Disparities in advanced stage breast cancer: The socioeconomic and geographic contributions.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19055-e19055
Author(s):  
Kelli Clemons ◽  
William Forehand ◽  
Hongyan Xu ◽  
Li Fang Zhang ◽  
Priyanka Raval
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Late Stage ◽  
Early Stage ◽  
Private Insurance ◽  
Clinical Stage ◽  
Metastatic Breast ◽  
P Value ◽  
Time Interval ◽  
Regular Screening

e19055 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). The early stage patients were 4.0 times more likely to have private insurance than late stage patients. Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). The late stage patients were 1/10 as likely to have regular screening for mammogram as early stage patients. 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.

Disparities in advanced-stage breast cancer: The socioeconomic and geographic contributions.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 134-134
Author(s):  
Kelli Clemons ◽  
William Forehand ◽  
Hongyan Xu ◽  
Li Fang Zhang ◽  
Priyanka Raval
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Late Stage ◽  
Early Stage ◽  
Private Insurance ◽  
Clinical Stage ◽  
Metastatic Breast ◽  
Cancer Center ◽  
P Value ◽  
Time Interval

134 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.

scholarly journals It doesn’t make sense, but we do: framing disease in an online metastatic breast cancer support community

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ariane B. Anderson
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Late Stage ◽  
Illness Perceptions ◽  
Early Stage ◽  
Metastatic Breast ◽  
Peer To Peer ◽  
Online Discussions ◽  
Breast Cancer Patients ◽  
Cancer Support

Using Weick’s sensemaking as a conceptual framework to investigate online discussions between members of a Facebook group of metastatic breast cancer patients, and using thematic analysis to examine textual threads between group members, this research examines participants’ framing of cancer survivorship. Participants in peer-to-peer disease support groups, which are not led by medical experts, communicate differently among themselves in order to cope with chronic and terminal illness. Perceptions of survivorship of late stage patients versus early stage patients differ for a variety of reasons, with late stage patients understanding their illness trajectory more often as chronic and declining. This analysis identified three properties of sensemaking used by members to manage their disease: identity, retrospective, and enactment. Results indicate that peer-to-peer online support group communication engenders distinct framing logics that members draw upon for group support as they manage a chronic and terminal disease.

Serum Carboxypeptidase N1 Serves as a Potential Biomarker Complementing CA15-3 for Breast Cancer

2020 ◽  
Vol 20 (17) ◽  
pp. 2053-2065
Author(s):  
Ranliang Cui ◽  
Chaomin Wang ◽  
Qi Zhao ◽  
Yichao Wang ◽  
Yueguo Li
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Critical Concentration ◽  
Tumour Size ◽  
Clinical Stage ◽  
Metastatic Breast ◽  
Breast Cancer Patients ◽  
Potential Biomarker ◽  
Incidence And Mortality ◽  
Combined Detection

Background: The incidence and mortality of breast cancer are increasing annually. Breast cancer seriously threatens women's health and quality of life. We aimed to measure the clinical value of CPN1, a new serum marker of breast cancer and to evaluate the efficacy of CPN1 in combination with CA15-3. Methods: Seventy samples of breast cancer with lymph node metastasis, seventy-three samples of nonmetastatic breast cancer and twenty-five samples of healthy human serum were collected. Serum CA15-3 concentration was determined by Roche Elecsys, and serum CPN1 concentration was determined by ELISA. Results: In breast cancer patients, serum CPN1 concentration was positively correlated with tumour size, clinical stage and CA15-3 concentration (r = 0.376, P<0.0001). ROC curve analysis showed that the optimal critical concentration of CPN1 for breast cancer diagnosis was 32.8pg/ml. The optimal critical concentration of CPN1 in the diagnosis of metastatic breast cancer was 66.121pg/ml. CPN1 has a greater diagnostic ability for breast cancer (AUCCA15-3=0.702 vs. AUCCPN1=0.886, P<0.0001) and metastatic breast cancer (AUCCA15-3=0.629 vs. AUCCPN1=0.887, P<0.0001) than CA15-3, and the combined detection of CA15-3 and CPN1 can improve the diagnostic efficiency for breast cancer (AUCCA15-3+CPN1=0.916) and for distinguishing between metastatic and non-metastatic breast cancer (AUCCA15-3+CPN1=0.895). Conclusion: CPN1 can be used as a new tumour marker to diagnose and evaluate the invasion and metastasis of breast cancer. The combined detection of CPN1 and CA15-3 is more accurate and has a certain value in clinical application.

Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer.

1995 ◽  
Vol 13 (4) ◽  
pp. 858-868 ◽  
Author(s):  
R P McQuellon ◽  
H B Muss ◽  
S L Hoffman ◽  
G Russell ◽  
B Craven ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Metastatic Breast Cancer ◽  
Life Expectancy ◽  
Metastatic Disease ◽  
Patient Preferences ◽  
Early Stage ◽  
Metastatic Breast ◽  
High Dose

PURPOSE The purpose of this study was to elicit preferences for the treatment of metastatic breast cancer in women with early-stage breast cancer who were given hypothetical treatment scenarios. We predicted that quality of life, demographic, and treatment variables would have an impact on patient preferences. PATIENTS AND METHODS One hundred fifteen patients with stage 1-IIIA breast cancer were interviewed. All patients had either mastectomy or lumpectomy plus radiotherapy as primary treatment. Sixty-seven (58%) had prior adjuvant chemotherapy. Patients were given four clinical scenarios that described a woman with metastatic breast cancer who was stated to have a life expectancy of 18 months. Side effects of the treatment options were systematically varied from low (hormonal therapy) to life-threatening (high-dose experimental therapy) and were consistent with common clinical situations. Patients were asked to select which treatment, with its associated toxicity, they would accept and prefer for a 50% chance of specified increments in life expectancy, ie, 5 years, 18 months, 1 year, 6 months, 1 month, and 1 week. RESULTS Quality of life at the time of interview, previous chemotherapy treatment, and degree of difficulty of previous treatments did not predict patient preferences. The greater the toxicity potential of the treatment, the less likely patients were to accept the treatment, although approximately 15% of patients would prefer high-risk treatment for as little as 1 month of added life expectancy. Between 34% and 82% of patients would prefer different therapies for a 6-month addition to life expectancy, whereas almost all patients would accept treatment for a 5-year increase in length of survival. Younger patients were more willing to assume the risks of treatment for a small increase in life expectancy. Of note, between 54% and 78% of patients would elect to start the different treatments even without symptoms related to metastatic disease. Moreover, 76% of patients would prefer standard treatment or an experimental agent to reduce symptoms or pain, even if such treatment did not prolong life. Additionally, only 10% of patients would allow randomization to a clinical trial comparing high-dose with standard chemotherapy. Participation in the study was not distressing to most patients. CONCLUSION Patients showed clear preferences for specific treatments for metastatic disease when given hypothetical scenarios. There was a wide range of patient preferences for treatment based on risk-benefit assessment, but a substantial percentage of patients would accept the risk of major toxicity for minimal increase in overall survival.

What is the evidence for rechallenging with anthracyclines or taxanes in metastatic breast cancer? A review of the data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1072-1072
Author(s):  
J. Krell ◽  
C. Harper-Wynne ◽  
D. Miles ◽  
V. Misra ◽  
S. Cleator ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Safety Data ◽  
Metastatic Breast ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Sequence ◽  
Pubmed Database ◽  
Current Evidence Base

1072 Background: Anthracyclines and taxanes are widely used in the adjuvant setting for high risk, early stage breast cancer. This raises the issue of what is the optimal therapy for those patients who relapse, and what the potential role, if any, there is for rechallenge with these agents. The current evidence base for rechallenging with anthracyclines/anthracediones and taxanes in metastatic breast cancer (MBC) is examined in this study. Methods: Medline/Pubmed database searches were performed upto October 2008 to identify studies in which patients (pts) were rechallenged with anthracyclines/anthracediones or taxanes in MBC. Results: The efficacy data, as well as the safety data relating to neurotoxicity and cardiotoxicity from these studies, are summarized in the Table. Twenty-seven studies were identified (20=anthracycline/anthracedione, 7= taxane) of which only two were prospective studies. Both were small (n= 74 & 51) and related to anthracycline rechallenging. Conclusions: Evidence exists to support rechallenging with anthracyclines and taxanes. However, there are few prospective data on reexposure to taxanes and no data comparing anthracyclines versus taxanes following adjuvant exposure to both agents, supporting the need for clinical trials in this area. Such trials should ideally incorporate a cross-over design at treatment failure, which would shed light on the optimal sequence in which these agents should be administered. [Table: see text] No significant financial relationships to disclose.

Open-label phase III randomized controlled trial comparing taxane-based chemotherapy (Tax) with lapatinib (L) or trastuzumab (T) as first-line therapy for women with HER2+ metastatic breast cancer: Interim analysis (IA) of NCIC CTG MA.31/GSK EGF 108919.

2012 ◽  
Vol 30 (18_suppl) ◽  
pp. LBA671-LBA671 ◽  
Author(s):  
Karen A. Gelmon ◽  
Frances Boyle ◽  
Bella Kaufman ◽  
David Huntsman ◽  
Alexey Manikhas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Phase Iii ◽  
Rank Test ◽  
Her2 Status ◽  
P Value ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

LBA671 Background: The relative efficacy of L vs T when combined with Tax chemotherapy in the first-line setting of metastatic breast cancer (BC) is unknown. Methods: MA.31 compares Tax-based therapy, paclitaxel 80mg/m2 wkly or docetaxel 75mg/m2 3 wkly for 24 wks in combination with L or T. The L dose was 1,250 mg po daily with Tax followed by 1,500 mg daily (LTax/L). After a loading dose, the T dose was 2 mg/kg wkly or 6 mg/kg 3 wkly + Tax followed by T 6 mg/kg 3 wkly (TTax/T). Stratification was by prior neo/adjuvant HER2 therapy, prior neo/adjuvant Tax, planned Tax (paclitaxel vs docetaxel), and liver metastases. The primary endpoint is ITT progression-free survival (PFS), defined as time from randomization to objective progressive disease based on RECIST criteria or death from any cause. The protocol-specified IA was performed after observing 333 PFS events; the trial was to stop if the 2-sided p-value from the stratified log-rank test was less than 0.03. The NCIC CTG’s independent DSMC reviewed IA results and recommended disclosure because the superiority boundary was crossed. A secondary analysis utilized central laboratory-confirmed HER2 + status. Results: Between July 17 2008 and Dec 1 2011, 652 pts were accrued. Data from 636 pts (525 HER2 centrally confirmed) were included in the IA with clinical cutoff date of Nov 7 2011 and database lock of Apr 13 2012. Median follow-up was 13.6 mos, 12.9 mos for LTax/L pts and 14.0 mos for TTax/T patients. In the ITT analysis, PFS was inferior with LTax/L compared to TTax/T hazard ratio (HR) =1.33; 95% CI 1.06-1.67; p=0.01. LTax/L had median PFS 8.8 mos (95% CI 8.3-10.6) compared to TTax/T 11.4 mos (95% CI 10.8-13.7). PFS in the centrally confirmed HER2+ had HR 1.48 (95%CI 1.15-1.92; p=0.003) (LTax/L to TTax/T). No difference in overall survival was detected (LTax/L to TTax/T) HR= 1.1 (95% CI 0.75-1.61; p=0.62). More grade 3-4 diarrhea and rash was observed with LTax/L (p<0.001). Conclusions: LTax/L therapy is associated with a shorter PFS compared to TTax/T as first line therapy for HER2+ metastatic BC. ClinicalTrials.gov: NCT00667251. CCSRI grant: 021039. Supported by GlaxoSmithKline.

Survival length differences in non-metastatic breast cancer patients with different chemo-radiation time intervals.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12096-e12096
Author(s):  
Ruaa Al-Ward ◽  
Wajdi Al Shweiat ◽  
Talasila Lakshmi ◽  
Sandeep Singh Grewal ◽  
Perla Subbaiah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Survival Duration ◽  
P Value ◽  
Breast Cancer Patients ◽  
Time Intervals ◽  
Cox Regression Analysis

e12096 Background: Chemotherapy-radiotherapy time intervals (CRTI) in breast cancer vary based on recovery from chemotherapy side effects and preferences of physicians and patients. Our study aimed to determine the association of the time-interval between chemotherapy and radiation with prognosis (recurrence and survival duration) in non-metastatic breast cancer patients (stages I-III). Methods: We included female patients from Karmanos Cancer Center (KCC) database > 21 years, diagnosed with non-metastatic breast cancer from 2005-2015, who underwent surgery, chemotherapy and radiation. CRTI was divided into <24, 24-30 and >30 weeks. Cox regression analysis using age, race, stage, grade, ER/PR status and CRTI variables was done to determine the independent predictors of prognosis. Kaplan-Meier survival curves were used to demonstrate differences in survival time of CRTI groups. Results: We included 553 patients, majority were Caucasian (460 [83.5%]) with a mean age of 57.0 years (SD 11.9). Patients in the >30 weeks CRTI group were more likely to have stage III breast carcinoma when compared to <24 and 24-30 weeks groups (45.0% vs.12.4% vs. 27.8%, p-value <0.001). There were no significant differences in the local and distant recurrence rates among the 3 groups. Patients in <24 weeks CRTI group had a greater mean survival (118.7 vs. 109.2 vs.100.9 months; p-value 0.016) when compared to 24-30 and >30 weeks groups. Only clinical stage (stage 3 vs. 1 HR 3.60; 95% CI 1.89-7.02) and ER/PR status (negative vs. positive HR 1.74; 95% CI 1.02-2.94) were independent predictors of overall survival in multivariate analysis. CRTI was not significantly associated with survival in multivariate analysis (<24 weeks ref, 24-30 weeks HR 1.09; 95% CI 0.59-1.93, >30 weeks HR 1.48; 95% CI 0.82-2.59). However, patients in >30 weeks group were at greater risk of dying when compared to <24 weeks, even after controlling for stage. Conclusions: Our study showed a trend towards a worse outcome in patients with longer chemo-radiation interval, despite controlling for other variables in the multivariate analysis. The conclusions of this single center study need to be verified by further studies with larger sample size.

scholarly journals Association of Metabolic, Inflammatory, and Tumor Markers With Circulating Tumor Cells in Metastatic Breast Cancer

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Ana Elisa Lohmann ◽  
Ryan J O Dowling ◽  
Marguerite Ennis ◽  
Eitan Amir ◽  
Christine Elser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Tumor Markers ◽  
Statistical Tests ◽  
Metastatic Breast ◽  
P Value ◽  
Fisher Exact Test ◽  
Plasminogen Activator Inhibitor 1

Abstract Background Circulating tumor cells (CTCs) are associated with worse prognosis in metastatic breast cancer (BC). We evaluated the association of metabolic, inflammatory, and tumor markers with CTCs in women with metastatic BC before commencing a new systemic therapy. Methods Ninety-six patients with newly diagnosed or progressing metastatic BC without current diabetes or use of anti-inflammatory agents were recruited from four Ontario hospitals. Women provided fasting blood for measurement of metabolic, inflammatory, and tumor markers and CTCs. CTCs were assayed within 72 hours of collection using CellSearch. Other blood was frozen at –80°C, and assays were performed in a single batch. Associations between CTC counts with study factors were evaluated using Spearman correlation, and the chi-square or Fisher exact test. All statistical tests were two-sided and P value ≤ .05 was considered statistically significant. Results The median age was 60.5 years; 90.6% were postmenopausal. The cohort included hormone receptor–positive (87.5%), HER2–positive (15.6%), and triple-negative (10.4%) BCs. Patients were starting firstline (35.5%), second-line (26.0%), or third-or-later-line therapy (38.5%). CTC counts (per 7.5 mL of blood) ranged from 0 to 1238 (median 2); an elevated CTC count, defined as five or more CTCs, was detected in 42 (43.8%) patients. Those with liver metastases (vs not) more frequently had an elevated CTC count (59.0% vs 33.3%, P = .02). CTCs were significantly associated with C-reactive protein (R = .22, P = .02), interleukin (IL)-6 (R = .25, P = .01), IL-8 (R = .38, P = .0001), plasminogen activator inhibitor 1 (R = .31, P = .001), carcinoembryonic antigen (R = .31, P = .002), and cancer antigen 15-3 (R = .40, P = .0001) and inversely associated with body mass index (R = –.23, P = .02) and leptin (R = –.26, P = .01). Conclusions CTC counts were positively associated with tumor and inflammatory markers and inversely associated with some metabolic markers, potentially reflecting tumor burden and cachexia.

scholarly journals Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer

2018 ◽  
Vol 129 ◽  
pp. 54-66 ◽  
Author(s):  
Ilaria Trestini ◽  
Luisa Carbognin ◽  
Sara Monteverdi ◽  
Sara Zanelli ◽  
Alessandro De Toma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Composition ◽  
Metastatic Breast Cancer ◽  
Clinical Implication ◽  
Early Stage ◽  
Metastatic Breast

Metastatic breast cancer and the elderly: A single institution, retrospective review.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 55-55
Author(s):  
Michael Kidd ◽  
Nina J. Karlin ◽  
Amylou C. Dueck
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cox Regression ◽  
Age Groups ◽  
Metastatic Breast ◽  
Age At Diagnosis ◽  
Her2 Status ◽  
P Value ◽  
Cox Regression Analysis ◽  
Hormone Status

55 Background: The aim of this retrospective study was to examine the overall survival (OS) of metastatic breast cancer patients over a decade and assess for any differences with respect to age, tumor characteristics, and ECOG status. Methods: Data on metastatic breast cancer cases from 1999-2010 were retrieved from the institutional cancer registry and linked to electronic medical records. Through chart review of 240 metastatic breast cancer cases, we determined hormone receptor (HR), HER2/neu (HER2), ECOG, age at diagnosis of metastatic cancer and mortality data. Kaplan-Meier survival curves for OS were used and compared between HR status, HER2 status, ECOG, and age at diagnosis using log-rank regression and Cox Regression analysis was performed to control for these variables. A 95% confidence interval (CI) was used. Results: The median OS of the sampled cases was 2.2 years (CI: 1.8-2.5 years). Analysis for overall survival by pre-determined age groups demonstrated no significant difference between the age groups (p value 0.46), but did yield a statistical difference based on ECOG status (p value 0.0001). Cox regression analysis showed consistent findings where survival was significantly affected by HR, HER2 status and ECOG but not age (HR: p value <0.0001; HER2: p value 0.0132; ECOG: p value <0.0001; age at diagnosis: p value 0.8462). Analysis for OS based on HR yielded a median survival of 1.4 years (CI: 0.9-1.6 years) for HR negative and 2.5 years (CI: 2.2-3.0 years) for HR positive (p value 0.0018). HER2 yielded a median survival of 1.8 years (CI: 1.4-2.3 years) for no amplification and 3.0 years (CI: 2.5 - 3.4 years) for amplification (p-value 0.0043). HR negative, HER2 non-amplified tumors had the poorest median OS at 0.7 years (CI: 0.5 - 1.1 years) whereas those tumors with HR positive, HER2 amplified had the best median OS at 3.0 years (CI: 2.5 - 4.7 years) with a p value < 0.0001. Conclusions: In this retrospective analysis, there was no significant survival difference with respect to age. Age continued to have no significant effect on survival when adjusting for ECOG, hormone status, and HER2/neu status. Those factors that did act as determinants of survival were ECOG status, hormone status and HER2/neu status of the tumor.

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