scholarly journals Optimizing vascular access for patients receiving intravenous systemic therapy for early-stage breast cancer—a survey of oncology nurses and physicians

2018 ◽  
Vol 25 (4) ◽  
Author(s):  
N. LeVasseur ◽  
C. Stober ◽  
K. Daigle ◽  
A. Robinson ◽  
S. McDiarmid ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Vascular Access ◽  
Systemic Therapy ◽  
Early Stage ◽  
Venous Access ◽  
Oncology Nurses ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph ◽  
Complication Rates

Background Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports).Methods Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema.Results Survey responses were received from 25 physicians and 57 oncology nurses. Administration of trastuzumab or an anthracycline was associated with a higher likelihood of a cvad being recommended. Other factors associated with recommendation of a cvad included prior difficult IV access and a recommendation from the chemotherapy nurse. Although the complication rates perceived to be associated with the use of piccs and ports remained high, respondents felt that cvads might improve patient quality of life. Risk factors perceived to be associated with the risk of lymphedema were axillary lymph node dissection, radiation to the axilla, and line-associated infection. Factors known to be unrelated to lymphedema risk (specifically, blood draws and blood pressure measurement) continue to be perceived as posing a higher risk.Conclusions Despite widespread use of chemotherapy for patients with breast cancer, the type of venous access used for treatment varies significantly, as do perceptions about the risks of cvad use and the risk for lymphedema development. Further prospective studies are needed to identify best-practice strategies.

scholarly journals Perceptions of vascular access for intravenous systemic therapy and risk factors for lymphedema in early-stage breast cancer— a patient survey

2018 ◽  
Vol 25 (4) ◽  
Author(s):  
N. LeVasseur ◽  
C. Stober ◽  
M. Ibrahim ◽  
S. Gertler ◽  
J. Hilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Vascular Access ◽  
Systemic Therapy ◽  
Perceived Risk ◽  
Early Stage ◽  
Patient Survey ◽  
Early Stage Breast Cancer ◽  
Evidence Based ◽  
Central Catheter

Background The choice of vascular access for systemic therapy administration in breast cancer remains an area of clinical equipoise, and patient preference is not consistently acknowledged. Using a patient survey, we evaluated the patient experience with vascular access during treatment for early-stage breast cancer and explored perceived risk factors for lymphedema.Methods Patients who had received systemic therapy for early-stage breast cancer were surveyed at 2 Canadian cancer centres.Results Responses were received from 187 patients (94%). The route of vascular access was peripheral intravenous line (IV) in 24%, a peripherally inserted central catheter (picc) in 42%, and a surgically inserted central catheter (port) in 34%. Anthracycline-based regimens were associated with a greater use of central vascular access devices (cvads— that is, a picc or port; 86/97, 89%). Trastuzumab use was associated with greater use of ports (49/64, 77%). Although few patients (7%) reported being involved in the decisions about vascular access, most were satisfied or very satisfied (88%) with their access type. Patient preference centred mainly on avoiding delays in the initiation of chemotherapy. Self-reported rates of complications (183 evaluable responses) were infiltration with peripheral IVs (9/44, 20%), local skin infections with piccs (7/77, 9%), and thrombosis with ports (4/62, 6%). Perceived risk factors for lymphedema included use of the surgical arm for blood draws (117/156, 75%) and blood pressure measurement (115/156, 74%).Conclusions Most patients reported being satisfied with the vascular access used for their treatment. Improved education and understanding about the evidence-based requirements for vascular access are needed. Perceived risk factors for lymphedema remain variable and are not evidence-based.

Preoperative Lymphedema-Related Risk Factors in Early-Stage Breast Cancer

2018 ◽  
Vol 16 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Zeynep Erdogan Iyigun ◽  
Tomris Duymaz ◽  
Ahmet Serkan Ilgun ◽  
Gul Alco ◽  
Cetin Ordu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Related Risk

scholarly journals Nodal micrometastases in early stage breast cancer: two case reports

2009 ◽  
Vol 12 (3) ◽  
Author(s):  
J. Reeder ◽  
S. Puhalla ◽  
V. Vogel
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Case Reports ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Micrometastatic Disease

AbstractThe most important predictor of outcome for women with early stage breast cancer is the presence or absence of metastases in the axillary lymph nodes. In the era of sentinel lymph node biopsies and improved pathology techniques, micrometastatic disease can be diagnosed. The question of whether or not to treat these women as if they have nodal disease remains in doubt. In order to further explore this topic, we identified two cases of women with nodal micrometastases at our institution. A literature review of PUBMED and SABCS abstracts was then performed. In this article, we discuss our results and the emerging clinical debate about the management of nodal micrometastases.

The role of radiotherapy in elderly women with early-stage breast cancer treated with breast conserving surgery

2018 ◽  
Vol 104 (6) ◽  
pp. 429-433 ◽  
Author(s):  
Mariacarla Valli ◽  
Simona Cima ◽  
Paola Fanti ◽  
Barbara Muoio ◽  
Alessandra Vanetti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Elderly Women ◽  
Early Stage ◽  
Conservative Surgery ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Significant Difference ◽  
The Impact

Objective: To analyze the impact of adjuvant radiotherapy (RT) on ipsilateral breast recurrence (IBR) and overall survival (OS) in patients older than 69 years with early-stage breast cancer. Methods: From January 2007 to June 2015, we analyzed retrospectively 137 women with estrogen receptor–positive T1–2 invasive breast cancer, with negative axillary lymph nodes, dividing them into 2 subgroups: 70 to 79 years and older than 79 years. Results: After a median follow-up of 43.2 months, the 3-year IBR-free survival in patients treated with surgery plus RT was 98.8% and 92.1% in patients treated with surgery alone, with a significant difference ( p = .01). Radiotherapy did not impact overall survival ( p = .10). A higher percentage of patients aged between 70 and 79 years received RT after conservative surgery if compared with the older subgroup ( p < .01). Conclusions: In elderly women, adjuvant RT reduced the IBR, but did not improve OS.

scholarly journals MicroRNA-1291 Is Associated With Locoregional Metastases in Patients With Early-Stage Breast Cancer

2020 ◽  
Vol 11 ◽  
Author(s):  
Daniel Escuin ◽  
Laura López-Vilaró ◽  
Olga Bell ◽  
Josefina Mora ◽  
Antonio Moral ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Signaling Pathways ◽  
Axillary Lymph Node ◽  
Target Genes ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Axillary Lymph ◽  
Illumina Platform ◽  
Down Regulation

Evidence that microRNAs (miRNAs) regulate the various steps of metastasis is increasing. Several studies have looked at the miRNA expression profile in primary breast tumors but few have compared primary tumor and sentinel lymph node (SLN) metastasis. We correlated the expression of miRNAs with the SLN status and the outcome of axillary lymph node dissection (ALND) in 60 patients with early breast cancer. We profiled the expression of miRNAs in paired breast tumor samples and SLNs using the NextSeq500 Illumina platform and key findings were validated by qPCR. MultiMiR Bioconductor and Reactome pathways analysis were performed to identify target genes and signaling pathways affected by altered expressed miRNAs. Our results show that nine miRNAs were differentially expressed in tumor tissues (q ≤ 0.05). In tumor samples, a 13.5-fold up-regulation of miR-7641-2 (q &lt; 0.001) and a 2.9-fold down-regulation of miR-1291 (q &lt; 0.001) were associated with tumors with positive SLNs. However, only down-regulation of miR-1291 (q = 0.048) remained significant in paired SLNs samples. Interestingly, a 10.5 up-regulation of miR-1291 in SLNs samples was associated with additional axillary lymph node involvement (q &lt; 0.001). The enrichment analyses showed that canonical and non-canonical WNT pathways and negative regulation of various receptor tyrosine kinases signaling pathways were targets of miR-1291 and supports the role of miR-1291 as a tumor suppressor gene (TSG). Further studies are warranted to investigate the use of miR-1291 as a surrogate biomarker of SLN node metastasis in patients with early-stage breast cancer.

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