Breast Cancer
Recently Published Documents


TOTAL DOCUMENTS

289370
(FIVE YEARS 118577)

H-INDEX

511
(FIVE YEARS 149)

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 188-188
Author(s):  
Elena Tsangaris ◽  
Rakasa Pattanaik ◽  
Joanna O'Gorman ◽  
Jessica Means ◽  
Noah Sarucia ◽  
...  

188 Background: Transition towards a patient-centered healthcare model has been recognized as an important step towards improving the quality and coordination of breast cancer care. Although evidence suggests that patient self-reporting of quality of life improves clinical care, there are significant barriers to successful collection and use of patient-reported data (PRD) including a lack of a technology designed to fully engage patients and providers, limited electronic health record (EHR) integration, and suboptimal clinical implementation strategies. To address this, our team developed imPROVE, an innovative and customizable patient-reported data (PRD) collection platform consisting of a patient web-application and a clinician portal. Methods: This study was performed as a quality improvement initiative at Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH). Multiple perspectives were sought from key stakeholders to ensure that the content and design of the platform target the needs of the end-users and garners the latest in technological advances. Development and testing were performed using best practices in user-centered design and agile development, and iterative programming sprints followed by stakeholder feedback and testing. Content was evaluated using probing questions about relevance, comprehensiveness, and clarity. Design was assessed through feedback about the look and feel of the platform and its usability. Results: A multidisciplinary team of 28 stakeholders in the field of breast cancer care, patient-reported outcomes research and value-based healthcare was assembled. Recurring group meetings (n = 8), individual patient interviews (n = 23), and two focus groups with the DF/HCC Breast Cancer Advocacy Group, were conducted. The resultant application is a hybrid mHealth application that is supported by iOS and Android and is comprised of five screens (myCare, myStory, myResources, myCommunity, myNotes). Patients are provided written and graphical displays of their PRD as well as tailored resources that are customized depending on their type and stage of treatment. The clinician portal is comprised of an overview table listing all patients enrolled for each individual clinician, as well as individual patient profiles demonstrating demographic, clinical, and outcomes data. Conclusions: imPROVE has the potential to create a paradigm shift in the delivery of care for breast cancer patients. Next steps will include implementation of imPROVE within the breast oncology and plastic surgery services at DFCI and BWH.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 259-259
Author(s):  
Preethi John ◽  
Mary P. Hodges ◽  
Gaurav Shah ◽  
Umber Dickerson ◽  
Julie Dreadin-Pulliam ◽  
...  

259 Background: In April 2021, it was found that 35% of our breast cancer patients seen in the breast surgery and medical oncology clinics had no financial coverage leading to significant financial toxicity at Parkland Memorial Hospital, a safety net hospital for Dallas county in Texas. In addition, only 8% of all our breast cancer patients were financially screened in April 2021. We aimed to increase pre-visit phone calls to financially screen patients within a week of their subsequent visit with a provider from a baseline rate of 8% to 20% for all breast cancer patients in hopes of capturing more unfunded patients and providing appropriate resources. Methods: We used the Institute for Health Improvement (IHI) model as our quality improvement framework. Based on our fish bone and pareto chart analysis, it was discovered that the lack of consistent financial screening was likely due to lack of standardized training across our ancillary staff, lack of standardized processes for financial screening, and lack of education of both providers and patients regarding the financial coverage process. To address these issues, we created a standardized process of financial screening called “pre-visit planning (PVP)” involving a telephone call by our schedulers to breast oncology patients within 1 week of their next visit. Screening included checking financial application status and educating patients on methods of application submission including epic my-chart enrollment. Screening also included checking financial coverage status and if unfunded, a referral to a financial counselor was made. Formal training of staff was performed with mock trial phone calls. We initiated implementation in the breast surgery clinic initially with plans to expand to the medical oncology clinic. Results: At baseline, in April 2021, 300 patients were seen in the breast surgery clinic of which 19 were financially screened (6.3%). Implementation of PVP for all patients in the breast surgery clinic began in May 2021 with data representing 2 weeks of financial screening by our staff. Total number of patients seen over the span of 2 weeks in the breast surgery clinic was 165 of which 59 were financially screened making up 36% of patients. In addition, 8 patients in the breast surgery clinic were screened by a financial counselor increasing the rate of financial screening to 40.6%. Conclusions: We successfully implemented PVP to better assist our patients in several ways including updating their financial coverage, educating them on the financial process, as well as referring them to a financial counselor for additional aid. Increased follow up time is needed to assess the downstream effects of PVP such as increase in financial counselor visits and decrease in unfunded patients.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 191-191
Author(s):  
Alexi Vasbinder ◽  
Hilaire Thompson ◽  
Oleg Zaslavsky ◽  
Susan R. Heckbert ◽  
Rowan T. Chlebowski ◽  
...  

191 Background: Radiation-induced fatigue (RIF) is common in breast cancer (BC) survivors and can last years after treatment. Despite the known physiological consequences of radiation, information on biomarkers of RIF is limited. Therefore, we examined the longitudinal association between serum biomarkers and post-BC fatigue in BC survivors treated with radiation: [oxidative stress] 8-hydroxyguanosine (8-OH-dG), myeloperoxidase (MPO); [inflammation] interleukin-6 (IL-6), C-reactive protein (CRP), growth differentiation factor-15 (GDF-15), placental growth factor (PGF), transforming growth factor-beta (TGF-B); [cardiac damage] cystatin-C, troponin-I (TnI). Methods: In an ancillary study in the Women’s Health Initiative (WHI), participants with incident BC (stages I-III) treated with radiation were followed for the development of fatigue post-BC. Women were eligible if they 1) had no prior cardiovascular disease and 2) had pre-and post-BC serum samples drawn approximately three years apart with fatigue measured using the Short-Form 36 (SF-36) vitality subscale at the same times. Biomarkers were analyzed using enzyme-linked immunosorbent assays. Higher SF-36 vitality scores correspond to lesser fatigue. Weighted linear regression adjusted for relevant demographic, lifestyle, and psychosocial factors, as well as pre-cancer fatigue. Each biomarker was modeled as the post-BC to pre-BC ratio and log transformed to base 2, thus, the effect estimates correspond to a doubling in value compared to pre-BC. Results: A total of 180 women with a mean (SD) age of 67.0 (5.5) were included. The mean (SD) vitality score was 66.2 (17.2) and 59.7 (19.7) pre- and post-BC, respectively. The median (IQR) time between pre-BC serum collection to BC was 1.9 (0.8, 2.6) years and 1.4 (0.7, 2.3) years between BC and the post-BC serum collection. After adjustment, a higher biomarker ratio of cystatin-C, IL-6, and GDF-15 were all associated with a lower SF-36 vitality score (i.e., higher fatigue) (Table). As an example, for a 2-fold difference in the cystatin-C biomarker ratio, the SF-36 vitality score was lower by 7.31 points (95% CI: -14.2, -0.45). Conclusions: Inflammatory and cardiac damage biomarkers are associated with RIF in BC survivors. Biomarkers could be measured in clinical practice or be included in risk prediction models to help identify patients at high risk for RIF. [Table: see text]


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 247-247
Author(s):  
Mariana Chavez Mac Gregor ◽  
Ashley Housten ◽  
Edna Paredes ◽  
Catalina Malinowski ◽  
Cassandra Harris ◽  
...  

247 Background: (Neo)Adjuvant chemotherapy decreases the risk of recurrence and improves overall survival among breast cancer patients; however, delays in chemotherapy initiation are associated with adverse outcomes. The causes of delay are complex and include interrelated social, economic, cultural, environmental, and health system factors . Project Start was a qualitative study designed to assess and identify the multilevel factors contributing to the barriers and facilitators of chemotherapy initiation. Methods: English or Spanish-speaking women, ≥18 years, diagnosed with primary invasive breast cancer experiencing (neo)-adjuvant chemotherapy initiation delay ( ≥60 days) were included. Participants completed semi-structured interviews designed to explore perceptions about individual, community, and system-level barriers and facilitators contributing to chemotherapy initiation. Interviews were audio-recorded, transcribed verbatim, and coded using the Sort and Sift, Think and Shift qualitative approach to identify concepts and themes within and across transcripts. To supplement qualitative data, sociodemographic data and health literacy/numeracy, physician trust, and social support questionnaires were obtained. Results: Participants (n = 22) identified as: Latina (n = 8); Black (n = 5); and non-Latina White (n = 9). While the interview guide included questions addressing chemotherapy delays, explicit insight into chemotherapy delay was rare. Participants described barriers and facilitators at the patient, family, medical, and community levels. Barriers at the patient level included patient’s hesitancy to initiate chemo due to shock, fear, and denial. Within the family level, we learned of participant’s family roles (e.g., caregiving, income), treatment costs, and the need for emotional support (e.g., not shutting family members out). Participants sought out and relied heavily on support from their communities (e.g., churches, other patients, survivors). Patients described their reliance on the medical team for information, the trust needed to navigate their treatment process, and the challenge of managing information associated with their treatment. Participants described the importance of self-efficacy to take an active role in treatment. Conclusions: Project Start is informing the design of a pilot study aimed to test the acceptability and feasibility of a navigation intervention. Using facilitators and barriers identified from Project Start, we are developing a checklist that will serve as a tool to identify the support each patient needs. Once areas of need are identified, appropriate referrals will be made in a personalized and culturally sensitive way with the goal of increasing self-efficacy and activating patients to avoid treatment delays.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 107-107
Author(s):  
Omar Peña-Curiel ◽  
Orestes Valles-Guerra ◽  
Karen M Velazquez-Ayala ◽  
Griselda Peña-Iturbide ◽  
Sonia Maria Flores Moreno ◽  
...  

107 Background: UNEME-DEDICAM (UD) clinics are part of a national public health initiative to provide women prompt access to cervical and breast cancer (BC) screening and diagnosis. Furthermore, UD clinics play a central role in the coordination and prioritization of patient transfer to treatment-specialized institutions. To facilitate this process, we planned and implemented an interinstitutional virtual multidisciplinary tumor board (VMDT). Herein, we present our current experience. Methods: We planned and implemented our VMDT in September 2020. Weekly sessions were established for the multidisciplinary discussion of every newly diagnosed patient at UD with a complete radiology and pathology report. Communication was accomplished through an encrypted and secure internet connection using Microsoft Teams software. VMDT members included breast pathologist, breast imaging, radio oncologist, medical oncologist, and surgical oncologist. Treatment consensus were registered in a Microsoft Word template and integrated into the medical record for each patient. Importantly, the report also included date and time for the consultation at the referral institution. Results: Between September 2020 through May 2021, 74 BC patients were diagnosed at UD. Mean age at diagnosis was 52 years. Sixty-eight patients had invasive BC, of whom early stage (I and II) accounted for 67% of patients; locally advanced (III) for 29%, and advanced (IV) for 4%. Luminal A and B type accounted for 68%; HER2+ve for 25%; and triple negative for 7%. Mean time from biopsy to complete histopathology report (biopsy-report interval) was 2.5 weeks. The mean time from VMDT consensus to patient´s first consultation at referral center (VMDT-referral interval) was 2 weeks. The mean time from biopsy to patient´s first consultation at referral center (total interval) was 5.5 weeks. Conclusions: The VMDT is a plausible strategy to streamline the inter-institutional organization for the timely care of BC patients. UD clinics play a central role in the coordination of transfer of BC patients to tertiary care centers.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 269-269
Author(s):  
Neda Stjepanovic ◽  
Sonal Gandhi ◽  
William Tran ◽  
Alia Thawer ◽  
Ellen Warner

269 Background: Patients with hormone-receptor positive advanced breast cancer (ABC) often require palliative radiation therapy (RT) while receiving systemic treatment with CDK4/6 inhibitors (CDK4/6i). There are conflicting reports in the literature regarding whether concurrent administration of CDK4/6i and RT increases RT or hematologic toxicity and there are currently no formal guidelines for this realm. A Canadian national survey was conducted to evaluate local practice patterns of CDK4/6i management during palliative RT. Methods: An anonymized online survey was distributed to 162 Canadian breast cancer health care professionals between November 2020 and January 2021. The survey collected provider demographics and questions regarding practice, experiences and opinions on CDK4/6i management during palliative RT for ABC. Results: The survey was completed by 76 (47%) of the invited participants: 40% were medical oncologists, 26% radiation oncologists, 16% pharmacists and 18% nurses, physician assistants or radiation therapists. Nine provinces were represented. The respondents' clinical practice settings were predominantly at an academic/cancer centre (84%), while 16% of clinicians were based at a community setting. Interrupting the CDK4/6i during RT was recommended always by 21% of respondents, sometimes by 46% and never by 9%, while 24% had no opinion. The majority of opinions were based on personal experience (55%), colleagues’ practice (37%), medical literature (33%) and experience with chemotherapy agents (18%). Unexpected RT toxicity observed in patients on concomitant CDK4/6i was reported by 9% of respondents and prolonged cytopenias by 15%. Among responders who always or sometimes interrupt CDK4/6i during palliative RT, the timeframe to hold CDK4/6i prior to RT was 4-7 days 45%, 1-3 days 32%, 8-14 days 13% and 10% were unsure. Responses were similar for the timeframe used to resume the drug after RT. The majority (94%) thought that advising the patient on what to do with the CDK4/6i during RT was the role of the Medical Oncologist, while 48% also thought it was the role of the Radiation Oncologist. 23% of respondents though the patient should always be reassessed prior to restarting the CDK4/6i; 45% said sometimes, and 29% said not necessary. 82% of respondents indicated a standardized protocol or guideline would be valuable in this setting. Conclusions: Two thirds of Canadian breast cancer specialists sometimes or routinely interrupt CDK4/6i treatment during RT with 15% having observed increased toxicity with concurrent administration. Consensus guidelines for the management of CDK4/6i and RT are necessary to reduce treatment variability and improve the quality and safety of care for these patients.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 193-193
Author(s):  
J. Vozmediano

193 Background: Integrative oncology has proven to be a useful approach to control cancer symptoms and improve the quality of life (QoL) and overall health of patients, delivering integrated patient care at both physical and emotional levels. The objective of this randomized trial was to evaluate the effects of a triple intervention program on the QoL and lifestyle of women with breast cancer. Methods: Seventy-five survivors of stage IIA-IIB breast cancer were randomized into 2 groups. The intervention group (IG) received a 6-month dietary, exercise, and mindfulness program that was not offered to the control group (CG). Data were gathered at baseline and at 6 months postintervention on QoL and adherence to Mediterranean diet using clinical markers and validated questionnaires. Between-group differences at baseline and 3 months postintervention were analyzed using Student’s t test for related samples and the Wilcoxon and Mann-Whitney U tests. Results: At 6 months postintervention, the IG showed significant improvements versus CG in physical functioning ( p =.027), role functioning ( p =.028), and Mediterranean diet adherence ( p =.02) and a significant reduction in body mass index ( p =.04) and weight ( p =.05), with a mean weight loss of 0.7 kg versus a gain of 0.55 kg by the CG ( p =.05). Dyspnea symptoms were also increased in the CG versus IG ( p =.066). Conclusions: These results demonstrate that an integrative dietary, physical activity, and mindfulness program enhances the QoL and healthy lifestyle of stage IIA-IIB breast cancer survivors. Cancer symptoms may be better managed by the implementation of multimodal rather than isolated interventions. Keywords: integrative oncology, breast cancer, quality of life, diet, exercise, mindfulness. Clinical trial information: NCT04150484.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 130-130
Author(s):  
Amina Dhahri ◽  
Teshome Tegene

130 Background: Breast cancer (BC) screening is an integral part of cancer prevention. COVID-19 posed multiple obstacles on ensuring continuity of cancer care. The short and long-term outcomes of the pandemic on BC screening is unknown. The purpose of this study is to examine the challenges the pandemic has on mammogram completion using a granular measure of social economic deprivation: Area deprivation index (ADI). Methods: A Retrospective cohort study was conducted at an academic hospital system at the epicenter of COVID-19 pandemic comparing BC screening rates during the year of 2019 (pre-COVID19) and 2020 (COVID-19). For the year 2020, only charts between January-February and July-December were reviewed. March-June period was avoided as the USA declared a national emergency and the American Cancer Society recommended to temporarily pause cancer screening. The outcome variable was mammogram completion. The predictor variables were: COVID-19 period, race, insurance, age and ADI. ADI is a validated dataset that ranks census block groups based on socioeconomic deprivation (SED). Chi-square and Wilcoxon rank sum test were used to compare categorical and continuous variables by receipt of mammography. A multivariate logistic regression was used for associations between mammogram completion and the predictor variables. Results: A total of 694 patients were deemed eligible for BC screening in the year of 2019 (394) and 2020 (300). During the follow up period, only 106 and 30 patients from the pre-COVID-19 and COVID-19 cohorts underwent BC screening, respectively. During the pandemic, 30/30 patients who completed their screening were African Americans and had a high SED. In a multivariable analysis, COVID-19 period is associated with 79% lower odds of mammogram completion (OR 0.21; 95% CI 0.13, 0.35). ADI and race were not associated with higher screening rates. Medicaid status is associated with higher odds of mammogram completion (OR 1.97; 95% CI 1.12, 3.47). Conclusions: COVID-19 caused significant disruption in BC screening. In an area with high SED and high COVID-19 infection rates, private insurance holders and white patients had low rates mammogram completion. One potential explanation is that these patients sought care elsewhere. [Table: see text]


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 165-165
Author(s):  
Saumya Umashankar ◽  
Moming Li ◽  
Mi-Ok Kim ◽  
Hope S. Rugo ◽  
Michelle E. Melisko ◽  
...  

165 Background: Young women diagnosed with breast cancer face unique challenges. The desire to have a biologic child (bchild) is often a factor in treatment decisions at diagnosis and follow-up. The aim of this study is to characterize the intentions, attitudes, and decision factors considered by young women who desire to have a bchild after a diagnosis of EBC. Methods: This prospective study included young women diagnosed with stage 1-3 EBC under age 45 who saw an oncologist at UCSF’s Breast Care Center (BCC). Young women < 6 months from diagnosis were invited to complete a baseline REDCap survey on fertility, child-bearing, and family-building. Descriptive statistics were used to summarize responses. Chi square and independent samples t tests were used to compare demographics. Covariates were analyzed using odds ratios. Results: From Feb 2018 to Dec 2020, 166 eligible pts seen at the UCSF BCC were contacted, 143 pts consented, and 108 (75.5%) completed the baseline survey. Of the 108 pts, 57 (53%) were interested in having a bchild in the future. Age was the biggest driver of whether participants were interested in future child-bearing vs. not (Mean = 35.4 vs 40.9, p < 0.001) and was not influenced by stage, receptor status, or treatment. 73.6% (N = 42) of those interested in future child-bearing underwent or planned to undergo fertility preservation (FP). FP was associated with full time employment (p = 0.03) and higher education (p = 0.02). Of the 57 pts interested in future child-bearing (42 HR+, 11 TN, 12 HER2+), 30% wished to start trying to conceive within 2 years from diagnosis, and only 20% would wait 5 years or more. 43% (N = 18) of those with HR+ disease were willing to complete 5 years of hormone therapy (HT) before trying to conceive. Given hypothetical risk scenarios of an incurable cancer recurrence, 16.3% of participants were interested in a future bchild despite a 75-100% hypothetical risk of recurrence (ROR). Young women self-identified as Asian were less inclined to pursue child-bearing with increasing risk (OR = 0.3 vs. Caucasian, p = 0.04), while BRCA-carriers were more likely to remain interested in future child-bearing despite increasing risk (OR = 6.43 vs. non-carriers, p = 0.03). 59% would stop adjuvant HT early if the hypothetical absolute increased ROR from early discontinuation was < 10%. Conclusions: In this single-institution study, over half of young women with EBC expressed a desire to have a future bchild. This was independent of stage, receptor status, and treatment; the majority of women wished to conceive < 5 years from diagnosis. The desire for a future bchild decreased with increasing hypothetical risk of incurable recurrence; however, a subset wished to attempt child-bearing even when an incurable recurrence was certain. Having a bchild after EBC is a priority for many young women and should be addressed at diagnosis and throughout the continuum of care.


Sign in / Sign up

Export Citation Format

Share Document