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Pulmonary complications after oncological treatments in breast-cancer survivors : a retrospective cohort study

Abbas, S. (2017) Pulmonary complications after oncological treatments in breast-cancer survivors : a retrospective cohort study.

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Abstract:Breast-cancer patients are treated mostly with a combination of surgery, radiation therapy, chemotherapy, and hormone therapy. Because of the short-term effects and the duration of the treatments the patient can experience the treatment as an intense treatment. These treatments will also induce long-term effects which can lead to neurological, cardiac, and pulmonary complications. Survival for breast-cancer patients is increasing due to early detection and better treatments. Considering the survival and the long-life expectancy both the short and long-term effects of breast-cancer treatment are valuable to study. The aim of this retrospective cohort study is to determine the long-term (10 to 20 years) pulmonary complications of breast-cancer oncological treatments in women, primarily treated through breast-conserving therapy. Patients and method: A retrospective cohort study, with data that was obtained from a database covering the period from 1987 to 2015. Fifty-three women, aged from 39 to 75 years, were included. All patients were treated for early-staged breast-cancer with a curative intent between July 1996 and May 2006. Patients received a primarily breast-conserving treatment, followed by loco-regional radiation treatment with or without adjuvant chemotherapy and/or hormonal therapy. Patients with a minimum survival of 10 years were included in this study. All medical records of each department were studied through the hospital’s electronic data system of the Medisch Spectrum Twente (MST), X-care. However, the records of the radiation oncology department, medical oncology department, pulmonary department, and radiology department were more extensively studied. A Cohens kappa test was used to determine the relation between the treated breast side (left or right) and the lung side (left or right) were the pulmonary complication is being diagnosed. A Kaplan-Meier analysis was used to determine the effect of smoking and alcohol consumption and the time until pneumonitis, pulmonary fibrosis, or COPD occurs after the oncological treatment. Furthermore, a cox-regression analysis was performed to evaluate the Body Mass Index (BMI) and age affecting the development of pneumonitis, pulmonary fibrosis, or COPD. Results: The relation between the treated breast side and the lung side were pneumonitis or pulmonary fibrosis was diagnosed showed a significant association (p<0.001); in all cases the pneumonitis or pulmonary fibrosis developed at the treated breast side. The relationship between smoking and developing pneumonitis was not statistically significant (p=0.195) and neither between smoking and pulmonary fibrosis (p=0.273). However, the relation between smoking and developing COPD showed a significant association (p=0.027). There was no significant difference between patients who consumed alcohol or not and the development of pneumonitis (p=0.332), pulmonary fibrosis (p=0.295) or COPD (p=0.421). Furthermore, there was no significant difference between the BMI, age, and the development of pulmonary complications. The age of the patients at the start of the treatment ranged from 39 years to 75 years with a mean of 58 years (SD 9.3). All 53 patients have been treated for an early stage of breast-cancer, 23 (43.4%) of them developed pulmonary complications. Out of the 53 patients, 30 were treated on the right side of the breast and 23 patients received treatment on the left side of the breast. Eight patients developed pneumonitis, 16 patients developed pulmonary fibrosis and seven patients developed COPD. Conclusion: There is a strong relation found between the treated breast side and the pulmonary complication side (p<0.001). There is no significant evidence that smoking, alcoholic consumption, BMI, or age are amplifying the development of pulmonary complications in breast-cancer survivors.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences MSc (66851)
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