Community Outreach and Engagement Strategies to Address Breast Cancer DisparitiesMcNeill, Lorna H.; Wu, Ivan H. C.; Cho, Dalnim; Lu, Qian; Escoto, Kamisha; Harris, Cassandra
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00374-z
Purpose of ReviewBreast cancer disproportionately affects racial/ethnic minority women compared with their non-Hispanic white counterparts. Community-based researchers have long sought to reduce breast cancer-related health disparities using the core principles of community outreach and engagement. The primary goal of this paper is to discuss community outreach and engagement (COE) strategies in the context of breast cancer disparities and discuss evidence-based applications of COE.Recent FindingsEvidence-based COE to address breast cancer disparities include patient navigation, co-development of community-based interventions, advisory boards, and patient boards. Recent strategies have included partnering with the Komen Tissue Bank, the development of culturally tailored expressive writing interventions, and the formation of community scientist and community mentorship programs.SummaryPartnering with the community across all stages of research can help eliminate breast cancer disparities. We find that community outreach and engagement can improve intervention efficacy, clinical trial retention, and community commitment. We hope that this paper will promote greater adoption of evidence-based COE strategies to help eliminate breast cancer disparities.
Psychosocial Issues Associated with Breast Cancer-Related Lymphedema: a Literature ReviewEaton, L. H.; Narkthong, N.; Hulett, J. M.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00376-xpmid: 32864036
Purpose of ReviewBreast cancer-related lymphedema (BCRL) is a chronic disease affecting breast cancer survivors. The purpose of this article is to update the scientific literature regarding psychosocial issues associated with BCRL.Recent FindingsReports describe economic burdens, social support, sexuality, BCRL patient-education needs, and interventions to reduce BCRL symptoms and improve QOL among women with breast cancer. The psychosocial impact of BCRL may differ between younger and older women which has implications for age-related interventions to reduce the adverse psychosocial experiences of women with BCRL. We did not locate studies reporting the psychosocial impact of BCRL on male breast cancer survivors.SummaryMore psychosocial-based interventions are needed that target the concerns of those with BCRL, including age-related needs, sexual concerns, body image, and social support. Future research is indicated to study the psychosocial impact of BCRL among men. Researchers may consider how pandemic-driven health care policies affect the psychosocial needs of those with BCRL.
Pathophysiology of Breast Cancer-Related LymphoedemaPiller, Neil B.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00377-w
Purpose of ReviewTo review the literature regarding the pathophysiological changes found in BCRL and to link them to the cancer and the type and sequencing of treatments and raise attention to the fact that not all parts of the arm at risk or with lymphoedema may have underlying changes which are similar or are progressing at the same rate.Recent FindingsThere still remains a lack of awareness regarding BCRL-related pathophysiology and of the range of reasons for it. Linked to this is a lack of appropriate in-clinic assessment of these changes and of the use of this information to better target and sequence treatment. We are refining and improving our consensus documents related to lymphoedema and the impact of the pathophysiology on its staging which will help in this.SummaryWe should link the pathophysiological changes we find and record with the functional changes which are signs of that underlying structural change through increased use of a range of assessment tools such as indurometry, bio-impedance spectroscopy, tissue dielectric constants, ICG, lympho-scintigraphy, etc. We must better target and sequence our treatments and relate them to our measures of pathophysiological and functional changes.
Drugs and Breast Cancer–Related Lymphoedema (BCRL): Incidence and ProgressionKeeley, Vaughan
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00379-8
Purpose of ReviewWhat is the current evidence for the role of drugs as risk factors for the development of breast cancer–related lymphoedema (BCRL) and in exacerbating existing BCRL? What are the mechanisms by which these effects occur?Recent FindingsThere is now evidence that taking calcium channel blockers (CCBs) during and after breast cancer treatment and receiving docetaxel chemotherapy are risk factors for the development of BCRL. CCBs cause oedema by increasing capillary filtration and docetaxel by inhibiting lymphatic vessel contractions.SummaryIdeally, CCBs should be avoided during and after treatment for breast cancer, but alternative options include changing to CCBs with a lower risk of causing oedema. An awareness of the potential role of medications in increasing the risk of BCRL and exacerbating existing BCRL is important in the appropriate management of patients treated for breast cancer.
Breast Cancer–Related Lymphedema: Personalized Plans of Care to Guide SurvivorshipAnbari, Allison B.; Ostby, Pamela; Ginex, Pamela K.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00380-1
PurposeTo present and discuss care domains (oncologic, cardiometabolic, aging, behavioral, environmental) for clinicians when approaching care for a breast cancer survivor at risk for developing breast cancer–related lymphedema (BCRL), as well as survivors who have been diagnosed with BCRL. Assessment using each domain aids in decision-making, yet also identifies barriers to pursuing personalized care for survivors with BCRL.Recent FindingsBCRL occurs from damage to the lymphatics during breast cancer treatment and occurs in approximately 20 to 40% of survivors. Prospective surveillance and early treatment for BCRL are supported in the literature; however, these approaches are frequently not used within evidence-based recommendations.SummaryThe five domains can be used to develop a personalized plan of BCRL care. Barriers to pursuing personalized care for survivors with BCRL are identified. Future work in developing evidence-based recommendations is needed to guide clinicians and survivors during prospective surveillance, successful risk reduction, early diagnosis, and treatment of BCRL.
Features, Predictors, and Treatment of Breast Cancer–Related LymphedemaZhang, Xiaochen; Oliveri, Jill M.; Paskett, Electra D.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00381-0pmid: 34012502
Purpose of ReviewBreast cancer–related lymphedema (BCRL) is a common sequelae among breast cancer survivors. This review provides updated information on recent studies to prevent, diagnose, and actively treat women with BCRL.Recent FindingsIn total, 63 articles were identified from 2015 and 2020 that assessed incidence, risk factors, surveillance, measurement and definition, treatment, and awareness of BCRL. Depending on the approach and timing of assessment, BCRL incidence rates ranged from 9.1 to 39%. Modified radical mastectomy, number of positive lymph nodes, and postoperative complications were linked to BCRL risk, in addition to chemotherapy, radiation, axillary lymph node dissection, advanced cancer stage, and higher body mass index. Early detection showed favorable BCRL outcomes (e.g., severity, symptoms). Exercise, self-management, complete decongestive therapy, bandaging, and surgery had positive effects on BCRL outcomes.SummaryNumerous gaps exist within BCRL literature, such as the value of self-reported surveillance options to identify BCRL early, measurement strategies, and definitions of BCRL. In terms of policies, efforts are needed to educate providers, patients, payers, and legislators about the need for consensus to reduce the burden of BCRL in women being treated for breast cancer.
Genomic Predictors for Radiation Sensitivity and Toxicity in Breast Cancer—from Promise to RealitySpeers, Corey; Pierce, Lori J.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00382-z
Purpose of ReviewPrecision medicine and personalized treatment recommendations have become standard for systemic therapy decision-making in women with breast cancer. Until recently, however, such opportunities have been lacking for radiation related treatment decisions.Recent FindingsRecent studies have explored the utility of using genomic signatures developed to make systemic therapy recommendations (e.g. Oncotype DX®, ProSigna®, IHC4-C) to guide recommendations for radiation as well. Emerging data suggests that these signatures, while prognostic, may not identify radiation benefit. Radiation-specific signatures are currently under clinical development and may soon be ready for clinical implementation. These classifiers may better be able to determine radiation benefit and detect cancers with intrinsic radiation resistance.SummaryWe are beginning to realize the promise of precision medicine for radiation treatment decisions in women with breast cancer. Previously developed genomic signatures are currently being tested for radiation-related questions, and radiation-specific signatures and radiation toxicity biomarkers are moving into clinical implementation. These advances make clear that genomic classifiers show more than mere promise and will soon allow for personalized radiation recommendations.
Radiation Therapy in the Management of Oligometastatic Breast Cancer: Current Evidence and Future DirectionsTurchan, William Tyler; Chmura, Steven J.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00383-y
Purpose of ReviewTo review the role of radiation therapy and specifically metastasis-directed stereotactic body radiation therapy (SBRT) in the management of patients with oligometastatic breast cancer with emphasis on potential toxicities and future directions.Recent FindingsRecent prospective studies have demonstrated encouraging initial results indicating the potential efficacy of metastasis-directed SBRT in the management of patients with oligometastatic disease. However, given potentially significant toxicities associated with metastasis-directed SBRT, additional data in the form of phase III randomized control trials are needed to define the role of SBRT in the management of patients with oligometastatic breast cancer; such studies are currently ongoing.SummaryWhile current data are encouraging, additional data are required to determine the benefit of SBRT in patients with oligometastatic breast cancer. Physicians opting to treat patients with metastasis-directed SBRT should ideally do so on protocol.
Accelerated Partial Breast Irradiation (APBI): Where Are We Now?Goldberg, Mira; Whelan, Timothy J.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00384-xpmid: 33101597
Purpose of ReviewAccelerated partial breast irradiation (APBI) is an alternative approach to breast conserving therapy (BCT) where radiation (RT) is delivered over a shorter period of time compared with whole breast irradiation (WBI), resulting in improved patient convenience and cost savings. APBI can be delivered using brachytherapy, intraoperative RT, or conformal external beam radiation therapy (EBRT) techniques. In this review, the authors appraise the latest modern randomized controlled trials (RCTs) of APBI and discuss the application of the data to clinical practice.Recent FindingsThe OCOG-RAPID and NSABP B-39/RTOG 0413 trials recently reported long-term outcomes of APBI. The OCOG-RAPID trial delivered 38.5 Gy/10 fractions twice daily (at least 6 h apart using EBRT) or WBI and demonstrated non-inferiority of APBI compared with WBI (8-year cumulative rate of ipsilateral breast tumor recurrence (IBTR) was 3% after APBI or 2.8% after WBI, HR 1.27, 90%CI: 0.84–1.91). While acute toxicity was reduced, late toxicity and breast cosmesis were worse with APBI. The NSABP B-39 trial included higher risk patients and was unable to demonstrate equivalence between APBI (38.5 Gy/10 fractions delivered twice daily using EBRT or brachytherapy techniques) and WBI. However, 10-year IBTR rates were low: 4.6% vs. 3.9%, respectively, HR 1.22, 90%CI: 0.94–1.58. The University of Florence demonstrated low rates of local recurrence at 10 years and overall excellent breast cosmetic outcomes when APBI was delivered using EBRT to a dose of 30 Gy/5 fractions delivered on non-consecutive days.SummaryRecent RCTs of APBI have shed light on important factors for the integration of APBI into clinical practice, including patient selection and treatment delivery. APBI should be limited to patients with low-risk ductal carcinoma in situ or early stage (T1) invasive ductal cancer with clear margins of excision, estrogen receptor positivity, and node negative disease. Ongoing research should focus on the optimal dose/fractionation for delivery of EBRT-based APBI.
New Frontiers in Hypofractionation for Regional Nodal Irradiation in Breast CancerOladeru, Oluwadamilola T.; Dunn, Samantha A.; Vanbenthuysen, Liam T.; Depauw, Nicolas; Ho, Alice Y.
2020 Current Breast Cancer Reports
doi: 10.1007/s12609-020-00385-w
Purpose of ReviewIn recent years, there have been a number of small, yet notable practice changes in the delivery of postmastectomy radiation therapy (PMRT) in breast cancer patients. Herein, we describe the role of PMRT and its evolving delivery with hypofractionated regimens.Recent FindingsThe UK START trials and whole-breast hypofractionation studies established the safety and effectiveness of accelerated radiotherapy. This has inspired further investigations of similar principles in patients with reconstruction, acute and late toxicities associated with hypofractionated regimens, socioeconomic benefit, and evolving delivery techniques.SummaryOverall, results from clinical trials evaluating hypofractionation for RNI or PMRT appear promising despite the limited length of follow-up. Ongoing clinical trials will provide valuable data on the safety of hypofractionation in breast cancer patients with immediate reconstruction. Hypofractionation for PMRT represents high-quality care that is not only more convenient for patients but also more cost-effective for the healthcare system.