First Experiences with Alpelisib in Clinical Routine: Case Reports from a German Breast Center

Breast Care ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. 129-134
Author(s):  
Anna Hester ◽  
Franziska Henze ◽  
Christiane Travi ◽  
Nadia Harbeck ◽  
Rachel Wuerstlein
Keyword(s):  
Side Effects ◽  
Case Reports ◽  
Growth Factor Receptor ◽  
Supportive Therapy ◽  
Tumor Board ◽  
Control Treatment ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Breast Center ◽  
Grade 3

<b><i>Introduction:</i></b> The phosphatidylinositol-3-kinase (PI3K) inhibitor alpelisib is the only approved agent for treating ­<i>PIK3CA</i>-mutated, hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC). Trials have reported hyperglycemia, diarrhea, and rash as the main grade 3 side effects. <b><i>Methods:</i></b> In a managed access program (ClinicalTrials.gov ID: NCT03706573; start: 06/2019), 8 HR+ HER2– ABC patients with a median 4.5 prior therapy lines were treated with alpelisib at the Breast Center of the Ludwig-Maximilian University (LMU) Hospital, Munich, based on the results of a new-generation sequencing (NGS) panel and <i>PIK3CA</i> mutation analysis by the Molecular Tumor Board of the Comprehensive Cancer Center, Munich. <b><i>Results:</i></b> Median therapy duration was 3.42 months for patients who discontinued and 3.95 months for those still on alpelisib (4 pts). Five had hyperglycemia (1 with grade 3) with fasting glucose levels of up to 450 mg/dL that required hospitalization and insulin therapy. Two experienced rash (grades 1 and 3) and 2 reported grade 3 diarrhea. Supportive therapy as well as interruption and/or dose reduction were necessary to control treatment-associated side effects. <b><i>Conclusion:</i></b> Patient education and a well-trained, interdisciplinary team including diabetologists, from the initiation of alpelisib treatment onwards, are essential to safely treat ABC patients with this new drug and to maintain their quality of life and ensure their survival.

scholarly journals Comparative Analysis of Public Knowledge Bases for Precision Oncology

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Steffen Pallarz ◽  
Manuela Benary ◽  
Mario Lamping ◽  
Damian Rieke ◽  
Johannes Starlinger ◽  
...  
Keyword(s):  
Genetic Alterations ◽  
Knowledge Bases ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Accurate Information ◽  
Precision Oncology ◽  
Cancer Genes ◽  
Qualitative Comparison ◽  
Data Set

PURPOSE Precision oncology depends on the availability of up-to-date, comprehensive, and accurate information about associations between genetic variants and therapeutic options. Recently, a number of knowledge bases (KBs) have been developed that gather such information on the basis of expert curation of the scientific literature. We performed a quantitative and qualitative comparison of Clinical Interpretations of Variants in Cancer, OncoKB, Cancer Gene Census, Database of Curated Mutations, CGI Biomarkers (the cancer genome interpreter biomarker database), Tumor Alterations Relevant for Genomics-Driven Therapy, and the Precision Medicine Knowledge Base. METHODS We downloaded each KB and restructured their content to describe variants, genes, drugs, and gene-drug associations in a common format. We normalized gene names to Entrez Gene IDs and drug names to ChEMBL and DrugBank IDs. For the analysis of clinically relevant gene-drug associations, we obtained lists of genes affected by genetic alterations and putative drug therapies for 113 patients with cancer whose cases were presented at the Molecular Tumor Board (MTB) of the Charité Comprehensive Cancer Center. RESULTS Our analysis revealed that the KBs are largely overlapping but also that each source harbors a notable amount of unique information. Although some KBs cover more genes, others contain more data about gene-drug associations. Retrospective comparisons with findings of the Charitè MTB at the gene level showed that use of multiple KBs may considerably improve retrieval results. The relative importance of a KB in terms of cancer genes was assessed in more detail by logistic regression, which revealed that all but one source had a notable impact on result quality. We confirmed these findings using a second data set obtained from an independent MTB. CONCLUSION To date, none of the existing publicly available KBs on gene-drug associations in precision oncology fully subsumes the others, but all of them exhibit specific strengths and weaknesses. Consideration of multiple KBs, therefore, is essential to obtain comprehensive results.

Cetuximab use without chronic antihistamine premedication

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13521-13521 ◽  
Author(s):  
J. Timoney ◽  
K. Y. Chung ◽  
V. Park ◽  
R. Trocola ◽  
C. Peake ◽  
...  
Keyword(s):  
Side Effects ◽  
Cancer Center ◽  
First Year ◽  
Institutional Practice ◽  
Chemotherapy Administration ◽  
Time Period ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Grade 3 ◽  
Severe Grade

13521 Background: Cetuximab is a human-murine chimeric monoclonal antibody against EGFR with approximately a 3% reported incidence of severe (≥ grade 3) anaphylactoid reactions. The overwhelming majority of such reactions have been reported with the initial dose of cetuximab. Diphenhydramine (Benedryl)or a related antihistamine is often given as a premedication for cetuximab, however this may cause fatigue or other side effects. Most early clinical trials of cetuximab permitted investigator discretion in use of premedication beyond the initial cetuximab dose. Methods: We obtained an IRB waiver of authorization to review the records of patients treated with cetuximab at Memorial Sloan Kettering Cancer Center for the first year of commercial availability of cetuximb (Feb, 2004 through Feb, 2005). Computerized pharmacy records were reviewed to identify all patients who were treated with cetuximab (outside of a clinical trial) and use of premedication was then evaluated. Records of institutional adverse event reports regarding chemotherapy administration were reviewed, and, any moderate or severe/life-threatening reactions were evaluated for presence or absence of concurrent premedication. Results: As per our institutional guidelines, all patients received 50 mg of diphenhydramine prior to the initial loading dose of cetuximab, and 25 mg of diphenhydramine prior to the second dose. While there was inconsistency in terms of cessation of diphenhydramine, overall a total of 115 patients received one or more doses of cetuximab without premedication. A total of 746 doses of cetuxmab without diphenhydramine premedication were given over this time period. No severe/life-threatening reactions to cetuximab occurred during these doses given without premedication. Conclusions: Omission of diphenhydramine premedication after the initial two doses of cetuximab is our current institutional practice, and appears not to alter the safety profile of cetuximab. Considering the side effects of diphenhydramine, routine long tern use of antihistamine premedication with cetuximab administration does not appear to be warranted. [Table: see text]

Phase II study of AZD2171 for the treatment of patients with myelodysplastic syndromes.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6570-6570
Author(s):  
Shannon Eileen O'Mahar ◽  
Alcee Jumonville ◽  
Patrick J. Flynn ◽  
Alvaro Moreno-Aspitia ◽  
Charles Erlichman ◽  
...  
Keyword(s):  
Adverse Events ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Prior Therapy ◽  
Starting Dose ◽  
Orally Bioavailable ◽  
Grade 3 ◽  
Endothelial Growth Factor

6570 Background: Inhibition of vascular endothelial growth factor receptors (VEGFR) can block growth and trigger apoptosis in neoplastic cells. AZD2171 (cediranib) is a highly potent, orally bioavailable, VEGFR-1/2 inhibitor. We conducted a phase II study of the efficacy of AZD2171 for the treatment of MDS. Methods: Adults with MDS (IPSS Int-2 or High) were eligible if they exhibited adequate organ function and ECOG 0-2. The primary endpoint was proportion of responses according to the IWG criteria assessed at one and every 3 months. Prior investigation of cediranib at 45 mg daily in patients with acute leukemia demonstrated toxicity concerns and therefore, the starting dose of this study was lowered to 30 mg daily. Results: A total of 16 pts with MDS (median age 73 years) were enrolled at a 30 mg starting dose, and all were evaluable. Median baseline marrow blasts were 12.0 % (range 2-18); 3 pts (18.8 %) had low, 6 (37.5 %) intermediate, and 7 (43.8 %) had high risk cytogenetics. Prior therapy included azacitidine (n=7), decitabine (n=2), cytarabine (n=2), erythropoietin-stimulating agents (ESAs) (n=2), lenalidomide (n=1), or none (n=6). Patients were treated for a median of two 28-day cycles (range 1 to 11). There were no confirmed responses. Patients with baseline blasts > 5% showed no significant reduction in the blast count at 4 and 12 weeks. Median OS was 4.7 mo (95% CI: 2.6 – 11.6). Median TTP was 3.8 mo (95% CI: 1.7 – 10.8). Grade 4 hematological adverse events at least possibly related to cediranib were neutropenia (n=2) and thrombocytopenia (n=4). Grade 3 hematological adverse events at least possibly related to study treatment included: neutropenia (n=3), thrombocytopenia (n=2), and anemia (n=2). Grade 3 non-hematological adverse events included fatigue (n=4), dyspnea (n=3), dehydration (n=2), diarrhea (n=2), nausea (n=2), asthenia (n=1), and hypertension (n=1). Hypertension and proteinuria was uncommon with the 30 mg/day dose. Conclusions: With no confirmed response from 16 patients, cediranib was determined to be ineffective at a dose of 30 mg daily in our patient population. Supported by NCI N01-CM62205, NCI P30-CA014520 and the UW Carbone Comprehensive Cancer Center.

Development of a patient-oriented navigation model for lung cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18033-e18033
Author(s):  
Christine Holmberg ◽  
Kathrin Gödde ◽  
Hella Fuegemann ◽  
Jacqueline Mueller-Nordhorn ◽  
Nina Rieckmann ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Data Analysis ◽  
Cancer Patients ◽  
Secondary Data ◽  
Secondary Data Analysis ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Optimal Care ◽  
Lung Cancer Patients

e18033 Background: Patient navigation is seen to support and enable patient-oriented, optimal care both in palliative and in screening settings. However, the evidence remains inconclusive on what patient groups are best targeted by navigation and what may be improved by such a care model. Lung cancer patients are at particular risk for sub-optimal care because they face complex care trajectories due to severe and rapid disease progression and accompanying comorbidity. Methods: To develop a navigation model for lung cancer, we conducted a mixed-methods study to investigate who may be at risk of receiving sub-optimal care in the German health care setting. To capture the patient perspective a longitudinal qualitative component was included with patients (N = 20) assessed at three dtime points. In addition, a secondary data analysis of cancer registry data of a comprehensive cancer center was conducted and a repository of patient support offers gathered. Results of the study components were integrated to develop a patient-oriented navigation model. Results: Secondary data analysis showed that medical care functioned according to tumor board recommendations. Patient data revealed institutional barriers that conflict with individual needs and preferences. A lack of contact persons, information provision as well as bureaucratic difficulties were identified. Patients without a social network seem particularly in need for support. Identification of regional support offers shows that there are resources available to meet some of these needs. However, knowledge on such offers was not common among patients and caregivers. Navigators should provide practical support, give advice on social care issues and refer to existing support offers. Conclusions: Social networks crucial. Patients lack knowledge to use available resources. Navigation needs to be implemented within existing care structures to reach patients.

Gemcitabine (G) and nab-paclitaxel (nab-P) in patients with refractory advanced pancreatic cancer (PC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 373-373
Author(s):  
Vinicius Ernani ◽  
Ikechukwu Immanuel Akunyili ◽  
Peter Joel Hosein ◽  
Jessica Macintyre ◽  
Caio Max S. Rocha Lima
Keyword(s):  
Chemotherapy Regimen ◽  
Single Agent ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Symptomatic Improvement ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hematologic Toxicity ◽  
Standard Chemotherapy Regimen ◽  
Grade 3

373 Background: There is no standard chemotherapy regimen for PC patients who have progressed on G and fluoropyrimidine-based therapy. Single agent nab-P had limited activity on a second-line phase II trial in PC. Synergistic preclinical studies with G and taxanes have been reported. Nab-P targets stromal cells and leads to improved delivery of chemotherapy to PC cells. The combination of G + nab-P might be an effective approach in pretreated PC. Methods: A retrospective analysis of advanced refractory PC patients treated from Sep 2010 to Aug 2011 with the combination of G + nab-P was performed at the Sylvester Comprehensive Cancer Center. Patients received G 1000mg/m2 and nab-P 100mg/m2 on D1, 8 and 15 of a 28 day cycle. Treatment response was assessed by review of imaging studies using the RECIST criteria, CA19-9 response and symptomatic improvement. The progression-free survival (PFS) and overall survival (OS) were calculated from time of commencement of G + nab-P until documented progression or death respectively. Results: 10 patients were treated with G + nab-P; 60%, 30% and 10% of patients had received 3, 2 and 1 prior chemotherapy regimen. 90% and 80% received prior G or fluoropyrimidine-based regimen respectively. Therapy was discontinued in one patient following only one dose of G + nab-P (Cycle 1, day 1) due to grade 2 thrombocytopenia. The remaining 9 patients received a median of 4 cycles. Two (22.2%) patients had confirmed PR, 3(33.3%) patients had confirmed stable disease while 4 (44.4%) patients progressed on therapy. The median PFS was 13.7 weeks. The median PFS was 20 weeks in patients with PR or SD and 9.9 weeks in patients with PD. Recurrent malignant ascitis resolved in a patient with peritoneal carcinomatosis. Treatment was well tolerated; grade 3-4 hematologic toxicity included anemia, thrombocytopenia and neutropenia in 2, 1 and 2 patients respectively. 70% of patients required G-CSF support. Non hematologic Grade 3-4 toxicities included fatigue, peripheral neuropathy; nausea and vomiting in 3, 2 and 1 patient respectively. Conclusions: G + nab-P resulted in clinical benefit in half of this group of advanced PC patients who had previously progressed on G and fluoropyrimidine-based regimens.

A closer look at next generation sequencing (NGS) in breast cancer: A retrospective analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13023-e13023
Author(s):  
Bahar Laderian ◽  
ANA CRISTINA Sandoval Leon ◽  
Loulwa Alsharhan ◽  
Dorraya El Ashry ◽  
Marc E. Lippman
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Stage Iv ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Consecutive Series ◽  
Subsequent Response ◽  
Number Of Patients ◽  
Progression Of Disease

e13023 Background: Targeted cancer therapy has been posited to revolutionize treatment paradigms in oncology. There are, a paucity of data regarding the use of NGS in breast cancer (BC). Herein we report our experience with NGS in a consecutive series of BC patients. Methods: Using an IRB approved protocol, we retrospectively identified patients with BC treated at the Sylvester Comprehensive Cancer Center (UMMSOM) who underwent NGS. Data were collected on demographics, tumor characteristics, genomic mutation profiles, and subsequent response to targeted therapy after 3 months. Results: Between January 2013 and April 2016, 101 BC patients underwent NGS. The mean age at diagnosis was 49. Ninety-one percent were stage IV, 6% were stage III, 2% were stage II, and 1% were stage I. Fifty percent had estrogen receptor (ER)+, HER2- tumors, 31% had triple-negative tumors, 13% had HER2+, ER+ tumors, and 6% had HER2+, ER- tumors. Ninety-six percent had at least one mutation, of which 78% had a targetable mutation. Sixteen patients received targeted therapy (TT). The average time between NGS and TT was 5 months ranging 0-22 months, during which seven patients received other systemic therapy. The most common reasons for not receiving TT were no actionable mutations (24%), not meeting criteria for an available clinical trial (14%), stable disease (SD) (13% ), lost to follow up (11%), physician decision (11%). Of the 16 patients who received TT, 7 patients had progression of disease, 3 died before response could be evaluated and presumably had no benefit, 2 discontinued TT due to side effects, 1 had SD, 1 had a partial response, and 2 were too early to be assessed. Conclusions: The majority of BC patients in our series had actionable mutations. However, TT was not offered to a significant number of patients for a multiplicity of reasons and the clinical benefit in those patients treated according to NGS findings was dismal. While NGS is surely a promising technology that should be utilized in combination with molecular tumor board, a host of reasons limit its usefulness at this time and its expense may well not justify its use outside of clinical trials.

A virtual tumor board-driven synaptic knowledge network.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 89-89
Author(s):  
Laurence J. Heifetz ◽  
Ahrin B. Koppel ◽  
Elaine Melissa Kaime ◽  
Daphne Palmer ◽  
Thomas John Semrad ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rural Areas ◽  
Cancer Care ◽  
Knowledge Network ◽  
Tumor Board ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hospital District ◽  
Number Of Patients ◽  
Tumor Boards

89 Background: In 2006, Tahoe Forest Hospital District—a 25-bed hospital in Truckee, CA, a mountain resort community one hour from regional and two hours from academic cancer services—designed and implemented an oncology program utilizing effective telecommunications with a committed academic partner, the UC Davis Comprehensive Cancer Center in Sacramento. Methods: The UC Davis Cancer Care Network was established with four remote cancer programs, enabling participation in daily virtual tumor boards, clinical trial enrollment, and quality assurance assistance. (Richard J. Bold, et. al., Virtual tumor boards: community-university collaboration to improve quality of care. Community Oncol 10(11):310-315, November 2013.; Laurence J. Heifetz, MD, et. al., A Model for Rural Oncology. J Oncol Pract, 7:168-171, May 2011.). An increasing number of patients were observed to in-migrate to Truckee from even more remote rural areas in the mountains. In 2013, the now Gene Upshaw Memorial Tahoe Forest Cancer Center developed four remote telemedicine clinics to allow even more physically distant patients the capacity to be followed locally. Results: Since we opened the remote telemedicine clinics, our Sullivan-Luallin patient satisfaction scores have averaged 4.82/5.00 for “overall satisfaction with the practice” and 4.90/5.00 for “recommending your provider to others”; our in-migration rate of patients from outside our primary catchment area increased from 43% to 52%: and clinical trial accrual rate averaged 10%. Conclusions: Reducing cancer health disparities is an ASCO mission. (cover, ASCO Connection, July 2014; Laurence J. Heifetz, MD. Country Docs with City Technology Can Address Rural Cancer Care Disparities. Oncol, 29(9):641-644, September 2015.). We believe this synaptic knowledge network effectively addresses that mission for rural communities. This model can be scaled in many configurations to address the inherent degradation of quality care as a function of physical distance to an academic center that rural doctors and patients deal with on a daily basis. The key is to insist on a cultural shift – Do something smart at lunch every day. Attend a virtual tumor board.

Immune checkpoint inhibitor induced hepatitis: Risk factors, outcomes, and impact on survival.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14525-e14525
Author(s):  
Abdul Miah ◽  
Songzhu Zhao ◽  
Sandip H. Patel ◽  
Andrew Johns ◽  
Madison Grogan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Comprehensive Cancer Center ◽  
Rank Test ◽  
Cancer Center ◽  
Grade 3

e14525 Background: Immune checkpoint inhibitors (ICIs) have improved the survival of patients with multiple cancer types, however ICI treatment is associated with a unique set of immune-related adverse events (irAEs) that can affect any organ. Few studies have evaluated the risk factors and outcomes of ICI induced hepatitis (ICIH). Methods: We utilized an institutional database of patients with advanced cancers treated with ICI between 2011 and 2017 at The OSU Comprehensive Cancer Center to identify patients with ICIH. Any patient who received at least one dose of ICI alone or in combination with other systemic therapies either as part of clinical trial or standard of care were included. Clinical data were extracted through chart abstraction. irAEs were graded using the Common Terminology Criteria for Adverse Events v5. Overall survival (OS) was calculated from the date of ICI initiation to death from any cause or the date of the last follow-up. OS with 95% confidence intervals were estimated using the Kaplan–Meier method. OS was also evaluated by occurrence of ICIH using the log-rank test. Results: We identified 1,096 patients treated with at least one dose of ICI. Most common cancers included lung (n=224, 20%) and melanoma (n=342, 31%). The most common ICIs were PD1/L1 (n=774, 71%) and CTLA-4 inhibitors (n=195, 18%). ICIH of any grade occurred in 64 (6%) patients. Overall, 46 (71%) were male and median age was 60 years. Severity of hepatitis was grade 1-2 in 30 patients (47%) (Table 1). The incidence of ≥grade 3 ICIH in the entire cohort was 3.1%. Median time to ICIH diagnosis was 63 days. ICIH occurred alone in 24 patients, and co-occurred with other irAEs in 40 patients. The most common co-occurring irAEs were pneumonitis (n=7); colitis (n=15), thyroid abnormality (n=14); and dermatitis (n=15). ICIH was more common in women (p=0.038), in patients treated with combination ICIs (p<0.001), and among patients receiving first line therapy (p=0.018). Patients who developed ICIH had significantly longer OS than patients who did not develop ICIH; there was no difference in OS between patients with ≥grade 3 ICIH vs grade 1-2 (Table). 33 out of 34 patients with ≥grade3 ICIH were treated with steroids; 3 received mycophenolate and one received infliximab. Of patients with ≥grade 3 ICIH, 11 resumed ICI therapy without recurrent ICIH. Conclusions: Female sex, combination immunotherapy, and line of therapy were associated with ICIH. Patients with ICIH had improved clinical outcomes compared to those that did not develop ICIH, even those with higher grade toxicity. Further study is needed to assist in developing risk stratification models and optimal treatment for ICIH. OS of patients with and without immune checkpoint inhibitor hepatitis.[Table: see text]

scholarly journals Validation of Prognostic Stage and Anatomic Stage in the American Joint Committee on Cancer 8th Edition for Inflammatory Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3105
Author(s):  
Kumiko Kida ◽  
Kenneth R. Hess ◽  
Bora Lim ◽  
Toshiaki Iwase ◽  
Sudpreeda Chainitikun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Growth Factor Receptor ◽  
Disease Free Survival ◽  
Staging System ◽  
Cancer Staging ◽  
Cancer Center ◽  
Cancer Specific Survival ◽  
Breast Cancer Staging ◽  
Grade 3

The AJCC updated its breast cancer staging system to incorporate biological factors in the “prognostic stage”. We undertook this study to validate the prognostic and anatomic stages for inflammatory breast cancer (IBC). We established two cohorts of IBC diagnosed without distant metastasis: (1) patients treated at The University of Texas MD Anderson Cancer Center between 1991 and 2017 (MDA cohort) and (2) patients registered in the national Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 (SEER cohort). For prognostic staging, estrogen receptor (ER)+/progesterone receptor (PR)+/ human epidermal growth factor receptor-2 (HER2)+/grade 1–2 was staged as IIIA; ER+/PR−/HER2−/grade 3, ER−/PR+/HER2−/grade 3, and triple-negative cancers as IIIC; and all others as IIIB. Endpoints were breast cancer-specific survival (BCSS), overall survival (OS), and disease-free survival (DFS). We studied 885 patients in the MDA cohort and 338 in the SEER cohort. In the MDA cohort, the prognostic stage showed significant predictive power for BCSS, OS, and DFS (all p < 0.0001), although the anatomic stage did not. In both cohorts, the Harrell concordance index (C index) was significantly higher in the prognostic stage than the anatomic stage for all endpoints. In conclusion, the prognostic stage provided more accurate prognostication for IBC than the anatomic stage. Our results show that the prognostic staging is applicable in IBC.

Promoting quality breast cancer care: Psychosocial distress screening

2013 ◽  
Vol 12 (1) ◽  
pp. 75-80 ◽  
Author(s):  
M. Tish Knobf ◽  
Maureen Major-Campos ◽  
Anees Chagpar ◽  
Andrea Seigerman ◽  
Ruth Mccorkle
Keyword(s):  
Administrative Support ◽  
Medical Oncology ◽  
Surgical Oncology ◽  
Psychosocial Distress ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Distress Screening ◽  
Two Phase ◽  
Breast Center ◽  
Number Of Patients

AbstractObjective:To evaluate the feasibility of implementing psychosocial distress screening in a breast center of a comprehensive cancer center, using a model of structure (personnel, resources), process (screening), and outcome (number of patients screened, number referred).Methods:The first step in the project was to establish administrative support, educate and engage breast center staff, identify stakeholders and persons with expertise in the conduct of evidence based initiatives. A two-phase implementation approach was agreed upon with Phase I being screening of new patients in surgical oncology and Phase II being screening women in medical oncology.Results:A total of 173 patients were screened. The new patients screened in surgical oncology reported higher average distress scores compared to patients in medical oncology (5.7 vs. 4.0). However, a greater number of patients in medical oncology reported scores >4 compared to the new patients screened in surgery (54% vs. 35%). Psychological distress was the most commonly reported distress for patients in surgery. In contrast, 60% of scores >4 in medical oncology were symptom related, managed by the nurse or physician.Significance of results:Nurse led implementation of psychosocial distress screening is feasible, addressing this important quality indicator of patient-centered care.

Sign in / Sign up

Export Citation Format

Share Document