Abstract P2-13-08: Biopsychosocial changes since diagnosis and the time taking endocrine therapy in Mexican patients with breast cancer

Background: The increasing of breast cancer survivors (BCS) as the result of treatment success involves patients demanding cares related to the adverse events of cancer treatment. Furthermore, the study of the course of the disease process and treatment over time has been a yielding perspective to understand cancer patients. Few studies have attempted to analyze changes over time since diagnosis (TSD) in women who remain disease free and are taking endocrine therapy (TET). It is known that some BCS reported high levels of quality of life (QoL), no changes in social support (SS) and that survivors without chemotherapy as adjuvant treatment had better QoL that those who had received it. However, the changes over time in terms of unmet needs (UN), QoL, and perceived SS outcomes in Mexican BCS have no examined, which is fundamental to identify convenient goals, better times of integrated interventions and optimize our human resources according to the trajectory of cancer treatment. Objective: Identify changes over TSD, and the time TET in terms of UN, SS perception and QoL on Mexican BCS. Method: 368 patients with BC and TET were enrolled in a cross-sectional and comparative design, were assessed using QoL (EORTC-30 and BR-23), UN (SCNS-SF32), SS (MOS-SSS14), validated and standardized instruments in a Mexican cancer population. Premenopausal patients with ovarian function suppression were excluded. Patients were divided into four groups according to TSD and time TET, both in ≤1year and >1year. Parametric and non-parametric analyses were used: t Student and U Mann Whitney. Results: Patients mean age was 54 (SD=10.6) years; mean of TSD was 38 (SD=24) months, and they had 30 months on average (SD= 19) TET. The level of global QoL was high (78%) as well as the level of SS (73%), the UN were low (28%). Cognitive function was the most rated concern in terms of QoL for all groups. “Help with daily shores" was the type of SS, which all groups perceived the lowest support. "Fear about cancer spreading" and “Concern about worries of those close to you” were the first and second rated UN in all groups. Additionally, we found that patients with ≤1year of TSD had more significantly insomnia, financial difficulties, psychological and global UN (p=.02; p=.01; p=.0005; p=.01, respectively) than patients with >1 year of TSD. Moreover, the results showed that after one year of time TET: psychological and global needs, besides tangible and global SS, diminished significantly (p=.002; p=.009; p=.01; p=.03, respectively), nevertheless, the future perspective of health increases significantly (p=.01). Discussion and conclusions: Our findings are consistent with previous studies in terms of QoL. These results indicate that not only BCS patients improve physically, but also psychosocially over time: they are more independent, also have a better perspective of their health even though the fear persists. In conclusion, all biopsychosocial aspects evaluated improve over time. These data suggest that the most optimal effort might be provided to newly diagnosed patients, which is fundamental information for a country as Mexico with a lack of human resources. For instance, health staff could be focused on providing tools to deal with fears, social concerns, and physical/cognitive symptoms as a priority in this vulnerable group.

Citation Format: Lizette Gálvez-Hernández, V Neri-Flores, I Paéz-Gerardo, E López-Muñiz, I Monroy-Ortiz, A Mohar-Betancourt, Enrique Bargallo-Rocha, Cynthia Villarreal-Garza, Paula Cabrera-Galeana. Biopsychosocial changes since diagnosis and the time taking endocrine therapy in Mexican patients with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-08.

Abstract P1-19-07: Real-world characteristics, treatment patterns, and overall survival in patients with metastatic breast cancer (mBC) and CNS metastases

Background:

CNS metastases are reported in about 10 to 15%. Knowledge about the management of these patients are limited because they are excluded from clinical trials due to its poor prognosis and morbidity. In these study, we aim to describe characteristics, treatment patterns, and overall survival (OS) of patients of mBC with CNS metastases at Instituto Nacional de Cancerología de Mexico (INCan) from january 2007 to december 2015.

Methods:

We include patients with histological diagnosis of mBC and tumoral activity in the CNS (at diagnosis or during de follow-up). mBC subtype was defined using HER2 and hormone receptor (HR) status by immunohistochemistry; systemic treatment, and mortality data were used to characterize mBC with CNS involment.

Results:

During the study period, we found 1272 patients diagnosed with metastatic disease, of whom 408 had CNS disease (novo/recurrence) the median follow up was 52 months. Table 1 describes the percentage of CNS metastases by subtype, clinical characteristics at diagnosis and median OS. Almost all patients (85.6%) were candidate to holocranial radiotherapy; after that, systemic treatment varied according to the subtype of mBC; 69.1% of TN received CT (26% based on platinum); 75.3% of HER2+ received systemic treatment, all included antiher2 therapy; luminal subtype, no one were treated with endocrine therapy.

Table 1.- characteristics and Overall suvival by subtype of mBC all mBC 1272 n(%)her2 positive 339 (26.6) n (%)triple negative 298 (23.4) n(%)luminal 636 (50) n(%)CNS metastasis at dianosis44 (3.5)12 (3.5)13 (4.4)19 (2.9)CNS mets after prog to systemic tx205(16.1)63(18.6)50(16.7)92(14.5)CNS as first place of recurrence159(12.5)75(22.2)34(11.4)50(7.8)prevalence on CNS mets408(10.7)150(14.7)97(10.8)161(8.4)median age at diagnosis of CNS mets50(28-84)50(29-84)48(28-80)51(28-80)median OS after CNS mets (months)14.927.29.3316.3

Conclusions:

HER2 positive breast cancer patients have the highest prevalence of CNS metastases, whereas luminal has the lowest. Patients with HER2+ and CNS metastases commonly receive treatment based on anti-HER2 therapy, maybe this target treatment contribute to the better survival achieved than patients with luminal or TN subtype. mBC with CNS metastases continues in the real world to be an unmet medical need.

Citation Format: Alvarado-Miranda A, Cabrera-Galeana P, Muñoz-Montaño WR, Lara-Medina F, Bargallo-Rocha E, Arrieta-Rodriguez O, Perez M, Porras-Reyes F, Mohar-Betancourt A, Gamboa C. Real-world characteristics, treatment patterns, and overall survival in patients with metastatic breast cancer (mBC) and CNS metastases [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 P1-19-07.

Factors associated with ever use of mammography in a limited resource setting. A mixed methods study

Objective

To evaluate facilitators and barriers influencing mammography screening participation among women.

Design

Mixed methods study.

Setting

Three hospital catchment areas in Hidalgo, Mexico.

Participants

Four hundred and fifty-five women aged 40-69 years.

Intervention

Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method.

Main Outcome Measure

Women were categorized as never having had mammography or having had at least one mammogram in the past.

Results

From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography.

Conclusions

Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.

Validation of the Mexican-Spanish version of the EORTC QLQ-C15-PAL questionnaire for the evaluation of health-related quality of life in patients on palliative care

e20557

Background: Health-related quality of life (HRQL) is a fundamental outcome in oncology and this is particularly important in the palliative care setting. Our aim was to validate the Mexican-Spanish version of the EORTC QLQ-C15-PAL questionnaire, which is a brief version of QLQ-C30, for the measure of HRQL in terminal patients with cancer. Methods: Patients attending the Palliative Care Unit at the Hospital from July to October 2008 with terminal cancer, diagnosed by biopsy and without any active anti-neoplasic treatment were included in this study. Mexican-Spanish version of the EORTC QLQ-C15-PAL questionnaire was used to measure HRQL. Linear transformation of scale scores were done after EORTC guidelines. Correlation analysis was done obtaining the Spearman correlation coefficient and the Cochran alpha. Association of clinical parameters and scale scores were analyzed using one-way ANOVA and Chi-squared test. Test-retest comparison was tested using ANOVA for repeated measurements. Survival analysis was performed using the Kaplan-Meier and Cox's methods. Results: Eighty-three patients were enrolled in this study (mean age of 61.2 years). Compliance rates were high; all patients answered the questionnaire in less than 20 minutes and it was well-accepted. Five missing values in five different items were found. Scales in the QLQ-C15 distinguished between other clinically distinct groups of patients. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Cronbach's alpha coefficients were >0.7 in three of four multi-item scales. Test-retest scores were obtained from 25 patients and scores were consistent. Emotional function, Dyspnea, Insomnia and Appetite scales demonstrated an important association with overall survival by multivariate analysis (p<0.05). Conclusions: The Mexican-Spanish version of EORTC QLQ-C15-PAL questionnaire is reliable and valid for HRQL measurement in terminal patients with cancer, and appropriate for its use in clinical trials in Mexican patients.

No significant financial relationships to disclose.

Mutational analysis of BRCA1 and BRCA2 genes in Mexican breast cancer patients

Germline mutations in the BRCA1 and BRCA2 genes predispose to breast and ovarian cancer. A variable incidence of mutations has been reported for these genes. The contribution of BRCA1 and BRCA2 mutations to Mexican women with breast and/or ovarian cancer is not known. Because of the increasing prevalence of breast cancer in this population, it is necessary to study the presence of mutations in both genes. We screened BRCA1 and BRCA2 genes in 40 patients: 29 patients with a history of breast and/or ovarian cancer, and 11 patients with early-onset breast cancer (< 40 years), through denaturing high performance liquid chromatography analyses. We found two frameshift mutations in BRCA1 and one missense mutation in each gene. Additionally we found several intronic variants as well as synonymous mutations. We found 5% of deleterious mutations in the BRCA genes. Larger studies are needed to establish the significance and prevalence of BRCA mutations among Mexican women.

The Systemic Absorption of Etoposide after Intravaginal Administration in Patients with Cervical Intraepithelial Lesions Associated with Human Papillomavirus Infection

PURPOSE

The purpose of this study was to determine the systemic absorption and the release of etoposide in cervical tissue administered via a vaginal ovule to women diagnosed with cervical intraepithelial lesions associated with human papillomavirus (HPV).

METHODS

Fifteen women with low- and high-grade intraepithelial neoplasia confirmed by colposcopic test received a 50-mg intravaginal etoposide dose three times a week for 3 weeks. At the end of the study period, paralleled with the last ovule administered, blood samples were collected over a period of 24 h, and in situ cervical samples were obtained at 3 and 10 h after drug administration. Etoposide concentrations were determined in plasma and in in situ cervical samples using the high-performance liquid chromatography method with electrochemical detection.

RESULTS

Pharmacokinetic analyses of plasma data indicated low or lack of systemic exposure of etoposide after the vaginal administration. Nevertheless, high concentrations of etoposide were found in all in situ cervical samples, indicating that etoposide could be released from its pharmaceutical formulation.

CONCLUSIONS

The results of the study suggest that the etoposide administered as intravaginal ovule is safe and tolerable and apparently could be a suitable option in patients with cervical intraepithelial neoplasia. Clinical results and the true impact on HPV infection and evolution of dysplasia need to be confirmed.

Angiocentric lymphomas of the palate: clinico-pathological considerations in 12 cases

Angiocentric lymphomas (AL) involving the mid-face are infrequent lesions. Their incidence seems to be higher in certain Asian and Latin American countries, where most of the reported series reveal a predominance of T-cell lineage and a high frequency of EBV-positive cells. The clinical and pathological features of 12 AL that affected the palate are presented. Immunophenotypic studies were performed in nine of these cases. Seven (77%) demonstrated T-cell lineage, one was of B-cell origin and one could not be classified. The high incidence of T-cell lesions in this and other studies supports the existence of geographical and possibly of etiological differences in these neoplasms.