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Smith KL, Mead‐Harvey C, Mazza GL, Shinn EH, Frank ES, Melisko ME, Eaton C, Liu Y, Salamone JM, Pollastro T, Spears PA, Caston NE, Wolff AC, Rocque GB. TBCRC 057: Survey about willingness to participate in cancer clinical trials during the pandemic. Cancer Med 2024; 13:e7090. [PMID: 38466037 PMCID: PMC10926883 DOI: 10.1002/cam4.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Breast cancer patients experienced heightened anxiety during the pandemic. Also, modifications to clinical trial activities allowing for virtual platforms, local assessments, and greater flexibility were introduced to facilitate participation. We sought to evaluate the association between pandemic-related anxiety and willingness to participate in trials and how pandemic-era modifications to trial activities affect the decision to participate. METHODS We conducted an online survey from August to September, 2021 of patients with breast cancer assessing pandemic-related anxiety; clinical trials knowledge and attitudes; willingness to participate during and before the pandemic; and how each modification affects the decision to participate. Fisher's exact tests evaluated differences in proportions and two-sample t-tests evaluated differences in means. The association of pandemic-related anxiety with a decline in willingness to participate during compared to prior to the pandemic was modeled using logistic regression. RESULTS Among 385 respondents who completed the survey, 81% reported moderate-severe pandemic-related anxiety. Mean willingness to participate in a trial was lower during the pandemic than prior [2.97 (SD 1.17) vs. 3.10 (SD 1.09), (p < 0.001)]. Severe anxiety was associated with higher odds of diminished willingness to participate during the pandemic compared to prior (OR 5.07). Each of the modifications, with the exception of opting out of research-only blood tests, were endorsed by >50% of respondents as strategies that would increase their likelihood of deciding to participate. CONCLUSIONS While pandemic-related anxiety was associated with diminished willingness to participate in trials, the leading reasons for reluctance to consider trial participation were unrelated to the pandemic but included worries about not getting the best treatment, side effects, and delaying care. Patients view trial modifications favorably, supporting continuation of these modifications, as endorsed by the National Cancer Institute and others.
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Affiliation(s)
- Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease GroupJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Present address:
AstraZenecaGaithersburgMarylandUSA
| | | | - Gina L. Mazza
- Department of Quantitative Health SciencesMayo ClinicScottsdaleArizonaUSA
| | - Eileen H. Shinn
- Department of Behavioral Science, Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Michelle E. Melisko
- Department of Medicine (Hematology/Oncology)University of CaliforniaSan FranciscoCaliforniaUSA
| | - Cyd Eaton
- Biostatistics, Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Yisi Liu
- Biostatistics, Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | | | - Patricia A. Spears
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Nicole E. Caston
- Division of Hematology and OncologyUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
| | - Antonio C. Wolff
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease GroupJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gabrielle Betty Rocque
- Division of Hematology and OncologyUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
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2
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Knoerl R, Sannes TS, Giobbie-Hurder A, Frank ES, McTiernan A, Winer EP, Irwin ML, Ligibel JA. Exploring anxiety as an influencing factor of the impact of exercise and mind-body prehabilitation on cognitive functioning among women undergoing breast cancer surgery. J Psychosoc Oncol 2023; 42:448-456. [PMID: 38044630 DOI: 10.1080/07347332.2023.2282021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The purpose of this secondary analysis was to describe the prevalence of anxiety, depression, and perceived stress among women newly diagnosed with breast cancer and the impact of baseline and changes in anxiety on cognitive functioning following exercise and mind-body prehabilitation interventions. METHODS The sample consisted of 49 women with newly diagnosed breast cancer (stages I-III) who planned to undergo breast cancer surgery at two academic cancer centers. Participants were randomized to receive an exercise or mind-body prehabilitation intervention between the time of diagnosis and breast cancer surgery. Participants completed self-report measures of anxiety, depression (HADS), perceived stress, and cognitive functioning (EORTC-QLQ-C30) at study enrollment and prior to surgery (post-intervention). The relationships between change in cognitive functioning and change in anxiety among all participants were estimated using linear regression modeling. RESULTS A significant proportion of women with newly diagnosed breast cancer had clinically significant anxiety (34.0%). Greater anxiety was moderately associated with worse cognitive functioning (r = -0.33) at baseline. Linear modeling found that changes in cognitive functioning and anxiety were inversely related: Each one-unit decrease in anxiety was associated with a two-unit improvement in cognitive function (p = .06). CONCLUSIONS Anxiety was common in women with newly diagnosed breast cancer and was related to worse cognitive functioning. Assessment of anxiety at the time of diagnosis may allow for earlier anxiety management and subsequent improvement in cognitive functioning.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Timothy S Sannes
- Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth S Frank
- Division of Breast Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric P Winer
- Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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3
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Byng D, Thomas SM, Rushing CN, Lynch T, McCarthy A, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Retèl VP, van Harten WH, Grimm LJ, Hyslop T, Hwang ES, Ryser MD. Surveillance Imaging after Primary Diagnosis of Ductal Carcinoma in Situ. Radiology 2023; 307:e221210. [PMID: 36625746 PMCID: PMC10068891 DOI: 10.1148/radiol.221210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 01/11/2023]
Abstract
Background Guidelines recommend annual surveillance imaging after diagnosis of ductal carcinoma in situ (DCIS). Guideline adherence has not been characterized in a contemporary cohort. Purpose To identify uptake and determinants of surveillance imaging in women who underwent treatment for DCIS. Materials and Methods A stratified random sample of women who underwent breast-conserving surgery for primary DCIS between 2008 and 2014 was retrospectively selected from 1330 facilities in the United States. Imaging examinations were recorded from date of diagnosis until first distant recurrence, death, loss to follow-up, or end of study (November 2018). Imaging after treatment was categorized into 10 12-month periods starting 6 months after diagnosis. Primary outcome was per-period receipt of asymptomatic surveillance imaging (mammography, MRI, or US). Secondary outcome was diagnosis of ipsilateral invasive breast cancer. Multivariable logistic regression with repeated measures and generalized estimating equations was used to model receipt of imaging. Rates of diagnosis with ipsilateral invasive breast cancer were compared between women who did and those who did not undergo imaging in the 6-18-month period after diagnosis using inverse probability-weighted Kaplan-Meier estimators. Results A total of 12 559 women (median age, 60 years; IQR, 52-69 years) were evaluated. Uptake of surveillance imaging was 75% in the first period and decreased over time (P < .001). Across the first 5 years after treatment, 52% of women participated in consistent annual surveillance. Surveillance was lower in Black (adjusted odds ratio [OR], 0.80; 95% CI: 0.74, 0.88; P < .001) and Hispanic (OR, 0.82; 95% CI: 0.72, 0.94; P = .004) women than in White women. Women who underwent surveillance in the first period had a higher 6-year rate of diagnosis of invasive cancer (1.6%; 95% CI: 1.3, 1.9) than those who did not (1.1%; 95% CI: 0.7, 1.4; difference: 0.5%; 95% CI: 0.1, 1.0; P = .03). Conclusion Half of women did not consistently adhere to imaging surveillance guidelines across the first 5 years after treatment, with racial disparities in adherence rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Rahbar and Dontchos in this issue.
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Affiliation(s)
- Danalyn Byng
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Samantha M. Thomas
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Christel N. Rushing
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Thomas Lynch
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Anne McCarthy
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Amanda B. Francescatti
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Elizabeth S. Frank
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Ann H. Partridge
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Alastair M. Thompson
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Valesca P. Retèl
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Wim H. van Harten
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Lars J. Grimm
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Terry Hyslop
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - E. Shelley Hwang
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
| | - Marc D. Ryser
- From the Division of Psychosocial Research and Epidemiology, the
Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam,
the Netherlands (D.B., V.P.R., W.H.v.H.); Health Technology and Services
Research Department, Technical Medical Centre, University of Twente, Enschede,
the Netherlands (D.B., V.P.R., W.H.v.H.); Duke Cancer Institute Biostatistics
Shared Resource (S.M.T., C.N.R., T.H.) and Department of Mathematics (M.D.R.),
Duke University, Durham, NC; Department of Biostatistics and Bioinformatics
(S.M.T., T.H.), Division of Surgical Sciences, Department of Surgery (T.L.,
E.S.H.), Department of Radiology (L.J.G.), and Department of Population Health
Sciences (M.D.R.), Duke University Medical Center, 215 Morris St, Durham, NC
27701; Cancer Programs, American College of Surgeons, Chicago, Ill (A.M.,
A.B.F.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Mass (E.S.F., A.H.P.); and Department of Surgery, Baylor College of Medicine,
Houston, Tex (A.M.T.)
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4
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Smith KL, Mazza GL, Mead-Harvey C, Shinn EH, Frank ES, Melisko ME, Eaton C, Salamone JM, Pollastro T, Spears P, Wolff AC, Rocque GB. The effect of modifications to clinical trial activities implemented during the COVID-19 pandemic on willingness to participate in clinical trials: The TBCRC 057 survey. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
97 Background: In order to maintain safety, clinical trial activities have been modified during the COVID-19 pandemic. As part of the TBCRC 057 survey, we assessed how pandemic-related modifications to trial activities affect breast cancer patients’ willingness to participate in clinical trials. Methods: US residents with breast cancer were eligible to complete the online survey 8/6/21 – 9/30/21. Respondents rated whether each of 11 modifications to clinical trial activities would affect their decision to participate in a trial during or after the pandemic. Items evaluated modifications that involved changing the location of trial activities to closer to home, switching trial activities to telemedicine and making the trial schedule more flexible and convenient. Response options were “much less likely to participate”, “somewhat less likely to participate”, “would not affect my decision whether or not to participate”, “somewhat more likely to participate” and “much more likely to participate”. Current trial participants were asked to consider how modifications would affect their decision to participate in another trial. Results are reported descriptively. Results: Among 385 respondents, median age was 52 (range 25-85), 88.6% were non-Hispanic White, 52.5% had metastatic disease, 93% were receiving active treatment, 48.6% received care at an academic center and 9.6% were current trial participants. Changing location of trial activities was viewed favorably, with 70.2%, 64.6% and 54.1% of respondents indicating they would be much or somewhat more likely to participate if they could complete trial blood tests, x-ray tests or doctor visits closer to home, respectively. Similarly, the option to complete trial activities electronically was viewed favorably, with 59.6%, 58.6% and 60.9% of respondents indicating they would be much or somewhat more likely to participate if they could complete trial doctor visits, consent and questionnaires via telemedicine, respectively. With regard to modifications to make the trial schedule more flexible and convenient, respondent feedback was also favorable. 71.4%, 67.7% and 82.4% of respondents indicated that requiring study site visits no more than once per 3 weeks, widening windows for trial activities and offering home delivery of oral study medications, respectively, would make them much or somewhat more likely to participate. Finally, 30.4% and 51.7% indicated that the flexibility to opt-out of research-only blood tests and biopsies, respectively, would make them much or somewhat more likely to participate. Conclusions: Patients view modifications to trial activities implemented during the pandemic favorably. Trials should be flexible and the option to conduct study activities close to home or electronically when possible should be maintained during the pandemic and beyond.
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Affiliation(s)
- Karen L. Smith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Eileen H. Shinn
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Michelle E. Melisko
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Cyd Eaton
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Teri Pollastro
- Seattle Cancer Care Alliance/Breast Cancer Advocacy Network, Seattle, WA
| | - Patricia Spears
- Lineberger Compehensive Cancer Center at University of North Carolina, Chapel Hill, NC
| | - Antonio C. Wolff
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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5
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Smith KL, Mazza GL, Mead-Harvey C, Shinn EH, Frank ES, Melisko ME, Eaton C, Salamone JM, Pollastro T, Spears P, Wolff AC, Rocque GB. TBCRC 057: An online survey about anxiety and willingness to participate in breast cancer clinical trials during the COVID-19 pandemic. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1564 Background: Enrollment in clinical trials has declined during the COVID-19 pandemic. Simultaneously, breast cancer patients have reported heightened anxiety. We assessed whether breast cancer patients’ anxiety about the pandemic affects their willingness to participate in trials. Methods: English or Spanish-speaking US residents with breast cancer were eligible to complete the online REDCap survey 8/6/21 – 9/30/21. Respondents rated their anxiety about the pandemic on an 11-point scale from 0 (no anxiety) to 10 (worst anxiety possible). Anxiety scores were categorized as no/mild (0-3), moderate (4-6) or severe (7-10). Knowledge about trials was assessed with 11 true/false items and attitudes toward trials with the Attitudes Toward Cancer Trials Scales - Cancer Treatment Subscale (ATCTS-CTS). Respondents rated their willingness to participate in a breast cancer clinical trial before and during the pandemic on 5-point scales from 0 (not at all willing) to 4 (definitely willing). Trial participants were considered “definitely willing.” Change in willingness to participate in trials during the pandemic compared to prior was defined as a binary outcome, "less willing" vs "no less willing." Means were compared via t-test and mean difference was tested via paired t-test. Multivariable logistic regression was used to model the association of anxiety and other factors with being less willing to participate in trials during compared to prior to the pandemic. Results: Among 385 respondents, median age was 52 (range 25-85), 271 (70%) were non-Hispanic White and 202 (53%) had metastatic disease. 154 (40%) received care at academic centers and 37 (10%) were current trial participants. Most rated their anxiety as moderate (43%) or severe (38%). Mean willingness to participate in a trial was lower during compared to prior to the pandemic (2.97 vs 3.10; p < 0.0001). Fifty (13%) respondents were less willing to participate in a trial during the pandemic compared to prior. After controlling for covariates, those with severe anxiety had 5.07 times odds of being less willing to participate during the pandemic compared to prior than those with no/mild anxiety (p = 0.01). For every 1-point increase in ATCTS-CTS score (indicating better attitude toward trials) there was a 3% decrease in the odds of being less willing to participate during the pandemic (p = 0.006). For every 1-point increase in the clinical trials knowledge score (indicating more knowledge) there was a 15% decrease in the odds of being less willing to participate during the pandemic (p = 0.02). Conclusions: Pandemic-related anxiety is common in breast cancer patients and is associated with being less willing to participate in trials during the pandemic compared to prior. Education about trials, including safety modifications implemented during the pandemic, may mitigate anxiety and improve willingness to participate.
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Affiliation(s)
- Karen L. Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | - Eileen H. Shinn
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Michelle E. Melisko
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Cyd Eaton
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Antonio C. Wolff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
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Lynch T, Frank ES, Collyar DE, Pinto D, Basila D, Partridge AH, Thompson AM, Hwang ESS, Li F, Ren Y, Hyslop T. Comparing an operation to monitoring, with or without endocrine therapy (COMET), for low-risk ductal carcinoma in situ (DCIS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS616 Background: Approximately 50,000 women in the U.S. are diagnosed with ductal carcinoma in situ (DCIS) each year. Without treatment, it is estimated that only 20-30% of DCIS will lead to invasive breast cancer (IBC). However, over 97% of women are currently treated with surgery +/- radiation. An alternative to surgery is active monitoring (AM), a management approach in which mammograms/physical exams are used to monitor breast changes and determine when, or if, surgery is needed. The COMET Study will compare risks and benefits of AM versus surgery for low-risk DCIS in the setting of a Phase III multicenter prospective randomized trial. The study is funded by the Patient-Centered Outcomes Research Institute. The COMET trial opened in the U.S. in June 2017 (Clinicaltrials.gov reference: NCT02926911). In November 2021, the Data Safety Monitoring Board reviewed the trial and suggested that it continue as planned. Patient accrual will continue until 12/31/2022. Methods: The primary objective is to assess whether the 2-year ipsilateral IBC rate for AM is non-inferior to that for surgery. Secondary objectives include determining whether AM is non-inferior to surgery for 2-year mastectomy rate; breast conservation rate; contralateral breast cancer rate; overall and breast cancer-specific survival. Patient reported outcomes will enable comparison of health-related quality of life and psychosocial outcomes between surgery and AM groups at baseline, 6-months, and years 1-5. Eligibility criteria include: age > 40 at diagnosis; pathologic confirmation of grade I/II DCIS or atypia verging on DCIS without invasion by two pathologists; ER and/or PR ≥ 10%; no mass on physical exam or imaging. The accrual goal is 1200 randomized patients across 100 Alliance for Clinical Trials in Oncology sites. Sample size is estimated using a 2-group test of non-inferiority of proportions, with the 2-year IBC rate in the surgery group assumed to be 0.10 based on published studies and non-inferiority margin of 0.05. Based on a 1-sided un-pooled z-test, with alpha = 0.05, a sample size of n = 446 per group will have 80% power to detect the specified non-inferiority margin. Final analysis plan will include a per protocol component as well as a pragmatic component for patients who are randomized and decline participation in their assigned arm. Primary analyses will adjust for dropout, non-compliance and contamination by utilizing instrumental variable methods. Clinical trial information: NCT02926911.
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Affiliation(s)
| | | | | | | | - Desiree Basila
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Fan Li
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC
| | - Yi Ren
- Duke University School of Medicine, Durham, NC
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC
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7
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Rosenberg SM, Gierisch JM, Revette AC, Lowenstein CL, Frank ES, Collyar DE, Lynch T, Thompson AM, Partridge AH, Hwang ES. "Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ. Cancer 2022; 128:1676-1683. [PMID: 35191017 PMCID: PMC9274613 DOI: 10.1002/cncr.34126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/15/2021] [Accepted: 10/20/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Of the nearly 50,000 women in the United States who undergo treatment for ductal carcinoma in situ (DCIS) annually, many may not benefit from treatment. To better understand the impact of a DCIS diagnosis, patients self-identified as having had DCIS were engaged regarding their experience. METHODS In July 2014, a web-based survey was administered through the Susan Love Army of Women breast cancer listserv. The survey included open-ended questions designed to assess patients' perspectives about DCIS diagnosis and treatment. Deductive and inductive codes were applied to the responses; common themes were summarized. RESULTS Among the 1832 women included in the analytic sample, the median age at diagnosis was 60 years. Four primary themes were identified: 1) uncertainty surrounding a DCIS diagnosis, 2) uncertainty about DCIS treatment, 3) concern about treatment side effects, and 4) concern about recurrence and/or developing invasive breast cancer. When diagnosed, participants were often uncertain about whether they had cancer or not and whether they should be considered a "survivor." Uncertainty about treatment manifested as questioning the appropriateness of the amount of treatment received. Participants expressed concern about the "cancer spreading" or becoming invasive and that they were not necessarily "doing enough" to prevent recurrence. CONCLUSIONS In a large, national sample, participants with a history of DCIS reported confusion and concern about the diagnosis and treatment, which caused worry and significant uncertainty. Developing strategies to improve patient and provider communications regarding the nature of DCIS and acknowledging gaps in the current knowledge of management options should be a priority.
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Affiliation(s)
- Shoshana M Rosenberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer M Gierisch
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Carol L Lowenstein
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth S Frank
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Thomas Lynch
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alastair M Thompson
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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8
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Eisen A, Somerfield MR, Accordino MK, Blanchette PS, Clemons MJ, Dhesy-Thind S, Dillmon MS, D'Oronzo S, Fletcher GG, Frank ES, Hallmeyer S, Makhoul I, Moy B, Thawer A, Wu JY, Van Poznak CH. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: ASCO-OH (CCO) Guideline Update. J Clin Oncol 2022; 40:787-800. [PMID: 35041467 DOI: 10.1200/jco.21.02647] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To update recommendations of the American Society of Clinical Oncology (ASCO)-Ontario Health (Cancer Care Ontario [CCO]) adjuvant bone-modifying agents in breast cancer guideline. METHODS An Expert Panel conducted a systematic review to identify new, potentially practice-changing data. RESULTS Four articles met eligibility criteria and form the evidentiary basis for revision of the previous recommendations. RECOMMENDATIONS Adjuvant bisphosphonate therapy should be discussed with all postmenopausal patients (natural or therapy-induced) with primary breast cancer, irrespective of hormone receptor status and human epidermal growth factor receptor 2 status, who are candidates to receive adjuvant systemic therapy. Adjuvant bisphosphonates, if used, are not substitutes for standard anticancer modalities. The benefit of adjuvant bisphosphonate therapy will vary depending on the underlying risk of recurrence and is associated with a modest improvement in overall survival. The NHS PREDICT tool provides estimates of the benefit of adjuvant bisphosphonate therapy and may aid in decision making. Factors influencing the decision to recommend adjuvant bisphosphonate use should include patients' risk of recurrence, risk of side effects, financial toxicity, drug availability, patient preferences, comorbidities, and life expectancy. When an adjuvant bisphosphonate is used to prevent breast cancer recurrence, the therapeutic options recommended by the Panel include oral clodronate, oral ibandronate, and intravenous zoledronic acid. The Panel supports starting bisphosphonate therapy early, consistent with the points outlined in the parent CCO-ASCO guideline; this is a consensus recommendation. The Panel does not recommend adjuvant denosumab to prevent breast cancer recurrence, because studies did not show a consistent reduction of breast cancer recurrence in any subset of those with early-stage breast cancer.Additional information can be found at www.asco.org/breast-cancer-guideline.
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Affiliation(s)
- Andrea Eisen
- Sunnybrook Odette Cancer Centre; Ontario Health, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Alia Thawer
- Sunnybrook Odette Cancer Centre; Ontario Health, Toronto, ON, Canada
| | - Joy Y Wu
- Stanford University, Palo Alto, CA
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9
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de Azambuja E, Eiger D, Procter MJ, Ponde NF, Guillaume S, Parlier D, Lambertini M, Desmet A, Caballero CA, Aguila C, Jerusalem GHM, Walshe JM, Frank ES, Bines J, Loibl S, Piccart-Gebhart MJ, Ewer MS, Dent SF, Plummer C, Suter TM. Cardiac safety of dual anti-HER2 blockade with pertuzumab plus trastuzumab (P+T) in the APHINITY trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
510 Background: Trastuzumab (T) increases the incidence of cardiac events (CEs) in patients (pts) with early breast cancer (BC). Dual blockade with P+T improves BC outcomes and is the standard of care for high-risk HER2-positive BC pts following the phase 3 APHINITY trial that evaluated the addition of P or placebo (Pla) to T and chemotherapy (CT). We analyzed the cardiac safety of P+T in APHINITY. Methods: APHINITY eligibility required a left ventricular ejection fraction (LVEF) ≥55% at study entry. LVEF assessment was performed every 3 months (mos) during treatment, every 6 mos up to month 36, and yearly thereafter. Primary CE was defined as heart failure (HF) class III/IV and a significant decrease in LVEF of at least 10 percentage points from baseline and to <50%, or cardiac death. Secondary CE was defined as a confirmed significant decrease in LVEF or CEs confirmed by the cardiac advisory board. Results: The safety analysis population consists of 4,769 pts. With 74 mos median follow-up (FU), CEs were observed in 159 pts (3.3%): 83 (3.5%) in the P+T and 76 (3.2%) in Pla+T arms, respectively. Most CEs occurred during anti-HER2 therapy: 123/159 (77.4%) and were asymptomatic or mildly symptomatic LVEF decrease (133/159; 83.6%) (Table 1). There were 2 cardiac deaths in each arm (0.1%). More CEs occurred in pts receiving an anthracycline-based CT compared to those receiving non-anthracycline CT (139 vs. 20 CEs, respectively). Acute recovery from a CE based on subsequent LVEF values was observed in 127/155 pts (81.9%). Conclusions: Dual blockade with P+T does not increase the risk of CE compared to Pla+T alone. The use of anthracycline-based CT increases the risk of a CE; hence non-anthracycline CT may be considered particularly in pts with other cardiovascular risk factors. Clinical trial information: NCT01358877. [Table: see text]
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Affiliation(s)
- Evandro de Azambuja
- Institut Jules Bordet and Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Daniel Eiger
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | - Damien Parlier
- Breast European Adjuvant Study Team (BrEAST) Data Center, Institut Jules Bordet, Brussels, Belgium
| | - Matteo Lambertini
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genoa, Italy
| | | | | | | | | | - Janice Maria Walshe
- NSABP/NRG Oncology, and Cancer Trials Ireland, St Vincent's University Hospital, Dublin, Ireland
| | | | - Jose Bines
- Instituto Nacional de Câncer, Rio De Janeiro, Brazil
| | | | | | - Michael S. Ewer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Chris Plummer
- Department of Cardiology, Freeman Hospital, Newcastle, United Kingdom
| | - Thomas M Suter
- Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
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10
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Byng D, Retel VP, van Harten W, Rushing CN, Thomas SM, Lynch T, McCarthy A, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Grimm L, Hyslop T, Hwang ESS, Ryser MD. Disparities in surveillance imaging after breast conserving surgery for primary DCIS. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6516 Background: Due to the elevated risk of ipsilateral invasive breast cancer (iIBC) after diagnosis with primary ductal carcinoma in situ (DCIS), professional guidelines recommend surveillance screening within 6-12 months (mo) after completion of initial local treatment and annually thereafter. To characterize adherence to these guidelines, we explored longitudinal patterns of utilization and factors associated with the use of surveillance imaging (mammography, MRI, ultrasound) for women with primary DCIS treated with breast conserving surgery (BCS) ± radiotherapy (RT) within 6 mo of diagnosis. Methods: A treatment-stratified random sample of patients diagnosed with screen-detected and biopsy-confirmed DCIS in 2008-15 was selected from 1,330 Commission on Cancer-accredited facilities (up to 20/site) in the US. All imaging exams coded as asymptomatic were collected from 6 mo up to 10 years (yr) post-diagnosis. Time was defined according to 12-mo long surveillance periods. To be included in a given surveillance period, women had to be alive and free of a new breast cancer diagnosis through the end of the period. Women were classified as “consistent” screeners if they had at least one surveillance screen during each period, for the first 5 yr post-treatment or until censoring, whichever occurred first. Repeated measures multivariable logistic regression with generalized estimating equations was used to model receipt of surveillance breast imaging over time. The model included clinical and socioeconomic features. Results: The final analytic cohort contained 12,559 women; 8,989 (71.6%) received RT after BCS. Median age was 60 yr (interquartile range: 52-69) and median follow-up was 5.6 yr (95% confidence interval [CI] 5.6-5.7). Among women who received BCS (instead of BCS+RT), 62.5% (79.7%) underwent surveillance imaging within 6-18 mo after diagnosis. 38.7% (54.0%) were categorized as “consistent” screeners. Compared to white women, Black women were less likely to receive surveillance screening after treatment for primary DCIS (odds ratio [OR] 0.85, 95% CI 0.77-0.94). Hispanic ethnicity had a similar association (OR 0.86, 95% CI 0.74-0.99) compared to non-Hispanic ethnicity. Women with private insurance, compared to government insurance, were more likely to receive screening (OR 1.20, 95% CI 1.11-1.30). Prognostic tumor features indicative of a higher risk of subsequent iIBC, including higher grade, presence of comedonecrosis, and hormone receptor-negative DCIS, were not associated with screening uptake. Conclusions: Despite guidelines recommending annual surveillance imaging, many women with primary DCIS do not undergo regular imaging after BCS. The findings from this US-based study suggest that disparities in screening uptake are associated with race/ethnicity and insurance status rather than prognostic tumor features.
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Affiliation(s)
- Danalyn Byng
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Samantha M. Thomas
- Duke University Medical Center, Department of Biostatistics and Bioinformatics, Durham, NC
| | | | | | | | | | | | | | - Lars Grimm
- Duke University Medical Center, Durham, NC
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC
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11
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Ryser MD, Rushing CN, Thomas SM, Lynch T, McCarthy A, Mohammed ZA, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Hyslop T, Hwang ES. Abstract PD5-03: Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ in patients with and without index surgery: The effects of endocrine therapy and radiation treatment. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd5-03] [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. Ongoing clinical trials are evaluating active surveillance as a potential alternative to immediate surgery in patients diagnosed with low-risk ductal carcinoma in situ (DCIS). Among women undergoing lumpectomy, the risk of ipsilateral invasive breast cancer (iIBC) after a diagnosis of DCIS can be reduced with adjuvant therapy, including endocrine therapy (ET) and radiation treatment (RT). Here we characterize the effects of ET and RT on iIBC risk after diagnosis with DCIS in a national cohort, in patients who received breast conserving surgery (BCS) within 6 months of diagnosis (BCS group) compared to patients who did not receive any locoregional treatment within 6 months of diagnosis (surveillance [SV] group). Methods. A treatment-stratified random sample of patients diagnosed with biopsy-confirmed DCIS in 2008-14 was selected from 1,330 Commission on Cancer-accredited facilities (20/site). Patients who received a mastectomy within 6 months of diagnosis were excluded. Subsequent breast events were abstracted up to 10 years after diagnosis. Primary outcomes were the population-averaged 8-year absolute risks of iIBC for the following five treatment modalities: BCS alone, SV alone, BCS + ET, SV+ET, BCS+RT, and BCS+ET+RT (where ET was defined as ≥5 years of continuous treatment). Secondary outcomes were the average treatment effects (ATE) of SV+ET vs SV, BCS+RT vs SV+ET, and BCS+RT+ET vs SV+ET. A propensity score (PS) model for treatment choice BCS vs SV was fitted with sampling design (SD) weighting and random effects for patients within facilities. Relative treatment effects (hazard ratios [HR]) for the five treatment groups were obtained using multivariable Cox proportional hazards models adjusted for tumor and patient characteristics. The models were weighted by SD and PS and included a robust sandwich covariance estimator to account for clustering of patients within facilities. Population-averaged risks and ATEs were derived from the marginal outcome probabilities: assuming that the entire population received the treatment of interest, each patient’s counterfactual probability of an iIBC event by 8 years was predicted, and then averaged across the weighted population. 95% confidence intervals (CI) were obtained by bootstrapping. Results. The final analytic cohort contained 14,245 (88.2%) BCS and 1,914 (11.8%) SV patients. Overall, median age at diagnosis was 61 years (IQR: 52-69) and median follow-up was 5.8 years (95% CI 5.7-6.1). The majority of patients were Caucasian (81.9%), with hormone receptor-positive (79.9%), and nuclear grade I/II (54.5%) DCIS. Uptake of any ET was 48.5% and 23.7% in BCS and SV patients, respectively. The relative treatment effects (HR) for the receipt of BCS, RT and ≥5 years of ET were 1.65 (95% CI: 1.14-2.39), 0.40 (95% CI: 0.27-0.61) and 0.55 (95% CI: 0.17-1.72) respectively. The 8-year population-averaged iIBC risks and corresponding ATEs are shown Table 1. Conclusion. The 8-year risk of iIBC was below 7% for all six management options. Relative and absolute treatment effects of ET and RT were comparable to previously reported estimates. In SV patients, receipt of ≥5 years of ET nearly halved the 8-year risk, indicating a substantial risk reduction potential for ET in patients who do not receive immediate surgery after diagnosis.
Table 1: Population-averaged 8-year iIBC risk and ATEs.TreatmentiIBC risk (%)95% CISurveillance6.906.79-7.01Surveillance + ET3.903.83-3.96BCS4.264.21-4.31BCS + RT1.761.73-1.79BCS + ET2.392.35-2.43BCS + ET + RT0.980.96-0.99Treatment comparisonATE (%)95% CISV+ET vs SV3.02.95-3.04BCS+RT vs SV+ET2.142.11-2.17BCS+RT+ET vs SV+ET2.922.78-2.97
Citation Format: Marc D Ryser, Christel N Rushing, Samantha M Thomas, Thomas Lynch, Anne McCarthy, Zahed A Mohammed, Amanda B Francescatti, Elizabeth S Frank, Anne H Partridge, Alastair M Thompson, Terry Hyslop, E. Shelley Hwang. Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ in patients with and without index surgery: The effects of endocrine therapy and radiation treatment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD5-03.
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Affiliation(s)
| | | | | | | | - Anne McCarthy
- 2Cancer Programs, American College of Surgeons, Chicago, IL
| | | | | | | | - Anne H Partridge
- 4Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Seah DS, Leone JP, Openshaw TH, Scott SM, Tayob N, Hu J, Lederman RI, Frank ES, Sohl JJ, Stadler ZK, Erick TK, Silverman SG, Peppercorn JM, Winer EP, Come SE, Lin NU. Perceptions of patients with early stage breast cancer toward research biopsies. Cancer 2020; 127:1208-1219. [PMID: 33320362 PMCID: PMC8247276 DOI: 10.1002/cncr.33371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/28/2020] [Accepted: 11/07/2020] [Indexed: 11/24/2022]
Abstract
Background The objective of this study was to describe the perspective of patients with early breast cancer toward research biopsies. The authors hypothesized that more patients at academic sites than at community‐based sites would be willing to consider these procedures. Methods In total, 198 patients with early stage breast cancer were recruited from 3 academic centers (n = 102) and from 1 community oncology practice (n = 96). The primary objective was to compare the proportion of patients willing to consider donating excess tissue biospecimens from surgery, from a clinically indicated breast biopsy, or from a research purposes‐only biopsy (RPOB) between practice types. Results Most patients (93% at academic sites, 94% at the community oncology site) said they would consider donating excess tissue from surgery for research. One‐half of patients from academic or community sites would consider donating tissue from a clinically indicated breast biopsy. On univariate analysis, significantly fewer patients from academic sites would consider an RPOB (22% at academic sites, 42% at the community site; P = .003); however, this difference was no longer significant on multivariate analysis (P = .96). Longer transportation times and unfavorable prior experiences were associated with less willingness to consider an RPOB on multivariate analysis. Significantly fewer patients from academic sites (14%) than from the community site (35%) would consider a research biopsy in a clinical trial (P = .04). Contributing to scientific knowledge, return of results, and a personal request by their physician were the strongest factors influencing patients' willingness to undergo research biopsies. Conclusions The current results rejected the hypothesis that more patients with early breast cancer at academic sites would be willing to donate tissue biospecimens for research compared with those at community oncology sites. These findings identify modifiable factors to consider in biobanking studies and clinical trials. In this study of the willingness of patients with early stage breast cancer to consider biospecimen collection procedures for the purposes of research, most patients were willing to provide blood samples for research but were less likely to consider percutaneous breast biopsies. Longer travel time to the clinic and adverse experiences with prior biopsies, but not treatment center type (academic versus community‐based center), were associated with less willingness to consider research biopsies.
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Affiliation(s)
- Davinia S Seah
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jose Pablo Leone
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sarah M Scott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nabihah Tayob
- Department of Data Science, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Jiani Hu
- Department of Data Science, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Ruth I Lederman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth S Frank
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jessica J Sohl
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy K Erick
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey M Peppercorn
- Department of Medicine, Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | - Eric P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Steven E Come
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nancy U Lin
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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13
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Piccart MJ, Hilbers FS, Bliss JM, Caballero C, Frank ES, Renault P, Naït Kaoudjt R, Schumacher E, Spears PA, Regan MM, Gelber RD, Davidson NE, Norton L, Winer EP. Road Map to Safe and Well-Designed De-escalation Trials of Systemic Adjuvant Therapy for Solid Tumors. J Clin Oncol 2020; 38:4120-4129. [PMID: 33052755 DOI: 10.1200/jco.20.01382] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 02/11/2024] Open
Abstract
An important challenge in the field of cancer is finding the balance between delivering effective treatments and avoiding adverse effects and financial toxicity caused by innovative, yet expensive, drugs. To address this, several treatment de-escalation trials have been conducted, but only a few of these have provided clear answers. A few trials had poor accrual or had design flaws that led to conflicting results. Members of the Breast International Group (BIG) and North American Breast Cancer Group (NABCG) believe the way forward is to understand the lessons from these trials and listen more carefully to what truly matters to our patients. We reviewed several adjuvant trials of different cancer types and developed a road map for improving the design and implementation of future de-escalation trials. The road map incorporates patients' insights obtained through focused group discussions across the BIG-NABCG networks. Considerations for the development of de-escalation trials for systemic adjuvant treatment, including noninferiority trial design, choice of end points, and prioritization of a patient's perspectives, are presented in this consensus article.
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Affiliation(s)
| | | | - Judith M Bliss
- The Institute of Cancer Research, Clinical Trials & Statistics Unit, London, United Kingdom
| | | | - Elizabeth S Frank
- Dana Farber Cancer Institute, Department of Medical Oncology, Boston, MA
| | | | | | | | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Meredith M Regan
- International Breast Cancer Study Group Statistical Center, Department of Data Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Data Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Harvard TH Chan School of Public Health, Boston, MA
- Frontier Science and Technology Research Foundation, Boston, MA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Larry Norton
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY
| | - Eric P Winer
- Dana Farber Cancer Institute, Department of Medical Oncology, Boston, MA
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14
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Bellon JR, Burstein HJ, Frank ES, Mittendorf EA, King TA. Multidisciplinary considerations in the treatment of triple-negative breast cancer. CA Cancer J Clin 2020; 70:432-442. [PMID: 32986241 DOI: 10.3322/caac.21643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jennifer R Bellon
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Harold J Burstein
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S Frank
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Elizabeth A Mittendorf
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tari A King
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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15
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Durbin AD, Kugener G, Zimmerman MW, Yan C, Dharia NV, Frank ES, Chen X, Ross KN, Paolella B, Krill-Burger M, Root DE, Boehm JS, Vazquez F, Hong AL, Tsherniak A, Langenau DM, Hahn WC, Golub TR, Abraham BJ, Young RA, Look AT, Stegmaier K. Abstract B10: Rhabdomyosarcoma requires MYC family genomic events to pathogenically subvert core-regulatory circuitry. Cancer Res 2020. [DOI: 10.1158/1538-7445.pedca19-b10] [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
Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood. Despite multimodality therapy and trials of molecularly targeted agents, limited improvements in overall survival have been realized for patients with high-risk disease. Thus, we aimed to determine the landscape of tumor-specific gene dependencies that underlie tumorigenesis in RMS and therefore provide a valuable group of targets for the development of novel therapeutics. Using unbiased genome-scale CRISPR-Cas9 approaches, we identified a set of RMS-specific tumor dependencies involved in tumor cell growth and survival. RMS dependencies were enriched for nucleic acid binding proteins, including transcription factors (TFs). We then used genome-wide chromatin-immunoprecipitation coupled to high-throughput sequencing analysis to demonstrate that a small number of essential TFs—MYCN, MYOD1, TCF12, SOX8, ZEB2, ZNF217, and SIX1—are members of the transcriptional core regulatory circuitry (CRC) that maintains the malignant cell state of RMS. Both c-MYC and MYCN were associated with gene and enhancer copy number increases in cell lines and primary tumors and represented strong dependencies in the RMS cell lines screened. c-MYC and MYCN function to similarly invade and regulate the CRC in respectively dependent cells. To disable the CRC, we tested A485, an inhibitor of the histone acetyltransferase enzymes involved in the establishment of super-enhancer elements that are associated with high level expression of the CRC factors. A485 caused a reversible and rapid loss of CRC factor and c-MYC and/or MYCN expression, and prolonged treatment resulted in cell cycle arrest, differentiation, and apoptosis in vitro and in vivo. This phenotype is rescued by exogenous re-expression of either c-MYC or MYCN in a manner insensitive to A485, indicating a mechanism by which these genes subvert a myogenic CRC to produce an oncogenic fate. This study defines a common set of critical dependency genes in RMS and identifies key genomic events surrounding the c-MYC and MYCN loci that lead to elevated expression and tumorigenesis.
Citation Format: Adam D. Durbin, Guillaume Kugener, Mark W. Zimmerman, Chuan Yan, Neekesh V. Dharia, Elizabeth S. Frank, Xiang Chen, Ken N. Ross, Brenton Paolella, Michael Krill-Burger, David E. Root, Jesse S. Boehm, Francisca Vazquez, Andrew L. Hong, Aviad Tsherniak, David M. Langenau, William C. Hahn, Todd R. Golub, Brian J. Abraham, Richard A. Young, A. Thomas Look, Kimberly Stegmaier. Rhabdomyosarcoma requires MYC family genomic events to pathogenically subvert core-regulatory circuitry [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr B10.
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Affiliation(s)
| | | | | | - Chuan Yan
- 3Massachusetts General Hospital Research Institute, Charlestown, MA,
| | | | | | - Xiang Chen
- 4St. Jude Children’s Research Hospital, Memphis, TN,
| | | | | | | | - David E. Root
- 2The Broad Institute of MIT and Harvard, Cambridge, MA,
| | | | | | | | | | - David M. Langenau
- 3Massachusetts General Hospital Research Institute, Charlestown, MA,
| | | | - Todd R. Golub
- 2The Broad Institute of MIT and Harvard, Cambridge, MA,
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16
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Ryser MD, Hendrix L, Thomas SM, Lynch T, McCarthy A, Mohammed Z, Francescatti AB, Frank ES, Partridge AH, Thompson AM, Hyslop T, Hwang ESS. Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ (DCIS): Comparison of patients with and without index surgery. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
519 Background: Most women diagnosed with ductal carcinoma in situ (DCIS) undergo surgical resection, potentially leading to overtreatment of patients who would not develop clinically significant breast cancer in the absence of locoregional treatment. We compared the risk of ipsilateral invasive breast cancer (iIBC) between DCIS patients who received breast conserving surgery (BCS) for their index diagnosis of DCIS (BCS group) and patients who did not receive any locoregional treatment within 6 months of diagnosis (surveillance [SV] group). Methods: A treatment-stratified random sample of patients diagnosed with screen-detected and biopsy-confirmed DCIS in 2008-14 was selected from 1,330 Commission on Cancer-accredited facilities (20/site). Excluding patients who received a mastectomy ≤6 months, the final analytic cohort contained 14,245 (88.2%) BCS and 1,914 (11.8%) SV patients. Subsequent breast events were abstracted up to 10 years after diagnosis. Primary outcome was the 8-year absolute difference in iIBC risk between BCS and SV; a subgroup analysis was performed for grade I/II patients. A propensity score (PS) model for treatment was fitted with sampling design (SD) weighting and random effects for patients within facilities. Absolute risk differences were estimated using PS-SD-weighted Kaplan Meier estimators. Results: Overall, median age at diagnosis was 61 years (IQR: 52-69) and median follow-up was 5.8 years (95% CI 5.7-6.1). The majority of patients were Caucasian (81.9%), with estrogen receptor-positive (80.6%), and nuclear grade I/II (54.5%) DCIS. The fraction of patients with a Charlson comorbidity score of ≥2 was higher in SV (14.2%) compared to BCS (6.4%, p < 0.001). The 8-year risk of iIBC was 3.0% (95% CI: 2.4%-3.6%) for BCS and 7.7% (95% CI: 4.9%-10.5%) for SV, with an absolute risk difference of 4.7% (95% CI: 4.5%-4.9%; log-rank p < 0.001). Among patients with grade I/II tumors, the 8-year risk of iIBC was 3.1% (95% CI: 2.3%-4.0%) for BCS and 6.1% (95% CI: 2.5%-9.8%) for SV; difference: 3.0% (95% CI: 2.7%-3.2%; p = 0.005). Conclusions: Despite an increased risk of iIBC in SV patients compared to BCS patients, the 8-year risk did not exceed 10% in either group. The risk of recurrence in BCS patients was comparable to previously reported estimates. These data demonstrate a considerable degree of overtreatment among patients with non-high grade DCIS. Prospective clinical trials will help determine the tradeoffs between universally directed as opposed to selectively applied surgery for low risk DCIS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC
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17
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Rosenberg SM, Hendrix LH, Schreiber KL, Thompson AM, Bedrosian I, Hughes KS, Lynch T, Basila D, Collyar DE, Frank ES, Darai S, Lanahan C, Marks JR, Plichta JK, Hyslop T, Partridge AH, Hwang ES. Abstract P1-21-07: The Patient-reported Outcomes after Routine Treatment of Atypical Lesions (PORTAL) study: Pain, psychosocial wellbeing, and quality of life among women undergoing guideline concordant care for DCIS vs. active surveillance for in situ and atypical lesions. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-21-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: Guideline-concordant care (GCC) for DCIS includes surgery, radiation, and endocrine treatment. Active surveillance (AS) is a strategy under study for management of low risk DCIS. The PORTAL Study was designed to evaluate patient reported outcomes (PROs) after GCC for DCIS compared to women who received AS for DCIS combined with women with a history of other atypical lesions (atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia/lobular carcinoma in situ (LN), as proxies for AS-managed DCIS. Methods: The PORTAL Study invited women age≥ 18, diagnosed with DCIS, ADH, or LN between 2012-2017 from 4 academic centers to complete a one-time, cross-sectional survey. Clinical, pathological, and treatment information was obtained from medical record review. The primary outcome was breast/chest wall pain assessed with the Breast Cancer Pain Questionnaire (BCPQ) including severity (10-point scale, ≥3=clinically relevant), a Pain Burden Index (PBI), which is a composite of severity, frequency, and location (breast, arm, side, axilla) and assessments of sensory disturbances, and impact of pain on emotional and physical functioning. Additional PROs included measures of generalized pain (Brief Pain Inventory), anxiety (STAI-Short Form), depression (CES-D), and QOL (Quality of Life in Adult Cancer Survivors). Pain, psychosocial, and QOL outcomes were compared between the GCC vs. AS groups using Wilcoxon Rank Sum and Chi-Square tests. Results: Of 1565 patients invited and sent a survey, 927 (59%) responded to the survey with evaluable pain outcome data. Median time from diagnosis was 3.8 years. Median age at survey completion was 58 (range: 26-94) years; 13% identified as non-White; 4% Hispanic. Among those with DCIS (n=554), 97% had GCC (62%, lumpectomy, 38%, mastectomy; 48%, radiation), representing 58% of participants vs 42% representing AS. The prevalence of clinically relevant pain was higher in the GCC vs. AS group (16.5% vs 9%, p=.0009). Median BCPQ-PBI, sensory disturbance, physical, and emotional impact scores were all higher (p<.0001) in the GCC vs. AS group (Table); BPI scores for pain severity and interference were similar between groups. QOL, anxiety and depressive symptoms were similar among women who had GCC compared to the AS group. Conclusion: Women with DCIS who have undergone GCC experience more breast/chest wall pain and report greater impact of pain on physical and emotional functioning in long term follow-up, compared to women who have undergone AS for DCIS or are managed for other atypical lesions. Given that many women with low risk DCIS may be unlikely to develop invasive cancer, improved understanding of the potential trade-offs of GCC vs AS can help support informed decision making in women with DCIS who are considering their treatment options. Ongoing prospective trials will provide further information regarding risks and benefits of AS vs GCC for women with low risk DCIS.
BCPQ Scores, GCC vs. ASGCCASMean (range)Median (IQR)Mean (range)Median (IQR)p*PBI6.4 (0-80)0 (0-9)2.9 (0-64)0 (0-0)<.0001Sensory disturbance1.4 (0-9)0 (0-2)0.6 (0-9)0 (0-0)<.0001Physical impact9.6 (0-67)0 (0-19)4.4 (0-56)0 (0-0)<.0001Emotional impact1.4 (0-33)0 (0-1)0.6 (0-38)0 (0-0)<.0001*Wilcoxon rank sum test comparing median scores
Citation Format: Shoshana M Rosenberg, Laura H Hendrix, Kristin L Schreiber, Alastair M Thompson, Isabelle Bedrosian, Kevin S Hughes, Thomas Lynch, Desiree Basila, Deborah E Collyar, Elizabeth S Frank, Sonja Darai, Conor Lanahan, Jeffrey R Marks, Jennifer K Plichta, Terry Hyslop, Ann H Partridge, E. Shelley Hwang. The Patient-reported Outcomes after Routine Treatment of Atypical Lesions (PORTAL) study: Pain, psychosocial wellbeing, and quality of life among women undergoing guideline concordant care for DCIS vs. active surveillance for in situ and atypical lesions [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 P1-21-07.
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18
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Ozanne EM, Soeteman DI, Frank ES, Clarke J, Hassett MJ, Stout NK, Punglia RS. Commentary: Creating a patient-centered decision aid for ductal carcinoma in situ. Breast J 2020; 26:1498-1499. [PMID: 32034829 DOI: 10.1111/tbj.13779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Elissa M Ozanne
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Djøra I Soeteman
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, Massachusetts
| | - Elizabeth S Frank
- Dana-Farber/Harvard Center Breast Cancer Advocacy Group, DFCI, Boston, Massachusetts
| | - John Clarke
- Cornerstone Systems Northwest Inc, Boston, Massachusetts
| | | | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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19
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Cremer A, Ellegast JM, Alexe G, Frank ES, Ross L, Chu SH, Pikman Y, Robichaud A, Goodale A, Häupl B, Mohr S, Rao AV, Walker AR, Blachly JS, Piccioni F, Armstrong SA, Byrd JC, Oellerich T, Stegmaier K. Resistance Mechanisms to SYK Inhibition in Acute Myeloid Leukemia. Cancer Discov 2019; 10:214-231. [PMID: 31771968 DOI: 10.1158/2159-8290.cd-19-0209] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/08/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
Abstract
Spleen tyrosine kinase (SYK) is a nonmutated therapeutic target in acute myeloid leukemia (AML). Attempts to exploit SYK therapeutically in AML have shown promising results in combination with chemotherapy, likely reflecting induced mechanisms of resistance to single-agent treatment in vivo. We conducted a genome-scale open reading frame (ORF) resistance screen and identified activation of the RAS-MAPK-ERK pathway as one major mechanism of resistance to SYK inhibitors. This finding was validated in AML cell lines with innate and acquired resistance to SYK inhibitors. Furthermore, patients with AML with select mutations activating these pathways displayed early resistance to SYK inhibition. To circumvent SYK inhibitor therapy resistance in AML, we demonstrate that a MEK and SYK inhibitor combination is synergistic in vitro and in vivo. Our data provide justification for use of ORF screening to identify resistance mechanisms to kinase inhibitor therapy in AML lacking distinct mutations and to direct novel combination-based strategies to abrogate these. SIGNIFICANCE: The integration of functional genomic screening with the study of mechanisms of intrinsic and acquired resistance in model systems and human patients identified resistance to SYK inhibitors through MAPK signaling in AML. The dual targeting of SYK and the MAPK pathway offers a combinatorial strategy to overcome this resistance.This article is highlighted in the In This Issue feature, p. 161.
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Affiliation(s)
- Anjali Cremer
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jana M Ellegast
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriela Alexe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Bioinformatics Graduate Program, Boston University, Boston, Massachusetts
| | - Elizabeth S Frank
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda Ross
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Haihua Chu
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yana Pikman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amanda Robichaud
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy Goodale
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Björn Häupl
- University Hospital Frankfurt, Department of Hematology/Oncology, Frankfurt/Main, Germany.,German Cancer Consortium/German Cancer Research Center, Heidelberg, Germany
| | - Sebastian Mohr
- University Hospital Frankfurt, Department of Hematology/Oncology, Frankfurt/Main, Germany
| | - Arati V Rao
- Gilead Sciences Inc., Foster City, California
| | - Alison R Walker
- Department of Internal Medicine, Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - James S Blachly
- Department of Internal Medicine, Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Scott A Armstrong
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John C Byrd
- Department of Internal Medicine, Division of Hematology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas Oellerich
- University Hospital Frankfurt, Department of Hematology/Oncology, Frankfurt/Main, Germany. .,German Cancer Consortium/German Cancer Research Center, Heidelberg, Germany
| | - Kimberly Stegmaier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. .,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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20
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Bowen DJ, Shinn EH, Gregrowski S, Kimmick G, Dominici LS, Frank ES, Smith KL, Rocque G, Ruddy KJ, Pollastro T, Melisko M, Ballinger TJ, Fayanju OM, Wolff AC. Patient-reported outcomes in the Translational Breast Cancer Research Consortium. Cancer 2019; 126:922-930. [PMID: 31743427 DOI: 10.1002/cncr.32615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 11/07/2022]
Abstract
Members of the Translational Breast Cancer Research Consortium conducted an expert-driven literature review to identify a list of domains and to evaluate potential measures of these domains for inclusion in a list of preferred measures. Measures were included if they were easily available, free of charge, and had acceptable psychometrics based on published peer-reviewed analyses. A total of 22 domains and 52 measures were identified during the selection process. Taken together, these measures form a reliable and validated list of measurement tools that are easily available and used in multiple cancer trials to assess patient-reported outcomes in relevant patients.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Eileen H Shinn
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Gretchen Kimmick
- Department of Medicine, Duke Cancer Institute, Durham, North Carolina
| | - Laura S Dominici
- Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Gabrielle Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama
| | | | | | - Michelle Melisko
- University of California at San Francisco, San Francisco, California
| | | | | | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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21
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Punglia RS, Ortiz Pimentel S, Cronin AM, Frank ES, Bellon JR, Abel GA, Uno H, Wong JS. Patient-preferred outcomes measurement after post-mastectomy radiation therapy and immediate reconstruction. Breast J 2019; 26:319-321. [PMID: 31495035 DOI: 10.1111/tbj.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Rinaa S Punglia
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts.,Division of Population Sciences, Center for Outcomes and Policy Research, DFCI, Boston, Massachusetts
| | - Sindy Ortiz Pimentel
- Division of Population Sciences, Center for Outcomes and Policy Research, DFCI, Boston, Massachusetts
| | - Angel M Cronin
- Division of Population Sciences, Center for Outcomes and Policy Research, DFCI, Boston, Massachusetts
| | - Elizabeth S Frank
- Dana-Farber/Harvard Center Breast Cancer Advocacy Group, DFCI, Boston, Massachusetts
| | - Jennifer R Bellon
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts
| | - Gregory A Abel
- Division of Population Sciences, Center for Outcomes and Policy Research, DFCI, Boston, Massachusetts
| | - Hajime Uno
- Division of Population Sciences, Center for Outcomes and Policy Research, DFCI, Boston, Massachusetts
| | - Julia S Wong
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts
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22
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Guenther LM, Dharia NV, Ross L, Conway A, Robichaud AL, Catlett JL, Wechsler CS, Frank ES, Goodale A, Church AJ, Tseng YY, Guha R, McKnight CG, Janeway KA, Boehm JS, Mora J, Davis MI, Alexe G, Piccioni F, Stegmaier K. A Combination CDK4/6 and IGF1R Inhibitor Strategy for Ewing Sarcoma. Clin Cancer Res 2018; 25:1343-1357. [PMID: 30397176 DOI: 10.1158/1078-0432.ccr-18-0372] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/04/2018] [Accepted: 10/31/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Novel targeted therapeutics have transformed the care of subsets of patients with cancer. In pediatric malignancies, however, with simple tumor genomes and infrequent targetable mutations, there have been few new FDA-approved targeted drugs. The cyclin-dependent kinase (CDK)4/6 pathway recently emerged as a dependency in Ewing sarcoma. Given the heightened efficacy of this class with targeted drug combinations in other cancers, as well as the propensity of resistance to emerge with single agents, we aimed to identify genes mediating resistance to CDK4/6 inhibitors and biologically relevant combinations for use with CDK4/6 inhibitors in Ewing. EXPERIMENTAL DESIGN We performed a genome-scale open reading frame (ORF) screen in 2 Ewing cell lines sensitive to CDK4/6 inhibitors to identify genes conferring resistance. Concurrently, we established resistance to a CDK4/6 inhibitor in a Ewing cell line. RESULTS The ORF screen revealed IGF1R as a gene whose overexpression promoted drug escape. We also found elevated levels of phospho-IGF1R in our resistant Ewing cell line, supporting the relevance of IGF1R signaling to acquired resistance. In a small-molecule screen, an IGF1R inhibitor scored as synergistic with CDK4/6 inhibitor treatment. The combination of CDK4/6 inhibitors and IGF1R inhibitors was synergistic in vitro and active in mouse models. Mechanistically, this combination more profoundly repressed cell cycle and PI3K/mTOR signaling than either single drug perturbation. CONCLUSIONS Taken together, these results suggest that IGF1R inhibitors activation is an escape mechanism to CDK4/6 inhibitors in Ewing sarcoma and that dual targeting of CDK4/6 inhibitors and IGF1R inhibitors provides a candidate synergistic combination for clinical application in this disease.
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Affiliation(s)
- Lillian M Guenther
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - Neekesh V Dharia
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts.,Broad Institute, Cambridge, Massachusetts
| | - Linda Ross
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - Amy Conway
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - Amanda L Robichaud
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - Jerrel L Catlett
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - Caroline S Wechsler
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth S Frank
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts.,Broad Institute, Cambridge, Massachusetts
| | | | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Rajarshi Guha
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Crystal G McKnight
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Katherine A Janeway
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | | | - Jaume Mora
- Department of Pediatric Oncology and Hematology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mindy I Davis
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Gabriela Alexe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts.,Broad Institute, Cambridge, Massachusetts.,Bioinformatics Graduate Program, Boston University, Boston, Massachusetts
| | | | - Kimberly Stegmaier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts. .,Broad Institute, Cambridge, Massachusetts
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23
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Lynch T, Frank ES, Collyar DE, Basila D, Pinto D, Partridge A, Thompson AM, Hwang ESS. Comparison of operative to monitoring and endocrine therapy for low-risk DCIS (COMET study). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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)
| | | | | | - Desiree Basila
- University of California San Francisco, San Francisco, CA
| | | | - Ann Partridge
- Adult Survivorship Program, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
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Hughes ME, Frank ES, Merrill MS, Santiago RA, Kuhnly N, Crowley LM, Gupta G, Winer EP, Lin NU. Abstract P4-10-04: EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: In contrast to early stage breast cancer, the quality of care for patients with metastatic breast cancer (MBC) has been relatively understudied, as have interventions to improve care in the real-world setting. Patients with MBC face a variety of unique needs related to their disease, treatment options, and supportive care. Little attention has been focused on leveraging the strengths of academic and community-based settings to provide optimal care for these patients. To address these critical issues, we have designed and implemented a comprehensive program that combines clinical care, clinical research, physician engagement and patient education to optimize the care of MBC patients.
Methods: We developed a consistent and comprehensive intake process and follow-up approach for MBC patients who were seen at least once in the Breast Oncology Clinic (BOC) at Dana-Farber Cancer Institute (DFCI). A key component of our approach is the EMBRACE coordinator who meets with each MBC patient at the first clinic visit to review the clinical program, available educational and supportive resources, and consents to research studies. Each coordinator supports the DFCI-based oncologist and follows a discrete patient panel longitudinally, for whom they are responsible for facilitating referrals to supportive care resources, identifying potential candidates for trial prescreening, tracking availability of results from molecular testing for clinical trial matching, facilitating communication between DFCI-based providers and referring providers and organizing re-consultation visits when clinically appropriate. The coordinator contacts patients every 3 months to inquire about the patient's overall health and needs and provides updates on upcoming educational and supportive care activities at our institution. Educational offerings have been expanded to include a bi-annual newsletter, quarterly email updates, webcasts and an annual educational patient forum. Results: The program was fully implemented in the BOC across 27 oncologists in August 2016, after the start of a pilot in July 2015. On average, the program enrolls 30 to 40 new MBC patients per month at their initial visit. The EMBRACE coordinators currently support the DFCI-based oncologists in the care of approximately 1500 new and existing MBC patients and facilitate collaborations with 350 referring providers.
Conclusions: The EMBRACE program has made a tangible improvement in the quality of care for patients with MBC in our clinic. We have successfully established the infrastructure of the coordinator role and a robust tracking system to support the patient, DFCI-based provider, and referring provider. While the program has been solely based at DFCI, we believe that our approach has the potential for impact beyond our institution and ultimately serve as a model for enhanced academic-community-patient partnership.
Citation Format: Hughes ME, Frank ES, Merrill MS, Santiago RA, Kuhnly N, Crowley LM, Gupta G, Winer EP, Lin NU. EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer [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 P4-10-04.
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Affiliation(s)
- ME Hughes
- Dana-Farber Cancer Institute, Boston, MA
| | - ES Frank
- Dana-Farber Cancer Institute, Boston, MA
| | - MS Merrill
- Dana-Farber Cancer Institute, Boston, MA
| | | | - N Kuhnly
- Dana-Farber Cancer Institute, Boston, MA
| | - LM Crowley
- Dana-Farber Cancer Institute, Boston, MA
| | - G Gupta
- Dana-Farber Cancer Institute, Boston, MA
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA
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25
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Rosenberg SM, Gierisch JM, Lowenstein C, Frank ES, Collyer D, Partridge AH, Hwang ES. Abstract P4-15-11: “Is it cancer or not?” A qualitative exploration of patient perspectives surrounding the diagnosis and treatment of DCIS. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-15-11] [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: Approximately 53,000 women in the US undergo treatment for ductal carcinoma in situ (DCIS) each year, of whom only 20-30% may benefit. To better understand both the clinical and psychosocial impact of a DCIS diagnosis and different management approaches, we sought to engage women with DCIS regarding their experience surrounding diagnosis (dx) and treatment.
Methods: In July 2014, we administered a web-based survey through an email listserv to the Susan Love Army of Women that resulted in over 2000 respondents self-identified as patients with DCIS. The survey included open-ended questions designed to assess patients' perspectives on their experiences with the dx and treatment of their DCIS. Responses were coded using an inductive coding schema; common themes were identified and summarized. Women who reported an invasive cancer, a second primary or recurrent tumor, or other benign breast lesions (in absence of DCIS) were excluded from analysis.
Results: Among 1,857 women included in the analytic sample, the average age at dx was 60 years; 18% women were ≤2 years from their dx; most women (93%) identified as white. Four primary themes were identified: 1) uncertainty about DCIS dx; 2) uncertainty surrounding treatment; 3) concern about side effects from treatment; and 4) concern about recurrence and invasive breast cancer. Uncertainty about treatment often manifested as women questioning whether they were over-treated for their DCIS, “over-reacting by having surgery,” or wondering if “watchful waiting might be better.” In addition to recalling bothersome side effects and sequelae from both their local and systemic (hormonal) therapy, women also expressed doubt about their treatment choices, specifically, that they were not necessarily “doing enough” with many women citing recurrence, the “cancer spreading”, or becoming invasive, as primary concerns. Uncertainty about whether DCIS was cancer or not, was noted by many women, with one calling it a “grey zone” and others articulating that DCIS is “having a dx that's not really cancer… yet you might still lose your breast,” and experiencing “confusion about my status as a cancer patient - as in I wasn't sure if I even was a cancer patient. I had no idea where I fit in…”
Conclusion: A DCIS dx can be confusing and distressing, with women making treatment decisions based on a limited understanding of the disease, its risks, and pros and cons of treatment options. There is a need to develop additional strategies to improve the management of this disease and other screen-detected conditions, through better understanding of the disease and its outcomes, coupled with improved methods to communicate this information to those affected. Our study highlights the potential value of collecting patient reported outcomes (PROs) to inform clinical research and care. Ongoing clinical trials like the COMET, LORIS, and LORD studies, which incorporate robust PROs, should provide additional evidence for patients, health care providers and other stakeholders regarding the medical and psychosocial benefits and harms of different DCIS management options.
Citation Format: Rosenberg SM, Gierisch JM, Lowenstein C, Frank ES, Collyer D, Partridge AH, Hwang ES. “Is it cancer or not?” A qualitative exploration of patient perspectives surrounding the diagnosis and treatment of DCIS [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 P4-15-11.
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Affiliation(s)
- SM Rosenberg
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
| | - JM Gierisch
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
| | - C Lowenstein
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
| | - ES Frank
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
| | - D Collyer
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
| | - AH Partridge
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
| | - ES Hwang
- Dana-Farber Cancer Institute; Duke University Medical Center; Patient Advocates in Research
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26
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Frank ES, Basila D, Collyar D, Pinto D, Smith ML, Geirisch J, Lynch T, Hwang S. Abstract P5-17-04: Changing the DCIS conversation: Development of an alternative discourse by patient stakeholders in the COMET study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-17-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The conversation about ductal carcinoma in situ (DCIS) is structured and influenced by traditional oncology values and beliefs, resulting in current standards of guideline concordant care (GCC). It is now widely known that DCIS is a heterogeneous condition requiring a tailored treatment approach based on characteristics of the specific lesion. Further, “low-risk” DCIS—defined as low grade, hormone-receptor positive condition—may be a subset with lower likelihood of progression to invasive breast cancer. Yet, most women diagnosed with any type of DCIS are encouraged to undergo the same immediate, aggressive treatments that women diagnosed with invasive breast cancer receive. Emerging evidence suggests that surgery may not increase overall survival compared to no surgery in many women diagnosed with low-risk DCIS.
The COMET (Comparison of Operative to Monitoring and Endocrine Therapy) study is a new randomized, prospective clinical trial funded by the Patient-Centered Outcomes Research Institute that aims to determine whether active surveillance is a safe and reasonable alternative to GCC for patients with low-risk DCIS. COMET also seeks to change the way patients, providers, and other key stakeholders view DCIS management options. Thus, COMET governance integrates patient collaborators into every aspect of planning and development via a Patient Leadership Team (PLT) and an independent external multi-stakeholder advisory board (SAB). The PLT is a fully integrated, yet autonomous part of the COMET study governance and is comprised of 4 patient advocates who meet independently and with COMET Principal Investigators (PIs). The SAB is a fully external and independent body of clinicians, content experts, payers, patients and patient advocates, and policymaker advisors.
To facilitate the cultural shift, the PLT developed communication materials with language and terminology that aims to communicate a diagnosis of DCIS without increasing unnecessary fear and anxiety that often accompanies a diagnosis of invasive cancer. In collaboration with study team PI's and the SAB, PLT also has developed content for a newly established website (www.DCISoptions.org), which includes patient-centered materials that aim to help newly diagnosed patients understand that a majority of DCIS is low-risk and that they have time to make informed decisions about their care.
The PLT contends that managing DCIS is as much a cultural phenomenon as a scientific one. As such, changing the conversation about DCIS between medical providers and patients is essential for generating a cultural shift in understanding the condition, correcting risk perception, and enabling improvement in patient experience. The novel approach of a stand-alone PLT that is also integrated throughout the trial's stakeholder structure ensures patient-centered involvement across all aspects of the study. The unique talents of each stakeholder group are leveraged in a unified effort to educate the DCIS community about low-risk DCIS, with the overarching goal of enabling a patient to choose the treatment approach that best reflects her risk profile and personal preferences, thus minimizing potential physical, emotional, and financial harms.
Citation Format: Frank ES, Basila D, Collyar D, Pinto D, Smith ML, Geirisch J, Lynch T, Hwang S. Changing the DCIS conversation: Development of an alternative discourse by patient stakeholders in the COMET study [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 P5-17-04.
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Affiliation(s)
- ES Frank
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - D Basila
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - D Collyar
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - D Pinto
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - ML Smith
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - J Geirisch
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - T Lynch
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
| | - S Hwang
- Dana-Farber Cancer Institute, Boston, MA; Patient Advocates in Research, Danville, CA; Research Advocacy Network, Plano, TX; Duke University, Durham, NC
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Van Poznak C, Somerfield MR, Barlow WE, Biermann JS, Bosserman LD, Clemons MJ, Dhesy-Thind SK, Dillmon MS, Eisen A, Frank ES, Jagsi R, Jimenez R, Theriault RL, Vandenberg TA, Yee GC, Moy B. Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology–Cancer Care Ontario Focused Guideline Update. J Clin Oncol 2017; 35:3978-3986. [DOI: 10.1200/jco.2017.75.4614] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases. Recommendations Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks. The analgesic effects of BMAs are modest, and they should not be used alone for bone pain. The Update Committee recommends that the current standard of care for supportive care and pain management—analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management—be applied. Evidence is insufficient to support the use of one BMA over another. Additional information is available at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Catherine Van Poznak
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Mark R. Somerfield
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - William E. Barlow
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - J. Sybil Biermann
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Linda D. Bosserman
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Mark J. Clemons
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Sukhbinder K. Dhesy-Thind
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Melissa S. Dillmon
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Andrea Eisen
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Elizabeth S. Frank
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Reshma Jagsi
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Rachel Jimenez
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Richard L. Theriault
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Theodore A. Vandenberg
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Gary C. Yee
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
| | - Beverly Moy
- Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario,
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Dhesy-Thind S, Fletcher GG, Blanchette PS, Clemons MJ, Dillmon MS, Frank ES, Gandhi S, Gupta R, Mates M, Moy B, Vandenberg T, Van Poznak CH. Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:2062-2081. [PMID: 28618241 DOI: 10.1200/jco.2016.70.7257] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose To make recommendations regarding the use of bisphosphonates and other bone-modifying agents as adjuvant therapy for patients with breast cancer. Methods Cancer Care Ontario and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. Results Adjuvant bisphosphonates were found to reduce bone recurrence and improve survival in postmenopausal patients with nonmetastatic breast cancer. In this guideline, postmenopausal includes patients with natural menopause or that induced by ovarian suppression or ablation. Absolute benefit is greater in patients who are at higher risk of recurrence, and almost all trials were conducted in patients who also received systemic therapy. Most studies evaluated zoledronic acid or clodronate, and data are extremely limited for other bisphosphonates. While denosumab was found to reduce fractures, long-term survival data are still required. Recommendations It is recommended that, if available, zoledronic acid (4 mg intravenously every 6 months) or clodronate (1,600 mg/d orally) be considered as adjuvant therapy for postmenopausal patients with breast cancer who are deemed candidates for adjuvant systemic therapy. Further research comparing different bone-modifying agents, doses, dosing intervals, and durations is required. Risk factors for osteonecrosis of the jaw and renal impairment should be assessed, and any pending dental or oral health problems should be dealt with prior to starting treatment. Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation. Use of these agents to reduce fragility fractures in patients with low bone mineral density is beyond the scope of the guideline. Recommendations are not meant to restrict such use of bone-modifying agents in these situations. Additional information at www.asco.org/breast-cancer-adjuvant-bisphosphonates-guideline , www.asco.org/guidelineswiki , https://www.cancercareontario.ca/guidelines-advice/types-of-cancer/breast .
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Affiliation(s)
- Sukhbinder Dhesy-Thind
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Glenn G Fletcher
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Phillip S Blanchette
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Mark J Clemons
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Melissa S Dillmon
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Elizabeth S Frank
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Sonal Gandhi
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Rasna Gupta
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Mihaela Mates
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Beverly Moy
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Ted Vandenberg
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
| | - Catherine H Van Poznak
- Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI
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Punglia RS, Cronin AM, Uno H, Stout NK, Ozanne EM, Greenberg CC, Frank ES, Schrag D. Association of Regional Intensity of Ductal Carcinoma In Situ Treatment With Likelihood of Breast Preservation. JAMA Oncol 2017; 3:101-104. [PMID: 27442038 DOI: 10.1001/jamaoncol.2016.2164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Large regional variation exists in the use of radiotherapy after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). Although patients who do not receive initial radiotherapy for DCIS are candidates for subsequent BCS if they experience a second breast event, many undergo mastectomy instead. Objective To examine whether regional practice patterns of radiotherapy for DCIS affect the use of mastectomy in these patients. Design, Setting, and Participants A retrospective analysis of population-based databases (Surveillance, Epidemiology, and End Results [SEER] and SEER-Medicare). Data were obtained for 2679 women in SEER with a diagnosis of DCIS between 1990 and 2011 and for 757 women in SEER-Medicare with a DCIS diagnosis between 1991 and 2009 who had not undergone radiotherapy for DCIS and experienced a subsequent breast cancer or DCIS diagnosis. Exposures Treatment intensity for primary DCIS (high, medium, low), as defined by separating health service areas (HSAs) into 3 clusters based on radiotherapy use. Main Outcomes and Measures Mastectomy vs BCS at a second breast event defined as DCIS recurrence or new invasive cancer. Results The median (SD) ages of the participants was 64 (13) years for the 2679 SEER population and 79 (6) years for the SEER-Medicare cohort. Residence in an HSA characterized by greater radiotherapy use for DCIS increased the likelihood of receiving mastectomy vs BCS at a subsequent breast event, even among women who had not previously received radiotherapy for DCIS. Adjusted odds ratios for receiving mastectomy were 1.43 (95% CI, 1.10-1.85) and 1.90 (95% CI, 1.27-2.84) in SEER and SEER-Medicare databases, respectively, among women residing in an HSA with the greatest radiotherapy use vs the least, corresponding to an adjusted increase from 40.8% to 49.6%, and from 38.6% to 54.5%. Conclusions and Relevance Areas with more radiotherapy use for DCIS had increased use of mastectomy at the time of a second breast event even among patients eligible for breast conservation. This association suggests that physician-related factors are affecting the likelihood of breast preservation.
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Affiliation(s)
- Rinaa S Punglia
- Department of Radiation Therapy, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Angel M Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Hajime Uno
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Elissa M Ozanne
- The Dartmouth Institute, Geisel School of Medicine, Hanover, New Hampshire
| | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine, Madison
| | - Elizabeth S Frank
- Dana-Farber/Harvard Center Breast Cancer Advocacy Group, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Deborah Schrag
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Ligibel JA, Giobbie-Hurder A, Shockro L, Rhei E, Troyan S, Dominici LS, Chagpar AB, Frank ES, McTiernan A, Yung RL, Freedman RA, Tolaney SM, O'Connor K, Stecker K, Dillon D, Irwin ML. Impact of a pre-operative exercise intervention on Ki-67 and metabolic markers in women with early breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
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Ligibel JA, Alfano CM, Hershman D, Ballard RM, Bruinooge SS, Courneya KS, Daniels EC, Demark-Wahnefried W, Frank ES, Goodwin PJ, Irwin ML, Levit LA, McCaskill-Stevens W, Minasian LM, O'Rourke MA, Pierce JP, Stein KD, Thomson CA, Hudis CA. Recommendations for Obesity Clinical Trials in Cancer Survivors: American Society of Clinical Oncology Statement. J Clin Oncol 2015; 33:3961-7. [PMID: 26324364 DOI: 10.1200/jco.2015.63.1440] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Observational evidence has established a relationship between obesity and cancer risk and outcomes. Interventional studies have demonstrated the feasibility and benefits of lifestyle change after cancer diagnosis, and guidelines recommend weight management and regular physical activity in cancer survivors; however, lifestyle interventions are not a routine part of cancer care. The ASCO Research Summit on Advancing Obesity Clinical Trials in Cancer Survivors sought to identify the knowledge gaps that clinical trials addressing energy balance factors in cancer survivors have not answered and to develop a roadmap for the design and implementation of studies with the potential to generate data that could lead to the evidence-based incorporation of weight management and physical activity programs into standard oncology practice. Recommendations highlight the need for large-scale trials evaluating the impact of energy balance interventions on cancer outcomes, as well as the concurrent conduct of studies focused on dissemination and implementation of interventions in diverse populations of cancer survivors, including answering critical questions about the degree of benefit in key subgroups of survivors. Other considerations include the importance of incorporating economic metrics into energy balance intervention trials, the need to establish intermediate biomarkers, and the importance of integrating traditional and nontraditional funding sources. Establishing lifestyle change after cancer diagnosis as a routine part of cancer care will require a multipronged effort to overcome barriers related to study development, funding, and stakeholder engagement. Given the prevalence of obesity and inactivity in cancer survivors in the United States and elsewhere, energy balance interventions hold the potential to reduce cancer morbidity and mortality in millions of patients, and it is essential that we move forward in determining their role in cancer care with the same care and precision used to test pharmacologic and other interventions.
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Affiliation(s)
- Jennifer A Ligibel
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ.
| | - Catherine M Alfano
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Dawn Hershman
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Rachel M Ballard
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Suanna S Bruinooge
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Kerry S Courneya
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Elvan C Daniels
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Wendy Demark-Wahnefried
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Elizabeth S Frank
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Pamela J Goodwin
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Melinda L Irwin
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Laura A Levit
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Worta McCaskill-Stevens
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Lori M Minasian
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Mark A O'Rourke
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - John P Pierce
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Kevin D Stein
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Cynthia A Thomson
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
| | - Clifford A Hudis
- Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ
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Vaz-Luis I, Zeghibe CA, Frank ES, Sohl J, Washington KE, Silverman SG, Fonte JM, Mayer EL, Overmoyer BA, Richardson AL, Krop IE, Winer EP, Lin NU. Prospective clinical experience with research biopsies in breast cancer patients. Breast Cancer Res Treat 2013; 142:203-9. [PMID: 24113744 PMCID: PMC3825285 DOI: 10.1007/s10549-013-2717-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/28/2013] [Indexed: 01/02/2023]
Abstract
There are ethical concerns regarding the performance of biopsies in patients for research purposes. We examined our single-institution experience regarding acceptance, safety, and success rate with research biopsies in patients with breast cancer. Among patients with data from paired samples, receptor status agreement between primary and metastatic samples was examined, either on first recurrence or after progression on one or more lines of therapy. An IRB-approved prospective study at the Dana-Farber Cancer Institute collects research biopsies as additional passes at the time of a clinical biopsy (AB, additional biopsy) or as a separate procedure for banking purposes (RPOB, research purposes only biopsy). Biopsies are not linked to a specific therapeutic or correlative trial. Grade 2–5 adverse events are prospectively collected. 151 patients were included in the analytic cohort (total procedures = 161); 80.8 % underwent AB, 17.2 % underwent RPOB, and 2.0 % underwent both AB and RPOB. Most patients were white (88.7 %) with a performance status of 0–1 (94.0 %). 96.0 % of patients underwent a biopsy in the setting of known or suspected metastatic disease. Receptor status between primary cancer and recurrent research biopsies differed in 43.2 % of patients with available data (18.8 % among patients who underwent the research biopsy before any systemic treatment, 48.1 % after treatment). Tissue was successfully collected in 92.3 % of patients undergoing AB and 100 % patients undergoing RPOB. Only three (2.0 %) patients had adverse events ≥grade-2: one grade-2 pain; one grade-2 pneumothorax; and one grade-3 pain. Our experience suggests research biopsies can be performed safely with a high rate of successful tissue collection. Consistent with previous reports we found a high rate of discordance between primary and metastatic samples, which was even higher among treated patients. This supports continued efforts to study tissue samples at multiple points in a patient’s disease course.
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Affiliation(s)
- Ines Vaz-Luis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
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Zeghibe CA, Luis IMVD, Frank ES, Sohl J, Washington KE, Silverman SG, Fonte JM, Mayer EL, Overmoyer B, Richardson AL, Krop IE, Winer EP, Lin NU. Prospective clinical experience with research biopsies in breast cancer patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17574 Background: There is active debate concerning the ethics and risks of non-clinically indicated biopsies (bxs) in patients (pts) with cancer. In this analysis we examined our single institution experience regarding acceptance, safety, and success rate with research biopsies in pts with breast cancer (BC). Methods: An IRB-approved ongoing prospective study at the Dana-Farber Cancer Institute collects research bxs from pts with BC. Research bxs are performed as additional passes at the time of a clinical bx (cohort 1) or as a separate procedure for banking purposes only (cohort 2) on known tumor or suspicious lesions. Bxs are not linked to a specific therapeutic or correlative trial. Bx-site related risks are pre-specified in consent forms. Grade 2-5 adverse events (AEs) associated with the procedure are prospectively collected. Chart review for bxs between 2005-2013 was performed in this analysis. Results: As of January 2013, 158 pts had consented to the study; 3 pts withdrew consent and 4 pts did not have bxs. 151 pts are in the analytic cohort (total bxs performed= 161); 82% in cohort 1, 18% in cohort 2. Most pts were white (89%) with a performance status of 0-1 (98%). A majority of pts (96%) underwent a bx in the setting of known or suspected metastatic disease. 39% of bxs were performed at time of diagnosis or first recurrence. The most common sites for bx were liver (38%, n=61), skin (24%, n=39) and breast (18%, n=29). Lung was uncommon (3%, n=4). Research biopsies were successfully performed in 114 (92%) pts in cohort 1 and 27 (100%) pts in cohort 2. In cohort 1, research biopsies were not successful in 10 pts. In 9 pts the clinical samples had insufficient material, leading to the forfeit of the banked research sample for clinical purposes; in 1 pt the bx was suspended for severe pain. Only 3 (1.9%) pts had AEs ≥ grade 2: 1 with grade 2 pain; 1 with grade 2 pneumothorax; and 1 with grade 3 pain. Conclusions: Our experience in an academic medical center suggests that pts with BC are willing to undergo research bxs outside the context of a therapeutic or translational trial. These procedures can be performed safely with a high rate of successful tissue collection. Additional data are needed to fully quantify the risks and to demonstrate the value of these procedures.
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Basch E, Abernethy AP, Mullins CD, Reeve BB, Smith ML, Coons SJ, Sloan J, Wenzel K, Chauhan C, Eppard W, Frank ES, Lipscomb J, Raymond SA, Spencer M, Tunis S. Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology. J Clin Oncol 2012; 30:4249-55. [PMID: 23071244 DOI: 10.1200/jco.2012.42.5967] [Citation(s) in RCA: 355] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Examining the patient's subjective experience in prospective clinical comparative effectiveness research (CER) of oncology treatments or process interventions is essential for informing decision making. Patient-reported outcome (PRO) measures are the standard tools for directly eliciting the patient experience. There are currently no widely accepted standards for developing or implementing PRO measures in CER. Recommendations for the design and implementation of PRO measures in CER were developed via a standardized process including multistakeholder interviews, a technical working group, and public comments. Key recommendations are to include assessment of patient-reported symptoms as well as health-related quality of life in all prospective clinical CER studies in adult oncology; to identify symptoms relevant to a particular study population and context based on literature review and/or qualitative and quantitative methods; to assure that PRO measures used are valid, reliable, and sensitive in a comparable population (measures particularly recommended include EORTC QLQ-C30, FACT, MDASI, PRO-CTCAE, and PROMIS); to collect PRO data electronically whenever possible; to employ methods that minimize missing patient reports and include a plan for analyzing and reporting missing PRO data; to report the proportion of responders and cumulative distribution of responses in addition to mean changes in scores; and to publish results of PRO analyses simultaneously with other clinical outcomes. Twelve core symptoms are recommended for consideration in studies in advanced or metastatic cancers. Adherence to methodologic standards for the selection, implementation, and analysis/reporting of PRO measures will lead to an understanding of the patient experience that informs better decisions by patients, providers, regulators, and payers.
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Affiliation(s)
- Ethan Basch
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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MacLean RA, Mathews NE, Grove DM, Frank ES, Paul-Murphy J. SURGICAL TECHNIQUE FOR TUBAL LIGATION IN WHITE‐TAILED DEER (ODOCOILEUS VIRGINIANUS). J Zoo Wildl Med 2006; 37:354-60. [PMID: 17319135 DOI: 10.1638/05-091.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Surgical tubal ligation was used to sterilize urban free-ranging white-tailed deer (Odocoileus virginianus) as a methodology of a larger study investigating the influences of intact, sterile females on population dynamics and behavior. Deer were either trapped in clover traps (n = 55) and induced with an i.m. injection of xylazine and tiletamine/zolazepam or induced by a similar protocol by dart (n = 12), then intubated and maintained on isoflurane in oxygen. Over 3 yr, individual female deer (n = 103) were captured in Highland Park, Illinois, with a subset of females sterilized using tubal ligation by ventral laparotomy (n = 63). Other sterilization procedures included tubal transection by ventral (n = 1) or right lateral (n = 2) laparoscopy and ovariohysterectomy by ventral laparotomy (n = 1). One mortality (1/ 67, 1.5%) of a doe with an advanced pregnancy was attributed to a lengthy right lateral laparoscopic surgery that was converted to a right lateral laparotomy. The initial surgical modality of laparoscopy was altered in favor of a ventral laparotomy for simplification of the project and improved surgical access in late-term gravid does. Laparotomy techniques included oviductal ligation and transection (n = 14), application of an oviductal mechanical clip (n = 9), ligation and partial salpingectomy (n = 40), and ovariohysterectomy (n = 1). As of 2 yr poststerilization, no surgical does were observed with fawns, indicating that these procedures provide sterilization with low mortality in urban white-tailed deer.
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Affiliation(s)
- Robert A MacLean
- University of Wisconsin-Madison, Department of Wildlife Ecology, 1630 Linden Drive, Madison, Wisconsin 53706, USA
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Chaudhuri M, Kleiman DG, Wildt DE, Bush M, Frank ES, Thau RB. Urinary steroid concentrations during natural and gonadotrophin-induced oestrus and pregnancy in the giant panda (Ailuropoda melanoleuca). J Reprod Fertil 1988; 84:23-8. [PMID: 3141616 DOI: 10.1530/jrf.0.0840023] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Urinary concentrations of conjugated oestrone and pregnanediol-3-glucuronide were measured during and after spontaneous and induced oestrus and during pregnancy. Behavioural oestrus was preceded by a rise in oestrone values from less than 10 ng/mg creatinine (Cr) to peaks of 45 ng/mg Cr. Maximal lordotic response and mating activity coincided with the decline in oestrone levels. After presumed ovulation, urinary pregnanediol glucuronide concentrations increased from less than 5 to 15-30 ng/mg Cr. Further increases in this steroid (to 60-80 ng/mg Cr) occurred 114 days after mating, presumably coincident with implantation. These high levels of pregnanediol glucuronide were maintained for 3 weeks, began to decline 1 week before parturition and fell to a nadir (less than 5 ng/mg Cr) immediately after delivery. When FSH was administered i.m. for 5 days, urinary oestrone values rose markedly and were maximal (580 ng/mg Cr) on Day 7. Mating first occurred on Day 20 and 500 i.u. hCG were given i.m. Urinary pregnanediol glucuronide levels during the next 5 months were similar to those in the previous year during pregnancy with values rising 105-108 days after mating. However, no birth occurred. These results support the suggestion that pandas exhibit delayed implantation and demonstrate that the panda is responsive to exogenous gonadotrophins.
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Mann PC, Bush M, Janssen DL, Frank ES, Montali RJ. Clinicopathologic correlations of tuberculosis in large zoo mammals. J Am Vet Med Assoc 1981; 179:1123-9. [PMID: 7035420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In August 1978, a black rhinoceros at the National Zoological Park died with generalized tuberculosis caused by Mycobacterium bovis. A 2nd black rhinoceros was euthanatized 9 months after M bovis was cultured from its lungs. After these 2 deaths, numerous large zoo mammals that had been potentially exposed were subjected to various procedures to ascertain their status regarding tuberculosis. The procedures were: intradermal tuberculin testing, evaluation of delayed hypersensitivity reaction on biopsy specimens, enzyme-linked immunosorbent assay (ELISA) testing, and culture of various secretions and organs. Several of the animals in this series died during the study. These were necropsied and examined for evidence of mycobacterial infection. The results of tuberculin testing varied from species to species and from site to site within a species. Delayed hypersensitivity responses generally correlated well with the amount of swelling at the tuberculin site. In some cases, however, positive reactions were found without any delayed hypersensitivity response. Results of ELISA testing were confirmatory in tuberculous animals. Several species were judged to be nonspecific reactors, based on positive or suspect tuberculin test results, with negative ELISA results and necropsy findings.
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