Abstract P2-06-08: Race is not a contributing factor to breast cancer-free interval outcome for patients with equal access to healthcare treated at a military medical center

AbstractSurvival of breast cancer patients has improved, and treatment-related changes regarding metabolic profile deterioration after neoadjuvant systemic treatment (NST) become important issues in cancer survivors. We sought to compare metabolic profile changes and the neutrophil-to-lymphocyte ratio (NLR) between patients undergoing neoadjuvant chemotherapy (NCT) and neoadjuvant endocrine therapy (NET) 3 years after the treatment. In a prospective, randomized, phase III trial which compared 24 weeks of NCT with adriamycin and cyclophosphamide followed by docetaxel and NET with goserelin and tamoxifen (NEST), 123 patients in the Asan Medical Center were retrospectively reviewed to evaluate metabolic changes, such as body mass index (BMI), blood pressure (BP), total cholesterol (TC), fasting glucose, and the NLR. The mean age of patients was 42 years. The changes in BMI, serum glucose, and TC during NST and after 3 years were significantly different between NCT and NET. The proportion of overweight + obese group and the mean BMI were significantly increased during NCT (26.6% to 37.5%, 22.84 kg/m2 to 23.87 kg/m2, p < 0.05), and these attributes found to have normalized at the 3-year follow-up. In the NET group, BMI changes were not observed (p > 0.05, all). There were no differences in changes over time among in the Hypertension group during NCT and NET (p = 0.96). The mean value of serum TC and fasting glucose significantly increased (< 0.05, both) during NCT and decreased 3 years after NCT (p < 0.05); however, no significant changes were observed in the NET group. The NLR was increased from 1.83 to 3.18 after NCT (p < 0.05) and decreased from 1.98 to 1.43 (p < 0.05) after NET. Compared with minimal metabolic effect of NET, NCT worsens metabolic profiles, which were recovered over 3 years. The NLR was increased after NCT but decreased after NET.

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Telemammography for breast cancer screening: a cost-effective approach in Argentina

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2021-100351 ◽

2021 ◽

Vol 28 (1) ◽

pp. e100351

Author(s):

Victoria Alba Malek Pascha ◽

Li Sun ◽

Ramiro Gilardino ◽

Rosa Legood

Keyword(s):

Breast Cancer ◽

Sensitivity Analysis ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Probabilistic Sensitivity Analysis ◽

Mammography Screening ◽

Cost Effective ◽

Access To Healthcare ◽

Over 40 Years ◽

Improve Access

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

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Complementary and Alternative Medicine Use in Breast Cancer Patients at a Medical Center in Taiwan: A Cross-Sectional Study

Integrative Cancer Therapies ◽

10.1177/1534735420983910 ◽

2020 ◽

Vol 19 ◽

pp. 153473542098391

Author(s):

Chieh-Ying Chin ◽

Yung-Hsiang Chen ◽

Shin-Chung Wu ◽

Chien-Ting Liu ◽

Yun-Fang Lee ◽

...

Keyword(s):

Breast Cancer ◽

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

Cancer Patients ◽

Medical Center ◽

Cancer Center ◽

Breast Cancer Patients ◽

Cross Sectional ◽

Cam Use ◽

Complementary And Alternative

Background Complementary and alternative medicine (CAM) is becoming more common in medical practice, but little is known about the concurrent use of CAM and conventional treatment. Therefore, the aim was to investigate the types of CAM used and their prevalence in a regional patient cohort with breast cancer (BC). Methods BC patients were interviewed with a structured questionnaire survey on the use of CAM in southern Taiwan at an Integrative Breast Cancer Center (IBCC). The National Centre for Complementary and Integrative Health (NCCIH) classification was used to group responses. Over a period of 8 months, all patients receiving treatment for cancer at the IBCC were approached. Results A total of 106 BC patients completed the survey (response rate: 79.7%). The prevalence of CAM use was 82.4%. Patients who were employed, were receiving radiotherapy and hormone therapy, and had cancer for a longer duration were more likely to use CAM ( P < .05). Multivariate analysis identified employment as an independent predictor of CAM use (OR = 6.92; 95% CI = 1.33-36.15). Dietary supplementation (n = 69, 82.1%) was the type of CAM most frequently used, followed by exercise (n = 48, 57.1%) and traditional Chinese medicine (n = 29, 34.5%). The main reason for using CAM was to ameliorate the side effects of conventional therapies. Almost half (46.4%) of these CAM users did not disclose that they were using it in medical consultations with their physicians. Most chose to use CAM due to recommendations from family and friends. Conclusion A large portion of BC patients at the IBCC undergoing anti-cancer treatment courses used CAM, but less than half discussed it with their physicians. Given the high prevalence of CAM, it would be justifiable to direct further resources toward this service so that cancer patients can benefit from a holistic approach to their treatment.

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The impact of sociodemographic factors on the utilization of radiation therapy in breast cancer patients in Estonia: a register-based study

International Journal for Equity in Health ◽

10.1186/s12939-021-01497-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Fereshteh Shahrabi Farahani ◽

Keiu Paapsi ◽

Kaire Innos

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Cancer Registry ◽

Psychosocial Support ◽

Sociodemographic Factors ◽

Stage I ◽

Equal Access ◽

Administrative Databases ◽

The Impact ◽

Over Time

Abstract Background Radiation therapy is an important part of multimodal breast cancer treatment. The aim was to examine the impact of sociodemographic factors on radiation therapy use in breast cancer (BC) patients in Estonia, linking cancer registry data to administrative databases. Methods Estonian Cancer Registry provided data on women diagnosed with BC in Estonia in 2007–2018, including TNM stage at diagnosis. Use of radiation therapy within 12 months of diagnosis was determined from Estonian Health Insurance Funds claims, and sociodemographic characteristics from population registry. Receipt of radiation therapy was evaluated over time and by clinical and sociodemographic factors. Poisson regression with robust variance was used to calculate univariate and multivariate prevalence rate ratios (PRR) with 95 % confidence intervals (CI) for receipt of radiation therapy among stage I–III BC patients age < 70 years who underwent primary surgery. Results Overall, of 8637 women included in the study, 4310 (50 %) received radiation therapy within 12 months of diagnosis. This proportion increased from 39 to 58 % from 2007 to 2009 to 2016–2018 (p < 0.001). Multivariate regression analysis showed that compared to women with stage I BC, those with more advanced stage were less likely to receive radiation therapy. Receipt of radiation therapy increased significantly over time and was nearly 40 % higher in 2016–2018 than in 2007–2009. Use of radiation therapy was significantly lower for women with the lowest level of education compared to those with a university degree (PRR 0.88, 95 % CI 0.80–0.97), and for divorced/widowed women (PRR 0.95, 95 % CI 0.91–0.99) and single women (PRR 0.92, 95 % CI 0.86–0.99), compared to married women. Age at diagnosis, nationality and place of residence were not associated with receipt of radiation therapy. Conclusions The study showed considerable increase in the use of radiation therapy in Estonia over the study period, which is in line with increases in available equipment. The lack of geographic variations suggests equal access to therapy for patients living in remote regions. However, educational level and marital status were significantly associated with receipt of radiation therapy, highlighting the importance of psychosocial support in ensuring equal access to care.

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The experiences of women with breast cancer who undergo fertility preservation

Human Reproduction Open ◽

10.1093/hropen/hoab018 ◽

2021 ◽

Vol 2021 (2) ◽

Author(s):

T Dahhan ◽

F van der Veen ◽

A M E Bos ◽

M Goddijn ◽

E A F Dancet

Keyword(s):

Breast Cancer ◽

Fertility Preservation ◽

Conflicts Of Interest ◽

Medical Center ◽

Academic Medical Center ◽

Psychosocial Care ◽

Phenomenological Approach ◽

Starting Point ◽

Competing Interest ◽

Experiences Of Women

Abstract STUDY QUESTION How do women, who have just been diagnosed with breast cancer, experience oocyte or embryo banking? SUMMARY ANSWER Fertility preservation was a challenging yet welcome way to take action when confronted with breast cancer. WHAT IS KNOWN ALREADY Fertility preservation for women with breast cancer is a way to safeguard future chances of having children. Women who have just been diagnosed with breast cancer report stress, as do women who have to undergo IVF treatment. How women experience the collision of these two stressfull events, has not yet been studied. STUDY DESIGN, SIZE, DURATION We performed a multicenter qualitative study with a phenomenological approach including 21 women between March and July 2014. Women were recruited from two university-based fertility clinics. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with breast cancer who banked oocytes or embryos 1–15 months before study participation were eligible. We conducted in-depth, face-to-face interviews with 21 women, which was sufficient to reach data saturation. MAIN RESULTS AND THE ROLE OF CHANCE The 21 women interviewed had a mean age of 32 years. Analysis of the 21 interviews revealed three main experiences: the burden of fertility preservation, the new identity of a fertility patient and coping with breast cancer through fertility preservation. LIMITATIONS, REASONS FOR CAUTION Interviewing women after, rather than during, fertility preservation might have induced recall bias. Translation of quotes was not carried out by a certified translator. WIDER IMPLICATIONS OF THE FINDINGS The insights gained from this study of the experiences of women undergoing fertility preservation while being newly diagnosed with breast cancer could be used as a starting point for adapting the routine psychosocial care provided by fertility clinic staff. Future studies are necessary to investigate whether adapting routine psychosocial care improves women’s wellbeing. STUDY FUNDING/COMPETING INTEREST(S) None of the authors in this study declare potential conflicts of interest. The study was funded by the Center of Reproductive Medicine of the Academic Medical Center.

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Increasing Pediatric Audiology Services via Telehealth

Seminars in Hearing ◽

10.1055/s-0041-1731694 ◽

2021 ◽

Vol 42 (02) ◽

pp. 136-151

Author(s):

Tommy Evans ◽

Timothy Nejman ◽

Erin Stewart ◽

Ian Windmill

Keyword(s):

Health Care ◽

Service Delivery ◽

Case Studies ◽

Health Care Services ◽

Medical Center ◽

Access To Healthcare ◽

Hospital Medical ◽

Care Services ◽

Telehealth Service ◽

Pediatric Audiology

AbstractTelehealth as a means to deliver health care services has been used by physicians for many years, but the use of telehealth in audiology, specifically in pediatrics, has been minimal. Barriers such as licensure, reimbursement, technology, and equipment have been cited as reasons for audiologists not participating in telehealth. However, the COVID-19 pandemic created the need for telehealth services to be widely used to safely increase access to healthcare, and emergent orders helped reduce previous barriers so that audiologists could participate in telehealth service delivery. This article details three cases where audiologists delivered telehealth services to children. These case studies demonstrate portions of the Division of Audiology Telehealth Program of the Cincinnati Children's Hospital Medical Center and how they increased access to hearing healthcare in response to the COVID-19 pandemic.

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Creation of a primary breast cancer culture repository from patients with a BMI >30 kg/m2: A Mexican endeavor.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12574 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12574-e12574

Author(s):

Daniela Shveid Gerson ◽

Alejandro Zentella - Dehesa ◽

Raquel Gerson Cwilich ◽

Benigno Rodriguez ◽

Omar Serrano Villamayor ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Cells ◽

Primary Breast Cancer ◽

Medical Center ◽

Primary Cultures ◽

Obese Women ◽

Cellular Analysis ◽

Response To Chemotherapy

e12574 Background: Currently there are no primary cultures or cell lines derived from patients with breast cancer and obesity. It has been postulated that breast cancer in obese women behaves differently as it does in non-obese women, as is composed of distinct biological features, as was generated in a different metabolic environment, as well as pertains to a different prognosis and different response to chemotherapy, lower rates of overall survival and a greater probability of recurrence. By creating a primary breast cancer culture bank of breast cancer tumors from women with obesity (BMI > 30kg/m2), we will establish a cell line exclusive to obese women in Mexico, where targeted therapy may be tested and treatment may be individualized depending on the characteristics of the patient. Methods: This study recruited 32 women with breast cancer and a BMI > 30 kg/m2, matched by 6 controls with are non-obese women with breast cancer. Elegibility criteria was determined by women with breast cancer confirmed by pathology, who had not been subjected to prior treatment regarding the neoplasm. The breast cancer removing surgeries and the patients were selected from the ABC Medical Center in Mexico City and all procedures were approved by the research and ethics committee of the hospital in question. Results: Through extensive communication a cooperative protocol was established between the departments of surgery, oncology, pathology and nursing to coordinate efforts and be able to take a 2 – 5 mm sample of the breast tumor removed from the patient. To be able to distinguish cancer cells from non-cancer cells (epithelial cells, fibroblasts, adipocytes) the Hayflick limit was be utilized. Once a primary breast cancer culture was established, 12 million cells will be injected into the subscapular area of athymic, nu-nu mice to be able to monitor tumoral growth in vivo and conduct a subsequent cellular analysis, determining it still pertains to the same characteristics of the tumor from which it was obtained. Conclusions: A primary breast cancer culture repository from patients with a BMI > 30 kg/m2 was established. This is the first primary breast cancer culture for both Mexican and obese women with breast cancer, the first in vitro method of analysis of specific characteristics typical of the Mexican population. Translational research may now be conducted on these new tumoral cultures to create individualized therapy for women with the distinct, aforementioned characteristics.

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Application of RSClin to guide treatment recommendations for premenopausal patients with early-stage hormone-positive breast cancer and intermediate risk oncotype recurrence scores.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12511 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12511-e12511

Author(s):

Brittney Shulman Zimmerman ◽

Shana Berwick ◽

Alaina J Kessler ◽

Danielle Seidman ◽

Sara Malin Hovstadius ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Medical Center ◽

Academic Medical Center ◽

Recurrence Score ◽

Treatment Recommendations ◽

Definitive Treatment ◽

Treatment Recommendation ◽

Intermediate Risk ◽

Premenopausal Patients

e12511 Background: The RSClin model, which incorporates the Oncotype Recurrence Score (RS) and clinicopathologic features, was recently developed to further tailor prognosis and prediction of chemotherapy benefit for patients with early-stage hormone positive (HR+) breast cancer (BC) (Sparano et al, 2020). The RSClin calculator is available online to assist treatment planning for situations where chemotherapy benefit is uncertain. Covariates include Oncotype RS, tumor grade, tumor size and patient age. The risk calculator generates a 10-year distant recurrence risk and absolute chemotherapy benefit. This tool may be especially helpful to determine treatment management for premenopausal patients with early-stage HR+ BC with intermediate risk (IR) Oncotype RS (16-25). We retrospectively applied RSClin to this patient population to determine if it would have changed treatment recommendations. Methods: We identified premenopausal women with node-negative early-stage BC with IR RS (16-25) within our large Oncotype database. Using the RSClin model, we selected >5% absolute chemotherapy benefit as a reasonable cutoff to recommend chemotherapy. We compared the treatment recommendation based on RSClin with the treatment previously recommended by breast oncologists at our large academic medical center in New York City. Results: There were 86 patients who met criteria with a median age of 46 years. Of these, 26 patients (30%) were recommended chemotherapy plus endocrine therapy (ET) and 60 (70%) were recommended ET alone. After applying the RSClin model (data available for 83/86 patients), 19 (23%) would have resulted in a change in treatment recommendation and 64 (77%) would have remained unchanged. Overall, 8 (10%) would have withheld chemotherapy when it was previously offered and 11 (13%) would have recommended chemotherapy when it was previously excluded. There were 8 (9%) secondary invasive breast events in this population, with 2 (2%) being ipsilateral, 3 (3%) being contralateral and 3 (3%) metastatic at a median follow up of 46.9 months. Conclusions: The RSClin model would have changed management of premenopausal patients with IR RS in 23% of patients. This model, although not yet prospectively validated, may help individualize therapy for patients with less definitive treatment plans. Using RSClin, we can aim to minimize recurrence rates and avoid unnecessary chemotherapy in selected patients. This model is easy to apply and will have important clinical utility moving forward.

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