Abstract P2-05-05: Not presented

This abstract was not presented at the symposium.

Utilisation d’une solution polyamphotère lors de lésions et brûlures chimiques oculaires cutanées et buccales. effet sur la douleur de la diphotérine®

Polyamphoteric washing solutions (PWS) have been used for several years, mainly in industries, for cases of chemical ocular or cutaneous splashes by acid or alkali. We collected 37 cases reporting the use of PWS for ocular and cutaneous chemical splashes from several centres. Among the 37 cases, 55.26% resulted from occupational exposure. Among ocular exposures, initial clinical symptoms included pain (20 cases), blepharospasm (4 cases), hyperaemia (15 cases), palpebral oedema (2 cases) and blurred vision (7 cases). Among cutaneous exposures, 2 injuries were classified as deep, and 11 as superficial. Mean (SD) pain (VAS) before PWS was 6,29 +/- 2,74; mean (SD) pain after PWS was 1,47 +/- 1,73. Early application of PWS to the eye or skin reduces the intensity of pain that is associated with chemical damage. Early application of amphoteric solution appears to reduce the incidence of sequelae, provided its pre-hospital and hospital use is early. However, further studies are needed.

Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease

BACKGROUND

Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. Beta-blockers reduce portal pressure and minimise haemorrhage risk. These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing.

AIM

To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease.

METHODS

This was a cross-sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation. All participants remained on their usual beta-blocker dose and timing prior to the test. Variables measured during cardiopulmonary exercise testing included the ventilatory threshold, peak oxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and the ventilatory equivalents for carbon dioxide slope.

RESULTS

Participants taking beta-blockers (n = 28) had a lower ventilatory threshold (P <.01) and peak oxygen uptake (P = .02), compared to participants not taking beta-blockers. After adjusting for age, the model of end-stage liver-disease score, liver-disease aetiology, presence of refractory ascites and ventilatory threshold remained significantly lower in the beta-blocker group (P = .04). The oxygen uptake efficiency slope was not impacted by beta-blocker use.

CONCLUSIONS

Ventilatory threshold is reduced in patients with advanced liver disease taking beta-blockers compared to those not taking the medication. This may incorrectly risk stratify patients on beta-blockers and has implications for patient management before and after liver transplantation. The oxygen uptake efficiency slope was not influenced by beta-blockers and may therefore be a better measure of cardiopulmonary performance in this patient population.

Characterizing the Extent of Spatially Integrated Floodplain and Wetland Systems in the White River, Indiana, USA

Floodplain delineation may inform protection of wetland systems under local, state, or federal laws. Nationally available Federal Emergency Management Agency Flood Insurance Rate Maps (FIRMs, "100-year floodplain" maps) focus on urban areas and higher-order river systems, limiting utility at large scales. Few other national-scale floodplain data are available. We acquired FIRMs for a large watershed and compared FIRMs to floodplain and integrated wetland area mapping methods based on (1) geospatial distance, (2) geomorphic setting, and (3) soil characteristics. We used observed flooding events (OFEs) with recurrence intervals of 25-50 to >100 years to assess floodplain estimate accuracy. FIRMs accurately reflected floodplain areas based on OFEs and covered 32% of river length, whereas soil-based mapping was not as accurate as FIRMs but characterized floodplain areas over approximately 65% of stream length. Geomorphic approaches included more areas than indicated by OFE, whereas geospatial approaches tended to cover less area. Overall, soil-based methods have the highest utility in determining floodplains and their integrated wetland areas at large scales due to the use of nationally available data and flexibility for regional application. These findings will improve floodplain and integrated wetland system extent assessment for better management at local, state, and national scales.

Centre-level variation of treatment and outcome in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento-facial outcomes

OBJECTIVES

Outline methods used to describe centre-level variation in treatment and outcome in children in the Cleft Care UK (CCUK) study. Report centre-level variation in dento-facial outcomes.

SETTING AND SAMPLE POPULATION

Two hundred and sixty-eight five-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP).

MATERIALS AND METHODS

Between January 2011 and December 2012, data were collected on a comprehensive range of outcomes. Child facial appearance and symmetry were assessed using photographic pictures. Dental arch relationships were assessed from standardized dental study models. Hierarchical statistical models were used to predict overall means and the variance partition coefficient (VPC)-a measure of amount of variation in treatment or outcome explained by the centre.

RESULTS

Data on dento-alveolar arch relationships and facial appearance were available on 197 and 252 children, respectively. The median age of the children was 5.5 years, and 68% were boys. Variation was described across 13 centres. There was no evidence of centre-level variation in good or poor dento-alveolar arch relationships with a VPC of 4% and 3%, respectively. Similarly, there was no evidence of centre-level variation in good or poor facial appearance with a VPC of 2% and 5%, respectively.

CONCLUSIONS

There was no evidence of centre-level variation for dento-facial outcomes although this study only had the power to detect large variation between sites.

Abstract P1-05-30: Genomic and microenvironmental intra-tumor heterogeneity in DCIS

Intra-tumor heterogeneity drives neoplastic progression by supplying the fuel for natural selection among neoplastic cells. It also complicates screening and treatment of neoplasms. We hypothesize that the degree of intra-tumor heterogeneity in DCIS should predict which tumors are likely to become invasive and metastatic. We initiated a pilot project to test this hypothesis by comparing 9 cases of pure DCIS to 9 cases of DCIS with adjacent invasive disease. For each case, we sequenced the exome from two spatially distinct regions of DCIS as well as normal tissue taken from a lymph node with no tumor involvement. This required the development of new methods to extract high quality sequencing data from small amounts of DNA extracted from FFPE samples. We calculated the genetic divergence between the two tumor regions, defined as percent of the sequenced regions of the genome showing differences between the two samples that had sufficient sequencing coverage and quality scores for confident scoring. We also employed automated imaging analysis to score microenvironmental differences between the two tumor regions. These microenvironmental measures are based on ecological methods for measuring organismal interactions and habitats. We will present initial data on differences in phenotypic and genotypic intra-tumor heterogeneity comparing pure DCIS to DCIS associated with invasive breast cancer. Our methods can be readily translated to large tissue banks of FFPE samples from DCIS.

Citation Format: Fortunato A, King L, Mallo D, Kovacheva V, Yuan Y, Boddy A, Graham T, Aktipis A, Mardis ER, Hall A, Marks JR, Hwang S, Maley CC. Genomic and microenvironmental intra-tumor heterogeneity in DCIS [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-30.

Abstract P3-11-02: Women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer

Background: Neoadjuvant systemic therapy (NAST) is a treatment option for selected patients with highly proliferative and/or large operable breast cancer. Whilst survival outcomes are equivalent between up-front surgery and NAST, the decision about treatment sequence can be difficult due to complexity and perceived urgency of the decision. Patients may value the outcomes of these options, such as down staging and prognostication, differently. Involving patients in decisions about their healthcare reduces anxiety, increases quality of life and satisfaction with care. Decision aids can improve patient involvement in health care decisions, but one is not available for the decision about NAST.

Aims/Methods: We conducted a prospective, single-arm pre-post study to evaluate a custom-designed decision aid developed for women who have been offered NAST. Eligible patients were: female; aged ≥18 years; diagnosed with an operable invasive breast cancer; considered for NAST with curative intent. Here, we report on the grounded theory qualitative analysis of a convenience sample of 16 semi-structured phone interviews to explore patient experience with this decision aid.

Results: Participants' median age was 52 (IQR=41-63), median time since breast cancer diagnosis was 5 months (IQR=2-8). Most were married or living with a partner (81.3%) and had a University level degree (68.8%). Patients perceived the decision aid to be useful for becoming more informed and involved in deciding on NAST. Specifically, the decision aid enhanced patients' understanding of their type of breast cancer and the treatment options available to them by summarising and extending the information they received during the consultation with their doctor. Some women perceived the included graphs and statistics to be particularly helpful to understand potential risks and benefits of their treatment options. All patients described the provided information as reliable, relevant and tailored to their needs. They found the decision aid easy to understand and balanced (not in favour of NAST or surgery). The amount of the information provided was seen to be just right. Most women received the decision aid after the initial consultation with their surgeon and perceived this as the right delivery timing. Reading and rereading the decision aid at home in between two consultations allowed women to easily integrate the decision aid into their care. They appreciated the opportunity to reconsider their options after consulting their doctor. A number of women reported that their family members used the decision aid as well and thus became more informed and involved in the decision making process. Some women took the decision aid to the next consultation with their doctor to discuss their preferences and concerns further. All patients followed their doctors' treatment recommendation. The decision aid seemed to confirm but not change women's decisions on NAST.

Discussion: These initial results suggest that this decision aid is a useful tool to assist breast cancer patients' involvement in the decision about NAST. A quantitative analysis of the decision aid's acceptability, feasibility and efficacy will be reported subsequently.Background: Neoadjuvant systemic therapy (NAST) is a treatment option for selected patients with highly proliferative and/or large operable breast cancer. Whilst survival outcomes are equivalent between up-front surgery and NAST, the decision about treatment sequence can be difficult due to complexity and perceived urgency of the decision. Patients may value the outcomes of these options, such as down staging and prognostication, differently. Involving patients in decisions about their healthcare reduces anxiety, increases quality of life and satisfaction with care. Decision aids can improve patient involvement in health care decisions, but one is not available for the decision about NAST.

Aims/Methods: We conducted a prospective, single-arm pre-post study to evaluate a custom-designed decision aid developed for women who have been offered NAST. Eligible patients were: female; aged ≥18 years; diagnosed with an operable invasive breast cancer; considered for NAST with curative intent. Here, we report on the grounded theory qualitative analysis of a convenience sample of 16 semi-structured phone interviews to explore patient experience with this decision aid.

Results: Participants' median age was 52 (IQR=41-63), median time since breast cancer diagnosis was 5 months (IQR=2-8). Most were married or living with a partner (81.3%) and had a University level degree (68.8%). Patients perceived the decision aid to be useful for becoming more informed and involved in deciding on NAST. Specifically, the decision aid enhanced patients' understanding of their type of breast cancer and the treatment options available to them by summarising and extending the information they received during the consultation with their doctor. Some women perceived the included graphs and statistics to be particularly helpful to understand potential risks and benefits of their treatment options. All patients described the provided information as reliable, relevant and tailored to their needs. They found the decision aid easy to understand and balanced (not in favour of NAST or surgery). The amount of the information provided was seen to be just right. Most women received the decision aid after the initial consultation with their surgeon and perceived this as the right delivery timing. Reading and rereading the decision aid at home in between two consultations allowed women to easily integrate the decision aid into their care. They appreciated the opportunity to reconsider their options after consulting their doctor. A number of women reported that their family members used the decision aid as well and thus became more informed and involved in the decision making process. Some women took the decision aid to the next consultation with their doctor to discuss their preferences and concerns further. All patients followed their doctors' treatment recommendation. The decision aid seemed to confirm but not change women's decisions on NAST.

Discussion: These initial results suggest that this decision aid is a useful tool to assist breast cancer patients' involvement in the decision about NAST. A quantitative analysis of the decision aid's acceptability, feasibility and efficacy will be reported subsequently.

Citation Format: Zdenkowski N, Herrmann A, Hall A, Boyle FM, Butow P. Women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-11-02.

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

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

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

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

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

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

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

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

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

Physiotherapy interventions for people with dementia and a hip fracture-a scoping review of the literature

BACKGROUND

People with dementia are 2.7 times more likely to suffer a hip fracture than those without and their management is estimated to cost £0.92 billion per year. Yet there has been little focus on the effectiveness of interventions for this population.

OBJECTIVE

The aim of this scoping review was to summarise the current available evidence for physiotherapy interventions for people with dementia who fracture their hip as well as to identify gaps in the literature that may require further research.

DATA SOURCES

A systematic search of the following databases was undertaken-TRIP, CINAHL, Amed, Embase, PEDro, PsycINFO, Cochrane Library, Open Grey, Ethos, ISRCTN, Proquest, PROSPERO and UK Clinical Trials Gateway.

STUDY SELECTION

Articles were included if they described an intervention which is considered within the scope of a physiotherapist and targeted those with both a hip fracture and dementia.

SYNTHESIS METHODS

A narrative summary was then undertaken to describe the current state of the literature.

RESULTS

Twenty six studies were included, of which thirteen were observational, six RCTs, two qualitative, two surveys and three systematic reviews. Only nine studies focused explicitly on physiotherapy interventions.

CONCLUSION

The findings of this scoping review suggest there is limited evidence to guide physiotherapists in the management of people with dementia who fracture their hip. No evidence was found about perceptions or experiences of patients in this group or of the physiotherapists involved in their care. Further research is needed to develop and evaluate physiotherapy interventions for people with dementia who fracture their hip.

Ethical issues and best practice in clinically based genomic research: Exeter Stakeholders Meeting Report

Current guidelines on consenting individuals to participate in genomic research are diverse. This creates problems for participants and also for researchers, particularly for clinicians who provide both clinical care and research to their patients. A group of 14 stakeholders met on 7 October 2015 in Exeter to discuss the ethical issues and the best practice arising in clinically based genomic research, with particular emphasis on the issue of returning results to study participants/patients in light of research findings affecting research and clinical practices. The group was deliberately multidisciplinary to ensure that a diversity of views was represented. This report outlines the main ethical issues, areas of best practice and principles underlying ethical clinically based genomic research discussed during the meeting. The main point emerging from the discussion is that ethical principles, rather than being formulaic, should guide researchers/clinicians to identify who the main stakeholders are to consult with for a specific project and to incorporate their voices/views strategically throughout the lifecycle of each project. We believe that the mix of principles and practical guidelines outlined in this report can contribute to current debates on how to conduct ethical clinically based genomic research.