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Introduction: Breast cancer is considered a chronic disease that has considerable impact on the quality of life (QoL) of the patients. Yet, there is not a totally satisfactory evaluation system reflecting the complexity of the breast cancer condition. Furthermore, most instruments are more addressed towards early-stage disease than advanced disease. Objective: To describe the methodology used to measure the QoL of life and coping strategies in a representative group of breast cancer patients including metastatic and non-metastatic patients. Methodology: Prospective study including patients with breast cancer at different stages of the disease recruited at the Medical Oncology Department of the Catalan Oncology Institute (ICO) previous informed consent. A protocol of approximately one hour face-to-face interview is run to collect sociodemographic information and to answer the questions of several QoL scales such as the QLCA-AFex Font, QLQ-C30, QLQ-BR23, HADS, DME, BRCS, MINI-MAC, LOT-R and OE questionnaires, complemented by a semi-structured interview. Results: From June 2017 to March 2020, 257 patients were included in the study. Mean age 57.9 years (SD 10.1), mostly women (98.8%), with children (87.9%) and married (65.4%). According to clinical status 75.5% were non-metastatic and 24.5% metastatic. Protocol compliance was achieved in more than 90% in all questionnaires without differences between metastatic and no metastatic patients. Conclusions: This multidimensional protocol enables us to make an integral assessment of the QoL of the patients and their unmet needs, as well as to reflect the patients’ concerns, both in early and advanced stages of the disease, complementing currently available assessment methods. In the next future a complied questionnaire with the most challenging questions could be developed to be useful as a routine instrument in clinical practice. Introducción: El cáncer de mama es considerado una enfermedad crónica que impacta de modo importante en la calidad de vida (QoL) de las pacientes. En la actualidad no se dispone de un sistema de evaluación totalmente satisfactorio que refleje la complejidad del cáncer de mama. Además, la mayoría de instrumentos están más orientados a la enfermedad en estadios iniciales que a la enfermedad avanzada. Objetivo: Describir la metodología utilizada para evaluar la calidad de vida y las estrategias de afrontamiento en un grupo representativo de cáncer de mama que incluye tanto pacientes metastásicas como no metastásicas. Método: Estudio prospectivo en pacientes con cáncer de mama del Servicio de Oncología Médica del Institut Català d’Oncologia (ICO) en diferentes estadios de la enfermedad, previo consentimiento informado. Se les aplica un protocolo de aproximadamente una hora de entrevista presencial donde se recoge su información sociodemográfica, y se contestan varios cuestionarios de calidad de vida como el cuestionario QLCA-AFex Font, QLQ-C30, QLQ-BR23 HADS, DME, BRCS, MINI-MAC, LOT-R y OE, que se completan con una entrevista semiestructurada. Resultados: De junio de 2017 a marzo de 2020, 257 pacientes han sido incluidas en el estudio. La media de edad es de 57,9 años (SD 10,1), la mayoría son mujeres (98,8%), con hijos (87,9%) y casadas (65,4%). Respecto al estadiaje clínico 75,5% son no-metastásicas y 24,5% metastásicas. El cumplimiento del protocolo se consiguió en más del 90% de los cuestionarios sin diferencias entre pacientes metastásicas y no metastásicas. Conclusión: Este protocolo multidimensional permite hacer una evaluación integral de la calidad de vida, así como reflejar las necesidades no atendidas y las preocupaciones que muestran las pacientes tanto en estadio precoz como avanzado, complementando los sistemas de valoración actualmente disponibles. Después del análisis de los resultados de este estudio sería interesante poder obtener un cuestionario único con las preguntas más relevantes que pudiera ser aplicado a la práctica clínica.

Editores: Salazar Soler, Albert; Salazar Macian, Ramon // Cada capítulo está escrito por diferentes autores., Este libro recoge los temas/capítulos del camino de la calidad orientada a los estudios de medicina desde la época antigua hasta la actualidad. Se realiza una secuencia de los temas desde el código de Hammurabi, pasando a los estudios generales de la calidad, y finalmente, a los mas específicos de la organización de la calidad en el ámbito hospitalario. En la segunda parte se estudian los temas/capítulos que abarcan el estudio de la organización y aplicación de los trabajos/ funciones que se desarrollan en un hospital.

Summary Proper immune system function hinders cancer development, but little is known about whether genetic variants linked to cancer risk alter immune cells. Here, we report 57 cancer risk loci associated with differences in immune and/or stromal cell contents in the corresponding tissue. Predicted target genes show expression and regulatory associations with immune features. Polygenic risk scores also reveal associations with immune and/or stromal cell contents, and breast cancer scores show consistent results in normal and tumor tissue. SH2B3 links peripheral alterations of several immune cell types to the risk of this malignancy. Pleiotropic SH2B3 variants are associated with breast cancer risk in BRCA1/2 mutation carriers. A retrospective case-cohort study indicates a positive association between blood counts of basophils, leukocytes, and monocytes and age at breast cancer diagnosis. These findings broaden our knowledge of the role of the immune system in cancer and highlight promising prevention strategies for individuals at high risk., Graphical Abstract, Highlights • Cancer risk genetic variants linked to immune/stromal cell tissue content • SH2B3 associated with BRCA1/2 cancer risk and immune cell counts • Peripheral immune cell types linked to breast cancer age at diagnosis, Immunology; Cancer Systems Biology; Cancer

We explored predictive factors of pseudoprogression (PsP) and its impact on prognosis in a retrospective series of uniformly treated glioblastoma patients. Patients were classified as having PsP, early progression (eP) or neither (nP). We examined potential associations with clinical, molecular, and basal imaging characteristics and compared overall survival (OS), progression‐free survival (PFS), post‐progression survival (PPS) as well as the relationship between PFS and PPS in the three groups. Of the 256 patients studied, 56 (21.9%) were classified as PsP, 70 (27.3%) as eP, and 130 (50.8%) as nP. Only MGMT methylation status was associated to PsP. MGMT methylated patients had a 3.5‐fold greater possibility of having PsP than eP (OR: 3.48; 95% CI: 1.606–7.564; P = 0.002). OS was longer for PsP than eP patients (18.9 vs. 12.3 months; P = 0.0001) but was similar for PsP and nP patients (P = 0.91). OS was shorter–though not significantly so—for PsP than nP patients (OS: 19.5 vs. 27.9 months; P = 0.63) in methylated patients. PPS was similar for patients having PsP, eP or nP (PPS: 7.2 vs. 5.4 vs. 6.7; P = 0.43). Neurological deterioration occurred in 64.3% of cases at the time they were classified as PsP and in 72.8% of cases of eP (P = 0.14). PsP confounds the evaluation of disease and does not confer a survival advantage in glioblastoma.

BACKGROUND: Antiangiogenic therapies for glioblastoma (GBM) such as bevacizumab (BVZ), have been unable to extend survival in large patient cohorts. However, a subset of patients having angiogenesis-dependent tumors might benefit from these therapies. Currently, there are no biomarkers allowing to discriminate responders from non-responders before the start of the therapy. METHODS: 40 patients from the randomized GENOM009 study complied the inclusion criteria (quality of images, clinical data available). Of those, 23 patients received first line temozolomide (TMZ) for eight weeks and then concomitant radiotherapy and TMZ. 17 patients received BVZ+TMZ for seven weeks and then added radiotherapy to the treatment. Clinical variables were collected, tumors segmented and several geometrical measures computed including: Contrast enhancing (CE), necrotic, and total volumes; equivalent spherical CE width; several geometric measures of the CE 'rim' geometry and a set of image texture measures. The significance of the results was studied using Kaplan-Meier and Cox proportional hazards analysis. Correlations were assessed using Spearman correlation coefficients. RESULTS: Kaplan-Meier and Cox proportional hazards analysis showed that total, CE and inner volume (p = 0.019, HR = 4.258) and geometric heterogeneity of the CE areas (p = 0.011, HR = 3.931) were significant parameters identifying response to BVZ. The group of patients with either regular CE areas (small geometric heterogeneity, median difference survival 15.88 months, p = 0.011) or those with small necrotic volume (median survival difference 14.50 months, p = 0.047) benefited substantially from BVZ. CONCLUSION: Imaging biomarkers related to the irregularity of contrast enhancing areas and the necrotic volume were able to discriminate GBM patients with a substantial survival benefit from BVZ. A prospective study is needed to validate our results. This work has been supported by Ministerio de Economía y Competitividad/FEDER, Spain [grant number MTM2015-71200-R], Consejería de Educación Cultura y Deporte from Junta de Comunidades de Castilla-La Mancha, Spain [grant number PEII-2014-031-P] and James S. Mc. Donnell Foundation 21st Century Science Initiative in Mathematical and Complex Systems Approaches for Brain Cancer [Special Initiative Collaborative – Planning Grant 220020420 and Collaborative award 220020450]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.