scholarly journals P958 Back to basis? Feasibility of standard and novel echocardiographic measurements after breast cancer surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Orstad ◽  
K Steine ◽  
T Nerdrum
Keyword(s):  
Breast Cancer ◽  
Image Quality ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Two Dimensional ◽  
Echocardiographic Image ◽  
The Impact

Abstract Background It is recommended that breast cancer patients should undergo cardiac follow-up during chemotherapy, with clinical assessment and echocardiogram. Standard measurements are robust and reproducible, but novel echocardiography methods as global longitudinal strain (GLS) and three-dimensional (3D) echocardiography are recommended due to their superior sensitivity. These methods require high-quality images. Breast cancer surgery may lead to reduced echocardiographic image quality in this population, in addition to age, obesity and smoking. Purpose We wanted to explore the feasibility of standard and novel echo methods in an unselected breast cancer population. Methods The present study included consecutive, unselected patients referred to baseline echocardiogram at the cardio oncology outpatient clinic in a large university hospital prior to start of adjuvant chemotherapy. Data on surgery, smoking habits, age and body mass index were collected. Feasibility was defined as the presence or absence to carry out meaningful measurements of left ventricular (LV) systolic function, from standard mitral annular plane systolic excursion (MAPSE) and two-dimensional LV ejection fraction (EF), to novel GLS and 3D LVEF. Multivariable logistic regression was performed to assess the impact of relevant variables on image quality. Results 116 female patients were included. 21 % of these patients had insufficient images for novel analyses. Left sided breast implant (OR 5,77; P 0,04), age (OR 3,89; P 0,02) and daily smoking (OR 3,57; P 0,03) were found to be independently associated with insufficient image quality. Standard analyses like two-dimensional EF and MAPSE were obtainable in 99 and 97 % of the examinations, respectively. Conclusion One of five in a postoperative breast cancer population cannot undergo follow-up using novel, sensitive echocardiographic measurements. Standard measurements, however, are obtainable in almost all patients. It is therefore important that these measurements are included in cardiac follow-up during chemotherapy.

P3118CMR Fast-SENC intramyocardial LV & RV segmental strain detects cardiotoxicity during oncology treatment and impact of cardioprotection therapy before echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Steen ◽  
M Montenbruck ◽  
P Wuelfing ◽  
S Esch ◽  
A K Schwarz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Therapy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lower Sensitivity ◽  
Pharmacological Agents ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background The incidence of cardiotoxicity during cancer therapy is underestimated due to limitations of current diagnostic tests. Current biomarkers (BNP, NT-pro-BNP, hs-Troponin, etc.) and imaging calculations (e.g. echocardiography) such as left ventricular ejection fraction (LVEF) are currently included in the guidelines to designate cardiotoxicity during cancer therapy. Unfortunately, these diagnostics identify systemic damage in symptomatic patients after the heart is unable to compensate for regional dysfunction. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) test that regionally detects subclinical intramyocardial dysfunction in 1 heartbeat. Methods This single center, prospective Prefect Study was used to evaluate cardiotoxicity and the impact of cardioprotective therapy in Breast Cancer and Lymphoma patients (NCT03543228). fSENC was acquired with a 1.5T MRI and processed with the software to quantify intramyocardial strain. Segmental strain was measured in three short axis scans (basal, midventricular, apical) with 16 LV/6 RV longitudinal segments & three long axis scans (2-, 3-, 4-chamber) with 21 LV/5 RV circumferential segments. fSENC CMR was performed before chemotherapy, during and after anthracycline/taxane therapy, at 1 year follow-up, and as needed in between designated follow-up periods. Cardioprotective therapy was offered to patients meeting the definition of cardiotoxicity by the ESC Guidelines on Cardiotoxicity and/or ESMO Clinical Practice Guidelines or those observing a substantial decline in cardiac function. Results Two hundred eight (208) CMRs were performed in fifty-two (52) patients (44 female). Patients had an average (± stdev) age of 53 (15) yrs, BMI of 26 (5) kg/m2; 77% had breast cancer, 23% had Lymphoma. fSENC CMRs required 11 (2) min total exam time. The % of normal fSENC (segmental stain <−17%) with a threshold of 65% showed a sensitivity of 87% and specificity of 89% in detecting cardiotoxicity while echocardiography GLS with a threshold of −17% observed a sensitivity of 20% and specificity of 88%. Figure 1 shows receiver operating characteristic curves for fSENC based on the percent of normal myocardium, and echocardiography global longitudinal strain (GLS) respectively. Global fSENC had substantially lower sensitivity than segmental fSENC despite having higher accuracy than the other global metrics. Figure 1 Conclusion Segmental fSENC intramyocardial strain detects subclinical dysfunction due to cardiotoxic response of chemotherapy before other biomarkers and imaging modalities. The ability to detect the subclinical cardiotoxicity of chemotherapy agents, or other pharmacological agents that cause or worsen heart failure, enables proactive prescription of cardioprotective medications to avoid tissue remodeling that precedes systemic cardiac dysfunction and worsening of global measures such as LVEF and current biomarkers.

Sickness absence following breast cancer surgery: a two-year follow-up cohort study

2017 ◽  
Vol 32 (2) ◽  
pp. 715-724 ◽  
Author(s):  
Lena-Marie Petersson ◽  
Marjan Vaez ◽  
Marie I. Nilsson ◽  
Fredrik Saboonchi ◽  
Kristina Alexanderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Sickness Absence ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

An Evaluation of BreastHealth Outpatient Follow-Up for Patients after Breast Cancer Surgery

2007 ◽  
Vol 33 (9) ◽  
pp. 1126-1127
Author(s):  
C CANNING ◽  
C CAREW ◽  
D BUGGY ◽  
F FLANAGAN ◽  
M STOKES
Keyword(s):  
Breast Cancer ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Financial Costs and Burden Related to Decisions for Breast Cancer Surgery

2019 ◽  
Vol 15 (8) ◽  
pp. e666-e676 ◽  
Author(s):  
Rachel A. Greenup ◽  
Christel Rushing ◽  
Laura Fish ◽  
Brittany M. Campbell ◽  
Lisa Tolnitch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Breast Conserving Surgery ◽  
Treatment Costs ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Bilateral Mastectomy ◽  
Financial Costs ◽  
The Impact

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.

scholarly journals Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Yvonne Ying Ru Ng ◽  
Patrick Mun Yew Chan ◽  
Juliana Jia Chuan Chen ◽  
Melanie Dee Wern Seah ◽  
Christine Teo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ambulatory Surgery ◽  
Standard Of Care ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Patient Acceptance ◽  
Wound Complications ◽  
Proper Patient Selection ◽  
The Impact ◽  
Ambulatory Procedures

Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23) service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission.Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010.Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01), those undergoing wide local excision (P<0.01) and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01), were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery.Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

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