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Roxburgh CSD, Strombom P, Lynn P, Cercek A, Gonen M, Smith JJ, Temple LKF, Nash GM, Guillem JG, Paty PB, Shia J, Vakiani E, Yaeger R, Stadler ZK, Segal NH, Reidy D, Varghese A, Wu AJ, Crane CH, Gollub MJ, Saltz LB, Garcia-Aguilar J, Weiser MR. Changes in the multidisciplinary management of rectal cancer from 2009 to 2015 and associated improvements in short-term outcomes. Colorectal Dis 2019; 21:1140-1150. [PMID: 31108012 PMCID: PMC6773478 DOI: 10.1111/codi.14713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/18/2018] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
AIM Significant recent changes in management of locally advanced rectal cancer (LARC) include preoperative staging, use of extended neoadjuvant therapies and minimally invasive surgery (MIS). This study was aimed at characterizing these changes and associated short-term outcomes. METHOD We retrospectively analysed treatment and outcome data from patients with T3/4 or N+ LARC ≤ 15 cm from the anal verge who were evaluated at a comprehensive cancer centre in 2009-2015. RESULTS In total, 798 patients were identified and grouped into five cohorts based on treatment year: 2009-2010, 2011, 2012, 2013 and 2014-2015. Temporal changes included increased reliance on MRI staging, from 57% in 2009-2010 to 98% in 2014-2015 (P < 0.001); increased use of total neoadjuvant therapy, from 17% to 76% (P < 0.001); and increased use of MIS, from 33% to 70% (P < 0.001). Concurrently, median hospital stay decreased (from 7 to 5 days; P < 0.001), as did the rates of Grade III-V complications (from 13% to 7%; P < 0.05), surgical site infections (from 24% to 8%; P < 0.001), anastomotic leak (from 11% to 3%; P < 0.05) and positive circumferential resection margin (from 9% to 4%; P < 0.05). TNM downstaging increased from 62% to 74% (P = 0.002). CONCLUSION Shifts toward MRI-based staging, total neoadjuvant therapy and MIS occurred between 2009 and 2015. Over the same period, treatment responses improved, and lengths of stay and the incidence of complications decreased.
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Affiliation(s)
- C S D Roxburgh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - P Strombom
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - P Lynn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - A Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - M Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - J J Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - L K F Temple
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - G M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - J G Guillem
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - P B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - J Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - E Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - R Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Z K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - N H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - D Reidy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - A Varghese
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - A J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - C H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - M J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - L B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - J Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - M R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
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Gunter MJ, Alhomoud S, Arnold M, Brenner H, Burn J, Casey G, Chan AT, Cross AJ, Giovannucci E, Hoover R, Houlston R, Jenkins M, Laurent-Puig P, Peters U, Ransohoff D, Riboli E, Sinha R, Stadler ZK, Brennan P, Chanock SJ. Meeting report from the joint IARC-NCI international cancer seminar series: a focus on colorectal cancer. Ann Oncol 2019; 30:510-519. [PMID: 30721924 PMCID: PMC6503626 DOI: 10.1093/annonc/mdz044] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite significant progress in our understanding of the etiology, biology and genetics of colorectal cancer, as well as important clinical advances, it remains the third most frequently diagnosed cancer worldwide and is the second leading cause of cancer death. Based on demographic projections, the global burden of colorectal cancer would be expected to rise by 72% from 1.8 million new cases in 2018 to over 3 million in 2040 with substantial increases anticipated in low- and middle-income countries. In this meeting report, we summarize the content of a joint workshop led by the National Cancer Institute and the International Agency for Research on Cancer, which was held to summarize the important achievements that have been made in our understanding of colorectal cancer etiology, genetics, early detection and treatment and to identify key research questions that remain to be addressed.
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Affiliation(s)
- M J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
| | - S Alhomoud
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, Division of Preventive Oncology and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - J Burn
- Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - G Casey
- Center for Public Health Genomics, University of Virginia, Charlottesville
| | - A T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, USA
| | - A J Cross
- School of Public Health, Imperial College London, London, UK
| | | | - R Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - R Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - M Jenkins
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - P Laurent-Puig
- SIRIC CARPEM, APHP European Georges Pompidou Hospital Paris, Universite Paris Descartes, Paris, France
| | - U Peters
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle
| | - D Ransohoff
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina, Chapel Hill
| | - E Riboli
- School of Public Health, Imperial College London, London, UK
| | - R Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Z K Stadler
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - P Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - S J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
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Robson ME, Gaissert P, Salo-Mullen EE, Amoroso K, Sheehan M, Berliner JL, Trottier M, Arnold AG, Sekhri N, Marcell V, Siegel B, Harlan Fleischut M, Hay JL, Walsh MF, Kauff ND, Stadler ZK, Offit K, Hamilton JG. Abstract P2-09-24: Information preferences and short-term psychological responses to multiplex genetic testing among individuals at risk for hereditary breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-24] [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: Multiplex genetic testing involves the simultaneous analysis of a panel of known cancer susceptibility genes. Although efficient and cost-effective, multiplex testing presents several challenges for patients and clinicians: these tests provide information about high and moderate penetrance genes of varying clinical utility, patients cannot choose which specific genes are tested, and multiple variants of uncertain significance can be identified at once. Multiplex testing is being increasingly integrated into clinical care, yet little is known about patients' preferences, uptake, or psychological responses to these tests.
Methods: To address this gap, we examined two data sources: Sample A) a cross-sectional clinical ascertainment of 189 patients evaluated for hereditary breast and other cancer syndromes (89% female), and Sample B) an ongoing prospective research study of multiplex testing among 194 breast cancer patients and survivors who previously received uninformative BRCA1/2 results (99% female, 84% white, ages 27-76, 60% had BRCA1/2 testing in the past year).
Results: In Sample A, 32% declined clinical multiplex testing in favor of more targeted testing. Female patients were more likely than males to decline (p=0.004). Self-reported reasons for declining included: concerns about uncertain clinical utility of moderate penetrance genes (51% of patients) and variants of uncertain significance (38%), feeling emotionally overwhelmed (23%), and not seeing the value of multiplex testing (20%). In Sample B, participants were allowed to select which information to receive from a multiplex test; 16% chose to learn less than all of the information available (e.g., not genes unrelated to breast/ovarian cancer, not genes without established clinical utility, not CDH1 or TP53). Information preferences were unrelated to demographic (age, race, time since cancer diagnosis and BRCA1/2 testing) and self-reported psychological factors (baseline genetic testing-related distress, uncertainty, and positive experiences; anxiety; depression). Participants who chose to learn all possible information reported greater concerns about their children's cancer risk than did those who chose to learn less information (p=0.01). Participants reported a small increase in both genetic testing-related distress and positive experiences from before testing to 1 week after receiving results (p<0.001). In multivariable analyses controlling for baseline psychological functioning, only non-white race was consistently associated with significantly increased post-result anxiety, depression, and genetic testing-related distress and uncertainty. Participants who had BRCA1/2 testing one or more years ago also reported fewer positive experiences 1 week after receiving results.
Conclusions: Together, these findings demonstrate that a sizable minority of patients have important concerns regarding multiplex tests that may limit their uptake of this novel testing, and suggest that some patients may prefer to customize the specific risk information provided. Results also highlight characteristics of those at risk for poorer emotional outcomes following testing; these individuals may benefit from additional support in this context.
Citation Format: Robson ME, Gaissert P, Salo-Mullen EE, Amoroso K, Sheehan M, Berliner JL, Trottier M, Arnold AG, Sekhri N, Marcell V, Siegel B, Harlan Fleischut M, Hay JL, Walsh MF, Kauff ND, Stadler ZK, Offit K, Hamilton JG. Information preferences and short-term psychological responses to multiplex genetic testing among individuals at risk for hereditary breast cancer. [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 P2-09-24.
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Affiliation(s)
- ME Robson
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - P Gaissert
- Memorial Sloan Kettering Cancer Center, NY, NY
| | | | - K Amoroso
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - M Sheehan
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - JL Berliner
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - M Trottier
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - AG Arnold
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - N Sekhri
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - V Marcell
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - B Siegel
- Memorial Sloan Kettering Cancer Center, NY, NY
| | | | - JL Hay
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - MF Walsh
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - ND Kauff
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - ZK Stadler
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - K Offit
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - JG Hamilton
- Memorial Sloan Kettering Cancer Center, NY, NY
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Seah DSE, Scott SM, Guo H, Najita J, Lederman R, Frank E, Sohl J, Kronwitz C, Stadler ZK, Silverman SG, Peppercorn J, Winer EP, Come SE, Lin NU. Abstract P4-19-01: Attitudes of medical oncologists towards research biopsies. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-19-01] [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:
There is increasing interest in studying tissue from patients (pts) with metastatic breast cancer (MBC). Historically, limited tissue has been available. Possible barriers to research biopsies (bx) include pt and provider opinions; the contribution of each factor is unknown.
Methods:
309 academic breast medical oncologists (MOs) identified from the websites of each of the National Cancer Institute - designated cancer centers were invited to complete either a self-administered paper or online survey. Eligible MOs (MOs who saw breast cancer pts and who saw pts 4 hours/week.) were asked to predict what proportion of their pts with MBC would consent to additional bx (ABs, additional bx performed with a clinically indicated bx) or research purposes only bx(RPOBs, research bx performed as a standalone procedure). They were also asked about their comfort levels in asking pts with MBC to consider participating in ABs or RPOBs for various organs. Median values are reported. Two-sided Fisher's exact test was used to compare categorical variables using a a level of .05.
Results:
191 (101F,85M, 5 unknown) eligible MOs completed the survey. 29 MOs were ineligible (response rate = 191/280,68%). Median age was 50 (Range 33-80). Median years of oncology experience was 15 (Range 1-45). MOs predicted that 90%, 75%, 70% and 50%, of their pts would definitely/probably consider ABs of blood, skin, breast, or liver respectively. MOs predicted that 90%, 60%, 33%, and 20% of their pts would definitely/probably consider RPOBs of blood, skin, breast, or liver. 98% (95% CI 96%-100%), 96% (95% CI 92%-98%), 93% (95% CI 88%-96%) and 70% (95% CI 63%-77%) of MOs were very/somewhat comfortable asking pts for an AB of blood, skin, breast and liver respectively. 98% (95% CI 95%-99%), 93% (95% CI 89%-96%), 78% (95% CI 72%-84%) and 50% (95% CI 43%-58%) of MOs were very/somewhat comfortable asking pts to participate in a RPOB of blood, skin, breast and liver respectively.
No demographic characteristics (eg. sex, age) were associated with MOs’ comfort levels of asking pts to have an AB of blood, skin and breast.
Factors associated with increased comfort discussing an AB of the liver were: age < 50 years (p = 0.01), in practice for < 15 years (p = 0.01), ≥ 1 pt enrolled on clinical trials per month (p = 0.02), or having pts who had undergone bx for research in prior 3 months (p<0.01).
MOs with ≥ 4 patients enrolled on clinical trials/month or whose pts had undergone research bx in the past 3 months were more likely to feel comfortable asking pts to have a RPOB of the breast (p<0.01; p<0.01) or liver (p = 0.03; p<0.01).
The 3 most common reasons why MOs were reluctant to refer pts for participation in an AB include risk of a bx procedure (n = 128, 67%), pain/discomfort of a bx (n = 125, 65%), and logistical barriers (n = 42, 22%). These reasons are similar for RPOB; risk of a bx procedure, (n = 137, 72%), pain/discomfort of a bx (n = 134, 70%), and inconvenience to pt (time involved, travel, etc) (n = 58, 30%).
Conclusions:
Many MOs predict that the majority of their MBC pts will consider ABs of various organs. However, this decreases with RPOBs, particularly as the procedure becomes more invasive. More research is needed to understand factors that may influence MOs’ comfort levels asking pts to participate in such studies.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-01.
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Affiliation(s)
- DSE Seah
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SM Scott
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - H Guo
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Najita
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - R Lederman
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E Frank
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Sohl
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C Kronwitz
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - ZK Stadler
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SG Silverman
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Peppercorn
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SE Come
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
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Seah DS, Scott SM, Najita J, Openshaw T, Krag K, Frank E, Sohl J, Stadler ZK, Garrett M, Silverman SG, Peppercorn J, Winer EP, Come SE, Lin NU. Attitudes of patients with metastatic breast cancer toward research biopsies. Ann Oncol 2013; 24:1853-1859. [PMID: 23493137 DOI: 10.1093/annonc/mdt067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Research studies involving human tissue are increasingly common. However, patients' attitudes toward research biopsies are not well characterized, particularly when the biopsies are carried out outside the context of therapeutic trials. PATIENTS AND METHODS One hundred sixty patients with metastatic breast cancer (MBC) from two academic (n = 80) and two community (n = 80) hospitals completed a 29-item self-administered survey to evaluate their willingness to consider providing research purposes only biopsies (RPOBs) (as a stand-alone procedure) and additional biopsies (ABs) (additional needle passes at the time of a clinically indicated biopsy). RESULTS Eighty-two (51%) of 160 patients would consider having RPOBs, of which 42 (53%) and 40 (50%) patients were from academic and community hospitals, respectively. Patients who had more prior biopsies were less likely to consider RPOBs (RR = 0.6, 95% CI: 0.4-1.0, P = 0.03). Of 160 patients, 115 (72%) patients would consider having ABs. Of these, 64 (80%) and 51 (64%) patients from academic and community hospitals, respectively, would consider ABs (RR = 1.2, 95% CI: 1.0-1.5, P = 0.03). CONCLUSIONS Many patients with MBC in both academic and community settings report willingness to consider undergoing biopsies for research. Further research is needed to understand ethical, logistical and provider-based barriers to broader participation in such studies.
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Affiliation(s)
- D S Seah
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S M Scott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - J Najita
- Department of Biostatics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - T Openshaw
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - K Krag
- Department of Medical Oncology, North Short Cancer Center, Danvers
| | - E Frank
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Sohl
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Z K Stadler
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - M Garrett
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - S G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston
| | - J Peppercorn
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - E P Winer
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S E Come
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - Nancy U Lin
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston.
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Seah DS, Scott SM, Najita J, Openshaw T, Krag KJ, Frank E, Sohl J, Stadler ZK, Garrett M, Winer EP, Come S, Lin NU. Abstract P2-16-04: Attitudes of metastatic breast cancer patients towards research biopsies. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-16-04] [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: In the era of molecularly targeted therapy, developing an understanding of the molecular basis of cancer is a principal or secondary goal of many research studies. For this reason, studies collecting tissue for research purposes are increasingly common. Understanding patients' attitudes towards research biopsies may lead to improvement in accrual to research biopsy studies.
Methods: Patients with metastatic breast cancer from two academic and two community hospitals completed a self-administered paper survey consisting of 29 questions in clinic to evaluate their willingness to consider providing additional biopsies (additional biopsy performed with a clinically indicated biopsy) and research purposes only biopsies (RPOB) (research biopsy performed as a stand alone procedure).
Results: 160 patients (n = 80 academic, n=80 community) completed the survey, with a response rate of 98%. As expected, demographic variables differed between sites, with patients from academic sites likely to be younger (p = 0.01), more educated (p = 0.002), employed (p = 0.01), have prior trial participation (P <0.001) and have a longer travel time (P <0.0001). 64 (80%) academic patients and 51 (64%) community patients would definitely or probably consider additional biopsies. 42 (53%) academic patients and 40 (50%) community patients would consider RPOB.
In univariate analyses of patients' willingness to have additional biopsies, patients in academic sites were more likely to agree to additional biopsies than those at community sites (RR = 1.2, 95% CI 1.0–1.5, p = 0.03). Statistically significant differences based on demographic characteristics such as age, education, marital status, prior trial participation, number of prior biopsies, and travel time were not observed.
For RPOB, patients having had more prior biopsies were less likely to consider research biopsies (RR = 0.6, 95% CI 0.4–1.0, p = 0.03). The following variables did not reach statistical significance: type of practice, age, education, marital status, prior trial participation, and travel time.
Patients' willingness in both academic and community sites to consider RPOB declined with more invasive biopsies. Although differences were observed, none were statistically significant between academic and community; skin (56%, 65%), bone marrow (30%, 27%), breast (43%, 49%) or liver (24%, 19%).
Of the 13/160 (8%) patients who would not consider additional biopsies, the most common reasons cited included pain or discomfort (n = 8/13, 62%), risk of biopsy (n = 8/13, 62%) and anxiety related to the biopsy (n = 6/13, 46%). Of the 37/160 (23%) patients who would not consider RPOB, the most common reasons cited included pain or discomfort (n = 23/37, 62%), risk of biopsy (n = 15/37, 41%) and inconvenience of the procedure to the patient (n = 13/37, 35%).
Conclusions: The majority of patients in this study indicated they would consider research biopsies, with a larger proportion willing to consider additional biopsies; patients seen at academic hospitals were more likely to consider additional biopsies compared to those seen at community hospitals. Breast cancer patients' willingness to undergo research biopsies may be higher than generally expected by clinicians and may not be the primary barrier to obtaining research biopsies.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-16-04.
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Affiliation(s)
- DS Seah
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SM Scott
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Najita
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T Openshaw
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - KJ Krag
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E Frank
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Sohl
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - ZK Stadler
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M Garrett
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S Come
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
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Zhang L, Fleischut MH, Kohut K, Spencer S, Wong K, Stadler ZK, Kauff ND, Offit K, Robson ME. Assessment of the prevalence of de novo mutations in the BRCA1 and BRCA2 genes. Clin Genet 2011; 80:97-8. [DOI: 10.1111/j.1399-0004.2011.01691.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Jhaveri KL, Patil S, Khasraw M, Bhatia J, Stadler ZK, Kauff ND, Hudis C, Offit K, Robson ME. Risk of breast cancer (BC) after BRCA-mutation associated ovarian cancer (BRCA-OC): Memorial Sloan-Kettering Cancer Center (MSKCC) experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Lowery MA, Stadler ZK, Ludwig E, Salo-Mullen E, D'Adamo DR, Allen PJ, Kurtz RC, Kelsen DP, O'Reilly EM. Clinical outcomes in pancreatic adenocarcinoma (PAC) associated with a known BRCA mutation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.268] [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: 11/20/2022] Open
Abstract
268 Background: BRCA1 and -2 germ-line mutations are associated with increased risk of PAC; approximately 5% of all cases of PAC are estimated to be due to an inherited genetic mutation (Lynch, HT, et al. Pancreatology, 2001;1(5):466-471). Other BRCA-associated cancers have demonstrated increased sensitivity to platinum chemotherapy and PARP inhibitors (PARPi) with improved clinical outcomes compared to sporadic cases (J Clin Oncol, 2008 Dec 1;26(34):5530-6). Outcomes in BRCA-associated pancreatic cancer are unknown. Methods: Patients with a known BRCA1 or -2 mutation and a diagnosis of PAC were retrospectively identified from the MSKCC Familial Pancreas Cancer Registry and via institutional database review. Outcomes and clinical characteristics were reviewed. 7 patients (1 male) with BRCA2 mutation and PAC, 4 patients (1 male) with BRCA1 mutation and PAC, were identified. Two further cases of BRCA mutation and cholangiocarcinoma were identified. Results: See Table for patient demographics. Treatment for advanced disease included a PARP inhibitor (PARPi) in 2 cases; both pts had a radiologic partial response (PR) to therapy. Five patients received platinum-based chemotherapy for advanced disease, 4 of whom had a PR. Median survival for all patients was 27.6 months. Conclusions: The use of platinum- containing chemotherapy, radiation therapy, and PARPi to target the BRCA-associated defective DNA repair mechanism is deserving of further investigation in these patients. PARPi have demonstrated promising efficacy in patients with BRCA-mutated breast and ovarian cancer and are undergoing prospective evaluation in PAC. Genetic testing in patients presenting with a personal history or strong family history of BRCA associated cancers may help to guide choice of therapy. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. A. Lowery
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Z. K. Stadler
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E. Ludwig
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - D. R. D'Adamo
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - P. J. Allen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - R. C. Kurtz
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - D. P. Kelsen
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Lowery MA, Stadler ZK, Ludwig Miller E, D'Adamo DR, Salo-Mullen E, Allen P, Kurtz RC, Kelsen DP, O'Reilly EM. Clinical outcomes in pancreatic adenocarcinoma (PAC) in breast cancer (BC) survivors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Stadler ZK, Stern R, Devlin V, Glogowski E, Kauff N, Offit K, Hurley K. Adherence to extracolonic cancer screening in Lynch syndrome kindreds. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1513] [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
1513 Introduction: In addition to colorectal cancer (CRC), Lynch syndrome (LS) patients are at increased risk of extracolonic malignancies including endometrial (EC), ovarian (OC), upper gastrointestinal and urothelial tract cancers. Although the efficacy of extracolonic cancer screening in LS has not been clearly demonstrated, multi-organ screening is routinely recommended for LS patients (Lindor et al., JAMA 2006). Anecdotal evidence suggests that adherence to such screening may be inferior to CRC screening. Methods: 35 adults, identified in the context of genetic counseling and testing (GCT) as being from LS kindreds, were given recommendations for multi-organ screening and enrolled on a prospective follow-up study. For participants with relevant organs at risk, these included colonoscopy, urine cytology, transvaginal ultrasound (TVUS), CA-125 level and endometrial sampling all to be performed at least annually. Adherence with screening, perceived risk of cancer subtype and future intentions regarding screening were evaluated at least 12 months after GCT. Results: Median age at time of GCT was 44, 66% were female and 69% were diagnosed with a LS- related cancer prior to GCT (15 CRC; 9 EC). At time of follow-up, 89% of patients without CRC had a colonoscopy within the year. Among women at-risk for OC, 25% had TVUS and 38% had CA-125 level within the year. Among women at risk for EC, 22% had TVUS and 22% had endometrial sampling within the year. Of all participants, 40% had urine cytology within the year. Of participants with relevant organs at-risk, 72%, 33%, 75% and 12% reported their risk of developing CRC, EC, OC, and urothelial tract cancer, respectively, as “moderately”, “very” or “extremely” high. Of patients with previous colonoscopy, 93% had definitive intentions to continue on schedule screening. However, only 68%, 50%, 60% and 50% of patients who underwent previous urine cytology, TVUS, CA-125 or endometrial sampling, respectively, had definitive intentions of continuing on schedule screening. Conclusions: Adherence with extracolonic cancer screening in LS kindreds is poor and patients persistently underestimate their extracolonic risk despite GCT. Possible interventions should be aimed at better educating patients about extracolonic cancer risk and importance of on-going surveillance. No significant financial relationships to disclose.
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Affiliation(s)
- Z. K. Stadler
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - R. Stern
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - V. Devlin
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E. Glogowski
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. Kauff
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Offit
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Hurley
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Stadler ZK, Stuart KE. Characteristics, treatment and outcome of patients with hepatocellular carcinoma (HCC) in the United States: An analysis of 328 patients from 1998–2005. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4615] [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
4615 Background: International studies have described the clinical characteristics and outcomes of patients with HCC. However, patient demographics, tumor characteristics, extent of liver disease, risk factors, treatment and outcome are less well established in the United States (US) where HCC remains rare. Methods: We identified 328 patients presenting to Beth Israel Deaconess Medical Center with a new diagnosis of HCC from 1998–2005. Characteristics including risk factors, underlying liver disease, tumor morphology and treatment were entered into a retrospective database. Child-Pugh grade and Cancer of the Liver Italian Program (CLIP) score were determined. Survival analysis was performed and data compared to our previously published HCC cohort from 1985–1995. Results: Patient characteristics were: Median age: 62; Male: 81%; Alcohol use (EtOH): 44%; Hepatitis C (HCV): 38%; Hepatitis B (HBV): 21%; No Risk Factor: 15%. EtOH was more common in HCV (57%) than in HBV (18%) patients. Treatment modality was: liver transplantation (LT) 14.4%, surgical resection 7.8%, chemoembolization or radiofrequency ablation (CE/RFA) 36%, chemotherapy 22%, no treatment 16%. Median overall survival was 13.5 months. Significantly better median survival was associated with Child-Pugh grade A (20.3 mos.), uninodular tumor in <50% of liver (34.3 mos.), absence of portal vein thrombosis (19.2 mos.), CLIP score of 0 (42.5 mos.), background of HBV (32.9 mos.) and No EtOH (16.2 mos.). Treatment correlated with survival: LT, resection, or CE/RFA showed significantly better survival than chemotherapy or no treatment. In comparison to the 1985–95 cohort, median survival improved from 10 to 13.5 months. The 1998–05 cohort had more HBV/HCV (57% versus 20%), more favorable tumor characteristics, less severe liver disease, and more LT (14.4% versus 2.8%). Conclusions: In this single US institution, survival of HCC patients improved by 35% over two decades. Our results are consistent with nationwide trends of increased prevalence of viral infection, screening to find earlier disease, and more widespread use of aggressive treatments. Changing patterns of approaching the cirrhotic patient with HCC may be leading to slightly better results. No significant financial relationships to disclose.
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Affiliation(s)
- Z. K. Stadler
- Beth Israel Deaconess Medical Center, Boston, MA; Lahey Clinic, Burlington, MA
| | - K. E. Stuart
- Beth Israel Deaconess Medical Center, Boston, MA; Lahey Clinic, Burlington, MA
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