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Adriaenssens N.,Oncology Center | Buyl R.,Vrije Universiteit Brussel | Lievens P.,Vrije Universiteit Brussel | Fontaine C.,Breast Clinic | Lamote J.,Oncological Surgery
Lymphology | Year: 2013

There is no consensus on the definition of Breast Cancer Related Lymphedema of the arm (BCRL) because there are no agreed standards in measurement methods and diagnostic criteria. The main objective of this study is to compare mobile infrared optoelectronic volumetry with a Perometer® with two commonly used methods for the evaluation of arm volume in patients with different degrees of BCRL. Bilateral arm volumes of eighty participants, with and without clinical BCRL, were calculated with a mobile Perometer®, by water displacement, and with circumferential measurements, integrated in the frustrum, single frustrum, and disc model method. The ICC of the Perometer® was between 0.997 and 0.999. The frustrum and disc model method produced the largest volume measurements and water displacement the smallest, while Perometer® measures were in between. On average, volume of the dominant arm was found to be 2.2% higher than the non-dominant arm in the healthy control group, cautioning for intra- patient differences between both arms when comparing ipsilateral to contralateral arm for the diagnosis of BCRL with a threshold value. Future research would likely benefit from the use of the Perometer® compared to the other arm volume evaluation tools for BCRL, and further, the single frustrum method should not be used for volume estimations of edematous arms.

Haines T.P.,Monash University | Sinnamon P.,Princess Alexandra Hospital | Wetzig N.G.,Princess Alexandra Hospital | Lehman M.,Southern Zone Radiation Oncology | And 3 more authors.
Breast Cancer Research and Treatment | Year: 2010

To evaluate the efficacy and economic efficiency of a multimedia, multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer. We conducted a randomized trial with concurrent incremental cost-effectiveness analysis and blinded baseline, 3, 6 and 12-month follow-up assessments amongst women undergoing adjuvant therapy following surgery for breast cancer (n = 89). The intervention was a multimedia, multimodal exercise program comprising strength, balance and endurance training elements. The control was sham flexibility and relaxation program delivered using similar materials. The primary outcome was health-related quality of life (EQ-5D & VAS, EORTC C30, BR23). Economic outcomes included direct health care costs and productivity gains and losses. Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [mean (sd) EQ-5D VAS (0-100) baseline: 72.6 (15.6), 3 month: 80.6 (11.6)] when compared to control group participants [baseline: 77.5 (13.5), 3 month: 74.1 (20.6), P = 0.006] and also improved more in terms of physical function [mean (sd) EORTC C30 physical function scale intervention (0-100) baseline: 84.9 (14.8), 3 month: 86.9 (10.7), control baseline: 91.3 (9.6), 3 month: 86.7 (14.9), P = 0.02]. These improvements were not sustained beyond this point. Upper limb volumes were also lower amongst intervention group participants. However, there was low probability that the intervention would be both less costly and more effective than the control condition (range probability = 0.05-50.02% depending on approach). Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of questionable economic efficiency. © 2010 Springer Science+Business Media, LLC.

Baccaro L.F.,University of Campinas | Conde D.M.,Breast Clinic | Costa-Paiva L.,University of Campinas | Pinto-Neto A.M.,University of Campinas
Clinical Interventions in Aging | Year: 2015

Brazil has an aging population, with an associated increase in the prevalence of chronic diseases. Postmenopausal osteoporosis is of particular concern because it leads to an increased risk of fractures, with subsequent negative impacts on health in older women. In recent years, efforts have been made to better understand the epidemiology of osteoporosis in Brazil, and to manage both direct and indirect costs to the Brazilian health care system. The reported prevalence of osteoporosis among postmenopausal women in Brazil varies from 15% to 33%, depending on the study methodology and the use of bone densitometry data or self-reporting by participants. A diagnosis of osteoporosis can be made on the basis of fractures occurring without significant trauma or on the basis of low bone mineral density measured by dual energy X-ray absorptiometry. To reduce the risk of osteoporosis, all postmenopausal women should be encouraged to maintain a healthy lifestyle, which includes physical activity and a balanced diet. Smoking and alcohol use should also be addressed. Special attention should be given to interventions to reduce the risk of falls, especially among older women. Calcium intake should be encouraged, preferably through diet. The decision to recommend calcium supplementation should be made individually because there is concern about a possible increased risk of cardiovascular disease associated with this treatment. Brazilian women obtain a minimal amount of vitamin D from their diet, and supplementation is warranted in women with little exposure to solar ultraviolet-B radiation. For women diagnosed with osteoporosis, some form of pharmacologic therapy should be initiated. Compliance with treatment should be monitored, and the treatment period should be individualized for each patient. The Brazilian government provides medication for osteoporosis through the public health system free of charge, but without proper epidemiological knowledge, the implementation of public health programs is impaired. © 2015 Baccaro et al.

Coleman R.,Academic Unit of Clinical Oncology | De Boer R.,Royal Melbourne and Western Hospitals | Eidtmann H.,Universitats Frauenklinik Kiel | Llombart A.,Institute Oncologica | And 12 more authors.
Annals of Oncology | Year: 2013

Background: Aromatase inhibitors are the preferred adjuvant endocrine therapy for the majority of postmenopausal women with hormone-responsive early breast cancer. Although generally more effective than tamoxifen, aromatase inhibitor therapy is associated with increased bone loss and fracture risk. Patients and methods: Postmenopausal women receiving adjuvant letrozole (2.5 mg/day for 5 years; N = 1065) were randomly assigned to immediate zoledronic acid (zoledronate) 4 mg every 6 months for 5 years, or delayed zoledronate (initiated for fracture or on-study bone mineral density [BMD] decrease). The primary end point was the change in lumbar spine BMD at 12 months. Lumbar spine and total hip BMD at subsequent follow-up, disease-free survival (DFS), and overall survival were assessed as secondary end points. Results: At 60 months (final analysis), the mean change in lumbar spine BMD was +4.3% with immediate zoledronate and -5.4% with delayed intervention (P < 0.0001). Immediate zoledronate reduced the risk of DFS events by 34% (hazard ratio [HR] = 0.66; P = 0.0375) with fewer local (0.9% versus 2.3%) and distant (5.5% versus 7.7%) recurrences versus delayed zoledronate. In the delayed group, delayed initiation of zoledronate substantially improved DFS versus no zoledronate (HR = 0.46; P = 0.0334). Conclusions: Immediate zoledronate in postmenopausal women receiving letrozole preserved BMD and is associated with improved DFS compared with letrozole alone. Clinical Trials Registration No: NCT00171340. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Mourouti N.,Harokopio University | Papavagelis C.,Harokopio University | Psaltopoulou T.,National and Kapodistrian University of Athens | Aravantinos G.,Second Pathology Oncology Clinic | And 5 more authors.
Maturitas | Year: 2013

In this work the aims, methodology and procedures of a case-control study that was developed for assessing the role of dietary habits, eating behaviors and environmental factors on the development of breast cancer, is presented. During 2010-2012, 250 consecutive women patients, newly diagnosed with breast cancer and 250 population-based, healthy subjects (controls) age-matched to the cases, were enrolled. Socio-demographic, dietary, psychological, lifestyle as well as environmental characteristics (i.e., exposure to pollution, pesticides, electromagnetic fields and radon) were recorded through face-to-face interviews with the participants. Dietary habits and eating behaviors were evaluated with a special questionnaire that had been developed for the study, and was found relatively valid and reliable. © 2012 Elsevier Ireland Ltd. All rights reserved.

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