bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preferences in educational topics of interest to women with triple-negative breast cancer: The role of age, race/ethnicity, and stage at diagnosis in topic selection.
Authors: Swiger Kathleen Dickerson , Guglielmino Janine E. , Labban Jeffrey D. , Rugo Hope S. , Anders Carey K. , Nelson Hillary C.M. , Hanson Arin Ahlum , Dinerman Hayley , Henry Catherine Creme 
Published: February 2017

100 Background: Women diagnosed with triple-negative breast cancer (TNBC) responded to an online 80-question survey to identify their educational needs. They self-reported breast cancer subtype, demographics, and level of interest in 35 educational topics. Methods: This analysis examined whether demographic factors of women with TNBC diagnosed after 2006 (n = 611) were associated with their topic interest. Interest ratings were collapsed into “Not Interested” and “Interested or Very Interested.” Measures of association between interest in the top 10 TNBC topics and demographic factors were calculated using Phi coefficients (white/non-white) and point biserial correlations (age, cancer stage at diagnosis). False discovery rate adjustments were applied to the significance threshold to account for multiple comparisons. Results: Significant levels of association between personal factors and topic interest were observed for age; younger women were more likely to be interested in breast reconstruction (rpb= -19), parenting issues (rpb= -.36), and fertility preservation (rpb= -.33). Marginally significant associations were observed for race/ethnicity and cancer staging: non-white women were more likely to be interested in fertility preservation (rpb= -.12), and women diagnosed initially at higher stages of disease were more likely to be interested in parenting issues (rpb= .11). Conclusions: Age, race/ethnicity, and stage can influence education preferences of women with TNBC. These data point to the importance of understanding the interaction of children and cancer stage in women with triple-negative breast cancer. TNBC is proportionately more common in younger and non-white women; therefore, developing targeted interventions to address these factors could maximize healthcare team interactions, and enhance quality of life.
Efficacy of screening and treatment of breast cancer patients reporting high level of distress.
Authors: West Ryan , Thomas John W , Smith Elaine , Dhillon Navneet , Pabbathi Haritha , McKnight John Edward , Johnson Anita , Alvarez Ricardo H. 
Published: February 2017

101 Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and specifically symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014].At Cancer Treatment Centers of America (CTCA) we perform screening assessments using a Symptom Inventory Tool (SIT) composed of 27 questions. Pts with moderate and severe levels of anxiety are evaluated by the Integrative Resource Assessment Program (IRAP) and subsequently referred to integrative oncology consultation. Methods: The SIT is an assessment tool that captures pts’ perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) and validated assessment instrument with 8 questions and a free text box added by CTCA. Symptoms were rated “at the worst” on an 11-point numeric scale ranging from 0 (“no present”) to 10 (“as bad as you can imagine”) in the previous 24 hours. Results: Between 9/1/2014 and 2/27/2015, 842 pts with multiple types of cancer were screened for distress and 435 (51.6%) scored 5 or greater, of which 212 completed a second screening assessment.58 breast cancer pts provided SIT distress scores at baseline and then again at least 23 days after the initial assessment. The average reduction in the distress scores for breast cancer patients was 2 (1st SIT mean = 6.2, 2ndSIT mean = 4.2) with 40 pts (69%) reporting a decrease, 7 pts (12%) having no change, and 11 pts (19%) reporting an increase in distress. The 4 interventions most frequently referred and completed by the pts were mind body therapy (100%), rehabilitation (66%), acupuncture (50%), and massage therapy (45%). Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in breast cancer pts using integrative oncology approaches will reduce the distress in 69% of cases.
Metabolic syndrome and breast cancer recurrence within the 21-gene recurrence score assay.
Authors: Muniz Jeanette , Kidwell Kelley M , Henry Norah Lynn 
Published: February 2017

104 Background: The 21-gene recurrence score (RS) assay (OncotypeDX) is prognostic in stage I-II, ER+, HER2-, node negative breast cancer (BC). While RS reflects tumor gene expression its interaction with host factors including metabolic syndrome (MS) is unclear. MS conditions such as obesity have been associated with increased risk of BC and worse prognosis. The aim of this study is to determine correlations between MS conditions and RS group or BC outcomes in both pre- and post-menopausal women. Methods: We retrospectively reviewed women with stage I-II, ER+, HER2- node negative BC evaluated with RS assay treated at University of Michigan since 2005. Demographic, pathologic and treatment data, MS criteria and menopausal status were abstracted from medical records. MS was defined as ≥ 3 of the following within 6 months of diagnosis: BMI ≥ 27.7kg/m2; hypertension (HTN); impaired fasting glucose (IFG); HDL < 50mg/dL; hypertriglyceridemia (trig). RS groups were defined as low ( < 18), intermediate (18-30) and high ( > 31). Results: Of 533 eligible women 74% had stage I disease and 61% were postmenopausal at diagnosis. MS criteria prevalence was 43% BMI, 42% HTN, 34% trig, 14% IFG and 13% HDL. MS was present in 22% and more common in post- vs pre-menopausal women (30% vs 9%; p < 0.0001). RS groups were 55% low, 38% intermediate and 7% high. There was no significant association between RS group and overall MS status or any individual criterion, controlling for stage, and no association after stratification by menopausal status. Postmenopausal status was associated with higher RS group (p = 0.039), independent of stage. Over the 4.2 year median follow-up there were 7 deaths and 20 events, including 5 DCIS, 3 local and 11 distant recurrences and 1 second primary BC. There was insufficient power to detect associations between event rate and MS status. Conclusions: MS and comprising conditions are present in many early stage breast cancer patients, especially postmenopausal women. We were unable to identify associations between RS group and MS criteria. Thus the known worse BC prognosis with MS is not reflected in the RS. Identification of factors underlying this higher risk will be important for optimizing management of patients with breast cancer and MS.
Motivation and mortality in geriatric patients with early stage breast cancer.
Authors: DuMontier Clark , Clough-Gorr Kerri , Silliman Rebecca A , Moser André 
Published: February 2017

105 Background: Evidence suggests that an older patient’s motivation and life outlook are associated with health outcomes. A measure of motivation called the Getting Out of Bed Scale (GOB) was previously validated in a cohort of geriatric patients with early stage breast cancer. The aim of our project was to assess the association between GOB and mortality, both all-cause and breast-cancer specific, using the same dataset. Methods: We evaluated 660 women ≥ 65-years old diagnosed with stage I-IIIA primary breast cancer in four geographic regions in the US. Data were collected over ten-years of follow-up from consenting women’s medical records, telephone interviews, National Death Index, and Social Security Death Index. To address attrition bias, a multiple imputation approach using two-fold fully conditional specification was used to generate a complete dataset and allow for sufficient power in our statistical testing. Results: Using this dataset, a cox regression survival analysis found no significant association between GOB and mortality, both all-cause [5 years HR (95% CI): 0.76 (0.50,1.15), 10 years: 0.77 (0.59, 1.01)] and breast-cancer-specific [5 years: 0.92 (0.48, 1.73), 10 years: 0.84 (0.53, 1.33)]. This observation held true even after adjustment for other validated health-related quality of life measures of mental health, physical functioning, and socioeconomic status. Notably, patients with high mental health scores as measured by the Mental Health Index Short Form had significantly lower mortality, both all-cause [5 years: 0.42 (0.27, 0.65), 10 years: 0.59 (0.44, 0.79)] and breast-cancer specific [5 years: 0.42 (0.20, 0.90), 10 years: 0.52 (0.31, 0.89)]. Conclusions: These results suggest that GOB does not predict mortality in geriatric patients with early stage breast cancer; however, more research is needed to assess hope and outcomes in geriatric cancer patients. This study would not have been possible without the multiple imputations approach, which allows for greater power in researching longitudinal datasets that would otherwise suffer from loss to follow up.
Effects of chemotherapy on quality of life in breast cancer survivors.
Authors: Wandell Kaitlin K. , Lustberg Maryam B. , Reinbolt Raquel E. , Orchard Tonya , Andridge Rebecca , Wandell Hayley , Schade Carly , Moran Tim , Yang Nan , Conlan Trisha 
Published: February 2017

112 Background: Women undergoing chemotherapy for breast cancer often experience side effects that can impact quality of life and tolerance of planned therapy. This can lead to poor outcomes. By understanding these changes, we can intervene and improve the treatment for women. We hypothesized that chemotherapy would be associated with changes in functional status and nutrition related symptoms in breast cancer survivors. Methods: Patients were prospectively recruited prior to initiation of their neo-adjuvant or adjuvant therapy. Body mass index (BMI) was abstracted from records. The patient’s functional status was assessed using the Duke Activity Status Index (DASI), and the Patient Generated Subjective Global Assessment (PG-SGA) characterized nutrition-related symptoms of patients. Participants completed these questionnaires prior to initiating the first cycle chemotherapy (time point 1), during the second cycle (time point 2), and during the last cycle of chemotherapy, 12-20 weeks after initiation of treatment (time point 3). Changes in BMI, functional status, and symptomatology were analyzed using linear mixed effects models. Results: Twenty-five women enrolled; 19 women with a median age of 51 (range 33-66) completed the study. There was no significant change in BMI (p = 0.18) over the duration of chemotherapy. Analysis of DASI data indicated that there was a significant decline in peak oxygen uptake (p = 0.005), showing a decrease in functional capacity from before the first cycle to both the second and the last cycles. This suggests that functional capacity dropped significantly once chemotherapy began and stayed below baseline. There was also a significant change in PG-SGA (p = 0.005), indicating significant reported nutrition-related symptoms. PG-SGA scores were significantly higher during the second cycle compared to the other two time points, indicating that patient’s showed the highest degree of symptoms shortly after initiation of treatment and then improved. Conclusions: Chemotherapy is associated with symptomatology and a decrease in functional capabilities. Improved understanding of symptom burden during chemotherapy will allow more specific interventions to be designed that can help improve quality of life.
Online video support group pilot: Connecting young women diagnosed with breast cancer.
Authors: Taylor Nicole Anne , Esser Michelle , Atkinson Lori , Sutliff Medha , Stephens Christina , Rowe Jean , Ajango Mary 
Published: February 2017

113 Background: Young Survival Coalition (YSC) is the premier global organization dedicated to the critical issues unique to young women and breast cancer. Young breast cancer survivors (YBCS) have a strong desire to connect in-person with other young survivors although location, timing of meetings and illness can deter in-person meetings. YSC sought to create a programmatic initiative where YBCS can connect online through video to “see” and support each other as well as reduce a sense of isolation. Methods: YSC initiated an 8 month online video support group pilot, with six groups meeting monthly. Two groups focused on specific populations: under age 30; and YBCS with metastatic breast cancer. A YSC staff person provided technology support at the start of each meeting. A paid facilitator or a peer volunteer led each meeting. A variety of technology platforms were tested, with “GoToMeeting” being the most reliable and the most commonly used. Results: Approximately 29 YBCS participated regularly across the six groups. Post-meeting and post-pilot evaluations were strongly positive. Eighty percent felt their concerns were addressed during the meetings and being able to “see” other YBCS helped to build community and add to the support received. The top reason for participating in the support group was to connect with other YBCS (70%). The topics of most interest were sex and intimacy and anxiety (tied) followed by discussion of side effects. A little over half of the respondents (54%) reported wanting a facilitator to lead the groups instead of a peer. Seventy-three percent said they would participate in online video support groups again if offered. A text message reminder of the upcoming support group meeting, received a day prior to the meeting, was preferred over email. Conclusions: YSC’s online video support group program is a viable and innovative method of connecting YBCS, by providing the opportunity to give and receive support in the comfort of their own home. This pilot provided YSC the information needed to move into a second stage of program implementation and evaluation.
The effect of neoadjuvant chemotherapy on short-term outcomes in breast surgery: A propensity score adjusted analysis of NSQIP data.
Authors: Cordeiro Erin , Arnaout Angel , Cil Tulin 
Published: February 2017

115 Background: Neoadjuvant chemotherapy (NAC) is increasingly used in the treatment of breast cancer. The primary objective of this study was to determine whether administration of NAC increased the proportion of overall 30-day post-operative complications among patients undergoing surgery for invasive breast cancer. Methods: An analysis of the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP) participant user files from 2005-2012 was performed. Patients undergoing surgery for invasive breast cancer were included; those with high-risk comorbidities or concurrent surgery were excluded. The primary outcome was a composite of overall 30-day post-operative complications. A propensity score was calculated and a propensity score adjusted multivariable logistic regression model was used to determine the independent effect of NAC on overall 30-day complications. Results: In the study period67,685 patients having surgery for invasive breast cancer were identified; of those, 3,624 (5.5%) received NAC. The rate of NAC use within this cohort increased from 5.5% to 10.2%. Patients who received NAC were: younger and had fewer medical comorbidities, but, were more likely to receive neoadjuvant radiation and undergo bilateral surgery. On unadjusted analysis, patients receiving NAC had significantly more post-operative complications than those not receiving NAC (4.9% vs. 3.7%, p = 0.0003) mainly due to infection and bleeding. However, after adjusting for confounders by propensity score adjusted multivariable regression, there was no longer a significant difference in overall 30-day post-operative complications between those receiving NAC versus not (odds ratio 1.16 [95%CI: 0.98, 1.36]). Conclusions: This is the largest study to examine the effect of NAC on post-operative complications in patients undergoing surgery for invasive breast cancer. The receipt of NAC does not impart a significantly increased risk of post-operative complications in this patient population.
Usefulness of digital breast tomosynthesis (DBT) in evaluation of pathological response after neoadjuvant chemotherapy (NAC) for breast cancer.
Authors: Arasaki Ayano , Uchiyama Nachiko , Kinoshita Takayuki 
Published: February 2017

119 Background: Digital breast tomosynthesis (DBT) has been developed recently and it provides an advantage in detection of breast masses compared to 2D mammography (MMG) since it allows to separate the tissue layers and to noticeably reduce occlusions caused by overlapping anatomical structures. Neoadjuvant chemotherapy (NAC) has been used increasingly for the treatment of breast cancer. The imaging methods that have been used until now to assess tumor response to NAC have serious limitations. Attaining pathological complete response (pCR) is the most important predictor of long-term survival in patients receiving NAC. We assessed the radiological findings and capability of DBT to predict response to NAC in comparison with 2D MMG. Methods: 33 woman (mean age, 47.3 y.o.) having 36 lesions were recruited. Image utilizing adjunction of DBT to 2D MMG were taken for diagnosis from January, 2010 to March, 2015. Pathological subtypes were IDC (n = 34), ILC (n = 1), and IMPC (n = 1). Pathological responses of the lesions to NAC were Grade1 (n = 16), Grade2 (n = 11), and Grade3 (n = 9). The clinical image data sets were acquired with a DBT system (MAMMOMAT Inspiration, Siemens, Germany).For each patient, CC and MLO views were taken for diagnosis. With one-view 2D MMG and DBT, those radiation dose, utilizing the ACR phantom 156, were 1.20mGy and 1.80mGy. Results: The clinical response to NAC was classified into the following categories: 1) Fairly Response (FR): reduction in size of the tumor by more than 70% including Complete Response (CR), 2) Partial Response (PR): reduction in size of the tumor by 30% or more but less than 70%, 3) Stable disease (SD): reduction in size of the tumor by less than 30%. DBT findings of pathological Grade2-3 cases were all suggested FR (28/28, 100.0%) Grade3 cases were all suggested CR (9/9,100.0%). Regarding the Grade1b cases, all lesions were suggested PR (8/8, 100.0%). Regarding the Grade1a cases, 3 out of 8 (36.5%) lesions were suggested CR, and 2 out of 8 (25%) lesions suggested PR, and 3 out of 8 lesions suggested SD. Conclusions: DBT will contribute to improved diagnosis accuracy with regard to NAC response to breast cancer in comparison with 2D MMG.
Eribulin and carboplatin in heavily pretreated patients with metastatic breast cancer: A single institution experience.
Authors: Martin Romano Patricia , Baraibar Iosune , Fernández-Hidalgo Oscar , Santisteban Marta , Espinós Jaime , Salas Diego , Sala Pablo , Gardeazabal Itziar , Zubiri Oteiza Leyre , Aramendia Jose M. 
Published: February 2017

122 Background: In recent years many drug combinations have demonstrated clinical activity in heavily pretreated patients (pts) with metastatic breast cancer (MBC). Eribulin (E) in monotherapy has shown a beneficial effect in overall survival (OS) with slight rate of objective responses (OR) and poor effect in progression free survival (PFS). The Eribulin – Carboplatin (Cb) combination has been studied in other types of tumors in a phase Ib with promising results. We initiated an exploratory program with an off-label combination of E – Cb in pts with visceral disease and ECOG < 2. Methods: We retrospectively analyzed pts with MBC previously treated with anthracyclines, taxanes, and Capecitabine. Chemotherapy regimen consisted of E 1.1mg/m2 on days 1 and 8 and Cb AUC: 5 on day 1 every 21 days. Toxicity was assessed according to CTC criteria v 4.0. OR, PFS and OS rates were also evaluated. RECIST criteria were used to appraise radiological response. Results: Treatment was delivered in 10 pts. Median (M) age was 56 (range, 39-65). Pts characteristics were defined as follows: ECOG 0 (1 pt), 1 (6 pts) and 2 (3 pts); histological subtypes: luminal 9 pts and Her-2, 1 pt. M of previous lines was 7 (3-11). M of metastatic localizations were 3 (1-4). M of administered cycles was 6’5 (1-10). Grade 2 toxicity was asthenia 40%, peripheral neuropathy 10% and nausea - vomiting 10%. G 3 anemia and thrombopenia were noted in 20%. G 3-4 neutropenia was observed in 5 pts. Two pts required hospital admission due to febrile neutropenia. OR rate: complete response 10%, partial response 50% and stable disease 40%. Biochemical response rate was 80%. M of follow-up was 11 months, with M PFS and OS of 8 (4-11) and 18 months (4-18) respectively. Conclusions: Eribulin and Carboplatin is feasible, achieving remarkable response and survival rates with an acceptable toxicity profile in heavily pretreated patients with metastatic breast cancer. Preliminary results are promising and encourage us to continue recruiting patients.
Lymph node ratio as prognostic after neoadjuvant therapy in breast cancer.
Authors: Bertoni Danielle Marie , Hernandez-Boussard Tina , Wapnir Irene 
Published: February 2017

123 Background: Lymph node ratio (LNR) is defined as the proportion of involved nodes over total number of nodes. The latter may be superior to TNM staging as a prognostic indicator in breast cancer treated surgically first. Pathological staging after neoadjuvant therapy (NAT) is based on the residual cancer burden (RCB) in breast and nodes. We hypothesized that LNR after NAT offers additional useful prognostic information. Methods: Patients receiving NAT were identified through the Stanford Tumor Registry. Based on previously published classifications LNRs in node positive disease was classified as low (L) 0.01-0.2, intermediate (I) 0.21-0.65, and high (H) > 0.65. Other discriminant cut-off points were sought. Kaplan-Meier log-rank test was used for survival analysis. Results: 105 node-negative and 92 node-positive cases were identified (2003 -2010). Median number of nodes examined was 13, range 2-40. LNR among the node-positive cohort varied from 0.03 to 1.0. The distribution of positive nodes for L was 1-4, for I 1-13, and for H 2-25. The 3-year DFS and OS were 94% and 98%, for node-negative cases, and 66% and 77% for node-positive cancers. Survival for L = 79% (median 55%); I = 56.2% (median 52%); and H = 55.6% (median 49%). Using 0.5 as a new discriminant, the 3 and 5-year OS for LNR < 0.5 was 78.1% and 69.9%, and for LNR > 0.5 was 52.2% and 39.8%, respectively (p = 0.02). Conclusions: LNR of 0.5 was found to discriminatefor survivalin patients after NAT. This differs from the LNR categories defined for patients who had surgery first. Further validation in larger dataset is warranted.