scholarly journals Undertreatment or overtreatment – how far from each other in geriatric oncology?

2020 ◽  
Vol 2 (1) ◽  
pp. 18-25
Author(s):  
Janusz Kocik
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Older Patients ◽  
Cancer Survival ◽  
Treatment Options ◽  
Geriatric Oncology ◽  
Premature Death ◽  
Screening Methods ◽  
Breast Cancer Patients ◽  
Choice Of Treatment

The mortality due to cancers of older patients, in age above 65 years of life, in comparison to younger is higher in majority of these diseases. It has been also reported that seniors are frequently denied the treatment according to current standards of therapy, thus suffer from undertreatment. There is solid evidence from controlled trials that older patients may tolerate pharmacological therapies in some cancers as well as young, providing they are under good supportive care. At the same time aggressive multimodal treatment may cause immediate or delayed side effects and exhaustion of reserves of the vital organs in elderly. This may cause a general deterioration, a decompensation of comorbidities, an evolution of geriatric syndromes and premature death, not directly caused by cancer. Such situation in aged cancer patients should be called the overtreatment. In diseases with better prognosis, with effective screening methods and large choice of treatment options like breast cancer, survival is getting better, although not in the eldest. The worse prognosis in old breast cancer patients may be caused to some extent by undertreatment. More fatal tumors like NSCLC await further optimization of cancer therapy towards better toxicity profile to avoid overtreatment.

scholarly journals Serum N-glycan profiles differ for various breast cancer subtypes

2021 ◽  
Author(s):  
Gerda C. M. Vreeker ◽  
Kiki M. H. Vangangelt ◽  
Marco R. Bladergroen ◽  
Simone Nicolardi ◽  
Wilma E. Mesker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Cancer Patients ◽  
High Resolution Mass Spectrometry ◽  
Case Control ◽  
Total Serum ◽  
Screening Methods ◽  
Breast Cancer Patients ◽  
Cancer Subtypes ◽  
Control Comparison

AbstractBreast cancer is the most prevalent cancer in women. Early detection of this disease improves survival and therefore population screenings, based on mammography, are performed. However, the sensitivity of this screening modality is not optimal and new screening methods, such as blood tests, are being explored. Most of the analyses that aim for early detection focus on proteins in the bloodstream. In this study, the biomarker potential of total serum N-glycosylation analysis was explored with regard to detection of breast cancer. In an age-matched case-control setup serum protein N-glycan profiles from 145 breast cancer patients were compared to those from 171 healthy individuals. N-glycans were enzymatically released, chemically derivatized to preserve linkage-specificity of sialic acids and characterized by high resolution mass spectrometry. Logistic regression analysis was used to evaluate associations of specific N-glycan structures as well as N-glycosylation traits with breast cancer. In a case-control comparison three associations were found, namely a lower level of a two triantennary glycans and a higher level of one tetraantennary glycan in cancer patients. Of note, various other N-glycomic signatures that had previously been reported were not replicated in the current cohort. It was further evaluated whether the lack of replication of breast cancer N-glycomic signatures could be partly explained by the heterogenous character of the disease since the studies performed so far were based on cohorts that included diverging subtypes in different numbers. It was found that serum N-glycan profiles differed for the various cancer subtypes that were analyzed in this study.

scholarly journals Annotating and Detecting Topics in Social Media Forum and Modelling the Annotation to Derive Directions-A Case Study

2021 ◽  
Author(s):  
Athira B ◽  
Josette Jones ◽  
Sumam Mary Idicula ◽  
Anand Kulanthaivel ◽  
Enming Zhang
Keyword(s):  
Breast Cancer ◽  
Social Media ◽  
Deep Learning ◽  
Cancer Patients ◽  
Learning Algorithm ◽  
Treatment Options ◽  
Healthcare Sector ◽  
Final Decision ◽  
Breast Cancer Patients ◽  
Deep Learning Algorithm

Abstract The widespread influence of social media impacts every aspect of life, including the healthcare sector. Although medics and health professionals are the final decision makers, the advice and recommendations obtained from fellow patients are significant. In this context, the present paper explores the topics of discussion posted by breast cancer patients and survivors on online forums. The study examines an online forum, Breastcancer.org, maps the discussion entries to several topics, and proposes a machine learning model based on a classification algorithm to characterize the topics. To explore the topics of breast cancer patients and survivors, approximately 1000 posts are selected and manually labeled with annotations. In contrast, millions of posts are available to build the labels. A semi-supervised learning technique is used to build the labels for the unlabeled data; hence, the large data are classified using a deep learning algorithm. The deep learning algorithm BiLSTM with BERT word embedding technique provided a better f1-score of 79.5%. This method is able to classify the following topics: medication reviews, clinician knowledge, various treatment options, seeking and providing support, diagnostic procedures, financial issues and implications for everyday life. What matters the most for the patients is coping with everyday living as well as seeking and providing emotional and informational support. The approach and findings show the potential of studying social media to provide insight into patients' experiences with cancer like critical health problems.

scholarly journals Statin use, HMGCR expression, and breast cancer survival – The Malmö Diet and Cancer Study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Olöf Bjarnadottir ◽  
Maria Feldt ◽  
Maria Inasu ◽  
Pär-Ola Bendahl ◽  
Karin Elebro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Survival ◽  
Cox Regression ◽  
Histological Grade ◽  
Breast Cancer Patients ◽  
Cancer Study ◽  
Drug Register ◽  
Diet And Cancer ◽  
Statin Use

AbstractStatins, commonly used to treat hypercholesterolemia, have also been proposed as anti-cancer agents. The identification of a predictive marker is essential. The 3-hydroxy-3-methylglutaryl-coenzyme-A reductase (HMGCR), which is inhibited by statins, might serve as such a marker. Thorough antibody validation was performed for four different HMGCR antibodies. Tumor expression of HMGCR (#AMAb90619, CL0260, Atlas Antibodies, Stockholm, Sweden) was evaluated in the Malmö Diet and Cancer Study breast cancer cohort. Statin use and cause of death data were retrieved from the Swedish Prescribed Drug Register and Swedish Death Registry, respectively. Breast cancer-specific mortality (BCM) according to statin use and HMGCR expression were analyzed using Cox regression models. Three-hundred-twelve of 910 breast cancer patients were prescribed statins; 74 patients before and 238 after their breast cancer diagnosis. HMGCR expression was assessable for 656 patients; 119 showed negative, 354 weak, and 184 moderate/strong expressions. HMGCR moderate/strong expression was associated with prognostically adverse tumor characteristics as higher histological grade, high Ki67, and ER negativity. HMGCR expression was not associated with BCM. Neither was statin use associated with BCM in our study. Among breast cancer patients on statins, no or weak HMGCR expression predicted favorable clinical outcome. These suggested associations need further testing in larger cohorts.

scholarly journals Breast Cancer: Reimbursement Policies and Adoption of New Therapeutic Agents by National Health Systems

Breast Care ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Dario Trapani ◽  
Giuseppe Curigliano ◽  
Alexandru Eniu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Priority Setting ◽  
Financial Distress ◽  
Quality Care ◽  
Premature Death ◽  
Health Coverage ◽  
Breast Cancer Patients ◽  
Middle Income ◽  
Timely Access

Background: Breast cancer is a cause of morbidity for more than half a million of patients in Europe, resulting in broad societal impacts that affect patients, families, and societies from a human, emotional, economic, and financial perspective. Expenditure for cancer medicines represents one of the principal driving costs of healthcare. The aim of this review is to describe the European policy and regulatory landscape of innovation uptake in breast oncology – with emphasis on value in cancer healthcare. Summary: In Europe, several reimbursement models or policy tools have been developed by countries to compose their benefit packages. The most commonly applied scheme is the product-specific eligibility model, prioritizing selected medicines and their indications. Mixed models are commonly developed, addressing the protection of more vulnerable people, ensuring protection from impoverishment caused by cancer and containing disparities. However, the risk to incur significant out-of-pocket expenses for essential or newer medicines for cancer is still substantial in Europe, especially in low- and middle-income countries, determining greater financial distress and poorer outcome for patients. Value-based priority setting is an essential mechanism to ensure timely access to the most valuable medicines for breast cancer patients. Estimations of the value of medicines can be provided within health technology assessment services and networks and informed by benefit scales and tools. Key Messages: There is ample room for reciprocal support across the diverse cultural and legal realities in Europe. The aim is common: save cancer patients from premature death by ensuring the timely access to the best care, protecting from financial hardships and distress to leave no cancer patient behind in poverty. Steps are to be taken to promote value-based priority setting, paving the way toward universal health coverage in Europe, where health of people is protected, and affordable best quality care is the only standard pursued and acceptable.

Communication Between Physicians and Older Women With Localized Breast Cancer: Implications for Treatment and Patient Satisfaction

2002 ◽  
Vol 20 (4) ◽  
pp. 1008-1016 ◽  
Author(s):  
Wenchi Liang ◽  
Caroline B. Burnett ◽  
Julia H. Rowland ◽  
Neal J. Meropol ◽  
Lynne Eggert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Options ◽  
Treatment Choice ◽  
Satisfaction With Care ◽  
Physician Communication ◽  
Breast Cancer Patients ◽  
Actual Treatment ◽  
The Impact

PURPOSE: To identify factors associated with patient-physician communication and to examine the impact of communication on patients’ perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients. MATERIALS AND METHODS: Data were collected from 613 pairs of surgeons and their older (≥ 67 years) patients diagnosed with localized breast cancer. Measures of patients’ self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes. RESULTS: Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients (≥ 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients’ perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery. CONCLUSION: Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.

scholarly journals Systemic Treatment Options for HER2-Positive Breast Cancer Patients with Brain Metastases beyond Trastuzumab: A Literature Review

Breast Care ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. 168-171 ◽  
Author(s):  
Elena Laakmann ◽  
Volkmar Müller ◽  
Marcus Schmidt ◽  
Isabell Witzel
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Cancer Patients ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Cytotoxic Agents ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

Background: The incidence of brain metastases (BM) in breast cancer patients has increased. Many retrospective analyses have shown that first-line treatment with trastuzumab prolongs survival in patients with HER2-positive BM. In contrast, the evidence for other therapies targeting HER2 for patients with BM is rare. Methods: The aim of this review is to update the reader about current systemic treatment options in patients with HER2-positive metastatic breast cancer with BM who had already received trastuzumab. A literature search was performed in the PubMed database in June 2016. 30 relevant reports concerning the efficacy of trastuzumab emtansine (T-DM1), lapatinib and its combination with other cytotoxic agents, pertuzumab and novel HER2-targeting substances were identified. Results: There is limited but promising evidence for the use of T-DM1 and pertuzumab in the treatment of BM. Up to now, most reported studies used lapatinib as treatment of HER2-positive breast cancer with BM, a treatment with only a modest effect and a high toxicity profile. The combination of lapatinib with cytotoxic agents seems to result in better response rates. Conclusion: Further prospective investigations are needed to investigate the efficacy of the established and novel HER2-targeting agents on BM in HER2-positive breast cancer patients.

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.

Barriers to Clinical Trial Participation by Older Women With Breast Cancer

2003 ◽  
Vol 21 (12) ◽  
pp. 2268-2275 ◽  
Author(s):  
M. Margaret Kemeny ◽  
Bercedis L. Peterson ◽  
Alice B. Kornblith ◽  
Hyman B. Muss ◽  
Judith Wheeler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Cancer Patients ◽  
Older Patients ◽  
Disease Stage ◽  
Trial Participation ◽  
Breast Cancer Patients ◽  
Retrospective Case ◽  
Younger Patients ◽  
Significant Difference

Purpose: Although 48% of breast cancer patients are 65 years old or older, these older patients are severely underrepresented in breast cancer clinical trials. This study tested whether older patients were offered trials significantly less often than younger patients and whether older patients who were offered trials were more likely to refuse participation than younger patients. Patients and Methods: In 10 Cancer and Leukemia Group B institutions, using a retrospective case-control design, breast cancer patients eligible for an open treatment trial were paired: less than 65 years old and ≥ 65 years old. Each of the 77 pairs were matched by disease stage and treating physician. Patients were interviewed as to their reasons for participating or refusing to participate in a trial. The treating physicians were also given questionnaires about their reasons for offering or not offering a trial. Results: Sixty-eight percent of younger stage II patients were offered a trial compared with 34% of the older patients (P = .0004). In multivariate analyses, disease stage and age remained highly significant in predicting trial offering (P = .0008), when controlling for physical functioning and comorbidity. Of those offered a trial, there was no significant difference in participation between younger (56%) and older (50%) patients (P = .67). Conclusion: In a multivariate analysis including comorbid conditions, age and stage were the only predictors of whether a patient was offered a trial. The greatest impediment to enrolling older women onto trials in the setting of this study was the physicians’ perceptions about age and tolerance of toxicity.

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