The effects of breast cancer treatment on cognitive functions

Aims Women with breast cancer have reported difficulties with memory, attention, and concentration during or after adjuvant treatment. Whether these symptoms are side effects of treatment has not been established. The aim of this project was to determine the effects of early-stage breast cancer (BC) diagnosis and treatment on cognitive functions, quality of life, and psychological wellbeing. A secondary aim was to identify any associations between cognitive, psychosocial, somatic, and treatment factors and time to return to work (RTW) among women treated for early-stage BC. Methods From the mammography screening program at Stockholm South General Hospital, we prospectively enrolled women aged 40 to 69 years who had a positive radiographic finding. All women completed the Headminder Web-based neuropsychological battery Cognitive Stability Index for response speed, processing speed, memory, and attention before diagnosis (T1), after surgery but before adjuvant treatment (T2), 6 months after starting adjuvant treatment (T3), and after another 3 months of follow-up (T4). Women with BC were divided into those receiving chemotherapy, hormone therapy, or no adjuvant medical therapy. Women eventually determined not to have BC served as healthy controls. At each test session, depression, anxiety, and quality of life were measured using the Swedish version of the Beck Depression Inventory, the Beck Anxiety Inventory, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and its BC supplementary measure. The secondary aim was addressed by comparing the above-mentioned scores from BC women who had returned to work with those who had not, at both T3 and T4. We also reviewed the medical certificates of women still on sick leave at 8, 11, and 18 months after diagnosis to determine why they had not returned to work. Results and Conclusion Of the 146 women enrolled, 77 had BC, of whom 18 received chemotherapy; 45, hormone therapy, and 14, no adjuvant medical therapy; 69 were healthy controls. At baseline, only response speed and processing speed differed significantly between groups. Our results suggest that a diagnosis of BC and subsequent surgery are not associated with substantial cognitive decline. However, the lack of improvement in attention at retest among BC patients may suggest a decline. Further, our results indicate subtle cognitive changes related to time and treatment. Chemotherapy may impair memory and response speed in women with BC, a finding consistent with those reported for BC survivors after adjuvant medical treatment. Breast cancer surgery and adjuvant treatment, irrespectively of type, reduces quality of life and psychological wellbeing, mostly related to time course. Global quality of life health status improved to baseline after 11 months from diagnosis. However, poor body image and lower subjective cognitive functions were sustained and should be addressed in long-term survivors of breast cancer to improve overall quality of life. Chemotherapy is associated with longer periods of sick leave. Cognitive functioning, objectively measured, does not predict RTW. Independently of any adjuvant therapy, most women eventually return to work in a few months. The ability to predict RTW after BC treatment should help prepare higher-risk women for delayed RTW and allow earlier interventions to restore their social relations and quality of life

Long-term and real-life incidence of cancer therapy-related cardiovascular toxicity in patients with breast cancer: a Swedish cohort study

BackgroundThe administration of anticancer drugs in females with comorbidity increases the risk for cancer therapy-related cardiovascular toxicity (CTR-CVT), which in turn contributes to cardiovascular disease (CVD). Furthermore, a pathophysiological connection between cancer and cardiovascular disease may exist.ObjectiveTo assess the long-term risks and predictors of CTR-CVT, including clinical hypertension (HT), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), as well as all-cause mortality in women diagnosed with early breast cancer (BC) and eligible for adjuvant chemotherapy in Sweden.MethodsData were extracted from Swedish registers and medical records on 433 women, 18-60 years of age, diagnosed 1998-2002 with lymph node-positive BC, and considered for adjuvant chemotherapy. CTR-CVT was defined as HT, CAD, HF, or AF after the diagnosis of BC. Follow-up was from the date of BC diagnosis until November 30, 2021, or death. Prevalence of CTR-CVT and all-cause mortality were calculated. Hazard ratios (HR) were determined for factors associated with CTR-CVT.ResultsThe median age was 50 (interquartile range (IQR) 32) years. 910 CTR-CVT events were diagnosed in 311 women with a median of 19.3 (IQR 15,3) years follow-up. The proportions of CTR-CVT events were: HT 281 (64%); CAD 198 (46%); HF 206 (47%); and AF 225 (51%). The cumulative incidence of CTR-CVT was 71.8%, and 50% of all 433 patients developed CTR-CVT within 11.7 years of BC diagnosis (standard deviation (SD) 0.57, 95% confidence interval (CI) 10.6-12.9). Age was a risk factor for CTR-CVT. Anthracycline increased the risk for HF (p=0,001; HR 2,0; 95%CI 1,4-2,8), CAD (p= 0,002; HR 1,7; 95% CI 1,2-2,4), and AF (p=0,013; HR 1,5; 95% CI 1,0-2,0). At the end of the 24-year study period, 227 of the 433 women were alive, and the total cumulative mortality was 47,6%.ConclusionThe prevalence of CTR-CVT and all-cause mortality is high after BC diagnosis and treatment, particularly in older patients and those receiving anthracyclines. These findings and the onset of CTR-CVT support cardio-oncology guidelines recommending initial risk stratification and cardiovascular monitoring during treatment, followed by long-term annual screening for cardiovascular risk factors and CTR-CVT among BC survivors

Influence of Persian gum and almond gum on the physicochemical properties of wheat starch

In this study, the influence of different levels (0.1, 0.2, and 0.3% w/w) of Persian gum or almond gum were incorporated into wheat starch, and their influences on water absorption, freeze–thaw stability, microstructure, pasting, and textural properties were investigated. The SEM micrographs revealed that the addition of hydrocolloids to starch leads to the formation of denser gels with smaller pores. The water absorption of starch pastes was improved in the presence of gums, and samples containing 0.3% almond gum had the highest water absorption. The rapid visco analyzer (RVA) data showed that the incorporation of gums significantly affected the pasting properties by increasing the pasting time, pasting temperature, peak viscosity, final viscosity, and setback and decreasing breakdown. In all the pasting parameters, the changes caused by almond gum were more obvious. Based on TPA measurements, hydrocolloids were able to improve the textural properties of starch gels, such as firmness and gumminess but decreased the cohesiveness, and springiness was not affected by the incorporation of gums. Moreover, the freeze–thaw stability of starch was enhanced by the inclusion of gums, and almond gum exhibited better performance

New insight in severe acute respiratory syndrome coronavirus 2 consideration: Applied machine learning for nutrition quality, microbiome and microbial food poisoning concerns

Although almost two years have passed since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in the world, there is still a threat to the health of people at risk and patients. Specialists in various sciences conduct various researches in order to eliminate or reduce the problems caused by this disease. Nutrition is one of the sciences that plays a very important supportive role in this regard. It is important for patients to pay attention to the potential of different diets in preventing or accelerating the healing process. The relationship between nutrition and microbiome regulation or the occurrence of food microbial poisoning is one of the factors that can directly or indirectly play a key role in the body's resilience to COVID-19. In this article, we introduce a link between nutrition, the microbiome, and the incidence of food microbial poisoning that may have great potential in preventing, treating COVID-19, or preventing deterioration in patients. In linking the components of this network, artificial intelligence (AI), machine learning (ML) and data mining (DM) can be important strategies and lead to the creation of a conceptual model called "Balance square", which we will introduce

How COVID-19 changed clinical research strategies: a global survey

Objective Clinical research has faced new challenges during the COVID-19 pandemic, leading to excessive operational demands affecting all stakeholders. We evaluated the impact of COVID-19 on clinical research strategies and compared different adaptations by regulatory bodies and academic research institutions in a global context, exploring what can be learned for possible future pandemics. Methods We conducted a cross-sectional online survey and identified and assessed different COVID-19-specific adaptation strategies used by academic research institutions and regulatory bodies. Results All 19 participating academic research institutions developed and followed similar strategies, including preventive measures, manpower recruitment, and prioritisation of COVID-19 projects. In contrast, measures for centralised management or coordination of COVID-19 projects, project preselection, and funding were handled differently amongst institutions. Regulatory bodies responded similarly to the pandemic by implementing fast-track authorisation procedures for COVID-19 projects and developing guidance documents. Quality and consistency of the information and advice provided was rated differently amongst institutions. Conclusion Both academic research institutions and regulatory bodies worldwide were able to cope with challenges during the COVID-19 pandemic by developing similar strategies. We identified some unique approaches to ensure fast and efficient responses to a pandemic. Ethical concerns should be addressed in any new decision-making process

Chemotherapy, genetic susceptibility, and risk of venous thromboembolism in breast cancer patients

Purpose: Venous thromboembolism (VTE) is highly heritable and a serious complication of cancer and its treatment. We examined the individual and joint effects of chemotherapy and genetic susceptibility on VTE risk in patients with breast cancer. Experimental design: A Swedish population-based study including 4,261 women diagnosed with primary invasive breast cancer between 2001 and 2008 in Stockholm, followed until 2012. Risk stratification by chemotherapy and genetic susceptibility [a polygenic risk score (PRS), including nine established VTE loci] was assessed using Kaplan-Meier and flexible parametric survival analyses, adjusting for patient, tumor, and treatment characteristics. Results: In total, 276 patients experienced a VTE event during a median follow-up of 7.6 years. Patients receiving chemotherapy [HR (95% CI) = 1.98; 1.40-2.80] and patients in the highest 5% of the PRS [HR (95% CI) = 1.90; 1.24-2.91] were at increased risk of developing VTE. Chemotherapy and PRS acted independently on VTE risk and the 1-year cumulative incidence in patients carrying both risk factors was 9.5% compared with 1.3% in patients not having these risk factors (P < 0.001). Stratified analyses by age showed that the risk-increasing effect of PRS was stronger in older patients (P interaction = 0.04), resulting in an excess risk among genetically susceptible patients receiving chemotherapy aged ≥ 60 years (1-year cumulative incidence = 25.0%). Conclusions: Risk stratification by chemotherapy and genetic susceptibility identifies patients with breast cancer at high VTE risk, who could potentially benefit from thromboprophylaxis. Our results further suggest that genetic testing is more informative in older patients with breast cancer.Swedish Research Council (20142271)Swedish Cancer Society (CAN 2013/469)Swedish Research Council for Health Working Life & Welfare (Forte) (2013-0474)PublishedAccepte

Time-dependent risk and predictors of venous thromboembolism in breast cancer patients: a population-based cohort study

BACKGROUND: Venous thromboembolism (VTE) is a serious complication of cancer and its treatment. The current study assessed the risk and clinical predictors of VTE in breast cancer patients by time since diagnosis. METHODS: This Swedish population-based study included 8338 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region with complete follow-up until 2012. Their incidence of VTE was compared with the incidence among 39,013 age-matched reference individuals from the general population. Cox and flexible parametric models were used to examine associations with patient, tumor, and treatment characteristics, accounting for time-dependent effects. RESULTS: Over a median follow-up of 7.2 years, 426 breast cancer patients experienced a VTE event (cumulative incidence, 5.1%). The VTE incidence was 3-fold increased (hazard ratio [HR], 3.28; 95% confidence interval [CI], 2.87-3.74) in comparison with the incidence in the general population and was highest 6 months after diagnosis (HR, 8.62; 95% CI, 6.56-11.33) with a sustained increase in risk thereafter (HR at 5 years, 2.19; 95% CI, 1.80-2.67). Independent predictors of VTE included the following: older age, being overweight, preexisting VTE, comorbid disease, tumor size > 40 mm, progesterone receptor (PR)-negative status, more than 4 affected lymph nodes, and receipt of chemo- and endocrine therapy. The impact of chemotherapy was limited to early-onset VTE, whereas comorbid disease and PR-negative status were more strongly associated with late-onset events. CONCLUSIONS: This study confirms the long-term risk of VTE in breast cancer patients and identifies a comprehensive set of clinical risk predictors. Temporal associations with patient, tumor, and treatment characteristics provide insight into the time-dependent etiology of VTE.Swedish Research CouncilFORTESwedish Cancer SocietyAccepte

Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran

Background and purpose: Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran.Materials and Methods: A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC.Results: Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent,followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion.Conclusion: The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children

Improving shared decision-making about cancer treatment through design-based data-driven decision-support tools and redesigning care paths:an overview of the 4D PICTURE project

Background: Patients with cancer often have to make complex decisions about treatment, with the options varying in risk profiles and effects on survival and quality of life. Moreover, inefficient care paths make it hard for patients to participate in shared decision-making. Data-driven decision-support tools have the potential to empower patients, support personalized care, improve health outcomes and promote health equity. However, decision-support tools currently seldom consider quality of life or individual preferences, and their use in clinical practice remains limited, partly because they are not well integrated in patients' care paths.Aim and objectives: The central aim of the 4D PICTURE project is to redesign patients' care paths and develop and integrate evidence-based decision-support tools to improve decision-making processes in cancer care delivery. This article presents an overview of this international, interdisciplinary project.Design, methods and analysis: In co-creation with patients and other stakeholders, we will develop data-driven decision-support tools for patients with breast cancer, prostate cancer and melanoma. We will support treatment decisions by using large, high-quality datasets with state-of-the-art prognostic algorithms. We will further develop a conversation tool, the Metaphor Menu, using text mining combined with citizen science techniques and linguistics, incorporating large datasets of patient experiences, values and preferences. We will further develop a promising methodology, MetroMapping, to redesign care paths. We will evaluate MetroMapping and these integrated decision-support tools, and ensure their sustainability using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We will explore the generalizability of MetroMapping and the decision-support tools for other types of cancer and across other EU member states.Ethics: Through an embedded ethics approach, we will address social and ethical issues.Discussion: Improved care paths integrating comprehensive decision-support tools have the potential to empower patients, their significant others and healthcare providers in decision-making and improve outcomes. This project will strengthen health care at the system level by improving its resilience and efficiency.Improving the cancer patient journey and respecting personal preferences: an overview of the 4D PICTURE projectThe 4D PICTURE project aims to help cancer patients, their families and healthcare providers better undertstand their options. It supports their treatment and care choices, at each stage of disease, by drawing on large amounts of evidence from different types of European data. The project involves experts from many different specialist areas who are based in nine European countries. The overall aim is to improve the cancer patient journey and ensure personal preferences are respected

Analysis, evaluation and visualization of extensive textual data with an emphasis on electronic citizen satisfaction survey as an aspect of e-government

Abweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in engl. Sprachehttp://stud3.tuwien.ac.at/ẽ9825956/In der vorliegenden Arbeit wird aufbauend auf der theoretischen Basis der empiri-schen Sozialforschung ein Einblick in die Problematik der Analyse unstrukturierter Texte im Umfeld von Bürgerzufriedenheitserhebungen erarbeitet.Gerade im Bereich des e-Government ist die Partizipation der Bürger wünschenswert und wichtig, weil nur bei Vorliegen von Feedback der Bürger eine positive verbesse-rung Veränderung verwaltungstechnischer und organisatorischer Abläufe möglich wird. Ein wichtiges Mittel für die Erhebung der Bürgermeinung sind Umfragen und Interviews.Die Zielsetzung dieser Arbeit ist es, einen Überblick über die relevanten Gebiete der empirischen Sozialforschung und über die technischen Aspekte der Auswertung von Umfragen zu schaffen, wobei neben der Erhebung und Analyse quantitativer Daten ganz besonders die Erhebung und Analyse qualitativer Daten eine wichtige Rolle spielt. Gerade bei Bürgerbefragungen sind häufig Antworten in Form unstrukturierter Texte zu finden, deren Auswertung mit hohem Zeitaufwand und somit hohen Kosten verbunden ist.Im technischen Teil dieser Arbeit werden die grundlegenden Algorithmen vorge-stellt, die notwendig sind, um qualitative Daten in Form von unstrukturierten Texten analysieren zu können, wobei ein Überblick über aktuelle Softwarelösungen gegeben wird. Abschließend wird anhand einer, im Rahmen der Diplomarbeit, ausgewerteten Bür-gerzufriedenheitsumfrage die Anwendung der vorgestellten Algorithmen demonst-riert.This thesis presents the problems of the analysis of unstructured text in the context of surveys regarding citizen satisfaction. We base this on the theoretical basis of empirical social research.The participation of citizens in the domain of e-Government is especially desirable and important as only the availability of feedback from citizens makes a positive change in administrative and organizational procedures feasible. Polls and interviews are two important means to conduct citizen opinion surveys.The objective of this thesis is to provide an overview of the relevant fields of empirical social research and the technical aspects of the evaluation of polls, whereas the surveying and evaluation of qualitative data plays a decisive role next to the quantitative of the same. A common occurrence in citizen interviews are replies in the form of unstructured text whose evaluation necessitates a high expenditure of time and therefore cost.The technical section of this thesis presents the necessary fundamental algorithms to allow the analysis of qualitative data in the form of unstructured text together with an overview on recent software solutions.Finally, the application of the presented algorithms is demonstrated within the scope of this thesis through an actual large-scale citizen satisfaction survey.11