scholarly journals Late effects of high-dose adjuvant chemotherapy on white and gray matter in breast cancer survivors: Converging results from multimodal magnetic resonance imaging

2011 ◽  
Vol 33 (12) ◽  
pp. 2971-2983 ◽  
Author(s):  
Michiel B. de Ruiter ◽  
Liesbeth Reneman ◽  
Willem Boogerd ◽  
Dick J. Veltman ◽  
Matthan Caan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Adjuvant Chemotherapy ◽  
Magnetic Resonance ◽  
Cancer Survivors ◽  
Gray Matter ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
High Dose ◽  
Resonance Imaging

scholarly journals Communicating Risks of Adjuvant Chemotherapy for Breast Cancer: Getting Beyond the Laundry List

2019 ◽  
Vol 15 (2) ◽  
pp. e98-e109 ◽  
Author(s):  
Eden R. Brauer ◽  
Elisa F. Long ◽  
Joy Melnikow ◽  
Peter M. Ravdin ◽  
Patricia A. Ganz
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Focus Groups ◽  
Cancer Survivors ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Theoretical Domains Framework ◽  
Long Term Effects ◽  
Medical Oncologists

PURPOSE: According to the Institute of Medicine, high-quality cancer care should include effective communication between clinicians and patients about the risks and benefits, expected response, and impact on quality of life of a recommended therapy. In the delivery of oncology care, the barriers to and facilitators of communication about potential long-term and late effects, post-treatment expectations, and transition to survivorship care have not been fully defined. PATIENTS AND METHODS: We collected qualitative data through semistructured interviews with medical oncologists and focus groups with breast cancer survivors and applied the Theoretical Domains Framework to systematically analyze and identify the factors that may influence oncologists’ communication with patients with breast cancer about the long-term and late effects of adjuvant therapy. RESULTS: Eight key informant interviews with medical oncologists and two focus groups with breast cancer survivors provided data. Both oncologists and patients perceived information on long-term effects as valuable in terms of improved clinical communication but had concerns about the feasibility of inclusion before treatment. They described the current approaches to communication of therapy risks as a brief laundry list that emphasized acute adverse effects and minimized more long-term issues. We describe the barriers to communication about potential long-term effects from the perspectives of both groups. CONCLUSION: This study provides insight into oncologists’ communication with patients with breast cancer regarding the potential long-term and late effects of adjuvant chemotherapy and about setting realistic expectations for life after treatment. Opportunities to improve oncologists’ communication about the potential toxicities of therapy, particularly regarding long-term and late effects, should be examined further.

Late Cardiac Effects of Adjuvant Chemotherapy in Breast Cancer Survivors Treated on Southwest Oncology Group Protocol S8897

2008 ◽  
Vol 26 (8) ◽  
pp. 1223-1230 ◽  
Author(s):  
Patricia A. Ganz ◽  
Michael A. Hussey ◽  
Carol M. Moinpour ◽  
Joseph M. Unger ◽  
Laura F. Hutchins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Survivors ◽  
Late Effects ◽  
Breast Cancer Survivors ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Oncology Group ◽  
Southwest Oncology Group ◽  
Cardiac Effects

Purpose The late cardiac effects of adjuvant anthracycline therapy in survivors of early-stage breast cancer have had limited study. Subclinical and clinical cardiac late effects may contribute to added comorbidity over time. Patients and Methods We recruited patients treated on Southwest Oncology Group (SWOG) protocol S8897 who had been randomly assigned to adjuvant chemotherapy with or without doxorubicin. Left ventricular ejection fraction (LVEF) was evaluated at 5 to 8 years and 10 to 13 years after treatment randomization. Cardiac risk factors and events were reported by clinicians annually between the two assessments. Results A total of 180 breast cancer survivors from a potential sample of 1,176 patients were entered, 163 patients at 5 to 8 years and 17 additional patients at 10 to 13 years, with 93 longitudinal assessments of LVEF. There was no significant difference in the proportion of women with an LVEF less than 50% at 5 to 8 (cyclophosphamide, doxorubicin, and fluorouracil [CAF] v cyclophosphamide, methotrexate, and fluorouracil [CMF]: 5% v 7%; P = .68) or 10 to 13 years (CAF v CMF: 3% v 0%; P = .16); however, in an exploratory analysis, the mean LVEF in the doxorubicin group was statistically significantly lower in the 5- to 8-year sample (64.8% v 61.4%; P = .01) but not in the 10- to 13-year sample. In the longitudinal analysis, there was no significant deterioration in LVEF. Conclusion Women enrolled onto an adjuvant chemotherapy treatment clinical trial for breast cancer were successfully recruited to participate in a research study of the late effects of treatment, although many SWOG institutions and potentially eligible patients chose not to participate. In this selected sample, with up to 13 years of follow-up, exposure to doxorubicin did not increase the likelihood of adverse cardiac effects.

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