Anke Bergmann’s research while affiliated with National Cancer Institute (USA), National Institutes of Health and other places

Introduction Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. Objective Assess seroma incidence and risk factors in women undergoing mastectomies. Method This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. Results A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02–3.61; p = 0.042; and OR = 2.06; 95% CI 1.17–3.63; p = 0.012), respectively. Conclusion Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).

Objective To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema. Design and Setting Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil. Participants Women in control phase of the breast cancer-related lymphedema. Interventions Compared use of ACWs versus compressive mesh. Main Measures Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval. Results Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group ( p = .041, ES 0.20), with improved functionality ( p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume ( p = .023, ES 0.26) and demonstrated improvement functionality ( p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome—excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups ( p > .05) at both times. Conclusions Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema.

Introduction: Adverse epidermal growth factor receptor (EGFR) dermatological events affect many patients and can impair the patient’s quality of life (QoL), leading to dose reduction or discontinuation of therapy. Objective: To carry out the translation, cross-cultural adaptation, reliability and validity of the Functional Evaluation of Cancer Therapy - Epidermal Growth Factor Receptor Inhibitor 18 (FACT-EGFRI-18) to be utilized in Portuguese. Method: Study to evaluate the cross-cultural adaptation, reliability and construct validation of the FACT-EGFRI-18 translated into Portuguese. To evaluate cross-cultural adaptation, semantic analysis was performed by ten patients and content analysis by experts. Reliability was assessed by internal consistency analysis using Cronbach’s alpha coefficient. Construct validity was determined by the correlation between the translated FACT-EGFRI-18 and the Dermatology Life Quality Index (DLQI) answered by 30 participants with cancer undergoing treatment with EGFR. A descriptive analysis of the study population was performed and Cronbach’s alpha coefficient was calculated to determine the internal consistency of the Portuguese version of the FACTEGFRI- 18 and Pearson’s demonstration coefficient was applied to determine the transparency between the questionnaires. ANOVA test was performed to compare the mean FACT-EGFRI-18 score according to demographic variables. Results: The semantic evaluation showed that all the participants understood the items of the translated questionnaire, which revealed strong internal consistency (Cronbach’s alpha = 0.89) and validity (Pearson's correlation = 0.66). Conclusion: The FACT-EGFRI-18 was easily understood by the patients and the results support its reliability and validity.

Introdução: O câncer de mama (CM) é o mais comum entre as mulheres. A quimioterapia neoadjuvante (QTNEO) visa melhorar as condições cirúrgicas em pacientes com CM localmente avançado. Objetivo: Comparar as características demográficas, clínicas e de tratamento de mulheres submetidas à QTNEO para tratamento de CM de acordo com a linfadenectomia axilar (LA) ou biópsia de linfonodo sentinela (BLS) e analisar os fatores associados à indicação de BLS em um cenário da vida real. Método: Estudo de coorte retrospectivo em mulheres com CM e indicação de QTNEO. Foram obtidas variáveis demográficas, clínicas, tumorais e de tratamento. Foi realizada regressão logística simples e múltipla para avaliar os fatores independentes associados à indicação de BLS. Resultados: Foram incluídas 918 pacientes, das quais 17,5% foram submetidas à BLS e 11,4% à BLS seguida de LA. As mulheres em estádio III tiveram 95% menos probabilidade de serem submetidas à BLS (OR = 0,05; IC 95%: 0,01-0,17; p < 0,001) em comparação com aquelas no estádio I. As submetidas à mastectomia apresentaram 90% menor chance de realizar BLS do que aquelas com cirurgia conservadora (IC95%: 0,06-0,17; p < 0,001). Considerando as respostas da QTNEO, os casos sem resposta ou com progressão da doença apresentaram chance 55% menor de serem submetidos à BLS em comparação às que apresentaram resposta total (OR = 0,45; IC 95%: 0,24-0,82; p = 0,009). Conclusão: A BLS foi realizada em 29% das pacientes após QTNEO. Pacientes que apresentavam estágio clínico mais avançado da doença e pior resposta à QTNEO e as que foram submetidas a mastectomias tiveram menor probabilidade de serem submetidas à BLS.

Introdução: Mulheres com câncer de mama podem apresentar diminuição da aptidão física, fadiga e fraqueza muscular após tratamento oncológico. Objetivo: Analisar alteração no nível de atividade física (AF) e na capacidade funcional de pacientes entre diagnóstico do câncer de mama e após tratamento cirúrgico. Método: Estudo de coorte prospectivo incluindo mulheres com indicação de cirurgia curativa para câncer de mama. As pacientes foram avaliadas no início do estudo e após cirurgia do câncer de mama. Para avaliar AF autorreferida, foi utilizado o IPAQ, e a capacidade funcional foi aferida mediante três testes físicos: teste de sentar e levantar de 30 segundos, marcha estacionária de dois minutos e força de preensão palmar (FPP). O teste de Wilcoxon comparou as variáveis pré e pós-cirurgia e o D de Cohen, o tamanho do efeito. Resultados: Foram incluídas 655 mulheres, a maioria na faixa etária ≤59 anos (62,9%), 49,6% em estadiamento clínico avançado (≥IIB), e 48,9% foram submetidas à cirurgia como primeiro tratamento oncológico. Após tratamento cirúrgico, houve redução dos níveis de AF total, caminhada, AF de intensidade moderada (p < 0,001 e D de Cohen = 0,31; 0,50; 0,15, respectivamente), e da FPP (p < 0,001; D de Cohen = 0,38). Foi observado aumento do desempenho da capacidade aeróbica e resistência de MMII (p < 0,001 em ambos os testes, D de Cohen = 0,23 e 0,39, respectivamente). Conclusão: As pacientes apresentaram aumento nos níveis de capacidade aeróbica e resistência de MMII. Entretanto, tiveram redução da FPP e diminuição nos níveis de AF de caminhada.

Objective To identify factors associated with delays in beginning adjuvant therapy and prognosis impacts on non‐metastatic breast cancer patients. Methods This assessment comprised a prospective cohort study concerning breast cancer patients treated at a public oncology centre. A time interval of ≥60 days between surgery and the beginning of the first adjuvant treatment was categorised as a delay. Factors associated with delays were evaluated through logistic regression analysis and the prognosis effects were assessed by a Cox regression analysis. Results The median time interval between surgery and the first adjuvant treatment for the 401 women included in this study was of 57.0 days (37.0–93.0). Independent factors associated with delays comprised not presenting an overexpression of the HER‐2 protein, not having undergone neoadjuvant chemotherapy, and having undergone chemotherapy or other therapeutic modalities other than hormone therapy and chemotherapy as the first adjuvant treatment. Delays did not affect recurrence, distant metastasis, or death risks. Factors associated with recurrence and distant metastasis risks comprised a clinical staging ≥2B, having undergone neoadjuvant chemotherapy, presenting the luminal molecular subtype B and triple‐negative tumours, and having children. Factors associated with death comprised triple‐negative molecular tumours and neoadjuvant chemotherapy. Conclusion Delays in beginning adjuvant treatment did not affect the prognosis of non‐metastatic breast cancer patients. Clinical and treatment‐related factors, on the other hand, were associated with delays, and recurrence, distant metastasis, and death risks.

Introduction: Recognizing factors associated with pain in advanced cancer patients may favor a better multidisciplinary approach. Objective: To identify factors associated with the most prevalent type of pain in cancer patients admitted to a palliative care unit. Method: Cohort-study-based cross-sectional analysis of baseline data collected from cancer inpatients at the palliative care unit assisted by the physiotherapy service. Sociodemographic, clinical data and pain characteristics were obtained and analyzed according to the most prevalent type of pain at hospital admission. An odds ratio (OR) logistic regression was utilized as a measure of effect at a 95% confidenceinterval (95% CI). Results: A total of 62 patients were assessed, mostly women (69.3%) with less than 60 years old (67.7%), the most frequent tumor sites were gynecological (25.8%) and breast (16.1%). Local disease progression associated with metastasis was observed in 87.1% of all patients, with 50.0% presenting bone metastasis and 37.1%, a bone event. The most prevalent type was moderate tosevere (69.3%) neuropathic pain (51.6%), associated with the presence of a bone event (OR = 3.16; 95% CI: 1.01-9.90) and less than 60 years old (OR = 4.08; 95% CI: 1.91 -17.52). Conclusion: Neuropathic pain was the most prevalent pain in cancer patients receiving palliative care associated with the presence of bone events and less than 60 years old.

Objective Evaluate patient adherence and satisfaction concerning postmastectomy compressive taping. Methods This comprises a preintervention and postintervention study carried out with women ≥18 years old who underwent taping during the first 7 postoperative days at the Cancer Hospital III/National Cancer Institute. Good adherence was considered as taping maintenance for 7 days. Satisfaction levels were classified as satisfied and dissatisfied. Results A total of 124 women with a mean age of 56.54 (±11.24) were included in the study. Most lived without a partner (58.1%), had more than 8 years of study (59.7%), referred to themselves as white (68.5%) and considered their health status to be good or very good (69.4%). Regarding treatment adherence, 90.3% patients displayed adherence. Patients with no bullous lesions were more likely to adhere to taping (OR 7.00; 95% CI 1.98 to 24.74; p=0.003). Regarding satisfaction, 78.2% of the patients felt satisfied. The absence of local discomfort (OR 4.51; 95% CI 1.73 to 11.74; p=0.002) and non-existence of self-reported oedema (OR 5.81; 95% CI 1.81 to 18, 66; p=0.003) were associated with greater patient satisfaction. Conclusion Patients exhibited good adherence and felt very satisfied with the use of postmastectomy compressive taping. Trial registration number NCT04471142 .

Purpose We aimed to investigate the relationship between pretreatment gynecologic cancer survival and the physical function of patients with myosteatosis. Understanding this relationship prior to treatment would help healthcare providers identify and refer patients with poor muscle quality to an exercise program prior to treatment. Methods We conducted a cross-sectional analysis of 73 GC patients. Physical function was quantified using handgrip strength and an adapted version of the Senior Fitness Test (aerobic endurance not included). The EORTC QLC-C30 was used to evaluate general health quality. Myosteatosis (values below the median muscle radiodensity), muscle mass, and adipose tissue variables were calculated from the computed tomography (CT) scan at the third lumbar vertebra using specific software. Results Seventy patients (50.9 ± 15.2) were included; 41.5% had stage III or IV disease, and 61.4% had cervical cancer. The myosteatosis group was 11.9 years older and showed reduced functioning compared to the normal-radiodensity group. Age and Timed Up and Go (TUG) test results were shown to be the most reliable predictors of muscle radiodensity in pretreatment gynecological patients according to multivariate regression analysis (R² = 0.314). Conclusion Gynecological healthcare professionals should be aware that prompt exercise programs might be especially beneficial for older patients with reduced TUG performance to preserve muscle function and quality.

Objective Neuroendocrine tumors (NETs) are a set of diseases that originate from neuroendocrine cells, which comprises a diffuse endocrine system present in various organs of the body. These tumors are more frequent in the gastrointestinal tract (70%) and the bronchopulmonary system (20%-30%). A NET incidence rate of 1-5 per 100,000 inhabitants has been estimated for several European countries and the USA employing 20 years of data. However, no comprehensive studies on this rare neoplasm are available in Brazil. In this context, the aim of this study was to characterize the epidemiological NET profile in the country. Material and methods This is a retrospective descriptive observational study based on data from Hospital Cancer Records available at the Brazilian National Cancer Institute and the São Paulo Oncocentro Foundation. Demographic, clinical and treatment-related variables were analyzed from selected cases employing descriptive statistics. Results and Conclusion A total of 15,859 cases were identified, most occurring in males (53.4%) and in individuals under 65 years old (63.3%). Small cell carcinoma was the most frequent histological type (46.7%). Bronchopulmonary tumors were the most frequent NETs, followed by pancreatic tumors, with cases mostly concentrated in high complexity centers in the Brazilian Southeast and treated mainly with surgery and chemotherapy, with over half of the patients diagnosed in advanced stages of the disease.