Improved treatments for early breast cancer have led to a significant increase in overall survival. While evidence regarding potential long-term sequelae of adjuvant treatments exists, relatively little research reports patients' own perceptions of change before and after adjuvant chemotherapy (AC). This study aimed to identify key ongoing issues associated with AC in daily life. An online survey developed for this study was completed by 198 women (mean age 49.7 years) in the UK, France and Germany who had AC 1-5 years previously for oestrogen receptor positive, HER2 negative early breast cancer. Women without AC and endocrine therapy, those treated with Trastuzumab or who had recurrent disease were excluded. A third of women who responded were currently unable to perform their former family role. The majority had needed support, particularly with child care, during treatment. While 54% were in full-time employment before diagnosis this had reduced to 32% following AC. Of those women still working, over half reported difficulties with tiredness or concentration. Most (85.8%) were satisfied with healthcare professionals' treatment information, but only 29.7% received information about returning to work. This exploratory survey highlights areas of women's lives affected 1-5 years following AC for early breast cancer. The impact on returning to work and issues surrounding childcare particularly, require further study.

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Findings suggest that adverse events in T2DM can be a burden for some individuals. The study indicates the potential importance of including information regarding AEs in economic evaluations. Although some states were rated severely in terms of utility; in reality, many of these only last a few days, therefore having a minimal quality-adjusted life year (QALY) impact.

with and without PNH. Full-texts (no date restriction) and conference abstracts (2017 or later) of clinical trials or observational studies conducted in the US or Western Europe that examined patient-reported fatigue or associations between fatiguescales and hemoglobin were included. Data (i.e., relationship between improvements in fatigue-scales and clinical outcomes; clinically meaningful fatigue-scale thresholds) were extracted using a standardized form. Results: Among 161 search results, 16 peer-reviewed publications (4 [25%] PNH and 12 [75%] cancer studies) were included. Four clinical trials conducted in patients with PNH receiving ravulizumab or eculizumab reported that patients achieved and sustained clinically meaningful improvements in fatigue (i.e., $3 points). However, these studies did not examine the association between fatigue and hemoglobin. Twelve studies conducted in patients with cancer (anemic; with or without chemotherapy) demonstrated a statistically significant association between increased hemoglobin and improvements in fatigue (p,0.05). Two studies showed the greatest incremental gain (i.e., .3 mm in Linear Analog Scale Assessment) in improvement in fatigue was observed when hemoglobin increased from 11-12 g/dL. Conclusions: Substantial evidence in non-PNH literature (i.e., anemia of chronic disease) demonstrates that increased hemoglobin levels are associated with clinically significant improvements in fatigue (e.g., an increase of $3 points as measured by Functional Assessment of Chronic Illness Therapy-Fatigue). Future studies establishing this connection should be further validated among patients with PNH.

Although the relationship between antipsychotic medication, particularly second-generation antipsychotics (SGAs), and metabolic disturbance is increasingly accepted, there is an important, but little recognised, potential interaction between this and the other important serious adverse effect of neuroleptic malignant syndrome (NMS). We report a case of a 35-year old female who developed new onset type II diabetes mellitus with hyperosmolar hyperglycaemic coma and acute renal failure following treatment with a SGA for a first manic episode. The history is strongly suggestive of concurrent NMS. This case raises important questions about non-ketotic, hyperosmolar diabetic coma with antipsychotics, the possible association between hyperglycaemia and hyperthermia, and the direction of causality in this, the recognition of either syndrome when they co-exist and management issues in such patients. These questions are considered in the context of currently available literature.