tbuckley/cabot-search huggingface dataset:
Association between clinical outcome of first EGFR-TKIs and T790M mutation in NSCLC patients harboring EGFR mutation with acquired resistance to EGFR-TKIs.
Authors: Yuko Oya, Tatsuya Yoshida, Kosuke Tanaka, Junichi Shimizu, Yoshitsugu Horio, Yukinori Sakao, Toyoaki Hida, Yasushi Yatabe
Journal: Journal of Clinical Oncology (2015)

e19123 Background: Patients with NSCLC with EGFR-activating mutations initially respond to EGFR-TKIs. However, clinical efficacy is limited by acquired resistance, and the secondary EGFR T790M mutation accounts for approximately half of acquired resistances to EGFR-TKI. Third generation EGFR-TKIs that specifically targets T790M mutation was developed for overcoming the acquired resistance. The clinicopathologic features related to T790M mutation in patients with acquired resistance to EGFR-TKIs remains unknown. Methods: We investigated 94 NSCLC patients harboring EGFR-activating mutations who underwent re-biopsy after acquired resistance to EGFR-TKIs from January 2005 to December 2014. Patient characteristic, progression pattern at the re-biopsy, and initial response on first EGFR-TKIs were retrospectively compared in patients with and without T790M. Results: Of the 94 patients had acquired resistance to EGFR-TKIs, Median age was 64(range: 36-83), 51 (54%) was male. 86 patients received gefitinib and 7 erlotinib and 1 afatinib as first EGFR-TKIs.At the time of re-biopsy, 45 (48%) had T790M mutation. Median PFS on first EGFR-TKIs in patients with T790M mutation was significantly longer than those without T790M mutation (447 days vs 239 days, p = 0.02). In 43 of 94 patients who underwent re-biopsy at RECIST-PD of first EGFR-TKIs, the patients with T790M mutation had significantly more local progression and less systemic progression than those without T790M (T790M+: local 71.4%, systemic 28.6% , T790M-: local 31.8%, systemic 68.2%, p = 0.002) Conclusions: The emergence of T790M mutation in patients who had acquired resistance to EGFR-TKIs is significantly related with longer PFS on first EGFR-TKIs and local progression at the time of re-biopsy.
Spread of a new Chlamydia trachomatis variant from men who have sex with men to the heterosexual population after replacement and recombination in ompA and pmpH genes
Authors: M. Rodríguez-Domínguez, J.M. González-Alba, T. Puerta, L. Martínez-García, B. Menéndez, R. Cantón, J. del Romero, J.C. Galán
Journal: Clinical Microbiology and Infection (2017)
THE ROLE OF CORONARY RESPONSE TO NITRATE IN PATIENTS WITH SUSPECTED VASOSPASTIC ANGINA
Authors: Seung-Hwan Han, Min Soo Kim, Pyung Chun Oh, Soon Young Suh, Yae Min Park, Kyounghoon Lee, Woong Chol Kang, Kwan Kon Koh, Taehoon Ahn
Journal: Journal of the American College of Cardiology (2017)
MORPHOLOGICAL FEATURES OF VASCULAR HEALING IN PACLITAXEL COATED BALLOON COMPARED TO PLAIN OLD BALLOON ANGIOPLASTY IN HUMAN PERIPHERAL ARTERY DISEASE
Authors: Purushothaman K-Raman, Meerarani Purushothaman, Baber Usman, Arthur Tarricone, Miguel Vasquez, Annapoorna Kini, Samin Sharma, Pedro Moreno, Prakash Krishnan
Journal: Journal of the American College of Cardiology (2017)
IDH1 mutation in progressive gliomas by allele-specific quantitative RT-PCR.
Authors: Marco Timmer, Moritz Perrech, Gabriele Roehn, Roland Goldbrunner
Journal: Journal of Clinical Oncology (2015)

e17085 Background: Diagnostic of the IDH1 mutation (IDH1mut) is so far based on DNA sequencing and immunohistochemistry (IHC), methods limited in terms of sensitivity and ease of use. Recently, measuring the IDH1mut level by real time PCR was introduced as alternative method. Therefore, we aimed to (i) validate this new technique in a larger patient cohort, compare it to control tissue, and (ii) investigate if the expression of both, IDH1mut and IDH1 wildtype (IDH1wt) correlates with the course of disease and different treatment regimens. Methods: A total of 113 tumor samples were obtained intraoperatively from 84 glioma patients with diagnosis of diffuse glioma (WHO°II), anaplastic glioma (WHO°III), secondary glioblastoma +/- chemotherapy (CTx), primary glioblastoma +/- CTx (WHO°IV). Tumor samples were snap frozen and processed for sectioning, RNA and protein isolation. The quantitative expression of IDH1 mRNA was assessed using real-time PCR with specific primers for IDH1mut and –wt; protein expression was verified by Western Blot analysis and IHC. Additionally, 19 samples of LGG and their consecutive HGG were analyzed at different time points of disease. Results: Our results with this new method confirmed previous data showing that most astrocytomas and secondary GBM bear the mutation (conc. 0.13 to 0.2) whereas most primary GBM do not (conc. ~0.025). Quantitative analysis revealed that IDH1mut expression is upregulated in sGBM (mean±SEM: 3.52±0.55) compared to lower grade glioma (II° = 1.54±0.22; III° = 1.67±0.23). By contrast, IDH1wt expression is upregulated in all glioma grades compared to control brain tissue. Moreover, semiquantitative protein expression analysis also showed higher expression levels of mutated IDH1 in sGBM. Conclusions: Taken together, recurrent disease and radiochemotherapy do not alter the general IDH1 status. Moreover, we found an increase of IDH1mut gene expression in sec. GBM compared to lower grade glioma indicating a pivotal role of IDH1mut not only in gliomagenesis but also in glioma progression.
A prospective study of reproductive factors, hormone use, and risk of lung cancer in postmenopausal women
Authors: C. S. Baik, G. M. Strauss, D. Feskanich
Journal: Journal of Clinical Oncology (2009)

1501 Background: There has been increased interest in understanding the role of hormonal factors in lung cancer (LC) in women with the observation that it exhibits different epidemiologic patterns and treatment response when compared to men. However, results of published studies have been inconsistent, possibly due to inadequate smoking adjustment. Methods: We prospectively examined the associations between reproductive factors, exogenous hormone use, and LC incidence in 106,574 postmenopausal women in the Nurses’ Health Study. Participants completed biennial questionnaires which included updated smoking history. We assessed age at menopause, age at menarche, type of menopause, parity, postmenopausal hormone (PMH), and oral contraceptive use. Cox proportional hazards modeling was used to estimate the relative risks (RR) of each exposure, adjusted for smoking status, number of cigarettes, time since quitting, age of initiating smoking, fruit/vegetable intake, body mass index, and environmental smoking exposure. Results: We identified 1,565 LC cases during follow up from 1984 to 2004. Parity was associated with decreased LC risk in never smokers (RR = 0.54, 95% CI 0.31–0.96) but increased risk in current smokers (RR = 1.44, 95% CI 1.03–2.02). No association was seen in former smokers. Also, younger age at menopause was associated with higher LC risk in women with natural menopause (p-trend = 0.016). PMH use was not associated with LC incidence. The RR for current PMH users was 1.01 (95% CI 0.87–1.17) and for past users was 0.95 (95% CI 0.82–1.1). No significant association was seen when assessed by duration of PMH use, time since last use, or type of PMH. However, past use of oral contraceptives for greater than 5 years was associated with increased LC risk (RR = 1.2, 95% CI 1.03–1.41). Conclusions: These results suggest that there may be an association between hormonal factors and LC development, and further suggest that the mechanism may differ in smokers versus lifelong never smokers. No significant financial relationships to disclose.
Comparison of Very Low-Dose Decitabine to Standard-Dose Hypomethylating Agents in Myelodysplastic Syndromes (MDS)
Authors: Connie Cheng, Caitlin Siebenaller, Paul Elson, Anjali S. Advani, Hetty E. Carraway, Kristin Colaluca, Betty K. Hamilton, Sean Hobson, Matt E. Kalaycio, Jaroslaw P. Maciejewski, Sudipto Mukherjee, Gin Rupp, Cassie Zimmerman, Mikkael A. Sekeres, Aaron T. Gerds
Journal: Blood (2014)
Racial/ethnic differences in end-of-life (EoL) treatment preferences: The role of religious beliefs about care.
Authors: Tracy A. Balboni, Paul K Maciejewski, Michael J. Balboni, Andrea Catherine Enzinger, M. Elizabeth Paulk, Francisco Munoz, Lorna Rivera, Jan Mutchler, Esme Finlay, Lisa Marr, Ruth McCorkle, Jennifer S. Temel, Jane C. Weeks, Tyler J. Vanderweele, Holly Gwen Prigerson
Journal: Journal of Clinical Oncology (2013)

6529 Background: Racial/ethnic minorities and patients who turn to religion to cope receive more aggressive EOL care. Beliefs underlying these associations are unknown. Methods: Coping with Cancer is an ongoing, multi-site, NCI-funded study examining factors influencing racial/ethnic EoL disparities. From 11/2010-10/2012, 133 advanced cancer patients underwent baseline interviews, including 7 items assessing religious beliefs about EoL care (RBEC). Univariate analyses assessed racial/ethnic differences in RBEC and EoL treatment preferences. Multivariable analyses (MVA) modeled mean RBEC score as a function of race/ethnicity, controlling for confounders, and assessed the relationship of race/ethnicity and RBEC to treatment preferences. Results: Religious beliefs about EoL care are common and more often held by racial/ethnic minorities (Table); racial/ethnic differences persisted in MVA (p&lt;.0001). Black patients were more likely than Whites to prefer aggressive EOL care (OR=5.03, p=.02), whereas Latino’s EOL preferences did not differ from Whites (p=.87). In MVA including race and RBEC score, Black race was not related to EOL care preferences (OR 1.61, p=0.55), whereas greater RBEC score was associated with greater preference for aggressive care (OR 2.48, p=0.003). Conclusions: Religious beliefs about EoL care are common and significantly more so among racial/ethnic minorities. Preliminary data suggest these beliefs mediate the relationship between race/ethnicity and EoL treatment preferences. [Table: see text]
COMPARISONS OF INVASIVE AND NON-INVASIVE CARDIAC OUTPUT MEASURMENT METHODS IN PULMONARY HYPERTENSION
Authors: Evrim Simsek, Emre Demir, Meral Kayikcioglu, Sanem Nalbantgil, Rashad Huseynov, Nesrin Mogolkoc, Levent Can, Hakan Kultursay
Journal: Journal of the American College of Cardiology (2017)
Immunomodulatory Drugs (IMiDs), Lenalidomide and Pomalidomide, Suppress Th1-Inducing Capacity of Dendritic Cells but Enhance Th2-Mediated Allergic Response
Authors: Tomoki Ito, Phan Thi Xuan Vien, Muneo Inaba, Hideaki Yoshimura, Masaaki Hotta, Takahisa Nakanishi, Shinya Fujita, Aya Nakaya, Atsushi Satake, Kazuyoshi Ishii, Shosaku Nomura
Journal: Blood (2016)
Bronchial neuroendocrine neoplasms: A Surveillance Epidemiology and End Results (SEER) database review of demographics and survival in 187,991 cases.
Authors: Mark Andrew Lewis, James C. Yao
Journal: Journal of Clinical Oncology (2015)

4097 Background: Bronchial neuroendocrine neoplasms (NENs) are a biologically heterogeneous group of malignancies whose differences are incompletely understood. We aimed to study the demographics and survival of patients with these neoplasms by reviewing the SEER database. Methods: We identified 945,331 cases in the SEER database with malignancies of the lung and extracted 187,991 bronchial NENs to examine patient characteristics & clinical outcomes by histology and stage. Results: By histology and grade, there were 130,092 cases of small cell carcinoma, 44,520 cases of large cell carcinoma, 3,349 cases of neuroendocrine carcinoma (grade 3/4), 9,135 cases of typical bronchial carcinoid (grade 1), and 895 cases of atypical bronchial carcinoid (grade 2). The ethnic predilection was Caucasian (87%, with 9% black and 4% other). Overall there were more cases in men (55% of the entire cohort), but women accounted for 66% of the carcinoid cases. Mean age at diagnosis for all NENs was 66, with typical carcinoids having the youngest mean age (60) than any other type. By SEER stage, 13% of NENs were localized, 24% were regional, and 63% were metastatic, with median survivals of 39.7, 14.4, and 4.3 months, respectively. Survival by histology is summarized in the table below. Conclusions: Bronchial NENs vary widely in their clinical behavior. By histology, large cell carcinomas carry the worst prognosis, whereas typical carcinoids are associated with the longest survival, as well as lowest age at diagnosis & female sex, Atypical carcinoids bear more semblance to typical carcinoids than to small cell, large cell, or neuroendocrine carcinomas in their biology. Tumor type Median survival (months) [95% CI] Large cell carcinoma 6.0 [5.9-6.1] Small cell carcinoma 7.0 [6.9-7.1] Neuroendocrine carcinoma 9.0 [8.5-9.5] Atypical carcinoid 101.0 [80.8-121.2] Typical carcinoid 201.0 [191.7-210.3]
RELATION OF LEFT VENTRICULAR REMODELING TO LEFT VENTRICULAR DIASTOLIC FUNCTION MEASURES AT MIDDLE AGE: CORONARY ARTERY RISK DEVELOPMENT IN YOUNG ADULTS (CARDIA) STUDY
Authors: Satoru Kishi, Jared Reis, Bharath A. Venkatesh, Yoshiaki Ohyama, Donald Lloyd-Jones, Cora Lewis, Stephen Sidney, Pamela Schreiner, Kiang Liu, Samuel Gidding, Akihiro Isogawa, Joao Lima
Journal: Journal of the American College of Cardiology (2017)
“Salvage” neoadjuvant bevacizumab in newly diagnosed glioblastoma multiforme (GBM).
Authors: Ciprian Barlog, Emeline Tabouret, Marc Sanson, Ahmed Idbaih, Caroline Houillier, Florence Laigle-Donadey, Agusti Alentorn
Journal: Journal of Clinical Oncology (2014)

2083 Background: Some patients (pts) with GBM are in such a poor condition at the onset of radiotherapy (RT), particularly because of severe steroid-resistant intracranial hypertension (ICH), that RT is cancelled. Our objective was to evaluate if upfront bevacizumab (BEV) could be of help in this rare setting, allowing some patients to resume standard radio-chemotherapy treatment. Methods: We retrospectively analyzed all pts with newly diagnosed GBM who could not start RT because of severe ICH or altered neurological status incompatible with the requirements for administering RT and who received BEV as neo-adjuvant therapy. Clinical, radiological characteristics and response to BEV were recorded. It was also noted if radio-chemotherapy could be secondarily delivered. Results: Twelve pts received neo-adjuvant BEV because of larger tumor volume (N=8) or altered neurological status (N=4). All but one were diagnosed by biopsy. Median age was 60 years (range 19-72). All pts were under high dose steroids. Seven pts (58%) could receive standard RT after BEV administration. After BEV and before RT, neurological status was improved in 6 pts, and 8 had stable or partial response on MRI. Completion of RT was correlated to age (p<0.001), but not to initial tumor volume (p=0.886) nor KPS (p=0.381). Median progression free survival (PFS) and overall survival (OS) were 3.7 (95% confidence interval (CI):1.4-6.0) and 10.1 (95%CI: 0-20.4) months, respectively. Median PFS for patients with or without RT were 8.2 (95%CI: 0.1-16.4) and 2.5 (95%CI: 2.2-2.9) months (p=0.150), respectively. Conclusions: “Salvage” neo-adjuvant BEV may be of help in some GBM patients whose very poor clinical condition, often with impeding herniation, does not allow the safe onset of RT. Prospective evaluation is warranted.
DIFFERENTIAL AMERICAN-STYLE FOOTBALL TRAINING INTENSITIES AND CARDIAC AND VASCULAR REMODELING PATTERNS
Authors: Jonathan H. Kim, Casey Hollowed, Morgan Irwin-Weyant, Keyur Patel, Kareem Hosny, Hiroshi Aida, Zaina Gowani, Patrick Gleason, Salman Sher, James Shoop, Angelo Galante, Craig Clark, Thomas Marshall, Gene Patterson, Gary Schmitt, Yi-An Ko, Arshed Quyyumi, Aaron Baggish
Journal: Journal of the American College of Cardiology (2017)
A Recessive Gene Variant in TGFB1 in the Donor Influences the Acute Graft Versus Host Disease Development and Impacts in the Outcome After Allogeneic Stem Cell Transplantation (Allo-SCT),
Authors: Beatriz Martin-Antonio, Damià Romero, Ildefonso Espigado, David Gallardo, Anna Bosch, Ismael Buno, Carolina Martinez-Laperche, Antonio Jimenz-Velasco, Rafael De La Camara, Salut Brunet, Jose B Nieto, Jose Román, Maria Suarez-LLedo, Francesc Fernandez-Avilés, Carmen Martinez, Montserrat Rovira, Alvaro Urbano-Ispizua
Journal: Blood (2011)
Prospective Randomized and Crossover Comparison of Two Apheresis Machines for Peripheral Blood Stem and Progenitor Cell Collection: A Multicenter Study
Authors: Kazuhiko Ikeda, Hitoshi Ohto, Kazuo Muroi, Shin-ichiro Fujiwara, Keiji Minagawa, Minami Yamada-Fujiwara, Yoshihiro Fujimori, Ryuji Tanosaki
Journal: Blood (2015)
Erratum: WTAP is a novel oncogenic protein in acute myeloid leukemia
Authors: H Bansal, Q Yihua, S P Iyer, S Ganapathy, D A Proia, L O Penalva, P J Uren, U Suresh, J S Carew, A B Karnad, S Weitman, G E Tomlinson, M K Rao, S M Kornblau, S Bansal
Journal: Leukemia (2014)
READMISSIONS FOR PATIENTS DISCHARGED WITH ACUTE DECOMPENSATED HEART FAILURE AND REDUCED VERSUS PRESERVED EJECTION FRACTION: THE ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY
Authors: Melissa Caughey, Sally Stearns, Amil Shah, Carla Sueta, Jo Rodgers, Wayne Rosamond, Patricia Chang
Journal: Journal of the American College of Cardiology (2017)
EXTENDED REMISSION AND LATE RE-DECOMPENSATION OF DILATED CARDIOMYOPATHY ASSOCIATED WITH A NOVEL RIBONUCLEIC ACID BINDING MOTIF PROTEIN 20 (RBM20) MUTATION
Authors: Rodrigo Mendirichaga, Celso De La Cruz Luque, Jeffrey Smith, Rhanderson Cardoso, Nanette Bishopric
Journal: Journal of the American College of Cardiology (2017)
Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury
Authors: Sean M. Bagshaw, Michael Darmon, Marlies Ostermann, Fredric O. Finkelstein, Ron Wald, Ashita J. Tolwani, Stuart L. Goldstein, David J. Gattas, Shigehiko Uchino, Eric A. Hoste, Stephane Gaudry
Journal: Intensive Care Medicine (2017)
ADVERSE OUTCOMES WITH USE OF HYDRALAZINE AND NITRATE COMBINATION THERAPY IN HOSPITALIZED OLDER NON-BLACK PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION (HFREF)
Authors: Phillip Hong Lam, Daniel Dooley, Essraa Bayoumi, Jonathan Segal, Cherinne Arundel, Gerasimos Filippatos, Javed Butler, Prakash C. Deedwania, Wen-Chih Wu, Michel White, Marc Blackman, Charity Morgan, Ioannis Kanonidis, Wilbert Aronow, Stefan Anker, Gregg Fonarow, Ali Ahmed
Journal: Journal of the American College of Cardiology (2017)
Deciphering Ibrutinib Resistance in Chronic Lymphocytic Leukemia
Authors: Georg Lenz
Journal: Journal of Clinical Oncology (2017)

Article Tools UNDERSTANDING THE PATHWAY Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES BTKC481S-Mediated Resistance to Ibrutinib in Chronic Lymphocytic Leukemia. February 13, 2017 ARTICLE CITATION DOI: 10.1200/JCO.2016.72.0102 Journal of Clinical Oncology - published online before print March 14, 2017 PMID: 28291389 Deciphering Ibrutinib Resistance in Chronic Lymphocytic Leukemia Georg LenzxGeorg LenzSearch for articles by this author Show More Georg Lenz, University Hospital Münster and Cells in Motion, Münster, Germany https://doi.org/10.1200/JCO.2016.72.0102 First Page Full Text PDF Figures and Tables © 2017 by American Society of Clinical Oncology Companion BTKC481S-Mediated Resistance to Ibrutinib in Chronic Lymphocytic Leukemia
BCR-ABL1 Transcript of 7.93% at 3 Months Is an Early Predictor for Long-Term Survival to Second-Line Therapy Using Next Generation Tyrosine Kinase Inhibitors in Imatinib-Resistant Chronic Phase Chronic Myeloid Leukemia
Authors: Sung-Eun Lee, Soo Young Choi, Yun Jeong Oh, Soo-Hyun Kim, Hye-Young Song, Hea-Lyun Yoo, Mi-Young Lee, Moon-Jung Chae, Ki-Hoon Kang, Hee-Jeong Hwang, Eun-Jung Jang, Dong-Wook Kim
Journal: Blood (2014)
PREVALENCE AND CORRELATES OF STATIN SIDE EFFECTS AND WILLINGNESS TO BE RE-CHALLENGED ON A STATIN: DATA FROM THE REASONS FOR GEOGRAPHIC AND RACIAL DIFFERENCES IN STROKE (REGARDS) STUDY
Authors: Rikki Tanner, Lisandro Colantonio, Monika Safford, Keri Monda, Ben Taylor, Paul Muntner, Robert Rosenson
Journal: Journal of the American College of Cardiology (2017)
In situ distribution of metallic platinum in tumor tissues after intraperitoneal platinum chemotherapy assessed by digital synchrotron-abetted x-ray fluorescence microscopy.
Authors: Robert N. Taub, Joshua Leinwand, Gleneara Bates, Elethea Hare, Alain C. Borczuk, Joseph Graziano, Antonio Lanzirotti, Lisa Miller
Journal: Journal of Clinical Oncology (2012)

e13067 Background: Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and catheter-administered intraperitoneal chemotherapy (CAIPEC) are used to treat peritoneal surface-spreading malignancies, including Malignant Peritoneal Mesothelioma (MPM), to maximize local drug concentrations. Previous HIPEC studies showed tissue penetration of cisplatin ~5mm from the peritoneal surface; biodistribution of CAIPEC has not been reported. Methods: Our protocol for MPM includes initial debulking surgery with HIPEC (41°C over 1 hour, drug is then removed), 6 cycles of CAIPEC (room temperature, indefinite dwell-time), and a second debulking surgery with HIPEC. To compare tissue drug penetrations in HIPEC versus CAIPEC, on an IRB-approved protocol we collected peritoneal tissue from 6 MPM patients receiving HIPEC at initial (n=2; both cisplatin) or second surgery (n=4; 2 cisplatin and 2 oxaliplatin) for digital image localization of in situ Pt by synchrotron-abetted (Brookhaven National Laboratory, Upton NY) x-ray fluorescence microscopy at a resolution of 10 microns. Results: Overall Pt levels were highest at second surgery post-HIPEC (median=26.1ppm, range: 2.2-113.4), lowest at initial surgery post-HIPEC (median=5.2ppm, range=4.7-5.8), and intermediate at second surgery pre-HIPEC (median=16.0ppm, range=5.6-21.8). Every sample had higher Pt at the peritoneal surface; also highest at second surgery post-HIPEC (median=40.4ppm, range=4.4-219.7), lowest at initial surgery post-HIPEC (median=11.3ppm, range=8.4-14.2), and intermediate at second surgery pre-HIPEC (median=25.9ppm, range=8.4-29.9). At second surgery, each sample’s overall Pt level was higher than contemporaneous plasma Pt, pre-HIPEC (median=0.27ppm, range=0.08-0.33) and post-HIPEC (median=1.86ppm, range=0.84-2.87). Conclusions: Both CAIPEC and HIPEC effect tissue drug accumulation, greatest at the peritoneal surface. The proportion of peritoneal surface Pt was lowest in second surgery pre-HIPEC samples, suggesting more homogeneous and/or extensive drug distribution in CAIPEC than HIPEC, likely due to longer dwell-time.
Adherence to clinical practice guidelines for adjuvant therapy of breast cance
Authors: A. Chan, J. Yau, S. Huan, D. Vergidis, M. Anthes, C. Falkson, A. Kirk, H. Dhaliwal
Journal: Journal of Clinical Oncology (2004)

716 Background: Discrepancy has been observed between consensus recommendations and actual use of adjuvant chemotherapy in women with breast cancer. The objective of this study was to evaluate adherence to local clinical practice guidelines for breast cancer at a regional cancer centre. Methods: A retrospective review of patients treated between June 2001 and June 2003 was undertaken. Results: 165 charts were reviewed. 23 patients were referred for radiotherapy only. 10 had metastatic disease. Of the remaining 132 patients, 1 patient was not assessed for hormone therapy due to lack of hormone receptor staining. 6 did not have axillary lymph node dissection. 126 patients were assessed for chemotherapy. The median age was 64.2 years. Guideline adherence rates are summarized in the table. Reasons for non-adherence when the guidelines recommended adjuvant hormone therapy were: patient's choice (50%), co-morbidities (20%), clinician's judgment (20%), and elderly age (10%). Reasons for non-adherence when the guidelines recommended adjuvant chemotherapy were: co-morbidities (35%), patient's choice (24%), elderly age (24%), clinician's judgment (12%), and active infection (6%). 1 patient received chemotherapy despite guideline recommendations, based on clinician's judgment. Conclusions: Adherence to guidelines recommending adjuvant therapy is unlikely to be uniform due to patient choice and co-morbidities. At our institution, adherence to guidelines was nearly complete when no adjuvant therapy was recommended. No significant financial relationships to disclose.