bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P3-08-10: Feasibility and promise of a self-directed walking program to reduce joint pain among older breast cancer patients on adjuvant aromatase inhibitors
Authors: Nyrop KA , Muss HB , Hackney B , Cleveland R , Callahan LF 
Published: August 2014

Abstract
Background: Most breast cancer cases diagnosed among postmenopausal women are hormone receptor positive (HR+); standard adjuvant endocrine treatment usually includes an aromatase inhibitor (AI). Joint pain/stiffness/achiness (arthralgia) is a common AI side-effect, and AI discontinuation due to this side-effect is an estimated 20-32%. There is a need for effective alternative or adjunctive approaches to arthralgia management that enable survivors to remain on AI therapy while optimizing as pain-free a life as possible. This pilot study investigates the feasibility of a highly scalable 6-week self-directed physical activity (PA) program – Walk With Ease (WWE) – among elderly female breast cancer survivors on AIs who report joint pain. WWE goal: minimum of 30 minutes of walking 5 days a week (150 minutes/week).
Methods: Recruitment: BC survivors age 65+ were recruited through the oncology clinic of a university-affiliated hospital. Eligibility: age 65+; Stage I-III breast cancer; currently on AI therapy; self-reported joint pain/stiffness; physician permission to engage in PA; English speaking. Measures: (1) walking – number of days per week and number of minutes per walk, (2) visual analog scales (VAS) for joint pain, fatigue and stiffness, and (3) arthritis self-efficacy (ASE) to manage joint pain and fatigue. Statistics: t-test evaluation of changes in mean values.
Results: Sample (N = 20) – mean age 71 (65-87), 85% Caucasian, 35% &lt; high school, mean BMI 29. 63% chemotherapy, 61% radiation therapy. 90% completed the 6-week intervention. Compared to baseline, total minutes of walking per week increased from 95 (0-450) to 172 (45-700) (p&lt;.001) and mean joint pain decreased 10% (p = 0.63), fatigue decreased 19% (p = 0.31), and joint stiffness decreased 32% (p = 0.07). Post-intervention, 71% of participants were “fairly” or “extremely” confident they would continue walking; 100% would recommend WWE to other breast cancer survivors experiencing joint pain or stiffness; 100% thought they had learned how joint pain or stiffness could be lessened by physical activity, and how to safely engage in moderate-intensity physical activity; 90% thought WWE had motivated them to become more physically active, and how to overcome physical and mental barriers to walking; and 90% were fairly to extremely confident they would continue walking.
Conclusions: A moderate-intensity self-directed walking program is feasible for older breast cancer patients on AI therapy and almost doubled the total time of walking per week over a 6 week period. Joint pain, stiffness, and fatigue decreased, and the walking program was perceived as informative and motivational. These data are promising and the WWE intervention warrants testing in a larger randomized trial of breast cancer survivors on AI therapy.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-10.
Abstract P3-08-11: Pregnancy after breast cancer and recurrence risk
Authors: Preusse C , Gammill H , McDougall J , Ma K , Gooley T , Li C , Gadi VK 
Published: August 2014

Abstract
Background: Several retrospective studies report an improved overall (and possibly disease-free) survival of women who become pregnant following breast cancer diagnosis compared to women who choose not to or are unable to become pregnant. The objective of the current study is to evaluate associations with breast cancer biologic and stage characteristics from the baseline tumor with different recurrence outcomes in women with and without a pregnancy subsequent to their cancer diagnosis.
Methods: From a population-based cohort study of all women aged 20-44 diagnosed with invasive breast cancer in the three county Seattle-Puget Sound metropolitan area, we conducted a secondary recontact interview. Recontact information included cancer recurrence and obstetric history, including all pregnancies occurring after breast cancer diagnosis. Univariate associations were evaluated using chi square. A time-to-event analysis was conducted, evaluating the relationship between pregnancy and recurrence, with consideration of stage and tumor type (triple negative tumor or not) as confounders.
Results: At this interim, an approximately 70% response rate for the re-contact study was achieved, yielding data from 458 women overall. Excluding 8 women who were pregnant at the time of their breast cancer diagnosis, 450 were available for analysis. Of these, 13 (2.9%) became pregnant at least once after their breast cancer diagnosis. Among women with complete pathologic information available (n = 274), those with a pregnancy subsequent to their cancer diagnosis had triple negative tumor types more often than those who did not have a subsequent pregnancy (4/8, 50% vs. 44/266, 17%, p = 0.03). Tumor stage did not differ between women with and without a subsequent pregnancy. Overall, 30 total cancer recurrences were captured in the re-contacted cohort; none of these occurred among women with subsequent pregnancy (0/13, 0% vs. 30/437, 6.9% among women without subsequent pregnancy), p = 0.3. For 448/450 women with complete information on timing of recurrence, a time-to-event analysis adjusting for tumor type did not show a significant association between subsequent pregnancy and recurrence risk, p = 0.14 by Likelihood Ratio test.
Conclusions: In this population, breast cancer recurrence risk was not increased among women with a pregnancy subsequent to their cancer diagnosis. Despite the more common triple negative tumor type among the group of women with subsequent pregnancy, none of these women experienced a cancer recurrence. Our study adds to a substantial literature suggesting that pregnancy after breast cancer does not appear to have a detrimental effect on disease recurrence. The relationship between tumor type and its potential influence on both decision-making regarding pregnancy and the biology of pregnancy as it relates to breast cancer recurrence merits further investigation.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-11.
Abstract P3-08-17: Objectively measured physical activity in breast cancer survivors
Authors: Soria A , Pagola I , Ortega MJ , Brea L , Fiuza C , Cebolla H , Palomo I , Montil M , Malón D , Guerra J , Lucia A , Ruiz A 
Published: August 2014

Abstract
Background: Obesity and physical inactivity are poor prognostic indicators for breast cancer (BC). Cardiorespiratory fitness (VO2max) is a good predictor of survival. Despite preserved LVEF, cardiorespiratory function is impaired in women with breast cancer after the completion of adjuvant therapy. International organizations recommend at least 150 minutes per week of moderate-vigorous physical activity (MVPA). Some studies show that a minority of cancer survivors are meeting the PA recommendations. A limitation of physical activity (PA) research has been the use of self-reported measures.
Eligibility criteria: 1) Age 18-79, 2) Able to walk a mile, 3) More than one year from diagnosis, 4) More than 3 months since the last therapy, 5) No evidence of disease.
Aims: Objective assessment of physical activity in breast cancer survivors. Adherence to international recommendations.
Material and methods: PA was evaluated through accelerometry (600 minutes per day, 5 days per week, 2 week-end days were required to consider as valid accelerometry values). Cardiorespiratory fitness was assessed through the “one-mile test”.
Results: 92 women (W) with BC history were included. 86 W were evaluable for accelerometry. 85 W were evaluable for VO2max. Age: 54.02 years (33-77), BMI: 27.89 (SD 8.89), waist perimeter: 89.74 cm (SD 17.37), median time from diagnosis 3.94 years, treatment with anthracyclines 55 W (63.9%), radiotherapy 69 W (80.23%). Accelerometry (86W): Average weekly time MVPA 351.14 min/wk (SD: 168.98). 76 (88%) met international recommendations of PA. Women previously treated with anthracyclines (47 W; 340.25 min/wk), radiotherapy (59 w; 343 min/wk) and both (48 W; 331 min/wk) exercised less than women who did not receive these therapies (8 W; 386 min/wk). This association was not statistically significant.
Average VO2max was 24.8 ml/kg/min (SD: 7.6).There was a significant effect of anthracyclines for VO2 max. Women not treated with anthracyclines had a VO2max: 26.41 whereas treated W had VO2max 22.08 ml/kg/min.
Discussion: A cohort of Spanish women met international recommendations of PA when it was objectively assessed. This cohort exhibited a poor cardiometabolic and cardiorespiratory profile. Previous exposure to anthracyclines predicted a poorer cardiorespiratory fitness. Specific research to investigate the role of exercise to mitigate that dysfunction in breast cancer survivors is warranted.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-17.
Abstract P3-09-14: Using lean methods to increase access to support services in younger breast cancer survivors
Authors: Mayer DK , Kinley T , Gerstel A , Jackson M , Shea T , Donald RL , Lawrence MB 
Published: August 2014

Abstract
Background: A variety of ‘structured support services’ (services) are available to patients (e.g. genetics, fertility, counseling, physical functioning, nutrition). Many of these services have value for breast cancer survivors (survivors) as they are often likely to face issues regarding genetic factors, fertility, parenting, relationships, work, and financial hard-ships. As part of an ongoing CDC-funded initiative, we report about barriers to services use for survivors.
Methods: We used lean techniques to analyze system complexity including: process mapping; inventorying support services, providers/staff, and referral methods; stake holder leadership events; and Kaizen events to facilitate system improvements.
Results: We identified several barriers to patients getting services which reflect the complexity of cancer care delivery in an academic cancer center including: varying care pathways, lack of standard processes; lack of staff awareness of available service (hospital staff are located in 5 different clinics and include physicians, APPs, clinic nurses, nurse navigators, and patient schedulers); numerous different contact and referral methods to services (tribal knowledge of staff necessary to make SS referrals). We initially identified 7 and found 38 services through inventorying and mapping systems.
We implemented a number of systematic and non-systematic interventions to address these barriers. Systematic implementations include assisting in the development and piloting new patient orientation binders to include services, implementation of a revised scheduling form to streamline referrals, created and disseminated a quick reference referral guide to educate staff for how to make referrals. Non-systematic interventions included hosting services fair for breast cancer providers to meet and learn about them and advertising services on waiting room TVs.
Conclusions: Patients and providers both perceive many challenges accessing support services. Applying improvements in a complex health care system is difficult and incrementally addresses identified barriers. We will now be measuring the impact of these changes on the receipt of support services in breast cancer survivors.
Funding: CDC Grant 1U58DP003414 (PI Marks, L.).
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-14.
Abstract P3-11-02: Women with pregnancy-associated early breast cancer achieve improved emotional well-being as a result of their cancer experience
Authors: Murthy RK , Schover LR , Theriault RL , Valero V , Woodard TL , Hodge S , Litton JK 
Published: August 2014

Abstract
Background: Pregnancy-associated early breast cancer (PAEBC) has increased in incidence as more women pursue childbearing at an older age. The objective of this study was to measure the impact of diagnosis and treatment on emotional health and evaluate the positive emotional outcomes in a group of women with PAEBC. Methods: Between 1989 and 2010, 81 patients were treated for PAEBC with 5-flurouracil, doxorubicin and cyclophosphamide (FAC) chemotherapy. Patients completed the Impact of Events Scale-Revised (IES-R), which is a questionnaire that measures subjective distress caused by traumatic events and the Post-traumatic Growth Inventory (PGI), which measures positive outcomes after a traumatic event. Results: Of the 81 women, 53% (43/81) completed the IES-R and 44% (36/81) also completed the PGI. The time since diagnosis ranged from 6 months to greater than 5 years. The median age of the participants was 33 years (range 26-43 years). Of the 43 patients who completed the IES-R, 91% (39/43) did not use avoidance as a primary coping strategy; they felt well equipped to deal with feelings about their diagnosis and treatment. Of patients who inadvertently thought about their diagnosis, 70% (30/43) noted that they avoided becoming upset by their thoughts. Less than 10% (9/43) of patients surveyed felt apathetic towards their diagnosis and subsequent treatment. In terms of positive outcomes, 94% (33/36) felt they were enabled to depend on others in times of crises and felt a greater appreciation for people and their kindness following their diagnosis of PAEBC. Eighty-six percent (31/36) had changed their priorities about what is important in life, felt more compassionate towards others, and felt a greater appreciation for the value of their own life. In addition, 86% (30/36) of patients indicated that they had discovered their inner strength and felt more inclined to change things in their life. Finally, 75% of patients surveyed felt they had developed a stronger religious faith because of their experience and had a better understanding of spiritual matters. The majority of patients reported improvement in interpersonal skills – placing more effort into their relationships and sharing a greater sense of closeness with others. Conclusions: Although women who experience PAEBC are thought to be at high risk for experiencing psychosocial distress, these findings suggest that most do not suffer negative emotional consequences; in fact, these data suggest that they often achieve improved emotional well-being as a result of their cancer experience. It is possible that these women have better emotional outcomes because they have successfully carried a pregnancy while facing a life-threatening illness. Comparisons to other premenopausal breast cancer survivors will be crucial in interpreting these findings.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-11-02.
Abstract P3-12-10: Feasibility of four cycles of docetaxel and cyclophosphamide every 14 days as an adjuvant regimen for breast cancer: A Wisconsin oncology network study
Authors: Wisinski KB , Burkard ME , Njiaju U , Donohue S , Hegeman R , Stella A , Mansky P , Shah V , Goggins T , Qamar R , Dietrich L , Kim K , Traynor A , Tevaarwerk A 
Published: August 2014

Abstract
Background: Dose-dense therapies have had a major impact on reducing toxicity and improving outcomes in breast cancer. A combination of docetaxel plus cyclophosphamide (TC) every 3 weeks has emerged as a common chemotherapy regimen used for treatment of node-negative or lower-risk node-positive breast cancer. We tested whether it is feasible to deliver TC on a dose-dense schedule.
Patients and Methods: We enrolled women with early stage breast cancer on a single-arm phase II study of adjuvant dose-dense TC (ddTC) through a regional oncology network (WON). All women completed primary surgery; subsequent therapy with TC was deemed appropriate by the treating physician. Planned treatment was docetaxel 75 mg/m2 plus cyclophosphamide 600 mg/m2 every 2 weeks for 4 cycles with subcutaneous pegfilgrastim 6 mg administered 24-48 hours after the administration of each chemotherapy cycle. The primary endpoint was feasibility of administering therapy within 10 weeks. A Simon Optimal 2-Stage design was employed for the study design.
Results: Of 42 women enrolled, 41 were evaluable by prespecified criteria. Median age was 54 (28-73). Most subjects had node negative (73%) or hormone receptor positive (71%) tumors. Of the 41 subjects, 37 (90.2%) completed therapy within 10 weeks and 34 (83%) completed therapy at 8 weeks without dose modification. Rates of grade 2 neuropathy were similar to that reported previously (15%) and there were no cases of grade 3 or higher neuropathy. The rate of neutropenic fever was low (2.5%). Rash and plantar/palmar erythrodythesia were common and reached grade 3 in four subjects (9.8%).
Conclusion: Dose-dense TC is feasible with tolerability profiles similar to standard TC and a low likelihood of neutropenic fever. This study supports further clinical development of this 8-week adjuvant chemotherapy regimen.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-10.
Abstract P3-12-11: Provincial variation in utilization of adjuvant chemotherapy regimens in early stage breast cancer: Data from the cancer care Ontario new drug funding program (NDFP)
Authors: Eisen A , Srikanthan A , Yeung L , Iyer R , Trudeau M 
Published: August 2014

Abstract
Objectives: Recent improvements in breast cancer mortality are partly due to increased utilization of appropriate systemic therapy in early stage disease. The objectives of this study were to 1. review utilization of the most effective adjuvant breast cancer regimens across Ontario, 2. identify regions where there are variations from best practices.
Methods: We used data from the Ontario NDFP to determine the utilization of 8 drug regimens approved for early stage breast cancer in each of the 14 provincial local health integration networks (LHINs). The NDFP funds the use of new and expensive cancer drugs; over 90% of all cancer treatments are funded through this mechanism. In Ontario, there were an estimated 9000 new cases of breast cancer in 2011. The analysis was restricted to patients with early stage, Her2 negative breast cancer treated in 2011-12. Data were obtained from individual cancer clinics in each LHIN. We estimate that data collection was &gt;95% complete for these regimens.
Results: 3375 women were treated with an NDFP regimen. Across the province, the most commonly used regimen was FEC-D (43%), followed by TC (23%) and ddACT (21%). The remaining regimens (AC-Docetaxel, ACT q 3 wks, CEF, FEC and AC-weekly P) were used in less than 5% of cases. However, there was important regional variation. In LHIN A, ACT q 3 wks was used in 42% of cases, and no patients received FEC-D. In LHIN P, TC was used in 40% of cases. In LHIN R, only 6% of patients received FEC-D, whereas 63% received ddACT.
Utilization of Adjuvant Chemo Regimens n = 3375 AC-DocetaxelddACT q2wksACT q3wksAC-weekly PCEF/FECTCFEC-DLHIN K212004109241LHIN J3417101545212LHIN Q12000640104LHIN D1530732568165LHIN V57120031027LHIN R5188390104018LHIN P2246184111115LHIN B35311182795LHIN C0588002326LHIN A0132581120LHIN H2410189109LHIN T510425466038LHIN M1011318319175263LHIN S1715004728Total (%)128 (4)708 (21)156 (5)37 (1)139 (4)766 (23)1441 (43)
Conclusion: The ACT q3 wks and TC regimens are widely used. This is of concern as they are likely less effective than FEC-D or ddACT. Factors such as tumour stage, geographic distance from treatment centre and private insurance coverage for supportive care medications may also affect choice of regimen. Consensus guidelines for the adjuvant systemic therapy of breast cancer in Ontario are being developed, along with a knowledge translation strategy to disseminate the results.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-11.
Abstract P3-12-12: Body mass index does not influence febrile neutropenia and delivered dose intensity in adjuvant chemotherapy for breast cancer
Authors: Mayr D , Hochreiner G , Fuchs D , Fridrik MA 
Published: August 2014

Abstract
Background
Obese patients are often not fully dosed when receiving adjuvant chemotherapy for breast cancer, which might influence the inferior outcomes seen in this patient population. Current guidelines recommend full, weight-based dosing of chemoherapy for obese patients. The aim of the present study was to assess toxicity and deliverable dose intensity in patients treated with adjuvant chemotherapy for breast cancer.
Patients and Methods
We conducted a single-center retrospective case review on patients treated with adjuvant chemotherapy for early breast cancer at our institution from 2009 to 2012. Data were extracted from electronic patient records and side effect were graded according to CTC AE 3.0 in the source data.
Statistics: Chi-Square, Fisher's exact test, MANOVA and repeated measures ANOVA. Software: SPSS 18.
The study received approval from the local ethics comitee.
Results
We included 187 patients (185 female, 2 male) who received a total of 924 courses of chemotherapy with full eight-based dosing with either 6 courses of FEC-T (n = ,%) or TC (n = ,%). There were no differences accross BMI categories for age, gender, endocrine receptor expression, grading or her2-status.
Obese patients had more unplanned admission (p = 0.008), infections (grade 3-4, p = 0.005, all grades, p = 0.025) and diarrhoe (all grades, p = 0.033) compared to normal-weight patients. This was not the case for overweight patients (p = 0.063, 0.322, 0.199, 0.107, 0.065). Obese and overweight patients had more constipation than normal-weight patients (all grades, p = 0.025 and 0.006, respectively). There were no signficant differences across weight categories for neutropenic fever, delivered dose intensity, dose reduction and premature discontinuation of therapy.
Discussion
Obese and overweight patients can be treated with full dose intensity and do not suffer from excessive serious complications compared to normal-weight patients. However, due to partly increased toxicity seen in obese patients, adequate supportive therapy is of particular importance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-12.