Breast Oncology Clinic Research Articles

Barriers and facilitators to recruitment to a culturally-based dietary intervention among urban Hispanic breast cancer survivors.

The purpose of this study was to understand factors related to recruitment to behavioral intervention trials among Spanish-speaking urban Hispanic breast cancer (BC) survivors. Potentially eligible Hispanic BC survivors were recruited from the Columbia University Breast Oncology Clinic, signed informed consent, and completed a screening interview on demographics, medical history, acculturation (Short Acculturation Scale for Hispanics), quality of life (QOL), and perceived benefits/risks of research participation. Trial eligibility criteria included stage 0-III BC, completion of adjuvant treatment, Hispanic, fluency in Spanish, willing to be randomized to active arm (9-session in-person culturally-based ¡Cocinar para su salud! dietary modification program) or control arm (written materials). We compared characteristics between eligible women who did and did not enroll in the trial. 102 women completed the screening interview and were eligible to participate. Overall mean age was 57.3 ± 9.5 years, mean time since diagnosis was 3.4 ± 2.1 years, 71% reported annual household income <$15,000 and mean acculturation index score was 1.6 ± 0.6 (scale 1-5, low-high). Of the 102 women, 70 enrolled and 32 declined participation. Reasons stated for non-participation included lack of interest in dietary change, illness, and work constraints. Compared to women who enrolled, women who did not enroll were less likely to be employed (P=0.03) and more likely to only read/speak Spanish (P=0.02). Compared to women who enrolled, non-enrollers were more likely to state that research is costly to participants (P=0.03). Lower participation was associated with unemployment, monolingualism, and the perception that research is costly to participants. Future behavioral intervention trials among minority BC survivors need to account for these and other factors that may be related to trial participation.

Abstract A15: An innovative intervention to promote breast cancer screening in Chinese American women

Abstract Background: The potential reduction in morbidity and mortality through cancer screening can only be realized when appropriate post screening follow-up care is received for abnormalities. Cancer control education should move beyond screening to include follow-up care. In addition, cancer is viewed among some groups as a death sentence and God's punishment. This is especially true for Asian-Americans. The fear of cancer manifests itself in fatalistic views, including fear of treatment and rejection, and leads many to deny cancer screening or delay cancer treatment. The purpose of our “A WalkThrough The Cure” intervention was to create an interactive environment to provide a mechanism for participants to understand the process of breast cancer care. The intervention allowed participants to gain knowledge through direct experience and provide an opportunity to communicate and discuss myths and perceptions about breast cancer with health providers in a less threatened real-life setting. Intervention: The intervention was designed to lead participants to go through the journey of breast cancer care. The theoretical underpinning of the intervention is that persuasion occurring through an exchange process will have greater success in moving the individual toward a positive decision. The intervention brought Chinese community health workers and community members to the University of Chicago Medical Center to learn firsthand about breast health, breast cancer diagnostic and treatment, as well as survivorship. The intervention also mobilized faculty and medical students from the University of Chicago to create a stimulating learning environment. Participants were led on a walking tour of breast cancer care related centers, including Breast Health Center, Oncology clinic and Infusion Center, Oncology Radiation Center and Cancer Resource Center at the medical center. Each stop of the tour was staffed by a faculty member. A mini lecture was given by the faculty at each stop and participants were encouraged to ask questions. The tour lasted about two hours, and ended with an interactive discussion led by breast cancer survivors who shared their story of survival. Results: Twelve community health professionals and community health workers, and 16 community members took part in the event. Participants were asked to fill out pre and post surveys. In both surveys, participants were asked to rate their knowledge on five different breast cancer topics: mammogram, chemotherapy, radiation therapy, breast health and breast surgery. Participants were also asked to describe two personally important outcomes of the event and their intention to have a yearly mammogram. Before the intervention, the percentages of participants reported no knowledge on the topics were: 29% for mammogram, 25% for chemotherapy, 32% for radiation therapy, 18% for breast health and 40% for breast surgery. After the intervention, the percentages of participants reported no knowledge on the topics declined to: 7% for mammogram, 7% for chemotherapy, 7% for radiation therapy, 7% for breast health and 11% for breast surgery. After the intervention, more than half of the participants (57%) reported that they would definitely have a yearly mammogram compared to none before the intervention. Conclusion: In sum, the “A Walk Through The Cure' intervention shines a new light to patient education science that a two-way communication exchange process and direct experience not only improve knowledge, but also strongly move individual to a positive decision. Citation Format: Helen Lam, Lisa Hinton, Karen Kim. An innovative intervention to promote breast cancer screening in Chinese American women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A15. doi:10.1158/1538-7755.DISP13-A15

Abstract A22: Developing an intervention to promote breast cancer control among minorities

Abstract Background: Many studies suggested that culturally specific interventions were needed to improve cancer screening among minorities. However, the development process of such interventions and how they work are rarely mentioned. Theory-driven interventions are highly recommended. Using theories to guide the development of interventions for minority groups may not be adequate, since most theories were developed and tested in Euro-Americans and may not reflect the minority groups' life experience. In this study, we described how an intervention to promote breast cancer control among minorities was developed based on a well-studied theory and life experience from one of the minority populations - African American (AA). Intervention Development: The development of this innovative intervention, “A Walk Through The Cure”, involved three phases. During the first phase, focus groups were conducted in the targeted AA community. Focus groups are useful to exploring people's knowledge, beliefs, perceptions and experiences. They allow us to examine not only what participants think, but how they think and why they think that way. Focus groups are particularly sensitive to cultural variables. In phase 2, the focus group findings were organized using the Theory of Planned Behavior (TPB). The TPB was designed to address behaviors over which individuals have some choices and control. The TPB is based on the assumption that individuals are rational and that they make systematic use of information available to them, and that they consider the implication of their actions before they behave. Phase 3 was to design an intervention based on the information from phase 2. The goal of the new intervention was to create an interactive environment to provide a mechanism for participants to understand the process of breast cancer care. The new intervention allows participants to gain knowledge through direct experience and provides an opportunity to communicate and discusses myths and perceptions with health providers in a less threatened real-life setting. Pilot Study: Twenty-five community health workers and community members from a local African American community were invited to participate in the “A Walk Through The Cure” program. Participants were led on a walking tour of breast cancer care related centers, including Breast Health Center, Oncology clinic and Infusion Center, Oncology Radiation Center and Cancer Resource Center at the medical center. Each stop of the tour was staffed by a faculty member. A mini lecture was given by the faculty at each stop and participants were encouraged to ask questions. The tour lasted about two hours, and ended with an interactive discussion led by breast cancer survivors who shared their story of survival. Qualitative data were collected through a survey with open-ended questions. The overall feedback was positive and encouraging, and all participants reported an increase in breast cancer control related knowledge by comparing a pre and post self-assessment. Conclusion: Most of the intervention studies focused on evaluating the overall relationship between an intervention and outcomes without concerning the transformation process or underlying mechanism. Without knowing what made the intervention work or not working, it would be difficult to pinpoint what needed to be done for future improvement or development. This study laid out the underlying mechanisms of an innovative intervention. Although strategies to replicate interventions from one minority group to another have yet to be identified, successful replications depend upon many factors, such as the degree of overlap in cultural beliefs, health beliefs, health practices, and the focus of the intervention. We plan to test the intervention in other minority groups. Citation Format: Lisa Hinton, Helen Lam, Karen Kim. Developing an intervention to promote breast cancer control among minorities. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A22. doi:10.1158/1538-7755.DISP13-A22

Body mass index, diabetes, and triple-negative breast cancer prognosis.

Higher body mass index (BMI) and diabetes are associated with worse breast cancer prognosis. However, few studies have focused on triple-negative breast cancer (TNBC). The goal of this study is to examine this association in a cohort of patients with TNBC. We retrospectively reviewed 501 consecutive patients with TNBC seen at the Washington University Breast Oncology Clinic. Cox proportional hazard models were used to determine the relationship between BMI and diabetes at diagnosis with overall survival (OS) and disease free survival (DFS). Four hundred and forty-eight patients had BMI recorded and 71 patients had diabetes. The median age at diagnosis was 53 (23-98)years and follow-up was 40.1months (IQR 25.2-62.9). Baseline BMI and diabetes were not associated with OS or DFS. OS hazard ratios (HRs) for patients who were overweight (BMI 25.0-29.99), with class I obesity (BMI 30-34.99), or BMI ≥35 were 1.22 (CI 0.78-1.91), 0.92 (CI 0.59-1.43), and 1.16 (CI 0.70-1.90), respectively. The HRs for DFS in patients who were overweight, with class I obesity, or BMI ≥35 were 1.01 (CI 0.65-1.56), 0.94 (CI 0.60-1.47), and 0.99 (CI 0.63-1.57), respectively. Similarly, the HRs for diabetics were 1.27 (CI 0.82-1.96) for OS and 0.98 (CI 0.64-1.51) for DFS. Obesity and diabetes did not significantly affect survival for patients with TNBC in this study.

Massachusetts General Hospital: Improving Patient Access to the Breast Oncology Clinic

As part of Massachusetts General Hospital's overall quality improvement program, the Massachusetts General Hospital Breast Oncology Program participated in the NCCN Breast Cancer Outcomes Database Opportunities for Improvement Program. A review of concordance to breast oncology quality measures revealed that a small proportion of patients with breast cancer started chemotherapy more than 120 days after diagnosis. Therefore, the research team designed a quality improvement project to increase the percentage of concordance with the ASCO quality measure that requires time to treatment of less than 120 days and to decrease the number weeks from last definitive surgery to first adjuvant chemotherapy by 2014. A multipronged approach of improvements was used: to systems and infrastructure, communication among providers, and recruitment of additional staff as needed. This article describes the project and future initiatives to further improve the quality of breast cancer care at the institution.

Racial differences in outcomes of triple-negative breast cancer

African American (AA) women have a higher incidence of triple-negative breast cancer (TNBC: negative for the expression of estrogen receptor, progesterone receptor, and HER2 gene amplification) than Caucasian (CA) women, explaining in part their higher breast cancer mortality. However, there have been inconsistent data in the literature regarding survival outcomes of TNBC in AA versus CA women. We performed a retrospective chart review on 493 patients with TNBC first seen at the Washington University Breast Oncology Clinic (WUBOC) between January 2006 and December 2010. Analysis was done on 490 women (30 % AA) for whom follow-up data was available. The median age at diagnosis was 53 (23-98) years and follow-up time was 27.2 months. There was no significant difference between AA and CA women in the age of diagnosis, median time from abnormal imaging to breast biopsy and from biopsy diagnosis to surgery, duration of follow-up, tumor stage, grade, and frequency of receiving neoadjuvant or adjuvant chemotherapy and pathologic complete response rate to neoadjuvant chemotherapy. There was no difference in disease free survival (DFS) and overall survival (OS) between AA and CA groups by either univariate or multivariate analysis that included age, race, and stage. The hazard ratio for AA women was 1.19 (CI 0.80-1.78, p = 0.39) and 0.91 (CI 0.62-1.35, p = 0.64) for OS and DFS, respectively. Among the 158 patients who developed recurrence or presented with stage IV disease (AA: n = 36, CA: n = 122), no racial differences in OS were observed. We conclude that race did not significantly affect the clinical presentation and outcome of TNBC in this single center study where patients received similar therapy and follow-up.

Racial differences in outcomes of triple-negative breast cancer.

1048 Background: The incidence and mortality of breast cancer can differ significantly among racial and ethnic groups. African American (AA) women have a lower incidence of breast cancer, but higher mortality compared to other racial groups. Triple negative breast cancer (TNBC: negative for the expression of estrogen receptor, progesterone receptor and HER2), which is an aggressive type of breast cancer, occurs more frequently in AA women. The few studies addressing whether racial differences exist in the outcomes of patients with TNBC have yielded inconsistent results. Methods: The Washington University Medical Oncology Database captures the clinical information for all new patients (pts) seen at the Breast Oncology Clinic. Most of these pts reside in the St. Louis metropolitan area. Using this database, we performed a retrospective analysis to examine the association of race with the clinical presentation and outcome of TNBC in this geographically defined patient population. Results: Between May 2006 and March 2011, 506 pts with TNBC were entered in the database. Analysis was done on 499 patients for whom follow up data is available. The median follow up (F/U) time was 24.5 months and the median age at diagnosis was 53 (24 to 98) years. Thirty percent of pts were AA. Only 5% presented with stage IV at diagnosis and the majority of tumors (86%) were high grade. Neoadjuvant chemotherapy was administered in 151 pts, 22% of whom achieved a pathologic complete response (pCR). There was no significant difference between races in the age of diagnosis, F/U time, tumor stage, grade, frequency of receiving neo/adjuvant chemotherapy and pCR rate to neoadjuvant chemotherapy. There was no difference in disease free survival (DFS) and overall survival (OS) between AA and other racial groups by either univariate or multivariate analysis that took into account tumor stage, grade, patient age and menopausal status. The HR for OS was 1.154 (CI 0.772 – 1.725, p value 0.4860) and for DFS it was 0.947 (CI 0.650 – 1.380, p value 0.7764) in AA compared to other races. In the 92 pts who recurred, there was no racial difference in time from recurrence to death. Conclusions: Race does not significantly affect the clinical presentation or outcome of TNBC in the St. Louis metropolitan area.

Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors

Insomnia is increasingly recognized as a major symptom outcome in breast cancer; however, little is known about its prevalence and risk factors among women receiving aromatase inhibitors (AIs), a standard treatment to increase disease-free survival among breast cancer patients. A cross-sectional survey study was conducted among postmenopausal women with stage 0-III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic of a large university hospital. The insomnia severity index (ISI) was used as the primary outcome. Multivariate logistic regression analyses were performed to evaluate risk factors. Among 413 participants, 130 (31.5 %) had subthreshold insomnia on the ISI, and 77 (18.64 %) exceeded the threshold for clinically significant insomnia. In a multivariate logistic regression model, clinically significant insomnia was independently associated with severe joint pain (adjusted odds ratio (AOR) 4.84, 95 % confidence interval (CI) 1.71-13.69, P = 0.003), mild/moderate hot flashes (AOR 2.28, 95 % CI 1.13-4.60, P = 0.02), severe hot flashes (AOR 2.29, 95 % CI 1.23-6.81, P = 0.015), anxiety (AOR 1.99, 95 % CI 1.08-3.65, P = 0.027), and depression (AOR 3.57, 95 % CI 1.48-8.52, P = 0.004). Age (>65 vs. <55 years; AOR 2.31; 95 % CI 1.11-4.81; P = 0.026) and time since breast cancer diagnosis (<2 vs. 2-5 years; AOR 1.94; 95 % CI 1.02-3.69; P = 0.045) were also found to be significant risk factors. Clinical insomnia was more common among those who used medication for treating insomnia and pain. Insomnia complaints exceed 50 % among AI users. Clinically significant insomnia is highly associated with joint pain, hot flashes, anxiety and depression, age, and time since diagnosis.

Incidence of febrile neutropenia with docetaxel plus cyclophosphamide in a university-based breast oncology clinic.

9061 Background: ASCO guidelines indicate that an incidence of febrile neutropenia (FN) greater than 20 percent justifies the use of prophylactic granulocyte colony stimulating factor (G-CSF) after a particular chemotherapy regimen. Docetaxel plus cyclophosphamide (TC) is a commonly used chemotherapeutic regimen for patients with early stage breast cancer, and an FN incidence of 5 percent has been reported by Jones, et al with this regimen. In clinical practice, the incidence of FN with TC may be higher than previously reported, and we sought to determine the incidence of febrile neutropenia in our outpatient clinic. Methods: We conducted a retrospective review of paper and electronic records for 130 patients with early-stage breast cancer who received at least one standard dose cycle of docetaxel (75 mg/m2) and cyclophosphamide (600 mg/m2) at a university-based practice between November 2007 and August 2010. Fever was defined as a temperature > 101 degrees Fahrenheit or clinician-defined fever, and neutropenia was defined as an absolute neutrophil count < 500 (grade 4 neutropenia). Chi-squared analysis was used for categorical data. Results: One hundred of 130 patients studied did not receive primary prophylactic G-CSF. The incidence of febrile neutropenia was found to be 23 percent amongst these 100 patients who received at least one cycle of TC without prophylactic G-CSF versus 3 percent of the 30 patients who received G-CSF starting cycle one (p = 0.015). Seventy-six of the 100 patients not receiving cycle one G-CSF experienced grade 4 neutropenia. The average length of hospitalization for those with FN was 3.14 days. Incidence of FN was not significantly affected by age, and this data is summarized in the table below (p = 0.658). Conclusions: The incidence of FN in the current study is higher than expected based on initial reports with the TC regimen. This warrants investigation in larger cohorts to determine whether primary prophylactic G-CSF should be considered to limit this morbidity for patients receiving TC. FN [n (%)] No FN [n (%)] Total Age ≤ 50 6 (18%) 28 (82%) 34 Age 51-64 14 (26%) 40 (74%) 54 Age ≥ 65 3 (25%) 9 (75%) 12 Total 23 (23%) 77 (77%) 100

Living post treatment: definitions of those with history and no history of cancer

Breast cancer is the leading cause of cancer, and the second leading cause of cancer death in women. Due to advances in medicine, the 10 year survival rate is 80%, resulting in a large and growing number of breast cancer survivors. Definitions of cancer survivorship from a number of professional organizations and researchers vary, but the research is scant on the meaning of cancer survivorship to people with and without a prior cancer history. Two studies were conducted (1) to compare individuals with and without a prior personal cancer diagnosis in terms of those who identified as survivors vs. those who did not identify as survivors and (2) to explore explanations of those with and without a prior personal cancer for the term cancer survivor. In Study 1, individuals were surveyed at cancer-themed community health fairs. In Study 2, women were surveyed at a breast oncology clinic. In Study 1 comparing those with and without a prior cancer diagnosis, prior cancer history was the best predictor of survivorship identity, and only three individuals without a prior cancer history included family and friends as survivors. In Study 2 of those with a personal history, longer time since diagnosis, type of cancer (ductal), and comparative risk (higher) were associated with survivor identity. Completion of treatment was seen as a 'rite of passage', and thus, may be seen as a shift from the patient identity, which may have negative connotations, to the positive identity of survivor. Definitions of survivorship vary considerably, and caution should be used when applying the term to those who have no prior personal cancer diagnosis and to those who have had a more recent cancer diagnosis with a more severe disease course.

Predictors of Yoga Use Among Patients With Breast Cancer

Emerging research suggests that yoga may be beneficial for reducing symptoms and improving quality of life among breast cancer patients. However, very little is known about the characteristics of breast cancer patients who use yoga; thus, this study seeks to identify the sociodemographic and clinical characteristics of yoga users among this population. A cross-sectional survey study was conducted. The study was conducted at an outpatient breast oncology clinic at a large university hospital. Three hundred postmenopausal breast cancer patients currently receiving aromatase inhibitors were included in this study. Self-reported use of yoga following the cancer diagnosis was collected along with sociodemographic and clinical data. Multivariate logistic regression was used to identify independent predictors of yoga use among breast cancer patients. Of 300 participants, 53 (17.7%) reported having used yoga following cancer diagnosis. White patients were significantly more likely to use yoga than nonwhite patients (P = .02). Higher education level, lower BMI (body mass index), part-time employment status, previous chemotherapy, and radiation therapy were all associated with greater yoga use (all P < .05). Controlling for other factors, greater yoga use was independently associated with higher education level (adjusted odds ratio [AOR] 2.72, 95% confidence interval [CI], 1.15-6.46), and lower BMI (AOR 0.25, 95% CI, 0.09-0.66). Yoga use following breast cancer diagnosis was substantially higher for white patients and those with lower BMI and higher education levels. Considering its potential benefits for symptom management in cancer, more research is needed to understand the attitudes and barriers to yoga use among individuals with nonwhite race, lower education, and higher BMI level. Such investigation will help design yoga programs that are aligned to the needs of these populations.

Prevalence and Risk Factors for Insomnia in Breast Cancer Survivors Receiving Aromatase Inhibitors.

Abstract Purpose: Insomnia is increasingly recognized as a major symptom outcome in oncology; however, its prevalence and risk factors have not been previously defined in women receiving aromatase inhibitors (AI) for breast cancer.Patients and Methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with stage 0-III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic at a large university hospital. The validated Insomnia Severity Index (ISI) was the primary outcome (Cronbach's alpha of 0.91 in this population). According to ISI, Insomnia was categorized as: no clinically significant insomnia, 0-7; sub-threshold insomnia 8-14; clinical insomnia (moderate severity), 15-12; clinical insomnia (severe), 22-28. We defined anyone who had clinical insomnia with a score of 15 or above. Multivariate logistic regression analyses were performed to assess risk factor(s).Results: 367 patients have been analyzed, with a mean age of 61.6 +/- 10 years. 83.6% were White and 12.9% Black. While 124 (34.1%) had sub-threshold insomnia, 67 (18.4%) met criteria for clinical insomnia based on ISI: 58 (15.9%) for clinically moderate insomnia and 9 (2.5%) clinically severe insomnia. Of the entire sample, 31% considered seeking treatment for insomnia over the previous month. In a multivariate logistic regression model, clinical insomnia was independently associated with current joint pain (odds ratio [OR], 4.41, 95% confidence interval [CI], 2.17-8.96, p&amp;lt;0.001) and hot flashes (OR, 3.00, 95% CI, 1.58-5.71, p=0.001). While education level (college only vs. graduate or professional degree) was also associated with increased risk for clinical insomnia (OR, 2.46, 95% CI, 1.18-5.14, p=0.016), no other demographic, clinical or treatment variable was related to clinical insomnia.Conclusions: Insomnia is a substantial problem among breast cancer survivors receiving aromatase inhibitors and is highly associated with joint pain and hot flashes. Thus, effective treatment of joint pain and hot flashes may help improve insomnia in this population. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1062.

Weight Gain Is Associated with Increased Risk of Hot Flashes in Breast Cancer Survivors on Aromatase Inhibitors.

Abstract Objective: Hot flashes in breast cancer survivors (BCS) receiving adjuvant aromatase inhibitor (AI) therapy are common, but risk factors for these symptoms are not well-defined. This study tested if body size is associated with hot flashes in BCS on AI therapy.Materials and methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with Stages 0-III breast cancer receiving adjuvant AI therapy at a university hospital-based outpatient breast oncology clinic. Subjects provided patient-reported outcomes on hot flashes, current and pre-breast cancer weight and height, and additional demographic and treatment data.The primary outcome was occurrence of hot flashes. Secondary outcomes included hot flash severity and frequency. The exposures of interest were 1) current weight and 2) weight change since breast cancer diagnosis, categorized as weight loss (lost 10 pounds or more), maintenance (+/- 10 pounds), or gain (gained 10 pounds or more). Multivariable logistic regression models examined the independent association between hot flash outcomes and current weight or weight change while controlling for confounders.Results: 300 participants were enrolled at a mean age of 61 years (range 33-86) after mean duration of AI exposure of 23 months (range 1 month-9 years). 177 (59%) reported hot flashes overall, 96 (32%) reported moderate to very severe hot flashes, and 60 (20%) had at least 4 hot flashes daily. 182 (61%) experienced weight maintenance, while 81 (27%) had weight gain and 34 (11%) had weight loss. In a multivariable model, weight gain was independently associated with hot flash occurrence (OR 2.1, 95% CI 1.1-4.4) and hot flash severity (OR 2.4, 95% CI 1.4-4.9), but not hot flash frequency, after adjusting for current weight and height, age, smoking, race, prior chemotherapy and prior tamoxifen therapy. Hot flash occurrence was also significantly associated with current smoking (OR 5.1, 95% CI 1.1-24.0) and age (OR for each additional year of age 0.93, 95% CI 0.90-0.97). Current weight, alcohol use, AI type, and AI duration were not associated with any of the three outcomes.Conclusions: In an outpatient BCS population on AI therapy, weight gain is a risk factor for both hot flash occurrence and severity. Women who gained at least ten pounds since breast cancer diagnosis were two times more likely to have hot flashes than women who maintained or lost weight. These results support the thermoregulatory model of hot flashes and argue against a protective effect of body fat in this population.Support: ACS MRSG-08-110-01-CCE, ACS CCDA#-08-107-01, Pennsylvania Department of Aging Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1059.

Onset and risk factors for aromatase inhibitor-related arthralgia in breast cancer survivors.

Abstract Abstract #1120 Purpose: Arthralgia is a common clinical phenomenon seen in postmenopausal women receiving aromatase inhibitors (AI). This study aims to evaluate the perceived onset, prevalence, and risk factors for AI-related arthralgia.&amp;#x2028; Patients and Methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with stage I-III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic at a large university hospital. Patient-reported symptoms and attribution of AI as a cause of arthralgia were main outcomes. Multivariate logistic regression analyses were performed to assess risk factor(s).&amp;#x2028; Results: 300 patients have been enrolled, with a mean age of 61 +/- 10 years, 84% White, and 38(13%) Black. A total of 173 (58%) reported AI-related arhtralgia during the course of AI treatment and 139 (47%) attributed AI as a cause of their current arthralgia. While 103 (34%) reported having “arthritis” prior to AI initiation, 13% reported onset of symptoms within 1 month of medication initiation, 42% between 1-3 months, 27% between 3-6 months, 12% between 6-12 months, and 20% after 12 months. In a multivariate logistic regression model, time since last menstrual period (LMP) was the only significant predictor of reporting AI-related arthralgia; age, race, employment status, chemotherapy, and weight gain since breast cancer were not associated with the clinical syndrome. Controlling for these covariates, those who had LMP within 5 years had the highest probability of reporting AI-related arthralgia (73%), while those with LMP beyond 10 years had the lowest (35%), p=0.017. Prior arthritis was unrelated to AI-related arthralgia either in univariate or multivariate analyses.&amp;#x2028; Conclusions: AI-related arthralgia is common and appears to be inversely related to the length of time since cessation of menstrual function. These findings suggest that estrogen withdrawal may compound these symptoms and may play a role in the mechanism of this disorder. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1120.

Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients

Most of the 182,460 women diagnosed with breast cancer in the United States this year will become long-term survivors. Helping these women transition from active treatment to survivorship is a challenge that involves both oncologists and primary care physicians (PCPs). This study aims to describe postmenopausal breast cancer survivors' (BCS) perceptions of PCP-related survivorship care. We conducted a cross-sectional survey of 300 BCSs seen in an outpatient breast oncology clinic at a large university hospital. The primary outcome measure was a seven-item self-reported measure on perceived survivorship care (Cronbach's alpha = .89). Multivariate regression analyses were used to identify factors associated with perceived care delivery. Overall, BCSs rated PCP-related survivorship care as 65 out of 100 (standard deviation = 17). The areas of PCP-related care most strongly endorsed were general care (78%), psychosocial support (73%), and health promotion (73%). Fewer BCSs perceived their PCPs as knowledgeable about cancer follow-up (50%), late effects of cancer therapies (59%), or treating symptoms related to cancer or cancer therapies (41%). Only 28% felt that their PCPs and oncologists communicated well. In a multivariate regression analysis, nonwhite race and level of trust in the PCP were significantly associated with higher perceived level of PCP-related survivorship care (P = .001 for both). Although BCSs perceived high quality of general care provided by their PCPs, they were not as confident with their PCPs' ability to deliver cancer-specific survivorship care. Interventions need to be tested to improve oncology-primary care communication and PCP knowledge of cancer-specific survivorship care.

Prevalence of Joint Symptoms in Postmenopausal Women Taking Aromatase Inhibitors for Early-Stage Breast Cancer

Aromatase inhibitors (AIs) improve survival in postmenopausal women with hormone-sensitive breast cancer, but can cause joint pain and stiffness. The purpose of the current study was to evaluate the prevalence of and identify risk factors for AI-related joint symptoms. We performed a cross-sectional survey of consecutive postmenopausal women receiving adjuvant AI therapy for early-stage hormone-sensitive breast cancer at an urban academic breast oncology clinic. Patients completed a 25-item self-administered questionnaire assessing the presence of joint symptoms that started or worsened after initiating AIs. Multivariate regression was used to compare those with AI-related arthralgia with those who did not report symptoms, adjusting for demographic and clinical factors. Of 200 patients who completed the survey, 94 (47%) reported having AI-related joint pain and 88 (44%) reported AI-related joint stiffness. In multiple logistic regression analysis, being overweight (body mass index of 25 to 30 kg/m(2)) and prior tamoxifen therapy were inversely associated with AI-related joint symptoms. Patients who received taxane chemotherapy were more than four times more likely than other patients to have AI-related joint pain and stiffness (odds ratio [OR] = 4.08, 95% CI, 1.58 to 10.57 and OR = 4.76; 95% CI, 1.84 to 12.28, respectively). Our study suggests that AI-related joint symptoms are more prevalent than what has been described previously in clinical trials. The success of AI therapy depends on patients' ability to adhere to treatment recommendations; therefore, additional studies of interventions that may alleviate these symptoms are needed.