Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach

Background: More than 50% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients

eHealth interventies tegen kanker-gerelateerde vermoeidheid en aspecten voor het personaliseren van de behandeling

Doelstelling Steeds meer patiënten overleven borstkanker. Hierdoor loopt een groeiende groep vrouwen risico op langetermijneffecten. Een van de meest gerapporteerde langetermijneffecten is kanker-gerelateerde vermoeidheid (cancer-related fatigue, CRF). Er zijn veel interventies tegen CRF, maar de effectiviteit verschilt per patiënt en is onder meer afhankelijk van voorkeuren van de patiënt. Deze voorkeuren hangen samen met aspecten van interventies, zoals duur en intensiteit. In dit onderzoek zochten we uit welke eHealth interventies tegen CRF bestaan en uit welke aspecten deze zijn opgebouwd die gebruikt kunnen worden voor het personaliseren van de behandeling. Methode Met een scoping review hebben we systematisch gezocht in Pubmed, Scopus en Web of Science (o.a. Medline) naar eHealth interventies tegen CRF. Van alle interventies hebben we ter vergelijking een overzicht gemaakt van de aspecten: duur, intensiteit, type interventie, effectiviteit, ondersteuning van professionals, in- en exclusiecriteria, taal/land, kosten en patiëntkarakteristieken die samenhangen met het wel/niet succesvol afronden van de interventie. Resultaten We hebben 44 artikelen gevonden die 36 interventies beschrijven. Voor een aantal van de genoemde aspecten kan een patiënt voorkeuren hebben. De duur van de interventies varieert van 4 weken tot 6 maanden en de intensiteit wisselt van 1x per week tot dagelijks. Het type interventie verschilt; zowel cognitieve therapie als bewegingstherapie, maar ook mindfulness en problem-solving therapie worden aangeboden. Zes interventies worden in Nederland aangeboden en het wisselt of de patiënt alleen aan de slag kan of dat de interventie uit blended care bestaat. Van de interventies met een resultatenstudie (n=24) hebben de meeste (n=21) een significant effect op vermoeidheid direct na behandeling. Conclusie De 36 gevonden interventies verschillen onder andere op duur, intensiteit en mate van blended care. De aspecten kunnen helpen bij het adviseren van een persoonlijk beste interventie tegen CRF na borstkanker. Deze informatie zorgt voor empowerment van de patiënt en maakt gedeelde besluitvorming mogelijk

Comparing costs of standard Breast-Conserving Surgery to Oncoplastic Breast-Conserving Surgery and Mastectomy with Immediate two-stage Implant-Based Breast Reconstruction

Background: Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as it often has better cosmetic results and it enables larger tumour resection. However, OP-BCS and M-IBR compared to C-BCS lengthens operative time and might lead to more complications and consequently to additional costs. Therefore, this study aimed to compare costs and complication rates of C-BCS, OP-BCS and M-IBR. Methods: This single-centre, retrospective cohort study, calculated costs for all patients who had undergone breast cancer surgery between January 2014 and December 2016. Patient-, tumour- and surgery-related data of C-BCS, OP-BCS and M-IBR patients were retrieved by medical record review. Treatment costs were calculated using hospital financial data. Differences in costs and complications were analysed. Results: A total of 220 patients were included: 74 patients in the C-BCS, 78 in the OP-BCS and 68 in the M-IBR group. From most expensive to least expensive, differences in total costs were found between C-BCS vs. OP-BCS and C-BCS vs. M-IBR (p=<0.01 and p=0.04, respectively). Costs of OP-BCS and M-IBR were comparable. Complication rates were 5.5% for C-BCS, followed by 17% for OP-BCS, and 34% for M-IBR (p<0.01). Conclusion: Considering total treatment costs, OP-BCS was financially non-inferior to M-IBR, whereas complication rates were higher following M-IBR. Therefore, when considering other benefits of OP-BCS, such as higher patient-reported outcomes and similar oncological outcomes, a shift from M-IBR to BCS using oncoplastic techniques seems justified

Everolimus Induces Rapid Plasma Glucose Normalization in Insulinoma Patients by Effects on Tumor As Well As Normal Tissues

Mammalian target of rapamycin inhibitor everolimus administered to 4 insulinoma patients rapidly controlled hypoglycemia. We wanted to identify the kinetics of everolimus effects on controlling hypoglycemia and understand underlying mechanisms. Everolimus normalizes plasma glucose levels in metastatic insulinoma within 14 days, coinciding with a lower glucose uptake in tumor and muscles and declining (pro)insulin levels. This effect on tumor as well as normal tissues explains the rapid controlling of hypoglycemia

Changes in breast cancer treatment during the COVID-19 pandemic: a Dutch population-based study

Purpose: We aimed to compare (1) treatments and time intervals between treatments of breast cancer patients diagnosed during and before the COVID-19 pandemic, and (2) the number of treatments started during and before the pandemic. Methods: Women were selected from the Netherlands Cancer Registry. For aim one, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the treatment of women diagnosed within four periods of 2020: pre-COVID (weeks 1–8), transition (weeks 9–12), lockdown (weeks 13–17), and care restart (weeks 18–26), with data from 2018/2019 as reference. Wilcoxon rank-sums test was used to compare treatment intervals, using a two-sided p-value < 0.05. For aim two, number of treatments started per week in 2020 was compared with 2018/2019. Results: We selected 34,097 women for aim one. Compared to 2018/2019, neo-adjuvant chemotherapy was less likely for stage I (OR 0.24, 95%CI 0.11–0.53), stage II (OR 0.63, 95%CI 0.47–0.86), and hormone receptor+/HER2− tumors (OR 0.55, 95%CI 0.41–0.75) diagnosed during transition. Time between diagnosis and first treatment decreased for patients diagnosed during lockdown with a stage I (p < 0.01), II (p < 0.01) or III tumor (p = 0.01). We selected 30,002 women for aim two. The number of neo-adjuvant endocrine therapies and surgeries starting in week 14, 2020, increased by 339% and 18%, respectively. The number of adjuvant chemotherapies decreased by 42% in week 15 and increased by 44% in week 22. Conclusion: The pandemic and subsequently altered treatment recommendations affected multiple aspects of the breast cancer treatment strategy and the number of treatments started per week