bluuebunny/crossref_metadata_2025_split huggingface dataset:
Who provides ongoing care to breast cancer survivors and does it make a difference?
Authors: Sowden M. , Sanft T. B. , Chagpar A. B. 
Published: February 2017

199 Background: There is a paucity of data regarding who provides ongoing care for breast cancer survivors, and the impact of this on adherence to screening guidelines. The purpose of this study was to define, in a population based cohort, with whom breast cancer survivors receive their ongoing care and the impact of provider choice on quality of care. Methods: Data from the 2005 National Health Interview Survey were queried for provider types and screening adherence in breast cancer survivors. Statistical analyses were performed using SAS and SUDAAN software. Results: 435 breast cancer survivors were surveyed in 2005. Their mean age was 66, and the median age at diagnosis was 57. 284 (60.9%) were more than 5 yrs out from diagnosis. Of respondents, 84.3% reported having a clinical breast exam (CBE) within the past year and 79.8% reported having had a mammogram (MMG) within the past 2 years. 429 (99%) reported whether they had seen a family physician (GP) and/or OBGYN in the preceding 12 months; specific reference to care by oncologist was unavailable. 91.8% of survivors had seen either their GP and/or OBGYN in the last year. No significant differences were seen in provider choice nor adherence to surveillance recommendations based on survivorship period (≥ or < 5 yrs). There was no significant difference in CBE and MMG between survivors who had seen their GP within the preceding 12 months and those who did not, but those who had seen their OBGYN had a significantly higher rate of having had a CBE (92.0% vs. 81.1%, p=0.01) and MMG (90.1% vs. 75.3%, p<0.01) than those who did not. Adherence to screening recommendations was superior for patients who had been seen by multiple providers than those who had not been seen by any. Conclusions: Breast cancer survivors get their follow-up care through a variety of providers, often relying on primary care. A collaborative survivorship plan involving multiple specialties may improve adherence to screening guidelines. [Table: see text]
The potential economic impact of the 21-gene recurrence score: Guided chemotherapy in a population-based cohort with node-negative and node-positive early-stage breast cancer.
Authors: Lamond N. W. D. , Skedgel C. , Rayson D. , Lethbridge L. , Younis T. 
Published: February 2017

201 Background: The 21-gene recurrence score (Oncotype DX: RS) appears to augment clinical-pathological prognostication and predicts adjuvant chemotherapy (chemo) benefits in patients with node-negative (N-) and node-positive (N+) hormone-receptor positive early-stage breast cancer. Economic analyses suggest that RS-guided chemo is a cost-effective strategy in N- breast cancer, but no evaluations were reported for N+ disease based on pre RS chemo utilization in clinical practice. We examined the cost-utility (CU) of a RS-guided chemo strategy, compared to current practice without RS in a population based cohort, in N- and N+ early-stage breast cancer. Methods: A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALY) over a 25-year horizon for patients with hormone-receptor positive early-stage breast cancer considered for chemo. We examined outcomes with and without chemo in RS-untested cohorts and in those with low, intermediate and high RS based on the reported prognostic and predictive impact of the RS. Chemo utilizations (current vs RS-guided), costs and utilities were derived from a Nova Scotia population based cohort, local resources and the literature. Sensitivity analyses were conducted for key model assumptions/parameters. Results: RS-guided chemo strategy is associated with incremental costs and QALY gains compared to chemo with no RS testing in both N- and N+ patients. The resultant CU ratios are $17,141/QALY and $5,772/QALY for N- and N+ disease, respectively. These CU ratios are well below commonly quoted thresholds and were most sensitive to RS-distribution, upfront chemo costs, chemo utilization rates and relative benefits of chemo in various RS-strata. Conclusions: RS-guided chemo in a population based cohort appears to be a cost-effective strategy, compared to chemo with no RS testing, in N- and N+ early-stage breast cancer.
Breast cancer (BC) care and outcomes in Latin America and the Caribbean (LAC).
Authors: Justo N. , Wilking N. E. , Jönsson B. 
Published: February 2017

202 Background: The global BC Care and Outcomes Report revealed ample differences in BC care and outcomes exist across continents, exposing the need for regionally focused studies. Aim: Provide an overview of the burden of BC and of BC care and outcomes in LAC and identify the major challenges Methods: Review of literature (PubMed, LILACS, SCIELO), public databases (Globocan 2002 and 2008, CEPALSTAT, DIRAC, PAHO, WHOSYS, etc) and conference presentations (ASCO, ISPOR). Local experts and patient organizations were surveyed. Current BC epidemiology in LAC, countries’ risk profiles and future trends, disease burden and available resources, patterns of care and treatment access (case studies), and outcomes (such as mortality-to-incidence ratios - MIRs) were analyzed and compared (Sweden as benchmark). Results: BC exhibits the highest annual incidence (114,900 cases) and mortality (37,000 deaths) of all cancers in LAC and is expected to double by 2030. Age is the main risk factor. Heavy burden is due to younger age at diagnosis. Poor outcomes are partly due to late diagnosis. Availability of specialized surgeons, waiting times, node clearance policy and access to breast reconstruction vary widely across countries and between public and private settings. Radiotherapy equipment is insufficient, except in Uruguay, Chile, and Venezuela. All modern systemic therapies are available, but some not widely diffused due to their costs. Palliative care is developing but, despite great efforts, problems persist. BC MIRs have improved, albeit unevenly, over time. Conclusions: Inequalities in access to diagnosis and treatment, fragmented organization and management of BC care and poor uptake of evidence-based best practices result in high morbidity and associated societal costs. [Table: see text]
Timeliness of breast tissue pathology reports: Quality thresholds for breast centers.
Authors: Kaufman C. S. , Shockney L. D. , Landercasper J. , Rabinowitz B. , Askew J. B. , Wiggins D. , Quality Committee T. 
Published: February 2017

204 Background: The National Quality Measures for Breast Centers (NQMBC) was started in 2005 to provide quality metrics for breast centers. Each center enters confidential aggregate results to questions regarding the process of breast care. Each data entry can be immediately compared with all other centers. We reviewed data regarding the timeliness of pathology reports after tissue sampling to look for variation among different types of breast centers. Methods: We reviewed the following measures: 1) Time between needle/core biopsy and availability of pathology report; 2) Time between surgical biopsy and availability of pathology report; and 3) Time between initial cancer surgery and availability of pathology report. We looked for variation in results according to structural differences of breast centers. Results: There were 391 center entries reviewing over 21,000 patient encounters between 2005 and 2011. Results included percentiles at 10, 25, 50, 75, and 90 and mean value. Overall, pathology reports for needle biopsy were available much sooner (mean 1.4 days) than any surgical biopsy or excision (2.1, 2.4 days). Results were not altered according to demographic characteristics (type of center, cancer volume, financial structure, size of city and geographic location). Conclusions: The timeliness of pathology reporting of breast specimens is very consistent throughout the participating NQMBC centers, regardless of type and size of breast center. In view of the consistency of those results, a threshold level of care (10th percentile) may be identified above which all centers should be expected to perform. This minimum level of performance is called the quality threshold. Centers that do not perform above this quality threshold should be ready to explain why their performance falls below this level. Centers who surpass this quality threshold should strive for a quality goal (50th percentile). We expect that by setting both the quality threshold and the quality goal for each measurement, we will have ongoing encouragement for achievable improvement for each measure.
Time interval as a quality measure: What is our baseline prior to nurse navigator implementation?
Authors: Amin M. , Basu M. , Patterson S. G. , Pinkerton H. , Torres M. A. , Newell M. , O'Regan R. , McCarthy C. , Tarpley R. , Gabram S. G. A. 
Published: February 2017

208 Background: There are various outcome measures to evaluate the quality of multidisciplinary care for breast cancer patients. The National Consortium of Breast Centers defines quality of breast cancer care as accurate evaluation and appropriate services in a timely manner. In a tertiary academic center a diverse referral pattern possibly influences time to treatment. We choose to examine two outcome measures before the start of a nurse navigator: Time from initial diagnosis to first consultation and if the pretreatment consultation for those receiving neoadjuvant chemotherapy or hormonal therapy included all subspecialists. Methods: Electronic medical records of female patients with breast cancer seen during January-June 2010 were reviewed. Patients with stage IV breast cancer were excluded. Results: 150 patients were divided into 4 categories: external pathology consult (B1), internally diagnosed with a primary care physician (PCP) at our institution (B2), evaluated by a surgical oncologist before the biopsy (B3), and internally diagnosed with PCP outside of the institution (B4). For B2, B3 and B4 we examined the time intervals to first surgical oncology appointment after diagnosis as shown in the table. For all patients (n=10) who received neoadjuvant therapy, 1 patient saw a surgical oncologist, medical oncologist and radiation oncologist, 9 patients saw 2 subspecialties prior to initiation of first treatment. Conclusions: Patients are seen within an average of 2 weeks whether they are diagnosed internally (B2, B3) or externally (B4). The group seen by a surgical oncologist prior to biopsy (B3) were seen sooner. For the patients receiving neoadjuvant therapy, 10% saw all 3 specialties prior to initiation of therapy. In July 2010 a nurse navigator was added to the care team. With this new position, our goal is to decrease the time from biopsy to visit by 33% and have 100% of patients receiving neoadjuvant therapy evaluated by all 3 specialists prior to treatment. Our intent is to quantify the effect of a nurse navigator in a large academic center as a quality metric in improving care. [Table: see text]
Training overweight/obese older women at high risk for breast cancer to use web-based weight loss tools: The HELP pilot study.
Authors: Cadmus Bertram L. A. , Pierce J. P. , Patterson R. E. , Ojeda-Fournier H. , Newman V. A. , Parker B. A. 
Published: February 2017

233 Background: Excess weight is one of the few modifiable risk factors for incident breast cancer. Many programs can achieve a 7% weight loss but few can maintain it over time. Training women to use self-help resources over the internet has potential for reducing intervention costs and ensuring program maintenance. Methods: 50 overweight/obese (BMI≥27.5 kg/m2) women at increased risk of breast cancer (Gail score≥1.7) were identified from a mammography registry and enrolled in the HELP pilot study and randomized with 2:1 probability to a 12-week lifestyle intervention or a comparison group. Twelve telephone-based coaching calls trained participants to use a free, publicly available website to set goals and track performance for dietary intake and physical activity. The comparison group received information but no training. At baseline and 12 weeks, participants were weighed, fitted with an accelerometer for physical activity pattern, and completed questionnaires. Results: At baseline, participants were 60.9±0.79 years of age with a BMI of 33.1±0.60 kg/m2; 39% were daily internet users. Thirty-three were randomized to the intervention group with 91% completing follow-up. Fifty-four percent were able to use the website reliably and found it to be helpful, including 44% of previously nondaily internet users. At 12 weeks, intervention group participants who found the website helpful had lost 5.6±0.7 kg, or 6.7% of initial weight, intervention participants who did not find it helpful lost 0.8±0.9kg or 1.1% of initial weight and the comparison group gained 1.0±0.94 kg (89% follow-up) The between-group difference weight change was 4.2 kg (p<.0001). 74% of intervention group participants lost weight, compared to only 34% of women assigned to the comparison group. Conclusions: A 12-session telephone coaching program to train women to use publicly available web-based weight loss programs effectively achieved a large short-term weight loss among the majority of participants. Further follow-up is needed to identify how well the initial weight loss is maintained without further intervention assistance.
A prospective, multicenter trial of complementary and alternative medicine (CAM) utilization by patients undergoing definitive breast radiotherapy.
Authors: Moran M. S. , Yang J. , Ma S. , Gaudreau B. , Higgins S. A. , Weidhaas J. B. , Wilson L. D. , Peschel R. , Fass D. , Rockwell S. 
Published: February 2017

241 Background: A substantial number of breast cancer (BC) pts use complementary and alternative medicines (CAM), but there is a paucity of data on CAM specifically during radiation therapy (RT). The purpose of this study was to prospectively assess the utilization of CAM during RT for BC pts. Methods: 456 pts w/stage 0-III BC were accrued from 5 RT centers from 9/07-2/09. Participating MDs were advised not to discuss CAM. A validated survey instrument was administered during the last week of RT under guidance of a study nurse, which included demographics, details regarding types/doses/frequency of CAM and skin assessments by pt and nurse. Results: 360 pts were eligible for analysis (79%); median age 57 yrs; stage 0-II, 91%; white race 89%; chemotherapy 39%; hormone therapy (HT) w/ RT, 26%; > college education, 59%. CAM was reported in 54% (n = 195), of which 72% reported programs/activities (i.e., Reiki, healing touch, visualization, etc.), and 66% oral/topical CAM. Only 16% reported counseling prior to starting CAM. CAM use did not differ by ethnicity, chemotherapy or stage (all p > 0.05), but correlated significantly with higher education level (p = 0.0001) and inversely correlated w/ HT/RT (p = 0.015). There was a trend towards CAM use in younger pts (p = 0.069). On MVA, education (RC: 1.859; OR: 6.417, 95% CI: 2.023, 20.357, p = 0.002) and HT/RT (RC: -0.530, OR: 0.589, 95% CI: 0.357, 0.970, p = 0.038) independently predicted for CAM use. Rationale for oral/topical: 32% “improve their chance of cure”; 24% “provide treatment-related symptom relief”. For programs/activities: 31% “relaxation/stress reduction”; 11% “reduces treatment-related symptoms”. Despite these beliefs, there were no significant differences between the perception of the pts to nursing skin assessment score as a function of CAM use (p = 0.497). Conclusions: To our knowledge, this is the first and largest prospective study of CAM during RT for BC pts. Given the high prevalence of undocumented CAM use during RT, questions regarding CAM should be considered during consultation and weekly tx visits. A better understanding of CAM practices during RT will facilitate evaluation of potential interactions of CAM and RT for BC.
Perforator flap breast reconstruction in thin patients.
Authors: Chen C. M. , Ahn C. , Levine J. 
Published: February 2017

242 Background: Perforator flap breast reconstruction has strong appeal for many women seeking breast reconstruction, but the procedure requires adequate donor site tissue to produce realistic breasts. Thin women requesting perforator flaps are often advised that they lack sufficient donor site tissue for autologous tissue breast reconstruction, and that implants are their only option. We have expanded the reconstructive options for thin women who seek an alternative to implants with innovative new techniques. Methods: A retrospective review was done of 223 patients who underwent 293 consecutive perforator flap breast reconstructions from April 2007-May 2011. Preoperative imaging allowed visualization of the microvascular anatomy and subcutaneous tissue. Donor sites evaluated included the abdomen, medial thigh, buttocks, and back. Complications included flap loss, hematoma, seroma, takeback, and fat necrosis. No patients were turned away for perforator flap breast reconstruction due to insufficient donor site tissue. Results: Out of 293 perforator flap breast reconstructions, 45 perforator flap breast reconstructions (15.4%) were reported in 26 thin women with a BMI < 23 (mean BMI 20.7, range BMI 18.2-22.7). Out of 45 perforator flap breast reconstructions in thin women, donor sites included 35 hemi-abdominal flaps (77.8%), 4 medial thigh flaps (8.9%), 7 buttock flaps (15.6%), and 2 back flaps (4.4%). Of the 35 hemi-abdominal flaps, 8 hemi-abdominal flaps were combined to create 4 stacked DIEP flaps (22.9%) while the remaining 27 hemi-abdominal flaps were regular DIEP flaps (77.1%). There was one seroma (2.2%) and one takeback for postoperative pain (2.2%); there were no flap losses. Conclusions: Even in thin women, perforator flap breast reconstruction is a safe, reliable, and consistent technique for recreating new breasts. While implant-based breast reconstruction may be acceptable to many women, there is a growing subgroup of patients who prefer autologous tissue breast reconstruction. By challenging common conceptions about the amount of donor site tissue required, we have been able to expand reconstructive options in thin women by using perforator flaps to construct natural, aesthetic breasts.
The experience of young women diagnosed with breast cancer who undergo fertility preservation (FP) consultation.
Authors: Hill K. A. , Nadler T. , Mandel R. , Burlein-Hall S. , Librach C. , Warner E. 
Published: February 2017

249 Background: In recent years FP has been a growing concern for young women diagnosed with breast cancer. ASCO has recommended that such women be referred to a reproductive specialist as early as possible before beginning systemic adjuvant therapy. Aim: To gather information about young breast cancer patients’ experiences with FP referral, consultation, and decision making. Methods: Anonymous questionnaires were mailed to consecutive breast cancer patients referred January 2005 through January 2010 from our center to the CReATe clinic in Toronto. Topics included information about demographics, cancer stage and treatment, previous fertility problems, referral source and timing, options presented and chosen, and satisfaction with the referral, consultation and decision making processes. Results: Of the 50 women identified 26 (52%) participated. Average age of respondents was 31 (range 24-41). 17 (65%) were married or in a long-term relationship, and 9 (35%) already had 1 child. Seven (27%) were referred before surgery, 16 (62%) after surgery but before systemic therapy, 2 (8%) after starting hormone therapy, and 1 after completing chemotherapy. Only 54% opted for FP. Of the 17 (66%) who reported plans to start/add to their family prior to diagnosis of breast cancer, 53% proceeded with FP and of the 9 who did not have plans to start/add to their family 5 (55%) pursued FP. 41% had difficulty with decision making and 50% found cost to be a significant barrier. A common theme among respondents was inadequate time for decision making. Several complained about the lack of written material before and/or after their consultation. 85% felt that access to a psychosocial counselor would have been beneficial to the decision making process. 57% were satisfied or extremely satisfied overall. Conclusions: (1) If appropriate, FP referral should be initiated by the surgeon as soon as a diagnosis of invasive cancer is made. Obtaining receptor and HER2 status on core biopsy samples may identify women who will require systemic therapy and may benefit from early FP referral. (2) Women need written materials before and after FP consultation. (3) There is a major role for a FP counselor who is able to spend additional time helping with decision making.
Usefulness of an original self-completed questionnaire for screening of cancer-related mental disorder in patients with newly diagnosed early breast cancer.
Authors: Kawaguchi K. , Tuyuki S. , Yoshitoshi E. Y. , Honda M. , Takase M. , Yoshida Y. , Kono Y. 
Published: February 2017

267 Background: Cancer-related mental disorder reduces (e.g., depression and anxiety disorder) not only treatment compliance but also compromises the quality of life of the patient. However, psychiatric intervention at the cancer notification has been barely performed in Japan because Japanese people traditionally tend to have a prejudice against psychiatric consultation and about sexual activity. In order to provide more effective treatment for breast cancer patients, it is necessary to treat cancer-related mental disorder in Japan. Methods: Based on Self-rating Depression Scale, Hamilton's Rating Scale for Depression and Beck Depression Inventory, the questionnaires were modified for Japanese patients by psychiatrists and clinical psychologists of our hospital. We asked newly diagnosed breast cancer patients an original self-completed questionnaire regarding the depression and anxiety disorder between January 2010 and March 2011. This questionnaire consists of 14 questions about depression and anxiety disorder without questions of sexual activity, which has two points each question (maximum total points were 28). We recommended the psychiatric interference by a psychiatrist and the clinical psychologist to all patients with more than 14 points in this questionnaire. Results: We obtained data from 116 patients. No patient refused to answer the questionnaire. 23 patients had higher than 14 points in this questionnaire. Of 23 patients, 9 patients received psychiatric intervention without medication, and four patients received psychotropic medications. Based on the results, we avoided the administration of anticancer agent by intravenous infusion in three patients who had higher than 14 points in the questionnaire. Multivariate analysis revealed that unmarried status is associated with a significantly higher score (OR 16.1; p = 0.013). Conclusions: Our data suggest that our original self-completed questionnaire is useful for the screening of the cancer-related mental disorder in order to provide appropriate therapy to newly diagnosed breast cancer patients.