The optimal time to initiation of adjuvant chemotherapy (TTAC) for triple negative breast cancer (TNBC) patients is unclear. This study evaluates the association between TTAC and survival in TNBC patients.We conducted a retrospective study using data from a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018, registered in the Tumor Centre Regensburg was conducted. Data included demographics, pathology, treatment, recurrence and survival. TTAC was defined as days from primary surgery to first dose of adjuvant chemotherapy. The Kaplan-Meier method was used to evaluate impact of TTAC on overall survival (OS) and 5-year OS.A total of 245 TNBC patients treated with adjuvant chemotherapy and valid TTAC data were included. Median TTAC was 29 days. The group receiving systemic therapy within 22 to 28 days after surgery had the most favorable outcome, with median OS of 10.2 years. Groups receiving systemic therapy between 29-35 days, 36-42 days, and more than 6 weeks after surgery had significantly decreased median survival, with median OS of 8.3 years, 7.8 years, and 6.9 years, respectively. Patients receiving therapy between 22-28 days had significantly better survival compared to those receiving therapy between 29-35 days (p = 0.043), and patients receiving therapy after 22-28 days also demonstrated significantly better survival compared to those receiving therapy after more than 43 days (p = 0.033).Timing of adjuvant systemic therapy can influence OS in TNBC patients. Efforts should be made to avoid unnecessary delays in administering chemotherapy to ensure timely initiation of systemic therapy and optimize patient outcomes. 

Clinical impact of delaying initiation of adjuvant chemotherapy in patients with early triple negative breast cancer.

Abstract Background Few measurements of fatigue and quality of life have been performed during neoadjuvant chemotherapy of early breast cancer. This study evaluates fatigue and quality of life experienced by early breast cancer patients during neoadjuvant chemotherapy and their association with different clinical parameters. Methods Fifty-four stage I–III patients’ responses to the Multidimensional Fatigue Inventory (MFI) and to the Functional Assessment of Cancer Therapy-Breast (FACT-B) were analyzed by a linear covariance pattern model. Chemotherapy regimen, age, baseline fatigue level, body-mass-index and cancer stage were added to the model to estimate their impact on both outcomes. Results All fatigue dimensions worsened in clinically relevant levels. Physical fatigue worsened the most, mental fatigue the least. For quality of life, physical and functional well-being worsened the most. Only emotional well-being improved during chemotherapy. Physical well-being worsened more during standard than during dose-dense chemotherapy, and more during anthracycline than during taxane cycles. Age, body-mass-index and cancer stage had no impact. The higher the fatigue levels at baseline, the less they worsened during chemotherapy. Conclusions Further actions to reduce fatigue and improve quality of life during neoadjuvant chemotherapy of early breast cancer are needed. Focus should be laid on the physical dimension. Future research should also investigate the impact of different chemotherapy sequences and densities on fatigue and quality of life. Study registration The study was registered in the German Clinical Trials Register in May 2019 (DRKS00016761). 

Fatigue and quality of life during neoadjuvant chemotherapy of early breast cancer: a prospective multicenter cohort study.

Forschung in zertifizierten Zentren

Diese Ausgabe des Versorgungs-Reports widmet sich schwerpunktmäßig der Bedeutung von medizinischen Leitlinien in der Gesundheitsversorgung. Leitlinien geben den Behandelnden diagnostische und therapeutische Empfehlungen an die Hand. Sie werden nach systematischen und evidenzbasierten Kriterien entwickelt und zielen darauf ab, die Versorgungsqualität für Patientinnen und Patienten zu verbessern. Als Patientenleitlinien nehmen sie Einfluss auf die Gesundheitskompetenz der Bevölkerung. Ihre Umsetzung im Versorgungsalltag ist herausfordernd. Die Expertenbeiträge im Versorgungs-Report setzen sich umfassend mit der Praxis von Leitlinien auseinander. Sie beschreiben Methodik und Verfahren zur Erstellung vertrauenswürdiger Leitlinien sowie zu ihrer Evaluation. Sie berichten über die Ergebnisse empirischer Untersuchungen zur Umsetzung von Leitlinienempfehlungen in der realen Versorgung und stellen praxisorientiert Versorgungsstrukturen und konkrete Vertragsmodelle zur Förderung der Leitlinienanwendung vor. Der Teil „Daten und Analysen“ berichtet auf Basis von AOK-Abrechnungsdaten über die Häufi gkeit von Erkrankungen und Behandlungen in Deutschland und nimmt dabei die Auswirkungen der Pandemie in den Blick. Weitere Daten zu Behandlungshäufigkeiten von mehr als 1.500 Krankheiten stehen unter www.mwv-open.de zur Verfügung. 

https://www.mwv-open.de/site/books/10.32745/9783954668007/download/9414/

Versorgungs-Report. Leitlinien – Evidenz für die Praxis

https://link.springer.com/content/pdf/10.1007/s12312-021-00953-w.pdf

Nationale Dekade gegen Krebs – Wissen generierende Versorgung: Was wird für die Zukunft benötigt?

Neoadjuvant chemotherapy (NACT) is frequently used in patients with early breast cancer. Randomized controlled trials have demonstrated similar survival after NACT or adjuvant chemotherapy (ACT). However, certain subtypes may benefit more when NACT contains regimes leading to high rates of pathologic complete response (pCR) rates. In this study we analyzed data using the OncoBox research from 94,638 patients treated in 55 breast cancer centers to describe the current clinical practice of and outcomes after NACT under routine conditions. These data were compared to patients treated with ACT. 40% of all patients received chemotherapy. The use of NACT increased over time from 5% in 2007 up to 17.3% in 2016. The proportion of patients receiving NACT varied by subtype. It was low in patients with HR-positive/HER2-negative breast cancer (5.8%). However, 31.8% of patients with triple-negative, 31.9% with HR-negative/HER2-positive, and 26.5% with HR-positive/HER2-positive breast cancer received NACT. The rates of pCR were higher in patients with HR-positive/HER2-positive, HR-negative/HER2-positive and triple-negative tumors (36, 53 and 38%) compared to HR-positive/HER2-negative tumors (12%). PCR was achieved more often in HER2-positive and triple-negative tumors over time.This is the largest study on use and effects of NACT in German breast cancer centers. It demonstrates the increased use of NACT based on recommendations in current clinical guidelines. An improvement of pCR was shown in particular in HER2-positive and triple-negative breast cancer, which is consistent with data from randomized controlled trails. 

/pdf/current-clinical-practice-and-outcome-of-neoadjuvant-29xdr51q.pdf

Current clinical practice and outcome of neoadjuvant chemotherapy for early breast cancer: analysis of individual data from 94,638 patients treated in 55 breast cancer centers

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Current clinical practice and outcome of neoadjuvant chemotherapy for early breast cancer: analysis of individual data from 94,638 patients treated in 55 breast cancer centers