Provider delay in the diagnosis and initiation of definitive treatment for breast cancer patients

AbstractPerineural invasion (PNI) is a pathologic finding observed across a spectrum of solid tumors, typically with adverse prognostic implications. Little is known about how the presence of PNI influences locoregional recurrence (LRR) among breast cancers. We evaluated the association between PNI and LRR among an unselected, broadly representative cohort of breast cancer patients, and among a propensity-score matched cohort. We ascertained breast cancer patients seen at our institution from 2008 to 2019 for whom PNI status and salient clinicopathologic features were available. Fine-Gray regression models were constructed to evaluate the association between PNI and LRR, accounting for age, tumor size, nodal involvement, estrogen receptor (ER), progesterone receptor (PR), HER2 status, histologic tumor grade, presence of lymphovascular invasion (LVI), and receipt of chemotherapy and/or radiation. Analyses were then refined by comparing PNI-positive patients to a PNI-negative cohort defined by propensity score matching. Among 8864 invasive breast cancers, 1384 (15.6%) were noted to harbor PNI. At a median follow-up of 6.3 years, 428 locoregional recurrence events were observed yielding a 7-year LRR of 7.1% (95% CI 5.5–9.1) for those with PNI and 4.7% (95% CI 4.2–5.3; p = 0.01) for those without. On univariate analysis throughout the entire cohort, presence of PNI was significantly associated with an increased risk of LRR (HR 1.39, 95% CI 1.08–1.78, p < 0.01). Accounting for differences in salient clinicopathologic and treatment parameters by multivariable Fine-Gray regression modeling, the association between PNI and LRR was potentiated (HR 1.57, 95% CI 1.2–2.07, p = 0.001). We further conducted propensity score matching to balance clinicopathologic parameters and treatments between the two groups (PNI vs not), again showing a similar significant association between PNI and LRR (HR 1.46, 95% CI 1.03–2.08, p = 0.034). PNI is significantly associated with LRR following the definitive treatment of invasive breast cancer. The excess risk conferred by PNI is similar in magnitude to that observed with LVI, or by ER/PR negativity. Breast cancer prognostication and therapeutic decision-making should consider the presence of PNI among other salient risk factors. Larger studies among more uniform breast cancer presentations may elucidate the extent to which these findings apply across breast cancer subtypes and stages.

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437. Gram-Negative Rod Skin and Soft-tissue infections following Breast Tissue Expander Surgery in Breast Cancer Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.510 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S217-S217

Author(s):

Ju Hee Katzman ◽

Sadaf Aslam ◽

Donna Mae M Pate ◽

Nicole Guidish ◽

Shelby Power ◽

...

Keyword(s):

Breast Cancer ◽

Pseudomonas Aeruginosa ◽

Soft Tissue ◽

Cancer Patients ◽

Tissue Expander ◽

Definitive Treatment ◽

Breast Cancer Patients ◽

Gram Positive ◽

Gram Negative ◽

Perioperative Antibiotics

Abstract Background Breast cancer patients who undergo tissue expander surgery (TES) are at an increased risk of developing gram-negative rod (GNR) skin and soft-tissue infection (SSIs) and its complications including prolonged antibiotic therapy, antibiotics side effects, and implant removal. Current perioperative antimicrobials focus mostly on gram-positive organisms, but the presence of a foreign body increases the risk of GNR SSI. We describe here the most common GNR bacteria and their susceptibility patterns that cause SSI after TES among breast cancer patients. Methods We conducted a retrospective cohort study at Moffitt Cancer Center, Tampa, FL from January 2016, to January 2018, on all breast cancer patients who developed GNR SSIs following TES. We reviewed records after approval from the Institutional Review Board. The data collected included patient’s age, pathogens from wound culture, antibiotic susceptibilities, the perioperative and definitive antibiotics used. Results A total of 38 cases of GNR SSI with a mean age of 56 ± 11 years were identified. The 3 most common pathogens were Pseudomonas aeruginosa (45%), Serratia marcescens (16%), and Klebsiella pneumoniae (8%) (Figure 1). The susceptibility pattern was available for 33 cases. Pseudomonas and Klebsiella isolates were susceptible to all tested antibiotics (Table 1). The Stenotrophomonas isolates showed resistance to ceftazidime. Enterobacter cloacae, Enterobacter aerogenes, Morganella morganii, and Acinetobacter baumannii complex, showed resistance to cefazolin. Twenty-five cases (74%) received perioperative antibiotics for gram-positive organisms; mostly cefazolin, and vancomycin. The common antibiotics used for definitive treatment were ciprofloxacin, cefepime, ceftazidime, piperacillin–tazobactam, and meropenem. Conclusion In centers with a high percentage of GNR SSI following TES should consider using perioperative antibiotics that include coverage against Pseudomonas aeruginosa, the most common isolate (45%). The use only of cefazolin or other antibiotics against gram-positive organism may be inadequate. However, GNR infection may occur from 48 hours to 2 weeks postoperatively and may be from the acquisition of the GNR at home in which perioperative antibiotics may have minimal effect. Disclosures All authors: No reported disclosures.

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