bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone mineral density and FRAX as predictors of fracture risk in women with breast cancer.
Authors: Edwards Beatrice J. , Gradishar William John , Smith Maureen , Pacheco Jennifer A. , Holbrook Jaimee S , Mckoy June M , Nardone Beatrice , Godinez-Puig Victoria , Bunta Andrew , Rosen Steven T. , West Dennis P. 
Published: February 2017

121 Background: The number of cancer survivors is rising in the USA, the 2007 CDC analysis of the SEER database estimated 11 million cancer survivors, with 90% being over the age of 65 years. Of these, 70% are women, and the most common cancer in survivors is breast cancer. Cancer therapy induced bone loss (CTIBL) contributes to an increase in fracture risk in women with breast cancer. Fractures are responsible for considerable morbidity, disability, hopitalizations and mortality in older adults. Fractures are often the cause for nursing home placement in seniors. Our objective was to analyze the prevalence of fractures after breast cancer therapy and to assess the effect of cancer therapy, clinical risk factors, bone density and the World Health Oragnization (WHO) fracture risk assessment [FRAX] as predictors of fracture occurrence. Methods: The study population consisted of breast cancer patients with invasive breast cancer who participated in a genetic databank within a NCI-Comprehensive Cancer Center. Demographic and clinical characteristics were abstracted from the EMR. Participants were followed for 6-12 years. Results: A total of 439 women with breast cancer were assessed; 79 had sustained fractures during the observation period (116 fractures), fractures occurred at multiple skeletal sites in 27 cases. The prevalence of fractures was 18%. Baseline characteristics revealed that women who sustained fractures were mostly Caucasian (91%, p=0.08), and had a family history of osteoporosis (36.9%, p=0.03). The time to fracture was 4.0 years (range 0-12 years) from diagnosis. Fracture cases had lower BMD at the femoral neck 0.86 ± 0.13 gm/cm2 (T-score= -1.0, p=0.04) than non- fracture cases, although BMD was in the low normal range. Eight cases of hip fractures were identified with a median age of 55 years (32-67 years) Median T-score -0.75. Cox proportional hazard analysis failed to identify any specific risk factors for fractures. Conclusions: Fractures occur shortly after commencing cancer therapy. BMD and FRAX risk calculation were not able to identify women who fractured. Occurrence of fractures in breast cancer raises the possibility of cancer-induced impairment in bone quality.
Ethnic disparities in adherence to breast cancer survivorship care.
Authors: Gole Pragati , Ying Jun , Theriault Richard L. , Melhem-Bertrandt Amal , Moulder Stacy L. , Tereffe Welela , Pini Tunghi May , Brewster Abenaa M. 
Published: February 2017

122 Background: Two major components of breast cancer survivorship care include surveillance with mammograms and clinic visits after completion of definitive treatment. Identifying disparities in adherence to survivorship care is critical for improving the care delivery and outcomes of patients. Methods: We evaluated adherence to survivorship care among 4,212 racially/ethnically diverse Texan residents who underwent surgery for stage I-III breast cancer at the MD Anderson Cancer Center between January, 1997 and December, 2006 and completed one year of survivorship care. We used generalized estimating equations (GEE) method to evaluate race/ethnicity differences in missed mammograms and clinic visits up to 4 years of survivorship care. Results: The mean age of the cohort was 53 years (range 22-91); 72% white, 11% black, 11% Hispanic and 5% other race/ethnicity. Over four years, 36% of patients missed an annual mammogram and 21% of patients did not have a minimum of 1 clinic visit per year. For the entire study cohort, the trend of missed annual mammograms per year of survivorship care follow-up was 6% (year 1), 17% (year 2), 19% (year 3) and 22% (year 4) (p-trend <0.0001). In multivariable GEE model adjusted for survivorship year, age, stage, chemotherapy, endocrine therapy, radiation therapy and county of residence, Hispanic (OR 1.48 95% CI 1.22-1.80) and black (OR 1.41, 95% CI 1.15-1.72) patients were more likely be nonadherent with annual mammograms compared to white patients. Hispanic (OR 1.58, 95% CI 1.25-2.00) and black (OR 1.45, 95% CI 1.14-1.84) patients were also more likely to be nonadherent with clinic visits compared to white patients. There was a significant interaction between ethnicity and non-receipt of adjuvant endocrine therapy on clinic visit nonadherence (p-interaction=0.04) and annual mammogram nonadherence (p-interaction=0.001) among Hispanic compared to white patients. Conclusions: Drop out of breast cancer survivorship care increases over time and black and Hispanic women are more likely to be nonadherent. Better characterization of the reasons for nonadherence is needed to design interventions to improve retention in breast cancer survivorship care, especially for patients not receiving adjuvant endocrine therapy.
Elevated extracellular fluid in the "at risk" arm from taxane-based chemotherapies in women treated for early breast cancer.
Authors: Kilbreath Sharon Lynn , Beith Jane McNeil , Refshauge Kathryn M. , Ward Leigh C. , Ung Owen , French James , Koelmeyer Louise , Kastanias Katrina , Simpson Judy M. , Yee Jasmine 
Published: February 2017

126 Background: Taxane-based regimes has improved survival in early breast cancer and now is used routinely. A common side effect is oedema which potentially increases the risk of lymphoedema in the arm after surgery. This has not been assessed prospectively. The aim of this study was to determine the effect of taxane-based regimens on extracellular fluid (ECF) in the arm on the side of surgery. Methods: Women (n=441) aged 56.8 (SD 11.2) years enrolled prior to surgery for early breast cancer and were reassessed within 1 month and 6, 12, and 18 months following surgery. Assessment included bioimpedance spectroscopy which quantifies ECF in each arm and used to derive the ECF ratio. Based on the ECF ratio, women were categorised as having, or not, swelling preferentially in their at risk arm at each time point and having no taxane-based chemotherapy (n=269), paclitaxel (n=73) or docetaxel chemotherapy (n=88). Results: Pre-surgery, the ECF ratio was not significantly different in women who later did or did not receive taxane-based chemotherapy. Following surgery but prior to commencing chemotherapy, 45 (11%) women had increased ECF in their at-risk arm. Both taxane-based chemotherapies and elevated postoperative arm swelling were associated with swelling at each follow-up timepoint (Table). Conclusions: In addition to pre-existing swelling, both taxel chemotherapies were associated with swelling preferentially in the at-risk arm between 6 and 18 months following surgery. Strategies to prevent or minimise this swelling need to be developed. [Table: see text]
Patient navigation for breast cancer patients with disabilities.
Authors: Fenton Mary Anne 
Published: February 2017

130 Background: Patient navigator programs (PNP) aid in evaluation and treatment of cancer in underserved populations. Along a patient’s journey obstacles to medical care can include cultural, financial, language, physical and transportation barriers, fear and anxiety, comprehension and retention of critical information and coordination of visits. PNP research has focused on addressing ethnic and racial barriers, with scant attention paid to the impact of PNP in the disabled. The Americans with Disabilities Amendments Act of 2008 defines as a “physical or mental impairment that substantially impairs one or more of major life activities." Methods: A retrospective analysis was performed of patients with stage I-III breast cancer under age 70 with disabilities enrolled in the PNP at Rhode Island Hospital or the Miriam Hospital (RIH/MH) from 2006-2012. Charts were reviewed and assessed for quality measures as defined by the National Comprehensive Cancer Center (NCCN) guidelines and American Society of Medical Oncology Quality Practice Initiative (QOPI) benchmarks, for demographics, stage at diagnosis, treatment recommended and received, and patient outcomes. Results: 44 patients were identified. All patients were recommended treatment in accordance with NCCN guidelines. Compliance with radiation and endocrine therapy guidelines was excellent. In the smaller cohort of patients for whom adjuvant chemotherapy was indicated, there was a higher rate of nonconcordance (25%) compared to 13% in the NCCN database. All nonconcordance was attributed to patient refusal (6) or delay due to comorbid conditions (3). Conclusions: Our analysis suggests PNP may enhance compliance with recommended treatment and thus quality care in breast cancer patients with disabilities. Integration of PNP in cancer care serves as a valuable adjunct in removing obstacles to cancer care for the disabled. [Table: see text]
Prevalence of self-reported cognitive dysfunction in breast cancer patients.
Authors: Skirbe Heidi , Hohn Gabriela , Klein Paula , Juliano Mary Ann , Winell Jeremy , Rosenwald Victoria , Boolbol Susan K. , Festa Joanne 
Published: February 2017

131 Background: In 2011 a series of four time-limited, psycho-educational workshops was conducted by a neuropsychologist at a major urban academic medical center, providing information, coping strategies, and resources to women who had been treated for breast cancer (BrCa) and who then sought cognitive treatment. Based on positive evaluations of these workshops, we assessed the prevalence of self-reported cognitive dysfunction in BrCa patients with the goal of expanding cognitive services to all affected cancer patients. Methods: The study was IRB approved. We surveyed a convenience sample of 50 BrCa patients in a single medical oncology waiting room over several weeks. Subjects completed a 16 item questionnaire assessing potential cognitive problems on a 4 point-scale. Results: Fifty patients completed the survey, of whom 46% were currently employed. Sixty-eight percent of respondents were currently receiving cancer treatment and of those, 61.8% had also received prior treatment. Conclusions: An unexpectedly large proportion of BrCa patients perceived cognitive difficulties that may have been compounded by fatigue and emotional dysfunction. Others may have failed to report cognitive difficulties, unaware of their onset. Quality of life of cancer patients is diminished by cognitive decline. The current data indicate a need for formal assessment and intervention programs that will identify patients with cognitive and emotional dysfunction and remediate the difficulties via workshops and therapy. Formal neuropsychological assessment and treatment resourcestargeting cognitive changes associated with cancer should be expanded to meet documented need. Further research will optimize the scheduling and structure of therapeutic interventions. [Table: see text]
Integrative model for breast cancer survivorship.
Authors: Reinbolt Raquel E. , Shapiro Charles L. , Garrett Julia , Basinger Heidi , Lester Joanne L. , Muscari Nicole , Ries Kathleen , Lustberg Maryam B. 
Published: February 2017

132 Background: Efforts to better address needs of survivors, summative care plans, and point of delivery are ongoing at academic, research, and community institutions. Lacking are empiric data to support one method over another. Methods: A quasi-experimental approach was used to measure a multidisciplinary integrative care model that involved the primary nurse, nurse practitioner, and medical oncologist to determine the best time, method, and application of cancer survivorship care planning. A concomitant cross-sectional study was ongoing in which patients completed the Distress Thermometer (0-10 analog score) plus a problem list (34 items) in early survivorship (e.g. during treatment, at its end, at 3- and 6-months later). Results: As a result of our teamwork, data from the electronic medical record (EMR) was integrated into end-of-treatment summaries and care plans; ‘smart-phrases’ provided links to personalized patient data which resulted in individualized care plans. The average self-reported distress level in early survivorship was 4.8, indicating a moderate to severe level of distress. Patients stated practical problems (e.g. finances, work) were of highest concern, followed by physical symptoms (e.g. fatigue, aches/pains), then emotional and family issues were prime distressors. The integrative model allowed our work teams to provide personalized services with a greater understanding of each individual patient. Data is presently being collected to quantify these services. Through this multidisciplinary approach, team-driven initiatives, and EMR integration, the preparation, delivery and follow up required for survivorship encounters was greatly streamlined. Conclusions: An integrative care model that is linked to the electronic medical record provides personalized care in a timely manner that is neither time nor resource intensive. We ‘listened’ to our patients and have diligently worked to increase and expand resources. Future initiatives include group educational sessions, earlier discussion of survivorship goals, and treatment summary generation at diagnosis. We believe this model will serve as the foundation for survivorship care expansion in our breast program, and can potentially be generalized to other institutions.
Group medical appointments: A novel approach in patient education for adjuvant endocrine therapy.
Authors: Vlahadamis Ann , Danilak Melanie , Rawson Krista M. , King Karen M. , Pituskin Edith 
Published: February 2017

133 Background: Group medical appointments (GMA) are currently practiced for a wide range of medical conditions such as diabetes, hypertension, asthma, and cardiovascular disease. Previously, postmenopausal estrogen receptor positive breast cancer patients (ERBCP) attended individual physician clinic appointments to learn about their options for adjuvant endocrine therapy. This resulted in variable education provided, lengthy medical oncologist (MO) clinic visits and significant wait-lists to attend clinic. Accordingly, we embarked on a pilot program to determine the feasibility and acceptability of GMA in this patient population. Methods: Since 2010, ERBCP requiring endocrine therapy were referred and scheduled in the biweekly GMA program. Education regarding choices, risks, benefits and side effects of endocrine therapy were provided by a nurse practitioner (NP) and/or pharmacist (RX). After questions were solicited from the group, individual ERBCP were provided with prescriptions and scheduled for guideline-based follow-up. Results: Approximately 900 ERBCP have attended GMA, with 100% of MOs referring eligible patients. Surveys indicate high levels of satisfaction with the information provided and the GMA format. Conclusions: GMA provided by NP and/or RX is feasible and acceptable to both ERBCP and MOs. Health system benefits include increased efficiency and reduced cost, with MO clinic reserved for complex patient needs. Patient benefits include timely access to care and high levels of reported satisfaction. Future work will examine the effects of GMA on patient compliance and medication reconciliation with endocrine therapy.
Heart failure and mortality risk in patients undergoing high-dose chemotherapy with autologous stem cell transplant for breast cancer after radiotherapy.
Authors: Singhvi Aditi , Garikapati Kiran , Khoulani Dania , Hassan Syed , Qureshi Waqas 
Published: February 2017

135 Background: High-dose chemotherapy (HDCT) with autologous hematopoietic stem cell transplant (HSCT) has been used as part of the treatment of metastatic breast cancer. However, the evidence behind this approach continues to be controversial. We hypothesize that previous radiation therapy (RT) may increase the risk of cardiomyopathy and mortality in these patients. Methods: Patients who underwent HSCT after HDCT for breast cancer treatment during 1988-2012 were included. The patients that underwent HSCT for indications other than breast cancer were matched 1:2 based on age and gender. The data was analyzed using the cox proportional hazard model, looking at time-to-survival with adjustments made for cardiotoxic chemotherapeutics, histology of cancer, ER/PR status, EGFR mutation status, number of RT sessions, age, and functional status. Results: Sixty-six patients with metastatic breast cancer underwent HSCT. Patients with breast cancer were more likely to develop systolic heart failure (10% vs. 6.1%, p=0.002). There were 29 (43.9%) patients who underwent whole breast RT (WBRT). Prior WBRT was an independent predictor of developing post-transplant systolic heart failure (HR 3.77; 95% CI 1.29–10.75, p=0.007). The Kaplan–Meier curve shows a better survival for patients without a previous WBRT (Log rank p=0.009). Patients with prior WBRT were found to have decreased survival (HR 1.59; 95% CI 1.16–2.17, p=0.004). Conclusions: Patients with a history of WBRT who underwent HSCT were more likely to develop new onset systolic heart failure than patients without WBRT. This might be due to the effects of RT on the coronary arteries and the cardiac myocytes, leading to worse outcomes. Future studies are needed to evaluate outcomes of HSCT in patients with metastatic breast cancer without prior WBRT.
Radiation therapy for breast cancer (BC) with central nervous system (CNS) metastases: A contemporary experience at Memorial Sloan-Kettering Cancer Center (MSKCC).
Authors: Morikawa Aki , Diab Adi , Patil Sujata , Forte Victoria , Blum Brian , Young Robert J. , Beal Kathryn , Hudis Clifford , Seidman Andrew David , McArthur Heather L. 
Published: February 2017

144 Background: Many of the well-studied prognostic factors for patients with breast cancer (BC) brain metastases (BM) are based on data from an era when stereotactic radiosurgery (SRS) was not commonly used. In this study, we examined patient characteristics and outcomes for patients with CNS metastases who recently underwent cranial radiation at MSKCC. Methods: 173 consecutive BC patients with CNS metastases receiving SRS or WBRT from January 2009 to December 2011 were identified. Clinico-pathologic and treatment information was obtained by retrospective review. Patient characteristics and associations were evaluated. Time from BM to death was evaluated by Kaplan-Meier and log-rank tests. Results: Of 173 patients (2 missing HER2 status), the subgroups were: HR+HER2-: 77 (45%), HR+HER2+: 28 (16%), HR-HER2+: 17(10%), and HR-HER2-(TNBC): 49 (29%). 121 had whole brain radiotherapy (4 with prior SRS), and 50 had SRS only. The use of SRS differed by subtype (overall Fisher’s exact p=0.02): 59% (HR-HER2+), 33% (TNBC), 29% (HR+HER2+), 21% (HR+HER2-). There were a total of 110 deaths. The median follow-up for survivors was 19mo (range: 6-67mo). The median time from BM to death for all patients was 17.5mo (95% confidence interval: 14-20mo): 41mo (HR-HER2+), 63mo (HR+HER2+), 14.5mo (HR+HER2-), 14mo (TNBC; log-rank test p=0.0001). Conclusions: Although HER2+ and TNBC subtypes are associated with a higher risk of BM, we noted a higher prevalence of HR+HER2- disease in BC patients with CNS metastasis, a group currently understudied. The prognostic information for time from BM to death differs according to subtype and may be important for future planning of clinical trials. Further evaluation of factors related to these outcomes is ongoing.
Impact of routine tumor genotyping on enrollment in targeted therapy trials for metastatic breast cancer (MBC): 4-year review.
Authors: Bardia Aditya , Juric Dejan , Isakoff Steven J. , Borger Darrell R. , Dias-Santagata Dora , Higgins Michaela Jane , Iafrate Anthony John , Flaherty Keith , Moy Beverly , Ellisen Leif William 
Published: February 2017

145 Background: Major barriers to enrollment in therapeutic clinical trials (<5% in United States) include low response rate in phase I/II trials and low enthusiasm among oncologists. Stratified clinical trial enrollment based on molecular profiling of tumors represents a potential paradigm shift in drug development. Here we assess the clinical utility of tumor genotyping for identification of oncogenic driver mutations and enrollment in therapeutic clinical trials for patients with metastatic breast cancer (MBC). Methods: A robust, high-throughput tumor genotyping assay (Snapshot), was developed at our institution to assess for presence of potentially actionable oncogenic driver mutations (15 genes, 130 mutations) using DNA derived from formalin-fixed, paraffin-embedded (FFPE) tissue. The tumor genotyping assay was ordered by oncologists in clinic for patients with MBC. Relevant clinical information was gathered from chart reviews. Descriptive statistics were used for analysis. Results: From 2009-2012, 347 breast tumors were prospectively genotyped in the study population (median age = 50, range 27-90). The common oncogenic mutations were seen in all breast cancer subtypes. PIK3CA mutation (23.3%) was the most common mutation detected overall, albeit at varying frequency in tumor subtypes: HR+ (29.1%, N= 210), HER-2+ (21.5%, N = 65), TN (8.3%, N = 72). Unanticipated mutations in KRAS, BRAF, IDH, and HER-2 were also discovered. Clinical genotyping helped identify breast origin for carcinomas of unknown primary and revealed changes in mutation profile in metastatic tumors from primary tumors. Enrollment in clinical trials for MBC almost quadrupled from 2005-2008 to 2009-2012, with approximately one-third of patients undergoing tumor genotype testing enrolling in clinical trials, particularly phase-I genotype-directed targeted therapy, such as PI3K inhibitor, Akt inhibitor, and PI3K/MEK inhibitor combination. Conclusions: Routine tumor genotyping can be successfully incorporated into clinical practice to significantly enhance therapeutic clinical trial enrollment and potentially accelerate development of genotype-directed targeted therapies for MBC.