The impact of chemotherapy dose density and dose intensity on breast cancer outcome: what have we learned?

Optimising chemotherapy dose density and dose intensity are strategies aimed at improving outcomes in adjuvant therapy for patients with breast cancer. There are, in theory, at least five models allowing the delivery of a higher overall drug dose intensity. These are reviewed in this article and vary according to three main variables: the dose per course, the interval between doses and the total cumulative dose. Cyclophosphamide, anthracyclines and taxanes are among the most active agents for the treatment of breast cancer and, as such, they have been or are currently the focus of prospective, randomised clinical trials testing some of these dose-intensity models in the adjuvant setting. The results of recent trials suggest that anthracyclines, but not cyclophosphamide, are associated with better outcomes if used at higher doses per course and at higher cumulative doses. However, care has to be taken with premenopausal women where an increased dose of anthracycline per course but a reduced cumulative dose appears to produce a worse outcome. Moreover, decreasing the interval between doses, for anthracyclines and cyclophosphamide, does not seem to provide, so far, additional benefits for women with locally advanced breast cancer. This approach is not feasible with docetaxel, since an increase in dose density induces unwanted side-effects. These results represent our current state of knowledge, but clinical trials are being performed to evaluate further the effect of dose intensity, dose density and cumulative dose of key therapeutic agents on patient outcomes.

We want to touch IT. Are hybrid laptops just new fancy gadgets or a new revolution?

While the number of traditional laptops and computers sold has dipped slightly year over year, manufacturers have developed new hybrid laptops with touch screens to build on the tactile trend. This market is moving quickly to make touch the rule rather than the exception and the sales of these devices have tripled since the launch of Windows 8 in 2012, to reach more than sixty million units sold in 2015. Unlike tablets, that benefit from easy-to-use applications specially designed for tactile interactions, hybrid laptops are intended to be used with regular user-interfaces. Hence, one could ask whether tactile interactions are suited for every task and activity performed with such interfaces. Since hybrid laptops are increasingly used in educational situations, this study focuses on information search tasks which are commonly performed for learning purposes. It is hypothesized that tasks that require complex and/or less common gestures will increase user's cognitive load and impair task performance in terms of efficacy and efficiency. A study was carried out in a usability laboratory with 30 participants for whom prior experience with tactile devices has been controlled. They were asked to perform information search tasks on an online encyclopaedia by using only the touch screen of and hybrid laptop. Tasks were selected with respect to their level of cognitive demand (amount of information that had to be maintained in working memory) and the complexity of gestures needed (left and/or right clicks, zoom, text selection and/or input.), and grouped into 4 sets accordingly. Task performance was measured by the number of tasks succeeded (efficacy) and time spent on each task (efficiency). Perceived cognitive load was assessed thanks to a questionnaire given after each set of tasks. An eye tracking device was used to monitor users' attention allocation and to provide objective cognitive load measures based on pupil dilation and the Index of Cognitive Activity. Each experimental run took approximately one hour. The results of this within-subjects design indicate that tasks involving complex gestures led to a lower efficacy, especially when the tasks were cognitively demanding. Regarding efficacy, there is no significant differences between sets of tasks excepted for tasks with low cognitive demand and complex gestures that required more time to be achieved. Surprisingly, users that declared the biggest experience with tactile devices spent more time than less frequent users. Cognitive load measures indicate that participants reported having devoted more mental effort in the interaction when they had to use complex gestures.

The bigger the better? or what we know and what we still need to learn about anthracycline dose per course, dose density and cumulative dose in the treatment of breast cancer.

Clinical Trial

Is intracytoplasmic sperm injection (ICSI) a safe procedure: What do we learn first trimester data in ICSI pregnancies ?

info:eu-repo/semantics/nonPublished