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Hatzipanagiotou ME, Pigerl M, Gerken M, Räpple S, Zeltner V, Hetterich M, Ugocsai P, Inwald EC, Klinkhammer-Schalke M, Ortmann O, Seitz S. Clinical impact of delaying initiation of adjuvant chemotherapy in patients with early triple negative breast cancer. Breast Cancer Res Treat 2024; 204:607-615. [PMID: 38238552 PMCID: PMC10959785 DOI: 10.1007/s10549-023-07207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE The optimal time to initiation of adjuvant chemotherapy (TTAC) for triple negative breast cancer (TNBC) patients is unclear. This study evaluates the association between TTAC and survival in TNBC patients. METHODS We conducted a retrospective study using data from a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018, registered in the Tumor Centre Regensburg was conducted. Data included demographics, pathology, treatment, recurrence and survival. TTAC was defined as days from primary surgery to first dose of adjuvant chemotherapy. The Kaplan-Meier method was used to evaluate impact of TTAC on overall survival (OS) and 5-year OS. RESULTS A total of 245 TNBC patients treated with adjuvant chemotherapy and valid TTAC data were included. Median TTAC was 29 days. The group receiving systemic therapy within 22 to 28 days after surgery had the most favorable outcome, with median OS of 10.2 years. Groups receiving systemic therapy between 29-35 days, 36-42 days, and more than 6 weeks after surgery had significantly decreased median survival, with median OS of 8.3 years, 7.8 years, and 6.9 years, respectively. Patients receiving therapy between 22-28 days had significantly better survival compared to those receiving therapy between 29-35 days (p = 0.043), and patients receiving therapy after 22-28 days also demonstrated significantly better survival compared to those receiving therapy after more than 43 days (p = 0.033). CONCLUSION Timing of adjuvant systemic therapy can influence OS in TNBC patients. Efforts should be made to avoid unnecessary delays in administering chemotherapy to ensure timely initiation of systemic therapy and optimize patient outcomes.
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Affiliation(s)
- Maria Eleni Hatzipanagiotou
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany.
| | - Miriam Pigerl
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Sophie Räpple
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Verena Zeltner
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Madeleine Hetterich
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Peter Ugocsai
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Elisabeth Christine Inwald
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg - Centre for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
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Ockerman KM, Bryan J, Wiesemann G, Neal D, Marji FP, Heath F, Kanchwala S, Oladeru O, Spiguel L, Sorice-Virk S. Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5028. [PMID: 37250834 PMCID: PMC10219713 DOI: 10.1097/gox.0000000000005028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 05/31/2023]
Abstract
Breast reductions, including oncoplastic breast surgery (OBS), have high postoperative wound healing complication (WHC) rates, ranging from 17% to 63%, thus posing a potential delay in the onset of adjuvant therapy. Incision management with closed incision negative pressure therapy (ciNPT) effectively reduces postoperative complications in other indications. This retrospective analysis compares postoperative outcomes and delays in adjuvant therapy in patients who received ciNPT on the cancer breast versus standard of care (SOC) after oncoplastic breast reduction and mastopexy post lumpectomy. Methods Patient demographics, ciNPT use, postoperative complication rates, and time to adjuvant therapy were analyzed from the records of 150 patients (ciNPT = 29, SOC = 121). Propensity score matching was used to match patients based on age, body mass index, diabetes, tobacco use, and prior breast surgery. Results In the matched cohort, the overall complication rate of ciNPT-treated cancerous breasts was 10.3% (3/29) compared with 31% (9/29) in SOC-treated cancerous breasts (P = 0.096). Compared with the SOC-treated cancerous breasts, the ciNPT breasts had lower skin necrosis rates [1/29 (3.4%) versus 6/29 (20.7%); P = 0.091] and dehiscence rates [0/29 (0%) versus 8/29 (27.6%); P = 0.004]. In the unmatched cohort, the total number of ciNPT patients who had a delay in adjuvant therapy was lower compared to the SOC group (0% versus 22.5%, respectively; P = 0.007). Conclusion Use of ciNPT following oncoplastic breast reduction effectively lowered postoperative wound healing complication rates and, most importantly, decreased delays to adjuvant therapy.
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Affiliation(s)
- Kyle M. Ockerman
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Jaimie Bryan
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Gayle Wiesemann
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Dan Neal
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Fady P. Marji
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | | | - Suhail Kanchwala
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Pennsylvania
| | | | - Lisa Spiguel
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Fla
| | - Sarah Sorice-Virk
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, Fla
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Chen X, Song R, Zhang J, Adams SA, Sun L, Lu W. On estimating optimal regime for treatment initiation time based on restricted mean residual lifetime. Biometrics 2022; 78:1377-1389. [PMID: 34263933 DOI: 10.1111/biom.13530] [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: 11/03/2020] [Revised: 05/13/2021] [Accepted: 07/08/2021] [Indexed: 12/30/2022]
Abstract
When to initiate treatment on patients is an important problem in many medical studies such as AIDS and cancer. In this article, we formulate the treatment initiation time problem for time-to-event data and propose an optimal individualized regime that determines the best treatment initiation time for individual patients based on their characteristics. Different from existing optimal treatment regimes where treatments are undertaken at a pre-specified time, here new challenges arise from the complicated missing mechanisms in treatment initiation time data and the continuous treatment rule in terms of initiation time. To tackle these challenges, we propose to use restricted mean residual lifetime as a value function to evaluate the performance of different treatment initiation regimes, and develop a nonparametric estimator for the value function, which is consistent even when treatment initiation times are not completely observable and their distribution is unknown. We also establish the asymptotic properties of the resulting estimator in the decision rule and its associated value function estimator. In particular, the asymptotic distribution of the estimated value function is nonstandard, which follows a weighted chi-squared distribution. The finite-sample performance of the proposed method is evaluated by simulation studies and is further illustrated with an application to a breast cancer data.
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Affiliation(s)
- Xin Chen
- School of Statistics and Mathematics, Shanghai Lixin University of Accounting and Finance, Shanghai, China.,Interdisciplinary Research Institute of Data Science, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Rui Song
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.,College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Liuquan Sun
- Institute of Applied Mathematics, Chinese Academy of Science, Beijing, China
| | - Wenbin Lu
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
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4
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Huttunen T, Leidenius M, Jahkola T, Mattson J, Suominen S, Meretoja T. Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction. BJS Open 2022; 6:6660948. [PMID: 35950555 PMCID: PMC9366640 DOI: 10.1093/bjsopen/zrac096] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/26/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with breast cancer undergoing mastectomy should be offered the option of immediate breast reconstruction (IBR). The aim of this retrospective study was to assess whether there is a delay in the initiation of adjuvant chemotherapy in patients undergoing mastectomy with or without IBR.
Method
The study included patients aged 70 years or younger with clinically node-negative breast cancer who underwent unilateral mastectomy with IBR (IBR group) or mastectomy alone (no-IBR group) followed by adjuvant chemotherapy at the Helsinki University Hospital between January 2012 to July 2018.
Results
A total of 645 patients were included; 186 in the IBR group and 459 in the no-IBR group. Sixty-six (35.5 per cent) patients in the IBR group and 102 (22.2 per cent) patients in the no-IBR group received their first chemotherapy cycle later than 6 weeks after surgery (P < 0.001). The respective numbers for later than 8 weeks were 17 (9.1 per cent) and 14 (3.1 per cent) (P = 0.001). Among all 645 patients, postoperative complications were a significant risk factor for a delay in the initiation of chemotherapy. Sixty-seven (39.9 per cent) patients with and 101 (21.2 per cent) patients without complications had a delay in chemotherapy (P < 0.001). The delay in chemotherapy was due to complications in 39 (59.1 per cent) in the IBR group and in 28 (27.5 per cent) in the no-IBR group (P < 0.001).
Conclusion
Patients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within 6 weeks after surgery compared with the IBR patients. IBR significantly increased the risk of postoperative complications in comparison with mastectomy alone. The complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy.
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Affiliation(s)
- Tuomas Huttunen
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Marjut Leidenius
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Tiina Jahkola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Johanna Mattson
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sinikka Suominen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Tuomo Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Tomita S, Matsunaga N, Fujita Y, de Kerckhove M, Fujii M, Honda Y, Tokisawa H, Aruga T, Terao Y. Safety evaluation of immediate breast reconstruction for locally advanced breast cancer in Japanese patients. J Plast Reconstr Aesthet Surg 2022; 75:2526-2534. [PMID: 35599220 DOI: 10.1016/j.bjps.2022.04.021] [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: 10/20/2021] [Revised: 02/27/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND While breast reconstruction often improves the quality of life of patients with locally advanced breast cancer, there is still no consensus on its safety. This retrospective report aimed to verify the safety of immediate breast reconstruction for locally advanced breast cancer. METHODS We retrospectively analyzed 500 breast cancer surgeries performed between January 2005 and December 2019 at our hospital, including 120 immediate breast reconstructions. The following five items were analyzed: the patients' choice of reconstruction method, rate of chemotherapy and radiotherapy, surgical margin positivity rate, complications associated with surgery, overall survival rate, and breast cancer-free survival rate. RESULTS Sixty-three of the 120 patients underwent autologous breast reconstruction. Of those who underwent reconstruction surgery, 95.8% received chemotherapy and 78.3% underwent post-mastectomy radiation therapy. Reconstruction failed in 8 cases with tissue expander and in 1 case with free TRAM flap. Breast reconstruction surgery was not a factor in delaying adjuvant therapy, but complications requiring intervention tended to increase the duration of adjuvant therapy. There was no statistically significant difference in the rate of surgical margin positivity, overall survival rate, or breast cancer-free survival rate. CONCLUSIONS Although complications associated with reconstructive surgery occurred, appropriate intervention prevented delays in breast cancer treatment, and the complications did not negatively affect the overall or breast cancer-free survival rates. Our study found no evidence to avoid primary breast reconstruction in patients with locally advanced breast cancer.
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Affiliation(s)
- Shoichi Tomita
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Noriko Matsunaga
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yoshihiko Fujita
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Maiko de Kerckhove
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Miwako Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yayoi Honda
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hiromi Tokisawa
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasunobu Terao
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Grigor EJM, Stein MJ, Arnaout A, Ghaedi B, Ramsay T, Zhang J. Outcomes of Immediate Breast Reconstruction in Triple Negative Breast Cancer: A Propensity Score-Matched Analysis. J Plast Reconstr Aesthet Surg 2022; 75:2542-2549. [PMID: 35599222 DOI: 10.1016/j.bjps.2022.04.012] [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: 06/14/2021] [Revised: 03/05/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Triple negative breast cancer (TNBC) patients have a significantly worse prognosis and survival compared to non-TNBC patients. Mastectomy and immediate breast reconstruction (MIBR) is associated with higher rates of complications overall, but whether MIBR significantly increases oncological risk in TNBC patients has not been fully elucidated. Our study aimed to evaluate the oncological safety of MIBR in patients with TNBC compared to non-TNBC. METHODS A 6-year prospectively maintained retrospective database at The Ottawa Hospital was reviewed from January 1, 2013 to May 31, 2019. Propensity score-matching was performed using the nearest-neighbour method with a matching ratio of 2:1. Kaplan-Meier and log rank tests were performed to provide statistical comparison of disease-free interval (DFI). DFI was defined as time from MIBR to locoregional recurrence or disease-specific mortality. P-value < 0.05 indicated statistical significance. RESULTS Of 277 eligible patients, 153 patients were matched. The cohort consisted of 51(33%) TNBC patients and 102 (67%) non-TNBC patients after 2:1 propensity score-matching. The rates of delays to first radiochemotherapy [17 (33%) vs.14 (14%), p = 0.10], postoperative complications [13 (26%) vs. 34 (33%), p = 0.50], and locoregional recurrence [2 (1.96%) vs. 1 (1.96%), p = 1.0] were statistically similar in TNBC and non-TNBC, respectively. DFI was not significantly different in TNBC compared to non-TNBC patients (log-rank p = 1.0). There was no mortality in this cohort. CONCLUSIONS This 6-year retrospective 2:1 propensity score-matched cohort study demonstrated similar oncological safety for MIBR in patients with TNBC and non-TNBC.. Overall, these findings provide additional support for the oncological safety of MIBR in TNBC. . Therefore, MIBR remains a therapeutic option for patients with TNBC.
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Affiliation(s)
- Emma J M Grigor
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Ottawa, Canada
| | - Michael J Stein
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Angel Arnaout
- Cancer Centre, The Ottawa Hospital, Ontario, Ottawa, Canada
| | - Bahareh Ghaedi
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA; Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Ottawa, Ontario, Ottawa, Canada
| | - Tim Ramsay
- Ottawa Methods Centre, The Ottawa Hospital, Ontario, Ottawa, Canada
| | - Jing Zhang
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA; Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Ottawa, Ontario, Ottawa, Canada.
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Metz G, Snook K, Sood S, Baron-Hay S, Spillane A, Lamoury G, Carroll S. Breast Radiotherapy after Oncoplastic Surgery-A Multidisciplinary Approach. Cancers (Basel) 2022; 14:1685. [PMID: 35406457 PMCID: PMC8996843 DOI: 10.3390/cancers14071685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Oncoplastic breast surgery encompasses a range of techniques used to provide equitable oncological outcomes compared with standard breast surgery while, simultaneously, prioritizing aesthetic outcomes. While the outcomes of oncoplastic breast surgery are promising, it can add an extra complexity to the treatment paradigm of breast cancer and impact on decision-making surrounding adjuvant therapies, like chemotherapy and radiotherapy. As such, early discussions at the multidisciplinary team meeting with surgeons, medical oncologists, and radiation oncologists present, should be encouraged to facilitate best patient care.
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Affiliation(s)
- Gabrielle Metz
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
| | - Kylie Snook
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- Breast and Surgical Oncology, The Poche Centre, Sydney, NSW 2060, Australia
- The Mater Hospital, Sydney, NSW 2060, Australia
| | - Samriti Sood
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- Breast and Surgical Oncology, The Poche Centre, Sydney, NSW 2060, Australia
- The Mater Hospital, Sydney, NSW 2060, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Sally Baron-Hay
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
| | - Andrew Spillane
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- Breast and Surgical Oncology, The Poche Centre, Sydney, NSW 2060, Australia
- The Mater Hospital, Sydney, NSW 2060, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- The Mater Hospital, Sydney, NSW 2060, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- The Mater Hospital, Sydney, NSW 2060, Australia
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8
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Guay E, Cordeiro E, Roberts A. Time to treatment and hospital visits for patients undergoing neoadjuvant chemotherapy for breast cancer in a single payer system. J Surg Oncol 2022; 125:824-830. [PMID: 34989410 DOI: 10.1002/jso.26786] [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: 10/28/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemotherapy (NAC) requires coordination of various services to ensure timely and accurate delivery of care. This can result in multiple hospital visits and extend time to treatment (TTT). The primary purpose of our study was to evaluate time to NAC for patients at a regional cancer centre. Healthcare resource use in the form of hospital visits before NAC was also evaluated. METHODS A retrospective chart analysis of patients with invasive breast cancer who underwent NAC between 1 January 2012 and 31 December 2018 was performed. RESULTS Overall, 286 patients underwent NAC. Median TTT was 22 days (range: 2-105). Median number of visits between first consultation and NAC was 5 (range: 0-12). Majority of additional visits were for diagnostic imaging/interventions, with a median number of 4 visits (range: 0-10). Each additional hospital visit increased time to NAC treatment by 14%. CONCLUSIONS Women undergoing NAC require multiple visits before initiating treatment-the majority of these visits are for diagnostic imaging. These results support the need for the coordination of multidisciplinary care and diagnostic imaging for breast cancer patients undergoing NAC to reduce hospital visits, improve the patient experience, and reduce TTT.
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Affiliation(s)
- Evelyne Guay
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Roberts
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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9
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Guay E, Cordeiro E, Roberts A. Young Women with Breast Cancer: Chemotherapy or Surgery First? An Evaluation of Time to Treatment for Invasive Breast Cancer. Ann Surg Oncol 2021; 29:2254-2260. [PMID: 34837134 PMCID: PMC8625669 DOI: 10.1245/s10434-021-11102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022]
Abstract
Background Breast cancer in young women (ages 18–40 years) is rare, yet remains a leading cause of cancer-related death. Time to treatment (TTT) is an increasingly important factor in breast cancer outcomes, specifically time to systemic therapy. Our objective was to review patterns of care for young women presenting with invasive breast cancer and compare TTT for surgery first versus neoadjuvant chemotherapy (NAC). Patients and Methods A retrospective chart review of young women with non-metastatic, non-inflammatory invasive breast cancer between 2012 and 2018 at a single institution was completed. The primary outcome was time to first treatment (surgery or NAC). Results One hundred forty-two young women were treated for invasive breast cancer during the study period. The majority of patients underwent surgery first (57.7%) compared with NAC (42.3%). Women who underwent NAC were more likely to have abnormal lymph nodes on imaging (p = 0.002) and clinical exam (p < 0.0001) and were also more likely to have larger tumor sizes (p < 0.05). The majority of triple negative patients underwent NAC first (88% [14/16]). Median TTT was significantly longer for surgery (27 [range 7–70] days) versus (20.5 [3–50] days) chemotherapy (p = 0.004). Median number of additional hospital visits prior to surgery was 4 (range 1–8) versus 5 (0–11) for NAC (p < 0.001). Conclusions Young women with breast cancer who undergo NAC have a shorter TTT and clinically similar median number of hospital visits compared with women undergoing surgery first. These results support the use of NAC in young women, when indicated, as additional workup and consultations prior to NAC do not delay care.
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Affiliation(s)
- Evelyne Guay
- School of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Roberts
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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10
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Ma X, Chen J, Ma D, Jiang Y, Liu Z, Chen S, Zhang Y, Shen Y, Yu X, Yang Z, Li S, Mo M, Qian Y, Liu G, Wu J, Shao Z, Yu K, Di G. Delayed initiation of radiation therapy is associated with inferior outcomes for breast cancer patients with hormone receptor-negative tumors after breast-conserving surgery. Gland Surg 2021; 10:2631-2643. [PMID: 34733713 DOI: 10.21037/gs-20-717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
Background To investigate whether the interval between adjuvant chemotherapy (CT) completion and postoperative radiation therapy initiation (ICR) after breast-conserving surgery (BCS) affects ipsilateral breast tumor recurrence (IBTR) or survival. Methods All women who were diagnosed with invasive breast cancer and underwent BCS between 2005 and 2014 were included. In total, 1,472 patients underwent adjuvant CT followed by postoperative radiation therapy (RT) (CT+), whereas 402 patients received postoperative RT alone (CT-). Analyses were stratified by ICR and the interval between surgery and the initiation of postoperative RT (ISR) in these two cohorts. The cutoff points for treatment delay were 47 days in the CT+ cohort and 69 days in the CT- cohort. IBTR, local-regional failure (LRF), disease-free survival (DFS), and overall survival (OS) were assessed through Kaplan-Meier (K-M) analysis. Univariate and multivariate regression analyses were performed to determine the prognostic factors of survival outcomes. Results The median follow-up duration was 56 months. There was an association between a delay in ICR and an increase in IBTR in the CT+ group (P=0.014 for intervals ≤47 vs. >47 days). This association was confirmed by multivariate analyses [hazard ratio (HR) of 2.766; P=0.046] in the hormone receptor-negative subgroup. The 5-year cumulative incidence rates of IBTR were 1.3% and 3.3% (≤47 vs. >47 days, respectively) in the CT+ cohort. For patients in the CT- cohort, a longer delay of initiation of postoperative RT (≤69 vs. >69 days) significantly decreased DFS (HR of 6.430; P=0.002). The 5-year cumulative incidence rates of disease recurrence were 3.0% for RT starting ≤69 days after surgery and 12.6% for RT starting >69 days after surgery. Conclusions A high IBTR rate was related to an ICR beyond 47 days. Delay of RT after CT or surgery among patients who undergo BCS should be avoided, especially among patients in the hormone receptor-negative subgroup.
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Affiliation(s)
- Xiaoyan Ma
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Chen
- Department of Thyroid and Breast Surgery, First People's Hospital of Taicang, Taicang, China
| | - Ding Ma
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yizhou Jiang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhebin Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Zhang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yizhou Shen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Yu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhaozhi Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuang Li
- Department of Breast Surgery, Liaoning Province Cancer Hospital, Shenyang, China
| | - Miao Mo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yongxiang Qian
- Department of Thyroid and Breast Surgery, First People's Hospital of Taicang, Taicang, China
| | - Guangyu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Keda Yu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Genhong Di
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Maniez P, Osada M, Reix N, Mathelin C. [uPA/PAI-1 and EPClin®: Comparison of their impact on the management of intermediate-prognosis breast cancers]. ACTA ACUST UNITED AC 2021; 50:298-306. [PMID: 34626849 DOI: 10.1016/j.gofs.2021.10.003] [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: 06/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The uPA/PAI-1 assay and the EPClin® test are useful tools that add to clinico-anatomical characteristics to determine the indication of adjuvant chemotherapy in case of intermediate-prognosis invasive breast cancer. The principal purpose of our study was to analyze the concordance of uPA/PAI-1 and EPClin® in classification of patients into two groups: low and high risk of relapse. METHODS We prospectively included 63 patients treated for intermediate-prognosis invasive breast cancer. All of these patients received a uPA/PAI-1 assay and an EPClin® test. RESULTS The uPA/PAI-1 assay and EPClin® test were consistent for 56.2% and inconsistent for 43.8%. In the event of a discrepancy, the treatment decision was based in 95.2% of patients on the EPClin® test result. In total, 38 patients were selected for adjuvant chemotherapy after achievement of the two tests. The mean time to report results after surgery was 9 days for the uPA/PAI-1 assay and 35 days for the EPClin® test. No cases of recurrence or death were found, with an average follow-up of 32 months. CONCLUSION The EPClin® test resulted in more chemotherapy prescriptions than indicated by uPA/PAI-1. However, we can't conclude to the superiority of one of these two tests, survival data and the effectiveness of our study being insufficient. In general, studies comparing different signatures useful to the therapeutic decision of intermediate prognosis breast cancers should be encouraged.
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Affiliation(s)
- P Maniez
- Hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
| | - M Osada
- Hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - N Reix
- ICube UMR 7357, université de Strasbourg/CNRS, Fédération de médecine translationnelle de Strasbourg (FMTS), Strasbourg, France; Laboratoire de biochimie et biologie moléculaire, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - C Mathelin
- Hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France; CNRS UMR7104 Inserm U964, Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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12
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Maes-Carballo M, Gómez-Fandiño Y, Estrada-López CR, Reinoso-Hermida A, Khan KS, Martín-Díaz M, Bueno-Cavanillas A. Breast Cancer Care Quality Indicators in Spain: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126411. [PMID: 34199302 PMCID: PMC8296231 DOI: 10.3390/ijerph18126411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 01/17/2023]
Abstract
Breast cancer (BC) management care requires an increment in quality. An initiative to improve the BC quality care is registered, and quality indicators (QIs) are studied. We appraised the appearance of QIs and their standards systematically in Spain. A prospective systematic search (Prospero no: CRD42021228867) for clinical pathways and integrated breast cancer care processes was conducted through databases and the World Wide Web in February 2021. Duplicate data extraction was performed with 98% reviewer agreement. Seventy-four QIs (QI per document mean: 11; standard deviation: 10.59) were found in 15 documents. The Catalonian document had the highest number of QIs (n = 30). No QI appeared in all the documents. There were 9/74 QIs covering structure (12.16%), 53/74 covering process (71.62%), and 12/74 covering outcome (16.22%). A total of 22/66 (33.33%) process and outcome QIs did not set a minimum standard of care. QIs related to primary care, patient satisfaction, and shared decision making were deficient. Most of the documents established a BC QI standard for compliance, but the high variability hinders the comparison of outcomes. Establishing a consensus-based set of QIs needs urgent attention.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (K.S.K.); (A.B.-C.)
- Department of General Surgery, Hospital Público de Verín, 32600 Ourense, Spain
- Correspondence:
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
| | - Carlos Roberto Estrada-López
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
| | - Ayla Reinoso-Hermida
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Manuel Martín-Díaz
- Department of General Surgery, Hospital de Motril, 18600 Granada, Spain;
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria IBS, 18012 Granada, Spain
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13
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Okines AFC, Kipps E, Irfan T, Coakley M, Angelis V, Asare B, Mohammed K, Walsh G, Ring A, Johnston SRD, Parton M, Turner NC, Smith IE. Impact of timing of adjuvant chemothapy for early breast cancer: the Royal Marsden Hospital experience. Br J Cancer 2021; 125:299-304. [PMID: 34017085 DOI: 10.1038/s41416-021-01428-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/23/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optimal time to deliver adjuvant chemotherapy has not been defined. METHODS A retrospective study of consecutive patients receiving adjuvant anthracycline and/or taxane 1993-2010. Primary endpoint included 5-year disease-free survival (DFS) in patients commencing chemotherapy <31 versus ≥31 days after surgery. Secondary endpoints included 5-year overall survival (OS) and sub-group analysis by receptor status. RESULTS We identified 2003 eligible patients: 1102 commenced chemotherapy <31 days and 901 ≥31 days after surgery. After a median follow-up of 115 months, there was no difference in 5-year DFS rate with chemotherapy <31 compared to ≥31 days after surgery in the overall population (81 versus 82% hazard ratio (HR) 1.15, 95% confidence interval (95% CI) 0.92-1.43, p = 0.230). The 5-year OS rate was similar in patients who received chemotherapy <31 or ≥31 days after surgery (90 versus 91%, (HR 1.21, 95% CI 0.89-1.64, p = 0.228). For 250 patients with triple-negative breast cancer OS was significantly worse in patients who received chemotherapy ≥31 versus <31 days (HR = 2.18, 95% CI 1.11-4.30, p = 0.02). DISCUSSION Although adjuvant chemotherapy ≥31 days after surgery did not affect DFS or OS in the whole study population, in TN patients, chemotherapy ≥31 days after surgery significantly reduced 5-year OS; therefore, delays beyond 30 days in this sub-group should be avoided.
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Affiliation(s)
| | - Emma Kipps
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Tazia Irfan
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Maria Coakley
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Bernice Asare
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Geraldine Walsh
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Alistair Ring
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Marina Parton
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Ian E Smith
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
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14
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Freedman RA, Sedrak MS, Bellon JR, Block CC, Lin NU, King TA, Minami C, VanderWalde N, Jolly TA, Muss HB, Winer EP. Weathering the Storm: Managing Older Adults With Breast Cancer Amid COVID-19 and Beyond. J Natl Cancer Inst 2021; 113:355-359. [PMID: 32449757 PMCID: PMC7313961 DOI: 10.1093/jnci/djaa079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Caring for older patients with breast cancer presents unique clinical considerations because of preexisting and competing comorbidity, the potential for treatment-related toxicity, and the consequent impact on functional status. In the context of the COVID-19 pandemic, treatment decision making for older patients is especially challenging and encourages us to refocus our treatment priorities. While we work to avoid treatment delays and maintain therapeutic benefit, we also need to minimize the risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposures, myelosuppression, general chemotherapy toxicity, and functional decline. Herein, we propose multidisciplinary care considerations for the aging patient with breast cancer, with the goal to promote a team-based, multidisciplinary treatment approach during the COVID-19 pandemic and beyond. These considerations remain relevant as we navigate the “new normal” for the approximately 30% of breast cancer patients aged 70 years and older who are diagnosed in the United States annually and for the thousands of older patients living with recurrent and/or metastatic disease.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Jennifer R Bellon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Caroline C Block
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tari A King
- Department of Surgery, Division of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christina Minami
- Department of Surgery, Division of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Noam VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Trevor A Jolly
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Hyman B Muss
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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15
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of oncoplastic procedures for partial breast reconstruction, and how they compare to breast conservation-therapy alone. 2. Have a working knowledge of oncoplastic techniques and how they are addressed from the multidisciplinary perspective. 3. Understand the limitations of oncoplastic techniques and how to avoid unfavorable results. SUMMARY Oncoplastic surgical techniques have expanded indications for breast conservation and have improved both oncologic and reconstructive outcomes. This article will focus on some of the barriers to adoption and discuss ways to improve safety through streamlining the process, understanding the oncologic concerns, and evaluating unfavorable outcomes that might interfere with the appropriate delivery of breast cancer care.
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16
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Wang W, Guo B, Cui C, Sun T, Liu S. Management of early-stage breast cancer patients during the coronavirus disease 2019 (COVID-19) pandemic: The experience in China from a surgical standpoint. J Cancer 2021; 12:2190-2198. [PMID: 33758597 PMCID: PMC7974893 DOI: 10.7150/jca.50501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women globally. Currently, due to limited data, there are no international guidelines for addressing the management of a large group of patients during infectious disease pandemics. Coronavirus disease 2019 (COVID-19), declared as a pandemic by the World Health Organization (WHO), has rapidly spread globally. The COVID-19 pandemic changed our daily routines and forced us to rethink the management of breast cancer patients. Clinicians need to take into account multiple factors such as the timing and delivery of cancer care, epidemic prevention and control, and the allocation of medical resources. Determining ways to reasonably adjust the treatment strategy is a real challenge. In this review, we aim to discuss particular challenges associated with managing breast cancer patients during the COVID-19 pandemic, share experience from Chinese oncologists and surgeons and propose some practical approaches to the management of early-stage breast cancer patients from a surgical standpoint.
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Affiliation(s)
- Wan Wang
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Baoliang Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Street, Harbin 150001, China
| | - Chunguo Cui
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Tong Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Shengnan Liu
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
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17
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Fertility preservation for cancer patients: treatment gaps and considerations in patients' choices. Arch Gynecol Obstet 2021; 303:1617-1623. [PMID: 33544203 DOI: 10.1007/s00404-021-05985-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Women with cancer may desire fertility preservation (FP) prior to initiating cancer treatment, but undergoing FP may result in treatment delays. This study sought to determine whether such delays existed in our population and which factors were associated with patients' decision to proceed with FP. METHODS This was a historical cohort study performed at Montefiore Medical Center's Institute for Reproductive Medicine and Health. Reproductive age women diagnosed with cancer and consulted for FP were included. The main outcome measure was the number of days between FP consultation and cancer treatment initiation. Factors associated with patients' decisions to proceed with FP were also analyzed. RESULTS Thirty out of 51 women in our study underwent FP including embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation (OTC), both oocyte and embryo cryopreservation, or GnRH agonist treatment. The majority of women who underwent FP chose embryo cryopreservation (36.7%), followed by oocyte cryopreservation (33.3%). Of the 20 patients with partners who underwent FP, 13 (65%) froze embryos. Only 4 of the 30 women who underwent FP had all, or a portion of their services, covered by insurance. The mean treatment delay was 18 days (p = 0.007), with a mean consultation to oncologic treatment gap of 23 ± 16.8 and 41.4 ± 25.9 days in the non-FP and FP groups, respectively. CONCLUSION Women with cancer diagnosis who underwent FP prior to initiating cancer treatment experienced a statistically significant delay in initiating cancer treatment. However, the clinical significance of this finding is unknown since FP treatments have not been associated with increased recurrence or mortality.
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18
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Balasubramanian I, Harding T, Boland MR, Ryan EJ, Geraghty J, Evoy D, McCartan D, McDermott EW, Prichard RS. The Impact of Postoperative Wound Complications on Oncological Outcomes Following Immediate Breast Reconstruction for Breast Cancer: A Meta-analysis. Clin Breast Cancer 2020; 21:e377-e387. [PMID: 33451964 DOI: 10.1016/j.clbc.2020.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 12/21/2022]
Abstract
The association between immediate breast reconstruction (IBR)-related wound complications and breast cancer recurrence (BCR) remains uncertain. This study aimed to investigate the oncological outcomes in patients with wound complications following mastectomy and IBR. A comprehensive search was undertaken for all studies describing complications in patients with breast cancer following IBR. Studies were included if they reported on complications and investigated their relationship with BCR. A meta-analysis was performed using a random-effects model, with data presented as odds ratios and 95% confidence intervals. A total of 1418 patients from five studies were included in the final analysis. The mean age of patients included was 47.2 years. A total of 382 (26.9%) patients had postoperative complications following a majority of implant-based IBR (929/1418). A total of 158 (11.1%) recurrences, which included 63 locoregional and 106 distant recurrences, was noted at a mean follow-up of 66 months. Although there was an increase in recurrence rates in the complication group (n = 66/382; 17.3% vs. n = 92/1036; 8.9%), there was no significant association between complications and BCR (17.3% vs. 8.9%; P = .18) or mortality (3.6% vs. 2.3%; P = .15). Time to adjuvant therapy was significantly increased in patients with complications (mean difference, 8.69 days; range, 1.18-16.21 days; P = .02; I2 = 0.02). This meta-analysis demonstrated a higher incidence of wound complications following IBR and a statistically significant increased time to adjuvant therapy. However, this did not translate into adverse oncological outcomes in patients with breast cancer undergoing IBR.
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Affiliation(s)
| | - Tim Harding
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Michael R Boland
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Eanna J Ryan
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - James Geraghty
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Enda W McDermott
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Ruth S Prichard
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
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19
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Morante Z, Ruiz R, Araujo JM, Pinto JA, Cruz-Ku GDL, Urrunaga-Pastor D, Namuche F, Flores C, Mantilla R, Luján MG, Fuentes H, Schwarz L, Aguilar A, Neciosup S, Gómez HL. Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer. Clin Breast Cancer 2020; 21:239-246.e4. [PMID: 33221201 DOI: 10.1016/j.clbc.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. PATIENTS AND METHODS We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. RESULTS In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). CONCLUSION A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.
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Affiliation(s)
- Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru
| | - Rossana Ruiz
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Jhajaira M Araujo
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | | | - Diego Urrunaga-Pastor
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Universidad Científica del Sur, Lima, Peru
| | - Fernando Namuche
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Claudio Flores
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Raúl Mantilla
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - María G Luján
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Hugo Fuentes
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Luis Schwarz
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Alfredo Aguilar
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Silvia Neciosup
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Henry L Gómez
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru.
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20
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Zeleke Alem A, Gebeye Zeleke E, Akalu TY. Time to Adjuvant Chemotherapy and Its Predictors Among Women with Breast Cancer at the University of Gondar Compressive Specialized Hospital: A Retrospective Follow-Up Study. BREAST CANCER (DOVE MEDICAL PRESS) 2020; 12:97-108. [PMID: 32982398 PMCID: PMC7509314 DOI: 10.2147/bctt.s260341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/07/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND Early adjuvant chemotherapy improves the outcomes of breast cancer patients by increasing the benefit provided by the cytotoxic systemic therapies. Despite these, the recommended time to adjuvant chemotherapy and its predictors is very limited. Therefore, this study was determining the time to adjuvant chemotherapy and its predictors among women with breast cancer at the University of Gondar Comprehensive Specialized Hospital. METHODS An institution-based retrospective follow-up study was conducted at the University of Gondar Compressive Specialized Hospital from January 2015 to February 2019 among all women with breast cancer. Stata version 14 was used for data analysis. A stratified Cox regression model was fitted to identify the potential predictors. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of the association. Cox-Snell residual test was used to check the goodness of fit. RESULTS In this study, the median time to adjuvant chemotherapy was 67 days with an interquartile range of 34-102 days. More than three-fourth (79.9%) of patients received chemotherapy after 30 days. Of the total, 96.6% of patients with co-morbidity received adjuvant chemotherapy after 30 days. Regarding surgical complications, 97.0% of the patients with a surgical complications were received adjuvant chemotherapy after 30 days. Older patients (AHR= 0.34, 95% CI: 0.16,0.71), presence of co-morbidity (AHR= 0.43, 95% CI: 0.29, 0.62), positive surgical margin (AHR= 0.40, 95% CI: 0.25, 0.64), and presence of surgical complication (AHR= 0.55, 95% CI: 0.34, 0.88) were significantly associated with delayed time to adjuvant chemotherapy. CONCLUSION In this study, time to adjuvant chemotherapy among women was longer. Age, co-morbidity, surgical complications, and margin status were significant predictors of time to adjuvant chemotherapy. Close follow-up is important for women with surgical complications, co-morbidities, elder patients, and patients with a positive margin.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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21
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Hammond JB, Han GR, Cronin PA, Kosiorek HE, Rebecca AM, Casey WJ, Kruger EA, Teven CM, Pockaj BA. Exploring the Effect of Post-mastectomy complications on 5-year survival. Am J Surg 2020; 220:1422-1427. [PMID: 32921402 DOI: 10.1016/j.amjsurg.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ramifications of postoperative complications on long-term survival after mastectomy are uncertain. METHODS Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS). RESULTS A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P < 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction. CONCLUSIONS Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival.
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Affiliation(s)
| | - Ga-Ram Han
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Patricia A Cronin
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heide E Kosiorek
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Alanna M Rebecca
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - William J Casey
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Erwin A Kruger
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Chad M Teven
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA.
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22
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Liu Y, Wang J, Tang Y, Su R, Yang Q. Surgical Management Strategy for Breast Cancer Patients During the COVID-19 Outbreak. Cancer Manag Res 2020; 12:6053-6058. [PMID: 32801857 PMCID: PMC7383096 DOI: 10.2147/cmar.s258121] [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: 04/15/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022] Open
Abstract
In December 2019, a new coronavirus pneumonia began to break out globally. COVID-19 pandemic challenges the health systems worldwide and influences the treatments for other diseases. The incidence rate of breast cancer ranks first among all malignant tumors among women. During the pandemic, medical workers should strictly monitor the condition of patients and strengthen the management and prevention measures to make sure patients can be operated safely. This article will discuss the arrangements and management of surgical treatment for patients with breast cancer.
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Affiliation(s)
- Yong Liu
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China, 510150
| | - Jiaming Wang
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China, 510150
| | - Yi Tang
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China, 510150
| | - Rong Su
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China, 510150
| | - Qianwen Yang
- The University of Melbourne, Melbourne, Australia, 3052
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23
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Heeg E, Marang-van de Mheen PJ, Van Maaren MC, Schreuder K, Tollenaar RAEM, Siesling S, Bos MEMM, Vrancken Peeters MJTFD. Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple-negative breast cancer. Int J Cancer 2020; 147:152-159. [PMID: 31721193 PMCID: PMC7317578 DOI: 10.1002/ijc.32788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022]
Abstract
Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype‐dependent and that TTC within 30 days should be warranted in patients with triple‐negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10‐year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast‐conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity‐score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10‐year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted. What's new? Current breast cancer treatment guidelines recommend that chemotherapy is initiated between 6‐12 weeks after surgery. Delayed treatment can lead to poorer outcome, but there's no precise definition of the optimal window. Recent work suggests that for patients with triple negative breast cancer (TNBC), it's best to initiate chemotherapy within 30 days. Here, the authors evaluated outcomes for TNBC patients correlated with time to chemotherapy. They found that in patients undergoing breast‐conserving surgery, an interval of more than 30 days before chemotherapy was associated with decreased survival. If the patient had undergone a mastectomy, a longer delay before chemotherapy did not impact survival.
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Affiliation(s)
- Erik Heeg
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Marissa C Van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Kay Schreuder
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Monique E M M Bos
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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24
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Prolonged Time to Adjuvant Chemotherapy Initiation Was Associated with Worse Disease Outcome in Triple Negative Breast Cancer Patients. Sci Rep 2020; 10:7029. [PMID: 32341397 PMCID: PMC7184599 DOI: 10.1038/s41598-020-64005-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/09/2020] [Indexed: 01/01/2023] Open
Abstract
The optimal time to adjuvant chemotherapy (TTC) for breast cancer (BC) patients remains uncertain. Herein, we aim to evaluate the association between TTC and prognosis among different subtypes in modern era of adjuvant chemotherapy. BC patients receiving operation and adjuvant chemotherapy between January 2009 and December 2015 were included. Enrolled patients were categorized into TTC ≤4 weeks and >4 weeks groups. Relapse-free survival (RFS) and overall survival (OS) were compared according to TTC and analyzed among different BC molecular subtypes. A total of 2611 patients were included. Elder age (P = 0.005), more comorbidities (P <0.001), breast-conserving surgery (P = 0.001), non-invasive ductal carcinoma (P = 0.012), and HER2-positivity (P <0.001) were associated with prolonged TTC. Among whole BC population, no significant difference was observed between two TTC groups in terms of RFS (P = 0.225) or OS (P = 0.355). However, for triple negative (TNBC) patients, TTC >4 weeks was independently related with worse RFS (5-year RFS 81.9% vs 89.3%; HR, 1.89; 95% CI, 1.09 to 3.27; P = 0.024) and OS (5-year OS 84.0% vs 94.0%; HR, 2.49; 95% CI, 1.30 to 4.76; P = 0.006) compared with those TTC ≤4 weeks. Prolonged TTC >4 weeks after BC surgery was not associated with worse survival outcomes in the whole BC patients. However, TTC >4 weeks may increase risk of relapse or death in TNBC patients, which deserves further clinical evaluation.
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25
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Lee KT, Jung JH, Mun GH, Pyon JK, Bang SI, Lee JE, Nam SJ. Influence of complications following total mastectomy and immediate reconstruction on breast cancer recurrence. Br J Surg 2020; 107:1154-1162. [DOI: 10.1002/bjs.11572] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/19/2019] [Accepted: 02/04/2020] [Indexed: 02/02/2023]
Abstract
Abstract
Background
Immediate breast reconstruction is safe from an oncological perspective, but the relatively high rate of postoperative complications raises oncological concerns. The present study aimed to evaluate the potential influence of postoperative complications after immediate breast reconstruction on breast cancer recurrence and survival.
Methods
Patients with breast cancer who had total mastectomy and immediate reconstruction between 2008 and 2013 were followed for at least 5 years. The impact of postoperative complications on oncological outcomes was assessed using multivariable Cox regression analyses.
Results
In total, 438 patients with a median follow-up of 82 months were analysed. Five-year local recurrence-free, disease-free and overall survival rates were 95·4, 93·1 and 98·4 per cent respectively. Postoperative complications developed in the operated breast in 120 patients (27·4 per cent) and at other sites (flap donor) in 30 patients (6·8 per cent). Development of breast complications was associated with significantly increased rate of recurrence compared with no complications (16·7 versus 5·9 per cent; P = 0·002). In multivariable analysis, patients with breast complications had significantly worse disease-free survival than those with no complications (hazard ratio (HR) 2·25; P = 0·015). This remained significant in patients who received adjuvant therapy without delay (8 weeks or less after surgery) (HR 2·45; P = 0·034).
Conclusion
Development of postoperative complications in the breast can have a negative impact on survival and recurrence after immediate reconstruction.
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Affiliation(s)
- K-T Lee
- Departments of Plastic Surgery, Seoul, South Korea
| | - J H Jung
- Departments of Plastic Surgery, Seoul, South Korea
| | - G-H Mun
- Departments of Plastic Surgery, Seoul, South Korea
| | - J K Pyon
- Departments of Plastic Surgery, Seoul, South Korea
| | - S I Bang
- Departments of Plastic Surgery, Seoul, South Korea
| | - J E Lee
- Departments of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - S J Nam
- Departments of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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26
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Yoon WS, Rim CH, Yang DS, Lee JA, Son GS, Chang YW, Woo SU, Kim DW, Dhong ES. Long-term outcomes of immediate autologous breast reconstruction after definite adjuvant therapy in intermediate and locally advanced breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:743. [PMID: 32042759 DOI: 10.21037/atm.2019.11.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background To analyze oncologic outcomes and reconstruction quality in locally advanced stage breast cancer after performing immediate autologous breast reconstruction (IABR). Methods From 2007 to 2014, data of patients aged ≤70 years old with stage II-III breast cancer who received total mastectomy (TM) were extracted from medical records. Exclusion criteria were: previous contralateral breast cancer, follow-up loss before adjuvant therapy completion, and artificial reconstruction. Patients were divided into two groups: (I) TM alone, and (II) TM + IABR. Overall survival (OS) and loco-regional recurrence free survival (LRRFS) were calculated. Times of minor revision, abnormal image findings in breast, and change of breast height were observed. Results Sixty-one of 188 patients received IABR after TM. Stage IIIB-C was the most important prognostic factor for OS (P<0.001) and LRRFS (P<0.001). For stage II, five-year TM and TM + IABR OS rates were 96.8% and 100% (P=0.324), respectively. For stage IIIB-C, five-year TM and TM + IABR OS rates were 57.6% and 62.5% (P=0.544), respectively. For stage II, five-year TM and TM + IABR LRRFS were 98.1% and 95.7% (P=0.998), respectively. For stage IIIB-C, five-year TM and TM + IABR LRRFS were 70.8% and 62.5% (P=0.378), respectively. Two major complications were observed after IABR. Minor revisions, abnormal image findings, and change of breast height were common without showing significant relation with adjuvant radiotherapy or tumor stage. Conclusions IABR showed feasible oncologic outcomes in 5-year follow-up. Adjuvant radiotherapy had little effect on quality of reconstruction. However, IABR in advanced stage should be cautiously applied considering expected survival and minor problems after IABR.
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Affiliation(s)
- Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea
| | - Dae Sik Yang
- Department of Radiation Oncology, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Jung Ae Lee
- Department of Radiation Oncology, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Gil Soo Son
- Department of Surgery, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea
| | - Young Woo Chang
- Department of Surgery, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea
| | - Sang Uk Woo
- Department of Surgery, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Guro Hospital, Korea University Medical Center, Ansan, Republic of Korea
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27
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Livingston-Rosanoff D, Hanlon B, Marka N, Vande Walle K, Stankowski-Drengler T, Schumacher J, Greenberg CC, Neuman H, Wilke LG. Time to initiation of neo-adjuvant chemotherapy for breast cancer treatment does not influence patient survival: A study of US breast cancer patients. Breast J 2019; 26:625-629. [PMID: 31513322 DOI: 10.1111/tbj.13625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Delays in the initiation of adjuvant chemotherapy or radiation therapy are associated with worse outcomes in patients undergoing treatment for breast cancer. However, the impact of the time to initiation of neo-adjuvant chemotherapy (NAC) on patient outcomes has not previously been studied. The purpose of this study was to determine whether delays in NAC initiation impact patient survival. The National Cancer Database was queried for women ≥ 18 years old who underwent NAC within 6 months of being diagnosed with stage I-III invasive breast cancer in 2010-2011. ER+ or PR+, Her2- cancers were excluded from analysis. Multivariable Cox proportional hazard modeling was used to evaluate the relationship between time to NAC, sociodemographic, diagnosis, and treatment factors with patient survival. The median age of the 12 806 women included in this study was 52 (range 21-90) with 62% presenting with cT2 disease and 62% with nodal involvement. Half of the women (50%) had triple negative, 30% ER/PR+Her2+ and 20% ER-PR-Her2+ cancers. The median time to starting NAC was 4 weeks (range 0-26) for all subtypes. Time to NAC initiation was not associated with a difference in survival for triple negative or Her2+ cancers. Delays from diagnosis to starting NAC are not associated with worse survival for patients with Her2+ or triple negative breast cancer. This study demonstrates that the majority of women in the modern era start NAC in a timely fashion and delays in starting NAC within 6 months of diagnosis do not impact long-term patient outcomes.
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Affiliation(s)
- Devon Livingston-Rosanoff
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI.,Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Bret Hanlon
- Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Nicholas Marka
- Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Kara Vande Walle
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI.,Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Trista Stankowski-Drengler
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI.,Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Jessica Schumacher
- Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Caprice C Greenberg
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI.,Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Heather Neuman
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI.,Department of Surgery, Wisconsin Institute for Surgical Outcomes Research, University of Wisconsin, Madison, WI
| | - Lee G Wilke
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI
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28
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Epirubicin-loaded polymeric micelles effectively treat axillary lymph nodes metastasis of breast cancer through selective accumulation and pH-triggered drug release. J Control Release 2018; 292:130-140. [DOI: 10.1016/j.jconrel.2018.10.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
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29
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Bleicher RJ, Chang C, Wang CE, Goldstein LJ, Kaufmann CS, Moran MS, Pollitt KA, Suss NR, Winchester DP, Tafra L, Yao K. Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 2018; 173:603-617. [DOI: 10.1007/s10549-018-5046-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
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30
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Zhang L, King J, Wu XC, Hsieh MC, Chen VW, Yu Q, Fontham E, Loch M, Pollack LA, Ferguson T. Racial/ethnic differences in the utilization of chemotherapy among stage I-III breast cancer patients, stratified by subtype: Findings from ten National Program of Cancer Registries states. Cancer Epidemiol 2018; 58:1-7. [PMID: 30415099 DOI: 10.1016/j.canep.2018.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype. METHODS Data on female non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic stage I-III breast cancer patients diagnosed in 2011 were obtained from a project to enhance population-based National Program of Cancer Registry data for Comparative Effectiveness Research. Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) were used to classify subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2-; and HR-/HER2 + . We used multivariable logistic regression models to examine the association of race/ethnicity with three outcomes: chemotherapy (yes, no), neo-adjuvant chemotherapy (yes, no), and delayed chemotherapy (yes, no). Covariates included patient demographics, tumor characteristics, Charlson Comorbidity Index, other cancer treatment, and participating states/areas. RESULTS The study included 25,535 patients (72.1% NHW, 13.7% NHB, and 14.2% Hispanics). NHB with HR+/HER2- (adjusted odds ratio [aOR] 1.22, 95% CI 1.04-1.42) and Hispanics with HR-/HER2- (aOR 1.62, 95% CI 1.15-2.28) were more likely to receive chemotherapy than their NHW counterparts. Both NHB and Hispanics were more likely to receive delayed chemotherapy than NHW, and the pattern was consistent across each subtype. No racial/ethnic differences were found in the receipt of neo-adjuvant chemotherapy. CONCLUSIONS Compared to NHW with the same subtype, NHB with HR+/HER2- and Hispanics with HR-/HER2- have higher odds of using chemotherapy; however, they are more likely to receive delayed chemotherapy, regardless of subtype. Whether the increased chemotherapy use among NHB with HR+/HER2- indicates overtreatment needs further investigation. Interventions to improve the timely chemotherapy among NHB and Hispanics are warranted.
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Affiliation(s)
- Lu Zhang
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Jessica King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Vivien W Chen
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Elizabeth Fontham
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Michelle Loch
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tekeda Ferguson
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States.
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31
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Abstract
BACKGROUND Even small delays in the treatment of breast cancer are a frequently expressed concern of patients. Knowledge about this subject is important for clinicians to counsel patients appropriately and realistically, while also optimizing care. Although data and quality measures regarding time to chemotherapy and radiotherapy have been present for some time, data regarding surgical care are more recent and no standard exists. This review was written to discuss our current knowledge about the relationship of treatment times to outcomes. METHODS The published medical literature addressing delays and optimal times to treatment was reviewed in the context of our current time-dependent standards for chemotherapy and radiotherapy. The surgical literature and the lack of a time-dependent surgical standard also were discussed, suggesting a possible standard. RESULTS Risk factors for delay are numerous, and tumor doubling times are both difficult to determine and unhelpful to assess the impact of longer treatment times on outcomes. Evaluation components also have a time cost and are inextricable from the patient's workup. Although the published literature has lack of uniformity, optimal times to each modality are strongly suggested by emerging data, supporting the current quality measures. Times to surgery, chemotherapy, and radiotherapy all have a measurable impact on outcomes, including disease-free survival, disease-specific survival, and overall survival. CONCLUSIONS Delays have less of an impact than often thought but have a measurable impact on outcomes. Optimal times from diagnosis are < 90 days for surgery, < 120 days for chemotherapy, and, where chemotherapy is administered, < 365 days for radiotherapy.
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Affiliation(s)
- Richard J Bleicher
- Department of Surgical Oncology, Room C-308, Fox Chase Cancer Center, Philadelphia, PA, USA.
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32
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Li S, Ma D, Shi HH, Yu KD, Zhang Q. The effect of delayed adjuvant chemotherapy on relapse of triple-negative breast cancer. J Thorac Dis 2018; 10:2837-2841. [PMID: 29997947 DOI: 10.21037/jtd.2018.04.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background For triple negative breast cancer (TNBC), the optimal time from surgery to initiation of adjuvant chemotherapy is controversial. We investigated the influence of time to adjuvant chemotherapy on outcome in TNBC patients. Methods Female patients with stage I-IIIa operable TNBC between 2006 and 2008 in our institutions were included. A total of 331 patients were divided into 3 groups according to the time to adjuvant chemotherapy: ≤30, 31-60, and >60 days. Relapse free survival (RFS) were calculated and compared. Results Prolonged delay of initiation of adjuvant chemotherapy (≤30 versus >60 days) significantly decreased the RFS in our TNBC cohort [adjusted hazard ratio (HR) of 2.39; 95% confidence interval (CI), 1.13-5.07, P=0.02]. While a moderate delay (≤30 versus 31-60 days) did not significantly influence RFS in all TNBC patients, it did compromise survival in lymph node positive patients (P=0.04). Conclusions Longer delay of adjuvant chemotherapy was associated with worse survival in TNBC patients. Early initiation of adjuvant chemotherapy should be considered, especially for relatively high risk node positive TNBCs.
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Affiliation(s)
- Shuang Li
- Department of Breast Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Ding Ma
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Children's Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hao-Hong Shi
- Department of Anesthesiology, Children's Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ke-Da Yu
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Children's Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qiang Zhang
- Department of Breast Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
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Zhan QH, Fu JQ, Fu FM, Zhang J, Wang C. Survival and time to initiation of adjuvant chemotherapy among breast cancer patients: a systematic review and meta-analysis. Oncotarget 2017; 9:2739-2751. [PMID: 29416807 PMCID: PMC5788675 DOI: 10.18632/oncotarget.23086] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/17/2017] [Indexed: 12/21/2022] Open
Abstract
The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. In order to illustrate the effect of delaying the initiation of AC on survival we have undertaken a systematic review and meta-analysis. We identified 12 available studies in the meta-analysis including 15 independent analytical groups. This meta-analysis showed that a 4-week delay before AC was associated with a significantly worse overall survival (OS)(HR=1.13; 95% confidence interval [CI], 1.08–1.19) and disease free survival (DFS)(HR=1.14; 95%CI, 1.05–1.24). Two studies categorized patients into hormone receptor-positive, ERBB2-positive, and triple-negative breast cancer (TNBC) patients according to the clinicopathological features of breast cancer. The HRs for OS between waiting time (WT) ≤30 days and 31–60 days in the subgroups were extracted and analyzed. The analysis demonstrated that a WT of 31–60 days was related to worse OS among patients with TNBC (HR, 1.26; 95% CI, 1.08–1.48), but had no significant effect on OS among those with hormone receptor-positive (HR, 1.02; 95% CI, 0.89–1.15) or ERBB2-postive (HR, 0.95; 95%CI, 0.79–1.14) tumors. In this meta-analysis of the eligible literatures reviewing the time to AC, a longer waiting time to adjuvant chemotherapy may lead to worse survival in breast cancer patients, especially in TNBC patients.
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Affiliation(s)
- Qiao-Hui Zhan
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Jian-Qin Fu
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Fang-Meng Fu
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Jie Zhang
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
| | - Chuan Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China
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