The SUPREMO trial reported adjuvant chest wall radiotherapy had no effect on 10-year overall survival (primary endpoint) in patients with intermediate-risk breast cancer after mastectomy. The quality of life (QOL) substudy of SUPREMO (UK patients only) examines the effects of chest wall radiotherapy in patients with intermediate-risk breast cancer 1 year, 2 years, 5 years, and 10 years after treatment. Here, we report 5-year QOL results (a secondary endpoint), including prespecified subgroup analyses. SUPREMO is an international, parallel-group, randomised, controlled, phase 3 trial. Women aged 18 years or older with intermediate-risk breast cancer (defined as pT1-2N1 or pT3N0 or pT2N0 with histological grade 3, or lymphovascular invasion, or both) who had undergone mastectomy (and axillary surgery) were randomly assigned (1:1) to receive chest wall radiotherapy (40-50 Gy in 15-25 fractions) or no radiotherapy. Randomisation was in permuted blocks with varying block length, stratified by centre, without masking of patients or investigators. All UK patients were invited to the QOL substudy. Consenting patients completed validated questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Core 30-item questionnaire; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Breast Cancer Module, 23 items; Body Image Scale; and Hospital Anxiety and Depression Scale) before randomisation and at 1 year, 2 years, 5 years, and 10 years. Here, we report the prespecified primary QOL outcomes of global QOL, fatigue, physical function, chest wall symptoms, shoulder and arm symptoms, body image, anxiety, and depression in the intention to treat population, using repeated measures mixed-effects models. This trial is registered with the ISRCTN registry, ISRCTN61145589 and is now completed. Between Aug 4, 2006, and April 29, 2013, SUPREMO recruited 1691 patients internationally, of whom 1679 were randomly assigned to receive chest wall radiotherapy (n=845) or not (n=834). Of 1233 patients from UK centres (619 in the chest wall radiotherapy group and 614 in the no chest wall radiotherapy group), 989 (80%) consented to the QOL substudy: 947 (96%) of 989 returned baseline questionnaires and 620 (75%) of 832 patients returned the expected year-5 questionnaires. Chest wall symptoms were worse with chest wall radiotherapy (effect estimate 1·99 [95% CI 0·36-3·62]; p=0·017) with an improvement between years 1, 2, and 5. Chemotherapy was associated with less improvement over time (effect estimate 2·97 [95% CI 0·24-5·71]; p=0·033) but without interaction with chest wall radiotherapy. No statistically significant differences were observed in other QOL domains (arm symptoms, body image, fatigue, pain, overall QOL, physical functioning, or anxiety and depression). In the subgroup analyses, patients who had a sentinel lymph node biopsy followed up by an axillary lymph node clearance with chest wall radiotherapy had worse chest wall symptoms than those having a single axillary operation (difference chest wall radiotherapy vs no chest wall radiotherapy -5·29 [95%CI -8·53 to -2·05]; p=0·0015). The 5-year QOL findings showed worse chest wall toxicity and no effect on other QOL domains. The subgroup analyses suggested a potential negative effect of chemotherapy and axillary clearance after sentinel node biopsy. UK Medical Research Council, National Institute for Health and Care Research, European Organisation for Research and Treatment of Cancer, Edinburgh Trustees of Breast Cancer Institute in Edinburgh and the Edinburgh Cancer Centre NHS Endowment funds, The Dutch Cancer Society, Trustees of the Hong Kong and Shanghai Banking Corporation.
Breast cancer screening is vital for early detection and improved health outcomes but requires robust health economic evaluations to guide implementation. This systematic review examines the methodology, quality, and results of health economic evaluations of screening strategies to support decision making and future research. A literature search was performed in PubMed, Embase, Web of Science, EconLit, and the HTA database. Health economic evaluations of breast cancer screening strategies using imaging modalities were included and screened independently by two reviewers. Data on study design, screening strategies, and outcomes were extracted and synthesized. Quality was assessed using the ISPOR checklist for model-based studies and the Consensus on Health Economics criteria (CHEC-extended) checklist for empirical data-based studies. All results were made publicly accessible via an interactive platform and the Open Science Framework, providing an open resource that facilitates transparency, reuse, and future updates. The review included 128 studies, comprising 96 model-based studies, 14 empirical data-based studies, 15 studies combining empirical data with extrapolation using a modeling approach, and 3 studies with unclear methods. Microsimulation and cohort simulation were used in 47 and 53 studies, respectively. Incremental cost-effectiveness ratios varied widely across studies depending on the screening modality, risk factors, age range of screening, and screening interval. Most studies found mammography to be cost effective compared with no screening, while some studies showed it as being not cost effective, especially for women at average risk of breast cancer, in young screening ages (40-49 years), or with an annual interval. Ultrasound-based screening programs were generally cost effective compared with no screening in the women with average risk of breast cancer. Supplementing magnetic resonance imaging (MRI) with mammography was generally cost effective in women with dense breasts and a family history of breast or ovarian cancer but not cost effective in women with previous treatment using radiation therapy. The median quality score was 55% for model-based studies, with microsimulations having higher quality than cohort simulations. Empirical data-based studies with and without extrapolation had a similar median quality score of 65%. Mammography was generally reported as cost effective compared with no screening. Supplementing mammography with ultrasound and/or MRI could be cost effective depending on comparator, risk factors, age range, and screening interval. Suboptimal quality was commonly observed across published health economic evaluations. Future studies should prioritize enhancing overall quality, particularly in data, validation, and reporting.
The National Quality Measures for Breast Centers (NQMBC) originated as an idea in 2003 by the National Consortium of Breast Centers (NCBC) board who felt that increased attention was warranted, initiated by the institute of medicine, to measure, evaluate and improve the quality of breast cancer care. To serve the widespread membership of NCBC, any quality assessment program would need to be web-based so that no matter where your breast center was located, your center could assess their own level of their quality care performance. The focus of quality performance was on the level of care actually delivered for each performance measure. The NQMBC is a set of quality measures including each discipline in the breast center; imaging, surgery, pathology, medical oncology, radiation oncology, genetics, navigation and the newly added inflammatory breast cancer. The NQMBC looks at real time data from participating breast centers across the country. Once a center's data on a particular is entered into the NQMBC, the website immediately provides comparisons with other centers' performance. The results show the submitted center's data and the comparison 25th, 50th and 75th percentile performance of all the other centers who have submitted data on that measure. A center can identify the level of performance on that specific measure and decide whether improvement is neded or congratulations is deserved. All data is confidential and hot shared with any other center. No patient data is used. Recently a government grant was awarded to a group headed by Aurora Inc., striving to improve the quality of care provided in China. Experts in breast cancer care were identified to aid in this effort. Many clinicians from China have been sent for two-month observerships to Montefiore-Einstein Medical Center to see how the US approaches breast cancer. To assess the quality of care provided, the NQMBC was chosen to assess the resultant quality of care it in at least three large breast centers in China. In-person exchanges occurred this last month to initiate the integration of NQMBC as a measure of their quality breast cancer care. Goals of these three facilities is to achieve the level of a quality breast center of excellence. Three main medical centers in three separate provinces, each serving a population of over 100 million, have agreed to integrate the NQMBC quality program as a measure of their breast care. This long-term pilot program has positive implications to improve the level of breast care in China, and a valuable extension of the international use of NQMBC.
Background and Objectives: Quality of life (QoL) is an important issue for breast cancer (BC) survivors. The objective of this study was to assess health-related QoL (HRQoL) of BC patients and investigate the impact of different demographic and clinical factors on physical and social functioning and BC-related symptoms. Materials and Methods: In this cross-sectional study, 107 BC patients undergoing chemotherapy in Greece completed a questionnaire collecting sociodemographic and clinical information and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) in order to assess HRQoL. Descriptive statistics and multiple linear regression analyses were used to identify factors linked to HRQoL outcomes. Results: Overall, participants reported moderate HRQoL, with high physical and social functioning and moderate emotional, cognitive, and role functioning. Fatigue was the most common symptom, whereas other symptoms were generally uncommon. Multiple regression analyses showed that marital status, place of residence, time since diagnosis, and type of surgery were significantly associated with the global QLQ-C30 score (R2 = 0.337, p < 0.001). Physical functioning was associated with comorbidity burden, time since diagnosis, and employment status (R2 = 0.155, p = 0.035), and social functioning with marital status and type of surgery (R2 = 0.171, p = 0.011). Emotional functioning showed exploratory associations with place of residence and type of surgery; however, the overall regression model for emotional functioning did not reach statistical significance. No symptom model reached overall significance, but time since diagnosis, treatment type, and surgery were linked to distinct symptoms. Conclusions: BC patients undergoing chemotherapy in Greece report an overall moderate level of HRQoL, which is significantly influenced by a combination of demographic and clinical factors; physical and social functioning were high, with moderate emotional, cognitive, and role functioning. These findings highlight the importance of individualized supportive care strategies in order to improve QoL of BC patients.
We evaluated whether offering access to a multicomponent mHealth app improves quality of life (QoL) and psychosocial outcomes among breast cancer survivors under pragmatic, nonprescriptive conditions. In this single-center, randomized, controlled trial at Hospital Clínic de Barcelona, women age ≥18 years, disease-free after breast cancer treatment, were recruited (December 2020-December 2021) and randomly assigned 1:1 to usual follow-up plus app access or usual follow-up alone. The app provided CTCAE v4.03-aligned symptom tracking with self-care guidance, educational content, an events calendar, and gamified smartphone-based step counting; no protocolized clinician monitoring or feedback was provided. Outcomes were assessed at baseline and 3, 6, 9, and 12 months using European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (QLQ)-C30/BR23, Hospital Anxiety and Depression Scale (HADS), and Three-Item Loneliness Scale (TILS). The primary end point was the difference in QLQ-C30 Global Health Status/QoL at 3 months. Analyses followed intention-to-treat using mixed models for repeated measures adjusted for baseline values. Of 124 women assessed, 121 were randomized (intervention n = 60; control n = 61). Patient-reported outcome measures were available for 106 of 121 (87.6%) at 3 months and 95 of 121 (78.5%) at 12 months. At 3 months, there was no significant difference in Global Health Status/QoL (adjusted mean difference [Intervention-Control], -2.24 [95% CI, -9.29 to 4.81]; P = .53); estimates at later time points were similarly imprecise. No significant between-group difference were observed for QLQ-BR23 domains, HADS anxiety/depression, or TILS. Exploratory subgroup analyses suggested possible heterogeneity in TILS by hormonal-treatment category; this was descriptive and hypothesis-generating only. App engagement was the highest in months 0-3 (48/60 [80.0%] with any use) and declined thereafter; 12 of 60 (20.0%) never used the app. In a pragmatic, nonprescriptive survivorship trial, offering access to a multicomponent mHealth app without closed-loop clinical integration did not show a statistically significant between-group differences in QoL or psychosocial outcomes; confidence intervals were compatible with meaningful harm and did not exclude small benefit depending on the threshold used to define clinical relevance.
Integrating cancer genetics, genomics and cancer risk assessment is increasingly relevant to the care of patients and there is a need for clinicians across practice disciplines to acquire and demonstrate knowledge and clinical competency in cancer genetics and cancer risk assessment. National Consortium of Breast Centers (NCBC's) certification program in Cancer Genetic Risk Assessment (CGRA) is a voluntary nationally (NCCA) accredited, examination-based certification program created to provide the assurance that healthcare providers with certification in CGRA possess the knowledge, skills and competency to provide cancer risk assessment services to patients and families. The certification has achieved recognition by national accrediting organizations (National Accreditation Program for Breast Centers/Commission on Cancer) and payor policies. NCBC's CGRA certification was developed by a multidisciplinary committee of dedicated breast care, oncology, and cancer genetics professionals and approved by NCBC's board of trustees. Testing first became available in May 2020 with testing opportunities provided throughout the year. Testing options include both remote and in-person examination. The target audiences for certification are physicians, advanced practice providers, nurses and other skilled health care practitioners who care for at-risk unaffected and affected patients and their families. Here we describe demographics and outcomes from the first six years of certification examination availability. A retrospective cohort of CGRA examination takers was collected from May 2020 (initial examination availability) through December 2025. Analyzed data includes total number of examination takers, pass/fail rates, and professional background and practice setting of the passing cohort. Descriptive statistics were used for analysis. 2020-2025 Total number of CGRA examination takers: 235 Total number (percent) passed: 207/235 (88.1%); failed: 28/235 (11.9%) Professional background of CGRA certificants: APRN - 109/207 (52.7%) RN - 37/207 (17.9%) PA - 30/207 (14.5%) MD - 26/207 (12.6%) RT - 5/207 (2.4%) Practice focus of CGRA certificants: Oncology - 132/207 (63.8%) Surgery - 26/207 (12.6%) High Risk/Genetics - 16/207 (7.7%) Gynecology - 14/207 (6.8%) Breast Center - 12/207 (5.8%) Radiology - 4/207 (1.9%) Primary Care - 1/207 (0.5%) Other - 2/207 (<1%). During the first 6 years of CGRA certification eligibility, a notable number of healthcare providers and other healthcare professionals have sought and obtained certification in CGRA through NCBC's CGRA certification program. Seventy percent of all certificant holders have a professional background in nursing. Two-thirds of all certificant holders are advanced practice providers, including advanced practice nurses/nurse practitioners and physician assistants. Twelve percent of certificant holders are physicians and two percent comprise radiologic technologists. The most prominent practice setting for certificant holders is oncology comprising approximately two-thirds of all represented specialties, followed by surgery at approximately twelve percent. Many other specialty practice settings are represented, including the screening and preventive care spaces. ln conclusion, the CGRA certification is a sought-after credential appealing to a broad range of healthcare providers/professionals across practice disciplines allowing for a diverse patient population, both affected and unaffected, to obtain competent cancer genetic and cancer risk assessment-related care.
To map global practice patterns and disparities in the use of preoperative breast magnetic resonance imaging (MRI) for early breast cancer (EBC) among members of the Senologic International Society (SIS) and SIS Working Group. A cross-sectional, web-based survey was distributed to SIS members worldwide. The questionnaire captured respondent demographics, center characteristics, local/national breast MRI use, guideline perceptions and personal practice, specific indications for MRI, and decision-making influences. We analyzed 114 responses from 17 countries. Significant variations were observed. While 36/46 (78.3%) of Japanese respondents perceived national guidelines as recommending preoperative MRI, only 18/60 (30%) of Europeans did. Overall, 96/114 (84.2%) of all respondents believed preoperative MRI provided a patient benefit, with none believing it caused harm. The most frequent indications in the total cohort were invasive lobular carcinoma (106/114, 93.0%), mammographic/sonographic suspicion of multifocality/multicentricity (96/114, 84.2%) and planned neoadjuvant therapy (89/114, 78.1%), while in Japan ductal carcinoma in situ (DCIS) or accompanying DCIS component was the most frequent indication (45/46, 97.8%). Half of respondents stated that national guidelines recommend preoperative breast MRI for EBC (57/114, 50%). Furthermore, 30/57 (52.6%) of these "guideline-positive" respondents reported performing more MRIs than advised while most guidelines recommending only selected preoperative indications such as invasive lobular histopathology, dense breasts, suspicion of multifocality/multicentricity or imaging inconsistencies. Key influencing factors included specialty, reimbursement, and time to access preoperative MRI. This SIS-based international survey revealed heterogeneous global adoption of preoperative breast MRI for EBC, highlighting a significant gap between evidence-based guidelines and real-world practice. Clinical decisions are heavily influenced by geography, culture and resources, and belief in patient benefit. These findings highlight the need to tailor guidelines to local contexts, and strengthen awareness and dissemination efforts, together with further research to clarify the role of MRI in the modern multidisciplinary management of EBC.
Oral mucositis is a frequent and debilitating adverse event observed in patients undergoing chemotherapy or radiotherapy. Current management strategies are limited in duration, require frequent application, and fail to address the mechanical irritation from teeth. A novel device, Soft Protector CPC, was developed to overcome these limitations. This multicenter, randomized, two-arm, open-label, confirmatory trial aims to evaluate the efficacy and safety of Soft Protector CPC in patients with breast cancer undergoing chemotherapy. A total of 154 participants will be randomly assigned in a 1:1 ratio to receive either oral care with Soft Protector CPC or oral care alone. The primary endpoint will be oral mucositis as assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 during the comparative treatment period. The secondary endpoints will include CTCAE v3.0 during the continuous treatment period, oral mucositis, pain (CTCAE v5.0), quality of life (Patient Reported Outcomes-CTCAE version 1.0 [PRO-CTCAE v1.0], the 15-item oral health questionnaire of the European Organization For Research And Treatment Of Cancer [EORTC QLQ-OH15], and the pain Numeric Rating Scale), onset and site of mucositis, completion of chemotherapy, use of rescue medications, technical feasibility, and patient preference. The safety endpoints will include adverse events, device malfunction, and laboratory tests. This trial is expected to establish the clinical utility of the Soft Protector CPC for the prevention and management of oral mucositis, with the potential to improve the patients' quality of life and adherence to cancer therapy. This study was approved by the Clinical Research Review Board and registered with the Japan Registry of Clinical Trials, jRCTs062250005, on April 18, 2025.
Health-related quality of life (HRQoL) data among patients with breast cancer (BC) in Malaysia remain limited. This study aimed to describe HRQoL and identify its key predictors to inform future health policy planning. A cross-sectional survey was conducted between April 2023 and January 2025 among BC outpatients in eight public specialist hospitals in Malaysia. Sociodemographic and clinical data were collected alongside patient-reported outcome measures, including the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L), a preference-based health utility measure, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), a cancer-specific HRQoL questionnaire. Multivariable linear regression models were used to identify independent predictors of HRQoL for each instrument. The mean (standard deviation) EQ-5D-5L health state utility value (HSUV) was 0.853 (0.179), the mean EQ-VAS score was 79.2 (19.1), and the mean (standard deviation) EORTC QLQ-C30 summary score was 83.3 (15.3). The EQ-5D-5L dimensions with the highest prevalence of reported problems were pain/discomfort and anxiety/depression. The EQ-5D-5L HSUV and VAS score demonstrated moderate to strong positive correlations with the EORTC QLQ-C30 summary score (ρ = 0.503 to 0.672, p < 0.001). In multivariable analysis, advanced cancer stage, Chinese ethnicity, and lower education were independently associated with poorer EQ-5D-5L HSUV. EQ-VAS scores were associated with Indian ethnicity and completion of the questionnaire in English. For EORTC QLQ-C30, advanced cancer stages and Chinese ethnicity remained significant predictors. HRQoL among patients with BC in Malaysia was primarily influenced by cancer stage, ethnicity, and education level. Advanced cancer stage was consistently associated with poorer patient-reported outcomes. The complementary use of EQ-5D-5L and EORTC QLQ-C30 provides more comprehensive estimates to inform survivorship care and future economic evaluations.
Breast cancer survivors frequently experience adverse changes in body composition, cardiometabolic biomarkers, functional capacity and quality of life that may worsen long-term prognosis, yet the comparative effectiveness of lifestyle interventions across delivery formats and supervision levels remains unclear. Background/Objectives: This systematic review assessed the effects of structured diet and exercise interventions on body composition, metabolic and inflammatory biomarkers, functional capacity, dietary habits and quality of life in breast cancer survivors. Methods: Following PRISMA guidelines, Cochrane, PubMed, Scopus and Web of Science were searched for randomized controlled trials and quasi-experimental studies published in English between 2016 and 2026. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. Results: Of 1413 records, 15 studies (11 RCTs; mean age 46-60 years; mostly overweight or obese post-treatment women) met the inclusion criteria; twelve interventions were supervised and three home-based or web-based. Within the assessed domains, many studies reported significant improvements in body composition, quality of life and metabolic or inflammatory biomarkers. Effects were larger in multimodal supervised programs combining caloric restriction with moderate-to-vigorous aerobic plus resistance training (5-8% weight loss; 19-29% visceral fat reduction; improved insulin, IGF-1, leptin, adiponectin and EORTC QLQ-C30 scores), whereas digital or low-intensity interventions produced smaller, less uniform objective effects despite improving dietary behaviors. GRADE certainty ranged from very low to moderate-high. Conclusions: Multimodal supervised programs offer the most robust benefits; digital formats require additional supervision. Standardized protocols and longer follow-up are needed.
Recent years have seen rapid advances in human epidermal growth factor receptor 2 (HER2)-directed therapies for breast cancer. The shifting therapeutic landscape has presented patients and clinicians with a plethora of effective treatment options, but optimal treatment sequencing can be challenging. Tucatinib is a HER2-selective tyrosine kinase inhibitor that, when given in combination with trastuzumab and capecitabine, has demonstrated survival benefits for patients with HER2-positive (HER2+) metastatic breast cancer (MBC) pretreated with trastuzumab, pertuzumab, and trastuzumab-emtansine. Real-world data, which can supplement knowledge gained from clinical trials, has begun to emerge for tucatinib, but a comprehensive review of these studies has yet to be conducted. A systematic literature review was conducted to identify studies published between January 2020 and January 2025 that evaluated the effectiveness and safety of tucatinib in routine clinical practice. Studies were eligible for inclusion if they utilized real-world data, involved patients with HER2+ MBC treated with tucatinib in any line of metastatic therapy, and assessed tucatinib's effectiveness, health-related quality of life (QoL), patient-reported outcomes (PROs), or safety. Of 468 unique references identified, 12 publications met the inclusion criteria, 3 of which were manuscripts and 9 of which were congress abstracts. Included studies were heterogeneous in sample size, the lines of therapy assessed, and outcomes reported. Tucatinib-based treatment outcomes in the post-trastuzumab deruxtecan (T-DXd) setting and for patients with brain metastases were also reported. Despite variability among studies, outcomes were broadly consistent with clinical trial findings. Overall, the available real-world evidence supports the clinical effectiveness of tucatinib-based therapies in HER2+ MBC, including heavily pretreated populations, patients with prior exposure to T-DXd, and those with brain metastases. However, gaps remain in the real-world data regarding the safety profile of tucatinib and its impact on health-related quality of life in routine clinical practice.
Psychoneurological symptom clusters (PNSCs) are common in patients with ovarian cancer and are associated with reduced quality of life, treatment interruption, and poor prognosis. However, effective interventions for PNSCs remain limited. Traditional Chinese medicine may provide comprehensive benefits for symptom management. This study aims to evaluate the efficacy and safety of the TiaoShenZhiAi (TSZA) regimen in alleviating PNSCs in patients with ovarian cancer and to assess its effects on quality of life and survival outcomes. A total of 316 patients with ovarian cancer aged 18 to 70 years with PNSCs will be included and randomly divided into 2 parallel groups. Both groups will receive standard treatment for ovarian cancer as the basic treatment. The intervention group will receive the TSZA regimen, that is, Compound Ciwujia Granules (containing Acanthopanax senticosus and Schisandra chinensis) combined with psychological intervention. The control group will receive a low-dose active control (simulated Compound Ciwujia Granules) combined with psychological intervention. The primary outcome is the remission rate of PNSCs at 3 months. The secondary outcome measures include the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the revised Piper Fatigue Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 Quality of Life Scale, the traditional Chinese medicine syndrome scale, sleep quality, sleep diary, and the 1-year survival analysis. In addition, this study also includes a series of exploratory indicators (including functional magnetic resonance imaging, biomarkers of peripheral blood and tumor tissue, proportion of immune cells, cytokine levels, hypothalamic-pituitary-adrenal axis function, and immune gene expression analysis) and safety indicators (including vital signs, liver and kidney function, and electrocardiogram). The study outcomes will be evaluated based on different indicators during the treatment period (baseline and the 1st, 2nd, and 3rd mo of enrollment) and the follow-up period (the 6th, 9th, and 12th mo of enrollment). Data analysis will be conducted using R (version 4.5.3) software. A one-sided P value of <.03 will be considered statistically significant. This study is designed to enroll a total of 316 participants. Participant enrollment is set to commence in October 2025, with no recruitment having occurred as of April 2026. The recruitment period will extend until September 2028 or until the target enrollment is met. Data analysis is scheduled for November 2028, with submission of the trial results to a peer-reviewed journal anticipated by May 2029. This study will evaluate the efficacy of the TSZA regimen in managing PNSCs in patients with ovarian cancer and generate clinical evidence for a new therapeutic option that improves quality of life and alleviates the symptom burden.
Breast cancer is the commonest cancer in women, and screening can allow earlier-stage diagnosis. While there are European recommendations on the age-range and frequency of breast cancer screening, participation in these programmes varies substantially, and this could be due to differences in how they are organised and implemented. The role that primary healthcare professionals play in the process is unclear.We aimed to describe the breast cancer screening programmes in European countries and investigate how primary healthcare professionals are involved in this screening process. A cross-sectional survey in 32 countries. Key informants with relevant expertise answered online questions about the characteristics of their screening programmes and general practitioners' (GPs') roles in this. Responses were refined through an iterative consensus process. Data were examined to identify patterns in GP engagement. We found important differences between European breast cancer screening systems. While most had population-based screening, four countries relied on opportunistic screening. In 15 countries GPs had little or no involvement in the process of breast cancer screening, and in 13 countries GPs had some involvement, including identifying eligible patients, issuing referrals, and following-up results. Screening uptake rates tended to be higher in countries with well-established population-based screening programmes which give little or no GP involvement. Few countries linked GP engagement to incentives or performance measures. Countries with lower screening uptake should consider either enhancing GP involvement or transitioning to a structured, population-based screening system. Further research should explore how best to integrate primary care within national screening strategies. Most European countries rely on population-based breast cancer screening.Screening uptake rates are higher in countries with well-established population-based screening programmes which give little or no GP involvement.Countries with lower screening uptake should consider transitioning to a structured, population-based screening system.
People newly diagnosed with breast cancer spend a considerable amount of time researching their diagnosis, treatment options and associated side effects. Even with access to trusted evidence-based information, such as Susan G. Komen's About Breast Cancer pages (https://www.komen.org/breast-cancer/), patients and doctors may struggle to account for the many factors in an individual's diagnosis that influence treatment and outcomes, making it hard to balance the potential benefits of therapy with the risks of side effects on a personalized basis. The discontinuation of the popular adjuvant! Online tool compounded this challenge, creating a need for a new, publicly available tool to provide survival estimates for the U.S. early-stage breast cancer population. Komen collaborated with teams from MD Anderson and Yale Cancer Centers to develop a web-based decision support tool that provides personalized five-year survival estimates for women with early-stage breast cancer. The tool, ASSESS, uses an algorithm developed with U.S.-based SEER data to estimate outcomes for various systemic adjuvant therapies based on an individual's clinical and pathological characteristics. The ASSESS online tool was designed and built by a multidisciplinary team of experts, including scientists, clinicians, website developers and marketing professionals, using an iterative approach to incorporate feedback from breast cancer patient advocates and clinicians. Initial design requirements for ASSESS included a simple, engaging user interface and a public-facing design suitable for clinical use as a shared decision-making tool. It was designed to be responsive and support use on multiple devices, incorporating best practices for communicating risks and offering a summary feature to save and print results. Cognitive interviews with patient advocates and breast cancer clinicians informed the tool's design, resulting in changes that made the interface and output clearer and more accessible to a lay audience. Once finalized, additional usability testing was conducted with patient advocates and breast cancer medical oncologists to ensure the tool was deployed as intended. The ASSESS tool (www.komen.org/assess-tool), which was launched in December 2025, helps providers visually demonstrate outcomes for different treatment options and provides links to accessible information that can be shared with patients for each treatment, including details on how it works, its side effects, and references to the associated expert clinical guidelines. Built using a patient-centered approach, the ASSESS tool supports shared decision-making for people with early-stage breast cancer, helping them make the best individual decisions for their treatment and care.
Randomized trials and international guidelines endorse hypofractionated whole-breast irradiation (HF-WBI) as standard of care for early breast cancer, offering equivalent tumour control with shorter treatment times and reduced system burden. In South Africa, where access and throughput are critical, real-world uptake is particularly relevant. This review evaluates our centre's adoption of HF-WBI and adherence to guideline-based practice. We retrospectively reviewed all breast cancer patients referred for radiotherapy from 2018-2024, stratifying fractionation as conventional WBI (CF-WBI; ~50 Gy/25 fractions), hypofractionation (40.05 Gy/15 or 42.5 Gy/16), and ultra-hypofractionation (≈26 Gy/5). Among those receiving breast-conserving therapy (BCT), we assessed annual HF-WBI adoption, age distribution (<50 vs. ≥50 years), and boost use. Across yearly datasets, HF-WBI increased steadily and substantially. In 2018, HF-WBI accounted for 17/138 CF/HF cases (12.3%). Uptake rose through 2019 (21.0%), 2020 (27.1%), 2021 (43.4%), 2022 (38.6%), 2023 (54.6%), and reached 82.4% in 2024 (103 HF vs. 22 CF). Ultra-hypofractionation (≈26 Gy/5) appeared from 2022 onward at low but increasing levels (e.g., 6 cases in 2024). Boost delivery was used across schedules; HF-WBI frequently included a boost (e.g., 59 cases in 2023; 70 in 2024), indicating protocol flexibility without abandoning shorter courses. Importantly, HF-WBI was used in both younger and older patients (e.g., 2024: <50 y = 32; ≥50 y = 70 within HF cases), reflecting rising clinician confidence across age groups as guideline-concordant practice matured. Our multi-year review demonstrates a decisive transition from conventional to HF breast RT, with HF-WBI becoming the predominant regimen by 2024. Real-world implementation was feasible with sustained boost utilisation and broad age inclusivity, aligning with international guidelines while improving patient convenience and departmental efficiency. Wider adoption of HF-WBI-and selective use of ultra-hypofractionation- can expand equitable access and support service sustainability in resource-constrained health systems. 1. Adopt "HF-by-default" for eligible BCT patients, requiring a documented exception for CF-WBI. 2. Scale a FAST-Forward pathway (≈26 Gy/5) where clinically appropriate with clear selection criteria. 3. Standardise boost indications in HF schedules (e.g., 10-16 Gy in 4-8 fractions). 4. Embed age-agnostic eligibility in MDM checklists to avoid age-based bias against HF. 5. Bundle HF-WBI with DIBH planning QA for left-sided cases to maintain cardiac/lung constraints. 6. Implement a KPI dashboard tracking HF share, median treatment days, boost rate, and re-planning rate. 7. Update patient-facing education to explain HF schedules and boost delivery, improving adherence.
Breast cancer is the most common malignancy among women in Dubai, yet the economic burden of its treatment remains understudied. This study aimed to estimate the direct medical costs of breast cancer care in Dubai in 2024 and to examine variations by encounter type, comorbidity burden, and provider setting. A retrospective cross-sectional analysis of insurance claims was conducted for January-December 2024. Breast cancer cases were identified using International Classification of Diseases, 10th revision, clinical modification codes, and comorbidity burden was assessed using the Charlson comorbidity index (CCI). Costs were analyzed by encounter type (outpatient, inpatient, day case) and by provider setting (clinic/center versus hospital). A Tweedie generalized linear model was applied to evaluate the effect of comorbidities and service characteristics on costs. A total of 8,967 patients (mean age 51.8 years) with 81,248 claims were identified. Outpatient visits constituted 86% of encounters and accounted for 81% of total expenditure (USD 48.7M). Inpatient admissions accounted for 6% of encounters and had the highest mean cost per patient (USD 10,808). The total expenditure was USD 60.0M. Costs increased significantly with comorbidity severity: patients with CCI ≥5 incurred 6.4-fold higher costs compared to those without comorbidities (p<0.0001). Hospital-based care increased costs by 16%, and pharmacy claims contributed an additional 31% to expenditures. Breast cancer treatment in Dubai imposes a substantial economic burden, largely driven by outpatient services, hospital-based care, and medication costs. Comorbidity significantly increases expenditures. These findings highlight the importance of integrated, risk-stratified care pathways and sustainable strategies to optimize resource allocation for breast cancer management in the United Arab Emirates.
The use of patient-reported outcome measures (PROM) can be beneficial in several ways. However, presentations of PROM data from individuals living with, through, or beyond cancer are scarce in the existing scientific literature, and challenges in presenting and interpreting PROM data may be an explanation. Our overall aim was to describe aspects of wellbeing in individuals living with current or previous cancer, 1-2 and 5-6 years after diagnosis. We also aimed to identify vulnerable subgroups of individuals and to facilitate the interpretation of PROM data by combining different presentation forms. Adults in the Southern healthcare region in Sweden with invasive breast, prostate, lung, or colorectal cancer diagnosed 1-2 or 5-6 years ago were invited to a survey using the European Organisation for Research and Treatment of Cancer (EORTC) instrument QLQ-C30 (C30). We analyzed subgroups of respondents using scale scores, clinically anchored problem ranges, and Quality-Adjusted Life Years weights. Moreover, we compared our C30 scores to Swedish general population reference values, EORTC diagnose-specific reference values, and other similar cancer studies. A total of 2,131 individuals responded (26% response rate). The results demonstrate consistent differences in C30 scale scores, where respondents with several comorbidities, younger age, and lung and colorectal cancer diagnoses had poorer scores. Respondents within problem ranges were consistent with the results on scale scores. Quality-Adjusted Life Years weights displayed a generally similar pattern. Our respondents showed no differences on C30 scales compared to the Swedish general population and recent similar studies. There were some differences compared to diagnose-specific reference values and some older similar studies. Aspects of wellbeing varied between subgroups, suggesting potential to develop care for certain patient groups with poorer scores, i.e. the younger age groups and in those with several comorbidities, and individuals diagnosed with lung cancer and colorectal cancer. However, individuals who lived 1-2 or 5-6 years after cancer diagnosis experienced no difference in wellbeing than published results from the Swedish general population. Our different ways of presenting PROM show similar results overall but serve to elucidate different aspects which may contribute to the practice of presenting and interpreting PROM data.
This study aimed to explore the effects of 3 immediate reconstruction methods - prosthesis implantation, latissimus dorsi flap (LDF), or their combination - on postoperative outcomes following breast cancer (BC) surgery. A retrospective, single-center, observational cohort study was conducted on 58 patients with BC who underwent immediate breast reconstruction at our hospital between June 2017 and June 2022. Patients were consecutively enrolled and categorized into 3 groups based on the reconstruction method: simple prosthesis implantation (n = 19), LDF reconstruction (n = 19), and a combination group (prosthesis implantation + LDF, n = 20). Outcomes, including postoperative drainage time, hospital stay duration, Strategies Used by People to Promote Health score, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items score, aesthetic satisfaction, and complication rates, were compared across groups. Statistical analyses were performed using one-way analysis of variance followed by Tukey's honestly significant difference test for continuous variables and chi-square tests for categorical variables, with a significance threshold of P < .05. No significant differences were observed in postoperative drainage time or hospital stay duration among the 3 groups (P > .05). Following surgery, Strategies Used by People to Promote Health and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items scores improved significantly in all groups, with the combination group demonstrating the highest scores, followed by the LDF group, and then the simple prosthesis group (P < .05). Similarly, aesthetic satisfaction (excellent/good rates) was highest in the combination group, followed by the LDF group, and then the simple prosthesis group (P < .05). The overall complication rates did not differ significantly among the groups (P > .05). This study suggests that LDF combined with immediate prosthesis implantation may be an effective option for breast reconstruction after early BC surgery, offering favorable aesthetic outcomes and patient satisfaction. However, further prospective studies with larger sample sizes are warranted to confirm these findings and establish clinical recommendations.
What is the effect of group exercise-based telerehabilitation compared with a single session of in-person assessment and advice on health-related quality of life in cancer survivors? What are the effects on activity, function, safety and cost-effectiveness? An assessor-blinded, pragmatic randomised controlled trial with embedded cost analysis, concealed allocation and intention-to-treat analysis. Adult cancer survivors with any cancer diagnosis who were receiving treatment or within 12 months of treatment completion. The experimental group received an 8-week, twice-weekly, physiotherapist-led exercise group via videoconferencing, supplemented with support resources and a single in-person session of assessment and advice (TeleCaRe). The control group received a single in-person session of exercise assessment and advice. Assessments were completed at baseline, after the intervention (week 9) and at follow-up (week 26). The primary outcome was health-related quality of life, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, at week 9. Secondary measures were walking capacity (6-minute walk test), physical activity (accelerometer), self-efficacy (Health Action Process Approach Questionnaire), adverse events, and health service and cost data. In total, 117 participants were recruited. Their mean age was 59 years, 82 (70%) were female, and 47 (40%) had breast cancer. Participants attended an average of seven out of 16 sessions (SD 6). There were no major adverse events. Intention-to-treat analysis found that TeleCaRe was not superior for improving quality of life (MD -5.3 units, 95% CI -13.3 to 2.6) or any secondary outcomes. TeleCaRe cost AU$363 per participant. Group exercise-based cancer telerehabilitation was safe but attendance was poor. The addition of telerehabilitation to assessment and advice was not superior to a single in-person physiotherapy session alone for improving quality of life. ACTRN12621001417875.
Although advances in systemic therapy have markedly improved survival in breast cancer, treatment-related toxicities remain a major determinant of health-related quality of life (HRQoL). Clinician reports may not fully capture the symptom burden experienced by patients. This study examined the concordance between clinician-reported toxicities and patient-reported symptom scores during adjuvant chemotherapy for early-stage, high-risk breast cancer in a randomized phase III clinical trial. Clinician-reported toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0, and patient-reported symptom scores were obtained with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EORTC QLQ-BR23 questionnaires at mid- and end-of-treatment. Analyses focused on six symptomatic domains with conceptual overlap between CTCAE and EORTC measures: diarrhea, nausea, vomiting, mucositis, pain, and fatigue. Concordance between clinician- and patient-reported scores was evaluated using weighted Cohen's kappa coefficients. A total of 1566 patients with available CTCAE and HRQoL data were included in the analysis. Agreement between clinician-reported toxicities and patient-reported symptom scores was low across all symptoms and time points, with kappa values indicating no to minimal concordance (kappa = 0.07-0.34). Clinician-assigned CTCAE grades were predominantly lower than patient-reported symptom severity. The highest discrepancy rates were observed for fatigue (36%-54%) and pain (23%-38%) across treatment arms and time points. Except for nausea and vomiting, the magnitude of the discrepancy increased from mid- to end-of-treatment in both study arms. Binary analyses comparing the presence of any versus no symptom confirmed persistently low agreement between clinicians and patients (kappa = 0.03-0.35). Clinician-reported toxicities showed poor concordance with patient-reported symptom severity, and the discrepancy increased over time. Incorporating patient-reported assessments into both clinical trials and routine care is essential to ensure more accurate evaluation of treatment tolerability.