bluuebunny/crossref_metadata_2025_split huggingface dataset:
Whole-breast hypofractionated IMRT and brachytherapy boost after conservative surgery for breast cancer: Early results of a prospective non-randomised trial.
Authors: Guix Benjamin , Garcia Ivan , Guix Ines , Lejarcegui Juan Antonio , Tello Jose Ignacio , Prats Miquel , Quinzaños Luis , Mases Joel , Algara Manel , Monne Josep Maria Sole , Guix Teresa 
Published: February 2017

46 Background: To report early results obtained in a prospective group of patients (pts) treated with whole breast IMRT radiotherapy plus a brachytherapy boost to the tumor bed after conservative surgery, given either with hypofractionated or normofractionated radiotherapy. Methods: Between 12/2008 and 06/2014, 829 pts with <4cm, N0-2 breast cancers treated with conservative surgery were assigned to enter the study. Pts were offered to be treated either with IMRT hypofrationated whole breast and lymphnode areas (if needed) radiotherapy 42.6 Gy (266cGyx16 fractions) plus a 7 Gy boost to the tumor bed, (hypofractionated group) or IMRT normofractionated 50 Gy (200cGyx25) to the whole breast and lymphatic areas (when needed) plus 16 Gy brachytherapy boost (200cGyx8 fractions) (normofractionated group). Treatment assignation was done according to the patients preference or, if none, were randomly assigned to have both groups uniformly balanced. During treatment and follow-up special attention was taken to early and late side-effects, breast fibrosis, arm lymphedema, skin reaction, patient satisfaction and local, regional and distant disease control. Results: A total of 309 pts were included in the hypofractionated group and 520 in the normofractionated group. All patients completed treatment. Pts were evaluated weekly during treatment and every 3 months for the first 2 years of follow-up and in a yearly basis after. Photographs were taken at each visit. SOMA-LENT scales were used in every visit. For quality of life EORTC QLQ-C30 plus the BR-15 module were used. No pts had adverse side-effect that required treatment ending in any group. In the hypofractionated group, there were 1 LR, 1 M1 and 1 death due to the disease. In the normofractionated group there were 12 LR, 7 M1 and 4 patients died due to the disease. Conclusions: Hypofractionated IMRT to the whole breast followed by a 1 fraction HDR breast implant was a safe and effective method of treatment for early breast cancer treated with conservative surgery, even in those patients N+ in which the supraclavicular fossa was included in the treatment fields. Pts satisfaction was greater in the hypofractionated group.
Identifying patterns of breast cancer care provided at high volume hospitals: A classification and regression tree analysis.
Authors: Kong Amanda L. , Pezzin Liliana E , Nattinger Ann B 
Published: February 2017

69 Background: There is a growing body of literature linking hospital volume to outcomes in breast cancer. However, the mechanism through which volume influences outcome is poorly understood. The purpose of this study was to examine the relationship between hospital volume of breast cancer cases and patterns of processes of care in a population-based cohort of Medicare patients. Methods: A previously described and validated algorithm was applied to Medicare claims for newly diagnosed breast cancer cases in 2003 to identify potential subjects. Breast cancer patients were recruited to participate in a survey study examining breast cancer outcomes, and data was merged with Medicare claims and state tumor registries. Hospital volume was divided into tertiles. A Classification and Regression Tree (CART) model was performed to look for statistically significant relationships between patterns of processes of care and hospital volume. Results: Using CART analysis, eight patterns of care were identified that differentiated breast cancer care at high versus low volume hospitals. Sentinel lymph node dissection (SLND) was the single process of care that demonstrated the greatest differentiation across hospitals with differing volumes. Four patterns of care significantly predicted that a patient was less likely to be treated at a high volume hospital. Conclusions: Our study demonstrates differences in patterns of processes of care between low and high volume hospitals. Hospital volume was associated with several patterns of care that reflect the most current standards of care, particularly SLND. Greater adoption of these patterns by low volume hospitals could improve the overall quality of care for breast cancer.
Inappropriate lumpectomy in early breast cancer: Experience from a Tertiary Care Centre in India.
Authors: Selvakumar Veda Padma Priya , Kumar Rajeev 
Published: February 2017

77 Background: In India the incidence of breast cancer has shown an increasing trend over the past few decades and the majority of patients present with early breast cancer in the cities. A disturbing trend in the present setting is that a substantial proportion of patients are referred for the management of early breast cancer after inappropriate excision as diagnostic procedure in the primary care setup. Methods: The medical records of all patients who underwent surgery for early breast cancer post-lumpectomy status from September 2010 to December 2014 were reviewed retrospectively. The patterns of incision for lumpectomy, the margins of excision, the T stage, pre-operative imaging, the type of surgery and adjuvant therapy, the lapses in lumpectomy and various challenges it poses for further management and how it was combated were scrutinized in detail. Results: About one hundred and fifteen women were found eligible for the study. The mean age of onset was 47.33 years [Range 28-78]. The ratio of Left : Right were 57 : 58. The Margins and T status were known only in seventeen patients. Imaging ruled out any residual disease in breast in twenty eight patients. Twenty-seven patients underwent breast conservation with reconstruction, 82 underwent modified radical mastectomy and six of them underwent only axillary dissection. Only 41 patients had no residual primary disease on final histopathological evaluation. All patients underwent adjuvant therapy based on the approximate T staging. 12 patients were lost to follow up at one month.103 patients are alive and 101 disease free at an average follow up of 13.6 months. Conclusions: In early breast cancer, inappropriate lumpectomy for diagnostic purpose alters the course of surgical and adjuvant management. Hence it should be discouraged and not advocated as standard of care.
Bone targeting agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in the US.
Authors: Henry David H. , Von Moos Roger , Body Jean-Jacques , Rider Alex , De Courcy Jonathan , Murray Grace , Bhowmik Debajyoti , Gatta Francesca , Arellano Jorge , Hechmati Guy , Roberts Zach , Qian Yi 
Published: February 2017

93 Background: Bone is the most common site of distant metastasis in patients with advanced breast cancer. Bone metastases (BMs) often lead to skeletal-related events (SREs) and may result in debilitating bone pain which impacts a patient’s quality of life. Bone targeting agents (BTAs) reduce the incidence of SREs and progression of pain due to BMs. This study aims to understand real world patients’ experience of bone pain and to assess BTAs treatment patterns. Methods: Data were extracted from the Adelphi Breast Cancer Disease-Specific Programme (DSP), a cross-sectional survey of 98 US oncologists conducted from February to May 2015 in the USA. Each physician completed comprehensive record forms capturing the following information about the next 12 patients being treated for advanced breast cancer: Presence of BMs, patient’s pain state at diagnosis of BMs, current pain state, time since diagnosis of BMs, current analgesic use and reasons for prescribing BTAs. Results: Bone pain was more prevalent (p < 0.001) in patients with BMs (67% of 485) than those without BM (7% of 791). Mean time for pain assessment was 6.2 months after BM diagnosis. Among breast cancer patients with BMs and bone pain (n = 323), 98% required analgesic medications to manage the pain, including 40% (n = 130) who were treated with strong opioids (e.g., morphine, oxycodone, hydromorphone, or methadone). Of these patients, 100 (77%) had moderate/severe bone pain. Of the patients with BMs, 69% (n = 337) were treated with a BTA and treatment was initiated within 3 months of BMs diagnosis in 91% (n = 306) of them. The reasons for prescribing a BTA within 3 months of BM diagnosis were “bone pain” (32%), “high risk of bone complications” (25%), “prior history of bone complications”(18%), “number of BMs” (11%) and “location of BMs” (4%). Conclusions: Advanced breast cancer patients with BMs are more likely to experience bone pain, and three-fourths of the patients treated with strong opioids experienced moderate/severe bone pain.The majority of patients with BMs receive a BTA prescription for the reduction of bone pain and risk of bone complications.
Impact of breast cancer treatment on body mass index (BMI) over time.
Authors: Reinbolt Raquel E. , Pan Xueliang Jeff , Wandell Kaitlin K. , Pilarski Robert , Layman Rachel M. , Mrozek Ewa , Ramaswamy Bhuvaneswari , Wesolowski Robert , Lustberg Maryam B. 
Published: February 2017

94 Background: Weight gain concerns breast cancer patients, can impact quality of life, may lead to therapy non-adherence, and is associated with increased recurrence risk and mortality. Early placebo-controlled trials did not identify a clear correlation between Tamoxifen (TAM) and weight gain; gain due to aromatase inhibitors (AIs) is not well characterized. We hypothesized that weight gain occurs more frequently than previously reported in breast cancer patients receiving endocrine therapy. Methods: This is a retrospective chart review investigating body mass index (BMI) change in women after breast cancer therapy. Patients with early stage breast cancer and whom had BMI and treatment data (at least 90 days) from 2003-2012 were identified in The Columbus Breast Cancer Tissue Bank. Patients were separated by treatment received: chemotherapy with and without endocrine therapy vs. endocrine therapy alone (including both TAM and AIs) vs. no other treatment. Results: A total of 970 subjects were included in the analysis. At diagnosis and/or treatment initiation, patients’ mean BMI was 29.2 ± 7.0 kg/m2; mean age 53.7± 11.6 years; and average length of therapy/follow up per patient, 1833 days (range 90-3,990). Patients who received an AI alone had significantly decreased BMIs during therapy (-0.65± 0.29 kg/m2, p = 0.025), whereas patients receiving chemotherapy alone, chemotherapy with TAM, or TAM followed by AI therapy, had significantly increased BMIs (0.51 ± 0.25, 0.73 ± 0.26, 1.01 ± 0.51 kg/m2; p = 0.039, 0.005, 0.045, respectively). Both older age and a higher BMI at diagnosis were associated with a significantly greater decline in BMI over treatment time (p < 0.001 and p < 0.001, respectively). In a multivariate regression model, after adjusting for age and initial BMI effect, the BMI change noted among different treatment groups was no longer significantly different (p = 0.43). BMI change was not statistically associated with treatment length (p = 0.26). Conclusions: Our review of a large, early stage breast cancer patient cohort showed no association between weight gain and endocrine therapy after adjusting for the effect of initial BMI and age at diagnosis. Additional study is needed to identify other factors impacting weight in this population.
Cancer-related insomnia: Evaluation by mobile technology.
Authors: O'Connor Brenda , Ui Dhuibhir Pauline , Walsh Declan 
Published: February 2017

107 Background: Insomnia is difficulty with sleep onset, maintenance, early morning wakening or non-restorative sleep. Cancer prevalence is 30-75%. Daytime consequences include fatigue. It is under-reported and impairs quality of life. Measurement previously required sleep laboratories. Technology advances help real-time measurement in the natural environment. This study investigated the feasibility and acceptability of a wireless device to evaluate sleep in cancer. Methods: Prospective observational study: Stage A: 10 consecutive in-patient hospice admissions; Stage B: 20 consecutive community patients Sleep quality was rated by Insomnia Severity Index (ISI). Participants used a wireless non-contact bedside monitor (SleepMinder) for 3 nights. Acceptability questionnaires were completed by participant and nurse (Stage A) or family (Stage B).Descriptive statistics were generated by Microsoft Excel. Results: 30 participants with metastatic cancer were recruited. Median age: 63 years (47-84). Median Eastern Cooperative Oncology Group (ECOG) performance score: 2 (0-3). In-patient (n=10): In 50%, sleep onset was delayed >30 minutes. Median duration: 8 hours. Median awakenings per night: 1 (0-8). Median sleep efficiency (proportion of time in bed spent asleep): 89% (74-100%). ISI score correlated with sleep duration in 70%. Participants and nurses reported 100% device acceptability. Community (n=20): Sleep onset was delayed >30 minutes in 25%. Median duration: 8 hours. Median awakenings per night: 3 (0-10). Median sleep efficiency: 91% (46-100). ISI score correlated with sleep duration in 90%. Participants and family reported 100% device acceptability. Conclusions: (1)A wireless monitor effectively measures sleep in cancer in both inpatient and community settings, (2) High acceptability supports clinical use, (3) Subjective sleep quality reports correlate with device, and (4) Further research: evaluate sleep improvement interventions with device.
Knowledge and perceptions of palliative care among oncology outpatients.
Authors: McKie Gillian 
Published: February 2017

118 Background: Palliative care is emerging as an integral component of oncology care. There is growing evidence of its benefits but providers struggle with how to integrate specialist palliative services for the oncology population. The purpose of this study was to measure patients’ knowledge and perceptions, and their intention to seek palliative services. This study helps inform and guide oncology and palliative providers in their efforts to bridge the gap for oncology patients. Methods: The study used a cross-sectional design. A convenience sample of adult oncology patients using ambulatory cancer services at a community hospital was surveyed using the Knowledge of Care Options (KOCO) and Perceptions of Palliative Care Instrument (PPCI). Clinical information was abstracted from their health records retrospectively. Descriptive statistics were used to describe all variables. The association between knowledge, perceptions, and intention was analyzed using Pearson’s r correlation and multivariate regression analysis. Results: The majority of the 139 participants enrolled were female (61.9%), white (76.7%), and had good functional status with ECOG of 0 or 1 (87.1%). Mean age was 63.4 years. The mean KOCO score was 84.4% although several items scored less than 70%. Overall intention to seek palliative care was low at 2.53 on a seven point scale; a majority of patients indicated that they were unlikely to seek palliative care. There was a positive correlation between overall perception and intention to seek palliative care in the next three months (r = 0.212, p = 0.02).In addition, patients with higher scores on perceived needs for palliative care were more likely to report an intention to seek palliative care (r = 0.308, p = 0.001). Conclusions: There remains a knowledge deficit about palliative care in the oncology population. Participants did not experience negative emotional or cognitive reactions in response to information about palliative care. Perceived needs were associated with intention to seek palliative care services. Routine screening for needs and effective educational strategies are needed to better integrate palliative and oncology care.
Is screening enough? Implications of a pilot utilizing standard screening criteria for early palliative referral.
Authors: Ramchandran Kavitha , Winget Marcy , Tribett Erika L , Anderson Bev , Morris Alison , Blayney Douglas W. 
Published: February 2017

119 Background: Early integration of palliative medicine (PM) into cancer care improves outcomes including quality of life, care coordination and survival. Despite broad endorsement and established guidelines for integration of PM into cancer care, patients are not routinely or comprehensively screened for PM needs. Misconceptions and biases about PM impede screening, uptake and access. A set protocol or triggers for PM may be able to overcome these barriers. This study evaluated the feasibility of using a basic screening protocol using NCCN criteria for automatic PM referral with nurse navigators in gynecologic oncology at one academic medical center. Methods: All patients attending the gynecologic oncology clinic at Stanford Cancer Institute between June 2014 and February 2015 with an assigned nurse navigator (n = 120) were screened for palliative medicine needs using the NCCN guidelines at their new patient visit. A one-page screening tool was developed and nurses were trained to make referrals to PM based on positive screen results. Chart reviews were conducted to identify the percent of new patients screened, the percent of patients who screened positive based on NCCN criteria, and the percent of patients referred to PM. Results: 50% of the cohort of patients were screened using the protocol. Less than 5% percent were referred to PM. However, chart review revealed that forty percent of all patients met NCCN criteria for referral to PM. Referrals to other support services based on screening included oncology social work and survivorship. Conclusions: Implementation of a standard screening tool is not sufficient to ensure that palliative care needs are assessed, and that appropriate referrals are made. Automated mechanisms to make screening facile, as well as algorithms for assessment and intervention are critical to ensure that patients unmet physical and psychosocial palliative needs are identified and treated. Additionally addressing barriers such as branding of palliative medicine, and education of staff on primary palliative care skills such as pain management and therapeutic communication may be strategies to incorporate going forward.
Promoting palliative care access to persons with cancer: A model for mapping statewide services.
Authors: Dahlin Constance , Nyambose Joshua , Merriam Gail , Gene Cherline 
Published: February 2017

127 Background: The CDC comprehensive cancer initiatives value comprehensive quality care within its mission and program development. Currently, over 75% of hospitals in the United States have palliative care services for cancer patients (CAPC 2011). In order to promote access to quality palliative care in the community outside the hospital, an evaluation is essential. The CDC model of comprehensive cancer care and prevention control structure is an appropriate mechanism to perform such an evaluation. From 2014-2015, the Massachusetts Comprehensive Cancer and Prevention Control Network Palliative Care Workgroup performed a survey to hospitals, home health agencies, hospices, long term care facilities, and community providers to determine palliative care services available to cancer patients across the state. Methods: Using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines, a robust palliative survey tool was created by the Massachusetts Comprehensive Cancer and Prevention Control Palliative Care Workgroup. It was individualized to each of the following settings - hospitals, home health organizations, hospices, skilled nursing facilities, and community health agencies. Follow-up telephonic key informant interviews regarding palliative care services were conducted within the various settings, service organizations, and insurers. Results: The results of qualitative and quantitative data will be concluded in August. Initial results reveal significant disparities in access to palliative care across by geography and setting of care. Hospices and hospitals had the most access to palliative care services. Long term care settings and community health settings had the least access. Conclusions: Data reveals disparities in palliative care access within Massachusetts by geography, race, and setting of cancer care. This data will serve as the basis of regional networks to promote better access to palliative care for cancer patients across all settings. It is hoped this evaluation process will serve as a model for other states to perform a similar evaluation.
The Intensive Palliative Care Unit (IPCU): Changing outcomes for hospitalized cancer patients in an academic medical center.
Authors: Zhang Haipeng , Rickerson Elizabeth , Barysauskas Constance , Catalano Paul J. , Jacobson Joseph O. , Dalby Carole Kathleen , Lindvall Charlotta , Selvaggi Kathy J. 
Published: February 2017

135 Background: Patients with advanced cancer often require complex symptom management. At Dana-Farber/Brigham and Women’s Cancer Center, the intensive palliative care unit (IPCU) admits oncology patients with uncontrolled symptoms throughout the trajectory of illness. A DNR/DNI is not required for admission. These patients are managed by an interdisciplinary team of palliative care clinicians who focus on symptom management and advanced care planning. The purpose of our analysis was to investigate goals of care outcomes and healthcare utilization after admission to the IPCU. Methods: We retrospectively reviewed patient, diagnosis, IPCU admission, and code status characteristics among 74 oncology patients admitted to the IPCU in August and September 2013. We examined the distribution of goals of care pre- and post-index IPCU admission. Results: A total of 67 IPCU patients received palliative chemotherapy and/or radiation while seven patients received curative intent treatment. All patients had documented goals of care discussion during the IPCU admission. Of the palliative intent treatment patients, 58% of patients were transferred to the IPCU from medical oncology and 42% were directly admitted. The median age was 64 (range: 25-90 years), and 57% were female. Forty-eight percent of the patients were diagnosed with metastatic lung, genitourinary, or gastrointestinal cancer. Eighty-seven percent of patients reported pain as the chief complaint and all patients documented multiple symptoms (median = two). Twenty-five patients (37%) experienced a change in code status from FULL to DNR/DNI. A total of eight patients died in the IPCU and 50% of these experienced a code status change during the index admission. Eighty-eight percent of patients were discharged alive. Of those, 49% were discharged to home hospice, general inpatient hospice, or an inpatient hospice facility. The risk of 30 day readmission was 4% (95% CI -1%-9%) adjusted for the competing risk of death. Conclusions: Our findings suggest the inpatient palliative care unit helps clarify goals of care, aids in appropriate hospice referrals, and decreases unnecessary hospital readmissions among advanced cancer patients.