Management of chemotherapy-related arm symptoms in patients with breast cancer

Anthracyclines are used widely as part of combination chemotherapy regimens to treat patients with early breast cancer. Epirubicin administered through a peripheral catheter may cause venous irritation resulting in symptoms of phlebitis. Management of phlebitis in oncology remains conflicted. In response to anecdotal patient reports of arm symptoms, a local audit was conducted to identify the incidence and type of arm symptoms during or after chemotherapy and their management. An audit questionnaire was designed by research and clinical staff and completed by 110 patients with breast cancer aged between 25 years and 76 years (± 52.7 years). FEC-80 was the most frequently administered (n=68) chemotherapy regimen. Out of 108 responses, 65 patients reported arm symptoms during chemotherapy, of which the most commonly reported were arm pain 43% (n=28), tightness 32% (n=21) and vein discolouration 22% (n=14). They were most commonly provided with a heat pad, ibuprofen gel or bandaging for symptom relief. Only 27 patients (25%) recalled being given aftercare advice on self-management of arm symptoms. While a number of interventions were used to manage symptoms, there was no standardised care. Uncertainty exists about appropriate intervention and advice on self-management of persisting arm symptoms. Future research and guideline development should focus on prevention and early detection, as well as assessing the effectiveness of interventions

Myofascial release for women undergoing radiotherapy for breast cancer: A pilot study

Aims: Following breast cancer surgery some patients proceeding to adjuvant radiotherapy experience restricted upper limb mobility, which may only be evident at the time of radiotherapy simulation. Myofascial release (MFR), a form of physiotherapy, may be of benefit to improve upper limb mobility for some patients undergoing radiotherapy. There is no research specifically on the use of MFR during radiotherapy. The aim of the study was to investigate the effectiveness of MFR to improve upper limb mobility during the radiotherapy period. Methods: 24 patients were recruited and randomized to receive MFR (n = 14) or usual care (n = 10). Outcome measures for range of movement, pain, disability and function, anxiety and depression were taken on three occasions, over a 4-month period. Results: Four ranges of movement at the shoulder improved in the MFR group, this improvement was statistically significant for abduction (p = 0.001) and combined abduction/flexion/external rotation (p < 0.001). Conclusion: MFR was well tolerated and may be beneficial for some women receiving radiotherapy who are experiencing difficulty or discomfort with upper limb movement. Further research into the optimal timing and frequency of MFR treatments for women undergoing radiotherapy for breast cancer is warranted

A randomised controlled trial of interventions for taxane-induced nail toxicity in women with early breast cancer

Onycholysis and paronychia has been associated with chemotherapy treatment for women with breast cancer. Our primary aim was to investigate the effectiveness of different topical interventions to ameliorate nail toxicity. Secondary aims were to explore the full range and severity of possible nail changes associated with taxane-based chemotherapy and the specific impact this had on quality of life, using two novel measures. This was an exploratory randomised controlled trial of three topical interventions (standard care, nail polish or specialist nail drops) for the prevention or reduction of nail changes induced by taxane-based chemotherapy. Outcomes included nail toxicity assessed at three time points (baseline, 3 weeks and 3 months post completion of chemotherapy) using two novel clinical tools (NToX-G12, NToX-QoL) and the Common Terminology Criteria for Adverse Events (CTCAE v3) and EQ-5D-5L. A total of 105 women were recruited (35 in each arm) and monitored up to three months post completion of chemotherapy. Almost 20% of patients were over the age of 60 years. There were 26 withdrawals, the majority from the nail polish arm. Residual Maximum Likelihood REML analysis indicated a significant arm, time and interaction effect for each intervention (p < 0.001). Less nail toxicity was observed in patients receiving specialist nail drops or standard care arms in comparison to those using nail polish. This study provides evidence to support clinicians’ suggestions on nail care recommendations based on the patients’ needs and preferences. Future investigations into comparing or combining cryotherapy and topical solutions that can support patient’s decisions are warranted

Non-permissive human conventional CD1c+ dendritic cells enable trans-infection of human primary renal tubular epithelial cells and protect BK polyomavirus from neutralization

International audienceThe BK polyomavirus (BKPyV) is a ubiquitous human virus that persists in the renourinary epithelium. Immunosuppression can lead to BKPyV reactivation in the first year post-transplantation in kidney transplant recipients (KTRs) and hematopoietic stem cell transplant recipients. In KTRs, persistent DNAemia has been correlated to the occurrence of polyomavirus-associated nephropathy (PVAN) that can lead to graft loss if not properly controlled. Based on recent observations that conventional dendritic cells (cDCs) specifically infiltrate PVAN lesions, we hypothesized that those cells could play a role in BKPyV infection. We first demonstrated that monocyte-derived dendritic cells (MDDCs), an in vitro model for mDCs, captured BKPyV particles through an unconventional GRAF-1 endocytic pathway. Neither BKPyV particles nor BKPyV-infected cells were shown to activate MDDCs. Endocytosed virions were efficiently transmitted to permissive cells and protected from the antibody-mediated neutralization. Finally, we demonstrated that freshly isolated CD1c+ mDCs from the blood and kidney parenchyma behaved similarly to MDDCs thus extending our results to cells of clinical relevance. This study sheds light on a potential unprecedented CD1c+ mDC involvement in the BKPyV infection as a promoter of viral spreading