Body mass index and risk of recurrence and mortality of luminal, triple-negative, and HER2- overexpressing breast cancer

Thesis (Master's)--University of Washington, 2022Breast cancer is a leading cause of death of women worldwide, and there is an understanding that risk factors for breast cancer recurrence and mortality differ by subtype. The most common subtypes are: luminal (estrogen receptor positive and/or hormone receptor positive), estrogen receptor negative and her2-overexpressing (H2E), and triple negative (TN). Overweight and obesity, as measured by body mass index (BMI), has been suspected to be associated with an increased risk of breast cancer recurrence and mortality but results have been inconsistent by subtype. We conducted a longitudinal cohort study to assess the association between BMI and breast cancer recurrence and breast cancer specific mortality (BCSM), stratified by breast cancer subtype using multi-variable adjusted Cox proportional hazards models. Our population consisted of 1,938 luminal (156 recurrences, 173 breast cancer deaths), 686 H2E (59 recurrences, 60 deaths), and 1,193 TN (260 recurrences, 273 deaths) patients. Mean follow up time was 4.1 years for recurrence and 10.4 years for BCSM. Compared to normal weight women, neither overweight nor obesity was associated with a significantly increased risk of recurrence for luminal subtype, (HR=1.15, 95% CI 0.78-1.71 and 1.23, 95% 0.84-1.79, respectively), while obesity (HR= 2.21, 95% CI 1.13-4.32), but not overweight (HR=1.42, 95% CI 0.70-2.88) was associated with recurrence in H2E patients. Overweight (HR=0.61, 95% CI 0.44-0.85) was inversely associated with recurrence in patients with TN breast cancer, while no association was observed for obese patients (HR=0.89, 95% CI 0.67-1.19). The pattern of results by subtype for BCSM was similar to that observed for recurrence. These findings add to the literature on associations between BMI and subtype specific recurrence and mortality risks and provides further evidence that associations differ by subtype, with moderate to strongly positive associations for obesity in H2E patients, and weaker associations for other subtypes

Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study

Objectives Perinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in mental health symptoms and transmission risks associated with in-person appointments, many clinics transitioned to providing telepsychiatry care during the COVID-19 pandemic. This study sought to identify the facilitators and barriers to receiving perinatal telepsychiatry care from the perspective of patients, clinic staff and psychiatrists.Design Qualitative study based on analysis of in depth semistructured interviews.Setting The study was conducted in a virtual specialty mental health clinic in an academic setting.Participants Eight patients who had been scheduled for an appointment with the perinatal telepsychiatry clinic between 14 May 2021 and 1 August 2021, seven of whom had attended their scheduled appointment with the clinic and one of whom had not, and five staff members including psychiatrists, navigators and clinic managers, participated in in-depth interviews.Results Telepsychiatry was perceived by most as preferable to in-person care and easy to attend and navigate. Alternatively, technological difficulties, personal preference for in-person care and scheduling conflicts related to the perinatal period were identified as barriers by some. Participants identified communication between care staff and patients, online patient portals, and appointment reminders as important for facilitating appointment preparedness and attendance.Conclusions The findings from this study suggest that telepsychiatry services are perceived positively by patients and care staff and have the potential to improve access to mental healthcare for perinatal patients