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Myers JS, Wertheimer JC, Kim JG, He J, Shirazipour CH, Hooper D, Penne Mays M, Klemp JR, Zegers C, Asher A. Emerging From the Haze™: Pilot Feasibility Study Comparing Two Virtual Formats of a Cognitive Rehabilitation Intervention. Oncol Nurs Forum 2024; 51:223-242. [PMID: 38668909 DOI: 10.1188/24.onf.223-242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To gather feasibility and preliminary data comparing two virtual delivery methods for providing Emerging From the Haze™ (Haze) to cancer survivors compared to waitlist control (WLC). SAMPLE & SETTING Eligible participants (N = 93) reported cancer-related cognitive impairment following chemotherapy for stage I-III solid tumors, Hodgkin lymphoma, or non-Hodgkin lymphoma. METHODS & VARIABLES A three-arm randomized design was used to compare virtual live group presentation of Haze sessions, virtual prerecorded Haze group sessions, and WLC. Data were collected at baseline, week 10, and week 14. RESULTS Feasibility was demonstrated. Significant cognitive function improvement at week 10 versus WLC was reported for the live group, and clinical improvement was reported for the prerecorded group. The prerecorded group reported significant improvement at week 14 versus WLC in physical activity, sleep, and health-related quality of life. IMPLICATIONS FOR NURSING Additional pilot and feasibility evidence for cognitive rehabilitation interventions was demonstrated. Prerecorded Haze delivery shows potential for clinical effectiveness and scalability. Future multisite research is warranted.
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Clark EB, Bonini KE, Pugh Yi RH, Kuhn E, Klemp JR, Rose D, Owens KN, Welcsh PL, Conaty J, Duquette D, Friedman SJ, Dean M. Experiences of genetic counselors in referring young and metastatic breast cancer patients to support services: A needs assessment. Patient Educ Couns 2023; 116:107946. [PMID: 37625308 DOI: 10.1016/j.pec.2023.107946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Conduct a needs assessment to explore the experiences, barriers, and needs of genetic counselors (GCs), who counsel and refer young and metastatic breast cancer (BC) patients to support services, in order to develop resources to address any noticeable gaps. METHODS GCs providing care to BC patients were eligible to complete the survey. Support services were defined as resources to address patient-centered healthcare, emotional, and quality-of-life needs. RESULTS Most participants (n = 117) reported familiarity with cancer prevention services (93%); fewer were familiar with services secondary to a BC diagnosis (e.g., fatigue=16% and sexual health=24%). The volume of GCs indicating familiarity with support services increased significantly as work experience increased for seven services. Many (>50%) never referred patients to most (9/12) support services, excluding cancer prevention, mental health, and financial issues. Open-ended responses highlighted that GCs considered referrals to be outside their scope of practice or that healthcare systems prevent GCs from making referrals. CONCLUSION GCs may benefit from curated resources and materials, especially for support services secondary to a BC diagnosis, to better support their patients. PRACTICAL IMPLICATIONS Collaboration of GCs with other health professionals through integrative care programs may decrease burdens to accessing support services.
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Affiliation(s)
| | - Katherine E Bonini
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Jennifer R Klemp
- The University of Kansas Cancer Center, Westwood, USA; Division of Clinical Oncology, Caris Life Sciences, Irving, USA
| | - Diane Rose
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, USA
| | - Kelly N Owens
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, USA
| | - Piri L Welcsh
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, USA
| | - Jessica Conaty
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Debra Duquette
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Marleah Dean
- Department of Communication, University of South Florida, Tampa, USA; Health Outcomes & Behavior Program, Moffitt Cancer Center. Tampa, USA.
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Hughes E, Probst B, Pederson HJ, Simmons T, Morris B, Domchek SM, Eng C, Gary M, Gordon O, Klemp JR, Mukherjee S, Offit K, Olopade OI, Robson ME, Vijai J, Whitworth PW, Wagner S, Lanchbury J, Slavin TP, Gutin A. A breast cancer (BC) risk model incorporating Tyrer-Cuzick version 8 (TCv8) and a polygenic risk score (PRS) for diverse ancestries. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
557 Background: BC risk assessment is important for guiding personalized screening and risk-reducing interventions. TCv8 is used to estimate BC risk based on age, breast density, family cancer history and other clinical factors. Accuracy may be improved by combining TCv8 with a PRS. We developed and validated a PRS for diverse ancestries based on 149 common genetic variants (PRS-149) comprised of 56 ancestry-informative and 93 BC-associated variants. Here, we describe a BC risk model that combines PRS-149 with TCv8. Methods: Subjects had multigene panel testing for hereditary cancer and were negative for pathogenic variants in known BC susceptibility genes. A combined risk score (CRS), incorporating PRS-149 and TCv8, was developed based on 189,230 women, including 43,444 (23%) with a history of BC. Breast Imaging Reporting and Data System (BI-RADS) breast density measurements were available for 12,363 women. We used multivariable logistic regression to test breast density and PRS-149 for association with risk of BC. An independent test cohort of 6,030 BC-unaffected women with BI-RADS assessment was used to evaluate the effect of PRS-149 on risk stratification. Relative contributions of family history, breast density, other clinical factors in TCv8 and PRS-149 were examined by adding terms sequentially to an ANOVA model. We compared differences in classification of women as high (20%) or low/moderate (20%) remaining lifetime risk according to TCv8 versus CRS. Results: In the development cohort, increased breast density was significantly associated with higher risk of BC (p=3.0x10-6) with an effect size consistent with TCv8. PRS-149 improved BC risk prediction over age, breast density and family history (OR per unit standard deviation: 1.41, 95% CI: 1.37 – 1.46; p: 1.8x10-105). PRS-149 was weakly but significantly correlated with both family history (r=0.09) and breast density (r=0.01). After adjusting for multiple testing, no other factors were correlated with PRS-149. In the independent test cohort, PRS-149 explained 27% of CRS variability after accounting for family history, breast density and other clinical factors. Adding PRS-149 to TCv8 significantly altered risk estimates, with 16.3% (983/6,030) of patients classified differently by CRS versus TCv8. By TCv8 alone, 38.0% (2,289/6,030) of patients were classified as high-risk. Among patients who were high-risk by TCv8, 25.2% (576/2,289) were downgraded by CRS. Conclusions: This is the first BC risk model that includes breast density, family history, and a PRS based on genetically determined ancestry that is validated for diverse populations. Addition of PRS-149 improved risk prediction and substantially modified risk stratification compared to TCv8 alone. Implementation of CRS may therefore lead to improved identification of women who are likely to benefit from increased surveillance and preventive medications.
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Affiliation(s)
| | | | | | | | | | | | - Charis Eng
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | | | - Ora Gordon
- Providence St Joseph Health, Burbank, CA
| | | | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Joseph Vijai
- Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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Nye LE, Smith S, Knight CJ, Klemp JR. Project BRA: Breast cancer risk assessment. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10549 Background: In Kansas, breast cancer (BC) incidence is similar in Black and white women, yet Black women are 42% more likely to die from the disease. In models where screening is equal, there is no difference in survival from early-stage BC. Barriers to BC early detection in Black women include provider lack of knowledge in cancer risk, performing risk assessments and providing culturally sensitive education to patients. Our team developed a didactic and case-based learning intervention using Project ECHO (Extension for Community Health Outcomes) to improve provider knowledge on performing BC risk assessment and enhance risk stratified screening in Community Health Clinics (CHCs). A Community Advisory Board (CAB) was established to address barriers to early detection. Methods: CHCs participated in five 1-hour ECHO sessions June thru August 2021. Session topics focused on calculating BC risk, community resources, and cultural sensitivity and were led by experts in breast oncology, risk, genetics, screening, and health care equity. Pre/post surveys administered to participants assessed knowledge and satisfaction and continuing education credits were offered. A CAB member survey gained insight into organizational characteristics and community reach. Asset mapping identified barriers, resources, and opportunities to promote BC screening. Descriptive statistical analyses and the RE-AIM framework were used to assess reach and scalability of the ECHO. Results: Seventy-seven individuals from 16 CHCs registered to participate with a mean of 26 attendees at each session and 34% attending two or more. Participants were physicians (19%), advanced practice providers (18%), nurses (29%), and allied health professionals (34%). Sixty-three (82%) completed the baseline survey and 10 (13%) completed the post-ECHO survey. At baseline, 32% of participants reported lack of training and time as barriers to performing risk assessment. While post-ECHO survey responses were low, 60% reported their knowledge greatly or moderately improved across all topics. Participants reported clinical practice change in assessing personal history of cancer and collecting family history beyond first degree relatives. CAB members reported a broad range of expertise in community engagement and development (44%), direct patient care (15%), healthcare access (15%) and patient advocacy (26%). CAB education and collaboration led to support for tomosynthesis for women screened in our state funded BC screening program, Early Detection Works (EDW). Ongoing asset mapping identified gaps in access for Black women to the EDW program. Conclusions: Project BRA demonstrated successful participation in a limited series Project ECHO and achieved perceived changes in knowledge on performing BC risk assessment. Next steps include incorporating CAB informed opportunities to expand risk-based screening across Kansas and advocate for improved access to risk stratified screening.
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Affiliation(s)
| | - Sharla Smith
- University of Kansas School of Medicine, Kansas City, KS
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Wulff-Burchfield EM, Potts M, Knight C, Klemp JR. Using tele-mentoring to optimize quality of care and quality of life for patients with renal cell carcinoma (TOQQ-RCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
326 Background: Overall survival from metastatic renal cell carcinoma (RCC) has risen in recent years due in part due to therapies such as immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI). TKI and ICI have unique and high-impact side effect profiles, and deficits persist in clinicians’ understanding of patient tolerance of and response to treatment, particularly in rural and community practices. We developed a tele-mentoring series to improve knowledge and clinical care gaps in ICI and TKI toxicity assessment and management for persons treated for RCC. Methods: Rural and community cancer care teams were invited by the Masonic Cancer Alliance, the outreach network of The University of Kansas Cancer Center, to participate in a five session Project ECHO (Extension for Community Health Outcomes) didactic and case-based educational series. Topics included distress screening, shared decision-making for RCC treatment, ICI and TKI toxicity assessment and management, at-home ICI administration, and implementing toxicity monitoring protocols. A mixed-methods approach collected data from participants pre- and post-TOQQ-RCC series. Clinician interviews assessed current practice protocols and were transcribed and analyzed thematically. Organizational Readiness for Implementing Change (ORIC) was administered pre- and post-TOQQ-RCC intervention; mean scores were calculated to determine readiness for change in toxicity monitoring and management protocols. Participant engagement and satisfaction were assessed; satisfaction measure included a Likert-like scale of poor, fair, average, good, and outstanding. Results: Fifty-two attendees from 11 cancer care institutions across Kansas and Missouri registered for the TOQQ-RCC sessions. An average of 15 participants attended each session including physicians, advanced practice providers, nurses, and other disciplines. Session evaluations rated content/delivery as good or outstanding. Themes from qualitative analysis revealed patient education as a primary barrier to effective toxicity identification and management. One-third of participants completed ORIC post-assessment; mean ORIC scores dropped by a mean 0.4 (10%) post-TOQQ-RCC series, indicating decreased readiness to implement changes to toxicity monitoring and management protocols. Conclusions: Rural and community oncology clinicians are willing to engage in tele-mentoring to improve knowledge and clinical care gaps regarding ICI and TKI toxicity assessment and management. Decrease in ORIC scores post-TOQQ-RCC series may indicate increased understanding of the complex processes and resources required to institute meaningful improvement to toxicity monitoring and management protocols for patients treated in rural and community settings. Future directions will include formal organizational needs assessments.
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Nye LE, Klemp JR, Powers KR, O'Dea AP, Kreutzjans AL, Metheny T, Phillips TA, Carlson SE, Kimler BF, Fabian CJ. Abstract P2-11-17: Feasibility of microbiome analysis from random periareolar fine needle aspiration in premenopausal women at increased risk for breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-11-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Nearly 10% of breast cancers (BC) are diagnosed in premenopausal woman under age 45 and of childbearing potential. Women considering future childbearing are typically excluded from BC prevention trials and are ineligible for standard of care chemoprevention. More biomarkers are needed to support BC prevention trials in this young cohort. Women of childbearing potential are encouraged to supplement diet with minimum of 300mg of EPA + DHA omega-3 fatty acids (FA) per day. EPA and DHA are thought to have a favorable effect on the gut microbiome implicated in cancer development. Few studies have characterized the breast microbiome by core biopsy or surgical sample but to our knowledge no studies have explored the feasibility of breast microbiome collection using the less invasive technique Random Periareolar Fine Needle Aspiration (RPFNA). In a pilot study, we demonstrated feasibility of recruiting premenopausal women considering future pregnancy to a BC prevention trial with a 6-month intervention of omega-3 FA supplementation (19-A-1921-SABCS). RPFNA was used to collect breast tissue for biomarker analysis, which is a mildly invasive technique used for repeated sample collection in BC prevention trials. Objectives: 1) To determine the feasibility of characterizing breast microbiome from specimens collected by RPFNA in premenopausal woman at high risk for BC, 2) To identify changes in the breast and stool microbiome with omega-3 FA supplementation in this population. Methods: Ten women between the ages of 21 and 40 who were considering future pregnancy and at high risk for BC were enrolled to a pilot study and took Omega-3-Acid Ethyl Ester (total of 750mg DHA and 930mg EPA) daily for 6 months. Tissue collection with RPFNA of breast as well as blood, urine and stool were completed at baseline and off-study visit. RPFNA samples from the first 2 passes at each site of breast (4 sites total) were collected for microbiome and placed in a 2mL tube with 0.5 – 1cc of PBS and flash frozen and stored at -80C. DNA was isolated from RPFNA samples using QIAamp DNA Mini Kit (51304). Microbiome profiling analysis was performed by Veracet using 16S V4 rRNA gene sequencing on the Illumina MiSeq platform. Wilcoxon signed rank test was used to compare paired samples. Results: Of the 10 women enrolled, median age was 33 years (range 22-37). 90% (9 of 10) returned for off-study visit. Of the 9 women who completed the off-study visit, 2 elected to not undergo off-study RPFNA. There were 16 total stool samples and 17 total RPFNA samples for microbiome evaluation. There were 6 paired (baseline and off-study) stool and 7 paired RPFNA samples. Mean DNA concentration from RPFNA samples was 10.36ng/µl (range 0.62 – 74.10). From all samples, 52.1% of operational taxonomic units (OTUs) were classified at the genus level. Breast samples were sequenced to a depth of mean 27,767 reads (range 5,745 – 125,445) and stool to a depth of mean 119,296 reads (range 72,979 – 188,867). The alpha diversity metric of OTU richness was 1069 (breast) and 438 (stool). Shannon diversity was 4.51 (breast) and 3.89 (stool). Mean OTU richness for baseline and off-study RPFNA samples were 1098 and 1028 respectively (V = 25, p value = 0.076). Mean OTU richness for baseline and off-study stool samples were 440 and 437 respectively (V = 15, p value = 0.40). Conclusion: We demonstrated feasibility of analyzing breast microbiome from an RPFNA specimen. Additional investigation with modifications to technique and/or sample population is. needed to achieve adequate sequencing depth for characterization of breast microbiome. Lower depth of sequencing in breast samples is thought to reflect differences in microbial DNA quantity. We were unable to assess change in microbiome composition in breast or stool samples with omega-3 fatty acid supplementation due to small sample size.
Citation Format: Lauren E Nye, Jennifer R Klemp, Kandy R Powers, Anne P O'Dea, Amy L Kreutzjans, Trina Metheny, Teresa A Phillips, Susan E Carlson, Bruce F Kimler, Carol J Fabian. Feasibility of microbiome analysis from random periareolar fine needle aspiration in premenopausal women at increased risk for breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-17.
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Affiliation(s)
- Lauren E Nye
- University of Kansas Medical Center, Westwood, KS
| | | | | | - Anne P O'Dea
- University of Kansas Medical Center, Westwood, KS
| | | | - Trina Metheny
- University of Kansas Medical Center, Kansas City, KS
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Klemp JR, Knight CJ, Lowry B, Long T, Bush C, Alsman K, Krebill H, Peereboom D, Overholser L, Greiner KA. Informing the delivery of cancer survivorship care in rural primary care practice. J Cancer Surviv 2022; 16:4-12. [PMID: 35107796 PMCID: PMC8881424 DOI: 10.1007/s11764-021-01134-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
Purpose The cancer survivor population is projected to increase to 22.2 million by 2030, requiring improved collaboration between oncology and primary care practices (PCP). PCPs may feel ill-equipped to provide cancer survivorship care to patients without input from cancer specialists. Compared with nonrural cancer survivors, rural cancer survivors report experiencing worse treatment-related symptoms. The goal of this study was to gain a better understanding of the perspectives of PCP teams towards survivorship care and to develop and test an interdisciplinary training program to improve cancer survivorship care in rural practice. Methods This study was conducted in two phases. First, focus groups were conducted with rural PCP teams to gather information regarding beliefs, practices, and barriers related to cancer survivorship care delivery. A thematic analysis was completed using an iterative process of reviewing transcripts. Results from phase 1 were used to inform the development of a pilot intervention tested within seven rural PCPs (phase 2). Pre- and post-intervention knowledge changes were compared, and post-session interviews assessed planned or sustained practice changes. Results Seven PCPs participated in focus groups (phase 1). Cross-cutting themes identified included (1) organizational barriers affecting the delivery of cancer survivorship care, (2) challenges of role delineation with specialists and patients, (3) difficulty accessing survivorship care and resources, and (4) providers’ lack of knowledge of cancer survivorship care. For phase 2, seven practices participated in four case-based educational sessions. Within and between practice changes were identified. Conclusion This project explored cancer survivorship perspectives among PCP teams. Lack of familiarity with evidence-based guidelines and the inability to identify cancer survivors was apparent during discussions and led to the implementation of the phase 2 intervention, iSurvive. As a result, PCPs either changed or planned changes to improve the identification and evidence-based care of cancer survivors. Implications for Cancer Survivors Address barriers to access cancer survivorship care in rural primary care practices.
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Affiliation(s)
- J R Klemp
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS, USA.
| | - C J Knight
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - B Lowry
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - T Long
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - C Bush
- Ascension, Wichita, KS, USA
| | - K Alsman
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - H Krebill
- Masonic Cancer Alliance, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - D Peereboom
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Overholser
- University of Colorado School of Medicine, Aurora, CO, USA
| | - K A Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Choucair K, Dixon D, Bansal A, Klemp JR, Abdulateef Y, Chalise P, Al-Rajabi RMT, Kasi A, Williamson SK, Baranda JC, Sun W, Saeed A. Phase II trial of moderate dose omega-3 acid ethyl esters for colorectal cancer prevention in patients with lynch syndrome (COLYNE). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.tps209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS209 Background: Lynch syndrome (LS) is the most common inherited colorectal cancer (CRC) syndrome and is responsible for about 3% of newly diagnosed CRC. It is caused by germline mutations in one of the DNA mismatch repair (MMR) genes, and patients with LS carry a lifetime risk of CRC ranging between 10% and 70%. The role of inflammation in driving this malignant transformation is now well established and retrospective studies have revealed a potential chemo-preventative role for omega-3 (ω-3) polyunsaturated fatty acids (PUFAs), possibly via inhibition of inflammatory pathways associated with the development of defective MMR CRC tumors. While patients with LS have the highest risk of developing CRC, the majority of chemoprevention trials are focused on sporadic CRC. Effective interventions to reduce the risk of developing CRC in this population are limited to close surveillance and surgical prophylaxis. There is an unmet need for safe, effective, and non-invasive chemo-preventive interventions in patients with LS. Methods: This pilot study is a single-arm, open-label, phase 2 clinical trial of omega-3 acid ethyl esters (generic Lovasa; 2 grams orally once daily) for adult patients (≥ 18 years of age) with confirmed LS (based on germline testing of the MMR genes panel: MLH1, MSH2, MSHS6, PMS2 or deletion in EPCAM gene). Patients who are not candidate for elective endoscopy and/or with prior history of right sided or pan-colectomy are excluded. Thirty-four patients are expected to enroll, with a primary objective to determine the feasibility (defined as 80% retention rate) of 12 months of treatment with 2 grams capsules of omega-3 acid ethyl esters daily. Secondary endpoints include safety and tolerability of the intervention. Correlative aims include pre and post treatment assessment of colon mucosal tissue proliferation (right sided colon specimens will be evaluated for markers of proliferation (Ki-67) and apoptosis (Caspase-3)), the effect of omega-3 acid ethyl esters on inflammatory markers in serum, urine and feces (PGE-2, COX-2, β-catenin levels, and EPA:AA ratios), and gene expression related to proliferation, apoptosis and cell survival in colon tissue (NF-κB/Wnt pathways). The impact of omega-3 acid ethyl esters on intestinal microbiota will also be assessed (16S rRNA-based profiling). Correlative Colon tissue, serum, urine and feces samples are collected at baseline and at 12 months. The study is actively enrolling with 20 patients enrolled at the time of submission. Clinical trial information: NCT03831698.
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Affiliation(s)
| | - Dan Dixon
- Kansas University Cancer Center, Fairway, KS
| | - Ajay Bansal
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS
| | | | | | | | | | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | | | | - Weijing Sun
- University of Kansas Medical Center, Kansas City, KS
| | - Anwaar Saeed
- Kansas University Cancer Center, Kansas City, KS
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Fabian CJ, Klemp JR, Marchello NJ, Vidoni ED, Sullivan DK, Nydegger JL, Phillips TA, Kreutzjans AL, Hendry B, Befort CA, Nye L, Powers KR, Hursting SD, Giles ED, Hamilton-Reeves JM, Li B, Kimler BF. Rapid Escalation of High-Volume Exercise during Caloric Restriction; Change in Visceral Adipose Tissue and Adipocytokines in Obese Sedentary Breast Cancer Survivors. Cancers (Basel) 2021; 13:cancers13194871. [PMID: 34638355 PMCID: PMC8508448 DOI: 10.3390/cancers13194871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Aerobic exercise reduces risk for developing breast cancer or for breast cancer recurrence. In obese women exercise can significantly augment the effects of caloric restriction on visceral fat, reducing metabolic abnormalities and cancer. Women who are older, obese, and sedentary, especially those who have been treated for breast cancer, find it difficult to initiate and achieve the minimum or optimum levels of exercise. In a two-part pilot we found that by providing older, obese, sedentary breast cancer survivors 12 weeks of twice weekly personal training sessions, they could safely increase exercise to ≥200 min/week by 9 weeks during caloric restriction. At 24 weeks, high levels of exercise were still observed with continued behavioral support and study-provided exercise facility. Substantial improvement in visceral fat and breast cancer risk biomarkers were observed with this affordable intervention that is readily exportable to the community. Abstract Aerobic exercise reduces risk for breast cancer and recurrence and promotes visceral adipose tissue (VAT) loss in obesity. However, few breast cancer survivors achieve recommended levels of moderate to vigorous physical activity (MVPA) without supervision. In a two-cohort study, feasibility of 12 weeks of partially supervised exercise was started concomitantly with caloric restriction and effects on body composition and systemic risk biomarkers were explored. In total, 22 obese postmenopausal sedentary women (including 18 breast cancer survivors) with median age of 60 and BMI of 37 kg/m2 were enrolled. Using personal trainers twice weekly at area YMCAs, MVPA was escalated to ≥200 min/week over 9 weeks. For cohort 2, maintenance of effect was assessed when study provided trainer services were stopped but monitoring, group counseling sessions, and access to the exercise facility were continued. Median post-escalation MVPA was 219 min/week with median 12-week mass and VAT loss of 8 and 19%. MVPA was associated with VAT loss which was associated with improved adiponectin:leptin ratio. In total, 9/11 of cohort-2 women continued the behavioral intervention for another 12 weeks without trainers. High MVPA continued with median 24-week mass and VAT loss of 12 and 29%. This intervention should be further studied in obese sedentary women.
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Affiliation(s)
- Carol J. Fabian
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Jennifer R. Klemp
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Nicholas J. Marchello
- Department of Nutrition, Kinesiology, and Psychological Sciences, University of Central Missouri, P.O. Box 800, Warrensburg, MO 64093, USA;
| | - Eric D. Vidoni
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (E.D.V.); (B.H.)
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (D.K.S.); (J.M.H.-R.)
| | - Jennifer L. Nydegger
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Teresa A. Phillips
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Amy L. Kreutzjans
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Bill Hendry
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (E.D.V.); (B.H.)
| | - Christie A. Befort
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA;
| | - Lauren Nye
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Kandy R. Powers
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Stephen D. Hursting
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, 235 Dauer Drive, Chapel Hill, NC 27599, USA;
| | - Erin D. Giles
- Department of Nutrition, Texas A&M University, 214 Cater-Mattil 2253 TAMU, 373 Olsen Blvd, College Station, TX 77843, USA;
| | - Jill M. Hamilton-Reeves
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (D.K.S.); (J.M.H.-R.)
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Bing Li
- Department of Pathology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA;
| | - Bruce F. Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
- Correspondence: ; Tel.: +1-913-588-4523
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10
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Fabian CJ, Befort CA, Phillips TA, Nydegger JL, Kreutzjans AL, Powers KR, Metheny T, Klemp JR, Carlson SE, Sullivan DK, Zalles CM, Giles ED, Hursting SD, Hu J, Kimler BF. Change in Blood and Benign Breast Biomarkers in Women Undergoing a Weight-Loss Intervention Randomized to High-Dose ω-3 Fatty Acids versus Placebo. Cancer Prev Res (Phila) 2021; 14:893-904. [PMID: 34244155 DOI: 10.1158/1940-6207.capr-20-0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
The inflammation-resolving and insulin-sensitizing properties of eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids have potential to augment effects of weight loss on breast cancer risk. In a feasibility study, 46 peri/postmenopausal women at increased risk for breast cancer with a body mass index (BMI) of 28 kg/m2 or greater were randomized to 3.25 g/day combined EPA and DHA (ω-3-FA) or placebo concomitantly with initiation of a weight-loss intervention. Forty-five women started the intervention. Study discontinuation for women randomized to ω-3-FA and initiating the weight-loss intervention was 9% at 6 months and thus satisfied our main endpoint, which was feasibility. Between baseline and 6 months significant change (P < 0.05) was observed in 12 of 25 serum metabolic markers associated with breast cancer risk for women randomized to ω-3-FA, but only four for those randomized to placebo. Weight loss (median of 10% for trial initiators and 12% for the 42 completing 6 months) had a significant impact on biomarker modulation. Median loss was similar for placebo (-11%) and ω-3-FA (-13%). No significant change between ω-3-FA and placebo was observed for individual biomarkers, likely due to sample size and effect of weight loss. Women randomized to ω-3-FA exhibiting more than 10% weight loss at 6 months showed greatest biomarker improvement including 6- and 12-month serum adiponectin, insulin, omentin, and C-reactive protein (CRP), and 12-month tissue adiponectin. Given the importance of a favorable adipokine profile in countering the prooncogenic effects of obesity, further evaluation of high-dose ω-3-FA during a weight-loss intervention in obese high-risk women should be considered. PREVENTION RELEVANCE: This study examines biomarkers of response that may be modulated by omega-3 fatty acids when combined with a weight-loss intervention. While focused on obese, postmenopausal women at high risk for development of breast cancer, the findings are applicable to other cancers studied in clinical prevention trials.
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Affiliation(s)
- Carol J Fabian
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
| | - Christie A Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Teresa A Phillips
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer L Nydegger
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Amy L Kreutzjans
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kandy R Powers
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Trina Metheny
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer R Klemp
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Carola M Zalles
- Department of Pathology, Boca Raton Regional Hospital, Boca Raton, Florida
| | - Erin D Giles
- Department of Nutrition, Agriculture and Life Sciences, Texas A&M University, College Station, Texas
| | - Stephen D Hursting
- Department of Nutrition and Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Bruce F Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas
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11
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Ranallo L, Nye LE, Williams M, Fabian F.A.S.C.O CJ, O'Dea A, Klemp JR. Point of care genetic testing in a breast cancer survivorship clinic. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10580 Background:: Breast cancer survivorship care (BCSC) includes the ongoing assessment of personal and family cancer history and offering genetic education, counseling and testing to survivors who meet NCCN, ASBrS and Medicare guidelines for germline genetic testing. It is reported that approximately 8% of patients with breast cancer (BC) will have a clinically actionable germline mutation. However, lower than expected rates of testing are seen in both the acute and extended phases of BCSC. We sought to identify the number of patients seen in a long-term survivorship clinic who had previously undergone or currently qualified for germline testing, and the prevalence of germline variants in BC survivors. Methods: In a Nurse Practitioner (NP) led clinic, 2,184 non-selected BC survivors were screened to determine if: germline testing was previously completed or if update germline testing or initial germline testing is needed (with a 3-generation review of family history). BC survivors eligible for initial or update germline testing (411 patients) were provided with genetic education, counseling, and offered multigene panel testing. Seven (7) BC survivors declined testing. Results: From May 2019 – January 2021, 2,184 BC survivors were seen in the clinic. The average age of survivors = 60.2 yrs; average time since diagnosis = 10.7 yrs; and average age at diagnosis = 50.1 yrs, gPV were identified in 10.4%. Out of pocket cost on average was $50.00 for 2.0% of those tested. Conclusions: Within a comprehensive Breast Cancer program where genetic testing is common practice, there is an ongoing need to screen breast cancer (BC) survivors for genetic testing eligibility. A significant number of BC survivors will test positive for a pathogenic mutation (10.4%) a decade after an initial diagnosis. Genetic testing is a necessary step to stratify a BC survivors’ risk of developing secondary cancers, appropriate screening and prevention strategies, cascade testing, and for some, treatment planning. This individualized approach to BCSC is often described, but difficult to put into action. Time/access and drop rates with a referral model are barriers. Incorporating a point of care genetic testing model requires additional support (genetic extender), professional development, education, and a commitment to provide patient centric care.[Table: see text]
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Affiliation(s)
- Lori Ranallo
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | - Anne O'Dea
- University of Kansas Medical Center, Westwood, KS
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12
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Hughes E, Tiemeny P, Gallagher S, Meek S, Eng C, Gary M, Gordon O, Klemp JR, Olopade OI, Pederson HJ, Weitzel JN, Whitworth PW, Yehia L, Wagner S, Slavin TP, Gutin A, Lanchbury J. Ancestrally unbiased polygenic breast cancer (BC) risk assessment. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10502 Background: BC risk is influenced by single-nucleotide polymorphisms (SNPs) with small effects that can be aggregated into polygenic risk scores (PRSs). PRSs have primarily been developed and validated for populations of European descent. To make a PRS available for all women, we developed and validated a novel global PRS (gPRS) that utilizes individual ancestral genetic composition. Methods: Ancestry-specific PRSs corresponding to 3 continental ancestries were developed from 149 SNPs (93 BC and 56 ancestry-informative): an African PRS was developed using a cohort of 31,126 self-reported African American patients referred for hereditary cancer testing; an East Asian PRS was developed based on published data from the Asia Breast Cancer Consortium; and a European PRS was developed using data from the Breast Cancer Association Consortium and 24,259 European hereditary cancer testing patients. For each patient, ancestry-informative SNPs were used to calculate the fractional ancestry attributable to each of the 3 continents. The gPRS was the sum of ancestry specific PRSs weighted according to genetic ancestral composition. In an independent validation cohort (N = 62,707), we evaluated discrimination and calibration of gPRS, and compared performance against a previously described 86-SNP PRS for women of European ancestry. Associations of SNPs and PRSs with BC were analyzed using logistic regression adjusted for personal and family cancer history, age, and ancestry. Odds ratios (ORs) are reported per standard deviation within the corresponding patient population. P-values are reported as two-sided. Results: The gPRS was strongly associated with BC in the full validation cohort and in sub-cohorts defined by self-reported ancestry (Table). 95% (88/93) of BC SNPs had ≥1% frequency of risk alleles within each of the self-reported populations. Compared to the aforementioned 86-SNP PRS, the gPRS showed improved discrimination overall, and within each sub-cohort, with the exception of the Asian population where the sample size was too small to show superiority of either score. The 86-SNP PRS was calibrated for white non-Hispanic women but mis-calibrated for non-European ancestries. The gPRS was properly calibrated for all women. Conclusions: The 149-SNP gPRS is validated and calibrated for women of all ancestries. Combined with clinical and biological risk factors, this approach may offer improved risk stratification for all women, regardless of ancestry.[Table: see text]
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Affiliation(s)
| | | | | | | | - Charis Eng
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | | | - Ora Gordon
- Providence Health & Services, Renton, WA
| | | | | | | | | | | | - Lamis Yehia
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH
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13
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Hamilton-Reeves JM, Johnson CN, Hand LK, Bechtel MD, Robertson HL, Michel C, Metcalf M, Chalise P, Mahan NJ, Mirza M, Lee EK, Sullivan DK, Klemp JR, Befort CA, Parker WP, Gibbs HD, Demark-Wahnefried W, Thrasher JB. Feasibility of a Weight Management Program Tailored for Overweight Men with Localized Prostate Cancer - A Pilot Study. Nutr Cancer 2020; 73:2671-2686. [PMID: 33295204 PMCID: PMC8371995 DOI: 10.1080/01635581.2020.1856890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Overweight men with prostate cancer are more likely to suffer from recurrence and death following prostatectomy compared with healthy weight men. This study tested the feasibility of delivering a comprehensive program to foster weight loss before and weight maintenance after surgery in overweight men with localized prostate cancer. METHODS Twenty overweight men scheduled for prostatectomy elected either the intervention (n = 15) or the nonintervention (n = 5). Anthropometrics, biomarkers, diet quality, nutrition literacy, quality of life, and long-term follow-up were assessed in both groups. RESULTS The intervention led to 5.55 kg of weight loss including 3.88 kg of fat loss from baseline to surgery (mean = 8.3 weeks). The intervention significantly increased fiber, protein, fruit, nut, and vegetable intake; and decreased trans fats intake during weight loss. The intervention significantly reduced insulin, C-peptide, systolic blood pressure, leptin:adiponectin ratio, and visceral adiposity compared to the nonintervention. Post-surgically, weight loss was maintained. Changes in lipid profiles, nutrition literacy, and follow-up were not statistically significant in either group. CONCLUSION Significant weight loss (≥5%) is feasible with a coaching intervention in overweight men preparing for prostatectomy and is associated with favorable cardiometabolic effects. This study is registered under NCT02252484 (www.clinicaltrials.gov).
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Affiliation(s)
- Jill M Hamilton-Reeves
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Chelsea N Johnson
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lauren K Hand
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Misty D Bechtel
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hilary L Robertson
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie Michel
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Meredith Metcalf
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nicholas J Mahan
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Moben Mirza
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Eugene K Lee
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Debra K Sullivan
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer R Klemp
- Breast Cancer Prevention Center, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Christie A Befort
- Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - William P Parker
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Heather D Gibbs
- Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Brantley Thrasher
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
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14
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Gunturu KS, Dizon DS, Johnson J, Mercurio AM, Mason G, Sparks DB, Lawton W, Klemp JR. Clinical Trials in the Era of Digital Engagement: A SWOG Call to Action. JCO Clin Cancer Inform 2020; 4:254-258. [PMID: 32191544 DOI: 10.1200/cci.19.00128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Krishna S Gunturu
- Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Don S Dizon
- Brown University and Lifespan Cancer Institute, Providence, RI
| | - Judy Johnson
- SWOG Cancer Research Network, Lung Committee Patient Advocate, St. Louis, MO
| | - Anne Marie Mercurio
- SWOG Cancer Research Network, Digital Engagement Committee, Cold Spring Harbor, NY
| | - Ginny Mason
- SWOG Cancer Research Network, Lung Committee Patient Advocate, West Lafayette, IN
| | - Dana B Sparks
- SWOG Cancer Research Network, Operations Office, San Antonio, TX
| | - Wendy Lawton
- SWOG Cancer Research Network, Group Chair's Office, Oregon Health and Science University Knight Cancer Institute, Portland, OR
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15
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Nye LE, O'Dea A, Sharma P, Nelson EL, McCarty T, Van Goethem K, Rush E, Nelson K, Krebill H, Boehmer L, Klemp JR. Incorporating of telementoring (Project ECHO) into practice: Efficacy of Point Of Service Testing-Breast Cancer (ePOST-BC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
113 Background: An estimated 327,630 breast cancers (BC) will be diagnosed in the US in 2020, and as high as 14% (45,868) may be related to a hereditary cancer syndrome. Testing eligible patients in clinical practice is hindered by multiple barriers including time, available workforce, cost, lack of organizational pathways, provider knowledge, as well as health disparities. To address some of these barriers, our team provided a telementoring and process improvement intervention for cancer care programs primarily serving rural patients across Kansas and Western Missouri using Project ECHO. We aimed to improve the process surrounding access to genetic education and testing for patients with BC. Methods: Rural and community cancer care teams were invited by the Masonic Cancer Alliance, the outreach arm of the University of Kansas Cancer Center, to participate in ePOST-BC. Five 1-hour Project ECHO sessions (community building, didactic, and case-based learning) covered topics included: 1) essential elements of HCS and genetic testing, 2) guidelines for genetic testing in BC 3) enhanced understanding of risk, screening, and management including precision medicine in HCS, and 4) overcoming barriers to genetic testing and management in low resource settings. Provider and practice readiness was assessed using the Organizational Readiness for Implementing Change survey. A REDCap database was used for registration, surveys and data collection. Results: Ten practices (6 = metro; 4 = rural) participated in the telementoring sessions and five practices participated in the optional process improvement intervention. Provider and clinic interest and participation was high and readiness was varied. Improvements were identified in knowledge, readiness, and patient access to genetic education and testing. The level of engagement in process improvement was impacted by an identified champion (either MD and/or APP), organizational commitment, and motivator (i.e., accreditation standard, business development). Conclusions: Rural and community oncology providers are interested and willing to engage in telementoring to improve implementation of point of service genetic education and testing. This improves provider knowledge, readiness and implementation of testing. Demonstrating a change in testing completion for eligible patients is difficult in a community setting without intensive data collection. Next steps include the incorporation of technology and standardized tools into practice to address provider and care team burden.
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Affiliation(s)
| | - Anne O'Dea
- Kansas University Medical Center, Westwood, KS
| | | | | | | | | | - Eric Rush
- University of Kansas Medical Center, Kansas City, KS
| | - Katie Nelson
- University of Kansas Cancer Center, Westwood, KS
| | - Hope Krebill
- Midwest Cancer Alliance, University of Kansas Medical Center, Fairway, KS
| | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
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16
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Fabian CJ, Khan SA, Garber JE, Dooley WC, Yee LD, Klemp JR, Nydegger JL, Powers KR, Kreutzjans AL, Zalles CM, Metheny T, Phillips TA, Hu J, Koestler DC, Chalise P, Yellapu NK, Jernigan C, Petroff BK, Hursting SD, Kimler BF. Randomized Phase IIB Trial of the Lignan Secoisolariciresinol Diglucoside in Premenopausal Women at Increased Risk for Development of Breast Cancer. Cancer Prev Res (Phila) 2020; 13:623-634. [PMID: 32312713 PMCID: PMC7335358 DOI: 10.1158/1940-6207.capr-20-0050] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023]
Abstract
We conducted a multiinstitutional, placebo-controlled phase IIB trial of the lignan secoisolariciresinol diglucoside (SDG) found in flaxseed. Benign breast tissue was acquired by random periareolar fine needle aspiration (RPFNA) from premenopausal women at increased risk for breast cancer. Those with hyperplasia and ≥2% Ki-67 positive cells were eligible for randomization 2:1 to 50 mg SDG/day (Brevail) versus placebo for 12 months with repeat bio-specimen acquisition. The primary endpoint was difference in change in Ki-67 between randomization groups. A total of 180 women were randomized, with 152 ultimately evaluable for the primary endpoint. Median baseline Ki-67 was 4.1% with no difference between arms. Median Ki-67 change was -1.8% in the SDG arm (P = 0.001) and -1.2% for placebo (P = 0.034); with no significant difference between arms. As menstrual cycle phase affects proliferation, secondary analysis was performed for 117 women who by progesterone levels were in the same phase of the menstrual cycle at baseline and off-study tissue sampling. The significant Ki-67 decrease persisted for SDG (median = -2.2%; P = 0.002) but not placebo (median = -1.0%). qRT-PCR was performed on 77 pairs of tissue specimens. Twenty-two had significant ERα gene expression changes (<0.5 or >2.0) with 7 of 10 increases in placebo and 10 of 12 decreases for SDG (P = 0.028), and a difference between arms (P = 0.017). Adverse event incidence was similar in both groups, with no evidence that 50 mg/day SDG is harmful. Although the proliferation biomarker analysis showed no difference between the treatment group and the placebo, the trial demonstrated use of SDG is tolerable and safe.
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Affiliation(s)
- Carol J Fabian
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | | | | | - William C Dooley
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Jennifer R Klemp
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer L Nydegger
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kandy R Powers
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Amy L Kreutzjans
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Carola M Zalles
- Department of Pathology, Boca Raton Hospital, Boca Raton, Florida
| | - Trina Metheny
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Teresa A Phillips
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Devin C Koestler
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Prabhakar Chalise
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Nanda Kumar Yellapu
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Cheryl Jernigan
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Brian K Petroff
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, Michigan
| | - Stephen D Hursting
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Bruce F Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas.
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17
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Nye LE, Klemp JR, Powers KR, O'Dea AP, Cruz KA, Kreutzjans AL, Metheny T, Phillips TA, Carlson SE, Kimler BF, Fabian CJ. Abstract P1-14-01: Feasibility study of moderate dose omega 3 fatty acid supplementation in premenopausal women at high risk for breast cancer considering future pregnancy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: 11% of women developing breast cancer are pre-menopausal women of childbearing potential under the age of 45. Pregnancy and breast feeding provide long term protection for breast cancer when they occur at an early age. The reasons for protection are poorly understood but likely involve both changes in the immune microenvironment and ductal and lobular epithelial differentiation. This pilot study is addressing a potential prevention strategy in a population otherwise excluded from breast cancer prevention trials and not eligible for standard of care chemoprevention.
Methods: Eligible individuals included pre-menopausal women ages 21-40 that were considering future pregnancy and are at high risk for breast cancer based on family history, prior precancerous biopsy, or 5-year Gail model risk estimate of ≥ 1.7% or 10-year Tyrer-Cuzick risk of 2x population risk as listed in the model. Participants were enrolled and baseline tissue collection included random periareolar fine-needle aspiration (RPFNA) of breast, as well as collection of blood, urine and stool. Women were asked to take two capsules of Omega-3-Acid Ethyl Esters daily (a total of 750 mg DHA and 930 mg EPA) for six months. Post-intervention visit included repeat tissue collection. If women were pregnant at time of post-intervention visit, RPFNA was not done. Baseline and post-intervention DHA Food Frequency Questionnaire (FFQ) and the BCPT Questionnaire were administered. The intervention length was shortened for some participants due to the study ending.
Objectives: 1) To determine feasibility of a breast cancer prevention intervention study in this cohort of pre-menopausal women at high risk for breast cancer and considering future pregnancy, 2) measure compliance with the omega-3 fatty acid supplement in this population, 3) identify novel biomarkers modulated by moderate dose omega-3 fatty acids in this population.
Results: Ten women were successfully enrolled at an average rate of 1.5/month from a single center high risk breast clinic. Of the ten women enrolled, median age was 33 years (range 22-37, ±5.04 stdev), 70% married, 80% Non-Hispanic White, 10% of Ashkenazi Jewish descent and 40% reported having a genetic mutation. Feasibility was achieved with 80% (8 out of 10) of participants returning for post-intervention visit. Reasons given for discontinuation of study were (n=1) side effect from supplement (bloating) and (n=1) scheduling conflicts. Of the eight women who completed the off study visit, two chose not to undergo the off study RPFNA due to discomfort with initial procedure or time commitment. Self-reported pill count showed an average of three missed pills/month. Grade 1 related adverse events reported included odor, nausea and flatulence. Post-intervention, more participants reported diarrhea, vaginal discharge and bleeding, weight gain, general aches and dizziness on BCPT items compared to baseline. Change in benign breast tissue biomarkers will be reported including breast tissue cytomorphology, Ki67, fatty acid analysis and selected gene expression.
Conclusion: It is feasible to recruit premenopausal women considering future pregnancy to a breast cancer prevention trial with a minimally invasive sampling procedure. Results from this trial will inform a larger randomized prevention trial.
Citation Format: Lauren E Nye, Jennifer R Klemp, Kandy R Powers, Anne P O'Dea, Kendra A Cruz, Amy L Kreutzjans, Trina Metheny, Teresa A Phillips, Susan E Carlson, Bruce F Kimler, Carol J Fabian. Feasibility study of moderate dose omega 3 fatty acid supplementation in premenopausal women at high risk for breast cancer considering future pregnancy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-14-01.
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18
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Dizon DS, Sedrak MS, Lewis MA, Cook E, Fisch MJ, Klemp JR, Sommers J, Ciccarella A, Gralow J, Lawton W, Nichols C. Incorporating Digital Tools to Improve Clinical Trial Infrastructure: A White Paper From the Digital Engagement Committee of SWOG. JCO Clin Cancer Inform 2019; 2:1-8. [PMID: 30652537 DOI: 10.1200/cci.17.00122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Progress toward improvement in cancer therapy relies on clinical trials. Yet, only a minority of eligible patients with cancer enroll as a result of multiple barriers at the patient, investigator, center, and national level. However, the rise of the Internet and mobile technology has created a slew of tools with medical applications, from Web sites to apps to social media platforms, all of which may aide clinicians in our quest to improve the clinical research enterprise. SWOG is one of five members in the National Cancer Institute's National Clinical Trials Network-the nation's oldest and largest publicly funded cancer research network-and is taking a leadership role in exploring and testing the promise of digital engagement through the empaneling of the Digital Engagement Committee. This article outlines the mission, principles, and priorities of the Digital Engagement Committee and proposes how this work may inform the use of digital tools for the cancer research community and, hopefully, translate to improved outcomes for our patients.
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Affiliation(s)
- Don S Dizon
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Mina S Sedrak
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Mark A Lewis
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Elise Cook
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Michael J Fisch
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Jennifer R Klemp
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Jonathan Sommers
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - AnneMarie Ciccarella
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Julie Gralow
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Wendy Lawton
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
| | - Craig Nichols
- Don S. Dizon, Lifespan Cancer Institute, Providence, RI; Mina S. Sedrak, City of Hope National Medical Center, Duarte, CA; Mark A. Lewis and Craig Nichols, Intermountain Medical Center, Murray, UT; Elise Cook and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; Jennifer R. Klemp, University of Kansas Medical Center, Kansas City, KS; Julie Gralow, University of Washington Medical Center, Seattle, WA; Wendy Lawton, Oregon Health and Science University, Portland, OR; and Jonathan Sommers and AnneMarie Ciccarella, Patient Advocates, SWOG Digital Engagement Committee
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19
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Blaes AH, Jewett PI, McKay K, Riley D, Jatoi I, Trentham-Dietz A, Chrischilles E, Klemp JR. Factors associated with genetic testing in a cohort of breast cancer survivors. Breast J 2019; 25:1241-1244. [PMID: 31270889 DOI: 10.1111/tbj.13440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
We examined factors associated with self-reported use of genetic testing among breast cancer survivors based on a 2015 cross-sectional survey at eight Midwestern sites. Genetic testing was reported in 39% of our 1235 study participants, with higher utilization among those aged <50 and with a triple-negative cancer. Bilateral mastectomy, having relatives with breast cancer, and younger age were associated with increased genetic testing use. Increasing income, in interaction with age, was associated with use of genetic testing among younger but not older patients. Rural residency emerged as a possible barrier for genetic testing among women with triple-negative cancer.
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Affiliation(s)
| | | | | | | | - Ismail Jatoi
- University of Texas Health Science Center, San Antonio, Texas
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
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20
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Fabian CJ, Klemp JR, Burns JM, Vidoni ED, Nye L, Befort CA, Hamilton-Reeves JM, Sullivan DK, Phillips TA, Hursting SD, Kimler BF. Abstract 2425: Moderate to vigorous physical activity reduces visceral adipose tissue in obese breast cancer survivors undergoing a weight loss intervention. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-2425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Body composition, adipose distribution, and fitness are likely superior to BMI alone in predicting outcomes in obese breast cancer survivors. Visceral adipose tissue (VAT) is thought to be disproportionately responsible for the metabolic and inflammatory changes linking obesity and breast cancer recurrence.
Purpose: Feasibility of achievement of high volume moderate-to-vigorous physical activity (MVPA) and its effect on body composition including VAT and other risk biomarkers in older sedentary, obese breast cancer survivors participating in a behavioral weight loss intervention.
Methods: Modest caloric restriction (350-500 kcal per day) was combined with a study provided YMCA membership and twice weekly personal trainer sessions. MVPA (40-80% of heart rate reserve in older women) was assessed by Garmin Vivoactive smart watches linked to GarminConnect. Total activity was escalated from 100 minutes week 1 to a total of 300 minutes per week by week 9 with a goal of > 200 min/wk as MVPA. Women were evaluated pre- and post-intervention for peak oxygen consumption (VO2peak), body composition by dual energy x-ray absorptiometry (GE Lunar iDXA), and serum levels of adipokines, cytokines, and hormones.
Results: 18 breast cancer survivors were enrolled and completed the 3 months of the behavioral weight loss intervention which included the YMCA membership and twice weekly personal trainer. Median age was 60, 11 had received prior chemotherapy, and 13 were currently taking aromatase inhibitors. Median (and range) baseline anthropomorphic values were BMI 37 (31-43) kg/m2, total mass 95 (76-125) kg, total fat 46 (34-66) kg, and VAT 1.7 (1.0-3.0) kg. All but one had a baseline VAT > 1.17 kg, consistent with elevated risk of metabolic syndrome. 17/18 achieved at least 150 min/wk of MVPA, with a median of 176 (range 55-291) min/wk for weeks 9-12. Fitness measured as VO2peak increased from 18.9 (13.7-25.3) to 21.1 (17.1-31.4) ml/kg/min (p=0.0003; Wilcoxon signed rank test). At 3 months, significant reductions were observed for total mass (median 7%), fat mass (median 13%), and VAT (median 20%, range 1-41%)(p<0.0003); as well as serum leptin, insulin, and leptin: adiponectin ratio (p<0.01). A strong correlation was observed between week 9-12 MVPA and leptin: adiponectin ratio (p=0.001) with more modest correlations between week 9-12 MVPA and VAT loss (p=0.043), and leptin: adiponectin ratio and VAT loss (p=0.013).
Conclusion: High volume moderate-to-vigorous physical activity can be achieved by older, sedentary, obese breast cancer survivors; and this translates to favorable modulation of body composition including VAT measures and serum risk biomarkers.
Citation Format: Carol J. Fabian, Jennifer R. Klemp, Jeffrey M. Burns, Eric D. Vidoni, Lauren Nye, Christie A. Befort, Jill M. Hamilton-Reeves, Debra K. Sullivan, Teresa A. Phillips, Stephen D. Hursting, Bruce F. Kimler. Moderate to vigorous physical activity reduces visceral adipose tissue in obese breast cancer survivors undergoing a weight loss intervention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2425.
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Affiliation(s)
| | | | | | | | - Lauren Nye
- 1University of Kansas Medical Center, Kansas City, KS
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21
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Sharma P, López-Tarruella S, García-Saenz JA, Khan QJ, Gómez HL, Prat A, Moreno F, Jerez-Gilarranz Y, Barnadas A, Picornell AC, Monte-Millán MD, González-Rivera M, Massarrah T, Pelaez-Lorenzo B, Palomero MI, González Del Val R, Cortés J, Fuentes-Rivera H, Morales DB, Márquez-Rodas I, Perou CM, Lehn C, Wang YY, Klemp JR, Mammen JV, Wagner JL, Amin AL, O'Dea AP, Heldstab J, Jensen RA, Kimler BF, Godwin AK, Martín M. Pathological Response and Survival in Triple-Negative Breast Cancer Following Neoadjuvant Carboplatin plus Docetaxel. Clin Cancer Res 2018; 24:5820-5829. [PMID: 30061361 PMCID: PMC6279513 DOI: 10.1158/1078-0432.ccr-18-0585] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/21/2018] [Accepted: 07/24/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Prognostic value of pathologic complete response (pCR) and extent of pathologic response attained with anthracycline-free platinum plus taxane neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) is unknown. We report recurrence-free survival (RFS) and overall survival (OS) according to degree of pathologic response in patients treated with carboplatin plus docetaxel NAC. PATIENTS AND METHODS One-hundred and ninety patients with stage I-III TNBC were treated with neoadjuvant carboplatin (AUC6) plus docetaxel (75 mg/m2) every 21 days × 6 cycles. pCR (no evidence of invasive tumor in breast and axilla) and Residual cancer burden (RCB) were evaluated. Patients were followed for recurrence and survival. Extent of pathologic response was associated with RFS and OS using the Kaplan-Meier method. RESULTS Median age was 51 years, and 52% were node-positive. pCR and RCB I rates were 55% and 13%, respectively. Five percent of pCR patients, 0% of RCB I patients, and 58% of RCB II/III patients received adjuvant anthracyclines. Three-year RFS and OS were 79% and 87%, respectively. Three-year RFS was 90% in patients with pCR and 66% in those without pCR [HR = 0.30; 95% confidence interval (CI), 0.14-0.62; P = 0.0001]. Three-year OS was 94% in patients with pCR and 79% in those without pCR (HR = 0.25; 95% CI, 0.10-0.63; P = 0.001). Patients with RCB I demonstrated 3-year RFS (93%) and OS (100%) similar to those with pCR. On multivariable analysis, higher tumor stage, node positivity, and RCB II/III were associated with worse RFS. CONCLUSIONS Neoadjuvant carboplatin plus docetaxel yields encouraging efficacy in TNBC. Patients achieving pCR or RCB I with this regimen demonstrate excellent 3-year RFS and OS without adjuvant anthracycline.
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Affiliation(s)
- Priyanka Sharma
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas.
| | - Sara López-Tarruella
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | | | - Qamar J Khan
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Henry L Gómez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Fernando Moreno
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Yolanda Jerez-Gilarranz
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Agustí Barnadas
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni C Picornell
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - María Del Monte-Millán
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Milagros González-Rivera
- Laboratory of Translational Oncology, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Tatiana Massarrah
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | | | - María Isabel Palomero
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Ricardo González Del Val
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Javier Cortés
- Department of Oncology, Ramón y Cajal University Hospital, Madrid, Spain. Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Hugo Fuentes-Rivera
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Denisse Bretel Morales
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Iván Márquez-Rodas
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - Charles M Perou
- Departments of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carolyn Lehn
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Yen Y Wang
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Jennifer R Klemp
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Joshua V Mammen
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Jamie L Wagner
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Amanda L Amin
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Anne P O'Dea
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Jaimie Heldstab
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Roy A Jensen
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Bruce F Kimler
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Andrew K Godwin
- Division of Medical Oncology, University of Kansas Medical Center, Westwood, Kansas
| | - Miguel Martín
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain.
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22
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Abstract
Over 200,000 women are diagnosed with breast cancer each year, and incarcerated women face unique risks associated with poor access to healthcare. Regular mammography can diagnose breast cancer early, giving the patient the best chance of survival. The objective of this study was to determine the proportion of jail incarcerated women who have received a mammogram and were up-to-date based on the most recent United States Preventive Services Task Force recommendations. This was a secondary analysis of data collected among jailed women who participated in a cervical cancer literacy program. Rates of mammography were calculated for the group overall and for those women 50 years or older. Subgroups were compared using chi-squared tests. Two hundred sixty-one women were included in the analysis, of which 42.1% (N = 110) had ever had a mammogram. Of women 50 years old or older (N = 28), 75.0% had ever received a mammogram, yet only 39.3% were up-to-date (within the past 2 years). Factors associated with up-to-date mammography included being up-to-date on cervical cancer screening (76.9%) compared with women who were not up-to-date on cervical cancer screening (12.5%), p < 0.01, and women experiencing intimate partner violence (IPV) in the past year (71.4%) compared with women with no IPV in the past year (14.2%), p = 0.02. The low rates of up-to-date mammography highlight the need for more breast cancer prevention programming among women with criminal justice histories.
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Affiliation(s)
- Michelle L Pickett
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Molly Allison
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Katelyn Twist
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer R Klemp
- Department of Medical Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Megha Ramaswamy
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
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Tevaarwerk AJ, Klemp JR, van Londen GJ, Hesse BW, Sesto ME. Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors. Cancer 2018; 124:4292-4300. [PMID: 30277575 DOI: 10.1002/cncr.31546] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/13/2018] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion-adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.
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Affiliation(s)
- Amye J Tevaarwerk
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
| | - Jennifer R Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, Kansas
| | - Gijsberta J van Londen
- University of Pittsburgh Cancer Institute and School/Department of Medicine, Pittsburgh, Pennsylvania
| | - Bradford W Hesse
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Mary E Sesto
- Department of Medicine, University of Wisconsin, Madison and Carbone Cancer Center, Madison, Wisconsin
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24
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Shah RH, Wang YY, Finke K, Yoder R, O'Dea A, Nye LE, Madhusudhana S, Hoffmann MS, Elia M, Crane GJ, Klemp JR, Khan QJ, Kimler BF, Sharma P. Comparison of outcomes for AJCC 8th Anatomic and Prognostic staging in contemporary triple negative breast cancer (TNBC) multisite registry. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yen Y. Wang
- University of Kansas Medical Center, Westwood, KS
| | | | - Rachel Yoder
- University of Kansas Medical Center, Westwood, KS
| | - Anne O'Dea
- Kansas University Medical Center, Westwood, KS
| | | | | | | | - Manana Elia
- University of Kansas Cancer Center, Mission Hill, KS
| | | | | | - Qamar J. Khan
- University of Kansas Medical Center, Kansas City, KS
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25
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Klemp JR, Vanbebber H, Folker T, Serig L, Metcalf T, Roberts A, Cooper M, Fernandez D. A health system wide approach to the delivery of survivorship care plans. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
42 Background: Survivorship care plans (SCPs) are recognized by organizations including the American Society of Clinical Oncology and the American College of Surgeons Commission on Cancer, as a best practice for improving survivor care. Little evidence supports this and hospitals and cancer centers are scrambling to meet deadlines for SCP development and delivery. The University of Kansas Cancer Center (KUCC) addressed this utilizing electronic health record (EHR) integration, developing a health system wide approach to education and delivery, and building referral workflows to primary care and specialists. We report on this approach to developing and growing a survivorship care program. Methods: KUCC is a NCI designated cancer center within an academic medical center and health system, with 11 outpatient locations across the Kansas City. Under the guidance of a multidisciplinary team: providers, health care informatics, administrators, nursing, tumor registry, quality improvement, and researchers, KUCC developed a step-wise process to deliver comprehensive survivorship care across the health system. This multi-year initiative aligned with institutional accreditation standards and an ongoing focus on expanding evidence based, comprehensive cancer and supportive care. Results: In 2014 a formal survivorship program plan was put into action: Support from leadership, providers, research priority; Staff and patient survivorship education & training; Integrated delivery of survivorship care at all locations with direct interaction and feedback from cancer care teams; Short & long-term programmatic goals; Management and referral of late effects of cancer; EPIC integrated SCP template: auto-populated, customized, personalized; treatment summary uses tools that pull in data stored discreetly in the patient "file"; SCP delivery targeting COC phase-in timeline: 2015: n= 539 (10% projection n= 434); 2016: n= 1,355 (25% projection n=1,253). Conclusions: This step-wise, integrated approach to survivorship care has resulted in a health system wide delivery of SCPs and meeting national accreditation standards. Next steps include the evaluation of cost and clinical/patient reported outcomes.
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Affiliation(s)
| | | | - Tanya Folker
- University of Kansas Health System, Kansas City, KS
| | - Lisa Serig
- University of Kansas Health System, Kansas City, KS
| | - Tim Metcalf
- University of Kansas Health System, Kansas City, KS
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26
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Klemp JR, Lowry BN, Johnston JA, Alsman K, Peereboom D, Long T, Krigel S, Krebill H, Greiner A. Delivery of survivorship care from rural primary care and oncology practices. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
85 Background: While evidence-based guidelines for survivorship care exist, implementation in oncology and primary care practices has fallen short. There is little evidence of the barriers preventing successful implementation in rural primary care and oncology practices. We sought to assess knowledge gaps and barriers to successful implementation of evidence-based survivorship care guidelines in rural Kansas practices. Methods: Midwest Cancer Alliance, outreach arm of the University of Kansas Cancer Center, and Kansas Patients and Providers Engaged in Prevention Research, completed interviews in rural primary care and oncology practices. Results: Primary Care (n=7) and Oncology Practices (n=4): Interviews with primary care physicians, medical oncologists, advanced practice providers, nurses, tumor registrar, outreach coordinator, and office management & staff. Conclusions: Rural primary care and oncology practices experienced barriers to delivering survivorship care including: educational gaps, communication of history, treatment, and recommendations, EHR integration, and lack of resources. Next steps focus on a unified approach to state-wide survivorship education of patients, primary care and oncology practices. [Table: see text]
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Affiliation(s)
| | | | - Judy A Johnston
- University of Kansas School of Medicine-Wichita, Wichita, KS
| | | | | | - Trish Long
- University of Kansas Medical Center, Kansas City, KS
| | - Susan Krigel
- Midwest Cancer Alliance, University of Kansas Medical Center, Fairway, KS
| | - Hope Krebill
- Midwest Cancer Alliance, University of Kansas Medical Center, Fairway, KS
| | - Allen Greiner
- University of Kansas Medical Center, Kansas City, KS
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Mina A, Lehn C, Wang YY, Klemp JR, O'Dea AP, Elia M, Hoffmann M, Crane G, Sheehan M, Madhusudhana S, Jensen RA, Godwin AK, Khan QJ, Kimler BF, Sharma P. Abstract P4-10-06: Influence of older age on triple negative breast cancer (TNBC) clinical-pathological characteristics and outcomes. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The impact of age at diagnosis on clinical presentation and treatment delivery for triple negative breast cancer (TNBC) is unclear. Utilizing data from a prospective registry, the aim of this study was to further elucidate the age-dependent correlation between TNBC clinical-pathological features, and the implications of age-bias on treatment delivery and prognosis.
Methods: 480 subjects with stage I-III TNBC were enrolled in an IRB approved multisite prospective registry between 2011 and 2016. Clinical, demographic, treatment information was collected and patients were followed for recurrence and survival. Patients were categorized as older (>60 years) or younger groups (<60 years). Recurrence free survival (RFS) and overall survival (OS) were estimated according to the Kaplan-Meier method and compared among groups by log-rank test.
Results: 145 (30%) of 480 TNBC patients were older (> 60 years) at time of diagnosis. Compared to younger patients, older patients were more likely to present with screen detected vs symptomatic cancer (47% vs 25% p=<0.001), more likely to have node negative cancer (71% vs 61% p=0.030), stage I disease (42% vs 28% p=0.003), and low level (1-10%) ER or PR positivity (19% vs 12% p=0.046). Compared to the younger patients, older patients were less likely to have a BRCA1/2 mutation (6% vs 23% p=0.0002) but more likely to have a prior history of hormone positive breast cancer (7% vs 1% p=0.0002). Compared to younger counterparts, older patients were less likely to receive neo/adjuvant chemotherapy (93% vs 99% p=0.0006), and less likely to receive > 4 cycles of neo/adjuvant chemotherapy (61% vs 78%, p=0.0003). Three year RFS for the entire cohort was 80% and was identical for older and younger patients at 80%. Three year OS for the entire cohort was 87% and was similar for older and younger patients. On multivariable analysis only tumor size and nodal status significantly impacted RFS.
Conclusions: A significant fraction (30%) of TNBC patients are older (> 60 years) at time of diagnosis. Despite presenting a with more favorable disease stage, older TNBC patients did not demonstrate better outcomes compared to the higher risk younger patients. The underlying reasons for this observation may be tumor biology differences between older and younger TNBC patients or perhaps could be related to underutilization of appropriate systemic chemotherapy (39% of older patients received < 4 cycles of chemotherapy). Further studies are warranted on this subject.
Citation Format: Mina A, Lehn C, Wang YY, Klemp JR, O'Dea AP, Elia M, Hoffmann M, Crane G, Sheehan M, Madhusudhana S, Jensen RA, Godwin AK, Khan QJ, Kimler BF, Sharma P. Influence of older age on triple negative breast cancer (TNBC) clinical-pathological characteristics and outcomes [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 P4-10-06.
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Affiliation(s)
- A Mina
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - C Lehn
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - YY Wang
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - JR Klemp
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - AP O'Dea
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - M Elia
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - M Hoffmann
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - G Crane
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - M Sheehan
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - S Madhusudhana
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - RA Jensen
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - AK Godwin
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - QJ Khan
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - BF Kimler
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
| | - P Sharma
- University of Kansas Medical Center, Kansas City, KS; Truman Medical Center, Kansas City, MO
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Fabian CJ, Klemp JR, Burns JM, Vidoni ED, Nydegger JL, Kreutzjans AL, Phillips TL, Baker HA, Hendry B, John C, Amin AL, Khan QJ, Mitchell MP, O'Dea AP, Sharma P, Wagner JL, Hursting SD, Kimler BF. Abstract P6-12-11: Feasibility and biomarker modulation due to high levels of moderate to vigorous physical activity as part of a weight loss intervention in older, sedentary, obese breast cancer survivors. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
We sought to demonstrate that older, sedentary, obese breast cancer survivors could achieve > 200 minutes per week of moderate to vigorous physical activity (MVI PA) as part of a weight loss intervention; and to assess modulation of risk biomarkers. This level of PA in combination with moderate calorie restriction is associated with weight losses of >10% in women without cancer, which in turn is associated with significant modulation of cancer risk biomarkers.
Eleven participants with BMI > 30 kg/m2 enrolled in a 12-week program that consisted of moderate caloric restriction, weekly phone group behavioral sessions, and individualized exercise plans based on measured heart rate reserve. Women were provided an accelerometer with heart rate monitor linked to GarminConnect, membership to a YMCA, twice weekly supervised exercise sessions with a personal trainer, and weekly feedback regarding weight and physical activity progress. The goal was to increase MVI PA (≥45% heart rate reserve) gradually from <60 to >200 minutes per week.
The median age was 61, 5/11 women had received prior chemotherapy, and 7/11 were currently taking aromatase inhibitors. Median values of baseline anthropomorphic measures acquired by dual energy x-ray absorptiometry (GE Lunar iDXA) included BMI, 37.3 kg/m2; total mass, 97.5 kg; fat mass, 47.6 kg; visceral fat, 1.7 kg (range 1.4-3.0); and fat mass index, 17.6 kg/m2. The majority had a baseline VO2 peak in the poor range for their age. All 11 participants completed the intervention, with no reported serious adverse events. Median MVI PA achieved over weeks 5-12 was 161 minutes/week (range 48-320). VO2 peak was increased in 10/11 with a median relative change of 12% from baseline. All but one lost weight with an overall median of 8% total mass loss, which was associated with 13% total fat mass loss and 21% visceral fat mass loss. For those with MVI PA above the median, values were 11%, 17%, and 40%, respectively. Visceral fat mass loss was linearly correlated with minutes per week of MVI PA (p=0.032); these parameters in turn were associated with changes in a number of serum biomarkers, including adiponectin-leptin ratio, TNF-alpha, as well as circulating adipose stromal cells, a potential marker for metastasis. Insulin and hs-CRP were favorably modulated in almost all participants but change was not linearly correlated with activity or mass loss parameters; thus these may not be ideal biomarkers to document a dose response to level of MVI PA.
Conclusion: These results demonstrate that older, sedentary, obese breast cancer survivors can safely achieve a high level of MVI PA when provided a structured program that includes an exercise trainer. It is feasible to design a clinical trial for such breast cancer survivors to examine biomarker modulation as a function of level of physical activity.
Citation Format: Fabian CJ, Klemp JR, Burns JM, Vidoni ED, Nydegger JL, Kreutzjans AL, Phillips TL, Baker HA, Hendry B, John C, Amin AL, Khan QJ, Mitchell MP, O'Dea AP, Sharma P, Wagner JL, Hursting SD, Kimler BF. Feasibility and biomarker modulation due to high levels of moderate to vigorous physical activity as part of a weight loss intervention in older, sedentary, obese breast cancer survivors [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 P6-12-11.
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Affiliation(s)
- CJ Fabian
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - JR Klemp
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - JM Burns
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - ED Vidoni
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - JL Nydegger
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - AL Kreutzjans
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - TL Phillips
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - HA Baker
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - B Hendry
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - C John
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - AL Amin
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - QJ Khan
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - MP Mitchell
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - AP O'Dea
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - P Sharma
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - JL Wagner
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - SD Hursting
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
| | - BF Kimler
- University of Kansas Medical Center, Kansas City, KS; University of North Carolina, Chapel Hill, NC
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Klemp JR, Myers JS, Fabian CJ, Kimler BF, Khan QJ, Sereika SM, Stanton AL. Cognitive functioning and quality of life following chemotherapy in pre- and peri-menopausal women with breast cancer. Support Care Cancer 2017; 26:575-583. [PMID: 28849337 DOI: 10.1007/s00520-017-3869-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/21/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of the study was to prospectively examine changes in subjective and objective cognitive functions and quality of life (QOL) for pre- and peri-menopausal women receiving chemotherapy for breast cancer and to explore potential predictors of cognitive changes. METHODS Participants were assessed as follows: prior to chemotherapy (T1), after cycle 3 (T2), within 2-3 weeks of completing adjuvant chemotherapy (T3) (N = 20), and 8+ years later (T4; n = 18). Objective cognitive function was measured with the High Sensitivity Cognitive Screen (T1, T3, T4). Subjective measures for cognitive function, depressive symptoms, fatigue, and mental and physical QOL were assessed at all time points. Estradiol levels were measured at T1, T2, and T3. The Functional Assessment of Cancer Therapy-Cognition and the MD Anderson Cancer Symptom Inventory item for neuropathy were administered at T4. RESULTS No significant changes in objective cognitive function were found. However, participants reported decreased cognitive function over the course of treatment accompanied by depressive symptoms and fatigue. Depression and fatigue returned to near-baseline levels at T4, but over half of the participants continued to report mild to moderate depression. Estradiol levels were not associated with cognitive function. Neuropathy and higher body mass index (BMI) were associated with persistent cognitive complaints at T4 (adjusted R 2 = 0.712, p = 0.001). Higher QOL was correlated with better subjective cognitive function (r = 0.705, p = 0.002) and lower body mass index (r = - 0.502, p = 0.017) at T4. CONCLUSIONS Further investigation of BMI, neuropathy, and depressive symptoms as predictors of persistent cognitive dysfunction following chemotherapy for breast cancer is warranted.
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Affiliation(s)
- Jennifer R Klemp
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Jamie S Myers
- University of Kansas School of Nursing, 3901 Rainbow Blvd, MS 4043, Kansas City, KS, 66160, USA. .,School of Nursing, University of Pittsburgh, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.
| | - Carol J Fabian
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Bruce F Kimler
- University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4033, Kansas City, KS, 66160, USA
| | - Qamar J Khan
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Annette L Stanton
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA, 90095-1563, USA
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Khan QJ, Kimler BF, Reddy PS, Sharma P, Klemp JR, Nydegger JL, Yeh HW, Fabian CJ. Randomized trial of vitamin D3 to prevent worsening of musculoskeletal symptoms in women with breast cancer receiving adjuvant letrozole. The VITAL trial. Breast Cancer Res Treat 2017; 166:491-500. [PMID: 28770449 DOI: 10.1007/s10549-017-4429-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) frequently occur in women being treated for breast cancer. Prior studies suggest high prevalence of vitamin D deficiency in breast cancer patients with musculoskeletal (MS) pain. We conducted a randomized, placebo-controlled trial to determine if 30,000 IU vitamin D3 per week (VitD3) would prevent worsening of AIMSS in women starting adjuvant letrozole for breast cancer. METHODS Women with stage I-III breast cancer starting adjuvant letrozole and 25(OH)D level ≤40 ng/ml were eligible. All subjects received standard daily supplement of 1200 mg calcium and 600 IU vitamin D3 and were randomized to 30,000 IU oral VitD3/week or placebo. Pain, disability, fatigue, quality of life, 25(OH)D levels, and hand grip strength were assessed at baseline, 12, and 24 weeks. The primary endpoint was incidence of an AIMSS event. RESULTS Median age of the 160 subjects (80/arm) was 61. Median 25OHD (ng/ml) was 25 at baseline, 32 at 12 weeks, and 31 at 24 weeks in the placebo arm and 22, 53, and 57 in the VitD3 arm. There were no serious adverse events. At week 24, 51% of women assigned to placebo had a protocol defined AIMSS event (worsening of joint pain using a categorical pain intensity scale (CPIS), disability from joint pain using HAQ-II, or discontinuation of letrozole due to MS symptoms) vs. 37% of women assigned to VitD3 (p = 0.069). When the brief pain inventory (BPI) was used instead of CPIS, the difference was statistically significant: 56 vs. 39% (p = 0.024). CONCLUSIONS Although 30,000 IU/week of oral vitamin D3 is safe and effective in achieving adequate vitamin D levels, it was not associated with a decrease in AIMSS events based on the primary endpoint. Post-hoc analysis using a different tool suggests potential benefit of vitamin D3 in reducing AIMSS.
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Affiliation(s)
- Qamar J Khan
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Bruce F Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160-7321, USA.
| | | | - Priyanka Sharma
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jennifer R Klemp
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jennifer L Nydegger
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hung-Wen Yeh
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Carol J Fabian
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Kimler BF, Nydegger JL, Kreutzjans AL, Phillips TL, Powers KR, Klemp JR, Sullivan DK, Befort CA, Carlson SE, Hursting SD, Fabian CJ. Abstract 4230: Modulation of adiponectin and leptin levels in obese post-menopausal women after 6 months of a structured weight loss intervention, randomized to placebo or supplemental omega-3 fatty acids. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Obesity is a modifiable risk factor for breast cancer in the United States. While structured interventions can achieve short-term weight loss, this does not necessarily correlate with favorable modulation of risk biomarkers at the blood or breast tissue level. We combined a proven intervention (calorie-controlled meals, moderate exercise, and weekly group behavioral session) with daily omega-3 fatty acid supplementation to examine whether we could improve either weight loss and/or biomarker modulation in women who are at high risk for development of breast cancer. Methods 46 post-menopausal high-risk women with a BMI > 27 kg/m2 (median 31 kg/m2) had baseline blood collections and random periareolar fine needle aspiration (RPFNA) benign breast tissue sampling for biomarkers. Two weeks after starting the weight loss intervention, subjects received study agent, randomized 1:1 to placebo vs. supplementation with 2100 mg Eicosapentaenoic Acid (EPA) + 1050 mg Docosahexaenoic Acid (DHA) daily. After 6 months, blood and tissue sampling were repeated. Results 42 women completed the 6 month weight loss intervention with all but one achieving a weight loss (median relative weight loss 12%; range 0 to 23%). For the entire cohort, there were substantial and favorable changes in levels in serum of blood collected fasting for adiponectin (increase; p<0.01) and leptin (decrease, p<0.001), as well as the ratio of adiponectin to leptin (A:L, increase, p<0.001). The same effect for all three measures was observed in serum collected 2 hours after a standard meal; and for leptin and the A:L ratio in breast tissue also collected postprandial. When dichotomized to relative weight losses of <10% vs >10%, women with >10% loss had greater favorable modulations for leptin and the A:L ratio for fasting and non-fasting serum (<0.0001 for all) as well as breast tissue (p<0.004). There were no significant differences between groups of women dichotomized by whether they exhibited (or not) an increase in the ratio of EPA:DHA to arachidonic acid in erythrocyte phospholipids at 6 months. Conclusions These results demonstrate that the cytokines adiponectin and leptin, and the ratio of the two, are robust biomarkers for modulation in serum and breast tissue of women achieving a successful weight loss on a structured intervention trial.Supported by a grant from the Breast Cancer Research Foundation and pilot funds from National Cancer Institute Cancer Center Support Grant P30 CA168524.
Citation Format: Bruce F. Kimler, Jennifer L. Nydegger, Amy L. Kreutzjans, Teresa L. Phillips, Kandy R. Powers, Jennifer R. Klemp, Debra K. Sullivan, Christie A. Befort, Susan E. Carlson, Stephen D. Hursting, Carol J. Fabian. Modulation of adiponectin and leptin levels in obese post-menopausal women after 6 months of a structured weight loss intervention, randomized to placebo or supplemental omega-3 fatty acids [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4230. doi:10.1158/1538-7445.AM2017-4230
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Prochaska LH, Godwin AK, Kimler BF, Lehn C, Klemp JR, O'Dea A, Elia M, Hoffmann MS, Crane G, McKittrick R, Sheehan M, Graff SL, Madhusudhana S, Khan QJ, Jensen RA, Sharma P. Abstract P5-16-02: Pathological complete response is associated with excellent outcomes in BRCA mutation associated triple negative breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-16-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Pathological complete response (pCR) in unselected triple negative breast cancer (TNBC) is associated with excellent long-term survival. However, controversy remains as to whether pCR in BRCA mutation associated (BRCA[+]) TNBC is predictive of improved long-term outcome. A recent study suggests that pCR was not a surrogate for outcomes in BRCA1 associated TNBC. All of the patients in this study harbored an Ashkenazi Jewish founder BRCA1 mutation and the majority of mutation carriers underwent lumpectomy. Impact of pCR as it relates to BRCA status in a larger, heterogeneous TNBC cohort treated in a contemporary time frame is not known.
Aim: Evaluate and compare the prognostic impact of pCR as it relates to the BRCA mutation status in patients enrolled in a prospective multisite TNBC registry.
Methods: 453 patients with stage I-III TNBC were enrolled within a multisite registry between 2011- 2015, out of which 173 received neoadjuvant chemotherapy (NAC) and also underwent germline BRCA testing. pCR in the breast and axilla was evaluated and patients were followed for reoccurrence and survival. Recurrence free survival (RFS) was estimated according to the Kaplan-Meier method and compared among groups with log-rank statistic.
Results: For the 173 eligible patients the median age was 49 years; African-American:14%; median tumor size:3 cm; 42%:Lymph node positive; and 18% (32/173) demonstrated BRCA mutation (BRCA1=28, BRCA2=4). All patients received anthracycline and/or taxane based NAC. pCR rates for BRCA[+] and wild type (BRCA[-]) patients was 72% and 46% respectively (p=0.01). 97% of BRCA[+] and 42% of BRCA[-] patients underwent bilateral mastectomy (p=0.001). The three year RFS was 92% and 81% in BRCA[+] and BRCA[-] patients, respectively (p=0.18). Attainment of pCR was associated with excellent 3 year RFS of 95% and 97% in BRCA[+] and BRCA[-] patients, respectively (p=0.85). Among BRCA[-] patients lack of pCR was associated with significantly worse 3 year RFS (70% RFS in patients without pCR, compared to 97% in patients with pCR; p=0.001). Among BRCA[+] patients lack of pCR was associated with numerically lower but not statistically significant worse 3 year RFS (83% RFS in patients without pCR, compared to 95% in patients with pCR; p=0.41). On multivariable Cox regression analysis, only stage III disease was associated with higher risk of relapse (p<0.001).
Conclusions: Our observation of higher pCR in BRCA-carriers compared to wild-type TNBC patients is consistent with previously published literature. In this contemporary cohort of TNBC patients for whom the majority of BRCA[+] patients underwent bilateral mastectomy, attainment of pCR carried an excellent prognosis in both BRCA[+] and BRCA[-] patients. On the other hand, BRCA[+] patients who do not attain pCR may have better outcomes compared to BRCA[-] patients without pCR. Further research to explore the underlying biological mechanisms involved in tumor response and relapse in BRCA[+] and BRCA[-] TNBC patients is needed. Furthermore, given these observations, germline BRCA mutation status should be used as a stratification variable in studies evaluating pCR and long term outcomes with investigational therapies in TNBC.
Citation Format: Prochaska LH, Godwin AK, Kimler BF, Lehn C, Klemp JR, O'Dea A, Elia M, Hoffmann MS, Crane G, McKittrick R, Sheehan M, Graff SL, Madhusudhana S, Khan QJ, Jensen RA, Sharma P. Pathological complete response is associated with excellent outcomes in BRCA mutation associated triple negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-02.
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Affiliation(s)
- LH Prochaska
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - AK Godwin
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - BF Kimler
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - C Lehn
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - JR Klemp
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - A O'Dea
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - M Elia
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - MS Hoffmann
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - G Crane
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - R McKittrick
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - M Sheehan
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - SL Graff
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - S Madhusudhana
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - QJ Khan
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - RA Jensen
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
| | - P Sharma
- University of Kansas Medical Center, Westwood, KS; Sarah Cannon Cancer Center, Overland Park, KS; Truman Medical Center, Kansas City, MO
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Fabian CJ, Kimler BF, Umar S, Ahmed I, Befort CA, Nydegger JL, Kreutzjans AL, Powers KR, Klemp JR, Spaeth KR, Sullivan DK. Abstract P4-13-03: Changes in the gut microbiome of post-menopausal women 2 weeks after initiating a structured weight loss intervention. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-13-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Change in the relative composition of the gut microbiome at the phyla level, particularly decreases in Bacteroidetes and increases in Firmicutes species, has been associated with both obesity and increased risk for breast cancer. It is unclear how rapidly the microbiome changes in response to a reduced calorie and fat diet during a weight loss intervention. As a planned sub-study of a clinical trial with a structured behavioral weight loss intervention with randomization to high dose omega-3 fatty acids or placebo (NCT02101970; clinical trials.gov), we evaluated changes in the gut microbiome after 2 weeks of dietary intervention.
Methods
46 post-menopausal women at increased risk for breast cancer with a BMI > 27 kg/m2 had a baseline 3 day food record, DXA, and blood and breast tissue sampling for biomarkers. They were then started on a reduced fat and calorie diet (~1200 kcal/day from 2 portion-controlled entrees, 3 low calorie high protein shakes, and 5 servings of fruits/vegetables daily), recommendation to exercise 225 minutes per week, and a weekly behavioral intervention. Fecal samples were collected at baseline, after 2 weeks of diet but prior to study agent, and after 6 months of weight loss intervention. Stool samples were stored at -20°C until brought to the clinic, and then at -80°C until DNA extraction. Bacterial taxonomic classification was performed using real-time PCR and 16S pyrosequencing using specific 16S rRNA primers. Baseline Healthy Eating Index (HEI) was calculated from the 3 day food record; fruit and vegetable servings were obtained from weekly food logs.
Results
42 women completed the 6 month weight loss intervention. At baseline, median BMI was 31.0 kg/m2 and HEI was 58 (range 28-90) with 12 and 23 servings of fruits and vegetables per week. Median relative weight loss at 6 months was -11.9 % (0 to -22.7 %). When dichotomized to relative losses of <10% vs >10% (which we have previously shown to be associated with significant improvement in blood and breast tissue risk biomarkers [Fabian Cancer Prev Res 2013]), women with 6 month >10% loss had favorable change in the two major stool phyla at 2 weeks with a median 10% increase for Bacteroidetes and 8% decrease for Firmicutes. Conversely, women with <10% loss showed a decrease (median -11%) in Bacteroidetes and an increase (median 16%) for Firmicutes. Fruit and vegetable consumption also differed between the weight loss groups. The >10% loss group had higher baseline consumption of vegetables and continued this after starting the diet. The more adherent a woman was to dietary recommendations in the first weeks of dietary intervention, the more likely she was to lose >10% weight by 6 months.
Conclusions
Favorable modulation of the gut microbiome early in a weight loss intervention is associated with subsequent substantial weight loss. Microbiome assessment after 6 months of weight loss intervention is in progress.
Supported by a grant from the Breast Cancer Research Foundation and pilot funds from National Cancer Institute Cancer Center Support Grant P30 CA168524.
Citation Format: Fabian CJ, Kimler BF, Umar S, Ahmed I, Befort CA, Nydegger JL, Kreutzjans AL, Powers KR, Klemp JR, Spaeth KR, Sullivan DK. Changes in the gut microbiome of post-menopausal women 2 weeks after initiating a structured weight loss intervention [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-13-03.
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Affiliation(s)
- CJ Fabian
- University of Kansas Medical Center, Kansas City, KS
| | - BF Kimler
- University of Kansas Medical Center, Kansas City, KS
| | - S Umar
- University of Kansas Medical Center, Kansas City, KS
| | - I Ahmed
- University of Kansas Medical Center, Kansas City, KS
| | - CA Befort
- University of Kansas Medical Center, Kansas City, KS
| | - JL Nydegger
- University of Kansas Medical Center, Kansas City, KS
| | - AL Kreutzjans
- University of Kansas Medical Center, Kansas City, KS
| | - KR Powers
- University of Kansas Medical Center, Kansas City, KS
| | - JR Klemp
- University of Kansas Medical Center, Kansas City, KS
| | - KR Spaeth
- University of Kansas Medical Center, Kansas City, KS
| | - DK Sullivan
- University of Kansas Medical Center, Kansas City, KS
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Abstract
233 Background: Cancer survivors are at increased risk for cancer recurrence and new primary cancer, and engage in lifestyle behaviors that can adversely affect risk and quality of life. Primary care physicians and oncologists are in a position to refer patients to evidence-based interventions for primary and secondary cancer prevention. This study aims to gain an understanding into the diagnostic characteristics of cancer survivors and lifestyle behaviors between persons ever diagnosed and never diagnosed with cancer in Kansas. Methods: Data from Kansas Cancer Registry (KCR) was used to examine the diagnostic characteristics by cancer status: cancer survivor (diagnosed and alive) or non-survivors (diagnosed and deceased). Group differences in selected characteristics were evaluated by t-tests and chi-square tests. Logistic regression was applied to assess the odds of being a survivor based on stage of diagnosis. The 2014 Kansas Behavioral Risk Factor Surveillance System (KS-BRFSS) data was used to compare health risk behaviors, health status, and health care access between persons ever diagnosed and never diagnosed with cancer. Distributions of both groups were evaluated by linear and logistic regression to produce adjusted percentages. Results: Significant group differences were observed between cancer survivors and non-survivors.The odds of being a non-survivor were 11.6 times greater for those initially diagnosed at a distant stage compared to those diagnosed with localized disease. Survivors were significantly more likely to be older, female, and retired; and were significantly more likely to be current smokers, physically inactive, and emotionally unhealthy. Conclusions: Cancer survivors are now living longer with and through their disease, but in our study reported an increase in unhealthy behaviors compared with those never diagnosed with cancer. Results from this study indicate the need of survivor health education and access to care, and provider continuing education (for both primary care physicians and oncologists), targeting lifestyle behaviors associated with cancer and chronic disease management.
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Sharma P, López-Tarruella S, García-Saenz JA, Ward C, Connor CS, Gómez HL, Prat A, Moreno F, Jerez-Gilarranz Y, Barnadas A, Picornell AC, del Monte-Millán M, Gonzalez-Rivera M, Massarrah T, Pelaez-Lorenzo B, Palomero MI, González del Val R, Cortes J, Fuentes H, Bretel D, Márquez-Rodas I, Perou CM, Wagner JL, Mammen JV, McGinness MK, Klemp JR, Amin AL, Fabian CJ, Heldstab J, Godwin AK, Jensen RA, Kimler BF, Khan QJ, Martin M. Efficacy of Neoadjuvant Carboplatin plus Docetaxel in Triple-Negative Breast Cancer: Combined Analysis of Two Cohorts. Clin Cancer Res 2017; 23:649-657. [PMID: 27301700 PMCID: PMC5156592 DOI: 10.1158/1078-0432.ccr-16-0162] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/09/2016] [Accepted: 05/23/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Recent studies demonstrate that addition of neoadjuvant (NA) carboplatin to anthracycline/taxane chemotherapy improves pathologic complete response (pCR) in triple-negative breast cancer (TNBC). Effectiveness of anthracycline-free platinum combinations in TNBC is not well known. Here, we report efficacy of NA carboplatin + docetaxel (CbD) in TNBC. EXPERIMENTAL DESIGN The study population includes 190 patients with stage I-III TNBC treated uniformly on two independent prospective cohorts. All patients were prescribed NA chemotherapy regimen of carboplatin (AUC 6) + docetaxel (75 mg/m2) given every 21 days × 6 cycles. pCR (no evidence of invasive tumor in the breast and axilla) and residual cancer burden (RCB) were evaluated. RESULTS Among 190 patients, median tumor size was 35 mm, 52% were lymph node positive, and 16% had germline BRCA1/2 mutation. The overall pCR and RCB 0 + 1 rates were 55% and 68%, respectively. pCRs in patients with BRCA-associated and wild-type TNBC were 59% and 56%, respectively (P = 0.83). On multivariable analysis, stage III disease was the only factor associated with a lower likelihood of achieving a pCR. Twenty-one percent and 7% of patients, respectively, experienced at least one grade 3 or 4 adverse event. CONCLUSIONS The CbD regimen was well tolerated and yielded high pCR rates in both BRCA-associated and wild-type TNBC. These results are comparable with pCR achieved with the addition of carboplatin to anthracycline-taxane chemotherapy. Our study adds to the existing data on the efficacy of platinum agents in TNBC and supports further exploration of the CbD regimen in randomized studies. Clin Cancer Res; 23(3); 649-57. ©2016 AACR.
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Affiliation(s)
- Priyanka Sharma
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Sara López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | | | - Claire Ward
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Carol S. Connor
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Henry L. Gómez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú ()
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain ()
- Translational Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain ()
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain ()
| | - Fernando Moreno
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain ()
| | - Yolanda Jerez-Gilarranz
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | - Augusti Barnadas
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona ()
| | - Antoni C. Picornell
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain ()
| | - Maria del Monte-Millán
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | - Milagros Gonzalez-Rivera
- Laboratory of Translational Oncology. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain ()
| | - Tatiana Massarrah
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | | | - María Isabel Palomero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | - Ricardo González del Val
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | - Javier Cortes
- Department of Oncology, Ramon y Cajal University Hospital, Madrid, Spain. Vall d’Hebron institute of Oncology (VHIO), Barcelona, Spain. ()
| | - Hugo Fuentes
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú ()
| | - Denisse Bretel
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú ()
| | - Iván Márquez-Rodas
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
| | - Charles M. Perou
- LinebergerComprehensiveCancer Center, Departments of Genetics and Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, ()
| | - Jamie L. Wagner
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Joshua V. Mammen
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Marilee K. McGinness
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Jennifer R. Klemp
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Amanda L. Amin
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Carol J. Fabian
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Jaimie Heldstab
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Andrew K. Godwin
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Roy A. Jensen
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Bruce F. Kimler
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Qamar J. Khan
- University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS, USA
| | - Miguel Martin
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Dr. Esquerdo 46, 28007 Madrid, Spain;
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Befort CA, Klemp JR, Sullivan DK, Shireman T, Diaz FJ, Schmitz K, Perri MG, Fabian C. Weight loss maintenance strategies among rural breast cancer survivors: The rural women connecting for better health trial. Obesity (Silver Spring) 2016; 24:2070-7. [PMID: 27581328 PMCID: PMC5039073 DOI: 10.1002/oby.21625] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Obesity is a risk factor for breast cancer recurrence. Rural women have higher obesity rates compared with urban women and are in need of distance-based interventions that promote long-term weight loss. METHODS In this two-phase trial, rural breast cancer survivors who lost >5% of their starting weight during a 6-month lifestyle intervention (delivered through weekly group conference calls) were randomized to one of two 12-month interventions for weight loss maintenance: continued biweekly phone-based group counseling or mailed newsletters. The primary outcome was weight regain from 6 to 18 months. Secondary outcomes included dichotomous measures of weight change and costs. RESULTS Mean weight loss at 6 months was 14.0 ± 5.1%. Participants in the group phone condition regained less weight (3.3 ± 4.8 kg) compared with participants in the newsletter condition (4.9 ± 4.8 kg; P = 0.03). At 18 months, 75.3% of participants in the group phone condition remained ≥5% below baseline weight compared with 57.8% in the newsletter condition (P = 0.02). Incremental cost-effectiveness ratios were $882 to keep one more person ≥5% below baseline weight. CONCLUSIONS A lifestyle intervention incorporating group phone-based support improved the magnitude of weight loss maintained and increased the proportion of survivors who maintained clinically significant reductions.
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Affiliation(s)
- Christie A Befort
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | - Jennifer R Klemp
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Theresa Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA
| | - Francisco J Diaz
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kathryn Schmitz
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Carol Fabian
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Barr JA, O'Dea A, Ranallo L, Fabian CJ, Klemp JR. Breast cancer survivorship: A model for risk assessment and follow-up care. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Anne O'Dea
- University of Kansas Medical Center, Westwood, KS
| | - Lori Ranallo
- University of Kansas Cancer Center, Westwood, KS
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Sharma P, Kimler BF, Ward C, O'Dea A, Hoffmann MS, Klemp JR, McGinness M, Wagner JL, Mammen J, Amin AL, Lehn C, Jensen RA, Godwin AK, Khan QJ. Prognosis of triple negative breast cancer patients who attain pathological complete response with neoadjuvant carboplatin/docetaxel and do not receive adjuvant anthracycline chemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Claire Ward
- University of Kansas Medical Center, Westwood, KS
| | - Anne O'Dea
- University of Kansas Medical Center, Westwood, KS
| | | | | | | | | | - Joshua Mammen
- University of Kansas Medical Center, Kansas City, KS
| | | | - Carolyn Lehn
- University of Kansas Medical Center, Westwood, KS
| | - Roy A. Jensen
- The University of Kansas Cancer Center, Kansas City, KS
| | | | - Qamar J. Khan
- University of Kansas Medical Center, Kansas City, KS
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Befort CA, Klemp JR, Sullivan DK, Diaz FJ, Schmitz KH, Perri MG, Fabian CJ. Abstract P3-08-02: Comparison of strategies for weight loss maintenance among rural breast cancer survivors: The rural women connecting for better health randomized controlled trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-08-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer survivors who reside in rural areas represent one of the largest medically underserved populations of breast cancer survivors in the nation and have higher obesity prevalence compared to their urban counterparts. Given the evidence linking obesity with poor breast cancer prognosis, trials are needed to demonstrate ability to produce long-term weight loss maintenance in this hard-to-reach group. Group phone-based counseling via conference calls is a low-technology approach with excellent reach to rural areas. This treatment delivery approach capitalizes on the support benefits of in-person groups by allowing participants to interact in real time while also diminishing costs.
Methods: In this 2 phase trial, overweight and obese (BMI 27 to 45 kg/m2) rural breast cancer survivors (with initial stage 0-III disease) were randomized to one of two extended care interventions for weight loss maintenance (Phase 2) subsequent to an initial 6-month weekly group phone-based behavioral weight loss intervention (Phase 1). To be eligible for randomization for maintenance, participants must have lost ≥ 5% of their baseline weight during Phase 1. In Phase 2, participants were randomized to continued group phone-based counseling reduced in frequency to every other week during maintenance vs every other week mailed newsletters that followed the same content.
Results: 210 breast cancer survivors with a mean time since treatment of 3.5 years ± 2.4 years, mean age of 58.1 ± 9.9 years, and mean BMI of 33.9 ± 4.4 kg/m2 residing in a three state region of the rural Midwest were entered in the 6-month weight loss phase. Retention from baseline to 6 months (Phase 1) was 91%. Mean percent weight loss at 6 months for the total sample was 12.9% with 82% of enrolled participants ≥ 5% below baseline weight. 172 participants with a mean initial loss of 14.0% of baseline weight (12.8 ± 4.9 kg) were randomized to a maintenance intervention. Retention from 6 to 18 months (Phase 2) was 92%. Intent-to-treat analyses with imputation of missing data revealed participants in the group phone condition regained less weight (3.3 ± 4.8 kg) compared to participants in the newsletter condition (4.9 ± 4.8 kg; p = 0.03). Mean percent weight loss from baseline to 18 months did not significantly differ between the group phone condition (10.2 ± 7.5%) and the newsletter condition (9.2 ± 7.9%). However, at 18 months 75.3% of participants in the group phone condition remained ≥ 5% below baseline weight compared to 57.8% in the newsletter condition (p = .02).
Discussion: The initial group phone-based weight loss intervention exceeded typical weight losses reported in the literature with over 80% of enrolled participants achieving clinically meaningful weight loss. Continued group phone counseling was modestly better in sustaining weight loss at 18 months than a mailed newsletter. However, for both maintenance approaches, the majority of participants maintained a weight at 18 months that was 5% or more below baseline.
Citation Format: Befort CA, Klemp JR, Sullivan DK, Diaz FJ, Schmitz KH, Perri MG, Fabian CJ. Comparison of strategies for weight loss maintenance among rural breast cancer survivors: The rural women connecting for better health randomized controlled trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-08-02.
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Affiliation(s)
- CA Befort
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
| | - JR Klemp
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
| | - DK Sullivan
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
| | - FJ Diaz
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
| | - KH Schmitz
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
| | - MG Perri
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
| | - CJ Fabian
- University of Kansas Medical Center; University of Pennsylvania; University of Florida
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Lowry BN, Alsman K, McClellan W, Klemp JR, Krebill H, Al-hihi E, Doolittle GC, Fulbright JM. Caring for adult survivors of childhood cancer: A primary care based adult transition clinic. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
40 Background: Long-term survival is an expected outcome for childhood cancer patients. Caring for adults who are childhood cancer survivors requires dedicated late effects monitoring. Recognizing transition challenges from pediatric to adult and oncologic to primary care settings, we developed a dedicated monthly survivorship transition clinic (STC) in an internal medicine office at the University of Kansas Medical Center. We describe the first year practice experience (2014-2015). Methods: Retrospective chart review was completed on 41 STC patients - age 20 to 52 years. Each survivor self-selected to establish in STC, with either consultative survivorship care (correspondence sent to existing primary care physician (PCP)) or combined primary and survivorship care (if no established PCP). Selections were recorded. Two oncology providers performed blinded independent reviews of treatment summaries and scored these using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Scores were provided to the STC and unblinded. ITR-3 scores were matched with data on subspecialty referral patterns for each survivor to determine if ITR-3 scores correlated with referral needs. Results: Of 41 patients, 26 (63%) requested PCP and survivorship care. Only 15 (37%) had an established PCP. Survivors were grouped by ITR-3 into low (1 or 2) or high (3 or 4) intensity scores. Subspecialty referrals in each group were analyzed as follows: total number of referrals / average referrals per survivor / median referral number. Referral data: low intensity group 14 / 1.27 / 1, high intensity group 96 / 3.56 / 3. Conclusions: Despite complex medical histories and long term follow-up needs, a high percentage of Midwest cancer survivors were in need of survivorship, PCP and subspecialty care emphasizing the importance of intentional transition efforts. ITR-3 scores correlated with subspecialty referral needs. Future research will include an increased number of survivors to determine further predicative value of this scale in estimating survivor needs complexity.
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Affiliation(s)
| | | | | | | | - Hope Krebill
- Midwest Cancer Alliance, University of Kansas Medical Center, Fairway, KS
| | - Eyad Al-hihi
- University of Kansas Medical Center, Kansas City, KS
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Klemp JR, Bush C, Spaulding A, Krebill H, Doolittle GC. Engaging a statewide network to expand survivorship care to rural and urban cancer survivors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
23 Background: Advances have been made in elevating cancer survivorship as a public health priority and defining elements needed to deliver high-quality follow-up care to survivors. However, a lack of research on how best to care for survivors and the most effective and efficient strategies for delivering survivorship care in the community setting still exists. We report our assessment of the current state of practice, knowledge and professional development, and plan to increase access to care of urban and rural practices across the state of Kansas. Methods: In 2014, the Midwest Cancer Alliance (MCA), a membership-based outreach arm of The University of Kansas Cancer Center, convened an educational summit and survey to assess the survivorship landscape in Kansas. Post-summit, individual interviews were conducted. Survey and interviews included questions regarding health records, treatment summaries, survivorship care plans (SCP), availability of survivorship programs and resources, access to primary care and specialists, distress screening, community support, and educational needs. Results: Ten MCA member health systems were invited to participate and 7 indicated interest in participating in the project. Only one organization provided an SCP to survivors. Barriers included lack of an integrated approach and knowledge. A majority of survivorship care could be delivered close to home, however, services including fertility preservation, genetic counseling, oncology rehab, sexual health, and second opinions, required travel of more than 50 miles. Identified educational needs focused on comprehensive survivorship care across the health care team. Conclusions: Survivorship care remains fragmented across the state of Kansas. Based on this project, we have secured a CDC survivorship grant that will facilitate clinical and technical assistance related to process improvement and electronic health record integration focused on survivorship care and delivery of an SCP. Next steps include engaging primary care providers and survivors to assure the SCP meets the needs of stakeholders. This work will focus on a translational process to meet the growing needs of the survivors and complex health care organizations.
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Affiliation(s)
| | - Carol Bush
- University of Kansas Medical Center, Kansas City, KS
| | | | - Hope Krebill
- Midwest Cancer Alliance, University of Kansas Medical Center, Fairway, KS
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McClellan W, Fulbright JM, Doolittle GC, Alsman K, Klemp JR, Ryan R, Nelson EL, Stegenga K, Krebill H, Al-hihi EM, Schuetz N, Heiman A, Lowry B. A Collaborative Step-Wise Process to Implementing an Innovative Clinic for Adult Survivors of Childhood Cancer. J Pediatr Nurs 2015. [PMID: 26202467 DOI: 10.1016/j.pedn.2015.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With a 5 year survival rate of approximately 80%, there is an increasing number of childhood cancer survivors in the United States. Childhood cancer survivors are at an increased risk for physical and psychosocial health problems many years after treatment. Long-term follow-up care should include education, development of individualized follow up plans and screening for health problems in accordance with the Children's Oncology Group survivor guidelines. Due to survivor, provider and healthcare system related barriers, adult survivors of childhood cancer (ASCC) infrequently are receiving care in accordance to these guidelines. In this paper we describe the stepwise process and collaboration between a children's hospital and an adult academic medical center that was implemented to develop the Survivorship Transition Clinic and address the needs of ASCC in our region. In the clinic model that we designed ASCC follow-up with a primary care physician in the adult setting who is knowledgeable about late effects of childhood cancer treatment and are provided transition support and education by a transition nurse navigator.
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Affiliation(s)
| | | | - Gary C Doolittle
- Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS; The University of Kansas Cancer Center, Westwood, KS; The University of Kansas School of Medicine, Kansas City, KS
| | - Kyla Alsman
- Children's Mercy Hospital, Kansas City, MO; Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS
| | | | - Robin Ryan
- Children's Mercy Hospital, Kansas City, MO
| | - Eve-Lynn Nelson
- The University of Kansas School of Medicine, Kansas City, KS
| | | | - Hope Krebill
- Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS
| | - Eyad M Al-hihi
- The University of Kansas School of Medicine, Kansas City, KS
| | - Nik Schuetz
- The University of Kansas School of Social Welfare, Lawrence, KS
| | - Ashley Heiman
- The University of Kansas School of Nursing, Kansas City, KS
| | - Becky Lowry
- Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS; The University of Kansas School of Medicine, Kansas City, KS
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Sharma P, Kimler BF, Klemp JR, Ward C, Elia M, Connor CS, Wagner JL, Mammen JMV, Amin AL, Fabian CJ, Godwin AK, Khan QJ. Use of non-anthracycline adjuvant chemotherapy in triple-negative breast cancer: Review from a prospective registry. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Claire Ward
- The University of Kansas Medical Center, Kansas City, KS
| | - Manana Elia
- University of Kansas Cancer Center, Mission Hill, KS
| | | | | | | | | | | | | | - Qamar J. Khan
- University of Kansas Medical Center, Kansas City, MO
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Sharma P, Kimler BF, Klemp JR, Ward C, Connor CS, McGinness M, Mammen JMV, Wagner JL, Amin AL, Fabian CJ, Jensen RA, Godwin AK, Khan QJ. Outcomes with neoadjuvant versus adjuvant chemotherapy for T1-2 node negative triple negative breast cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Claire Ward
- The University of Kansas Medical Center, Kansas City, KS
| | | | | | | | | | | | | | | | | | - Qamar J. Khan
- University of Kansas Medical Center, Kansas City, MO
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Greenlee H, Lew D, Hershman DL, Pierce JP, Hansen LK, Newman VA, Korner J, Sayegh A, Fehrenbacher L, Lo SS, Klemp JR, Rinn K, Robertson JM, Unger JM, Gralow J, Albain KS, Krouse RS, Fabian CJ. Phase II feasibility study of a physical activity and dietary change weight loss intervention in a subset analysis of breast cancer survivors (SWOG S1008). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Danika Lew
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | | | | | | | | | - Louis Fehrenbacher
- NRG Oncology/NSABP, and Kaiser Permanente Northern California, Novato, CA
| | | | | | | | | | | | - Julie Gralow
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA
| | - Kathy S. Albain
- NRG Oncology/NSABP, SWOG, and Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Robert S. Krouse
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ
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Klemp JR, Sanft TB, Blaes AH, Sesto ME, Tevaarwerk A. Breast cancer survivorship programming at four NCI designated cancer centers: Our experiences and lessons learned. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sharma P, Powers BC, Kimler BF, Ward C, Klemp JR, Connor CS, McGinness MK, Mammen JMV, Wagner JL, Khan QJ, Jensen RA, Godwin AK, Fabian CJ. Abstract P3-06-16: Thrombocytopenia is associated with pathological complete response to neoadjuvant carboplatin/docetaxel chemotherapy in BRCA wild type triple negative breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-06-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Growing evidence demonstrates activity of neoadjuvant carboplatin in triple negative breast cancer (TNBC). Underlying germline and somatic Homologous Recombination (HR) repair deficiency may predict response to DNA damaging agents like platinum compounds in TNBC. Certain DNA repair machinery genes (Fanconi Anemia gene) are also involved in the maintenance of hematopoetic stem cell (HSC) function and impaired repair of DNA double strand breaks can lead to HSC and progenitor cell dysfunction. Thus, in presence of HR defects DNA damaging chemotherapy may lead to unique hematological toxicity. It is also possible that in presence of HR defects breast cancer response and hematological toxicity with DNA damaging agents will parallel each other.
Aim: To evaluate the impact of hematological toxicity on response to neoadjuvant Carboplatin/Docetaxel chemotherapy in patients with sporadic and BRCA associated TNBC utilizing clinical and BRCA mutation data from a prospective TNBC registry.
Methods: 288 patients with Stage I (T>1cm) II and III TNBC were enrolled on a multisite prospective registry between 3/2011 to 4/2014, out of which 49 patients received neoadjuvant Carboplatin AUC 6 + Docetaxel 75mg/m2 every 21 days (4-6 cycles) and have undergone breast surgery. Carboplatin was dosed using the modified Cockcroft-Gault formula. Hematologic toxicity was graded using the CTCAE version 4.03. All patients received prophylactic pegfilgrastim on day 2. Pathological complete response (pCR) was defined as absence of invasive disease in the breast and axilla. All patients underwent comprehensive BRACAnalysis®(Myriad).
Results: For the 49 eligible patients median age was 50 years, median weight was 172 lbs, 18% were African American, and 37% had LN+ disease. 26% (13 /49) of patients carried deleterious BRCA mutation (9 BRCA1, 4 BRCA2). pCR of the cohort was 65%. Overall 61%, 96%, and 12 % patients demonstrated > Grade1 thrombocytopenia (Tp), anemia, or neutropenia, respectively; 4%, 6%, and 6% patients demonstrated grade 3/4 thrombocytopenia, anemia, or neutropenia, respectively. There was no association between pCR and anemia or neutropenia. Carboplatin dose reductions/delays/omission was more common in patients with Tp compared to patients without Tp (33% vs. 5%; p=0.02). Patients with Tp were more likely to achieve a pCR compared to patients without Tp (85% vs. 47%; p=0.013). 77% of BRCA carriers and 64% of BRCA wild type TNBC demonstrated Tp (NS). pCR rates in BRCA wild type patients with and without Tp were 82% and 47%, respectively (p=0.041). pCR rates in BRCA mutation carriers with and without Tp were 89% and 50%, respectively (p=0.20). On multivariable platelet count was independently associated with pCR (p=0.001)Conclusions: Tp was associated with decreased dose delivery of carboplatin but an improved pCR in BRCA wild type TNBC. Comprehensive assessment of HR defects beyond germline BRCA mutation status may be required to elucidate the biological process that explains this observation. Tp may be a harbinger of underlying HR deficiency and further correlative studies exploring this association of Tp with pathological response to carboplatin in TNBC are warranted.
Citation Format: Priyanka Sharma, Benjamin C Powers, Bruce F Kimler, Claire Ward, Jennifer R Klemp, Carol S Connor, Marilee K McGinness, Joshua MV Mammen, Jamie L Wagner, Qamar J Khan, Roy A Jensen, Andrew K Godwin, Carol J Fabian. Thrombocytopenia is associated with pathological complete response to neoadjuvant carboplatin/docetaxel chemotherapy in BRCA wild type triple negative breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-06-16.
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Abstract
OBJECTIVES To describe the delivery of survivorship care and methods to stratify risk to support the notion that "one size does not fit all." DATA SOURCES Published articles between 2007 and 2014 and original research findings. CONCLUSION The development and implementation of survivorship care into practice provides barriers and opportunities. National mandates are pushing the delivery of a survivorship care plan, which requires the ability to develop and deliver this tool and the necessary health care delivery model to manage the unique needs of each cancer survivor. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses and advanced practice nurses will play a crucial role in the development of survivorship care from education and assessment to the delivery of coordinated care.
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Klemp JR, Ranallo L, Knight CJ, Williams M, Fabian CJ. Breast cancer survivorship care: A continuity of care model of delivery. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
116 Background: With more than 2.9 million BrCa survivors in the US, it is imperative to determine how best to deliver post-treatment survivorship care. National accreditation standards are pushing survivorship care plans, while evidence supporting specific methods of delivery and outcomes are lacking. The University of Kansas Breast Cancer Survivorship Center opened in 2007 as a continuity of care, post-treatment survivorship clinic. We report prospective findings from a group of BrCa survivors from 2007-2013. Methods: Four hundred twenty-four BrCa survivors consented to an IRB approved, longitudinal survivorship registry. Baseline variables on demographics, disease history, summary of cancer treatment, late effects, medications and health status were collected. Follow-up data collection included disease status or new primary cancer, patient’s health status and late/long-term effects. Comparisons from baseline to subsequent visits provided information on changes in key variables over time. Results: Participants were ~57 years old, primarily Caucasian, attended at least some college, made >$40K per year, and 49% were premenopausal at diagnosis. Forty-five women reported having another malignancy and 10 were diagnosed with either a recurrence or a second primary breast cancer while followed in the survivorship center. Significant self-reported symptoms included menopausal symptoms: hot flashes (n=164), vaginal dryness (n=211) and a lack of sexual activity (195). 95% were seen for >1 post-baseline visit. Menopausal symptom interventions, lifestyle recommendations (weight loss and increasing physical activity), referrals to specialists (77% referred for colonoscopy completed colon ca screening; 92% referred attending cardio-oncology screening visit; 100% referred completed a bone mineral density analysis), and lymphedema education and management increased significantly. Conclusions: Multidisciplinary care facilitated through a continuity of care survivorship clinic improves compliance with recommended follow-up and cancer screening, however additional research on the cost and impact of delivering survivorship care is needed to evaluate sustainability and long-term patient outcomes.
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Affiliation(s)
| | - Lori Ranallo
- University of Kansas Cancer Center, Westwood, KS
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Befort CA, Bennett L, Christifano D, Klemp JR, Krebill H. Effective recruitment of rural breast cancer survivors into a lifestyle intervention. Psychooncology 2014; 24:487-90. [PMID: 24953687 DOI: 10.1002/pon.3614] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Christie A Befort
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
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