Abstract P3-14-08: The impact of a structured surveillance protocol using bioimpedance spectroscopy (BIS) on preventing breast cancer related lymphedema (BCRL) in high-Risk patients

Abstract Background Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates. Methods Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery. Results 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3–5.5) for background studies (n = 35), 1.5% (95% CI: 0.6–2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6–9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction). Conclusions Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.

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Quantitative analysis of diffusion-weighted imaging in high-risk patients and newly diagnosed breast cancer patients; a systematic review

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1538825110 ◽

2019 ◽

pp. 1

Author(s):

Basmah Altuwayjiri

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Quantitative Analysis ◽

High Risk ◽

Cancer Patients ◽

Diffusion Weighted Imaging ◽

Newly Diagnosed ◽

Breast Cancer Patients ◽

High Risk Patients ◽

Risk Patients

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Impact of the 21-gene assay on treatment decisions in high-risk patients with ER-positive HER2-negative early breast cancer: Results of the KARMA Dx study

Annals of Oncology ◽

10.1093/annonc/mdz095.027 ◽

2019 ◽

Vol 30 ◽

pp. iii9-iii10

Author(s):

A. Llombart ◽

R. Andrés ◽

A. Anton Torres ◽

N. Martinez ◽

C. Rodriguez ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Early Breast Cancer ◽

Treatment Decisions ◽

High Risk Patients ◽

Gene Assay ◽

Er Positive ◽

Risk Patients

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Impact of Different Modules of 21-Gene Assay in Early Breast Cancer Patients

Frontiers in Endocrinology ◽

10.3389/fendo.2021.759338 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mengdi Chen ◽

Deyue Liu ◽

Weilin Chen ◽

Weiguo Chen ◽

Kunwei Shen ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Cancer Patients ◽

Low Risk ◽

Breast Cancer Patients ◽

Younger Patients ◽

Gene Assay ◽

Risk Patients ◽

Gene Modules ◽

The Impact

BackgroundThe 21-gene assay recurrence score (RS) provides additional information on recurrence risk of breast cancer patients and prediction of chemotherapy benefit. Previous studies that examined the contribution of the individual genes and gene modules of RS were conducted mostly in postmenopausal patients. We aimed to evaluate the gene modules of RS in patients of different ages.MethodsA total of 1,078 estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients diagnosed between January 2009 and March 2017 from Shanghai Jiao Tong University Breast Cancer Data Base were included. All patients were divided into three subgroups: Group A, ≤40 years and premenopausal (n = 97); Group B, >40 years and premenopausal (n = 284); Group C, postmenopausal (n = 697). The estrogen, proliferation, invasion, and HER2 module scores from RS were used to characterize the respective molecular features. Spearman correlation and analysis of the variance tests were conducted for RS and its constituent modules.ResultsIn patients >40 years, RS had a strong negative correlation with its estrogen module (ρ = −0.76 and −0.79 in Groups B and C) and a weak positive correlation with its invasion module (ρ = 0.29 and 0.25 in Groups B and C). The proliferation module mostly contributed to the variance in young patients (37.3%) while the ER module contributed most in old patients (54.1% and 53.4% in Groups B and C). In the genetic high-risk (RS >25) group, the proliferation module was the leading driver in all patients (ρ = 0.38, 0.53, and 0.52 in Groups A, B, and C) while the estrogen module had a weaker correlation with RS. The impact of ER module on RS was stronger in clinical low-risk patients while the effect of the proliferation module was stronger in clinical high-risk patients. The association between the RS and estrogen module was weaker among younger patients, especially in genetic low-risk patients.ConclusionsRS was primarily driven by the estrogen module regardless of age, but the proliferation module had a stronger impact on RS in younger patients. The impact of modules varied in patients with different genetic and clinical risks.

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The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients

PLoS ONE ◽

10.1371/journal.pone.0257941 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0257941

Author(s):

Claudia de Souza Gutierrez ◽

Katia Bottega ◽

Stela Maris de Jezus Castro ◽

Gabriela Leal Gravina ◽

Eduardo Kohls Toralles ◽

...

Keyword(s):

Quality Improvement ◽

High Risk ◽

Clinical Deterioration ◽

Surgical Patients ◽

Predictive Tool ◽

Postoperative Death ◽

High Risk Patients ◽

Death Probability ◽

Risk Patients ◽

The Impact

Background Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. Methods A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. Results Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. Conclusion Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.

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