Background: Little research has been conducted on the quality of life (QoL), functional status, and traumatic symptoms related to the diagnosis and treatment of cancer in the Arab region, particularly in Palestine, where the psychological problems in patients with cancer are often neglected.Objective: The aim of the study was to assess QoL and post-traumatic stress disorder (PTSD) symptoms among adult female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem.Method: Participants were recruited from 4 April 2015 to the end of July 2015. The sample included 253 female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem. Data were collected using self-reported questionnaires, including a socio-demographic data sheet, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the post-traumatic stress disorder checklist for PTSD symptoms.Results: The current study showed poor global QoL (57.4%) and poor physical function (48.5%) for female patients with cancer. Insomnia, fatigue, and loss of appetite were the most troublesome symptoms that the participants complained about. The prevalence of PTSD symptoms was 3%. Regarding PTSD symptom severity, 2% reported severe symptoms, 23.3% reported moderate symptoms, and (68.8%) reported mild symptoms, based on a 1991 classification of PTSD symptom severity scores. Finally, Pearson\'s test revealed a strong, statistically significant, inverse relationship between QoL domains and PTSD.Conclusion: The study found that the overall QoL of female patients with cancer was low and strongly associated with PTSD symptoms, suggesting that early detection and treatment of these symptoms is critical.
Post-traumatic stress disorder is being increasingly diagnosed among patients with cancer, in addition to low quality of life.The literature reveals a lack of studies in Palestine assessing these problems in female patients with cancer.A cross-sectional study including 253 patients with cancer using three self-reported questionnaires was conducted.Job loss circumstances and coping strategies (but not socio-demographic and work variables) were associated with class membership.

OBJECTIVE: To evaluate the use of radioactive iodine-125 seed (RIS) in breast and/or axillary surgery, in patients with breast cancer treated with neoadjuvant chemotherapy (NAC).
METHODS: Prospective study between January 2016 and June 2020. 80 women T1-3,N0-2,M0: 30 RIS marking the breast tumor, 36 both the tumor and the biopsied positive axillary node, and 14 only the axilla. Age: 54.7 ± 11.4 years. Tumor size: 34.1 ± 14.6 mm. Histological type: invasive ductal carcinoma 90.0%. Molecular subtypes: luminal-A 23.8%, luminal-B/HER2- 33.7%, luminal-B/HER2+ 18.8%, HER2+ 7.5%, basal-like 16,2%.
RESULTS: Of the 66 patients with RIS marking of the tumor (51 pre-NAC, 15 post-NAC), 92.1% had tumor-free surgical margins, with a specimen volume of 126.7 ± 111.2 cm3. Of the 5 s local excisions, in 3 the resection margin was involved (1 mastectomy). Of the 50 patients N1 with RIS marking (MLN), 44 pre-NAC and 6 post-NAC, MLN was identified in 97.2%: negative 23, positive 26. In 45/50 patients, sentinel node biopsy (SNB) was performed and it was identified in 93.3%: negative 26, positive 16. In 1 case RIS was not placed correctly and SNB was not identified due to non-migration. In 61.9% of the patients, MLN was among the SNB identified in the surgery. In 5 patients with mismatched SNB and MLN, the pathological result of the SNB was negative and the MLN was positive. Axillary lymph node dissection was performed in 53.8% of the patients.
CONCLUSIONS: RIS allow to perform breast-conserving surgery and improve detection of residual axillary disease in patients treated with NAC.

OBJECTIVE: This study aimed to determine the prognostic role of baseline maximum standardized uptake value (SUVmax) obtained by pretreatment PET/CT and the change in SUVmax (ΔSUVmax [%]) in patients with axillary lymph node-positive breast cancer receiving neoadjuvant chemotherapy (NAC).
METHODS: One hundred and eighty patients with baseline SUVmax and 121 patients with SUVmax measurement after treatment were evaluated in the study. The baseline SUVmax value of the breast (SUVmaxBI) and axilla (SUVmaxAI) and the change in the SUVmax of the breast (ΔSUVmaxB) and axilla (ΔSUVmaxA) were measured. The optimal cut-off value of SUVmax and ΔSUVmax were determined by ROC curve analysis. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier curves.
RESULTS: ΔSUVmaxB, pCRB, pCRA, and pCR parameters were found to be associated with relapse (P < .001, P = .033, P = .016, and P = .013, respectively). ΔSUVmaxB and SUVmaxAI were associated with mortality (P = .001 and P = .006, respectively). Multiple Cox regression analyses revealed that ΔSUVmaxB value was an independent prognostic factor for relapse and mortality (P = .013 and P = .010, respectively).
CONCLUSIONS: The results showed that ΔSUVmaxB was an independent prognostic factor for relapse and mortality in patients with axillary lymph node-positive breast cancer who received NAC.

OBJECTıVES: This study investigates whether textural features (TFs) extracted from 18F-FDG positron emission tomography/computed tomography (PET/CT) are associated with immunohistochemical characteristics (IHCs) of invasive ductal breast carcinoma (IDBC).
METHODS: The relationship of TFs with IHCs [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67 proliferation index, and histological grades] from solely excised primary tumors were evaluated for a more accurate assessment. Therefore patients with early-stage IDBC who underwent pre-operative 18F-FDG PET/CT scan for staging were included in this retrospective study. The clinical staging was performed according to the 8th edition of the American Joint Committee on Cancer. Maximum standardized uptake value (SUVmax) and 37TFs of the primary tumor were extracted from 18F-FDG PET/CT. Spearman\'s rank correlation test was used to evaluate the correlation between TFs and SUVmax. Receiver operating characteristic curves were generated to define the diagnostic performance of each parameter. Among these parameters, those with the highest diagnostic performance were included in the multivariate logistic regression model to identify the independent predictors of histopathological characteristics.
RESULTS: A total of 124 patients were included. Histogram-uniformity, grey-level co-occurrence matrix (GLCM), GLCM-energy, and GLCM-homogeneity showed a strong negative correlation with SUVmax, while grey-level run-length matrix (GLRLM), GLRLM-SRHGE, grey-level zone length matrix (GLZLM), GLZLM-HGZE, GLRLM-HGRE, GLCM-entropy, GLCM-contrast, histogram-entropy, and GLCM-dissimilarity showed a strong positive correlation. Some of the TFs were independently associated with ER-negativity, PR-negativity, HER-2-positivity, and increased Ki-67 proliferation index (GLCM-contrast, GLZLM-GLNU, histogram-uniformity, and shape-sphericity respectively). While SUVmax had an independent association with high-grade and triple-negativity, GLZLM-SZLGE, a high-order TF that shows the distribution of the short homogeneous zones with low grey-levels, had an independent association with axillary lymph node metastasis.
CONCLUSIONS: ER-negative, PR-negative, HER-2-positive, triple-negative, high-grade, highly proliferative, and high-stage tumors were found to be more glycolytic and metabolically heterogeneous. These findings suggest that the use of TFs in addition to SUVmax may improve the prognostic value of 18F-FDG PET/CT in IDBC, as certain TFs were independently associated with many IHCs and predicted axillary lymph node involvement.

BACKGROUND: Numerous prospective studies have shown that the incorporation of genomic assays into clinical practice significantly impacts the choice of adjuvant treatments for patients with early-stage breast cancer. However, the same evidence does not exist for the treatment of locoregional recurrences.
OBJECTIVE: The main objective of this work was to identify the clinicopathological, molecular, and genetic parameters that allow patients to be more precisely categorised into risk groups, in order to create a locoregional recurrence riskclassification tool, the PersonalRT27.
METHODS: To create PersonalRT27, we retrospective assessed the variables of patients with early breast cancer (stages I or II) who had undergone the OncotypeDx ® and MammaPrint ® genetic tests. These variables and factors included in the tests were categorised and weighted to obtain scores between 1 and 5 pointsto represent a lower or higher risk of relapse, respectively, based on these factors and as determined by the researchers.
RESULTS: The mean follow-up time was 60.5 months (range 25-96 months); locoregional progression-free survival at the time of the analysis was 98.4%, and overall survival was 97.5%, of which 0.6% of the deaths had been cancer specific. The area under the curve for the PersonalRT27 was 0.76 (95% CI [0.70, 0.81]), sensitivity was 78%, and the specificity was 58.9%. We used these factors to create an inhospital web-based nomogram.
CONCLUSIONS: The PersonalRT27 is a novel tool that integrates clinical-pathological, molecular, and genetic parameters. External and independent validation will be required to implement its clinical use.

OBJECTIVE: To evaluate the migration of 99mTc-tilmanocept from the injection site (IS) as well as the uptake in sentinel nodes (SNs) and non-SNs for lymphatic mapping in patients with breast cancer and melanoma, scheduled for SN biopsy after interstitial tracer administration.
METHODS: For 29 primary tumours in 28 patients (mean age: 62y, range: 45-81y) scheduled for SN biopsy planar images were acquired 10 and 120min after administration of 74MBq 99mTc-tilmanocept, in order to evaluate lymphatic drainage as well as uptake ratios between injection site (IS), SN and non-SN. SPECT-CT was performed immediately after delayed planar images to enable anatomical lymph node localization.
RESULTS: SNs were visualized in all patients (100%) with drainage to 34 basins. Uptake in non-SNs was perceived in 16 basins (47%). Number of SNs was concordant between early and delayed images in all basins excepting five (86%). In 24 patients tracer migrated to one lymph node basin (LNB), in three to 2 and in one to 4. When IS was included (N=29) on image, IS/SN ratio could be measured per LNB. The IS/SN ratio at 2h compared to 15min decreased with an average of 66% (range: 15-96%). SN/non-SN 2h ratio in LNBs with visible non-SNs averaged 6.6 (range: 2.3-15.6). In 9 patients with two SNs SN1/SN2 ratio averaged 1.9 on delayed images. At histopathology, SNs were found to be tumour positive in 7 basins (20%).
CONCLUSIONS: 99mTc-tilmanocept appears to meet the requirements for improved SN imaging in breast cancer and melanoma on the basis of early and persistent SN visualization frequently accompanied by no or markedly less non-SN uptake. This is associated to rapid migration from the injection site together with increasing SN uptake and retention as expressed by decreasing IS/SN and persistently high SN/non-SN ratios. Further head-to-head comparison of 99mTc-tilmanocept with standard SN radiotracers in larger series of patients is necessary.

Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.

OBJECTIVE: To measure 3-year care costs of breast, prostate, colorectal and lung cancers disaggregated by site and clinical stage.
METHODS: A retrospective observational design was employed to investigate care costs of cases recorded in the Registry of the Basque Country between 2010 and 2015. Data gathered included TNM stage and demographic, clinical and resource use variables. Total costs per patient with stage IV disease were calculated by combining generalized linear models with parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service.
RESULTS: The sample comprised 23,782 cancer cases (7801 colorectal, 5530 breast, 4802 prostate and 5649 lung cancer). The mean 3-year costs per patient with stage I to III disease were €11,323, €13,727, €8,651 and €12,023 for colorectal, breast, prostate and lung cancer, respectively. The most important cost components were surgery and chemotherapy. Total survival-adjusted costs until death for patients with stage IV disease (€27,568, €26,296, €16,151 and €15,931 for breast, colorectal, lung and prostate cancer, respectively) were higher than the 3-year costs for those with earlier-stage disease.
CONCLUSIONS: This study quantitatively shows the pattern of changes in the economic burden of cancer throughout its natural history and the great magnitude of this burden for the health system. The use of indicators based on real-world data from each regional health service would allow cancer care in each region to be tailored to local population needs.

To adapt and validate for the Chilean context the instrument Informed Choice (IC) to measure informed decision for mammography.
Primary Health Care Center in southeast Santiago, Chile.
Individual, transversal, analytical and psychometric adaptation and validation study.
We 1) translated and back-translated IC; 2) conducted a focus group for cultural/linguistic relevance; 3) reviewed content validity; 4) piloted the instrument; 5) applied IC for validation. Analysis was performed by using Cronbach alpha, correlation, Bartlett\'s test of sphericity, Kaiser-Meyer-Olkin measure and factor analysis.
Three versions of the IC were developed, which included changes according to the views of users and experts. Validation was conducted in a sample of 70 women. Mean age was 54,4 years, 47,1% had completed secondary school and 92,9% have had at least one mammography. After factor analysis item 1 was removed and the final Cronbach Alpha was 0,79.
The Chilean IC is reliable to measure decision women for mammography, this evaluate knowledge, attitude and intention towards the screening. The validation of an instrument to the cultural context is necessary and may have any variations to the original version according to local needs.

Breast cancer and its pharmacological treatment often induce an impairment in women\'s sexual functioning and couple relationships, as a consequence of physiological changes and psychosocial issues that may arise and persist long after treatment. This study aims to evaluate the sexual functioning, the quality of the couple relationship, and the overall health status of breast cancer survivors. A further objective is to determine the predictive role of specific clinical and sociodemographic variables for sexual functioning and the couple relationship. Sixty-four breast cancer survivors completed the following questionnaires: the Female Sexual Function Index (FSFI), the Dyadic Adjustment Scale (DAS), the Short Form Health Survey-12 (SF-12), and a self-report questionnaire to collect sociodemographic characteristics. Clinical information was retrieved from medical records. Compared to normative data, our sample reported significantly (p < .01) lower mean scores in the FSFI, DAS, and Physical Component (PCS) and Mental Component Summary (MCS) of the SF-12. Multiple regression analyses show a significant effect of age, hormonal therapy, and psychological well-being on sexual functioning and a significant effect of physical and mental well-being on the quality of the couple relationship. Additionally, 75% of patients qualified for sexual dysfunction as measured by the FSFI global scale, and 71.9% declared they were not adequately informed about the side effects of treatments on sexuality. The high prevalence of sexual dysfunction in breast cancer survivors underlines the need for specific attention to this problem, starting from a complete and targeted communication between patients and health providers regarding these side effects.
El cáncer de mama y su tratamiento farmacológico frecuentemente producen un deterioro del funcionamiento sexual de las mujeres y de las relaciones de pareja como consecuencia de los cambios fisiológicos y los problemas psicosociales que pueden surgir y continuar mucho después del tratamiento. Este estudio tiene como finalidad evaluar el funcionamiento sexual, la calidad de la relación de pareja y el estado de salud general de las sobrevivientes de cáncer de mama. Otro objetivo es determinar el papel predictivo que desempeñan las variables clínicas y sociodemográficas específicas para el funcionamiento sexual y la relación de pareja. Sesenta y cuatro sobrevivientes de cáncer de mama contestaron los siguientes cuestionarios: el Índice de la Función Sexual Femenina (Female Sexual Function Index, FSFI), la Escala de Ajuste Diádico (Dyadic Adjustment Scale, DAS), la Encuesta Breve sobre la Salud-12 (Short Form Health Survey-12, SF-12) y un cuestionario de autoinforme para recopilar características sociodemográficas. Se obtuvo información clínica de expedientes médicos. En comparación con los datos normativos, nuestra muestra informó puntajes de la media significativamente más bajos (p<0.01) en el FSFI, en la DAS y en el Resumen del Componente Físico (PCS) y del Componente Mental (MCS) de la SF-12. Los análisis de regresión múltiple indican un efecto significativo de la edad, la terapia hormonal y el bienestar psicológico en el funcionamiento sexual, y un efecto significativo del bienestar físico y mental en la calidad de la relación de pareja. Además, el 75 % de las pacientes reunió los requisitos de disfunción sexual según la medición de la escala global del FSFI, y el 71.9 % declaró que no estaba adecuadamente informado acerca de los efectos secundarios de los tratamientos en la sexualidad. La alta prevalencia de disfunción sexual en las sobrevivientes de cáncer de mama subraya la necesidad de atender este problema de manera específica, partiendo de una comunicación completa y dirigida entre pacientes y profesionales de la salud con respecto a estos efectos secundarios.
乳腺癌及其药物治疗往往会对妇女的性功能和夫妻关系造成损害，这是由生理变化和社会心理问题引起的，并在治疗后长期存在。本研究旨在评估乳腺癌幸存者的性功能、夫妻关系的质量和整体健康状况。另一个目标是确定特定临床和社会人口学变量对性功能和夫妻关系的预测作用。 对64名乳腺癌幸存者进行调查。他们完成了以下问卷：女性性功能指数(FSFI)、二元调整量表(DAS)、健康调查简表-12(SF-12)，以及一份收集社会人口特征的自我报告问卷。临床资料则从病历中提取。 与常模数据相比，我们的样本报告的FSFI、DAS、SF-12的生理成分（PCS）和心理成分总结（MCS）的平均得分显著降低（P<0.01）。多元回归分析显示，年龄、激素治疗和心理健康对性功能有显著影响，身心健康对夫妻关系质量有显著影响。此外，75%的患者符合FSFI全局量表测量的性功能障碍，71.9%的患者宣称没有充分了解乳腺癌治疗对性欲方面的副作用。性功能障碍的发病率高。乳腺癌幸存者中性功能障碍的高发率凸显了对这一问题给予特别关注的必要性，从患者和医疗服务提供者之间就这些副作用进行全面和有针对性的沟通开始。.