Abstract LB-191: Association of anti-estrogen therapy in breast cancer patients and subsequent risk of rheumatoid arthritis: An electronic health record study

Purpose: In conjunction with women being diagnosed earlier with breast cancer and a rapidly aging population, advances in cancer therapies have swiftly propelled cardiotoxicity as a major health concern for breast cancer patients. Frequent cardiotoxicity outcomes include: reduced left ventricular ejection fraction (LVEF), myocardial infarction, asymptomatic or hospitalized heart failure, arrhythmias, hypertension, and thromboembolism. The purpose of this study was to use an electronic health records system determine if an increased odds of heart disease was present among women with breast cancer. Methods: Data from the Research Action for Health Network (REACHnet) was used for the analysis. REACHnet is a clinical data research network that uses the common data model to extract electronic health records (EHR) from health networks in Louisiana (n=100,000).Women over the age of 30 with data (n=35,455) were included in the analysis. ICD-9 diagnosis codes were used to classify heart disease (HD) (Hypertensive HD, Ischemic HD, Pulmonary HD, and Other HD) and identify breast cancer patients. Additional EHR variables considered were smoking status, and patient vitals. Chi-square tests, crude, and adjusted logistic regression models were computed utilizing SAS 9.4. Results: Utilizing diagnoses codes our study team has estimated 28.6% of women over the age of 30 with a breast cancer diagnosis (n=816) also had a heart disease diagnosis, contrasted with 15.6% of women without a breast cancer diagnosis. Among patients with heart disease, there was no significant difference in the distribution of the type of heart disease diagnoses by breast cancer status (p=0.87). There was a 2.21 (1.89, 2.58) crude odds ratio of having a CVD diagnoses among breast cancer cases when referenced to cancer free women. After adjusting for age (30-49, 50-64, 65+), race (black/white), and comorbidities (obesity/overweight, diabetes, current smoker) there was an increased risk of heart disease (OR: 1.24 (1.05, 1.47)). Conclusion: The short-term and long-term consequences of cardiotoxicity on cancer treatment risk-to-benefit ratio, survivorship issues, and competing causes of mortality are increasingly being acknowledged. Our next efforts will include making advances in predictive risk modeling. Maximizing benefits while reducing cardiac risks needs to become a priority in oncologic management and monitoring for late-term toxic effects.

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Caregivers' role in using a personal electronic health record: a qualitative study of cancer patients and caregivers in Germany

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01172-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Aline Weis ◽

Sabrina Pohlmann ◽

Regina Poss-Doering ◽

Beate Strauss ◽

Charlotte Ullrich ◽

...

Keyword(s):

Qualitative Study ◽

Electronic Health Record ◽

Cancer Patients ◽

Health Record ◽

Electronic Health

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Abstract LB-278: Metformin exposure on survival in localized breast cancer patients with type II diabetes mellitus using electronic health records

10.1158/1538-7445.am2014-lb-278 ◽

2014 ◽

Author(s):

Matthew K. Breitenstein ◽

Leiwei Wang ◽

Richard M. Weinshilboum ◽

Jyotishman Pathak

Keyword(s):

Breast Cancer ◽

Diabetes Mellitus ◽

Electronic Health Records ◽

Cancer Patients ◽

Type Ii Diabetes ◽

Type Ii Diabetes Mellitus ◽

Type Ii ◽

Breast Cancer Patients ◽

Health Records ◽

Electronic Health

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Differences in Longitudinal Disease Activity Between Research Cohort and Noncohort Participants with Rheumatoid Arthritis Using Electronic Health Record Data

ACR Open Rheumatology ◽

10.1002/acr2.1017 ◽

2019 ◽

Vol 1 (2) ◽

pp. 113-118 ◽

Cited By ~ 1

Author(s):

Milena A. Gianfrancesco ◽

Laura Trupin ◽

Charles E. McCulloch ◽

Stephen Shiboski ◽

Gabriela Schmajuk ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Electronic Health Record ◽

Disease Activity ◽

Health Record ◽

Electronic Health Record Data ◽

Record Data ◽

Electronic Health

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Association of the phosphorylation of the estrogen receptor at serine 118 and 167 with prognosis in postmenopausal breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.562 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 562-562

Author(s):

Karin J. Beelen ◽

Mark Opdam ◽

Rutger H.T. Koornstra ◽

Andrew D. Vincent ◽

Jan Baptist Vermorken ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Cancer Patients ◽

Estrogen Therapy ◽

Postmenopausal Breast Cancer ◽

Tamoxifen Treatment ◽

Adjuvant Tamoxifen ◽

Breast Cancer Patients ◽

Premenopausal Breast Cancer ◽

Cox Models

562 Background: The sensitivity of the estrogen receptor (ERα) to anti-estrogen therapy can be affected by phosphorylation events. In premenopausal breast cancer patients, phosphorylation of the ERα at serine 118 (ERαS118-p) is predictive for benefit from adjuvant tamoxifen. Since ERαS118-p represents the common hallmark of different signaling cascades that differ in E2 dependency, the resulting effect on estrogen sensitivity may differ between pre- and postmenopausal patients. Phosphorylation of serine 167 (ERαS167-p) has been associated with favorable disease outcome, but whether ERαS167-p can predict tamoxifen sensitivity is currently unknown. We tested the predictive value of both ERαS118-p and ERαS167-p for benefit from adjuvant tamoxifen in postmenopausal breast cancer patients. Methods: We collected primary tumor blocks from 563 ERα positive (stage I-III) postmenopausal patients who had been randomized between tamoxifen (1 to 3 years) vs. no adjuvant therapy (IKA trial). The median follow-up of patients without a recurrence event was 9.4 years. Immunohistochemistry was performed on a TMA using monoclonal antibodies for ERαS118-p and ERαS167-p. The percentage of positive nuclei was scored and a score of ≥ 10 % was considered as positive. Multivariate Cox models were used to assess hazard ratios (HRs) for recurrence free interval and the interaction between these phosphorylations and tamoxifen treatment. Results: We did not find a significant interaction between either ERαS118-p (p=0.99) or ERαS167-p (p=0.44) and tamoxifen, suggesting that the relative benefit from adjuvant tamoxifen in postmenopausal patients is not dependent on the presence of one of these phosphorylations. Both tamoxifen treated patients as well as control patients had a better prognosis when their tumor was positive for ERαS118-p (adjusted HR 0.60 p=0.02) or ERαS167-p (adjusted HR 0.62, p=0.02) compared to patients whose tumor did not express these ERα phosphorylations. Conclusions: In postmenopausal patients ERαS118-p and ERαS167-p are both associated with better prognosis, but do not predict differential benefit from tamoxifen.

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Enhancing the electronic health record to promote and measure adherence to breast cancer clinical pathways.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.322 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 322-322

Author(s):

Lauren E. Geisel ◽

Helen M. Johnson ◽

Andrew Weil ◽

Mahvish Muzaffar ◽

Nasreen A. Vohra ◽

...

Keyword(s):

Breast Cancer ◽

Family History ◽

Electronic Health Record ◽

Clinical Pathways ◽

Clinical Stage ◽

Baseline Data ◽

Clinical Staging ◽

Health Record ◽

Electronic Health ◽

Multidisciplinary Conference

322 Background: Clinical pathways are widely accepted tools for improving the quality of cancer care. We developed and implemented, within the electronic health record (EHR), a standardized multidisciplinary breast cancer conference template comprised of NCCN clinical pathway elements, with triggers to promote adherence and measure compliance. Methods: The records of breast cancer patients diagnosed from January 2016 to December 2017 were reviewed. Baseline data on (1) the documentation of clinical stage prior to prospective presentation at multidisciplinary conference, (2) documentation of family history, and (3) functional breast imaging utilization were recorded. EHR enhancements developed throughout 2018 were implemented in January 2019. Post-implementation data were obtained via an EHR query of records from January 2019 to the present. Results: At baseline, 56.5% of new patients (n = 435) had a clinical stage documented appropriately (goal 100%). After the EHR enhancements went live, this rate increased to 76.9% (n = 78 new diagnoses), ranging from 40% for patients with metastatic disease to 85.7% for non-metastatic. Compared with baseline data, EHR-derived data from 149 multidisciplinary conference notes demonstrated relatively stable rates of compliance with the family history and imaging metrics: 94.3% to 93.9% (goal 100%), and 12.8% to 13.4% (goal ≤20%), respectively. In 2019, there were 128 instances of an EHR trigger prompting physicians to review the multidisciplinary conference recommendations. While 89.1% of users responded that they reviewed the note, only 42.1% of these clicked on the link to view it. Conclusions: The EHR is a powerful tool for incorporating clinical pathways into oncology providers’ daily workflow. Quality improvement data can be extracted rapidly and efficiently, which facilitates continuous QI. We observed a notable improvement in documentation of clinical staging prior to multidisciplinary conference after the implementation of the clinical pathways in the EHR. Our first report identified several areas for improvement, which will be the focus of subsequent PDSA cycles.

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The effects of anti-estrogen therapy on lymphocyte functions in breast cancer patients

Apmis ◽

10.1111/j.1699-0463.1991.tb05134.x ◽

1991 ◽

Vol 99 (1-6) ◽

pp. 163-170 ◽

Cited By ~ 12

Author(s):

TIMO PAAVONEN ◽

HANNU ARONEN ◽

SEPPO PYRHÖNEN ◽

ALAJOS HAJBA ◽

LEIF C. ANDERSSON

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Estrogen Therapy ◽

Breast Cancer Patients

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Electronic health record use among cancer patients: Insights from the Health Information National Trends Survey

Health Informatics Journal ◽

10.1177/1460458217704246 ◽

2017 ◽

Vol 25 (1) ◽

pp. 83-90 ◽

Cited By ~ 3

Author(s):

Yulia A Strekalova

Keyword(s):

Electronic Health Records ◽

Electronic Health Record ◽

Cancer Patients ◽

Health Information ◽

Information Seeking ◽

Health Record ◽

Online Information ◽

Health Records ◽

Electronic Health ◽

National Trends

Over 90% of US hospitals provide patients with access to e-copy of their health records, but the utilization of electronic health records by the US consumers remains low. Guided by the comprehensive information-seeking model, this study used data from the National Cancer Institute’s Health Information National Trends Survey 4 (Cycle 4) and examined the factors that explain the level of electronic health record use by cancer patients. Consistent with the model, individual information-seeking factors and perceptions of security and utility were associated with the frequency of electronic health record access. Specifically, higher income, prior online information seeking, interest in accessing health information online, and normative beliefs were predictive of electronic health record access. Conversely, poorer general health status and lack of health care provider encouragement to use electronic health records were associated with lower utilization rates. The current findings provide theory-based evidence that contributes to the understanding of the explanatory factors of electronic health record use and suggest future directions for research and practice.

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