confirmation of clinical diagnosis of the neurological complication and 6 months later. In each of the follow-up periods, a neurological examination has been performed by a neurologist. Data were collected on sociodemographic and clinical characteristics, quality of life, sleep quality, and anxiety and depression. Between January and December 2012, we recruited and conducted the baseline evaluation of 506 participants. The end of the follow-up period is scheduled for December 2015. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Portuguese Oncology Institute of Porto and all patients provided written informed consent. All study procedures were developed in order to assure data protection and confidentiality. Results from this project will be disseminated in international peer-reviewed journals and presented in relevant conferences.

Model-based patterns in prostate cancer mortality worldwide.

Background:Prostate cancer mortality has been decreasing in several high income countries and previous studies analysed the trends mostly according to geographical criteria. We aimed to identify patterns in the time trends of prostate cancer mortality across countries using a model-based approach.Methods:Model-based clustering was used to identify patterns of variation in prostate cancer mortality (1980–2010) across 37 European, five non-European high-income countries and four leading emerging economies. We characterised the patterns observed regarding the geographical distribution and gross national income of the countries, as well as the trends observed in mortality/incidence ratios.Results:We identified three clusters of countries with similar variation in prostate cancer mortality: pattern 1 (‘no mortality decline’), characterised by a continued increase throughout the whole period; patterns 2 (‘later mortality decline’) and 3 (‘earlier mortality decline’) depict mortality declines, starting in the late and early 1990s, respectively. These clusters are also homogeneous regarding the variation in the prostate cancer mortality/incidence ratios, while are heterogeneous with reference to the geographical region of the countries and distribution of the gross national income.Conclusion:We provide a general model for the description and interpretation of the trends in prostate cancer mortality worldwide, based on three main patterns.

Neuropathic Pain After Breast Cancer Treatment: Characterization and Risk Factors

CONTEXT Neuropathic pain (NP) may be an important contributor to the morbidity burden of breast cancer. OBJECTIVES We aimed to quantify the incidence of NP in the first year after diagnosis of breast cancer and to identify its main determinants. METHODS We performed a prospective cohort study including 506 patients with incident breast cancer, recruited at the Portuguese Institute of Oncology of Porto, and followed for one year; patients with incident NP were additionally evaluated when this condition was diagnosed and after six months, to identify chronic NP. RESULTS During the first year, 156 patients were diagnosed with NP (30.8%, 95% CI 27.0-35.0). Anxiety (relative risk [RR] 1.50; 95% CI 1.06-2.13), arm symptoms (RR 1.44; 95% CI 1.02-2.05), cancer Stage III/IV (RR 2.47; 95% CI 1.66-3.66), breast-conserving surgery with axillary lymph node dissection (RR 3.13; 95% CI 1.51-6.48), mastectomy with axillary lymph node dissection (RR 2.52; 95% CI 1.25-5.11), and damaging of the intercostobrachial nerve (RR 2.05; 95% CI 1.25-3.37) were predictors of a higher risk of NP. A total of 97 patients (62.2%, 95% CI 54.4-69.4) diagnosed with NP remained symptomatic after six months. CONCLUSION NP and chronic NP were frequent in this population, being associated with anxiety and arm symptoms before breast cancer treatments and type of surgical management. These results highlight the need for monitoring the occurrence of this neurologic side effect of treatments and to develop strategies for reducing the morbidity burden of breast cancer.