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De Rose F, Meduri B, Carmen De Santis M, Ferro A, Marino L, Ray Colciago R, Gregucci F, Vanoni V, Apolone G, Di Cosimo S, Delaloge S, Cortes J, Curigliano G. Rethinking breast cancer follow-up based on individual risk and recurrence management. Cancer Treat Rev 2022; 109:102434. [DOI: 10.1016/j.ctrv.2022.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
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La Rocca E, De Santis MC, Silvestri M, Ortolan E, Valenti M, Folli S, de Braud FG, Bianchi GV, Scaperrotta GP, Apolone G, Daidone MG, Cappelletti V, Pruneri G, Di Cosimo S. Early stage breast cancer follow-up in real-world clinical practice: the added value of cell free circulating tumor DNA. J Cancer Res Clin Oncol 2022; 148:1543-1550. [PMID: 35396978 PMCID: PMC9114063 DOI: 10.1007/s00432-022-03990-7] [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: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose Physical examinations and annual mammography (minimal follow-up) are as effective as laboratory/imaging tests (intensive follow-up) in detecting breast cancer (BC) recurrence. This statement is now challenged by the availability of new diagnostic tools for asymptomatic cases. Herein, we analyzed current practices and circulating tumor DNA (ctDNA) in monitoring high-risk BC patients treated with curative intent in a comprehensive cancer center. Patients and methods Forty-two consecutive triple negative BC patients undergoing neoadjuvant therapy and surgery were prospectively enrolled. Data from plasma samples and surveillance procedures were analyzed to report the diagnostic pattern of relapsed cases, i.e., by symptoms, follow-up procedures and ctDNA. Results Besides minimal follow-up, 97% and 79% of patients had at least 1 non-recommended imaging and laboratory tests for surveillance purposes. During a median follow-up of 5.1(IQR, 4.1–5.9) years, 13 events occurred (1 contralateral BC, 1 loco-regional recurrence, 10 metastases, and 1 death). Five recurrent cases were diagnosed by intensive follow-up, 5 by symptoms, and 2 incidentally. ctDNA antedated disseminated disease in all evaluable cases excepted two with bone-only and single liver metastases. The mean time from ctDNA detection to suspicious findings at follow-up imaging was 3.81(SD, 2.68), and to definitive recurrence diagnosis 8(SD, 2.98) months. ctDNA was undetectable in the absence of disease and in two suspected cases not subsequently confirmed. Conclusions Some relapses are still symptomatic despite the extensive use of intensive follow-up. ctDNA is a specific test, sensitive enough to detect recurrence before other methods, suitable for clarifying equivocal imaging, and exploitable for salvage therapy in asymptomatic BC survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-03990-7.
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Affiliation(s)
- E La Rocca
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M C De Santis
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Silvestri
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E Ortolan
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Valenti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Folli
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Breast Cancer Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - F G de Braud
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - G V Bianchi
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G P Scaperrotta
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M G Daidone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - V Cappelletti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Pruneri
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy.,Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
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Feng R, Jing J, Zhang X, Li M, Gao J. Adherence to post-surgery follow-up assessment and its association with sociodemographic and disease characteristics in patients with breast cancer in Central China. BMC Cancer 2020; 20:1098. [PMID: 33183247 PMCID: PMC7659108 DOI: 10.1186/s12885-020-07600-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background Follow-up after curative surgery is increasingly recognized as an important component of breast cancer care. Although current guideline regulates the follow-ups, there are no relevant studies on the adherence to it in China. This study investigated the post-surgery follow-up and explored its association with patients, tumor and treatment characteristics. Methods A total of 711 patients underwent surgical treatment in Shanxi Bethune Hospital from March 2012 to May 2018 were included in this study. Baseline sociodemographic, tumor, and treatment characteristics were obtained from the hospital electronic medical records. The post-surgery follow-up was reviewed and assessed from the patient’s follow-up examination record. Factors associated with the first three-year follow up was evaluated using logistic regression analysis. Results The annual follow-up rate after surgery decreased gradually from 67.1% at the 1st year, 60.2% at the 3rd year to 51.9% at the 4th year, and 43.5% at the 5th year. Loss of follow-up during the first 3 years after surgery was significantly associated with older age (> 65 years), lower medical insurance coverage, axillary lymph node dissection, and less intensity of systemic treatment. Conclusion A significant downtrend of annual follow-up rate for breast cancer survivors was confirmed in this study. Loss of follow-up within the first 3 years after surgery was associated with both patient’s characteristics and treatment. These results will provide evidence to help clinicians to develop tailored patient management after curative surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07600-y.
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Affiliation(s)
- Ran Feng
- Department of Breast Surgery, The Affiliated Shanxi Bethune Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan, 030032, Xiaodian District, China
| | - Jingfeng Jing
- Department of Breast Surgery, The Affiliated Shanxi Bethune Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan, 030032, Xiaodian District, China
| | - Xiaojun Zhang
- Department of Breast Surgery, The Affiliated Shanxi Bethune Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan, 030032, Xiaodian District, China
| | - Ming Li
- Cancer Research Institute, University of South Australia, Adelaide, 5000, Australia
| | - Jinnan Gao
- Department of Breast Surgery, The Affiliated Shanxi Bethune Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan, 030032, Xiaodian District, China.
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Niño de Guzmán E, Song Y, Alonso-Coello P, Canelo-Aybar C, Neamtiu L, Parmelli E, Pérez-Bracchiglione J, Rabassa M, Rigau D, Parkinson ZS, Solà I, Vásquez-Mejía A, Ricci-Cabello I. Healthcare providers' adherence to breast cancer guidelines in Europe: a systematic literature review. Breast Cancer Res Treat 2020; 181:499-518. [PMID: 32378052 PMCID: PMC7220981 DOI: 10.1007/s10549-020-05657-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
Purpose Clinical guidelines’ (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers’ adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers’ adherence. Methods We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Results Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8–67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68–77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10–80%), for the follow-up, to 90% (IQR 87–92.5%) for ET. Internal factors that potentially impact on healthcare providers’ adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers’ adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration: PROSPERO (CRD42018092884). Electronic supplementary material The online version of this article (10.1007/s10549-020-05657-8) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Ena Niño de Guzmán
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.
| | - Yang Song
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy.
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | | | - Montserrat Rabassa
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - David Rigau
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Zuleika Saz Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | - Iván Solà
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Ignacio Ricci-Cabello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Balearic Islands Health Research Institute (IdISBa), Palma, Spain.,Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
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Bošković L, Gašparić M, Petrić Miše B, Petković M, Gugić D, Ban M, Jazvić M, Dabelić N, Belac Lovasić I, Vrdoljak E. Optimisation of breast cancer patients' follow-up - potential way to improve cancer care in transitional countries. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L. Bošković
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
| | | | - B. Petrić Miše
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
| | - M. Petković
- Clinic for Oncology and Radiotherapy; University Hospital Rijeka; Rijeka Croatia
| | - D. Gugić
- University Hospital Osijek; Osijek Croatia
| | - M. Ban
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
| | - M. Jazvić
- Department of Oncology and Nuclear Medicine; University Hospital Sestre Milosrdnice; Zagreb Croatia
| | - N. Dabelić
- Department of Oncology and Nuclear Medicine; University Hospital Sestre Milosrdnice; Zagreb Croatia
| | - I. Belac Lovasić
- Clinic for Oncology and Radiotherapy; University Hospital Rijeka; Rijeka Croatia
| | - E. Vrdoljak
- Clinic for Oncology and Radiotherapy; University Hospital Split; Split Croatia
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Bond-Bero S. Filling the Gap for Early-Stage Breast Cancer Follow-Up: An Overview for Primary Care Providers. J Midwifery Womens Health 2017; 61:166-76; quiz 284. [PMID: 27037535 DOI: 10.1111/jmwh.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Earlier detection and newer treatments now make breast cancer highly survivable, and breast cancer survivors are the largest female cancer survivor group in the United States. With earlier detection, more women are being diagnosed with early-stage breast cancer and need follow-up care. With the increasing number of breast cancer survivors, there is a projected shortage in the workforce of oncology specialists to care for these women. The American Society of Clinical Oncology recommends that breast cancer follow-up care can be provided by an oncologist or primary care provider, as long as the primary care provider has spoken to the oncologist about appropriate follow-up care. Several studies have shown that primary care providers and oncologists have comparable outcomes for follow-up care of women with early-stage breast cancer. The National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) are considered the gold standard for breast cancer treatment and follow-up. These guidelines are clear and straightforward. Using knowledge of the NCCN Guidelines, primary care providers can fill the gap for follow-up care of women with early-stage breast cancer.
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Follow-Up of Patients with Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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