Abstract P1-15-02: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Schwab R, Clark A, Yau C, Wolf D, Chien AJ, Majure M, Ewing C, Wallace A, Roesch E, Helsten T, Forero A, Stringer-Reasor E, Vaklavas C, Nanda R, Jaskowiak N, Boughey J, Haddad T, Han H, Lee C, Albain K, Isaacs C, Elias A, Ellis E, Shah P, Lang J, Lu J, Tripathy D, Kemmer K, Yee D, Haley B, Korde L, Edmiston K, Northfelt D, Viscusi R, Khan Q, I-SPY 2 Consortium, Symmans WF, Perlmutter J, Hylton N, Rugo H, Melisko M, Wilson A, Singhrao R, Asare S, van't Veer L, DeMichele A, Berry D, Esserman L. Withdrawn [abstract].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 P1-15-02.

The value of embedding: integrated palliative care for patients with metastatic breast cancer

PURPOSE

The American Society of Clinical Oncology recommends concurrent palliative care (PC) for patients with metastatic cancer. Recent data show benefits of early PC (at least 90 days before death). However, little is known about PC among patients who die from metastatic breast cancer.

METHODS

Patients with metastatic breast cancer at a comprehensive cancer center. Analysis of medical records and clinician and patient surveys. Assess referral patterns and value to patients at the end of life (EOL) of a specialty PC service embedded in a breast oncology program; compare to a prior period of stand-alone PC.

RESULTS

In the 18-month study period, oncologists referred for palliative care 105 of their 515 (20.4%) patients; 59 (11.5%) patients were seen by the PC physician. Of the 38 referred patients who died, 23 (60.5%) were seen by embedded PC and all 23 received PC within 90 days of death; 0 of 18 decedents with data available for analysis had ICU stays within 30 days of death. In an earlier 24-month period of stand-alone PC, 43 patients died after receiving PC, but only 11 (25.5%) received PC within 90 days of death (p < 0.01) and 7 of 43 had ICU stays within 30 days of death (p = 0.074).

CONCLUSIONS

Embedded PC was well-received by patients and oncologists, increased early PC referrals, and improved EOL care. Avoidable, unnecessary health care utilization at the end of life, such as ICU stays in the last month of life, represent an important potential reduction in patient suffering and system costs.

A common presentation of an uncommon cause of neonatal respiratory distress: pneumonia alba

While lung involvement is an uncommon presentation of congenital syphilis, respiratory distress is a common leading symptom in sick newborns. We describe an infant who presented with respiratory distress thought to be secondary to congenital syphilis and discuss the findings suggestive of an etiology other than respiratory distress syndrome (RDS).

Unusual manifestation of Stevens-Johnson syndrome involving the respiratory and gastrointestinal tract

There are many recognized acute complications of Stevens-Johnson syndrome: however, long-term sequelae involving the respiratory and gastrointestinal tracts are exceedingly rare. We present an 8-year-old girl who developed esophageal stricture and chronic lung disease while recovering from Stevens-Johnson syndrome and discuss these complications with possible mechanisms for their occurrence.

Risk factors for the development of posterior subcapsular cataracts in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis treated with corticosteroids

Posterior subcapsular cataracts (PSCC) occur in a high percentage of patients treated with long-term systemic corticosteroids (Naumann Gott, Apple DJ, eds: Pathology of the Eye. New York: Springer-Verlag, 1986). Fifteen patients with cystic fibrosis treated at Duke University Medical Center between January 1982 and October 1987 required prednisone for treatment of allergic bronchopulmonary aspergillosis (ABPA). Two of these patients (13.3%) were noted to have PSCC during prednisone therapy. We retrospectively examined factors associated with steroid administration that may have been predictive of the development of PSCC in these patients including: 1) steroid therapy for longer than 2 years, 2) steroid dose of 10 mg/day or greater for longer than 6 months, 3) steroid dose of 40 mg/day or greater for longer than 2 months, and 4) change in linear growth pattern during steroid therapy. None of these factors predicted the risk of developing PSCC. Therefore, we recommend that all patients with cystic fibrosis who receive steroids for the treatment of a concomitant condition such as ABPA should undergo careful examination for opacities of the ocular lens at each clinical visit regardless of the duration or dose of steroids.