Can the Reboot coaching programme support critical care nurses in coping with stressful clinical events? A mixed-methods evaluation assessing resilience, burnout, depression and turnover intentions

BACKGROUND

Critical care nurses (CCNs) are routinely exposed to highly stressful situations, and at high-risk of suffering from work-related stress and developing burnout. Thus, supporting CCN wellbeing is crucial. One approach for delivering this support is by preparing CCNs for situations they may encounter, drawing on evidence-based techniques to strengthen psychological coping strategies. The current study tailored a Resilience-boosting psychological coaching programme [Reboot] to CCNs. Other healthcare staff receiving Reboot have reported improvements in confidence in coping with stressful clinical events and increased psychological resilience. The current study tailored Reboot for online, remote delivery to CCNs (as it had not previously been delivered to nurses, or in remote format), to (1) assess the feasibility of delivering Reboot remotely, and to (2) provide a preliminary assessment of whether Reboot could increase resilience, confidence in coping with adverse events and burnout.

METHODS

A single-arm mixed-methods (questionnaires, interviews) before-after feasibility study design was used. Feasibility was measured via demand, recruitment, and retention (recruitment goal: 80 CCNs, retention goal: 70% of recruited CCNs). Potential efficacy was measured via questionnaires at five timepoints; measures included confidence in coping with adverse events (Confidence scale), Resilience (Brief Resilience Scale), depression (PHQ-9) and burnout (Oldenburg-Burnout-Inventory). Intention to leave (current role, nursing more generally) was measured post-intervention. Interviews were analysed using Reflexive Thematic Analysis.

RESULTS

Results suggest that delivering Reboot remotely is feasible and acceptable. Seventy-seven nurses were recruited, 81% of whom completed the 8-week intervention. Thus, the retention rate was over 10% higher than the target. Regarding preliminary efficacy, follow-up measures showed significant increases in resilience, confidence in coping with adverse events and reductions in depression, burnout, and intention to leave. Qualitative analysis suggested that CCNs found the psychological techniques helpful and particularly valued practical exercises that could be translated into everyday practice.

CONCLUSION

This study demonstrates the feasibility of remote delivery of Reboot and potential efficacy for CCNs. Results are limited due to the single-arm feasibility design; thus, a larger trial with a control group is needed.

Social Capital and Formal Volunteering Among Family and Unpaid Caregivers of Older Adults

Using data from 1745 caregivers in the National Study of Caregiving (2017), this study explores the connection between caregiving and formal volunteering by identifying the relationship between social capital and formal volunteering among family and other unpaid caregivers of older adults. In addition, this study examines the representative prevalence of formal volunteering in caregivers. We conducted logistic regression models along with established volunteerism correlates from the prior research literature. Approximately a quarter of caregivers participated in volunteering (25.4%). Being male, having higher educational attainment, being a spouse, living separately from the care recipient, caregiving for multiple care recipients, having a better quality of relationship with the care recipient, having better psychological well-being, receiving more social support, attending religious services, and participating in group activity were positively associated with formal volunteer participation. Findings underscore the role of both human and social capital, including the caregiving context, in formal volunteering among caregivers.

Adjunctive Medication Management and Contingency Management to enhance adherence to acamprosate for alcohol dependence: the ADAM trial RCT

Background

Acamprosate is an effective and cost-effective medication for alcohol relapse prevention but poor adherence can limit its full benefit. Effective interventions to support adherence to acamprosate are therefore needed.

Objectives

To determine the effectiveness of Medication Management, with and without Contingency Management, compared to Standard Support alone in enhancing adherence to acamprosate and the impact of adherence to acamprosate on abstinence and reduced alcohol consumption.

Design

Multicentre, three-arm, parallel-group, randomised controlled clinical trial.

Setting

Specialist alcohol treatment services in five regions of England (South East London, Central and North West London, Wessex, Yorkshire and Humber and West Midlands).

Participants

Adults (aged 18 years or more), an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of alcohol dependence, abstinent from alcohol at baseline assessment, in receipt of a prescription for acamprosate.

Interventions

(1) Standard Support, (2) Standard Support with adjunctive Medication Management provided by pharmacists via a clinical contact centre (12 sessions over 6 months), (3) Standard Support with adjunctive Medication Management plus Contingency Management that consisted of vouchers (up to £120) to reinforce participation in Medication Management. Consenting participants were randomised in a 2 : 1 : 1 ratio to one of the three groups using a stratified random permuted block method using a remote system. Participants and researchers were not blind to treatment allocation.

Main outcome measures

Primary outcome: self-reported percentage of medication taken in the previous 28 days at 6 months post randomisation. Economic outcome: EuroQol-5 Dimensions, a five-level version, used to calculate quality-adjusted life-years, with costs estimated using the Adult Service Use Schedule.

Results

Of the 1459 potential participants approached, 1019 (70%) were assessed and 739 (73 consented to participate in the study, 372 (50%) were allocated to Standard Support, 182 (25%) to Standard Support with Medication Management and 185 (25%) to Standard Support and Medication Management with Contingency Management. Data were available for 518 (70%) of participants at 6-month follow-up, 255 (68.5%) allocated to Standard Support, 122 (67.0%) to Standard Support and Medication Management and 141 (76.2%) to Standard Support and Medication Management with Contingency Management. The mean difference of per cent adherence to acamprosate was higher for those who received Standard Support and Medication Management with Contingency Management (10.6%, 95% confidence interval 19.6% to 1.6%) compared to Standard Support alone, at the primary end point (6-month follow-up). There was no significant difference in per cent days adherent when comparing Standard Support and Medication Management with Standard Support alone 3.1% (95% confidence interval 12.8% to -6.5%) or comparing Standard Support and Medication Management with Standard Support and Medication Management with Contingency Management 7.9% (95% confidence interval 18.7% to -2.8%). The primary economic analysis at 6 months found that Standard Support and Medication Management with Contingency Management was cost-effective compared to Standard Support alone, achieving small gains in quality-adjusted life-years at a lower cost per participant. Cost-effectiveness was not observed for adjunctive Medication Management compared to Standard Support alone. There were no serious adverse events related to the trial interventions reported.

Limitations

The trial's primary outcome measure changed substantially due to data collection difficulties and therefore relied on a measure of self-reported adherence. A lower than anticipated follow-up rate at 12 months may have lowered the statistical power to detect differences in the secondary analyses, although the primary analysis was not impacted.

Conclusions

Medication Management enhanced with Contingency Management is beneficial to patients for supporting them to take acamprosate.

Future work

Given our findings in relation to Contingency Management enhancing Medication Management adherence, future trials should be developed to explore its effectiveness and cost-effectiveness with other alcohol interventions where there is evidence of poor adherence.

Trial registration

This trial is registered as ISRCTN17083622 https://doi.org/10.1186/ISRCTN17083622.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 22. See the NIHR Journals Library website for further project information.

Factors associated with discharge against medical advice in alcohol withdrawal patients

This study aimed to examine characteristics associated with discharge against medical advice from the hospital in alcohol withdrawal patients, supporting the work of hospital staff and Alcohol Care Teams and identifying characteristics that may help target patients most likely to discharge against medical advice. We used Hospital Episode Statistics Data to identify demographic and clinical variables and compare these in alcohol withdrawal patients who discharged against medical advice from hospital, compared with those who were discharged by the clinical team. Factors significantly associated with alcohol withdrawal patients discharging against medical advice from hospital were: being admitted as an emergency; discharged on a weekend; living with no fixed abode; being male; being younger and having a shorter length of stay. This study identifies characteristics that can be used to support acute hospitals and Alcohol Care Teams, particularly in the allocation of resources to reduce discharges against medical advice and subsequent readmissions to the hospital. Particular consideration should be given to clinical provision in hospitals in emergency departments and on weekends, and also those patients who are admitted and are of no fixed abode.

Outcomes of Gender-Affirming Voice and Communication Modification Training for Non-binary Individuals: A Case Series

OBJECTIVES

There is currently no research reporting solely on outcomes of voice and communication modification training (VCMT) in individuals who identify as non-binary and genderqueer (NBGQ) in the English literature. This study aimed to describe the objective and subjective impact of VCMT on the voice of NBGQ individuals undergoing a 12-week gender-affirming VCMT program.

METHODS

A retrospective consecutive case series of NBGQ individuals enrolled in a VCMT program was performed. Demographics, Transgender Self-Evaluation Questionnaire (TSEQ), fundamental frequency (F0), and frequency range were collected before and after the program.

RESULTS

Four NBGQ individuals enrolled between January 2019 and June 2021; the mean age was 27.0 years. While all four participants represented in this case series showed improvement in at least one of their initial goals, only one improved both their F0 and TSEQ scores; the other three participants had mixed results.

CONCLUSION

NBGQ individuals experienced improvements in self-reported outcomes and changes in acoustic measures after completing VCMT in our case series. Individuals experienced significant improvement in subjective outcomes despite small changes in acoustic measures, and vice versa. More research is needed to better understand the voice and communication needs of NBGQ individuals, along with their outcomes with VCMT.

LEVEL OF EVIDENCE

Level 4.

^{138}Ba(d,α) Study of States in ^{136}Cs: Implications for New Physics Searches with Xenon Detectors

We used the ^{138}Ba(d,α) reaction to carry out an in-depth study of states in ^{136}Cs, up to around 2.5 MeV. In this Letter, we place emphasis on hitherto unobserved states below the first 1^{+} level, which are important in the context of solar neutrino and fermionic dark matter (FDM) detection in large-scale xenon-based experiments. We identify for the first time candidate metastable states in ^{136}Cs, which would allow a real-time detection of solar neutrino and FDM events in xenon detectors, with high background suppression. Our results are also compared with shell-model calculations performed with three Hamiltonians that were previously used to evaluate the nuclear matrix element (NME) for ^{136}Xe neutrinoless double beta decay. We find that one of these Hamiltonians, which also systematically underestimates the NME compared with the others, dramatically fails to describe the observed low-energy ^{136}Cs spectrum, while the other two show reasonably good agreement.

Genomic characterisation of hormone receptor-positive breast cancer arising in very young women

BACKGROUND

Very young premenopausal women diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+HER2-) early breast cancer (EBC) have higher rates of recurrence and death for reasons that remain largely unexplained.

PATIENTS AND METHODS

Genomic sequencing was applied to HR+HER2- tumours from patients enrolled in the Suppression of Ovarian Function Trial (SOFT) to determine genomic drivers that are enriched in young premenopausal women. Genomic alterations were characterised using next-generation sequencing from a subset of 1276 patients (deep targeted sequencing, n = 1258; whole-exome sequencing in a young-age, case-control subsample, n = 82). We defined copy number (CN) subgroups and assessed for features suggestive of homologous recombination deficiency (HRD). Genomic alteration frequencies were compared between young premenopausal women (<40 years) and older premenopausal women (≥40 years), and assessed for associations with distant recurrence-free interval (DRFI) and overall survival (OS).

RESULTS

Younger women (<40 years, n = 359) compared with older women (≥40 years, n = 917) had significantly higher frequencies of mutations in GATA3 (19% versus 16%) and CN amplifications (CNAs) (47% versus 26%), but significantly lower frequencies of mutations in PIK3CA (32% versus 47%), CDH1 (3% versus 9%), and MAP3K1 (7% versus 12%). Additionally, they had significantly higher frequencies of features suggestive of HRD (27% versus 21%) and a higher proportion of PIK3CA mutations with concurrent CNAs (23% versus 11%). Genomic features suggestive of HRD, PIK3CA mutations with CNAs, and CNAs were associated with significantly worse DRFI and OS compared with those without these features. These poor prognostic features were enriched in younger patients: present in 72% of patients aged <35 years, 54% aged 35-39 years, and 40% aged ≥40 years. Poor prognostic features [n = 584 (46%)] versus none [n = 692 (54%)] had an 8-year DRFI of 84% versus 94% and OS of 88% versus 96%. Younger women (<40 years) had the poorest outcomes: 8-year DRFI 74% versus 85% and OS 80% versus 93%, respectively.

CONCLUSION

These results provide insights into genomic alterations that are enriched in young women with HR+HER2- EBC, provide rationale for genomic subgrouping, and highlight priority molecular targets for future clinical trials.

First Evidence of Axial Shape Asymmetry and Configuration Coexistence in ^{74}Zn: Suggestion for a Northern Extension of the N=40 Island of Inversion

The excited states of N=44 ^{74}Zn were investigated via γ-ray spectroscopy following ^{74}Cu β decay. By exploiting γ-γ angular correlation analysis, the 2_{2}^{+}, 3_{1}^{+}, 0_{2}^{+}, and 2_{3}^{+} states in ^{74}Zn were firmly established. The γ-ray branching and E2/M1 mixing ratios for transitions deexciting the 2_{2}^{+}, 3_{1}^{+}, and 2_{3}^{+} states were measured, allowing for the extraction of relative B(E2) values. In particular, the 2_{3}^{+}→0_{2}^{+} and 2_{3}^{+}→4_{1}^{+} transitions were observed for the first time. The results show excellent agreement with new microscopic large-scale shell-model calculations, and are discussed in terms of underlying shapes, as well as the role of neutron excitations across the N=40 gap. Enhanced axial shape asymmetry (triaxiality) is suggested to characterize ^{74}Zn in its ground state. Furthermore, an excited K=0 band with a significantly larger softness in its shape is identified. A shore of the N=40 "island of inversion" appears to manifest above Z=26, previously thought as its northern limit in the chart of the nuclides.

FACTORS ASSOCIATED WITH VOLUNTEERING AMONG FAMILY CAREGIVERS OF OLDER ADULTS

Family caregiving has been linked to an increased risk of poor mental health, poor physical health, and higher rates of perceived social isolation among caregivers. Despite the connection between caregiving and negative outcomes, or perhaps because of this connection, caregivers seek out and enjoy other life roles and activities including formal volunteerism. To explore the connection between informal caregiving and volunteering and establish the representative prevalence of formal volunteering among caregivers, descriptive and multivariate logistic regression analyses were carried out with data from 1,745 caregivers in the National Study of Caregiving (NSOC) (2017). Utilizing social capital theory four models were constructed with salient demographic characteristics associated with volunteering (model 1), caregiving context (model 2), caregiver physical and mental health (model 3), along with participation in informal and formal social networks (model 4). About a quarter of the sample participated in volunteering (26%). The average age was 60.5 years (SD = 14.3) and more than half consisted of female caregivers (67.11%). Non-Hispanic Whites (62.9%) were the majority of the sample, followed by non-Hispanic Blacks (28%), Hispanic (6.5%), and caregivers in other racial/ethic groups (2.6%). Gender, educational achievement, caregiving for a spouse, coresiding with care recipient, caregiving for multiple care recipients, quality of relationship with care recipient, caregiver psychological well-being, having emotional/physical support, attending religious services, and group activity participation were all significant indicators for caregiver volunteerism. Findings support the importance of both human and social capital in volunteering among caregivers.

PUTTING THE 4MS INTO PRACTICE: IMPLICATIONS FOR TRAINING AND TECHNOLOGY

The AgingME Geriatrics Workforce Enhancement Program (AgingME GWEP), a statewide collaboration led by the University of New England and the University of Maine, is guided by an annual statewide survey of community and professional stakeholders. The aim of this research is to identify training and resource gaps related to age-friendly healthcare and topics of interest. Of the 245 survey respondents, 15% indicated existing knowledge of the 4Ms framework. The top sources of 4M’s framework exposure included trainings or webinars (30%) and web-based resources (19%). Of those with knowledge of the 4M’s, 33% of providers and 29% of older adults/community members reported employing the 4Ms in their professional practices and personal lives, respectively. Respondents also noted the need for more training on how to use technology to locate healthcare information (33%), using technology to reduce isolation and loneliness among older adults (29%), and keeping providers connected with older patients (26%). Additional write-in responses (11%) suggest a need for general technology training and improving access to technology overall. Respondents' (N = 157) top five categories for needed aging-related training topics were community resources for older adults (15%), aging-in-place (14%), exercise and nutrition (11%), improving provider/patient communication (9%), and 4M’s of age-friendly healthcare overview (8%). Responses also identified themes related to improving patient/provider communications, availability of resources, and ageism that could be addressed through upcoming GWEP activities. Results indicate a need to facilitate the translation of 4Ms knowledge into practice and increasing technology training and access.

ASSESSING INTERPROFESSIONAL ORAL HEALTH EDUCATION AND PRACTICE FACILITATION OUTCOMES WITHIN LONG-TERM CARE

Older adults residing in long-term care (LTC) settings are at an increased risk of poor oral health due to comorbidities and limited ability to provide self-care. Routine oral care is essential for maintaining overall health. Coupled with resident vulnerability is a traditional lack of training and focus on oral health care in LTC. MOTIVATE (Maine’s Oral Team-Based Initiative: Vital Access to Education) is a pilot (N = 8 sites) interprofessional education program focused on daily oral health care within LTC, providing education and technical assistance to advance staff knowledge, skills, and attitudes about oral health. An evaluation was carried out using a pre/post survey design with instruments administered immediately before and after learning module completion along with a survey administered one month after implementation. Knowledge, attitudes, and oral health practices were assessed. A statistical comparison between baseline (N = 491) and post-launch (N = 215) scores revealed a statistically significant improvement (p &lt; 0.001) across all knowledge and attitudes measures including the perceived importance of oral health, understanding of interprofessional roles among the care team, the role of oral health in supporting resident dignity and quality of life, and confidence in providing oral health care. Factors facilitating the transfer of knowledge to practice (N = 478) included personal interest in the topic (46.4%), knowing where to obtain information when needed (47.6%), and knowing how to apply learning to LTC daily care responsibilities (62.4%). Findings underscore the importance of oral health training and implications for practice transformation in an interprofessional context.

Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe

OBJECTIVE

Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN.

METHODS

We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up.

RESULTS

Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence.

CONCLUSION

The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.

Study protocol for the online adaptation and evaluation of the 'Reboot' (Recovery-boosting) coaching programme, to prepare critical care nurses for, and aid recovery after, stressful clinical events

Background

Critical care nurses (CCNs) are routinely exposed to highly stressful events, exacerbated during the COVID-19 pandemic. Supporting resilience and wellbeing of CCNs is therefore crucial to prevent burnout. One approach for delivering this support is by preparing critical care nurses for situations they may encounter, drawing on evidence-based techniques to strengthen relevant psychological coping strategies. As such, the current study seeks to tailor a Resilience-boosting psychological coaching programme [Reboot] for CCNs, based on cognitive behavioural therapy (CBT) principles and the Bi-Dimensional Resilience Framework (BDF), and (1) to assess the feasibility of delivering Reboot via online, remote delivery to CCNs, and (2) to provide a preliminary assessment of whether Reboot could increase resilience and confidence in coping with adverse events.

Methods

Eighty CCNs (n=80) will be recruited to the 8-week Reboot programme, comprised of two group workshops and two individual coaching calls. The study uses a single-arm before-after feasibility study design and will be evaluated with a mixed-methods approach, using online questionnaires (all participants) and telephone interviews (25% of participants). Primary outcomes will be confidence in coping with adverse events (the Confidence scale) and resilience (the Brief Resilience Scale) measured at four time points.

Discussion

Results will determine whether it is feasible to deliver and evaluate a remote version of the Reboot coaching programme to CCNs, and will indicate whether participating in the programme is associated with increases in confidence in coping with adverse events, resilience and wellbeing (as indicated by levels of depression).

Service Users' Views and Experiences of Alcohol Relapse Prevention Treatment and Adherence: New Role for Pharmacists?

AIMS

To understand service users' views and experiences of alcohol relapse prevention medication, views of a telephone behavioural modification intervention delivered by pharmacists and the use of Contingency Management (CM) to support acamprosate adherence following assisted alcohol withdrawal.

METHODS

Four focus groups were conducted within four alcohol treatment and recovery groups across England (UK), with service users with lived experience of alcohol dependence (26 participants). Semi-structured topic guide was used to explore participants' views and experiences of alcohol relapse prevention medication, a telephone behavioural modification medication intervention delivered by pharmacists, and the use of CM to support acamprosate adherence. These were audio-recorded, transcribed verbatim and thematically analysed inductively and deductively.

RESULTS

Four themes were identified: concerns about support and availability of alcohol relapse prevention medication; lack of knowledge and understanding about acamprosate treatment; positive perceptions of acamprosate adherence telephone support from pharmacists; and negative perceptions of CM to support acamprosate adherence. There were misunderstandings about acamprosate's mode of action and strong negative beliefs about CM. However, most were positive about pharmacists' new role to support acamprosate adherence.

CONCLUSION

This study highlighted challenges service users face to commence alcohol relapse prevention medication. It appears service users could benefit from a pharmacist-led telephone intervention to improve understanding about acamprosate medication, particularly, if delivered in an engaging and motivating way.

Outcomes of Gender-Affirming Voice and Communication Modification for Transgender Individuals

OBJECTIVES

Transgender individuals' voices are closely related to gender identity. A primary goal of gender-affirming voice modification is to help individuals alter their voices to improve gender congruence; however, there is a paucity of research to support this approach. This study aimed to evaluate the outcomes of a 12-week gender-affirming voice and communication modification program.

STUDY DESIGN

Retrospective cohort study.

METHODS

A retrospective consecutive case series of transgender women enrolled in a voice and communication modification program was performed. Demographics, Trans Woman Voice Questionnaire (TWVQ), fundamental frequency (F₀ ), and frequency range were collected before and after the program. A Wilcoxon signed-rank test assessed changes in outcomes. Spearman's rank-order correlation coefficients quantified associations between self-reported outcomes and acoustic measures.

RESULTS

A total of 16 trans women individuals were enrolled. The mean age was 31.5 years. After program completion, TWVQ improved 20.4 points, F₀ increased 26.5 Hz (spontaneous speech) and 25.7 Hz (reading), and the range increased 24.7 Hz (spontaneous speech) and 0.1 Hz (reading). None of the changes in acoustic measures significantly correlated with improvement in TWVQ scores in the cohort.

CONCLUSION

Trans women experience improvements in self-reported outcomes and changes in acoustic measures after completing a gender-affirming voice and communication modification program. Individuals may experience significant improvement in subjective outcomes despite small changes in acoustic measures and vice versa.

LEVEL OF EVIDENCE

Level 4 (case series) Laryngoscope, 2021.

Double-blind, placebo-controlled trial of mifepristone on cognition and depression in alcohol dependence

Background

Alcohol dependence is a significant issue contributing to disease burden. Changes in cortisol concentrations during alcohol withdrawal are associated with cognitive deficits and symptoms of depression. Current treatments are only successful for a small proportion of people and do not target cognitive deficits and symptoms of depression experienced by those who are alcohol dependent. The aim of this research is to determine the potential efficacy of mifepristone, a type II glucocorticoid receptor antagonist, to prevent symptoms of depression and cognitive deficits following alcohol detoxification.

Methods

This was a phase 2 therapeutic use trial. It was a double-blind randomised controlled clinical trial of mifepristone versus inactive placebo treatment. The trial aimed to recruit 120 participants who met the inclusion criteria: (1) male, (2) aged 18–60 years inclusive, and (3) alcohol dependent for 5 or more years. Participants were randomised to 600 mg a day mifepristone (200 mg morning, afternoon, and evening) for 7 days and 400 mg for the subsequent 7 days (200 mg morning and evening) or the equivalent number of placebo tablets for 14 days. Primary outcome measures were cognitive function (measured using the Cambridge Neuropsychological Test Automated Battery (CANTAB)) and symptoms of depression (measured using the Beck Depression Inventory (BDI)) at 4 weeks post-randomisation.

Results

Difficulties recruiting participants due to significant changes in the provision of inpatient care for alcohol dependence resulted in only 27 participants recruited to the trial, with data available for 21 participants. Fourteen participants were randomised to receive mifepristone and 13 to receive placebo.

Conclusion

Larger trials would be needed to draw conclusions about the efficacy of mifepristone.

Trial registration

ISRCTN registry ISRCTN54001953. Registered on 29 September 2011.

Demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma: a UK population study

OBJECTIVE

To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma.

DESIGN

A retrospective national population-based study.

SETTING

UK 1995-2015.

POPULATION

A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield.

METHODS

Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics.

MAIN OUTCOMES

Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group.

RESULTS

Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%.

CONCLUSIONS

Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age.

TWEETABLE ABSTRACT

National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.

Public Health Surveillance Studies of Alcohol Industry Market and Political Strategies: A Systematic Review

OBJECTIVE

This review examines public health surveillance (PHS) studies of alcohol industry actors that explore the implications of the integration of business and political strategies for public health.

METHOD

Eligible for inclusion were studies published in English language peer-reviewed journals since 1980 that sought to investigate both alcohol industry business and political strategies and their implications for public health. Studies were also required to present economic, political, and health data together. Seven databases were searched until May 2018.

RESULTS

Six studies were identified as eligible for inclusion in this review, undertaken in high-, middle-, and low-income countries and published between 2000 and 2015. Political strategies are driven largely by business interests, whether at the company, sectoral, or industry level, and corporate social responsibility activities may be integrated within overall strategies. There is a high degree of collaboration in political strategy development between companies, facilitated by growing concentration among global producers operating in increasingly oligopolistic markets. There are limited insights into the dynamics of market competition and limited methodological data available.

CONCLUSIONS

PHS studies play a valuable role in identifying aspects of alcohol industry strategies that warrant more detailed and carefully designed research, as well as in elucidating global health implications. Further research in PHS and other kinds of studies will assist efforts to reduce the global burden of disease caused by alcohol.

nab-Paclitaxel plus carboplatin or gemcitabine versus gemcitabine plus carboplatin as first-line treatment of patients with triple-negative metastatic breast cancer: results from the tnAcity trial

Background

Metastatic triple-negative breast cancer (mTNBC) has a poor prognosis and aggressive clinical course. tnAcity evaluated the efficacy and safety of first-line nab-paclitaxel plus carboplatin (nab-P/C), nab-paclitaxel plus gemcitabine (nab-P/G), and gemcitabine plus carboplatin (G/C) in patients with mTNBC.

Patients and methods

Patients with pathologically confirmed mTNBC and no prior chemotherapy for metastatic BC received (1 : 1 : 1) nab-P 125 mg/m2 plus C AUC 2, nab-P 125 mg/m2 plus G 1000 mg/m2, or G 1000 mg/m2 plus C AUC 2, all on days 1, 8 q3w. Phase II primary end point: investigator-assessed progression-free survival (PFS); secondary end points included overall response rate (ORR), overall survival (OS), percentage of patients initiating cycle 6 with doublet therapy, and safety.

Results

In total, 191 patients were enrolled (nab-P/C, n = 64; nab-P/G, n = 61; G/C, n = 66). PFS was significantly longer with nab-P/C versus nab-P/G [median, 8.3 versus 5.5 months; hazard ratio (HR), 0.59 [95% CI, 0.38-0.92]; P = 0.02] or G/C (median, 8.3 versus 6.0 months; HR, 0.58 [95% CI, 0.37-0.90]; P = 0.02). OS was numerically longer with nab-P/C versus nab-P/G (median, 16.8 versus 12.1 months; HR, 0.73 [95% CI, 0.47-1.13]; P = 0.16) or G/C (median, 16.8 versus 12.6 months; HR, 0.80 [95% CI, 0.52-1.22]; P = 0.29). ORR was 73%, 39%, and 44%, respectively. In the nab-P/C, nab-P/G, and G/C groups, 64%, 56%, and 50% of patients initiated cycle 6 with a doublet. Grade ≥3 adverse events were mainly hematologic.

Conclusions

First-line nab-P/C was active in mTNBC and resulted in a significantly longer PFS and improved risk/benefit profile versus nab-P/G or G/C.

Enantiomeric 4'-Truncated 3-deaza-1',6'-isoneplanocins: Synthesis and antiviral properties including Ebola

Enantiomeric 3-deaza-1',6'-isoneplanocins (C-3 unsubstituted 7a/7b and C-3 with a bromine 8a/8b) lacking the 4'-hydroxymethyl as mechanistically designed anti-viral targets have been prepared by utilizing the Ullmann reaction. Anti-Ebola properties were found for the D-like 7a and 8a and L-like 8b. All four products showed effects against human cytomegalovirus while D-like 7a/8a affected measles; 7a was effective versus norovirus and 8a inhibited Pichinde. Both 7a and 8a produced SAHase inhibitory effects. However, the anti-EBOV activity of 7a and 8a cannot be readily correlated with this observation due with their contrasting IC₅₀ values (8a > 7a). It is to be noted that 7b showed no effects on this enzyme and 8b was minimally inhibitory. These results offer preliminary insight into the differing mechanisms of action of D- and L- like structures and enlighten structural features to guide additional antiviral agent pursuit in the isoneplanocin series.

Urban blue: A global analysis of the factors shaping people's perceptions of the marine environment and ecological engineering in harbours

Marine harbours are the focus of a diverse range of activities and subject to multiple anthropogenically induced pressures. Support for environmental management options aimed at improving degraded harbours depends on understanding the factors which influence people's perceptions of harbour environments. We used an online survey, across 12 harbours, to assess sources of variation people's perceptions of harbour health and ecological engineering. We tested the hypotheses: 1) people living near impacted harbours would consider their environment to be more unhealthy and degraded, be more concerned about the environment and supportive of and willing to pay for ecological engineering relative to those living by less impacted harbours, and 2) people with greater connectedness to the harbour would be more concerned about and have greater perceived knowledge of the environment, and be more supportive of, knowledgeable about and willing to pay for ecological engineering, than those with less connectedness. Across twelve locations, the levels of degradation and modification by artificial structures were lower and the concern and knowledge about the environment and ecological engineering were greater in the six Australasian and American than the six European and Asian harbours surveyed. We found that people's perception of harbours as healthy or degraded, but not their concern for the environment, reflected the degree to which harbours were impacted. There was a positive relationship between the percentage of shoreline modified and the extent of support for and people's willingness to pay indirect costs for ecological engineering. At the individual level, measures of connectedness to the harbour environment were good predictors of concern for and perceived knowledge about the environment but not support for and perceived knowledge about ecological engineering. To make informed decisions, it is important that people are empowered with sufficient knowledge of the environmental issues facing their harbour and ecological engineering options.

Public Health Surveillance Studies of Alcohol Industry Market and Political Strategies: A Systematic Review

OBJECTIVE

This review examines public health surveillance (PHS) studies of alcohol industry actors that explore the implications of the integration of business and political strategies for public health.

METHOD

Eligible for inclusion were studies published in English language peer-reviewed journals since 1980 that sought to investigate both alcohol industry business and political strategies and their implications for public health. Studies were also required to present economic, political, and health data together. Seven databases were searched until May 2018.

RESULTS

Six studies were identified as eligible for inclusion in this review, undertaken in high-, middle-, and low-income countries and published between 2000 and 2015. Political strategies are driven largely by business interests, whether at the company, sectoral, or industry level, and corporate social responsibility activities may be integrated within overall strategies. There is a high degree of collaboration in political strategy development between companies, facilitated by growing concentration among global producers operating in increasingly oligopolistic markets. There are limited insights into the dynamics of market competition and limited methodological data available.

CONCLUSIONS

PHS studies play a valuable role in identifying aspects of alcohol industry strategies that warrant more detailed and carefully designed research, as well as in elucidating global health implications. Further research in PHS and other kinds of studies will assist efforts to reduce the global burden of disease caused by alcohol.

Abstract P1-17-01: Long term survival benefits of adjuvant zoledronic acid associated with maf status of primary tumor

Background: Meta-analysis of clinical trials has shown that adjuvant bisphosphonates reduce bone metastases and improve survival in postmenopausal (PM) breast cancer and are now recommended for routine clinical use by international guidelines1. However, evaluation of menopause is imprecise and the biological rationale for lack of benefit in premenopausal women unclear. To address this, the biomarker, transcription factor MAF on 16q23 was tested retrospectively in the prospective randomized AZURE trial of standard adjuvant therapy +/- zoledronic acid (ZOL). Initial evaluation indicated that women with MAF negative tumors treated with ZOL had a lower rate of disease relapse irrespective of menopausal status.2 Here we present the long-term findings of this predictive biomarker on 10 year overall survival.

Materials and methods: The biomarker analysis was completed on TMAs from primary tumors. Quadruplicate cores of breast tumor tissue were arrayed across replicate TMAs. MAF+ was detected using a validated (MAF/D16Z3) FISH test (Inbiomotion SL, Spain). A central laboratory (Targos, Germany) validated the assay for analytic and diagnostic performance, established acceptance criteria, included appropriate quality controls for each assay, and performed the analyses in a blinded fashion. A copy number cut-off ≥2.5 was preset for MAF+ for both prognostic and predictive testing. Interactions between MAF+ and effects of ZOL on Invasive disease free (IDFS), overall (OS) survival and time to bone metastases by menopausal status were evaluated using a Cox proportional hazards model.

Results: 1769 of the 3360 AZURE pts donated primary tumor samples. Median follow-up was 117 (interquartile range 70.4-120) months. 865 pts (49%) had 2 FISH evaluable cores and were included in the analysis. These pts had similar disease and treatment characteristics to the overall study population as well as similar IDFS and OS at 10 years. 184 (21%) had MAF+ tumors and these tumors were more likely to be of higher grade, ER-ve and HER2+. In 680 pts with MAF- tumors, ZOL was associated with improved IDFS (HR=0.75; 95%CI:0.58-0.97, [P=0.02]), reduced relapse in bone (HR=0.65; 95%CI:0.45-0.94, [P=0.022] and, most importantly, better OS (HR=0.69; 95%CI:0.50-0.94, [P=0.019]). In the 185 patients with MAF+ tumors, there was a suggestion of worse outcome (IDFS HR=1.54; 95%CI:0.96-2.47 and OS HR 1.40; 95%CI:0.83-2.33), with a strong interaction between treatment effects and menopausal status. Outcomes in ZOL treated MAF+ pts who were non-PM appeared to be much worse (IDFS HR=2.31; 95%CI:1.18-4.42] and OS HR=2.28; 95%CI:1.07-4.82) due predominantly to an excess of extra-skeletal metastases in ZOL treated patients (HR=4.47; 95%CI:1.66-12.57).

Conclusions: Adjuvant ZOL significantly improved disease outcomes in 79% of patients with MAF negative tumors, irrespective of menopausal status and other clinico-pathologic features. Conversely, more extra-skeletal metastases and breast cancer deaths were seen in women with MAF+ tumors who were not PM at the start of treatment. If validated in ongoing studies, the MAF FISH test could provide a clinically useful biomarker for selection of patients for adjuvant bisphosphonate treatment.

1EBCTCG, Lancet 2015; 2Coleman RE et al, Lancet Oncol 2017

Citation Format: Coleman R, Gregory W, Jean-Mairet J, Tercero JC, Torres-Martin J, Gomis R. Long term survival benefits of adjuvant zoledronic acid associated with maf status of primary tumor [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 P1-17-01.

Comparing estimates of disability prevalence using federal and international disability measures in national surveillance

BACKGROUND

The National Health Interview Survey (NHIS) is changing the annual inclusion of standardized disability identifiers, reinvigorating the priority to examine existing disability question sets. These sets include questions developed by the United States (U.S.) National Center for Health Statistics in conjunction with the U.S. Census Bureau (the American Community Survey questions, ACS) and United Nations (the Washington Group Short Set questions, WGSS), that are policy relevant, comparable across populations, and short enough to be included in censuses and surveys across countries.

OBJECTIVE

To compare disability prevalence estimates from federal and international standardized disability questions across demographic factors.

METHODS

Bivariate analysis of disability question sets asking adults about vision, hearing, ambulation, cognition, and self-care difficulties and demographic factors using secondary data from supplements in the 2010 and 2013-2015 NHIS.

RESULTS

Our study found substantial and statistically significant differences in the percentage of disabilities (overall and by type) based on comparable ACS and WGSS questions across demographic categories. Dependent on response coding, WGSS-based disability prevalence was consistently and significantly larger or smaller than ACS-based disability prevalence. Overall disability prevalence using ACS and two different WGSS response combinations were 16.3% and 9.2% or 39.4%, respectively.

CONCLUSION

ACS and WGSS measures identify predictably different sized populations of adults with disabilities. Further, with some exceptions, ACS and WGSS questions identify populations with disabilities with relatively consistent demographic factors. Additional research is recommended to understand the comparability of disability prevalence and health disparities and inequities people with disabilities experience when using these measures.

The Effect of Brief Interventions for Alcohol Among People with Comorbid Mental Health Conditions: A Systematic Review of Randomized Trials and Narrative Synthesis

Aims

To review the evidence on the effect of brief interventions (BIs) for alcohol among adults with risky alcohol consumption and comorbid mental health conditions.

Methods

A systematic review of randomized controlled trials (RCTs) published before May 2016 was undertaken and reported according to PRISMA guidelines. The findings were combined in a narrative synthesis. The risk of bias was assessed for included trials.

Results

Seventeen RCTs were included in the review and narrative synthesis: 11 in common mental health problems, and 6 in severe mental illness. There was considerable heterogeneity in study populations, BI delivery mode and intensity, outcome measures and risk of bias. Where BI was compared with a minimally active control, BI was associated with a significant reduction in alcohol consumption in four out of nine RCTs in common mental disorders and two out of five RCTs in severe mental illness. Where BI was compared with active comparator groups (such as motivational interviewing or cognitive behavioural therapy), findings were also mixed. Differences in the findings may be partly due to differences in study design, such as the intensity of BI and possibly the risk of bias.

Conclusions

Overall, the evidence is mixed regarding the effects of alcohol BI in participants with comorbid mental health conditions. Future well-designed research is required to answer this question more definitively.

Adjuvant zoledronic acid reduces fractures in breast cancer patients; an AZURE (BIG 01/04) study

The fracture impact of adjuvant bisphosphonates in breast cancer is not defined with most trials reporting changes in bone mineral density as a surrogate. The AZURE trial (ISRCTN79831382) evaluated the impact of adjuvant zoledronic acid (ZOL) on fractures. The AZURE trial is an academic, multi-centre, randomised phase III study evaluating the addition of ZOL 4 mg to standard therapy (neo/adjuvant chemotherapy and/or endocrine therapy) for 5 years (administered by intravenous (iv) infusion every 3-4 weeks for 6 doses, then 3 monthly × 8 and 6 monthly × 5) in patients with stage II/III early breast cancer. Fracture data collected as part of skeletal-related adverse event reporting were analysed after a median of 84.2 months of follow-up and 966 disease-free survival (DFS) events. We assessed number of fractures, time-to-first fracture and the incidence of fractures before and after disease recurrence. Two hundred forty-four patients reported ≥1 fracture, 140 (8.3%) in the control arm (171 fractures) and 104 (6.2%) in the ZOL arm (120 fractures). Of the 291 fractures reported, 207 fractures occurred in the absence of recurrence (control 111, ZOL 96), 80 after recurrence (control 59, ZOL 21). The 5-year fracture rate was reduced from 5.9% (95%CI 4.8, 7.1%; control) to 3.8% (95%CI 2.9, 4.7%) with ZOL. ZOL significantly increased time-to-first fracture (HR 0.69, 95%CI 0.53-0.90; P = 0.0053) but the majority of fracture prevention benefit occurred after a DFS event (HR 0.3; 95%CI 0.17, 0.53; P < 0.001). Fracture benefits from ZOL were similar across menopausal sub-groups. In conclusion, adjuvant ZOL reduced the risk of clinical fractures, the majority of this protection occurred after disease recurrence.

Abstract GS3-03: A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial)

Background

Inhibition of COX-2 has been shown to attenuate the metastatic process in pre-clinical models of human breast cancer (BC). The primary aim of this study was to assess the effect of 2 years adjuvant therapy with the COX-2 inhibitor celecoxib compared with placebo in HER2-ve primary BC patients.

Patients & Methods

Patients were randomised in a 2:1 ratio to receive celecoxib 400mg once daily or placebo for 2 years. Patients had to have completely resected BC with prior local and systemic adjuvant treatment according to local practice. Concurrent radiotherapy was permitted and hormone receptor +ve patients received endocrine therapy according to local practice. Patients with HER2+ or node negative, T1 and grade 1 disease were excluded. Median age of patients was 55 years (IQR: 49-63). 50% of patients had tumours &gt;2cm; 42% were grade 3; 48% had node +ve disease. According to local assessment 73% were ER/PgR +ve. Primary endpoint was Disease Free Survival (DFS); defined as time from randomisation to date of first event, with events contributing to analysis defined as recurrence (distant/local), new primary BC (ipsilateral/contralateral) and death. Secondary endpoints included Overall Survival (OS), toxicity, cardiovascular mortality and incidence of second primaries. Subgroup analysis by hormone receptor status was pre-planned. Survival endpoints are analysed using Cox-proportional hazards and log-rank tests; restricted mean survival is used where proportional hazards do not hold.

Results

Between January 2007 and November 2012, 2639 patients were randomised (1763 celecoxib; 876 placebo) from 181 centres across the UK and Germany. At 13th April 2017, median follow up was 60 months (IQR: 48-72) with 428 DFS events reported. Unadjusted survival analysis results are presented below, with hazard ratio&lt;1 favouring celecoxib:

 5 year survival estimate (95% CI)Hazard ratio (95% CI)p-valueDFS (all patients)   Celecoxib83% (81, 85)1.02 (0.83 – 1.24)0.88Placebo83% (80, 86)1-    DFS within ER+   Celecoxib87% (85, 89)0.89 (0.69 – 1.16)0.40Placebo86% (83, 89)1-    DFS within ER-   Celecoxib72% (68, 76)1.17 (0.85 – 1.61)0.33Placebo75% (69, 80)1-    OS (all patients)   Celecoxib90% (88, 91)0.97 (0.75 – 1.25)0.81Placebo90% (88, 92)1-

The interaction between ER status and treatment was not significant; p=0.36.

In the celecoxib and placebo groups there were 17 and 8 deaths respectively in patients who had not relapsed. These were due to cardiac (n=3; 2) and other (n=14; 6) in the celecoxib and placebo groups respectively; none were GI related. In total 304 serious adverse events were observed in 265 patients (186/1763 celecoxib; 79/876 placebo). In the celecoxib and placebo groups respectively these were related to cardiac (n=12; 7), GI (n=9; 2) and other (n=193; 81). Work is ongoing to determine whether a subset of ER+ patients whose primary tumours show the characteristics of a COX-2 signature receive greater benefit from celecoxib.

Conclusions

There is no benefit of celecoxib in the ITT population. Further exploratory studies focussing on the ER+ subpopulation are ongoing. Celecoxib treatment is not associated with significant toxicity when compared to placebo in this population of BC patients.

Citation Format: Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial) [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 GS3-03.

Echocardiographic imaging options in ovine research subjects

OBJECTIVES

To determine the feasibility of acquiring quality transesophageal (TEE), epicardial (EE), and intracardiac (ICE) echocardiographic images in ovine subjects and to discuss the merits of each technique with a focus on ICE image acquisition.

ANIMALS

Eleven male castrated Dorset adult sheep.

METHODS

Transesophageal echocardiography was performed under general anesthesia. Epicardial echocardiography was performed as part of an open chest (thoracotomy or sternotomy) experiment. Subjects were recovered with permanent jugular vein indwelling catheter and ICE from this approach was described. Feasibility of each technique was qualitatively assessed based on subjective image quality from three images for each image plane in each sheep.

RESULTS

Transesophageal echocardiography was technically challenging and did not provide adequate image quality for consistent interpretation. Epicardial echocardiography and ICE had more favorable results with ICE demonstrating unique benefits for post-operative serial monitoring.

CONCLUSIONS

Epicardial echocardiography and ICE were effective imaging techniques. Epicardial echocardiography required the least specialized training but was considered to have limited feasibility due to its requirement for an open chest procedure. Even with the necessity for permanent indwelling jugular cannulation, ICE was the least invasive of the three imaging techniques and potentially the most practical approach for chronic studies by minimizing post-operative stress. Transesophageal echocardiography was not a feasible technique in this study.

Abstract P6-17-01: Adjuvant treatment with zoledronic acid (ZOL) in stage II/III breast cancer. The AZURE trial (BIG 01/04) 10 year follow-up

This abstract was not presented at the symposium.

Abstract P1-09-01: Impact of MAF gene amplification on disease recurrence and effects of adjuvant zoledronic acid in early breast cancer

Background: Meta-analysis of clinical trials has shown that adjuvant bisphosphonates reduce bone metastases and improve survival in postmenopausal (PM) pts1. However, we are unable to select pts most likely to benefit. To address this, the recently identified early breast cancer bone relapse biomarker, 16q23(MAF) gain (MAF+)2, was tested retrospectively in the large prospectively randomized AZURE trial3 of standard adjuvant therapy +/- zoledronic acid (ZOL) to determine the prognostic value of MAF and its potential to predict the effects of ZOL on disease outcomes.

Materials and methods: All analyses were performed with ethics approval and consent. The biomarker analysis was completed on TMAs from primary tumors. Quadruplicate cores of breast tumor tissue were arrayed across replicate TMAs. MAF+ was detected using a validated (MAF/D16Z3) FISH test (Inbiomotion SL, Barcelona, Spain). A central laboratory (Targos, Kassel, Germany) validated the assay for analytic and diagnostic performance, established acceptance criteria, included appropriate quality controls for each assay, and performed the analyses in a blinded fashion. A copy number cut-off ≥2.5 was preset for MAF+. Invasive disease free (IDFS), overall (OS) survival and time to bone metastases multivariate analyses were performed in control and ZOL pts separately. Subsequently, interactions between MAF+ and effects of ZOL on disease outcomes by menopausal status were evaluated.

Results: 1769 of the 3360 AZURE pts donated primary tumor samples. Median follow-up was 84 months. 865 pts (49%) had 2 FISH evaluable cores and were included in the analysis of which 184 (21%) had MAF+ tumors. Tumors that were MAF+ were more likely to be of higher grade, ER-ve and Her2+.

In control pts, MAF was not prognostic for IDFS or OS although there were differences in IDFS by menopause (HR for MAF-/MAF+ in PM=0.47 [95%CI 0.25-0.88]; HR in non-PM=1.58 [0.82-3.03], test for interaction (TFI) by menopause P=0.007). In ZOL pts, MAF was prognostic for IDFS (HR=0.52 [0.36-0.75] and OS (HR=0.48 [0.31-0.75]). There were insufficient bone events (19 MAF+, 73 MAF-) in this sample set to reliably assess the impact of MAF+ on relapse in bone.

In pts with MAF- tumors, ZOL was associated with improved IDFS (HR=0.74 [0.56-0.98]) and OS (HR=0.78 [0.55-1.10]). However, the effects of ZOL in MAF+ were profoundly influenced by menopausal status with possibly better outcomes in PM women (HR for IDFS=0.74 [0.35-1.58]) but clearly worse IDFS and OS outcomes in ZOL treated MAF+ pts who were non-PM (HR for IDFS 2.46 [1.23-4.92], TFI by treatment P=0.002 and HR for OS=2.27 [1.04-4.93], TFI by treatment P=0.032). The interactions between disease outcomes, ZOL use and menopause were driven largely by an association between MAF+ and an increased risk of extra-skeletal recurrence with the use of ZOL in women who were not PM.

Conclusions: Absence of MAF amplification is associated with improved disease outcomes with adjuvant ZOL. However, the use of adjuvant ZOL in women with MAF+ tumors who are not PM at the start of treatment is associated with extraskeletal spread and worse DFS and OS.

1EBCTCG Lancet 2015;386:1353–1361; 2Pavlovic M et al JNCI 2015;107(12):djv256; 3Coleman RE et al Lancet Oncol 2014;15:997-1006.

Citation Format: Coleman R, Hall A, Bell R, Cameron D, Marshall H, Jean-Mairet J, Tercero J, Rojo F, Albanell J, Gomis R. Impact of MAF gene amplification on disease recurrence and effects of adjuvant zoledronic acid in early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-01.