Adjuvant chemotherapy for breast cancer patients: Patients’ expectations and physicians’ attitudes

2012 ◽  
Vol 10 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Frida Barak ◽  
Lev A. Ostrowsky ◽  
Shulamith Kreitler
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Breast Cancer Patients ◽  
Sources Of Information

AbstractObjective:Findings show that there is a certain degree of refusal on the part of breast cancer patients to undergo adjuvant therapy. Accordingly, the major goals of the study were, first, to learn more about the beliefs of breast cancer patients in regard to adjuvant therapy; second, to find out about the sources of the patients’ beliefs; and third, to learn about the attitudes of oncologists concerning the same aspects of adjuvant therapy to which the patients’ beliefs referred.Method:The participants were 92 breast cancer patients (mean age 61.2) and 57 doctors of both genders specialized in oncology or affiliated domains. Both groups were administered questionnaires referring to goals of adjuvant treatment, the chances of attaining these goals, side effects, and difficulty of the treatment. Doctors were specifically asked about the views they thought proper to communicate to patients in regard to the mentioned issues. Patients were also asked about whether they had doubts about the treatment and sources of information.Results:The findings showed disparities between the views of patients and doctors in regard to goals, chances of attainment, side effects, and difficulty of treatment. Patients endorsed more goals than doctors and tended to assign to them lower chances of attainment. Doctors were divided in their views about whether to communicate the side effects and difficulties.Significance of results:The results reveal the importance of outlining goals for patients undergoing adjuvant treatment and the disagreements between doctors about what should be communicated to patients, and highlight the complexity of providing to patients information that is both scientifically correct and emotionally helpful.

Cost-effective treatment with half year of trastuzumab and chemotherapy as adjuvant treatment for overexpression of Her2/neu breast cancer patients: Two institutional experiences in Taiwan

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10765-10765
Author(s):  
C. J. Tai ◽  
C. K. Pan ◽  
C. H. Wu ◽  
C. S. Chen
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Stage Ii ◽  
Stage Iii ◽  
Breast Cancer Patients ◽  
Alternative Treatment Option ◽  
Cost Effective Treatment

10765 Background: In this study, we are evaluating the utilizing trastuzumab as an adjuvant combination with chemotherapy in an half year interval for breast cancer (1–3). Methods: Patients after October 2000 with HER2-positive (3+ by immunohistochemistry; if 2+, should fit over expression by FISH) stage II/III breast cancer who received adjuvant trastuzumab (4mg/kg ×1, then 2mg/kg/wk ×22, equals 6 bottles of trastuzumab) in combination with chemotherapy. The chemotherapy utilized for stage II breast cancer patients received CEF only and for those patients with LN(+) but ER/PR(−/−) also added paclitaxel for another 4 cycles besides CEF with interval of 3 weeks, and for those with stage III breast cancer patient with ER or PR(+), the docetaxel was given with CEF for 6 cycles). Clinical response rates were followed by using imaging studies with chest films, CT scanning, bone scan and sonography. Results: Overall, there were 37 patients enrolled in this study. The median age was 43 years old (22–74 y/o). Two patients (including the youngest one) were found to have bilateral breast cancer on diagnosis but both were still alive without disease so far. There were 3 patients developed disease progression after adjuvant chemotherapy with trastuzumab and 2 of them died thereafter and all these 3 patients were stage III disease. The oldest patient was one of the exception without receiving adjuvant chemotherapy and received monotherapy of trastuzumab only and so far, she was still alive without disease. The side effect including chills (24.32%), dizziness (8.10%), cough (2.10%), cold sweating (2.10%). Conclusions: For her2/neu overexpression patients, trastuzumabwith chemotherapy may have positive role in adjuvant therapy. In this study, our main goal is to achieve patient’s treatment outcome in disease free status. Nonetheless, the cost was high if we applied trastuzumab as adjuvant therapy with 1- or 2-year interval (4–6). Even if this required further time to demonstrate this study’s final outcome, I suppose that utilization of trastuzumab as adjuvant treatment plus chemotherapy in a half interval will be a good alternative treatment option. No significant financial relationships to disclose.

Communicating adjuvant treatment goals and side effects to older breast cancer patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8541-8541
Author(s):  
A. Naeim ◽  
B. Pezeshki ◽  
J. Levin ◽  
N. Bartfeld ◽  
A. Coscarelli
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Los Angeles ◽  
Adjuvant Therapy ◽  
Focus Groups ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Patient Specific ◽  
Recent Experience ◽  
Breast Cancer Patients

8541 Background: The use of adjuvant therapy, particularly adjuvant chemotherapy, in older breast cancer patients is controversial. For patients to participate and provide their treatment preferences, information regarding adjuvant treatment and its side effects need to be communicated in lay language. This study explored what older breast cancer women understand about adjuvant therapy, and to elicit feedback on a pre-developed informational handout. Methods: This qualitative study of 35 women with breast cancer over the age of 65 with recent experience with adjuvant therapy participated in six focus groups in Los Angeles County. Focus groups were audio taped and transcribed. In addition, patients filled 2 questionnaires: (a) a demographic questionnaire regarding age, income, education, insurance, and beliefs about cancer and treatment benefits and (b) another to define adjuvant therapy and document patient specific experiences with side effects and physician-patient discussion related to adjuvant therapy. Transcript based analysis was used to identify themes and patterns that arise during the groups. Results: One (3%) of the 35 participants was able to define the term correctly and 63% of participants were unable to answer or provided an incorrect guess to the definition of adjuvant therapy. In addition, patients perceptions were spit between: (a) curing current disease versus (b) preventing future re-occurence. In terms of symptoms, many participants were shocked at their underestimation of fatigue and reoccurring discussions occurred within and throughout each group as to whether side effects were related to treatment or advanced age. Participants unanimously agreed that a handout describing adjuvant therapy would be beneficial. Conclusion: Discussions regarding adjuvant therapy are conceptually challenging, thus providing information regarding the goals and side effects of treatment using lay language is the 1st step in helping older breast cancer patients participate in the decision making process. [Table: see text] [Table: see text]

Persistence of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients predicts increased risk for relapse—Results of pooled European data

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10083-10083 ◽  
Author(s):  
W. J. Janni ◽  
G. Wiedswang ◽  
T. Fehm ◽  
J. Jueckstock ◽  
E. Borgen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Prognostic Significance ◽  
Primary Diagnosis ◽  
Nodal Status ◽  
Breast Cancer Patients ◽  
Increased Risk

10083 Background: The prognostic significance of DTC in the BM of breast cancer patients at the time of primary diagnosis has recently been confirmed by a large pooled analysis. If the persistence of DTC after adjuvant therapy confers a similar risk for relapse, there might be an indication for secondary adjuvant treatment. Methods: We analyzed BM aspirates of 697 patients from academic breast cancer units in Oslo (n=356), Munich (n=228) and Tuebingen (n=113) during recurrence-free follow-up at a median interval of 32.4 months (standard deviation [std] 19.4 mon) after primary diagnosis of breast cancer pT1–4, pN0–3 pM0. Carcinoma cells were detected using a standardized immunoassay with the monoclonal antibodies A45-B/B3 (Munich, Tuebingen), or AE1 and AE3 (Oslo), directed against cytokeratin (CK). Patients were followed for a median of 54.2 months (std 24.5 mon) after primary diagnosis. Results: Persistent DTC in the BM were detected in 15.6% of the patients (n=109). The Kaplan-Meier estimate for mean distant relapse-free survival estimate was 155.6 mon (142.4 - 168.9 95%CI) in patients with negative and 102.3 mon (93.6 - 111.0, 95% CI, p< .0001, log rank test) in patients with positive BM status. Patients without evidence of persistent DTC had a significantly longer overall survival (164.4 [155.6 - 173.3]), than patients with positive BM status (101.7 mon [89.4 - 113.9], p< .0001). In multivariate Cox regression analysis, allowing for bone marrow status, tumor size, nodal status, histopathological grading and hormone receptor status, DTC was of higher independent prognostic significance for subsequent reduced breast cancer specific survival (RR 5.9, 2.8 - 12.8, 95% CI, p< .0001), than nodal status at time of primary diagnosis (RR 1.2, 1.0 - 1.3, 95% CI, p=.014). Conclusion: Evidence of persistent DTC in breast cancer patients indicates an increased risk for subsequent relapse, and may serve for monitoring in future clinical trials. Such trials might investigate the benefit of individualized secondary adjuvant treatment or extended adjuvant therapy of patients with DTC. No significant financial relationships to disclose.

Early-stage breast cancer patients reporting difficulty sleeping, mood issues, or pain are more likely to refuse adjuvant hormone therapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12065-e12065
Author(s):  
Christian A. Thomas
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Hormone Therapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Adjuvant Hormone Therapy

e12065 Background: Adjuvant hormone therapy is a crucial part of the treatment for patients with early stage breast cancer and an important quality measure for programs such as QOPI and the oncology care model (OCM). However, it is not known which factors influence some patients with early stage breast cancer to decline adjuvant hormone therapy. We hypothesized that specific self-reported symptoms might impact a patient’s decision to accept or decline adjuvant hormone therapy. Methods: Patients with stage 0 or I breast cancer were identified by chart review from 2011-2016 and de-identified. On the day patients received a recommendation for adjuvant treatment the following patient reported outcome measures (PROs) were analyzed: difficulty sleeping (DS), fatigue (F), mood (M such as anxiety and depression), and pain (P) on a 0-4 symptom scale based on CTCAE v. 4. PROs were then linked with a patient’s decision to accept or decline adjuvant therapy. Results: A total of 287 patients with stage 0 (n = 80) or stage I (n = 207) breast cancer were identified. 38 stage O and 103 stage I patients had evaluable PROs on the same day a recommendation for adjuvant hormone therapy was made. Overall 18/38 (47.4%) of stage 0 patients and 90 of 103 (87.4%) of stage I patients accepted adjuvant treatment. Stage 0 patients declining adjuvant therapy reported any grade of PROs: DS (40%, n = 8), F (35%, n = 7), M (35%, n = 7), P (20%, n = 4). Stage 0 patients accepting treatment reported: DS (22%, n = 4), F (44%, n = 8), M (6%, n = 1), P (20%, n = 4). Stage I patients who declined treatment reported: DS (54%, n = 7), F (46%, n = 6), M (38%, n = 5), P (62%, n = 8). Stage I patients accepting treatment reported: DS (41%, n = 37), F (49%, n = 44), M (31%, n = 28), P (36%, n = 32). Conclusions: Early stage breast cancer patients declining adjuvant hormone therapy are more likely to self report symptoms such as difficulty sleeping, mood disturbances (anxiety, depression), and pain than those accepting treatment.

scholarly journals Dose-Dense Docetaxel versus Weekly Paclitaxel following Dose-Dense Epirubicin and Cyclophosphamide as Adjuvant Chemotherapy in Node-Positive Breast Cancer Patients: A Retrospective Cohort Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Sara Khoshroo ◽  
Saleh Sandoughdaran ◽  
Parisa Sabetrasekh ◽  
Parastoo Hajian ◽  
Pegah Bikdeli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Weekly Paclitaxel ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Positive ◽  
Dose Dense ◽  
Positive Breast Cancer

Background/Aims. The anthracycline and taxane-based chemotherapy regimens are the standard adjuvant treatment of node-positive breast cancer patients. Although it was believed that docetaxel and paclitaxel are similarly effective as adjuvant treatment in node-positive breast cancer, recent studies report that weekly paclitaxel is superior to weekly and triweekly docetaxel schedules in terms of overall survival (OS) and disease-free survival (DFS). However, to the best of our knowledge, no study has compared weekly paclitaxel with a dose-dense regimen of docetaxel. The current study is aimed at evaluating the outcome of women with node-positive breast cancer who had received weekly paclitaxel compared with those treated with dose-dense docetaxel. Methods. This study included patients from two prospective studies conducted in our institute from April 2007 to March 2009. Ninety-one women with axillary lymph node-positive breast cancer who had received four cycles of dose-dense epirubicin and cyclophosphamide were treated with either weekly paclitaxel (80 mg/m2) for 12 doses or biweekly docetaxel (75 mg/m2) for four cycles. Results. After a median follow-up of 88 and 109 months, 11 (23.4%) and 10 (22.7%) patients had experienced disease recurrence ( p = 0.16 ), while 10 (21.3%) and 5 (11.4%) patients had died in the paclitaxel and docetaxel arm, respectively ( p = 0.56 ). No significant difference could be seen in 5-year DFS or OS among groups (HR: 0.58; 95% CI: 0.19–1.81, p = 0.35 ; HR: 0.58; 95% CI: 0.19–1.81, p = 0.35 , respectively). Conclusion. In conclusion, both evaluated adjuvant chemotherapy regimens have comparable effectiveness regarding DFS and OS.

Adjuvant trastuzumab (T) therapy in HER2+ breast cancer after ASCO 2005: Patients’ attitudes and immediate economic burden

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10565-10565
Author(s):  
S. M. Benn ◽  
G. Jha ◽  
T. W. Ratliff ◽  
K. Spiers ◽  
R. Baskin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Economic Burden ◽  
Breast Cancer Patients ◽  
Her2 Breast Cancer ◽  
Number Of Patients ◽  
Study Results ◽  
To Receive

10565 Background: Data from 3 large randomized trials documenting the efficacy of T in the adjuvant setting were reported at ASCO 2005, and subsequently published in NEJM 2005; 353: (16) pp 1659–72 and 1673–1684 . We decided to offer T, and attempted to assess patients’ characteristics that influence its acceptance, in a subgroup of HER2 + patients that had already completed adjuvant chemotherapy at our institution within 12 months prior to these reported results. Methods: Using Electronic Medical Records (OpTx, Canada), we identified HER2+ breast cancer patients who had completed adjuvant therapy within the prior 12 months and administered an informational synopsis about the study results. They then completed a questionnaire, including their demographic information, that established their understanding of the data and documented their decision to receive or to not receive adjuvant T as an afterthought. Results: We identified 1442 breast cancer patients in Optx that were seen at UTCI for initial or follow up visits between May 2004 and May 2005. Those with 3 or fewer visits within the last year and those who received no chemotherapy (n = 770) were excluded. Of the remaining 672 patients, only 104 (15%) had documented HER2+ disease. Fourteen HER2+ patients had metastatic disease, while 84 patients, though HER2+, had either completed adjuvant chemotherapy greater than 12 months prior or were currently receiving adjuvant therapy or T, and/or had other reasons to not be suitable for T. Six patients qualified for this study; 5 decided to receive adjuvant T and 1 chose not to because she perceived the additional benefit to be minimal. Conclusions: While our sample size was too small in the end to draw conclusions about patients’ attitudes towards new data on adjuvant T, we were struck by the small number of patients who could be offered T as an afterthought despite our large patient volume. The magnitude of the perceived economic burden and its imminence after the release of these data may have been overestimated. [Table: see text]

Explanation model using pathological data for treatment outcome of patients with early-stage breast cancer with hormonal receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12006-e12006
Author(s):  
Naiyarat Prasongsook
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Hormonal Therapy ◽  
Tumor Size ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Ki 67

e12006 Background: The decision to initiate adjuvant chemotherapy for early-stage breast cancer patients with HR+ and HER2- is still unclear. Although the 21-gene Recurrence Score (RS) assay is a validated testing and becomes an emerging decision-making tool; it is still controversial guidance on adding adjuvant chemotherapy for patients with intermediate RS. This study aimed to develop the explanation model by using pathological information for prediction of the best outcome from adjuvant systemic treatment in these patients.Methods: Early-stage breast cancer patients with HR+, and HER2- who underwent complete resection registered within electronic medical record from 2003 to 2013 were included. Patient’s characteristics and pathological information were collected and analyzed. Univariate and multivariate analysis were conducted by using stepwise logistic regression. The explanation model was explored by using association between multivariate models and overall survival (OS).Results: 236 patients who underwent complete surgery treatment were included. 121 patients (51%) were treated with sequential adjuvant treatment, and 115 patients (48%) with anti-hormonal therapy alone. Clinicopathological parameters between two groups were demonstrated in Table1. Tumor size (≥2 – 5 cm), Estrogen receptor-negative/ Progesterone receptor-positive (ER-/PgR+), and Ki-67 expression were statistically significant multivariate independent prognostic factors for OS. When we adjusted for tumor size, HR status, and Ki-67 expression, the explanation model predicted 10-year OS was 99.2% for patients with sequential adjuvant treatment, whereas 89.5% for patients with adjuvant anti-hormonal alone (difference: 9.7%); p-value = 0.01.Conclusions: We found substantial discordance in 10-year OS benefit between early-breast cancer patients with HR+, HER2- with sequential adjuvant therapy and adjuvant hormonal therapy alone. Adjuvant chemotherapy should be considered in early-breast cancer patients with 2-3 cm in tumor size, ER-/PgR+, and Ki 67 expression.

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