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

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.

Triple-negative breast cancer treatment pattern and factors associated with its treatment in the United States: A population study using Central Cancer Registry data, 2013-2015.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 24-24
Author(s):  
Manxia Wu ◽  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Registry ◽  
Treatment Options ◽  
Treatment Pattern ◽  
Stage I ◽  
Registry Data ◽  
Factors Associated ◽  
Cancer Registry Data ◽  
The Us

24 Background: Large population-based studies on TNBC epidemiology and treatment pattern in the US were generally limited due to lack of routinely data collection on these biomarkers until recent years. This study examined and documented general treatment status and factors associated with the treatments among TNBC patients in the US. Methods: We used the latest released NPCR and SEER combined cancer registry data, which covers 100% of the US population. All women in the US with a primary invasive TNBC breast cancer diagnosed between 2013 and 2015 were included. First course treatment patterns by AJCC staging on TNBC were examined based on corresponding year’s NCCN guideline recommendations. Regression analysis were performed to identify factors associated with treatments. Results: There were 74,952 TNBC women included in the study. Ninety three percent of women with early stage of TNBC had surgery, and 35% women with mastectomy chose to undergo contralateral prophylactic mastectomy. Among stage I-III patients, those aged < 35, Non-Hispanic Asian Pacific Islander, living in other regions than northeast or metropolitan were more likely to have mastectomy compared to BCS. Radiation therapy were only received for 65% women with breast conserving surgery (BCS), which were less likely to be performed in non-Hispanic Black, Hispanic, and among those aged < 35 or > 70+. Chemotherapy were received for 75% of TNBC women, ranged from 63% (stage I) to 86% (stage III). Treatment variations among different demographic and geographic characteristics in chemotherapy were also observed. Conclusions: Overall, current treatment practice for TNBC in the US is generally concordance with the recommended breast cancer care except a relative low radiation therapy among BCS women. However, treatment disparities existed within the limited treatment options, and factors associated with the disparities also varied. More effective treatment options and treatment equality are warranted to improve overall care of this subtype.

Impact of patient, tumour and treatment factors on psychosocial outcomes in invasive breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 568-568
Author(s):  
David W Lim ◽  
Helene Retrouvey ◽  
Isabel Kerrebijn ◽  
Kate Butler ◽  
Anne C. O'Neill ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Procedure ◽  
Psychosocial Outcomes ◽  
Well Being ◽  
Stage I ◽  
Bilateral Mastectomy ◽  
Pathologic Stage ◽  
Modifiable Factors ◽  
The Impact ◽  
Over Time

568 Background: In breast cancer, clinicians aim to improve survival while patients value quality of life. We aim to delineate the impact of patient, tumour and treatment factors on psychosocial outcomes after treatment. Methods: A prospective cohort of women with unilateral stage I-III breast cancer were recruited at University Health Network in Toronto, Canada between 2014-2017. Validated questionnaires (BREAST-Q, Impact of Event, Hospital Anxiety & Depression Scales) were completed pre-operatively, and 6 and 12 months after surgery. Change in psychosocial scores over time by surgical procedure was assessed using linear mixed models, controlling for age, pathologic stage, hormone (HR) and HER2 receptor, and treatments. Predictors of psychosocial outcomes at 12 months were assessed using multivariable linear regression models. P values <.05 were significant. Results: 413 women underwent unilateral lumpectomy (48%), unilateral mastectomy (36%) and bilateral mastectomy (16%). Pathologic stage were: 18 ypT0/Tis (4%), 201 stage I (49%), 136 stage II (33%) and 58 stage III (14%). Receptor profiles were as follows: 277 HR+/HER2- (68%), 59 HR+/HER2+ (14%), 31 HR-/HER2+ (8%) and 39 HR-/HER2- (10%). Over time, women having unilateral lumpectomy had the highest scores of breast satisfaction ( P<.01), psychosocial ( P<.01) and sexual ( P<.01) well-being, with no difference between unilateral versus bilateral mastectomy groups. Age was inversely related with distress ( P <.01), psychosocial ( P <.01) and physical ( P =.001) well-being. Radiotherapy was associated with worse breast satisfaction (-8.1, P<.01), psychosocial (-6.9, P<.01) and physical (-5.8, P<.01) well-being, while chemotherapy was associated with worse sexual well-being (-5.5, P=.04). Endocrine therapy was associated with worse distress (6.7, P <.01), physical (-5.2, P <.01) and sexual (-6.4, P =.03) well-being. Women with a pathologic complete response had less anxiety compared to stage I (-2.0, P=.03). Women with triple-negative disease had worse breast satisfaction (-8.0, P=.03), distress (8.0, P =.01), anxiety (2.4, P <.01) and psychosocial (-7.5, P =.047) well-being than HR+/HER2- disease. In our regression model at 12 months, surgical procedure was a significant predictor of breast satisfaction ( P <.01), psychosocial ( P<.01), physical ( P<.01) and sexual ( P<.01) well-being. HER2 positivity predicted worse satisfaction ( P=.045), psychosocial ( P =.047), physical ( P =.02) and sexual ( P =.01) well-being. Income level ( P=.01) predicted breast satisfaction and physical well-being. Ethnicity (P <.01) and education level (P =.04) predicted distress scores. Conclusions: Psychosocial functioning after breast cancer is influenced by an interplay between patient, tumour and treatment factors. Delineating these influences identifies potentially modifiable factors with de-escalation therapy and enhancing psychosocial support.

Dermatography: 10 Years of Applications as an Adjuvant Treatment after Nipple and Areola Reconstruction

2000 ◽  
Vol 17 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Eddy M. Van Der Velden ◽  
Brigitte H. I. M. Drost ◽  
Otto E. Ijsselmuiden ◽  
Abraham M. Baruchin
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Surgery ◽  
Total Resection ◽  
Refined Method ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Small Parts ◽  
Bilateral Reconstruction ◽  
Over Time

Introduction: Nipple and areola reconstruction have recently become in demand because more women are having breast surgery because of breast cancer diagnoses. Many methods for reconstructing the nipple and areola of the breast have been described and several treatment methods have been developed to improve the aesthetic results. The purpose of this paper is to describe one method, dermatography, a refined method of medical tattooing and the results obtained from this method. Materials and Methods: Over 10 years, 112 patients were treated with dermatography for nipple and areola reconstructions. Of these, 89 patients had received a unilateral reconstruction and 23 received a bilateral reconstruction. The first dermatographic treatment was given 8–12 months after the last intervention by the plastic surgeon. The average session lasted 45 minutes. Results were assessed by means of a short questionnaire. Results over time were evaluated by comparing pictures from previous sessions. Dermatography uses a modified tattooing called a dermainjector machine. Keloidectomy is the technique used to reduce keloid in postoperative scars. The needles of the dermainjector are positioned at an angle of 70–90 degrees to the scar surface. Small parts of the keloid are removed. At the same time pigmentation is performed. Results: Patients evaluated their results as satisfactory. Pigmentation over 5 years was judged to be stable with minor loss of pigment in only 6% of the patients, all of whom received radiation therapy for their cancer. Dermatography was well tolerated by the patients. None of the patients required local anesthesia. Discussion: Patients receiving total resection of their breasts are getting younger and perceiving the results as a severe deformation of their bodies. Results of reconstruction are judged very critically. We found that our patients considered the general visual aspect of the nipple and areola shape more important, and most of the patients did not consider reconstruction of the actual nipple mound to be necessary.

The impact of the COVID-19 pandemic on stage at diagnosis of breast and colorectal cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6501-6501
Author(s):  
Jade Zhou ◽  
Shelly Kane ◽  
Celia Ramsey ◽  
Melody Ann Akhondzadeh ◽  
Ananya Banerjee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Cancer Screening ◽  
Late Stage ◽  
Stage Iv ◽  
Stage I ◽  
Screening Programs ◽  
Stage Distribution ◽  
Number Of Patients ◽  
The Impact

6501 Background: Effective cancer screening leads to a substantial increase in the detection of earlier stages of cancer, while decreasing the incidence of later stage cancer diagnoses. Timely screening programs are critical in reducing cancer-related mortality in both breast and colorectal cancer by detecting tumors at an early, curable stage. The COVID-19 pandemic resulted in the postponement or cancellation of many screening procedures, due to both patient fears of exposures within the healthcare system as well as the cancellation of some elective procedures. We sought to identify how the COVID-19 pandemic has impacted the incidence of early and late stage breast and colorectal cancer diagnoses at our institution. Methods: We examined staging for all patients presenting to UCSD at first presentation for a new diagnosis of malignancy or second opinion in 2019 and 2020. Treating clinicians determined the stage at presentation for all patients using an AJCC staging module (8th edition) in the electronic medical record (Epic). We compared stage distribution at presentation in 2019 vs 2020, both for cancers overall and for colorectal and breast cancer, because these cancers are frequently detected by screening. Results: Total numbers of new patient visits for malignancy were similar in 2019 and 2020 (1894 vs 1915 pts), and stage distribution for all cancer patients was similar (stage I 32% in 2019 vs 29% in 2020; stage IV 26% in both 2019 and 2020). For patients with breast cancer, we saw a lower number of patients presenting with stage I disease (64% in 2019 vs 51% in 2020) and a higher number presenting with stage IV (2% vs 6%). Similar findings were seen in colorectal cancer (stage I: 22% vs 16%; stage IV: 6% vs 18%). Conclusions: Since the COVID-19 pandemic, there has been an increase in incidence of late stage presentation of colorectal and breast cancer, corresponding with a decrease in early stage presentation of these cancers at our institution. Cancer screening is integral to cancer prevention and control, specifically in colorectal and breast cancers which are often detected by screening, and the disruption of screening services has had a significant impact on our patients. We plan to continue following these numbers closely, and will present data from the first half of 2021 as it becomes available.

scholarly journals 352. Definitive Radiation Therapy for Stage I, II Breast Cancer : Dose Distribution of Open Field Beam-(Part 3)

1991 ◽  
Vol 47 (8) ◽  
pp. 1383
Author(s):  
Manabu Nakata ◽  
Takashi Okada ◽  
Shinsuke Yano ◽  
Naomi Enoki ◽  
Hiroki Nohara
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Open Field ◽  
Dose Distribution ◽  
Stage I

scholarly journals 274. Definitive Radiation Therapy for Stage I, II Breast Cancer : Possibility in Tangential Irradiation for 10 MV X-ray Beams (Part 4)

1992 ◽  
Vol 48 (8) ◽  
pp. 1357
Author(s):  
Manabu Nakata ◽  
Naomi Enoki ◽  
Shinsuke Yano ◽  
Satoshi Fukumoto ◽  
Takashi Okada ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Stage I ◽  
X Ray

scholarly journals Analysis of Radiation Dose to the Shoulder by Treatment Technique and Correlation With Patient Reported Outcomes in Patients Receiving Regional Nodal Irradiation

2021 ◽  
Vol 11 ◽  
Author(s):  
Jose G. Bazan ◽  
Dominic DiCostanzo ◽  
Karen Hock ◽  
Sachin Jhawar ◽  
Karla Kuhn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Radiation Dose ◽  
Patient Reported Outcomes ◽  
Late Complication ◽  
Treatment Technique ◽  
Regional Nodal Irradiation ◽  
Patient Reported ◽  
The Impact ◽  
Dash Questionnaire

Background/PurposeShoulder/arm morbidity is a late complication of breast cancer treatment with surgery and regional nodal irradiation (RNI). We set to analyze the impact of radiation technique [intensity modulated radiation therapy (IMRT) or 3D conformal radiation therapy (3DCRT)] on radiation dose to the shoulder with a hypothesis that IMRT use results in smaller volume of shoulder receiving radiation. We explored the relationship of treatment technique on long-term patient-reported outcomes using the quick disabilities of the arm, shoulder, and hand (q-DASH) questionnaire.Materials/MethodsWe identified patients treated with adjuvant RNI (50 Gy/25 fractions) from 2013 to 2018. We retrospectively contoured the shoulder organ-at-risk (OAR) from 2 cm above the ipsilateral supraclavicular (SCL) planning target volume (PTV) to the inferior SCL PTV slice and calculated the absolute volume of shoulder OAR receiving 5–50 Gy (V5–V50). We identified patients that completed a q-DASH questionnaire ≥6 months from the end of RNI.ResultsWe included 410 RNI patients: 54% stage III, 72% mastectomy, 35% treated with IMRT. IMRT resulted in significant reductions in the shoulder OAR volume receiving 20–50 Gy vs. 3DCRT. In total, 82 patients completed the q-DASH. The mean (SD) q-DASH=25.4 (19.1) and tended to be lower with IMRT vs. 3DCRT: 19.6 (16.4) vs. 27.8 (19.8), p=0.078.ConclusionWe found that IMRT reduces radiation dose to the shoulder and is associated with a trend toward reduced q-DASH scores ≥6 months post-RNI in a subset of our cohort. These results support prospective evaluation of IMRT as a technique to reduce shoulder morbidity in breast cancer patients receiving RNI.

Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer.

1997 ◽  
Vol 15 (3) ◽  
pp. 1252-1260 ◽  
Author(s):  
J A Hayman ◽  
D L Fairclough ◽  
J R Harris ◽  
J C Weeks
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Early Stage ◽  
Conservative Surgery ◽  
Sociodemographic Factors ◽  
Early Stage Breast Cancer ◽  
Health States ◽  
Trade Off ◽  
Risks And Benefits

PURPOSE To assess patients' preferences regarding the trade-off between risks and benefits of radiation therapy after conservative surgery for early-stage breast cancer. PATIENTS AND METHODS Utilities (measures of preference) of 97 early-stage breast cancer patients treated with conservative surgery and radiation therapy and 20 medical oncology nurses were assessed for five health states using standard gambles. RESULTS Patients had the highest mean utility for treatment with conservative surgery and radiation therapy without a local recurrence (0.92), intermediate utilities for treatment with conservative surgery alone followed either by no local recurrence or by a local recurrence salvaged by conservative surgery and radiation therapy (0.88 and 0.87, respectively), and the lowest utilities for treatment with or without radiation therapy followed by a local recurrence salvaged by mastectomy and reconstructive surgery (0.82 and 0.81, respectively). All differences between health states' utilities were significant (P < .0001), except between the two intermediate and two lowest rated health states. None of the clinical or sociodemographic factors examined explained more than 5% of the variability in the patients' utilities or their differences. Nurses' utilities were similar to those of the patients. CONCLUSIONS These results strongly suggest that fear of a local recurrence and an actual local recurrence leading to mastectomy have such a negative impact on quality of life that patients are willing to accept the risks and inconvenience of radiation therapy to avoid them. There is also considerable interpatient variability that was not explained by the clinical or sociodemographic factors examined.

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