scholarly journals Acute Care Use by Breast Cancer Patients on Adjuvant Chemotherapy in Alberta: Demonstrating the Importance of Measurement to Improving Quality

2021 ◽  
Vol 28 (6) ◽  
pp. 4420-4431
Author(s):  
Che Hsuan David Wu ◽  
May Lynn Quan ◽  
Shiying Kong ◽  
Yuan Xu ◽  
Jeffrey Q. Cao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Acute Care ◽  
Population Based ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Institutional Differences ◽  
Improvement Programs ◽  
Ed Visits

Breast cancer patients receiving adjuvant chemotherapy are at increased risk of acute care use. The incidence of emergency department (ED) visits and hospitalizations (H) have been characterized in other provinces but never in Alberta. We conducted a retrospective population-based cohort study using administrative data of women with stage I-III breast cancer receiving adjuvant chemotherapy. Rates of ED and H use in the 180 days following chemotherapy initiation were determined, and logistic regression was performed to identify risk factors. We found that 47% of women receiving adjuvant chemotherapy experienced ED or H, which compared favourably to other provinces. However, Alberta had the highest rate of febrile neutropenia-related ED visits, and among the highest chemotherapy-related ED visits. The incidence of acute care use increased over time, and there were significant institutional differences despite operating under a single provincial healthcare system. Our study demonstrates the need for systematic measurement and the importance of quality improvement programs to address this gap.

scholarly journals Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years

Cancer ◽  
2015 ◽  
Vol 121 (22) ◽  
pp. 4062-4070 ◽  
Author(s):  
Arnold L. Potosky ◽  
Suzanne C. O'Neill ◽  
Claudine Isaacs ◽  
Huei-Ting Tsai ◽  
Calvin Chao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Adjuvant Chemotherapy ◽  
Gene Expression Profiling ◽  
Cancer Patients ◽  
Expression Profiling ◽  
Population Based ◽  
Breast Cancer Patients ◽  
Population Based Study

Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study

2005 ◽  
Vol 23 (34) ◽  
pp. 8597-8605 ◽  
Author(s):  
John J. Doyle ◽  
Alfred I. Neugut ◽  
Judith S. Jacobson ◽  
Victor R. Grann ◽  
Dawn L. Hershman
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Primary Tumors ◽  
Increased Risk

Purpose Adjuvant chemotherapy, especially with anthracyclines, is known to cause acute and chronic cardiotoxicity in breast cancer patients. We studied the cardiac effects of chemotherapy in a population-based sample of breast cancer patients aged ≥ 65 years with long-term follow-up. Patients and Methods In the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we analyzed treatments and outcomes among women ≥ 65 years of age who were diagnosed with stage I to III breast cancer from January 1, 1992 to December 31, 1999. Propensity scores were used to control for baseline heart disease (HD) and other known predictors of chemotherapy, and Cox proportional hazards models were used to estimate the risk of cardiomyopathy (CM), congestive heart failure (CHF), and HD after chemotherapy. Results Of 31,748 women with stage I to III breast cancer, 5,575 (18%) received chemotherapy. Chemotherapy was associated with younger age, fewer comorbidities, hormone receptor negativity, multiple primary tumors, and advanced disease. Patients who received chemotherapy were less likely than other patients to have pre-existing HD (45% v 55%, respectively; P < .001). The hazard ratios for CM, CHF, and HD for patients treated with doxorubicin (DOX) compared with patients who received no chemotherapy were 2.48 (95% CI, 2.10 to 2.93), 1.38 (95% CI, 1.25 to 1.52), and 1.35 (95% CI, 1.26 to 1.44), respectively. The relative risk of cardiotoxicity among patients who received DOX compared with untreated patients remained elevated 5 years after diagnosis. Conclusion When baseline HD was taken into account, chemotherapy, especially with anthracyclines, was associated with a substantially increased risk of CM. As the number of long-term survivors grows, identifying and minimizing the late effects of treatment will become increasingly important.

Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy?

2015 ◽  
Vol 23 (10) ◽  
pp. 3025-3032 ◽  
Author(s):  
L. Barbera ◽  
R. Sutradhar ◽  
D. Howell ◽  
J. Sussman ◽  
H. Seow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Symptom Screening ◽  
Ed Visits

Treatment-related leukemia in breast cancer patients treated with fluorouracil-doxorubicin-cyclophosphamide combination adjuvant chemotherapy: the University of Texas M.D. Anderson Cancer Center experience.

1996 ◽  
Vol 14 (10) ◽  
pp. 2722-2730 ◽  
Author(s):  
E Diamandidou ◽  
A U Buzdar ◽  
T L Smith ◽  
D Frye ◽  
M Witjaksono ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Cancer Center ◽  
Routine Practice ◽  
Breast Cancer Patients ◽  
University Of Texas ◽  
Increased Risk ◽  
Fac Chemotherapy ◽  
The University

PURPOSE Adjuvant chemotherapy for breast cancer has been the routine practice in the past decade. A number of studies have observed an increased incidence of treatment-related leukemias following chemotherapy with alkylating agents and/or topoisomerase II inhibitors. We evaluated the incidence of treatment-related leukemias in breast cancer patients treated in four adjuvant and two neoadjuvant chemotherapy trials at The University of Texas M.D. Anderson Cancer Center. PATIENTS AND METHODS Between 1974 and 1989, 1,474 patients with stage II or III breast cancer were treated in six prospective trials of adjuvant (n = 4) or neoadjuvant (n = 2) chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide (CTX) (FAC) with or without other drugs. The median observation time was 97 months. In 1,107 patients, FAC chemotherapy was given postoperatively; 367 patients received induction chemotherapy, as well as postoperative chemotherapy. Eight hundred ten patients had surgery followed by radiotherapy and chemotherapy; 664 patients had surgery and chemotherapy only. Patients in two adjuvant and one neoadjuvant study received higher cumulative doses of CTX compared with those in the other studies. RESULTS Fourteen cases of leukemia were observed. Twelve of these patients had received radiotherapy and chemotherapy, and two had received chemotherapy only. Six of the reported patients with leukemia were treated with a cumulative CTX dose of greater than 6 g/ m2. Five of these patients had received both radiotherapy and chemotherapy. The median latency period in the 14 patients was 66 months (range, 22 to 113). Six of 10 patients with adequate cytogenetic analyses had abnormalities that involved chromosomes 5 and/or 7. The rest of the patients had nonspecific cytogenetic abnormalities or lacked cytogenetic information. The 10-year estimated leukemia rate was 1.5% (95% confidence interval [CI], 0.7% to 2.9%) for all patients treated, 2.5% (95% CI, 1.0% to 5.1%) for the radiotherapy-plus-chemotherapy group, and 0.5% (95% CI, 0.1% to 2.4%) for the chemotherapy-only group; this difference was statistically significant (P = .01). The 10-year estimated leukemia risk for the higher-dose (> 6 g/m2) CTX group was 2% (95% CI, 0.5% to 5.0%) compared with 1.3% (95% CI, 0.4% to 3.0%) for the lower-dose group, a difference that was not statistically significant (P = .53). CONCLUSION These data illustrate that patients treated with adjuvant FAC chemotherapy plus radiotherapy have a slightly increased risk of leukemia. This information needs to be considered in the treatment plans for patients with breast cancer. However, for most patients, the benefits of adjuvant therapy exceed the risk of treatment-related leukemia.

Recurrence patterns among T1-2N0 triple-negative breast cancer patients following mastectomy.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 93-93
Author(s):  
Rebekah Young ◽  
Kimberly Gergelis ◽  
Shalom Kalnicki ◽  
Jana Lauren Fox
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Single Institution ◽  
Early Stage Disease ◽  
Increased Risk

93 Background: Women with early-stage TN breast cancers are at increased risk for recurrence (RR) compared to other molecular subtypes, and are often treated with mastectomy without local adjuvant therapy. We wish to evaluate the RR for these women. Methods: In this single institution retrospective study, women with T1-2N0 TN breast cancer who underwent mastectomy between 2008-12 were identified from tumor registry. Adjuvant chemotherapy was allowed, but adjuvant radiotherapy (RT) was excluded. Of 3,000 cases reviewed, 52 women were identified. Median age was 58.5 (30–90). Lesions were high-grade (83%), and T1-2 (47%, 53%). 21 women (42%) had at least 1 risk factor. 5 women were BRCA+. Women underwent total mastectomy or modified radical mastectomy, and the majority (84%) had adjuvant chemotherapy. Results: At a median follow-up of 3.5 years (6-71 months), there were 8 recurrences (15.4%). 3 (5.8% of cohort) were locoregional (LR) only (2 chest wall (CW) and 1 ipsilateral axilla), 6 (11.5%) involved a concurrent LR and distant recurrence, and 2 (3.8%) were distant only. Median time to recurrence was 17.3 months. The isolated LR recurrences (LRR) were at 14, 15.6 and 15.1 months. Most women (41, 78.8%) were alive with NED. 3 were alive with disease, underdoing treatment, and 1 woman was disease free after treatment for CW recurrence. 8 patients (15.4%) are deceased, half from their cancer. On univariate analysis, there was no significant correlation (p>0.05) between age or high-risk features and RR (STATA v 11). Conclusions: T1-2N0 breast cancer patients are believed to have a low RR following mastectomy. TN disease, however, is more aggressive, and the question of irradiating early stage disease after mastectomy has arisen. A single institution, retrospective study found women with T1-2N0 TN disease fare better with BCT that includes RT, compared to mastectomy alone. Other studies have shown no statistical difference in RR between these 2 groups. We found an isolated LRR rate at 3.5 years of 5.8%. Follow-up and ultimately prospective data is needed to determine whether the isolated LRR warrants a change in treatment recommendations for this pt subset.

Sarcopenia to predict tolerance of adjuvant breast cancer chemotherapy.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 138-138
Author(s):  
Michael S. Sabel ◽  
Anna S.C. Conlon ◽  
Kent A. Griffith ◽  
Michael Englesbe ◽  
Stewart Wang
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Subcutaneous Fat ◽  
Pulmonary Complications ◽  
Muscle Size ◽  
Ct Scans ◽  
Breast Cancer Patients ◽  
Mineral Density ◽  
Increased Risk

138 Background: Despite improved survival with adjuvant chemotherapy among older women, it is less often recommended for fear they cannot complete therapy or will have excessive toxicity. Analytic morphometrics uses objective imaging measurements such as muscle size, bone mineral density (BMD) and body composition to improve risk stratification. We examined whether morphometrics might help predict toxicity of chemotherapy in breast cancer patients. Methods: Our prospective IRB-approved breast cancer database was queried for all patients who underwent adjuvant or neoadjuvant chemotherapy and had CT scans of the chest, abdomen and pelvis prior to chemo. Complications of chemotherapy were graded according to the NCI-CTC. CT scans were processed using semi-automated algorithms (MATLAB v13.0) to measure psoas area (PA) and density (PD), BMD and subcutaneous fat (SF), visceral fat (VF), and total body area (TBA. Outcome (DFS and OS) was assessed by K-M, and logistic regression models and ANOVA were used for toxicity events. Results: We identified 129 patients, ranging in age from 24 to 83 (median 52). 105 (81%) received AC/T while 19% received alternate regimens, all full weight based. T-stage, nodal status and HER2 expression were significantly associated with measures of obesity, except BMI, but not sarcopenia. After adjusting for stage and Her-2, BMI remained a significant predictor of DFS (OR 1.07 (95%CI 1.01, 1.13)) and OS (OR 1.06 (95% CI 1.00, 1.12)).After controlling for age, PD and VF were predictors of chemotherapy completion. The OR for completing chemotherapy decreased 0.95 (95% CI: 0.90, 1.01, p=0.08) for every increase of 1000 in VF and increased 1.08 (95% CI: 1.01, 1.15, p=0.03) for every unit increase in PD. Sarcopenia was associated with an increased risk of pulmonary complications (p=0.01) and anemia (p=0.06). Conclusions: Although age is a significant predictor of increased toxicity and inability to complete chemotherapy, sarcopenia is an objective, independent predictor of chemotherapy completion. Psoas density, easily obtainable from a pre-treatment CT scan, can help the clinician older breast cancer patients for adjuvant chemotherapy.

Pregnancy after breast cancer: A population-based study of survival and obstetric outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18783-e18783
Author(s):  
Jose Alejandro Rauh-Hain ◽  
Roni Nitecki ◽  
Alexander Melamed ◽  
Jose Zubizarreta ◽  
Shuangshuang Fu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Health Planning ◽  
Population Based ◽  
Cox Proportional Hazards Model ◽  
Obstetric Outcomes ◽  
Breast Cancer Patients ◽  
Bipartite Matching ◽  
Increased Risk

e18783 Background: Studies have suggested that pregnancy after breast cancer is safe, but the women who are able to conceive after cancer may also have a better prognosis. We sought to evaluate survival and obstetric outcomes among breast cancer patients in a population-based cohort. Methods: We studied women aged 18-45 years with a history of stage I-III breast cancer reported to the California Cancer Registry (CCR, 2000-2012). CCR data were linked to the 2000-2012 California Office of Statewide Health Planning and Development (OSHPD) birth cohort to ascertain both oncologic characteristics and obstetric outcomes. We compared overall survival (OS) for breast cancer patients who did or did not conceive at least 1 year after diagnosis. Breast cancer patients who conceived were matched in a 1:5 ratio to breast cancer patients who did not conceive via optimal bipartite matching accounting for follow-up time such that controls were diagnosed within a 3-month window of the cases and were alive at the time the case delivered; the distributions of cases and controls were directly balanced on socioeconomic and clinical covariates including stage, hormone receptors, and receipt of chemotherapy and radiation. For the obstetric outcomes, propensity score matching in a 1:5 ratio was used to match the same breast cancer patients who conceived to population based controls without cancer who delivered during the study years. Wald statistics, conditional Cox proportional hazards model, and conditional logistic regressions were used to evaluate outcomes. Results: We matched 417 patients aged 18-45 years at time of breast cancer diagnosis who conceived at least one year following diagnosis with 2,085 breast cancer patients who did not conceive. All covariates were balanced within 0.1 mean standardized difference. The majority of the cohort was non-Hispanic White (51%), with stage II disease (53%). The 5-year overall survival for cases relative to controls was 97.6% and 95.7% respectively. There was no difference in overall survival between patients who conceived and those who did not conceive following treatment for breast cancer (HR 0.58, 95% CI 0.3-1.1). Breast cancer patients did not have higher risks of preterm birth before 37 weeks (odds ratio [OR] 0.91, 95% CI 0.39-2.14), small-for-gestational age birthweight ( < 10th percentile: OR 0.93, 95% CI 0.67-1.29; < 5th percentile: OR 0.67, 95% CI 0.39-1.14), cesarean delivery (OR 1.12, 95% CI 0.92-1.35), severe maternal morbidity (OR 1.14, 95% CI 0.61-2.12), or neonatal morbidity (OR 1.08, 95% CI 0.77-1.53) relative to controls. Conclusions: In a population-based cohort, breast cancer patients who conceived at least 1 year after diagnosis did not have worse OS than matched breast cancer patients who did not conceive. Breast cancer patients who conceived during the study period did not have an increased risk of adverse obstetric outcomes compared to population-based controls without cancer.

scholarly journals Emergency Department Use in Patients with Cancer: A Population-Based Study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Grace Wang ◽  
Jeff Bakal ◽  
Andrew McRae ◽  
Harvey Quon
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Admission Rate ◽  
Population Based ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Patient Identification ◽  
Significant Burden ◽  
Ed Visits ◽  
Medical Records System

IntroductionEmergency Department (ED) visits in cancer patients represent a significant burden to both patients and the health care system. Emergency Care of cancer patients is complex compared to the population. There is lack of knowledge regarding the pattern and reasons for ED visits in this population. Objectives and ApproachWe sought to identify factors and patterns associated with ED use among cancer patients, in the first year after diagnosis. Adult cancer patients diagnosed between 2011 and 2013 were identified from the Alberta Cancer Registry. This was linked with cancer related treatments extracted from medical records system at provincial cancer centers. ED visits and outpatient clinics were acquired from National Ambulatory Care Reporting System (NACRS). Databases were linked by unique patient identification number. Previous cancer patients were defined by having at least one cancer related diagnosis in NACRS before. The other patients were treated as non-cancer patients. ResultsCancer patients accounted for 6.7% of ED visits and 10\% of ED hours. They had higher male percentage (53% vs. 49%), higher admission rate (23% vs. 10%), ambulance usage (20% vs. 12%) and longer stay (LOS) (171 vs. 131 mins) compared to non-cancer patients. 24% of cancer patients had 4 or more ED visits/year and accounted for 59% of visits. Lung and liver cancer patients had higher ED utilization than patients with other cancers. Breast cancer patients had more after-treatment-ED-visits (41% within a week vs. 26% in lung cancer). Use of ED was highest within 1 month of diagnosis for all types except breast cancer, which was highest at 2 months after. Differences were observed between urban and rural area for numbers reported above. Conclusion/ImplicationsThese data suggest high ED utilization by cancer patients, and variation in utilization by cancer type. Identifying the timing and risk factors of ED visit for each cancer type, especially on frequent ED users presents opportunities to improve care in oncology clinics and ED.

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