Effect of Telerehabilitation Versus In-Clinic Rehabilitation Delivery on Self-Efficacy in Breast Cancer–Related Lymphedema

Statistical analysis demonstrates the potential for telehealth as an effective alternative to in-person treatment for individuals with BCRL undergoing oncology-related rehabilitation Participants responded that overall they felt more confident in progressing with their treatment plan, and monitoring their conditions at home, even when difficult The ability to monitor and recognize changes in a condition, as well as selfmanage symptoms, is particularly important for individuals with lymphedema

Rehabilitation practitioners must be prepared to embrace technologies and service delivery models valued in the new post-COVID-19 healthcare environment Telehealth will be valued for its effectiveness and cost-efficiency in addition to the cultivation of self-efficacy Stakeholders and policymakers must realize that oncology rehabilitation services delivered via telehealth technologies can empower people to be active participants in improving quality of life and are an integral component in achieving optimal survivorship

Conclusion

There is value in telehealth to rehabilitate women with a diagnosis of BCRL. Further research needs to distinctly explore self-efficacy across various modes and dosages of delivery Rehabilitation practitioners must advocate for inclusion in future studies and articulate the distinct value of telehealth in rehabilitation for cancer survivorship, chronic disease management, and health promotion Further research is necessary to validate the efficacy and cost-effectiveness of rehabilitation assessments and interventions delivered through telehealth technologies.

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A recent study from South Africa found that 64.9% of patients were diagnosed by IHC4 as B-like, 15 3% as TNC, 13 8% as A-like, and 6 0% as HER2-enriched An earlier country-wide study, found that black South African women had higher levels of ER-negative and PR-negative tumors than women of European, South Asian or admixture heritage, but did not have significantly different HER2 levels More recently, a study showed that white South African women had similar IHC profiles to European women and white American women, with more aggressive subtypes predominant in young women and less aggressive subtypes in older women, whereas black South African women did not have substantial profile changes according to age.

Wits researchers involved: Thérèse Dix-Peek, Boitumelo Phakathi, Eunice van den Berg, Caroline Dickens, Tanya Augustine , Herbert Cubasch, Maureen Joffe, Paul Ruff, Raquel Duarte

Breast cancer is the most commonly diagnosed cancer among South African women accounting for 27.1% of all cancers diagnosed in these women. Breast cancer diagnoses on the African continent have been steadily increasing over the past decades, attributed to longer lifespans and changes in lifestyle associated with westernization In Africa, mortality rates are higher than in Europe and the United States, largely due to late stage at diagnosis and fewer treatment options. Breast cancer is a heterogeneous disease, differing in gene expression patterns, growth rates, responses to treatment and clinical outcomes.

The last decade has seen the development of many commercialized multigene tests to guide treatment and provide prognostic information for patients with breast cancer The PAM50/ Prosigna assay has a 50gene signature that groups tumors into intrinsic molecular subtypes luminal-A, luminal-B, HER2enriched and basal-like. The PAM50 assay is less subjective than the Immunohistochemistry-based (IHC) techniques, but is much more expensive and labor intensive than IHC. In South African public hospitals, IHC continues to be used for clinical subtyping because of its lower cost.

The South African Breast Cancer and HIV Outcomes (SABCHO) cohort studied patients recruited at the breast clinic of Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa. Participants were consenting women with biopsy-confirmed breast cancer who self-identified as Black African Exclusion criteria were age < 18 years or current pregnancy Clinical staging was according to the American Joint Committee on Cancer (AJCC) system. The mean age of study participants was 49 7 years Most patients had stage II or III cancers, and were more likely to have grade-2 or -3 tumors between 20 and 50 mm (AJCC T2), with some nodal involvement. The researchers focused on IHC classification of tumors, PAM50 intrinsic subtyping and Statistical analysis

Most of the study participants had hormone receptor positive breast cancer, and even tumors with the HER2-enriched subtype were more likely to be HR positive than HR negative PAM50 is widely used for breast cancer subtyping, with IHC often used in resource constrained settings. The cost and labor of the PAM50 method make it prohibitive for the South African public health care sector and its inability to distinguish between HER2-positive B-subtypes and HR negative/HER2 positive subtypes must also give pause.

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Wits researchers involved: Samson Adeyemi, Zardad Az-Zamakhshariy, Yahya Choonara

Solid lipid nanoparticles (SLNs) are used extensively to achieve site-specific drug delivery with improved bioavailability and reduced toxicity. This work focused on a new approach to provide site-specific stimuli-responsive delivery of SLNs loaded within thermo-sonic nanoorganogel (TNO) variants to deliver the model chemotherapeutic agent 5-FU in treating cervical cancer. Pharmaceutically stable nanospherical SLNs comprising poly-L-lactic acid (PLA), palmitic acid (PA), and polyvinyl alcohol (PVA) were prepared and incorporated into TNO variants augmented by external thermal and ultrasound stimuli for release of 5-FU in the cervix.

The establishment of nanomedicine has revolutionized advances in chemotherapy for oncology Nanoenabled drug delivery systems continue to progress as an efficient therapeutic approach using various nanostructures such as nanoparticles, nanomicelles, or nanoliposomes. For example, the chemotherapeutic agent 5-flourouracil (5FU) has been successfully used as adjunct drug therapy to treat cervical cancer, and recent research has shown that when applied locally within nanolipids, it provides enhanced drug loading and controlled-release chemotherapy for women diagnosed with cervical intraepithelial neoplasia 2 (CIN II)

Similarly, solid lipid nanoparticles (SLNs) are widely used to achieve site-specific drug delivery with superior bioavailability SLNs provide an augmented drug encapsulating capacity during formulation and surface functionalization can occur for the targeted delivery of bioactives However, a disadvantage of SLNs used in chemotherapeutic applications is their rapid clearance from the body.

Conventional gels used to carry SLNs have a fibrous network comprising gelators that support the solvent molecules and therefore display sponge-like viscoelastic properties. Alternatively, organogels are a class of gels constituting a liquid organic phase embedded within a three-dimensional crosslinked network

Poly-L-lactic acid (PLA), palmitic acid (PA), poly(vinyl alcohol) (PVA), dichloromethane (DCM), methanol, 5Fluorouracil (5-FU), ethylene glycol (EG), ethanol, dimethyl sulfoxide (DMSO), N-(Isopropyl Acrylamide) (NIPAM), sebacic acid (SA), 1,3 4-(carboxyphenoxy) propane (CPP), sodium dodecyl sulfate (SDS), methylene bis-acrylamide (MBA), and ammonium persulfate (APS) were purchased from Sigma-Aldrich Inc. (St. Louis, MO, USA).

SLNs assembled into TNO variants were prepared and characterized for their in situ application to the cervix as a potential site-specific treatment for cervical cancer. In keeping with the objective of achieving stimuli-responsive site-specific and sustained release of 5-FU from the TNO variants, the formulations were augmented by introducing thermal (T) and/or ultrasound (U) responsivity to preferentially increased 5-FU release when applied to the site. Stable 5-FUloaded SLNs were successfully produced with desirable micromeritic and morphological stability before incorporation into three TNO variants to assess 5-FU release in the presence of single (T)/combined (TU) stimuli

Results revealed that 5-FU was released from the TNO in a sustained release manner over 15 days in simulated cervical fluid The release rate was primarily influenced by the SLN:TO ratio to produce controlled drug release in tandem with system biodegradation and hydrodynamic influx Variants TNO 1 and 2 presented the most desired results in terms of controlled 5-FU release under combined thermo-sonic (TU) stimuli and are most promising for superior sitespecific delivery of 5-FU to cancerous cervical tissue

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