Breast Care Center Research Articles

Self-Reported Cancer-Related Cognitive Impairment in Patients With Breast Cancer Is Associated With Potassium Channel Gene Polymorphisms.

To evaluate for associations of polymorphisms for potassium channel genes in patients with breast cancer who were classified as having high or low-moderate levels of cancer-related cognitive impairment (CRCI). 397 women who were scheduled to undergo surgery for breast cancer on one breast were recruited from breast care centers located in a comprehensive cancer center, two public hospitals, and four community practices. CRCI was assessed using the Attentional Function Index prior to and for six months after surgery. The attentional function classes were identified using growth mixture modeling. Differences between patients in the high versus low-moderate attentional function classes were evaluated. Six single nucleotide polymorphisms for potassium channel genes were associated with low-moderate class membership. The results contribute to knowledge of the mechanisms for CRCI. These findings may lead to the identification of high-risk patients and the development of novel therapeutics.

Evaluating the use of vacuum-assisted excisions in the management of B3 breast lesions.

To evaluate the use of vacuum-assisted excisions (VAEs) in the management of B3 lesions within a single UK breast care centre. Assessment was made by determining the upgrade rates of the different B3 lesions at VAE. The study population comprised all patients who had a B3 result and subsequently underwent a VAE between November 2016 and October 2021. Patients with ipsilateral cancers were excluded. Retrospective biopsy and VAE results were reviewed. Upgrade rates and confidence intervals were calculated, and statistical significance was tested to determine any differences between upgrade rates of the B3 groups. 480 VAEs for B3 lesions were performed, with 10 excluded. Overall upgrade rate was 5%. 87.5% of upgrades were to non-invasive disease. Atypical intraductal epithelial proliferation (AIDEP) had a 15% upgrade rate, significantly different to lobular neoplasia (2%), papilloma without atypia (0%), and radial scar without atypia (0%). 10% of B3 lesions with atypia were upgraded, significantly different to 0% of B3 lesions without atypia. B3 lesions diagnosed by vacuum-assisted biopsy (VAB) had a significantly higher upgrade rate of 8% compared with 2% for lesions diagnosed by core biopsy (CBX), although this result was impacted by high numbers of AIDEP diagnosed by VAB. The results suggest using VAE for the management of AIDEP is appropriate. However, they also indicate that by performing VAEs of papillomas and radial scars without atypia, overtreatment may be occurring. This study adds to the ongoing discussion on the best treatment of B3 breast lesions.

Risk factors and predictors of tumor recurrence among breast cancer patients in a tertiary government hospital in the Philippines.

7 Background: This study aims to identify the risk factors and predictors of tumor recurrence of breast cancer patients using the local data available in the Breast Care Center in East Avenue Medical Center, Quezon City, Philippines. Methods: A chart review of 529 charts was done at the Breast Care Center between 2011–2017, and 474 charts were included. Demographics and Clinicopathologic features were gathered from the chart. Cox-proportional hazard regression was used to compute hazard ratios [95% confidence interval] of the different variables to compare the recurrence rates. Results: Breast cancer subtypes are as follows: 246 (52%) patients were HR+/Her2-, 52 (11%) were HR-/Her2+, 81 (17%) were HR+/Her2+, and 95 (20%) were HR-/Her2-. The mean age at diagnosis was 50 years old. The median BMI was 25 kg/m2. Most have hypertension (HTN) (21.7%) and diabetes mellitus (DM) (7%). The most common histology was invasive carcinoma NOS (92.6%), and 42.5% had a lymphovascular invasion. Only 6.7% received neoadjuvant systemic therapy, the rest had adjuvant systemic therapy. Mostly underwent modified radical mastectomy (92.8%). The most common cytotoxic agent used were cyclophosphamide (96.14%), doxorubicin (87.13%), docetaxel (53.37%), and 5-fluorouracil (37.87%). In the her2+ subtype, only 19.54% received trastuzumab. Among breast cancer subtypes, HR-/Her2+ has the highest tumor recurrence (15.38%), and HR+/Her2-, HR+/Her2+, and HR-/Her2- had 8.54%, 7.41%, and 11.96% had tumor recurrence, respectively. The median time to recurrence was 47, 24, 39.5, and 47 months with HR+/Her2-, HR-/Her2+, HR+/Her2+, and HR-/Her2-, respectively. The most common site of recurrence were bone (39%) and local recurrence (32.37%). Contralateral breast recurrence occurred in 2 patients with HR-/Her2+. In univariate analysis, HTN (HR 0.34 [0.13, 0.85], p=0.022), DM (HR 2.55 [1.19, 5.48], p=0.016), stage IIIA (HR 3.78 [1.04, 13.73], p=0.044), IIIB (HR 9.11 [2.46, 33.68] p=0.001), IIIC (HR 12.59 [3.50, 45.22], p<0.001), positive lymph nodes (HR 1.07 [1.02, 1.12] p=0.002), and patients who received doxorubicin (HR 0.44[0.23, 0.86], p=0.015) were statistically significant for tumor recurrence. In multivariate analysis, HTN (HR 0.32 [0.11, 0.94], p=0.038) and doxorubicin (HR 0.30 [0.13, 0.70], p=0.005) have the strongest effect for decreasing recurrence rate and DM (HR 7.45 [2.85, 19.46] p<0.001) and locally advanced stage (IIIB) (HR 10.97 [2.51, 48.06], p=0.001) were associated with greater risk of recurrence. Conclusions: In this study, we determined the risk factors and predictors of breast cancer tumor recurrence in a tertiary government hospital in a third-world country like the Philippines. Certain co-morbidities (HTN and DM), locally advanced stage at diagnosis, and systemic treatment received (doxorubicin) significantly affected tumor recurrences with breast cancer in our setting.

Providers Respond to USPSTF Report on Screening for Breast Cancer

Providers Respond to USPSTF Report on Screening for Breast Cancer

Association Between Expression of Vitamin D Receptor and Insulin-Like Growth Factor 1 Receptor Among Breast Cancer Patients.

Vitamin D receptor (VDR) and insulin-like growth factor 1 receptor (IGF1R) are known to be involved in breast cancer (BC) progression. Our previous work reported a correlation of differential localization of IGF1R with hormone receptor status in BC. A recent report described VDR and IGF1R as potential indicators of BC prognosis, but their interplay was not discussed. The present study focused on understanding the association of VDR expression with IGF1R activation, different molecular markers, and subtypes of BC. A retrospective study was designed to evaluate the VDR expression among 48 BC patients pathologically diagnosed as invasive BC and were surgically treated at Sharjah Breast Care Center, University Hospital Sharjah (UHS), United Arab Emirates (UAE). Formalin-fixed paraffin-embedded (FFPE) tumor blocks with appropriate clinicopathological data were subjected to immunohistochemistry (IHC), and VDR protein expression was interpreted based on the staining intensity (SI) and the percentage of the positively stained cells (PP). Nearly 44% of cases in the study were vitamin D deficient. A positive VDR expression with strong intensity (score > 4) was seen in 27 cases (56.3%). The expression pattern for VDR was equally distributed in cytoplasm and nucleus. For the IGF1R intensity, 24 cases (50%) of total cohort showed strong expression. A significant association was detected between IGF1R and VDR expression (P = 0.031). The present study identified positive association between IGF1R and VDR expression where most of the cases with strong VDR expression displayed strong IGF1R expression. These findings may contribute to current understanding on the role of VDR in BC and its interaction with IGF1R.

How Can Oncoplastic Breast Surgery Contribute to the Management of Locally Advanced Breast Cancer in Sub-Saharan Africa?

Because of resource constrains in sub-Saharan African countries, breast-conserving surgery (BCS) has no role in patients with locally advanced breast cancer (LABC) following neoadjuvant chemotherapy (NACT), and mastectomy remains the standard surgical treatment for these patients. The first objective of the study was to assess the safety of oncoplastic BCS in patients with LABC who showed good clinical response to NACT in a breast center with enhanced level of resources in Sudan. The second objective was to assess the cosmetic outcome. Two hundred and fifty patients with LABC were treated with NACT at Khartoum Breast Care Center during the period 2013-2019. Out of this, 52 patients were surgically treated with oncoplastic breast-conserving surgery. Kaplan-Meier curve was used to calculate the survival rates. The cosmetic outcome was subjectively assessed by the Harris scale. The median follow-up period was 53 months. The 3- and 5-years distant metastasis-free survival rates were 92.9% and 82.2%, respectively. One patient developed regional recurrence, and 6 patients developed distant metastasis. Eighty percentage of patients were admitted to have good to excellent cosmetic outcome. This Sudanese experience showed that oncoplastic BCS is oncologically safe and aesthetically satisfactory in patients with LABC who demonstrated good clinical response to NACT in a setting with enhanced levels of resources for breast cancer care.

Ductography and Microdochectomy: the Diagnostic Procedure of Choice Alongside the Conventional Tools for Nipple discharge

Introduction: Nipple discharge is the presenting complaint in 3-10% of all women with breast-related complaints. It causes considerable anxiety in the modern cancer-conscious woman. Breast surgeons frequently use various tools for diagnosing the underlying cause of nipple discharge. A definitive diagnostic approach is crucial for an accurate diagnosis of the aetiology and exclusion of any malignant breast lesion. The objective of this study was to evaluate diagnostic performances of ductography and microdochectomy and compare these with other conventional diagnostic tools. Methods: This retrospective study included 153 female patients presenting with significant nipple discharge to “Breast Care Center” from December 2011 to December 2018. Informed consent was taken from all participants. History, clinical examination, relevant imaging, cytology and histology findings of all the patients were recorded in electronic database. Results: Mean and median age of the cohort were 38.4 years and 35 years respectively. 18 of the 153 patients, had a positive family history for breast cancer which was statistically significant. 3.9% (6/153) patients were eventually diagnosed (cytopathology-1, FNAC-1, ductography-1 & microdochectomy-3) with in situ or invasive malignancies while being evaluated for nipple discharge. Breast ultrasound has sensitivity and specificity of 28.6% (5.1-69.7) & 99.3% (95.7-99.9) respectively at 95% CI in detecting risk lesions. Sensitivity of ductography in detecting risk lesions was 100% (95% CI: 5.4-100) with specificity value of 95.2% (95% CI: 85.8-98.8). Again, microdochectomy has been used as final diagnostic as well as therapeutic tools in the study. Conclusion: Ductography is a noninvasive imaging modality whereas microdochectomy, although invasive, helps reach a definitive tissue diagnosis. Ductography and microdochectomy together can serve as indispensable diagnostic tools alongside the conventional radiological and histological tools. J Bangladesh Coll Phys Surg 2022; 40: 263-269

Review of rapid access clinic referrals in breast care centre during the COVID-19 pandemic

Background: The continuation of cancer services throughout the Covid pandemic has required careful consideration of referral numbers, footfall to the hospital and provision of a secure environment. Concerns regarding delayed diagnosis and resumption of near to normal activity has seen an increase in referrals. There is scope now to modify the referral into the two-week wait system and put units in better stance if future pandemic waves occur.Aim: To introduce and measure a guidance tool for primary care in determining actual need for one-stop clinic as per the Association of Breast Surgery Guidelines (October 2020) through an electronically distributed letter.Design and setting: Retrospective data analysis using information from electronic patient notes.Method: A snapshot audit was then undertaken over a two week long period before and after the tool was distributed. Referral criteria and triple assessment outcomes were measured to see if this guidance was being followed.Results: Following guidance to Primary Care, breast pain as the only presenting symptom fell by 58%, the number of patients being discharged with 'no pathology detected' halved, and there was no drop in the number of cancer diagnoses.Conclusion: Use of explicit guidance for Primary Care with regards to low risk symptoms as per NICE guidelines can have a significant effect on the pressures of the two-week wait system and reduce footfall to the hospital. A larger study period and close tracking of patients will help to ensure safety and allow units to manage referrals in a timely manner. Background: The continuation of cancer services throughout the Covid pandemic has required careful consideration of referral numbers, footfall to the hospital and provision of a secure environment. Concerns regarding delayed diagnosis and resumption of near to normal activity has seen an increase in referrals. There is scope now to modify the referral into the two-week wait system and put units in better stance if future pandemic waves occur. Aim: To introduce and measure a guidance tool for primary care in determining actual need for one-stop clinic as per the Association of Breast Surgery Guidelines (October 2020) through an electronically distributed letter. Design and setting: Retrospective data analysis using information from electronic patient notes. Method: A snapshot audit was then undertaken over a two week long period before and after the tool was distributed. Referral criteria and triple assessment outcomes were measured to see if this guidance was being followed. Results: Following guidance to Primary Care, breast pain as the only presenting symptom fell by 58%, the number of patients being discharged with 'no pathology detected' halved, and there was no drop in the number of cancer diagnoses. Conclusion: Use of explicit guidance for Primary Care with regards to low risk symptoms as per NICE guidelines can have a significant effect on the pressures of the two-week wait system and reduce footfall to the hospital. A larger study period and close tracking of patients will help to ensure safety and allow units to manage referrals in a timely manner.

The challenge of equipoise: qualitative interviews exploring the views of health professionals and women with multiple ipsilateral breast cancer on recruitment to a surgical randomised controlled feasibility trial

BackgroundA multicentre feasibility trial (MIAMI), comparing outcomes and quality of life of women with multiple ipsilateral breast cancer randomised to therapeutic mammoplasty or mastectomy, was conducted from September 2018 to March 2020. The MIAMI surgical trial aimed to investigate recruitment of sufficient numbers of women. Multidisciplinary teams at 10 breast care centres in the UK identified 190 with MIBC diagnosis; 20 were eligible for trial participation but after being approached only four patients were recruited. A nested qualitative study sought to understand the reasons for this lack of recruitment.MethodsInterviews were conducted from November 2019 to September 2020 with 17 staff from eight hospital-based breast care centres that recruited and attempted to recruit to MIAMI; and seven patients from four centres, comprising all patients who were recruited to the trial and some who declined to take part. Interviews were audio-recorded, anonymised and analysed using thematic methods of building codes into themes and sub-themes using the process of constant comparison.ResultsOverarching themes of (1) influences on equipoise and recruitment and (2) effects of a lack of equipoise were generated. Within these themes, health professional themes described the barriers to recruitment as ‘the treatment landscape has changed’, ‘staff preferences and beliefs’ which influenced equipoise and patient advice; and how different the treatments were for patients. Patient themes of ‘altruism and timing of trial approach’, ‘influences from consultants and others’ and ‘diagnostic journey doubts’ all played a part in whether patients agreed to take part in the trial.ConclusionsBarriers to recruiting to breast cancer surgical trials can be significant, especially where there are substantial differences between the treatments being offered and a lack of equipoise communicated by healthcare professionals to patients. Patients can become overwhelmed by numerous requests for participation in research trials and inappropriate timing of trial discussions. Alternative study designs to the gold standard randomised control trial for surgical interventions may be required to provide the high-quality evidence on which to base practice.Trial registrationISRCTN (ISRCTN17987569) registered on April 20, 2018, and ClinicalTrials.gov (NCT03514654).

Variations and Challenges to Performing Outside Study Interpretations in Breast Imaging: A National Survey of the Society of Breast Imaging Membership.

Second-opinion interpretations of outside facility breast imaging provide value-added care but are operationally challenging for breast radiologists. Our objective was to survey members of the Society of Breast Imaging (SBI) to assess practice patterns and perceived barriers to performing outside study interpretations (OSIs). An anonymous survey was developed by the Patient Care and Delivery Committee of the SBI and distributed via e-mail to SBI radiologist members. Survey questions included practice demographics and OSI volumes, billing practices, clinical scenarios, and imaging modalities, logistics, and barriers. Responses were aggregated and comparisons were made by univariate analysis using likelihood ratio tests, t-tests, and Spearman's rank correlation tests as appropriate. Ordinal or nominal logistic modeling and linear regression modeling was also performed. There were 371 responses (response rate of 13%). Most respondents practice at an affiliated specialty breast care center (306/371, 83%) and said their practice performed OSIs (256/371, 69%). Academic practices reported the highest OSI volumes (median 75 per month) and were most likely to indicate increases in OSI volumes over time (100/144, 69%). The most common indication for OSI was second opinion for a biopsy recommendation (245/256, 96%). Most practices provide a final BI-RADS assessment (183/261, 70%). The most cited barrier to performing OSIs was physician time constraints (252/369, 68%). Breast imaging OSI practice patterns are variable among SBI members with notable differences by practice setting and multiple barriers identified. More unified guidelines and recommendations may be needed for radiologists to better perform this valuable task.

Accreditation Gold Standard Systems Reduce time to treatment delays; Three-year review of a South African Internationally Accredited Site.

Background: The Netcare breast Care centre has been a multi-disciplinary breast care centre since 2000. It sought accredited status in December 2016. 3 years of patient time to treatment data were analysed comparing the pre-accreditation rate to the mid accreditation and post accreditation.

Analysis of NAPBC accreditation data from a multi-disciplinary accredited unit in JHb SA shows that tumour biology not stage dictates treatment choice with increasing use of neo-adjuvant chemotherapy

Background: The Netcare Milpark Breast Care Centre of Excellence in Johannesburg, South Africa received its first NAPBC accreditation in November 2016 and received its full reaccreditation in November 2019. Seeing more than 500 newly diagnosed cancers every year, the centre implements international best practice guidelines and is at the forefront of innovation in breast cancer patient care.

Characterizing attitudes related to child-bearing in young women diagnosed with early breast cancer (EBC).

165 Background: Young women diagnosed with breast cancer face unique challenges. The desire to have a biologic child (bchild) is often a factor in treatment decisions at diagnosis and follow-up. The aim of this study is to characterize the intentions, attitudes, and decision factors considered by young women who desire to have a bchild after a diagnosis of EBC. Methods: This prospective study included young women diagnosed with stage 1-3 EBC under age 45 who saw an oncologist at UCSF’s Breast Care Center (BCC). Young women < 6 months from diagnosis were invited to complete a baseline REDCap survey on fertility, child-bearing, and family-building. Descriptive statistics were used to summarize responses. Chi square and independent samples t tests were used to compare demographics. Covariates were analyzed using odds ratios. Results: From Feb 2018 to Dec 2020, 166 eligible pts seen at the UCSF BCC were contacted, 143 pts consented, and 108 (75.5%) completed the baseline survey. Of the 108 pts, 57 (53%) were interested in having a bchild in the future. Age was the biggest driver of whether participants were interested in future child-bearing vs. not (Mean = 35.4 vs 40.9, p < 0.001) and was not influenced by stage, receptor status, or treatment. 73.6% (N = 42) of those interested in future child-bearing underwent or planned to undergo fertility preservation (FP). FP was associated with full time employment (p = 0.03) and higher education (p = 0.02). Of the 57 pts interested in future child-bearing (42 HR+, 11 TN, 12 HER2+), 30% wished to start trying to conceive within 2 years from diagnosis, and only 20% would wait 5 years or more. 43% (N = 18) of those with HR+ disease were willing to complete 5 years of hormone therapy (HT) before trying to conceive. Given hypothetical risk scenarios of an incurable cancer recurrence, 16.3% of participants were interested in a future bchild despite a 75-100% hypothetical risk of recurrence (ROR). Young women self-identified as Asian were less inclined to pursue child-bearing with increasing risk (OR = 0.3 vs. Caucasian, p = 0.04), while BRCA-carriers were more likely to remain interested in future child-bearing despite increasing risk (OR = 6.43 vs. non-carriers, p = 0.03). 59% would stop adjuvant HT early if the hypothetical absolute increased ROR from early discontinuation was < 10%. Conclusions: In this single-institution study, over half of young women with EBC expressed a desire to have a future bchild. This was independent of stage, receptor status, and treatment; the majority of women wished to conceive < 5 years from diagnosis. The desire for a future bchild decreased with increasing hypothetical risk of incurable recurrence; however, a subset wished to attempt child-bearing even when an incurable recurrence was certain. Having a bchild after EBC is a priority for many young women and should be addressed at diagnosis and throughout the continuum of care.

Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief

Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient’s spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31–92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.

Concordance between patient-reported (PR) and physician-documented (PD) comorbidities and symptoms among Stage 4 breast cancer patients (pts).

e24089 Background: Comorbidities (Co) and symptoms (Sx) in metastatic breast cancer (MBC) pts impact treatment decisions, eligibility for clinical trials, and influence prognosis and quality of life. The aim of this study was to evaluate the concordance between PR and PD Co and Sx in an electronic medical record to document pts’ health, identify Co or Sx that may be more comprehensively reported by pts vs physicians (phy), and understand if PR, PD, or concordant Co or Sx were more predictive of pt survival. Methods: New pts at UCSF’s Breast Care Center (BCC) are administered an electronic intake survey assessing PR health history, Co and Sx. Chart reviews of the initial clinic visit were conducted for PD Co and Sx. Pt and phy concordance was summarized for 54 Co and 42 Sx. Agreement was quantified using Cohen’s kappa (κ) (poor (κ < 0.2), fair (0.2≤κ < 0.4), moderate (0.4≤κ < 0.6), substantial to high (κ ≥0.6)). Cox-proportional hazards models were used to determine hazard ratios (HR) for survival with PR, PD, and concordant Co and Sx, controlling for factors including age, sites of metastatic disease, tumor biology, etc. Results: Between Nov 2016 and Feb 2020, 168 pts with confirmed MBC seen at the BCC who consented to use of their clinical data for research were included in the analysis (median age, 56 years; median time from MBC diagnosis, 0.46 years). Highest PD Co were obesity, hypertension (HTN) and thyroid disease, while highest PR Co were HTN, depression and arthritis. 23 of 54 Co had a moderate to high level of agreement between physician and pt reports (κ≥0.40). Agreement was high for diabetes, HTN, and low for obesity, anxiety, and gastroesophageal reflux disease (GERD). After controlling for clinical covariates, of these Co, only PR GERD was significantly associated with survival (HR = 1.87, p < 0.05). Only 2 of 42 Sx (shortness of breath and cough) had a moderate to high agreement between PD and PR. PR Sx were the primary drivers for predicting survival (HR > 1, p < 0.05 for PR Sx including vomiting, fatigue, weight loss and others). PD and PR agreement for these sx was poor (κ < 0.2). Conclusions: In this review of data collected as part of routine care at an academic medical center, there was substantial variance in the concordance of Co and Sx reported by pt vs phy. Concordance was higher for Co, with phy documenting a higher number of Co that can be objectively measured by lab values (diabetes, HTN) while pts reported higher rates of Co that were more subjective (anxiety, GERD). Overall, pts reported more Sx than phy. PR Sx were also the highest predictors of survival. Intriguingly, Co such as diabetes and HTN did not predict survival in this metastatic population. This suggests that incorporating PR Sx, either secondary to their cancer or related to their Co, may provide a more informative estimate of a pt’s predicted survival, and assist phy in evaluating trial eligibility and reasonable treatment options.

Incorporation of Patient-Reported Outcomes Measurement Information System to assess quality of life among patients with breast cancer initiating care at an academic center.

Symptom burden and reduced quality of life (QOL) are considerable hurdles in oncology. The authors used the Patient-Reported Outcomes Measurement Information System (PROMIS), which assesses physical and psychosocial health, to establish a mean symptom burden, examine potential drivers, and characterize severe symptom burden in breast cancer patient subgroups with the goal of characterizing stage IV patient QOL and triaging patients to individualized supportive care services. New patients at the University of California San Francisco Breast Care Center received questionnaires with 8 PROMIS domains: depression, anxiety, fatigue, sleep-related impairment, sleep disturbance, cognitive function, cognitive abilities, and physical function. PROMIS values were scored with the HealthMeasures service and were compared by age, cancer stage, and educational status. Stage IV patients with breast cancer (n = 169) reported higher depression and fatigue and worse cognitive function, cognitive abilities, and physical function than patients with stage 0 to III disease (n = 2577). As age increased, cognitive function impairment, depression, anxiety, and sleep-related symptoms decreased. More educated patients showed better physical function and less severe sleep disturbance and fatigue. Across all subgroups, patients with high anxiety had the greatest probability of worse symptom burden and function in other domains. This study provides an additional set of PROMIS population estimates across breast cancer demographic groups. The analysis of a large stage IV population reinforces that metastatic patients have impaired QOL across multiple domains. Because anxiety emerged as a potential driver of impaired QOL in other domains, earlier interventions to reduce anxiety could improve QOL overall. These analyses will help to determine appropriate thresholds of intervention. Patients receiving treatment for breast cancer can experience decreased quality of life. This study characterized differences in self-reported quality of life among patients of different ages, with different stages of cancer, and with different educational backgrounds. This study also examined the effect of decreased quality of life in one area (eg, anxiety) on another area (eg, difficulty in sleeping). Patients who were younger, had not attended college or technical school, or had stage IV cancer tended to have worse quality of life. Patients who had high levels of anxiety also tended to have high levels of impairment in other areas.

Impact of COVID-19 On Breast Cancer Management: A Radiological Prespective from A Tertiary Centre.

The coronavirus-2019 (COVID-19) pandemic caused delaying breast cancer management, increasing time interval in chemotherapy cycles and surgery. This has implications on radiological manifestation of cancer. Further, we evaluated changes observed in mammography. This case control study was conducted from March 25th, 2020 to August 15th, 2020 at the Integrated Breast Care Centre, All India Institute of Medical Science Rishikesh (AIIMS), Rishikesh. Sonomammography was performed on follow-up patients who were on chemotherapy and were scheduled for surgery. Moreover, duration of delay from the last neoadjuvant chemotherapy (NACT) cycle was recorded. Similar data in the pre-COVID-19 period from November 4th, 2019 to March 24th, 2020 was compared with post-COVID-19 data and was analyzed by SPSS Version 23. The study included 54 patients who presented between March 25th, 2020 and August 15th, 2020. Furthermore, the delay in NACT cycles has been shown to be associated with disease progression (p = 0.045). Subgroup analysis of treatment duration with various parameters revealed significant correlation between size, appearance of ulceration, and response evaluation (p<0.05). However, no significant association was found between duration of delay and the histological subtype of lesion (p>0.05). A substantial difference was seen in the evaluation of NACT response in pre- and post-COVID-19 time, with partial response (n = 39, 58.24%) seen as the most common response in pre-COVID-19 time and progressive disease (n = 28, 51.9%) as the most common response in post-COVID-19 time (p<0.001). The coronavirus pandemic has severe impact on breast cancer management. A delay in NACT causes progression in cancer. This can be seen in ultrasound and mammogram.

Specialty Space: Breast Care Centers.

As background, breast care centers around the world vary in interior design based on geographical location and the trends of the healthcare design process at the time of construction. However, at the forefront of healthcare interior design is the evidence-based design (EBD) process and the Universal Design (UD) guidelines. The Center for Health Design states that the EBD process differs from the linear design process, in that EBD uses relevant evidence to educate and guide the design decisions. The objective of this study was to support future EBD and UD use in the development of patient areas in breast care center interior design. The methods for this study incorporated an extensive review of the literature, examples of eight breast care centers around the world, observations, an interview, and a staff survey concerning the interior design of a local breast care center. The results revealed that using the EBD process and UD, to develop guidelines for patient areas in breast care centers' interior design, directors could use guidelines to evaluate existing breast care centers or preconstruction for new breast care centers. This study concluded with design guidelines for patient areas in breast care center interior design. The recommended guidelines targeted the following features: robes (vs. hospital gowns), spa-like atmosphere, monochromatic color scheme, use of wood and stone, private check-in areas, wayfinding, room temperature comfort, seating comfort, seating style choices including bariatric, personal items storage, access to natural light, indirect artificial lighting, living plants, views of nature, flooring comfort, and wheelchair accessibility.

Abstract PS9-05: Concordance between patient-reported and physician-documented comorbidities among stage 4 breast cancer patients

Abstract Background Comorbidities in metastatic breast cancer patients (pts) impact treatment decisions, eligibility for clinical trials, and influence prognosis and quality of life (QoL). The aim of this study was to evaluate the concordance between pt-reported and physician-documented (PD) comorbidities in an electronic medical record to (1) reliably document pts’ health histories to establish eligibility for clinical trials and novel therapeutics, and, (2) identify comorbidities that may be more comprehensively reported by pts rather than physicians. Patients and Methods All new pts at UCSF’s Breast Care Center (BCC) are administered an electronic intake survey that includes an assessment of pt-reported health history, comorbidities and symptoms. Between November 2016 and March 2020, 305 pts self-reported metastatic breast cancer (described as “breast cancer spread to sites other than breast or axillary lymph nodes”), and 222 consented to use of their clinical data for research. Chart-reviews were conducted for PD comorbidities at their initial BCC clinic visit. Pt and physician concordance was summarized for 54 comorbidities. Cohen’s kappa (κ) was used to quantify level of agreement. Concordance was classified using Landis and Koch thresholds with agreement as poor or slight (κ &amp;lt;0.20), fair (κ ≥0.20 to &amp;lt;0.40), moderate (κ ≥0.40 to &amp;lt;0.60), substantial (κ ≥0.60 to &amp;lt;0.80), or almost perfect (κ ≥0.80). Results Of the 222 pts, 37 pts (17%) incorrectly reported having metastatic breast cancer, 4 (2%) had duplicate surveys, 7 (3%) cancelled appointment and 5 (2%) had metastatic cancer from another primary. Thus, 168 pts with confirmed metastatic disease were included in the analysis (median age, 56 years; age range, 29-86 years; median time from diagnosis of metastatic breast cancer, 0.46 years). Highest PD comorbidities were obesity, hypertension (HTN) and thyroid disease, while highest reported comorbidities by pts were HTN, depression and arthritis. 23 of 54 comorbidities had a moderate to high level of agreement between physician and pt reports (κ≥0.40). As shown in Table 1, agreement was high for diabetes (type 1 or 2), HTN and thyroid disease, moderate for asthma/bronchitis and depression, and low for obesity, anxiety, stomach ulcers/gastroesophageal reflux disease (GERD) and arthritis. Conclusion In this review of data collected as part of routine care at an academic medical center, rates of comorbidities were relatively low, and there is substantial variance in the concordance of comorbidity reporting between pt and physicians. Pt-reported comorbidity data may help physicians more comprehensively document conditions such as depression, anxiety, arthritis and stomach ulcers/GERD, which in some cases may be subjective in nature but may significantly impact a pt’s quality of life and performance status. However, pts may underreport conditions such as obesity and heart disease, and inaccurately report other conditions such as non-insulin dependent diabetes. Recognition of depression, anxiety and GERD as comorbidities is important since some medications for these conditions may be contraindicated in some clinical trials. Understanding this concordance data may inform how we collect pt reported data to optimize understanding of a pt’s global health condition. Table 1: Concordance between physician-documented and patient-reported comorbiditiesComorbidityPhysician ReportedPatient ReportedConcordanceκDiabetes6%5%98%0.83Hypertension24%20%93%0.79Thyroid Disease20%18%92%0.74Insulin dependent Diabetes1%1%99%0.66Depression11%20%87%0.51Asthma/bronchitis12%15%89%0.51Stomach ulcers/ GERD11%18%84%0.36Obesity34%15%75%0.36Heart disease/heart valve disease7%4%93%0.32Anxiety10%18%83%0.30Non-insulin dependent diabetes3%1%97%0.27Arthritis9%20%78%0.14 Citation Format: Saumya Umashankar, Michelle E. Melisko, Madeline Matthys, Laura Van't Veer, Amrita Basu. Concordance between patient-reported and physician-documented comorbidities among stage 4 breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-05.

Abstract PS9-17: Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients

Abstract Introduction A nurse navigator is a registered nurse who serves as a patient advocate, educator, and coordinator for newly referred cancer patients. Nurse navigators assist with the coordination of care before a patient’s first appointment with their provider. In some healthcare centers, they are also the point-person throughout a patient’s entire treatment process. The nurse navigator role is designed to promote cancer patient empowerment through advocacy, educational support, resource navigation, and psychosocial care. Our study attempted to assess the impact of a newly implemented nurse navigator program, in an academic setting, and measure the effect on patient knowledge, care coordination, and emotional well-being before their breast oncology appointment. Methods A mixed-methods approach was implemented. We provided an Institutional Review Board-approved 9-question survey created from items adapted from Patient Satisfaction with Interpersonal Relationship with Navigators (PSN-I) to UCSF Breast Care Center patients before their first appointments with a breast oncology provider. After survey completion, patients were asked to participate in an open-ended interview about their patient experience with a member of the study team. Results 50 patients were surveyed. 22 (44%) patients surveyed had nurse contact and 28 (56%) did not have prior nurse contact before their appointment. With regards to patient knowledge prior to the oncology appointment, 16 out of 22 (73%) of patients with nurse contact felt informed compared to 16 out of 28 (57%) of patients without nurse contact. With regards to having initial questions answered before their visit, 11 out of 22 (50%) of patients with nurse contact strongly agreed compared to 4 out of 28 (14.3%) of patients without nurse contact. In response to the statement, “my care is coordinated effectively in the Breast Care Center,” 15 out of 22 (68%) of patients with nurse contact strongly agreed compared to 12 out of 28 (43%) of patients without nurse contact. Patients with nurse contact were asked whether speaking with a nurse did 1) improve their patient experience and 2) better deal with stressful emotions. Among 22 patients with nurse contact, 16 (73%) of patients with nurse contact strongly agreed to statement 1, and 20 (91%) agreed with statement 2. Patients without nurse contact were asked to predict whether nurse contact would 1) improve their patient experience and 2) better deal with stressful emotions. Out of 28 patients, 14 (50%) strongly agreed to both statements. From our open-ended interviews, we found the following themes: appreciation for preliminary knowledge, identification of knowledge gaps, appointment scheduling, and insurance coverage barriers, and humanistic care from nurse navigators. Patients reported that they appreciate not only a nurse navigator’s facilitation in coordination and education but also their companionship during their cancer journey. Conclusions Nurse navigators can play a vital role in improving patient knowledge, workflow/care coordination, and emotional well-being at cancer centers. A greater proportion of patients with initial nurse contact felt informed before their appointment and believed their care was effectively coordinated than those without nurse contact. The majority of patients with nurse contact believed their nurses improved their patient experience and relieved anxiety and stress. Based on this study, we will fully implement initial contact with patients to provide information and coordinate services for in-person visits. Given the changes brought by COVID, that first contact could also be with a nurse or physician via video consult prior to an in-person appointment. Future studies should investigate the impact of a longitudinal nurse navigator in providing continuity of care beyond the first referral. Citation Format: Tianyi Wang, Yash Huilgol, Jennifer James, Jeff Belkora, Janet Black, Carrie D'Andrea, Laura Esserman. Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-17.