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Pearson SA, Taylor S, Marsden A, O'Reilly JD, Krishan A, Howell S, Yorke J. Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review. Syst Rev 2024; 13:35. [PMID: 38238821 PMCID: PMC10795363 DOI: 10.1186/s13643-023-02382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/03/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The review aimed to investigate geographic and sociodemographic factors associated with receipt of systemic anticancer therapies (SACT) for women with secondary (metastatic) breast cancer (SBC). METHODS Included studies reported geographic and sociodemographic factors associated with receipt of treatment with SACT for women > 18 years with an SBC diagnosis. Information sources searched were Ovid CINAHL, Ovid MEDLINE, Ovid Embase and Ovid PsychINFO. Assessment of methodological quality was undertaken using the Joanna Briggs Institute method. Findings were synthesised using a narrative synthesis approach. RESULTS Nineteen studies published between 2009 and 2023 were included in the review. Overall methodological quality was assessed as low to moderate. Outcomes were reported for treatment receipt and time to treatment. Overall treatment receipt ranged from 4% for immunotherapy treatment in one study to 83% for systemic anticancer therapies (unspecified). Time to treatment ranged from median 54 days to 95 days with 81% of patients who received treatment < 60 days. Younger women, women of White origin, and those women with a higher socioeconomic status had an increased likelihood of timely treatment receipt. Treatment receipt varied by geographical region, and place of care was associated with variation in timely receipt of treatment with women treated at teaching, research and private institutions being more likely to receive treatment in a timely manner. CONCLUSIONS Treatment receipt varied depending upon type of SACT. A number of factors were associated with treatment receipt. Barriers included older age, non-White race, lower socioeconomic status, significant comorbidities, hospital setting and geographical location. Findings should however be interpreted with caution given the limitations in overall methodological quality of included studies and significant heterogeneity in measures of exposure and outcome. Generalisability was limited due to included study populations. Findings have practical implications for the development and piloting of targeted interventions to address specific barriers in a socioculturally sensitive manner. Addressing geographical variation and place of care may require intervention at a commissioning policy level. Further qualitative research is required to understand the experience and of women and clinicians. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020196490.
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Affiliation(s)
- Sally Anne Pearson
- Division of Nursing, Midwifery and Social Work, The Christie NHS Foundation Trust, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Antonia Marsden
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Jessica Dalton O'Reilly
- Christie Patient Centred Research, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Ashma Krishan
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Sacha Howell
- Division of Cancer Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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Jiménez-Salazar JE, Rivera-Escobar RM, Damián-Ferrara R, Maldonado-Cubas J, Rincón-Pérez C, Tarragó-Castellanos R, Damián-Matsumura P. Estradiol-Induced Epithelial to Mesenchymal Transition and Migration Are Inhibited by Blocking c-Src Kinase in Breast Cancer Cell Lines. J Breast Cancer 2023; 26:446-460. [PMID: 37704382 PMCID: PMC10625871 DOI: 10.4048/jbc.2023.26.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/18/2023] [Accepted: 07/19/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE The epithelial-to-mesenchymal transition (EMT) is the main event that favors cell migration and metastasis in breast cancer. Previously, we demonstrated that 1 nM estradiol (E2) promotes EMT, induced by c-Src kinase, causing changes in the localization of proteins that compose the tight junction (TJ) and adherens junction (AJ). METHODS The present work highlights the central role of c-Src in the initiation of metastasis, induced by E2, through increasing the ability of MCF-7 and T47-D cells, which express estrogen receptor alpha (ERα), to migrate and invade before they become metastatic. RESULTS Treatment with E2 can activate two signaling pathways, the first one by the phosphorylated c-Src (p-Src) which forms the p-Src/E-cadherin complex. This phenomenon was completely prevented by incubation with a selective inhibitor of c-Src (5 µM PP2). p-Src then promotes the downregulation of E-cadherin and occludin, which are epithelial phenotype marker proteins of the AJ and TJ, respectively. In the second pathway, E2 binds to ERα, creating a complex that translocates to the nucleus, inducing the synthesis of SNAIL1 and N-cadherin proteins, markers of the mesenchymal phenotype. Both processes increased the migratory and invasive capacities of both cell lines. CONCLUSION The present study demonstrate that E2 enhance EMT and migration, through c-Src activation, in human breast cancer cells that express ERα and become potential therapeutic targets.
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Affiliation(s)
- Javier E Jiménez-Salazar
- Department of Biology of Reproduction, Biological Sciences and Health Division (DCBS), Autonomous Metropolitan University (UAM), Mexico City, México
- Escuela Militar de Graduados de Sanidad, Secretaría de la Defensa Nacional (SEDENA), Mexico City, México
| | - Rene M Rivera-Escobar
- Department of Biology of Reproduction, Biological Sciences and Health Division (DCBS), Autonomous Metropolitan University (UAM), Mexico City, México
| | - Rebeca Damián-Ferrara
- Monterrey Institute of Technology and Higher Education (ITESM), School of Engineering and Sciences, Monterrey, México
| | | | - Catalina Rincón-Pérez
- Escuela Militar de Graduados de Sanidad, Secretaría de la Defensa Nacional (SEDENA), Mexico City, México
| | - Rosario Tarragó-Castellanos
- Department of Biology of Reproduction, Biological Sciences and Health Division (DCBS), Autonomous Metropolitan University (UAM), Mexico City, México
| | - Pablo Damián-Matsumura
- Department of Biology of Reproduction, Biological Sciences and Health Division (DCBS), Autonomous Metropolitan University (UAM), Mexico City, México.
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Schwartzberg L, Broder MS, Ailawadhi S, Beltran H, Blakely LJ, Budd GT, Carr L, Cecchini M, Cobb P, Kansal A, Kim A, Monk BJ, Wong DJ, Campos C, Yermilov I. Impact of early detection on cancer curability: A modified Delphi panel study. PLoS One 2022; 17:e0279227. [PMID: 36542647 PMCID: PMC9770338 DOI: 10.1371/journal.pone.0279227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Expert consensus on the potential benefits of early cancer detection does not exist for most cancer types. We convened 10 practicing oncologists using a RAND/UCLA modified Delphi panel to evaluate which of 20 solid tumors, representing >40 American Joint Committee on Cancer (AJCC)-identified cancer types and 80% of total cancer incidence, would receive potential clinical benefits from early detection. Pre-meeting, experts estimated how long cancers take to progress and rated the current curability and benefit (improvement in curability) of an annual hypothetical multi-cancer screening blood test. Post-meeting, experts rerated all questions. Cancers had varying estimates of the potential benefit of early cancer detection depending on estimates of their curability and progression by stage. Cancers rated as progressing quickly and being curable in earlier stages (stomach, esophagus, lung, urothelial tract, melanoma, ovary, sarcoma, bladder, cervix, breast, colon/rectum, kidney, uterus, anus, head and neck) were estimated to be most likely to benefit from a hypothetical screening blood test. Cancer types rated as progressing quickly but having comparatively lower cure rates in earlier stages (liver/intrahepatic bile duct, gallbladder, pancreas) were estimated to have medium likelihood of benefit from a hypothetical screening blood test. Cancer types rated as progressing more slowly and having higher curability regardless of stage (prostate, thyroid) were estimated to have limited likelihood of benefit from a hypothetical screening blood test. The panel concluded most solid tumors have a likelihood of benefit from early detection. Even among difficult-to-treat cancers (e.g., pancreas, liver/intrahepatic bile duct, gallbladder), early-stage detection was believed to be beneficial. Based on the panel consensus, broad coverage of cancers by screening blood tests would deliver the greatest potential benefits to patients.
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Affiliation(s)
- Lee Schwartzberg
- Division of Medical Oncology and Hematology, Renown Institute for Cancer, Reno, Nevada, United States of America
| | - Michael S. Broder
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, California, United States of America
| | - Sikander Ailawadhi
- Department of Medicine, Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Himisha Beltran
- Department of Medical Oncology, Divisions of Genitourinary Oncology and Molecular and Cellular Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - L. Johnetta Blakely
- Health Economics and Outcomes Research, Tennessee Oncology, Nashville, Tennessee, United States of America
| | - G. Thomas Budd
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Laurie Carr
- Department of Medicine, Division of Medical Oncology, National Jewish Health, Denver, Colorado, United States of America
| | - Michael Cecchini
- Department of Internal Medicine, Division of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Patrick Cobb
- Oncology Research, Intermountain Healthcare, Billings, Montana, United States of America
| | - Anuraag Kansal
- Health Economics and Outcomes Research, GRAIL, LLC, a subsidiary of Illumina Inc., currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021, Menlo Park, California, United States of America
| | - Ashley Kim
- Health Economics and Outcomes Research, GRAIL, LLC, a subsidiary of Illumina Inc., currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021, Menlo Park, California, United States of America
- * E-mail:
| | - Bradley J. Monk
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, Arizona, United States of America
| | - Deborah J. Wong
- Department of Medicine, Division of Hematology/Oncology, UCLA Health, Los Angeles, California, United States of America
| | - Cynthia Campos
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, California, United States of America
| | - Irina Yermilov
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, California, United States of America
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Jaber Chehayeb R, Hood A, Wang X, Miksad R, Schellhorn Mougalian S, Lustberg MB, Wang SY, Greenup RA, Pusztai L, Kunst N. Treatment Sequencing Patterns and Associated Direct Medical Costs of Metastatic Breast Cancer Care in the United States, 2011 to 2021. JAMA Netw Open 2022; 5:e2244204. [PMID: 36445704 PMCID: PMC9709649 DOI: 10.1001/jamanetworkopen.2022.44204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Advances in treatment of metastatic breast cancer (MBC) led to changes in clinical practice and treatment costs in the US over the past decade. There is limited information on current MBC treatment sequences and associated costs by MBC subtype in the US. OBJECTIVES To identify treatment patterns by MBC subtype and associated anticancer and supportive drug costs from health care sector and Medicare perspectives. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation analyzed data of patients with MBC obtained from the nationwide Flatiron Health database, an electronic health record-derived, deidentified database with data from community and academic practices across the US from 2011 to 2021. Participants included women aged at least 18 years diagnosed with MBC, who had at least 6 months of follow-up data, known hormone receptor (HR) and human epidermal growth factor receptor 2 (ERBB2) receptor status, and at least 1 documented line of therapy. Patients with documented receipt of clinical study drugs were excluded. Data were analyzed from June 2021 to May 2022. MAIN OUTCOMES AND MEASURES Outcomes of interest were frequency of different drug regimens received as a line of therapy by subtype for the first 5 lines and mean medical costs of documented anticancer treatment and supportive care drugs per patient by MBC subtype and years since metastatic diagnosis, indexed to 2021 US dollars. RESULTS Among 15 215 patients (10 171 patients [66.85%] with HR-positive and ERBB2-negative MBC; 2785 patients [18.30%] with HR-positive and ERBB2-positive MBC; 802 patients [5.27%] with HR-negative and ERBB2-positive MBC; 1457 patients [9.58%] with triple-negative breast cancer [TNBC]) who met eligibility criteria, 1777 (11.68%) were African American, 363 (2.39%) were Asian, and 9800 (64.41%) were White; the median (range) age was 64 (21-84) years. The mean total per-patient treatment and supportive care drug cost using publicly available Medicare prices was $334 812 for patients with HR-positive and ERBB2-positive MBC, $284 609 for patients with HR-negative and ERBB2-positive MBC, $104 774 for patients with HR-positive and ERBB2-negative MBC, and $54 355 for patients with TNBC. From 2011 to 2019 (most recent complete year 1 data are for patients diagnosed in 2019), annual costs in year 1 increased from $12 986 to $80 563 for ERBB2-negative and HR-positive MBC, $99 997 to $156 712 for ERBB2-positive and HR-positive MBC, and $31 397 to $53 775 for TNBC. CONCLUSIONS AND RELEVANCE This economic evaluation found that drug costs related to MBC treatment increased between 2011 and 2021 and differed by tumor subtype. These findings suggest the growing financial burden of MBC treatment in the US and highlights the importance of performing more accurate cost-effectiveness analysis of novel adjuvant therapies that aim to reduce metastatic recurrence rates for early-stage breast cancer.
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Affiliation(s)
| | - Annette Hood
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, Connecticut
| | | | | | | | | | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
| | - Rachel A. Greenup
- Department of Surgery and Smilow Cancer Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Lajos Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Natalia Kunst
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Squeo GC, Lattimore CM, Simone NL, Suralik G, Dutta SW, Schad MD, Su L, Libby B, Janowski EM, Showalter SL, Lobo JM, Showalter TN. A comparative study using time-driven activity-based costing in single-fraction breast high-dose rate brachytherapy: An integrated brachytherapy suite vs. decentralized workflow. Brachytherapy 2022; 21:334-340. [PMID: 35125328 PMCID: PMC9149052 DOI: 10.1016/j.brachy.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Precision breast intraoperative radiation therapy (PB-IORT) is a novel approach to adjuvant radiation therapy for early-stage breast cancer performed as part of a phase II clinical trial at two institutions. One institution performs the entire procedure in an integrated brachytherapy suite which contains a CT-on-rails imaging unit and full anesthesia capabilities. At the other, breast conserving surgery and radiation therapy take place in two separate locations. Here, we utilize time-driven activity-based costing (TDABC) to compare these two models for the delivery of PB-IORT. METHODS Process maps were created to describe each step required to deliver PB-IORT at each institution, including personnel, equipment, and supplies. Time investment was estimated for each step. The capacity cost rate was determined for each resource, and total costs of care were then calculated by multiplying the capacity cost rates by the time estimate for the process step and adding any additional product costs. RESULTS PB-IORT costs less to deliver at a distributed facility, as is more commonly available, than an integrated brachytherapy suite ($3,262.22 vs. $3,996.01). The largest source of costs in both settings ($2,400) was consumable supplies, including the brachytherapy balloon applicator. The difference in costs for the two facility types was driven by personnel costs ($1,263.41 vs. $764.89). In the integrated facility, increased time required by radiation oncology nursing and the anesthesia attending translated to the greatest increases in cost. Equipment costs were also slightly higher in the integrated suite setting ($332.60 vs. $97.33). CONCLUSIONS The overall cost of care is higher when utilizing an integrated brachytherapy suite to deliver PB-IORT. This was primarily driven by additional personnel costs from nursing and anesthesia, although the greatest cost of delivery in both settings was the disposable brachytherapy applicator. These differences in cost must be balanced against the potential impact on patient experience with these approaches.
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Affiliation(s)
- Gabriella C Squeo
- Division of Breast and Melanoma Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Courtney M Lattimore
- Division of Breast and Melanoma Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Greg Suralik
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Sunil W Dutta
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Michael D Schad
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Lucy Su
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Einsley-Marie Janowski
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Shayna L Showalter
- Division of Breast and Melanoma Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Jennifer M Lobo
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
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Eslami SP, Hassanein K. Understanding Data Analytics Recommendation Execution: The Role of Recommendation Quality. JOURNAL OF COMPUTER INFORMATION SYSTEMS 2022. [DOI: 10.1080/08874417.2021.2010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Levels of Evidence for Radiation Therapy Recommendations in the National Comprehensive Cancer Network (NCCN) Clinical Guidelines. Adv Radiat Oncol 2021; 7:100832. [PMID: 34869943 PMCID: PMC8626664 DOI: 10.1016/j.adro.2021.100832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The National Comprehensive Cancer Network (NCCN) clinical guidelines influence medical practice, payor coverage, and standards of care. The levels of evidence underlying radiation therapy recommendations in NCCN have not been systematically explored. Herein, we aim to systematically investigate the NCCN recommendations pertaining to the categories of consensus and evidence (CE) for radiation therapy. Methods and Materials We evaluated the distribution of CE underlying current treatment recommendations for the 20 most prevalent cancers in the United States with at least 10 radiation therapy recommendations in the NCCN clinical guidelines. For context, the distribution of evidence in the radiation therapy guidelines was compared with that of systemic therapy using a χ2 test. The proportion of category I CE between radiation and systemic therapy was compared using a 2-proportion, 2-tailed z-test in total and for each disease site. A P value of < .05 was considered significant. Results Among all radiation therapy recommendations, the proportions of category I, IIA, IIB, and III CE were 9.7%, 80.6%, 8.4%, and 1.3%, respectively. When analyzed by disease site, cervix and breast cancer had the highest portion of category I CE (33% and 31%, respectively). There was no radiation therapy category I CE for hepatobiliary, bone, pancreatic, melanoma, and uterine cancers. There was a significant difference in the distribution of CE between the systemic therapy recommendations and the radiation therapy recommendations (χ2 statistic 64.16, P < .001). Overall, there was a significantly higher proportion of category I CE in the systemic therapy recommendations compared with the radiation therapy recommendations (12.3% vs 9.7%, P = .043). Conclusions Only 9.7% of radiation therapy recommendations in NCCN guidelines are category I CE. The highest levels of evidence for radiation therapy are in breast and cervical cancers. Despite major advances in the field, these data underline that the majority of NCCN radiation therapy recommendations are based on uniform expert opinion and not on higher level evidence.
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Lin J, Hu H, Shriver CD, Zhu K. Survival among Breast Cancer Patients: Comparison of the U.S. Military Health System with the Surveillance, Epidemiology and End Results Program. Clin Breast Cancer 2021; 22:e506-e516. [PMID: 34961733 DOI: 10.1016/j.clbc.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/24/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Accessibility to health care is important to cancer survival. The U.S. military health system (MHS) provides universal health care access. However, whether the universal care has been translated into improved cancer survival is unknown. We compared survival of patients with breast cancer in the MHS with that in the U.S. general population and assessed the differences in cancer stage at diagnosis and treatment receipt between the two populations. METHODS The MHS patients (n = 31,548) were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (n = 63,096) were identified from the Surveillance, Epidemiology, and End Results (SEER) program. The two populations were matched on age, race, and diagnosis year. Multivariable Cox regression hazard modeling was used to estimate hazard ratios (HRs) comparing ACTUR with SEER. Multivariable logistic regression was used to estimate odds ratios (ORs) comparing stage and treatment receipt. RESULTS ACTUR patients exhibited a 24% lower overall mortality than the SEER patients (HR = 0.76, 95% CI, 0.71-0.80). They were less likely to present with later stage compared to the SEER patients (OR = 0.61, 95% CI, 0.55-0.67 for stage IV tumors). The ACTUR patients with stages I-III tumors were more likely to receive surgery (OR = 1.35, 95% CI, 1.20-1.52) but less likely to receive radiation (OR = 0.91, 95% CI, 0.88-0.94). The survival advantage of ACTUR patients remained regardless of surgery or radiation receipt. CONCLUSIONS Breast cancer patients with universal health care access had improved survival compared to patients in the general population.
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Affiliation(s)
- Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Hai Hu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
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Targeted doxorubicin delivery and release within breast cancer environment using PEGylated chitosan nanoparticles labeled with monoclonal antibodies. Int J Biol Macromol 2021; 184:325-338. [PMID: 34119547 DOI: 10.1016/j.ijbiomac.2021.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
Breast cancer has been one of the top chronic and life-threatening diseases worldwide. Nano-drug therapeutic systems have proved their efficacy as a selective treatment compared to the traditional ones that are associated with serious adverse effects. Here, biodegradable chitosan nanoparticles (CSNPs) were synthesized to provide selective and sustained release of doxorubicin (DOX) within the breast tumor microenvironment. CSNPs surface was modified using Polyethylene glycol (PEG) to enhance their blood circulation timing. To provide high drug selectivity, CSNPs functionalized with two different types of breast cancer-specific monoclonal antibodies (mAb); anti-human mammaglobin (Anti-hMAM) and anti-human epidermal growth factor (Anti-HER2). Anti-hMAM PEGylated DOX loaded CSNPs and Anti-HER2 PEGylated DOX loaded CSNPs nano-formulations were the most cytotoxic against MCF-7 cancer cells than L-929 normal cells compared to free DOX. Finally, we believe that dose-dependent system toxicity of freely ingested DOX can be managed with such targeted nano-formulated drug delivery platforms.
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Vyas A, Mantaian T, Kamat S, Kurian S, Kogut S. Association of guideline-concordant initial systemic treatment with clinical and economic outcomes among older women with metastatic breast cancer in the United States. J Geriatr Oncol 2021; 12:1092-1099. [PMID: 34099411 DOI: 10.1016/j.jgo.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We examined guideline-concordant initial systemic treatment among women with metastatic breast cancer, its predictors, and if guideline-concordant treatment was associated with mortality, healthcare utilization and Medicare expenditures. METHODS This retrospective observational cohort study was conducted using the Surveillance, Epidemiology, End Results-Medicare linked database. Women aged 66-90 years diagnosed with metastatic breast cancer during 2010-2013 (N = 1282) were included. The National Comprehensive Cancer Network treatment guidelines were used to determine the guideline-concordant initial systemic treatment following cancer diagnosis. A logistic regression analysis was conducted to examine significant predictors of guideline-concordant treatment. Generalized linear regressions were used to examine the association between guideline-concordant treatment and healthcare utilization and average monthly Medicare expenditures. RESULTS About 74% of the study cohort received guideline-concordant initial systemic treatment. Women who received guideline-concordant treatment were significantly more likely to be comparatively younger (p < 0.05), were married/partnered (p = 0.0038), had HER2 positive tumors, and had good performance status. Adjusted hazards ratios for all-cause (2.364, p < 0.0001) and breast-cancer specific mortality (2.179, p < 0.0001) were higher for women who did not receive guideline-concordant treatment. Rates of healthcare utilization were also higher for women not receiving guideline-concordant treatment. Average monthly Medicare expenditures were 100.4% higher (95% confidence interval: $77.3%-126.5%) for women who did not receive guideline-concordant treatment compared to those who received guideline-concordant treatment (p < 0.0001). CONCLUSION One fourth of the study cohort did not receive guideline-concordant initial systemic treatment. Guideline-concordant initial treatment was associated with reduced mortality, and lower healthcare utilization and Medicare expenditures in women with metastatic breast cancer.
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Affiliation(s)
- Ami Vyas
- University of Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI, United States of America.
| | - Tyler Mantaian
- University of Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI, United States of America
| | - Shweta Kamat
- University of Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI, United States of America
| | - Sobha Kurian
- West Virginia University, School of Medicine, Morgantown, WV, United States of America
| | - Stephen Kogut
- University of Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI, United States of America
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Werutsky G, Reinert T, Rosa ML, Barrios CH. Real-world Data on First-line Systemic Therapy for Hormone Receptor-positive HER2-negative Metastatic Breast Cancer: A Trend Shift in the Era of CDK 4/6 Inhibitors. Clin Breast Cancer 2021; 21:e688-e692. [PMID: 33992526 DOI: 10.1016/j.clbc.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/24/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022]
Abstract
Hormone receptor-positive (HR+) human epidermal growth factor receptor-2 negative (HER2-) tumors represent the most common subtype of metastatic breast cancer (MBC). International guidelines clearly state that endocrine therapy (ET) should be considered the preferred first-line therapy for these patients in the absence of very symptomatic visceral disease or evidence of endocrine resistance. Nonetheless compliance with guidelines significantly vary worldwide for many different reasons. Historically, a substantial proportion of patients with HR+ HER2- MBC have been treated with chemotherapy (CT) in first-line setting, jeopardizing patients' quality of life without a significant benefit in outcome. In 17 observational studies, including more than 63,000 patients, ET was most frequently used in first-line treatment of HR+/HER2- MBC (range, 42%-87%), nonetheless a high proportion of patients received CT (13%-66%) as initial therapy. More recently, results of clinical trials with CDK 4/6 inhibitors improved response, progression-free and overall survival in this population and are currently the standard of care. There was a trend toward increased use of ET in recent years. This review article aims to evaluate real-world data on patterns of first-line treatment of HR+ HER2- MBC with a special focus on the use of CT in this setting and the potential implications and perceived preliminary changes after the introduction of CDK 4/6 inhibitors.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Tomás Reinert
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Grupo Oncoclínicas, Porto Alegre, Brazil
| | - Mahira Lopes Rosa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Carlos Henrique Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Grupo Oncoclínicas, Porto Alegre, Brazil
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12
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Piazza T, Izidoro JB, Portella MAMP, Panisset U, Afonso Guerra-Júnior A, Cherchiglia ML. [Assessment of Brazilian clinical guidelines in oncology: gaps in drafting, applicability, and editorial independence]. CAD SAUDE PUBLICA 2021; 37:e00031920. [PMID: 33886704 DOI: 10.1590/0102-311x00031920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
The expansion in the variety of clinical guidelines in oncology is perceptible worldwide, highlighting the need to guarantee the quality of these documents. The study thus aimed to assess the quality of Brazilian national guidelines for treatments of breast, prostate, and colon and rectal cancers. We selected 12 Brazilian guidelines published by four different drafting groups (Ministry of Health, Supplementary Health System, and medical societies and associations), and the AGREE II instrument was applied. In all these guidelines, we identified important weaknesses in more than one Domain, especially low values for "applicability" and "editorial independence". The patterns observed per Domains are more related to the drafting group than the respective clinical conditions. Lower scores in "drafting rigor" and "editorial independence" were obtained by nongovernmental drafting groups, including absence of information or lack of its transparency. Although the "clarity of presentation" in the Ministry of Health guidelines was relatively lower, all the guidelines presented major limitations in "applicability". Consequently, in the overall assessment, none of the guidelines was recommended without modifications, and four were not recommended at all. Finally, it is necessary to upgrade the guidelines according to the underlying evidence ("methodological rigor") and to present the recommended practices in a comprehensible and applicable way ("applicability"), and to mitigate conflicting interests in order to offer cancer patients the best available care in Brazil.
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Affiliation(s)
- Thais Piazza
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Ulysses Panisset
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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13
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Hull O, Niranjan SJ, Wallace AS, Williams BR, Turkman YE, Ingram SA, Williams CP, Smith T, Knight SJ, Bhatia S, Rocque GB. Should we be talking about guidelines with patients? A qualitative analysis in metastatic breast cancer. Breast Cancer Res Treat 2020; 184:115-121. [PMID: 32737711 DOI: 10.1007/s10549-020-05832-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little data exist on perceptions of guideline-based care in oncology. This qualitative analysis describes patients' and oncologists' views on the value of guideline-based care as well as discussing guidelines when making metastatic breast cancer (MBC) treatment decisions. PATIENTS AND METHODS In-person interviews completed with MBC patients and community oncologists and focus groups with academic oncologists were audio-recorded and transcribed. Two coders utilized a content analysis approach to analyze transcripts independently using NVivo. Major themes and exemplary quotes were extracted. RESULTS Participants included 20 MBC patients, 6 community oncologists, and 5 academic oncologists. Most patients were unfamiliar with the term "guidelines." All patients desired to know if they were receiving guideline-discordant treatment but were often willing to accept this treatment. Five themes emerged explaining this including trusting the oncologist, relying on the oncologist's experiences, being informed of rationale for deviation, personalized treatment, and openness to novel therapies. Physician discussions regarding the importance of guidelines revealed three themes: consistency with scientific evidence, insurance coverage, and limiting unusual practices. Oncologists identified three major limitations in using guidelines: lack of consensus, inability to "think outside the box" to personalize treatment, and lack of guideline timeliness. Although some oncologists discussed guidelines, it was often not considered a priority. CONCLUSIONS Patients expressed a desire to know whether they were receiving guideline-based care but were amenable to guideline-discordant treatment if the rationale was made clear. Providers' preference to limit discussions of guidelines is discordant with patients' desire for this information and may limit shared decision-making.
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Affiliation(s)
- Olivia Hull
- Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, WTI 240, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Soumya J Niranjan
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Audrey S Wallace
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Beverly R Williams
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yasemin E Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, WTI 240, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, WTI 240, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Tom Smith
- Division of Palliative Care, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sara J Knight
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytical Sciences (IDEAS) Center, Department of Veteran Affairs, Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, The University of Alabama at Birmingham, WTI 240, 1720 2nd Avenue South, Birmingham, AL, 35294, USA. .,Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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14
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Burnett-Hartman AN, Udaltsova N, Kushi LH, Neslund-Dudas C, Rahm AK, Pawloski PA, Corley DA, Knerr S, Feigelson HS, Hunter JE, Tabano DC, Epstein MM, Honda SA, Ter-Minassian M, Lynch JA, Lu CY. Clinical Molecular Marker Testing Data Capture to Promote Precision Medicine Research Within the Cancer Research Network. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31487201 DOI: 10.1200/cci.19.00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate health care systems for the availability of population-level data on the frequency of use and results of clinical molecular marker tests to inform precision cancer care. METHODS We assessed cancer-related molecular marker test data availability across 12 US health care systems in the Cancer Research Network. Overall, these systems provide care to a diverse population of more than 12 million people in the United States. We performed qualitative analyses of test data availability for five blood-based protein, nine germline, and 14 tissue-based tumor marker tests in each health care system's electronic health record and tumor registry using key informants, test code lists, and manual review of data types and output. We then performed quantitative analyses to estimate the proportion of patients with cancer with test utilization data and results for specific molecular marker tests. RESULTS Health systems were able to systematically capture population-level data on all five blood protein markers, six of 14 tissue-based tumor markers, and none of the nine germline markers. Successful, systematic data capture was achievable for tests with electronic data feeds for test results (blood protein markers) or through prior manual abstraction by tumor registrars (select tumor-based markers). For test results stored in scanned image files (particularly germline and tumor marker tests), information on which test was performed and test results was not readily accessible in an electronic format. CONCLUSION Even in health care systems with sophisticated electronic health records, there were few codified data elements available for evaluating precision cancer medicine test use and results at the population level. Health care organizations should establish standards for electronic reporting of precision medicine tests to expedite cancer research and facilitate the implementation of precision medicine approaches.
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Affiliation(s)
| | | | | | | | | | | | | | - Sarah Knerr
- University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - David C Tabano
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Mara M Epstein
- University of Massachusetts Medical School, Worcester, MA
| | | | | | - Julie A Lynch
- Department of Veterans Affairs Salt Lake City Health System, Salt Lake City, UT
| | - Christine Y Lu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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15
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Rocque GB, Gilbert A, Williams CP, Kenzik KM, Nakhmani A, Kandhare PG, Bhatia S, Burkard ME, Azuero A. Prior Treatment Time Affects Survival Outcomes in Metastatic Breast Cancer. JCO Clin Cancer Inform 2020; 4:500-513. [PMID: 32479187 PMCID: PMC7444642 DOI: 10.1200/cci.20.00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Sequential drug treatments in metastatic breast cancer (MBC) are disparate. Clinical trial data includes limited reporting of treatment context, primarily including the number of prior therapies. This study evaluates the relationship between prior treatment time, prior lines of treatment, and survival using a novel visualization technique coupled with statistical analyses. PATIENTS AND METHODS This retrospective cohort study used a nationwide, de-identified electronic health record-derived database to identify women with hormone receptor-positive, human epidermal growth factor receptor 2-negative MBC diagnosed in 2014 who subsequently received paclitaxel. Images were created, with individual patients represented on the y-axis and time, on the x-axis. Specific treatments were represented by colored bars, with Kaplan-Meier curves overlaying the image. Separate images assessed progression-free survival and overall survival (OS). Hazard ratios (HRs) and 95% CIs from Cox proportional hazards models evaluated the association between prior treatment time and OS. RESULTS Of 234 patients, median survival from first paclitaxel administration was 20 months (interquartile range, 8-53 months). An inverse relationship was observed between OS after paclitaxel and timing of administration. In adjusted models, each year on treatment prior to paclitaxel was associated with a 16% increased hazard of death after paclitaxel (HR, 1.16; 95% CI, 1.05 to 1.29). CONCLUSION OS after a specific treatment is dependent on when a drug is given in the disease context, highlighting the potential for an overall OS benefit to be observed on the basis of treatment timing. Prior time on treatment should be considered as a stratifying factor in randomized trials and a confounding factor when examining survival in observational data.
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Affiliation(s)
- Gabrielle B. Rocque
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham (UAB), Birmingham, AL
- Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
| | - Aidan Gilbert
- Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
| | - Courtney P. Williams
- Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
| | - Kelly M. Kenzik
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham (UAB), Birmingham, AL
- Department of Medicine, Division of Hematology and Oncology, UAB, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, UAB, Birmingham, AL
| | - Arie Nakhmani
- Department of Electrical and Computer Engineering, UAB, Birmingham, AL
| | | | - Smita Bhatia
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham (UAB), Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, UAB, Birmingham, AL
| | - Mark E. Burkard
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin, Madison, WI
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16
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Stangl S, Haas K, Eichner FA, Grau A, Selig U, Ludwig T, Fehm T, Stüber T, Rashid A, Kerscher A, Bargou R, Hermann S, Arndt V, Meyer M, Wildner M, Faller H, Schrauder MG, Weigel M, Schlembach U, Heuschmann PU, Wöckel A. Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease-the "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry. Pilot Feasibility Stud 2020; 6:11. [PMID: 32042437 PMCID: PMC7001276 DOI: 10.1186/s40814-019-0541-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023] Open
Abstract
Background Patients with metastatic breast cancer (MBC) are treated with a palliative approach with focus on controlling for disease symptoms and maintaining high quality of life. Information on individual needs of patients and their relatives as well as on treatment patterns in clinical routine care for this specific patient group are lacking or are not routinely documented in established Cancer Registries. Thus, we developed a registry concept specifically adapted for these incurable patients comprising primary and secondary data as well as mobile-health (m-health) data. Methods The concept for patient-centered “Breast cancer care for patients with metastatic disease” (BRE-4-MED) registry was developed and piloted exemplarily in the region of Main-Franconia, a mainly rural region in Germany comprising about 1.3 M inhabitants. The registry concept includes data on diagnosis, therapy, progression, patient-reported outcome measures (PROMs), and needs of family members from several sources of information including routine data from established Cancer Registries in different federal states, treating physicians in hospital as well as in outpatient settings, patients with metastatic breast cancer and their family members. Linkage with routine cancer registry data was performed to collect secondary data on diagnosis, therapy, and progression. Paper and online-based questionnaires were used to assess PROMs. A dedicated mobile application software (APP) was developed to monitor needs, progression, and therapy change of individual patients. Patient’s acceptance and feasibility of data collection in clinical routine was assessed within a proof-of-concept study. Results The concept for the BRE-4-MED registry was developed and piloted between September 2017 and May 2018. In total n = 31 patients were included in the pilot study, n = 22 patients were followed up after 1 month. Record linkage with the Cancer Registries of Bavaria and Baden-Württemberg demonstrated to be feasible. The voluntary APP/online questionnaire was used by n = 7 participants. The feasibility of the registry concept in clinical routine was positively evaluated by the participating hospitals. Conclusion The concept of the BRE-4-MED registry provides evidence that combinatorial evaluation of PROMs, needs of family members, and raising clinical parameters from primary and secondary data sources as well as m-health applications are feasible and accepted in an incurable cancer collective.
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Affiliation(s)
- Stephanie Stangl
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany.,2Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Kirsten Haas
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Felizitas A Eichner
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Anna Grau
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Udo Selig
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Timo Ludwig
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Tanja Fehm
- 3Department of Obstetrics and Gynecology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tanja Stüber
- 2Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Asarnusch Rashid
- Zentrum für Telemedizin Bad Kissingen (ZTM), Bad Kissingen, Germany
| | - Alexander Kerscher
- 5Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.,Clinical Cancer Registry Lower Franconia, Würzburg, Germany
| | - Ralf Bargou
- 5Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Silke Hermann
- 7Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center, Heidelberg, Germany
| | - Volker Arndt
- 7Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center, Heidelberg, Germany
| | - Martin Meyer
- 8Centre of Early Cancer Detection and Cancer Registration, Bavarian Health and Food Safety Authority, Nürnberg, Germany
| | | | - Hermann Faller
- 5Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.,10Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Michael G Schrauder
- Clinic of Gynecology and Obstetrics, Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Michael Weigel
- Clinic for Gynecology and Obstetrics, Hospital Leopoldina Schweinfurt, Schweinfurt, Germany
| | - Ulrich Schlembach
- Clinic of Gynecology, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Peter U Heuschmann
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany.,14Center for Clinical Studies, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Centre, Würzburg, Germany
| | - Achim Wöckel
- 2Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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17
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Rocque GB, Williams GR. Bridging the Data-Free Zone: Decision Making for Older Adults With Cancer. J Clin Oncol 2019; 37:3469-3471. [PMID: 31675251 DOI: 10.1200/jco.19.02588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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18
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Zhao B, Tsai C, Hunt KK, Blair SL. Adherence to surgical and oncologic standards improves survival in breast cancer patients. J Surg Oncol 2019; 120:148-159. [PMID: 31172534 DOI: 10.1002/jso.25506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/27/2019] [Accepted: 05/03/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Adherence to evidence-based standards can lead to improved outcomes for patients with breast cancer. However, adherence rates to standards and their effects on patient outcomes are unknown. OBJECTIVES To examine adherence rates to standards compiled by the American College of Surgeons Clinical Research Program and its effects on patient outcomes. METHODS Using the National Cancer Database (2004-2015), we identified cohorts of breast cancer patients: clinical T1N0M0 under age of 70 (cT1), clinical T2N0M0 or T3N0M0 (cT2/3), and clinical M0 and pathologic N2 or N3 (pN2/3). Standards included negative margins, any adjuvant therapy, and two or more lymph nodes (LNs) examined (for cT1 or cT2/3 patients) or more than 10 LNs examined (for pN2/3 patients). We performed Kaplan-Meier and Cox proportional hazards analysis. RESULTS We identified 318 853 (65.0%) cT1, 164 593 (67.3%) cT2/3, and 77 626 (67.7%) pN2/3 patients who met the standards. More than 90% of patients had negative margins and adjuvant therapy, but less than 80% met LN standards. The median overall survival (OS) was significantly longer for patients who met the standards. Individual components of the standards were predictors of improved OS. CONCLUSIONS One-third of patients did not meet the evidence-based standards in their treatment for breast cancer. Efforts to improve the knowledge of and adherence to these standards should be emphasized.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California, San Diego, California
| | - Catherine Tsai
- Department of Surgery, University of California, San Diego, California
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Sarah L Blair
- Department of Surgery, University of California, San Diego, California
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19
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Rocque GB, Kandhare PG, Williams CP, Nakhmani A, Azuero A, Burkard ME, Forero A, Bhatia S, Kenzik KM. Visualization of Sequential Treatments in Metastatic Breast Cancer. JCO Clin Cancer Inform 2019; 3:1-8. [PMID: 30840488 DOI: 10.1200/cci.18.00095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Treatment sequencing of metastatic breast cancer (MBC) is heterogeneous. The primary objective of this study was to develop a visualization technique to understand population-level treatment sequencing for MBC. Secondary outcomes were to describe the heterogeneity of MBC treatment sequencing, as measured by the proportion of patients with a rare sequence, and to generate hypotheses about the impact of sequencing on overall survival. METHODS This retrospective review evaluated treatment sequencing for patients with MBC in the SEER-Medicare database. Patients with either de novo MBC or International Classification of Diseases, Ninth Revision, diagnosis codes for secondary metastasis (197.XX-198.XX) on two separate dates, excluding breast (198.81, 198.82, 198.2) and lymph nodes (196.XX), were included. Complete Medicare Parts A, B, and D coverage was required. A treatment sequence that fewer than 11 patients received was considered rare. A graphic was created with each nonrare treatment-sequence grouping on the y-axis and time on the x-axis. Bars representing time on hormonal therapy, chemotherapy, human epidermal growth factor receptor 2-targeted therapy, and other targeted therapies were color coded. Kaplan-Meier-like curves were overlaid on treatment maps, using estimated median survival for each sequence. RESULTS Of 6,639 patients with MBC, 56% received a treatment sequence that fewer than 11 other patients received, with 2,985 other unique, rare sequences were identified. Sequence visualization demonstrated differential survival, with longer median survival for those initially receiving hormonal therapy. The median time receiving initial treatment was similar for patients receiving first-line chemotherapy. CONCLUSION Treatment-sequence visualization can enhance the capacity to effectively conceptualize treatment patterns and patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
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