Adult Breast Cancer Patients Research Articles

Balancing Fertility Preservation and Treatment Efficacy in (Neo)adjuvant Therapy for Adolescent and Young Adult Breast Cancer Patients: a Narrative Review.

Adolescent and young adult (AYA) breast cancer survivors face a significant risk of infertility due to the gonadotoxic effects of (neo)adjuvant therapy, which complicates their ability to conceive post-treatment. While (neo)adjuvant therapy primarily aims to improve recurrence-free and overall survival, fertility preservation strategies should also be considered for young patients. This narrative review explores recent advancements in fertility preservation techniques, such as oocyte, embryo, and ovarian tissue cryopreservation, and evaluates the feasibility of modifying breast cancer (neo)adjuvant therapy to preserve fertility without compromising survival outcomes. Our review highlights that clinical trials with co-primary endpoints of oncological safety and fertility preservation are limited, and substituting standard treatment regimens solely for fertility preservation is currently not recommended. Nevertheless, new clinical studies have emerged that either exclude highly ovarian-toxic agents, such as cyclophosphamide, or omit adjuvant therapy altogether, even if fertility preservation is not their primary endpoint. Unfortunately, many of these trials have not evaluated ovarian toxicity. Notably, since 2020, major oncology organizations, including the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO) have advocated for the routine assessment of ovarian toxicity in all clinical trials. The review underscores the importance of incorporating ovarian toxicity as a standard endpoint in future trials involving premenopausal breast cancer patients to identify treatment regimens that can effectively balance fertility preservation with treatment efficacy.

Characterizing access for oral oncolytics used to treat breast cancer at an academic medical center.

116 Background: Everolimus, CDK 4/6, PIK3CA, Her2 tyrosine kinase, and PARP inhibitors are commonly used oral oncolytic agents for breast cancer patients. However, oral oncolytics are tiered differently for insurance cost coverage than IV therapies. We characterized the financial toxicity associated with breast cancer oral oncolytics, investigated the prevalence of financial assistance mechanisms utilized, and explored the association of these mechanisms with timing of treatment initiation in adult breast cancer patients. Methods: Patients 18 years or older with a primary breast cancer diagnosis who received care at the outpatient breast cancer clinic and were prescribed an oral oncolytic by a Michigan Medicine provider were included. Using the electronic medical record, we identified initial prescriptions for everolimus, CDK 4/6 inhibitors (palbociclib, ribociclib, abemaciclib), PIK3CA inhibitor (alpelisib), HER2 tyrosine kinase inhibitors (lapatinib, neratinib, tucatinib), and PARP inhibitors (olaparib, talazoparib) dated between January 1, 2014 and November 30, 2022. Patient demographics, adjuvant versus metastatic status, insurance coverage, monthly out-of-pocket costs, financial assistance obtained, prescribed date, planned medication start date, pill-to-mouth date, duration of treatment and reason for treatment discontinuation were collected. Results: There were 418 unique patients in our final cohort. Almost one third of all prescriptions were filled with financial assistance (n=126, 31.2%). The three most common assistance mechanisms were copay cards (n=55, 43.6%), grants (n=34, 26.9%) and patient assistance programs (n=31, 24.6%). For monthly out-of-pocket costs before any financial assistance was obtained, the three most common cost groups were $0-$15 (n=155, 36%), $15-$100 (n=101, 23.7%) and >$500 (n=91, 21%). Among the 48 prescriptions that were never filled, almost one third were due to prohibitive cost (n=15, 28.3%). For insurance coverage, the three most common types were commercial (n=224, 54%), Medicare Part D (n=108, 26%), and Medicaid (n=57, 14%). The median number of days treatment was delayed was 10 days (range 0-495 days). Insurance approval/denial delays accounted for 33.9% of delays (n=120). Conclusions: One third of breast cancer oral oncolytic prescriptions were filled with financial assistance. In the instances in which patients were not able to receive timely treatment for their cancer, one out of three times it was due to insurance delay.

Cancer cost-related subjective financial distress among breast cancer: a scoping review.

This article provided a comprehensive scoping review, synthesizing existing literature on the financial distress faced by breast cancer patients. It examined the factors contributing to financial distress, the impact on patients, coping mechanisms employed, and potential alleviation methods. The goalwas to organize existing evidence and highlight possible directions for future research. We followed the scoping review framework proposed by the Joanna Briggs Institute (JBI) to synthesize and report evidence. We searched electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, for relevant literature. We included English articles that met the following criteria: (a) the research topic was financial distress or financial toxicity, (b) the research subjects were adult breast cancer patients, and (c) the article type was quantitative, qualitative, or mixed-methods research. We then extracted and integrated relevant information for reporting. After removing duplicates, 5459 articles were retrieved, and 43 articles were included based on the inclusion and exclusion criteria. The articles addressed four main themes related to financial distress: factors associated with financial distress, impact on breast cancer patients, coping mechanisms, and potential methods for alleviation. The impact of financial distress on patients was observed in six dimensions: financial expenses, financial resources, social-psychological reactions, support seeking, coping care, and coping lifestyle. While some studies reported potential methods for alleviation, few discussed the feasibility of these solutions. Breast cancer patients experience significant financial distress with multidimensional impacts. Comprehensive consideration of possible confounding factors is essential when measuring financial distress. Future research should focus on exploring and validating methods to alleviate or resolve this issue.

Factors influencing psychological distress among breast cancer survivors using machine learning techniques

Breast cancer is the most commonly diagnosed cancer among women worldwide. Breast cancer patients experience significant distress relating to their diagnosis and treatment. Managing this distress is critical for improving the lifespan and quality of life of breast cancer survivors. This study aimed to assess the level of distress in breast cancer survivors and analyze the variables that significantly affect distress using machine learning techniques. A survey was conducted with 641 adult breast cancer patients using the National Comprehensive Cancer Network Distress Thermometer tool. Participants identified various factors that caused distress. Five machine learning models were used to predict the classification of patients into mild and severe distress groups. The survey results indicated that 57.7% of the participants experienced severe distress. The top-three best-performing models indicated that depression, dealing with a partner, housing, work/school, and fatigue are the primary indicators. Among the emotional problems, depression, fear, worry, loss of interest in regular activities, and nervousness were determined as significant predictive factors. Therefore, machine learning models can be effectively applied to determine various factors influencing distress in breast cancer patients who have completed primary treatment, thereby identifying breast cancer patients who are vulnerable to distress in clinical settings.

Efficacy of a combined diet and exercise intervention in patients with breast cancer undergoing chemotherapy: A meta-analysis of randomized controlled trials.

e12517 Background: Breast cancer treatment presents challenging side effects that may compromise patients’ health and quality of life (QoL). While exercise programmes have been shown to improve survival, the impact of combined exercise and dietary interventions compared to usual practices alongside chemotherapy remains controversial. Methods: PubMed, Embase, Cochrane Central, and ClinicalTrials.gov were systematically searched up to October 2023. We included randomized controlled trials (RCTs) involving adult breast cancer patients undergoing chemotherapy and comparing combined diet and exercise interventions with usual care. Outcomes of interest included weight change, relative dose intensity (RDI), and Functional Assessment of Cancer Therapy-General scale (FACT-G) score for QoL. Statistical analysis was performed using Review Manager 5.4.1 and RStudio version 4.1.2. The protocol was registered on PROSPERO (ID: CRD42023463543). Results: Seven RCTs with 960 patients undergoing breast cancer therapy were included, of whom 506 (53%) were assigned to combined exercise and dietary interventions. Participants had a mean BMI of 26.6 kg/m2, and approximately 52% were postmenopausal. Combined exercise and dietary interventions resulted in significant reductions in weight loss (MD -1.06 kg, 95% CI -1.68 to -0.44; p<0.01), BMI (MD -0.44; 95% CI -1.76 to -0.13; p<0.01), body fat (MD -2.12%; 95% CI -3.99 to -0.26; p=0.03), and FACT-G (MD -3.40; 95% CI -6.25 to -0.55; p=0.02) compared to usual care. No significant differences were observed in waist circumference (p=0.05), RDI (p=0.23), or fatigue levels (p=0.98) between groups. Conclusions: In this meta-analysis of randomized trials, combined exercise and dietary interventions improved weight management in breast cancer patients undergoing chemotherapy but did not significantly impact chemotherapy completion, fatigue levels, and worsened FACT-G score (QoL). Findings can help to further holistic cancer care, taking into account both physical and psychosocial dimensions of patient health.

Association between lymphovascular invasion (LVI) and prognostic factors in breast cancer.

Association between lymphovascular invasion (LVI) and prognostic factors in breast cancer.

Abstract 3822: Oncotype DX testing and differences in use of chemotherapy by age in an integrated system

Abstract Introduction: Oncotype DX (ODX) identifies breast cancer patients who are less likely to benefit from chemotherapy. We investigated patient factors associated with clinical application of ODX testing and chemotherapy use. Methods: We identified a cohort of adult breast cancer patients with stage I-IIA, estrogen receptor positive, human epidermal growth factor receptor 2 negative, lymph node negative disease diagnosed within Kaiser Permanente Northern California between 2015 - 2021 eligible for ODX testing. Chi-square tests were used for bivariate analysis of categorical variables. Multivariable logistic regression was used to identify independent predictors of chemotherapy use in female patients with high risk ODX scores (>25). Results: 8017 patients were eligible for ODX testing; of which 5,136 received testing (64%) and 576 patients (7%) had high risk ODX. ODX testing increased over the years (45% of eligible patients in 2015; 79% of eligible patients in 2021). Testing was frequent in larger lesions (74%), poorly differentiated tumors (73%), and younger patients (83% in patients <40 years at diagnosis; 12% in patients > 80 years). Chemotherapy was frequently administered in younger patient, and for larger, poorly differentiated tumors. For patients who possessed a high risk ODX score, chemotherapy administration differed by age. In comparison with the 90% of high risk patients <45 years who received chemotherapy, 58% of patients 60+ years at diagnosis with high risk ODX received chemotherapy. Comorbidity index and chemotherapy administration was not statistically significant (Table 1). Conclusion: Oncologists frequently use ODX testing to guide chemotherapy management. Despite high risk ODX scores, older patients received less chemotherapy compared to their younger counterparts. Further investigation is needed to determine how age impacts clinician decision making and clinical outcomes following ODX testing. Table 1. Multivariable Logistic Regression Analysis of Factors Associated with Chemotherapy Women > 60 years with high risk oncotype DX scores (N=467) Adjusted Odds Ratio (95% Confidence Interval) P-values (Calculated using the Wald χ2 Statistic) Age at Cancer Diagnosis (Reference: 60 - 69 years old) 70-79 0.62 (0.40-0.96) 0.03 >79 0.11 (0.02-0.55) 0.01 Charlson Comorbidity Index (Reference = 0) 1 0.76 (0.48-1.22) 0.26 2 0.62 (0.30-1.29) 0.20 3 0.65 (0.26-1.60) 0.35 4 0.54 (0.20-1.44) 0.22 5+ 0.37 (0.10-1.35) 0.13 Citation Format: Ashley Aller, Liisa Lyon, Laurel Habel, Aida Shirazi, Raymond Liu. Oncotype DX testing and differences in use of chemotherapy by age in an integrated system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3822.

Depression and associated factors among adult breast cancer patients attending at selected public hospital in Addis Ababa, Ethiopia.

Depression is a major public health problem among adult breast cancer patients. Although there are few studies on depression, data were mainly from a single center and the potential risk factors were not exhaustively addressed. Thus, we aimed to investigate the prevalence of depression and risk factors among adult breast cancer patients at two big hospitals in Addis Ababa. To assess depression and its associated factors among breast cancer patients attending public hospitals in Addis Ababa, Ethiopia, in 2021. An institution-based cross-sectional study was conducted among adult patients with breast cancer attending at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College from June to July 2021. Simple random sampling was used to obtain a sample size of 318. Data were collected using the standard Patient Health Questionnaire-9, structured questionnaire interviews, and chart reviews. SPSS version 25 was used for analysis; the correlation between independent and dependent variables was evaluated using a logistic regression model. Each analysis regarded a p-value less than 0.05 as statistically significant. The mean age of the participants was 43.1 ± 11.3 years. The prevalence of depression among adult breast cancer patients was 33 (10.6%), and according to the patient health questionnaires (PHQ)-9 score categorization, 116 (37.3%) were minor, 28 (9%) were moderate, and 5 (1.6%) had moderate severity. The duration of diagnosis was <12 months and stage 2 breast cancer was more protective against depression than stage 4 breast cancer. A lower monthly income and poor social support were significantly associated with depression. The prevalence of depression was moderate among adult patients with breast cancer; the stage of cancer, duration of diagnosis, income, and poor social support were significantly associated with depression, emphasizing the value of counseling.

Establishment of local diagnostic reference levels for breast cancer CT protocols in radiotherapy in a single Moroccan center

The objective of this study was to establish local diagnostic reference levels (LDRLs) for breast cancer computed tomography imaging in radiotherapy (CT-RT) at a single hospital in Morocco. Data were collected from 106 adult breast cancer patients aged between 33 and 78 yr during five months. Data were obtained using a Hitachi Supria 16-slice CT simulator at a regional oncology center in Morocco. CT-RT images are intended for 3D conformal radiotherapy treatment planning. Dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were evaluated by determining the 75th percentile as diagnostic reference levels for CT-RT breast cancer. LDRLs for CT-RT breast cancer have been determined in terms of DLP and CTDIvol, and they were 330.4 mGy.cm and 6.8 mGy, respectively. The DRLs were compared with other Europeans study. DRLs for this study were lower than those for the United Kingdom (UK), Croatia and Slovenia. The results of this study can be a reference for the establishment of local and national DRLs in Morocco and the optimization of CT-RT breast cancer procedures.

Pathogenic germline variants in patients with breast cancer: conversations across generations, practices and patients' attitude.

Background: Breast cancer susceptibility genes such as BRCA1, BRCA2, PALB2, CHEK2 and many others are increasingly recognized among our patient population. In addition to their impact on treatment decisions of tested patients themselves, identifying at-risk family members offer opportunities for cancer preventive measures. Methods: This is an observational cross-sectional study of adult breast cancer patients with positive breast-cancer-susceptibility germline variants who received treatment at our institution. Patients with variants of uncertain significance (VUS), or who refused to give consent, were excluded. The data was collected from an eligible sample of breast cancer patients using a structured questionnaire developed by the study team and tested for validity and reliability, as well as a clinical chart review form. Patients were invited to participate in the study during their scheduled oncology clinics visit. Results: 169 patients were enrolled, including 42 (24.9%) with pathogenic/likely pathogenic (P/LP) BRCA1 variants, 84 (49.7%) with BRCA2 and 43 (25.4%) with non-BRCA variants. All patients were female and the mean age was 45 ± 9.9years. Among 140 eligible patients, 104 (74.3%) underwent prophylactic mastectomy, while 79 (59.0%) of 134 eligible patients had prophylactic bilateral salpingo-oophorectomy (BSO). Results were communicated with family members by majority (n = 160, 94.7%), including 642 first degree female relatives, and 286 (44.5%) of them have taken no action. Fear of positive test results, cost of testing, unwillingness to undergo preventive measures, and social stigma were cited as barriers to genetic testing in 54%, 50%, 34% and 15%, respectively. Conclusion: Risk-reducing interventions including mastectomy and BSO were carried by majority of patients with P/LP variants. However, though the rate of communication of genetic testing results with family members was high, proper preventive measures were relatively low. Cost and fear of cancer diagnosis, were the leading causes that prevented cascade testing in our cohort.

(056) Dyadic Approaches in Oncosexology: Understanding the Relationship between Couples’ Coping and Sexual Satisfaction among Young Adult Breast Cancer Patients and Their Partners

Abstract Introduction Recent evidence supports bio-psycho-social and non-linear models of sexual functioning. These models expand current understanding of cancer-related sexual health problems to include interpersonal factors such as relationship discord, fear of intimacy, and lack of communication (Bober &amp; Varela, 2012). Sexual satisfaction, defined as “an affective response arising from one’s subjective evaluation of the positive and negative dimensions associated with one’s sexual relationship” (Lawrence &amp; Byers, 1995; p. 268), is regarded as an important metric of sexual health and wellbeing. However, most studies have included only one member of the couple, and little is known about how each partner’s coping may mutually contribute to sexual satisfaction. We examined the reciprocal influence of couples’ coping behaviors on the individual’s and the partner’s sexual satisfaction. Objective The present work describes the relationship between couples’ coping behaviors and satisfaction with sexual relationship among young adult breast cancer patients and partners. Methods A sample of 40 romantic couples receiving care at an NCI-designated comprehensive cancer center completed cross-sectional online surveys. Validated questionnaires of satisfaction with sexual relationship (GMSEX), sexual function (IIEF, FSFI), and couple coping [Dyadic Coping Inventory, (DCI)] were administered. Couple coping includes both partners’ strategies implemented to manage their own and their partners’ distress, as well as shared coping behaviors. Items are organized in multiple subscales: stress communication, supportive, delegate, negative, and common dyadic coping. Stress communication refers to the strategies implemented by the partners to communicate to each other that they are stressed. Supportive dyadic coping occurs when one partner implements problem- and/or emotion-focused coping strategies to support the other person. Delegated dyadic coping occurs when one partner takes over responsibilities to reduce their partner’s stress. Negative dyadic coping includes behaviors that are hostile, ambivalent, and superficial. Common dyadic coping indicates coordinated responses between partners. Descriptive statistics and paired sample t-tests were used to assess differences between partners’ measures. In addition, confirmatory factor analysis (CFA) was used to estimate measurement models using Mplus8, while the pooled regression approach was utilized to estimate the Actor-Partner Interdependence Model (APIM). Results In the present sample, supportive and delegated dyadic coping behaviors contributed to greater sexual satisfaction for both partners, whereas only an actor effect was detected for stress communication, negative, and common dyadic coping. Significant differences were identified between partners, with breast cancer patients reporting higher stress communication (p&amp;lt;.05), partner-reported supportive (p&amp;lt;.05) and delegated coping behaviors (p&amp;lt;.05). Male partners rated higher patients’ engagement in stress communication behaviors (p&amp;lt;.05). In addition, more than one-half of patients screened positive for clinically significant sexual dysfunction (60.6%), compared to 20% of their partners. Conclusions These results provide evidence about the importance of dyadic approaches to investigating sexual satisfaction and functioning post-cancer treatment. Stress communication exerted an individual, rather than mutual, influence on sexual satisfaction of patients and partners. Delegated and supportive dyadic coping styles resulted in reciprocal influence and were associated with the higher sexual satisfaction among dyad members. Additional research is needed to confirm these findings in larger samples of cancer patients and develop effective interventions. Disclosure No

Chinese American and Non-Hispanic White Breast Cancer Patients' Knowledge and Use of BRCA Testing.

Breast cancer is the most commonly diagnosed cancer among Chinese American women. Knowing the BRCA1 and BRCA2 (BRCA1/2) gene mutation status can improve breast cancer patients' health outcomes by guiding targeted treatment towards preventing breast cancer recurrence and other BRCA-related cancers. Nevertheless, it is unclear if there is a disparity in knowledge and use of BRCA testing among Chinese American breast cancer patients. This cross-sectional study investigated the possible presence of differences in the knowledge and the use of BRCA testing between Chinese American and Non-Hispanic White (NHW) breast cancer patients. We surveyed 45 Chinese American and 48 NHW adult breast cancer patients who had been diagnosed with breast cancer within the previous two years through telephone interviews. The results showed that race was not statistically related to the use of BRCA testing. BRCA testing utilization was associated with family history (p < 0.05) and age (p < 0.05). However, Chinese American participants' understanding of BRCA testing was significantly lower than that of NHW participants (p = 0.030). Our findings suggest that a disparity exists in BRCA testing knowledge between Chinese American and NHW breast cancer patients. Genetic education and counseling are needed to improve BRCA testing knowledge and uptake among Chinese American breast cancer patients.

In Adult Breast Cancer Patients, the Effect of Compression Garments on Changes in the Volume of Breast Cancer lymphedema: A Literature Review

Background About 21% of women treated for cancer develop breast cancer-associated lymphedema (BCRL), which could lead to negative changes in self-image, increased anxiety and reduced quality of life. Currently, there are a variety of treatments to improve lymphedema, and wearing compression garments is considered necessary, however, evidence is lacking to assess the effectiveness of BCRL compression garments. Purpose To evaluate the efficacy and safety of wearing compression garments for lymphedema volume in adult breast cancer patients. Methods By searching MEDLINE, PubMed, Psych Articles, Academic Search Complete, CINAHL and Cochrane Library, the search was limited to peer-reviewed literature published between 2017 and 2022 in English. Inclusion criteria were participants aged ≥18 years and the intervention was wearing a compression garment. The primary outcome was lymphedema volume change and adverse events. Results A total of 903 literature were obtained, and the literature were screened through the PRISMA flow chart, and five literature that met the criteria were finally included, all of which were randomized controlled trials (RCT). Risk of bias assessment and quality of evidence graded for these five RCTs were performed by two independent researchers using the Cochrane Risk of Bias Tool and the GRADE grading System. The five included RCTs were biased to varying degrees because the intervention was obvious, and the quality of the evidences were moderate, but wearing compression garment was effective and safe in all trials. Conclusion In adult breast cancer patients, wearing compression garments could significantly reduce the volume of lymphedema, and the longer the daily wear time, the better the effect, and the safer than Kinesio Taping. Future studies should conduct higher-quality, multicenter randomized controlled trials to further determine the optimal pressure range for compression garment use.

Factors Influencing Pharmacokinetics of Tamoxifen in Breast Cancer Patients: A Systematic Review of Population Pharmacokinetic Models.

Tamoxifen is useful in managing breast cancer and it is reported to have significant variability in its pharmacokinetics. This review aimed to summarize reported population pharmacokinetics studies of tamoxifen and to identify the factors affecting the pharmacokinetics of tamoxifen in adult breast cancer patients. A systematic search was undertaken in Scopus, Web of Science, and PubMed for papers published in the English language from inception to 20 August 2022. Studies were included in the review if the population pharmacokinetic modeling was based on non-linear mixed-effects modeling with a parametric approach for tamoxifen in breast cancer patients. After initial selection, 671 records were taken for screening. A total of five studies were selected from Scopus, Web of Science, PubMed, and by manual searching. The majority of the studies were two-compartment models with first-order absorption and elimination to describe tamoxifen and its metabolites' disposition. The CYP2D6 phenotype and CYP3A4 genotype were the main covariates that affected the metabolism of tamoxifen and its metabolites. Other factors influencing the drug's pharmacokinetics included age, co-medication, BMI, medication adherence, CYP2B6, and CYP2C19 genotype. The disposition of tamoxifen and its metabolites varies primarily due to the CYP2D6 phenotype and CYP3A4 genotype. However, other factors, such as anthropometric characteristics and menopausal status, should also be addressed when accounting for this variability. All these studies should be externally evaluated to assess their applicability in different populations and to use model-informed dosing in the clinical setting.

Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients: A Five-Year Retrospective Study in 10 Centers.

Cardiotoxicity as a result of anthracycline chemotherapy has been linked to increased morbidity and mortality in breast cancer patients. There is a need for early detection through risk factor identification. To date, no large multicenter study has been conducted to describe the incidence, risk factors and clinical and demographic profiles of breast cancer patients with anthracycline-induced cardiotoxicity (AIC) in the Philippines. This was a nationwide multicenter retrospective cohort study among adult breast cancer patients who underwent anthracycline chemotherapy from 2015 to 2020 in 10 sites in the Philippines. Baseline characteristics and possible risk factors for AIC were retrieved from medical records and cancer registries. AIC was defined as a reduction of left ventricular ejection fraction (LVEF) by > 10% from baseline to a value of < 53% or the development of overt left ventricular systolic dysfunction or heart failure (HF). Odds ratios from logistic regression were computed to determine risk factors associated with AIC using STATA-15.0 software. Out of 341 patients included, 33 had AIC, accounting for an incidence of 9.68%. Nine patients (2.6%) had clinical HF. AIC patients had a mean age of 53.91 ± 10.84 years. Breast cancer AIC patients were significantly older and had lower body mass index (BMI) than those without AIC. AIC patients had significantly more comorbidities, especially hypertension and atrial fibrillation. Multivariate analysis showed that patients with any preexisting comorbidity are approximately 12.37 times as likely to have AIC, while those with concurrent chemotherapy are 0.07 times or 93% less likely to have AIC. Among adult breast cancer patients undergoing anthracycline chemotherapy, we determined a high incidence of cardiotoxicity at 9.68%. Having preexisting comorbidities gave patients 12 times increased odds of developing anthracycline cardiotoxicity. The presence of concurrent non-anthracycline chemotherapy showed an inverse association with the development of AIC which we attribute largely to patient selection in a retrospective study. The significantly higher propensity for AIC development in patients with preexisting comorbidities may warrant closer monitoring and control of patient comorbidities such as hypertension among patients undergoing anthracycline chemotherapy.

Association between age and the presence and mortality of breast cancer synchronous brain metastases in the United States: A neglected SEER analysis.

BackgroundThe extent of the relationship between age and the presence of breast cancer synchronous brain metastases (BCSBMs) and mortality has not yet been well-identified or sufficiently quantified. We aimed to examine the association of age with the presence of BCSBMs and all-cause and cancer-specific mortality outcomes using the SEER database.MethodsAge-associated risk of the presence and survival of BCSBMs were evaluated on a continuous scale (restricted cubic spline, RCS) with logistic or Cox regression models. The main endpoints were the presence of BCSBMs and all-cause mortality or cancer-specific mortality. Cox proportional hazards regression and competing risk models were used in survival analysis.ResultsAmong 374,132 adult breast cancer patients, 1,441 (0.38%) had BMs. The presence of BCSBMs displayed a U-shaped relationship with age, with the highest point of the curve occurring at the age of 62. In both the younger (age ≤ 61) and older (age ≥ 62) groups, the observed curve showed a nearly linear relationship between age and the presence of BCSBMs. The relationship between age and all-cause mortality (ASM) and cancer-specific mortality (CSM) was linear. Older age at diagnosis was associated with a higher risk of ASM (HR 1.019, 95% CI: 1.013–1.024, p < 0.001) and CSM (HR 1.016, 95% CI: 1.010–1.023, p < 0.001) in multivariable Cox models. Age (sHR 1.007, 95% CI 1–1.013, p = 0.049) was substantially related to a significantly increased risk of CSM in competing risk models.ConclusionAge had a non-linear U-shaped relationship with the presence of BCSBMs and a linear relationship with BCSBMs mortality.

The role of psychosocial factors in patients' recollections of breast reconstruction options discussed with their surgeons.

A patient’s comprehension and memory of conversations with their providers plays an important role in their healthcare. Adult breast cancer patients whose legal sex was female and who underwent treatment at the Center for Reconstructive Surgery at The University of Texas MD Anderson Cancer Center were asked to indicate which breast reconstruction procedures they discussed with their surgeon. We focused on the three most frequent responses: (a) participants who remembered discussing implant-based, tissue-based, and combination procedures; (b) participants who remembered only an implant-based option being discussed; and (c) participants who remember only a tissue-based option being discussed. We used multinomial logistic regression models to explore the psychosocial factors associated with patients’ recollections of their breast reconstruction options after discussions with their reconstructive surgeons, controlling for medical factors that impact surgical decision-making. Our analyses identified body mass index, body image investment, and body image as statistically significantly associated with the reconstructive options that a participant recalls discussing with their surgeon. Our findings highlight body image investment and body image as important psychological factors that may influence what patients remember from consultations about breast reconstruction options.

Development of a multivariable clinical prediction model for liposomal doxorubicin-induced cardiotoxicity in adult breast cancer patients: a retrospective multicenter study

BackgroundThe clinical use of anthracyclines is limited by the risk of cardiotoxicity. So, we aim to develop a clinical prediction model for liposomal doxorubicin-induced cardiotoxicity in adult breast cancer patients.MethodsWe designed a multicenter retrospective cohort study. A total of 257 hospitalized breast cancer patients treated with doxorubicin liposomes were finally enrolled in the study, including 58 patients from Beijing Friendship Hospital and 199 from Beijing Cancer Hospital. In all, 32 cases developed cardiotoxicity, including 4 at the Beijing Friendship Hospital and 28 at the Beijing Cancer Hospital. The study involved breast cancer patients with no pre-existing heart disease, whose clinical data were collected from their medical records. All patients underwent electrocardiogram (ECG) and/or left ventricular ejection fraction (LVEF) measurements prior to treatment with doxorubicin liposomes. Patients were clinically assessed after each cycle of treatment, and ECG and/or LVEF measurements were performed at least once after treatment. Liposomal doxorubicin-induced cardiotoxicity was defined when one of the following three conditions was met: (I) a reduction in LVEF of at least 5% from the baseline and the absolute value was less than 55%, accompanied by congestive heart failure (CHF) symptoms or signs; (II) a reduction in LVEF of at least 10% to an absolute value of less than 55%, without CHF symptoms or signs; (III) the definite diagnosis of CHF. Variables associated with cardiotoxicity were identified by univariate and multivariate logistic regression, and the consistency and differentiation of the final model were evaluated.ResultsIn our final model, age [odds ratio (OR): 5.626, 95% confidence interval (CI): 2.321 to 13.639], cancer metastasis (OR: 3.873, 95% CI: 1.220 to 12.299), paclitaxel (OR: 3.601, 95% CI: 1.010 to 12.843), and hypertension (OR: 2.435, 95% CI: 1.046 to 5.671) were significantly associated with cardiotoxicity. The final model was tested for Hosmer-Lemeshow goodness-of-fit, the χ2 was 2.696 and the P value was 0.747, and the resultant predictive model had an area under the receiver operating characteristic (ROC; AUC) curve of 0.781.ConclusionsThis study established a risk prediction model for liposomal doxorubicin-induced cardiotoxicity in breast cancer patients and performed a stratified risk scores

Prevalence and Associated Factors of Anemia among Breast Cancer Patients Undergoing Chemotherapy: A Prospective Study.

Purpose The purpose of this study was to ascertain the prevalence and factors associated with anemia (hemoglobin [Hb] 12 g/dL) in breast cancer patients undergoing chemotherapy. Materials and Methods We conducted a prospective longitudinal study to collect demographic and clinical data on adult breast cancer patients with or without anemia who were admitted to HKL, UMMC, and NCI. The incidence of anemia was determined by detecting whether or not anemia developed during the course of chemotherapy. Mild, moderate, or severe anemia was defined. A chi-squared and logistic regression model were used to assess the effect of demographic and clinical factors on the incidence of anemia and multiple logistic regression analysis was used to evaluate the associations of potential risk factors with the presence of CRA. Results The study enrolled a total of 292 breast cancer patients. Anemia occurred at a rate of 41.1% (n = 120). Our findings indicated that clinical factors such as the number of chemotherapy regimens, dose reduction, and type of chemotherapy, for example, docetaxel, as well as demographic covariates such as age and BMI, all contribute to the incidence of anemia in cancer patients. Conclusions According to this study, the prevalence of anemia in breast cancer patients is high. Patients' age, BMI, number of chemotherapy regimens, and docetaxel were risk factors; thus, protocols are needed to identify subgroups of breast cancer likely to benefit from novel management strategies.

Abstract P2-01-12: Detection of circulating tumor cells in cerebrospinal fluid for patients with suspected breast cancer leptomeningeal metastases: A prospective study

Abstract Background Breast cancer (BC) is the most frequent cause of leptomeningeal metastases (LM). LM diagnosis is confirmed by the detection of tumor cells in the cerebrospinal fluid (CSF) using conventional cytology (gold standard). However, even with optimal CSF sample volume and time to the analysis, the sensitivity of this technique is low, demanding repeated samples. Here, we aimed to evaluate the value of circulating tumor cell (CTC) detection in CSF using the CellSearch® system for LM diagnosis. Materials and Methods This prospective, monocentric study included adult BC patients with suspected LM (clinical and/or radiological signs). CSF samples from 1-3 lumbar puncture(s) were analyzed: protein level, conventional cytology (60 drops), and CTC detection with the CellSearch® system (60 drops, first lumbar puncture only). Sensitivity (Se) and specificity (Sp) were calculated, using the results of the conventional cytology as the gold-standard. Results Forty-nine eligible patients were included (Jan 2017-Jan 2020): median age 51.8, 95.9% women, 20.4% HER2+ BC, 93.8% previously diagnosed with metastatic BC, 89.8% with clinical symptoms. Among them, 40 were evaluable (CTC detection failure: n=8, eligibility criteria failure: n=1). Median sample volume was 3.0 mL for conventional cytology samples (median time to analysis: 22min) and 3.3 mL for CTC samples. Of the 40 evaluable patients, 18 had a positive cytology (on CSF sample n=°1/n°2: n=16/n=2) and were therefore diagnosed with LM using the gold-standard method. Protein level was elevated in 88.2% of these patients, compared with 45.1% of patients with negative CSF cytology (p=0.005). CTCs were detected in these 18 patients (median 5824 CTCs, range 93-45052). CTCs were also detected in 5/22 patients with a negative cytology (median 2 CTCs, range 1-44). Among them, one patient (44 CTCs) was diagnosed with a cytologically-proven LM 9 months later, while there was no further argument for LM in the other 4 patients’ history (1-3 CTC), who died of the extra-cerebral disease after a median time of 5.2 months (range 0.9-25.9). The detection of at least one CTC in CSF was associated with a Se of 100.0% (IC95% 82.4-100) and a Spe of 77.3% (IC95% 64.3-90.3) for the diagnosis of LM. Considering the number of CTC as a quantitative value, we determined the cut-off maximizing the Youden index using the ROC analysis (93 CTC). The detection of at least 93 CTC in CSF was associated with a Se and a Spe of 100.0% for the diagnosis of LM (area under the curve [AUC]: 1.0). Conclusion CTCs were detected with the CellSearch® system in all patients diagnosed with a cytologically-proven LM, as well as in a few patients without a cytological confirmation of LM. The prognosis of these patients with CSF cytology-/CTCs+ needs to be further investigated in a larger cohort. Citation Format: Amélie Darlix, Stéphane Pouderoux, Simon Thezenas, Alexis Bievelez, William Jacot, Laure Cayrefourcq, Nicolas Menjot-de-Champfleur, Cristina Leaha, Catherine Alix-Panabières. Detection of circulating tumor cells in cerebrospinal fluid for patients with suspected breast cancer leptomeningeal metastases: A prospective study [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 P2-01-12.