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Revista Brasileira de Ginecologia e Obstetrícia. 12-04-2024;46:e-rbgo93
, , , , , , , To analyze the prognosis of patients with breast cancer who developed trastuzumab-induced cardiotoxicity and to analyze factors associated with and resulting from cardiotoxicity.
This was a retrospective cohort study that included 255 HER2-positive breast cancer patients who received adjuvant trastuzumab therapy. The inclusion criteria were a diagnosis of HER2-positive breast cancer and adjuvant trastuzumab therapy; disease stage I-III; <70 years; and a baseline echocardiogram showing a left ventricular ejection fraction (LVEF) ≥ 55%. The Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model were used.
In all, 15.3% (39/255) of patients presented with cardiotoxicity. Treatment was suspended in 92.3% (36/39) of patients who presented with cardiotoxicity during trastuzumab treatment. The treatment was suspended in 46 of 255 patients and it was permanently interrupted in 84.8% (33/46) of these patients, with 84.8% (28/33) due to cardiotoxicity. Cardiotoxicity was not associated with disease-free survival (DFS) (hazard ratio (HR) = 1.48; 95% confidence interval (CI = 0.79-2.78) or overall survival (OS) (HR = 1.68; 95%CI= 0.83-3.41). Patients with clinical stage III and whom trastuzumab therapy was suspended (all causes) had worse DFS; (HR = 3.19; 95% CI=1.77-5.74) and (HR = 1.83; 95% CI=1.01-3.32) respectively. Those with clinical stage III and whom trastuzumab therapy was permanently interrupted had worse OS; (HR = 3.80; 95% CI =1.82-7.94), and (HR = 2,26; 95% CI =1.09-4.68 respectively.
Cardiotoxicity was not associated with DFS or OS. Clinical stage III, Suspension and permanent interruption of treatment regardless of the cause were associated with worse DFS and OS in breast cancer patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 12-04-2024;46:e-rbgo93
, , , , , , , To analyze the prognosis of patients with breast cancer who developed trastuzumab-induced cardiotoxicity and to analyze factors associated with and resulting from cardiotoxicity.
This was a retrospective cohort study that included 255 HER2-positive breast cancer patients who received adjuvant trastuzumab therapy. The inclusion criteria were a diagnosis of HER2-positive breast cancer and adjuvant trastuzumab therapy; disease stage I-III; <70 years; and a baseline echocardiogram showing a left ventricular ejection fraction (LVEF) ≥ 55%. The Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model were used.
In all, 15.3% (39/255) of patients presented with cardiotoxicity. Treatment was suspended in 92.3% (36/39) of patients who presented with cardiotoxicity during trastuzumab treatment. The treatment was suspended in 46 of 255 patients and it was permanently interrupted in 84.8% (33/46) of these patients, with 84.8% (28/33) due to cardiotoxicity. Cardiotoxicity was not associated with disease-free survival (DFS) (hazard ratio (HR) = 1.48; 95% confidence interval (CI = 0.79-2.78) or overall survival (OS) (HR = 1.68; 95%CI= 0.83-3.41). Patients with clinical stage III and whom trastuzumab therapy was suspended (all causes) had worse DFS; (HR = 3.19; 95% CI=1.77-5.74) and (HR = 1.83; 95% CI=1.01-3.32) respectively. Those with clinical stage III and whom trastuzumab therapy was permanently interrupted had worse OS; (HR = 3.80; 95% CI =1.82-7.94), and (HR = 2,26; 95% CI =1.09-4.68 respectively.
Cardiotoxicity was not associated with DFS or OS. Clinical stage III, Suspension and permanent interruption of treatment regardless of the cause were associated with worse DFS and OS in breast cancer patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-01-2015;37(4):152-158
DOI 10.1590/SO100-720320150005282
To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil.
A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms.
The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 04-01-2015;37(4):152-158
DOI 10.1590/SO100-720320150005282
To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil.
A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms.
The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-25-2014;36(4):157-162
DOI 10.1590/S0100-720320140050.0002
It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).
This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).
Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.
These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-25-2014;36(4):157-162
DOI 10.1590/S0100-720320140050.0002
It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).
This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).
Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.
These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 01-18-2013;35(1):10-15
DOI 10.1590/S0100-72032013000100003
PURPOSES: To investigate the effect of an individualized and supervised exercise program for the pelvic floor muscles (PFM) in the postpartum period of multiparous women, and to verify the correlation between two methods used to assess PFM strength. METHODS: An open clinical trial was performed with puerperal, multiparous women aged 18 to 35 years. The sample consisted of 23 puerperal women divided into two groups: Intervention Group (IG, n=11) and Control Group (CG, n=12). The puerperal women in IG participated in an eight-week PFM exercise program, twice a week. The puerperal women in CG did not receive any recommendations regarding exercise. PFM strength was assessed using digital vaginal palpation and a perineometer. The statistical analysis was performed using the following tests: Fisher's exact, c², Student's t, Kolmogorov-Smirnov for two samples, and Pearson's correlation coefficient. Significance was defined as p<0.05. RESULTS: The participants' mean age was 24±4.5 years in IG and 25.3±4 years in CG (p=0.4). After the exercise program, a significant difference was found between the groups in both modalities of muscle strength assessment (p<0.001). The two muscle strength assessment methods showed a significant correlation in both assessments (1st assessment: r=0.889, p<0.001; 2nd assessment: r=0.925, p<0.001). CONCLUSIONS: The exercise program promoted a significant improvement in PFM strength. Good correlation was observed between digital vaginal palpation and a perineometer, which indicates that vaginal palpation can be used in clinical practice, since it is an inexpensive method that demonstrated significant correlation with an objective method, i.e. the use of a perioneometer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 01-18-2013;35(1):10-15
DOI 10.1590/S0100-72032013000100003
PURPOSES: To investigate the effect of an individualized and supervised exercise program for the pelvic floor muscles (PFM) in the postpartum period of multiparous women, and to verify the correlation between two methods used to assess PFM strength. METHODS: An open clinical trial was performed with puerperal, multiparous women aged 18 to 35 years. The sample consisted of 23 puerperal women divided into two groups: Intervention Group (IG, n=11) and Control Group (CG, n=12). The puerperal women in IG participated in an eight-week PFM exercise program, twice a week. The puerperal women in CG did not receive any recommendations regarding exercise. PFM strength was assessed using digital vaginal palpation and a perineometer. The statistical analysis was performed using the following tests: Fisher's exact, c², Student's t, Kolmogorov-Smirnov for two samples, and Pearson's correlation coefficient. Significance was defined as p<0.05. RESULTS: The participants' mean age was 24±4.5 years in IG and 25.3±4 years in CG (p=0.4). After the exercise program, a significant difference was found between the groups in both modalities of muscle strength assessment (p<0.001). The two muscle strength assessment methods showed a significant correlation in both assessments (1st assessment: r=0.889, p<0.001; 2nd assessment: r=0.925, p<0.001). CONCLUSIONS: The exercise program promoted a significant improvement in PFM strength. Good correlation was observed between digital vaginal palpation and a perineometer, which indicates that vaginal palpation can be used in clinical practice, since it is an inexpensive method that demonstrated significant correlation with an objective method, i.e. the use of a perioneometer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-23-2010;32(5):247-253
DOI 10.1590/S0100-72032010000500008
PURPOSE: to compare the quality of life (QL) of women with and without chronic pelvic pain (CPP) and to investigate the factors associated with QL in women with CPP. METHODS: a cross-sectional study was conducted on 30 women with CPP and 20 women without CPP. Sociodemographic and clinical characteristics were evaluated. QL was investigated by applying the SF-36 questionnaire, which contains eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. These domains can be summarized into two groups: physical component summary (PCS) and mental component summary (MCS). Pain intensity was investigated by applying the visual analogue scale. Linear regression analysis was used to compare QL scores between women with and without CPP and to identify factors associated with the QL of women with CPP. RESULTS: the mean age of women with and without CPP was 35.2±7.5 and 36±9.3 years (p=0.77), respectively. Women with CPP had a lower monthly family income (p=0.04) and a higher prevalence of dysmenorrhea (87 versus 40%; p<0.01) and depression (30 versus 5%; p=0.04) compared to women without CPP. Adjusted analysis for potential confounding variables revealed that women with CPP had lower QL scores in the pain (p<0.01) and social aspects (p<0.01) domains. Depression was negatively associated with the emotional aspects domain (p=0.05) and with the MCS (p=0.03), while pain intensity was negatively related to the pain domain (p<0.01) of the QL of women with CPP. CONCLUSIONS: women with CPP presented a worse QL compared to women without CPP. Depression and pain intensity were negatively related to the QL of women with CPP. Thus, the evaluation and treatment of pain and depressive symptoms must be among the priorities that aim to improve the QL of women with CPP.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-23-2010;32(5):247-253
DOI 10.1590/S0100-72032010000500008
PURPOSE: to compare the quality of life (QL) of women with and without chronic pelvic pain (CPP) and to investigate the factors associated with QL in women with CPP. METHODS: a cross-sectional study was conducted on 30 women with CPP and 20 women without CPP. Sociodemographic and clinical characteristics were evaluated. QL was investigated by applying the SF-36 questionnaire, which contains eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. These domains can be summarized into two groups: physical component summary (PCS) and mental component summary (MCS). Pain intensity was investigated by applying the visual analogue scale. Linear regression analysis was used to compare QL scores between women with and without CPP and to identify factors associated with the QL of women with CPP. RESULTS: the mean age of women with and without CPP was 35.2±7.5 and 36±9.3 years (p=0.77), respectively. Women with CPP had a lower monthly family income (p=0.04) and a higher prevalence of dysmenorrhea (87 versus 40%; p<0.01) and depression (30 versus 5%; p=0.04) compared to women without CPP. Adjusted analysis for potential confounding variables revealed that women with CPP had lower QL scores in the pain (p<0.01) and social aspects (p<0.01) domains. Depression was negatively associated with the emotional aspects domain (p=0.05) and with the MCS (p=0.03), while pain intensity was negatively related to the pain domain (p<0.01) of the QL of women with CPP. CONCLUSIONS: women with CPP presented a worse QL compared to women without CPP. Depression and pain intensity were negatively related to the QL of women with CPP. Thus, the evaluation and treatment of pain and depressive symptoms must be among the priorities that aim to improve the QL of women with CPP.
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Revista Brasileira de Ginecologia e Obstetrícia. 08-25-2006;28(3):195-204
DOI 10.1590/S0100-72032006000300010
Breast cancer is one of the most common malignancies among women. Its diagnosis and treatment have social, economic, physical, emotional/psychological and sexual repercussions. The main parameters used to assess the results of anticancer therapy are disease-free survival and overall survival. More recently, quality of life (QOL) has been considered an additional parameter. No consensus exists about the definition of QOL. However, most definitions take into account multidimensional and subjective aspects of QOL. The identification of factors related to QOL and comprehension of how these factors contribute to the perception of QOL are reasons for debate, since the concept of QOL is directly related to the social and cultural context in which the individual is inserted. Age at diagnosis, chemotherapy, type of surgery, climacteric symptoms, relationship between the couple, and sexuality are several factors associated with QOL in women with breast cancer. QOL associated with different antineoplastic therapies may help patients and physicians choose the best therapeutic modality. Towards this end, the current article addresses various aspects of QOL of breast cancer women, and presents the state-of-the-art knowledge on the topic.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 08-25-2006;28(3):195-204
DOI 10.1590/S0100-72032006000300010
Breast cancer is one of the most common malignancies among women. Its diagnosis and treatment have social, economic, physical, emotional/psychological and sexual repercussions. The main parameters used to assess the results of anticancer therapy are disease-free survival and overall survival. More recently, quality of life (QOL) has been considered an additional parameter. No consensus exists about the definition of QOL. However, most definitions take into account multidimensional and subjective aspects of QOL. The identification of factors related to QOL and comprehension of how these factors contribute to the perception of QOL are reasons for debate, since the concept of QOL is directly related to the social and cultural context in which the individual is inserted. Age at diagnosis, chemotherapy, type of surgery, climacteric symptoms, relationship between the couple, and sexuality are several factors associated with QOL in women with breast cancer. QOL associated with different antineoplastic therapies may help patients and physicians choose the best therapeutic modality. Towards this end, the current article addresses various aspects of QOL of breast cancer women, and presents the state-of-the-art knowledge on the topic.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-28-2005;27(8):502-502
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-28-2005;27(8):502-502