Breast Cancer Patients’ Response to COVID-19-Related Imaging and Treatment Delays: An Online Forum Analysis

e18354 Background: Myelosuppression during chemotherapy can lead to life-threatening infections, dose reductions, treatment delays, as well as prolonged hospitalizations, early morbidity, and early mortality. According to NCCN guideline, Pegfilgrastim 6mg per cycle is recommended for breast cancer patients receiving chemotherapy, and dosage modification based on body weight is not required. However, primary PEGylated G-CSF prophylaxis comes with significant extra cost, which has a great impact on health care resources, especially for patients without insurance coverage. Methods: We analyzed clinical data of patients, weighing between 45 and 65 kilogram, received a single subcutaneous PEGylated recombinant human G-CSF injection at fixed doses of either 3 mg or 6 mg per chemotherapy cycle approximately 24 hours after completion of each cycle of chemotherapy. Data for this retrospective study were obtained from Thyroid and Breast Surgical Department of the First Affiliated Hospital of Sun Yat-sen University between July 1, 2017, and October 31, 2017. Results: 41 cycles in 33 patients were included in 3mg PEGylated G-CSF group, and 46 cycles in 39 patients were included in 6mg PEGylated G-CSF group. Among chemotherapy cycles, the incidence of neutropenic event was19.5%and 2.2% in 3mg PEGylated G-CSF group and 6mg PEGylated G-CSF group, respectively. No patients experienced dose reductions or treatment delays in both groups. Using single-factor Logistic Regression Analysis, we found that dose of PEGylated G-CSF(3mg vs 6mg) was significantly associated with occurrence of neutropenic event(p = 0.028). Multi-factor Logistic Regression Analysis also showed that dose of PEGylated G-CSFwas significantly associated with occurrence of neutropenic event (p = 0.031). Conclusions: Our study showed that dose of prophylactic PEGylated G-CSF was significantly associated with occurrence of neutropenic events. So adequate dose of PEGylated G-CSF is important to reduce chemotherapy induced neutropenic events and to guarantee the quality of chemotherapy in patients with breast cancer.

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Use of G-CSF to Sustain Dose Intensity in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Pilot Study

Cancer Control ◽

10.1177/107327489600300605 ◽

1996 ◽

Vol 3 (6) ◽

pp. 1-4 ◽

Cited By ~ 18

Author(s):

Jack Webster ◽

Nicole Kuderer ◽

Gary H. Lyman

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Dose Reduction ◽

Cancer Patients ◽

Dose Intensity ◽

Treatment Delay ◽

Breast Cancer Patients ◽

Treatment Delays ◽

Prospective Trials ◽

The Impact

Background Adjuvant chemotherapy for breast cancer is frequently accompanied by neutropenia requiring dose reduction or treatment delay that can potentially compromise therapeutic effectiveness. Recombinant granulocyte-colony stimulating factor (G-CSF) reduces the duration and severity of neutropenia. Methods Nineteen patients with newly diagnosed breast cancer receiving adjuvant systemic chemotherapy met criteria for dose reduction or treatment delay due to neutropenia. All were treated with G-CSF. The mean duration of G-CSF therapy was five days. Results An increase in mean absolute neutrophil count was seen in cycles with G-CSF. Chemotherapy treatment was delayed less often following the use of G-CSF. Conclusions Breast cancer patients receiving adjuvant chemotherapy who face treatment delays or dose reductions can continue on full-dose intensity therapy using supportive G-CSF. Prospective trials are needed to accurately measure the impact of G-CSF on dose intensity and long-term disease control.

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A Prospective Pilot Study to Evaluate Molecular Changes in the Hematopoietic System after Receipt of Chemotherapy or Radiotherapy and Its Clinical Implications Among Racially Diverse Breast Cancer Survivors: Breast Survivorchip Study

Blood ◽

10.1182/blood-2020-138740 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 34-35

Author(s):

Monica Peravali ◽

Chidera Nosiri ◽

Christopher S. Hourigan ◽

Christopher Gallagher ◽

Aarthi Shenoy

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Cancer Patients ◽

Breast Cancer Survivors ◽

Breast Cancer Patients ◽

Racially Diverse ◽

Advisory Committees ◽

Treatment Delays ◽

Clonal Hematopoiesis

Background: Clonal hematopoiesis (CH) increases in inflammatory states, and in retrospective epidemiological studies, has been associated with increased rates of atherosclerotic coronary artery disease, ischemic stroke, neurocognitive disorders, and hematologic malignancies.Previous data in non-cancer patients reported approximately 5% incidence of CH in patients aged 60-69. Next-generation sequencing (NGS) has demonstrated CH in 25% of predominantly white cancer survivors (21% in breast cancer patients) following chemotherapy and radiotherapy and 16% in a subset of patients prior to treatment suggesting a higher incidence of CH at baseline with malignancy and an increase in incidence following cancer treatment. The variance in CH rate among racially diverse cancer patients has not been well reported. The purpose of this prospective pilot investigator-initiated translational study is to characterize baseline profiles of existing CH, patterns of clonal evolution, and clinical implications of CH in a racially diverse population of breast cancer patients in a longitudinal fashion prior to and one year after receiving cancer directed therapy. This study will be performed at MedStar Washington Hospital Center (MWHC). MWHC is a not-for-profit, 912-bed, teaching and research hospital caring for a racially and socioeconomically diverse population in Washington, D.C. Study Design: Newly diagnosed breast cancer patients stages 0-III, who are candidates for surgery, chemotherapy and/or radiation, and/or endocrine therapy and/or Her2 directed therapy at WHC will be eligible. Baseline demographic data, comprehensive history, quality of life and cognitive assessments will be obtained at baseline and at 12 ± 1 months post initiation of therapy.Clinical data including blood counts, treatment delays, dose adjustments, and echocardiography results will be collected throughout treatment and entered into RedCap database. Blood will be collected in Paxgene tubes for each timepoint. Error-corrected NGS will be performed in a NIH laboratory on regions of genes known to be recurrently mutated in CH allowing for the sensitive and reproducible detection of low-level variants and accurate quantification of changes over time. Research sequencing results will not be returned to treating physicians or patients. Study Outcomes: The primary outcome of this study is to determine baseline rate of CH in a cohort of 100 breast cancer patients. We expect 50-60% of our patients to be black and therefore, can specifically evaluate CH in this group of patients compared to whites. Secondary outcome is to describe change in mutational profile after cancer-directed therapy. Descriptive analysis of the relationship of CH to treatment tolerance including prolonged myelosuppression or organ dysfunction leading to dose reductions and treatment delays as well as reduction in quality of life and cognition will be conducted as part of the exploratory analysis. Statistical methods: Descriptive statistics would be presented using frequency and proportions for categorical data and means and standard deviation for continuous data. Medians and quartiles will be presented for continuous data with non-normal distribution. Proportion of CH in breast cancer patients pre-treatment would be compared to proportion of CH post treatment using McNemar test for comparison of marginal proportions in paired data. Difference in baseline incidence of CH among different race categories would be evaluated using chi-squared test of independence. Effect of CH on delay in treatment would be evaluated using Kaplan Meier method for comparison of time to treatment between patients with CH and patients without CH. Clinical Significance: Life expectancy of breast cancer survivors is inferior to the general population and more so for black women. These differences may extend beyond psychosocial disparities and may have their foundation in genomic differences. Understanding clonal hematopoiesis in our racially diverse breast cancer patients will have significant implications both during the delivery of cancer directed therapy and in their long-term survivorship care. We currently have 25 patients enrolled in our study with their samples awaiting processing for NGS at NIH. Disclosures Gallagher: Seattle Genetics:Membership on an entity's Board of Directors or advisory committees;Daiichi Sankyo:Membership on an entity's Board of Directors or advisory committees.

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Breast cancer surgical delays in a racially and ethnically diverse California cancer registry cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12589 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12589-e12589

Author(s):

Stephanie Navarro ◽

Yifei Yang ◽

Carol Ochoa ◽

Sue Kim ◽

Lihua Liu ◽

...

Keyword(s):

Breast Cancer ◽

Surgical Treatment ◽

Cancer Patients ◽

Population Based ◽

Breast Cancer Patients ◽

Treatment Delays ◽

California Cancer Registry ◽

Ethnic Subgroups ◽

To Receive ◽

Timely Treatment

e12589 Background: Surgical delays for invasive breast cancer have been increasing over time and are associated with an increased risk of mortality. Black and Hispanic breast cancer patients are more likely to experience surgical delays than white patients; however, surgical delays among Asian ethnic subgroups remain unstudied. Methods: We used data from the population-based California Cancer Registry to identify all females diagnosed with stage I-III invasive breast cancer from 2012-2017. Our main independent variable was patient race/ethnicity, including five Asian ethnic subgroups. Covariates captured tumor, treatment-related, and patient sociodemographic characteristics. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of shorter time to surgical treatment. Results: Of 106,441 breast cancer patients, 57.5% were non-Hispanic white (NHW), 20.7% were Hispanic, 5.9% were non-Hispanic black (NHB), and 12.6% were Asian (consisting of 33.7% Filipino, 24.6% Chinese, 8.1% Asian Indian or Pakistani (AIP), 7.7% Japanese, 6.7% Korean, and 19.2% other Asian (OA) patients). Compared to NHWs, Hispanics and NHBs were less likely to receive surgical treatment within 30 and 90 days of diagnosis (Hispanic, 30-day: OR = 0.94, 95% CI = 0.89-0.98; Hispanic, 90-day: 0.89, 0.85-0.92; NHB, 30-day: 0.91, 0.85-0.98; NHB, 90-day: 0.86, 0.80-0.92). However, Chinese and AIP patients were more likely than NHWs to receive surgery within 30 and 90 days of diagnosis (Chinese, 30 day: OR = 1.30, 95% CI = 1.19-1.41; Chinese 90-day: 1.26, 1.08-1.47; AIP 30-day: 1.29, 1.11-1.50; AIP 90-day: 1.34, 1.17-1.53). In addition, Koreans were more likely than NHWs to receive surgery within 90 days of diagnosis (OR = 1.26, 95% CI = 1.08-1.47). Hispanics, NHBs, and OAs were less likely to receive timely treatment compared to NHWs (Hispanic: HR = 0.95, 95% CI = 0.94-0.97; NHB: 0.91, 0.89-0.94; OA: 0.95, 0.92-0.99), while Chinese, AIP, and Korean patients were more likely to receive timely treatment compared to NHWs (Chinese: HR = 1.15, 95% CI = 1.11-1.20; AIP: 1.10, 1.04-1.17; Korean: 1.10, 1.03-1.17). Lastly, patients diagnosed in 2017 were 14% less likely to receive timely treatment than those diagnosed in 2012 (HR: 0.86, 95% CI = 0.84-0.88). Conclusions: In this population-based cohort of female breast cancer patients in California, Hispanics and NHBs continue to experience surgical treatment delays and Asian American minority subgroups experience similar delays compared to NHWs. In addition, increasing delays over time could potentially exacerbate racial/ethnic disparities in breast cancer mortality. Continued work investigating the causes of breast cancer treatment delays among Asian ethnic subgroups is necessary to fully elucidate and target racial/ethnic treatment disparities.

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