bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presentation of contralateral axillary involvement from breast cancer.
Authors: Prowler Vanessa Leilani , Kiluk John , Lee Marie Catherine , Khakpour Nazanin , Laronga Christine , Cox Charles E. 
Published: February 2017

49 Background: Metastatic breast cancer to the contralateral axilla is defined as stage IV disease. We postulate that metastatic disease to the contralateral axilla is secondary to extension of aggressive, local regional disease rather than distant metastatic disease and may have a better outcome. Methods: An IRB-approved retrospective review of breast cancer cases presenting to a single institution between January 2005 and December 2011 was performed to identify cases with contralateral axillary disease. Eligibility for the study included unilateral primary breast cancer at presentation with synchronous/metachronous documented metastasis to the contralateral axilla without a documented primary invasive breast cancer within the contralateral breast by surgery or MRI. Clinicopathologic data was recorded for these patients (pts). Results: Thirteen pts were identified that fulfilled eligibility criteria. The average age was 53 years (range 26.3-72.2) with 12/13 (92%) pts presenting with a locally advanced breast tumor or an ipsilateral in-breast recurrence. 10/13 (77%) pts had documented dermal involvement of tumor either at presentation or local recurrence. Contralateral metastatic disease occurred synchronously with the initial primary tumor (3pts, 23%), concomitant with a local recurrence (5 pts, 38%), metachronously with the initial tumor in (3pts, 23%), and metachronously with a local recurrence in (2pts, 15%). Resection of involved contralateral nodes was performed in 10/13 (77%) pts; 5/13 (38%) patients received contralateral axillary radiation; all 13 (100%) received systemic therapy. 9/13 pts (69%) developed distant metastatic disease with a mean follow up of 2.6 years (range 0.3-6.8 years). 3/13 pts (23%) have no evidence of disease at a mean follow up of 4.7 years (range 1.5-6.8). Conclusions: Contralateral axillary spread of breast cancer carries a poor prognosis but may have different prognostic implications than metastatic disease. Contralateral axillary metastatic disease may occur through dermal lymphatic spread and requires multidisciplinary management. Further study is warranted on the prognosis and management of these challenging and rare cases.
Racial disparities in clinical presentation, treatment, and outcome of women with breast cancer: Analysis of national inpatient sample database.
Authors: Dehal Ahmed , Abbas Ali , Johna Samir 
Published: February 2017

66 Background: Despite the established consensus, guidelines, and treatment protocols, there is wide variability in practice patterns among women treated for breast cancer, leading to variable results, with less favorable outcomes among minorities. The objective of this study was to examine racial/ethnic disparities in stage of disease and comorbidities (pre-treatment factors), surgical treatment allocation (breast conserving surgery [BCS] versus mastectomy [MAS]), and postoperative complication and mortality (post-treatment outcomes). Methods: National inpatient sample is a nationwide clinical and administrative database compiled from 44 states representing 95% of all hospital discharges in the Unites States. Patient discharges with primary diagnosis code of breast cancer and coincident procedure code for breast surgery (BCS or MAS) from 2005 to 2009 were identified using International Disease Codes 9th edition. Information about demographics, hospital characteristics, comorbidities, stage, surgical treatment, post-operative complications, and in-patient death was obtained. Multivariate logistic regression analyses were used to examine risk adjusted association between race and the aforementioned outcomes. Results: We identified 75,100 patient discharges with a mean age of 61 years. Overall, 58.3% of women were white, 8.6% black, 5.7% Hispanic, 2.6% Asian, and 24.8% others. Compared to whites, blacks were more likely to present with regional or metastatic disease (1.17, p <0.001) and more likely to present with comorbidities (1.58, p 0.003). Compared to whites, blacks (1.30, p <0.001) and Hispanics (1.20, p <0.001) were more likely to receive BCS whereas Asians were less likely to undergo BCS (0.80, p 0.01). Compared to whites, blacks were more likely to develop postoperative complications (1.35, p<0.001) and in-hospital mortality (1.87, p 0.13). Conclusions: After controlling for potential confounders, we found some racial/ethnic disparities in clinical presentation, treatment, and outcomes. Future researches should examine the underlying factors of these disparities.
Improving cancer care by linking community cancer center physicians to breast cancer disease site-specific experts.
Authors: Hardenbergh Patricia H. 
Published: February 2017

70 Background: The goal of this project is to improve the quality of cancer care across the U.S. by connecting community cancer center radiation oncologists with highly specialized, disease site-specific radiation oncologists. Methods: We have developed a website named chartrounds.com that allows community radiation oncologist members to interact online in a peer review forum with disease site-specific specialists on a scheduled basis. At the conclusion of each session, participants are asked to complete a questionnaire which requests feedback on the quality and relevance of the session and the manner in which it might result in changes to their practice. Results: To date, 575 community radiation oncology physician members from 50 states have enrolled online. In the initial 18-month period, nine disease site-specific specialists have led 81 breast-specific chart rounds sessions with an average attendance ratio, during the past six months, of eight community physician members to one breast cancer disease site-specific specialist. From 309 initial responses, on a five-point Likert scale with five representing the greatest impact possible, the mean response to feedback questions is as follows: session quality; 4.7, time used effectively; 4.6, discussions relevant to daily practice; 4.7, session is likely to result in a change in practice; 4.0. More specifically, 139 members reported that they would make the following changes in their practice: change in clinical management of the radiation patient: 37%, change in the selection of patients for radiation: 22%, change in the technical delivery of radiation including target, field and dose adjustments: 20%. Conclusions: The chartrounds.com website appears to be making an impact on individual radiation oncology practices resulting in changes in management and the delivery of treatment to patients in community cancer centers. Future directions of this project are aimed at demonstrating how these changes may result in significant improvements in survival of breast cancer patients across the U.S. This work is funded by the Improving Cancer Care Grant of the ASCO Conquer Cancer Foundation supported by Susan G. Komen for the Cure.
Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer.
Authors: Arrington Amanda Kathleen , Kruper Laura , Vito Courtney , Yim John H. , Chen Steven L. 
Published: February 2017

71 Background: Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. We examined SLNB utilization in urban versus rural settings as this procedure was adopted. We hypothesized that SLNB rates in urban centers quickly increased prior to 2000, while the technology shift and acceptance of SLNB was slower in rural centers. Methods: The SEER registry was used to identify patients with invasive ductal or lobular breast cancer from 1998-2008. Exclusion criteria included evidence of distant metastatic disease, T4 tumors, no curative-intent operation performed, or incomplete staging data. Residential setting was divided into three groups based on population density: rural, intermediate population, and urban. Results: The overall rate of SLNB increased with time (9.5% in 1998 to 72.7% in 2008). The adoption of SLNB was slower in rural settings than in urban populations (p<0.001). By 2003, only urban areas were utilizing SLNB in over 50% of cases. When stratified by population density, there was a significant difference in SLNB rates according to type of surgery performed (lumpectomy vs mastectomy) as well as by T-stage, with lower T-stage positively correlating with the likelihood of SLNB usage in all categories. Overall, there was a two-year lag in the adoption of between the increases in SLNB utilization rates in these groups. Conclusions: Since 1998, the use of SLNB for breast cancer has slowly increased throughout the United States. Though widely accepted as the preferred staging method, the overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1-T2 had increased to over 50% in all population categories. There was an overall 2-year lag in adoption of SLNB in less populated areas. While this may represent a more conservative approach as noted by the higher utilization in small tumors, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions. The provision of continued training in emerging technologies for rural surgeons, such as SLNB, should remain a priority in continuing surgical education.
Health care utilization and costs associated with skeletal-related events (SREs) in patients with breast cancer (BC) and bone metastases (BMets).
Authors: Hagiwara May , Chung Karen , Delea Thomas E. 
Published: February 2017

72 Background: Patients with BMets secondary to BC are predisposed to SREs, defined as spinal cord compression (SCC), pathologic fracture (PF), surgery to bone (SB), and radiation therapy to bone (RT). Information on health care utilization and costs to treat SRE episodes in BC patients are limited. The objective of this study was to document current patterns of healthcare utilization and costs of SRE in patients with BC and BMets. Methods: This was a retrospective, observational study using the Thomson MedStat MarketScan Commercial Claims and Encounters database from 9/2002 to 6/2011. Study subjects included all persons with claims for BC (ICD-9-CM 174.xx) and for BMets (ICD-9-CM 170.xx or 198.5x), and ≥1 claim(s) for SRE. Key inclusion criteria included no other primary cancer and continuous enrollment ≥6 mos prior to BMets diagnosis. Unique SRE episodes were identified based on a gap of ≥90 days without an SRE claim, and classified by treatment setting (inpatient [IP, hospitalized for SRE during episode] or outpatient [OP]) and SRE type (SCC; PF [and no SCC]; SB [and no SCC or PF]; RT [and no SCC, PF, or SB]). Results: Of 22,709 BC patients with BMets, 11,941 had ≥1 SRE. Among 5,809 patients who met all other criteria, there were 7,617 SRE episodes over a mean (SD) follow-up of 17.2 (15.2) mos. The percent of SRE episodes that required IP treatment ranged from 11% (RT) - 76% (SB) (23% overall). On average, IP SCC episodes were most costly; while OP PF episodes were least costly. Of the total SRE costs (mean [SD] $21,072 [$36,462]/episode), 36% were for OP RT and 31% were for IP PF. Conclusions: In patients with BC and BMets, SREs are frequent and associated with high costs and hospitalizations. OP RT and IP PF account for a large share of SRE costs. Treatments that prevent SREs in these patients may reduce these costs. [Table: see text]
Psycho-oncological screening in patients with newly diagnosed or relapsing breast cancer.
Authors: Karthaus Meinolf , Schuth I. C. 
Published: February 2017

80 Background: Breaking news in breast cancer (BC) pts often has to be supported by psychological help. It remains unclear which and how many BC pts need supportive psycho-oncological care, since pts may react in different ways. Some pts show high risk profiles for anxious reactions or depressions after breaking bad news and should be detected for interventions. Need for pychological intervention was screened with a simple 14-point item test (HADS). A scoring of <15 points was assumed to be at low risk for anxiousness and depression, a scoring of 15-21 points was considered medium risk while a score of >21 was assumed to describe high-risk pts. Pts considered to be at low risk, did not receive further intervention. Pts detected to be at medium or high risk received further psychological intervention. The aim was to evaluate efficacy of psychological support in pts with newly diagnosed BC or relapse of cancer >1 yr after a curative approach. Methods: Psycho-oncological screenings and interventions were analyzed in a tertiary cancer within a two-year period. Results: Out of a total of 611 cancer pts, 202 pts had BC. 63 pts had a newly diagnosis of cancer or a relapse of >1 year since primary diagnosis or therapy and signed informed consent. Pts assumed to be at low risk had a mean score of 6,97 (SD 3.71) prior and 7,03 (SD4.97) after the end of cancer therapy. In this group of low risk pts there was no further psychological intervention. In pts detected with a medium risk (15-21) mean HADS score prior therapy was 16.63 (SD 1.38) and fell down during cancer treatment and supportive psychotherapeutically intervention to 13.58 post therapy (SD 6.16). Pts with the highest risk at diagnosis had a mean of 28.25 (SD 4.41) and decreased to a mean HADS of 16.83 (SD 4.84) at the end of cancer therapy while being under supportive psychotherapeutically care. Mean number of psychotherapeutic sessions was 3.86/patient with a mean duration of intervention time of 1.38 h. Conclusions: BC pts with a HADS <15 should not be considered to be candidates for routine psychotherapeutically supportive care. Pts being at high-risk gained most benefit. A simplified scoring system for anxiousness and depression is recommended to detect pts with a need for further therapeutic treatment.
Comorbidity and outcomes after surgery among women with breast cancer: Analysis of national in-patient sample database.
Authors: Dehal Ahmed , Abbas Ali , Johna Samir 
Published: February 2017

83 Background: Evidence is scarce about the influence of comorbidity on short-term outcomes of patients with breast cancer after surgery. The objective of this study was to examine the effect of comorbidity on risk of postoperative complications, prolonged hospitalization (defined as above median length of stay), and in-patient death among women with breast cancer. Methods: National inpatient sample is a nationwide clinical and administrative database. Patient discharges with primary diagnosis code of breast cancer and coincident procedure code for breast surgery from 2005 to 2009 were identified using International Disease Codes 9th edition (ICD-9). Information about demographics, hospital characteristics, comorbidities, stage, surgical treatment, postoperative complications, length of hospital stay, and in-patient deaths was obtained. Comorbidities were identified using ICD-9 codes and used to calculate modified Charlson comorbidity index (CCI) score. We divided patients based on these scores into 4 groups: 0, 1, 2, and 3 or more. Multivariate logistic regression analyses were used to examine risk adjusted association between CCI score and the aforementioned outcomes. Results: We identified 75,100 patient discharges with a mean age of 61 years. Compared to patients with a CCI score of 0, as a reference group, CCI scores of 1, 2, and 3 or more increased the risk of post-operative complications by 1.7 fold, 2.6 fold, and 4.6 fold, respectively (p <0.001). Compared to patients with a CCI score of 0, CCI scores of 1, 2, and 3 or more increased the risk of prolonged hospitalization by 1.2 fold, 1.6 fold, and 2.3 fold, respectively (p <0.001). Similarly, Compared to patients with a CCI score of 0, CCI scores of 1, 2, and 3 or more increased the risk of in-patient death by 3.1 fold, 5.4 fold, and 15.8 fold, respectively (p <0.001). Conclusions: After controlling for potential confounders, we found a strong and statistically significant association between comorbidity and outcomes of patients with breast cancer after surgery. Effective control of comorbidity in breast cancer patients may reduce post-operative morbidity and mortality.
Uptake and experiences of breast cancer patients referred for fertility preservation.
Authors: Lewis Jaime D , Silva Celso , Quinn Gwendolyn P. , Lee Marie Catherine 
Published: February 2017

86 Background: The 2006 ASCO guidelines suggest women of childbearing age receive counseling and referrals regarding the impact of treatment on fertility. Less is known about the use and uptake of FP in these women. The objective of this study was to evaluate the experience of patients referred for FP from a multidisciplinary breast cancer program. Methods: After IRB approval, patients diagnosed with a primary breast cancer between January 1, 2006 and June 30, 2011 and referred for FP counseling were identified via queries of institutional databases. Clinicopathologic, treatment, and outcome data were collected. Patients who received a consultation with a reproductive endocrinologist (REI) and did not pursue FP were selected for further contact via telephone survey. Results: Twenty-two patients had a consultation with REI; 10 were nulliparous. Fifteen of these saw an REI prior to any treatment. Thirteen (59%) had embryo or oocyte preservation. The majority (9) underwent consultation with both surgical and medical oncology prior to REI. Nine of the 13 had surgery prior to FP. Of the remaining 9, 7 (78%) responded to a telephone survey. Six (86%) recalled counseling at the initial visit or prior to chemotherapy. Barriers to FP included: cost (3), perceived delay in chemotherapy (2), being overwhelmed by cancer diagnosis (2), uncertainty of FP effects on cancer (1), and ethical concerns (1). Conclusions: Patients counseled by multiple oncology providers in a multidisciplinary setting prior to REI consultation were more likely to pursue FP. Those who did not cited a number of factors in their decision. Consultation with multiple oncology specialists may enhance decision-making regarding FP. [Table: see text]
Risk of skeletal-related events (SREs) in patients with breast cancer (BC) and newly diagnosed metastases to bone.
Authors: Taneja Charu , Lamerato Lois , Glass Andrew , Richert-Boe Kathryn E. , Edelsberg John , Wolff Greg G. , Czapski Natalie , Chung Karen , Richhariya Akshara , Oster Gerry 
Published: February 2017

91 Background: Bone is a common site of metastatic involvement in patients (pts) with BC. Bony metastases (mets) are often associated with SREs (spinal cord compression [SCC], pathologic fracture [PF], surgery to bone [SB], radiotherapy to bone [RT]). Skeletal complications cause significant morbidity and mortality. Current estimates of SRE risk come principally from randomized clinical trials. Information from routine clinical practice is limited. Methods: Using the tumor registry and electronic data stores at a large U.S. Midwest healthcare system that serves approximately 800,000 persons, we retrospectively identified all pts aged ≥18 yrs with primary BC and newly diagnosed bone mets between 1/1/95 and 12/31/09. Electronic medical records were reviewed by trained abstractors for evidence of SREs between date of bone mets diagnosis and death, loss to follow-up, or end of study. Cumulative incidence of SREs was estimated in the presence of competing risk of death. Results: We identified a total of 378 pts with primary BC and newly diagnosed bone mets; 87 pts had evidence of SREs at initial diagnosis of bone mets and were excluded from the analyses. Among the remaining 291 pts, mean (SD) age was 58.2 yrs (14.3 yrs), and 99% were women; 48% were African-American and 46% were Caucasian. Median duration of follow-up after diagnosis of bone mets was 16.1 months (mos). At 12 mos, cumulative incidence of SREs was 44.5% (SCC, 5.2%; PF, 21.0%; SCC and/or PF, 23.3%; SB, 7.6%; RT, 34.3%) (Table). Corresponding figures at 24 mos were 53.8% (SCC, 7.5%; PF, 29.3%; SCC and/or PF, 32.5%; SB, 9.4%; RT, 41.7%). Approximately one-half (45.0%) of study subjects received intravenous bisphosphonates prior to SRE. Conclusions: Pts with BC in routine clinical practice are at high risk of SREs following initial diagnosis of bone mets. [Table: see text]
Male breast cancer: Overall survival in a single institution.
Authors: Bergmann Anke , Bello Marcelo Adeodato , Costa Celia Regina Andrade , Bender Paulo Francisco Mascarenhas , Thuler Luiz Claudio Santos 
Published: February 2017

93 Background: Male breast cancer is an uncommon disease and the therapy is mainly based on what is know from female breast cancer. Objective: To investigate the clinicopathologic characteristics of male breast cancer and the overall survival in a single institution. Methods: The clinical data and survival status of 75 male breast cancer treated in a Brazilian public cancer hospital from 2000 to 2009 were collected. The association with clinicopathological characteristics and overall survival was analyzed using Kaplan-Meier curves and the Cox proportional hazards regression (enter method) was used to assess survival differences after adjusting for confounders. The study was approved by National Cancer Institute Research and Ethics Committee (number 128/11). Results: The median patient age was 64 years (range 33-86). Estrogen receptor (ER) was positive in 58 (77.3%) patients, while progesterone receptor (PR) were positive in 47 (62.7%). Histology type was ductal infiltrant carcinoma for 57 (76.0%) and 51 (68.0%) patients underwent surgery. The median follow-up period was 43,1 months (range 2.7-147.8). The median survival from the diagnosis of breast cancer was 97.0 months (95%CI 53.6 -140.4) with a 61.7% 5-year overall survival (OS). In the final Cox regression model, independent factors associated with increased risk of death were metastasis at diagnosis (HR = 18.1; 95%CI: 5.9-55.2), ≥ 65 years old (HR = 4.3; 95%CI: 1.7-10.5); tumor stages ≥ IIb (HR = 3.5; 95%CI: 1.3-9.7) and smoking (HR = 1.6; 95%CI: 1.04-2.6). Conclusions: Invasive ductal carcinoma is the main pathologic type. The median survival from the diagnosis of breast cancer was 97.0 months and metastasis at diagnosis, patient age, tumor stage and smoking are independent prognostic factors.