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Salute to Service Dogs
The psychological and moral comfort of a presence at once humble and understanding—this is the greatest benefit that the dog has bestowed upon man. Percy Bysshe Shelley
The nature of their special training to perform specific tasks for the safety and well-being of veterans distinguishes service dogs from pets or emotional support animals. Most of us recognize the happiness and meaning animals bring to our lives. What we may not appreciate is the impressive contribution service dogs make to the health and rehabilitation of those who have served their country. Veteran patients with neurologic conditions such as seizures know the difference a service dog trained to warn them of an emerging seizure makes for their freedom of movement and peace of mind. Veterans with diabetes have described times when their service dogs sought help before they realized their blood sugar was dangerously low.
Patients, friends, and neighbors who have been paired with service dogs describe ways their new companion helped them transition from a life in which even surviving was a struggle to one of holistic thriving. A Vietnam veteran neighbor with a significant tremor due to Parkinson disease benefitted from the ability of his dog to fetch and bring, retrieve, and carry. His dog has learned to hold essential items still, which would otherwise be too shaky in human hands, enabling the veteran to open his closet door and dress independently each morning. One veteran classmate avoided all forms of public transportation due to memories of a traumatic mobile-based mass evacuation she assisted with during her military service. She dreaded her long, inconvenient daily drive back and forth to work. She was then partnered with a large dog breed that was trained to stand a short distance from her to protect her sense of space and open air. The dog would stretch out his body to claim more space for her among crowds. This veteran started to ride the bus to campus each morning and appreciated the interaction with other riders as well as the saved travel time, mileage, gasoline expense, and parking stress.
A veteran brought his sweet retriever to the neighborhood weekly “Paws-itive Reading” program for children in the local public library. When MW’s daughter was busy reading to his furry friend, the veteran shared that for at least 5 years after his combat tours, he rarely left his window-shuttered home. His dog’s steady comfort re-established his ability to participate in his community. He now generously shares his dog’s patient affection with children learning to read.
MW recently witnessed the profound and protective presence of a service dog in comforting a veteran during a posttraumatic stress disorder (PTSD)–related crisis. The service dog offered a lean and reassuring paw pressure on the veteran’s shoulder if he was reexperiencing trauma. The dog’s steady breathing and familiar warmth helped to reorient their human companion to the safety of his present physical surroundings. Bearing witness to the dog’s trained interaction with the veteran left MW speechless. The trust between them was therapeutic in a way that transcended her ability to articulate what she experienced. This compelled MW to investigate whether this was a rare relationship or whether there was existing data on the impact of trained service dogs and PTSD.
Service dog placement with veterans with PTSD has been shown to have a positive influence on both physiological (arousal-related functioning and cortisol awakening response) and psychosocial well-being, including decreased isolation and increased physical activity.1,2 Veterans with PTSD paired with service dogs showed significantly fewer PTSD-related symptoms, better sleep quality, and improved well-being, compared with those with just a pet.3 A recent meta-analysis revealed that veteran partnerships with a service dog had a clinically meaningful, significant, and large effect on PTSD severity scores (P < .001).2 The mechanism for impact is thought to be not only the dog’s working role but also the transcendent loyalty of the canine-veteran bond.
Many accredited dog training programs describe a certain reciprocity to the dog-human relationship. Some use rescue puppies to give the dogs a new life and purpose. Dogs who have undergone challenges often need patience, time, safe relationships, and trustworthy new experiences to maximize their potential. Reciprocally, trained service dogs have the potential to foster access to these same emotional, relational, existential, and physical safety needs for veterans exposed to trauma.
Recent legislation has made progress in recognizing the role of service dogs for veterans and improving access. The Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act (38 USC §1705, 1714) was passed in 2021. The PAWS Act implemented a policy and 5-year pilot program to connect trained canines to eligible veterans diagnosed with PTSD as an element of an integrative health program, regardless of whether the veteran has a mobility impairment. The PAWS Act gives federal funding to accredited dog training organizations to help pair eligible veterans with service dogs by covering veteran travel expenses for the training, training program participation, and relevant veterinary expenses. The bipartisan Service Dogs Assisting Veterans Act (SAVES) Act was introduced this summer to award grants to nonprofit organizations Assistance Dog International has accredited to help these groups provide service dogs to veterans.
The US Department of Veterans Affairs (VA) has made strides in welcoming service dogs. Trained service dogs of all breeds under the control of a human companion are now allowed in VA facilities other than in areas where safety and infection control standards would be compromised (ie, sterile equipment rooms).4 A prescribing clinician can now evaluate eligible veterans to determine their ability, resources, and goals for having a service dog.5 An assessment of the veteran’s ability to care for a dog and education on expectations for the partnership is critical to success and animal welfare. Those veterans approved for a service dog are then referred to accredited agencies. The VA Veterinary Health Insurance Benefit includes aspects of coverage for the veteran to attend service dog training, veterinary wellness (preventive care, immunizations, dental cleanings, certain prescriptions, etc), and care for the dog’s illnesses when treatment enables the dog to perform duties in service to the veteran.6
The productive purpose and friendship of a service dog become a formidable force in a veteran’s life. Veterans spent an average of 82% of their time with service dogs (assessed via Bluetooth proximity between collar and smartphone).7 Human partners of veterans with service dogs may experience improved quality of life and relationship functioning with the inclusion of a service dog in the family unit.8 Veterans depict increased community engagement, social connectedness, and personal confidence as a result of the canine companionship.9,10 Veterans with service dogs often speak of the ways the dog’s presence transformed their lives and many speak of the dog literally saving their lives.11 Meta-analyses showed improved mental health treatment engagement, medication adherence, and decreased suicidality.2,12
A story was recently shared with us about the compassion and competence of VA staff in a perioperative unit. A veteran was scheduled for a life-altering surgery and yet was anxious about entering the room for his scheduled pre-anesthesia check-in, knowing his service dog could not accompany him through the entire procedure. The staff recognized that the veteran was increasingly nervous and even started to question whether he would stay for the scheduled procedure they deemed would benefit his health. The perioperative team then proactively worked together to safely walk the veteran through the preparation processes in a sterile setting while keeping the dog within sight of the veteran. They then ensured that the veteran’s service dog was by his side early in the recovery room so that the veteran woke to wags and licks. In these months of canine recognition, we honor the ways the VA has fostered companionship and courage in veterans’ lives through the inclusion of service dogs in so many aspects of their care and life.
1. Rodriguez KE, Bryce CI, Granger DA, O’Haire ME. The effect of a service dog on salivary cortisol awakening response in a military population with posttraumatic stress disorder (PTSD). Psychoneuroendocrinology. 2018;98:202-210. doi:10.1016/j.psyneuen.2018.04.026
2. Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. PloS One. 2022;17(9):e0274960. doi:10.1371/journal.pone.0274960
3. Van Houtert EAE, Rodenburg TB, Vermetten E, Endenburg N. The impact of service dogs on military veterans and (ex) first aid responders with post-traumatic stress disorder. Front Psychiatry. 2022;13:834291. doi:10.3389/fpsyt.2022.834291
4. VHA Directive 1188(1). Animals on Veterans Health Administration (VHA) Property. Veterans Health Administration. August 26, 2015. Amended April 25, 2019. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3138
5. Veteran Affairs Rehabilitation and Prosthetic Services. Service Dog Veterinary Health Benefit. US Department of Veterans Affairs. Updated September 19, 2019. Accessed August 21, 2023. https://www.prosthetics.va.gov/serviceandguidedogs.asp
6. Service Dog Veterinary Health Insurance (VHIB) Benefit Rules. US Department of Veterans Affairs Rehabilitation and Prosthetic Services. Updated December 2022. Accessed August 21, 2023. https://www.prosthetics.va.gov/factsheet/PSAS-FactSheet-ServiceDogs.pdf
7. Jensen CL, Rodriguez KE, MacLean EL, Abdul Wahab AH, Sabbaghi A, O’Haire ME. Characterizing veteran and PTSD service dog teams: exploring potential mechanisms of symptom change and canine predictors of efficacy. PloS One. 2022;17(7):e0269186. doi:10.1371/journal.pone.0269186
8. McCall CE, Rodriguez KE, Wadsworth SMM, Meis LA, O’Haire ME. “A Part of Our Family”? Effects of psychiatric service dogs on quality of life and relationship functioning in military-connected couples. Mil Behav Health. 2020;8(4):410-423. doi:10.1080/21635781.2020.1825243
9. Krause-Parello CA, Sarni S, Padden E. Military veterans and canine assistance for post-traumatic stress disorder: a narrative review of the literature. Nurse Educ Today. 2016;47:43-50. doi:10.1016/j.nedt.2016.04.020
10. Van Houtert EAE, Endenburg N, Wijnker JJ, Rodenburg B, Vermetten E. The study of service dogs for veterans with post-traumatic stress disorder: a scoping literature review. Eur J Psychotraumatol. 2018;9(suppl 3):1503523. doi:10.1080/20008198.2018.1503523
11. Sherman M, Hutchinson AD, Bowen H, Iannos M, Van Hooff M. Effectiveness of Operation K9 assistance dogs on suicidality in Australian veterans with PTSD: a 12-month mixed-methods follow-up study. Int J Environ Res Public Health. 2023;20(4):3607. Published 2023 Feb 17. doi:10.3390/ijerph20043607
12. Richerson JT, Saunders GH, Skelton K, et al. A randomized trial of differential effectiveness of service dog pairing to improve quality of life for veterans with PTSD. Office of Research and Development, Veterans Health Administration. 2020:186. https://www.research.va.gov/REPORT-Study-of-Costs-and-Benefits-Associated-with-the-Use-of-Service-Dogs-Monograph1.pdf
The psychological and moral comfort of a presence at once humble and understanding—this is the greatest benefit that the dog has bestowed upon man. Percy Bysshe Shelley
The nature of their special training to perform specific tasks for the safety and well-being of veterans distinguishes service dogs from pets or emotional support animals. Most of us recognize the happiness and meaning animals bring to our lives. What we may not appreciate is the impressive contribution service dogs make to the health and rehabilitation of those who have served their country. Veteran patients with neurologic conditions such as seizures know the difference a service dog trained to warn them of an emerging seizure makes for their freedom of movement and peace of mind. Veterans with diabetes have described times when their service dogs sought help before they realized their blood sugar was dangerously low.
Patients, friends, and neighbors who have been paired with service dogs describe ways their new companion helped them transition from a life in which even surviving was a struggle to one of holistic thriving. A Vietnam veteran neighbor with a significant tremor due to Parkinson disease benefitted from the ability of his dog to fetch and bring, retrieve, and carry. His dog has learned to hold essential items still, which would otherwise be too shaky in human hands, enabling the veteran to open his closet door and dress independently each morning. One veteran classmate avoided all forms of public transportation due to memories of a traumatic mobile-based mass evacuation she assisted with during her military service. She dreaded her long, inconvenient daily drive back and forth to work. She was then partnered with a large dog breed that was trained to stand a short distance from her to protect her sense of space and open air. The dog would stretch out his body to claim more space for her among crowds. This veteran started to ride the bus to campus each morning and appreciated the interaction with other riders as well as the saved travel time, mileage, gasoline expense, and parking stress.
A veteran brought his sweet retriever to the neighborhood weekly “Paws-itive Reading” program for children in the local public library. When MW’s daughter was busy reading to his furry friend, the veteran shared that for at least 5 years after his combat tours, he rarely left his window-shuttered home. His dog’s steady comfort re-established his ability to participate in his community. He now generously shares his dog’s patient affection with children learning to read.
MW recently witnessed the profound and protective presence of a service dog in comforting a veteran during a posttraumatic stress disorder (PTSD)–related crisis. The service dog offered a lean and reassuring paw pressure on the veteran’s shoulder if he was reexperiencing trauma. The dog’s steady breathing and familiar warmth helped to reorient their human companion to the safety of his present physical surroundings. Bearing witness to the dog’s trained interaction with the veteran left MW speechless. The trust between them was therapeutic in a way that transcended her ability to articulate what she experienced. This compelled MW to investigate whether this was a rare relationship or whether there was existing data on the impact of trained service dogs and PTSD.
Service dog placement with veterans with PTSD has been shown to have a positive influence on both physiological (arousal-related functioning and cortisol awakening response) and psychosocial well-being, including decreased isolation and increased physical activity.1,2 Veterans with PTSD paired with service dogs showed significantly fewer PTSD-related symptoms, better sleep quality, and improved well-being, compared with those with just a pet.3 A recent meta-analysis revealed that veteran partnerships with a service dog had a clinically meaningful, significant, and large effect on PTSD severity scores (P < .001).2 The mechanism for impact is thought to be not only the dog’s working role but also the transcendent loyalty of the canine-veteran bond.
Many accredited dog training programs describe a certain reciprocity to the dog-human relationship. Some use rescue puppies to give the dogs a new life and purpose. Dogs who have undergone challenges often need patience, time, safe relationships, and trustworthy new experiences to maximize their potential. Reciprocally, trained service dogs have the potential to foster access to these same emotional, relational, existential, and physical safety needs for veterans exposed to trauma.
Recent legislation has made progress in recognizing the role of service dogs for veterans and improving access. The Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act (38 USC §1705, 1714) was passed in 2021. The PAWS Act implemented a policy and 5-year pilot program to connect trained canines to eligible veterans diagnosed with PTSD as an element of an integrative health program, regardless of whether the veteran has a mobility impairment. The PAWS Act gives federal funding to accredited dog training organizations to help pair eligible veterans with service dogs by covering veteran travel expenses for the training, training program participation, and relevant veterinary expenses. The bipartisan Service Dogs Assisting Veterans Act (SAVES) Act was introduced this summer to award grants to nonprofit organizations Assistance Dog International has accredited to help these groups provide service dogs to veterans.
The US Department of Veterans Affairs (VA) has made strides in welcoming service dogs. Trained service dogs of all breeds under the control of a human companion are now allowed in VA facilities other than in areas where safety and infection control standards would be compromised (ie, sterile equipment rooms).4 A prescribing clinician can now evaluate eligible veterans to determine their ability, resources, and goals for having a service dog.5 An assessment of the veteran’s ability to care for a dog and education on expectations for the partnership is critical to success and animal welfare. Those veterans approved for a service dog are then referred to accredited agencies. The VA Veterinary Health Insurance Benefit includes aspects of coverage for the veteran to attend service dog training, veterinary wellness (preventive care, immunizations, dental cleanings, certain prescriptions, etc), and care for the dog’s illnesses when treatment enables the dog to perform duties in service to the veteran.6
The productive purpose and friendship of a service dog become a formidable force in a veteran’s life. Veterans spent an average of 82% of their time with service dogs (assessed via Bluetooth proximity between collar and smartphone).7 Human partners of veterans with service dogs may experience improved quality of life and relationship functioning with the inclusion of a service dog in the family unit.8 Veterans depict increased community engagement, social connectedness, and personal confidence as a result of the canine companionship.9,10 Veterans with service dogs often speak of the ways the dog’s presence transformed their lives and many speak of the dog literally saving their lives.11 Meta-analyses showed improved mental health treatment engagement, medication adherence, and decreased suicidality.2,12
A story was recently shared with us about the compassion and competence of VA staff in a perioperative unit. A veteran was scheduled for a life-altering surgery and yet was anxious about entering the room for his scheduled pre-anesthesia check-in, knowing his service dog could not accompany him through the entire procedure. The staff recognized that the veteran was increasingly nervous and even started to question whether he would stay for the scheduled procedure they deemed would benefit his health. The perioperative team then proactively worked together to safely walk the veteran through the preparation processes in a sterile setting while keeping the dog within sight of the veteran. They then ensured that the veteran’s service dog was by his side early in the recovery room so that the veteran woke to wags and licks. In these months of canine recognition, we honor the ways the VA has fostered companionship and courage in veterans’ lives through the inclusion of service dogs in so many aspects of their care and life.
The psychological and moral comfort of a presence at once humble and understanding—this is the greatest benefit that the dog has bestowed upon man. Percy Bysshe Shelley
The nature of their special training to perform specific tasks for the safety and well-being of veterans distinguishes service dogs from pets or emotional support animals. Most of us recognize the happiness and meaning animals bring to our lives. What we may not appreciate is the impressive contribution service dogs make to the health and rehabilitation of those who have served their country. Veteran patients with neurologic conditions such as seizures know the difference a service dog trained to warn them of an emerging seizure makes for their freedom of movement and peace of mind. Veterans with diabetes have described times when their service dogs sought help before they realized their blood sugar was dangerously low.
Patients, friends, and neighbors who have been paired with service dogs describe ways their new companion helped them transition from a life in which even surviving was a struggle to one of holistic thriving. A Vietnam veteran neighbor with a significant tremor due to Parkinson disease benefitted from the ability of his dog to fetch and bring, retrieve, and carry. His dog has learned to hold essential items still, which would otherwise be too shaky in human hands, enabling the veteran to open his closet door and dress independently each morning. One veteran classmate avoided all forms of public transportation due to memories of a traumatic mobile-based mass evacuation she assisted with during her military service. She dreaded her long, inconvenient daily drive back and forth to work. She was then partnered with a large dog breed that was trained to stand a short distance from her to protect her sense of space and open air. The dog would stretch out his body to claim more space for her among crowds. This veteran started to ride the bus to campus each morning and appreciated the interaction with other riders as well as the saved travel time, mileage, gasoline expense, and parking stress.
A veteran brought his sweet retriever to the neighborhood weekly “Paws-itive Reading” program for children in the local public library. When MW’s daughter was busy reading to his furry friend, the veteran shared that for at least 5 years after his combat tours, he rarely left his window-shuttered home. His dog’s steady comfort re-established his ability to participate in his community. He now generously shares his dog’s patient affection with children learning to read.
MW recently witnessed the profound and protective presence of a service dog in comforting a veteran during a posttraumatic stress disorder (PTSD)–related crisis. The service dog offered a lean and reassuring paw pressure on the veteran’s shoulder if he was reexperiencing trauma. The dog’s steady breathing and familiar warmth helped to reorient their human companion to the safety of his present physical surroundings. Bearing witness to the dog’s trained interaction with the veteran left MW speechless. The trust between them was therapeutic in a way that transcended her ability to articulate what she experienced. This compelled MW to investigate whether this was a rare relationship or whether there was existing data on the impact of trained service dogs and PTSD.
Service dog placement with veterans with PTSD has been shown to have a positive influence on both physiological (arousal-related functioning and cortisol awakening response) and psychosocial well-being, including decreased isolation and increased physical activity.1,2 Veterans with PTSD paired with service dogs showed significantly fewer PTSD-related symptoms, better sleep quality, and improved well-being, compared with those with just a pet.3 A recent meta-analysis revealed that veteran partnerships with a service dog had a clinically meaningful, significant, and large effect on PTSD severity scores (P < .001).2 The mechanism for impact is thought to be not only the dog’s working role but also the transcendent loyalty of the canine-veteran bond.
Many accredited dog training programs describe a certain reciprocity to the dog-human relationship. Some use rescue puppies to give the dogs a new life and purpose. Dogs who have undergone challenges often need patience, time, safe relationships, and trustworthy new experiences to maximize their potential. Reciprocally, trained service dogs have the potential to foster access to these same emotional, relational, existential, and physical safety needs for veterans exposed to trauma.
Recent legislation has made progress in recognizing the role of service dogs for veterans and improving access. The Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act (38 USC §1705, 1714) was passed in 2021. The PAWS Act implemented a policy and 5-year pilot program to connect trained canines to eligible veterans diagnosed with PTSD as an element of an integrative health program, regardless of whether the veteran has a mobility impairment. The PAWS Act gives federal funding to accredited dog training organizations to help pair eligible veterans with service dogs by covering veteran travel expenses for the training, training program participation, and relevant veterinary expenses. The bipartisan Service Dogs Assisting Veterans Act (SAVES) Act was introduced this summer to award grants to nonprofit organizations Assistance Dog International has accredited to help these groups provide service dogs to veterans.
The US Department of Veterans Affairs (VA) has made strides in welcoming service dogs. Trained service dogs of all breeds under the control of a human companion are now allowed in VA facilities other than in areas where safety and infection control standards would be compromised (ie, sterile equipment rooms).4 A prescribing clinician can now evaluate eligible veterans to determine their ability, resources, and goals for having a service dog.5 An assessment of the veteran’s ability to care for a dog and education on expectations for the partnership is critical to success and animal welfare. Those veterans approved for a service dog are then referred to accredited agencies. The VA Veterinary Health Insurance Benefit includes aspects of coverage for the veteran to attend service dog training, veterinary wellness (preventive care, immunizations, dental cleanings, certain prescriptions, etc), and care for the dog’s illnesses when treatment enables the dog to perform duties in service to the veteran.6
The productive purpose and friendship of a service dog become a formidable force in a veteran’s life. Veterans spent an average of 82% of their time with service dogs (assessed via Bluetooth proximity between collar and smartphone).7 Human partners of veterans with service dogs may experience improved quality of life and relationship functioning with the inclusion of a service dog in the family unit.8 Veterans depict increased community engagement, social connectedness, and personal confidence as a result of the canine companionship.9,10 Veterans with service dogs often speak of the ways the dog’s presence transformed their lives and many speak of the dog literally saving their lives.11 Meta-analyses showed improved mental health treatment engagement, medication adherence, and decreased suicidality.2,12
A story was recently shared with us about the compassion and competence of VA staff in a perioperative unit. A veteran was scheduled for a life-altering surgery and yet was anxious about entering the room for his scheduled pre-anesthesia check-in, knowing his service dog could not accompany him through the entire procedure. The staff recognized that the veteran was increasingly nervous and even started to question whether he would stay for the scheduled procedure they deemed would benefit his health. The perioperative team then proactively worked together to safely walk the veteran through the preparation processes in a sterile setting while keeping the dog within sight of the veteran. They then ensured that the veteran’s service dog was by his side early in the recovery room so that the veteran woke to wags and licks. In these months of canine recognition, we honor the ways the VA has fostered companionship and courage in veterans’ lives through the inclusion of service dogs in so many aspects of their care and life.
1. Rodriguez KE, Bryce CI, Granger DA, O’Haire ME. The effect of a service dog on salivary cortisol awakening response in a military population with posttraumatic stress disorder (PTSD). Psychoneuroendocrinology. 2018;98:202-210. doi:10.1016/j.psyneuen.2018.04.026
2. Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. PloS One. 2022;17(9):e0274960. doi:10.1371/journal.pone.0274960
3. Van Houtert EAE, Rodenburg TB, Vermetten E, Endenburg N. The impact of service dogs on military veterans and (ex) first aid responders with post-traumatic stress disorder. Front Psychiatry. 2022;13:834291. doi:10.3389/fpsyt.2022.834291
4. VHA Directive 1188(1). Animals on Veterans Health Administration (VHA) Property. Veterans Health Administration. August 26, 2015. Amended April 25, 2019. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3138
5. Veteran Affairs Rehabilitation and Prosthetic Services. Service Dog Veterinary Health Benefit. US Department of Veterans Affairs. Updated September 19, 2019. Accessed August 21, 2023. https://www.prosthetics.va.gov/serviceandguidedogs.asp
6. Service Dog Veterinary Health Insurance (VHIB) Benefit Rules. US Department of Veterans Affairs Rehabilitation and Prosthetic Services. Updated December 2022. Accessed August 21, 2023. https://www.prosthetics.va.gov/factsheet/PSAS-FactSheet-ServiceDogs.pdf
7. Jensen CL, Rodriguez KE, MacLean EL, Abdul Wahab AH, Sabbaghi A, O’Haire ME. Characterizing veteran and PTSD service dog teams: exploring potential mechanisms of symptom change and canine predictors of efficacy. PloS One. 2022;17(7):e0269186. doi:10.1371/journal.pone.0269186
8. McCall CE, Rodriguez KE, Wadsworth SMM, Meis LA, O’Haire ME. “A Part of Our Family”? Effects of psychiatric service dogs on quality of life and relationship functioning in military-connected couples. Mil Behav Health. 2020;8(4):410-423. doi:10.1080/21635781.2020.1825243
9. Krause-Parello CA, Sarni S, Padden E. Military veterans and canine assistance for post-traumatic stress disorder: a narrative review of the literature. Nurse Educ Today. 2016;47:43-50. doi:10.1016/j.nedt.2016.04.020
10. Van Houtert EAE, Endenburg N, Wijnker JJ, Rodenburg B, Vermetten E. The study of service dogs for veterans with post-traumatic stress disorder: a scoping literature review. Eur J Psychotraumatol. 2018;9(suppl 3):1503523. doi:10.1080/20008198.2018.1503523
11. Sherman M, Hutchinson AD, Bowen H, Iannos M, Van Hooff M. Effectiveness of Operation K9 assistance dogs on suicidality in Australian veterans with PTSD: a 12-month mixed-methods follow-up study. Int J Environ Res Public Health. 2023;20(4):3607. Published 2023 Feb 17. doi:10.3390/ijerph20043607
12. Richerson JT, Saunders GH, Skelton K, et al. A randomized trial of differential effectiveness of service dog pairing to improve quality of life for veterans with PTSD. Office of Research and Development, Veterans Health Administration. 2020:186. https://www.research.va.gov/REPORT-Study-of-Costs-and-Benefits-Associated-with-the-Use-of-Service-Dogs-Monograph1.pdf
1. Rodriguez KE, Bryce CI, Granger DA, O’Haire ME. The effect of a service dog on salivary cortisol awakening response in a military population with posttraumatic stress disorder (PTSD). Psychoneuroendocrinology. 2018;98:202-210. doi:10.1016/j.psyneuen.2018.04.026
2. Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. PloS One. 2022;17(9):e0274960. doi:10.1371/journal.pone.0274960
3. Van Houtert EAE, Rodenburg TB, Vermetten E, Endenburg N. The impact of service dogs on military veterans and (ex) first aid responders with post-traumatic stress disorder. Front Psychiatry. 2022;13:834291. doi:10.3389/fpsyt.2022.834291
4. VHA Directive 1188(1). Animals on Veterans Health Administration (VHA) Property. Veterans Health Administration. August 26, 2015. Amended April 25, 2019. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3138
5. Veteran Affairs Rehabilitation and Prosthetic Services. Service Dog Veterinary Health Benefit. US Department of Veterans Affairs. Updated September 19, 2019. Accessed August 21, 2023. https://www.prosthetics.va.gov/serviceandguidedogs.asp
6. Service Dog Veterinary Health Insurance (VHIB) Benefit Rules. US Department of Veterans Affairs Rehabilitation and Prosthetic Services. Updated December 2022. Accessed August 21, 2023. https://www.prosthetics.va.gov/factsheet/PSAS-FactSheet-ServiceDogs.pdf
7. Jensen CL, Rodriguez KE, MacLean EL, Abdul Wahab AH, Sabbaghi A, O’Haire ME. Characterizing veteran and PTSD service dog teams: exploring potential mechanisms of symptom change and canine predictors of efficacy. PloS One. 2022;17(7):e0269186. doi:10.1371/journal.pone.0269186
8. McCall CE, Rodriguez KE, Wadsworth SMM, Meis LA, O’Haire ME. “A Part of Our Family”? Effects of psychiatric service dogs on quality of life and relationship functioning in military-connected couples. Mil Behav Health. 2020;8(4):410-423. doi:10.1080/21635781.2020.1825243
9. Krause-Parello CA, Sarni S, Padden E. Military veterans and canine assistance for post-traumatic stress disorder: a narrative review of the literature. Nurse Educ Today. 2016;47:43-50. doi:10.1016/j.nedt.2016.04.020
10. Van Houtert EAE, Endenburg N, Wijnker JJ, Rodenburg B, Vermetten E. The study of service dogs for veterans with post-traumatic stress disorder: a scoping literature review. Eur J Psychotraumatol. 2018;9(suppl 3):1503523. doi:10.1080/20008198.2018.1503523
11. Sherman M, Hutchinson AD, Bowen H, Iannos M, Van Hooff M. Effectiveness of Operation K9 assistance dogs on suicidality in Australian veterans with PTSD: a 12-month mixed-methods follow-up study. Int J Environ Res Public Health. 2023;20(4):3607. Published 2023 Feb 17. doi:10.3390/ijerph20043607
12. Richerson JT, Saunders GH, Skelton K, et al. A randomized trial of differential effectiveness of service dog pairing to improve quality of life for veterans with PTSD. Office of Research and Development, Veterans Health Administration. 2020:186. https://www.research.va.gov/REPORT-Study-of-Costs-and-Benefits-Associated-with-the-Use-of-Service-Dogs-Monograph1.pdf
CDK4/6i can replace chemotherapy in ER+/HER2− advanced BC with impending or established visceral crisis
Key clinical point: Compared with paclitaxel chemotherapy, treatment with first-line cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) demonstrated better survival outcomes and a similar speed of improvement in patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (BC) who had a visceral crisis (VC) or impending VC (IVC).
Major finding: CDK4/6i vs paclitaxel improved time-to-treatment failure (hazard ratio [HR] 0.33; P = .0002), progression-free survival (HR 0.38; P = .002), and overall survival (HR 0.37; P = .002) outcomes. The median time to first improvement in IVC/VC was comparable between the treatment groups (P = .773).
Study details: Findings are from a retrospective study including 59 patients with ER+/HER2− advanced BC who had either VC or IVC, of whom 27 patients received first-line treatment with CDK4/6i + endocrine therapy and 32 patients who were treated with weekly paclitaxel.
Disclosures: This study did not receive any funding. Two authors declared having joint working agreements with or receiving honoraria, conference fees, travel expenses, or research funding from various sources.
Source: Behrouzi R et al. CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2− advanced breast cancer with impending or established visceral crisis. Breast Cancer Res Treat. 2023 (Aug 16). doi: 10.1007/s10549-023-07035-6
Key clinical point: Compared with paclitaxel chemotherapy, treatment with first-line cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) demonstrated better survival outcomes and a similar speed of improvement in patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (BC) who had a visceral crisis (VC) or impending VC (IVC).
Major finding: CDK4/6i vs paclitaxel improved time-to-treatment failure (hazard ratio [HR] 0.33; P = .0002), progression-free survival (HR 0.38; P = .002), and overall survival (HR 0.37; P = .002) outcomes. The median time to first improvement in IVC/VC was comparable between the treatment groups (P = .773).
Study details: Findings are from a retrospective study including 59 patients with ER+/HER2− advanced BC who had either VC or IVC, of whom 27 patients received first-line treatment with CDK4/6i + endocrine therapy and 32 patients who were treated with weekly paclitaxel.
Disclosures: This study did not receive any funding. Two authors declared having joint working agreements with or receiving honoraria, conference fees, travel expenses, or research funding from various sources.
Source: Behrouzi R et al. CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2− advanced breast cancer with impending or established visceral crisis. Breast Cancer Res Treat. 2023 (Aug 16). doi: 10.1007/s10549-023-07035-6
Key clinical point: Compared with paclitaxel chemotherapy, treatment with first-line cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) demonstrated better survival outcomes and a similar speed of improvement in patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (BC) who had a visceral crisis (VC) or impending VC (IVC).
Major finding: CDK4/6i vs paclitaxel improved time-to-treatment failure (hazard ratio [HR] 0.33; P = .0002), progression-free survival (HR 0.38; P = .002), and overall survival (HR 0.37; P = .002) outcomes. The median time to first improvement in IVC/VC was comparable between the treatment groups (P = .773).
Study details: Findings are from a retrospective study including 59 patients with ER+/HER2− advanced BC who had either VC or IVC, of whom 27 patients received first-line treatment with CDK4/6i + endocrine therapy and 32 patients who were treated with weekly paclitaxel.
Disclosures: This study did not receive any funding. Two authors declared having joint working agreements with or receiving honoraria, conference fees, travel expenses, or research funding from various sources.
Source: Behrouzi R et al. CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2− advanced breast cancer with impending or established visceral crisis. Breast Cancer Res Treat. 2023 (Aug 16). doi: 10.1007/s10549-023-07035-6
Meta-analysis indicates an elevated risk for type 2 diabetes in breast cancer survivors
Key clinical point: Patients who survive breast cancer (BC) may have an elevated risk of developing type 2 diabetes mellitus (T2D), especially after receiving tamoxifen therapy.
Major finding: The risk for incident T2D was elevated in patients with BC (effect estimate [EE] 1.23; 95% CI 1.13-1.33), particularly those who received endocrine therapy (EE 1.23; 95% CI 1.16-1.32), compared with individuals without BC. Moreover, the risk of developing T2D was higher among patients with BC who did vs did not receive tamoxifen (EE 1.28; 95% CI 1.18-1.38).
Study details: Findings are from a meta-analysis of 15 observational studies.
Disclosures: This study was funded by the Novo Nordisk Foundation and other sources. The authors declared no conflicts of interest.
Source: Jordt N et al. Breast cancer and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis. Breast Cancer Res Treat. 2023 (Sep 1). doi: 10.1007/s10549-023-07043-6
Key clinical point: Patients who survive breast cancer (BC) may have an elevated risk of developing type 2 diabetes mellitus (T2D), especially after receiving tamoxifen therapy.
Major finding: The risk for incident T2D was elevated in patients with BC (effect estimate [EE] 1.23; 95% CI 1.13-1.33), particularly those who received endocrine therapy (EE 1.23; 95% CI 1.16-1.32), compared with individuals without BC. Moreover, the risk of developing T2D was higher among patients with BC who did vs did not receive tamoxifen (EE 1.28; 95% CI 1.18-1.38).
Study details: Findings are from a meta-analysis of 15 observational studies.
Disclosures: This study was funded by the Novo Nordisk Foundation and other sources. The authors declared no conflicts of interest.
Source: Jordt N et al. Breast cancer and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis. Breast Cancer Res Treat. 2023 (Sep 1). doi: 10.1007/s10549-023-07043-6
Key clinical point: Patients who survive breast cancer (BC) may have an elevated risk of developing type 2 diabetes mellitus (T2D), especially after receiving tamoxifen therapy.
Major finding: The risk for incident T2D was elevated in patients with BC (effect estimate [EE] 1.23; 95% CI 1.13-1.33), particularly those who received endocrine therapy (EE 1.23; 95% CI 1.16-1.32), compared with individuals without BC. Moreover, the risk of developing T2D was higher among patients with BC who did vs did not receive tamoxifen (EE 1.28; 95% CI 1.18-1.38).
Study details: Findings are from a meta-analysis of 15 observational studies.
Disclosures: This study was funded by the Novo Nordisk Foundation and other sources. The authors declared no conflicts of interest.
Source: Jordt N et al. Breast cancer and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis. Breast Cancer Res Treat. 2023 (Sep 1). doi: 10.1007/s10549-023-07043-6
Predictors of 4 or more axillary lymph node metastases in clinically node-negative BC patients
Key clinical point: Certain preoperative clinicopathological factors can predict the presence of ≥4 pathologically positive lymph nodes in postmenopausal women with clinically node-negative (cN0) breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB) with or without completion axillary lymph node dissection (cALND).
Major finding: Only 2.5% of the evaluated patients reported having ≥4 positive lymph nodes, with the factors serving as independent predictors of ≥4 positive nodes being larger tumor size (odds ratio [OR] 1.42; P < .0001), invasive lobular carcinoma (ILC) or mixed invasive ductal carcinoma/ILC histology (OR 3.03 or 1.99, respectively; P = .008), multifocality (OR 3.58; P < .0001), and the presence of lymphovascular invasion (OR 4.77; P < .0001).
Study details: This retrospective review included 2532 postmenopausal women with cN0 BC who underwent SLNB, of whom 24.3% underwent cALND.
Disclosures: This study was supported by an US National Institutes of Health/National Cancer Institute Cancer Center Support Grant. Some authors declared serving on medical or scientific advisory boards of, receiving research funding or support for clinical trials from, or having other ties with various sources.
Source: Farley C et al. To dissect or not to dissect: Can we predict the presence of four or more axillary lymph node metastases in postmenopausal women with clinically node-negative breast cancer? Ann Surg Oncol. 2023 (Sep 5). doi: 10.1245/s10434-023-14245-1
Key clinical point: Certain preoperative clinicopathological factors can predict the presence of ≥4 pathologically positive lymph nodes in postmenopausal women with clinically node-negative (cN0) breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB) with or without completion axillary lymph node dissection (cALND).
Major finding: Only 2.5% of the evaluated patients reported having ≥4 positive lymph nodes, with the factors serving as independent predictors of ≥4 positive nodes being larger tumor size (odds ratio [OR] 1.42; P < .0001), invasive lobular carcinoma (ILC) or mixed invasive ductal carcinoma/ILC histology (OR 3.03 or 1.99, respectively; P = .008), multifocality (OR 3.58; P < .0001), and the presence of lymphovascular invasion (OR 4.77; P < .0001).
Study details: This retrospective review included 2532 postmenopausal women with cN0 BC who underwent SLNB, of whom 24.3% underwent cALND.
Disclosures: This study was supported by an US National Institutes of Health/National Cancer Institute Cancer Center Support Grant. Some authors declared serving on medical or scientific advisory boards of, receiving research funding or support for clinical trials from, or having other ties with various sources.
Source: Farley C et al. To dissect or not to dissect: Can we predict the presence of four or more axillary lymph node metastases in postmenopausal women with clinically node-negative breast cancer? Ann Surg Oncol. 2023 (Sep 5). doi: 10.1245/s10434-023-14245-1
Key clinical point: Certain preoperative clinicopathological factors can predict the presence of ≥4 pathologically positive lymph nodes in postmenopausal women with clinically node-negative (cN0) breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB) with or without completion axillary lymph node dissection (cALND).
Major finding: Only 2.5% of the evaluated patients reported having ≥4 positive lymph nodes, with the factors serving as independent predictors of ≥4 positive nodes being larger tumor size (odds ratio [OR] 1.42; P < .0001), invasive lobular carcinoma (ILC) or mixed invasive ductal carcinoma/ILC histology (OR 3.03 or 1.99, respectively; P = .008), multifocality (OR 3.58; P < .0001), and the presence of lymphovascular invasion (OR 4.77; P < .0001).
Study details: This retrospective review included 2532 postmenopausal women with cN0 BC who underwent SLNB, of whom 24.3% underwent cALND.
Disclosures: This study was supported by an US National Institutes of Health/National Cancer Institute Cancer Center Support Grant. Some authors declared serving on medical or scientific advisory boards of, receiving research funding or support for clinical trials from, or having other ties with various sources.
Source: Farley C et al. To dissect or not to dissect: Can we predict the presence of four or more axillary lymph node metastases in postmenopausal women with clinically node-negative breast cancer? Ann Surg Oncol. 2023 (Sep 5). doi: 10.1245/s10434-023-14245-1
Surgical complications likely in obese patients undergoing mastectomy with immediate reconstruction
Key clinical point: Patients with obesity and stages I-III breast cancer (BC) who undergo mastectomy with immediate reconstruction have a higher likelihood of experiencing surgical complications than patients without obesity.
Major finding: Compared with patients who underwent lumpectomy, the risk for surgical complications was significantly higher in those who underwent mastectomy with (odds ratio [OR] 7.45; P < .0001) or without (OR 3.15; P = .002) immediate reconstruction. Moreover, obesity vs non-obesity was associated with worse surgical complications among patients undergoing mastectomy with reconstruction (OR 2.25; P = .02).
Study details: Findings are from a retrospective study including 692 patients with stages I-III BC who underwent surgery and received body composition measurements using bioelectrical impedance spectrometry.
Disclosures: This study did not disclose the funding source. SA Valente and HCF Moore declared serving as consultants for, receiving fees or grants from, or having contracts with various sources.
Source: Aleixo GFP et al. Association of body composition and surgical outcomes in patients with early-stage breast cancer. Breast Cancer Res Treat. 2023 (Aug 28). doi: 10.1007/s10549-023-07060-5
Key clinical point: Patients with obesity and stages I-III breast cancer (BC) who undergo mastectomy with immediate reconstruction have a higher likelihood of experiencing surgical complications than patients without obesity.
Major finding: Compared with patients who underwent lumpectomy, the risk for surgical complications was significantly higher in those who underwent mastectomy with (odds ratio [OR] 7.45; P < .0001) or without (OR 3.15; P = .002) immediate reconstruction. Moreover, obesity vs non-obesity was associated with worse surgical complications among patients undergoing mastectomy with reconstruction (OR 2.25; P = .02).
Study details: Findings are from a retrospective study including 692 patients with stages I-III BC who underwent surgery and received body composition measurements using bioelectrical impedance spectrometry.
Disclosures: This study did not disclose the funding source. SA Valente and HCF Moore declared serving as consultants for, receiving fees or grants from, or having contracts with various sources.
Source: Aleixo GFP et al. Association of body composition and surgical outcomes in patients with early-stage breast cancer. Breast Cancer Res Treat. 2023 (Aug 28). doi: 10.1007/s10549-023-07060-5
Key clinical point: Patients with obesity and stages I-III breast cancer (BC) who undergo mastectomy with immediate reconstruction have a higher likelihood of experiencing surgical complications than patients without obesity.
Major finding: Compared with patients who underwent lumpectomy, the risk for surgical complications was significantly higher in those who underwent mastectomy with (odds ratio [OR] 7.45; P < .0001) or without (OR 3.15; P = .002) immediate reconstruction. Moreover, obesity vs non-obesity was associated with worse surgical complications among patients undergoing mastectomy with reconstruction (OR 2.25; P = .02).
Study details: Findings are from a retrospective study including 692 patients with stages I-III BC who underwent surgery and received body composition measurements using bioelectrical impedance spectrometry.
Disclosures: This study did not disclose the funding source. SA Valente and HCF Moore declared serving as consultants for, receiving fees or grants from, or having contracts with various sources.
Source: Aleixo GFP et al. Association of body composition and surgical outcomes in patients with early-stage breast cancer. Breast Cancer Res Treat. 2023 (Aug 28). doi: 10.1007/s10549-023-07060-5
Home-based exercise and nutritional intervention may benefit patients with newly diagnosed BC
Key clinical point: Home-based exercise and nutritional intervention vs usual care (UC) routine improved the physical activity levels, diet quality, and pathological complete response (pCR) rates in patients who initiated chemotherapy after a breast cancer (BC) diagnosis.
Major finding: Women in the intervention vs UC group reported greater improvements in physical activity (143.4 vs 47.7 minutes/week; P < .001) and a higher intake of fruits, vegetables, and dietary fiber (P ≤ .01) along with increased pCR rates (53% vs 28%; P = .037).
Study details: Findings are from the Lifestyle, Exercise, and Nutrition Early After Breast Cancer study including 173 women with newly diagnosed stages I-III breast cancer who initiated chemotherapy and were randomly assigned to undergo either a UC routine or a home-based exercise and nutritional intervention.
Disclosures: This study was financially supported by the corresponding author ML Irwin. Some authors declared serving in the speakers’ bureau of or in consulting, advisory, or leadership roles in or receiving honoraria from various sources.
Source: Sanft T et al. Randomized trial of exercise and nutrition on chemotherapy completion and pathologic complete response in women with breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis study. J Clin Oncol. 2023 (Sep 1). doi: 10.1200/JCO.23.00871
Key clinical point: Home-based exercise and nutritional intervention vs usual care (UC) routine improved the physical activity levels, diet quality, and pathological complete response (pCR) rates in patients who initiated chemotherapy after a breast cancer (BC) diagnosis.
Major finding: Women in the intervention vs UC group reported greater improvements in physical activity (143.4 vs 47.7 minutes/week; P < .001) and a higher intake of fruits, vegetables, and dietary fiber (P ≤ .01) along with increased pCR rates (53% vs 28%; P = .037).
Study details: Findings are from the Lifestyle, Exercise, and Nutrition Early After Breast Cancer study including 173 women with newly diagnosed stages I-III breast cancer who initiated chemotherapy and were randomly assigned to undergo either a UC routine or a home-based exercise and nutritional intervention.
Disclosures: This study was financially supported by the corresponding author ML Irwin. Some authors declared serving in the speakers’ bureau of or in consulting, advisory, or leadership roles in or receiving honoraria from various sources.
Source: Sanft T et al. Randomized trial of exercise and nutrition on chemotherapy completion and pathologic complete response in women with breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis study. J Clin Oncol. 2023 (Sep 1). doi: 10.1200/JCO.23.00871
Key clinical point: Home-based exercise and nutritional intervention vs usual care (UC) routine improved the physical activity levels, diet quality, and pathological complete response (pCR) rates in patients who initiated chemotherapy after a breast cancer (BC) diagnosis.
Major finding: Women in the intervention vs UC group reported greater improvements in physical activity (143.4 vs 47.7 minutes/week; P < .001) and a higher intake of fruits, vegetables, and dietary fiber (P ≤ .01) along with increased pCR rates (53% vs 28%; P = .037).
Study details: Findings are from the Lifestyle, Exercise, and Nutrition Early After Breast Cancer study including 173 women with newly diagnosed stages I-III breast cancer who initiated chemotherapy and were randomly assigned to undergo either a UC routine or a home-based exercise and nutritional intervention.
Disclosures: This study was financially supported by the corresponding author ML Irwin. Some authors declared serving in the speakers’ bureau of or in consulting, advisory, or leadership roles in or receiving honoraria from various sources.
Source: Sanft T et al. Randomized trial of exercise and nutrition on chemotherapy completion and pathologic complete response in women with breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis study. J Clin Oncol. 2023 (Sep 1). doi: 10.1200/JCO.23.00871
HER2+ metastatic BC with brain metastasis: Pyrotinib shows long-term meaningful outcomes in real world
Key clinical point: Pyrotinib led to promising long-term outcomes and was well-tolerated in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC) and brain metastases (BM).
Major finding: In patients with BM, the overall median progression-free survival (PFS), considering both intracranial and extracranial lesions, was 7.50 months (95% CI 5.84-9.16) and median overall survival was 21.27 months (95% CI 20.10-22.44), with the median PFS not improving in patients who received vs did not receive radiotherapy (P = .319). Diarrhea (any grade) was the most common adverse event.
Study details: This real-world study included 239 patients with HER2+ metastatic BC who received pyrotinib-based therapy, of whom 61 patients had BM.
Disclosures: This study was supported by the keyAtlas precision medicine and clinical research project of Shanghai Science & Technology Development Foundation, China. The authors declared no conflicts of interest.
Source: Liang X et al. Long-term outcome analysis of pyrotinib in patients with HER2-Positive metastatic breast cancer and brain metastasis: A real-world study. Oncologist. 2023 (Aug 17). doi: 10.1093/oncolo/oyad228
Key clinical point: Pyrotinib led to promising long-term outcomes and was well-tolerated in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC) and brain metastases (BM).
Major finding: In patients with BM, the overall median progression-free survival (PFS), considering both intracranial and extracranial lesions, was 7.50 months (95% CI 5.84-9.16) and median overall survival was 21.27 months (95% CI 20.10-22.44), with the median PFS not improving in patients who received vs did not receive radiotherapy (P = .319). Diarrhea (any grade) was the most common adverse event.
Study details: This real-world study included 239 patients with HER2+ metastatic BC who received pyrotinib-based therapy, of whom 61 patients had BM.
Disclosures: This study was supported by the keyAtlas precision medicine and clinical research project of Shanghai Science & Technology Development Foundation, China. The authors declared no conflicts of interest.
Source: Liang X et al. Long-term outcome analysis of pyrotinib in patients with HER2-Positive metastatic breast cancer and brain metastasis: A real-world study. Oncologist. 2023 (Aug 17). doi: 10.1093/oncolo/oyad228
Key clinical point: Pyrotinib led to promising long-term outcomes and was well-tolerated in patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (BC) and brain metastases (BM).
Major finding: In patients with BM, the overall median progression-free survival (PFS), considering both intracranial and extracranial lesions, was 7.50 months (95% CI 5.84-9.16) and median overall survival was 21.27 months (95% CI 20.10-22.44), with the median PFS not improving in patients who received vs did not receive radiotherapy (P = .319). Diarrhea (any grade) was the most common adverse event.
Study details: This real-world study included 239 patients with HER2+ metastatic BC who received pyrotinib-based therapy, of whom 61 patients had BM.
Disclosures: This study was supported by the keyAtlas precision medicine and clinical research project of Shanghai Science & Technology Development Foundation, China. The authors declared no conflicts of interest.
Source: Liang X et al. Long-term outcome analysis of pyrotinib in patients with HER2-Positive metastatic breast cancer and brain metastasis: A real-world study. Oncologist. 2023 (Aug 17). doi: 10.1093/oncolo/oyad228
Adjuvant capecitabine plus ibandronate combination fails in phase 3 study
Key clinical point: Adjuvant capecitabine plus ibandronate failed to show improved survival outcomes compared with ibandronate alone in older patients with node-positive/high-risk node-negative breast cancer (BC).
Major finding: At a median follow-up of 61 months, the 5-year invasive disease-free survival rates were comparable between the adjuvant ibandronate + capecitabine and ibandronate arms (hazard ratio 0.96; 95% CI 0.78-1.19). The incidences of high-grade gastrointestinal disorders (6.7% vs 1.0%; P < .001) and skin toxicity (14.6% vs 0.6%; P < .01) were significantly higher in the ibandronate + capecitabine vs ibandronate arm.
Study details: Findings are from a phase 3 study including 1358 patients age ≥ 65 years with early BC who were randomly assigned to receive ibandronate with or without capecitabine.
Disclosures: This study was sponsored by the German Breast Group. Some authors declared receiving personal fees, grants, contracts, consulting fees, payment, honoraria, support for attending meetings, or travel support from or having other ties with various sources.
Source: Schmidt M et al. Adjuvant capecitabine versus nihil in older patients with node-positive/high-risk node-negative early breast cancer receiving ibandronate - The ICE Randomized Clinical Trial. Eur J Cancer. 2023;113324 (Sep 6). doi: 10.1016/j.ejca.2023.113324
Key clinical point: Adjuvant capecitabine plus ibandronate failed to show improved survival outcomes compared with ibandronate alone in older patients with node-positive/high-risk node-negative breast cancer (BC).
Major finding: At a median follow-up of 61 months, the 5-year invasive disease-free survival rates were comparable between the adjuvant ibandronate + capecitabine and ibandronate arms (hazard ratio 0.96; 95% CI 0.78-1.19). The incidences of high-grade gastrointestinal disorders (6.7% vs 1.0%; P < .001) and skin toxicity (14.6% vs 0.6%; P < .01) were significantly higher in the ibandronate + capecitabine vs ibandronate arm.
Study details: Findings are from a phase 3 study including 1358 patients age ≥ 65 years with early BC who were randomly assigned to receive ibandronate with or without capecitabine.
Disclosures: This study was sponsored by the German Breast Group. Some authors declared receiving personal fees, grants, contracts, consulting fees, payment, honoraria, support for attending meetings, or travel support from or having other ties with various sources.
Source: Schmidt M et al. Adjuvant capecitabine versus nihil in older patients with node-positive/high-risk node-negative early breast cancer receiving ibandronate - The ICE Randomized Clinical Trial. Eur J Cancer. 2023;113324 (Sep 6). doi: 10.1016/j.ejca.2023.113324
Key clinical point: Adjuvant capecitabine plus ibandronate failed to show improved survival outcomes compared with ibandronate alone in older patients with node-positive/high-risk node-negative breast cancer (BC).
Major finding: At a median follow-up of 61 months, the 5-year invasive disease-free survival rates were comparable between the adjuvant ibandronate + capecitabine and ibandronate arms (hazard ratio 0.96; 95% CI 0.78-1.19). The incidences of high-grade gastrointestinal disorders (6.7% vs 1.0%; P < .001) and skin toxicity (14.6% vs 0.6%; P < .01) were significantly higher in the ibandronate + capecitabine vs ibandronate arm.
Study details: Findings are from a phase 3 study including 1358 patients age ≥ 65 years with early BC who were randomly assigned to receive ibandronate with or without capecitabine.
Disclosures: This study was sponsored by the German Breast Group. Some authors declared receiving personal fees, grants, contracts, consulting fees, payment, honoraria, support for attending meetings, or travel support from or having other ties with various sources.
Source: Schmidt M et al. Adjuvant capecitabine versus nihil in older patients with node-positive/high-risk node-negative early breast cancer receiving ibandronate - The ICE Randomized Clinical Trial. Eur J Cancer. 2023;113324 (Sep 6). doi: 10.1016/j.ejca.2023.113324
Adding ovarian suppression to adjuvant tamoxifen is beneficial for women with existing ovarian function and ER+ BC
Key clinical point: Adding ovarian function suppression (OFS) to adjuvant tamoxifen for 2 years demonstrated consistent improvement in disease-free survival (DFS) outcomes and high overall survival (OS) rates in women with estrogen receptor-positive (ER+) breast cancer (BC) who remained premenopausal or regained ovarian function after chemotherapy.
Major finding: The 8-year DFS rates improved consistently in women who received tamoxifen + OFS vs tamoxifen only (85.4% vs 80.2%; hazard ratio 0.67; P = .003). Although the 8-year OS rates were comparable between both treatment groups (P = .305), they were considerably high (>95%).
Study details: Findings are from an 8-year follow-up of the phase 3 ASTRRA trial including 1282 premenopausal women with ER+ BC, who remained premenopausal or regained ovarian function after chemotherapy and were randomly assigned to receive tamoxifen with or without OFS.
Disclosures: This study was supported by the Korea Health Industry Development Institute, Republic of Korea. Some authors declared receiving honoraria or research funding from or serving in consulting or advisory roles with various sources.
Source: Baek SY et al. Adding ovarian suppression to tamoxifen for premenopausal women with hormone receptor-positive breast cancer after chemotherapy: An 8-year follow-up of the ASTRRA trial. J Clin Oncol. 2023 (Aug 22). doi: 10.1200/JCO.23.00557
Key clinical point: Adding ovarian function suppression (OFS) to adjuvant tamoxifen for 2 years demonstrated consistent improvement in disease-free survival (DFS) outcomes and high overall survival (OS) rates in women with estrogen receptor-positive (ER+) breast cancer (BC) who remained premenopausal or regained ovarian function after chemotherapy.
Major finding: The 8-year DFS rates improved consistently in women who received tamoxifen + OFS vs tamoxifen only (85.4% vs 80.2%; hazard ratio 0.67; P = .003). Although the 8-year OS rates were comparable between both treatment groups (P = .305), they were considerably high (>95%).
Study details: Findings are from an 8-year follow-up of the phase 3 ASTRRA trial including 1282 premenopausal women with ER+ BC, who remained premenopausal or regained ovarian function after chemotherapy and were randomly assigned to receive tamoxifen with or without OFS.
Disclosures: This study was supported by the Korea Health Industry Development Institute, Republic of Korea. Some authors declared receiving honoraria or research funding from or serving in consulting or advisory roles with various sources.
Source: Baek SY et al. Adding ovarian suppression to tamoxifen for premenopausal women with hormone receptor-positive breast cancer after chemotherapy: An 8-year follow-up of the ASTRRA trial. J Clin Oncol. 2023 (Aug 22). doi: 10.1200/JCO.23.00557
Key clinical point: Adding ovarian function suppression (OFS) to adjuvant tamoxifen for 2 years demonstrated consistent improvement in disease-free survival (DFS) outcomes and high overall survival (OS) rates in women with estrogen receptor-positive (ER+) breast cancer (BC) who remained premenopausal or regained ovarian function after chemotherapy.
Major finding: The 8-year DFS rates improved consistently in women who received tamoxifen + OFS vs tamoxifen only (85.4% vs 80.2%; hazard ratio 0.67; P = .003). Although the 8-year OS rates were comparable between both treatment groups (P = .305), they were considerably high (>95%).
Study details: Findings are from an 8-year follow-up of the phase 3 ASTRRA trial including 1282 premenopausal women with ER+ BC, who remained premenopausal or regained ovarian function after chemotherapy and were randomly assigned to receive tamoxifen with or without OFS.
Disclosures: This study was supported by the Korea Health Industry Development Institute, Republic of Korea. Some authors declared receiving honoraria or research funding from or serving in consulting or advisory roles with various sources.
Source: Baek SY et al. Adding ovarian suppression to tamoxifen for premenopausal women with hormone receptor-positive breast cancer after chemotherapy: An 8-year follow-up of the ASTRRA trial. J Clin Oncol. 2023 (Aug 22). doi: 10.1200/JCO.23.00557
Chemotherapy-free anti-ERBB2 strategy may be a first-line treatment option in ERBB2+ metastatic BC
Key clinical point: In patients with human epidermal growth factor receptor 2-positive (ERBB2+, aka HER2+) metastatic breast cancer (BC), anti-ERBB2 treatment without vs with chemotherapy worsened the progression-free survival (PFS) rate but did not yield detrimental overall survival (OS) outcomes.
Major finding: Patients who did not receive vs received chemotherapy showed comparable OS rates at 2 years (79.0%; 90% CI 71.4%-85.4% vs 78.1%; 90% CI 70.4%-84.5%) but had shorter median PFS (8.4 months; 95% CI 7.9-12.0 vs 23.3 months; 95% CI 18.9-33.1).
Study details: This secondary analysis of a phase 2 trial included 210 patients with ERBB2+ metastatic BC who were randomly assigned to receive pertuzumab + trastuzumab with or without chemotherapy followed by trastuzumab-emtansine as the second-line therapy in both groups.
Disclosures: This study was supported by F. Hoffmann-La Roche AG and other sources. B Thürlimann declared owning stocks from F. Hoffmann-La Roche AG and some other authors declared ties with various sources, including F. Hoffmann-La Roche AG.
Source: Huober J et al for the Swiss Group for Clinical Cancer Research, Unicancer Breast Group, and Dutch Breast Cancer Research Group. Pertuzumab plus trastuzumab with or without chemotherapy followed by emtansine in ERBB2-positive metastatic breast cancer: A secondary analysis of a randomized clinical trial. JAMA Oncol. 2023 (Aug 10). doi: 10.1001/jamaoncol.2023.2909
Key clinical point: In patients with human epidermal growth factor receptor 2-positive (ERBB2+, aka HER2+) metastatic breast cancer (BC), anti-ERBB2 treatment without vs with chemotherapy worsened the progression-free survival (PFS) rate but did not yield detrimental overall survival (OS) outcomes.
Major finding: Patients who did not receive vs received chemotherapy showed comparable OS rates at 2 years (79.0%; 90% CI 71.4%-85.4% vs 78.1%; 90% CI 70.4%-84.5%) but had shorter median PFS (8.4 months; 95% CI 7.9-12.0 vs 23.3 months; 95% CI 18.9-33.1).
Study details: This secondary analysis of a phase 2 trial included 210 patients with ERBB2+ metastatic BC who were randomly assigned to receive pertuzumab + trastuzumab with or without chemotherapy followed by trastuzumab-emtansine as the second-line therapy in both groups.
Disclosures: This study was supported by F. Hoffmann-La Roche AG and other sources. B Thürlimann declared owning stocks from F. Hoffmann-La Roche AG and some other authors declared ties with various sources, including F. Hoffmann-La Roche AG.
Source: Huober J et al for the Swiss Group for Clinical Cancer Research, Unicancer Breast Group, and Dutch Breast Cancer Research Group. Pertuzumab plus trastuzumab with or without chemotherapy followed by emtansine in ERBB2-positive metastatic breast cancer: A secondary analysis of a randomized clinical trial. JAMA Oncol. 2023 (Aug 10). doi: 10.1001/jamaoncol.2023.2909
Key clinical point: In patients with human epidermal growth factor receptor 2-positive (ERBB2+, aka HER2+) metastatic breast cancer (BC), anti-ERBB2 treatment without vs with chemotherapy worsened the progression-free survival (PFS) rate but did not yield detrimental overall survival (OS) outcomes.
Major finding: Patients who did not receive vs received chemotherapy showed comparable OS rates at 2 years (79.0%; 90% CI 71.4%-85.4% vs 78.1%; 90% CI 70.4%-84.5%) but had shorter median PFS (8.4 months; 95% CI 7.9-12.0 vs 23.3 months; 95% CI 18.9-33.1).
Study details: This secondary analysis of a phase 2 trial included 210 patients with ERBB2+ metastatic BC who were randomly assigned to receive pertuzumab + trastuzumab with or without chemotherapy followed by trastuzumab-emtansine as the second-line therapy in both groups.
Disclosures: This study was supported by F. Hoffmann-La Roche AG and other sources. B Thürlimann declared owning stocks from F. Hoffmann-La Roche AG and some other authors declared ties with various sources, including F. Hoffmann-La Roche AG.
Source: Huober J et al for the Swiss Group for Clinical Cancer Research, Unicancer Breast Group, and Dutch Breast Cancer Research Group. Pertuzumab plus trastuzumab with or without chemotherapy followed by emtansine in ERBB2-positive metastatic breast cancer: A secondary analysis of a randomized clinical trial. JAMA Oncol. 2023 (Aug 10). doi: 10.1001/jamaoncol.2023.2909