A Qualitative Study of the Impact of the COVID-19 Pandemic on Metastatic Breast Cancer Care

The COVID-19 pandemic substantially impacted the delivery of oncology care, particularly for individuals with metastatic cancers. The objective of this study was to qualitatively evaluate the impacts of COVID-19 on metastatic breast cancer (MBC) care among patients. This study consisted of 36 semi-structured qualitative interviews conducted virtually with people living with MBC, who were members of a patient support organization called Project Life. Project Life is an MBC patient-led, web-based wellness community. Responses were analyzed using Phronetic Iterative Analysis. Interviews were conducted from March 14, 2022, to May 31, 2022. Analysis from 36 individual in-depth qualitative interviews revealed the following themes during COVID-19: (1) variable preferences for telehealth (2) disruptions to care, (3) virtualization of social care. Wide variations existed in preferences surrounding telehealth, centered around ideas of convenience. Disruptions to care included delays to diagnostic care, isolation from caregivers, and interruptions associated with COVID-19 infection. These results call for adaptability in oncology care given wide-ranging preferences on telehealth and the shifting of available support services

Impacto da pluviosidade na incidência de Dengue durante a pandemia de COVID-19 no município de Belém-Pará: Impact of rainfall on the incidence of Dengue during the COVID-19 pandemic in the municipality of Belém-Pará-Brazil

Objetivo: Avaliar a interferência da pluviosidade no surgimento de novos casos de dengue durante o COVID-19 no município de Belém-Pará. Métodos: trata-se de um estudo ecológico, transversal, realizado com dados secundários. Coletou-se dados mensais de pluviosidade e temperatura em Belém e, casos de dengue no período de 2017 a 2021. E coletou-se casos novos de COVID-19 de em 2020 e 2021. Analisou-se o perfil epidemiológico dos casos de dengue, comparando com os dados de pluviosidade e casos de COVID-19. Avaliou-se os dados a partir de uma tendência temporal gaussiana e modelo parabólico de 6ª ordem e correlação linear. Resultado: A tendência temporal gaussiana de 260 semanas epidemiológicas de incidência de dengue observada foi não linear, R² = 0,1485, por isso, ajustou-se para o modelo parabólico de 6ª ordem, o que permitiu observar três tendências: 1) declínio na incidência de dengue de 2017 para 2018; 2) aumento de 2018 para 2019 e 3) aumento acentuado de 2020 para 2021, R²=0,3691. À análise da relação entre dengue e COVID-19, nos anos de 2020 e 2021, a correlação linear mostrou-se significativa em 2021 com p<0,0001 e R²=0,3023. Além disso, a correlação da incidência de dengue com índices pluviométricos por meses nos anos de 2017 a 2021, também foi significativa em 2021, com p=0,04 e R²=0,3528. Conclusão: A incidência de dengue mostrou aumento acentuado em 2021 na cidade de Belém-PA, estando associada aos casos de COVID-19 e à pluviosidade neste ano

Estigmatização do aleitamento materno: uma revisão sistemática

O artigo objetiva avaliar a influência dos estigmas sociais sobre o aleitamento materno. Trata-se de uma revisão sistemática da literatura a qual seguiu a metodologia PRISMA, sendo realizada a partir da pergunta de pesquisa: “Como a estigmatização sobre o aleitamento materno pode afetar a saúde da mulher e do bebê nos âmbitos público, familiar, laboral e da saúde?”, que guiou a pesquisa, na qual foram usadas as bases de dados Biblioteca Virtual de Saúde (BVS) e Pubmed com o uso dos descritores “Breast feeding", "Stigma", "Health" e "Women". Inicialmente, encontraram-se 82 artigos com a aplicação dos descritores e dos filtros nas bases de dados BVS e PUBMED. Contudo, após a análise meticulosa de cada artigo, obtiveram-se apenas 8 artigos elegíveis incluídos na revisão sistemática, que se relacionaram com seis eixos temáticos: o reconhecimento dos benefícios do aleitamento pelas mães, o julgamento que as mães estavam impostas ao amamentar em público, a desaprovação familiar sobre o aleitamento materno continuado, a dificuldade de retorno ao trabalho sofrida pelas mães, a presença de redes de apoio e o apoio de profissionais da saúde para a continuidade do aleitamento materno por dois anos. Analisando-se a revisão sistemática desenvolvida, é fulcral ressaltar a influência dos estigmas sociais sobre o aleitamento materno, havendo necessidade de medidas de suporte para essas mães, além do combate ao estigma

Measured Economic Mobility in the District Is Below the U.S. Average

is composed of four zones, each of which is centered around one of the four main cities: Little Rock, Louisville, Memphis and St. Louis. Is intergenerational economic mobility high or low in the Eighth District? Are there areas with extremely high or extremely low mobility? In this District Overview, we provide answers to these questions, using results from a 2014 study by economists Raj Chetty, Nathaniel Hendren, Patrick Kline and Emmanuel Saez (CHKS hereafter). The CHKS study has attracted a great deal of interest, in large part because it measure

Dysregulation of 4q35- and muscle-specific genes in fetuses with a short D4Z4 array linked to facio-scapulo-humeral dystrophy

International audienceFacio-scapulo-humeral dystrophy (FSHD) results from deletions in the subtelomeric macrosatellite D4Z4 array on the 4q35 region. Upregulation of the DUX4 retrogene from the last D4Z4 repeated unit is thought to underlie FSHD pathophysiology. However, no one knows what triggers muscle defect and when alteration arises. To gain further insights into the molecular mechanisms of the disease, we evaluated at the molecular level, the perturbation linked to the FSHD genotype with no a priori on disease onset, severity or penetrance and prior to any infiltration by fibrotic or adipose tissue in biopsies from fetuses carrying a short pathogenic D4Z4 array (n 5 6) compared with fetuses with a non-pathogenic D4Z4 array (n 5 21). By measuring expression of several muscle-specific markers and 4q35 genes including the DUX4 retrogene by an RT-PCR and western blotting, we observed a global dysregulation of genes involved in myogenesis including MYOD1 in samples with <11 D4Z4. The DUX4-fl pathogenic transcript was detected in FSHD biopsies but also in controls. Importantly, in FSHD fetuses, we mainly detected the non-spliced DUX4-fl isoform. In addition, several other genes clustered at the 4q35 locus are upregulated in FSHD fetuses. Our study is the first to examine fetuses carrying an FSHD-linked genotype and reveals an extensive dysregulation of several muscle-specific and 4q35 genes at early development stage at a distance from any muscle defect. Overall, our work suggests that even if FSHD is an adult-onset muscular dystrophy, the disease might also involve early molecular defects arising during myogenesis or early differentiation

Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline

PURPOSEAmerican Society of Radiation Oncology (ASTRO) has developed a guideline on appropriate radiation therapy for brain metastases. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.METHODS"Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline"2 was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel subsequently reviewed the content and the recommendations.RESULTSThe ASCO Endorsement Panel determined that the recommendations from the ASTRO guideline, published May 6, 2022, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorses "Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline."2RECOMMENDATIONSWithin the guideline, stereotactic radiosurgery (SRS) is recommended for patients with Eastern Cooperative Oncology Group performance status of 0-2 and up to four intact brain metastases, and conditionally recommended for patients with up to 10 intact brain metastases. The guideline provides detailed dosing and fractionation recommendations on the basis of the size of the metastases. For patients with resected brain metastases, radiation therapy (SRS or whole-brain radiation therapy [WBRT]) is recommended to improve intracranial disease control; if there are limited additional brain metastases, SRS is recommended over WBRT. For patients with favorable prognosis and brain metastases ineligible for surgery and/or SRS, WBRT is recommended with hippocampal avoidance where possible and the addition of memantine is recommended. For patients with brain metastases, limiting the single-fraction V12Gy to brain tissue to ≤ 10 cm3 is conditionally recommended.Additional information is available at www.asco.org/neurooncology-guidelines

Anticonvulsant prophylaxis and steroid use in adults with metastatic brain tumors: summary of SNO and ASCO endorsement of the Congress of Neurological Surgeons guidelines

BACKGROUND: The Congress of Neurological Surgeons (CNS) has developed a series of guidelines on the treatment of adults with metastatic brain tumors, including systemic therapy and supportive care topics. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS: Two CNS Guidelines were reviewed for developmental rigor by methodologists and an independent multi-disciplinary Expert Panel was formed to review the content and assess agreement with the recommendations. The expert panel voted to endorse the two guidelines and ASCO and SNO independently reviewed and approved the ASCO/SNO guideline endorsement. RESULTS: The ASCO/SNO Expert Panel determined that the recommendations from the CNS anticonvulsants and steroids guidelines, published January 9, 2019, are clear, thorough, and based upon the most relevant scientific evidence. ASCO/SNO endorsed these two CNS guidelines, with minor alterations. CONCLUSIONS: Key recommendations include: prophylactic anti-epileptic drugs were not recommended for routine use; corticosteroids (specifically dexamethasone) were recommended for temporary symptomatic relief in patients with neurologic symptoms and signs related to mass effect from brain metastases

Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

PURPOSE To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors. METHODS ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base. RECOMMENDATIONS Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non-small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status # 50 or Karnofsky Performance Status, 70 with no systemic therapy options do not derive benefit from radiation therapy. Additional information is available at www.asco.org/neurooncology-guidelines

HER2DX ERBB2 mRNA expression in advanced HER2- positive breast cancer treated with T-DM1

In advanced HER2-positive (HER2+) breast cancer (BC), the new antibody-drug conjugate trastuzumab deruxtecan (T-DXd) is more effective compared to trastuzumab emtansine (T-DM1). However, T-DXd can have significant toxicities, and the right treatment sequence is unknown. Biomarkers to guide the use of anti-HER2 therapies beyond HER2 status are needed. Here, we evaluated if pre-established levels of ERBB2 mRNA expression according to the HER2DX standardized assay are associated with response and survival following T-DM1. In ERBB2 low, medium, and high groups, the overall response rate was 0%, 29% and 56%, respectively (P<.001). ERBB2 mRNA was significantly associated with better progression-free survival (p = 0.002) and overall survival (OS; P = 0.02). These findings were independent of HER2 IHC levels, hormone receptor, age, brain metastasis and line of therapy. The HER2DX risk-score (P=.04) and the immunoglobulin (IGG) signature (P=.04) were significantly associated with OS since diagnosis. HER2DX provides prognostic and predictive information following T-DM1 in advanced HER2+ BC