Population Of Breast Cancer Survivors Research Articles

Impact of diabetes and other comorbidities on cardiovascular mortality in elderly breast cancer patients

Breast cancer (BC), like most cancer, is a disease of aging. According to the Surveillance Epidemiology and End Results registry, the median age of BC diagnosis is 62 with 40% > 65 years, among whom 16% additionally suffer from diabetes mellitus (DM). As survival time increases with more effective treatment, CVD risk factors (CVDRF) are now increasing in this aging population. The aim of this study was to assess the impact of DM and other CVDRF on cardiovascular disease (CVD) mortality in elderly BC patients. This retrospective study included women aged > 55 who were initially diagnosed with BC recruited from the registry of the cardio-oncology unit of Casablanca, Morocco, from January 2014 to March 2021. Patients were divided into 4 categories: no comorbidity, DM only, DM and other comorbidity or other comorbidity without DM. Overall, 1843 patients with non-metastasized BC were included. Mean age of our series was 61.3 years, comorbidities at baseline prior to BC were: hypertension in 19.3%, DM in 9.8%, dyslipidemia in 11.8% and obesity in 10.4%. In our series, the short-term Overall survival (OS) was higher in patients with DM only compared with patients without comorbidity (HR: 1.16, 95% CI: 0.85–1.88) ( P = 0.037) and similar with those with other comorbidity without DM (HR: 0.76, 95% CI: 0.48–0.92) ( P = 0.066), while patients with DM and additional comorbidity had the worst short-term OS (HR: 1.82, 95% CI: 1.54–2.16) ( P < 0.001) especially in patients aged ≥ 75 years ( P = 0.028). In our study, among elderly BC patients, diabetes mellitus is associated with poorer prognosis and shorter OS compared to patients without any comorbidity, especially if associated with additional comorbidities such as hypertension, dyslipidemia and obesity. Larger registries to better understand the true incidence of CVD and the utility of current treatments would be invaluable for this growing population of breast cancer survivors.

Assessment of the prognostic role of body mass index on breast cancer survivors: A Moroccan center experience

Positive association between elevated body mass index (BMI) and reduced survival in breast cancer (BC) women was demonstrated in previous meta-analyses of published data. Meanwhile, recent studies have reported that low BMI was associated with BC recurrence and overall mortality, which is paradoxical. The aim of our study was to evaluate the impact of BMI on mortality risk in a population of BC survivors. This retrospective study included 2284 female BC survivors recruited from the registry of the cardio-oncology unit of Casablanca between 2014 and 2021. BMI defined by the WHO criteria as follow: underweight (UW; BMI < 18.5 kg/m 2 ), normal weight (NW; BMI = 18.5–24.9 kg/m 2 ) and overweight or obese (OW; BMI ≥ 25 kg/m 2 ). We performed to evaluate the association between low BMI and clinical outcome in BC patients. The clinicopathological characteristics and clinical outcomes of patients after BC diagnosis were analyzed. In our study, 9.2% patients were UW and 23.9% were OW. OW group was associated with older age, larger size tumors, and higher cardiotoxicity ( P = 0.032, 0.025, P < 0.001, respectively). The overall survival (OS) decreased in OW patients ( P = 0.014), and both OW and obesity were independent predictors for increased risks of BC relapse and death ( P = 0.028). On the other hand, UW was more prominent in young women ( P = 0.018) and no significant association was found between BC recurrence rate and the UW group ( P = 0.082 and 0.056, respectively). However, multivariate regression analysis found that low BMI was an independent OS prognostic factor in young patients [HR: 1.72 (95% CI: 1.18–2.32), P = 0.029]. Our results demonstrate the prognostic role of BMI on BC survivors that might depend on patients’ age and clinical stage. Both overweight and underweight might be independently associated with poorer prognosis in BC patients. Efforts should be made to maintain BC patients in normal weight in order to improve survival.

Late effects in a high-risk population of breast cancer survivors.

To better understand the impact of cancer and treatment on outcomes and guide program development, we evaluated breast cancer survivors at risk for long-term medical and psychosocial issues who participated in survivorship care visits (SVs) at Johns Hopkins Hospital. We conducted a prospective survey study of women with stage I-III breast cancer who participated in SVs from 2010-2016. The same 56-item questionnaire administered at SV and follow-up included an assessment of symptoms, social factors, demographics, anxiety, depression, and comorbidities. We added the Godin Exercise questionnaire to the follow-up. In 2018, 74 participants were identified as disease-free and mailed a follow-up survey; 52 (70.3%) completed the survey. At a median follow-up time of 3.1years after diagnosis, participants were less likely to be employed (54% vs. 67%) than at the SV. About two-thirds were sedentary, and this was associated with high body mass index (p = 0.02). Sufficiently active participants (≥ 150min per week of moderate-intensity activity) were less likely to report pain (p = 0.02) or fatigue (p = 0.001). Although 19% had moderate/severe anxiety or depression at follow-up, participants who reported employment satisfaction were less likely to be depressed (p = 0.02). Awareness of issues faced by survivors is critical for enhancing care and developing models to identify patients who might benefit most from targeted long-term interventions. Interventions to address physical activity, persistent symptoms, and mental health are critical for breast cancer survivors.

'Energy-Dense, High-SFA and Low-Fiber' Dietary Pattern Lowered Adiponectin but Not Leptin Concentration of Breast Cancer Survivors.

Dietary pattern (DP) and its relationship with disease biomarkers have received recognition in nutritional epidemiology investigations. However, DP relationships with adipokines (i.e., adiponectin and leptin) among breast cancer survivors remain unclear. Therefore, we assessed relationships between DP and high-molecular weight (HMW) adiponectin and leptin concentration among breast cancer survivors. This cross-sectional study involved 128 breast cancer survivors who attended the oncology outpatient clinic at two main government hospitals in the East Coast of Peninsular Malaysia. The serum concentration of HMW adiponectin and leptin were measured using enzyme-linked immunosorbent assay (ELISA) kits. A reduced rank regression method was used to analyze DP. Relationships between DP with HMW adiponectin and leptin were examined using regression models. The findings show that with every 1-unit increase in the ‘energy-dense, high-SFA, low-fiber’ DP z-score, there was a reduction by 0.41 μg/mL in HMW adiponectin which was independent of age, BMI, education level, occupation status, cancer stage, and duration since diagnosis. A similar relationship with leptin concentration was not observed. In conclusion, the ‘energy-dense, high-saturated fat and low-fiber’ DP, which is characterized by high intake levels of sugar-sweetened drinks and fat-based spreads but low intake of fruits and vegetables, is an unhealthy dietary pattern and unfavorable for HMW adiponectin concentration, but not for leptin. These findings could serve as a basis in developing specific preventive strategies that are tailored to the growing population of breast cancer survivors.

EPRO-based individual follow-up care for women treated for early breast cancer: impact on service use and workflows.

The increasing population of breast cancer survivors highlights the need to (re)consider how we utilize available services for survivorship care in oncology clinics. Electronic Patient-Reported Outcomes (ePROs) can be used to identify patients' individual care needs and triage them to the right services. We examined the impact on service use, workflow and workload following the introduction of an ePRO-based individual follow-up (PIFU) for women treated for early breast cancer. A multi-method approach was used. In a pilot randomized controlled trial, the use of consultations, telephone calls, and specialist referrals were systematically recorded. Comparison was done between PIFU and standard follow-up care (SFU). Focus group interviews with nurse navigators evaluated the impact on workflow and workload qualitatively. The 64 women randomized to attend SFU used a mean of 3.8 (95% CI: 3.5-4.1) planned consultations during the 2-year study period compared with a mean of 1.9 consultations (95% CI: 1.4-2.4) for the 60 women randomized to PIFU (P < 0.001). Urgent appointments were more frequent in SFU (mean of 0.47 vs 0.22 per patient, P = 0.03). No statistically significant differences were observed in the use of telephone calls and specialist referrals. The nurse navigators did not experience an increase in their workload, but implementation of PIFU may require a re-structured workflow. The ePRO-based individual follow-up could change organization of care and re-allocate services for those in need of it. ePRO-based individual follow-up could potentially ensure more time for those most in need of face-to-face care.

Narrowing the Gap for Minority Cancer Survivors: Exercise Oncology in the Past, Present, and Future

ABSTRACTWhile the field of exercise oncology has substantially progressed in recent years, a significant void exists in the inclusion of and focus on minority patients diagnosed with cancer, particularly blacks and Hispanics. Blacks and Hispanics are less physically active, experience higher rates of comorbid conditions, and have poorer cancer prognosis when compared to white counterparts. Exercise prevents and reduces an array of health conditions, including cardiovascular disease, diabetes, obesity, and risk of certain cancers. However, black and Hispanic cancer survivors are underrepresented across exercise intervention trials. In this review, we discuss previous explorations among minority cancer survivors with a focus on exercise prescription, targeted outcomes, patient demographics, and barriers to exercise. We also discuss knowledge gaps and future directions necessary to progress the field of exercise oncology to include a more diverse cancer survivor cohort. In brief, we found few studies have evaluated the effect of exercise on physiologic health outcomes in black and Hispanic cancer survivors, with much research focused on psychosocial health. A majority of minority population-based research specifically targets the black breast cancer survivor population, with reported exercise-induced improvements observed in weekly physical activity, cardiorespira-tory fitness, muscle strength, quality of life, and fatigue. Minority cancer survivors also face unique challenges and barriers to exercise participation despite acknowledgement of the benefits with physical activity. Future investigations warrant explorations of exercise timing across the cancer continuum, inclusion of different types of cancer survivors, and novel exercise strategies with inclusion of culturally tailored educational and behavioral components.

The utility of magnetic resonance imaging in early-stage breast cancer survivors-An institutional experience and literature review.

The role of breast magnetic resonance imaging (MRI) in the screening of breast cancer survivors with remaining breast tissue is not well studied. We sought to evaluate the outcomes of screening breast MRI in a cohort of breast cancer survivors. A population of patients with history of stage I-IIIa breast cancer and ≥1 MRI a year or later from diagnosis between 2006-2008 were identified using the National Comprehensive Cancer Network data base from two large Boston-area cancer centers. Patient and disease characteristics were obtained from the data base, and medical records were reviewed to identify the index MRI (first eligible), indications, and two-year outcomes. Overall, 647 patients had breast MRI scans during the study period including 342 eligible patients whose index MRIs were done for breast screening purposes. 47/342 (13.7%) were abnormal, and 3.8% (13/342) underwent biopsy, resulting in the detection of 3 cases of locoregional recurrence or new primary breast cancer (0.9%, 95% CI=0.2%-2.5%). Of 295 patients with a normal index screening MRI, 12 had a breast cancer recurrence diagnosed within 2years (4.1% 95%CI=2.1%-7.0%), and 5 of these recurrences were limited to MRI-screened breast tissue. No statistically significant difference in the rate of 2-year locoregional or distant recurrence was observed between patients with an abnormal screening MRI and those with a normal scan. Adjunct single breast MRI surveillance in a general population of breast cancer survivors one year after diagnosis detected few recurrences, and its effect on short-term outcomes was unclear.

Satisfaction with care and adherence to treatment when using patient reported outcomes to individualize follow-up care for women with early breast cancer – a pilot randomized controlled trial

Background: The population of breast cancer survivors is increasing as a positive consequence of early detection and enhanced treatment. The disease and treatment associated side-effects or late-effects often impact on quality of life and daily life functions during survivorship. This calls for optimization of follow-up care. We aimed to evaluate the patients’ satisfaction with the care provided, when using electronic patient reported outcomes (ePROs) to individualize follow-up care in women with early breast cancer receiving adjuvant endocrine therapy.Material and methods: Postmenopausal women treated for hormone receptor positive early breast cancer were included in a pilot randomized controlled trial and randomized to receive standard follow-up care with prescheduled consultations every six months or individualized follow-up care with the active use of ePROs to screen for the need of consultations. ePROs were distributed every third month over a two-year period. Primary outcomes were satisfaction with the assigned follow-up care and unmet needs. Secondary outcomes were use of consultations, adherence to treatment and quality of life.Results: Of the 207 consecutive patients who were potentially eligible for the study, 134 women were enrolled (65%). In total 64 women in standard care and 60 women in individualized care were analyzed. No statistically significant differences were reported in relation to satisfaction, unmet needs, adherence to treatment or quality of life. Women in standard care attended twice as many consultations during the two year follow-up period as women in individualized care; 4.3 (95% CI 3.9–4.7) versus 2.1 (95% CI: 1.6–2.6), p < .001.Conclusion: A significant reduction in consultations was observed for the group attending individualized care without compromising the patients’ satisfaction, quality of life or adherence to treatment. For the majority of postmenopausal women treated for early breast cancer, implementation of ePROs to individualize follow-up care was feasible.

UNICANCER: French prospective cohort study of treatment-related chronic toxicity in women with localised breast cancer (CANTO)

BackgroundCorresponding with improved survival among patients with breast cancer, the awareness of the long-term effects of cancer treatments has increased. CANcer TOxicities (CANTO) aims to identify predictors of development and persistence of long-term toxicities in patients treated for stages I–III breast cancer and to characterise their incidence, as well their impact. In this paper, we describe the methodology used in this study and provide a first characterisation of the study population.MethodsCANTO (NCT01993498) is a French prospective, longitudinal cohort study enrolling patients with invasive cT0-cT3cN0-3M0 breast cancer of 26 French cancer centres. Patients are assessed at diagnosis, 3–6 (M0), 12 (M12), 36 (M36) and 60 (M60) months after completion of primary surgery, chemotherapy or radiotherapy whichever comes last. CANTO collects clinical, treatment, toxicity data, an extensive list of validated patient-reported outcomes (focusing on quality of life, psychological and behavioural questionnaires) and ad hoc socioeconomic questionnaires. Blood collection is performed at diagnosis, M0, M12, M36 and M60. Biologic sub-studies are ongoing (eg, microbiotic and cognitive sub-study).ResultsEnrolment started in 2012; by October 2018, 12 012 patients had been enrolled. Data collected have a low missing completion rate (<5% for key clinical variables, <20% for patient-reported outcomes). Blood, serum and plasma samples are stored in over 96% of patients. Among the first 5801 patients enrolled in CANTO, 76.7% of patients had hormone receptor positive and human epidermal growth factor 2 negative tumours; 73.1% of patients had breast conserving surgery; 90.4% received adjuvant radiotherapy, 53.4% (neo) adjuvant chemotherapy, 11.3% adjuvant trastuzumab and 80.3% adjuvant hormonotherapy.ConclusionsCANTO represents a unique opportunity to explore important medical, biological and psychosocial outcomes on breast cancer survivor population.

Rest-activity circadian rhythm in breast cancer survivors at 5 years after the primary diagnosis

ABSTRACTRest-activity circadian rhythm (RAR) is a marker of the circadian timing system. Particular attention has been given to RAR characteristics in cancer diseases. Specifically, alterations of RAR parameters have been found, at different stages of clinical pathway, in breast cancer (BC) patients. No studies to date have analyzed RAR alterations in breast cancer survivors several years after the diagnosis. The aim of this study was to determine RAR by actigraphy in a population of BC survivors at 5 years after the primary diagnosis, and to compare their RAR characteristics with healthy controls. The study sample was 28 women: 15 BC survivors at 5 years from the primary diagnosis (BC-group) and 13 healthy controls (Ctrl-group), matched for age and body mass index. All participants have been monitored for 7 days by actigraphy to evaluate RAR. A statistically significant circadian rhythm (T = 24) was found in all 28 subjects (p < .001). The group analysis revealed a significant RAR both in BC- and Ctrl-group (p < .001). The acrophase was not different between the BC- and Ctrl-group (15:09 vs. 15:01 hr:min in BC- and Ctrl-group, respectively). In contrast, the MESOR (Midline Estimating Statistic of Rhythm) and the amplitude were lower in the BC-group with respect to the Ctrl-group. Indeed, the MESOR was 192.0 vs. 276.4 activity counts in BC- and Ctrl-group, respectively (p < .001), while the amplitude was 167.0 vs. 222.6 activity counts in BC- and Ctrl-group, respectively (p < .001). These results provide the first experimental evidence of alterations in RAR parameters in BC survivors at 5 years after the primary diagnosis. Larger studies with a prospective design are needed to assess the role of RAR in the quality of life and prognosis in BC survivors.

Translation and perceptions of the French version of the Cancer Survivor Profile-Breast Cancer (CSPro-BC): a tool to identify and manage unmet needs.

Worldwide healthcare systems continue to struggle to reduce the unmet needs of a growing population of breast cancer survivors (BCSs). The Cancer Survivor Profile-Breast Cancer (CSPro-BC) survey was developed to address BCS's specific needs. This study aims to produce a culturally adapted French version of the CSPro-BC. The CSPro-BC(French) was developed through five steps including back translation, use of a multidisciplinary committee, and pretest with BCS (n = 22). Healthcare providers (HCP) (n = 7) from cancer and primary care settings were also interviewed to obtain perceptions of facilitators and barriers to utilization in daily practice. BCS were 40-69years old (50%), ≥ 5years post-diagnosis (45%), received chemotherapy alone or in combination (73%). Questionnaire instructions were perceived as clear, the number of questions (n = 73) acceptable, the questions non-intrusive and not complicated. Clarity of questions (min = 1; max = 7) ranged from 4 to 7 with a mean score of 5.9 out of 7. HCP perceived the CSPro-BC(French) as useful for improving communication with BCS. However, HCP stressed implementation concerns regarding competencies, BCS acceptability, and limited resources in the healthcare system to meet the identified concerns. CSPro-BC(French) is a credible tool for assessment in Francophone nations. Our study provides an important perspective in the translation method, including both survivors and HCP perspectives. Further research is required to evaluate its psychometric qualities, sensitivity to change and its clinical signification. Access to assessment tools specific to French-speaking cancer survivors having a potential to improve support from HCP and self-management capacity for BCS.

Unemployment following breast cancer diagnosis: A population-based study

ObjectivesThe population of breast cancer survivors is growing. In Western societies, many of these women are working age, and therefore, potentially desire to return to the work force. We aimed to evaluate the unemployment risk for up to 8 years following a breast cancer diagnosis and identify contributing socio-economic factors. MethodsThis historical prospective study included baseline measurements from the Israeli Central Bureau of Statistics 1995 National Census, with follow-up to 2011. We retrieved data on employment from the Israeli Tax Authority database and cancer status from the National Cancer Registry. A control group without cancer was selected to match the patients. Analyses were controlled for socio-economic factors and the baseline employment status 2 years prior to diagnosis. ResultsWe retrieved data for 2341 patients with breast cancer and 6837 age-matched women without cancer. We found an elevated risk of unemployment during the 8 years after breast cancer diagnosis (2-year OR 1.82, 95%CI: 1.59–2.075; 8-year OR 1.26, 95%CI: 1.07–1.47). Age and all examined socio-economic variables were correlated to increased risk of unemployment. The strongest predictor was pre-diagnosis unemployment (2-year OR 18.95, 95%CI: 16.68–21.52; 8-year OR 4.92, 95%CI: 4.07–5.96). Surprisingly, patients with axillary involvement were associated with less risk of unemployment than other patients. ConclusionsBreast cancer survivorship was associated with long-term risk of unemployment. Older patients and patients with lower socio-economic status were at increased risk of unemployment.

Survivorship care visits in a high-risk population of breast cancer survivors.

Breast cancer survivors face numerous challenges after diagnosis and treatment. Several models have been developed to attempt to improve quality of care. Here, we describe characteristics and outcomes of patients who participated in survivorship visits (SV) at Johns Hopkins (JH). We retrospectively reviewed charts of breast cancer patients who participated in an optional SV 1-3months after completing locoregional therapy and initial systemic therapy. We report patient demographics, comorbidities, tumor characteristics, treatments, and responses to symptom questionnaires. We compared the characteristics of SV participants to stage I-III analytical cases in the 2010-2015 JH Cancer Registry (JHCR). We identified 87 women with stage I-III breast cancer who participated in SVs from 2010 to 2016. Compared to patients in the JHCR (n = 2942), SV participants were younger, more likely to be African American and more likely to have a higher TNM stage, hormone receptor-negative disease, and HER2-positive disease. They were more likely to have received chemotherapy and radiation therapy. They also have similar recurrence rates despite the SV cohort's shorter median follow-up time. Among SV participants, the prevalence of comorbidities including peripheral neuropathy, anemia, lymphedema, anxiety, deep vein thrombosis, and depression increased significantly from time of diagnosis to most recent follow-up. Compared to the JHCR cohort, SV participants had higher risk cancers and a high frequency of comorbidities potentially associated with breast cancer and therapy. These high-risk patients may benefit most from specific interventions targeting survivorship care, and their experiences may help improve care delivery models.

Survivourship Issues As Determinants of Quality of Life After Breast Cancer Treatment: Report From a Limited Resource Setting

Background: Cancer survivorship is an unremitting struggle for breast cancer patients, as the consequence of complex treatment processes and its multitude of residual and late emerging side effects, have a significant impact on their quality of life (QOL). Unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being of women. Amid a growing population of breast cancer survivors (BCs) worldwide, supportive care research is assuming greater importance in breast cancer care. Focus of survivorship research is to identify issues impacting QOL of the cancer survivors so that supportive care services can be tailored to their specific needs. Role of individual survivor's issues have been widely reported but a comprehensive picture is lacking. Aim: This study was conducted with the aim to identify important survivorship issues adversely affecting QOL of women after breast cancer treatment. Main objectives were to (1) estimate prevalence of various survivorship issues (2) assess QOL of survivors by using FACT-B and SF-36 questionnaires (3) study impact of time elapsed since treatment on survivorship issues and QOL scores (4) identify most important issues from the perspective of impact on QOL. Methods: This descriptive, hospital based, cross sectional study was conducted in 230 breast cancer survivors and a group of 112 healthy age-matched-controls, in an academic healthcare setting in northern India. A checklist of 14 commonly reported survivorship issues, and questionnaires for QOL assessment were administered to participants. Main outcome measures were (1) frequencies of survivorship issues and QOL scores among three groups divided on the basis of time elapsed since treatment (&lt; 2 year follow-up, 2-5 year follow-up and &gt; 5 year follow-up) (2) association of survivorship issues with QOL scores (3) stepwise regression analysis to identify issues with most significant impact on QOL of survivors. Results: Breast cancer survivors showed an improvement in their QOL over time which was sustained in long term survivors. However their quality of life remains poorer, compared with healthy women, irrespective of the duration of follow-up. The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy induced cessation of menstruation (73.3%) and loss of sexual desire (60%). However the issues which had maximum adverse effect on QOL scores were emotional distress, fatigue, postmastectomy chronic pain, cessation of menstruation, body and joint pain, vaginal dryness and sleep disturbances. Conclusion: Thus in this study, emotional distress and cancer related fatigue were found to be the chief determinants of poor QOL. Further premature menopause, with its attendant systemic symptoms, vulvo-vaginal atrophy and sexual dysfunction emerged as a key contributor to poor QOL in BCs.

Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008⁻2015.

Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.

Abstract P3-09-06: Predicting cardiovascular versus cancer mortality in a cohort of breast cancer survivors

Abstract Background: Given improved survival after breast cancer diagnosis for women with non-metastatic disease, many will likely survive their disease and ultimately die from causes other than breast cancer, the most frequent being cardiovascular disease. There are numerous risk prediction models, such as the Framingham risk score, to identify persons who are at high risk for a cardiovascular event or death. However, these models have been developed for use in the general population and have not been validated in any cohorts of cancer survivors, who are at increased risk for competing causes of death. We evaluated commonly used risk models for cardiovascular events on a contemporary cohort of breast cancer survivors, and developed a new risk model to simultaneously predict the likelihood of death from breast cancer or cardiovascular disease (CVD). Methods: We included all women diagnosed with stage I-III breast cancer between January 1, 2000 and December 31, 2010 in Kaiser Permanente Northern California (KPNC) with follow-up through April 30, 2015. Specifically, we extracted from KPNC clinical and other databases: breast cancer characteristics, cardiovascular risk factors (cholesterol, blood pressure (BP), diabetes, BP lowering medication, smoking status), cardiovascular events, and cause of death. We assessed discrimination for the Framingham, CORE and SCOREOP cardiovascular risk models using the area under the receiver operating characteristic curve (AUC), and calibration by comparing the observed to the expected events. We used a multi-state model based on Cox cause specific hazards (CSH) to jointly model the risk of cardiovascular death and breast cancer death, while accounting for all other causes. Results: In this population of 20,462 KPNC breast cancer survivors with a median follow-up of 7.5 years, there were 695 cardiovascular and 842 breast cancer deaths. The existing cardiovascular risk models discriminated adequately (AUCs ranging 0.64 – 0.78), though models predicting cardiovascular mortality tended to over-predict, while those predicting non-fatal events tended to under-predict. Models developed to predict in a shorter time frame (&amp;lt;5 years), performed slightly better (E/O ratios of 1.08 and 1.18 for Framingham predicting events in the next 2 and 4 years, respectively). In our multi-state model, many of the traditional cardiovascular risk factors were no longer statistically significant (diabetes, BP) in predicting cardiovascular mortality, while the breast cancer characteristics (grade, tumor size, nodal involvement), as well as a prior history of CVD, were most useful in predicting cause of death. The model performed well, with AUCs of 0.85 (95% CI 0.83, 0.86) for 5-year risk of cardiovascular death and 0.85 (95% CI 0.84, 0.87) for breast cancer death. Conclusion: If replicated in an independent cohort, our model suggests that breast cancer characteristics can help predict overall mortality as well as cardiovascular death. Given the risk of cardiovascular death in the population of breast cancer survivors, joint modeling of breast and cardiovascular mortality is warranted. Citation Format: Leoce NM, Terry MB, Jin Z, Kushi LH, Roh JM, Laurent CA. Predicting cardiovascular versus cancer mortality in a cohort of 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 P3-09-06.

Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA

BackgroundConsumer credit may reflect financial hardship that patients face due to cancer treatment, which in turn may impact ability to manage health after cancer; however, credit’s relationship to economic burden and health after cancer has not been evaluated.MethodsFrom May to September 2015, 123 women with a history of breast cancer residing in Pennsylvania or New Jersey completed a cross-sectional survey of demographics, socioeconomic position, comorbidities, SF-12 self-rated health, economic burden since cancer diagnosis, psychosocial stress, and self-reported (poor to excellent) credit quality. Ordinal logistic regression evaluated credit’s contribution to economic burden and self-rated health.ResultsMean respondent age was 64 years. Mean year from diagnosis was 11.5. Forty percent of respondents were Black or Other and 60% were White. Twenty-four percent self-reported poor credit, and 76% reported good to excellent credit quality. In adjusted models, changing income, using savings, borrowing money, and being unable to purchase a health need since cancer were associated with poorer credit. Better credit was associated with 7.72 ([1.22, 14.20], p = 0.02) higher physical health t-score, and a − 2.00 ([− 3.92, − 0.09], p = 0.04) point change in psychosocial stress.ConclusionsThis exploratory analysis establishes the premise for consumer credit as a marker of economic burden and health for breast cancer survivors. Future work should validate these findings in larger samples and for other health conditions.Implications for Cancer SurvivorsStabilizing and monitoring consumer credit may be a potential intervention point for mitigating economic burden after breast cancer.

Analysis of patient-detected breast cancer recurrence.

After primary surgical resection, breast cancer survivors regularly undergo surveillance using multiple modalities to detect recurrences. The goal of this study was to determine how breast cancer recurrences were detected in our sample population of breast cancer survivors. We hypothesize that the majority of recurrences are patient-detected. This was a retrospective observational study evaluating patients with a detected breast cancer recurrence between 2010 and 2015. Patients were analyzed by initial detection modality (patient versus clinician versus imaging). Other variables of interest included insurance status, ambulation capability, living situation, age at diagnosis and recurrence, and time to recurrence. Statistical methods included chi-square tests, log-rank tests, and analysis of variance. 115 patients were identified with a recurrence (mean age 61 years). 88 (77%) recurrences were patient-detected, 14 (12%) were detected by imaging, and 13 (11%) were clinician-detected (chi-square goodness of fit test p < 0.001). Median time to recurrence was 4 years in the patient-detection group compared to 3 for the clinician group and 2 for imaging detection (log-rank test p = 0.01). While the majority of recurrences were patient-detected, these were detected later and at a more advanced clinical stage. This could represent an opportunity to enhance outcomes by empowering patient detection strategies.

Dietary intake of soy and cruciferous vegetables and treatment-related symptoms in Chinese-American and non-Hispanic White breast cancer survivors.

This project was undertaken to examine the association between dietary intake of soy or cruciferous vegetables and breast cancer treatment-related symptoms among Chinese-American(CA) and Non-Hispanic White (NHW) breast cancer survivors. This cross-sectional study included 192 CA and 173 NHW female breast cancer survivors (stages 0-III, diagnosed between 2006 and 2012) recruited from two California cancer registries, who had completed primary treatment. Patient-reported data on treatment-related symptoms and potential covariates were collected via telephone interviews. Dietary data were ascertained by mailed questionnaires. The outcomes evaluated were menopausal symptoms (hot flashes, night sweats, vaginal dryness, vaginal discharge), joint problems, fatigue, hair thinning/loss, and memory problems. Associations between soy and cruciferous vegetables and symptoms were assessed using logistic regression. Analyses were further stratified by race/ethnicity and endocrine therapy usage (non-user, tamoxifen, aromatase inhibitors). Soy food and cruciferous vegetable intake ranged from no intake to 431 and 865g/day, respectively, and was higher in CA survivors. Higher soy food intake was associated with lower odds of menopausal symptoms (≥24.0 vs. 0g/day, OR 0.51, 95% CI 0.25, 1.03), and fatigue (≥24.0 vs. 0g/day, OR 0.43, 95% CI 0.22, 0.84). However, when stratified by race/ethnicity, associations were statistically significant in NHW survivors only. Compared with low intake, higher cruciferous vegetable intake was associated with lower odds of experiencing menopausal symptoms (≥70.8 vs.<33.0g/day, OR 0.50, 95% CI 0.25, 0.97) in the overall population. In this population of breast cancer survivors, higher soy and cruciferous vegetable intake was associated with less treatment-related menopausal symptoms and fatigue.

Randomized Controlled Trial of Survivorship Care Plans Among Low-Income, Predominantly Latina Breast Cancer Survivors.

Purpose The purpose of this study was to examine the effects of a randomized controlled trial (RCT) of treatment summaries and survivorship care plans coupled with a nurse counseling session, primarily on physician implementation of and secondarily on patient adherence to recommended survivorship care, among a low-income population of breast cancer survivors (survivors). Methods We recruited 212 low-income, predominantly Latina (72.6%) survivors with stage 0 to III breast cancer, with an average age of 53 years, from two Los Angeles County public hospitals into an RCT of a survivorship care nurse counseling session coupled with the provision of individualized treatment summaries and survivorship care plans to patients and their health care providers from December 2012 to July 2014. One hundred seven survivors received the experimental intervention, and 105 survivors received usual care. Multiple linear regression analyses were performed to assess intervention effects on physician implementation of and patient adherence to recommended survivorship care. Scales that served as covariables were Knowledge of Survivorship Issues, Perceived Efficacy in Patient-Physician Interactions, and Satisfaction With Care and Information. Results Survivors in the intervention group reported greater physician implementation of recommended breast cancer survivorship care, for example, treatment of depression or hot flashes, than did those in the control group (adjusted difference, 16 ± 5.3; P = .003). Baseline Satisfaction With Care and Information was positively associated with physician implementation (coefficient, 5.2 ± 2.2; P = .02). Being married/partnered (-11.8 ± 4.0; P = .004) and age (-0.5 ± 0.2; P = .028) were negatively associated with patient adherence. Conclusion To our knowledge, this is the first RCT of survivorship care plans to show benefits in clinical outcomes, in this case, showing increased physician implementation of recommended breast cancer survivorship care in the intervention group, compared with the control group.