scholarly journals Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Daniel S. O’Neil ◽  
Nancy L. Keating ◽  
Jean Marie V. Dusengimana ◽  
Vedaste Hategekimana ◽  
Aline Umwizera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Sub Saharan Africa ◽  
Cancer Center ◽  
Incidence And Mortality ◽  
Sub Saharan

Purpose As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center. Patients and Methods We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis. Results Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor–positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up. Conclusion Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival.

scholarly journals Investigating Associations Between Health-Related Quality of Life and Endocrine Therapy Underuse in Women With Early-Stage Breast Cancer

2017 ◽  
Vol 13 (5) ◽  
pp. e463-e473 ◽  
Author(s):  
Laura C. Pinheiro ◽  
Stephanie B. Wheeler ◽  
Katherine E. Reeder-Hayes ◽  
Cleo A. Samuel ◽  
Andrew F. Olshan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Endocrine Therapy ◽  
Early Stage ◽  
Health Related Quality ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Related Quality ◽  
Health Related

Purpose: Endocrine therapy (ET) underuse puts women at increased risk for breast cancer (BC) recurrence. Our objective was to determine if health-related quality of life (HRQOL) subgroups were associated with underuse. Methods: Data came from the third phase of the Carolina Breast Cancer Study. We included 1,599 women with hormone receptor–positive BC age 20 to 74 years. HRQOL was measured, on average, 5 months postdiagnosis. Subgroups were derived using latent profile (LP) analysis. Underuse was defined as not initiating or adhering to ET by 36 months postdiagnosis. Multivariable logistic regression models estimated adjusted odds ratios (ORs) between HRQOL LPs and underuse. The best HRQOL LP was the reference. Chemotherapy- and race-stratified models were estimated, separately. Results: Initiation analyses included 953 women who had not begun ET by their 5-month survey. Of these, 154 never initiated ET. Adherence analyses included 1,114 ET initiators, of whom 211 were nonadherent. HRQOL was not significantly associated with noninitiation, except among nonchemotherapy users, with membership in the poorest LP associated with increased odds of noninitiation (adjusted OR, 5.5; 95% CI, 1.7 to 17.4). Membership in the poorest LPs was associated with nonadherence (LP1: adjusted OR, 2.2; 95% CI, 1.2 to 4.0 and LP2: adjusted OR,1.9; 95% CI, 1.1 to 3.6). Membership in the poorest LP was associated with nonadherence among nonchemotherapy users (adjusted OR, 2.1; 95% CI, 1.2 to 5.1). Conclusion: Our results suggest women with poor HRQOL during active treatment may be at increased risk for ET underuse. Focusing on HRQOL, a modifiable factor, may improve targeting of future interventions early in the BC continuum to improve ET initiation and adherence and prevent BC recurrence.

Breast cancer in Sub-Saharan Africa: 1,000 patients with primary breast cancer in Addis Ababa followed for up to 5 years.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 580-580
Author(s):  
Eva Johanna Kantelhardt ◽  
Peter Zerche ◽  
Pietro Trocchi ◽  
Assefa Mathios ◽  
Anne Reeler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Addis Ababa ◽  
Right Censoring ◽  
Sub Saharan Africa ◽  
Endocrine Treatment ◽  
Worst Case Analysis ◽  
Worst Case ◽  
Sub Saharan ◽  
Stage 1

580 Background: There is little information on breast cancer (BC) patients (pts) receiving standardized treatment in Sub-Saharan Africa. This study evaluates pts presenting 2005-10 at the University Radiotherapy Center in Addis Ababa, the only institution in the country offering standardized radiotherapy, systemic therapy and free endocrine treatment (ET) during that time. Methods: All pts with histologically verified BC were included. Ethical approval was obtained. Axios/AstraZenaca provided free ET. Therefore, the majority of pts underwent regular follow-up (FUP). We analyzed survival at 18 months by means of Kaplan-Meier survival analysis. We assumed right-censoring to be unrelated to the risk of metastasis. In a worst case sensitivity analysis, we considered all censored pts developing metastasis. Results: Pts with primary diagnosis between July 1st, 2005 and December 31st, 2010 were included (n=1303). The majority of pts were female (95.2%), most (52.3%) postmenopausal. Mean age was 44.1yrs (20-88yrs). Stages 1-4 presented in 3/19/53/25% respectively (36% unknown). Grade 2 tumors were seen in 434 out of 574 pts (58%). Estrogen receptor was pos. in 251 out of 381 pts (66%). Most M0-pts (n=942) underwent surgery (84%), received chemotherapy (59%), and received ET (63%). Median FUP was 18.4 months, 186 events (metastases) occurred. Metastasis-free survival (MFS) was 86%. Worst case analysis on censored observations revealed that MFS declined down to 52%. Pts with early stage 1/2 showed a better MFS than pts with stage 3 disease (93 to 77%). Surgery (no surgery 78% vs surgery 87%) and ET (79% vs 89%) improved MFS. The 5-year MFS for stage 1/2 was 78% and stage 3 was 38%. Conclusions: To our knowledge this is the first presentation of clinical features in 1300 pts with BC in Sub-Saharan Africa. Most pts in Addis Ababa (AA) are <45yrs and present at stage 3/4. Differences to 5-year MFS from Europe stage 1/2 around 90% (AA 78%) and stage 3 around 70% (AA 38%) are smaller in pts treated with surgery and ET. This data is consistent with overall survival in a treated pt cohort from Uganda stage 1/2: 74% and stage 3/4: 39% (n=285) (Gakwaya Brit J Cancer 2008). Policies should focus on earlier presentation and access to care.

Use of diagnostic testing for patients with early-stage breast cancer in a multi-hospital quality collaborative in Michigan.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 242-242
Author(s):  
Tara M. Breslin ◽  
James Kubus ◽  
Haythem Y. Ali ◽  
T. Trevor Singh ◽  
Paul T. Adams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Imaging ◽  
Early Stage ◽  
Diagnostic Testing ◽  
Early Stage Breast Cancer ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Positron Emission ◽  
Bone Scans

242 Background: In 2012, ASCO identified five opportunities to improve the quality of cancer care and reduce costs. Two of these recommendations focused on limiting use of advanced diagnostic imaging with computed tomography (CT), Positron Emission Tomography (PET), and radionuclide bone scans (BS) at diagnosis and during surveillance for women with early stage breast cancer with a low risk of metastasis. We describe the use of diagnostic imaging among patients with early stage breast cancer treated at hospitals in Michigan. Methods: The Michigan Breast Oncology Quality Initiative is a collaboration between Michigan hospitals, the University of Michigan Comprehensive Cancer Center, and the National Comprehensive Cancer Network (NCCN). This collaborative collects longitudinal demographic, staging, treatment, and follow up data using the NCCN Breast Outcomes Database platform. We analyzed use of advanced diagnostic testing with CT, PET, BS and contrast it with use of traditional imaging (mammography/ultrasound) at diagnosis and during follow up in patients with stage 0, I, II breast cancer between 1998 to 2009. Patients who died or recurred were excluded. Results: The cohort included 7,632 patients (19.6% stage 0, 48.1% stage I, 32.3% stage II) treated at 17 hospitals. Use of traditional imaging was documented in nearly 100% of patients at diagnosis and throughout the follow up period. With respect to advanced diagnostic imaging, 20.3 % underwent CT, 4.7% underwent PET, and 11.6% underwent BS at diagnosis. Advanced testing use decreased over time (Table). Conclusions: Despite published guidelines, which recommend against their routine use, advanced diagnostic imaging use was prevalent among patients treated for early breast cancer at MiBOQI hospitals. Education efforts should target physicians and patients on the lack of proven benefit and potential risks of using advanced diagnostic imaging in this population. [Table: see text]

Moderate-to-severe symptoms among survivors of early-stage breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19644-e19644
Author(s):  
Helene B. Zonder ◽  
Joanne E. Mortimer ◽  
Carolyn E. Behrendt ◽  
Robin Smith ◽  
Meghan Zomorodi
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Stage ◽  
Hot Flashes ◽  
Poor Quality ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Quality Of Sleep ◽  
The Past

e19644 Background: This cross-sectional survey describes the prevalence of moderate/severe symptoms among patients in a survivorship clinic. Methods: We administered QoL questionnaires (FACT-B, SF-36, HADS) to pts. treated for stage I-III disease at a survivorship visit. For symptoms reported by at least 18/55 subjects, we identified risk factors using logistic regression. Results: Subjects (n=55) were age 55.9(+8.9) yrs at study, age 52.6(+9.3) at dx, and median 23.7 (range 6.3-157.2) mos. from dx of stage I (30.9%), II (54.5%), or III (14.6%) disease. Systemic treatment included chemotherapy only (20.0%), endocrine therapy only (30.9%), or both therapies (49.1%). Currently, 65.5% were on endocrine therapy. Symptoms experienced “quite a bit” or “very much” during the past wk were: hot flashes (45.5%), joint pain (30.9%), weight gain (30.9%), loss of libido (30.9%), vaginal dryness (27.3%), and night sweats (27.3%). In the past mo., 43.6% accomplished less than they would have liked due to physical health, and 30.9% felt worn out at least “a good bit of the time”. Sleep quality was rated “fairly to very bad” (32.7%), and 25.5% felt fatigued at least half the day during the past week. Vigorous activities were “limited a lot” for 36.4%, and increased with age at dx. Fre-quent hot flashes were associated with age < 50 years (6.40, 1.75-23.35) and being within 1year of dx (10.67, 1.05-108.69). Adjusted for age at dx, poor quality of sleep increased with stage of disease (9.68, 2.25-41.69, per step increase) and was associated with having received endocrine therapy only (9.98, 1.40-71.03) and being within the first year after dx (9.54, 0.76-119.47). Conclusions: Limitation in activities, poor quality of sleep, and symptoms of hormonal suppression are common among survivors of early stage breast cancer. Poor quality sleep and frequent hot flashes appear to decrease in prevalence 1 yr after dx, but other common symptoms do not. A longitudinal cohort study is underway.

Vascular toxicities of endocrine therapy in early-stage breast cancer: Encouraging observations in a nontrial setting.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 68-68
Author(s):  
Susan Faye Dent ◽  
Freya L. Crawley ◽  
Nadine A. Graham ◽  
Michelle M. Campbell
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Life Experience ◽  
Early Stage ◽  
Real Life ◽  
Standard Of Care ◽  
T Test ◽  
Early Stage Breast Cancer ◽  
Cancer Center ◽  
Increased Risk

68 Background: Endocrine therapy (ET) is the standard of care for postmenopausal (PM) women with early stage breast cancer (EBC). Studies suggest higher risk of vascular toxicities (VT) on aromatase inhibitor (AI) therapy. We report incidence/discontinuation rates of VTs in a cardiac clinic. Methods: PM women with hormone receptor positive EBC treated with ET (tamoxifen (T) ± AI) at Ottawa Hospital Cancer Center 01/99-2/06. Data included: demographics, vascular co-morbidities (VCM), ET, duration, VTs. Results: 626 pts, median age 59 years (r: 30-92), median follow-up 98 months (m), stage: I (196 pts), II (341 pts) III (89 pts) EBC. Majority (52.5%) pts had VCM at ET initiation; hypertension (HTN) (36%), hyperlipidemia (HYLP) (17%), coronary disease (12%), thrombosis (9%), angina (6%) TIA (6%). Treatment discontinued due to VT 3x more with T vs. AI. Most common VTs: edema, arrhythmias (ARR), cardiovascular (CVS) event, and HYLP. With Letrozole and T, previous VCM significantly increased risk of developing VT (chi-square: P=0.022 and 0.009). Time to develop VT shortest for T and exemestane. Previous VCM did not affect this interval. Longer exposure to T correlated with higher VT rate (t-test: p=0.046) not seen with AIs. Exposure to multiple AIs associated with higher VT rate (t-test: p=0.009). Conclusions: This cohort study reports similar VT rates with AI therapy as reported in the literature. T was associated with higher discontinuation rates (10.5%) due to VTs compared to AIs (2.8-3.3%). Longer duration of AI therapy was not associated with increased risk of VTs. These encouraging results reflect the real-life experience of women exposed to ET. [Table: see text]

scholarly journals Pilot Survey of Breast Cancer Management in Sub-Saharan Africa

2017 ◽  
Vol 3 (3) ◽  
pp. 194-200 ◽  
Author(s):  
Verna D.N.K. Vanderpuye ◽  
Olufunmilayo I. Olopade ◽  
Dezheng Huo
Keyword(s):  
Breast Cancer ◽  
Online Survey ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Sub Saharan Africa ◽  
Pilot Survey ◽  
Chemotherapy Drugs ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Sub Saharan

Purpose To understand the current state of breast cancer management in sub-Saharan Africa. Methods We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013. Results Twenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment. Conclusion This pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.

Use of a novel convolutional neural network-based mammographic evaluation to assess response to adjuvant endocrine therapy in women with early-stage breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 530-530
Author(s):  
Julia Elizabeth McGuinness ◽  
Vicky Ro ◽  
Simukayi Mutasa ◽  
Richard Ha ◽  
Katherine D. Crew
Keyword(s):  
Breast Cancer ◽  
Neural Network ◽  
Prognostic Factors ◽  
Convolutional Neural Network ◽  
Endocrine Therapy ◽  
Risk Score ◽  
Early Stage ◽  
Stage I ◽  
Risk Scores

530 Background: The standard of care for early-stage hormone receptor (HR)-positive breast cancer (BC) is 5-10 years of adjuvant endocrine therapy (ET), which leads to a 50-60% relative risk reduction in BC recurrence. However, 10-40% of patients may relapse up to 20 years (y) after diagnosis, and there is a need for biomarkers of response to ET. We developed a novel, fully-automated convolutional neural network (CNN)-based mammographic evaluation that accurately predicts BC risk, which is being evaluated as a pharmacodynamic response biomarker to adjuvant ET. Methods: We conducted a retrospective cohort study among women with HR-positive stage I-III unilateral BC diagnosed at Columbia University Irving Medical Center from 2007-2017, who received adjuvant ET and had at least 2 mammograms of the contralateral breast (baseline and annual follow-up). Demographics, clinical characteristics, BC treatments, and relapse status were extracted from the electronic health record and New York-Presbyterian Hospital Tumor Registry. We performed CNN analysis of mammograms at baseline (start of ET) and annual follow-up. Our primary endpoint was change in CNN risk score, expressed as a continuous variable (range, 0-1). We used two-sample t-tests to assess for differences in mean CNN scores between patients who relapsed or remained in remission. We evaluated if CNN score at baseline and change from baseline were associated with relapse using logistic regression, with adjustment for known prognostic factors. Results: Among 870 evaluable women, mean age at diagnosis was 59.5y (standard deviation [SD], 12.4); 60.3% had stage I tumors, 72.6% underwent lumpectomy, and 45.8% received chemotherapy. With a median follow-up of 4.9y, there were 68 (7.9%) breast cancer relapses (36 distant, 26 local, 6 new primary). Median number of evaluable mammograms per patient was 5 (range, 2-13). Mean baseline CNN risk scores were significantly higher among women who relapsed compared to those in remission (0.258 vs 0.237, p = 0.022), which remained significant after adjustment for known prognostic factors. There was a significant difference in mean absolute change in CNN risk score from baseline to 1y follow-up between those who relapsed vs. remained in remission (0.001 vs. -0.022, p = 0.027), but this was no longer significant in multivariable analysis. Conclusions: We demonstrated that higher baseline CNN risk score was an independent predictor of BC relapse. A greater decrease in mean CNN risk scores at 1-year follow-up after initiating adjuvant ET was seen among BC patients who remained in remission compared to those who relapsed. Therefore, baseline CNN risk scores may identify patients at high-risk for breast cancer recurrence to target for more intensive adjuvant treatment. Early changes in CNN risk scores may be used to predict response to long-term ET in the adjuvant setting.

Prognostic value of health-related quality-of-life parameters in early-stage breast cancer: an 8-year follow-up study

2010 ◽  
Vol 20 (10) ◽  
pp. 1102-1107 ◽  
Author(s):  
Inger Schou Bredal ◽  
Leiv Sandvik ◽  
Rolf Karesen ◽  
Oivind Ekeberg
Keyword(s):  
Breast Cancer ◽  
Prognostic Value ◽  
Early Stage ◽  
Health Related Quality ◽  
Follow Up Study ◽  
Related Quality ◽  
Health Related ◽  
Value Of Health
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