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Villarreal-Garza C, Lopez-Martinez EA, Deneken-Hernandez Z, Maffuz-Aziz A, Muñoz-Lozano JF, Barragan-Carrillo R, Ramos-Elias P, Moreno B, Diaz-Perez H, Peña-Curiel O, Curiel-Valdez JDJ, Bautista-Piña V. Change in therapeutic management after the EndoPredict assay in a prospective decision impact study of Mexican premenopausal breast cancer patients. PLoS One 2020; 15:e0228884. [PMID: 32160201 PMCID: PMC7065749 DOI: 10.1371/journal.pone.0228884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the change in adjuvant therapeutic decision in a cohort of young women with breast cancer discussed by a multidisciplinary team, before and after EndoPredict testing. Patients and methods 99 premenopausal women with hormone receptor-positive, HER2-negative, T1-T2, and N0-N1 breast cancer were included. Clinicopathological characteristics were recorded and cases were presented in a multidisciplinary tumor board. Consensual therapeutic decisions before and after EndoPredict results were registered. Medical records were reviewed at six-month follow-up to determine physicians’ adherence to therapeutic recommendations. Pearson chi-square and McNemar’s tests were used to analyze differences between groups and changes in treatment recommendations, respectively. Results Median age at diagnosis was 43 years. The most frequent tumor size was pT2 (53.5%) and 27% of patients had 1–3 positive lymph nodes. 46% of patients had a low-risk EPclin result. Nodal status and tumor grade were significantly associated with EPclin result (p < .00001 and p = .0110, respectively), while Ki67 levels and age ≤40 years were not. A change in chemotherapy decision was registered in 19.2% of patients (p = .066), with the greatest impact in de-escalation (9% net reduction). A change in chemotherapy or endocrine therapy regimen was suggested in 19% and 20% of cases, respectively, after EPclin results were available. A significant difference was found in the median EPclin score between patients with a low- vs. high-intensity chemotherapy and endocrine therapy regimen recommendation (p = 0.049 and p = 0.0001, respectively). Tumor board treatment recommendation adherence with the EndoPredict result was 95% and final treatment adherence to EPclin result was 93%. Conclusions The EndoPredict test successfully assisted the clinical decision-making process in premenopausal patients, with a clinically significant change in overall decision-making, with the greatest impact seen in chemotherapy reduction, and a high rate of therapeutic adherence.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
- Research and Breast Cancer Department, Instituto Nacional de Cancerologia, Mexico City, Mexico
- * E-mail:
| | | | | | | | | | | | - Pier Ramos-Elias
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
| | - Brizio Moreno
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
| | - Hector Diaz-Perez
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
| | - Omar Peña-Curiel
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
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Villarreal-Garza C, Platas A, Miaja M, Lopez-Martinez EA, Muñoz-Lozano JF, Fonseca A, Pineda C, Barragan-Carrillo R, Martinez-Cannon BA, Chapman JAW, Goss PE, Bargallo-Rocha JE, Mohar A, Castro-Sanchez A. Abstract P1-11-17: Effects of depression, anxiety, and sexual functioning on quality of life among young breast cancer patients in Mexico. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-11-17] [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: Despite the disproportionately high-rates of breast cancer (BC) in young women in Mexico, cancer-control efforts have been predominantly aimed at improving oncological treatment, bypassing survivorship issues and supportive care for this group. The “Joven & Fuerte” cohort, the first supportive care and research program for young BC patients in Latin America, aims to describe and assess the burden of BC in young Mexican women. In this study, we focused on evaluating the association between quality of life (QoL) and anxiety, depression, and sexual functioning in young women with BC (≤ 40 years).
Methods: This study included non-metastatic and non-recurrent patients belonging to the cohort's pilot phase. QoL was assessed with the EORTC QLQ-C30 global score. Patients were classified in the domains of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) as either probable case, doubtful case, or not a case. Sexual functioning was assessed with the Female Sexual Function Index (FSFI) and the sexual functioning and enjoyment domains of the EORTC QLQ-BR23. Assessments were performed at baseline, 6 months, 1 year, and 2 years. Pearson chi-square and analysis of variance (ANOVA) were used for analysis. Nominal unadjusted significance is reported with p<0.05.
Results: 73 out of 96 (76%) pilot phase patients met the inclusion criteria and had complete assessments up to 2 years follow-up. Global QoL was significantly worse for cases with anxiety and depression at baseline (means for non-cases, doubtful cases and cases, respectively: for anxiety, 81.09, 69.54, and 61.54, p<.001; and for depression, 75.63, 64.17, and 55.00, p=0.01) and depression at 6 months (76.55, 66.67, and 35.42, respectively, p<.001). Classification of case level anxiety was associated with FSFI morbidity during the first year (baseline, p=0.03; 6 months, p=0.09; 1 year, p=0.04). There was no significant association between case level depression and FSFI morbidity in the first 2 years. Neither anxiety nor depression was generally associated with significantly different BR23 sexual functioning or sexual enjoyment; however, a sporadic association was observed between anxiety and BR23 sexual functioning at 6 months (p=0.04).
Conclusion: This study confirmed an association between anxiety and/or depression and worse QoL at diagnosis of BC and after 6 months. Additionally, worse sexual function was significantly associated with the classification of case level anxiety. These findings support the current recommendation that physicians should regularly assess patients' psychosocial health and sexual functioning and provide prompt referral to corresponding supportive care services. Additional efforts must be conducted in low-resource settings, where sexual health and psychosocial care are not considered routine cancer treatment. Dedicated programs that promote multidisciplinary and supportive care services, such as “Joven & Fuerte”, should be incorporated into institutional health-care protocols to systematically address patients' emerging needs and improve QoL.
Citation Format: Villarreal-Garza C, Platas A, Miaja M, Lopez-Martinez EA, Muñoz-Lozano JF, Fonseca A, Pineda C, Barragan-Carrillo R, Martinez-Cannon BA, Chapman J-AW, Goss PE, Bargallo-Rocha JE, Mohar A, Castro-Sanchez A. Effects of depression, anxiety, and sexual functioning on quality of life among young breast cancer patients in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-17.
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Affiliation(s)
- C Villarreal-Garza
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - A Platas
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - M Miaja
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - EA Lopez-Martinez
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - JF Muñoz-Lozano
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - A Fonseca
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - C Pineda
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - R Barragan-Carrillo
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - BA Martinez-Cannon
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - J-AW Chapman
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - PE Goss
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - JE Bargallo-Rocha
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - A Mohar
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - A Castro-Sanchez
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Instituto Nacional de Cancerologia, Mexico City, Mexico; Breast Cancer Center, Tecnologico de Monterrey, Monterrey, Mexico; (Retired) Canadian Cancer Trials Group, Queen's University, Kingston, Canada; Global Cancer Institute, Boston; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico City, Mexico
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Villarreal-Garza CM, Platas A, Miaja M, Fonseca A, Lopez-Martinez EA, Martinez-Cannon BA, Barragan-Carrillo R, Muñoz-Lozano JF, Vega Y, Chapman JAW, Inoyo IE, Goss PE, Bargallo-Rocha E, Mohar A, Peña-Curiel O, Castro-Sanchez A. Changes in quality of life at baseline, 6, and 12-months of the “Joven y Fuerte” prospective cohort pilot phase. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18854] [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)
| | - Alejandra Platas
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Melina Miaja
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Alan Fonseca
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Edna Anakarenn Lopez-Martinez
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | | | - Regina Barragan-Carrillo
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Jose Felipe Muñoz-Lozano
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Yoatzin Vega
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | | | | | | | - Enrique Bargallo-Rocha
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Alejandro Mohar
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Omar Peña-Curiel
- Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
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