Prospective synoptic template recording to assess for compliance of care with NCCN guidelines for breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 197-197
Author(s):  
Titilayo Adegboyega ◽  
Jeffrey Landercasper ◽  
Jared Linebarger ◽  
Jeanne Johnson ◽  
Leah L. Dietrich ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Recognition ◽  
Performance Comparison ◽  
Molecular Profile ◽  
Breast Cancer Patients ◽  
Preoperative Testing ◽  
Nccn Guidelines ◽  
Real Time Analysis ◽  
Cancer Network

197 Background: There is a wide variation of compliance with National Comprehensive Cancer Network (NCCN) guidelines for diagnosis and treatment. Overutilization of preoperative testing and underutilization of adjuvant treatments have been documented. The former is associated with higher costs of care; the latter with poor patient outcomes. Prior reports of adherence to NCCN Guidelines contain methodological limitations due to lack of contemporary review and incomplete listing of reasons for non-compliance. This limits the “real time” analysis of breast cancer quality and delays action plans to address quality and cost issues of care. Methods: NCCN Guideline compliance was recorded prospectively by use of electronic synoptic templates for all newly diagnosed breast cancer patients treated at a single institution between January 2010 and December 2011. A retrospective review of the synoptic templates was then conducted. Accuracy of the synoptic auditing method was assessed as well as NCCN compliance and reasons for non-compliance. Results: A total of 312 new breast cancer patients who underwent surgery as initial treatment were identified. Compliance with NCCN Guidelines for preoperative testing, breast surgery and lymph node surgery was 98% (306/312), 99.7% (311/312) and 93% (290/312) respectively. Reasons for non-compliance include patient refusal, comorbidities, advanced age and overutilization of systemic imaging. There was 100% compliance to College of American Pathologist (CAP) molecular profile documentation for all breast cancer cases. There were two discrepancies noted between the prospective template reporting and medical record review. The average time needed to populate data into synoptic templates was less than 2 minutes per patient. Conclusions: Prospective auditing of adherence to NCCN Guidelines with electronic synoptic templates is accurate and time efficient. High compliance rates with NCCN Guidelines were demonstrated. Electronic synoptic NCCN templates potentially facilitate early recognition of quality gaps in compliance and provide a framework for peer performance comparison.

Adherence to NCCN Guidelines for Genetic Testing in Breast Cancer Patients: Who Are We Missing?

2020 ◽  
Vol 28 (1) ◽  
pp. 281-286 ◽  
Author(s):  
J. Jaime Alberty-Oller ◽  
Sarah Weltz ◽  
Antonio Santos ◽  
Kereeti Pisapati ◽  
Meng Ru ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Nccn Guidelines

BRCA1/2 mutation prevalence among triple-negative breast cancer patients from a large commercial testing cohort.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1544-1544 ◽  
Author(s):  
Kristilyn Dillman Zonno ◽  
Rajesh R. Kaldate ◽  
Christopher Arnell ◽  
Jennifer Saam ◽  
Brian Abbott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
African Ancestry ◽  
Parp Inhibitors ◽  
Ashkenazi Jewish ◽  
Breast Cancer Patients ◽  
Cancer Network ◽  
Testing Criteria

1544 Background: BRCA1/2 deleterious mutation identification among triple-negative breast cancer (TNBC) patients has gained importance due to cancer-risk management implications for patients and their relatives, and also has an emerging role in guiding treatment selection for therapies such as PARP inhibitors. The National Comprehensive Cancer Network (NCCN) currently recommends BRCA1/2 testing for TNBC patients diagnosed at age <60. Mutation prevalence among TNBC patients has previously been studied only in small regionalized cohorts. A recent study in unselected patients using the updated definitive criteria for TNBC reported mutation prevalence as 10.6%. Methods: Following the 2011 NCCN Hereditary Breast and Ovarian Cancer (HBOC) Testing Criteria update, serial cohorts of > 5,000 Ashkenazi Jewish and > 65,000 non-Ashkenazi Jewish breast cancer patients undergoing commercial BRCA1/2 testing were analyzed. Age at diagnosis, ethnicity, and provider-reported TN status were obtained from test requisition forms completed by ordering providers, and correlated with test results. Neither the accuracy nor definitive criteria used for TN status reported was independently verified. Results: Incidence of TNBC was reported as 9.7% among non-Ashkenazi patients and 16.5% within the subset with African ancestry. Incidence of TNBC was reported as 4.5% among Ashkenazi patients, but this is likely affected by test ordering for this population. The Table displays the BRCA1/2mutation rates classified by ethnicity and age-group. Conclusions: This study provides the most robust estimate to date of BRCA1/2 mutation prevalence among TNBC patients of all ages. The mutation rates seen among TNBC patients diagnosed after age 60 also illustrate the importance of testing such patients who may not meet the current NCCN HBOC testing criteria. [Table: see text]

Rate of use of NCCN “preferred” chemotherapy regimens for the treatment of HER2 positive breast cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 163-163
Author(s):  
Eric J. Gratias ◽  
Margaret Rausa ◽  
Lee N. Newcomer ◽  
Kurt Andrews ◽  
Nick Andrews ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Treatment Options ◽  
Management Program ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Nccn Guidelines ◽  
Her2 Breast Cancer

163 Background: The National Comprehensive Cancer Network (NCCN) Guidelines represent a well-established standard of care for the treatment of HER2+ breast cancer patients. eviCore healthcare is a licensee of NCCN that uses the NCCN guidelines to support its proprietary chemotherapy management program. All regimens assigned NCCN Category of Evidence 1, 2A, or 2B are adherent treatments in the eviCore program. NCCN recommends many systemic treatment options for HER2+ breast cancer, and a limited group is designated by NCCN as “preferred” based on superior efficacy and/or safety. This study evaluated the frequency of NCCN-preferred regimen use by practicing oncologists in HER2+ breast cancer patients. Methods: Chemotherapy authorizations for all HER2+ breast cancer patients with ≥ 1 injectable drug from 4/1/2015-9/30/2016 for multiple payers were included; > 90% of authorizations occurred in United HealthCare members. Cases with incomplete data were excluded. 3685 fully evaluable cases were stratified by stage, ER/PR status, and NCCN-preferred vs. NCCN-recommended status. The frequency of NCCN-preferred regimen selection was calculated for each subgroup. Results: There were 2883 HER2+/ER+ and/or PR+ cases and 802 HER2+/ER-/PR- cases. The highest frequency of NCCN-preferred regimen use occurred in neoadjuvant chemotherapy for patients with Stage III HER2+/ER+ and/or PR+ disease, where 88% of 289 patients used an NCCN-preferred regimen. Metastatic HER2+ patients had a markedly lower rate of NCCN-preferred regimen use at 62% of 557 cases. Only 48% of 1096 patients with Stage I/II HER2+/ER+ and/or PR+ disease received NCCN-preferred regimens. Conclusions: Patients receiving neoadjuvant chemotherapy for HER2+ breast cancer receive NCCN-preferred regimens at significantly higher rates than patients receiving adjuvant chemotherapy or metastatic treatment. Less than half of patients receiving adjuvant chemotherapy are receiving NCCN-preferred regimens. Further study is needed to determine the reasons for low preferred regimen use and ways to optimize preferred regimen use in HER2+ breast cancer.

Adherence to National Comprehensive Cancer Network Guidelines for BRCA testing among breast cancer patients.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e13624-e13624 ◽  
Author(s):  
Nadine M. Tung ◽  
Priyanka J. Bobbili ◽  
Temitope O. Olufade ◽  
Maral DerSarkissian ◽  
Rachel Bhak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
National Comprehensive Cancer Network ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Brca Testing ◽  
Cancer Network

Mutational status and thromboembolic risk in lung, gastrointestinal and breast cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23147-e23147
Author(s):  
Marco Platania ◽  
Federico Nichetti ◽  
Filippo G. De Braud
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Clinical Manifestations ◽  
Gene Mutations ◽  
Molecular Profile ◽  
Breast Cancer Patients ◽  
Vein Thrombosis ◽  
Mutational Status ◽  
Cancer Associated Thrombosis ◽  
Low Prevalence

e23147 Background: Cancer-Associated Thrombosis (CAT) is one of the most threatening complications of cancer. Recent evidences suggested a link between the molecular profile of solid tumors and the incidence of CAT. The aim of this study was to explore the relationship between the mutational status of breast, lung and gastrointestinal cancer patients and the risk of CAT. Methods: We retrospectively evaluated the molecular profile, analysed as per clinical practice, of all consecutive patients hospitalized at the National Cancer Institute’s Department in Milan from October 2017 to November 2018. Patients with previous thromboembolic events and patients under anticoagulant therapy at cancer diagnosis were excluded. Due to death as competing risk, the Fine and Gray proportional regression model was used to detect statistical association and estimate relative risk. Results: The resulting cohort consisted of 484 patients, of whom 47% had gastrointestinal cancers, 18% had lung cancer and 15% had breast cancer. Molecular investigations were available for 375 (77%) patients; in particular, a 50-gene Next Generation Sequencing (NGS) panel was performed on 148 (31%) patients. After a median follow up of 17 months, 118 patients (24%) exhibited clinical manifestations of thrombosis (i.e. deep vein thrombosis, pulmonary thromboembolism, splanchnic thrombosis, disseminated intravascular coagulation, arterial thrombosis) and 117 (24%) patients deceased without thrombotic events. A statistically significant association was observed between incidence of CAT and presence of TP53 (HR 0.50, p = 0.04), c-KIT (HR 4.30, p = 0.041), and SMAD4 (HR 3.19, p = 0.029) mutations. No significant association was detected for KRAS and MET gene mutations, even if HRs were >2. Conclusions: In this study, the mutational status of TP53, SMAD4 and c-KIT genes was statistically associated to the risk of thrombosis. Due to methodological limits and low prevalence of mutations, large prospective studies are warranted, with the aim of better defining the role of oncogenes in CAT risk.

scholarly journals Family Process with Breast Cancer Patient in Indonesia

Jurnal NERS ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. 180
Author(s):  
Sarah Kartika Wulandari ◽  
Yanti Hermayanti ◽  
Ahmad Yamin ◽  
Ferry Efendi
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Health Workers ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Outpatient Setting ◽  
Breast Cancer Patients ◽  
Targeted Interventions ◽  
Analysis Process ◽  
The Family

Introduction: Breast cancer occupies the first position in Asia’s women cancer cases in recent years. Signs and symptoms experienced by the patient affect the stress condition of the patient as well as the family as a caregiver. The condition changes to deal with problems during patient assistance as a major problem in an outpatient setting. The demands of adaptation to through the needs during the period of assistance by the family is more complex. The study aimed to determine the experience of stress and adaptation of breast cancer patient’s family. Methods: The qualitative method used with in-depth interviews on seven respondents who were the family caregiver of breast cancer patients. Setting carried out at the shelter house in Bandung. The analysis process used thematic analysis based on Braun & Clarke. Results: The results found five main themes are: 1) Stressor on breast cancer patients, 2) Crisis fulfillment of companion needs, 3) Crisis accompaniment, 4) Coping mechanisms of caregiver, and 5) Ability in adaptation. Conclusions: Family experience in assisting breast cancer patients who undergo outpatient also impact families tension who traversed with a subjective effort optimally to adapt in accompanying patients and the needs of other resource support system. Suggestions for future step are early recognition of stress by health workers especially nurses to be able to provide targeted interventions to develop positive adaptation to clients. The development through research is needed in applying family center care both the outpatient and inpatient care in an integrated manner.

Limitations in assessment of ER, PR, and HER2 status of breast cancer patients: Yangon experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11078-e11078
Author(s):  
Yin Yin Mon
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Advanced Technology ◽  
Molecular Profile ◽  
Molecular Testing ◽  
Breast Cancer Patients ◽  
Financial Problem ◽  
Lack Of Information ◽  
Number Of Patients ◽  
Her 2

e11078 Background: Management of breast cancer become individualized nowadays especially in developed countries. Molecular profile of breast cancer is essential to have this management. However, there are still limitations to examine such molecular profile in developing countries like Myanmar. Our aim in this study is to know the number of patients who underwent ER, PR and HER 2 status assessment among breast cancer patients in Myanmar and to analyze types of limitations for the molecular assessment in management of breast cancer. Methods: Total number of 823 breast cancer patients who registered from January 2009 to December 2011 at Medical Oncology Unit of Yangon General Hospital and two private oncology clinics were studied. Results: The age range from 19-80 years and mean age of 44.36 years. Among 823 breast cancer patients, ER, PR and HER 2 status were done in 134 patients (16.28% ) whereas 689 patients( 83.71% ) were not. 604 (87.66%) out of 689 patients who did not undergo profiling were due to financial problem. 60 patients (8.70 %) were found to have lack of information about molecular profiling although they were affordable . 25 patients (3.62 %) lost their tissue due to technological limitation Conclusions: Financial problem is the major limitation to get molecular profile for breast cancer patients in Myanmar. Patients need self expense to do advanced technology examinations in different health care system of our country. In this study we also found out that there was lack of information which leads not to undergo further investigations to some well to do patients. Overall, we believe that molecular technology support with reduced expense will help more patients in future to get better management in breast cancer in Myanmar. Besides, we need to provide update information about molecular testing in breast cancer to not only patients but also health professionals in our country.

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