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Hourston G, Joglekar S, Down S, Downey S, Pereira J. Has the time come for de-escalation in oncoplastic breast conserving surgery? Eur J Surg Oncol 2021; 48:309-311. [PMID: 34740479 DOI: 10.1016/j.ejso.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- George Hourston
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom.
| | - Sandeep Joglekar
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom
| | - Sue Down
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
| | - Sarah Downey
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom
| | - Jerome Pereira
- Breast Care Unit, James Paget University Hospitals NHS Foundation Trust, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
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Austin JD, Tehranifar P, Rodriguez CB, Brotzman L, Agovino M, Ziazadeh D, Moise N, Shelton RC. A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation. Implement Sci Commun 2021; 2:110. [PMID: 34565481 PMCID: PMC8474751 DOI: 10.1186/s43058-021-00217-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/14/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is growing concern that routine mammography screening is overused among older women. Successful and equitable de-implementation of mammography will require a multi-level understanding of the factors contributing to mammography overuse. METHODS This explanatory, sequential, mixed-methods study collected survey data (n= 52, 73.1% Hispanic, 73.1% Spanish-speaking) from women ≥70 years of age at the time of screening mammography, followed by semi-structured interviews with a subset of older women completing the survey (n=19, 63.2% Hispanic, 63.2% Spanish-speaking) and providers (n=5, 4 primary care, 1 obstetrics and gynecology) to better understand multi-level factors influencing mammography overuse and inform potential de-implementation strategies. We conducted a descriptive analysis of survey data and content analysis of qualitative interview data. Survey and interview data were examined separately, compared, integrated, and organized according to Norton and Chambers Continuum of Factors Influencing De-Implementation Process. RESULTS Survey findings show that 87.2% of older women believe it is important to plan for an annual mammogram, 80.8% received a provider recommendation, and 78.9% received a reminder in the last 12 months to schedule a mammogram. Per interviews with older women, the majority were unaware of or did not perceive to have experienced overuse and intended to continue mammography screening. Findings from interviews with older women and providers suggest that there are multiple opportunities for older women to obtain a mammogram. Per provider interviews, almost all reported that reducing overuse was not viewed as a priority by the system or other providers. Providers also discussed that variation in mammography screening practices across providers, fear of malpractice, and monetary incentives may contribute to overscreening. Providers identified potential strategies to reduce overscreening including patient and provider education around harms of screening, leveraging the electronic health record to identify women who may receive less health benefit from screening, customizing system-generated reminder letters, and organizing workgroups to develop standard processes of care around mammography screening. CONCLUSIONS Multi-level factors contributing to mammography overuse are dynamic, interconnected, and reinforced. To ensure equitable de-implementation, there is a need for more refined and empirical testing of theories, models, and frameworks for de-implementation with a strong patient-level component that considers the interplay between multilevel factors and the larger care delivery process.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laura Brotzman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Mariangela Agovino
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Danya Ziazadeh
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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Saavedra-Leos MZ, Jordan-Alejandre E, López-Camarillo C, Pozos-Guillen A, Leyva-Porras C, Silva-Cázares MB. Nanomaterial Complexes Enriched With Natural Compounds Used in Cancer Therapies: A Perspective for Clinical Application. Front Oncol 2021; 11:664380. [PMID: 33869067 PMCID: PMC8047625 DOI: 10.3389/fonc.2021.664380] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
Resveratrol and quercetin are natural compounds contained in many foods and beverages. Reports indicate implications for the health of the general population; on the other hand the use of both compounds has interesting results for the treatment of many diseases as cardiovascular affections, diabetes, Alzheimer's disease, viral and bacterial infections among others. Based on their capacities described as anti-inflammatory, antioxidant, and anti-aging, resveratrol and quercetin showed antiproliferative and anticancer activity specifically in maligned cells. These molecular characteristics trigger the pharmacological repurposing of both compounds and improved its research for treating different cancer types with interesting results at in vitro, in vivo, and clinical trial studies. Meanwhile, the development of different systems of drug release in specific sites as nanomaterials and specifically the nanoparticles, potentiates the personal treatment perspective in conjunct with the actual cancer therapies; regularly invasive and aggressive, the perspective of nanomedicine as higher effective and lower invasive has gained popularity. Knowledge of molecular interactions of resveratrol and quercetin in diseases confirms the evidence of multiple benefits, while the multiple analyses suggested a positive response for the treatment and diagnostics of cancer in different stages, including at metastatic stage. The present work reviews the reports related to the impact of resveratrol and quercetin in cancer treatment and its effects when the antioxidants are encapsulated in different nanoparticle systems, which improve the prospects of cancer treatment.
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Affiliation(s)
| | | | - César López-Camarillo
- Posgrado en Ciencias Genómicas, Universidad Autónoma de la Ciudad de México, Mexico City, Mexico
| | - Amaury Pozos-Guillen
- Laboratorio de Ciencias Básicas, Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - César Leyva-Porras
- Laboratorio Nacional de Nanotecnología, Centro de Investigación en Materiales Avanzados S.C. (CIMAV), Chihuahua, Mexico
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The Comprehensive Complication Index is Related to Frailty in Elderly Surgical Patients. J Surg Res 2019; 244:218-224. [DOI: 10.1016/j.jss.2019.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023]
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Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: an observational prospective study. Cir Esp 2014; 93:166-73. [PMID: 25443149 DOI: 10.1016/j.ciresp.2014.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/08/2014] [Accepted: 08/25/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. OBJECTIVE To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. METHODS Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. RESULTS A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). CONCLUSIONS An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients.
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Schonberg MA, Hamel MB, Davis RB, Griggs MC, Wee CC, Fagerlin A, Marcantonio ER. Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med 2014; 174:417-24. [PMID: 24378846 PMCID: PMC4017368 DOI: 10.1001/jamainternmed.2013.13639] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed. OBJECTIVES To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older. DESIGN We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information. SETTING AND PARTICIPANTS Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated. INTERVENTIONS The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise. MAIN OUTCOMES AND MEASURES Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information. RESULTS The median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (≥ 2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful. CONCLUSIONS AND RELEVANCE A DA may improve older women's decision making about mammography screening.
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Affiliation(s)
- Mara A Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mary Beth Hamel
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - M Cecilia Griggs
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christina C Wee
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Angela Fagerlin
- Center for Bioethics and Social Sciences in Medicine, Departments of Internal Medicine and Psychology, University of Michigan, and Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan
| | - Edward R Marcantonio
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Schonberg MA, Kistler CE, Nekhlyudov L, Fagerlin A, Davis RB, Wee CC, Marcantonio ER, Lewis CL, Stanley WA, Crutchfield TM, Hamel MB. Evaluation of a Mammography Screening Decision Aid for Women Aged 75 and Older: Protocol for a Cluster-randomized Controlled Trial. JOURNAL OF CLINICAL TRIALS 2014; 4:191. [PMID: 26229741 PMCID: PMC4517685 DOI: 10.4172/2167-0870.1000191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE There is insufficient evidence to recommend mammography for women >75 years. Guidelines recommend that older women be informed of the uncertainty of benefit and potential for harm, especially for women with short life expectancy. However, few older women are informed of harms of screening and many with short life expectancy are screened. Therefore, we aim to test whether a mammography screening decision aid (DA) for women >75 years affects their use of mammography, particularly for women with <10 year life expectancy. METHODS/DESIGN The DA is a self-administered pamphlet that includes information on screening outcomes, tailored information on breast cancer risk, health, life expectancy, and competing mortality risks, and includes a values clarification exercise. We are conducting a large cluster randomized controlled trial (RCT) of the DA with the primary care provider (PCP) as the unit of randomization to evaluate its efficacy. We plan to recruit 550 women 75-89 years from 100 PCPs to receive either the mammography DA or a pamphlet on home safety for older adults (control arm) before a visit with their PCP, depending on their PCP's randomization assignment. The primary outcome is receipt of mammography screening assessed through chart abstraction. Secondary outcomes include effect of the DA on older women's screening intentions, knowledge, and decisional conflict, and on documented discussions about mammography by their PCPs. We will recruit women from 5 Boston-based primary care practices (3 community-based internal medicine practices and 2 academic practices), and 2 North Carolina-based academic primary care practices. DISCUSSION It is essential that we test the DA in a large RCT to determine if it is efficacious and to substantiate the need for broad translation into clinical practice. Our DA has the potential to improve health care utilization and care in a manner dictated by patient preferences.
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Affiliation(s)
- Mara A Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christine E Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Larissa Nekhlyudov
- Department of Population Medicine, Harvard Medical School and Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA, USA
| | - Angela Fagerlin
- VA Ann Arbor Center for Clinical Management, Departments of Internal Medicine and Psychology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor MI, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christina C Wee
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Edward R Marcantonio
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carmen L Lewis
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Whitney A Stanley
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Trisha M. Crutchfield
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Beth Hamel
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Breast cancer in the elderly-Should it be treated differently? Rep Pract Oncol Radiother 2012; 18:26-33. [PMID: 24381744 DOI: 10.1016/j.rpor.2012.05.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/27/2012] [Indexed: 12/27/2022] Open
Abstract
Breast cancer risk increases with age and about a third of female breast cancers are diagnosed in patients aged older than 70. Breast cancer in the elderly has, however, poorer outcome with lower survival rate compared to younger subjects. This may be partly explained by the delay in diagnosis and the 'under-treatment' of elderly breast cancer patients. In this review I try to provide recommendations for screening, surgery, radiotherapy, (neo)adjuvant hormone treatment and chemotherapy, and also the treatment of metastatic disease. Since large randomised trials usually exclude elderly patients with breast cancer, there is still an insufficient evidence for the treatment of such patients.
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Tahir M, Robinson T, Stotter A. How not to neglect the care of elderly breast cancer patients? Breast 2011; 20:293-6. [DOI: 10.1016/j.breast.2011.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/13/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022] Open
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Lestrade L. Cancer épithélial évolué de l’ovaire de la patiente âgée: quel état des lieux suite à la Conférence internationale de Vancouver? ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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March Villalba J, Martinez Jabaloyas J, Pastor Hernandez F, Gunthner Stefan F, Rodriguez Navarro R, Chuan Nuez P. Cistectomía radical como tratamiento del cáncer vesical infiltrante en el paciente de edad avanzada. Actas Urol Esp 2008; 32:696-704. [DOI: 10.1016/s0210-4806(08)73917-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre V, Brain E, Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, Aapro M. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 2007; 8:1101-1115. [PMID: 18054880 DOI: 10.1016/s1470-2045(07)70378-9] [Citation(s) in RCA: 215] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality in women worldwide. Elderly individuals make up a large part of the breast cancer population, and there are important specific considerations for this population. The International Society of Geriatric Oncology created a task force to assess the available evidence on breast cancer in elderly individuals, and to provide evidence-based recommendations for the diagnosis and treatment of breast cancer in such individuals. A review of the published work was done with the results of a search on Medline for English-language articles published between 1990 and 2007 and of abstracts from key international conferences. Recommendations are given on the topics of screening, surgery, radiotherapy, (neo)adjuvant hormone treatment and chemotherapy, and metastatic disease. Since large randomised trials in elderly patients with breast cancer are scarce, there is little level I evidence for the treatment of such patients. The available evidence was reviewed and synthesised to provide consensus recommendations regarding the care of breast cancer in older adults.
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Affiliation(s)
- Hans Wildiers
- Department of General Medical Oncology, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Ian Kunkler
- Edinburgh Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Jacques Fracheboud
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - George Vlastos
- Senology and Surgical Gynecologic Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Bernard-Marty
- Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Arti Hurria
- Division of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, CA, USA
| | - Martine Extermann
- H Lee Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Véronique Girre
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Etienne Brain
- Medical Oncology, René Huguenin Cancer Centre, Saint-Cloud, France
| | | | - Harry Bartelink
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Mary Barton
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Sharon H Giordano
- Department of Breast Medical Oncology, University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Hyman Muss
- Hematology Oncology Unit, University of Vermont and Vermont Cancer Center, Burlington, VT, USA
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
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