Local Tissue Water in At-Risk and Contralateral Forearms of Women with and without Breast Cancer Treatment-Related Lymphedema

Published Online:24 Sep 2009

Background: Quantitative measurements to help detect incipient or latent lymphedema in patients at risk for breast cancer treatment-related lymphedema (BCRL) are potentially useful supplements to clinical assessments. Suitable measurements for routine use include arm volumes, arm bioimpedance, and local tissue water (LTW) determined from the tissue dielectric constant (TDC). Because BCRL initially develops in skin and subcutis, measures that include whole arms may not be optimally sensitive for detecting the earliest changes. Thus, there is also a need for a local measurement in which tissues most likely to demonstrate early lymphedematous changes can be more selectively assessed. The TDC method satisfies this criterion. Our goal was to use this method to compare arm-to-arm differences in LTW within and among women grouped as healthy normal (HN), diagnosed with breast cancer (BC), but prior to surgery and established unilateral lymphedema (LE).

Conclusions: The findings indicate that LTW of at-risk arms is not affected by breast cancer and that lymphedema does not significantly affect LTW of contralateral arms as measured with the TDC method. Further, based on the standard deviation of measured arm ratios, an at-risk/contralateral TDC ratio of 1.26 is suggested as a possible threshold for detecting preclinical or latent lymphedema.

https://www.liebertpub.com/doi/abs/10.1089/lrb.2009.0008

https://doi.org/10.1089/lrb.2009.0008

{May require subscription to access full article.}

Compound found in red wine opens door for new treatments for depression, anxiety

Resveratrol, found in grape skin, shuts down depression-causing enzyme in brain

Date:

July 29, 2019

Source:

University at Buffalo

Summary:

A new study has revealed that the plant compound resveratrol, which is found in red wine, displays anti-stress effects by blocking the expression of an enzyme related to the control of stress in the brain.

https://www.sciencedaily.com/releases/2019/07/190729094553.htm

http://www.buffalo.edu/news/releases/2019/07/032.html

{Not strictly BC but potentially related to SE's. As the article notes, consumption of alcohol carries various health risks, including addiction.}

Adding reference for journal article:

The antidepressant- and anxiolytic-like effects of resveratrol: Involvement of phosphodiesterase-4D inhibition

https://www.sciencedirect.com/science/article/pii/S002839081930139X?via%3Dihub

https://doi.org/10.1016/j.neuropharm.2019.04.022

Surviving Cancer Costs

One in 4 cancer survivors struggles to pay medical bills and 1 in 3 worries about medical bills, according to a CDC report.

{Brief commentary on the financial toxicity of cancer and link to CDC study on the topic.}

https://jamanetwork.com/journals/jama/fullarticle/2738563

doi:10.1001/jama.2019.9666

https://www.cdc.gov/mmwr/volumes/68/wr/mm6822a2.htm?s_cid=mm6822a2_w

CLEOPATRA End-of-Study Analysis in Metastatic Breast Cancer: 37% Alive at 8 Years

The end-of-study analysis of the landmark CLEOPATRA trial shows that 37% of patients with HER2-positive metastatic breast cancer are still alive at 8 years... The unprecedented overall survival improvement earlier shown with a first-line regimen of pertuzumab, trastuzumab, and docetaxel was maintained after an additional 4 years of long-term follow-up, as were the safety and cardiac safety profiles, she reported.

"These are 'knock-your-socks-off' data! There's never been another study in metastatic breast cancer to show anywhere near this kind of survival benefit with this length of follow-up," "As of November 2018, the data cutoff, 59 patients are still on study and have not progressed. It's a possibility—though I hesitate to use the word—that these patients are cured," she commented.

"These are spectacular results. Over one-third of patients who would have died years ago without HER2-targeted treatment are now alive at 8 years. The question now is when to stop treatment?" Dr. Swain said. "As of November, many patients were still on HER2-targeted treatment in this trial, and we see the same thing in our clinical practices. Patients often don't want to stop treatment."

https://www.ascopost.com/issues/july-10-2019/cleopatra-end-of-study-analysis-in-metastatic-breast-cancer/?fbclid=IwAR0Y2Aoylr6yPFYKJGmNpusWzXCuwHwJxNeTxXsSKkB_GaEmcfKLqT2RqQI

How Are States Dealing With Challenges Facing Patients With Cancer?

High costs of care, particularly for prescription drugs, dominated a discussion of cancer care at the state level during the June 27, 2019, National Comprehensive Cancer Network Policy Summit in Washington, DC.

July 31, 2019

https://www.ajmc.com/focus-of-the-week/how-are-states-dealing-with-challenges-facing-patients-with-cancer

Wanderingneedle: Thanks for the link to the LA Times article. Sharing the general theme:

"...we published a research letter in JAMA Internal Medicine summarizing industry payments to the 53 physicians who direct major academic cancer centers across the United States. These are the nation's most prominent cancer centers, those designated by the National Cancer Institute in recognition of their scientific leadership.... About a third of all directors...{received industry payments in 2017} above {$5,000} – typically receiving payments for research and consulting. A few were well above it (one had payments exceeding $2 million)."

The data are public and available to anyone with an internet connection.

{The article goes on to discuss the conflicts of interest that this situation creates given that these centers conduct clinical trials.}

"The public has an interest in the unbiased evaluation of new products....Industry-funded evaluations are more likely to reach pro-industry conclusions."

https://www.latimes.com/opinion/story/2019-08-05/directors-cancer-centers-money-drug-companies

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740204

doi:10.1001/jamainternmed.2019.3098

Decreased CTCs/ctDNA Post-Chemo Prognostic in Advanced Breast Ca

Clearance of both associated with improved outcomes, largest prospective cohort assessing the two shows

New data from the French cohort COMET study, presented at the 2019 ASCO annual meeting, evaluated the role of circulating tumor cells (CTCs) and circulating tumor (ct) DNA in predicting patient outcome to first-line treatment...While more data are needed, this study suggests the feasibility and importance of CTC/ctDNA testing in guiding chemotherapy choices in breast cancer patients. Additionally, it highlights the need for further quantification of CTC/ctDNA to assess tumor response to treatment, and the need for use of both serum markers in the measurement of tumor aggressiveness.

https://www.medpagetoday.com/reading-room/asco/breast-cancer/81445?xid=nl_mpt_DHE_2019-08-07&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-08-07&utm_term=NL_Daily_DHE_Active

Primary Source

Journal of Clinical Oncology

Source Reference: Pierga Y-V, et al "Multimodality liquid biopsy for early monitoring and outcome prediction in first-line metastatic HER2-negative breast cancer: Final results of the prospective cohort from the French Breast Cancer InterGroup Unicancer (UCBG) -- COMET study" J Clin Oncol 2019; 37 (suppl; abstr 3019).

There Is Such Thing as a Too-High LVEF

Study suggests sweet spot and proposes fourth left ejection phenotype

Higher is not necessarily better when it comes to left ventricular ejection fraction (LVEF), according to a retrospective study.

Compared with an LVEF of 60-65%, both reduced and elevated LVEFs were associated with worse all-cause mortality that persisted after multivariable adjustment...

https://www.medpagetoday.com/cardiology/pci/81479?xid=nl_mpt_DHE_2019-08-08&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-08-08&utm_term=NL_Daily_DHE_Active

Primary Source

European Heart Journal

Source Reference: Wehner GJ, et al "Routinely reported ejection fraction and mortality in clinical practice: Where does the nadir of risk lie?" Eur Heart J 2019; DOI: 10.1093/eurheartj/ehz550.

{Those of use who get regular echos may have wondered....}