Andree Faridi

Background/Objectives: Women with breast cancer (BC) and gynaecological cancer (GC) often undergo extensive oncological treatment, which can lead to pelvic floor disorders (PFD). However, there is still limited evidence regarding their real-world treatment practices, patient counselling, and prevalence. This study aims to systematically evaluate the prevalence of PFD and current treatment approaches, identify unmet needs, and improve future care. Methods: This observational multicentre survey was conducted at four university hospitals and one gynaecological oncology outpatient clinic in Germany. Women with BC and GC, who had undergone at least one oncological treatment, completed anonymously a study-specific questionnaire and the validated German Pelvic Floor Questionnaire. Recruitment was undertaken over a period of nine months, reflecting real-world daily care. Results: A total of 246 patients were included (median age 57 years, range 30–88); 74% were postmenopausal, and 52% had at least one vaginal delivery. BC was the most common diagnosis (63.8%). The most common symptoms were urinary incontinence (22.3% in BC, 38.1% in GC) and urgency (32.5% in BC, 35.7% in GC). Pelvic radiotherapy was significantly associated with increased urgency symptoms (p = 0.017), pelvic surgery with urgency symptoms (p = 0.048) and dyspareunia (p = 0.045), and antihormonal therapy with vaginal dryness (p = 0.028). The combination of chemotherapy and antihormonal therapy was associated with significantly higher rates of vaginal dryness in women with GC, whereas no such association was observed in women with BC (p = 0.036). Among the 108 patients classified as having new-onset symptoms, 51 (47.2%) reported symptom onset within one year of the cancer diagnosis. Overall, 34.1% of patients reported impairment in more than one patient-reported domain, including daily life, social life, sexual well-being, and psychological well-being. The median study-specific impact rating for the most bothersome pelvic floor symptom was 5/10. Only 28.0% of patients received prior counselling on PFD, and 19.9% were actively asked about symptoms. In total, 26.0% received urogynaecological treatment, whereas 15.4% reported unmet treatment needs. Conclusions: PFD is highly prevalent in women with BC and GC. Symptoms are clinically relevant but underestimated in routine care. Despite the availability of effective treatment options, significant gaps exist in patient counselling, early detection, and access to specialised care.

Gynecomastia vera (GM) is the most common benign abnormality of the male breast, with a prevalence of 32?65% (1). GM is not an independent entity but a manifestation of disease that leads to an imbalance of estrogen and androgen in the organism (1,...

Purpose: Hydrofilm, a polyurethane-based barrier film, can be used to prevent acute radiation dermatitis (RD) in adjuvant whole-breast irradiation (WBI) for breast cancer. This cost-effective prophylactic measure is currently being recommended to a growing number of patients, yet long-term safety data and its impact on late radiation-induced skin toxicity such as pigmentation changes and fibrosis have not been investigated. Methods: We objectively evaluated patients who were previously enrolled in either of two intrapatient-randomised (lateral versus medial breast halve) controlled trials on the use of Hydrofilm for RD prevention (DRKS00029665; registered on 19 July 2022). Results: Sixty-two patients (47.7% of the initial combined sample size) provided consent for this post-hoc examination, with a median follow-up time (range) of 58 (37–73) months. Following WBI, there was a significant increase in yellow skin tones of the entire breast when compared to baseline measurements before WBI (p < 0.001) and a significant increase of cutis, subcutis, and oedema thickness (p < 0.001, p < 0.001, and p = 0.004, respectively). At follow-up, there were no significant differences in either pigmentation changes or skin fibrosis between the Hydrofilm and standard of care breast halves. Conclusion: These data suggest that Hydrofilm can be safely used in the context of acute RD prevention, without affecting late side effects, supporting its widespread use.

Background and Purpose: This study aimed to differentially assess the frequency and severity of late radiation-induced toxicity following adjuvant whole-breast irradiation for early breast cancer with conventional fractionation (CF) and moderate hypofractionation (mHF). Materials and Methods: Patients recruited in a previous randomised controlled trial comparing acute toxicity between CF and mHF without disease recurrence were included in a post hoc analysis. Spectrophotometric and ultrasonographic examinations were performed for an objective evaluation and subsequent comparison of long-term skin toxicity. Furthermore, patient- and clinician-reported outcomes were recorded. Results: Sixty-four patients with a median age of 58 (37–81) years were included. The median follow-up was 57 (37–73) months. A total of 55% underwent CF and 45% mHF. A total of 52% received a sequential boost to the tumour bed. A significant decrease in mean L* (p = 0.011) and an increase in a* (p = 0.040) and b* values (p < 0.001) were observed, indicating hyperpigmentation. In comparison with the non-irradiated breast, there was a significant increase in both cutis (+14%; p < 0.001) and subcutis (+17%; p = 0.011) thickness, significantly more pronounced in CF patients (p = 0.049). In CF patients only, a sequential boost significantly increased the local cutis thickness and oedema compared to non-boost regions in the same breast (p = 0.001 and p < 0.001, respectively). Conclusions: mHF objectively resulted in reduced long-term skin toxicity compared to CF. A sequential boost increased the local fibrosis rate in CF, but not in mHF. This might explain the subjectively reported better cosmetic outcomes in patients receiving mHF and reinforces the rationale for favouring mHF as the standard of care.

Zielsetzung Die multizentrische, internationale, prospektive PRO (patient reported outcome)-Pocket Studie untersucht Lebensqualität, Zufriedenheit mit dem kosmetischen Ergebnis und die Komplikationsrate nach präpektoraler implantatbasierter Brustrekonstruktion mit Netzunterstützung (TiLOOP Bra Pocket). Materialien und Methoden Im Rahmen der PRO-Pocket Studie (clinicaltrials.gov NCT03868514) wurde bei 311 Patientinnen in 12 Studienzentren in Deutschland und Österreich eine präpektorale Brustrekonstruktion mit Unterstützung der titanisierten Netztasche TiLOOP Bra Pocket (pfm medical ag, Köln) durchgeführt. Die bisher vorliegenden Angaben zur Operation wurden ausgewertet. Ergebnisse Es wurden insgesamt 440 Rekonstruktionen durchgeführt, davon 41 % (N = 129) bilateral. Am häufigsten wurde die Netztasche an den Fixationspunkten 1 Uhr (60 % rechts, 64 % links) und 11 Uhr (59 % rechts, 63 % links), sowie bei der linken Brust 3 Uhr (63 %) und bei der rechten Brust 9 Uhr (64 %) fixiert. Am häufigsten wurden TiLOOP Bra Pocket der Größe medium (N = 189) verwendet, gefolgt von small (N = 162) und large (N = 89) Netzen. Das Implantatvolumen betrug im Mittel 347,7 ± 126,6 ccm, die Mehrheit der Implantate hatte eine texturierte Oberfläche (74,1 %, N = 317) und war anatomisch geformt (68,5 %, N = 293). Es traten neun Kapselfibrosen Baker Grad III und fünf Baker Grad IV (gesamt 3 %) auf; zehn Kapselfibrosen wurden operativ behandelt. Zusammenfassung Die Daten zeigen eine hohe Übereinstimmung der gewählten Fixationspunkte der Netztasche durch die verschiedenen Operateure der Studienzentren. Die bisherige Kapselfibroserate ist niedrig – niedriger als im gleichen Untersuchungszeitraum aus der PRO-Bra-Studie, die die subpektorale Implantateinlage untersucht hatte. Article published online: 11 October 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

Radiation dermatitis (RD) is the most common acute side effect of breast irradiation. More than a century following the therapeutic utilisation of X-rays, potent preventative and therapeutic options are still lacking. Non-invasive physical plasma (NIPP) is an emerging approach towards treatment of various dermatological disorders. In this study, we sought to determine the safety and feasibility of a NIPP device on RD. Thirty patients undergoing hypofractionated whole-breast irradiation were included. Parallel to radiation treatment, the irradiated breast was treated with NIPP with different application regimens. RD was assessed during and after NIPP/radiation, using clinician- and patient-reported outcomes. Additionally, safety and feasibility features were recorded. None of the patients was prescribed topical corticosteroids and none considered the treatment to be unpleasant. RD was less frequent and milder in comparison with standard skin care. Neither NIPP-related adverse events nor side effects were reported. This proven safety and feasibility profile of a topical NIPP device in the prevention and treatment of RD will be used as the framework for a larger intrapatient-randomised double-blind placebo-controlled trial, using objective and patient-reported outcome measures as an endpoint.

Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the 70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ≥2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the 70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ≥2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364