Non-breast Cancer Patients Research Articles

Durable responses to trastuzumab deruxtecan in patients with leptomeningeal metastases from breast cancer with variable HER2 expression.

Emerging data suggest that trastuzumab deruxtecan (T-DXd) is an active treatment for brain metastases from HER2 + breast cancer. We aimed to characterize the activity of T-DXd in the treatment of leptomeningeal metastases (LM) from a range of HER2-altered cancers. We reviewed neuro-oncology clinic records between July 2020 and December 2023 to identify patients who received T-DXd to treat LM. Of 18 patients identified, 6 had HER2 + breast cancer, 8 had HER2-low/negative breast cancer, 2 had HER2 + gastroesophageal cancer, and 2 had HER2-mutant non-small cell lung cancer (NSCLC). 10/18 (56%) patients had cytologically confirmed LM by CSF cytology or circulating tumor cell (CTC) capture. A partial response (PR) on MRI using the EORTC/RANO-LM Revised-Scorecard occurred in 4/6 (67%) patients with HER2 + breast LM, 2/8 (25%) patients with HER2-low/negative breast cancer, and 0/4 (0%) patients with HER2 + gastroesophageal cancer or HER2-mutant NSCLC. Median overall survival after initiating T-DXd was 5.8 months. Survival after initiating T-DXd was numerically longer for HER2 + breast cancer patients compared with HER2-low/negative breast and HER2-altered non-breast cancer patients (13.9 months vs. 5.2 months and 4.6 months, respectively). Landmark analysis showed that patients with radiologic LM response to T-DXd by 2.5 months had longer survival than non-responders (14.2 months vs. 2.6 months, HR 0.18, 95% CI 0.05-0.63, p < 0.05), and landmark analyses at 3.5 and 4.5 months after starting T-DXd showed a similar but nonsignificant trend. T-DXd induces LM responses in a subset of patients, and such responses may be associated with prolongation of survival. Prospective trials are needed to clarify the role of T-DXd in treating LM and which patients are most likely to benefit.

Impact of quantitative CT texture analysis on the outcome of CT-guided bone biopsy

Texture analysis can provide new imaging-based biomarkers. Texture analysis derived from computed tomography (CT) might be able to better characterize patients undergoing CT-guided percutaneous bone biopsy. The present study evaluated this and correlated texture features with bioptic outcome in patients undergoing CT-guided bone biopsy. Overall, 123 patients (89 female patients, 72.4 %) were included into the present study. All patients underwent CT-guided percutaneous bone biopsy with an 11 Gauge coaxial needle. Clinical parameters and quantitative imaging features were investigated. Random forest classifier was used to predict a positive biopsy result. Overall, 69 patients had osteolytic metastasis (56.1 %) and 54 had osteoblastic metastasis (43.9 %). The overall positive biopsy rate was 72 %. The developed radiomics model demonstrated a prediction accuracy of a positive biopsy result with an AUC of 0.75 [95 %CI 0.65 – 0.85]. In a subgroup of breast cancer patients, the model achieved an AUC of 0.85 [95 %CI 0.73 – 0.96]. In the subgroup of non-breast cancer patients, the signature achieved an AUC of 0.80 [95 %CI 0.60 – 0.99]. Quantitative CT imaging findings comprised of conventional and texture features can aid to predict the bioptic result of CT-guided bone biopsies. The developed radiomics signature aids in clinical decision-making, and could identify patients at risk for a negative biopsy.

Do breast cancer patients have increased risk of complications after primary total hip and total knee arthroplasty?

Breast cancer survivors have known risk factors that might influence the results of total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study evaluated clinical outcomes of patients with breast cancer history after primary THA and TKA. Our total joint registry identified patients with breast cancer history undergoing primary THA (n = 423) and TKA (n = 540). Patients were matched 1:1 based upon age, sex, BMI, procedure (hip or knee), and surgical year to non-breast cancer controls. Mortality, implant survival, and complications were assessed via Kaplan-Meier methods. Clinical outcomes were evaluated via Harris Hip Scores (HHSs) or Knee Society Scores (KSSs). Mean follow-up was six years (2 to 15). Breast cancer patient survival at five years was 92% (95% confidence interval (CI) 89% to 95%) after THA and 94% (95% CI 92% to 97%) after TKA. Breast and non-breast cancer patients had similar five-year implant survival free of any reoperation or revision after THA (p ≥ 0.412) and TKA (p ≥ 0.271). Breast cancer patients demonstrated significantly lower survival free of any complications after THA (91% vs 96%, respectively; hazard ratio = 2 (95% CI 1.1 to 3.4); p = 0.017). Specifically, the rate of intraoperative fracture was 2.4% vs 1.4%, and venous thromboembolism (VTE) was 1.4% and 0.5% for breast cancer and controls, respectively, after THA. No significant difference was noted in any complications after TKA (p ≥ 0.323). Both breast and non-breast cancer patients experienced similar improvements in HHSs (p = 0.514) and KSSs (p = 0.132). Breast cancer survivors did not have a significantly increased risk of mortality or reoperation after primary THA and TKA. However, there was a two-fold increased risk of complications after THA, including intraoperative fracture and VTE.

Septin9 DNA methylation is associated with breast cancer recurrence or metastasis.

We aimed to explore the prognostic value of Septin9 DNA methylation in breast cancer. Breast cancer patients with and without recurrence or metastasis and matched non-breast cancer patients were screened retrospectively from 2014 to 2016. Bisulfite conversion and fluorescence quantitative methylation-specific polymerase chain reaction were used to detect the Septin9 methylation status and distribution levels in patient breast tissues. Septin9 DNA methylation was more frequent in breast cancer tissues than in non-breast cancer tissues, but was not significantly correlated with any relevant breast cancer patient clinicopathological characteristic. Septin9 methylation rates were higher in patients with recurrence or metastasis. Septin9 methylation, tumor size, lymph node status, and progesterone receptor (PR) expression could influence prognosis. Septin9 methylation was significantly associated with worse disease-free survival in breast cancer patients, with receiver operating characteristic curve analysis indicating that it had good prognostic ability, with an area under the curve (AUC) value of 0.719. The AUC values increased when Septin9 methylation was combined with tumor size, lymph node status, and PR to predict prognosis. Septin9 DNA methylation was an independent predictors of breast cancer prognostic risk. This could possibly help improve comprehensive prognosis prediction methods when combined with other risk factors.

Radioactive Seed Localization for Non-Breast Tissue Excision.

Lymph nodes are common basins for cancer recurrence; however, during surgery, lymphatic tissue is often indistinguishable from surrounding tissue making local excision difficult. Novel breast surgery techniques have utilized radioactive seed localization (RSL) to preoperatively tag tissue so it can be identified intraoperatively with a gamma probe. Our goal was to assess the use of RSL in non-breast tissues. This was a retrospective case series of non-breast cancer patients undergoing RSL. Overall, 42 patients met inclusion criteria. Pathology results indicated benign findings in 20 patients (47.62%), toxoplasma in 1 patient (2.38%), non-necrotizing granulomatous disease in 2 patients (4.76%), and malignant progression in 19 patients (45.24%). Two patients had non-lymphatic tissue removed: one in the abdominal wall and one in the lower lumbar region. Radioactive seed localization is an effective technique to localize and excise non-palpable lymph nodes and masses identified on imaging, highlighting its wide variety of uses in non-breast cancer cases.

Combined Hyperthermia and Re-Irradiation in Non-Breast Cancer Patients: A Systematic Review.

This systematic literature review summarizes clinical studies and trials involving combined non-ablative hyperthermia and re-irradiation in locoregionally recurrent cancer except breast cancer. One database and one registry, MEDLINE and clinicaltrials.gov, respectively, were searched for studies on combined non-ablative hyperthermia and re-irradiation in non-breast cancer patients. Extracted study characteristics included treatment modalities and re-irradiation dose concepts. Outcomes of interest were tumor response, survival measures, toxicity data and palliation. Within-study bias assessment included the identification of conflict of interest (COI). The final search was performed on 29 August 2022. Twenty-three articles were included in the final analysis, reporting on 603 patients with eight major tumor types. Twelve articles (52%) were retrospective studies. Only one randomized trial was identified. No COI statement was declared in 11 studies. Four of the remaining twelve studies exhibited significant COI. Low study and patient numbers, high heterogeneity in treatment modalities and endpoints, as well as significant within- and across-study bias impeded the synthesis of results. Outside of locoregionally recurrent breast cancer, the role of combined moderate hyperthermia and re-irradiation can so far not be established. This review underscores the necessity for more clinical trials to generate higher levels of clinical evidence for combined re-irradiation and hyperthermia.

ASO Visual Abstract: Stage IV Non-Breast Cancer Patients and Screening Mammography: It is Time to Stop.

ASO Visual Abstract: Stage IV Non-Breast Cancer Patients and Screening Mammography: It is Time to Stop.

Stage IV Non-breast Cancer Patients and Screening Mammography: It is Time to Stop.

Patients diagnosed with metastatic cancer have shortened life expectancy with questionable benefit of routine screening mammography (SM). The aim of this study was to evaluate the incidence and consequences of continued SM in the setting of reduced survival from stage IV non-breast cancer. Women diagnosed with Stage IV non-breast cancer at a single institution from 2015 to 2019 were queried from the institutional tumor registry for demographics, stage IV cancer diagnosis, and survival. Incidence and timing of SM after stage IV diagnosis and further diagnostic workup were extracted from the medical record. 790 women with Stage IV non-breast cancer were identified, 109 (14%) had at least 1 SM, 23% required diagnostic mammography, 7% breast biopsy, and 1% breast surgery. No breast cancers were identified. SM was ordered most often in stage IV gynecological cancers (28%), with more common cancers still seeing a high percentage of patients screened (lung 10%, colorectal 15%). Study 3-year survival was 26% (95% confidence interval [CI] 23-30%), with 74% mortality during follow up and median time from Stage IV diagnosis to death of 1.2 years (CI 0.4-2.3years). Of patients screened, 41/109 died within 2 years of undergoing SM. Despite low overall survival for patients diagnosed with metastatic non-breast cancer, 14% of women underwent SM which resulted in additional imaging, biopsies, and surgery with no new breast cancers identified. Continued SM in this population offers risk without benefit of reduced breast cancer mortality and should no longer continue in women with stage IV non-breast cancer.

Retrospective review of cutaneous metastasis among 11,418 patients with solid malignancy: A tertiary cancer center experience.

Cutaneous metastasis (CM) occurs infrequently and usually presents during the later stages of cancer, and has a poor prognosis. Although there are insufficient current data, cancer treatment changes could have a positive impact on the outcome. This retrospective study aimed to review the pattern and prognosis of CM in patients with solid malignancy in a tertiary cancer center in Thailand.We reviewed the medical records of cancer patients diagnosed with CM between October 2009 and August 2015 at Chulabhorn Hospital, a tertiary cancer center in Thailand. Patients with primary skin cancer and hematological malignancies were excluded. We collected and analyzed data, including the time of cancer diagnosis and CM, type of cancer, clinical characteristics, and survival outcome.Of 11,418 patients, there were 33 (0.3%) were diagnosed with CM. Breast cancer was the most common primary cancer (12 cases, 36%). Skin nodules were commonly detected on the anterior chest wall. Also, 79% of CM patients had concomitant visceral metastasis. The median overall survival of those with CM was 9.21 months (95% confidence interval 4.75–83.38 months) regardless of presentation either at onset or disease recurrence (P = .083). However, the change of management was affected in 78% diagnosed with a later stage of CM. No statistical difference in survival was observed between breast cancer and non-breast cancer patients (8.79 vs 9.21 months, P = .613).Despite CM being a sign of poor prognosis, it may still be an indicator for changing cancer patients’ treatment. Hence, early CM diagnosis and prompt novel therapy may positively affect outcomes for cancer patients.

Identification of Subclinical Myocardial Dysfunction in Breast Cancer Patients with Metabolic Syndrome after Cancer-Related Comprehensive Therapy.

Background Breast cancer patients with metabolic syndrome have an increased risk of cardiovascular disease. These patients are more prone to suffer from cardiotoxicity after anticancer therapy. Patients after completion of cancer-related comprehensive therapy, who show normal myocardial function, may already have subclinical myocardial dysfunction. We sought to evaluate the subclinical myocardial dysfunction in breast cancer patients with metabolic syndrome after cancer-related comprehensive therapy. Methods. In this study, 45 breast cancer patients with metabolic syndrome after completion of cancer-related comprehensive therapy, 45 non-breast cancer patients with metabolic syndrome, and 30 breast cancer patients without metabolic syndrome after therapy were enrolled. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were measured using echocardiogram. Results All the patients had normal LVEF. However, nine breast cancer patients with metabolic syndrome (20%) had GLS that was lower than –17%, while all the noncancer patients had normal GLS. Breast cancer patients with metabolic syndrome had a decrease of GLS and LVEF, compared with noncancer patients with metabolic syndrome. Furthermore, we found that decrease of age was associated with reduction of LVEF and that use of trastuzumab for 1 year was a significant factor associated with reduction of GLS. In addition, breast cancer patients with metabolic syndrome had a decrease of GLS, compared with breast cancer patients without metabolic syndrome after cancer-related therapy. Conclusions Breast cancer patients with metabolic syndrome after completion of cancer-related comprehensive therapy suffered from subclinical myocardial dysfunction. GLS should be routinely performed to early identify subclinical myocardial damage of patients, in order to prevent the cardiotoxicity of cancer-related comprehensive therapy.

Targeting G1/S phase cell-cycle genomic alterations and accompanying co-alterations with individualized CDK4/6 inhibitor-based regimens.

BACKGROUNDAlthough CDK4/6 inhibitors are an established treatment for hormone receptor–positive, HER2-negative metastatic breast cancers, their benefit in other malignancies remains limited.METHODSWe investigated factors associated with clinical outcomes from CDK4/6 inhibitor–based therapy among patients with G1/S phase cell-cycle alterations (CDK4/6 amplifications, CCND1/2/3 amplifications, or CDKN2A/B alterations).RESULTSOverall, 2457 patients with diverse solid tumors that underwent clinical-grade, next-generation sequencing (182–465 genes) and therapy outcome of (non–breast cancer) patients treated with matched CDK4/6 inhibitors were analyzed. G1/S phase cell-cycle alterations occurred in 20.6% (507 of 2457) of patients; 99% of those patients (n = 501) harbored ≥1 characterized co-alteration (median, 4; range, 0–24). In 40 patients with G1/S phase cell-cycle alterations given CDK4/6 inhibitors as part of their regimen, significantly longer median progression-free survival (PFS) was observed when CDK4/6 inhibitor–based therapies matched a larger proportion of tumor alterations, often because CDK4/6 inhibitors were administered together with other drugs that were matched to genomic co-alterations, hence achieving a high matching score (high vs. low [≥50% vs. <50%] matching score, PFS, 6.2 vs. 2.0 months, P < 0.001 [n = 40] [multivariate]) and higher rate of stable disease ≥6 months or an objective response (57% vs. 21%, P = 0.048).CONCLUSIONIn summary, in cell-cycle–altered cancers, matched CDK4/6 inhibitors, as part of an individualized regimen targeting a majority of genomic alterations, was independently associated with longer PFS.TRIAL REGISTRATIONClinicalTrials.gov NCT02478931.FUNDINGJoan and Irwin Jacobs Fund, National Cancer Institute (P30 CA023100, R01 CA226803), and the FDA (R01 FD006334).

Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran

Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran

Intraoperative radiation therapy in non-breast cancer patients: A report of 26 cases from Shiraz, south of Iran.

Background: Intraoperative radiation therapy (IORT) is the delivery of radiation at the time of surgery. Whereas the dose delivered by external beam radiation therapy (EBRT) is limited by the tolerance of the surrounding normal tissues, IORT allows exclusion of a part or all of the dose-limiting sensitive structures by operative mobilization and/or direct shielding of these structures. The aim of the present study was to report the non-breast cancer patients' outcomes after receiving IORT in Shiraz, Iran. Methods: In this retrospective study, all cases who had received IORT and had non-breast malignancies were selected. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI) and computed tomography (CT). IORT was applied by self-shielded, LIAC 6-12 MeV Sordina mobile linear accelerator. Typically, a single dose of 10-21 Gy was given for maximally resected tumors. The statistical analyses were carried out using SPSS (version 21). Results: Twenty-six patients were treated with IORT alone or combined with EBRT. Different tumors were treated, including colorectal adenocarcinoma (10 cases, 38.4 %), Soft Tissue Sarcomas (STS, 11 cases, 42.3 %), head and neck cancers (3 cases, 11.5 %), one cervix malignancy case and one paravertebral fibromatosis case. Mean ± SD overall survival was 15±14.89 (0-38) and 34.3±15.72 (14-53) months for colorectal cancer and STS, respectively. Conclusion: IORT is mostly useful for pelvic and abdominal malignancies where normal bowel limits the dose that can be delivered with EBRT. However, the dose delivered in a single fraction with IORT is rarely sufficient for tumor control; therefore, IORT is usually preceded or followed by additional EBRT which should be further evaluated preferably in prospective randomized trials.

Breast Cancer Patients Perceive Psychosocial Side Effects of Cancer Radiation Therapy as Worse than Non-Breast Cancer Patients

As cancer care improves, quality-of-life (QOL) is increasingly paramount but is difficult to quantify. No studies report which side effects (SE) patients undergoing a prolonged course of radiotherapy (RT)-predominant care perceive as the most severe. The prevalence, absolute severity, and natural history of psychosocial SE in cancer patients is well understood, but their severity relative to physical SE is unknown. We conducted a survey to use patient report outcomes to identify and rank SE perceived by 55 patients on the final day of ≥ 4 weeks of RT. Patients who had received ≥ 4 weeks of chemotherapy prior to RT start were excluded. Patients selected from 67 cards listing symptoms all those experienced (40 physical and 27 psychosocial) and the 5 most troublesome. A score of 5, 4, 3, 2, and 1 (15 points total) was assigned to top 5 selected SE, respectively. A total of 49% were female, mean age was 57 years, 58% were Hispanic, and mean RT dose was 57 Gy. Differences in ranking of severity of SE were evident when patient groups were divided by location of RT (Table). Psychosocial SE filled 46% of the 15 points in breast cancer patients compared to only 20% in non-breast cancer patients (p=.01; OR <.01 [<.01, .29]). Incidental cancer discovery (40% of cohort; e.g. mammogram, elevated PSA) versus discovery from symptoms showed 43% vs 23% (p=.01) in this manner but fell out of significance on logistic regression (OR 3.44 [0.59, 20]). Patients receiving concurrent systemic treatment (55% of cohort) perceived physical SE > psychosocial SE in severity (OR 0.12 [0.02, 0.89]). Patients with >6 months’ elapsed time from diagnosis to RT completion (44% of cohort) versus <6 months showed 44% vs 21% in this manner (OR 5.10 [1.08, 24.18]; worst SE anxiety and their sequelae). Perceptions of the SE of cancer RT are dominated by physical QOL concerns and are influenced by the anatomic area receiving RT. However, in certain groups, psychosocial SE are equivalent in severity to physical SE. Roughly half of the most severe SE in breast cancer patients are psychosocial in nature. In other groups, psychosocial SE are more common. Patients living with a cancer diagnosis for >6 months more commonly report anxiety-related psychosocial SE.Tabled 1Abstract TU_42_3738; Table 1Breast/Thorax/Abdomen (n=22)H&N (n=14)Pelvis (n=19)RankSymptomPsychosocial (Psy) or Physical (Ph)ScoreSymptomPsy or PhScoreSymptomPsy or PhScore1Burning or painful skinPh42Trouble or pain with swallowingPh30DiarrheaPh382Feeling tense or anxiousPsy24Sore mouth and/or throatPh23Increased urinationPh263Feeling low (depression)Psy18Loss of appetitePh22Painful urinationPh234Headaches, migrainePh17Difficulty sleepingPh16Weight lossPh165NauseaPh16Change in the way things tastePh15Loss of appetitePh146IrritabilityPsy16Dry mouthPh13Affects my work/home dutiesPsy137Constantly tiredPh15Weight lossPh12Stomach achePh128Affects my work/home dutiesPsy12NauseaPh11Burning or painful skinPh12 Open table in a new tab

Long-Term Follow-Up of Oligometastases Patients Treated with Hypofractionated, Stereotactic Radiation Therapy (HSRT) on a Prospective Study

To analyze the long-term follow up of patients treated with HSRT for oligometastases from non-breast malignancies. From 2001-2006, 82 non-breast cancer patients with 1-5 radiographically apparent metastatic lesions were enrolled on a prospective study of HSRT. The eligibility requirements included age ≥ 18 y, KPS ≥ 70, and metastases to 1-3 organ sites. Net GTV represents the sum of each lesion’s contoured GTV, and was grouped into five categories (<20, 20-40, 40-60, 60-80, and >100cc). A stereotactic x-ray was used. The PTV was generated with a volumetric GTV expansion of 10 mm in the craniocaudal direction and 7 mm in other directions, and was covered by the 80% isodose line. FFDM was defined from date of enrollment until death, an event (i.e. widespread distant metastasis not amenable to local therapy), or last radiographic study. Lesion local recurrence was scored as an event if pathologically confirmed or if increased by ≥20% using RECIST criteria. Prognostic variables were assessed using Cox regression analysis, and FFDM and OS rates were calculated using Kaplan-Meier survival analysis. The mean age was 61 ± 11 y with a male to female ratio of 46/36. The most common histologies were adenocarcinoma (61%), squamous cell carcinoma (9%), and sarcoma (9%). The most common metastatic sites were liver (50%), lung (48%), thoracic lymph nodes (18%), and bone (5%). 61 had 1 involved organ and 18 had 1 lesion treated. 50 Gy in 10 fractions (52/82 patients) was the preferred schedule. The mean and median net GTV were 32 and 55 ml respectively (range 0.3-422). Other analyzed variables included prior curative-intent local therapy (35%), previously had >5 metastatic lesions (20%), and systemic therapy at some point after diagnosis of metastatic disease (74%). The median follow-up was 1.7 y (and 13.4 y for 4 of 82 patients alive at last follow-up). Eleven patients lived >5 years, and 6 lived >10 years. The 5-year OS, FFDM, and LC rates were 13.4%, 13.6%, and 62.2%, and the 10-y OS, FFDM, and LC rates were 7.3%, 12.3%, and 61.0%, respectively. On both univariate (UV) and multivariate (MV) analysis, net GTV was the only variable significant for OS (MV p=0.034, HR 1.36). GTV also proved to be significant on UV and MV (p=0.039, HR 2.31) for lesion LC. Having more than one organ involved with metastasis was not significant on UV (p=0.49) but was significant on MV analysis (p=0.020) for local control. Analysis for FFDM showed that net GTV was not a significant factor. On MV analysis, systemic therapy during metastatic diagnosis was significantly associated with FFDM (p=0.046, HR 0.47). Select non-breast cancer patients with limited metastasis treated with HSRT are long-term survivors. Net GTV is a significant factor for tumor control and survival. By 5 years, only 1 in 8 patients treated remained free from distant metastasis. Further research is needed to help better select patients most likely to benefit from local therapy for metastatic disease.

Improving Information and Support for Metastatic Breast Cancer in Nigeria

Background: Breast cancer is a global health problem of the 21th century. In developing countries, it is the third most common cause of death after infectious, parasitic, and cardiovascular diseases. Experience of late stage cancer carries a high emotional burden, due to poor outcomes and lack of comprehensive care. Currently in Nigeria, most cancer patients are looked after almost solely by their primary clinical oncologists, with minimal psychological and social care. There is a great need to broaden the care to include the psychosocial component now, considered a priority in clinical practice guidelines worldwide. Aim: To assess distress levels and improve quality of life of metastatic breast cancer patients through a continued support group system and psychotherapy. Produce field-tested audio-visual community education, psychosocial support and advocacy materials aimed at improving early diagnosis and reducing breast cancer death. Methods: This is a mixed-methods design study including a prepost design and qualitative focus group discussions. The study will enroll all consecutive patients in advanced stages 3 and 4 of their illness who consent to be included in the study until the estimated sample size of about 100 for the given period of the study is attained. The knowledge and attitude questionnaires, quality of life instruments as well as the distress thermometer will be administered to the patients to ascertain both their levels at baseline presentation as well as identify those who may benefit from psychotherapy. The eligible (stage 3 and 4) patients will be exposed to group psychosocial supportive interventions for three months before reassessment of the baseline parameters to ascertain the value of these interventions for the patients. Breast cancer education tools will be developed during the group interactions and construct validated with nonbreast cancer patients in the community. Results from focus group discussions will be used to triangulate the findings from the other aspects of the study. Data will be analyzed both descriptively and inferentially. Results: Progress to date includes obtaining ethical committee approval for the study protocol with the registration number NHREC/05/01/2008a from the UI/UCH Joint Research Ethics Committee. The research nurses have been trained in distress assessment. Their sociodemographic characteristics, knowledge and attitudes in regard of cancer, distress states, effects of the various psychological and social interventions on the patients and advocacy tools from the group therapy will be the products of this research. Conclusion: The results of this work will be used to advance cancer care and promote advocacy in the UCH and other similar cancer care settings in Nigeria and other developing countries.

Medical costs of treating breast cancer among younger Medicaid beneficiaries by stage at diagnosis.

Younger women (aged 18-44years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, and lower survival rates than older women. In this study, we estimated incident breast cancer costs by stage at diagnosis and by race for younger women enrolled in Medicaid. We analyzed cancer registry data linked to Medicaid claims in North Carolina from 2003 to 2008. We used Surveillance, Epidemiology, and End Results (SEER) Summary 2000 definitions for cancer stage. We split breast cancer patients into two cohorts: a younger and older group aged 18-44 and 45-64years, respectively. We conducted a many-to-one match between patients with and without breast cancer using age, county, race, and Charlson Comorbidity Index. We calculated mean excess total cost of care between breast cancer and non-breast cancer patients. At diagnosis, younger women had a higher proportion of regional cancers than older women (49 vs. 42%) and lower proportions of localized cancers (44 vs. 50%) and distant cancers (7 vs. 9%). The excess costs of breast cancer (all stages) for younger and older women at 6months after diagnosis were $37,114 [95% confidence interval (CI)=$35,769-38,459] and $28,026 (95% CI=$27,223-28,829), respectively. In the 6months after diagnosis, the estimated excess cost was significantly higher to treat localized and regional cancer among younger women than among older women. There were no statistically significant differences in excess costs of breast cancer by race, but differences in treatment modality were present among younger Medicaid beneficiaries. Younger breast cancer patients not only had a higher prevalence of late-stage cancer than older women, but also had higher within-stage excess costs.

Patient navigation core metrics before and after implementation of a nurse navigation program at CHI St. Francis Cancer Treatment Center: A community based cancer program.

e18040 Background: Patient navigation is an intervention to improve cancer outcomes by facilitating timely access to cancer care. Few comparative data exist about the effects of nurse navigation in core navigation metrics (CNM) in a community oncology setting. Methods: During one-year period of a community-based/patient entry-point navigation program, CNMs of newly diagnosed breast and non-breast cancer patients were collected and compared to that of a demographic and tumor characteristics-matched control group prior to navigation. Electronic medical records and tumor registry data were utilized to gather 10 CNMs and 12-mo survival. Results: 72 breast/107 non-breast newly diagnosed navigated cancer patients were compared to same number of matched patients who did not receive navigation. With navigation, significant improvements were observed in interval time to biopsy, pathologic diagnosis, oncology visit, first treatment, and frequency of ancillary consults in breast cancer group. In non-breast cancer group, significant improvements were observed in all CNMs except interval time to pathology diagnosis. Adherence to guidelines and treatment, and 12-mo survival were not different between two groups. Conclusions: A dedicated community based nurse navigation program can significantly improve CNMs and enhance care in both breast and non-breast cancer population in a community oncology setting. [Table: see text]

Breast cancer treatment costs in younger, privately insured women

Younger women (under age 45years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, lower survival rates, and greater financial hardship. The purpose of this study was to estimate breast cancer costs by stage at diagnosis during the first 18months of treatment for privately insured younger women. We analyzed North Carolina cancer registry data linked to claims data from private insurers from 2003 to 2010. Breast cancer patients were split into two cohorts: a younger and older group aged 21-44 and 45-64years, respectively. We conducted a cohort study and matched women with and without breast cancer using age, ZIP, and Charlson Comorbidity Index. We calculated mean excess costs between breast cancer and non-breast cancer patients at 6, 12, and 18months. For younger women, AJCC 6th edition stage II cancer was the most common at diagnosis (40%), followed by stage I (34%). On the other hand, older women had more stage I (46%) cancer followed by stage II (34%). The excess costs for younger and older women at 12months were $97,486 (95% confidence interval [CI] $93,631-101,341) and $75,737 (95% CI $73,962-77,512), respectively. Younger breast cancer patients had both a higher prevalence of later-stage disease and higher within-stage costs. The study reports high costs of treatment for both younger and older women than a non-cancer comparison group; however, the estimated excess cost was significantly higher for younger women. The financial implications of breast cancer treatment costs for younger women need to be explored in future studies.

A feasibility study of a new smartphone application for patients with cancer.

211 Background: Smartphone-applications have been used for self-care, but not all applications have a sufficient level of efficacy. We evaluated the feasibility of a new smartphone application (the App) which has two main functions—diary function and SNS function—and investigated the characteristics of active users. Methods: Patients who visited the Breast and Medical Oncology or GI Medical Oncology divisions at National Cancer Center Hospital were recruited between March and April in 2016. Participants could use the App for 28 days. Web-based survey was performed before and 28 days after using the App. The primary endpoint was Daily Active User (DAU) rate (the number of daily log-in user divided by the number of patients who completed installation). A mean DAU rate higher than 20% was predetermined as feasible. The secondary endpoints were daily diary function user rate, daily SNS function user rate, and overall user rate and change of Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-j) before and after the App use. “Active user” was defined as a participant who used the AppeWe more than median active days for diary or SNS function. Duration of App use was counted from the date of installation to the date of last use, and overall user rate was calculated by Kaplan Meier method. Results: One-hundred and four patients (96%) completed the App installation and answered the first survey. All patients were followed for 28 days. The mean DAU rate was 50.9%. Active diary function user rate was 53% and active SNS function user rate was 40%. Overall user rate was 87.5%. Diary function was used more frequently by male patients than female, and non-breast cancer patients. SNS function was used more frequently by unemployed patients than others, and by patients younger than 40 y/o. We could evaluate the change of ESAS-r-j score in 80 patients who answered the second survey. There was a significant improvement of depression score among patients who were single and who had metastatic disease. Conclusions: The App was considered feasible. Gender, cancer type, job status, and age may influence the behavior of the App use. The App may improve patients’ psychological symptoms, but further investigations are warranted to reveal the clinical utility of the App.