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Cox K, Dineen N, Weeks J, Allen D, Akolekar D, Chalmers R, Burcombe R, Harper-Wynne C, Jyothirmayi R, Abson C. Enhanced axillary assessment using contrast enhanced ultrasound (CEUS) before neo-adjuvant systemic therapy (NACT) in breast cancer patients identifies axillary disease missed by conventional B-mode ultrasound that may be clinically relevant. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cox KL, Sharma N, Taylor-Phillips S, Weeks J, Mills P, Lim A, Haigh I, Sever A, Wallis M, DeSilva T, Hashem M. Abstract PD2-04: Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound (CEUS) to identify and biopsy sentinel lymph nodes (SLN) in breast cancer is a reproducible technique and may characterise a group of patients who can completely avoid axillary surgery. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd2-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
In patients with breast cancer, avoiding overtreatment of the axilla without compromising oncological outcomes is an important clinical goal. Previous work has suggested that patients with a normal grey-scale ultrasound and benign radiological core biopsy of SLN identified with CEUS are unlikely to have high volume axillary metastases. We therefore assessed the reproducibility of this biopsy technique in multiple centres and in 2 centres, measured the volume of axillary metastases at the end of primary surgical treatment in patients with a false negative SLN core biopsy.
Materials and Methods
Between 2010 and 2016 data were collected on patients with early breast cancer; 1361 from Maidstone Breast Clinic (1) (prospective, sequential), 376 from Tunbridge Wells Breast Clinic (2) (retrospective, sequential), 122 from Leeds Breast Clinic (3) (retrospective, selected) and 48 from Imperial College Healthcare (4) (prospective, selected). Patients at Centres 1 and 2 had a normal grey-scale axillary ultrasound. Patients had a CEUS SLN core biopsy procedure prior to axillary surgery (sentinel lymph node excision (SLNE)/axillary lymph node dissection (ALND)).
Results
SLN were successfully core biopsied (nodal tissue retrieved) in 80% (Centre 1), 79.5% (Centre 2), 77.5% (Centre 3) and 88% (Centre 4). Patients with invasive breast cancer and a successful SLN core biopsy went on to have primary surgical treatment, 816 (Centre 1), 215 (Centre 2), 80 (Centre 3) and 38 (Centre 4). As a test to identify all SLN metastases, the sensitivities were 47.5% (95% CI 39.9-55.1), 52.5% (95% CI 39.1-65.7), 46.4% (95% CI 27.5-66.1) and 45.5% (95% CI 16.7-76.6) respectively. Specificities; 99.7% (95% CI 98.9-100), 98.1 (95% CI 94.5-99.6), 100% (95% CI 93.2-100%) and 96.3% (95% CI 81-99.9) respectively. Negative predictive values; 87.3% (95% CI 84.6-89.6), 84.5% (95% CI 78.4-89.5), 86.9% (95% CI 82.4-90.3) and 86.2% (95% CI 78.4-91.5) respectively. At Centres 1 and 2, 13/637 (2%) and 6/183 (3%) respectively of patients with a benign microbubble/ CEUS SLN core biopsy had 2 or more LN macrometastases found at SLNE/ ALND.
Conclusion
The identification and biopsy of SLN using CEUS is a reproducible technique. Despite the low sensitivity, the negative predictive value is high and in a large cohort of patients from centres 1 and 2, only a small proportion of patients had 2 or more 2 lymph node macro metastases that were both occult on grey-scale ultrasound and missed by SLN core biopsy. In the era of axillary conservation, these results indicate that some patients may be suitable for complete radiological staging of the axilla and thus safely avoid axillary surgery.
Citation Format: Cox KL, Sharma N, Taylor-Phillips S, Weeks J, Mills P, Lim A, Haigh I, Sever A, Wallis M, DeSilva T, Hashem M. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound (CEUS) to identify and biopsy sentinel lymph nodes (SLN) in breast cancer is a reproducible technique and may characterise a group of patients who can completely avoid axillary surgery [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-04.
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Affiliation(s)
- KL Cox
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - N Sharma
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - S Taylor-Phillips
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - J Weeks
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - P Mills
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - A Lim
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - I Haigh
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - A Sever
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - M Wallis
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - T DeSilva
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
| | - M Hashem
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; WMS - Population Evidence and Technologies, University of Warwick, Coventry, United Kingdom; Leeds Breast Unit, Leeds, Yorkshire, United Kingdom; Breast Care Unit, Kings College Hospital, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; Addenbrooke's Treatment Centre, Cambridge, United Kingdom; School of Surgery, KSS, London, United Kingdom
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Cox KL, Sharma N, Leaver A, Lim A, Mills P, Weeks J, Sever A, Hashem M, DeSilva T. Abstract P2-01-34: Identification and biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound (CEUS) in pre-operative breast cancer patients: Early collective experience of the UK Microbubble Group. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-01-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- KL Cox
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - N Sharma
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A Leaver
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A Lim
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - P Mills
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - J Weeks
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A Sever
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Hashem
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - T DeSilva
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom; Leeds Teaching Hospital NHS Trust, Leeds, Yorkshire, United Kingdom; Queen Elizabeth Hospital Gateshead, Gateshead, Tyne and Wear, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
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Jin W, Liu Q, Dougherty DB, Cullen WG, Reutt-Robey JE, Weeks J, Robey SW. C60 chain phases on ZnPc/Ag(111) surfaces: Supramolecular organization driven by competing interactions. J Chem Phys 2015; 142:101910. [DOI: 10.1063/1.4906044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W. Jin
- Department of Chemistry and Biochemistry, University of Maryland at College Park, College Park, Maryland 20742, USA
| | - Q. Liu
- Institute for Physical Science and Technology, University of Maryland, College Park, Maryland 20742, USA
| | - D. B. Dougherty
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - W. G. Cullen
- Department of Physics, University of Maryland at College Park, College Park, Maryland 20742, USA
| | - J. E. Reutt-Robey
- Department of Chemistry and Biochemistry, University of Maryland at College Park, College Park, Maryland 20742, USA
| | - J. Weeks
- Institute for Physical Science and Technology, University of Maryland, College Park, Maryland 20742, USA
| | - S. W. Robey
- National Institute of Standards and Technology, Gaithersburg, Maryland 20878-8372, USA
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Sever AR, Pietrosanu R, Weeks J, Mills P. PB.16. Breast screening mammograms: recall or not to recall. What is the golden ratio? Breast Cancer Res 2014. [PMCID: PMC4243422 DOI: 10.1186/bcr3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Weeks J, Mooney P, Lipscomb G, Pearson JM, Ong A, Singh S. An unexpected finding on gastroscopy: gastro-gastric fistula with Helicobacter pylori and Giardia lamblia. Endoscopy 2014; 45 Suppl 2 UCTN:E118. [PMID: 23716087 DOI: 10.1055/s-0032-1326259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J Weeks
- Department of Gastroenterology, Royal Bolton Hospital NHS Foundation Trust, Bolton, United Kingdom
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Stephenson M, Sever A, Weeks J, Mills P, Fish D, Jones S, Devalia H, Jones P, Cox K. Volume of axillary metastases in patients with early breast cancer and a normal grey-scale axillary ultrasound. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.01.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cox K, Sever A, Jones S, Weeks J, Mills P, Devalia H, Fish D, Jones P. Validation of a technique using microbubbles and contrast enhanced ultrasound (CEUS) to biopsy sentinel lymph nodes (SLN) in pre-operative breast cancer patients with a normal grey-scale axillary ultrasound. Eur J Surg Oncol 2013; 39:760-5. [PMID: 23632319 DOI: 10.1016/j.ejso.2013.03.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/24/2013] [Accepted: 03/27/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In patients with breast cancer, grey-scale ultrasound often fails to identify lymph node (LN) metastases. We aimed to validate the technique of contrast-enhanced ultrasound (CEUS) as a test to identify sentinel lymph node (SLN) metastases and reduce the numbers of patients requiring a completion axillary node clearance (ANC). METHODS 371 patients with breast cancer and a normal axillary ultrasound were recruited. Patients received periareolar intra-dermal injection of microbubble contrast agent. Breast lymphatics were visualised by CEUS and followed to identify and biopsy axillary SLN. Patients then underwent standard tumour excision and either SLN excision (benign biopsy) or axillary clearance (malignant biopsy) with subsequent histopathological analysis. RESULTS The technique failed in 46 patients, 6 patients had indeterminate biopsy results and 24 patients were excluded. In 295 patients with a conclusive SLN biopsy, the sensitivity of the technique was 61% and specificity 100%. Given a benign SLN biopsy result, the post-test probability that a patient had SLN metastases was 8%. 35 patients were found to have SLN metastases and had a primary ANC (29 macrometastases and 6 micrometastases/ITC). There were 22 false negative results (10 macrometastases and 12 micrometastases). Macrometastases in core biopsy specimens correlated with LN macrometastases on surgical excision. CONCLUSION Pre-operative biopsy of SLN reduced the numbers of patients requiring completion ANC. Despite the low sensitivity, only 22 patients (8%) with a benign SLN biopsy were subsequently found to have LN metastases. Without the confirmation of macrometastases on core biopsy specimens, patients with micrometastases/ITC may be inadvertently selected for primary ANC.
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Affiliation(s)
- K Cox
- Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone, Kent ME16 9QQ, United Kingdom.
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Breslin T, Hwang S, Mamet R, Hughes M, Otteson R, Edge S, Moy B, Rugo H, Wong YN, Wilson J, Laronga C, Weeks J, Silver S, Marcom P. Abstract P1-01-13: Patterns of definitive axillary management in the era prior to reporting ACOSOG Z0011: comparison between NCCN Centers and hospitals in Michigan. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-01-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The results of the ACOSOG- Z0011 trial have had potential practice changing implications for the management of patients with positive sentinel lymph node (SLN) undergoing lumpectomy and radiation for breast cancer. However, some evidence suggests a shift in axillary management even prior to the initial report of data supporting sentinel lymph node biopsy (SLNB) alone in mid-2010. We analyzed data in the National Comprehensive Cancer Network (NCCN) outcomes database from NCCN centers and the Michigan Breast Oncology Quality Initiative (MiBOQI) hospitals to examine institutional practice patterns with respect to use of completion axillary dissection (CALND) for SLN positive breast cancer in the years leading up to publication of these trial results. We hypothesized that CALND would be omitted more frequently in women treated at NCCN centers compared to those treated at MiBOQI programs.
Methods: We identified 2,172 women with clinical T1/T2 N0 breast cancer who underwent breast surgery and SLNB and had a positive SLN from 2007 through 2010 at one of 12 participating NCCN centers or 12 MiBOQI sites. Patient and tumor characteristics, definitive breast procedure, year of diagnosis, and institutional affiliation were analyzed as predictors of use of SLNB alone in univariate Chi-Square and multivariable logistic regression models.
Results: CALND was omitted in 314 (14.5%) of the 2,172 patients. Over time, there was a dramatic increase in the use of SLNB alone (12% in 2007 to 23% in 2010). In the univariate analyses, increased patient age, later year of diagnosis, lower T stage, and lower pathologic N stage were significant predictors of use of SLNB alone (all p < .0001). There was no association between definitive breast surgery type, hormone receptor status, Her-2 Neu status, or institutional affiliation and use of SLNB alone. In the multivariable model, older age at diagnosis, later year of diagnosis, and lower pathologic N stage remained significant independent predictors of SLNB alone. There were no significant differences in rates of omission of CALND between NCCN and MIBOQI sites.
Conclusions: Omission of CALND occurred frequently in women with SLN positive breast cancer cared for in both NCCN and MiBOQI institutions in advance of reporting results of ACOSOG-Z0011. This shift was seen in management of patients undergoing lumpectomy as well as mastectomy. Further study is warranted to determine the extent of durable practice changes as well as any impact on survival and local-regional control.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-13.
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Affiliation(s)
- T Breslin
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - S Hwang
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - R Mamet
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - M Hughes
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - R Otteson
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - S Edge
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - B Moy
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - H Rugo
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - Y-N Wong
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - J Wilson
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - C Laronga
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - J Weeks
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - S Silver
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
| | - P Marcom
- University of Michigan, Ann Arbor, MI; Duke University; City of Hope; Dana-Farber/Brigham and Women's Cancer Center; Roswell Park Cancer Institute; University of California San Fransicso; Fox Chase Cancer Center; Ohio State University; Moffitt Cancer Center; Massachusetts General Hospital Cancer Center
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McCormick B, Ottesen R, Hughes M, Javid S, Khan S, Mortimer J, Niland J, Weeks J, Edge S. Impact of Guideline Changes in the Elderly With Early Breast Cancer (BC): Practice Patterns at NCCN Institutions. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weeks J, Swedler D, Pollack K, Agnew J. RISK FACTORS FOR FATALITIES IN SMALL UNDERGROUND COAL MINES IN THE U.S. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580a.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lubbe W, Li T, Hughes M, Ottesen R, Cristofanilli M, Weeks J, Wong YN. P4-20-02: Inflammatory Breast Cancer (IBC) in the National Comprehensive Cancer Network (NCCN): The Disease, the Recurrence Pattern and the Outcome. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-20-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Inflammatory breast cancer (IBC) is a unique clinicopathologic entity that is characterized by rapid progression and aggressive behavior from the onset. The clinical presentation consists of erythema, rapid enlargement of the breast, skin ridging, and a characteristic peau d'orange appearance of the skin secondary to dermal lymphatic tumor involvement. Because of its uncommon presentation leading to frequent misdiagnosis, most reports are from small single institution series which describe a predictable pattern of recurrence in spite of appropriate multidisciplinary treatments. We sought to confirm these observations using the large multi-institutional National Comprehensive Cancer Network (NCCN) outcomes database.
Methods: Patients (pts) with newly diagnosed IBC treated between 1999 and 2009 at 12 participating NCCN institutions were identified. The clinical diagnoses of IBC was based on the AJCC definition and staged as clinical T4d, N0-3, M0-1. The baseline pathological characteristics included histological type, estrogen receptor (ER), progesterone-receptor (PR), and HER-2/neu status. Pts were classified as receiving multimodality therapy if they received two of the following three treatments: surgery (lumpectomy or mastectomy), perioperative (neoadjuvant or adjuvant) systemic therapy, or perioperative radiation therapy.
Results: We identified a cohort of 673 pts with newly diagnosed IBC with a median follow-up of 28.9 months. Of which 195 (29%) had metastatic disease at presentation. The median age at presentation was 52.6 years. Caucasians were 79.4% of the cohort, African American 9.7%, and 11.0% other ethnic groups. Invasive ductal type comprised 84% of histologies. Biomarker assessment revealed ER+ (44.7%), PR+ (34.3%), and Her2/neu+ (33.4%). LVI was documented in 53.3%. Of stage III patients, 75.7% pts received perioperative radiation, 82% received perioperative systemic therapy and 70.7% underwent surgery. All three modalities were received by 64.4% of women. Of the stage III pts, 203 recurred. The most frequent sites of recurrence for were CNS (20.2%), bone (17.2%), chest wall (13.8%), lung (12.3%), liver (11.3%), distant (7.4%) and regional lymph nodes (6.9%). With a median of 30 and 20 months of follow-up for stage III & IV respectively, the median survival was 66 months (95% CI 54–107) for stage III pts and 26 months (95% CI: 22–33) for stage IV Among the 82% of stage III pts who received multimodality therapy, the 5 year and 10 year OS of 62% and 47%.
Discussion: This is a large retrospective multiinstitutional study that confirms the aggressive clinical features, recurrence patterns and adverse prognosis of IBC described in previous single institution series. Even with aggressive multimodal therapy, the long term survival of IBC shorter is than non-IBC. Future investigations are needed to address the aggressive biology of IBC to improve diagnosis and therapy.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-20-02.
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Affiliation(s)
- W Lubbe
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - T Li
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - M Hughes
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - R Ottesen
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - M Cristofanilli
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - J Weeks
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - Y-N Wong
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
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Sever A, Broillet A, Schneider M, Cox K, Jones S, Mills P, Weeks J, Jones P. Intradermal microbubbles and contrast-enhanced ultrasound can dynamically visualise lymphatic channels and sentinel lymph nodes in a swine model and patients with breast cancer. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sarakbi W, Jones S, Mills P, Sever A, Weeks J, Fish D, Withington J, Jones P. In breast cancer, predicting which patients with macrometastasis in sentinel lymph nodes (SLN) have non SLN metastases is not possible. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kwok A, Hu Y, Jiang W, Ting G, Taback N, Weeks J, Greenberg C. Invasive Procedures In Stage IV Cancer Patients. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sever A, Broillet A, Schneider M, Cox K, Jones S, Weeks J, Mills P, Fish D, Jones P. Dynamic visualization of lymphatic channels and sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in a swine model and patients with breast cancer. J Ultrasound Med 2010; 29:1699-1704. [PMID: 21098840 DOI: 10.7863/jum.2010.29.12.1699] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Sentinel lymph node (SLN) identification using intradermal micro-bubbles and contrast-enhanced ultrasound (CEUS) has been recently reported in swine models and patients with breast cancer. The objective of this study was to investigate the dynamics of intradermally administered microbubbles as they travel to draining SLNs in pigs. We also performed a detailed study of the passage of microbubbles through breast lymphatic channels in a small group of patients with breast cancer. METHODS Nine anesthetized healthy pigs were used for the study, and 5 female patients with primary breast cancer were recruited. Pigs received intradermal injections of a microbubble contrast agent in several territories to access lymphatic drainage to regional lymph nodes. Patients had periareolar intradermal injection of the microbubble contrast agent. Ultrasound examination was performed in the real-time contrast pulse sequencing mode with a commercial scanner. RESULTS Sentinel lymph nodes were identified rapidly (<1 minute) and consistently in pigs. Intradermal microbubble injection and CEUS were found to have perfect concordance with the Evans blue dye method in locating swine SLNs. In all 5 patients with breast cancer, the microbubble contrast agent entered breast lymphatic channels and traveled to draining ipsilateral axillary SLNs within 3 minutes. CONCLUSIONS Intradermally injected microbubbles traverse readily though lymphatic channels in pigs and human breast tissue. The ability to rapidly identify SLNs in the diagnostic period would enable targeted biopsy and may facilitate preoperative axillary staging in patients with early breast cancer.
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Affiliation(s)
- Ali Sever
- Department of Radiology, Maidstone Hospital Breast Clinic, Maidstone and Tunbridge Wells National Health Service Trust, Maidstone, Kent, England
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Cox K, Sever A, Jones S, Weeks J, Mills P, Fish D, Broillet A, Schneider M, Jones P. 352 Sentinel lymph node detection using intradermal microbubbles and contrast-enhanced ultrasound in a swine model and patients with breast cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Sever A, Jones S, Cox K, Weeks J, Mills P, Jones P. Preoperative localization of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasonography in patients with breast cancer. Br J Surg 2009; 96:1295-9. [PMID: 19847869 DOI: 10.1002/bjs.6725] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is the standard procedure for axillary staging in early breast cancer. Lymphatic imaging after intraparenchymal microbubble injection has been reported in animal models. The aim of this study was to identify and localize SLNs before surgery by contrast-enhanced ultrasonography after intradermal injection of microbubbles in patients with breast cancer. METHODS Fifty-four consecutive, consenting patients with primary breast cancer were recruited. Patients received a periareolar intradermal injection of microbubble contrast agent. Breast lymphatics were visualized by ultrasonography and followed to identify putative axillary SLNs. A guidewire was deployed to localize the SLN. The next day, patients underwent standard tumour excision and SLN biopsy. RESULTS SLNs were identified and guidewires inserted in 48 patients. In these patients operative findings confirmed that the wired lymph nodes were SLNs. The sensitivity of SLN detection, compared with radioisotope and blue dye, was 89 per cent. Five patients were found to have metastases in SLNs. In these patients the SLNs were identified correctly and localized before surgery with guidewires. CONCLUSION SLNs may be identified and localized before surgery using contrast-enhanced ultrasonography after injection of microbubbles.
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Affiliation(s)
- A Sever
- Department of Radiology, Maidstone Hospital Breast Clinic, The Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
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Sever A, Jones S, Cox K, Weeks J, Mills P, Fish D, Jones P. 5185 Identification and localisation of sentinel lymph nodes using microbubble enhanced ultrasound in pre-operative breast cancer patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Hannemann M, Weeks J, Evans A, Pring A, Hirschowitz L. Incidence, pathology and outcome of gynaecological cancer in patients under the age of 21 years in South-west England 1995–2004: Comparison of data from regional, national and international registries. J OBSTET GYNAECOL 2009; 28:722-7. [DOI: 10.1080/01443610802463462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sever A, Jones S, Cox K, Weeks J, Mills P, Fish D, Jones P. A novel approach to identify sentinel lymph nodes using microbubbles and contrast enhanced ultrasound in preoperative breast cancer patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11543 Background: In patients with early invasive breast cancer, surgical excision of sentinel lymph nodes (SLN) has been shown to be a safe and accurate first-line technique to stage the axilla. In animal models, superficial lymphatics can be imaged using ultrasound and intradermal microbubbles. We investigated the ability of contrast enhanced ultrasound to identify SLN preoperatively in breast cancer patients. Methods: We recruited 46 consecutive consenting patients with primary breast cancer. Pre-operatively; patients received periareolar intra-dermal injection of microbubble contrast agent, breast lymphatics were visualised by ultrasound and followed to identify putative axillary SLN. In 41 patients, we aimed to place guide-wires in the SLN. Patients then underwent standard operative tumour excision, SLN biopsy and histopathological analysis. Results: Microbubble enhancement identified putative SLN in 5 successive patients. In 36 patients, putative SLN were visualised and guide-wires deployed. Operative findings confirmed the wired lymph nodes (LN) were SLN. In 2 cases, SLN contrast enhancement failed but guide-wires were placed into prominent grey-scale imaged LN. These wired LN were not SLN. In 3 patients, the procedure failed. Contrast enhanced ultrasound correctly identified SLN in 36 of 41 patients (88%). Five patients were found to have metastasis. In all metastatic cases, SLN were correctly identified and localised with guide-wires pre-operatively. Conclusions: Microbubbles readily enter breast lymphatics and contrast enhanced ultrasound may represent a practical method to identify SLN. Improvements in percutaneous techniques may facilitate ultrasound guided SLN excision in the breast clinic and could reduce the numbers of patients requiring axillary surgery. No significant financial relationships to disclose.
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Affiliation(s)
- A. Sever
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
| | - S. Jones
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
| | - K. Cox
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
| | - J. Weeks
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
| | - P. Mills
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
| | - D. Fish
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
| | - P. Jones
- Maidstone Hospital Breast Clinic, Maidstone, United Kingdom
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Partridge A, Adloff K, Blood E, Dees EC, Kaelin C, Golshan M, Ligibel J, de Moor JS, Weeks J, Emmons K, Winer E. Risk Perceptions and Psychosocial Outcomes of Women With Ductal Carcinoma In Situ: Longitudinal Results From a Cohort Study. J Natl Cancer Inst 2008; 100:243-51. [DOI: 10.1093/jnci/djn010] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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O'Brien JM, Adair CD, Lewis DF, Hall DR, Defranco EA, Fusey S, Soma-Pillay P, Porter K, How H, Schackis R, Eller D, Trivedi Y, Vanburen G, Khandelwal M, Trofatter K, Vidyadhari D, Vijayaraghavan J, Weeks J, Dattel B, Newton E, Chazotte C, Valenzuela G, Calda P, Bsharat M, Creasy GW. Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 2007; 30:687-96. [PMID: 17899572 DOI: 10.1002/uog.5158] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. Treatment of preterm labor with tocolysis has not been successful in improving infant outcome. The administration of progesterone and related compounds has been proposed as a strategy to prevent preterm birth. The objective of this trial was to determine whether prophylactic administration of vaginal progesterone reduces the risk of preterm birth in women with a history of spontaneous preterm birth. METHODS This randomized, double-blind, placebo- controlled, multinational trial enrolled and randomized 659 pregnant women with a history of spontaneous preterm birth. Between 18 + 0 and 22 + 6 weeks of gestation, patients were assigned randomly to once-daily treatment with either progesterone vaginal gel or placebo until either delivery, 37 weeks' gestation or development of preterm rupture of membranes. The primary outcome was preterm birth at </= 32 weeks of gestation. The trial was analyzed using an intent-to-treat strategy. RESULTS Baseline characteristics were similar in the two treatment groups. Progesterone did not decrease the frequency of preterm birth at </= 32 weeks. There was no difference between the groups with respect to the mean gestational age at delivery, infant morbidity or mortality or other maternal or neonatal outcome measures. Adverse events during the course of treatment were similar for the two groups. CONCLUSION Prophylactic treatment with vaginal progesterone did not reduce the frequency of recurrent preterm birth (</= 32 weeks) in women with a history of spontaneous preterm birth. The effect of progesterone administration in patients at high risk for preterm delivery as determined by methods other than history alone (e.g. sonographic cervical length) requires further investigation.
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Affiliation(s)
- J M O'Brien
- Perinatal Diagnostic Center, Central Baptist Hospital, Lexington, Kentucky, USA.
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25
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DeFranco EA, O'Brien JM, Adair CD, Lewis DF, Hall DR, Fusey S, Soma-Pillay P, Porter K, How H, Schakis R, Eller D, Trivedi Y, Vanburen G, Khandelwal M, Trofatter K, Vidyadhari D, Vijayaraghavan J, Weeks J, Dattel B, Newton E, Chazotte C, Valenzuela G, Calda P, Bsharat M, Creasy GW. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 2007; 30:697-705. [PMID: 17899571 DOI: 10.1002/uog.5159] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the efficacy of vaginal progesterone to prevent early preterm birth in women with sonographic evidence of a short cervical length in the midtrimester. METHODS This was a planned, but modified, secondary analysis of our multinational, multicenter, randomized, placebo-controlled trial, in which women were randomized between 18 + 0 and 22 + 6 weeks of gestation to receive daily treatment with 90 mg of vaginal progesterone gel or placebo. Cervical length was measured with transvaginal ultrasound at enrollment and at 28 weeks of gestation. Treatment continued until either delivery, 37 weeks of gestation or development of preterm rupture of membranes. Maternal and neonatal outcomes were evaluated for the subset of all randomized women with cervical length < 28 mm at enrollment. The primary outcome was preterm birth at </= 32 weeks. RESULTS A cervical length < 28 mm was identified in 46 randomized women: 19 of 313 who received progesterone and 27 of 307 who received the placebo. Baseline characteristics of the two groups were similar. In women with a cervical length < 28 mm, the rate of preterm birth at </= 32 weeks was significantly lower for those receiving progesterone than it was for those receiving the placebo (0% vs. 29.6%, P = 0.014). With progesterone, there were fewer admissions into the neonatal intensive care unit (NICU; 15.8% vs. 51.9%, P = 0.016) and shorter NICU stays (1.1 vs. 16.5 days, P = 0.013). There was also a trend toward a decreased rate of neonatal respiratory distress syndrome (5.3% vs. 29.6%, P = 0.060). CONCLUSION Vaginal progesterone may reduce the rate of early preterm birth and improve neonatal outcome in women with a short sonographic cervical length.
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Affiliation(s)
- E A DeFranco
- Department of Obstetrics and Gynecology and Center for Preterm Birth Research, Washington University School of Medicine, St. Louis, Missouri, USA.
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26
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Falconer AD, Hirschowitz L, Weeks J, Murdoch J. The impact of improving outcomes guidance on surgical management of vulval squamous cell cancer in southwest England (1997-2002). BJOG 2007; 114:391-7. [PMID: 17378814 DOI: 10.1111/j.1471-0528.2006.01181.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the impact of reorganisation of gynaecological services in southwest England following adoption of regionally agreed evidence-based guidelines and publication of the National Improving Outcomes Guidance in 1999. DESIGN Prospective audit with cross-checking against histological reports. SETTING All 19 acute hospitals in the four Cancer Networks of southwest England. SAMPLE All subjects with squamous or verrucous vulval cancer diagnosed between 1997 and 2002. METHOD A one-page minimum data set proforma agreed by the South West Gynaecology Tumour Panel was completed by surgeons after treatment of each patient, and was sent to South West Cancer Intelligence Service for entry, collation and analysis. Data are presented for the years 1997 to 2002 inclusive, and comparisons were made between each of the three 2-year cohorts. MAIN OUTCOME MEASURES These are standards derived from the guidance. RESULTS There were 436 squamous or verrucous vulval cancers registered. Recording of staging was missing in 20% of subjects. The percentage of subjects operated upon by lead gynaecological cancer surgeons increased from 78% in cohort 1 to 93% in cohort 3 (P < 0.001). There is a trend towards more conservative operations, which have lower co-morbidity. High activity surgeons achieved better rates of tumour-free skin margins, but even these were adequate only in 49% of operations. Lymphadenectomy rates did not follow guidance. CONCLUSION Centralisation of care of this rare cancer should continue, but specialists need to increase their efforts to ensure adequate skin margins and lymphadenectomy rates while balancing morbidity and the likelihood of recurrence in both fit and frail patients.
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Affiliation(s)
- A D Falconer
- Department of Gynaecology, Derriford Hospital, Plymouth, UK
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27
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Bailey J, Murdoch J, Anderson R, Weeks J, Foy C. Stage III and IV ovarian cancer in the South West of England: five-year outcome analysis for cases treated in 1998. Int J Gynecol Cancer 2006; 16 Suppl 1:25-9. [PMID: 16515563 DOI: 10.1111/j.1525-1438.2006.00318.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study evaluates the 5-year outcome data for the management of advanced ovarian cancer in the South West of England. Anonymized data for 361 stage III and IV ovarian cancers registered between January 1, 1998, and December 31, 1998, were obtained from the central gynecological tumor database. The following data were identified: age at diagnosis, FIGO stage, American Society of Anesthesiologists (ASA) grade, tumor differentiation, treating network and surgeon, amount of residual disease after debulking surgery, current life status, and date of death if applicable. Survival analysis was performed using Kaplan-Meier crude survival for univariate analysis, and multivariate analysis was performed by Cox regression. In our data the 5-year survival for patients with stage III was 16% and with stage IV was 10%. Survival analysis demonstrated that patients in whom the disease was debulked to less than 1 cm were more likely to be alive 5 years after diagnosis than those with a 2-cm residuum (P < 0.0001). There was no significant survival difference for those patients operated on by subspecialist surgeons despite these surgeons being twice as likely to achieve optimal debulking. Therefore, there must be other variables influencing survival apart from cytoreductive surgery. While there is near-complete data collection about ovarian cancer surgery, our database on chemotherapy is incomplete. This is clearly crucial for a complete view of cancer care in our region.
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Affiliation(s)
- J Bailey
- St. Michael's Hospital, Bristol, United Kingdom.
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28
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Earle CC, Landrum M, Jeffrey S, Neville B, Weeks J, Ayanian J. Consistency in regional trends of aggressiveness in cancer care near the end of life for elderly Americans, 1991–2000. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6004 Background: We have previously developed and reported on performance measures assessing the aggressiveness of cancer treatment near the end of life for selected cancers during 1993–96. Methods: We compared the care delivered in the 77 Health Care Service Areas (HCSAs) monitored by the Surveillance, Epidemiology, and End Results (SEER) program to all Medicare-eligible patients aged 65 and over who died of cancer (any diagnosis) between 1991 and 2000. We used hierarchical regression models to estimate regional variation in both levels and trends of each indicator. We then ranked each region according to the model-estimated rate of each indicator and computed the correlation among relative ranks of each region over the ten-year study period. Results: 215,488 patients met eligibility criteria. Within this broader and more recent sample we confirmed previous observations of steadily and significantly increasing use of chemotherapy within 2 weeks of death, emergency room visits, and intensive care unit admissions in the last month of life, and, among those admitted to hospice, an increasing proportion of late admissions within 3 days of death. There was significant regional variation in all measures, but the relative rankings of health care service areas from one year to the next were stable, with correlations of ranks ranging from .91–.98 from 1991–1992, and .66–.84 over the 5-year span from 1991–1995. Because of significant regional variation in trends, we found only moderate correlations ranging from .40–.61 over the entire decade. Conclusions: Cancer treatment near the end of life continued to become increasingly aggressive over the 1990s, however, there was significant regional variation in trends. The stability of regional practice patterns supports the reliability of these measures for quality surveillance purposes. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- C. C. Earle
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - M. Landrum
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - S. Jeffrey
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - B. Neville
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - J. Weeks
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - J. Ayanian
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
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Bailey J, Murdoch J, Anderson R, Weeks J, Foy C. Stage III and IV ovarian cancer in the South West of England: five-year outcome analysis for cases treated in 1998. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200602001-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This study evaluates the 5-year outcome data for the management of advanced ovarian cancer in the South West of England. Anonymized data for 361 stage III and IV ovarian cancers registered between January 1, 1998, and December 31, 1998, were obtained from the central gynecological tumor database. The following data were identified: age at diagnosis, FIGO stage, American Society of Anesthesiologists (ASA) grade, tumor differentiation, treating network and surgeon, amount of residual disease after debulking surgery, current life status, and date of death if applicable. Survival analysis was performed using Kaplan–Meier crude survival for univariate analysis, and multivariate analysis was performed by Cox regression. In our data the 5-year survival for patients with stage III was 16% and with stage IV was 10%. Survival analysis demonstrated that patients in whom the disease was debulked to less than 1 cm were more likely to be alive 5 years after diagnosis than those with a 2-cm residuum (P < 0.0001). There was no significant survival difference for those patients operated on by subspecialist surgeons despite these surgeons being twice as likely to achieve optimal debulking. Therefore, there must be other variables influencing survival apart from cytoreductive surgery. While there is near-complete data collection about ovarian cancer surgery, our database on chemotherapy is incomplete. This is clearly crucial for a complete view of cancer care in our region.
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30
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Danilowicz C, Kafri Y, Conroy RS, Coljee VW, Weeks J, Prentiss M. Measurement of the phase diagram of DNA unzipping in the temperature-force plane. Phys Rev Lett 2004; 93:078101. [PMID: 15324279 DOI: 10.1103/physrevlett.93.078101] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Indexed: 05/23/2023]
Abstract
We separate double stranded lambda phage DNA by applying a fixed force at a constant temperature ranging from 15 to 50 degrees C, and measure the minimum force required to separate the two strands. The measurements also offer information on the free energy of double stranded DNA (dsDNA) at temperatures where dsDNA does not thermally denature in the absence of force. While parts of the phase diagram can be explained using existing models and free energy parameters, others deviate significantly. Possible reasons for the deviations between theory and experiment are considered.
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Affiliation(s)
- C Danilowicz
- Physics Department, Harvard University, Cambridge, Massachusetts 02138, USA
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Romanus D, Neumann P, Earle C, Weinstein M, Tsai J, Neville B, Weeks J. Out-of-pocket costs (OPC) and time costs (TC) for patients with stage IV non-small cell lung cancer (NSCLC) and their caregivers. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Romanus
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
| | - P. Neumann
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
| | - C. Earle
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
| | - M. Weinstein
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
| | - J. Tsai
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
| | - B. Neville
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
| | - J. Weeks
- Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA
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32
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Adloff KO, Partridge A, Blood E, Dees C, Kaelin C, Weeks J, Emmons K, Winer E. Accuracy of risk perceptions of women with ductal carcinoma in situ. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. O. Adloff
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - A. Partridge
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - E. Blood
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - C. Dees
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - C. Kaelin
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - J. Weeks
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - K. Emmons
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
| | - E. Winer
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Brigham and Women's Hospital, Boston, MA
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Ng AK, Li S, Neuberg D, Silver B, Weeks J, Mauch P. Factors influencing treatment recommendations in early-stage Hodgkin’s disease: a survey of physicians. Ann Oncol 2004; 15:261-9. [PMID: 14760120 DOI: 10.1093/annonc/mdh044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to explore variation in practice patterns and identify factors associated with physicians' treatment decisions for early-stage Hodgkin's disease. METHODS We conducted a one-time mail survey of oncologists randomly selected from directories of national oncology societies (n = 207) and Hodgkin's disease experts (n = 147). The survey included questions on (i) physician factors, (ii) preferred treatment choices for six case scenarios of early-stage Hodgkin's disease that varied by patient factors, and (iii) thresholds for changing treatment recommendations. RESULTS The response rate was 50%. For non-bulky Hodgkin's disease, 69% of respondents chose combined modality therapy (CMT). On multivariate analysis, physician factors that independently predicted for choice of CMT included a high Hodgkin's disease case load (P = 0.02) and a high percentage of patients enrolled in clinical trials (P = 0.05). Radiation oncologists had a lower threshold for adding radiation therapy (P = 0.02). More experience with second malignancy cases and longer time in practice were associated with a higher threshold for adding radiation therapy (P = 0.04 and P = 0.008, respectively). In stratified analyses, treatment decisions of non-experts were significantly influenced by physician factors, but not by patient factors. Conversely, choices of Hodgkin's disease experts were insensitive to all physician factors, but experts were significantly more likely to select chemotherapy alone in young women and CMT in older patients. CONCLUSIONS Our results indicate that physician factors including practice type and experience may in part explain variation in practice pattern for Hodgkin's disease therapy. Hodgkin's disease experts are more likely to tailor therapy according to individual patient factors.
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Affiliation(s)
- A K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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Abstract
This study investigated the management of women with apparent early ovarian cancer in the South West region of England. This was retrospective review of prospectively collected data supplement by case note review. All women registered with stage 1 ovarian cancer in the 2 years from January 1997 to December 1998 were identified from the database of the Regional Cancer Organisation (RCO). Data on staging and subsequent management were obtained from the RCO database. Additional information was collected from the patients' casenotes. We considered the accuracy of staging, consideration of fertility-sparing surgery, evidence of multidisciplinary approach to management, appropriateness of oncological referral and adjuvant therapy. Of 222 cases of stage 1 ovarian cancer identified from the RCO database, 168 casenotes were available for inspection. Eighty-seven cases were confirmed as FIGO stage 1 but the substage was amended in 21 cases. There were insufficient data available in 75 cases to confirm the stage assigned. Six cases were re-staged to FIGO stage 3a. Fertility-sparing surgery was considered in four of 10 nulliparous patients of reproductive age. Thirty-nine patients with disease more advanced than FIGO stage 1b were not referred for onco1 logical opinion. Even after Calmine-Hine guidelines are implemented, women with early ovarian cancer may still be treated in general hospitals. There is an urgent need to provide clear local guidelines for the management of these patients.
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Abstract
The surgical management of epithelial ovarian cancer in the South West of England was studied in the two years 1997-1998 in order to determine the factors that influence the outcome of surgery and to provide a baseline from which to assess the effect of centralisation of cancer services. All hospitals in the South West region of England participating in the Regional Cancer Organisation's longitudinal study of outcomes in gynaecological malignancies are included. Six hundred and eighty-two patients with epithelial ovarian cancer were registered with the RCO in the two-year study period. Five hundred and ninety-five women were offered primary cytoreductive surgery of which 438 were said to be optimally cytoreduced. Applying multivariate models to analyse the outcome of surgery, older patients (OR = 0.82 per 5-year increase in age, P = 0.0003), patients treated in hospitals managing fewer than ten cases of ovarian cancer per year (OR = 1.92, P = 0.02) and patients with FIGO stage 3 (OR = 0.02, P < 0.0001) or 4 (OR = 0.002, P < 0.0001) disease were less likely to be optimally cytoreduced. Gynaecological oncologists were 2.06 times more likely to attain optimal cytoreduction when compared to general gynaecologists and this was statistically significant (P = 0.01). The results from this study support the argument that limiting surgery for ovarian malignancy to specialised surgeons improves the extent of cytoreductive surgery.
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Affiliation(s)
- A Olaitan
- Department of Gynaecological Oncology, St Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK
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McCrum A, Howe K, Weeks J, Kirkpatrick A, Murdoch J. A prospective regional audit of surgical management of endometrial cancer in the South and West of England. J OBSTET GYNAECOL 2001; 21:605-9. [PMID: 12521780 DOI: 10.1080/01443610120085582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The results of a prospective audit of surgical management of endometrial cancer in the South and West of England is presented. A minimum data set was defined and information collected prospectively. There was limited tertiary referral to a gynaecological oncologist. The role of centralisation of endometrial cancer care has been questioned, as surgery has traditionally been simple in patients perceived to be at increased risk of more radical surgery. However, this audit demonstrates that standards of even this simple care within the region are often inadequate, with only one-third of patients having basic staging procedures performed fully. This has important implications for patients management, future interpretation of outcome data and clinical governance in endometrial cancer care.
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Affiliation(s)
- A McCrum
- St Michael's Hospital, Bristol, UK
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Stewart D, Weeks J, Bent S. Utilization, patient satisfaction, and cost implications of acupuncture, massage, and naturopathic medicine offered as covered health benefits: a comparison of two delivery models. Altern Ther Health Med 2001; 7:66-70. [PMID: 11452569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
CONTEXT Increasing numbers of health plans in the United States offer complementary and alternative medicine (CAM) benefits despite limited information. OBJECTIVE To determine the utilization rates and costs associated with providing CAM services in 2 benefit designs, and to determine the satisfaction of patients in both plans. DESIGN Two health plans were identified: a traditional indemnity plan offered through a defined preferred provider organization (PPO) of CAM providers and a health maintenance organization (HMO). Costs and utilization rates for CAM services were compared during a 1-year period of coverage beginning November 1, 1996. SETTING AND PARTICIPANTS 1091 patients in both plans who used CAM services during the month of May 1997 in Washington state. RESULTS Only 1% of all patients covered for CAM accessed these services during the study period. A significantly higher percentage of patients in the PPO plan (1.2%) used CAM services compared to the HMO plan (0.6%) (P < .001). However, the average total cost of annual CAM services (plan benefit + user contribution) was similar ($347 in the HMO and $376 in the PPO), and the price per member per month was nearly identical ($0.20 in the HMO and $0.19 in the PPO). Most users perceived these services as helpful. CONCLUSIONS Utilization of CAM services and per member per month costs were lower than expected given the high interest in CAM services reported in consumer surveys. The high level of satisfaction with CAM services and self-reported decrease in the use of pain medications suggests the need for prospective studies examining the effect of CAM treatments.
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Weeks J. Comment on Cleary-Guida et al.: CAM coverage. Survey outcomes pose more critical questions. J Altern Complement Med 2001; 7:275-6. [PMID: 11439849 DOI: 10.1089/107555301300328151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Weeks
- Integration Strategies for Natural Healthcare, Seattle, WA, USA.
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Lilenbaum R, Herndon J, List M, Desch C, Watson D, Holland J, Weeks J, Green M. Single-agent versus combination chemotherapy in advanced non-small cell lung cancer (NSCLC): A CALGB randomized trial of efficacy, quality of life, and cost-effectiveness. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81051-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Weeks J. C. A. M. Complementary & alternative medicine. Mission & money in integrative medicine. Health Forum J 2001; 44:44. [PMID: 11225560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Garite TJ, Weeks J, Peters-Phair K, Pattillo C, Brewster WR. A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women. Am J Obstet Gynecol 2000; 183:1544-8. [PMID: 11120525 DOI: 10.1067/mob.2000.107884] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE One variable that has the potential to affect the course of labor but has not been evaluated previously is the adequacy of maternal hydration. Typical orders provide for 125 mL of intravenous fluids per hour in patients taking limited oral fluids. Many such patients are clinically dehydrated. Physiologists have shown that increased fluids improve skeletal muscle performance in prolonged exercise. This study was designed to determine whether increased intravenous fluids affect the progress of labor. STUDY DESIGN Nulliparous women with uncomplicated singleton gestations at term, in spontaneous active labor with dilatation between 2 and 5 cm, and with a cephalic presentation were included. Patients who gave consent were randomly selected to receive either 125 mL or 250 mL of intravenous fluids per hour. RESULTS One hundred ninety-five patients were randomly selected, 94 to the 125-mL group and 101 to the 250-mL group. Prerandomization variables were well matched between the 2 groups. The mean volume of total intravenous fluids was significantly greater in the 250-mL group (2008 mL vs 2487 mL; P =.002), as was the mean hourly rate (152 mL/h in the 125-mL group vs 254 mL/h in the 250-mL group; P =.001). The frequency of labor lasting >12 hours was statistically higher in the 125-mL group (20/78 [26%] vs 12/91 [13%]; P =.047). In addition, there was a trend favoring longer mean duration of the first stage and total duration of labor in patients delivered vaginally in the 125-mL group, by 70 and 68 minutes, respectively (P =.06). There was a trend toward a lower frequency of oxytocin administration for inadequate labor progress in the higher fluid rate group (61 [65%] in the 125-mL group vs 51 [49%] in the 250-mL group; P =.06). Cesarean deliveries were more frequent in the 125-mL group (n = 16) than in the 250-mL group (n = 10) but did not reach statistical significance. CONCLUSION This study presents the novel finding that increasing fluid administration for nulliparous women in labor above rates commonly used is associated with a lower frequency of prolonged labor and possibly less need for oxytocin. Thus inadequate hydration in labor may be a factor contributing to dysfunctional labor and possibly cesarean delivery. Consideration of this factor in clinical management and in future studies considering variables that affect labor is warranted.
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Affiliation(s)
- T J Garite
- University of California Irvine Medical Center, Orange 92868, USA
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Weeks J. What makes a physician an expert in CAM? Med Econ 2000; 77:109-10, 117. [PMID: 11010271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Weeks J. Is alternative medicine more cost-effective? Med Econ 2000; 77:139-42. [PMID: 10977200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Weeks J. How alternative providers get their credentials. Med Econ 1999; 76:130, 133-4. [PMID: 10788235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Schrag D, Weeks J. Costs and cost-effectiveness of colorectal cancer prevention and therapy. Semin Oncol 1999; 26:561-8. [PMID: 10528905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
For cancer, the evaluation of new prevention and therapeutic strategies has traditionally focused almost exclusively on safety and efficacy. However, comparison of the costs and cost-effectiveness of medical interventions is increasingly being recognized as an important goal. Cancer care is a prime target for scrutiny because US cancer treatment consumes over $40 billion per year or approximately 12% of total health care expenditures. Colorectal cancer (CRC) treatment costs over $6.5 billion per year and, among malignancies, is second only to breast cancer at $6.6 billion per year. Nonetheless, there are relatively few published studies addressing the economic consequences of CRC. This review describes the strengths and limitations of the major types of health economic analyses, as well as the existing literature on the costs and cost-effectiveness of CRC prevention and treatment. Although standard approaches to both CRC screening and treatment appear cost-effective when compared with no intervention, the relative cost-effectiveness of different screening, treatment, and posttherapeutic surveillance strategies remains uncertain. As databases and information systems able to integrate comprehensive cost and treatment data grow in availability and sophistication, it should become easier to compare the impact of various approaches in terms of both traditional and economic outcomes. Over the next few years, the results of the first clinical trials that prospectively assess economic end points in CRC are anticipated; the experience resulting from these efforts should stimulate and enhance future studies.
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Affiliation(s)
- D Schrag
- Center for Outcomes and Policy Research and Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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Weeks J. Moving CAM (complementary and alternative medicine) out of quarantine. Health Forum J 1999; 42:29-32. [PMID: 10621215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Weeks J. Outcomes assessment in the NCCN: 1998 update. National Comprehensive Cancer Network. Oncology (Williston Park) 1999; 13:69-71. [PMID: 10370922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The assessment of outcomes is a major priority of the National Comprehensive Cancer Network (NCCN). To date, the NCCN's outcomes program has (1) made a systematic inventory of member institutions' existing data sources; (2) begun a collaborative project with the National Cancer Data Bank to compare specific surgical patterns of care in NCCN institutions with national norms; and (3) begun the creation of a prospective outcomes database within the NCCN. As the first step in the database initiative, five NCCN institutions participated in a pilot project in one disease, breast cancer, aimed at developing and testing techniques of data collection, aggregation, and analysis. Six more sites were added to the pilot program in 1998. As of September 1998, data on over 1,000 unique cases had been submitted to the database, with the number of additional cases expected to triple or quadruple within the ensuing 12 months. Future plans call for (1) further expansion of the breast cancer database, both in terms of the number of institutions participating and the scope of data being collected; (2) the addition of a second disease, non-Hodgkin's lymphoma, to the database; and (3) the establishment of partnerships with other organizations for whom the database might provide useful information, such as insurers, pharmaceutical and biotechnology firms, and regulatory and accrediting bodies.
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Affiliation(s)
- J Weeks
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Abstract
BACKGROUND Effective mite allergen avoidance measures are presumed to reduce airborne allergens yet the quantity in the air is rarely measured. OBJECTIVE To monitor airborne allergen during a placebo-controlled mite allergen avoidance study. METHODS Bedrooms of 56 atopic asthmatic children were randomly allocated to hot washing and encasing covers + acaricide (active regime) or placebo treatment. Dust was collected from the mattress, bedding and carpets; airborne allergen was measured using Casella samplers and dust settling in open Petri dishes. Der p 1, Der p 2 and Fel d 1 were measured. RESULTS After 24 weeks of mite allergen avoidance the Casella air-samplers collected Der p 1 less frequently in active than placebo-treated bedrooms (0 vs. 29%, P<0.05) and Petri dishes in the active group collected less than baseline (0.2 vs. 0.6 ng/day P<0.05). Homes without cats had less cat allergen than cat-owning homes and when actively treated for 24 weeks showed a greater reduction (P = 0.03) in mattress cat allergen than the placebo group. CONCLUSION Encasing covers and hot washing of bed linen reduced mite aeroallergen (and mattress cat allergen in the absence of cats). This could mean dual benefits to a patient sensitive to both mite and cat.
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Affiliation(s)
- F Carswell
- Institute of Child Health, Royal Hospital for Sick Children, Bristol, UK
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Abstract
Using a surveillance system that captures data on construction workers treated in an urban emergency department, we identified a series of injuries caused by vessels and tools under air pressure. We describe those six cases, as well as similar cases found in the Census of Fatal Occupational Injuries; we also review data from the National Surveillance for Traumatic Occupational Fatalities database and data from the Bureau of Labor Statistics. Among the injuries and deaths for which we had good case descriptions, the majority would have been prevented by adherence to existing Occupational Safety and Health Administration standards in the construction industry.
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Affiliation(s)
- L S Welch
- Department of Environmental and Occupational Health, George Washington University, Washington, DC, USA
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