乳腺癌患者随访的相关因素分析

随访是指医疗、科研工作中，为定期或不定期了解某些门诊患者或出院患者在院期间医疗处理的了贞后情况、健康恢复情况、远期疗效及新技术临床应用效果，采取的家庭访视及预约到某医疗机构进行复诊检查或者用通讯方式了解病情的手段。癌症患者随访是病案工作巾必不可少的重要部分。通过对癌症患者的随访，可以了解患哲出院后的生存情况、远期疗效、肿瘤的复发转移情况及心理因素等信息，不断从中总结疾病的发生、发展、治疗、预后的变化和规律，从而提高医疗、科研、教学质量，加强医患沟通，更好的为患者服务.通过对本院2003～2006年812例乳腺癌手术后患者采用多种方式进行随访，以便总结经验，发现一些影响随访率的因素，提出提高随访率的方法。     

三阴性乳腺癌5年随访

Objective: The aim of the study was to investigate the long-term therapeutic effects of triple negative breast cancers (TNBCs) and find a standardized treatment. Methods: The clinical data and survival status of 69 patients with TNBC were collected, who were treated from 2003 to 2007 at Chongqing Cancer Institute, China. Results: Median observation for 61 months showed the local recurrence rate was 13.0% (9/69), the overall survival (OS) rate was 76.8% (53/69) and the disease free survival (DFS) rate was 59...     

中医药可以减轻乳腺癌化疗的副作用

目前乳腺癌常用化疗方案是以蒽环类药物为主的AC(阿霉素 环磷酰胺)或CAF(环磷酰胺 阿霉素 氟尿嘧啶),以及CMF方案(环磷酰胺 甲氨喋呤 氟尿嘧啶).近年来抗癌新药紫杉醇和多西紫杉醇、去甲长春花碱与阿霉素或顺铂组成的方案也广泛用于术后及进展期乳腺癌的临床研究,显示出较好的疗效及预后.     

乳腺癌基因学变化和相关药物研究进展

乳腺癌是一类与基因学变化密切相关的恶性肿瘤。研究表明，在乳腺癌的发生，发展过程中癌基因，抑癌基因，雌激素孕激素受体基因，雌激素调节蛋白基因，生长因子受体基因，细胞分裂的相关基因等均有不同程度变化。针对这些基因学改变采用相应药物干预方法也证明有助于乳腺癌的预后。综述近年乳腺癌发病过程中的基因学变化及一些相关药物研究进展。     

乳腺癌基因学变化和相关药物研究进展

乳腺癌是一类与基因学变化密切相关的恶性肿瘤。研究表明,在乳腺癌的发生、发展过程中癌基因、抑癌基因、雌激素孕激素受体基因、雌激素调节蛋白基因、生长因子受体基因、细胞分裂相关基因等均有不同程度变化。针对这些基因学改变采用相应药物干预方法也证明有助于乳腺癌的预后。综述近年乳腺癌发病过程中的基因学变化及一些相关药物研究进展。     

乳腺癌心理干预的研究进展

乳腺癌患者多有不同程度的心理异常,由于其心理状态可影响到自身的预后和生活质量,对乳腺癌患者进行心理行为干预便成为癌症治疗的组成部分。该文对目前有关国内外乳腺癌心理干预的文献作一综述,旨在探讨乳腺癌心理干预的方式及其疗效。     

乳腺癌患者长期管理策略研究

为了探讨乳腺癌患者长期管理的意义和影响因素及管理策略,对康复期乳腺癌患者面临的主要问题及影响长期管理的因素进行分析,同时对乳腺癌患者心理康复俱乐部"汝康沙龙"的实践经验进行阶段性总结.初步研究的结果发现,乳腺癌康复期患者面临着后继治疗不足及治疗依从性不好、复发监测不规范、心理障碍等影响乳腺癌患者长期管理效果的问题.良好的长期管理策略对于患者长期治疗依从性的提高,转移复发的系统监测,患者身心的完满康复都有积极的意义.而建立一个完善的、富有成效的乳腺癌患者康复组织,将有助于乳腺癌患者长期管理目标的实现.     

他莫昔芬治疗乳腺癌的副作用

他莫昔芬(ｔａｍｏｘｉｆｅｎ,ＴＡＭ)为非甾体类抗雌激素药物。长期服用ＴＡＭ可使乳腺癌患者的生存期延长,乳腺癌复发减少,对侧乳腺癌的发生率降低。在多数大规模的临床试验中,参加者多能耐受ＴＡＭ的标准治疗剂量,但是有关ＴＡＭ在治疗乳腺癌过程对眼、肝脏、卵巢、骨?..     

单核苷酸多态与乳腺癌治疗反应相关研究进展

单核苷酸多态(SNP)指基因组DNA序列中频率大于1%的单核苷酸变异。这种变异有时导致其编码不同的蛋白从而引起生物学特征的变化,在乳腺癌的治疗上表现为不同患者出现不同的治疗反应和毒性。研究不同基因的SNP与乳腺癌治疗反应的相关性可以为实现乳腺癌个体化治疗提供坚实的理论基础。     

美国用针灸治疗乳腺癌内分泌疗法的副作用

根据美国肿瘤放射治疗学会年会的报告,针灸有助减少与乳腺癌内分泌治疗有关的不愉快的副作用,可以像抗忧郁药一样有效。     

Use of Conjoint Analysis to Assess Breast Cancer Patient Preferences for Chemotherapy Side Effects

Objective.

Our objective was to evaluate preferences associated with grade I/II and grade III/IV chemotherapy side effects among breast cancer patients receiving chemotherapy. We also assessed trade-offs that patients are willing to make between treatment side effects and the route and schedule of treatment administration.

Methods.

In this cross-sectional study, patients receiving chemotherapy for breast cancer completed a one-time Web survey. Conjoint analysis was used to elicit preferences for 17 grade I/II and III/IV side effects associated with available chemotherapies and regimens. In the analysis, the risk of each side effect was increased by 5%, holding all others constant, and the respective impact on patient preferences was identified.

Results.

A total of 102 women participated (mean age 54 ± 11). Among the grade I/II side effects, a 5% reduction in the risk of sensory neuropathy, nausea, and motor neuropathy had the highest impact on preferences. Among grade III/IV side effects, motor neuropathy, nausea/vomiting, and myalgia made the most difference. An oral twice-daily regimen was most preferred; however, patients were willing to receive an intravenous regimen relative to oral to avoid an increased risk of 5% in the majority of side effects. Avoiding an increased chance of grade III/IV motor neuropathy was associated with willingness to tolerate one of the least preferred administration schedules.

Conclusion.

This study identified relative preferences among both mild/moderate to severe side effects from the patient perspective. Patients appear to be willing to make trade-offs between side effects and different regimens. These findings may help to inform medical decision-making processes.     

乳腺癌术后早期发现复发转移方法的回顾性分析

目的：分析乳腺癌患者术后早期发现复发转移的方法。方法：回顾性分析126例早期乳腺癌术后发生复发转移患者的临床资料．包括最早发生复发转移的部位及其发现方法(症状、自查、医生查体和血液学、影像学检查)。结果：80例(63．5％)在常规随诊时发现复发转移，其中影像学或血液学检查发现65例(51．6％)，查体发现15例(11．9％)；28例(22．2％)经自查发现病变；仅18例(14．3％)因症状而就诊。结论：乳腺癌术后常规随诊是早期发现复发转移的主要方法．其中影像和血液学检查是必要的。     

Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer

Objective

To explore the impact of symptoms on physical function in women on adjuvant endocrine therapy for breast cancer.

早期乳腺癌保乳术后大分割放疗Ⅱ期临床研究——中期安全性及有效性分析

背景与目的：乳腺癌保乳术后全乳大分割放疗的安全性和有效性在多项随机临床试验中已经得到证实,但全乳大分割瘤床同期加量的放疗模式目前仍不明确。本研究旨在探讨中国人群早期乳腺癌保乳术后大分割放疗同期瘤床加量的安全性及有效性。方法：前瞻性入组保乳术后切缘阴性、病理诊断为浸润性癌、分期pT_1-2N₀M₀、术中瘤床钛夹标记的患者接受全乳大分割同期瘤床加量放疗（ClinicalTrail.gov: NCT02617043）。放疗处方剂量为全乳计划靶体积（planned target volume,PTV） 40 Gy/15次/3周,同期瘤床加量至48 Gy/15次/3周。放疗后评估急性不良反应、美容效果以及预后。结果：2015年1月—2016年8月,共计358例患者前瞻性连续性入组本研究。患者中位年龄45岁（25~71岁）,71.2%（255例）为绝经前的年轻女性,其中T1和T2患者分别为276例（77.1%）和82例（22.9%）。放疗期间及放疗后3个月内,53.6%和8.1%的患者出现Ⅰ~Ⅱ度的放射性皮炎,主要表现为放疗区红斑（38.8%）以及放疗后干性脱皮（41.3%）。13例（3.6%）患者出现湿性脱皮,主要位于乳头、乳晕区,无Ⅲ度以上放射性皮炎。4例Ⅰ度放射性肺炎,1例Ⅲ度放射性肺炎。美容效果自评“极好”和“好”率分别为37.0%和44.8%。中位随访28.3个月（6.0~40.7个月）,3例患者出现局部区域复发,4例远处转移（2例合并复发）,2年无病生存率（disease-free survival,DFS）为98.6%。结论：对于早期乳腺癌保乳术后患者,全乳大分割同期瘤床加量放疗不良反应轻、耐受性好,具有一定的安全性及有效性,其晚期不良反应以及对疾病局部控制的有效性仍需长期随访来证实。     

Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients

Purpose: To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress.

Methods and Materials: Between January 1997 and April 1998, 111 women (33–84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis.

Results: The internal subject–related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: ≤58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful.

Conclusion: Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff.     

Effects of life event stress and social support on the odds of a ≥2 cm breast cancer

Objective  To examine the contribution of life event and social support factors to diagnosis with a ≥2 cm breast cancer. Methods  We studied 1,459 Australian women aged 40–69 diagnosed in 2002–2003 with a first primary invasive breast cancer 1.1 cm or larger. We measured stressful life events, perceived stress levels, and social support in the year before diagnosis and collected information on other potential risk factors and confounders. Results  The odds of a ≥2 cm breast cancer relative to a 1.1–1.9 cm breast cancer were reduced in women who reported tension or change in an intimate relationship in the year before diagnosis (OR = 0.71 95% CI 0.54–0.92; p = 0.009); the reduction was greatest in women living with a partner (OR = 0.64 95% CI 0.47–0.88; p = 0.006) and was largely unaffected by adjustment for other variables independently associated with a ≥2 cm breast cancer in our study. There was no evidence that the total number or severity of all studied life events influenced cancer size. Low partner support increased the odds of a ≥2 cm cancer but only in women not living with a partner. Conclusion  Intimate relationship stress may reduce risk of a ≥2 cm breast cancer. Suppression by stress of estrogen synthesis and metabolism is a possible mechanism.     

中国乳腺癌随诊随访与健康管理指南(2022版)

近年来,随着对乳腺癌筛查的重视与规范化诊疗技术的提升,中国乳腺癌患者治愈率显著提高,患者生存时间显著延长。伴随乳腺癌患者随诊随访期的延长,患者面临的肿瘤及相关其他健康问题也逐渐增加,需要制定更为精准而长远的随诊随访计划,关注更广泛的健康风险。抗肿瘤治疗、年龄、激素水平变化等因素导致的乳腺癌患者心血管、骨健康、心理健康等问题,已成为乳腺癌患者管理的新难题,其不仅影响患者的生活质量,甚至转化为疾病复发和死亡风险。因此,除了落实规范化治疗外,患者科学规范的随诊随访、伴随疾病的全方位管理、跨学科协作、全面康复也是乳腺癌治疗的关键环节,这对于提高患者的治疗效果,提升患者健康水平和生活质量均有重大意义。基于当前中国乳腺癌患者的治疗及随诊随访现状,根据文献及指南,结合跨学科专家诊疗建议,在2019版《乳腺癌随访及伴随疾病全方位管理指南》基础上进行更新,修订2022版《中国乳腺癌随诊随访与健康管理指南》,包括随诊随访路径图、随诊随访管理、全方位健康管理以及患者报告结局四大部分,旨在规范乳腺癌患者的长期随诊随访,指导临床医师积极开展乳腺癌患者全方位跨学科健康管理,从而进一步提高中国乳腺癌患者预后与生活质量。