Jiajia Qiu

Background: Cancer-related lymphedema (CRL) seriously affects patients’ quality of life. Many practice guidelines emphasize the importance of early prevention. However, a significant gap exists between these guidelines and clinical practice. This study aimed to understand the current status of lymphedema management in Chinese hospitals and to provide a basis for promoting standardized practices in lymphedema care. Methods: A cross-sectional survey was conducted from September to November 2024 using a self-designed questionnaire on lymphedema management. A convenience sample of 45 hospitals nationwide was surveyed. Results: The survey revealed that 60% of hospitals had established outpatient clinics for lymphedema, while 46.7% routinely implemented manual lymphatic drainage. Additionally, 68.9% of hospitals performed routine high-risk screening or preoperative assessments for lymphedema. Regarding treatment management, the application rate of complete decongestive therapy (CDT) was 88.9%, but 42.2% of hospitals lacked a standardized fee system. Concerning personnel training, 37.8% of hospitals had not conducted lymphedema training. Conclusions: Challenges in lymphedema management in Chinese hospitals include the limited implementation of standardized care protocols, incomplete fee systems for treatments, and the low coverage of specialized training. Efforts should focus on enhancing medical staff training, establishing standardized care pathways, and improving technical fee structures to advance the standardized development of lymphedema care.

Background: Breast cancer-related lymphedema (BCRL) seriously affects patients’ quality of life. We aimed to understand the stage of postoperative lymphedema and the occurrence of related symptoms in breast cancer patients, and to analyze the relationship between the two, so as to provide reference for the implementation of targeted clinical interventions. Methods: Convenience sampling method was used to select postoperative breast cancer patients attending the lymphedema evaluation clinic of a tertiary hospital in Shanghai for questionnaire survey. A professional lymphedema therapist assessed the severity of the patients’ lymphedema according to the International Society of Lymphology (ISL) lymphedema grading criteria, and the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI) was used to assess the severity of the patients’ lymphedema and patients’ experience of lymphedema-related symptoms. This study aimed to understand the occurrence of lymphedema in breast cancer patients after surgery, and to explore the characteristics of related symptoms in patients with different stages of lymphedema. Results: Of the 1,021 patients, 744 (72.86%) were in stage 0, 161 (11.36%) in stage 1, 98 (9.5%) in stage 2, and 18 (1.7%) in stage 3. The higher the lymphedema stage, the number and severity of symptoms significantly increased (PConclusions: The number of symptom presentations, symptom severity and their degree of distress increased with higher lymphedema stage. Attention should be paid to patients' symptom complaints, and early identification and timely intervention should be made in patients with stage 0 and 1 lymphedema to alleviate their symptoms and slow down the progression of edema.

Background: Aromatase inhibitors-related musculoskeletal syndrome (AIMSS) is a common side effect experienced by early breast cancer patients undergoing endocrine therapy. This condition can result in medication discontinuation and a diminished quality of life. The objective of this study was to characterize AIMSS, investigate its pathogenesis, and identify potential biomarkers at both the protein and metabolic levels. Methods: We collected peripheral blood samples from 60 women diagnosed with breast cancer undergoing aromatase inhibitor therapy, of whom 30 had AIMSS and 30 did not. The samples were analyzed using four-dimensional data-independent acquisition (DIA)-based proteomics and untargeted metabolomics, employing liquid chromatography–mass spectrometry (LC–MS) on the latest platform. Results: The mean age of participants was 49.2 (11.3) years in the AIMSS group and 50.1 (11.5) years in the non-AIMSS group. There were no statistically significant differences between the two groups in terms of age, BMI, education level, clinical stage, and treatment. In total, we identified 3473 proteins and 1247 metabolites in the samples. The chemokine signaling pathway (p = 0.015), cytokine–cytokine receptor interaction (p = 0.015), complement and coagulation cascades (p = 0.004), neuroactive ligand–receptor interaction (p = 0.004), and the estrogen signaling pathway (p = 0.004) were significant enriched in differentially expressed proteins (DEPs). GnRH secretion (p < 0.001), sphingolipid signaling pathways (p < 0.001), endocrine resistance (p < 0.001), the estrogen signaling pathway (p = 0.001), endocrine and other factor-regulated calcium reabsorption (p = 0.001), dopaminergic synapse (p = 0.003), regulation of lipolysis in adipocytes (p = 0.004), biosynthesis of cofactors (p = 0.004), thyroid hormone synthesis (p = 0.008), aldosterone synthesis and secretion (p = 0.001), taurine and hypotaurine metabolism (p = 0.011), ovarian steroidogenesis (p = 0.011), and the cAMP signaling pathway (p = 0.011) were significantly enriched in differentially expressed metabolites (DEMs). Complement C3 (p = 0.004), platelet factor 4 (p = 0.015), KRT10 (p = 0.004), KRT14 (p = 0.004), beta-estradiol (p = 0.019), testosterone (p = 0.023), sphingosine (p < 0.001), and 1-stearoyl-2-arachidonoyl-sn-glycerol (p = 0.039) could be the monitoring and therapeutic targets for AIMSS. Conclusions: This study offered new insights into the mechanisms underlying musculoskeletal symptoms associated with aromatase inhibitors. It also highlighted potential biomarkers for predicting and addressing these symptoms in breast cancer patients, paving the way for improved intervention strategies.

Background: Breast cancer has the highest incidence rate among malignant tumors in China, with a trend of affecting younger women. The treatment has short- and long-term adverse effects such as damage to the ovaries, which may result in infertility. Such consequences then increase patients’ concerns over future reproduction. At present, nor do medical staffs continuously assess their overall well-being, or ensure that they have the knowledge necessary to manage their reproductive concerns. This qualitative study aimed to explore psychological and reproductive decision-making experiences of young women who had experienced childbirth after their diagnosis. Methods: The phenomenological research, as a kind of qualitative study, was conducted on 12 young women who experienced childbirth after breast cancer diagnosis. Data collection was from September 2021 to January 2022 and content analysis method was used to analyze the data. Results: Five main themes were identified: (1) desire for childbearing from individual, familial, and social aspects after the diagnosis of breast cancer; (2) emotional experiences through pregnancy till raising children; (3) support needs from professionals, family, and peer; (4) self and doctors’ influencing factors on reproductive decision-making; and (5) satisfaction with the outcome of reproductive decision-making. Conclusions: The desire for childbearing of young women should be considered during the reproductive decision-making process. A multidisciplinary team is suggested to be set up to provide professional support. During the reproductive process, professional and peer support should be strengthened to improve decision-making abilities, alleviate negative emotional experience, and smoothen the process of reproductive experience for young patients.

Background: Breast cancer has the highest incidence rate among malignant tumors in China, with a trend of affecting younger women. The survival rate of young women with breast cancer has improved significantly, but the treatment to which they are subjected has short- and long-term adverse effects such as damage to the ovaries, which may result in infertility. Such consequences, in turn, increase patients’ concerns over future reproduction and childbearing. At present, patients lack easy access to the informative consultations and accurate patient education. Nor do medical staffs continuously assess their overall well-being, engage in mental healthinterventions, or ensure that they have the knowledge necessary to manage their reproductive concerns. This qualitative study aims to explore the reproductive and psychological experiences of young women with breast cancer who have experienced childbirth after their cancer diagnosis.Methods: A descriptive qualitative study with purposive sampling using audio‑recorded fact‑to‑face interviews was conducted. A total of 12 young women with breast cancer who experienced childbirth after cancer diagnosis participated in this study. Data collection was from September, 2021 to January, 2022 and content analysis method was used to analyze the data. Results: Five distinct themes emerged from the analyses:(1) multifaceted reproductive motivation, (2) multiple emotional experiences, (3) multi-dimensional support needs, (4) influencing factors on reproductive decision-making, and (5) outcome experience of reproductive decision-making. Conclusions: The reproductive decision-making process of young women with breast cancer was affected by many factors. Reproductive motivation came from many aspects. Patients had various emotional experiences in the whole reproductive process and face various difficulties in supporting their needs. Therefore, the reproductive needs of young women with breast cancer should be considered during the reproductive decision-making process, and their reproductive willingness should be recognized as dynamically changing. Professional support and peer support should be provided in the reproductive process to build an effective communication channel for reproductive decision-making, improve the decision-making ability, alleviate the negative emotional experience, and promote a smooth process of reproductive experience for young patients.