bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic and predictable value of COX2 expression in Russian women with stage I breast cancer.
Authors: Kolyadina Irina Vladimirovna , Kuppen P. J. K. , Van De Velde Cornelis J. H. , Poddubnaya Irina Vladimirovna , Dekker-Ensink N.G. , Prinse B. , Frank G. , Karseladze A. , Komov D. , Engles C. , Ermilova V. 
Published: February 2017

80 Background: Some previous studies found worse prognosis among cyclooxygenase-2 (COX2)-expressing breast cancers; we study prognostic and predictiable value of COX2 expression in breast cancer stage I. Methods: our study included Russian women with breast cancer stage I (n=315) treated in RCRC, RMAPE (1985-2009). A Tissue Micro Array (TMA) with triplicate 1 mm tumor tissue punches taken from tumor blocks was constructed in LUMC; sections were immunohistochemically stained for ER, PR, HER2-status, Ki67 (by standard morphological criteria); COX2-expression were evaluated as positive (>median; 31/309 cases, 10%) or negative (≤median; 278/209 cases, 90%). Also the histological type, grade, age and adjuvant endocrine therapy were examined. We analyzed the clinic and morphological data of COX2-positive tumors, prognostic value for survival (relapses free- RFS, overall- OS and cancer specific- CSS) and predictable value for endocrine therapy. Results: COX2-positive tumor were associated with ductal histological type (p=0,018), PR-negative status (p=0,027) and high Ki67 (p<0,0001), but not correlated (p>0,05) with age, grade, ER, HER2 status or biological subtype. In women with ER-negative tumors (104 patients, 34,1%) COX2-expression did not associate with worse survival (p>0,05). In contrast to this, in patients with ER-positive tumors (201 women, 65,9%) COX2-expression strongly correlated with worse RFS in univariate (HR 2,829, 95% CI 1,366-5,860, p=0,005) and multivariate analyses (HR=2,972, 95% CI 1,190-7,423, p=0,02). The same value of COX2-expression in women with ER-positive tumors was found for CSS (univariate: HR 3,421, 95% CI 1,436-8,149, p=0,005; multivariate: HR 4,260, 95% CI 1,344-13,504, p=0,014), but not for OS (p>0,05). In women who did not receive adjuvant endocrine therapy (145 patients, 46%) COX2 expression did not have any prognostic value for RFS, OS and CSS (p>0,05) but in patients that used adjuvant endocrine therapy (170 women, 54%) COX2-expression strongly associated with worse cancer-specific survival (HR 5,614 95% CI 1,165-27,059, p=0,032), but not with RFS and OS (p>0,05). Conclusions: COX2 expression plays a role in hormonal pathways and sensitivity for endocrine therapy.
Identifying the surgical cavity following oncoplastic breast surgery.
Authors: Cross Michael , Lebovic Gail , Stubbs James , Ross Joe , Jones Scott , Beck Thad 
Published: February 2017

81 Background: Oncoplastic surgery (OPS) has improved outcomes for partial mastectomy. However, tissue rearrangement poses challenges in the post-operative management of these patients. In most cases, these patients will require post-operative radiotherapy. Accurately visualizing the surgical cavity can be particularly troublesome in patients who have oncoplastic closure of the resection cavity. Recent advances have made it feasible to perform external beam radiation using advanced methods, but these are not commonly used for breast cancer. This is due to the difficulty in identifying the exact area of the surgical site. In this series of patients, a novel method for marking the surgical site when using oncoplastic techniques was evaluated. Methods: 65 patients had a 3-D tissue marker implanted at the time of lumpectomy. All patients were candidates for partial mastectomy and local breast reconstruction using OPS. Post-operative treatment plans for radiation and/or adjuvant chemotherapy were completed. Patients were evaluated with standard breast imaging methods for treatment planning. Results: The marker was easily identified and clearly delineated within the lumpectomy cavity. It provided 3-D characterization of the borders surrounding the cavity, and was easily distinguished from seroma and other tissue changes. Respiratory motion was easily tracked using the device making it possible to use IMRT and accelerated protocols. Use of the marker resulted in treatment volumes that were reduced by an average of 50% when compared to standard methods. In appropriate patients when the marker facilitated an accelerated protocol, total treatment time was decreased to 5-7 days. No complications were reported, and overall patient outcomes were excellent. Conclusions: This novel 3-D marker was consistently visualized without difficulty, was readily incorporated into standard practices and had appreciable benefits when designing optimal treatment plans. Its unique features were helpful in all cases, but particularly useful when using oncoplastic techniques to reconstruct the breast with local tissue flaps.
Contralateral mastectomy in young women with breast cancer: A population-based analysis of predictive factors and clinical impact.
Authors: Bouchard-Fortier Antoine , Baxter Nancy N. , Fernandes Kimberley , Camacho Ximena , Quan May Lynn 
Published: February 2017

82 Background: Contralateral mastectomy (CM) has recently been shown to be associated with survival benefit in women with breast cancer. The objectives of the present study were to describe factors predictive of CM in young women (≤35 years old) with invasive breast cancer and evaluate its impact on survival, in a large population based cohort. Methods: All women diagnosed with invasive breast cancer aged ≤35 from 1994 – 2003 treated with mastectomy were identified from the Ontario Cancer Registry. Patient demographics, complete tumour and treatment characteristics were abstracted from primary chart review. Cox proportional hazard regression was performed to assess factors associated with performance of CM and its effect on recurrence and overall survival, performance of CM was modeled as a time varying co-variate. The models were controlled for known predictors including age, tumor size, nodal status, ER/PR, LVI, histologic grade, systemic therapy and adjuvant radiation. Results: There were 628 women identified. Of these, 101 underwent a CM (16.1%). On multivariable analysis, factors predictive of CM were negative lymph node status (HR: 1.74, 95% CI [1.052-2.872]; p-value = 0.031) and negative estrogen receptor status (HR: 2.7, 95% CI [1.314-5.736]; p-value = 0.007). After a median follow up of 11 years, no significant survival benefit was observed in women undergoing CM compared to those who did not (HR: 0.95, 95% CI [0.61-1.46], p-value = 0.80). Conclusions: Performance of CM in young women with invasive breast cancer did not result in a significant survival benefit, compared to those without CM. Factors found to be predictive of performance of CM negative lymph node status and negative estrogen receptor status. Further studies are needed to determine if a subset of young women might benefit from CM.
The effect of adjuvant radiation on survival for patients with resected localized or regional primary small cell carcinoma of the breast.
Authors: Hare Felicia , Patel Jashmin Kirankumar , Fenton Moon Jung , Martin Michael Gary 
Published: February 2017

87 Background: Primary small cell carcinoma of the breast (SCCB) is rare and prognosis, the role of radiation therapy and outcomes are largely undefined. Methods: Using case listing session of SEER 18 (1973-2010) we examined outcomes for patients (pts) with SCCB. Analyses were conducted with SEER*Stat 8.1.2, Microsoft Excel 2007 and GraphPad Prism 6. Comparisons were made using the chi-squared test and log rank test (Mantel-Cox); all p-values were 2-sided. Results: 199 pts with primary SCCB with staging were identified; median age was 65 (range 28-97); 98% were female. 84 (42%) had localized disease (dz), 77 (39%) had regional dz and 38 (19%) had distant dz. 95% of pts with localized dz and 88% of pts with regional dz had breast surgery. Median overall survival (OS) varied by stage (150 months [m] v 56m v 7m, p<0.001) and radiation did not impact OS for pts with either localized (202m v 147m, p=0.477) or regional (52m v 75m, p=0.650) dz. For comparison 81,933 cases of small cell lung cancer (SCLC) were identified in SEER; 8% localized, 29%regional and 63% distant disease. Outcomes were superior for pts with SCCB with localized (150m v 16m, p<0.001) and regional dz (56m v 13m, p<0.001) but not distant dz (7m v 7m, p=0.043). Conclusions: SCCB presents at an earlier stage than and has a more favorable prognosis by stage for localized and regional dz than SCLC. Adjuvant radiation does not improve survival for patients with localized or regional SCCB.
A prospective evaluation of the relationship between bone mineral density and breast cancer.
Authors: Geffen David Barry , Novack Victor , Shafat Tali , Tokar Margarita , Lazarev Irena , Bogomolni Leonid , Troitsa Rita , Magidovich Hila , Liel Yair , Koretz Michael , Siris Ethel , Norton Larry , Shany Shraga , Fraenkel Merav 
Published: February 2017

9 Background: Osteoporosis and breast cancer (BC) are each mediated by circulating estrogens. Insulin and insulin growth factors 1-2 have been linked to increased bone mineral density (BMD) and BC cell growth. The relationship between BMD and BC incidence has been analyzed in a number of retrospective studies with conflicting results. We have previously reported on a study of BC risk in 15,268 women who underwent BMD testing. Women in the highest Z-score tertile at the femoral neck had a higher risk of developing BC compared to those in the lowest tertile (OR 2.15, p = 0.004). The current study was undertaken in order to determine whether there is a direct correlation between BMD and BC when evaluated prospectively. Methods: This case-control study is planned to include 400 consecutive patients (pts) with newly diagnosed BC and 800 matched controls without BC. Pts and controls undergo BMD examination using dual photon technology. Serum is obtained for vitamin D, calcium, and a panel of bone turnover markers and cytokines. Pts and controls are interviewed and a questionnaire about BC and osteoporosis risk factors is completed. Results: We present clinical and BMD data from the first 200 BC patients recruited to the study. Median age 60, interquartile range 49.5-66. Body Mass Index: 28.4 ± 5.4 (mean ± SD). Postmenopausal: 148 patients, 74%. T-scores (mean ± SD): femoral neck: -0.68 ±-1.10, total hip: -0.28 ± 1.17, L1-L4: -0.52 ± 1.39. T-score of less than minus 2.5 (cut-off for osteoporosis) at any of the 3 sites, 24 (11.9 %) pts. Estrogen receptor pos: 162 (81%).BC stage: T0-T2, 175 (87.5 %). N0: 108 (54.5%), N1-2-3: 86 (43.4%). % pts node pos (N1-2-3) in each T score range: ≤ -2.5, 20%; -2.5 < T score ≤ -1,36%; -1 < T-score ≤+ 1,50%; +1 < T-score, 60%. % pts low grade in each T score range: ≤ -2.5, 25%;-2.5 < T-score ≤ -1,35%;-1 < T-score ≤ +1,37 % ;+1 < T-score, 20%. Conclusions: Only 11.9% of the first 200 BC patients studied had osteoporosis by BMD at diagnosis.Pts with higher BMD showed a trend for more nodal involvement. Pts with T-score > +1 had fewer cases of low grade histology compared to pts with lower T-scores. These preliminary results hint that higher BMD may be associated with more aggressive BC.
The significance of margin status in patients with DCIS undergoing breast-conserving surgery.
Authors: Gentile Rachel , Currey Adam D. , Forrester Jared , Tuyishimire Bonifride , Lin Jonathan , Kong Amanda L. 
Published: February 2017

98 Background: Recently, SSO/ASTRO published a consensus statement on margins for stage I and II invasive breast cancer treated with breast conserving surgery (BCS). We examined patients with ductal carcinoma in situ (DCIS) who underwent BCS to determine the effect of clinicopathologic and treatment factors including margin status, on locoregional recurrence (LRR), breast cancer-specific (BCSS) and overall survival (OS). Methods: From 2003-2010, we conducted a retrospective chart review of 253 consecutively diagnosed patients who underwent BCS for DCIS. Clincopathologic and treatment data were extracted. Margin status was defined by pathology reports with a negative margin as ≥ 2mm, close margin < 2mm and positive margin as tumor on ink. Clinicopathologic variables were tested using the Fisher’s exact test, Chi-square test, ANOVA F-test, and Kruskal-Wallis test. A Cox proportional - Hazards model was used to calculate the impact of these factors on LRR, BCSS and OS. Results: The median age of the cohort was 57 (range 21-89) and the majority were white (79%), ER+ (78%) and underwent radiation therapy (67%). Forty six percent took anti-endocrine therapy. Of 252 patients, 29% had close margins, 63% had negative margins and 7% had unknown margins. One patient had a positive margin and was alive without disease at last follow-up. At a median follow-up of 5 years, OS was 96%. Thirteen patients experienced a LRR with a median time to recurrence of 4.9 years (5 with close margins, 7 with negative, 1 unknown). On multivariate analysis, age and PR status were significant predictors of LRR. Patients with age >70 were more likely to recur than those age 50-69 (HR 6.7 95% CI (1.7-25.4) p= 0.005) as were patients with PR negative tumors (HR 5.7 95% CI (1.7-19.5) p= 0.005). Those patients who did not receive radiation therapy had a worse OS than those who did (HR 4.3 95%CI (1.5-12.6) p = 0.007). No variables were significant for BCSS. Conclusions: In this cohort of patients with DCIS treated with BCS, age and PR status were the only predictors of LRR. OS was only impacted by receipt of radiotherapy. Margin status was not predictive of LRR, BCSS or OS. This data suggests that routine re-excision for close margins may not be warranted.
Novel data sharing between a comprehensive cancer center and a private payer to better understand care at the end of life.
Authors: Stuver Sherri Oliver , Fraile Belen , Donohue Caitlin C. , Odejide Oreofe Olukemi , Abel Gregory Alan , Dodek Anton , Fallon John A. , Jacobson Joseph O. 
Published: February 2017

1 Background: Assessment of care at the end of life (EOL) is critical to improving the quality of care for oncology patients. EOL measures based on guidelines from the National Quality Forum (NQF) and ASCO have been examined in older cancer patients using Medicare claims. We performed a project to evaluate the use of private payer claims data to enumerate EOL measures in patients of all ages at a comprehensive cancer center. Methods: Claims data were obtained for Dana-Farber Cancer Institute (DFCI) adult patients who died between July 1, 2010, and December 31, 2012, and were insured by Blue Cross Blue Shield of Massachusetts (BCBSMA). We assessed NQF-based measures related to hospitalizations, emergency department visits, and intensive care unit admissions in the last 30 days of life, chemotherapy in the last 14 days, hospice stay, and death in a hospital. In addition, we examined red blood cell and platelet transfusions, radiation therapy, and surgery in the last 30 days of life, as well as death in the ICU. Results: Of a total of 674 patients, 580 had solid tumors and 82 had hematologic malignancies; their median age was 59 years (range, 18-92). The Table provides results for the EOL measures examined. Up to 50% of the measured events did not occur at a DFCI-affiliated hospital. Conclusions: Using private insurance claims data in conjunction with medical records, we were able to successfully capture a broad range of EOL quality measures. Access to the claims data provided information not readily available in hospital medical records and for care not occurring at DFCI. Data sharing between private payers and cancer centers may provide a unique method of comprehensively examining quality of EOL care for oncology patients. [Table: see text]
Converting a clinical indicator on patient missed treatments into a functional quality improvement metric.
Authors: Harrison Amy S. , Doyle Laura A. , Hurwitz Mark , Babinski Lilya , Williamson Jamie , Dicker Adam , Yu Yan , Anne' Rani , Den Robert Benjamin 
Published: February 2017

101 Background: Extended time to complete a course of radiation can be detrimental to a patient’s overall local tumor control and survival. The American College of Radiology (ACR) Radiation Oncology Practice Guideline requires review of any unplanned interruptions during treatment. However, factors that impact missed treatments are neither required to be reviewed nor well characterized within the literature. We sought to understand the variables contributing to missed treatments by generating a functional metric for quality improvement. Methods: The departmental electronic medical record (EMR) was modified to create sub-sets of classifications for missed treatments. These categories were divided into intended and unintended breaks, with intended classification of physician prescribed break and eight subcategories of unintended breaks: patient preference, physician mandated, patient feels ill, transportation/social services, cancelled, no-show, weather, and machine downtime. Missed treatments were documented real-time by the treating radiation therapists using one of these eight categories. A custom report was generated to extract and separate missed treatments by category. Results: Over three years of ACR tracking, our department missed treatment rate ranged from 5-10%, out of 64,000 patient treatments. The new subcategory metric has been in place for the past six months. Overall compliance with documentation by therapists was 100%. The new metric yielded a six month total rate of missed treatments of 8% with detailed analysis showing the main reasons as: patient preferences (14%), inclement weather (14%), and machine down time (9%). Transportation was only a minor issue for the patient population. Conclusions: This stratification of a simple clinical indicator has identified the major factors influencing the total time to complete a course of treatment. Based on this analysis, our departmental quality committee is focusing on engaging and educating patients about the negative impact of missed treatments on their overall cancer care. Future research will attempt to identify patient characteristics that may predict individuals more likely to miss treatments.
Socioeconomic status and recurrent emergency visits amongst chemotherapy patients.
Authors: Kapil Priyanka , Enright Katherine 
Published: February 2017

106 Background: Multiple studies have found that cancer patients undergoing cytotoxic chemotherapy have a high rate of emergency department (ED) utilization throughout the course of their treatment and up to 20% of patients have recurrent ED visits. We assessed the effect of socioeconomic status (SES) on recurrent ED visits for infectious causes amongst chemotherapy patients. Methods: All patients who visited the Peel Regional Cancer Centre ED within 30 days of receiving cytotoxic chemotherapy between 04/12 - 3/13 were identified. Patients were included in the study if their primary reason for presentation was either fever or infection. Postal codes were cross-matched against 2011 census data from Statistics Canada to obtain estimates of income, education, and occupation. The impact of SES factors on the likelihood of multiple ED visits was analyzed. Results: 239 patients with at least 1 visit to the ED for infection were identified. Of these patients 103 (43.1%) had recurrent ED visits. Patients from areas with a higher proportion of arts, sports, culture, recreation, agriculture, and natural resources employment had a significantly (p<0.02) lower incidence of recurrent visits compared to single visits. Patients from areas with a lower proportion of healthcare, natural sciences, and applied sciences employment had a significantly (p<0.04) lower incidence of recurrent visits compared to single visits. Patients from areas with a greater proportion of people for whom the highest education completed was only high school had a significantly (p= 0.01) lower incidence of recurrent visits compared to single visits. Conclusions: Instead of observing a higher rate of ED visits for infection among patients with lower SES, patients residing in areas of lower education or in areas with a higher proportion of employment in fields associated with lower SES were less likely to have recurrent visits. It remains unclear if this represents decreased adherence to fever recommendations in patients with lower SES or over usage of ED services in patients with higher SES. Further studies are planned to better understand these observations to help inform educational interventions and community-based monitoring aimed at decreasing the risk of ED visits.
Provider perceptions of a cancer quality program.
Authors: Holcombe Randall F. 
Published: February 2017

112 Background: In 3/2011, The Tisch Cancer Institute at Mount Sinai implemented a cancer quality program This involved the establishment of several new committees including a QI committee and a chemotherapy council focused on the provision of evidence-based treatment regimens, implementation of an EMR (7/2011) and an electronic chemotherapy ordering platform (3/2012), relocation to a new practice facility (10/2012) with a focus on operational efficiency and multidisciplinary care, creation of new nursing and pharmacy policies & procedures and successful achievement of quality certifications including Magnet, QOPI and ACOS. We wished to evaluate provider perceptions of the quality initiatives that had been implemented over the past 3 years. Methods: A 10-question survey was distributed to physicians, nurses (practice and infusion), mid-level providers and oncology pharmacists. There were 80 respondents (MD-32, RN/NP-39, Pharm-9) which represents ~50% of providers in the cancer program. Results: Overwhelmingly, the “best measure of quality” (68% of respondents) was felt to be patient outcomes, not achieving standardized benchmarks, high patient satisfaction scores or certifications. 29% felt that use of evidence-based protocols was the best measure of quality care delivery. Initiatives with the greatest impact on quality were implementation of an EMR and the QI committee. Operational efficiency was felt to be the most important influence on patient experience. Certifications felt to be a reflection of quality care delivery were (in order): QOPI, Magnet (#1 for RN/NPs), ACOS. Only 6% cited Leapfrog. Factors most important for the quality delivery of chemotherapy included certified infusion RNs, electronic chemotherapy ordering, defined nursing and pharmacy protocols and MD/mid-level oversight. 35% felt that patient satisfaction scores were a good measure of quality while 28% felt that patient satisfaction scores were either overemphasized or a poor measure of quality. Conclusions: This survey defines provider views on new quality-focused initiatives and their impact on the quality of patient care delivery for a large, academically-based oncology program. This information can be utilized to inform future initiatives at Mount Sinai and other centers.