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Mariotto AB, Botta L, Bernasconi A, Zou Z, Gatta G, Capocaccia R. Prediction of Risk of Metastatic Recurrence for Female Breast Cancer Patients in the Presence of Competing Causes of Death. Cancer Epidemiol Biomarkers Prev 2023; 32:1683-1689. [PMID: 37707367 PMCID: PMC10979392 DOI: 10.1158/1055-9965.epi-23-0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND To estimate risk of recurrence for women diagnosed with nonmetastatic breast cancer considering the risks of other causes mortality. METHODS We extend a method based on the diagnosis-metastasis-death pathway to include risks of other causes mortality. We estimate three probabilities as cumulative incidence of: (i) being alive and recurrence-free, (ii) death for other causes before a recurrence, and (iii) recurrence. We apply the method to female breast cancer relative survival from the Surveillance, Epidemiology, and End Results Program registries (2000-2018) data. RESULTS The cumulative incidence of recurrence shows a higher increase with more advanced cancer stage and is less influenced by age at diagnosis. At 5 years from diagnosis, the cumulative incidence of recurrence is less than 3% for those diagnosed with stage I, 10% to 13% for those diagnosed with stage II, and 37% to 47% for those diagnosed with stage III breast cancer. The estimates of recurrence considering versus ignoring the risks of dying from other causes were generally consistent, except for older women with more advanced stage, and longer time since diagnosis. In these groups, the net probability of recurrence, excluding the risks of dying from other causes, were overestimated. CONCLUSIONS For patients with cancer who are older or long-term survivors, it is important to include the risks of other cause mortality as the crude cumulative incidence of recurrence is a more appropriate measure. IMPACT These estimates are important in clinical decision making, as higher competing mortality may preclude the benefits of aggressive treatments.
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Affiliation(s)
- Angela B. Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Zhaohui Zou
- Information Management Services Inc., Calverton, Maryland, USA
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Riccardo Capocaccia
- Independent Researcher (formerly affilliated with Istituto Superiore di Sanita), Rome, Italy
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2
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Mohamed A, Olsson LT, Geradts J. Differential distribution of actual and surrogate oncotype DX recurrence scores in breast cancer patients by age, menopausal status, race, and body mass index. Breast Cancer Res Treat 2023; 201:447-460. [PMID: 37453958 DOI: 10.1007/s10549-023-07025-8] [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: 04/29/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The Oncotype DX Recurrence Score (RS) is a widely used prognostic tool for estrogen receptor-positive breast cancer patients. Multiple surrogate models can predict RS with good accuracy. In this study we aimed to determine whether the RS and two surrogate indices were differentially distributed by age, menopausal status, race, and body mass index (BMI). METHODS 516 breast cancer cases treated at a single institution were analyzed. Epidemiologic data, RS, tumor size, grade, and biomarker data were abstracted. Breast Cancer Prognostic Score (BCPS) and modified Magee equation 2 were used to calculate surrogate RS. Patients were stratified into different groups based on age, menopausal status, race, BMI, or a combination of strata. Mean and standard deviation were calculated for each group/subgroup. RESULTS Age below median (< 63) was associated with higher RS, especially in obese and Black patients. RS was also higher in obese and Black patients in the premenopausal subgroup. Black patients had a higher RS compared to White women in the premenopausal and non-obese subgroups. BMI < 30 was associated with higher RS, especially in older, postmenopausal, and Black patients. Some of these observations were replicated by the two surrogate models. The surrogate recurrence scores were higher in the younger age group, in non-obese older/postmenopausal women, and in younger/premenopausal obese individuals. CONCLUSIONS Higher RS was observed in younger and premenopausal breast cancer patients, especially among the Black and obese subgroups, and in non-obese patients, especially among Black and older/postmenopausal women, suggesting more aggressive disease in these subgroups. Some statistical differences could be replicated by both surrogate models, suggesting that they may have utility in breast cancer epidemiology studies that do not have access to Oncotype DX RS or patient outcome data.
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Affiliation(s)
- Anas Mohamed
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Mailstop 642, Greenville, NC, 27834, USA
| | - Linnea T Olsson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph Geradts
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Mailstop 642, Greenville, NC, 27834, USA.
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3
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Koleva-Kolarova R, Vellekoop H, Huygens S, Versteegh M, Mölken MRV, Szilberhorn L, Zelei T, Nagy B, Wordsworth S, Tsiachristas A. Budget impact and transferability of cost-effectiveness of DPYD testing in metastatic breast cancer in three health systems. Per Med 2023; 20:357-374. [PMID: 37577962 DOI: 10.2217/pme-2022-0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The cost-effectiveness and budget impact of introducing extended DPYD testing prior to fluoropyrimidine-based chemotherapy in metastatic breast cancer patients in the UK, The Netherlands and Hungary were examined. DPYD testing with ToxNav© was cost-effective in all three countries. In the UK and The Netherlands, the ToxNav strategy led to more quality-adjusted life years and fewer costs to the health systems compared with no genetic testing and standard dosing of capecitabine/5-fluorouracil. In Hungary, the ToxNav strategy produced more quality-adjusted life years at a higher cost compared with no testing and standard dose. The ToxNav strategy was found to offer budget savings in the UK and in The Netherlands, while in Hungary it resulted in additional budget costs.
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Affiliation(s)
| | - Heleen Vellekoop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Simone Huygens
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maureen Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - László Szilberhorn
- Syreon Research Institute, Budapest, Hungary
- Eötvös Loránd University, Budapest, Hungary
| | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | - Balázs Nagy
- Syreon Research Institute, Budapest, Hungary
| | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
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4
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Calabrese A, Santucci D, Gravina M, Faiella E, Cordelli E, Soda P, Iannello G, Sansone C, Zobel BB, Catalano C, de Felice C. 3T-MRI Artificial Intelligence in Patients with Invasive Breast Cancer to Predict Distant Metastasis Status: A Pilot Study. Cancers (Basel) 2022; 15:cancers15010036. [PMID: 36612033 PMCID: PMC9817717 DOI: 10.3390/cancers15010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The incidence of breast cancer metastasis has decreased over the years. However, 20-30% of patients with early breast cancer still die from metastases. The purpose of this study is to evaluate the performance of a Deep Learning Convolutional Neural Networks (CNN) model to predict the risk of distant metastasis using 3T-MRI DCE sequences (Dynamic Contrast-Enhanced). METHODS A total of 157 breast cancer patients who underwent staging 3T-MRI examinations from January 2011 to July 2022 were retrospectively examined. Patient data, tumor histological and MRI characteristics, and clinical and imaging follow-up examinations of up to 7 years were collected. Of the 157 MRI examinations, 39/157 patients (40 lesions) had distant metastases, while 118/157 patients (120 lesions) were negative for distant metastases (control group). We analyzed the role of the Deep Learning technique using a single variable size bounding box (SVB) option and employed a Voxel Based (VB) NET CNN model. The CNN performance was evaluated in terms of accuracy, sensitivity, specificity, and area under the ROC curve (AUC). RESULTS The VB-NET model obtained a sensitivity, specificity, accuracy, and AUC of 52.50%, 80.51%, 73.42%, and 68.56%, respectively. A significant correlation was found between the risk of distant metastasis and tumor size, and the expression of PgR and HER2. CONCLUSIONS We demonstrated a currently insufficient ability of the Deep Learning approach in predicting a distant metastasis status in patients with BC using CNNs.
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Affiliation(s)
- Alessandro Calabrese
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Roma, Italy
- Correspondence:
| | - Domiziana Santucci
- Department of Radiology, Sant’Anna Hospital, Via Ravona, 22042 San Fermo della Battaglia, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Michela Gravina
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80131 Naples, Italy
| | - Eliodoro Faiella
- Department of Radiology, Sant’Anna Hospital, Via Ravona, 22042 San Fermo della Battaglia, Italy
| | - Ermanno Cordelli
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Paolo Soda
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Universitetstorget, 490187 Umeå, Sweden
| | - Giulio Iannello
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Carlo Sansone
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80131 Naples, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, University of Rome “Campus Bio-medico”, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Carlo Catalano
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Roma, Italy
| | - Carlo de Felice
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Roma, Italy
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5
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Lord SSJ, Daniels B, Kiely BE, O'Connell DL, Beith J, Pearson S, Chiew KL, Bulsara MK, Houssami N. Long term risk of distant metastasis in women with non-metastatic breast cancer and survival after metastasis detection: a population-based linked health records study. Med J Aust 2022; 217:402-409. [PMID: 35987521 PMCID: PMC9804703 DOI: 10.5694/mja2.51687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To estimate the long term risk of distant metastases (DM) for women with initial diagnoses of non-metastatic breast cancer; to estimate breast cancer-specific and overall survival for women with DM. DESIGN Population-based health record linkage study. SETTING, PARTICIPANTS Women diagnosed with localised or regional primary breast cancer recorded in the NSW Cancer Registry, 2001-2002. MAJOR OUTCOME MEASURES Time from breast cancer diagnosis to first DM, time from first DM to death from breast cancer. SECONDARY OUTCOME time to death from any cause. RESULTS 6338 women were diagnosed with non-metastatic breast cancer (localised, 3885; regional, 2453; median age, 59 years [IQR, 49-69 years]). DM were recorded (to 30 September 2016) for 1432 women (23%; median age, 62 years [IQR, 51-73 years]). The 14-year cumulative DM incidence was 22.2% (95% CI, 21.1-23.2%; localised disease: 14.3% [95% CI, 13.2-15.4%]; regional disease: 34.7% [95% CI, 32.8-36.6%]). Annual hazard of DM was highest during the second year after breast cancer diagnosis (localised disease: 2.8%; 95% CI, 2.3-3.3%; regional disease: 9.1%; 95% CI, 7.8-10.3%); from year five it was about 1% for those with localised disease, from year seven about 2% for women with regional disease at diagnosis. Five years after diagnosis, the 5-year conditional probability of DM was 4.4% (95% CI, 3.7-5.1%) for women with localised and 10.4% (95% CI, 9.1-12.0%) for those with regional disease at diagnosis. Median breast cancer-specific survival from first DM record date was 28 months (95% CI, 25-31 months); the annual hazard of breast cancer death after the first DM record declined from 36% (95% CI, 33-40%) during the first year to 14% (95% CI, 11-18%) during the fourth year since detection. CONCLUSIONS DM risk declines with time from diagnosis of non-metastatic breast cancer, and the annual risk of dying from breast cancer declines with time from initial DM detection. These findings can be used to inform patients at follow-up about changes in risk over time since diagnosis and for planning health services.
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Affiliation(s)
- Sarah Sally J Lord
- The University of Notre Dame, Sydney, NSW.,NHMRC Clinical Trials Centre, the University of Sydney, Sydney, NSW
| | - Benjamin Daniels
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, NSW
| | - Belinda E Kiely
- NHMRC Clinical Trials Centre, the University of Sydney, Sydney, NSW
| | - Dianne L O'Connell
- The Daffodil Centre, the University of Sydney and Cancer Council NSW, Sydney, NSW.,The University of Newcastle, Newcastle, NSW
| | - Jane Beith
- Central Clinical School, Chris O'Brien Lifehouse, Sydney, NSW
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, NSW
| | | | - Max K Bulsara
- Institute of Health Research, University of Notre Dame, Fremantle, WA
| | - Nehmat Houssami
- The Daffodil Centre, the University of Sydney and Cancer Council NSW, Sydney, NSW.,Sydney School of Public Health, the University of Sydney, Sydney, NSW
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6
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Joun I, Nixdorf S, Deng W. Advances in lipid-based nanocarriers for breast cancer metastasis treatment. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:893056. [PMID: 36062261 PMCID: PMC9433809 DOI: 10.3389/fmedt.2022.893056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022] Open
Abstract
Breast cancer (BC) is the most common cancer affecting women worldwide, with over 2 million women diagnosed every year, and close to 8 million women currently alive following a diagnosis of BC in the last 5-years. The side effects such as chemodrug toxicity to healthy tissues and drug resistance severely affect the quality of life of BC patients. To overcome these limitations, many efforts have been made to develop nanomaterial-based drug delivery systems. Among these nanocarriers, lipid-based delivery platforms represented one of the most successful candidates for cancer therapy, improving the safety profile and therapeutic efficacy of encapsulated drugs. In this review we will mainly discuss and summarize the recent advances in such delivery systems for BC metastasis treatment, with a particular focus on targeting the common metastatic sites in bone, brain and lung. We will also provide our perspectives on lipid-based nanocarrier development for future clinical translation.
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Affiliation(s)
- Ingrid Joun
- School of Chemical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Sheri Nixdorf
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wei Deng
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
- *Correspondence: Wei Deng
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7
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Zhang DX, Dang XTT, Vu LT, Lim CMH, Yeo EYM, Lam BWS, Leong SM, Omar N, Putti TC, Yeh YC, Ma V, Luo JY, Cho WC, Chen G, Lee VKM, Grimson A, Le MTN. αvβ1 integrin is enriched in extracellular vesicles of metastatic breast cancer cells: A mechanism mediated by galectin-3. J Extracell Vesicles 2022; 11:e12234. [PMID: 35923105 PMCID: PMC9451529 DOI: 10.1002/jev2.12234] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
Breast cancer cells release a large quantity of biocargo-bearing extracellular vesicles (EVs), which mediate intercellular communication within the tumour microenvironment and promote metastasis. To identify EV-bound proteins related to metastasis, we used mass spectrometry to profile EVs from highly and poorly metastatic breast cancer lines of human and mouse origins. Comparative mass spectrometry indicated that integrins, including αv and β1 subunits, are preferentially enriched in EVs of highly metastatic origin over those of poorly metastatic origin. These results are consistent with our histopathological findings, which show that integrin αv is associated with disease progression in breast cancer patients. Integrin αv colocalizes with the multivesicular-body marker CD63 at a higher frequency in the tumour and is enriched in circulating EVs of breast cancer patients at late stages when compared with circulating EVs from early-stage patients. With a magnetic bead-based flow cytometry assay, we confirmed that integrins αv and β1 are enriched in the CD63+ subsets of EVs from both human and mouse highly metastatic cells. By analysing the level of integrin αv on circulating EVs, this assay could predict the metastatic potential of a xenografted mouse model. To explore the export mechanism of integrins into EVs, we performed immunoprecipitation mass spectrometry and identified members of the galectin family as potential shuttlers of integrin αvβ1 into EVs. In particular, knockdown of galectin-3, but not galectin-1, causes a reduction in the levels of cell surface integrins β1 and αv, and decreases the colocalization of these integrins with CD63. Importantly, knockdown of galectin-3 leads to a decrease of integrin αvβ1 export into the EVs concomitant with a decrease in the metastatic potential of breast cancer cells. Moreover, inhibition of the integrin αvβ1 complex leads to a reduction in the binding of EVs to fibronectin, suggesting that integrin αvβ1 is important for EV retention in the extracellular matrix. EVs retained in the extracellular matrix are taken up by fibroblasts, which differentiate into cancer associated fibroblasts. In summary, our data indicate an important link between EV-bound integrin αvβ1 with breast cancer metastasis and provide additional insights into the export of integrin αvβ1 into EVs in the context of metastasis.
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Affiliation(s)
- Daniel Xin Zhang
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Biomedical Sciences, Jocky Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR.,Department of Molecular Biology and Genetics, Cornell University, Ithaca, New York, USA
| | - Xuan T T Dang
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Luyen Tien Vu
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Molecular Biology and Genetics, Cornell University, Ithaca, New York, USA
| | - Claudine Ming Hui Lim
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Eric Yew Meng Yeo
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Brenda Wan Shing Lam
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Sai Mun Leong
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Noorjehan Omar
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Thomas Choudary Putti
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Yu Chen Yeh
- Department of Biomedical Sciences, Jocky Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Victor Ma
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - Jia-Yuan Luo
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Victor Kwan Min Lee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Andrew Grimson
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, New York, USA
| | - Minh T N Le
- Department of Pharmacology and Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.,Department of Surgery, Cancer Program, Immunology Program, and Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
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8
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Porter I, Theodoulou E, Holen I, Harper-Wynne C, Baron-Hay S, Wilson C, Brown J. Adoption of adjuvant bisphosphonates for early breast cancer into standard clinical practice: Challenges and lessons learnt from comparison of the UK and Australian experience. J Bone Oncol 2021; 31:100402. [PMID: 34804788 PMCID: PMC8581365 DOI: 10.1016/j.jbo.2021.100402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022] Open
Abstract
Adoption of adjuvant bisphosphonates for early breast cancer into standard clinical practice. UK and Australian experience of adjuvant bisphosphonates in early breast cancer. Pathway taken for adjuvant bisphosphonates implementation in the UK. Steps to increase update of adjuvant bisphosphonates in early breast cancer. Improve the care of women with early breast cancer.
International guidelines recommend adjuvant bisphosphonates (BPs) for post-menopausal women with early breast cancer to reduce recurrence and mortality. However, globally, wide variation exists in their adoption. In the UK, adjuvant BPs were a recommendation in the breast cancer Clinical Reference Group service specification and were included as a priority for implementation by the national oncologists group UK Breast Cancer Group in November 2015, promoting national uptake, guidance and funding arrangements. In 2018, adjuvant BPs were recommended by the UKs National Institute for Health and Care Excellence. In Australia, adjuvant BPs are still ‘off-label’ and do not receive national reimbursement or endorsement. To date there has been no research into the prescribing habits of these agents in Australia. With the aim to gather data on adjuvant BPs prescribing practices, online surveys were developed and disseminated to breast oncologists in both countries between December 2018 and June 2019. Almost all of the UK oncologists prescribed adjuvant BPs, demonstrating that education, endorsement from professional bodies, presence of national guidelines and funding decisions have been critical to implementation. In contrast, only 48% of the Australian responders prescribed adjuvant BPs, while 83% reported that they would prescribe them if funding was available. Lack of local protocol guidance was also seen as a major barrier. This study was intended to assess the pathway taken for adjuvant BP implementation in the UK and how it might inform changes in Australian practice and also guide other countries with similar issues with the ultimate aim of improving the care of women with early breast cancer globally.
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Affiliation(s)
- I Porter
- Royal North Shore Hospital, Sydney, Australia
| | - E Theodoulou
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| | - I Holen
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| | - C Harper-Wynne
- Kent Oncology Centre, Maidstone Tunbridge Wells NHS Trust, United Kingdom
| | - S Baron-Hay
- Royal North Shore Hospital, Sydney, Australia
| | - C Wilson
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
| | - J Brown
- Department of Oncology and Metabolism, University of Sheffield, Weston Park Cancer Centre, Sheffield, United Kingdom.,Sheffield Experimental Cancer Medicine Centre, Sheffield, United Kingdom
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9
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Boers J, Loudini N, Brunsch CL, Koza SA, de Vries EFJ, Glaudemans AWJM, Hospers GAP, Schröder CP. Value of 18F-FES PET in Solving Clinical Dilemmas in Breast Cancer Patients: A Retrospective Study. J Nucl Med 2021; 62:1214-1220. [PMID: 33990400 DOI: 10.2967/jnumed.120.256826] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
Breast cancer (BC) is a heterogeneous disease in which estrogen receptor (ER) expression plays an important role in most tumors. A clinical dilemma may arise when a metastasis biopsy to determine the ER status cannot be performed safely or when ER heterogeneity is suspected between tumor lesions. Whole-body ER imaging, such as 16α-18F-fluoro-17β-estradiol (18F-FES) PET, may have added value in these situations. However, the role of this imaging technique in routine clinical practice remains to be further determined. Therefore, we assessed whether the physician's remaining clinical dilemma after the standard workup was solved by the 18F-FES PET scan. Methods: This retrospective study included 18F-FES PET scans of patients who had (or were suspected to have) ER-positive metastatic BC and for whom a clinical dilemma remained after the standard workup. The scans were performed at the University Medical Center of Groningen between November 2009 and January 2019. We investigated whether the physician's clinical dilemma was solved, defined either as solving the clinical dilemma through the 18F-FES PET results or as basing a treatment decision directly on the 18F-FES PET results. In addition, the category of the clinical dilemma was reported, as well as the rate of 18F-FES-positive or -negative PET scans, and any correlation to the frequency of solved dilemmas was determined. Results: One hundred 18F-FES PET scans were performed on 83 patients. The clinical dilemma categories were inability to determine the extent of metastatic disease or suspected metastatic disease with the standard workup (n = 52), unclear ER status of the tumor (n = 31), and inability to determine which primary tumor caused the metastases (n = 17). The dilemmas were solved by 18F-FES PET in 87 of 100 scans (87%). In 81 of 87 scans, a treatment decision was based directly on 18F-FES PET results (treatment change, 51 scans; continuance, 30 scans). The frequency of solved dilemmas was not related to the clinical dilemma category (P = 0.334). However, the frequency of solved dilemmas was related to whether scans were 18F-FES-positive (n = 63) or 18F-FES-negative (n = 37; P < 0.001). Conclusion: For various indications, the 18F-FES PET scan can help to solve most clinical dilemmas that may remain after the standard workup. Therefore, the 18F-FES PET scan has added value in BC patients who present the physician with a clinical dilemma.
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Affiliation(s)
- Jorianne Boers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Naila Loudini
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Celina L Brunsch
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Sylvia A Koza
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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10
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Lao C, Elwood M, Kuper-Hommel M, Campbell I, Lawrenson R. Impact of menopausal status on risk of metastatic recurrence of breast cancer. Menopause 2021; 28:1085-1092. [PMID: 34260475 DOI: 10.1097/gme.0000000000001817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Menopausal status at diagnosis is an important factor for the management of breast cancer in younger women, and may affect the prognosis for these women. We aim to examine the association of menopausal status and risk of metastatic relapse for stage I-III breast cancer. METHODS We included women diagnosed with stage I-III breast cancer at 45 to 55 years in the Auckland and Waikato Breast Cancer Registers. Cumulative incidence of metastatic relapse was examined by age group and by menopausal status after stratifying by estrogen receptor (ER) and progesterone receptor (PR) status. Cox proportional hazards model was used to estimate the adjusted hazard ratio of metastatic relapse by menopausal status after adjustment for age, ethnicity, year of diagnosis, socioeconomic status, public/private hospital treatment, mode of detection, cancer stage, grade and human epidermal growth factor receptor 2 status. RESULTS We have identified 5,309 eligible women: 2,799 premenopausal, 929 perimenopausal, and 1,581 post-menopausal. There was significant difference in risk of metastatic recurrence between menopausal statuses for ER+ and/or PR+ cases, with a 10-year cumulative incidence of 11.2% for premenopausal, 12.4% for perimenopausal, and 15.6% for postmenopausal women. The adjusted hazard ratio of metastatic recurrence for postmenopausal compared to premenopausal women was 1.38 for ER+ and/or PR+ cases. Age did not affect the risk of metastatic relapse for ER+ and/or PR+ cases but affected the risk for ER- and PR- cases with a hazard ratio of 0.94 per year. CONCLUSIONS Women with earlier age at menopause, and ER+ and/or PR+ stage I-III breast cancer were more likely to develop metastatic breast cancer. Age increased the risk of metastatic relapse for women with ER- and PR- disease, but not for ER+ and/or PR+ cancers.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Mark Elwood
- School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Ian Campbell
- School of Medicine, University of Auckland, Auckland, New Zealand
- General Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand
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11
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Bell RJ. Menopausal status at diagnosis of breast cancer and risk of metastatic recurrence. ACTA ACUST UNITED AC 2021; 28:1079-1080. [PMID: 34260476 DOI: 10.1097/gme.0000000000001830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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12
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Lao C, Kuper-Hommel M, Elwood M, Campbell I, Lawrenson R. Metastatic relapse of stage I-III breast cancer in New Zealand. Cancer Causes Control 2021; 32:753-761. [PMID: 33830387 DOI: 10.1007/s10552-021-01426-0] [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: 09/09/2020] [Accepted: 03/26/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aims to investigate the factors that influence the risk of metastatic relapse in women presenting with stage I-III breast cancer in New Zealand. METHODS The study included women diagnosed with stage I-III breast cancer. Cumulative incidence of distant metastatic relapse was examined with the Kaplan-Meier method by cancer stage and subtype. Cox proportional hazards models were used to estimate the adjusted hazard ratio of developing recurrent metastatic breast cancer by cancer stage and biomarker subtype after adjustment for other factors. RESULTS A total of 17,543 eligible women were identified. The 5-year cumulative incidence of metastatic recurrence was 3.7% for stage I, 13.3% for stage II and 30.9% for stage III disease. The adjusted hazard ratios (HR) of stage II and stage III breast cancer developing metastatic disease were 2.07 and 4.82 compared to stage I. The adjusted risk of distant metastatic relapse was highest for luminal B HER2- cancers (adjusted HR: 1.59 compared to luminal A disease). Higher grade cancers were associated with a higher risk of metastases. After adjustment, women aged 60-69 years and Asian women had the lowest risk of distant metastatic relapse. CONCLUSIONS The prognosis of women with locally invasive breast cancer differs greatly with the chance of developing metastatic disease depending on the stage of disease at diagnosis and the subtype. Grade of disease at diagnosis was also important. Māori or Pacific ethnicity did not influence the risk of developing metastatic disease, although Asian women seemed less likely to develop metastases.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | | | - Mark Elwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- School of Medicine, The University of Auckland, Auckland, New Zealand.,General Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.,Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand
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13
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Geng Z, Wang J, Zhang Y, Wu F, Yuan C. Physical activity in the context of advanced breast cancer: An integrative review. J Adv Nurs 2020; 77:2119-2143. [PMID: 33314310 DOI: 10.1111/jan.14709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/31/2022]
Abstract
AIMS To describe and synthesize diverse empirical evidence regarding physical activity (PA) in the context of advanced breast cancer (ABC). DESIGN Integrative review guided by the work of Whittemore and Knafl (2005). DATA SOURCES Six electronic databases were systematically searched to identify relevant literature published between January 2007-June 2019. REVIEW METHODS Abstracts of papers that met the inclusion criteria were reviewed by two researchers and full texts of eligible papers were assessed. Data were extracted by two independent researchers and inter-rater reliability of data extraction established. Quality of papers was evaluated using the Mixed Methods Appraisal Tool. Data were organized according to comprehensive thematic analysis and the biobehavioural model for the study of exercise interventions. RESULTS Of the 532 abstracts, 18 studies met the inclusion criteria which included six randomized controlled trials, one quantitative non-randomized study, seven quantitative descriptive studies, three mixed method studies and one qualitative study. Results from studies enrolled fell into four domains: PA performance and its influence on survival; barriers and preferences for PA; interventions to enhance PA; perceived benefits of PA from qualitative feedback. CONCLUSION Evidence suggests that ABC patients are physically inactive. Main barriers of PA are less aerobic fitness and heavy symptom burden. Simple, tailored and specialist-supervised PA is preferred by ABC patients. Form of joint self-instructed and group accompanying is advocated as well. PA intervention programmes identified in this review vary on type, intensity, duration and frequency, while generally, are found to be feasible, safe and beneficial to patients' physical and psychosocial well-being. IMPACT The results propose tailored, supervised, group-based PA programmes are in urgent need for ABC patients. Clinical professionals should manage more feasible and safer PA interventions to help improve patients' overall health. More research with rigorous methodology design is warranted to explore PA's effect on long-term health outcomes.
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Affiliation(s)
- Zhaohui Geng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingting Wang
- School of Nursing, Second Military Medical University, Shanghai, China
| | - Yingting Zhang
- School of Nursing, Second Military Medical University, Shanghai, China
| | - Fulei Wu
- School of Nursing, Fudan University, Shanghai, China
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14
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Kunst N, Alarid-Escudero F, Aas E, Coupé VMH, Schrag D, Kuntz KM. Estimating Population-Based Recurrence Rates of Colorectal Cancer over Time in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:2710-2718. [PMID: 32998946 PMCID: PMC7747688 DOI: 10.1158/1055-9965.epi-20-0490] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/01/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Population-based metastatic recurrence rates for patients diagnosed with nonmetastatic colorectal cancer cannot be estimated directly from population-based cancer registries because recurrence information is not reported. We derived population-based colorectal cancer recurrence rates using disease-specific survival data based on our understanding of the colorectal cancer recurrence-death process. METHODS We used a statistical continuous-time multistate survival model to derive population-based annual colorectal cancer recurrence rates from 6 months to 10 years after colorectal cancer diagnosis using relative survival data from the Surveillance, Epidemiology, and End Results Program. The model was based on the assumption that, after 6 months of diagnosis, all colorectal cancer-related deaths occur only in patients who experience a metastatic recurrence first, and that the annual colorectal cancer-specific death rate among patients with recurrence was the same as in those diagnosed with de novo metastatic disease. We allowed recurrence rates to vary by post-diagnosis time, age, stage, and location for two diagnostic time periods. RESULTS In patients diagnosed in 1975-1984, annual recurrence rates 6 months to 5 years after diagnosis ranged from 0.054 to 0.060 in stage II colon cancer, 0.094 to 0.105 in stage II rectal cancer, and 0.146 to 0.177 in stage III colorectal cancer, depending on age. We found a statistically significant decrease in colorectal cancer recurrence among patients diagnosed in 1994-2003 compared with those diagnosed in 1975-1984 for 6 months to 5 years after diagnosis (hazard ratios between 0.43 and 0.70). CONCLUSIONS We derived population-based annual recurrence rates for up to 10 years after diagnosis using relative survival data. IMPACT Our estimates can be used in decision-analytic models to facilitate analyses of colorectal cancer interventions that are more generalizable.
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Affiliation(s)
- Natalia Kunst
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- LINK Medical Research, Oslo, Norway
| | - Fernando Alarid-Escudero
- Division of Public Administration, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Aguascalientes, Mexico
| | - Eline Aas
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Deborah Schrag
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen M Kuntz
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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15
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Saxby K, Nickson C, Mann GB, Velentzis L, Bromley HL, Procopio P, Canfell K, Petrie D. The financial impact of a breast cancer detected within and outside of screening: lessons from the Australian Lifepool cohort. Aust N Z J Public Health 2020; 44:219-226. [PMID: 32311194 DOI: 10.1111/1753-6405.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the government and out-of-pocket community costs (out-of-hospital medical services and prescription medicines) associated with screen-detected and community-detected cancers (i.e. cancers detected outside of Australia's organised screening program [BreastScreen]). METHODS We analyse administrative data on government-subsidised medical services and prescription medicines for 568 Victorian women diagnosed with breast cancer or ductal carcinoma in situ (DCIS). Using multivariable regression analysis, we estimate the government and out-of-pocket community costs incurred in the three years after diagnosis for screen-detected cancers and community-detected cancers. Additionally, we estimate the government costs associated with diagnosis within and outside of BreastScreen. RESULTS Average government costs for breast cancer diagnosis were similar within and outside of BreastScreen [$808 (lower limit 676; upper limit 940) vs $837 (95%CI 671; 1,003) respectively]; however, women with community-detected cancers incurred an additional $254 (95%CI 175; 332) out-of-pocket. Controlling for differences in known cancer characteristics, compared to screen-detected cancers, community-detected breast cancers were associated with an additional $2,622 (95%CI 644; 4,776) in government expenditure in the three years following diagnosis. Adverse cancer characteristics that were more prevalent in community-detected cancers (high grade, lymph node involvement, HER2 positive receptor status) were associated with increased government and out-of-pocket costs. CONCLUSIONS Community-detected breast cancers were associated with increased government and out-of-pocket costs. Implications for public health: These costs should be considered when evaluating current and alternative breast cancer screening strategies.
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Affiliation(s)
- Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Victoria
| | - Carolyn Nickson
- Cancer Research Unit, Cancer Council NSW, New South Wales.,Melbourne School of Population and Global Health, University of Melbourne, Victoria.,School of Public Health, The University of Sydney, New South Wales
| | - G Bruce Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Victoria.,Department of Surgery, The University of Melbourne, Victoria
| | - Louiza Velentzis
- Cancer Research Unit, Cancer Council NSW, New South Wales.,Melbourne School of Population and Global Health, University of Melbourne, Victoria.,School of Public Health, The University of Sydney, New South Wales
| | - Hannah L Bromley
- Health Economics Unit, University of Birmingham, UK.,Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Pietro Procopio
- Cancer Research Unit, Cancer Council NSW, New South Wales.,Melbourne School of Population and Global Health, University of Melbourne, Victoria.,School of Public Health, The University of Sydney, New South Wales
| | - Karen Canfell
- Cancer Research Unit, Cancer Council NSW, New South Wales.,School of Public Health, The University of Sydney, New South Wales
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Victoria
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16
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Wigginton B, Thomson ZO, Sandler CX, Reeves MM. Reflexive Intervention Development: Using Qualitative Research to Inform the Development of an Intervention for Women With Metastatic Breast Cancer. QUALITATIVE HEALTH RESEARCH 2020; 30:666-678. [PMID: 31744371 DOI: 10.1177/1049732319884901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is growing consensus around the limited attention given to documenting the process of intervention development, specifically the role of qualitative research. In this article, we seek to describe a missing piece of this process: how qualitative research, and related methodologies and theories, informs intervention development. We use our research as a case study of "reflexive intervention development." We begin by describing our interview study, consisting of 23 in-depth interviews with women diagnosed with metastatic breast cancer, and go on to detail our methodological framework and research team. We then explain how this interview study directly informed our development of the intervention materials, allowing us to attend carefully to language and its potential implications for women. We conclude by inviting researchers to reflect on the knowledge production process that is inherent in intervention development to consider not only their role in this process but also the role of qualitative research.
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Affiliation(s)
| | - Zoe O Thomson
- The University of Queensland, Brisbane, Queensland, Australia
| | - Carolina X Sandler
- The University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marina M Reeves
- The University of Queensland, Brisbane, Queensland, Australia
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17
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Lord SJ, Kiely BE, Pearson SA, Daniels B, O'Connell DL, Beith J, Bulsara MK, Houssami N. Metastatic breast cancer incidence, site and survival in Australia, 2001-2016: a population-based health record linkage study protocol. BMJ Open 2019; 9:e026414. [PMID: 30709862 PMCID: PMC6367965 DOI: 10.1136/bmjopen-2018-026414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Advances in systemic therapy for early and metastatic breast cancer (BC) over the last two decades have improved patients' survival, but their impact on metastatic disease outcomes at a population level is not well described. The aim of this study is to investigate changes in the incidence, site and survival of metastatic disease for women with a first diagnosis of BC in 2001-2002 vs 2006-2007. METHODS AND ANALYSIS Population-based retrospective cohort study of women with first primary invasive BC registered in the New South Wales (NSW) Cancer Registry in 2001-2002 and 2006-2007. We will use linked records from NSW hospitals, dispensed medicines, outpatient services and death registrations to determine: women's demographic and tumour characteristics; treatments received; time to first distant metastasis; site of first metastasis and survival. We will use the Kaplan-Meier method to estimate cumulative incidence of distant metastasis, distant recurrence-free interval and postmetastasis survival by extent of disease at initial diagnosis, site of metastasis and treatment-defined tumour receptor type (hormone receptor-positive, human epidermal growth factor receptor-2-positive, triple negative). We will use Cox proportional hazards regression to estimate the relative effects of prognostic factors, and we will compare systemic therapy patterns by area-of-residence and area-level socioeconomic status to examine equity of access to healthcare. ETHICS AND DISSEMINATION Research ethics committee approval was granted by the Australian Institute of Health and Welfare (#EO2017/2/255), NSW Population and Health Services (#HREC/17/CIPHS/19) and University of Notre Dame Australia (#0 17 144S). We will disseminate research findings to oncology, BC consumer and epidemiology audiences through national and international conference presentations, lay summaries to BC consumer groups and publications in international peer-reviewed oncology and cancer epidemiology journals.
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Affiliation(s)
- Sarah J Lord
- The School of Medicine, University of Notre Dame Australia - Darlinghurst, Darlinghurst, New South Wales, Australia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Belinda E Kiely
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sallie-Anne Pearson
- The Centre for Big Data Research in Health, The University of NSW, Kensington, NSW, Australia
| | - Benjamin Daniels
- The Centre for Big Data Research in Health, The University of NSW, Kensington, NSW, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, The University of Sydney, Camperdown, New South Wales, Australia
| | - Max K Bulsara
- The Institute of Health Research and the School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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18
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Blaschke SM, Gough KC, Chua BH, Francis PA, Cockerell R, Drosdowsky AF, Sheeran L, Krishnasamy M. Implementation of a Multidisciplinary Model of Care for Women With Metastatic Breast Cancer: Challenges and Lessons Learned. Clin Breast Cancer 2018; 19:e327-e336. [PMID: 30661949 DOI: 10.1016/j.clbc.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The present study examined the feasibility and effects of integrating a multidisciplinary team (MDT) model of care for women with metastatic breast cancer (MBC) into a large Australian cancer center. The challenges encountered and lessons learned are described. PATIENTS AND METHODS In the present prospective, longitudinal, mixed-methods implementation study, the MDT model included face-to-face consultations with a breast care nurse and social worker, followed by a MDT case discussion and face-to-face delivery of a personalized management plan. Data were collected to describe the cohort of women living with MBC who had attended a specialist breast cancer service and their supportive care needs. RESULTS A total of 62 women with median age of 60 years (interquartile range [IQR], 37-82 years) participated. The median interval from the first breast cancer diagnosis was 5.7 years (IQR, 2.0-11.6 years), and the median interval from the diagnosis of MBC was 2.0 years (IQR, 0.9-3.6 years). The MDT care model required new resources and cross-sector participation. However, the participants indicated a preference for personalized needs assessment and care planning at the diagnosis of MBC. CONCLUSIONS The results highlight the challenges of implementing and evaluating an MDT care model for women with MBC. The model coordinated MDT collaboration to strengthen the delivery of complex care plans. Investment in cross-sector partnerships to optimize care coordination for women with MBC was needed.
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Affiliation(s)
- Sarah-May Blaschke
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Karla C Gough
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Boon H Chua
- University of New South Wales, Sydney and Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Robyn Cockerell
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Allison F Drosdowsky
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lisa Sheeran
- Breast Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Meinir Krishnasamy
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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19
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Mariotto AB, Zou Z, Zhang F, Howlader N, Kurian AW, Etzioni R. Can We Use Survival Data from Cancer Registries to Learn about Disease Recurrence? The Case of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:1332-1341. [PMID: 30337342 DOI: 10.1158/1055-9965.epi-17-1129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/27/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Population-representative risks of metastatic recurrence are not generally available because cancer registries do not collect data on recurrence. This article presents a novel method that estimates the risk of recurrence using cancer registry disease-specific survival.Methods: The method is based on an illness-death process coupled with a mixture cure model for net cancer survival. The risk of recurrence is inferred from the estimated survival among the noncured fraction and published data on survival after recurrence. We apply the method to disease-specific survival curves from female breast cancer cases without a prior cancer diagnosis and with complete stage and hormone receptor (HR) status in Surveillance, Epidemiology and End Results registries (1992-2013).Results: The risk of recurrence is higher for women diagnosed with breast cancer at older age, earlier period, more advanced stage, and HR-negative tumors. For women diagnosed at ages 60-74 in 2000-2013, the projected percent recurring within 5 years is 2.5%, 9.6%, and 34.5% for stages I, II, and III HR-positive, and 6.5%, 20.2%, and 48.5% for stages I, II, and III HR-negative tumors. Although HR-positive cases have lower risk of recurrence soon after diagnosis, their risk persists longer than for HR-negative cases. Results show a high degree of robustness to model assumptions.Conclusions: The results show that it is possible to extract information about the risk of recurrence using disease-specific survival, and the methods can in principle be extended to other cancer sites.Impact: This study provides the first population-based summaries of the risk of breast cancer recurrence in U.S. women. Cancer Epidemiol Biomarkers Prev; 27(11); 1332-41. ©2018 AACR.
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Affiliation(s)
- Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
| | - Zhaohui Zou
- Information Management Services Inc., Calverton, Maryland
| | - Fanni Zhang
- Information Management Services Inc., Calverton, Maryland
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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20
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Dasgupta P, Baade PD, Youlden DR, Garvey G, Aitken JF, Wallington I, Chynoweth J, Zorbas H, Youl PH. Variations in outcomes by residential location for women with breast cancer: a systematic review. BMJ Open 2018; 8:e019050. [PMID: 29706597 PMCID: PMC5935167 DOI: 10.1136/bmjopen-2017-019050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN Systematic review. METHODS Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | - Helen Zorbas
- Cancer Australia, Sydney, New South Wales, Australia
| | - Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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21
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Larson KE, Grobmyer SR, Valente SA. Evaluation of recurrence patterns and survival in modern series of young women with breast cancer. Breast J 2018; 24:749-754. [PMID: 29687541 DOI: 10.1111/tbj.13041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/10/2017] [Accepted: 10/04/2017] [Indexed: 01/12/2023]
Abstract
The data on oncologic outcomes in young women with breast cancer (BC) are dated as it relates to recurrences and mortality. Our goal was to assess these outcomes in a modern series of young women with BC. A retrospective chart review identified women ≤40 years old with stage I-III BC diagnosed from 2006 to 2013 at our institution. Demographics, tumor biology, type of operation, recurrence, and survival were analyzed. Overall, 322 women were identified. Most had ER+(70%) infiltrating ductal tumors (88%) with low stage (42% T1; 41% T2; 56% N0). Follow-up was 4.2 years with 5.6% local-regional recurrence (LRR), 15.2% metastatic recurrence (MR), and 8% mortality. There was no survival difference based on demographics, tumor biology, or type of operation. T3 tumors (P < .001) and node positivity (P < .001) were associated with worse disease-free survival. In this modern series of young women with BC, stage rather than tumor biology or surgical choice has more effect on recurrence-free survival. MR was more common than LRR, with most MR occurring within the first 2 years after surgery.
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Affiliation(s)
- Kelsey E Larson
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen R Grobmyer
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie A Valente
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
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22
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Koleva-Kolarova RG, Greuter MJW, Feenstra TL, Vermeulen KM, de Vries EFJ, Parkin D, Buskens E, de Bock GH. Molecular imaging with positron emission tomography and computed tomography (PET/CT) for selecting first-line targeted treatment in metastatic breast cancer: a cost-effectiveness study. Oncotarget 2018; 9:19836-19846. [PMID: 29731987 PMCID: PMC5929430 DOI: 10.18632/oncotarget.24869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/24/2018] [Indexed: 12/11/2022] Open
Abstract
Our aim was to evaluate the potential cost-effectiveness of PET/CT with FES and 89Zr-trastuzumab compared to pathology to select first-line targeted treatment in metastatic breast cancer (MBC) patients with non-rapidly progressive disease. A previously published and validated model was extended and adapted for this analysis. Two alternative scenarios were compared. In the care as usual pathway first-line targeted treatment of MBC patients was assigned on the basis of pathology results, while in the intervention pathway treatment selection was based on the results from the PET/CT imaging. Costs, life years gained (LYG) and incremental cost-effectiveness ratios (ICER) were calculated. More MBC lesions were detected in the intervention pathway than in the care as usual pathway. The diagnostic costs to evaluate the receptor status and the treatment costs were higher in the intervention strategy, as were total costs and total LYG. The ICER for replacing biopsies with PET/CT imaging with FES and 89Zr-trastuzumab, assuming sensitivity of 77.1% and specificity of 80%, ranged from €71,000 to €77,000 per LYG. When assuming sensitivity of 80% and specificity of 76.7%, the ICER for replacing biopsies with PET/CT imaging with FES and 89Zr-trastuzumab ranged from to €74,000 to €80,000 per LYG. The application of PET/CT with FES and 89Zr-trastuzumab in first-line treatment selection for MBC patients has the potential to be a cost-effective intervention. Our analysis demonstrated that even a small increase in the sensitivity and the specificity of PET/CT can have a large impact on its potential cost-effectiveness.
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Affiliation(s)
- Rositsa G Koleva-Kolarova
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,School of Population Health Sciences, Faculty of Life Sciences and Medicine and Biomedical Research Center, King's College London, London, United Kingdom
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Talitha L Feenstra
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services Research, Bilthoven, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Parkin
- Department of Economics, City University London, London, United Kingdom
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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23
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Lyle G, Hendrie GA, Hendrie D. Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence. Int J Equity Health 2017; 16:182. [PMID: 29037209 PMCID: PMC5644132 DOI: 10.1186/s12939-017-0676-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum – namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience. Methods An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram. Results We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive. Conclusions In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.
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Affiliation(s)
- Greg Lyle
- Centre for Population Health Research, Curtin University, Perth, Australia.
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Australia
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24
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Colorectal cancer metastatic disease progression in Australia: A population-based analysis. Cancer Epidemiol 2017; 49:92-100. [DOI: 10.1016/j.canep.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 01/05/2023]
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25
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Kalantari Khandani B, Tavakkoli L, Khanjani N. Metastasis and its Related Factors in Female Breast Cancer Patients in Kerman, Iran. Asian Pac J Cancer Prev 2017; 18:1567-1571. [PMID: 28669169 PMCID: PMC6373806 DOI: 10.22034/apjcp.2017.18.6.1567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Metastasis is important in survival and the quality of life of female breast cancer patients. This study was run in order to investigate metastasis and its related factors in female breast cancer patients in Kerman province from 2005 to 2015. The aim of this study was to investigate the factors associated with secondary metastasis in female breast cancer patients in the largest province of Iran (Kerman). Materials and Methods: In this case-control study, medical records of women diagnosed with breast cancer between the years of 2005 to 2015 were studied. Among them, 200 breast cancer patients with secondary metastasis were randomly selected as cases and 400 patients without metastasis were selected as the control group. Backward logistic regression, chi-square test, t-test and Mann-Whitney-U test were performed for comparing the two groups in SPSS 22. Results: Disease stage at diagnosis was significantly associated with secondary metastasis (p<0.001). Female patients with stage III breast cancer at the time of diagnosis had a higher chance OR=9.11 (CI 95%=2.99-27.76) of metastasis than women with stage 0 and 1 at diagnosis. Also, patients from rural areas had a higher chance for metastasis OR=1.89 (CI 95%=1.04-3.41). Other factors such as age, tumor size, tumor grade at diagnosis, hormone receptor status of estrogen and progesterone and Her-2 showed no significant association with metastasis (p>0.05). Conclusion: Stage at diagnosis and the residential location of patients were the most important factors related to secondary metastasis. These results emphasize the importance of early diagnosis, adequate education and awareness for breast cancer screening.
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Affiliation(s)
- Behjat Kalantari Khandani
- Department of Internal Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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26
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Tjokrowidjaja A, Lee CK, Houssami N, Lord S. Metastatic breast cancer in young women: a population-based cohort study to describe risk and prognosis. Intern Med J 2015; 44:764-70. [PMID: 24863750 DOI: 10.1111/imj.12481] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is limited information on the risk of metastatic breast cancer (MBC) to inform younger women, particularly those under 40 years. AIMS We conducted a retrospective analysis of a population-based cohort study to describe the risk, site and prognosis of MBC in young women under 40 years with an initial diagnosis of non-metastatic breast cancer and compared with older women. METHODS Data were extracted from the New South Wales Central Cancer Registry and the Admitted Patient Data Collection database between 2001-2007. Main outcome measures were 5-year cumulative incidence of MBC, prognostic factors for MBC and overall survival (OS) from the date of MBC diagnosis. RESULTS Three hundred and ninety-five (6%) of 6640 women with non-metastatic BC were <40 years. The 5-year cumulative incidence of MBC was 24% (95% CI 20-29%) for women <40 years with non-metastatic BC, compared with 9% (95% CI 9-10%) for women ≥40 years. Significant independent risk factors for MBC ≤ 5 years were age <40, regional disease at diagnosis, low socioeconomic status and the presence of other non-breast primary. At first record of MBC, visceral sites were more common for women <40 years than ≥40 (54% vs 43%; P = 0.03). Median survival for women with MBC within 5 years was not significantly different between young and older women (<40 years 18 months vs ≥40 years 14 months; log-rank P = 0.21). CONCLUSIONS Women with non-metastatic BC before age 40 have a higher 5-year risk of developing MBC than older women. There were no significant differences in median survival following MBC between young and older women.
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Affiliation(s)
- A Tjokrowidjaja
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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27
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A population-based study of progression to metastatic prostate cancer in Australia. Cancer Epidemiol 2015; 39:617-22. [DOI: 10.1016/j.canep.2015.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/18/2022]
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28
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Saadatmand S, Obdeijn IM, Rutgers EJ, Oosterwijk JC, Tollenaar RA, Woldringh GH, Bergers E, Verhoef C, Heijnsdijk EA, Hooning MJ, de Koning HJ, Tilanus-Linthorst MM. Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC). Int J Cancer 2015; 137:1729-38. [PMID: 25820931 DOI: 10.1002/ijc.29534] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 11/05/2022]
Abstract
Adding MRI to annual mammography screening improves early breast cancer detection in women with familial risk or BRCA1/2 mutation, but breast cancer specific metastasis free survival (MFS) remains unknown. We compared MFS of patients from the largest prospective MRI Screening Study (MRISC) with 1:1 matched controls. Controls, unscreened if<50 years, and screened with biennial mammography if ≥50 years, were matched on risk category (BRCA1, BRCA2, familial risk), year and age of diagnosis. Of 2,308 MRISC participants, breast cancer was detected in 93 (97 breast cancers), who received MRI <2 years before breast cancer diagnosis; 33 BRCA1 mutation carriers, 18 BRCA2 mutation carriers, and 42 with familial risk. MRISC patients had smaller (87% vs. 52% <T2, p < 0.001), more often node negative (69% vs. 44%, p = 0.001) tumors and received less chemotherapy (39% vs. 77%, p < 0.001) and hormonal therapy (14% vs. 47%, p < 0.001) than controls. Median follow-up time was 9 years (range 0-14). Breast cancer metastasized in 9% (8/93) of MRISC patients and in 23% (21/93) of controls (p = 0.009). MFS was better in MRISC patients overall (log-rank p = 0.008, HR 0.36, 95% CI 0.16-0.80), with familial risk (log-rank p = 0.024, HR: 0.21, 95% CI 0.04-0.95), and in BRCA1 mutation carriers (log-rank p = 0.055, HR 0.30, 95% CI 0.08-1.13). MFS remained better in MRISC patients after lead time correction (log-rank p = 0.020, HR 0.40, 95% CI 0.18-0.90). Overall survival was non-significantly better in MRISC patients (log-rank p = 0.064, HR 0.51, CI 0.24-1.06). Annual screening with MRI and mammography improves metastasis free survival in women with BRCA1 mutation or familial predisposition.
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Affiliation(s)
- Sepideh Saadatmand
- Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | - Inge-Marie Obdeijn
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emiel J Rutgers
- Department of Surgery, the Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center, Groningen University, Groningen, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Gwendolyn H Woldringh
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisabeth Bergers
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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The value of PET/CT with FES or FDG tracers in metastatic breast cancer: a computer simulation study in ER-positive patients. Br J Cancer 2015; 112:1617-25. [PMID: 25880006 PMCID: PMC4430721 DOI: 10.1038/bjc.2015.138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/10/2015] [Accepted: 03/16/2015] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of this study was to evaluate the effect on the number of performed biopsies and costs associated with implementing positron emission tomography (PET) and computed tomography (PET/CT) with 16α-[18F]fluoro-17β-oestradiol (FES) or 2-[18F]fluoro-2-deoxy-D-glucose (FDG) as an upfront imaging test for diagnosing metastatic breast cancer (MBC) in comparison with the standard work-up in oestrogen receptor-positive women with symptoms. Methods: A published computer simulation model was adapted and validated. Three follow-up strategies were evaluated in a simulated cohort of women with primary breast cancer over a 5-year-time horizon: (1) the standard work-up, (2) upfront FES-PET/CT and (3) upfront FDG-PET/CT. The main outcome was the number of avoided biopsies to assess MBC. The costs for all three strategies were calculated based on the number of imaging tests and biopsies. The incremental cost-effectiveness ratio (ICER) to avoid a biopsy was calculated only based on the costs of initial imaging and staging tests. Results: The FES-PET/CT strategy decreased the number of biopsies by 39±9%, while upfront FDG-PET/CT increased the number of biopsies by 38±15% when compared with the standard work-up. Both PET/CT strategies reduced the number of imaging tests and false positives when compared with the standard work-up. The number of false negatives decreased only in the FES-PET/CT strategy. The ICER in the FES-PET/CT strategy per avoided biopsy was 12.1±3.4 thousand Euro. In the FDG-PET/CT strategy, the costs were higher and there were no avoided biopsies as compared with the standard work-up, hence this was an inferior strategy in terms of cost effectiveness. Conclusions: The number of performed biopsies was lower in the FES-PET/CT strategy at an ICER of 12.1±3.4 thousand Euro per biopsy avoided, whereas the application of the FDG-PET/CT did not reduce the number of biopsies and was more expensive. Whether the FES-PET/CT strategy has additional benefits for patients in terms of therapy management has to be evaluated in clinical studies.
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Yee J, Davis GM, Beith JM, Wilcken N, Currow D, Emery J, Phillips J, Martin A, Hui R, Harrison M, Segelov E, Kilbreath SL. Physical activity and fitness in women with metastatic breast cancer. J Cancer Surviv 2014; 8:647-56. [PMID: 24986228 DOI: 10.1007/s11764-014-0378-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/18/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aimed to explore differences in physical activity and fitness between women with metastatic breast cancer compared to healthy controls and factors associated with their physical activity levels. METHODS Seventy-one women with metastatic breast cancer, aged (mean (SD)) 57.7 (9.5) and 2.9 (3.1) years after the onset of metastatic disease, and 71 healthy controls aged 55.0 (9.4) years participated. Of those with metastatic disease, 27% had bone-only metastases, 35% visceral-only metastases and 38% bone and visceral metastases. Patient-reported outcomes and physical measures of muscle strength and aerobic fitness assessments were obtained. Participants wore a SenseWear® physical activity monitor over 7 days, and the average steps/day and the time spent in moderate-to-vigorous intensity physical activity were determined. RESULTS Women with metastases were significantly (i) less aerobically fit than the control group (25.3 (5.4) vs. 31.9 (6.1) mL • kg(-1) • min(-1); P < 0.001); (ii) weaker (e.g. lower limb strength for the metastatic and control groups was 53.5 (23.7) vs. 76.0 (27.4) kg, respectively; P < 0.001); (iii) less active, with the metastatic group attaining only 56% of the mean daily step counts of the healthy women; and (iv) more symptomatic, reporting higher levels of fatigue and dyspnoea (P < 0.001). CONCLUSION Women living in the community with metastatic breast cancer possessed lower aerobic fitness, reduced muscular strength and less daily physical activity compared to healthy counterparts. They also experienced poorer functioning and higher symptom burden. IMPLICATIONS FOR CANCER SURVIVORS Women living with metastatic breast cancer may benefit from a physical activity programme to address their physical impairments.
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Affiliation(s)
- Jasmine Yee
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
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31
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Willis K, Lewis S, Ng F, Wilson L. The experience of living with metastatic breast cancer--a review of the literature. Health Care Women Int 2014; 36:514-42. [PMID: 24579717 DOI: 10.1080/07399332.2014.896364] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984-2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.
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Affiliation(s)
- Karen Willis
- a Faculty of Health Sciences , University of Sydney , Sydney , New South Wales , Australia
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32
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Masood S. Characteristics of systemic diseases in the breast: clinical, imaging and pathologic features. ACTA ACUST UNITED AC 2012; 8:593-9. [PMID: 22934732 DOI: 10.2217/whe.12.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite tremendous efforts placed on advances in diagnosis and treatment of the spectrum of breast disease, the impact of systemic diseases on the breast has remained under recognized. Distinction between a variety of benign breast diseases versus those that are manifestations of a systemic disease is critically important for appropriate treatment planning and follow-up of patients. This article is designed to provide an overview of different systemic diseases that can present as a breast lesion. Attempts are made to highlight the significance of the distinction between benign breast disease versus benign conditions that present as the result of a systemic disease. Naturally, distinction between any benign condition versus breast carcinoma is a part of the evaluation process.
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Affiliation(s)
- Shahla Masood
- Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
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