Abstract P6-12-14: Quality of life and ability to work in patients at different disease stages of HER2+ breast cancer

OBJECTIVES: Health-related quality of life (HRQoL) and ability to work in patients treated for HER2+ early breast cancer (EBC) are poorly understood. This study compared HRQoL and ability to work in 3 HER2+ patient cohorts: EBC during adjuvant treatment, EBC after treatment, and metastatic disease (MBC).

METHODS: A cross-sectional observational cohort study of 299 female consenting patients with HER2+BC, from 14 UK secondary care centres. Group1 (n=89): receiving targeted HER2 therapy±chemotherapy for EBC; Group2 (n=108): in follow up post-targeted treatment for eBC; Group3 (n=102): MBC on treatment. Data collected between Dec 2016-Mar 2017: HRQoL, demographic and employment status data collected via patient-reported questionnaires (including EQ-5D-5L and Functional Assessment of Cancer Therapy [FACT-B]); clinical data collected from medical records. Inter-group differences were assessed using univariate Analysis of variance (ANOVA) and chi-square tests as appropriate. [NCT03099200].

RESULTS: Table1 shows patient demographics, disease characteristics, employment status, and EQ-5D-5L scores. Group1 and Group2 patients did not differ in overall health utility or visual analogue scale (VAS) scores. However, Group3 patients reported significantly poorer health utility than Group1 (p<0.02) and Group2 (p<0.001), and significantly worse VAS scores than Group2 (p<0.001). Significantly fewer Group2 patients and more Group3 patients were unable to work (p<0.003), and fewer Group3 patients were employed than expected (by chi-square, p<0.003).

CONCLUSIONS: HRQoL in patients with EBC was similar whether on or off treatment, and better than those with MBC. HRQoL scores reported on the generic EQ-5D will be compared with those from the disease-specific FACT-B. A smaller proportion of patients with MBC were employed compared to the EBC groups, reflecting the impact of advanced disease. Fewer patients with EBC reported being unable to work than we expected, suggesting these patients maintain function.

Table1

 Group1 (n=89)Group2 (n=108)Group3 (n=102)Age (years)↑55 (11)58 (11)55 (11)Hormone receptor status¥Positive64 (72%)84 (78%)74 (73%)Negative25 (28%)24 (22%)26 (26%)Unknown0 (0%)0 (0%)2 (2%)Time since diagnosis (months)+EBC9 (6)45 (32) (n=103)80 (82) (n=71*)MBC--39 (36) (n=101)Employment status¥Employed45 (51%)55 (51%)28 (28%)§Not employed41 (46%)52 (48%)69 (68%)Retired22 (25%)39 (36%)33 (32%)Unable to work7 (8%)5 (5%)§27 (27%)§Other12 (14%)8 (7%)9 (9%)Unknown3 (3%)1 (1%)5 (5%)EQ-5D summary scoresVisual analogue scale72.7 (18.4)†77.0 (17.5)†65.8 (22.9)† (n=99)Utility value0.809 (0.170)† (n=86)0.818 (0.181)†0.695 (0.262)† (n=97)↑mean (standard deviation); ¥n (%); +median (interquartile range); *excludes 27/102 patients (27%) with de novo MBC. Bold text: observed differences between three groups at significance thresholds of ‡p<0.05, §p<0.003 or †p<0.001. EBC/MBC: early/metastatic breast cancer. %s have been rounded so may not total 100%

Citation Format: Verrill M, Wardley A, Retzler J, Smith AB, McNicol D, Dando S, Tran I, Leslie I, Schmid P. Quality of life and ability to work in patients at different disease stages of HER2+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-14.

Often atypical? The distribution of sensory disturbance in carpal tunnel syndrome

This study aimed to examine the disturbance of hand sensation in patients with carpal tunnel syndrome (CTS) and assess the usefulness of objective and subjective measures. The study included 64 patients with CTS confirmed by electrophysiological testing. Sensory assessment was made by objective (pressure aesthesiometry) and subjective (hand symptom diagram) measures in different anatomical areas. The results of the subjective and objective testing were correlated with nerve conduction studies by a kappa analysis. Sensory disturbance occurred more frequently in areas innervated by the median nerve (index finger, 94%) but also with great frequency in other areas (little finger, 39%). Pain occurred frequently in anticipated areas (wrist crease, 33%) but also in other areas (little finger, 11%). There was very poor correlation between objective measures and electrophysiological testing or subjective measures. This study does therefore not support the use of objective sensory assessment for the initial diagnosis of CTS. An atypical distribution of symptoms is a common occurrence and should not discourage diagnosis of CTS. The patient's description of symptoms remains the most important tool in diagnosis.

Standardised consent forms on the website of the British Orthopaedic Association

The British Orthopaedic Association has endorsed a website, www.orthoconsent.com, allowing surgeons free access to a bank of pre-written consent forms. These are designed to improve the level of information received by the patient and lessen the risk of successful litigation against surgeons and Health Trusts.

Development of computational wear simulation of metal-on-metal hip resurfacing replacements

As one of the alternatives to traditional metal-on-polyethylene total hip replacements, metal-on-metal hip resurfacing prostheses demonstrating lower wear have been introduced for younger and more active patients during the past decade. However, in vitro hip simulator testing for the predicted increased lifetime of these surface replacements is time-consuming and costly. Computational wear modelling based on the Archard wear equation and finite element contact analysis was developed in this study for artificial hip joints and particularly applied to metal-on-metal resurfacing bearings under simulator testing conditions to address this issue. Wear factors associated with the Archard wear equation were experimentally determined and based on the short-term hip simulator wear results. The computational wear simulation was further extended to a long-term evaluation up to 50 million cycles assuming that the wear rate stays constant. The prediction from the computational model shows good agreement with the corresponding simulator study in terms of volumetric wear and the wear geometry. The simulation shows the progression of linear wear penetrations, and the complexity of contact stress distribution on the worn bearing surfaces. After 50 million cycles, the maximum linear wear was predicted to be approximately 6 and 8 microm for the cup and head, respectively, and no edge contact was found.

Types of gowns used in trauma and orthopaedic theatres

Trauma and orthopaedic surgeons are at an increased risk of acquiring viral blood-borne infections during elective and especially trauma surgery. The British Orthopaedic Association (BOA) published guidelines in 1991 for the prevention of cross-infection between patients and staff. It was recommended that only waterproof gowns be used in orthopaedic and trauma theatres. The aim of this study was to determine the compliance with the BOA recommendations. A telephone survey of 79 hospitals in England shows that only a minority (41 per cent) of hospitals use waterproof gowns exclusively.

Properties of variant forms of human stem cell factor recombinantly expressed in Escherichia coli

The gene for human stem cell factor (SCF) encodes a leader sequence followed by 248 amino acids (Martin et al., 1990, Cell 63, 203). Of these 248 amino acids, the first 189 correspond to an extracellular domain and the remainder correspond to a hydrophobic transmembrane domain plus a cytoplasmic domain. A naturally occurring soluble form, released by proteolytic cleavage after amino acid 165, has been described. An alternatively spliced mRNA, lacking the codons for exon 6, has also been described. Since the amino acids encoded by exon 6 include the proteolytic cleavage site, the form expressed from the alternatively spliced mRNA tends to remain membrane-bound. In the present study, we have begun to explore structure/function relationships within the extracellular domain of SCF. Forms beginning at amino acid 1 (after the leader sequence) and ranging from 127 to 189 at the C-terminus have been recombinantly expressed in Escherichia coli and purified. In addition, forms missing the amino acids encoded by exon 6, forms missing up to 10 amino acids from the N-terminus, and forms with disulfide bond alterations have been expressed and purified. The forms have been characterized structurally, as well as functionally, in quantitative cell proliferation and receptor-binding assays. The results indicate that amino acids 1-141 comprise a structural and functional core and allow conclusions about the necessity of each of the two disulfide bonds for structure and function.

Purification and characterization of soluble forms of human and rat stem cell factor recombinantly expressed by Escherichia coli and by Chinese hamster ovary cells

Stem cell factor (SCF) is a novel, early-acting hematopoietic factor. It was isolated from the medium of a rat cell line in a soluble, processed form (Zsebo et al., 1990, Cell 63, 195). The cloned human and rat genes encode the soluble form plus additional C-terminal amino acids including a hydrophobic transmembrane domain (Martin et al., 1990, Cell 63, 203). We have recombinantly expressed forms of human and rat SCF corresponding to the soluble, processed form in Escherichia coli and in Chinese hamster ovary (CHO) cells. After expression in E. coli, folding and oxidation of the SCF polypeptides are required. The SCFs expressed in CHO cells are secreted into the medium in active state and, like the natural SCF, are glycosylated. Purification of the recombinant SCFs is described. Biological and biochemical characterization includes activity toward responsive human and mouse cell lines, N-terminal amino acid sequences, disulfide bond linkages, and sites of glycosylation.

Alcohol consumption among victims of violence and among comparable U.K. populations

Controlled investigations of alcohol consumption in victims of assault are lacking. A prospective survey was performed to compare victims' drinking habits with age and sex matched U.K. populations. All 539 adult victims of assault who attended an inner-city Accident and Emergency (A and E) Department in 1986 were interviewed. Seventy-four per cent of male victims and 42% of female victims reported alcohol consumption in the 6 hours prior to assault: 30% of males and 4% of females had consumed greater than 10 units. Forty per cent males and 25% of females exceeded established safe-levels of consumption while 16% of males and 26% of females demonstrated abnormally high gamma-GT levels. Mean expenditure on alcohol by assault victims was 14% of net income, compared to 7.5% by the U.K. adult population overall. Results suggested that young male victims of assault may not be distinguishable from other young males on the basis of habitual or binge alcohol consumption. Assault victims over 25 years of age drank excessively compared to control populations and should be a priority group for alcohol education programmes.

The nucleoprotein content of fibroblasts growing in vitro. 4. Changes in the ribonucleic acid phosphorus (RNAP) and deoxyribonucleic acid phosphorus (DNAP) content

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