Time to deterioration in quality of life score as a modality of longitudinal analysis in patients with breast cancer.

International audiencePURPOSE: This prospective multicenter study explored different definitions of time to deterioration (TTD) in quality of life (QoL) scores, according to different cutoffs of the minimal clinically important difference (MCID) as a modality for longitudinal QoL assessment in breast cancer patients. METHODS: QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR-23 before surgery, after surgery, and 6 and 12 months later. The global health score, arm symptoms score (BRAS), and breast symptoms score were analyzed. For a given baseline score, QoL was considered to have deteriorated if this score decreased by ≥5 points at any time point after baseline. Analyses were repeated using an MCID of 10 points and taking the score after surgery as the reference score (to explore the occurrence of response shift). TTD was calculated using the Kaplan-Meier method and Cox regression was used to identify independent factors associated with TTD. RESULTS: Two hundred thirty-five patients underwent axillary lymph node dissection (ALND), 222 underwent sentinel lymph node biopsy (SLNB), and 61 underwent SLNB plus ALND. Patients who underwent SLNB had a significantly longer TTD for the BRAS dimension than those who underwent ALND. Cox multivariate analyses showed that treatment using SLNB and age >59 years were independently associated with longer TTD for the BRAS, whereas surgery elsewhere than at the Centre Georges François Leclerc was associated with a shorter TTD. CONCLUSION: Exploration of different definitions of TTD in QoL provides meaningful longitudinal QoL results for clinicians

Multiresponsive Hybrid Microgels and Hollow Capsules with a Layered Structure

Various stimuli-responsive composite particles with a high control of their internal structure and their corresponding hollow capsules are synthesized and characterized by photon correlation spectroscopy, TEM, and AFM. Core−shell particles with a silica core and a thermoresponsive shell are obtained by polymerization of N-isopropylacrylamide (NIPAM) in the presence of silica seeds grafted with a high density of γ-methacryloxypropyltrimethoxysilane (MPS). The influence of the synthesis conditions is studied. The shell thickness increases when the monomer concentration increases in a limited range where uniform composite particles with a single core are obtained. At constant monomer concentration, the shell thickness does not depend on the size of the silica seeds, but the presence of free unbound microgels is observed when the silica surface area decreases. A range of particle diameters and shell thicknesses is thus obtained, which can lead to the corresponding hollow capsules by exposure to hydrofluoric acid solution. The volume phase transition temperature of these materials can be easily tuned by replacing the NIPAM monomer by another N-alkylacrylamide derivative. However, the incorporation of comonomers such as acrylic acid (AA) and a phenylboronic acid (PBA) derivative inhibits the formation of core−shell structures. In order to get pH or glucose responsiveness, these functional groups can be incorporated in the outer shell of a core−double shell structure, with pNIPAM as intermediate shell. pH-responsive and glucose-responsive composite particles are obtained by this method with a high control of their internal structure