Breast CancerSECCONCT06164119
Effects of Diet and Osteopathy on Quality of Life and Inflammation in Breast Cancer Patients Under Hormonal Therapy
A study testing manual treatment with osteopathic techniques and nutritional treatment, manual treatment with osteopathic techniques and nutritional treatment in people with Breast Cancer, run by Fondazione IRCCS Istituto Nazionale dei Tumori, Milano at 1 site in Italy.
Trial summary
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment and as a result, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high. Read more about this study
- Who is it for?
- Ages 18 to 85 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Breast Cancer
- What is being tested?
- manual treatment with osteopathic techniques and nutritional treatment, manual treatment with osteopathic techniques and nutritional treatment
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 600 participants
- Where
- 1 siteItaly
- Study dates
- 19 Dec 2023to Dec 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 85 years
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Age >18 years
- Voluntary written informed consent
- Histologically confirmed estrogen receptor-positive invasive breast cancer or in situ breast cancer after breast surgery
- Absence of locoregional relapse or distant metastasis
- Premenopausal or postmenopausal status
- Hormonal therapy with tamoxifen and/or LHRH analogues or aromatase inhibitors
Show all 9Show fewer
- Patients with or without neoadjuvant or adjuvant chemotherapy
- Patients with a BMI > 18.5 kg/m^2
- Absence of language barrier
Who cannot join
- Previous hormonal therapy
- Use of medical treatments that contrast adjuvant hormonal therapy adverse effects (e.g. menopausal symptoms and arthralgia).
- Underweight patients (BMI <18.5 kg/m^2)
- Patients diagnosed with eating disorders (e.g. anorexia nervosa, bulimia, binge eating, orthorexia)
- Psychiatric disorders or cognitive impairments
- Previous malignancies other than in situ cervical carcinoma or non-melanoma skin cancer
Show all 10Show fewer
- Non-epithelial breast cancer at histological examination
- In situ lobular breast cancer
- Participation in other randomized clinical trials that could interfere with current study
- Patients living distant from trial center and unable to attend for check-ups and meetings.
Trial locations and contacts
1 site in 1 country.
Italy1 site, 1 recruiting
- Recruiting
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, 20133
Chiara Listorti, MD, +39 02 2390 2659, chiara.listorti@istitutotumori.mi.it
About this study
Official title: A Randomised Effectiveness-implementation Trial for Evaluating Dietary and Manual Treatment With Osteopathic Techniques on Quality of Life and on Modulation of the Inflammatory State of Patients Diagnosed With Breast Cancer Undergoing Antiestrogenic Hormonal Treatment.
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment and as a result, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high.
Promoting weight control and the adoption of healthy lifestyle habits in breast cancer survivors has an impact on hormonal status, quality of life and physical functioning, contributing to reduce cancer recurrence risk, cancer-related and chronic-condition-related mortality.
Read more
Manipulation procedures, such as manual treatment with osteopathic techniques, have positive effects on osteoarticular pain, peripheral neuropathies, anxious-depressive disorders, asthenia and sleep disorders, also improving immune and neuroendocrine responses.
The aim of this study is to evaluate the effects of dietary intervention and manual treatment with osteopathic techniques in women diagnosed with breast cancer under antiestrogenic hormonal treatment through the assessment of:
- modifications of quality of life (QoL)
- frequency and severity of symptoms related to antiestrogenic hormonal treatment
- body weight
- body composition
- food habits
- metabolic and inflammatory state
- physical performance
- patient's satisfaction to multidisciplinary treatment.
This study focuses on patient's centricity evaluating the effects that long lasting adjuvant therapies have on breast cancer survivors. Improving personalized patient's treatment through collaborative interactions between clinicians, osteopaths and nutrition specialists might result in implementation strategies to determine novel evidence-based treatments for ameliorating patient's adherence to oncological therapies, impacting prognosis and survival.
Read the detailed description
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment. Premenopausal women may encounter the classic symptoms of menopausal syndrome: hair thinning or loss; hot flashes, sweating, fatigue, insomnia, joint pain, vaginal dryness, decreased libido, anxious-depressive disorders, cognitive dysfunction; dry eyes; weight gain. Postmenopausal women may instead experience joint stiffness and joint pain, depressive and anxious symptoms, fatigue and irritability.
Since most of these adverse events do not resolve spontaneously a few weeks/months after starting treatment, they often negatively impact patient's quality of life.
As a result of treatment-related adverse events, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high and this may negatively impact patient's prognosis and survival.
Patients with breast cancer frequently experience weight gain during and after adjuvant hormonal treatment. Indeed, menopause, musculoskeletal pain and the consequent physical activity reduction, work together to reduce the basal energy metabolism. On the other side, the psychological distress and the eventual use of food for emotional reward, do promote weight gain. Notably, breast cancer patients who are overweight or obese show an increased risk of overall mortality, cancer-specific mortality, breast cancer relapse or second primary contralateral breast cancer. The explanation lies in the fact that the increase in fat mass is directly correlated to an increased production of estrogens, insulin, leptin and proinflammatory cytokines which, all together, exhibit a mitogenic activity on mammary cells. Proinflammatory cytokines and insulin deregulation on their turn, favor with time the onset of other chronic diseases such as diabetes, dyslipidemia, metabolic syndrome in general, thus increasing the risk of overall mortality. Conversely, weight loss can improve hormonal status, quality of life and physical functioning and contribute to reduce cancer recurrence risk, cancer-related and chronic-condition-related mortality. Therefore, it is important to promote weight control and the adoption of healthy lifestyle habits in breast cancer survivors.
Manipulation procedures, such as manual treatment with osteopathic techniques, involve the mechanical displacement of fluids and the removal of toxic substances with neurovascular and neuromuscular effects, thus producing positive alterations at the metabolic, biochemical and circulatory level. Several studies conducted on patients with breast cancer have supported the positive effect of manual therapy (acupuncture, shiatsu treatments, massages) on the control of various problems such as osteoarticular pain, peripheral neuropathies, anxious-depressive disorders, asthenia and sleep disorders, also improving immune and neuroendocrine responses.
Nevertheless, there are no studies on the effect of manual treatment with osteopathic techniques on the control of symptoms related to the side effects induced by anti-tumor therapies.
The aim of this study is to evaluate the effects of dietary intervention and manual treatment with osteopathic techniques in women diagnosed with breast cancer under antiestrogenic hormonal treatment through the assessment of:
- modifications of quality of life (QoL)
- frequency and severity of symptoms related to antiestrogenic hormonal treatment
- body weight
- body composition
- food habits
- metabolic and inflammatory state
- physical performance
- patient's satisfaction to multidisciplinary treatment.
This study focuses on patient's centricity evaluating the effects that long lasting adjuvant therapies have on breast cancer survivors. Improving personalized patient's treatment through collaborative interactions between clinicians, osteopaths and nutrition specialists might result in implementation strategies to determine novel evidence-based treatments for ameliorating patient's adherence to oncological therapies, impacting prognosis and survival.
- Conditions
- Breast Cancer
- Being tested
- manual treatment with osteopathic techniques and nutritional treatment, manual treatment with osteopathic techniques, nutritional treatment
- Keywords
- hormonal therapy, treatment-related adverse events, osteopathic techniques, diet, quality of life
- Medical subject headings
- Breast Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
manual treatment with osteopathic techniques and nutritional treatmentOther
manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet)
manual treatment with osteopathic techniquesOther
manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques)
nutritional treatmentOther
nutritional treatment (personalized Mediterranean Diet)
| Study group | Role | What they receive |
|---|---|---|
| A1: manual treatment with osteopathic techniques and nutritional treatment in premenopausal patients | Experimental | Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet). Receives: Other: manual treatment with osteopathic techniques and nutritional treatment |
| A2: manual treatment with osteopathic techniques in premenopausal patients | Experimental | Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques). Receives: Other: manual treatment with osteopathic techniques |
| A3: nutritional treatment in premenopausal patients | Experimental | Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with nutritional treatment (personalized Mediterranean Diet). Receives: Other: nutritional treatment |
| A4: control group in premenopausal patients | No intervention | Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues receive general counselling on healthy dietary habits and lifestyle in accordance to the World Cancer Research Fund (WCRF) guidelines. |
| B1: osteopathic techniques and nutritional treatment in postmenopausal patients | Experimental | Postmenopausal breast cancer patients under aromatase inhibitors are treated with manual treatment (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet). Receives: Other: manual treatment with osteopathic techniques and nutritional treatment |
| B2: manual treatment with osteopathic techniques in postmenopausal patients | Experimental | Postmenopausal breast cancer patients under aromatase inhibitors are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques). Receives: Other: manual treatment with osteopathic techniques |
| B3: nutritional treatment in postmenopausal patients | Experimental | Postmenopausal breast cancer patients under aromatase inhibitors are treated with nutritional treatment (personalized Mediterranean Diet). Receives: Other: nutritional treatment |
| B4: control group in postmenopausal patients | No intervention | Postmenopausal breast cancer patients under aromatase inhibitors receive general counselling on healthy dietary habits and lifestyle in accordance to the World Cancer Research Fund (WCRF) guidelines. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Evaluation of the effect of dietary intervention and manual treatment with osteopathic techniques on quality of life (QoL) of women diagnosed with breast cancer under hormonal treatment
Quality of life will be assessed using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) questionnaire comparing the before-and-after treatment difference in FACT-ES QoL scale (range 0-200; the higher the FACT-ES score, the better the quality of life, QoL) evaluated at baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3).
The difference between pre treatment (baseline, T0) score and 24-weeks (six months, T2) score of the FACT ES QoL scale will be analyzed by ANOVA, and the interaction between the dietetic treatment and manual treatment with osteopathic techniques will be tested at 5% significance level. In a secondary ANOVA analysis, the baseline-to-52-weeks (T3) follow-up difference of the FACT ES QoL scale scores will additionally be analyzed.
These analyses will be conducted separately in Groups A and B.
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Secondary outcomes (27)
Treatment-related adverse events of hormonal treatment in premenopausal and postmenopausal patients
Symptoms related to hormonal treatment will be evaluated using Menopause Rating Scale (MRS) (range 0-44; higher scores indicating worse symptoms) in Group A and EORTC Quality of Life Questionnaire - Breast Cancer Module (EORTC-QLQ-C30/BR23) (range 0-100; higher scores corresponding to worse symptoms) in Group B, respectively.
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Body weight
Body weight will be evaluated using body mass index (BMI), measuring weight in kilograms divided by the square of height in meters.
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Body composition
Body composition will be evaluated combining two anthropometric measures: the waist circumference (cm) and calf circumference (cm).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Food habits
Food habits will be assessed through a food frequency questionnaire.
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Hemoglobin
Hemoglobin will be assessed collecting blood exams measuring hemoglobin levels (g/dL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Red blood cells
Red blood cells will be assessed collecting blood exams measuring red blood cells count (cells/mcL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Platelets
Platelets will be assessed collecting blood exams measuring platelets count (cells/mcL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
White blood cells
White blood cells will be assessed collecting blood exams measuring white blood cells count (cells/mcL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Lymphocytes
Lymphocytes will be assessed collecting blood exams measuring lymphocytes count (cells/mcL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Monocytes
Monocytes will be assessed collecting blood exams measuring monocytes count (cells/mcL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Neutrophils
Neutrophils will be assessed collecting blood exams measuring neutrophils count (cells/mcL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: erythrocyte sedimentation rate
inflammatory state will be assessed collecting blood exams measuring erythrocyte sedimentation rate (ESR) (mm/h)
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Vitamin D
Vitamin D will be assessed collecting blood exams measuring Vitamin D levels (ng,mL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: plasma glycemia
Metabolic state will be assessed collecting blood exams measuring plasma glycemia (mg/dl)
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: serum insulin concentration
Metabolic state will be assessed collecting blood exams measuring serum insulin concentration (µU/ml).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: total cholesterol
Metabolic state will be assessed collecting blood exams measuring total cholesterol (mg/dL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: low-density lipoprotein (LDL) cholesterol
Metabolic state will be assessed collecting blood exams measuring low-density lipoprotein (LDL) cholesterol (mg/dL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: high-density lipoprotein (HDL) cholesterol
Metabolic state will be assessed collecting blood exams measuring high-density lipoprotein (HDL) cholesterol (mg/dL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: triglycerides
Metabolic state will be assessed collecting blood exams measuring triglycerides (mg/dL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: c-reactive protein (CRP)
inflammatory state will be assessed collecting blood exams measuring c-reactive protein (CRP) (mg/L).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Sex hormone binding globulin (SHBG)
Sex hormone binding globulin (SHBG) will be assessed collecting blood exams measuring sex hormone binding globulin levels (SHBG) (nmol/L).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: Interleukin-6 (IL-6)
inflammatory state will be assessed collecting blood exams measuring Interleukin-6 (IL-6) levels (pg/mL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: Tumour necrosis factor-α (TNF-α)
inflammatory state will be assessed collecting blood exams measuring Tumour necrosis factor-α (TNF-α) levels (pg/ml).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Testosterone
Testosterone levels will be assessed collecting blood exams measuring testosterone levels (ng/dL).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Modifications of blood lipid profile
modifications of blood lipid profile will be assessed collecting blood exams measuring plasma lipids by UPLC-MS.
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Physical performance
Physical performance will be assessed using International Physical Activity Questionnaires (IPAQ) measuring physical activity levels (higher scores indicating higher physical activity).
Measured: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Patient's satisfaction to multidisciplinary treatment
Patient's satisfaction to multidisciplinary treatment will be assessed with Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - General questionnaire (FACIT-TS-G) (range 0-25; the higher the score, the better the satisfaction).
Measured: 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Dec 2023
- Study start19 Dec 2023
- Primary completionDec 2025 (estimated)
- Study completionDec 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (42)Papers the sponsor has linked to this study.
- Other trials for Breast CancerStudies of the same condition, open and under way.
- More trials run by Fondazione IRCCS Istituto Nazionale dei Tumori, MilanoThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Model description
- This is an hybrid type I effectiveness-implementation trial, testing the effectiveness of clinical therapeutic interventions, coupled by exploration of the effects of the implementation of the effective intervention(s) in clinical practice (professional practice changes, changes in processes of care, quality of intervention delivery, patient's satisfaction). The effectiveness study will be a before-and-after randomized trial performed according to a 2 × 2 factorial design. Two groups are identified: * Group A: Premenopausal breast cancer patients treated with tamoxifen and/or luteinizing hormone-releasing hormone (LHRH) analogues. * Group B: Postmenopausal breast cancer patients treated with aromatase inhibitors. Patients in each group will be randomly assigned to four treatments arms: Arm 1, manual treatment with osteopathic techniques and nutritional treatment. Arm 2, manual treatment with osteopathic techniques. Arm 3, nutritional treatment. Arm 4, control.
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 600 participants (estimated)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Cristina Ferraris, MD, Principal investigator, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06164119
- Sponsor's protocol ID
- INT 107/23
- Acronym
- SECCO
- Status last verified
- Dec 2023
- First submitted
- 1 Dec 2023
- Last updated
- 8 Mar 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Sauter ER. Breast Cancer Prevention: Current Approaches and Future Directions. Eur J Breast Health. 2018 Apr 1;14(2):64-71. doi: 10.5152/ejbh.2018.3978. eCollection 2018 Apr.
PubMed 29774312Sharma R, Hamilton A, Beith J. LHRH agonists for adjuvant therapy of early breast cancer in premenopausal women. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004562. doi: 10.1002/14651858.CD004562.pub3.
PubMed 18843661Martino G, Catalano A, Agostino RM, Bellone F, Morabito N, Lasco CG, Vicario CM, Schwarz P, Feldt-Rasmussen U. Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PLoS One. 2020 Mar 26;15(3):e0230681. doi: 10.1371/journal.pone.0230681. eCollection 2020.
PubMed 32214378Glaus A, Boehme Ch, Thurlimann B, Ruhstaller T, Hsu Schmitz SF, Morant R, Senn HJ, von Moos R. Fatigue and menopausal symptoms in women with breast cancer undergoing hormonal cancer treatment. Ann Oncol. 2006 May;17(5):801-6. doi: 10.1093/annonc/mdl030. Epub 2006 Feb 28.
PubMed 16507565Mantas, D., Kostakis, J.D. & Markopoulos, C. Aromatase inhibitors: A comprehensive review in mechanisms of action, side effects and treatment in postmenopausal early breast cancer patients. Hellenic J Surg 88, 245-251 (2016). https://doi.org/10.1007/s13126-016-0326-6
Henry NL, Azzouz F, Desta Z, Li L, Nguyen AT, Lemler S, Hayden J, Tarpinian K, Yakim E, Flockhart DA, Stearns V, Hayes DF, Storniolo AM. Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. J Clin Oncol. 2012 Mar 20;30(9):936-42. doi: 10.1200/JCO.2011.38.0261. Epub 2012 Feb 13.
PubMed 22331951Sestak I, Cuzick J, Sapunar F, Eastell R, Forbes JF, Bianco AR, Buzdar AU; ATAC Trialists' Group. Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol. 2008 Sep;9(9):866-72. doi: 10.1016/S1470-2045(08)70182-7. Epub 2008 Aug 12.
PubMed 18703382Vance V, Mourtzakis M, Hanning R. Relationships Between Weight Change and Physical and Psychological Distress in Early-Stage Breast Cancer Survivors. Cancer Nurs. 2019 May/Jun;42(3):E43-E50. doi: 10.1097/NCC.0000000000000612.
PubMed 29847347Kangas M, Henry JL, Bryant RA. Posttraumatic stress disorder following cancer. A conceptual and empirical review. Clin Psychol Rev. 2002 May;22(4):499-524. doi: 10.1016/s0272-7358(01)00118-0.
PubMed 12094509Kadakia KC, Snyder CF, Kidwell KM, Seewald NJ, Flockhart DA, Skaar TC, Desta Z, Rae JM, Otte JL, Carpenter JS, Storniolo AM, Hayes DF, Stearns V, Henry NL. Patient-Reported Outcomes and Early Discontinuation in Aromatase Inhibitor-Treated Postmenopausal Women With Early Stage Breast Cancer. Oncologist. 2016 May;21(5):539-46. doi: 10.1634/theoncologist.2015-0349. Epub 2016 Mar 23.
PubMed 27009936Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012 Jul;134(2):459-78. doi: 10.1007/s10549-012-2114-5. Epub 2012 Jun 12.
PubMed 22689091Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011 Apr;126(2):529-37. doi: 10.1007/s10549-010-1132-4. Epub 2010 Aug 28.
PubMed 20803066Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. 2017 May 6;67(3):194-232. doi: 10.3322/caac.21397. Epub 2017 Apr 24.
PubMed 28436999Hernandez-Reif M, Ironson G, Field T, Hurley J, Katz G, Diego M, Weiss S, Fletcher MA, Schanberg S, Kuhn C, Burman I. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. J Psychosom Res. 2004 Jul;57(1):45-52. doi: 10.1016/S0022-3999(03)00500-2.
PubMed 15256294Lissoni P, Messina G, Lissoni A, Franco R. The psychoneuroendocrine-immunotherapy of cancer: Historical evolution and clinical results. J Res Med Sci. 2017 Apr 26;22:45. doi: 10.4103/jrms.JRMS_255_16. eCollection 2017.
PubMed 28567065
Study at a glance
From the registry record, last updated by the sponsor on 8 Mar 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomised Effectiveness-implementation Trial for Evaluating Dietary and Manual Treatment With Osteopathic Techniques on Quality of Life and on Modulation of the Inflammatory State of Patients Diagnosed With Breast Cancer Undergoing Antiestrogenic Hormonal Treatment.
- ClinicalTrials.gov ID
- NCT06164119
- Acronym / sponsor ID
- SECCO / INT 107/23
- Conditions
- Breast Cancer
- Keywords
- hormonal therapy, treatment-related adverse events, osteopathic techniques, diet, quality of life
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 600 participants (estimated)
- Lead sponsor
- Fondazione IRCCS Istituto Nazionale dei Tumori, MilanoUniversity, hospital or other
- Study start
- 19 Dec 2023 (actual)
- Primary completion
- Dec 2025 (estimated)
- Study completion
- Dec 2025 (estimated)
- First posted
- 11 Dec 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment and as a result, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high.
Promoting weight control and the adoption of healthy lifestyle habits in breast cancer survivors has an impact on hormonal status, quality of life and physical functioning, contributing to reduce cancer recurrence risk, cancer-related and chronic-condition-related mortality.
Manipulation procedures, such as manual treatment with osteopathic techniques, have positive effects on osteoarticular pain, peripheral neuropathies, anxious-depressive disorders, asthenia and sleep disorders, also improving immune and neuroendocrine responses.
The aim of this study is to evaluate the effects of dietary intervention and manual treatment with osteopathic techniques in women diagnosed with breast cancer under antiestrogenic hormonal treatment through the assessment of:
- modifications of quality of life (QoL)
- frequency and severity of symptoms related to antiestrogenic hormonal treatment
- body weight
- body composition
- food habits
- metabolic and inflammatory state
- physical performance
- patient's satisfaction to multidisciplinary treatment.
This study focuses on patient's centricity evaluating the effects that long lasting adjuvant therapies have on breast cancer survivors. Improving personalized patient's treatment through collaborative interactions between clinicians, osteopaths and nutrition specialists might result in implementation strategies to determine novel evidence-based treatments for ameliorating patient's adherence to oncological therapies, impacting prognosis and survival.
Detailed description
Breast cancer patients under hormonal therapy may experience significant adverse events related to this treatment. Premenopausal women may encounter the classic symptoms of menopausal syndrome: hair thinning or loss; hot flashes, sweating, fatigue, insomnia, joint pain, vaginal dryness, decreased libido, anxious-depressive disorders, cognitive dysfunction; dry eyes; weight gain. Postmenopausal women may instead experience joint stiffness and joint pain, depressive and anxious symptoms, fatigue and irritability.
Since most of these adverse events do not resolve spontaneously a few weeks/months after starting treatment, they often negatively impact patient's quality of life.
As a result of treatment-related adverse events, failure to adhere to adjuvant therapies or discontinuation of treatment has been reported to be high and this may negatively impact patient's prognosis and survival.
Patients with breast cancer frequently experience weight gain during and after adjuvant hormonal treatment. Indeed, menopause, musculoskeletal pain and the consequent physical activity reduction, work together to reduce the basal energy metabolism. On the other side, the psychological distress and the eventual use of food for emotional reward, do promote weight gain. Notably, breast cancer patients who are overweight or obese show an increased risk of overall mortality, cancer-specific mortality, breast cancer relapse or second primary contralateral breast cancer. The explanation lies in the fact that the increase in fat mass is directly correlated to an increased production of estrogens, insulin, leptin and proinflammatory cytokines which, all together, exhibit a mitogenic activity on mammary cells. Proinflammatory cytokines and insulin deregulation on their turn, favor with time the onset of other chronic diseases such as diabetes, dyslipidemia, metabolic syndrome in general, thus increasing the risk of overall mortality. Conversely, weight loss can improve hormonal status, quality of life and physical functioning and contribute to reduce cancer recurrence risk, cancer-related and chronic-condition-related mortality. Therefore, it is important to promote weight control and the adoption of healthy lifestyle habits in breast cancer survivors.
Manipulation procedures, such as manual treatment with osteopathic techniques, involve the mechanical displacement of fluids and the removal of toxic substances with neurovascular and neuromuscular effects, thus producing positive alterations at the metabolic, biochemical and circulatory level. Several studies conducted on patients with breast cancer have supported the positive effect of manual therapy (acupuncture, shiatsu treatments, massages) on the control of various problems such as osteoarticular pain, peripheral neuropathies, anxious-depressive disorders, asthenia and sleep disorders, also improving immune and neuroendocrine responses.
Nevertheless, there are no studies on the effect of manual treatment with osteopathic techniques on the control of symptoms related to the side effects induced by anti-tumor therapies.
The aim of this study is to evaluate the effects of dietary intervention and manual treatment with osteopathic techniques in women diagnosed with breast cancer under antiestrogenic hormonal treatment through the assessment of:
- modifications of quality of life (QoL)
- frequency and severity of symptoms related to antiestrogenic hormonal treatment
- body weight
- body composition
- food habits
- metabolic and inflammatory state
- physical performance
- patient's satisfaction to multidisciplinary treatment.
This study focuses on patient's centricity evaluating the effects that long lasting adjuvant therapies have on breast cancer survivors. Improving personalized patient's treatment through collaborative interactions between clinicians, osteopaths and nutrition specialists might result in implementation strategies to determine novel evidence-based treatments for ameliorating patient's adherence to oncological therapies, impacting prognosis and survival.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Single blind (participant)
- Number of arms
- 8
- Model description
- This is an hybrid type I effectiveness-implementation trial, testing the effectiveness of clinical therapeutic interventions, coupled by exploration of the effects of the implementation of the effective intervention(s) in clinical practice (professional practice changes, changes in processes of care, quality of intervention delivery, patient's satisfaction). The effectiveness study will be a before-and-after randomized trial performed according to a 2 × 2 factorial design. Two groups are identified: * Group A: Premenopausal breast cancer patients treated with tamoxifen and/or luteinizing hormone-releasing hormone (LHRH) analogues. * Group B: Postmenopausal breast cancer patients treated with aromatase inhibitors. Patients in each group will be randomly assigned to four treatments arms: Arm 1, manual treatment with osteopathic techniques and nutritional treatment. Arm 2, manual treatment with osteopathic techniques. Arm 3, nutritional treatment. Arm 4, control.
| Arm | Type | Receives |
|---|---|---|
| A1: manual treatment with osteopathic techniques and nutritional treatment in premenopausal patients | Experimental | Other: manual treatment with osteopathic techniques and nutritional treatmentPremenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet). |
| A2: manual treatment with osteopathic techniques in premenopausal patients | Experimental | Other: manual treatment with osteopathic techniquesPremenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques). |
| A3: nutritional treatment in premenopausal patients | Experimental | Other: nutritional treatmentPremenopausal breast cancer patients under tamoxifen and/or LHRH analogues are treated with nutritional treatment (personalized Mediterranean Diet). |
| A4: control group in premenopausal patients | No intervention | –Premenopausal breast cancer patients under tamoxifen and/or LHRH analogues receive general counselling on healthy dietary habits and lifestyle in accordance to the World Cancer Research Fund (WCRF) guidelines. |
| B1: osteopathic techniques and nutritional treatment in postmenopausal patients | Experimental | Other: manual treatment with osteopathic techniques and nutritional treatmentPostmenopausal breast cancer patients under aromatase inhibitors are treated with manual treatment (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet). |
| B2: manual treatment with osteopathic techniques in postmenopausal patients | Experimental | Other: manual treatment with osteopathic techniquesPostmenopausal breast cancer patients under aromatase inhibitors are treated with manual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques). |
| B3: nutritional treatment in postmenopausal patients | Experimental | Other: nutritional treatmentPostmenopausal breast cancer patients under aromatase inhibitors are treated with nutritional treatment (personalized Mediterranean Diet). |
| B4: control group in postmenopausal patients | No intervention | –Postmenopausal breast cancer patients under aromatase inhibitors receive general counselling on healthy dietary habits and lifestyle in accordance to the World Cancer Research Fund (WCRF) guidelines. |
Who may qualify
- Ages
- 18 to 85 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (9 listed)
- Age >18 years
- Voluntary written informed consent
- Histologically confirmed estrogen receptor-positive invasive breast cancer or in situ breast cancer after breast surgery
- Absence of locoregional relapse or distant metastasis
- Premenopausal or postmenopausal status
Key exclusion criteria (10 listed)
- Previous hormonal therapy
- Use of medical treatments that contrast adjuvant hormonal therapy adverse effects (e.g. menopausal symptoms and arthralgia).
- Underweight patients (BMI <18.5 kg/m^2)
- Patients diagnosed with eating disorders (e.g. anorexia nervosa, bulimia, binge eating, orthorexia)
- Psychiatric disorders or cognitive impairments
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| manual treatment with osteopathic techniques and nutritional treatmentmanual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques) and nutritional treatment (personalized Mediterranean Diet) | Other | A1: manual treatment with osteopathic techniques and nutritional treatment in premenopausal patients, B1: osteopathic techniques and nutritional treatment in postmenopausal patients |
| manual treatment with osteopathic techniquesmanual treatment with osteopathic techniques (8 once-a-week manual treatments with osteopathic techniques) | Other | A2: manual treatment with osteopathic techniques in premenopausal patients, B2: manual treatment with osteopathic techniques in postmenopausal patients |
| nutritional treatmentnutritional treatment (personalized Mediterranean Diet) | Other | A3: nutritional treatment in premenopausal patients, B3: nutritional treatment in postmenopausal patients |
Primary outcome
Evaluation of the effect of dietary intervention and manual treatment with osteopathic techniques on quality of life (QoL) of women diagnosed with breast cancer under hormonal treatment
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Quality of life will be assessed using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) questionnaire comparing the before-and-after treatment difference in FACT-ES QoL scale (range 0-200; the higher the FACT-ES score, the better the quality of life, QoL) evaluated at baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3). The difference between pre treatment (baseline, T0) score and 24-weeks (six months, T2) score of the FACT ES QoL scale will be analyzed by ANOVA, and the interaction between the dietetic treatment and manual treatment with osteopathic techniques will be tested at 5% significance level. In a secondary ANOVA analysis, the baseline-to-52-weeks (T3) follow-up difference of the FACT ES QoL scale scores will additionally be analyzed. These analyses will be conducted separately in Groups A and B.
27 secondary outcomes
Treatment-related adverse events of hormonal treatment in premenopausal and postmenopausal patients
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Body weight
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Body composition
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Food habits
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Hemoglobin
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Red blood cells
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Platelets
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
White blood cells
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Lymphocytes
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Monocytes
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Neutrophils
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: erythrocyte sedimentation rate
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Vitamin D
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: plasma glycemia
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: serum insulin concentration
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: total cholesterol
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: low-density lipoprotein (LDL) cholesterol
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: high-density lipoprotein (HDL) cholesterol
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Metabolic state: triglycerides
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: c-reactive protein (CRP)
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Sex hormone binding globulin (SHBG)
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: Interleukin-6 (IL-6)
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Inflammatory state: Tumour necrosis factor-α (TNF-α)
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Testosterone
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Modifications of blood lipid profile
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Physical performance
Time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Patient's satisfaction to multidisciplinary treatment
Time frame: 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Mar 2024.
- Background: PubMed 29774312Sauter ER. Breast Cancer Prevention: Current Approaches and Future Directions. Eur J Breast Health. 2018 Apr 1;14(2):64-71. doi: 10.5152/ejbh.2018.3978. eCollection 2018 Apr.
- Background: PubMed 18843661Sharma R, Hamilton A, Beith J. LHRH agonists for adjuvant therapy of early breast cancer in premenopausal women. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004562. doi: 10.1002/14651858.CD004562.pub3.
- Background: PubMed 32214378Martino G, Catalano A, Agostino RM, Bellone F, Morabito N, Lasco CG, Vicario CM, Schwarz P, Feldt-Rasmussen U. Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PLoS One. 2020 Mar 26;15(3):e0230681. doi: 10.1371/journal.pone.0230681. eCollection 2020.
- Background: PubMed 16507565Glaus A, Boehme Ch, Thurlimann B, Ruhstaller T, Hsu Schmitz SF, Morant R, Senn HJ, von Moos R. Fatigue and menopausal symptoms in women with breast cancer undergoing hormonal cancer treatment. Ann Oncol. 2006 May;17(5):801-6. doi: 10.1093/annonc/mdl030. Epub 2006 Feb 28.
- BackgroundMantas, D., Kostakis, J.D. & Markopoulos, C. Aromatase inhibitors: A comprehensive review in mechanisms of action, side effects and treatment in postmenopausal early breast cancer patients. Hellenic J Surg 88, 245-251 (2016). https://doi.org/10.1007/s13126-016-0326-6
- Background: PubMed 22331951Henry NL, Azzouz F, Desta Z, Li L, Nguyen AT, Lemler S, Hayden J, Tarpinian K, Yakim E, Flockhart DA, Stearns V, Hayes DF, Storniolo AM. Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. J Clin Oncol. 2012 Mar 20;30(9):936-42. doi: 10.1200/JCO.2011.38.0261. Epub 2012 Feb 13.
- Background: PubMed 18703382Sestak I, Cuzick J, Sapunar F, Eastell R, Forbes JF, Bianco AR, Buzdar AU; ATAC Trialists' Group. Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol. 2008 Sep;9(9):866-72. doi: 10.1016/S1470-2045(08)70182-7. Epub 2008 Aug 12.
- Background: PubMed 29847347Vance V, Mourtzakis M, Hanning R. Relationships Between Weight Change and Physical and Psychological Distress in Early-Stage Breast Cancer Survivors. Cancer Nurs. 2019 May/Jun;42(3):E43-E50. doi: 10.1097/NCC.0000000000000612.
- Background: PubMed 12094509Kangas M, Henry JL, Bryant RA. Posttraumatic stress disorder following cancer. A conceptual and empirical review. Clin Psychol Rev. 2002 May;22(4):499-524. doi: 10.1016/s0272-7358(01)00118-0.
- Background: PubMed 27009936Kadakia KC, Snyder CF, Kidwell KM, Seewald NJ, Flockhart DA, Skaar TC, Desta Z, Rae JM, Otte JL, Carpenter JS, Storniolo AM, Hayes DF, Stearns V, Henry NL. Patient-Reported Outcomes and Early Discontinuation in Aromatase Inhibitor-Treated Postmenopausal Women With Early Stage Breast Cancer. Oncologist. 2016 May;21(5):539-46. doi: 10.1634/theoncologist.2015-0349. Epub 2016 Mar 23.
- Background: PubMed 22689091Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012 Jul;134(2):459-78. doi: 10.1007/s10549-012-2114-5. Epub 2012 Jun 12.
- Background: PubMed 20803066Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011 Apr;126(2):529-37. doi: 10.1007/s10549-010-1132-4. Epub 2010 Aug 28.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Cristina Ferraris, MD principal investigator
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing manual treatment with osteopathic techniques and nutritional treatment, manual treatment with osteopathic techniques and nutritional treatment in people with Breast Cancer, run by Fondazione IRCCS Istituto Nazionale dei Tumori, Milano at 1 site in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 9 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 8 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Cristina Ferraris, MD (+39 02 2390 2659, cristina.ferraris@istitutotumori.mi.it), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Evaluation of the effect of dietary intervention and manual treatment with osteopathic techniques on quality of life (QoL) of women diagnosed with breast cancer under hormonal treatment (time frame: baseline (T0), after 12 weeks (T1), after 24 weeks (T2) and after 52 weeks (T3)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06164119, which also lists 42 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Mar 2024.