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Yeo HY, Liew AC, Chan SJ, Anwar M, Han CHW, Marra CA. Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review. Patient Prefer Adherence 2023; 17:2679-2706. [PMID: 37927344 PMCID: PMC10625390 DOI: 10.2147/ppa.s432821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients' treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options. Methods We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings. Results The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment. Conclusion The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient.
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Affiliation(s)
- Hui Yee Yeo
- School of Pharmacy, University of Otago, Dunedin, New Zealand
- Clinical Research Center, Hospital Seberang Jaya, Penang, Malaysia
| | - Ai Ch’i Liew
- Clinical Research Center, Hospital Seberang Jaya, Penang, Malaysia
| | - Suz Jack Chan
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Mudassir Anwar
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Catherine Hye-Won Han
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Carlo A Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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2
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Edmonds MC, Kim SJ, Wells M, Dahman B, Sheppard VB. A Mixed Method Approach to Examine Surveillance Mammography Experiences in Black and White Breast Cancer Survivors. Clin Breast Cancer 2022; 22:801-811. [PMID: 36137937 DOI: 10.1016/j.clbc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The use of surveillance mammography following a breast cancer (BC) diagnosis is associated with early detection of disease relapse and increased overall survival; yet Black women compared to White women have the lowest surveillance mammography rates, with limited explanation. To further understand this racial disparity the present study examines the association of mammography beliefs, knowledge, and healthcare delivery factors on receipt of surveillance mammography among Black and White breast cancer survivors. METHODS This is a convergent parallel mixed method study design of an online survey and online focus groups among Black and White BC survivors (N = 266) recruited from community engagement. The online focus groups consisted of a series of theory-informed questions via social media platforms (eg Breastcancer.org, Quora, Reddit). An in-depth thematic analysis approach was used to extract themes from online focus group data. Bivariate (χ2) and multivariable logistic regression analyses were conducted using the survey data to examine associated factors with receipt of a surveillance mammography within 12 months (yes vs. no). RESULTS 76% (n = 177) of women were Black, 62% were <5 years since diagnosis, 98% had health insurance, with an age range from 23 to 79 (mean = 55) years. 72% of the sample received a surveillance mammogram relative to 27%. Women more frequently received a surveillance mammogram if they reported perceived mammography benefits (<.001), underwent lumpectomy (P< .001) and had health insurance (P = .04). Black women without communication about surveillance care with providers had a lower likelihood of receiving a surveillance mammogram (OR:0.09,95% CI: 0.01-0.45, P = .003). Thematic findings from online focus groups included motivators for receipt of surveillance mammograms: physician recommendation, regular physical exams, and knowledge of recommended guidelines. Barriers of non-receipt of surveillance mammograms included: transportation, medical cost/financial barriers, feeling ignored from providers, and medical mistrust. CONCLUSION Women may require more individualized information regarding their surveillance care to support routine guideline concordant follow-up. Patient-provider-communication is an integral part of Black survivors' surveillance care needs. Improving patient-provider communication for Black women's is necessary to address this group cancer care needs.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Matthew Wells
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
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3
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Freedman RA, Ko NY, Lederman RI, Gagnon H, Fikre T, Gundersen DA, Revette AC, Odai-Afotey A, Kantor O, Hershman DL, Crew KD, Keating NL. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. Breast Cancer Res Treat 2022; 196:623-633. [PMID: 36220997 PMCID: PMC9552717 DOI: 10.1007/s10549-022-06752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
Purpose The degree to which breast cancer survivors know about their tumors and understand treatment rationales is not well understood. We sought to identify information gaps within a diverse sample and explore whether knowledge about breast cancer and treatment may impact care. Methods We conducted a one-time, interviewer-administered survey of women who were diagnosed with breast cancer during 2013–2017 and received care at one of three centers in Boston, MA, and New York, NY. We examined knowledge of breast cancer and treatment rationales, information preferences, and treatment receipt. Results During 2018–2020, we interviewed 313 women (American Association for Public Opinion Research Cooperation Rates 58.4–76.5% across centers) who were 56.9% White, 23.6% Black, 14.1% Hispanic, and 5.4% other. Among the 296 included in analyses, we observed high variability in knowledge of breast cancer and treatment rationales, with a substantial number demonstrating limited knowledge despite feeling highly informed; > 25% actively avoided information. Black and Hispanic (vs. White) women consistently knew less about their cancers. Lack of understanding of treatment rationales for chemotherapy, radiation, and hormonal therapy was common but not consistently different by race and ethnicity. Understanding treatment rationale (but not cancer knowledge) was associated with treatment initiation, but small sample sizes limited in-depth examination. Conclusions Our study highlights the need for enhanced informational support for breast cancer survivors, who are challenged with complex information during the decision-making process and beyond. More research is needed to understand how to further educate and empower diverse populations of patients with breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06752-8.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Olga Kantor
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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4
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Mitchell KAR, Brassil KJ, Osborne ML, Lu Q, Brown RF. Understanding racial-ethnic differences in patient-centered care (PCC) in oncology through a critical race theory lens: A qualitative comparison of PCC among Black, Hispanic, and White cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2346-2354. [PMID: 34857428 PMCID: PMC9117574 DOI: 10.1016/j.pec.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Patient-centered care (PCC) experiences can vary by race and ethnicity and likely contribute to cancer care disparities. We compared PCC concepts between Non-Hispanic White (White), Hispanic, and Non-Hispanic Black (Black) cancer patients utilizing Critical Race Theory (CRT) to understand the relationships between racial-ethnic identity and PCC. METHODS A thematic analysis and in-depth CRT-informed analysis of individual interviews exploring patient values, unmet needs, preferences, and priorities were performed. RESULTS Participants were aged> 25 yrs old, 53% male, and included 5 Hispanic, 4 Black and 6 White cancer patients. Unmet needs for time to make decisions, and provider interaction between visits and the value for finding meaning in the illness emerged among Blacks and Whites. The unmet need for a long-term treatment plan emerged among Blacks, and the preference of research participation among Whites. A value for optimism was observed among Hispanics and Whites. Racial-ethnic variations in patient descriptions and experiences of their values, unmet needs, preferences, and priorities were identified. CONCLUSIONS Underrepresented groups face subtle but significant challenges in feeling cared for and understood, voicing concerns, and obtaining quality care. PRACTICE IMPLICATIONS Increased mutual understanding and provider knowledge of unique PCC experiences among underrepresented cancer patients are needed.
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Affiliation(s)
| | | | | | - Qian Lu
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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5
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Braithwaite D, Anton S, Mohile S, DeGregori J, Gillis N, Zhou D, Bloodworth S, Pahor M, Licht J. Cancer and aging: A call to action. AGING AND CANCER 2022; 3:87-94. [PMID: 36188489 PMCID: PMC9521708 DOI: 10.1002/aac2.12055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
Background The intersection of cancer and aging is an emerging public health challenge in developed countries because of the aging and expansion of the population. Aims We convened a panel of experts to share their insights on this topic at the inaugural University of Florida Health Cancer Center's (UFHCC's) Cancer and Aging Symposium, which was held virtually in February 2022. Methods We featured presentations from four leading scientists, whose research spans multiple disciplines including basic science, translational research, geriatric oncology, and population science. Results Each speaker offered their unique perspective and insight on the intersection between cancer and aging and discussed their current and ongoing research in this field. In addition to this panel of experts, scientists from the National Institutes of Health and the National Cancer Institute, as well as a UFHCC-affiliated citizen scientist, shared their perspectives on strategies to move the field forward. Some of the key open questions and opportunities for future research offered by these presenters in aging and cancer include but are not limited to infusing health disparities research into the field of cancer and aging, assessing the value of geriatric assessment in identifying early vulnerabilities that may affect response to emerging cancer therapies in older patients, and assessing biological age and other biomarkers (e.g., clonal hematopoiesis) in relation to clinical endpoints and the development of primary, secondary, and tertiary cancer prevention interventions. Conclusion Research is needed to accelerate knowledge regarding the dynamic interplay of cancer and aging and optimize care in diverse older adults to achieve equity in cancer outcomes.
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Affiliation(s)
- Dejana Braithwaite
- Departments of Surgery and Epidemiology, University of Florida, Gainesville, Florida, USA
- University of Florida Health Cancer Center, University of Florida, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Stephen Anton
- University of Florida Health Cancer Center, University of Florida, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - James DeGregori
- Department of Biochemistry and Molecular Genetics, University of Colorado, Aurora, Colorado, USA
| | - Nancy Gillis
- Department of Cancer Epidemiology and Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Daohong Zhou
- Department of Biochemistry and Structural Biology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Shirley Bloodworth
- University of Florida Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Marco Pahor
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Jonathan Licht
- University of Florida Health Cancer Center, University of Florida, Gainesville, Florida, USA
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6
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Yan J, Wei Y, Teng Y, Liu S, Li F, Bao S, Ren Y, Chen Y. Physician Preferences and Shared-Decision Making for the Traditional Chinese Medicine Treatment of Lung Cancer: A Discrete-Choice Experiment Study in China. Patient Prefer Adherence 2022; 16:1487-1497. [PMID: 35747587 PMCID: PMC9211799 DOI: 10.2147/ppa.s365109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND With progress being made in the treatment of cancer, various clinical and treatment options are being pursued. In China, Traditional Chinese Medicine (TCM) is used widely in the treatment of cancer. OBJECTIVE To estimate TCM treatment preferences and SDM mode of physicians in China. METHODS This study was conducted among physicians (n=185) from nine tertiary hospitals in China by discrete-choice experiment (DCE) survey and Shared Decision-Making Questionnaire-physician version (SDM-Q-Doc) survey. The DCE was developed with the inclusion of the most relevant attributes at appropriate levels for the TCM treatment of lung cancer. The empirical data analyses of physicians were performed using mixed logit models. Additionally, subgroup analysis was conducted. RESULTS In total, 185 respondents completed the questionnaire. All attributes were statistically significant except out-of-pocket costs. Physicians showed the strongest preferences for increasing disease control rate, relieving nausea and vomiting, and reducing the risk of side effects. Most of the physicians (78.38%) self-reported a high willingness to use SDM during the decision-making process. The physicians with a higher SDM-Q-Doc score had more preference for improving all three attributes than those with a lower score. Little variation was found in preferences among the physicians with other sociodemographic characteristics. CONCLUSION In China, physicians considered disease control rate as the most essential attribute in the TCM treatment of lung cancer. The physicians in China mainly preferred SDM, and the preference was different according to SDM mode when involving the TCM therapy for patients with lung cancer. The study findings could inform future TCM therapy for lung cancer and promote SDM.
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Affiliation(s)
- Juntao Yan
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Yan Wei
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Yan Wei, National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, People’s Republic of China, Tel +86-18930749707, Email
| | - Yue Teng
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
- Outpatient Department of Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Shimeng Liu
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Fuming Li
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Shiyi Bao
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Yanfeng Ren
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
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7
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Panattoni L, Phelps CE, Lieu TA, Alexeeff S, O'Neill S, Mandelblatt JS, Ramsey SD. Feasibility of Measuring Preferences for Chemotherapy Among Early-Stage Breast Cancer Survivors Using a Direct Rank Ordering Multicriteria Decision Analysis Versus a Time Trade-Off. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:557-566. [PMID: 32447608 DOI: 10.1007/s40271-020-00423-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Chemotherapy is increasingly a preference-based choice among women diagnosed with early-stage breast cancer. Multicriteria decision analysis (MCDA) is a promising but underutilized method to facilitate shared decision making. We explored the feasibility of conducting an MCDA using direct rank ordering versus a time trade-off (TTO) to assess chemotherapy choice in a large population-based sample. METHODS We surveyed 904 early-stage breast cancer survivors who were within 5 years of diagnosis and reported to the Western Washington State Cancer System and Kaiser Permanente Northern California registries. Direct rank ordering of 11 criteria and TTO surveys were conducted from September 2015 to July 2016; clinical data were obtained from registries or medical records. Multivariable regressions estimated post hoc associations between the MCDA, TTO, and self-reported chemotherapy receipt, considering covariates. RESULTS Survivors ranged in age from 25 to 74 years and 73.9% had stage I tumors. The response rate for the rank ordering was 81.0%; TTO score was 94.2%. A one-standard deviation increase in the difference between the chemotherapy and no chemotherapy MCDA scores was associated with a 75.1% (95% confidence interval 43.9-109.7%; p < 0.001) increase in the adjusted odds of having received chemotherapy; no association was found between the TTO score and chemotherapy receipt. CONCLUSIONS A rank-order-based MCDA was feasible and was associated with chemotherapy choice. Future research should consider developing and testing this MCDA for use in clinical encounters. Additional research is required to develop a TTO-based model and test its properties against a pragmatic MCDA to inform future shared decision-making tools.
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Affiliation(s)
- Laura Panattoni
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, USA
| | | | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Suzanne O'Neill
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, USA.
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8
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Sutton AL, Hagiwara N, Perera RA, Sheppard VB. Assessing Perceived Discrimination as Reported by Black and White Women Diagnosed with Breast Cancer. J Racial Ethn Health Disparities 2021; 8:589-595. [PMID: 32808196 PMCID: PMC7962667 DOI: 10.1007/s40615-020-00817-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although a number of factors contribute to racial disparities in breast cancer outcomes, perceived discrimination in healthcare may be a key factor that hinders positive interactions and negatively impacts patient outcomes. The goals of our study were to (1) assess the prevalence of perceived discrimination as reported by breast cancer patients and (2) identify factors related to discrimination in women overall as well as by race. DESIGN This study is a secondary analysis of a larger study, "Narrowing the Gaps in Adjuvant Therapy," where a convenience sample of 359 women completed one telephone survey assessing sociodemographics, and attitudes and beliefs concerning breast cancer treatments and care. Chi-square analysis was used to assess the relationship of categorical variables with perceived discrimination, while the F-test was employed for continuous variables. Logistic regression determined predictors of perceived discrimination, a dichotomous variable (none vs. any). RESULTS A majority of women were Black (58%), privately insured (85%), and had at least a Bachelor's degree (48%). Discrimination was reported by 32.4% of women, with significantly more Black women reporting discrimination than White women. Insurance status, attitudes toward treatment, and distress factors were significantly related to perceived discrimination. In the logistic model, women who were less trusting of their providers (OR = 0.863 [0.751, 0.993], p = .021) and Black women (OR = 7.241 [0.751, 0.993], p = .039) were more likely to report incidences of discrimination. CONCLUSIONS Our findings suggest a need to understand Black survivor's experiences with healthcare. Similarly, future work must focus on identifying ways to improve provider trust amongst breast cancer survivors.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
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9
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Jung CS, Jung YJ, Kim DI, Lee S, Kang SK, Nam SB, Kim HY. A comparative study of the clinical characteristics and outcomes of HR-positive HER2-negative breast cancer patients over and under 65 years old. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:1-7. [PMID: 36945204 PMCID: PMC9942741 DOI: 10.14216/kjco.21001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 11/07/2022]
Abstract
Purpose The purpose of this study was to compare the clinical characteristics and outcomes of hormone receptor-positive (HR+) human epidermal growth factor 2-negative (HER2-) breast cancer among elderly patients (over 65 years old) and younger patients. Methods This was a retrospective cohort study of 328 patients who were treated for breast cancer at Pusan National University Yangsan Hospital between January 2009 and December 2014. Tumor characteristics, surgical methods, and survival outcomes were compared between the two age groups (<65 and ≥65 years old). Kaplan-Meier curves for disease-free survival (DFS) and overall survival (OS) were also constructed according to the age groups. Results Among the 328 patients with HR+ HER2- breast cancer, 184 (56.1%) were <65 years old and 144 (43.9%) were ≥65 years old. Breast cancer stages were similar between the two age groups, but the older patients were treated less often with chemotherapy (81% vs. 66%, P=0.002). During the follow-up period, 17 deaths and 36 cases of recurrence or metastasis were reported. There was no difference in DFS between the two groups (P=0.840); however, the OS of the older age group was significantly lower than that of the younger age group (P=0.015). Conclusion This study suggested that HR+ HER2- breast cancer patients belonging to the two age groups had no significant difference in DFS. However, older age is an independent factor affecting OS rate. Therefore, even if patients are old, but their physical condition is satisfactory, standard and active treatment may be necessary, similar to that given to younger patients.
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Affiliation(s)
- Chang Shin Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seungju Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seok Kyung Kang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun Yul Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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10
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Van Dyk K, Zhou X, Small BJ, Ahn J, Zhai W, Ahles T, Graham D, Jacobsen PB, Jim H, McDonald BC, Nudelman Holohan K, Patel SK, Rebeck GW, Root JC, Saykin AJ, Cohen HJ, Mandelblatt JS, Carroll JE. Protective Effects of APOE ε2 Genotype on Cognition in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. JNCI Cancer Spectr 2021; 5:pkab013. [PMID: 33748669 PMCID: PMC7962698 DOI: 10.1093/jncics/pkab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
Background Cancer-related cognitive decline (CRCD) has been linked to apolipoprotein E (APOE) gene ε4 polymorphisms. APOE ε4 polymorphisms are also the strongest genetic risk for late-onset Alzheimer disease (AD), whereas ε2 polymorphisms protect against AD. However, the effects of ε2 polymorphisms on CRCD have not been evaluated. Methods We evaluated nonmetastatic breast cancer survivors (n = 427) and matched noncancer controls (n = 407) ages 60-98 years assessed presystemic therapy from August 2010 to December 2017 with annual follow-up to 24 months. Neuropsychological assessment measured attention, processing speed, executive function, and learning and memory. Linear mixed-effects models tested the effects of having an ε2 allele (vs none) on longitudinal cognitive domain z scores by treatment group (chemotherapy with or without hormonal therapy, hormonal therapy, and control) controlling for covariates; participants with ε2/ε4 genotype were excluded. Sensitivity analyses examined effects of other covariates and any ε4 positivity. Results There was an interaction with genotype for attention, processing speed, and executive functioning domain scores (Beta = 0.32, 95% confidence interval = 0.00 to 0.65); the chemotherapy group with an ε2 allele had higher scores at baseline and maintained higher scores over time compared with those without an ε2 allele, and this protective effect was not seen for other groups. There was no effect of ε2 on learning and memory domain scores. Conclusions APOE ε2 polymorphisms may protect against CRCD in older breast cancer survivors receiving chemotherapy. With replication, this information could be useful for survivorship care and informing future studies of possible links to AD and defining mechanisms of protection.
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Affiliation(s)
- Kathleen Van Dyk
- UCLA Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Senior Member, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly Nudelman Holohan
- Department of Medical and Molecular Genetics, Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita K Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - G William Rebeck
- Department of Neurosciences, Georgetown University School of Medicine, Georgetown University, Washington, DC, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana Alzheimer’s Disease Research Center, and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- UCLA Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Sedrak MS, Freedman RA, Cohen HJ, Muss HB, Jatoi A, Klepin HD, Wildes TM, Le-Rademacher JG, Kimmick GG, Tew WP, George K, Padam S, Liu J, Wong AR, Lynch A, Djulbegovic B, Mohile SG, Dale W. Older adult participation in cancer clinical trials: A systematic review of barriers and interventions. CA Cancer J Clin 2021; 71:78-92. [PMID: 33002206 PMCID: PMC7854940 DOI: 10.3322/caac.21638] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.
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Affiliation(s)
| | | | | | - Hyman B. Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - Tanya M. Wildes
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - William P. Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA, USA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA, USA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - Andrea Lynch
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA, USA
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12
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Liao J, Wu B, Mao J, Ni P. Preference for Aggressive End-of-Life Care among Advanced Cancer Patients in Wuhan, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186592. [PMID: 32927824 PMCID: PMC7560226 DOI: 10.3390/ijerph17186592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
Life-sustaining treatments (LSTs) and end-of-life (EOL) care’s goal for prolonging one’s life are defined as aggressive EOL care among critically ill patients. They have limited effects and add unnecessary financial burden to advanced cancer patients. A questionnaire survey was conducted to collect information on demographics, disease conditions, preference for LSTs, and goal of EOL care among advanced cancer patients of comprehensive grade-A tertiary hospitals in Wuhan, mainland China. Most patients preferred to accept LSTs when they were in a critical condition, including cardiopulmonary resuscitation (89.9%), mechanical ventilation support (85.7%), nasogastric tube feeding (84.1%), blood transfusion (89.8%), general surgery (87.5%), and hemodialysis (85.8%). Most (88%) preferred prolonging life as the goal of EOL care. Logistic regression showed common influencing factors were participants who completed junior high/high school or below and were financially adequate had higher reference for aggressive EOL care. Patients whose physician had accurately disclosed prognosis; however, showed a decrease trend for aggressive EOL care. Most advanced cancer patients preferred to accept aggressive EOL care. Discussions about prognosis disclosure among physicians and patients should be improved. Education about LSTs’ limitations and comfort-oriented care’s benefits should be promoted among the advanced cancer patients in mainland China.
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Affiliation(s)
- Jing Liao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY 10010, USA;
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
- Correspondence: ; Tel.: +86-1387-154-0316
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13
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Impact of hearing loss on clinical interactions between older adults and health professionals: a systematic review. Eur Geriatr Med 2020; 11:919-928. [DOI: 10.1007/s41999-020-00358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
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14
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Gannon MR, Dodwell D, Jauhari Y, Horgan K, Clements K, Medina J, Cromwell DA. Initiation of adjuvant chemotherapy and trastuzumab for human epidermal growth receptor 2-positive early invasive breast cancer in a population-based cohort study of older women in England. J Geriatr Oncol 2020; 11:836-842. [PMID: 32007402 DOI: 10.1016/j.jgo.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinical guidance on recommended treatment for older patients with breast cancer is often ambiguous, particularly in the context of comorbidities and poor functional status. Older patients, aged 70 years and over, account for a substantial proportion of women with breast cancer yet are underrepresented in randomized controlled trials. This paper investigates the initiation of adjuvant chemotherapy and trastuzumab in older patients in routine care. MATERIALS AND METHODS Women, aged 50 years and over, newly diagnosed with human epidermal growth receptor 2 (HER2)-positive early invasive breast cancer from January 2014 to December 2017 were identified from the England Cancer Registry. Chemotherapy and trastuzumab use was obtained from the Systemic Anti-Cancer Therapy (SACT) dataset. Patient and tumor characteristics influential in treatment decision-making were included in multilevel mixed-effects logistic regression models. RESULTS 10% of women had HER2-positive tumors. Initiation of adjuvant chemotherapy and trastuzumab decreased with age from ≥70% among women aged 50-64 years to <15% among women aged 80+ years. Initiation varied additionally by tumor characteristics and number of comorbidities. Age remained a factor in treatment decisions despite favorable other factors, with lower use among women aged 70+ years. There was also marked variation across geographical regions. CONCLUSIONS In women with operable HER2-positive early invasive breast cancer, adjuvant chemotherapy plus trastuzumab was started less frequently as age increased, regardless of tumor characteristics or comorbidity burden. There was substantial variation in the proportion of women who started these treatments across the country.
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Affiliation(s)
- Melissa Ruth Gannon
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yasmin Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; St Georges Healthcare NHS Trust, London, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Karen Clements
- National Cancer Registration and Analysis Service, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - David Alan Cromwell
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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15
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Edmonds MC, Sutton AL, He J, Perera RA, Sheppard VB. Correlates of Adjuvant Therapy Attitudes in African American Breast Cancer Patients. J Natl Med Assoc 2020; 112:167-175. [PMID: 32197898 DOI: 10.1016/j.jnma.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/11/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Black breast cancer patients delay and underutilize adjuvant breast cancer therapies; yet, very few studies have specifically examined Black women's attitudes toward breast cancer therapy. This study observed the influence of self-reported interpersonal processes of care (e.g. self-efficacy) clinical and sociodemographic factors and sociocultural (e.g. religiosity), related to Black breast cancer patients' attitudes toward radiation and systemic therapies (chemotherapy and adjuvant endocrine therapy - "AET"). METHODS This was a secondary analysis of data from the Narrowing Gaps in Adjuvant Therapy Study (2006-2011). The analysis included 210 Black women who were newly diagnosed with breast cancer. Bivariate and multiple regression analyses were performed between independent variables (e.g., demographics) and three outcome variables (chemotherapy, AET, and radiation therapy) to asses women's perceptions of therapy type. The lasso method was used to select variables correlated with therapy attitudes. RESULTS Most women reported negative attitudes toward AET (56%) and radiation (54%); fewer negative attitudes were observed toward chemotherapy (47%). Higher education and greater perceived susceptibility of a recurrence were associated with more positive attitudes toward chemotherapy. Regarding radiation therapy, women with greater patient satisfaction were more likely to have more positive attitudes. CONCLUSIONS Our study findings may aid in the development of behavioral interventions targeted to mitigate Black women breast cancer treatment disparities. We found modifiable factors (e.g. communication, satisfaction ratings) that support opportunities for clinicians to better address Black women's needs regarding adjuvant treatment options. The development of tailored interventions for newly diagnosed Black breast cancer patients on patient related factors in health care are warranted for Black women with lower educational levels.
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Affiliation(s)
- Megan C Edmonds
- Department of Health Behavior and Policy, USA; VCU Massey Cancer Center Office of Health Equity and Disparities Research, 830 East Main Street, 9th Floor, Richmond, VA, 23219, USA.
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, USA; VCU Massey Cancer Center Office of Health Equity and Disparities Research, 830 East Main Street, 9th Floor, Richmond, VA, 23219, USA
| | - Jun He
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, USA; VCU Massey Cancer Center Office of Health Equity and Disparities Research, 830 East Main Street, 9th Floor, Richmond, VA, 23219, USA
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16
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Eidam A, Roth A, Lacroix A, Goisser S, Seidling HM, Haefeli WE, Bauer JM. Methods to Assess Patient Preferences in Old Age Pharmacotherapy - A Systematic Review. Patient Prefer Adherence 2020; 14:467-497. [PMID: 32184575 PMCID: PMC7061412 DOI: 10.2147/ppa.s236964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. MATERIAL AND METHODS Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. RESULTS Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. CONCLUSION Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.
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Affiliation(s)
- Annette Eidam
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - Anja Roth
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - André Lacroix
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - Sabine Goisser
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg69115, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg69120, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg69120, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg69120, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg69120, Germany
| | - Jürgen M Bauer
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg69115, Germany
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17
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Benchetrit L, Torabi SJ, Tate JP, Mehra S, Osborn HA, Young MR, Burtness B, Judson BL. Gender disparities in head and neck cancer chemotherapy clinical trials participation and treatment. Oral Oncol 2019; 94:32-40. [PMID: 31178210 DOI: 10.1016/j.oraloncology.2019.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To characterize the representation of women in clinical trials directing the National Comprehensive Cancer Network (NCCN) guidelines for chemotherapy use in head and neck squamous cell carcinoma (HNSCC), as well as the relationship between gender and chemotherapy administration in the definitive treatment of HNSCC in the United States. METHODS A review of all HNSCC chemotherapy clinical trials cited by the 2018 NCCN guidelines was performed. Sex-based proportions were compared with the corresponding proportions in the general U.S. population of patients with HNSCC between 1985 and 2015, derived from the Surveillance, Epidemiology, and End Results (SEER) program. A second analysis using the National Cancer Database (NCDB), identified 63,544 adult patients diagnosed with stages III-IVB HNSCC between 2004 and 2014 and treated with definitive radiotherapy or chemoradiotherapy. Univariable and multivariable logistic regression analyses were used to identify predictors of chemotherapy administration. RESULTS While women comprised 26.2% of U.S. patients with HNSCC between 1985 and 2015, they comprised only 17.0% of patients analyzed in U.S. NCCN-cited chemotherapy clinical trials between 1985 and 2017. On multivariable analysis, women had decreased odds of receiving chemotherapy (Odds Ratio [OR]: 0.875; 95% Confidence Interval [CI]: 0.821-0.931; p < 0.001). CONCLUSION Women are underrepresented in HNSCC chemotherapy clinical trials cited by the national guidelines. Additionally, women are less likely than men to receive definitive chemoradiotherapy as oppose to definitive radiotherapy. Reasons for these disparities warrant further investigation as well as re-evaluation of eligibility criteria and enrollment strategies, in order to improve relevance of clinical trials to women with HNSCC.
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Affiliation(s)
- Liliya Benchetrit
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States
| | - Sina J Torabi
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States
| | - Janet P Tate
- Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Saral Mehra
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States
| | - Heather A Osborn
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States
| | - Melissa R Young
- Yale Cancer Center, New Haven, CT, United States; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
| | - Barbara Burtness
- Yale Cancer Center, New Haven, CT, United States; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Benjamin L Judson
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States.
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18
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Sheppard VB, Walker R, Phillips W, Hudson V, Xu H, Cabling ML, He J, Sutton AL, Hamilton J. Spirituality in African-American Breast Cancer Patients: Implications for Clinical and Psychosocial Care. JOURNAL OF RELIGION AND HEALTH 2018; 57:1918-1930. [PMID: 29627925 DOI: 10.1007/s10943-018-0611-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Spirituality has been shown to be important to many individuals dealing with a cancer diagnosis. While African-American breast cancer survivors have been reported to have higher levels of spirituality compared to White women, little is known about how levels of spirituality may vary among African-American breast cancer survivors. The aims of this study were to examine factors associated with spirituality among African-American survivors and test whether spirituality levels were associated with women's attitudes about treatment or health care. The primary outcome, spirituality, was nine-item scale (Cronbach's α = .99). Participants completed standardized telephone interviews that captured sociocultural, healthcare process, and treatment attitudes. Medical records were abstracted post-adjuvant therapy for treatment and clinical information. In bivariate analysis, age was not correlated with spirituality (p = .40). Married/living as married women had higher levels of spirituality (m = 32.1) than single women (m = 30.1). Contextual factors that were associated with higher levels spirituality were: collectivism (r = .44; p < 0.0001, Afrocentric worldview (r = .185; p = .01), and self-efficacy scale (r = .17; p = .02). In multivariable analysis, sociodemographic factors were not significant. Collectivism remained a robust predictor (p < 0.0001). Attitudes about the efficacy of cancer treatment were not associated with spirituality. The high levels of spirituality in African-American survivors suggest consideration of integrating spiritual care within the delivery of cancer treatment. Future studies should consider how spirituality may contribute to positive coping and/or behaviors in African-American women with high levels of spirituality.
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Affiliation(s)
- Vanessa B Sheppard
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA.
| | | | | | | | - Hanfei Xu
- Georgetown University Medical Center, Washington, DC, USA
| | | | - Jun He
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
| | - Arnethea L Sutton
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
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Krok-Schoen JL, Fernandez K, Unzeitig GW, Rubio G, Paskett ED, Post DM. Hispanic breast cancer patients’ symptom experience and patient-physician communication during chemotherapy. Support Care Cancer 2018; 27:697-704. [DOI: 10.1007/s00520-018-4375-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/24/2018] [Indexed: 12/28/2022]
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20
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The preference to receive chemotherapy and cancer-related outcomes in older adults with breast cancer CALGB 49907 (Alliance). J Geriatr Oncol 2018; 9:221-227. [PMID: 29602735 DOI: 10.1016/j.jgo.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/02/2018] [Accepted: 02/13/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Chemotherapy preference refers to a patient's interest in receiving chemotherapy. This study examined whether chemotherapy preference was associated with toxicity, efficacy, quality of life (QoL), and functional outcomes during and after completion of adjuvant chemotherapy in older women with breast cancer. MATERIALS AND METHODS This study is a secondary analysis of CALGB 49907, a randomized trial that compared standard adjuvant chemotherapy versus capecitabine in patients age 65 years or older with breast cancer. A subset of 145 patients completed a questionnaire to describe chemotherapy preference pre-treatment. The association of this pre-treatment preference with the patient's perception of self-health, predicted and actual QoL, patient- and professional-reported toxicity, mental health, self-rated function, and survival was studied during and after treatment. RESULTS The median age of patients was 71 years and 47% had a high preference for chemotherapy. On baseline demographics, the low preference group had a higher proportion of white patients (95% vs. 78%, p = 0.004). Before treatment, low chemotherapy preference was associated with greater nausea/vomiting (p = 0.008). Mid-treatment, low preference was associated with lower QoL, worse social, emotional and physical function (all p ≤ 0.02) and worse nausea/vomiting, cancer symptoms and financial worries (all p < 0.05). The association noted mid-treatment, resolved after treatment completion except with financial worries which persisted at 24 months. Low preference was associated with higher rates of grade 3-5 adverse events (53% vs. 34%, p = 0.02) but was not associated with survival. CONCLUSIONS Low chemotherapy preference prior to treatment initiation was associated with lower QoL, worse physical symptoms and self-rated function and more adverse events mid-treatment. There is no association of chemotherapy preference with survival.
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Laryionava K, Heußner P, Hiddemann W, Winkler EC. "Rather one more chemo than one less…": Oncologists and Oncology Nurses' Reasons for Aggressive Treatment of Young Adults with Advanced Cancer. Oncologist 2017; 23:256-262. [PMID: 29133515 DOI: 10.1634/theoncologist.2017-0094] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Empirical research demonstrates that there is a tendency to administer tumor-directed therapy to patients with advanced cancer close to death, especially if they are young. The aim of this qualitative study was to understand oncologists' treatment decisions and oncology nurses' perception of these decisions in young adult patients and to investigate the extent to which young age was a factor in cancer treatment decisions. MATERIALS AND METHODS We conducted 29 face-to-face interviews with oncologists and oncology nurses at the Department of Hematology and Oncology at the University Hospital in Munich, Germany. The interviews were analyzed according to the grounded theory approach. RESULTS Oncologists and nurses reported that decisions about limiting cancer treatment with young adult patients are the most challenging and stressful in clinical practice. Apart from using young age as a proxy for patient's medical fitness, oncologists' decisions in favor of more aggressive treatment of younger patients were mainly guided by ethical reasons such as patient preferences and the perceptions of injustice associated with dying at a young age, as well as by psychological reasons, such as identification and emotional entanglement. CONCLUSION "Struggling" together with the patient against the injustice of dying young for a longer lifetime is an important factor driving aggressive treatment in young adult patients. However, oncologists might run a risk of neglecting other ethical aspects, such as a principle of nonmaleficence, that might even result in life-shortening adverse events. IMPLICATIONS FOR PRACTICE This study identifies two ethical and one psychological reasons for patients' overtreatment: 1) patients' preference for further treatment; 2) oncologists' perception of un-fairness of dying young; and 3) identification and emotional entanglement with patient. These findings emphasize the need for oncologists' awareness of the reasons guiding their treatment decisions - a sole focus on patients' preferences and on the fighting against the unfairness of dying young might lead to neglecting obligations of non-maleficence. Self-reflection, the balance of empathy and professional distance as well as timely end of life discussions and involvement of psycho-oncologists are needed in the care of young cancer patients.
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Affiliation(s)
- Katsiaryna Laryionava
- Department of Medical Oncology, National Center for Tumor Diseases, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Pia Heußner
- Department of Internal Medicine III, University Hospital Großhadern; Ludwig-Maximilian University, Munich, Germany
- Interdisciplinary Center of Psycho-Oncology, University Hospital Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital Großhadern; Ludwig-Maximilian University, Munich, Germany
| | - Eva C Winkler
- Department of Medical Oncology, National Center for Tumor Diseases, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany
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22
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Soto-Perez-de-Celis E, de Glas NA, Hsu T, Kanesvaran R, Steer C, Navarrete-Reyes AP, Battisti NML, Chavarri-Guerra Y, O’Donovan A, Avila-Funes JA, Hurria A. Global geriatric oncology: Achievements and challenges. J Geriatr Oncol 2017. [DOI: 10.1016/j.jgo.2017.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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23
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Bluethmann SM, Alfano CM, Clapp JD, Luta G, Small BJ, Hurria A, Cohen HJ, Sugarman S, B Muss H, Isaacs C, Mandelblatt JS. Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance). Breast Cancer Res Treat 2017; 165:677-686. [PMID: 28653250 DOI: 10.1007/s10549-017-4353-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). METHODS Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1-3 years); and late discontinuation (>3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. RESULTS Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. CONCLUSIONS Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA.
| | - Catherine M Alfano
- American Cancer Society, Inc., 1875 Connecticut Ave NW, Washington, DC, 20009, USA
| | - Jonathan D Clapp
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 Duarte Rd, Duarte, CA, 91010, USA
| | - Harvey J Cohen
- Department of Medicine and Center for the Study of Aging and Human Development, Duke University, DUMC, Room 3502 Busse Building, Blue Zone, Duke South, Box 3003, Durham, NC, 27710, USA
| | - Steven Sugarman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hyman B Muss
- Department of Medicine, UNC-Chapel Hill School of Medicine, University of North Carolina, 321 South Columbia Street, Chapel Hill, NC, 27514, USA
| | - Claudine Isaacs
- Department of Medicine, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA.,Department of Medicine, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
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24
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How Informed Is the Decision About Breast Reconstruction After Mastectomy?: A Prospective, Cross-sectional Study. Ann Surg 2017; 264:1103-1109. [PMID: 26727092 DOI: 10.1097/sla.0000000000001561] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess how informed patients are about breast reconstruction, and how involved they are in decision making. SUMMARY BACKGROUND DATA Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making. METHODS We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model. RESULTS A total of 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%). CONCLUSIONS Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages.
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25
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Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2017; 165:17-39. [DOI: 10.1007/s10549-017-4295-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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26
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Cohen JM, Blustein J, Weinstein BE, Dischinger H, Sherman S, Grudzen C, Chodosh J. Studies of Physician-Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review. J Am Geriatr Soc 2017; 65:1642-1649. [DOI: 10.1111/jgs.14860] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jamie M. Cohen
- State University of New York Upstate Medical University; Syracuse New York
| | - Jan Blustein
- Wagner Graduate School of Public Service, New York University; New York New York
- Department of Population Health; New York University School of Medicine; New York New York
| | - Barbara E. Weinstein
- Doctor of Audiology Program; The Graduate Center, City University of New York; New York New York
| | - Hannah Dischinger
- Oregon Health & Science University School of Medicine; Portland Oregon
| | - Scott Sherman
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
| | - Corita Grudzen
- Department of Emergency Medicine; New York University School of Medicine; New York New York
| | - Joshua Chodosh
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
- VA New York Harbor Heathcare System; New York New York
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27
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Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance). Breast Cancer Res Treat 2017; 164:107-117. [PMID: 28364214 DOI: 10.1007/s10549-017-4222-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Breast cancer patients aged 65+ ("older") vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality. METHODS Older patients (n = 1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004 to 2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7 years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting. RESULTS Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy ± hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37 and 36%, p = 0.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n = 209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail versus robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail versus robust patients (absolute difference of 14%). Treatment differences did not account for the relationships between frailty and mortality. CONCLUSIONS Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.
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28
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Vaz-Luis I, O'Neill A, Sepucha K, Miller KD, Baker E, Dang CT, Northfelt DW, Winer EP, Sledge GW, Schneider B, Partridge AH. Survival benefit needed to undergo chemotherapy: Patient and physician preferences. Cancer 2017; 123:2821-2828. [PMID: 28323331 DOI: 10.1002/cncr.30671] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Published studies have suggested that most patients with early stage breast cancer are willing, for modest survival benefits, to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil, an older regimen that is used infrequently today. We examined preferences regarding the survival benefit needed to justify 6 months of a contemporary chemotherapy regimen. METHODS The Eastern Cooperative Oncology Group Protocol 5103 was a phase 3 trial that randomized breast cancer patients to receive standard adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Serial surveys to assess quality of life were administered to patients enrolled between January 1, 2010, and June 8, 2010. Survival benefit needed to justify 6 months of chemotherapy by patients was collected at the 18-month assessment. A parallel survey was sent to physicians who had enrolled patients in the study. RESULTS Of 519 patients who had not withdrawn at a time point earlier than 18 months, 87.8% responded to this survey. A total of 175 physicians participated. We found considerable variation in patient preferences, particularly for modest survival benefits: for 2 months of benefit, 57% would consider 6 months of chemotherapy, whereas 96% of patients would consider 6 months of chemotherapy for 24 months. Race and education were associated with the choices. Physicians who responded were less likely to accept chemotherapy for modest benefit. CONCLUSIONS Among patients who received contemporary adjuvant chemotherapy in a randomized controlled trial, we found substantial variation in preferences regarding benefits that justified undergoing chemotherapy. Differences between patients' and physicians' choices were also apparent. Eliciting preferences regarding risks and benefits of adjuvant chemotherapy is critical. Cancer 2017;123:2821-28. © 2017 American Cancer Society.
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Affiliation(s)
| | - Anne O'Neill
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen Sepucha
- Massachusetts General Hospital, Boston, Massachusetts
| | - Kathy D Miller
- Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Emily Baker
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chau T Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Eric P Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - George W Sledge
- Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Bryan Schneider
- Indiana University Simon Cancer Center, Indianapolis, Indiana
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29
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Meresse M, Bouhnik AD, Bendiane MK, Retornaz F, Rousseau F, Rey D, Giorgi R. Chemotherapy in Old Women with Breast Cancer: Is Age Still a Predictor for Under Treatment? Breast J 2016; 23:256-266. [DOI: 10.1111/tbj.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mégane Meresse
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Anne-Déborah Bouhnik
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
| | - Marc-Karim Bendiane
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Frédérique Retornaz
- Departemental Geriatric Center; Polyvalent Geriatric Center; Marseille France
- Unit of Care and Research in Internal Medicine; Hôpital Européeen; Marseille France
| | - Frédérique Rousseau
- Pilot Unit of Research and Coordination in Geriatric Oncology; Department of Medicine; Institut Paoli-Calmettes; Marseille France
| | - Dominique Rey
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Roch Giorgi
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- Biostatistics & Information and Communication Technology Unit; APHM Timone hospital; Marseille France
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30
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Mandelblatt JS, Clapp JD, Luta G, Faul LA, Tallarico MD, McClendon TD, Whitley JA, Cai L, Ahles TA, Stern RA, Jacobsen PB, Small BJ, Pitcher BN, Dura-Fernandis E, Muss HB, Hurria A, Cohen HJ, Isaacs C. Long-term trajectories of self-reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance). Cancer 2016; 122:3555-3563. [PMID: 27447359 PMCID: PMC5113662 DOI: 10.1002/cncr.30208] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/24/2016] [Accepted: 05/02/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals. METHODS A cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group. RESULTS Survivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline. CONCLUSIONS Trajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society Among older survivors of breast cancer who were followed for up to 7 years, approximately 42% reported maintaining high cognitive function, but receipt of chemotherapy (with or without hormonal therapy) appeared to double the odds of being in the group that reported accelerated cognitive decline (vs maintaining high function), compared with receiving hormonal treatment alone. Further research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Jonathan D Clapp
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Gheorghe Luta
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Leigh Anne Faul
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michelle D Tallarico
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Trina D McClendon
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Jessica A Whitley
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Ling Cai
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert A Stern
- Department of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, Massachusetts
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Brandelyn N Pitcher
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Estrella Dura-Fernandis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Visiting Researcher, Georgetown University, Washington, DC
| | - Hyman B Muss
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Harvey J Cohen
- Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Claudine Isaacs
- Department of Medicine, Georgetown University School of Medicine, Washington, DC.,Breast Cancer Program, Lombardi Comprehensive Cancer Center, Washington, DC
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31
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Bluhm M, Connell CM, Janz N, Bickel K, DeVries R, Silveira M. Oncologists’ End of Life Treatment Decisions. J Appl Gerontol 2016. [DOI: 10.1177/0733464815595510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Optimal treatment decisions for older end-stage cancer patients are complicated, and are influenced by oncologists’ attitudes and beliefs about older patients. Nevertheless, few studies have explored oncologists’ perspectives on how patient age affects their treatment decisions. Methods: In-depth interviews were conducted with 17 oncologists to examine factors that influence their chemotherapy decisions for adults with incurable cancer near death. Transcripts of recorded interviews were coded and content analyzed. Results: Oncologists identified patient age as a key factor in their chemotherapy decisions. They believed older adults were less likely to want or tolerate treatment, and felt highly motivated to treat younger patients. Discussion: Qualitative analysis of in-depth interviews resulted in a nuanced understanding of how patient age influences oncologists’ chemotherapy decisions. Such understanding may inform practice efforts aimed at enhancing cancer care at the end of life for older patients.
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Affiliation(s)
| | | | | | - Kathleen Bickel
- Veterans Affairs White River Junction Medical Center, Geisel School of Medicine at Dartmouth, USA
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32
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Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Buono DL, Nathanson SD, Bovbjerg DH, Mandelblatt JS, Tsai WY, Jacobson JS, Hershman DL. A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL). Breast Cancer Res Treat 2016; 158:127-138. [PMID: 27287779 PMCID: PMC5492513 DOI: 10.1007/s10549-016-3855-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and reasons for early discontinuation of adjuvant chemotherapy in women with breast cancer. We conducted a prospective cohort study among three U.S. health care organizations. Of 1158 women with newly diagnosed non-metastatic breast cancer, 2006-2010, we analyzed 445 (38.4 %) patients who initiated standard adjuvant chemotherapy as defined by accepted guidelines. We interviewed patients at baseline and twice during treatment regarding sociodemographic/psychosocial factors and treatment decision-making and collected clinical data. They were categorized according to the number of cycles required by the chemotherapy regimen they had initiated. The outcome was early discontinuation (<80 % of planned cycles). Of patients analyzed, 392 (88.1 %) completed the prescribed therapy. The strongest predictor was receipt of a regimen entailing >4 cycles of therapy (18.1 % for longer regimens, 7.4 % for 4 cycles) (odds ratio [OR] 2.59, 95 % CI 1.32-5.08), controlling for race, age, stage, hormone receptor status, social support, optimism, spirituality, stress, and physical symptoms. Higher levels of psychological symptoms on the Memorial symptom assessment scale also increased the odds of early discontinuation (OR 1.92, 95 % CI 0.998-3.68). The large majority of patients who initiated adjuvant chemotherapy for breast cancer completed their prescribed regimens, but early discontinuation was associated with lengthier regimens and, with borderline statistical significance, for those with psychological side effects.
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Affiliation(s)
- Alfred I Neugut
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA.
| | - Grace Clarke Hillyer
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Donna L Buono
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Dana H Bovbjerg
- Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Wei-Yann Tsai
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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33
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Hershman DL, Kushi LH, Hillyer GC, Coromilas E, Buono D, Lamerato L, Bovbjerg DH, Mandelblatt JS, Tsai WY, Zhong X, Jacobson JS, Wright JD, Neugut AI. Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL). Breast Cancer Res Treat 2016; 157:133-43. [PMID: 27086286 DOI: 10.1007/s10549-016-3788-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/05/2016] [Indexed: 11/25/2022]
Abstract
Non-adherence to adjuvant endocrine therapy (ET) for breast cancer (BC) is common. Our goal was to determine the associations between psychosocial factors and ET non-persistence. We recruited women with BC receiving care in an integrated healthcare system between 2006 and 2010. Using a subset of patients treated with ET, we investigated factors related to ET non-persistence (discontinuation) based on pharmacy records (≥90 days gap). Serial interviews were conducted at baseline and every 6 months. The Functional Assessment of Cancer Therapy (FACT), Medical Outcomes Survey, Treatment Satisfaction Questionnaire (TSQM), Impact of Events Scale (IES), Interpersonal Processes of Care measure, and Decision-making beliefs and concerns were measured. Multivariate models assessed factors associated with non-persistence. Of the 523 women in our final cohort who initiated ET and had a subsequent evaluation, 94 (18 %) were non-persistent over a 2-year follow-up. The cohort was primarily white (74.4 %), stage 1 (60.6 %), and on an aromatase inhibitor (68.1 %). Women in the highest income category had a lower odds of being non-persistent (OR 0.43, 95 % CI 0.23-0.81). Quality of life and attitudes toward ET at baseline were associated with non-persistence. At follow-up, the FACT, TSQM, and IES were associated with non-persistence (p < 0.001). Most women continued ET. Women who reported a better attitude toward ET, better quality of life, and more treatment satisfaction, were less likely to be non-persistent and those who reported intrusive/avoidant thoughts were more likely to be non-persistent. Interventions to enhance the psychosocial well-being of patients should be evaluated to increase adherence.
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Affiliation(s)
- Dawn L Hershman
- Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Epidemiology, Columbia University, New York, NY, USA.
| | - Lawrence H Kushi
- Division of Research, Kaiser-Permanente of Northern California, Oakland, CA, USA
| | - Grace Clarke Hillyer
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Ellie Coromilas
- Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA
| | - Donna Buono
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Dana H Bovbjerg
- Departments of Psychiatry, Psychology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xiaobo Zhong
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Jason D Wright
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Obstetrics and Gynecology, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University, 161 Ft Washington, Room 1068, New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
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Pondé N, Dal Lago L, Azim HA. Adjuvant chemotherapy in elderly patients with breast cancer: key challenges. Expert Rev Anticancer Ther 2016; 16:661-71. [PMID: 27010772 DOI: 10.1586/14737140.2016.1170595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Elderly women with early breast cancer (BC) form a heterogeneous and large subgroup (41.8% of women with BC are over 65). Decision making in this subgroup is made more difficult by lack of familiarity with their physical, cognitive and social issues. Adequate management depends on biological factors and accurate clinical evaluation through comprehensive geriatric assessment (CGA). CGA can help to better select and determine potential risks factors for patients who are candidates for adjuvant chemotherapy. It is still recently introduced in geriatric oncology and there is a lack of awareness of its importance. Available data on adjuvant chemotherapy for BC is limited but suggests it can be of benefit for well selected patients, though the risk of short and long-term toxicity is significant. Here we provide a discussion of the key practical issues in decision making in the setting of adjuvant chemotherapy for elderly BC patients.
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Affiliation(s)
- Noam Pondé
- a BrEAST Data Centre, Department of Medicine, Institut Jules Bordet , Université Libre de Bruxelles , Brussels , Belgium
| | - Lissandra Dal Lago
- b Medicine Department, Institut Jules Bordet , Université Libre de Bruxelles , Brussels , Belgium
| | - Hatem A Azim
- a BrEAST Data Centre, Department of Medicine, Institut Jules Bordet , Université Libre de Bruxelles , Brussels , Belgium
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Evans CN, Brewer NT, Vadaparampil ST, Boisvert M, Ottaviano Y, Lee MC, Isaacs C, Schwartz MD, O'Neill SC. Impact of genomic testing and patient-reported outcomes on receipt of adjuvant chemotherapy. Breast Cancer Res Treat 2016; 156:549-555. [PMID: 27059031 PMCID: PMC5065914 DOI: 10.1007/s10549-016-3780-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/18/2022]
Abstract
Practice guidelines incorporate genomic tumor profiling, using results such as the Oncotype DX Recurrence Score (RS), to refine recurrence risk estimates for the large proportion of breast cancer patients with early-stage, estrogen receptor-positive disease. We sought to understand the impact of receiving genomic recurrence risk estimates on breast cancer patients' well-being and the impact of these patient-reported outcomes on receipt of adjuvant chemotherapy. Participants were 193 women (mean age 57) newly diagnosed with early-stage breast cancer. Women were interviewed before and 2-3 weeks after receiving the RS result between 2011 and 2015. We assessed subsequent receipt of chemotherapy from chart review. After receiving their RS, perceived pros (t = 4.27, P < .001) and cons (t = 8.54, P < .001) of chemotherapy increased from pre-test to post-test, while perceived risk of breast cancer recurrence decreased (t = 2.90, P = .004). Women with high RS tumors were more likely to receive chemotherapy than women with low RS tumors (88 vs. 5 %, OR 0.01, 0.00-0.02, P < .001). Higher distress (OR 2.19, 95 % CI 1.05-4.57, P < .05) and lower perceived cons of chemotherapy (OR 0.50, 95 % CI 0.26-0.97, P < .05) also predicted receipt of chemotherapy. Distressed patients who saw few downsides of chemotherapy received this treatment. Clinicians should consider these factors when discussing chemotherapy with breast cancer patients.
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Affiliation(s)
- Chalanda N Evans
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Noel T Brewer
- Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Marc Boisvert
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | - Claudine Isaacs
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Marc D Schwartz
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Suzanne C O'Neill
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
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Zhu Z, Huo Q, Wang S, Yang Q. Occupational type affects the receipt of breast cancer adjuvant chemotherapy in China. Oncol Lett 2015; 10:2547-2552. [PMID: 26622887 DOI: 10.3892/ol.2015.3571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/07/2015] [Indexed: 01/10/2023] Open
Abstract
Adjuvant chemotherapy has been demonstrated to improve the prognosis of patients with early-stage breast cancer; however, the high cost and side effects associated with this treatment may discourage patients from receiving it. The present study assessed the candidate factors that may influence decisions regarding postoperative adjuvant chemotherapy in females with early-stage breast cancer. Patients diagnosed with invasive breast cancer between January 2000 and December 2007 were enrolled in the study. Information about the patients, including socio-demographic factors, clinicopathological characteristics and receipt of adjuvant chemotherapy, was obtained from their medical records. Overall, 434 out of 1,296 (33.5%) patients with breast cancer decided against receiving adjuvant chemotherapy. Receipt of chemotherapy was significantly associated with the age of the patient at the time of diagnosis (P=0.029), occupational type (P=0.023), and lymph node status (P<0.001). Moderate associations were also observed between receipt of adjuvant chemotherapy and the patients family history of cancer (P=0.055) and hormone-receptor status (P=0.075). The results of the present study suggest that the occupational type of the patient is associated with receipt of adjuvant chemotherapy in China. This observation may provide a novel strategy for physicians to improve patients compliance regarding adjuvant chemotherapy. Further studies in additional developing countries are required in order to validate these observations.
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Affiliation(s)
- Zhengzhi Zhu
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China ; Department of Oncology Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Qiang Huo
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Shengying Wang
- Medical Center of Breast Disease, Anhui Tumor Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Epstein AJ, Wong YN, Mitra N, Vachani A, Hin S, Yang L, Smith-McLallen A, Armstrong K, Groeneveld PW. Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer. J Clin Oncol 2015; 33:4259-67. [PMID: 26598749 DOI: 10.1200/jco.2015.61.9023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We assessed the associations between the 21-gene recurrence score assay (RS) receipt, subsequent chemotherapy use, and medical expenditures among patients with early-stage breast cancer. PATIENTS AND METHODS Data from the Pennsylvania Cancer Registry were used to assemble a retrospective cohort of women with early-stage breast cancer from 2007 to 2010 who underwent initial surgical treatment. These data were merged with administrative claims from the 12-month periods before and after diagnosis to identify comorbidities, treatments, and expenditures (n = 7,287). Propensity score-weighted regression models were estimated to identify the effects of RS receipt on chemotherapy use and medical spending in the year after diagnosis. RESULTS The associations between RS receipt and outcomes varied markedly by patient age. RS use was associated with lower chemotherapy use among women younger than 55 (19.2% lower; 95% CI, 10.6 to 27.9). RS use was associated with higher chemotherapy use among women 75 to 84 years old (5.7% higher; 95% CI, 0.4 to 11.0). RS receipt was associated with lower adjusted 1-year medical spending among women younger than 55 ($15,333 lower; 95% CI, $2,841 to $27,824) and with higher spending among women who were 75 to 84 years old ($3,489 higher; 95% CI, $857 to $6,122). CONCLUSION RS receipt was associated with reduced use of adjuvant chemotherapy and lower health care spending among women with breast cancer who were younger than 55. Conversely, among women 75 and older, RS testing was associated with a modest increase in chemotherapy use and slightly higher spending. From a population perspective, the impact of RS testing on breast cancer treatment and health care costs is much greater in younger women.
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Affiliation(s)
- Andrew J Epstein
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Yu-Ning Wong
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Nandita Mitra
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Anil Vachani
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Sakhena Hin
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Lin Yang
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Aaron Smith-McLallen
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Katrina Armstrong
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Peter W Groeneveld
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
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Hurria A, Levit LA, Dale W, Mohile SG, Muss HB, Fehrenbacher L, Magnuson A, Lichtman SM, Bruinooge SS, Soto-Perez-de-Celis E, Tew WP, Postow MA, Cohen HJ. Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.63.0319] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.
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Affiliation(s)
- Arti Hurria
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Laura A. Levit
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - William Dale
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Supriya G. Mohile
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Hyman B. Muss
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Louis Fehrenbacher
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Allison Magnuson
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Stuart M. Lichtman
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Suanna S. Bruinooge
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Enrique Soto-Perez-de-Celis
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - William P. Tew
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Michael A. Postow
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
| | - Harvey J. Cohen
- Arti Hurria, City of Hope, Duarte; Louis Fehrenbacher, Kaiser Permanente Northern California, Vallejo, CA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Laura A. Levit and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; William Dale, University of Chicago Medical Center, Chicago, IL; Supriya G. Mohile and Allison Magnuson, University of Rochester Medical Center, Rochester; Stuart M. Lichtman, William P
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Adams I, Christopher J, Williams KP, Sheppard VB. What Black Women Know and Want to Know About Counseling and Testing for BRCA1/2. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:344-52. [PMID: 25301325 PMCID: PMC4393763 DOI: 10.1007/s13187-014-0740-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Black women are just as likely to have hereditary breast cancer mutations as White women, yet their participation in genetic counseling and testing is substantially lower. This study sought to describe Black women's awareness and perceptions of BRCA1/2 testing and to identify barriers and motivators to seeking BRCA1/2 services. Fifty intercept interviews were conducted with Black women in public places (a professional women's basketball game, a grocery store, a faith-based community event, and the waiting area at a breast care clinic) in Washington, DC. More than half of the women (54%) were aware that genetic tests to determine risk for certain breast and ovarian cancers exist, but the majority (88%) had never heard of BRCA1/2, specifically. After hearing a description of BRCA1/2 genetic markers, 82% stated that they would agree to BRCA1/2 testing if it was offered to them. Perceived advantages of testing included cancer prevention and the ability to share information with family members. Perceived disadvantages included emotional distress associated with identification of the mutation and the potential misuse of results to deny healthcare or employment. Physician recommendation, self-care, and known family history were among the motivators for testing. Women listed possible media and venues for intervention. In spite of low rates of BRCA1/2 testing in the Black community, women in this sample were open to the idea. Interventions that address barriers and include cultural tailoring are necessary.
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Affiliation(s)
- Inez Adams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 401 Park Dr., Room 403-E, Boston, Massachusetts 02215
| | - Juleen Christopher
- Center for Innovative Kidney Care, Minneapolis VA Health Care System Nephrology Section/Medicine Service. One Veterans Drive, Minneapolis, MN 55417
| | - Karen Patricia Williams
- Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 626 E. Fee Hall East Lansing, MI 4882
| | - Vanessa B. Sheppard
- Department of Oncology, Breast Cancer Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW., Suite 4100. Washington DC 20007
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Blank PR, Filipits M, Dubsky P, Gutzwiller F, Lux MP, Brase JC, Weber KE, Rudas M, Greil R, Loibl S, Szucs TD, Kronenwett R, Schwenkglenks M, Gnant M. Cost-effectiveness analysis of prognostic gene expression signature-based stratification of early breast cancer patients. PHARMACOECONOMICS 2015; 33:179-190. [PMID: 25404424 PMCID: PMC4305105 DOI: 10.1007/s40273-014-0227-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The individual risk of recurrence in hormone receptor-positive primary breast cancer patients determines whether adjuvant endocrine therapy should be combined with chemotherapy. Clinicopathological parameters and molecular tests such as EndoPredict(®) (EPclin) can support decision making in patients with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative cancer. OBJECTIVE Using a life-long Markov state transition model, we determined the health economic impact and incremental cost effectiveness of EPclin-based risk stratification in combination with clinical guidelines [German-S3, National Comprehensive Cancer Center Network (NCCN), and St. Gallen] to decide on chemotherapy use. METHODS Information on overall and metastasis-free survival came from Austrian Breast & Colorectal Cancer Study Group clinical trials 6/8 (n = 1,619) and published literature. Effectiveness was assessed as quality-adjusted life-years (QALYs). Costs (2010) were assessed from a German third-party payer perspective. RESULTS Lifetime costs per patient ranged from <euro>28,268 (St.Gallen and EPclin) to <euro>33,756 (NCCN). Due to an imperfect prognostic value and differences in chemotherapy use, strategies achieved between 13.165 QALYs (NCCN) and 13.173 QALYs (EPclin alone) per patient. Using German-S3 as reference, three strategies showed dominant results (St. Gallen and EPclin, German-S3 and EPclin, EPclin alone). Compared to German-S3, the addition of EPclin saved <euro>3,388 and gained 0.002 QALYs per patient. Combining guidelines with EPclin remained preferable in sensitivity analysis. CONCLUSION Our study suggests that molecular markers can be sensibly combined with clinical guidelines to determine the risk profile of adjuvant breast cancer patients. Compared with the current German best practice (German-S3), combinations of EPclin with the St. Gallen, German-S3 or NCCN guideline and EPclin alone were dominant from the perspective of the German healthcare system.
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Affiliation(s)
- Patricia R Blank
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland,
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Hurria A, Muss H. Special Issues in Older Women with Breast Cancer. IMPROVING OUTCOMES FOR BREAST CANCER SURVIVORS 2015; 862:23-37. [DOI: 10.1007/978-3-319-16366-6_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Hurria A, Dale W, Mooney M, Rowland JH, Ballman KV, Cohen HJ, Muss HB, Schilsky RL, Ferrell B, Extermann M, Schmader KE, Mohile SG. Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 2014; 32:2587-94. [PMID: 25071116 DOI: 10.1200/jco.2013.55.0418] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A majority of cancer diagnoses and deaths occur in patients age ≥ 65 years. With the aging of the US population, the number of older adults with cancer will grow. Although the coming wave of older patients with cancer was anticipated in the early 1980s, when the need for more research on the cancer-aging interface was recognized, many knowledge gaps remain when it comes to treating older and/or frailer patients with cancer. Relatively little is known about the best way to balance the risks and benefits of existing cancer therapies in older patients; however, these patients continue to be underrepresented in clinical trials. Furthermore, the available clinical trials often do not include end points pertinent to the older adult population, such as preservation of function, cognition, and independence. As part of its ongoing effort to advance research in the field of geriatric oncology, the Cancer and Aging Research Group held a conference in November 2012 in collaboration with the National Cancer Institute, the National Institute on Aging, and the Alliance for Clinical Trials in Oncology. The goal was to develop recommendations and establish research guidelines for the design and implementation of therapeutic clinical trials for older and/or frail adults. The conference sought to identify knowledge gaps in cancer clinical trials for older adults and propose clinical trial designs to fill these gaps. The ultimate goal of this conference series is to develop research that will lead to evidence-based care for older and/or frail adults with cancer.
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Tzelepis F, Sanson-Fisher RW, Hall AE, Carey ML, Paul CL, Clinton-McHarg T. The quality of patient-centred care: haematological cancer survivors' perceptions. Psychooncology 2014; 24:796-803. [PMID: 25504965 DOI: 10.1002/pon.3728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/21/2014] [Accepted: 10/29/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) that assess the quality of patient-centred cancer care have failed to measure all six patient-centredness dimensions endorsed by the Institute of Medicine (IOM). This study is the first to use the Quality of Patient-Centered Cancer Care (QPCCC) measure that covers all six IOM patient-centredness dimensions to examine haematological cancer survivors' perceptions of care and characteristics associated with perceived quality of care. METHODS Haematological cancer survivors diagnosed in the last 6 years and aged 18-80 years were recruited from two Australian state population-based cancer registries. Survivors were mailed the 48-item QPCCC measure. RESULTS Overall, 545 haematological cancer survivors completed the measure. Areas of care most commonly identified as delivered were hospital staff showing respect to survivors (93%) and making sure the correct treatment was received (93%). Aspects of care most frequently nominated as not delivered were hospital staff helping family and friends (34%) or the survivor (32%) to find other people with similar experiences to talk to. Characteristics associated with survivors perceiving higher quality care was delivered included being employed, having private health insurance, being younger, a Non-Hodgkin lymphoma diagnosis and more recent diagnosis. Being depressed or stressed was associated with perceived lower quality of care. CONCLUSIONS Provision of peer support programs that allow haematological cancer survivors and families and friends to talk to others in similar situations could be improved. Using PROMs to identify areas where cancer survivors perceive improvements are needed is essential to quality improvement efforts.
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Affiliation(s)
- Flora Tzelepis
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Robert W Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Alix E Hall
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Callaghan, New South Wales, Australia
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Sheppard VB, O'Neill SC, Dilawari A, Horton S, Hirpa FA, Isaacs C. Patterns of 21-gene assay testing and chemotherapy use in black and white breast cancer patients. Clin Breast Cancer 2014; 15:e83-92. [PMID: 25555816 DOI: 10.1016/j.clbc.2014.11.011] [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: 07/18/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND In women with early stage, hormone receptor (HR)-positive (HR(+)) breast cancer, the 21-gene recurrence score (RS) assay quantifies recurrence risk and predicts chemotherapy responsiveness. Recent data suggest that not all women with early-stage, HR(+) disease receive this testing. We examined sociodemographic, clinical, and attitudinal factors associated with RS testing receipt and the RS testing effect on chemotherapy use in black and white patients. PATIENTS AND METHODS Women with newly diagnosed invasive, nonmetastatic breast cancer were recruited and interviewed to collect sociocultural and health care process data; clinical data were collected from charts. Of the sample (n = 359), 270 had HR(+) disease. Primary analysis focused on those with HR(+) node-negative disease (n = 143); secondary analyses included node-positive women. Logistic regression models evaluated factors associated with receipt of RS testing and chemotherapy. RESULTS Among women eligible for the 21-gene assay, 62 patients [43%] received RS testing. In multivariable analysis, older age (odds ratio, 1.04 per 1 year increase; 95% confidence interval, 1.01-1.08) was associated with RS testing after adjustment for covariates. Chemotherapy use was 23%. In multivariable analysis, positive attitudes about chemotherapy and greater risk of recurrence were associated with chemotherapy use (P < .05). CONCLUSION Patterns of genomic testing might vary according to age. Efforts to understand factors associated with low testing rates will be important.
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Affiliation(s)
- Vanessa B Sheppard
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC.
| | - Suzanne C O'Neill
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Asma Dilawari
- Medstar Georgetown University Hospital, Washington, DC
| | - Sara Horton
- Department of Oncology, Howard University Hospital, Washington, DC
| | - Fikru A Hirpa
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Claudine Isaacs
- Breast Cancer Program, Lombardi Comprehensive Cancer Center and Departments of Oncology and Medicine, Georgetown University School of Medicine, Medstar Georgetown University Hospital, Washington, DC
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daCosta DiBonaventura M, Copher R, Basurto E, Faria C, Lorenzo R. Patient preferences and treatment adherence among women diagnosed with metastatic breast cancer. AMERICAN HEALTH & DRUG BENEFITS 2014; 7:386-96. [PMID: 25525495 PMCID: PMC4268769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Given the various profiles (eg, oral vs intravenous administration, risk of hot flashes vs fatigue) of treatment options (eg, endocrine therapy, chemotherapy) for metastatic breast cancer (mBC), how patients value these attributes of their medications has implications on making treatment decisions and on adherence. OBJECTIVES To understand how patients trade off medication side effects with improved effectiveness and/or quality of life, to provide estimates of nonadherence among women with mBC, and to quantify the association of medication nonadherence with health outcomes. METHODS The study was a cross-sectional, Internet-based survey of 181 women diagnosed with mBC who were recruited from cancer-specific online panels (response rate, 7%). Treatment information, demographics, nonadherent behaviors, and quality of life assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B) were collected in the survey, and each respondent completed a choice-based conjoint exercise to assess patient preferences. The patients' preferences were analyzed using hierarchical Bayesian logistic regression models, and the association between the number of nonadherent behaviors and the health outcomes was analyzed using general linear models. RESULTS The mean age of the patient sample was 52.2 years (standard deviation, ±9.1), with 93.9% of participants being non-Hispanic white. Results from the conjoint model indicated that effectiveness (overall survival) was of primary importance to patients, followed by side effects-notably alopecia, fatigue, neutropenia, motor neuropathy, and nausea/vomiting-and finally, dosing regimen. In all, 34.8% of survey respondents either discontinued their treatment or were nonadherent to their treatment regimen. Among those who have ever used oral chemotherapy (N = 95; 52.5%) and those currently using oral chemotherapy (N = 44; 24.3%), the number of nonadherent behaviors was significantly associated with a decrease in functional well-being (b [unstandardized regression coefficient] = -2.01 for patients who had ever used a targeted therapy and b = -3.14 for current users of a targeted therapy), FACT-General total score (b = -4.30 and b = -7.37, respectively), FACT-B total score (b = -3.93 and b = -6.11, respectively), and FACT trial outcome index (b = -5.22 and b = -8.63, respectively; all P <.05). CONCLUSIONS Patients were willing to accept substantial additional risks from side effects for gains in overall survival. Approximately 33% of women with mBC reported engaging in nonadherent behaviors. Because forgetfulness and adverse events were among the most frequent reasons for nonadherence, these results suggest that less complex treatment regimens, as well as regimens with less toxic profiles, may be associated with improvements in adherence and, subsequently, could correspond to perceptible patient benefits.
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Affiliation(s)
| | - Ronda Copher
- Associate Director, Health Economics and Outcomes Research, Eisai Inc, Woodcliff Lake, NJ
| | | | - Claudio Faria
- Director, Health Economics and Outcomes Research, Eisai Inc, Woodcliff Lake, NJ
| | - Rose Lorenzo
- Senior Director of Research, Kantar Health, New York, NY
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Hamelinck VC, Bastiaannet E, Pieterse AH, Jannink I, van de Velde CJ, Liefers GJ, Stiggelbout AM. Patients’ preferences for surgical and adjuvant systemic treatment in early breast cancer: A systematic review. Cancer Treat Rev 2014; 40:1005-18. [DOI: 10.1016/j.ctrv.2014.06.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 01/26/2023]
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Neuner JM, Zokoe N, McGinley EL, Pezzin LE, Yen TWF, Schapira MM, Nattinger AB. Quality of life among a population-based cohort of older patients with breast cancer. Breast 2014; 23:609-16. [PMID: 25034932 DOI: 10.1016/j.breast.2014.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/06/2014] [Accepted: 06/05/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Growing numbers of older women receive adjuvant breast cancer therapies, but little is known about the long-term effects of current therapies upon health-related quality of life outside of clinical trials. METHODS A population-based cohort of postmenopausal women with incident breast cancer aged sixty-five and older was identified from Medicare claims from four states and followed over five years. General health-related quality of life (HRQOL) was assessed using the Medical Outcomes Study SF-12 Health Survey, and breast cancer-related HRQOL was assessed using the breast cancer subscale of the functional assessment of cancer therapy (FACT-B BCS). The association of HRQOL with sociodemographic variables, comorbidity, and breast cancer variables (stage, treatments, and treatment sequelae) was examined in longitudinal models. RESULTS Among the 3083 older breast cancer survivors, general HRQOL as measured by SF-12 mental and physical component scores was similar to norms for non-cancer populations, and remained stable throughout follow-up. Breast cancer treatments, including surgery and radiation, adjuvant hormonal therapy, and cytotoxic chemotherapy were not associated with worsened general health scores. A similar pattern was seen for breast cancer-related HRQOL scores, except that chemotherapy was associated with slightly worse scores. Lymphedema occurred in 17% of the cohort, and was strongly associated with all measures of HRQOL. Reductions in general HRQOL with lymphedema development were larger than those with an age increase of 10 years. CONCLUSIONS There is little association of breast cancer treatment with HRQOL in older breast cancer patients followed for up to five years, but the development of lymphedema is associated with substantial reductions in HRQOL.
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Affiliation(s)
- Joan M Neuner
- Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
| | - Nathan Zokoe
- Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Emily L McGinley
- Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Liliana E Pezzin
- Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Tina W F Yen
- Medical College of Wisconsin, Department of Surgical Oncology, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
| | - Marilyn M Schapira
- Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Ann B Nattinger
- Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA
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Loibl S, Reinisch M. Present status of adjuvant chemotherapy for elderly breast cancer patients. ACTA ACUST UNITED AC 2014; 7:439-44. [PMID: 24715824 DOI: 10.1159/000345867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Elderly breast cancer patients are underrepresented in clinical trials, leading to a lack of knowledge regarding their tolerance of modern chemotherapy regimens. In addition, physicians are often reluctant to treat older patients with chemotherapy due to potential side effects. This article summarizes the up-to-date literature on chemotherapy in elderly patients with breast cancer, evaluates the impact of the patients' comorbidities and treatment alterations and aims to encourage treating patients adequately according to their disease in combination with the biological age rather than the chronological age alone. Finally, a short overview is given of the recruiting studies in Europe evaluating chemotherapy in elderly patients.
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Affiliation(s)
- Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany ; Städtische Kliniken Offenbach, Germany
| | - Mattea Reinisch
- German Breast Group, Neu-Isenburg, Germany ; Frauenklinik, Bürgerhospital Frankfurt/M., Germany
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Sonmez OU, Arslan UY, Esbah O, Helvaci K, Turker I, Uyeturk U, Budakoglu B, Bal O, Oksuzoglu B. Effects of comorbidities and functional living activities on survival in geriatric breast cancer patients. Contemp Oncol (Pozn) 2014; 18:204-10. [PMID: 25520582 PMCID: PMC4268993 DOI: 10.5114/wo.2014.42252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY We evaluated the possible effects of comorbid diseases and functional capacity on the survival of elderly female patients with breast cancer. MATERIAL AND METHODS The study included 159 breast cancer patients aged 65 years or older. Functional status of the patients was evaluated using Katz's index of activities of daily living (ADL) and Lawton and Brody's Instrumental ADL (IADL) scale. RESULTS ADL-based evaluation revealed 121 patients (76.1%) were independent, 34 (21.4%) semi-dependent and 4 (2.5%) dependent whereas IADL-based evaluation showed 69 patients (43.4%) were independent, 67 patients (42.1%) semi-dependent and 23 patients (14.5%) dependent. Among the patients, 69 (43.4%) had one comorbid disease, 62 (39.0%) had two and 26 (16.4%) had three or more. Of the entire cohort, 60.4% received adjuvant chemotherapy. Based on ADL index, overall survival (OS) was significantly better in semi-dependent and independent patients than in dependent patients (p = 0.001). In the upfront non-metastatic patient subgroup, disease-free survival (DFS) was favourable in the independent patients according to ADL index (p = 0.001). Having more than one comorbid disease had an unfavourable effect on OS. In the multiple regression analysis of non-metastatic patients, stage, triple-negative histology and ADL index remained significant in terms of OS (p = 0.008, HR: 3.17, CI: 1.35-7.44; p = 0.027, HR: 2.78, CI: 1.172-6.91; and p = 0.006, HR: 0.29, CI: 0.12-0.70, respectively). CONCLUSIONS In elderly patients with breast cancer, evaluation of daily living activities and comorbid diseases are as important as staging and subclassification of breast cancer in the determination of prognosis and survival.
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Affiliation(s)
- Ozlem U Sonmez
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ulku Y Arslan
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Onur Esbah
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Kaan Helvaci
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ibrahim Turker
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ummugul Uyeturk
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Burcin Budakoglu
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Oznur Bal
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Berna Oksuzoglu
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
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50
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Sheppard VB, Faul LA, Luta G, Clapp JD, Yung RL, Wang JHY, Kimmick G, Isaacs C, Tallarico M, Barry WT, Pitcher BN, Hudis C, Winer EP, Cohen HJ, Muss HB, Hurria A, Mandelblatt JS. Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901. J Clin Oncol 2014; 32:2318-27. [PMID: 24934786 DOI: 10.1200/jco.2013.51.7367] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation. PATIENTS AND METHODS A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor-positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively. RESULTS Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003). CONCLUSION Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.
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Affiliation(s)
- Vanessa B Sheppard
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA.
| | - Leigh Anne Faul
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - George Luta
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Jonathan D Clapp
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Rachel L Yung
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Judy Huei-Yu Wang
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Gretchen Kimmick
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Claudine Isaacs
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Michelle Tallarico
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - William T Barry
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Brandelyn N Pitcher
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Clifford Hudis
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Eric P Winer
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Harvey J Cohen
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Hyman B Muss
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Arti Hurria
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Jeanne S Mandelblatt
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
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