bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes and feasibility of nipple-sparing mastectomy for node-positive breast cancer patients.
Authors: Murphy Brittany L. , Hoskin Tanya L. , Boughey Judy Caroline , Degnim Amy C. , Jakub James W. , Krajewski Adam C , Jacobson Steven R. , Hieken Tina J. 
Published: February 2017

60 Background: Indications for nipple-sparing mastectomy (NSM) with immediate reconstruction have expanded. For cancer patients, NSM is thought best-suited for early stage patients, with nodal involvement initially viewed as a relative contraindication. We undertook this study to evaluate the use and early outcomes of NSM in node-positive (LN+) breast cancer. Methods: We identified 240 cancers in 226 patients (14 bilateral) scheduled for NSM and operated on at our institution 1/2009-6/2014. Data on intraoperative conversion from NSM, recurrence and follow-up was abstracted from the medical record. Chi-square and long-rank tests were used for statistical analysis. P-values < 0.05 were considered significant. Results: Of 240 cancers, 182 were LN- and 58 were LN+. More LN+ patients had T2/T3 tumors (27/58, 47%) than LN- patients (31/182, 17%), p < 0.0001, but ER and HER2 status was similar. Of 58 LN+ cases, 19 (33%) were cN1 confirmed by positive LN cytology and 39 (67%) were cN0 but LN+ at operation. 10 patients LN+ at diagnosis received neoadjuvant therapy (NT) followed by operation (at which 6 were pLN+ and 4 rendered ypN0); 39 cN0 (4 NT, 35 primary surgery) and 9 cN1 primary surgery patients were pLN+ at operation with a median of 1 LN+. NSM was successful in 13/14 LN+ NT patients (93%) and 39/44 LN+ primary surgery patients (89%), p = 0.64. Six LN+ patients (10%) were converted to skin-sparing mastectomy (SSM) at initial operation based on frozen section pathology (n = 5) or at a second operation (n = 1) vs 13/182 LN- patients (7%), p = 0.44. Among cancer patients treated with NSM, 7 locoregional recurrences (5 in LN+, 2 in LN- patients) occurred at 25 mos median follow-up. 3-year locoregional disease-free estimates were 87% (95% CI 75-100%) for LN+ vs 99% (95% CI 97-100%) for LN- patients, p = 0.007. One nipple-areolar recurrence occurred, in a LN- patient. 3-year breast cancer-specific survival was 97% (95% CI 92-100%) in LN+ vs 99% (95% CI 98-100%) in LN- patients, p = 0.40. Conclusions: Conversion from planned NSM to SSM did not differ significantly between LN+ and LN- patients. Short-term oncologic outcomes were satisfactory. These data suggest that NSM may be appropriate for carefully selected LN+ breast cancer patients.
Avoidance of axillary dissection in cN0 breast cancer patients with metastatic sentinel lymph node(s) using ACOSOG Z-0011 criteria: Is it appropriate for Indian patients?
Authors: Agarwal Gaurav , Gambhir Sanjay , Lal Punita , Krishnani Narendra , Rajan Sendhil 
Published: February 2017

62 Background: A relatively newer algorithm for surgical management of axilla, where axillary node dissection (ALND) is avoided in cN0 EBC patients with 1 to 2 metastatic sentinel nodes (SLN) is now widely practiced in North America. ASCO & NCCN guidelines, and St Gallen consensus statement too have endorsed this strategy. This algorithm, based on the ACOSOG-Z0011 trial results has evoked quite a debate in India too. Concerns relating the quality of Z0011 data and its wide applicability persist. On the other hand, avoidance of ALND and its morbidity seems attractive to the oncologists and patients. In a single institution validation SLN Biopsy (SLNB) data-set, we evaluated the applicability of the “Z0011 strategy” to know its impact on an Indian patient cohort. Methods: In a prospective data-set of 120 cN0 EBC patients (mean age 51.1 years, T1 = 14, T2 = 106, mean tumor size 3.8 cm, 51.7% ER/PR+) who underwent validation SLNB (ALND irrespective of SLNB histology), such patients who fulfilled the selection criteria of ACOSOG-Z0011, i.e. those who underwent BCS and tangential field whole breast irradiation, and 1-2 metastatic SLNs were identified. Results: 66 (55%) of the 120 patients underwent BCS and tangential field whole breast irradiation. Of the 25 out of 66 patients with metastatic SLNs, 5 patients had 3 or more metastatic SLNs, and 2 had extra-nodal spread, thus not fitting the Z0011 criteria. Thus only 18 patients (15% of entire study cohort, and 27.3% of those undergoing BCS) with 1 to 2 metastatic SLNs were eligible for avoidance of ALND based Z0011 criteria. Of these 18 eligible patients, 7 (38.9%) had non-sentinel metastatic nodes. These 7, and the 3 with false negative SLNs could be seen as being left with undertreated axillae. Conclusions: In Indian context, where the majority of patients have large tumors and many opt for mastectomy, avoidance of ALND in presence of metastatic SLNs can be offered to a small proportion of patients. In a single institution validation SLNB data-set, only 15% patients qualified for avoidance of ALND using the Z0011 trial criteria. Besides, avoidance of ALND would have left 8.3% patients potentially undertreated in the axilla.
Locoregional failure rates after mastectomy for breast cancer patients with T1-2 tumors and axillary nodal microscopic metastases.
Authors: Majithia Lonika , Bazan Jose , Quick Allison Marie , Terando Alicia Maria , Agnese Doreen Marie , Mrozek Ewa , Farrar William Blair , White Julia R. 
Published: February 2017

64 Background: The indications for postmastectomy radiotherapy (PMRT) are expanding to include patients 1-3 axillary nodal metastases (ALN). Improvements in diagnostic evaluation have led to increasing numbers of breast cancer (BC) patients who are found to have microscopic nodal metastases (N1mic). The challenge today is whether these BC patients have risk that warrants the routine delivery of PMRT. Methods: We reviewed patients with pathologic T1-2N1 BC treated with initial mastectomy (mast) and adjuvant systemic therapy (ST) from 2000-2013. The primary endpoint was locoregional failure (LRF), defined as a recurrence in either the ipsilateral chestwall or regional lymphatics (axillary, internal mammary, or supraclavicular). Secondary endpoints were disease-free survival (DFS, failure or death) and overall survival (OS). The log-rank test was used to compare survival between groups. Results: We identified 550 eligible patients from our prospectively maintained cancer registry with 5 year median follow-up. 95 patients (17%) had N1mic disease. Baseline characteristics include: median age 53 yrs, 61% pathologic T2, 39% grade 3, 72% hormone receptor positive, 16% HER2+, 12% triple-negative. Treatment included chemotherapy in 78% (n = 428), PMRT in 15% (n = 82), and anti-endocrine therapy in 70% (n = 385). A median of 18 ALN (range, 1-68) were removed. Among the patients with N1mic disease, 81 had 1+ node, 13 had 2+ nodes, and 1 had 3+ nodes. The 5 yr LRF was 0% for patients with N1mic disease vs. 4.6% in those macro metastases (p = 0.84). The 5 yr LRF rate for the entire cohort was 3.9%; patients with 1+, 2+, and 3+ nodes had 5 yr LRF of 2.6%, 4.7% and 6.4%, respectively (p = 0.79). Patients with N1mic disease had a trend towards improved DFS (91.6% vs. 82.3%, p = 0.07) and significantly improved OS (96.9% vs. 87.6%, p = 0.03) compared to patients with macrometastases. Conclusions: In a cohort of patients with T1-2,N1 BC treated with modern therapy, we found overall low rates of LRF. Patients with N1mic disease had no LRF events and improved OS compared to patients with macrometastases. These findings support that PMRT should not be routinely recommended for N1mic BC patients with T1-2 tumors.
Are patients with triple-negative breast cancer screened for BRCA mutations according to NCCN guidelines?
Authors: Aubry Staci , Petersen Lindsay Floch , Burgess Kelly , Rao Ruta D. , Kopkash Katherine , Madrigrano Andrea 
Published: February 2017

7 Background: Ten to 25 percent of patients diagnosed with breast cancer have triple negative breast cancer (TNBC), defined as tumors negative for estrogen, progesterone, and Her2-neu receptors. TNBC is more aggressive than receptor positive cancer. The National Comprehensive Cancer Network (NCCN) recommends BRCA genetic testing for women less than age 60 when diagnosed with TNBC. Methods: The Commission on Cancer registry tumor database was queried for TNBC from 2006 to 2013. Patient demographics were analyzed. Data regarding pathologic details and BRCA testing was collected. Analyses using the Fisher's exact test were conducted. Results: TNBC tumors were identified in the database (n = 173). Sixty-one percent (105/173) of patients were less than 60 years of age, therefore BRCA testing was indicated. Fifteen patients were BRCA positive. Eighty-three percent (87/105) of patients underwent BRCA testing. Seventeen percent (18/105) of patients did not receive BRCA testing that should have under the current guidelines. Patients that did not undergo recommended BRCA testing were more likely to be greater than or equal to 55 years of age (p = 0.002), African-American (p = 0.001), have Medicaid listed as a primary payer (p = 0.021), and have American Joint Commission on Cancer (AJCC) stage 3 disease (p = 0.014). Conclusions: Risk factors for not completing BRCA testing include older age, African-American race, Medicaid insurance status, and stage 3 disease. Health provider awareness of this opportunity for improvement is important to decrease these health disparities. [Table: see text]
Adherence to osteoporosis screening guidelines in seniors with breast cancer treated with anti-estrogen therapy: A population-based study.
Authors: Henault David , Chang Sue-Ling , Dumitra Sinizana , Kramer Richard , Mayo Nancy , Meguerditchian Ari 
Published: February 2017

72 Background: Aromatase inhibitors (AI) improve recurrence and survival rates in women ≥ 65 with hormone-receptor positive (HR+) breast cancer (BC). However, AI’s are associated to increased bone demineralization in a population already at risk for osteoporosis. Bone mineral densitometry (BMD) is therefore recommended at treatment start, to minimize treatment-related toxicity. This study assesses compliance to BMD recommendations in older BC survivors treated with an AI and identifies predictors of non-adherence to guidelines. Methods: A population-based historical prospective cohort study was conducted in Quebec (Canada), where universal health insurance provides medical and pharmaceutical services. All women ≥ 65 with incident stage I, II or III BC (1998-2012) were identified from the provincial cancer registry. Administrative claims were accessed to track receipt of BMD (±12 months from treatment start) and potential predictors: age, economic status, Charlson comorbidity index, breast and axillary surgery, chemotherapy, radiotherapy, bisphosphonate use, adherence to anti-estrogen therapy (AET), physician specialty and having a primary care physician (PCP). Multivariate logistic regression was performed using generalized estimating equations to identify predictors of BMD, adjusting for clustering within physicians. Results: Of 16,480 patients, 36.1% had a BMD at AET start. This increased to 58.4% for women on AI. Factors predicting baseline BMD non-use in AI patients were: older age (OR 0.42; 95% CI, 0.36 – 0.49), lower annual income (OR 0.57; 95%CI, 0.47 – 0.70), not having a PCP (OR 0.77; 95%CI, 0.68 – 0.86), chemotherapy and radiotherapy outside of guidelines (OR 0.80; 95%CI, 0.66 – 0.96 and 0.69; 95%CI, 0.54 – 0.87, respectively), non-surgical specialist managing AET (OR 0.81; 95%CI, 0.67 – 0.98), older physicians (OR 0.61; 95% CI, 0.46 – 0.81), and non-adherence to AET (OR 0.69; 95%CI 0.60-0.79). The same predictors persisted in patients on any AET. Conclusions: Bone health management in seniors receiving AET is suboptimal. Factors related to underutilization of BMD can be easily identified and used to optimize chronic care of older BC survivors.
A misperceived threat: Understanding the increasing mastectomy rates.
Authors: Covelli Andrea Marie , Baxter Nancy N. , Fitch Margaret , Wright Frances Catriona 
Published: February 2017

75 Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. Both surgeons’ preference and patients’ choice have been suggested to play a role. Methods: A qualitative study was conducted examining surgeon’s practices and patient’s decision-making during treatment for ESBC. The Health-Belief Model was applied identifying factors influential in the choice for UM+/-CPM. Purposive sampling identified non-high-risk women across Toronto, Canada who were candidates for breast conserving therapy (BCT) but underwent UM+/-CPM. Academic and community breast surgeons from across Ontario, Canada and the United States were also recruited. Data were collected through semi-structured interviews. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons were interviewed. The dominant theme was the ‘misperceived threat of ESBC: an overestimated risk’. Surgeons described the high survivability of ESBC, yet patients greatly overestimated the threat of death from their cancer and strived to eliminate this threat by choosing UM+/-CPM. Surgeons described BCT and UM as equivalent treatment options for ESBC, and recommended BCT. In this average-risk population CPM was discouraged by the surgeons describing no survival advantage; despite this, women requested UM+CPM. Personal cancer experiences with family and friends were extremely influential in women’s request for UM+/-CPM. Previous negative experiences translated into an overestimated risk of recurrence, contralateral cancer, metastasisand subsequent death. Patients’ misperceived the severity of ESBC, and believed that by choosing UM+/-CPM they would live longer. Most women did not perceive any risks of undergoing mastectomy, yet many had ongoing issues with skin sensation, cosmesis and body image. Conclusions: Despite surgeons counseling otherwise, women greatly overestimated the risk of ESBC and misperceived the benefits of mastectomy. As undergoing UM+/-CPM is not without risks, improved discussion of patient sources of information and fears around survival may benefit surgical consultations, facilitating informed decision-making.
Characteristics of chemotherapy-induced peripheral neuropathy in patients with breast cancer.
Authors: Sawada Namie Okino , Zandonai Alexandra Paola 
Published: February 2017

85 Background: In Brazil, breast cancer has the second highest incidence of neoplasms, the most common among women. It is expected there will be 57,120 new cases and a risk 56.09 cases per 100 thousand women. For its treatment, neurotoxic chemotherapeutics that can cause chemotherapy-induced peripheral neuropathy (CIPN) are used. Methods: This is an exploratory descriptive study developed in a cancer treatment reference hospital in the city of Sao Paulo, Brazil. Aim: To search the patients with breast cancer during treatment with neurotoxic agents and evaluate the presence of CIPN with application of Chemotherapy-Induced Peripheral Neuropathy Assessment Tool questionnaire (CIPNAT). Results: The sample was 44 women with a mean age of 52 years (SD = 10.54), 47.7% had local disease, 72.7% were treating with taxanes neurotoxic agents. The main neuropathic symptoms measured at CIPNAT: 75% had motor symptom weakness with an average score for severity of 6.45 causing an average of distress 5.36; 65.9% muscle and joint pain average severity of 6.31 causing an average of 5.59 distress; and 56.8% sensitive symptom numbness in the hands average severity of 4.76 causing an average of 3.52 distress. These symptoms had a negative impact in the activities of daily living (ADL) such as physical exercise (mean score = 5.32), enjoyment of life (mean score = 4.77) and leisure activities (mean score = 4, 03). Although few (13.6%) reported that suffered some injury or accident due to CIPN. Discussion: The results are consistent with those presented in the scientific literature, but measured with other assessment tools such as the NCI CTCAE, WHO and EORTC QLQ-C30 and CIPN20, which also showed that motor disorders (weakness, muscle cramps and loss of strength in the hands) and sensory (numbness and tingling in the hands and feet). Conclusions: The study explores the relationship between CIPN and ADL affected during treatment for breast cancer. Through the motor and sensory symptoms reported by CIPNAT, nursing will have grant to develop educational strategies to prevent and minimize negative impacts on the quality of life of women with breast cancer undergoing treatment with neurotoxic agents.
Role of neutrophils in the early presymptomatic stages of doxorubicin cardiotoxicity in breast cancer.
Authors: Todorova Valentina K , Beggs Marjorie L , Siegel Eric R , Makhoul Issam , Wei Jeanne , Klimberg V. Suzanne 
Published: February 2017

98 Background: Doxorubicin (DOX) cardiotoxicity is cumulative-dose-dependent and begins with the first dose of chemotherapy. No biomarker for early presymptomatic detection of DOX cardiotoxicity has been validated. Our preliminary microarray-based study on DOX cardiotoxicity of breast cancer patients showed that neutrophil-associated inflammation was partly responsible for this side effect of DOX Based on our preliminary finding, the aim of this study was to examine the expression of the top dysregulated neutrophil-specific genes, including alpha-defensins, arginase, cathepsin G, elastase, haptoglobin, metalloprotease 9, cathelicidin 8 in the peripheral blood mononuclear cells (PBMCs) of breast cancer patients treated with DOX-based chemotherapy. Methods: Blood samples of 15 women treated for breast cancer with DOX-based chemotherapy were collected before the start and after the 1st cycle of chemotherapy. Cardiac function was assessed before the start and after the completion of chemotherapy. A decrease of left ventricle ejection fraction (LVEF) > 10% or < 55% was considered abnormal. PBMC gene expressions of the target genes were assessed by quantitative RT-PCR and normalized to 18S. Data were analyzed using 2-deltadelta CT method and compared between patients with abnormal versus those with normal LVEF. Results: A single dose of DOX-based chemotherapy induced significantly greater mRNA levels of the examined genes in PBMC of patients with subsequent abnormal decline of LVEF (n = 5) versus those patients who maintained a normal LVEF. The elevated neutrophil-associated transcripts in the early stages of DOX-based chemotherapy were independent of the neutrophil count. Conclusions: We have identified a set of transcripts in the early stages of DOX-based chemotherapy that can serve as biomarkers for prediction of later impairment of cardiac function in breast cancer patients. Biomarkers for early prediction of DOX-induced cardiotoxicity could allow individualization of chemotherapy and/or testing the effectiveness of cardio-preventive medication, and ultimately will help to reduce the incidence of the cardiotoxicity-associated morbidity and mortality in cancer survivors.
Symptoms associated with circadian rest-activity rhythm disruption in 237 patients with metastatic colorectal cancer.
Authors: Innominato Pasquale F. , Palesh Oxana , Bjarnason Georg A. , Ulusakarya Ayhan , Spiegel David , Levi Francis 
Published: February 2017

1 Background: The circadian timing system exerts temporal control over physiology, generating rhythms of about 24 hours. Its alteration in benign conditions has been associated with several systemic symptoms, including fatigue, appetite loss and poor sleep. However, the clinical impact of circadian disruption in cancer patients remains overlooked. We hypothesized that patients with circadian disruption would report more severe symptoms than those with robust circadian function. Methods: Data were available for 237 patients with metastatic colorectal cancer: M/F ratio: 1.66; median age: 60.4 years; range: 20.7-77.6; WHO Performance Status (PS) = 0/1: 59.7%/33.5%. We estimated the occurrence of circadian disruption using a validated parameter (the dichotomy index I < O), derived from wrist-actigraphy for at least 72 consecutive hours. Symptoms were self-reported by the patients using the EORTC QLQ-C30 questionnaire. Mann-Whitney U test was used to compare symptom severity according to the presence or absence of circadian disruption. Cohen’s d effect sizes were computed to evaluate the clinical meaningfulness of the observed differences. Subgroup analyses were performed according to gender, age, and WHO Performance Status (PS). Results: Circadian disruption (I < O lower than or equal to 97.5%) occurred in 130 (54.9%) patients. Fatigue (p < 0.0001), appetite loss (p < 0.0001), difficulty sleeping (p = 0.009), pain (p < 0.0001) and dyspnea (p = 0.001) were significantly more severe in patients with circadian disruption than in those with robust circadian function. Largest effect sizes were observed for fatigue (0.64), appetite loss (0.59) and pain (0.57). Subgroup analyses showed similar results, regardless of gender, age or PS. Conclusions: In this large international study, the presence of circadian disruption was associated with a clinically meaningfully higher severity of fatigue, appetite loss, pain, dyspnea and sleep problems. Correcting circadian dysfunction with the use of pharmacological and/or behavioural interventions could improve these often difficult-to-manage systemic symptoms.
Palliative care and hospice use among melanoma patients treated with immunotherapy.
Authors: Nipp Ryan David , Betof Allison Shayna , Rubin Krista M. , Blackmon Shauna M. , Flaherty Keith , Lawrence Donald P. , Sullivan Ryan J. 
Published: February 2017

116 Background: PD-1/PD-L1 inhibitors (PD-1/PD-L1i) have revolutionized the treatment of patients with metastatic melanoma. However, little is known about the supportive care needs and use of palliative care (PC) services in these patients. We sought to assess rates and correlates of PC consultation and hospice use among melanoma patients treated with PD-1/PD-L1i. Methods: We retrospectively collected data on all patients with melanoma treated with PD-1/PD-L1i at the Massachusetts General Hospital (MGH) from May 2009 to March 2015. We determined rates of PC consultation and hospice use in this sample. We used logistic regression with purposeful selection of covariates to identify correlates of PC consultation. Results: Of 122 patients treated at MGH (mean age = 61.2 years), most were married (n = 91, 75%) and college educated (n = 66, 54%). Overall, 83 patients (68%) experienced autoimmune toxicities, 22 (18%) had liver metastases, 87 (71%) had cancer progression and 44 (36%) died during our study period. We found that 36 patients (30%) received PC consultation during their treatment course; 9 (25%) of these occurred over 6 months prior to the patients’ death, and 11 (31%) in their last month of life. Among the patients who died, 36 (82%) received hospice services, and 11 (31%) enrolled in hospice during their last week of life. In our regression model, younger age, having cancer progression and presence of liver metastases correlated with increased likelihood of receiving PC consultation. Conclusions: Melanoma patients treated with immunotherapy often receive PC and hospice services late in their treatment course. These data underscore the difficulty understanding when to involve hospice and PC for these patients, and highlight the need for further PC research in this patient population. Additionally, younger age, presence of cancer progression and liver metastases were associated with receiving PC consultation, thus suggesting the need for integrated PC services among certain subpopulations of these patients. [Table: see text]