bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient satisfaction with cancer care delivery through telemedicine at a comprehensive cancer center across three years during and after the COVID-19 pandemic.
Authors: Doshi Sahil D , Khadem Charvadeh Yasin , Seier Kenneth , Bange Erin Mary , Daly Robert Michael , Polubriaginof Fernanda C. G. , Buckley Michael T. , Kuperman Gilad , Stetson Peter D. , Schrag Deb , Morris Michael J. , Panageas Katherine 
Published: May 2024

1632 Background: Telemedicine, once sparingly utilized, surged during the COVID-19 pandemic to enhance care accessibility and safety concerns. Despite initial satisfaction, its usage remains highly variable across institutions. We sought to explore patient satisfaction at a comprehensive cancer center, associations with demographic characteristics, and change over time. Methods: A survey was sent to all first-time telemedicine users at Memorial Sloan Kettering Cancer Center from September 2021 to October 2023. Adult patients who had their initial telemedicine visit, regardless of specialty, received the questionnaire. It comprised 10 general questions about the telemedicine experience and 11 questions regarding clinical trial education and informed consent. To analyze the unstructured free text responses, we employed BERTopic, a topic modeling algorithm that leverages transformer-based embeddings to facilitate the creation of easily interpretable topics within a collection of text documents. Through topic modeling with BERT embeddings, we captured subtle nuances and semantic relationships in language to identify topics more effectively. Results: A total of 15,111 patients completed 15,251 questionnaires; 140 patients completing two surveys. Patient demographics are summarized in Table 1; the median age at encounter was 66 years and 98% of patients preferred English. Satisfaction levels were high, with 92% expressing willingness for future telemedicine visits and 90% recommending it to other patients. Notably, 21% found telemedicine superior to in-person visits, while 53% considered them equal. Further, satisfaction remained consistent across six-month intervals from 2021-2023. In 1606 (11%) surveys, patients noted discussing clinical trials; 17% preferred in-person discussions for the informed consent process while most either preferred telemedicine or had no preference. Topic modeling revealed 18 topics within the unstructured dataset; key topics included comments on video & audio quality, connectivity and technology issues, convenience for patients who live outside of the city and those with physical limitations, and long wait time to see a doctor. Conclusions: Our analysis confirms high patient satisfaction with telemedicine, including discussions on clinical trial enrollment, that has remained consistent in the years following the COVID-19 pandemic. Given variability in use, it is important to identify how to better deliver telemedicine to those patients who prefer it.[Table: see text]
Oncologic outcome of response-guided axillary treatment in patients with cN1 breast cancer after primary systemic therapy.
Authors: van Hemert Annemiek , van Loevezijn Ariane , Baas Marie-Sophie , Stokkel Marcel P , Groen Emilie , van der Noort Vincent , Loo Claudette , Sonke Gabe S. , Russell Nicola , van Duijnhoven Frederieke H , Vrancken Peeters Marie-Jeanne T.F.D 
Published: May 2024

514 Background: In breast cancer, the majority of clinically node positive (cN1) patients are treated with primary systemic treatment (PST), with increasing rates of axillary pathologic complete response (pCR). Evidence supporting tailoring axillary treatment according to the response is growing. However, it is still debatable whether ALND is beneficial in cN1 patients with residual nodal disease and if any further axillary treatment is necessary in patients achieving pCR. In this study, we present the four-year oncologic outcome of cN1 patients undergoing either axillary radiation treatment or no axillary treatment according to the ‘Marking Axillary lymph nodes with Radioactive Iodine seeds’ (MARI)-protocol. Methods: Between 2014 and 2021, we prospectively enrolled patients with node positive breast cancer and 1 - 3 involved axillary lymph nodes on FDG-PET/CT pre-PST, who were treated according to the MARI-protocol. Patients with residual disease of the MARI node (ypN1) received axillary radiotherapy (RT), while patients with a pCR of the MARI node (ypN0) received no further axillary treatment. The primary endpoint was the axillary recurrence rate. Secondary endpoints include invasive disease free survival (iDFS) and overall survival (OS), calculated using the Kaplan-Meier method. Results: Of the 367 included patients, more than half (54%, n= 198) had hormonal receptor positive (HR+)/Human Epidermal growth factor 2 negative (HER2-) breast cancer; 59 patients (16%) had HR+/HER2+; 39 patients (11%) had HR-/HER2+ and 71 patients (19%) had triple negative (TN) subtype. Median age was 49 (IQR 41 – 56) years. 231 (63%) patients who had ypN1 received RT and 136 patients (37%) who achieved ypN0 received no further axillary treatment. Median follow up was 49 (IQR 32 – 70) months. Axillary recurrence rate was 3.5% ( n= 8) in patients with ypN1 and 0.7% ( n= 1) in patients with ypN0. Most axillary recurrences ( n= 6) occurred simultaneously with distant metastases in the ypN1 group. In patients with ypN1, the iDFS was 86% and the OS 93%; in ypN0 patients, the iDFS was 93% and the OS 98%. Conclusions: Response-guided axillary treatment in patients with limited nodal disease according to the MARI protocol is associated with favorable oncologic outcome without performing ALND’s. De-escalation can therefore be considered safe. [Table: see text]
Recurrence score gene axes scores and outcomes by race and ethnicity in the RxPONDER trial.
Authors: Abdou Yara , Hoag Jess R , Barlow William E. , Gralow Julie R. , Meric-Bernstam Funda , Albain Kathy S. , Hayes Daniel F. , Lin Nancy U. , Perez Edith A. , Goldstein Lori J. , Chia Stephen K. L. , Dhesy-Thind Sukhbinder K. , Rastogi Priya , Schott Anne F. , Racz Jennifer M. , Tripathy Debashish , Hortobagyi Gabriel N. , Pusztai Lajos , Sharma Priyanka , Kalinsky Kevin 
Published: May 2024

515 Background: Racial inequities in breast cancer outcomes remain a significant healthcare concern. In a previous analysis of the RxPONDER trial by race/ethnicity, we showed that non-Hispanic Black (NHB) women have worse outcomes compared to non-Hispanic Whites (NHW) despite similar 21-gene recurrence scores (RS). The RS is determined by an assay consisting of 16 cancer-related genes involved in invasion, ER and HER2 signaling, and proliferation. To provide a better understanding of the differences in underlying tumor biology amongst different racial/ethnic groups, we analyzed RS gene axes scores amongst each group and associations with outcomes. Methods: A total of 3,102 women were included: Hispanic (15.5%), NHB (4.7%), Asian (9.5%), and NHW (70.2%). The primary outcome was invasive disease-free survival (IDFS). This analysis extends median follow-up from 5 to 7 years and evaluates gene axes scores that are components of the RS by race/ethnicity. Impact of proliferation, ER, GRB7 (HER2), and invasion axes scores on IDFS was evaluated in Cox regression models. Results: There were no differences in RS distribution across racial/ethnic groups, and RS remained prognostic for each group with no significant variation in RS prognostic value. However, NHBs were noted to have significantly higher proliferation axis scores than NHWs (p<0.001); HER2 axis scores was higher for Asians than NHWs (p<0.001); and Hispanics had both higher HER2 (p=0.002) and proliferation (p=0.02) axes scores compared to NHWs. These results remained statistically significant after adjusting for age. Relative to NHWs, IDFS was worse for NHBs (HR 1.41; 95% CI 0.98-2.03) and better for Asians (HR 0.63; 95% CI 0.43-0.91) in unadjusted analysis. Adjusting for treatment arm, age, grade, menopausal status, proliferation, ER and HER2 axes scores attenuated the impact of race on IDFS for NHBs (HR 1.22; 95% CI 0.84-1.76), although the findings were unchanged for Asians (HR 0.64; 95% CI 0.44-0.93; Table). In a multivariable model, proliferation axis (HR 1.56; 95% CI 1.35-1.80) and ER axis (HR 0.81; 95% CI 0.71-0.93) were prognostic for IDFS. Conclusions: RS gene axes scores differ by race/ethnicity with higher proliferation axis scores noted in NHBs, which could partially explain their inferior outcomes noted in RxPONDER. These findings suggest that tumor biology is indeed important, however, we must dig deeper to uncover intricate factors that contribute to disparities, which is key to designing comprehensive strategies to address them. Clinical trial information: NCT01272037 . [Table: see text]
Estimating benefit from dose dense adjuvant chemotherapy for early breast cancer in the PANTHER randomized phase 3 trial.
Authors: Matikas Alexios , Gnant Michael , Johansson Hemming , Untch Michael , Tsiknakis Nikolaos , Greil Richard , Loibl Sibylle , Foukakis Theodoros , Bergh Jonas C. S. 
Published: May 2024

521 Background: Adjuvant dose dense chemotherapy for early breast cancer improves patient outcomes across all subgroups compared with standard interval treatment. However, the effect of dose dense treatment based on individual patient risk and over time, and the performance of the PREDICT model at this setting are not well-studied. Methods: This is an exploratory analysis from the phase 3 PANTHER trial (NCT00798070) that compared adjuvant sequential epirubicin/cyclophosphamide (EC) and docetaxel (D) administered in either tailored dose dense (tDD EC/D, every 2 weeks) or standard interval schedule (FEC/D, every 3 weeks) to patients with high-risk resected early breast cancer. Dose tailoring in the experimental arm was performed according to a predefined algorithm based on hematologic and non-hematologic toxicity. We evaluated the performance of PREDICT in terms of calibration and discrimination in the entire cohort and subgroups of interest, conducted a subpopulation treatment effect pattern plot (STEPP) analysis and observed the relative treatment effect over time. Results: The intention-to-treat population consists of n=2003 randomized patients. Median follow-up was 10.3 years (interquartile range, 9.1 – 10.5 years). PREDICT consistently underestimated 5-year (absolute difference 1.4%) and 10-year overall survival (absolute difference 6.6%) in the entire population and across all subgroups, but mostly so in the highest risk patients where the difference between observed and predicted 10-year survival reached 20.4% for patients with tumors larger than 5 cm. Discriminatory accuracy was lower for 10-year than for 5-year survival (AUC 0.728 and 0.786, respectively), although the difference in model performance between the two treatment groups was small. In STEPP analysis, absolute benefit from tDD EC/D in the primary endpoint of breast cancer relapse free survival was stable across risk-defined overlapping subpopulations and ranged from 3.8% in the lowest risk patients to 3.6% in the highest risk ones. There was no evidence of differential treatment effect through time (pinteraction >0.1 for all time-to-event endpoints). Conclusions: In this largely node-positive population, PREDICT consistently overestimated risk for death in all patient subgroups. We could not reliably identify any subgroup not benefiting from dose dense treatment, which should be the standard of care for primary resected high-risk breast cancer. Clinical trial information: NCT00798070 .
Patient-reported provider communication skills and adherence to recommended treatment in breast cancer.
Authors: Chino Fumiko , Chino Junzo P. , Thom Bridgette , Meske Sam , Ganz Patricia A. , Weiss Marisa C. 
Published: May 2024

537 Background: Effective communication is essential to build trust and improve patient understanding of cancer diagnosis and treatment. Little is known about patient comprehension of provider explanations and whether better communication influences adherence to recommended treatment especially in breast cancer (BC) which may require years of adjuvant treatment. Methods: Between 7/2023-8/2023, active patients and survivors were recruited from Breastcancer.org and consented to participate in an anonymous online survey in English or Spanish. Eligibility included: US resident, age ≥18, and diagnosed with BC within the past 10 years. Survey assessed patient-reported overall communication, side effect communication, and treatment adherence. Multivariate analysis (MVA) assessed relationship of patient-reported understanding and treatment adherence after controlling for gender, age, stage, race, ethnicity, and education. Results: Of 1266 screened, 997 met eligibility and participated. 98.2% identified as women, 81.2% White, 4.8% Black, and 4.2% Hispanic. Median age was 62 (interquartile range IQR 53-69) and median time since diagnosis 2.1 years (IQR 1-5.1). 6.5% had metastatic disease. 77.3% had a college degree. 93.4% participants reported their doctors “usually” or “always” explained things in a way they could understand. On MVA, there was a trend for minoritized groups (Black, Hispanic, Indigenous patients) to report their doctors were less likely to explain things well (OR 0.57, 95%CI 0.30-1.06, p=0.08) but there were no significant differences. Most felt their doctors “definitely” (45.8%) or “to some extent” (10.3%) explained possible short-term side effects. One-third (35.2%) stated their doctors explained “to some extent” and that they also did their own research to fully understand short-term side effects; 6.1% stated that their own research was the only thing that helped them understand as their doctors did not explain. Less than one-third (27.9%) felt their doctors “definitely” explained possible long-term side effects. 7.7% participants took less medication that their doctors prescribed due to treatment side effects, 15.1% stopped taking a medication or treatment altogether. Patients who reported that their doctors were “sometimes” or “never” understandable were more likely to reduce or stop their treatment (44.4% vs 21.3%, p<0.001). This held true on MVA: patients reporting poor communication were less likely to adhere to recommended treatment (OR 0.36, 95%CI 0.21-0.62, p<0.001). Conclusions: Surveyed patients with BC report good provider communication skills overall but note that side effect profiles are not always well-explained, especially for long-term side effects. More than 1 in 5 did not follow some aspect of BC treatment as recommended, and those who reported poor communication with their providers were 64% less likely to be adherent to recommended care.
Long-term oncologic outcome of breast-conserving surgery in breast cancer with BRCA 1/2 mutation (ON-BRCA II, KoREa-BSG 06).
Authors: Lee Janghee , Ryu Jai Min , Kim Hong-Kyu , Park Hyung Seok , Kang Byeongju , Ahn Sung Gwe , Chung Min Sung , Shin Seon-Hi , Go Junwon , Kim Sanghwa , Kim Eun Young , Kang Young-Joon , Min Sun Young , Lee Moo Hyun , Shin Eunju , Shin Jisoo , Lee Sae Byul , CHA CHIHWAN 
Published: May 2024

552 Background: Among patients with sporadic breast cancer, it is well known that prognoses are similar following breast-conserving surgery (BCS) versus mastectomy. However, previous data assessing oncologic outcomes between BCS and mastectomy in patients with BRCA mutation are limited and inconsistent. Thus, this study aims to compare the oncologic outcomes including locoregional recurrence (LRR), distant recurrence (DR), and overall survival (OS) among this population. Methods: Patients with BRCA mutation and index breast cancer who underwent BCS or mastectomy between January 2008 and December 2015 were retrospectively screened from 13 institutions. We included patients aged from 20-80 with invasive breast cancer (pT1-3 N0-3). Patients with de novo metastasis were excluded. To minimize selection bias from retrospective nature, the propensity score matching (PSM) with Greedy nearest neighbor method was performed for covariates including age, molecular subtype, and tumor stage. Results: A total of 553 patients with BRCA mutation were identified. Among them, 367 (66.2%) patients received BCS and 186 (33.8%) were treated with mastectomy. After 1:1 PSM, there was no significant differences in age, molecular subtype, tumor size, nodal status, and histologic tumor grade between patients undergoing BCS versus mastectomy. At 8.3 years of median follow up, LRR, DR, and OS rates did not differ between groups (all p > 0.05). On multivariate analysis, type of breast surgery (BCS vs. mastectomy) was not significantly associated with the oncologic outcomes after adjusting covariates including age, molecular subtype, tumor stage, and histologic grade (all p > 0.05). Additionally, we performed subgroup analysis in matched patients based on tumor size, LN metastasis, HG, and subtype. In all subgroup, the type of breast surgery was not a significant risk factor influencing disease recurrence. Conclusions: Our findings suggest that there was no difference in oncologic outcomes among BRCA mutation carriers who underwent BCS or mastectomy. Breast conservation with close surveillance is a reasonable treatment option for BRCA mutation carriers. Further studies combined with prospectively collected data are warranted to validate our findings.
Radiogenomics of homologous recombination deficiency (HRD) in breast cancer: Radiomics-based image biomarker for HRD.
Authors: Lim Joonoh , Paik Pill Sun , Lee Jeongmin , Oh Brian Baek-Lok , Kim Ryul , Ju Young Seok , Lee Jeong Seok , Kwon Minsuk , Lee Sangmoon , Lee Won-Chul 
Published: May 2024

554 Background: Homologous recombination deficiency (HRD) in breast cancer is an actionable target, with treatment efficacy potentially linked to timely detection. Notably, BRCA1 and BRCA2 are key genes implicated in HRD, and their pathogenic germline mutations are crucial criteria for the use of poly (ADP-ribose) polymerase inhibitors (PARPi). Although germline BRCA1/2 mutations are detectable in only a small fraction (1-5%) of breast cancers, recent whole-genome sequencing (WGS) studies have revealed that up to 22% of breast cancers also exhibit HRD-like genomic characteristics, suggesting a broader potential for HRD-targeted therapy. This has spurred the development of genomic-feature-based HRD identification methods. However, the invasive and costly nature of these methods poses a challenge. This has prompted our investigation into non-invasive image biomarkers for HRD identification. Methods: Invasive breast cancer patients were recruited from March 2021 to August 2022. Eligibility criteria included availability of fresh-frozen tumor tissue for WGS and suitability for dynamic contrast-enhanced (DCE) MRI to facilitate radiomics analysis. The association between HRD and radiomic features as well as clinicopathologic factors was investigated through rigorous genomic and statistical analysis. Results: This study encompassed 145 patients aged 20 to 69 years, of whom 16.6% (24 out of 145) were genomically identified as HRD. All patients harboring pathogenic germline mutations in BRCA1 (n=3) or BRCA2 (n=2), along with concomitant somatic LOH, exhibited HRD. A comprehensive analysis of 214 radiomic features revealed that tumor sphericity, informational measure of correlation 1 (IMC1), size-zone non-uniformity normalized (SZNN), and small area emphasis (SAE) derived from subtracted early dynamic T1-weighted imaging were significantly correlated with HRD. Moreover, these radiomic features demonstrated substantial diagnostic value, as evidenced by their ROC-AUC and PR-AUC performance against baseline models: Sphericity (ROC: 0.62, p=0.055; PR: 0.22, p=0.053), SAE (ROC: 0.63, p=0.052; PR: 0.32, p=0.007), SZNN (ROC: 0.63, p=0.04; PR: 0.30, p=0.007), and IMC1 (ROC: 0.62, p=0.067; PR: 0.29, p=0.02). Additionally, our findings suggest that these radiomic features are more directly related to HRD than to the triple-negative phenotype, which is commonly linked to HRD. Conclusions: We found that four radiomic features from MRI have significant predictive value for identifying HRD in breast cancer. Given their fair predictability and immediate availability, these features are ideally suited for a screening approach, potentially identifying more patients eligible for targeted treatment. This finding represents a significant advancement in the fields of radiology and precision oncology, opening new avenues for patient-specific treatment strategies.
Postpartum breast cancer: Analysis of factors related to pregnancy and identification of differential prognostic markers.
Authors: García Cesteros Natalia , López-Herrero López María , Guevara Madrid Geraldina , Mora Martin Fernando , Teso Martín Beatriz , De La Fuente Dominguez Iciar , Guil Luna Silvia , Aranda Aguilar Enrique , De La Haba Juan 
Published: May 2024

557 Background: Postpartum breast cancer (PPBC) has an increasing incidence. It is associated with a worse prognosis compared to other breast cancers diagnosed outside of this stage. Objectives: To study clinical and histopathological differences between PPBC (diagnosed within 10 years after delivery) and non-postpartum breast cancer (NPBC, diagnosed more than 10 years after delivery or in nulliparous). Analyze whether reproductive factors such as parity or lactation influence these characteristics. Methods: An observational, analytical and retrospective case-control study is carried out. For the first part, we consider those women with PPBC as case; healthy mothers as control. For the second part, we consider PPBC women as case; NPBC women as control. The data have been analyzed with SPSS v.22. Results: 2698 women under 45 years were recruited. 264 (9.8%) have breast cancer and 2434 (90.2%) are healthy women. The percentage of ex-smokers is higher in PPBC compared to healthy mothers (30.6% vs. 19.7%) (X2=9.632; p=0.022; SS). The proportion of women with previous gynecological pathology is higher in PPBC group than in the group of healthy mothers (48.9% vs. 25.7%) (X2=33.767; p<0.001; SS). The same occurs with previous breast pathology (51.9% vs. 21.7%) (X2=62.75; p<0.001; SS). Women with early PPBC (diagnosed within 5 years after delivery) have higher percentage of previous mastitis compared to the rest of groups that develop tumor beyond 5 years postpartum (20.3% vs. 3.6%) (X2=17.76; p=0.023; SS). The percentage of female pregnancies is more frequent in early PPBC (58.6%) compared to non-postpartum or late PPBC (42.4%) (X2=4.039; p=0.044; SS). The percentage of women who abruptly discontinued breastfeeding is higher in those with PPBC with 27.5% compared to healthy mothers (12.6%) (X2=18.448; p<0.001; SS) (Table). PPBC has higher percentage of stages II (63.9%), the other group of NPBC is mostly diagnosed in stage I (64.9%) (X2=9.808; p=0.002; SS). We found higher elevated expression of Ki67 in early PPBC (90.1%), compared to non-postpartum cancer or late PPBC (77%) (X2=6.252; p=0.012; SS). We observe higher proportion of negative estrogen receptors in early PPBC (36.6%) compared to late PPBC or non-postpartum cancer (13.6%) (X2=9.880; p=0.002; SS). Conclusions: Postpartum breast cancer presents different clinical and histopathological characteristics, highlighting differences in early postpartum period. PPBC has worse prognosis, it constitutes a different entity. Breastfeeding abrupt interruption is associated with development of PPBC. [Table: see text]