Metastatic breast cancer

[Basal and myoepithelial phenotype of metastatic mammary carcinomas. A prognostic factor in the palliative situation?]

AIMS

The aim of the present study was to evaluate the prognostic impact of basal and myoepithelial phenotype in breast carcinomas (BBC and MBC) in the palliative situation.

METHODS

Paraffin-embedded material from 244 primary breast carcinomas of patients with subsequent metastatic disease was stained immunohistochemically for CK 5/6, CK14, smooth-muscle actin, p63, estrogen receptor and progesterone receptor. BBC was defined as positive for CK5/6 and/or CK14 and MBC as positive for SMA and/or p63. Clinical and pathological data were available for all patients and follow-up data for 96.3% (range 5 days-151 months).

RESULTS

Until the end of the follow-up period 90.2% of patients died and 6.1% are still alive. Of the tumours 28.7% could be classified as BBC and 8.2% as MBC. Kaplan Meier analysis revealed a trend for reduced survival after first diagnosis of metastasis (OASM) for BBC and MBC. Differences in survival were significant for BBC (log-rank =5.0; p=0.025), but not for MBC. CK5/6+ and CK14+ double positive tumours (n=18; 7.4%) were identified as a subgroup of BBC associated with reduced OASM (log-rank=8,6; p=0.003). This subgroup, but not BBC or MBC was an independent negative prognostic factor in a multivariate analysis including age, typing, tumour size, grading, axillary nodes, HR, Her2/neu, site of first metastasis and disease-free interval.

CONCLUSION

The association of BBC and MBC with reduced OASM in metastatic breast carcinomas is not independent from established prognostic factors. CK5/6+ CK14+ double positive tumours may be a subgroup of BBC with particularly unfavourable outcome.

Pattern of Care at the End of Life: Does Age Make a Difference in What Happens to Women With Breast Cancer?

Purpose

In the last 40 years, palliative care has become the standard of care at the end of life. However, there are limited data about the degree of access to such care at the population level.

Methods

Using administrative databases, a care-oriented profile score was created to describe the care received during the last 6 months of life for 2,291 women who were dying of breast cancer in the province of Quebec, Canada, during the years 1992 to 1998. The care received was described through indicators of care that would reflect a palliative care philosophy. An ordinal score was developed for comparisons among age groups of women using a proportional odds ordinal regression model.

Results

We found that only 6.9% of women died at home, while 69.6% of them died in acute care beds. While most women (75%) had few indicators indicating provision of palliative care during the last 6 months of life, younger women (< 50 years) were even less likely (odds ratio, 0.70; 95% CI, 0.54 to 0.90) to receive such care compared with middle aged women (50 to 59 years; serving as the reference group), while older women (> 70 years) were more likely (odds ratio, 1.85; 95% CI, 1.49 to 2.29).

Conclusion

Our study indicates that a sizeable proportion of women terminally ill from breast cancer do not have access to palliative care—an issue that health care policy makers may wish to explore further.

Results of whole brain radiotherapy in patients with brain metastases from breast cancer: a retrospective study

PURPOSE

To analyze the factors that affect survival in patients with brain metastases (BM) from breast cancer who were treated with whole brain radiotherapy (WBRT).

METHODS AND MATERIALS

We identified 116 women with breast cancer who were treated with WBRT alone between February 1984 and September 2000. All patients had treatment and follow-up data available in their medical charts, which we extracted for this retrospective study. We evaluated a number of potential predictors of survival after WBRT: age, primary tumor stage, control of primary tumor, presence of other systemic metastases, site of systemic metastases, Karnofsky performance status, Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis class, total dose of WBRT, and number of BM. Eighteen patients received a total dose >3000 cGy and 7 received a partial brain boost.

RESULTS

For the entire cohort, the median survival from the start of WBRT was 4.2 months. The 1-year survival rate was 17%, and the 2-year survival rate was 2%. Using univariate analysis, only Karnofsky performance status (p = 0. 0084), recursive partitioning analysis class (p = 0. 0147), and total WBRT dose (p = 0.0001) were predictive of longer survival. In multivariate analysis, Karnofsky performance status was the only significant predictor.

CONCLUSION

Overall survival in breast cancer patients with BM treated with WBRT is poor. We recommend breast cancer patients with BM be enrolled in prospective trials to improve results.

Routine follow-up examinations in breast cancer patients have minimal impact on life expectancy: a simulation study

BACKGROUND

Little is known about the effects of routine follow-up examinations on life expectancy in cancer patients. Lately, the benefits of follow-up examinations have been debated, which has given rise to less extensive, though still frequent, follow-up strategies. In this study, a simulation model was applied to evaluate the impact of different follow-up strategies on life expectancy in breast cancer patients.

MATERIALS AND METHODS

A five-state Markov chain model was developed, with which various follow-up strategies with regard to frequency and elaborateness were simulated. Calculations were based on a hypothetical population of breast cancer patients treated with curative intent. Medical aspects were studied, such as life expectancy and the proportion of patients who died from breast cancer. Social and psychological aspects and quality of life were not taken into account. Data from the literature were used to estimate the parameters needed for the model.

RESULTS

The gain in life expectancy with standard follow-up compared to no follow-up examination, was about 2 months in breast cancer patients aged 50 years treated with curative intent. The percentage of patients who died from breast cancer was 45.4% with standard follow-up, versus 45.8% without follow-up. In older women, the gain was even less. Sensitivity analyses showed that the effects on life expectancy were robust.

CONCLUSIONS

Our model showed that standard follow-up had minimal impact on the prognosis of breast cancer patients. It may be unnecessary to continue standard follow-up by medical specialists after the end of the surveillance period of the primary therapy, provided that the patients continue to have easy access to health care facilities in the case of symptoms or concern. However, future research is needed to study quality of life aspects of follow-up.