Cancer and quality of life. Breast cancer overdiagnosis and design of an intervention to improve the quality of life of oncological patients in palliative care

Early detection of breast cancer (BC) with mammography may cause overdiagnosis and overtreatment. In the other extreme, for advanced cancer patients in palliative care quality of life is the most important outcome. Our aims are: to model invasive BC incidence trends in Catalonia and quantify the extent of BC overdiagnosis; to perform a systematic review of all the clinical outcomes reported in cancer after the supplementation with vitamin D (VD); to assess serum VD deficiency and its relationship with quality of life, fatigue, and physical and functional performance; and to design a randomized controlled trial (VIDAFACT) to assess VD effectiveness in increasing quality of life. Our estimates support the existence of overdiagnosis in Catalonia attributable to mammography usage. The results from both the cross-sectional study and the systematic review, support the need for VIDAFACT to provide data about VD supplementation effectiveness on improving overall quality of life.La detecció precoç del càncer de mama (CM) mitjançant mamografia pot causar sobrediagnòstic i sobretractament. En l’altre extrem, pels malalts amb càncer avançat en cures pal·liatives la qualitat de vida és l'aspecte més important. Els objectius són: modelitzar les tendències de la incidència dels CM invasius a Catalunya i quantificar el grau de sobrediagnòstic de CM; realitzar una revisió sistemàtica de tots els resultats clínics reportats en càncer després de la suplementació amb vitamina D (VD); avaluar la deficiència de VD i la relació amb qualitat de vida, fatiga, i rendiment físic i funcional; i dissenyar un assaig clínic aleatori controlat (VIDAFACT) per avaluar l'eficàcia de VD en l'augment de la qualitat de vida. Les nostres estimacions recolzen l'existència de sobrediagnòstic a Catalunya atribuïble a l'ús de la mamografia. Els resultats tant de l'estudi transversal com de la revisió sistemàtica, admet la necessitat de VIDAFACT per proporcionar dades sobre l'eficàcia en la suplementació de VD en millorar la qualitat de vida en general

Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis

Objective: The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies is to assess the effect of decision aids (DAs) in women aged 50 and below facing the decision to be screened for breast cancer. Setting: Screening for breast cancer. Intervention: DAs aimed to help women make a deliberative choice regarding participation in mammography screening by providing information on the options and outcomes. Eligible studies: We included published original, non-pilot, studies that assess the effect of DAs for breast cancer screening. We excluded the studies that evaluated only participation intention or actual uptake. The studies' risk of bias was assessed with the Cochrane Collaboration's tool for RCTs and the National Institutes of Health Quality Assessment Tool for non-RCTs. Primary and secondary outcomes: The main outcome measures were informed choice, decisional conflict and/or confidence, and knowledge. Secondary outcomes were values, attitudes, uncertainty and intention to be screened. Results: A total of 607 studies were identified, but only 3 RCTs and 1 before-after study were selected. The use of DAs increased the proportion of women making an informed decision by 14%, 95% CI (2% to 27%) and the proportion of women with adequate knowledge by 12%, 95% CI (7% to 16%). We observed heterogeneity among the studies in confidence in the decision. The meta-analysis of the RCTs showed a significant decrease in confidence in the decision and in intention to be screened. Conclusions: Tools to aid decision making in screening for breast cancer improve knowledge and promote informed decision; however, we found divergent results on decisional conflict and confidence in the decision. Under the current paradigm change, which favours informed choice rather than maximising uptake, more research is necessary for the improvement of DAs

Sequential In-catalyzed intramolecular hydroarylation and Pd-catalyzed cross-coupling reactions using bromopropargyl aryl ethers and amines

[Abstract] A sequential one-pot indium-catalyzed intramolecular hydroarylation (IMHA) of bromopropargyl aryl ethers and amines, and palladium-catalyzed cross-coupling reaction using triorganoindium reagents (R3In) has been developed. In this transformation, the IMHA of 3-bromo-2-propynyl aryl ethers under indium(III) catalysis, proceeds regioselectively through a 6-endo dig pathway to afford 4-bromo-2Hchromenes. Subsequent palladium-catalyzed cross-coupling with R3In gives 4-substituted-2H-chromenes in one-pot. This sequential transformation was extended to 3-bromo-2-propynyl-N-tosylanilines to afford 4-substituted-1,2-dihydroquinolines. The dual-catalyzed procedure takes place efficiently with a variety of propargyl aryl ethers and amines and R3In (R = aryl, heteroaryl, alkyl or alkynyl), showing the efficiency of these organometallics and proving the compatibility of indium and palladium in catalysis.Ministerio de Economía y Competividad; CTQ2015-68369-PXunta de Galicia. Consellería de Cultura, Educación e Ordenación Universitaria; GRC2014/04

Informed choice in breast cancer screening: the role of education

[spa ] Objetivo: Evaluar el efecto de recibir información sobre los beneficios y los efectos adversos del cribado del cáncer de mama en la elección informada, en función del nivel educativo. Método: Análisis secundario de un estudio experimental aleatorizado y controlado, en cuatro programas de cribado en Cataluña˜ y Canarias. Se analizaron 400 mujeres que iban a ser invitadas a participar por primera vez. El grupo de intervención recibió una herramienta informativa que mostraba los beneficios y los efectos adversos del cribado. El grupo control recibió un folleto estándar que recomendaba participar en el cribado. El nivel de estudios se agrupó en dos categorías: bajo y alto. La variable principal fue la elección informada definida como un conocimiento adecuado y la concordancia entre las actitudes y las intenciones. Resultados: La intervención produjo un mayor aumento del conocimiento en las mujeres con nivel educativo alto respecto a las de menor nivel educativo. Entre las mujeres que recibieron la intervención, la elección informada fue casi tres veces superior en las de nivel educativo alto (27% vs. 11%). No se observaron diferencias entre niveles educativos en los grupos de intervención y control en cuanto a conflicto decisional, confianza en la decisión, ansiedad y preocupación por el cáncer de mama. Conclusiones: Una herramienta informativa para el cribado del cáncer de mama tuvo mucho más impacto sobre la elección informada en las mujeres con nivel educativo alto. En aquellas con nivel educativo bajo mejoró la actitud frente al cribado y produjo un aumento en la intención de participar en él. [eng] Conclusions: A decision aid for breast cancer screening had much more impact on informed choice among women with a high educational level. In women with low educational level, the attitude towards screening improved and there was an increase in the intention to be screened. Objective: To evaluate the effect of receiving information about the benefits and harms of breast cancer screening in informed choice, according to educational level. Method: Secondary analysis of a randomized, controlled study, in four screening programs, in Catalonia and the Canary Islands (Spain). We analyzed 400 women who were going to be invited to participate for the first time. The intervention group received a decision aid that showed the benefits and harms of screening. The control group received a standard brochure that recommended participating in the screening program. Educational level was grouped into two categories, low and high. The primary out- come was informed choice defined as adequate knowledge and consistency between attitudes and intentions. Results: The intervention produced a greater increase in knowledge in women with a high educational level compared to those with a lower educational level. Among women who received the intervention, informed choice was almost three times higher in those with a high educational level (27% versus 11%). No differences were observed between educational levels in decisional conflict, confidence in the decision, anxiety and worry about breast cancer, in the intervention and control groups

Competing risks to breast cancer mortality in Catalonia

Background: Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. Methods: The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. Results: There was an increasing impact of breast cancer on mortality in the first part of the 20(th) century, with a peak for cohorts born in 1945-54 in the 40-49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. Conclusion: We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia

Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form in Spanish Subjects

Diabetic foot ulcer (DFU) is a chronic complication that negatively affects the quality of life (QoL) of diabetic patients. In Spain, there is no specifically designed and validated instrument to assess the QoL of patients with DFU. Our aim was to adapt the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire to a Spanish population and validate it. A prospective, observational design was used. The DFS-SF was administered by personal interview. The validated SF-36 and EQ-5D generic instruments were used as reference tools. The reliability, validity, and sensitivity to changes were assessed using standard statistical methods. A sample of 141 patients with DFU was recruited. The content validity was 3.46 on average (maximum score of 4). The internal consistency of the DFS-SF subscales showed a standardized Cronbach’s α range between 0.720 and 0.948. The DFS-SF domains showed excellent reproducibility measures (intraclass correlation coefficient from 0.77–0.92). The criterion validity was good with significant correlations between each DFS-SF subscale and its corresponding SF-36 and EQ-5D subscales (p < 0.001). However, the questionnaire structure was not validated (comparative fit index = 0.844, root mean square error of approximation = 0.095, and standardized root mean square residual = 0.093). The instrument showed high sensitivity to ulcer changes over time (p < 0.001). The adapted and validated Spanish version of the DFS-SF questionnaire has good psychometric properties and shows good sensitivity to ulcer changes, although the construct validity was not optimal. The adapted questionnaire will be a useful tool specifically to assess the QoL in subjects with diabetic foot ulcers in the clinical and research settings in Spain.CIBERDEM is an initiative from Instituto de Salud Carlos III (Plan Nacional de I + D + I and Fondo Europeo de Desarrollo Regional). M.G.-C. held a predoctoral fellowship from the Ministerio de Educación, Cultura y Deporte, FPU15/03005. This project was developed in the context of the Programme “Doctorat en Medicina de la Universitat Autònoma de Barcelona”, Autonomous University of Barcelona

Competing risks to breast cancer mortality in Catalonia

Background: Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. Methods: The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. Results: There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. Conclusion: We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia