bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of adjuvant trastuzumab on locoregional recurrence in human epidermal growth factor receptor 2-positive breast cancer treated with post-mastectomy radiation therapy.
Authors: Lanning Ryan Michael , Riaz Nadeem , Morrow Monica , Moo Tracy-Ann , El-Tamer Mahmoud , Krause Kate , Chen Yu , Pei Xin , Powell Simon N. , Ho Alice Y. 
Published: February 2017

61 Background: HER2 overexpression is associated with an increased risk of LRR after mastectomy in the era prior to the use of adjuvant trastuzumab. The purpose of this study was to examine the effect of adjuvant trastuzumab on rates of LRR and whether this effect varied with the use of PMRT. Methods: From our institutional database, 474 women with Stage I-III HER2+ invasive breast cancer treated with mastectomy +/- adjuvant therapy from 1999-2007 were identified. Those patients lost to follow-up, treated with lapatinib, or diagnosed between 5/2004 to 5/2005 (when trastuzumab prescribing practices varied) were excluded; leaving 395 in the final study population. Two cohorts were compared: 139 women who received trastuzumab (5/2005-12/2007) and 256 women who did not (prior to 5/2005). Competing risks analyses were used to estimate cumulative incidence of LRR. Competing risks regression was used to evaluate the association between treatment factors and LRR. To minimize lead-time bias, patient data was censored at 5 years after mastectomy in both groups. Results: There were 18 LRRs in the entire cohort (16 no trastuzumab, 2 trastuzumab). Women in the no trastuzumab group were less likely to be node positive, receive chemotherapy or PMRT (all p<0.001). The hazard ratio for LRR was 0.218in the trastuzumab group (p= 0.04, 95% C.I. 0.05-0.94) with a 5-year risk of LRR of 1.5% in the trastuzumab versus 6.6% in the no trastuzumab group. After adjusting for PMRT and chemotherapy receipt, trastuzumab trended towards significance in decreasing LRR (p= 0.063). On subset analysis of 139 women who received PMRT, trastuzumab significantly reduced LRR (7.3% no trastuzumab, 0% trastuzumab, p=0.025). Among those who did not receive PMRT (256), trastuzumab did not significantly decrease LRR (6.3% no trastuzumab, 2.9 % trastuzumab, p=0.28). Conclusions: Adjuvant trastuzumab significantly reduced LRR in women with HER2+ breast cancer who received PMRT. A trend toward decreased LRR was observed in the entire population, but did not reach statistical significance, suggesting that the benefit is greater in HER2+ patients receiving multimodality therapy.
OSNA for detection of sentinel lymph node metastasis.
Authors: Suzuki Masahiko 
Published: February 2017

74 Background: SLN (sentinel lymph node) biopsy is a common procedure in surgical treatment of clinically node-negative breast cancer. OSNA (One-step nucleic acid amplification) is a semi-automated examination using molecular biological technique, and OSNA allows straightforward diagnosis of SLN metastasis without a pathologist by quantitative evaluation of CK19 m-RNA. The objective of this study was to confirm the reliability of OSNA for detection of sentinel Lymph node metastasis, and OSNA is also useful even in neoadjuvant chemotherapy (NAC) patients. Methods: Surgically obtained 159 SLNs from 106 breast cancer patients were evaluated and compared. The SLNs were sectioned into three pieces along the major axis. The central piece was sent to pathologists in an outside laboratory for postoperative histological investigation to diagnose metastasis. The other two pieces were examined with the OSNA to detecting metastasis during an operation. The OSNA analysis and the histological investigation were compared. Then, the patients were divided into two groups, one group was the patients with NAC (22 SLNs from 13 patients), and another group was the patients without NAC (137 SLNs from 93 patients). It was examined whether those concordance rates were similar. Results: 151 SLNs were same diagnosis using both methods. 4 SLNs were negative on OSNA but positive on histology, and these 4 SLNs contained only micrometastasis lesion. Other 4 SLNs were positive on OSNA but negative on histology. The concordance rate was 95.0%. In the patients with NAC, 20 SLNs were same diagnosis. Two SLNs were negative on OSNA but positive on histology, and these 2 SLNs were micrometastasis. The concordance rate was 90.9%. In the patients without NAC, 131 SLNs were same diagnosis. 2 SLNs were positive on OSNA but negative on history, and these 2 SLNs were micrometastasis. 4 SLNs were positive on OSNA but negative on history. The concordance rate was 95.6%. Conclusions: The concordance rate in patients with NAC was as high level as the rate in patients without NAC. The false negative SLNs were all micrometastasis. These results suggest that OSNA is very useful for detecting SLN metastasis and it is clinically acceptable in NAC patients.
Safe negative-margin width in breast-conservative therapy: Results from a population with a high percentage of negative prognostic factors.
Authors: Bhatti Abu Bakar Hafeez , Khan Amina Iqbal , Aamir Muhammad Awais , Shah Mazhar Ali , Siddiqui Neelam , Muzaffar Narjis 
Published: February 2017

75 Background: There remains a controversy in literature regarding adequate width of negative surgical margins in breast conservative therapy (BCT). Majority of patients included in studies on outcomes of BCT had favorable prognostic factors. Pakistani population is known to have an elevated expression of unfavorable prognostic factors. This study was done to determine safe negative margin width in a patient population with significantly higher percentage of unfavorable prognostic factors undergoing BCT. Methods: A review of patients who received BCT from 1997-2009 at Shukat Khanum Cancer Hospital was performed. A total of 603 patients whose margin status could be assessed were included. Patients were divided into close ( ≤ 2mm), free (> 2-10mm), and wide (> 10mm) margin groups. Patient characteristics, medical treatment modalities, and number of locoregional recurrences were observed for each margin group. Chi square and Fisher’s exact test were used for categorical variables. Five year locoregional control was determined for margin groups. Univariate and multivariate Cox regression analysis was performed to determine independent predictors of locoregional recurrence. Results: Out of total, 415 (69%) patients were <50 years of age. There were 82 (15%) T3/T4, 337 (56%) poorly differentiated and 238 (39%) ER/PR–ve tumors. Nodal positivity was present in 314 (52%) patients. A higher percentage of T3/T4 tumors in close margin group (25% versus 13% and 7%) (p < 0.0001) was observed. Use of neoadjuvant chemotherapy was significantly higher in close margin group (33% versus 29% and 16%) (p < 0.0001). The actual number of observed locoregional recurrences was 16 (12%), 8 (3%), and 10 (4.6%) in close, free, and wide margin groups (p = 0.002) while the expected 5 year locoregional control was 90%, 97%, and 96% (p = 0.002) respectively. On multivariate analysis tumor size stage, nodal involvement and negative margin width were independent predictors of locoregional failure. Conclusions: A negative margin width of 2mm might represent an adequate negative margin width in populations with a higher percentage of unfavorable prognostic factors.
Significance of HER2/neu overexpression in pure ductal carcinoma in situ: A clinicopathologic study with long-term follow-up.
Authors: Al-Mansour Zeina , Stockl Thomas , Khan Ashraf , Horner Richard , Cosar Ediz , Hsieh Chung-Cheng , Kandil Dina 
Published: February 2017

85 Background: The prognostic value of HER2 (c-ERB2) overexpression in invasive breast cancer is well known, and correlates with aggressivene behavior. HER2 overexpression was reported in 13-56% of ductal carcinoma in-situ (DCIS). The significance of HER2 overexpression in DCIS has yet to be elucidated. The aim of this study was to correlate HER2 status with known prognostic indicators of DCIS and to evaluate whether the HER2 overexpression correlates with disease recurrence. Methods: All cases of DCIS diagnosed at our institution between 2000 and 2005 were retrieved. Cases without follow-up, those treated with mastectomy or those with concurrent invasive component were excluded. Clinicopathologic data were collected, including age at time of diagnosis, size of the lesion, nuclear grade, presence of comedo necrosis, margin status, estrogen (ER) and progesterone receptor (PR) status, type of adjuvant treatment received and length of follow-up. A representative block from each case was immunostained using the Hercept test. Slides were reviewed by 2 pathologists and interpreted in accordance with ASCO/CAP guidelines. Equivocal cases were reflexed for FISH testing. Results: A total of 152 cases were examined. Mean follow-up period was 77 months (range 12 to 138 months). HER2 was overexpressed in 49 cases (33%), and was significantly associated with high nuclear grade and presence of comedo necrosis. HER2-positive patients were more likely to be ER and PR negative. HER2 positive and negative patients did not differ significantly with respect to age at presentation or size of DCIS. On univariate analysis, HER2-type DCIS showed a higher risk of recurrence (P=0.037), however, this trend did not reach statistical signifance on multivariate analysis. Conclusions: HER2 overexpression was found to be associated with high nuclear grade, comedo necrosis as well as negativity for ER and PR but not with age or the size of DCIS. Patients with HER2-type DCIS (ER/PR-, HER2+) had a higher risk of disease recurrence than other types. However, after adjusting for all the other clinical variables, the molecular phenotype did not withhold its statistical significance as an independent predictor for recurrence.
Rethinking the Harvard scale of breast cosmesis: An analysis of patients treated with breast-conserving therapy on a phase II clinical trial.
Authors: Hunter Allison M. , Dragun Anthony E. 
Published: February 2017

88 Background: The Harvard Scale of cosmetic outcome is frequently used to assess quality of life (QOL) outcomes and late toxicity in patients who have undergone breast conservation treatment. Our purpose is to evaluate its objectivity and reproducibility in the modern era of digital photography in a prospective phase II protocol. Methods: This assessment included at total of 68 digital photographs taken atfourpredetermined post-lumpectomy time points for seventeen (17) patients enrolled on a phase II protocol of once-weekly hypofractionated whole-breast radiotherapy for early stage breast cancer. Each time point assessment was completed by the principal investigator (PI) using the four-tier Harvard Scale (Excellent, Good, Fair, Poor) to compare the treated breast to the control breast. A computer-based survey including the same de-identified images was then distributed to forty-four (44) medical students and residents to determine congruence with the assessment of the PI. Results: Of the 44 respondents, there was equal distribution between male (23) and female (21), with the majority of whom were single (82%), Caucasian (70%), and less than twenty-nine (29) years of age (89%). The respondent assessment of cosmetic outcome differed somewhat from the PI averages: Excellent (43% vs. 27%), Good (34% vs. 34%), Fair (20% vs. 28%) and Poor (3% vs. 11%). PI-respondent congruence for the same four categories was 49%, 37%, 44%, and 86%, respectively. Combining the categories into a bimodal representation of Excellent/Good (70%) and Fair/Poor (72%), produced significantly better congruence (70% and 72%, respectively). Conclusions: Pysician-assessed cosmetic outcome using the traditional four-point Harvard Scale is highly variable and influenced by evaluator factors. A two point scale increases congruence among evaluators and may be a more reproducible and pragmatic approach for results reporting in cosmesis studies.
A breast cancer nomogram for prediction of non–sentinel-node metastasis in patients with sentinel node metastasis and validations of the 14 models.
Authors: Kuru Bekir , Koca Bulent , Ozen Necati , Yuruker Savas , Bek Yuksel 
Published: February 2017

93 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph node (SLN)-negative patients with SLN-positive axilla, nomograms for predicting the status of the axillary non-SLNs have been developed in many centers. We created a new nomogram predicting non-SLN metastasis in SLN positive patients with invasive breast cancer and evaluated 14 existing breast cancer models in our patient group. Methods: Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the present study. Based on the independent predictive factors for non-SLN metastasis identified by logistic regression analysis, we developed a new nomogram. Receiver operating characteristics (ROC) curves for the models were created, and the areas under the curves (AUC) were computed. Results: In a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN in mm, the number of negative SLNs, and the multifocality were found to be independent predictive factors for non-SLN metastasis. The AUC was found to be 0.87 which is the highest value reported to date for previous models, and calibration was good for the present Ondokuz Mayis nomogram. Among the 14 validated models, the MSKCC, Stanford, Turkish, MD Anderson, MOU (Masaryk), Ljubljana, and 9 Eylul models yielded excellent AUC values of > 0.80. Conclusions: We present a new model (the Ondokuz Mayis nomogram) to predict the likelihood of non-SLN metastasis. Each clinic should determine and use the most suitable nomogram or should create their own nomograms for the prediction of non-SLN metastasis. [Table: see text]
Impact of care at NCI comprehensive cancer centers (NCICCC) on outcomes in children, adolescents, and young adults (AYA) with central nervous system tumors (CNSt).
Authors: Wolfson Julie Anna , Sun Can-Lan , Kang Tongjun , Bhatia Smita 
Published: February 2017

123 Background: AYA (15-39yo) have not seen the same survival improvement as younger cancer patients with similar diagnoses (dx), leaving an AYA Gap. Treatment on pediatric trials is associated with superior survival in 15-21yo. However, impact of care at NCICCC for complex diseases with poor prognosis that require evidence-based care available at NCICCC (e.g. CNSt), remain unstudied. Methods: We constructed a cohort of 560 children (0-14yo) and 785 AYA with newly-dx CNSt, reported to the LA County (LAC) cancer registry between 1998 and 2008. While 82% of children (0-14y) and 65% of young AYA (15-18y) were treated at one of 3 NCICCC or 3 COG sites in LAC, only 17% of older AYA (19-39y) were treated at one of 3 NCICCC. We sought to determine the impact of NCICCC/COG on overall survival (OS) and barriers to access to care at NCICCC/COG in AYA with CNSt. Since distance to NCICCC/COG could serve as a barrier to accessing care, Geographic Information Systems were used to derive distance between patient’s residence to the nearest NCICCC/COG. Results: OS rates were uniformly good for children and AYA with grade 1 CNSt (96 vs. 89% at 5y, p=0.2) and uniformly poor for children and AYA with grade 3/4 CNSt (43 vs. 43% at 5y, p=0.6). Among patients with WHO grade 2 CNSt, AYA had worse outcome (HR=1.9, p<0.01) after adjustment for race/ ethnicity, SES, and gender. This difference in outcome between AYA and children was abrogated by care at NCICCC (HR 1.4, p=0.2). Furthermore, patients cared at non-NCICCC saw worse outcome (HR=1.6, p=0.04). Compared with children, young AYA (15-18yo) were less likely to receive care at NCICCC (OR=0.3, p=0.02); race/ ethnicity, SES and distance to NCICCC did not influence care at NCICCC. Among older AYA (19-39yo), low SES (OR 0.4, p=0.01), public/ no insurance (OR 0.3, p<0.01) and longer distance to NCICCC (5-12mi: OR=0.3 , p<0.01; >12mi OR 0.5 , p=0.05) reduced likelihood to receive care at NCICCC. Conclusions: Population-based data reveal that receipt of care at NCICCC abrogates the inferior outcome in AYA with WHO grade 2 CNSt. Young AYA are less likely to use NCICCC than children, as are older AYA with low SES, public/ no insurance, or living > 5 miles from an NCICCC.
Assessment of communication about palliative care between physicians and their patients with cancer prior to admission to the palliative care unit (PCU).
Authors: Storek Benjamin , Nickel Sebastian , Markwordt Janett , Behzadi Asita , Thuss-Patience Peter C. , Sturm Isrid 
Published: February 2017

18 Background: Discussions on palliative care are particularly challenging for both cancer patients (pts) and their treating physicians. From the pts perspective, prior to their admission to the PCU, information about palliative care is often lacking and their opinions are not adequately respected. In our study, we evaluated 1) whether pts were satisfied with the received information about palliative care prior to admission to the PCU, 2) the pts level of understanding about palliative care options and 3) pts wishes for their stay at the PCU. Methods: n=180 from n=273 pts participated in the study (time period: 12 months). A standardized palliative care assessment was performed on the day of admission. Study interview was performed within 48h after admission; the questionnaire contained free response and multiple-choice questions. Analysis: Likert scaling method with descriptive statistics using SPSS. Results: Baseline characteristics: n=92 male, n=88 female, median age 64 (range 26-89), 53% with an ECOG 3, n=25 hematological and n=155 oncological malignancies. Symptoms: 56% had 8-14 physical symptoms, 36% had 3-4 emotional problems, 38% had high levels of distress. Prior knowledge about palliative care: 38% did not know what a PCU was and 31% believed it was a unit for dying patients. 44% received none, 26% some information about palliative care prior admission. 42% did not feel well informed, 34% felt they received some information on palliative care. Prior information about the disease: 27% felt minimally, 64% felt well informed about their current disease state. The following points were not addressed from the physicians: living will 57%, health care proxy 59%, home care supply 70%, hospice 70%, psychooncological care 52%, prognosis 43%. Wishes of pts on the PCU: improvement in their general condition 47%, pain relief 30%. Conclusions: Our study shows that the majority of pts do not feel sufficiently informed about palliative care prior to the admission at the PCU. A communication barrier between physicians and their pts may explain patient’s views. The data confirm the importance of early integration of palliative care in addition to oncological care.
An interdisciplinary process for improving pain management in oncology.
Authors: Goforth Harold W. , Karius Diana , Day Kathy , Fitz Anne , Akins Patti , Fetto Julie , Guthrie Amy E. , Stevenson James 
Published: February 2017

182 Background: Upcoming changes in Medicare reimbursement models take into account HCAHP scores, and over the next 1-3 years, penalties will be enacted towards those institutions falling below a standard on their publicly available HCAHP scores. The HCAHP pain domain can be one of the most challenging to impact directly due to lack of pain management knowledge, proper assessment skills, expertise in managing complex pain syndromes, and the heterogeneity of pain symptomatology reported by advanced cancer patients. Methods: This project identified inpatient oncology units with suboptimal HCAHP scores. The objective was to improve HCAHP pain scores to > 90th percentile. Nursing intervention focused on five primary areas: a) A requirement to attend a mandatory class on malignant pain management; b) making available nursing pain mentors; c) a requirement to address pain during rounds with physicians; d) priority access to medications to address pain; and, e) encouraging event reporting for uncontrolled pain issues. Resident physicians were provided expectations for pain management and attended a mandatory class on malignant pain taught by a palliative medicine attending physician. A palliative medicine physician was also assigned to the unit to evaluate patients with pain scores > 6/10 or complex pain needs. An algorithm for pain control was designed to include a timeline for intervention as well as an escalation process for slow or inadequate physician response. A hand-off report was provided to the charge nurse by the senior resident physician at the end of each day that included a tentative plan for treating any escalating pain. Results: All initiatives were implemented in September 2012. By February 2013, Pain HCAHP scores increased 10% over the entire Taussig Cancer Institute, and increased 20% for the solid tumor oncology unit. This placed all units who received this targeted intervention above the 90th percentile as compared to other hospitals on the HCAHPS pain score. Conclusions: A well-defined collaborative model between physicians and nursing produced measurable improvement in pain outcomes for oncology inpatients. An interdisciplinary approach is essential for the management of complex pain issues in an oncology patient population.
High-needs hematology/oncology patients: A quality improvement project.
Authors: Tobin Swanee , Fenuta Joyce , Kruchowski Julie , Hicks Lisa K. 
Published: February 2017

197 Background: St. Michael’s Hospital (SMH) is an academic, inner-city hospital in Toronto, Canada. In the hematology/oncology (hem/onc) program, a small number of patients appeared to contribute disproportionately to hospital admissions and emergency department (ED) visits. We hypothesized that high needs hem/onc patients could be recognized early in their care and that ED visit and admission rates among these patients could be decreased through targeted interventions. Methods: Members of the hem/onc team were interviewed regarding characteristics, which they felt predicted higher needs and greater liklihood for hospital admission/ED visit. A list of high risk features was generated. ED visit and admission rates for a prospectively identified high needs cohort were compared to rates for the entire hem/onc clinic. An intervention targeting high needs hem/onc patients is on-going. Pre and post-intervention ED visit and admission rates will be compared. Results: Interviews with 3 nurses, 1 social worker, 1 discharge planner, and 4 physicians identified 10 factors that the hem/onc team believed were predictive of higher needs and subsequent higher ED visit and admission rates. Between December 1, 2012, and February 28, 2013, 42 high needs hem/onc out-patients were prospectively identified. The ED visit and admission rates for this cohort were retrospectively compared to those of the entire hem/onc clinic and found to be dramatically higher (Table). Begininng in June 2013, hem/onc patients identified as “high needs” were offered enrollment in a NP-based program offering telephone assessments following ED visits, hospital admissions or discharges. Assessment of the impact of this intervention is ongoing. Conclusions: It is possible to prospectively identify hem/onc patients who are at risk of higher than usual ED visit and admission rates. Identifying this population may provide an opportunity to decrease their ED visit and admission rates. An evaluation of an intervention targeting high needs hem/onc patients is ongoing. Preliminary data will be presented. [Table: see text]