Browsing by Author "Ramírez Parada, Karol Lilia"

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    Actividad física y cáncer de mama: un tratamiento dirigido
    (2017) Ramírez Parada, Karol Lilia; Acevedo Claros, Francisco Nicolás; Herrera, María Elisa; Ibáñez, Carolina; Sánchez, César
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    Axillary web syndrome among Chilean women with breast cancer : incidence and possible predisposing factors
    (2020) Ramírez Parada, Karol Lilia; Garay-Acevedo, D.; Mella Abarca, Williams Andrés; Petric Guajardo, Militza Paulina; Sánchez Rojel, César Giovanni; McNeely, M. L.; Leao-Ribeiro, I.; Fernández Verdejo, Rodrigo
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    Clinical characteristics, risk factors, and outcomes in Chilean triple negative breast cancer patients: a real-world study
    (2023) Acevedo Claros, Francisco Nicolás; Walbaum, Benjamin; Medina, Lidia; Merino Lara, Tomás Rodrigo; Camus Appuhn, Mauricio Gonzalo; Puschel Illanes, Klaus; Ramírez Parada, Karol Lilia; Manzor, Manuel; Veglia, Paulina; Martinez, Raul; Guerra, Constanza; Navarro, Marisel; Bauerle, Catherine; Domínguez Covarrubias, Francisco José; Sánchez Rojel, César Giovanni
    Background Latin American (LA) studies on triple-negative breast cancer (TNBC) and their characteristics are scarce. This forces physicians to make clinical decisions based on data obtained from studies that include non-Hispanic patients. Our study sought to obtain local epidemiological data, including risk factors and clinical outcomes from a Chilean BC registry. Methods This was a retrospective population-cohort study that included patients treated at a community hospital (mid-low income) or an academic private center (high income), in the 2010-2021 period. Univariate and multivariate analyses were performed to identify prognostic factors associated with survival. Results 647 out of 5,806 BC patients (11.1%) were TNBC. These patients were younger (p = 0.0001) and displayed lower rates of screening-detected cases (p = 0.0001) compared to non-TNBC counterparts. Among TNBC patients, lower income (i. e., receiving treatment at a community hospital) was associated with poorer overall survival (HR: 1.53; p = 0.0001) and poorer BC specific survival (HR: 1.29; p = 0.004). Other risk factors showed no significant differences between TNBC and non-TNBC. As expected, 5-year OS was significantly shorter on TNBC versus non-TNBC patients (p = 0.00001). In our multivariate analyses TNBC subtype (HR: 2.30), locally advanced stage (HR: 7.04 for stage III), lower income (HR: 1.64), or non-screening detected BC (HR: 1.32) were associated with poorer OS. Conclusion To the best of our knowledge, this is the largest LA cohort of TNBC patients. Interestingly, the proportion of TNBC among Chileans was smaller compared to similar studies within LA. As expected, TNBC patients had poorer survival and higher risk for early recurrence versus non-TNBC. Other relevant findings include a higher proportion of premenopausal patients among TNBC. Also, mid/low-income patients that received medical attention at a community hospital displayed lower survival versus private health center counterparts.
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    Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B)
    (Frontiers Media SA, 2022) Ramírez Parada, Karol Lilia; López Garzón, María; Sánchez Rojel, César Giovanni; Petric Guajardo, Militza Paulina; Alfaro Barra, Margarita Eugenia; Fernández Verdejo, Rodrigo; Reyes Ponce, Álvaro Renato; Merino Pereira, Gina Francesca; Cantarero Villanueva, Irene
    Objectives: To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy. Design: Randomized control trial. Participants: One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years. Interventions: Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity. Main Outcome Measures: The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models. Discussion: The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL.
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    Physical activity levels and preferences of patients with breast cancer receiving chemotherapy in Chile
    (2019) Ramírez Parada, Karol Lilia; Courneya, K. S.; Muniz, S.; Sánchez Rojel, César Giovanni; Fernández Verdejo, Rodrigo
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    Sistema de selección de sistemas elastocompresivos en personas con cáncer de mama de un hospital con recursos limitados
    (Dirección de Extensión y Educación Continua, Escuela de Medicina, Pontificia Universidad Católica de Chile, 2020) Mella Abarca, Williams Andrés; Barraza Sánchez, Valentina Andrea; Ramírez Parada, Karol Lilia
    El cáncer de mama es un problema de salud pública en Chile. El linfedema es un trastorno linfovascular secundario a la extirpación de los ganglios linfáticos por cirugía en el cáncer de mama, que produce un aumento del volumen y la fibrosis en el miembro superior. Diferentes prendas de compresión son usadas para la prevención y el tratamiento del linfedema. Por eso, el programa de Garantías Explícitas en Salud garantiza la entrega de sistemas elastocompresivos a las personas con diagnóstico de cáncer de mama para prevenir y tratar el linfedema. Sin embargo, en hospitales públicos los sistemas elastocompresivos pueden ser recursos limitados, por eso, muchas veces se deben priorizar. Este artículo tiene por objetivo describir un sistema de selección de sistemas elastocompresivos en personas con diagnóstico de cáncer de mama en el modelo de atención kinesiológico temprano y prospectivo.
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    Suboptimal use of ovarian function suppression in very young women with early breast cancer: a real-world data study
    (2024) Heredia Castro, Ana Manuela; Walbaum García, Benjamín Vicente; Vidal, María ; Itriago Giménez, Laura Morella; Camus Appuhn, Mauricio Gonzalo; Domínguez Covarrubias, Francisco José; Manzor, Manuel ; Martínez, Raúl ; Murature, Geraldine ; Muñiz Muñoz, María Sabrina; Navarro, Marisel ; Guerra, Constanza ; Merino Lara, Tomás Rodrigo; Medina Araya, Lidia Marjorie; Ibáñez Cáceres, Carolina; Ramírez Parada, Karol Lilia; Acevedo Claros, Francisco Nicolás; Sánchez Rojel, César Giovanni
    Purpose The incidence of breast cancer in young women (BCYW) has increased in recent decades. Malignant disease in this subset is characterized by its aggressiveness and poor prognosis. Ovarian function suppression (OFS) in these patients improves survival especially in hormone receptor-positive (HR +) cases. The Regan Composite Risk (RCR) is a prognostic tool to identify high-risk HR + BC candidates for OFS. Our study sought to characterize a Chilean cohort of early HR + BCYW assessing the use of OFS and its related prognosis and the utility of RCR in our patients.MethodsThis was a retrospective population cohort study that included ≤ 35-year-old early HR + /human epidermal growth factor receptor 2 -negative (HER2-) BC patients treated between 2001 and 2021. Analysis included clinical-pathological characteristics, treatment strategies, and survival. Also, we evaluated the association between RCR and survival.ResultsA total of 143 patients were included into our study, representing 2.9% of all early BC cases in our registry. Median age was 31 years old (range: 19–35). Most patients (93%) received endocrine therapy (ET). Of these, 18% received OFS. No survival differences were observed among treatment strategies. Median RCR score for patients treated with CT plus ET was significantly higher vs. ET alone (2.95 vs. 1.91; p = 0.0001). Conversely, patients treated with tamoxifen alone had significantly lower RCR scores vs. OFS (2.72 vs. 3.14; p = 0.04). Higher RCR scores were associated with poorer overall survival.ConclusionLess than 20% of very young women with early HR + /HER2-BC in our cohort received OFS, in most cases, this involved surgical oophorectomy. RCR score was higher in patients that underwent CT and OFS and was associated with survival, regardless of treatment. We confirm the RCR score as a valuable prognostic tool to identify high-risk BC patients who could benefit from OFS.
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    Telerehabilitation for people with breast cancer through the COVID-19 pandemic in Chile
    (2020) Mella Abarca, Williams Andrés; Barraza-Sanchez, V.; Ramírez Parada, Karol Lilia
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    Terapia descongestiva como complemento a la cirugía de anastomosis linfáticovenosas y transferencia de linfonodos vascularizados
    (2022) Riady Aleuy, Layla Marysel; Rodríguez Astudillo, José Ramón; Ramírez Parada, Karol Lilia
    Introducción: El linfedema es una enfermedad inflamatoria crónica que afecta cerca de 250 millones de personas en el mundo. El tratamiento tradicional es la terapia descongestiva. Últimamente, existe la opción de complementar el tratamiento tradicional con procedimientos quirúrgicos fisiológicos como anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Sin embargo, la evidencia del uso de la te- rapia descongestiva en los cuidados pre y posoperatorios en estas cirugías es limitada. Objetivo: Evaluar el uso de terapia descongestiva como complemento a la cirugía de linfedema mediante anastomosis linfá- ticovenosas y transferencia de linfonodos vascularizados. Materiales y Método: Se realizó una revisión de la literatura en las siguientes bases de datos: Cochrane, Pubmed y Google académico, utilizando los siguientes términos mesh: “anastomosis, surgical”, “lymphedema”, “perioperative care”, “microsurgery”, “rehabilitation”, “therapy”, “lymph nodes”, “bypass”, “lymphedema and microsurgery”. Se incluyó aquellos artículos que describían el uso de la terapia descongestiva en los cuidados pre- y posoperatorios. Resultados: Se identificó un total de 201 artículos y 12 fueron incluidos en el análisis. La evidencia reporta que las terapias más usadas en el cuidado pre- y posoperatorio son compresión, drenaje linfático manual y tratamientos personalizados. Sin embargo, la mayoría de los autores hace una descripción vaga de las terapias mencionadas. Discusión y Conclusión: La evidencia respecto al uso de terapia descongestiva como tratamiento complementario es débil. Los expertos recomiendan su uso, sin embargo, se necesitan futuras investigaciones que describan el uso de cada uno de sus componentes como complemento de procedimientos quirúrgicos fisiológicos para el manejo del linfedema.
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    Upper-Limb Disability and the Severity of Lymphedema Reduce the Quality of Life of Patients with Breast Cancer-Related Lymphedema
    (2023) Ramírez Parada, Karol Lilia; González Santos, Angela ; Riady Aleuy, Layla ; Pinto, Mauricio P.; Ibáñez Cáceres, Carolina; Merino Lara, Tomás Rodrigo; Acevedo Claros, Francisco Nicolás; Walbaum García, Benjamín Vicente; Fernández Verdejo, Rodrigo ; Sánchez Rojel, César Giovanni
    Breast cancer-related lymphedema (BCRL) is characterized by arm swelling, pain, and discomfort, reducing the quality of life (QoL) of affected individuals. BRCL is caused via the blockage or disruption of the lymphatic vessels following cancer treatments, leading to an accumulation of fluid in the affected arm. While current BCRL rehabilitation treatments seek to reduce arm swelling, our study aimed to examine the impact of both the magnitude of lymphedema (ΔVolume) and arm disability on three dimensions of QoL: social, physical, and psychological. Using the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Upper Limb Lymphedema 27 questionnaire (ULL) in a group of 30 patients, we found that the magnitude of lymphedema (ΔVolume) was associated with the social dimension of QoL (r = 0.37, p = 0.041), but not with other dimensions. On the other hand, arm disability was associated with all evaluated dimensions of QoL (social, physical, and psychological: p < 0.001, p = 0.019, and p = 0.050 (borderline), respectively). These findings suggest that BCRL rehabilitation strategies should not only aim to reduce the magnitude of lymphedema but should also seek to improve or preserve arm functionality to enhance the QoL of BCRL patients.