scholarly journals Breast cancer survivorship and level of institutional involvement utilizing integrative oncology.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18588-e18588
Author(s):  
Terri Crudup ◽  
Linna Li ◽  
Jennifer Wright Dorr ◽  
Elizabeth Lawson ◽  
Rachel Stout ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Multivariate Modeling ◽  
Breast Cancer Patients ◽  
Integrative Oncology ◽  
Academic Setting ◽  
Significant Difference ◽  
The Relationship

e18588 Background: A growing body of evidence has shown that a Whole Person Integrative Oncology approach, adding the use of complementary and lifestyle therapies to cancer treatments, benefits patients by improving patient-reported outcomes and potentially extending overall survival. This study aims to investigate the relationship between the survival outcomes of breast cancer patients and the level of involvement in Integrative Oncology at the institutions treating those patients. Methods: Between January 2013 and December 2014, 4,815 breast cancer patients were available for survival analysis using an established claims-based method. These patients were filtered to include those with clear mapping to treating oncologists and treating institutions. To measure each institution’s level of Integrative involvement, a scoring system was developed with the Samueli Foundation and oncologists from each institution were surveyed on the education, availability, and financing of 12 complementary and lifestyle approaches during the treatment timeframe. Statistical analysis using multivariate modeling with logistic regression and a lasso approach were employed. 19 variables across region, patient demographics, and institutional profile were included. Model coefficients are exponentiated and presented as odds-ratios, with less than one having a negative impact on survival and greater than one improved survival. Results: We identified 173 patients mapping to 103 institutions and 103 oncologists who responded to our survey. Median age of breast cancer patients was 51 (range: 32-76). 14 of the patients (8%) were identified as metastatic. The 5-year overall survival among the Low scoring institutions was 89%, Low-Mid 96%, Mid-High 96%, High 95%. Chi square testing across these cohorts showed no statistically significant difference between them. On multivariate modeling, age, geography, metastatic status, academic setting, and Integrative score were predictors of 5-year survival. The most significant 9 variables are shown in Table. Having metastatic disease, treatment at a non NCCN designated facility, treatment at Midwest or Western Region predicts for lower 5-year survival. Older age, treatment at an academic setting, and having a High or Low-Mid Integrative score are predictors of improved survival. Conclusions: This study suggests that in addition to traditional predictors of survival such as metastatic disease and younger age, patients receiving treatment at an institution that supports Integrative Oncology programs may be associated with improved survival. More work is needed to evaluate the relationship between Integrative Oncology and cancer treatment outcomes.[Table: see text]

scholarly journals Relationship Between Obesity and Pathologic Response to Neoadjuvant Chemotherapy Among Women With Operable Breast Cancer

2008 ◽  
Vol 26 (25) ◽  
pp. 4072-4077 ◽  
Author(s):  
Jennifer K. Litton ◽  
Ana M. Gonzalez-Angulo ◽  
Carla L. Warneke ◽  
Aman U. Buzdar ◽  
Shu-Wan Kau ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Pathologic Complete Response ◽  
Operable Breast Cancer ◽  
Obese Patients ◽  
Breast Cancer Patients ◽  
Significant Difference ◽  
Response To Neoadjuvant Chemotherapy

Purpose To understand the mechanism through which obesity in breast cancer patients is associated with poorer outcome, we evaluated body mass index (BMI) and response to neoadjuvant chemotherapy (NC) in women with operable breast cancer. Patients and Methods From May 1990 to July 2004, 1,169 patients were diagnosed with invasive breast cancer at M. D. Anderson Cancer Center and received NC before surgery. Patients were categorized as obese (BMI ≥ 30 kg/m2), overweight (BMI of 25 to < 30 kg/m2), or normal/underweight (BMI < 25 kg/m2). Logistic regression was used to examine associations between BMI and pathologic complete response (pCR). Breast cancer–specific, progression-free, and overall survival times were examined using the Kaplan-Meier method and Cox proportional hazards regression analysis. All statistical tests were two-sided. Results Median age was 50 years; 30% of patients were obese, 32% were overweight, and 38% were normal or underweight. In multivariate analysis, there was no significant difference in pCR for obese compared with normal weight patients (odds ratio [OR] = 0.78; 95% CI, 0.49 to 1.26). Overweight and the combination of overweight and obese patients were significantly less likely to have a pCR (OR = 0.59; 95% CI, 0.37 to 0.95; and OR = 0.67; 95% CI, 0.45 to 0.99, respectively). Obese patients were more likely to have hormone-negative tumors (P < .01), stage III tumors (P < .01), and worse overall survival (P = .006) at a median follow-up time of 4.1 years. Conclusion Higher BMI was associated with worse pCR to NC. In addition, its association with worse overall survival suggests that greater attention should be focused on this risk factor to optimize the care of breast cancer patients.

Clinical significance of brain metastases occurrence in HER2 overexpressing metastatic breast cancer patients treated with trastuzumab

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10593-10593
Author(s):  
V. Mari ◽  
E. Chamorey ◽  
A. Italiano ◽  
F. Van Den Bos ◽  
R. Ferri-Dessens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Study Cohort ◽  
Breast Cancer Patients ◽  
Specific Patient ◽  
Study Results ◽  
Significant Difference

10593 Background: Recent data report that HER2 overexpressing metastatic breast cancer patients (HER+ MBC pts) treated with trastuzumab (T) have a high rate of Brain metastasis (BM). This study aimed to evaluate the prognostic significance of BM occurrence and the related clinical outcome in a specific patient population. Methods: All the HER+MBC patients treated with trastuzumab (with or without chemotherapy) between 09/1999 and 12/2004 were included in this study. Results: A total of forty three patients were enrolled into the study cohort. The median follow-up was 48 months (range, 11–166). Fifteen patients (35%) developped BM. The median interval from the the first MBC event to BM was 18 months (range, 1–65). In multivariate analysis; younger age was the only factor associated with BM occurrence (46 versus 57 years; p = 0.01). Patients with BM tend to have a longer median duration of response to T than patients without BM (16 months versus 13 months; p = 0.1). At the time of BM appearance, 6 of the 15 patients (40%) were still responding or had achieved extracranial stable disease while receiving trastuzumab. Twelve out of 15 (80%) pts received a whole-brain radiation therapy, and 8 pts continued to receive trastuzumab until extracranial disease progression. The median overall survival for patients diagnosed with BM was 10 months (range, 2–42). At three-year, there was no significant difference in overall survival rates between the two groups. The 3-YS was 63.5% and 66.7% for pts with or without BM, respectively; (p = 0.7). Conclusions: The BM occurrence in HER2+ MBC pts treated with Trastuzumab is not linked to tumour resistance, but likely related to the T inability to cross the blood-brain barrier. There is no impaired survival for these pts treated with effective and appropriate therapy. [Table: see text]

The association of comorbid conditions and BMI on overall survival in geriatric breast cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21525-e21525
Author(s):  
Meghna R. Desai ◽  
Muhammad Iqbal ◽  
Sukesh Manthri ◽  
Kathy Robinson ◽  
Robert S. Mocharnuk
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Eligible Patient ◽  
Cox Proportional Hazards ◽  
Breast Cancer Patients ◽  
Comorbid Conditions ◽  
Organ Systems ◽  
Significant Difference

e21525 Background: Breast cancer is the most common cancer and the second leading cause of cancer death in women. More than one-half of all women diagnosed with breast cancer are older than 65 years, and the incidence increases with age. Geriatric cancer patients also have higher comorbidity than the general cancer population. Patients with 3 or more comorbid conditions had a 20-fold higher rate of mortality from causes other than breast cancer. The purpose of this study was to determine whether specific comorbidities associated with specific organ systems, in addition to increased BMI, resulted in decreased survival. Methods: In this retrospective analysis, 269 patients with histologically confirmed invasive or in-situ breast cancer and above 65 years of age at the time of diagnosis were eligible. Patient comorbidities were recorded by system, including cardiovascular, renal, pulmonary, endocrine, neurologic, psychiatric and other systems. Patient BMI was also recorded. The primary outcome was overall survival (OS). Survival analysis was conducted by Kaplan Meier estimation and Cox proportional hazards regression analysis. Results: Patients with renal comorbidities were found to have decreased OS, disease free and progression free survival compared with rest of the population (HR 2.65, p = 0.023; HR 2.71, p = 0.021; HR 27.5, p = 0.019). For patients with cardiovascular (HR 1.46, p = 0.479), pulmonary (HR 1.63, p = 0.176), endocrine (HR 0.99, p = 0.991), neurologic (HR 1.92, p = 0.15) and psychiatric (HR 1.68, p = 0.187) comorbidities, there was no significant difference in OS compared with their counterparts. Patients with 4 or more systemic comorbidities had decreased OS compared with patients with either 1 or 2 systemic comorbidities (HR 0.178, p = 0.012; HR 0.404, p = 0.038). There was no significant change in OS with increased BMI (HR 0.998, p = 0.871). Conclusions: In patients with newly diagnosed breast cancer age 65 or older, those with renal comorbidities were found to have decreased OS, DFS and PFS. Patients with 4 or more systemic comorbidities also had decreased OS compared with those who had 1 or 2 comorbidities. Other comorbidities and BMI did not affect OS in these patients.

Prognostic Value of S-Phase Fraction in 920 Breast Cancer Patients: Focus on T1N0 Status

2003 ◽  
Vol 18 (4) ◽  
pp. 273-279 ◽  
Author(s):  
R. Largillier ◽  
M. Namer ◽  
A. Ramaioli ◽  
J.M. Ferrero ◽  
N. Magné ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Size ◽  
Cox Model ◽  
Univariate Analysis ◽  
S Phase ◽  
Phase Fraction ◽  
Breast Cancer Patients ◽  
Significant Difference

The aim of this study was to reexamine the prognostic role of tumor cell kinetics measured by S-phase fraction (SPF) and to establish its clinically relevant threshold values. SPF was determined by flow cytometry in a group of 920 consecutive breast cancer patients, all followed at our institute for 10 years (1988 to 1998). Mean age was 60.5 years (27–89 years). Median follow-up was 63 months (3–150 months). All patients had initial surgical treatment. SPF quartiles were: Q1=3.08%, median value = 5.98%, Q3=10.22%. A significant difference in overall specific survival was obtained between two populations divided by a cutoff at Q1 (p<0.0001). A multifactorial analysis including SPF and known prognostic factors such as tumor size, node status, histological grade, ER and PR status was performed using the Cox model in a population of 719 patients: univariate analysis showed that each of these factors had significant influence on overall survival. Multivariate analysis selected three of them, ranked by decreasing order of hazard ratio (HR) value: SPF (HR: 3.88, p<0.001), tumor size (HR: 2.49, p<0.001) and nodal status (HR: 2.28, p<0.001). In addition, when tumors were stratified according to SPF quartile values, there were statistically different overall survival curves in patients with small tumors (<2 cm) and in axillary node-negative patients.

The effects of tamoxifen on homocysteine levels in breast cancer patients

Open Medicine ◽  
2009 ◽  
Vol 4 (4) ◽  
pp. 450-453
Author(s):  
Aydan Eroğlu ◽  
Yonca Eğin ◽  
Nejat Akar
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Mthfr C677t ◽  
Breast Cancer Patients ◽  
Serum Homocysteine ◽  
Intron 1 ◽  
Increased Risk ◽  
Significant Difference ◽  
The Relationship ◽  
Control Study

AbstractTamoxifen is widely used in the treatment of breast cancer and associated with an increased risk of thromboembolism (TE). An elevated homocysteine is one of the risk factors for TE. The aim of the study was to assess the effect of tamoxifen on serum homocysteine levels in breast cancer patients. We performed a case-control study in 20 female subjects to evaluate the relationship between homocysteine levels, and 5,10-methylenetetrahyrofolate reductase (MTHFR) C677T and dihydrofolate reductase (DHFR) 19-bp intron-1 deletion polymorphisms in breast cancer patients and in control subjects. It was observed that homocysteine levels were decreased during tamoxifen therapy, but this finding was not statistically significant. There was also no statistically significant difference in homocysteine levels between the two groups (p> 0.05). MTHFR C677T and DHFR 19-bp deletion polymorphisms were not associated with serum homocysteine value in either group.

scholarly journals Comentário do Artigo - Relationship between CA 15-3 serum levels and disease extent in predicting overall survival of breast cancer patients with newly diagnosed metastatic disease

2001 ◽  
Vol 47 (1) ◽  
pp. 21-23
Author(s):  
André Cavalcanti Gentil
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Serum Levels ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Disease Extent

Comentário do artigo, Relationship between CA 15-3 serum levels and disease extent in predicting overall survival of breast cancer patients with newly diagnosed metastatic disease, publicado no Br J Cancer; 75(5): 698-702, 1997. doi: https://doi.org/10.1038/bjc.1997.124

Bone Marrow Micrometastases in Breast Cancer Patients: A Long-Term Follow-up Study

2008 ◽  
Vol 2 ◽  
pp. 117955490800200
Author(s):  
Annamaria Molino ◽  
Monica Giovannini ◽  
Rocco Micciolo ◽  
Alessandra Auriemma ◽  
Elena Fiorio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Overall Survival ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Primary Surgery ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Disease Free

In 125 early breast cancer patients who underwent multiple bone marrow aspirates, there was no significant difference in terms of disease-free and overall survival after a median follow-up of 163 months between the patients with or without micrometastasis at the time of primary surgery. However, when the time-dependent evolution of the bone marrow aspirates was taken into account, some evidence for a longer disease-free and overall survival was found for the patients with negative bone marrow

Genetic Analysis of Oligo-Metastatic Breast Cancer: Correlation with Clinicopathological Features

2021 ◽  
Author(s):  
Kuikui Jiang ◽  
Danyang Zhou ◽  
Fei Xu ◽  
Wen Xia ◽  
Qiufan Zheng ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Genetic Analysis ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Metastatic Breast ◽  
Good Prognosis ◽  
Clinicopathological Features ◽  
Breast Cancer Patients ◽  
Significant Difference

Abstract Purpose: We aimed to identify the relationship between the genomic characteristics and clinicopathological features of oligo-metastatic breast cancer.Methods: Oligo-metastatic breast cancer diagnosed by pathology from January 2001 and August 2019 were identified and we matched the poly-metastatic patients based on the clinicopathological features of the oligo-metastatic patients included. The database of all genomic alterations was shown according to the FoundationOne CDx reports. Clinicopathological characteristics were collected and the results of next-generation sequencing were analyzed.Results: A total of 26 breast cancer patients were enrolled in our study, including 14 patients with oligo-metastatic disease and 12 patients with poly-metastatic disease. There was no significant difference in number of gene alteration, tumor mutational burden, variants of unknown significance (VUS), and actional mutation in oligo- and poly-metastasis. PIK3CA, TP53 and ERBB2 were the most common shared alterations identified in patients included. Based on the median time of oligo-progression disease (oligo-PD), we divided the patients with oligo-metastasis into longer oligo-PD group (oligo-PD > 31.04 months) and shorter oligo-PD group (oligo-PD ≤ 31.04 months). The analysis of PIK3CA mutation sites showed that H1047R was associated with a good prognosis in patients with metastatic breast cancer. HER2 positive patients with oligo-metastasis was more likely to have a good prognosis. In addition, VUS might also be a potential prognostic biomarker in metastatic breast cancer. Conclusion: Through the genetic analysis of oligo-metastasis, we found PIK3CA H1047R, HER2 and VUS might predict the different clinical outcomes of breast cancer patients with oligo-metastasis for the individualized treatment.

scholarly journals Preoperative Neoadjuvant Hormonal Therapy and Neoadjuvant Chemotherapy for Stage 3B and 4 Breast Cancer Patients in Dharmais Hospital-National Cancer Center, Indonesia: A Cohort Study

2019 ◽  
Vol 12 (4) ◽  
pp. 109
Author(s):  
Ramadhan Karsono ◽  
Denni Joko Purwanto ◽  
Samuel J. Haryono ◽  
Bambang Karsono ◽  
Lenny Sari ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cohort Study ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Hormonal Therapy ◽  
Cancer Center ◽  
Breast Cancer Patients ◽  
Neoadjuvant Hormonal Therapy ◽  
Significant Difference

Background: There are no data of efficacy comparison between primary systemic therapy in stage 3B and 4 breast cancer patients in Indonesia. This study compared long term outcomes of breast cancer patients treated with neoadjuvant hormonal therapy (NAHT) and those treated with neoadjuvant chemotherapy (NACT)Methods: This was a cohort study conducted from 2011 to 2017. A total of 122 patients with stage 3B and 4 breast cancer received NAHT (n = 62) or NACT (n = 60) within a 6 cycles for NACT and 6 months for NAHT were included. Patients were excluded if they had a mastectomy before treatment, were pregnant, had been given hormonal therapy or chemotherapy before, had a contra-indication of chemotherapy, had a contra-indication of salpingo-oophorectomy bilateral for premenopausal patients, and declined to enter this study. The primary outcome of this study was overall survival. The outcomes were analysed using Kaplan-Meier for survival analysis and cox proportional hazard regression to estimate the hazard ratio.Results: There was a statistically significant difference in overall survival (p = 0.038). Median overall survival for NAHT patients was 1265 days and for NACT patients was 654 days. The hazard ratio showed NACT patients had a higher risk than NAHT patients (1.7 95% CI 1.03 – 2.9). Pathological complete response rate was higher in the NACT group than in the NAHT group (3.3% vs. 0%).Conclusions: Neoadjuvant hormonal therapy was superior to neoadjuvant chemotherapy in term of overall survival.

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