Measurement of Depression in Breast Cancer Patients by Using a Mobile Application : A Feasibility and Reliability Study

Yoojin Sim,Guiyun Sohn,Byung Ho Son,Sei Hyun Ahn,Jong Won Lee,Yong-Wook Shin 대한신경정신의학회 2016 신경정신의학 Vol.55 No.3

Objectives This study examined feasibility and reliability of a mobile application to measure depression in breast cancer patients. Methods Forty-two breast cancer patients from the Department of Surgery at Asan Medical Center were included in the study. The Beck Depression Inventory (BDI), EuroQol Five Dimensional Questionnaire, and EuroQol Visual Analogue Scale were assessed at baseline and twice after surgery at regular intervals. The Patient Health Questionnaire-9 (PHQ-9) was delivered by as a push notification via mobile application every two weeks for 12 months. Feasibility was calculated using number of respondents and total number of PHQ-9 completed. Reliability was calculated from the relationship between PHQ-9 and BDI scores obtained within each two week period. Agreement between PHQ-9 and BDI scores in the diagnosis of depression was evaluated by kappa statistic and McNemar s test. Results One thousand and ninety-two notifications for PHQ-9 were sent, and 622 responses were reported (compliance rate=57%). The compliance rate was not related to demographic factors except for the date of the first use of the application. Pearson s r between PHQ-9 and BDI scores was 0.599 (p<0.001), and kappa analysis demonstrated moderate level of agreement in diagnosis of depression (κ=0.431). Conclusion The compliance rate for patients reporting their symptoms by mobile application is high and the scores of PHQ-9 and BDI are correlated, which suggests that the mobile data measuring depression is reliable. However, this is a preliminary study and further study is needed to determine other factors that influence compliance rate.

Daily Collection of Self-Reporting Sleep Disturbance Data via a Smartphone App in Breast Cancer Patients Receiving Chemotherapy: A Feasibility Study

Min, Yul Ha,Lee, Jong Won,Shin, Yong-Wook,Jo, Min-Woo,Sohn, Guiyun,Lee, Jae-Ho,Lee, Guna,Jung, Kyung Hae,Sung, Joohon,Ko, Beom Seok,Yu, Jong-Han,Kim, Hee Jeong,Son, Byung Ho,Ahn, Sei Hyun JMIR Publications Inc. 2014 Journal of medical Internet research Vol.16 No.5

<P><B>Background</B></P><P>Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy.</P><P><B>Objective</B></P><P>The primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions.</P><P><B>Methods</B></P><P>Between March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients’ demographics, interval from enrollment to first self-report, baseline Beck’s Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process.</P><P><B>Results</B></P><P>A total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0%, 1215/2700). The median value of individual patient-level reporting rates was 41.1% (range 6.7-95.6%). The longitudinal day-level compliance curve fell to 50.0% at day 34 and reached a nadir of 13.3% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50% at day 70 and continued to fall to 45% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6%, SD 24.0 and 29.6%, SD 25.3, respectively; <I>P</I>=.03).</P><P><B>Conclusions</B></P><P>The 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care.</P>

Predicting Successful Conservative Surgery after Neoadjuvant Chemotherapy in Hormone Receptor-Positive, HER2-Negative Breast Cancer

Chang Seok Ko,Kyu Min Kim,Jong Won Lee,Han Shin Lee,Sae Byul Lee,Guiyun Sohn,Jisun Kim,Hee Jeong Kim,Il Yong Chung,Beom Seok Ko,Byung Ho Son,Seung Do Ahn,Sung-Bae Kim,Hak Hee Kim,Sei Hyun Ahn 한국유방암학회 2018 Journal of Breast Disease Vol.6 No.2

Purpose: This study aimed to determine whether clinicopathological factors are potentially associated with successful breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) and develop a nomogram for predicting successful BCS candidates, focusing on those who are diagnosed with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative tumors during the pre- NAC period. Methods: The training cohort included 239 patients with an HR-positive, HER2-negative tumor (≥3 cm), and all of these patients had received NAC. Patients were excluded if they met any of the following criteria: diffuse, suspicious, malignant microcalcification (extent >4 cm); multicentric or multifocal breast cancer; inflammatory breast cancer; distant metastases at the time of diagnosis; excisional biopsy prior to NAC; and bilateral breast cancer. Multivariate logistic regression analysis was conducted to evaluate the possible predictors of BCS eligibility after NAC, and the regression model was used to develop the predicting nomogram. This nomogram was built using the training cohort (n=239) and was later validated with an independent validation cohort (n=123). Results: Small tumor size (p<0.001) at initial diagnosis, long distance from the nipple (p=0.002), high body mass index (p=0.001), and weak positivity for progesterone receptor (p=0.037) were found to be four independent predictors of an increased probability of BCS after NAC; further, these variables were used as covariates in developing the nomogram. For the training and validation cohorts, the areas under the receiver operating characteristic curve were 0.833 and 0.786, respectively; these values demonstrate the potential predictive power of this nomogram. Conclusion: This study established a new nomogram to predict successful BCS in patients with HR-positive, HER2-negative breast cancer. Given that chemotherapy is an option with unreliable outcomes for this subtype, this nomogram may be used to select patients for NAC followed by successful BCS.

The reality in the follow-up of breast cancer survivors

Ku Sang Kim,Zisun Kim,Eun-Jung Shim,Nam Hyoung Kim,So-Youn Jung,Jisun Kim,Guiyun Sohn,Jong Won Lee,Jihyoung Cho,Jung Eun Lee,Juhyung Lee,Hyun Jo Youn,Jihyoun Lee,Min Hyuk Lee 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.88 No.3

Purpose: Follow-up after primary treatment for breast cancer is an important component of survivor care and various international guidelines exist for the surveillance. However, little is known about current actual practice patterns of physicians whether they adhere to or deviate from recommended guidelines. The aim of this study was to determine how physicians follow-up their patients after primary treatment for breast cancer in Korea. Methods: A questionnaire survey with 34 questions in 4 categories was e-mailed to the members of Korean Breast Cancer Society from November to December 2013. Respondents were asked how they use follow-up modalities after primary treatment of breast cancer and we compared the survey results with present guidelines. Results: Of the 129 respondents, 123 (95.3%) were breast surgeons. The most important consideration in follow-up was tumor stage. History taking, physical examinations, and mammography were conducted in similar frequency recommended by other guidelines while breast ultrasonography was performed more often. The advanced imaging studies such as CT, MRI, and bone scan, which had been recommended to be conducted only if necessary, were also examined more frequently. Regular screenings for secondary malignancy were performed in 38 respondents (29.5%). Five years later after primary treatment, almost the whole respondents (94.6%) themselves monitored their patients. Conclusion: A majority of respondents have been performed more intensive follow-up modalities in comparison with present guidelines and less frequently screenings for secondary malignancy. For optimal follow-up of breast cancer survivors, tailored delivery system should be considered.

Effects of Less than 60 Days Delay in Surgery on Tumor Progression and Survival Outcomes in Invasive Breast Cancer Patients

Jonguk Lee,손병호,Saebyul Lee,Jong Won Lee,Beom Seok Ko,Hee Jeong Kim,Jisun Kim,Il Yong Chung,Guiyun Sohn,Sei Hyun Ahn 한국유방암학회 2016 Journal of Breast Disease Vol.4 No.2

Purpose: The effect of delays in surgical treatment on survival outcomes in patients with breast cancer remains uncertain, but it is an issue of importance to both patients and clinicians. The purpose of this study was to determine the impact of delayed surgical treatment on survival and tumor progression such as changes in tumor size and lymph node metastasis. Methods: Among 1,219 patients who underwent breast cancer surgery at Asan Medical Center between January 2008 and December 2008, 1,074 patients were finally included in the study following the application of inclusion and exclusion criteria. Patients were divided into two groups based on the interval between diagnosis and surgery: ≤30 days (group 1) and >30 days (group 2). We retrospectively analyzed clinical characteristics, changes in tumor size and axillary lymph-node status, and overall survival (OS) and disease-free survival (DFS) rates. Results: Between group 1 and group 2, there were no differences in clinical characteristics or in changes in tumor size between findings based on ultrasonography (USG) with biopsy at diagnosis and pathologic results (p=0.134). Furthermore, changes in tumor size and lymph-node status between USG results at Asan Medical Center and pathologic results also showed no differences (p=0.249 and p=0.233, respectively). There were also no significant differences in DFS (p=0.395) or OS (p=0.813). Conclusion: Our study showed that short-term delays of ≤2 months between diagnosis and surgery for breast cancer do not negatively affect cancer progression or survival rates.