Receiving Treatment For Breast Cancer Research Articles

Abstract PO4-23-06: Outcomes and experiences of women denied immediate breast REconstruction after maSTectOmy for bREast cancer during the COVID-19 pandemic - The RESTORE C19 Study

Abstract Introduction 40% of women diagnosed with breast cancer in the UK each year undergo mastectomy and immediate breast reconstruction (IBR) is routinely offered to improve quality of life. During COVID19, this offer was withdrawn to prioritise frontline and emergency services. The RESTORE C19 study aimed to use mixed methods to explore the outcomes, lived experiences and views of women denied IBR during the pandemic. Methods Women not offered IBR between March & October 2020, were identified via B-Map-C, a UK prospective multicentre cohort study documenting changes in breast cancer treatment decisions during the pandemic. All patients were followed up between December 2021 & July 2022 (21-28 months following mastectomy) to explore their ongoing management including whether they had undergone, were awaiting, or had decided against delayed breast reconstruction (DBR) and the procedures performed. Descriptive statistics were used to summarise results. Semi-structured qualitative interviews were undertaken to explore the experiences of this group in more depth. Women were purposively sampled based on treatment centre, age, decision regarding DBR, and procedure performed. A topic guide was developed to explore experiences of breast cancer care; feelings about not having been offered IBR and factors influencing subsequent surgical decision-making. Interviews were transcribed in full and analysed thematically, with data collection and analysis undertaken concurrently and iteratively until saturation was achieved. Full ethical approval was obtained: IRAS 302580, Wales REC 4 21/WA/0347. Results Some 366 women were identified as not having been offered IBR in the B-MaP-C study for whom follow up data was available for 311 (85.0%) from 55 centres. The median age was 50 (range 27-83 years). Most women presented with symptomatic breast cancer (n=239, 76.8%), were fit with no significant comorbidities, had T1 or 2 tumours (n=215, 69.1%) and were node negative (n=186, 59.6%). Almost a fifth (n=58, 18.6%) of women had decided against breast reconstruction completely. Of the remainder, just under 60% (n=149/253), had attended a surgical consultation to discuss DBR and only a third (n=91/253, 36%) had been referred to plastic surgical services to discuss autologous procedures. Only 21 women (6.8%) had received DBR; (16 free flaps, 4 implants, 1 pedicled flap+/-implant). Interviews were performed with 18 women from 5 centres with a median age of 49 years (range 34-67): n=5 women had either received/were awaiting DBR; n=4 had undergone/were awaiting contralateral symmetrising mastectomy and n=9 had decided against/were undecided about further surgery. Whilst all women reported feeling ‘grateful’ for their breast cancer treatment, some felt ‘abandoned’ by healthcare professionals, others that they needed to chase breast surgical teams for care, advice, and support. Partners were also impacted by their experiences with some women describing lasting effects on their relationships. Many women described how their desire for symmetry, either by breast reconstruction or symmetrising mastectomy, had “paled into insignificance” in the months and years following treatment. Conclusions The impact of COVID19 continues to be felt by women treated for breast cancer in the UK. Most women not offered IBR are either still awaiting DBR almost three years after their initial mastectomy or have decided against further surgery. The interviews highlight the trauma many women experienced receiving breast cancer treatment during the pandemic and ongoing issues that, for some, are yet to be fully addressed. There is a need for individualised support to provide women with equitable and timely access to DBR and/or symmetrising mastectomy depending on patient preference to help them move on with their lives. Citation Format: Katherine Fairhurst, Rajiv Dave, Baek Kim, Rachel O'Connell, Raghavan Vidya, P.G. Roy, Stuart McIntosh, Patricia Fairbrother, Jo Skillman, Leila Rooshenas, Shelley Potter. Outcomes and experiences of women denied immediate breast REconstruction after maSTectOmy for bREast cancer during the COVID-19 pandemic - The RESTORE C19 Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-23-06.

E020 Osteoporosis service improvement audit

Abstract Background/Aims Osteoporosis referrals are sent to rheumatology departments for consideration of parenteral treatments in those who are unable to tolerate oral bisphosphonates or have failed treatment. The rheumatology services at Croydon University Hospital (CUH) are oversubscribed which results in long waiting times for appointments and increased workload on clinicians. The aim of this audit is to identify the scope of osteoporosis workload, the source of referrals, to improve distribution of the osteoporosis workload in CUH and redesign the pathway for osteoporosis referrals. A secondary aim is to identify patients that could be managed without referral enabling more consultation slots within the rheumatology department for patients that present with early inflammatory arthritis. Methods Data was collected retrospectively from all the patients that had been referred to the rheumatology department, either internally or externally and offered a new osteoporosis appointment from June to mid-September 2022 (104 patients in total). A data collection sheet was created from electronic patient records. The data included the patients’ hospital number, age, sex, height, weight, BMI, race, source of referral, reason for referral, fractures sustained, admissions for fracture, prior treatment with IV/ oral bisphosphonates, which oral bisphosphonate treatment and reasons for stopping, co-prescription of calcium/ vitamin D and the follow up plan. Results Among patients who were surveyed, 33 were internal referrals. Referring departments were as follows: 18 from fracture liaison service (FLS), 7 from care of the elderly (COTE), 3 from orthopaedics, 1 from rheumatology, 1 from nephrology, 1 from endocrinology, 1 from haematology and 1 from respiratory. In the GP cohort (71 patients), many were intolerant to oral bisphosphonates due to gastrointestinal upset. Reasons for referral were as follows: 36 for intolerance to oral medication, 14 for declining BMD, 11 for restarting medication after drug holding, 9 for complexity of cases (including young age/ male/ anorexia/ osteogenesis imperfecta), 8 unspecified, 7 had sustained a fracture on treatment, 6 received breast cancer treatment, 6 had renal impairment, 6 for a second opinion and 1 for considering a drug holiday. Conclusion This audit highlights the issues associated with osteoporosis workload and suggests improvements for managing the referrals both internally and externally. GP education is important for managing patients not tolerating oral bisphosphonates before accepting referrals. We have started recommending GP to try alternative oral bisphosphonates or effervescent alendronic acid prior to referral. Some internal workload can be managed by the referring team with advice being provided by the rheumatology team in order to reallocate rheumatology appointments for other conditions. The rheumatology department at Croydon University Hospital met with stakeholders from COTE and FLS and discussed the audit results. The COTE team agreed to initiate and continue IV zoledronate to reduce the osteoporosis burden on the rheumatology department. Disclosure S. Taheri: None. R. Suresh: None. J. Burton: None. S. Adil: None. T. Ahmed: None. N. Horwood: None. R. Sathananthan: None.

Abstract A060: “If it’s something that I can do for my future generations…”: Using multiple qualitative methods to inform an intervention to promote shared decision making and participation in clinical trials among Black women diagnosed with breast cancer

Abstract Background: Black women are more likely to present with advanced stage disease and to die following a breast cancer (BC) diagnosis compared to women from other racial/ethnic groups. While there are many contributing factors to this inequity (i.e., tumor biology, social and structural health determinants, racial injustice, and differential access to and utilization of high-quality mammography, diagnostics and therapies), persistent underrepresentation of Black patients in cancer clinical trials (CTs) slows scientific advancements. Objective: The goal of the FOR ME (Fostering Opportunities in Research through Messaging and Education) Study is to develop, optimize, and test a narrative decision aid intervention (web-based video) for Black women diagnosed with BC to promote shared decision making and CT participation. Here, we report on the development phase, wherein our objective was to identify salient themes and to understand lived experiences to enhance authenticity and to inform video content. Methods: Guided by community-based participatory research approaches, we used multiple qualitative methods (key informant interviews (KIIs) and story circles) to identify barriers and facilitators that support decision-making and CT participation. The KIIs, completed in-person, via phone, or video conferencing, were recorded and professionally transcribed. The research team used thematic analysis and inductive coding approaches. First, a subset of transcripts was annotated, then annotations were compiled into a preliminary codebook. Inter-coder reliability testing is ongoing to improve quality and to refine the codebook. The analysis team is using Dedoose, to analyze quotations and code co-occurrences, application frequencies, and relationships. Data collection and analysis of the story circles is ongoing. Results: In total, 30 Black women with BC participated in KIIs. Interviewees ranged in age from 27 to 75 years (M=59 + 12 years); concerning insurance, 63% had a public and 33% had a private source. About 27% were currently receiving BC treatment and 27% had prior CT participation. Participants expressed both positive and negative perceptions of CTs, sometimes concurrently. Barriers to CT participation included competing responsibilities, logistical burdens, ineffective provider communication, a lack of knowledge of CTs, individual and systemic racism, CT burdensome characteristics (invasive, potential for side effects), and comorbidities. Facilitators to CT participation included strong patient-provider communication and relationships, CT non-burdensome characteristics (non-invasive, minimal side effects), having a sense that participation benefits future generations, increased understanding of the CT, and feeling empowered in decision-making .Conclusion: To promote health equity in CTs, interventions should promote strong culturally sensitive patient-provider communication with emphasis on shared decision-making and patient empowerment along with emphasis on benefits toward future generations to promote a willingness to participate in CTs. Citation Format: Leslie R Carnahan, Vida Henderson, Tigist Mersha, Neha Hippalgaonkar, Ryan Nguyen, Eliza B Cohn, Kauthar Salum, Ana Williams, Lolita Coleman, Beulah Brent, AnneMarie Murphy, Paris Thomas, Paramjeet Khosla, Kent Hoskins. “If it’s something that I can do for my future generations…”: Using multiple qualitative methods to inform an intervention to promote shared decision making and participation in clinical trials among Black women diagnosed with breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A060.

Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial

IntroductionNearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for...

The Effect of COVID-19 on the Mental Health of Breast Cancer Patients Undergoing Treatment: A Scoping Review

Introduction: Patients with breast cancer experienced difficulties making appointments, treatment delays, and delayed screening during the COVID-19 pandemic. As a result of these challenges for individuals with breast cancer diagnoses, it is believed that the COVID-19 pandemic had a detrimental effect on these patients’ mental health. The purpose of this review was to examine the effect of COVID-19 on the mental health of breast cancer patients undergoing treatment through a scoping review. Methods: The methods were guided by the Arksey and O’Malley framework, described in the Joanna Briggs Institute guidelines, and the reporting is compliant with PRISMA-ScR Checklist. Searches were conducted in the databases Medline via OVID and CINAHL from February 2023 to March 2023, with studies being published only from January 2020 to present. Inclusion criteria were breast cancer patients receiving breast cancer treatment such as surgery or chemotherapy, observational studies such as cross-sectional, and studies that measured the impact on mental health during the COVID-19 pandemic. Data were then extracted using a charting form. Results: A total of 21 studies were included. Either depression, anxiety or stress or a combination of them were examined in all the studies that were included. Thirteen of the studies included used the Hospital Anxiety Depression Scale (HADS) and/or the Generalized Anxiety Disorder (GAD-7) for their measures. Seventeen studies showed that while undergoing active treatment during COVID-19, there were increased levels of depression, anxiety, and stress. Four studies that were included did not see a difference in these mental health outcomes during the pandemic. Discussion: Many studies stated the importance of how mental health interventions can be key to preventing higher rates of depression and anxiety. As such, the mental health of breast cancer patients must be prioritized by introducing changes to health care distribution and through providing psychological interventions to these patients. Conclusion: This scoping review demonstrated that breast cancer patients had increased rates of depression, anxiety, stress, and other mental health outcomes during the pandemic. Future research should be conducted to examine the effects on psychological interventions that focus on improving mental health in breast cancer patients.

Outcomes of Different Quality of Life Assessment Modalities After Breast Cancer Therapy

Improvement in clinical understanding of the priorities of patients with breast cancer (BC) regarding postoperative aesthetic outcomes (AOs) is needed. To assess expert panel and computerized evaluation modalities against patient-reported outcome measures (PROMs), the gold standard of AO assessment, in patients after surgical management of BC. Embase, MEDLINE, PsycINFO, PubMed, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were interrogated from inception through August 5, 2022. Search terms included breast conserving AND aesthetic outcome AND breast cancer. Ten observational studies were eligible for inclusion, with the earliest date of database collection on December 15, 2022. Studies with at least 1 pairwise comparison (PROM vs expert panel or PROM vs computerized evaluation with Breast Cancer Conservation Treatment cosmetic results [BCCT.core] software) were considered eligible if they included patients who received BC treatment with curative intent. Studies reporting solely on risk reduction or benign surgical procedures were excluded to ensure transitivity. Two independent reviewers extracted study data with an independent cross-check from a third reviewer. The quality of included observational studies was assessed using the Newcastle-Ottawa Scale, and the level of evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Confidence in network meta-analysis results was analyzed with the Confidence in Network Meta-analysis semiautomated tool. Effect size was reported using random-effects odds ratios (ORs) and cumulative ratios of ORs with 95% credibility intervals (CrIs). The primary outcome of this network meta-analysis was modality (expert panel or computer software) discordance from PROMs. Four-point Likert responses across PROMs, expert panel assessment, and BCCT.core evaluation of AOs were assessed. A total of 10 observational studies including 3083 patients (median [IQR] age, 59 [50-60] years; median [range] follow-up, 39.0 [22.5-80.5] months) with reported AOs were assessed and homogenized in 4 distinct Likert response groups (excellent, very good, satisfactory, and bad). Overall network incoherence was low (χ22 = 0.35; P = .83). Overall, panel and software modalities graded AO outcomes worse than PROMs. Specifically, for excellent vs all other responses, the panel to PROM ratio of ORs was 0.30 (95% CrI, 0.17-0.53; I2 = 86%) and the BCCT.core to PROM ratio of ORs was 0.28 (95% CrI, 0.13-0.59; I2 = 95%), while the BCCT.core to panel ratio of ORs was 0.93 (95% CrI, 0.46-1.88; I2 = 88%). In this study, patients scored AOs higher than both expert panels and computer software. Standardization and supplementation of expert panel and software AO tools with racially, ethnically, and culturally inclusive PROMs is needed to improve clinical evaluation of the journey of patients with BC and to prioritize components of therapeutic outcomes.

Body composition and chemotherapy toxicity among women treated for breast cancer: a systematic review

Toxicity is a significant problem among women receiving systemic chemotherapy for breast cancer, with up to 60% experiencing hematologic and 14% experiencing non-hematologic toxicity. Chemotherapy is dosed using body surface area, which does not account for heterogeneity in lean body mass (LBM) and adipose tissue (AT). This systematic review, registered with the PROSPERO International Prospective Register of Systematic Reviews (#CRD42021279874), evaluates associations between body composition and chemotherapy-related toxicity during breast cancer treatment. Scientific literature databases (PubMed, Scopus, CINAHL, and CENTRAL) were systematically searched in November 2021 for studies evaluating associations between body composition (assessed using computed tomography or dual x-ray absorptiometry) and chemotherapy-related toxicity among women receiving breast cancer treatment. Eligibility was not limited by year or country of publication. Article screening and data abstraction was conducted using the Covidence Systematic Review Management System. Predetermined criteria were used to evaluate rigor of participant recruitment, representativeness of the population, and use of validated measures of body composition and toxicity. An inverse association between LBM and toxicity was reported in seven of the eight included studies, although definitions of low LBM differed across studies. Three studies evaluated the association between AT and chemotherapy toxicity with inconsistent findings. Heterogeneity in body composition measures/definitions and treatment regimens precluded the ability to perform meta-analyses. Low LBM appears to be a risk factor for chemotherapy toxicity, but the role of AT is unclear. Further research that accounts for guideline concordance in chemotherapy prescriptions and the use of supportive care medications is needed.

Side effects of COVID-19 vaccinations in patients treated for breast cancer.

Lymph node swelling is a side effect of the mRNA COVID-19 vaccines, a distressing side effect for women treated for breast cancer. The purpose of this study is to present side effects reported by a cohort of patients treated for breast cancer. A survey link was sent to 4945 women who received breast cancer treatment and were prospectively screened for breast cancer-related lymphedema. In total, 621 patients who received an mRNA vaccine and responded to the survey were included in analysis. We assessed the frequency and predictors of side effects. The most frequent side effects reported were injection site soreness, fatigue, generalized muscle soreness, headache, and chills, with median duration ≤ 48h. Lymph node swelling occurred most often in the axilla ipsilateral to the vaccine. The median duration was 1 week or less after all doses. These data will inform patient education regarding future vaccine doses, including reassurances about which side effects to expect, particularly lymph node swelling which may impact mammograms after vaccination. Type and duration of side effects were similar to that reported by the general population in Phase 3 testing trials of the mRNA vaccines. Clinical Trial Registration NCT04872738 posted May 4, 2021.

Abstract P1-12-04: Side Effects of the mRNA COVID-19 Vaccines in Women Treated for Breast Cancer

Abstract Background: The introduction of the novel COVID-19 vaccination raised concerns regarding side effects from patients who had undergone breast cancer treatment. Lymph node swelling after the mRNA vaccines (Moderna, Pfizer) is a distressing side effect for women treated for breast cancer as it may indicate cancer progression or recurrence. Patients at risk of breast cancer-related lymphedema (BCRL) are fearful that lymph node swelling from the vaccine could incite or worsen BCRL. Data investigating associated side effects in this population is essential for patient education and future self-advocacy. Purpose: The purpose of this study was to elicit side effects associated with the COVID vaccine in women treated for breast cancer. Methods: 4,945 surveys were sent to women over the age of 18 who had received breast cancer treatment and had been prospectively screened for BCRL with perometry. 621 participants who received an mRNA vaccine and responded to the survey were included in analysis, 469 of whom completed booster dose surveys. Participants were asked about type and duration of side effects after each vaccine dose. Solicited side effects included injection site soreness, swelling, or redness; swelling, numbness, or heaviness of the arm; generalized muscle soreness (GMS); fatigue; headache; joint pain; chills; nausea; vomiting; fever; Bell’s palsy; axillary or supraclavicular lymph node swelling; other; or none of the above. We computed frequencies and the median duration of side effects for each dose. To investigate predictors of side effects, we fit multivariable logistic regression models separately for each side effect, with random effects for participants to account for clustered responses. We considered significant predictors those with p < 0.05. Results: Of the 621 participants, the median follow-up time between breast surgery and date of first vaccine dose was 69 months. The distribution of the top 5 side effects is presented in Table 1. Of note, the majority of participants who reported lymph node swelling (9.8% dose 1, 12.9% dose 2, 11.3% dose 3) reported it in the axilla ipsilateral to the vaccine (54.1% D1, 61.3% D2, 71.7% D3). Lymph node swelling was also reported in the axilla contralateral to the vaccine (45.9% D1, 45% D2, 24.5% D3), supraclavicular region ipsilateral (29.5% D1, 26.3% D2, 32.1% D3) and contralateral (18% D1, 18.8% D2, 9.4% D3) to the vaccine. Older patients reported each side effect significantly less frequently. Those who had received neoadjuvant chemotherapy reported significantly more GMS and headache than those who did not. Those who had received regional lymph node radiation were less likely to report GMS, as were patients who had sentinel lymph node biopsies (vs. no lymph node surgery). The median duration of side effects for all three doses was 48 hours or less, with the plurality (41.0% D1, 38.7% D2, 44.1% D3) of participants reporting side effects lasting 24 hours or less. While all side effects apart from injection site soreness were significantly more common in the second than the first doses, the duration of side effects only increased for 28.1% of participants. Conclusion: Over 86% of women treated for breast cancer may experience at least one side effect after any dose of the COVID-19 vaccine. This data, collected specifically for patients with breast cancer, will help enhance guidelines for structured and universal education regarding additional doses of the vaccine in the future. This will allow patients to better understand COVID vaccine side effect profiles after breast cancer treatment and self-advocate prior to future doses. Table 1. Top 5 Side Effects Reported Citation Format: Brooke Juhel, Cheryl L. Brunelle, Madison C. Bernstein, Louisa H. Smith, Amanda W. Jung, Elizabeth K. Hausman, Loryn K. Bucci, George E. Naoum, Alphonse G. Taghian. Side Effects of the mRNA COVID-19 Vaccines in Women Treated for Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-12-04.

Neprilysin Inhibition in the Prevention of Anthracycline-Induced Cardiotoxicity.

Anthracycline-induced cardiotoxicity (AIC) poses a clinical challenge in the management of cancer patients. AIC is characterized by myocardial systolic dysfunction and remodeling, caused by cardiomyocyte DNA damage, oxidative stress, mitochondrial dysfunction, or renin-angiotensin-aldosterone system (RAAS) dysregulation. In the past decade, after positive results of a PARADIGM-HF trial, a new class of drugs, namely angiotensin receptor/neprilysin inhibitors (ARNi), was incorporated into the management of patients with heart failure with reduced ejection fraction. As demonstrated in a variety of preclinical studies of cardiovascular diseases, the cardioprotective effects of ARNi administration are associated with decreased oxidative stress levels, the inhibition of myocardial inflammatory response, protection against mitochondrial damage and endothelial dysfunction, and improvement in the RAAS imbalance. However, data on ARNi's effectiveness in the prevention of AIC remains limited. Several reports of ARNi administration in animal models of AIC have shown promising results, as ARNi prevented ventricular systolic dysfunction and electrocardiographic changes and ameliorated oxidative stress, mitochondrial dysfunction, endoplasmic reticulum stress, and the inflammatory response associated with anthracyclines. There is currently an ongoing PRADAII trial aimed to assess the efficacy of ARNi in patients receiving breast cancer treatment, which is expected to be completed by late 2025.

Sleep Disorders and Quality of Life in Patients With Cancer: Prospective Observational Study of the Rafael Institute.

Sleep disorders are a common occurrence in the general population. Yet today, it is clearly agreed that sleep disorders represent both a cancer risk factor and a biological consequence of the of the activation of the immuno-inflammatory system induced by cancer itself. The aim of this study was to assess the impact of sleep disorders on quality of life and identify the type of disorder and its causes in order to offer an adapted and personalized care plan. In a survey completed during the COVID-19 lockdown, 2000 hours of interviews were collected by remote consultations. During these calls, we administered a sleep questionnaire. This questionnaire was inspired by the STOP-BANG questionnaire and enquired about 6 items. The demographic details of each patient (eg, age and sex), the nature of the pathology, their past treatments, the ongoing cancer treatment, the mood, whether or not the patient is anxious or depressed, and the use of sleeping drug pills were analyzed. A univariate analysis was performed according to the presence or absence of fatigue. Chi-square test was applied to assess possible differences of variables' link to sleep disturbance between patients complaining of fatigue and those without fatigue. The same test was then used to analyze patients on hormone therapy and those with no hormone therapy for 2 types of cancer-breast cancer and prostate cancer. A total of 905 patients were prospectively included in this study. The average age was 66.7 (5 SD) years, and 606 (67%) patients were women; 142 patients declared being overweight. Breast cancer was the most frequently reported cancer. Nocturnal awakening was reported by 70% (n=633), fatigue by 50% (n=452), difficulty falling asleep by 38% (n=343), snoring reported by an independent observer in 38% (n=343), and apnea reported by an independent observer in 9% (n=81) of the patients. The univariate analysis showed that the feeling of tiredness was significantly greater in patients reporting difficulty falling asleep (P≥.99), pain (P<.001), and frequent awakening (P<.001), as well as in patients who were not receiving cancer treatment (P<.001). The univariate analysis showed that patients who were receiving breast cancer treatment and were under hormone therapy reported difficulty falling asleep (P=.04) and pain (P=.05). In a univariate analysis of patients treated for prostate cancer, being overweight was the only factor reported that had a statistically significant value. Our preliminary data support and are consistent with data in the literature regarding the importance of sleep disorders in oncology. This justifies the usefulness of a diagnosis and early treatment of sleep disorders in patients with cancer. The Rafael Institute sleep observatory will enable patients to be identified and treated.

Efficacy of proprioceptive neuromuscular facilitation in improving shoulder biomechanical parameters, functionality, and pain after axillary lymph node dissection for breast cancer: A randomized controlled study

PurposeAxillary lymph node dissection and radiotherapy have been associated with pain, physical symptoms, and decreased functional abilities in the upper extremity. This study aimed to evaluate the potential effects of the proprioceptive neuromuscular facilitation (PNF) technique on muscle strength, pain and functionality in this patient group in comparison with progressive resistance training (PRT). MethodsThe study was conducted with a randomized clinical trial design. Sixty-six women were included in the study and randomly divided into three groups: the PNF group (n = 22), the PRT group (n = 22), and the control group (n = 22). The participants were evaluated at the baseline and after eight weeks of treatment. Outcome measures were determined as pain (the Visual Analog Scale), upper extremity strength (isokinetic dynamometer), functionality (the Disabilities of the Arm, Shoulder and Hand questionnaire), and perception of change (the Global Rating of Change Scale). Trial registrationClinicalTrials.gov identifier: NCT05288036. ResultsThe results showed statistically significant changes in both treatment groups in terms of shoulder flexors/extensors, abductor/adductors, internal/external rotators strength/power/endurance measurement, pain, and functionality (p < 0.05). Concerning functionality and perception of change, the PNF group had a statistically significantly higher improvement compared to the remaining two groups (p < 0.05). ConclusionPNF is an effective technique in increasing upper extremity muscle strength, reducing pain during rest and activity, and improving functionality in patients receiving breast cancer treatment.

RISK FACTORS FOR DEVELOPING UPPER LIMB CELLULITIS AFTER BREAST CANCER TREATMENT

Cellulitis is one of the most important troubling complications of breast cancer treatment. Therefore, elucidating the risk factors for cellulitis in patients that have undergone breast cancer treatment is crucial. This is a retrospective medical record study among 523 patients who had received breast cancer treatment and were referred to the Lymphedema Clinic. Data on age, height, weight, BMI (body mass index), education level, arm dominance, history of previous surgery, axillary lymph node dissection, radiotherapy, and chemotherapy were noted. The time between operation and onset of lymphedema, duration of lymphedema, history of cellulitis, and number of cellulitis attacks were recorded. Circumference measurements were taken at four points on the upper limb. Univariate analysis showed that longer duration of lymphedema, larger circumference of the unaffected arm and larger circumference of the arm with lymphedema were associated with higher risk of cellulitis (p=0.008, p=0.007, p< 0.001, respectively). The incidence of cellulitis was higher in patients with lymphedema than patients who had no lymphedema (p< 0.001). Moreover, the frequency of cellulitis was higher in patients with lower education level (p=0.015). It was deter-mined that patients with cellulitis needed more compression garments (p< 0.001) and multi-layered bandage therapy (p< 0.001) than those without. Regression analysis revealed that presence of lymphedema (p=0.036), duration of lymphedema (p=0.048), radiotherapy (p=0.01) and educational level (0.019) are significantly associated with developing upper extremity cellulitis. It is important to consider these risk factors for the prevention and management of cellulitis in patients who undergo treatment for breast cancer. Early detection and treatment of lymphedema also remains essential for these patients.

Factors associated with pelvic floor dysfunction in women with breast cancer

Purpose:To determine the prevalence of pelvic floor (PF) dysfunction according to breast cancer characteristics and examine the association between breast cancer characteristics and the prevalence, distress and impact of PF dysfunction in women with breast cancer. Outcome measures:The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence, distress and impact of PF dysfunction. Results:Data from 120 women with breast cancer were included in this analysis. Women who underwent chemotherapy experienced the highest rates of UI (n=23/29; 79%) and FI (n=7/29; 24%). The associations between breast cancer characteristics and the presence of pelvic floor dysfunction were not statistically significant. Being older (β 0.25 95%CI 0.05, 0.44), and having stage IV breast cancer (β 0.83 95%CI 0.24, 1.42) were statistically significant predictors of reporting high distress of PF dysfunction. Being older (β 0.22 95%CI 0.01, 0.45), having breast irradiation (β 0.51 95%CI 0.08, 0.93) and more time since diagnosis (β 0.35 95%CI 0.16, 0.54) were also statistically significant predictors of experiencing higher impact of PF dysfunction. Implications:Our findings show that UI and FI are prevalent in women receiving breast cancer treatment, with increasing distress demonstrated in older women with more advanced disease. The impact of PF dysfunction appears to increase with more time after breast cancer diagnosis. A greater focus by health services and clinicians to assess and offer treatment for PF dysfunction may be warranted in women with breast cancer.

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study.

To examine cardiovascular disease (CVD) and mortality risk in women with breast cancer (BC) by cancer therapy received relative to women without BC. The study population comprised Kaiser Permanente Northern California members. Cases with invasive BC diagnosed from 2005 to 2013 were matched 1:5 to controls without BC on birth year and race/ethnicity. Cancer treatment, CVD outcomes, and covariate data were from electronic health records. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs of CVD incidence and mortality by receipt of chemotherapy treatment combinations, radiation therapy, and endocrine therapy. A total of 13,642 women with BC were matched to 68,202 controls without BC. Over a 7-year average follow-up (range < 1-14 years), women who received anthracyclines and/or trastuzumab had high risk of heart failure/cardiomyopathy relative to controls, with the highest risk seen in women who received both anthracyclines and trastuzumab (HR, 3.68; 95% CI, 1.79 to 7.59). High risk of heart failure and/or cardiomyopathy was also observed in women with BC with a history of radiation therapy (HR, 1.38; 95% CI, 1.13 to 1.69) and aromatase inhibitor use (HR, 1.31; 95% CI, 1.07 to 1.60), relative to their controls. Elevated risks for stroke, arrhythmia, cardiac arrest, venous thromboembolic disease, CVD-related death, and death from any cause were also observed in women with BC on the basis of cancer treatment received. Women with BC had increased incidence of CVD events, CVD-related mortality, and all-cause mortality compared with women without BC, and risks varied according to the history of cancer treatment received. Studies are needed to determine how women who received BC treatment should be cared for to improve cardiovascular outcomes.

Consommations de tabac et d’alcool chez des femmes traitées pour un cancer du sein dans un service de chirurgie oncologique : des comportements fréquents à considérer

Tobacco and alcohol represent the two most important risk factors increasing cancer incidence and mortality, particularly among women with breast cancer. However, few researches have focused on the consumption of psychoactive substances in women treated for breast cancer. The present study describes the prevalence of tobacco and alcohol consumption and their relationships with the sociodemographic, medical and psychological variables in a population of women receiving surgery treatment for breast cancer. Between October 2014 and August 2015, a group of women receiving breast cancer treatment were recruited to participate to a screening and brief intervention program (SBI) for the consumption of tobacco and alcohol, adapted to the oncology context. Data on tobacco and alcohol consumption were collected using two questionnaires: the smoking status identification (NIDA) and alcohol consumption (AUDIT-C). A questionnaire for socio- demographic data and two for psychological data (Thermometer of psychological distress; ESAS), have been used. The medical data were reported by participants and verified on medical records. In a total of 11 months, 120 women with breast cancer were included in this study. A large majority of patients were hospitalized for a first-time cancer (80.8%), type invasive ductal carcinoma (70.8%) and were receiving surgery as primary treatment (45%). Furthermore, 30.8% of the women reported tobacco consumption and 38.4% high-risk alcohol consumption. Regarding mental health, 40.8% presented moderate to intense levels of psychological distress. No significant relationships were found between consumption scores and sociodemographic, medical or psychological characteristics. Only the patient's age was negatively associated with tobacco consumption. Tobacco and at-risk alcohol consumption are frequently reported behaviors during breast cancer treatment. Intervention strategies targeting risk behaviors related to addictive consumption should be implemented during the full treatment of breast cancer patients.

Abstract 67: Quantifying Transportation Barriers in Rwandan Patients Seeking Treatment for Breast Cancer

Abstract Purpose: Comprehensive cancer care in many sub-Saharan African countries is concentrated within a few centers. With only two comprehensive treatment facilities in Rwanda, travel distance, travel time, and travel cost may represent underappreciated barriers to accessing cancer treatment. Here we describe travel and transportation experiences of patients receiving curative breast cancer treatment at Butaro Cancer Center of Excellence (BCCOE). Methods: A cross-sectional telephone survey assessing contributors of care-continuum delays was administered to female patients receiving curative breast cancer treatment. Between July and November 2020, 89 (75%) of eligible patients were reached by phone, all of whom provided verbal consent and voluntarily participation. Patient demographic information and transportation experience were descriptively summarized. Results Participants had a median age of 48 years, and they represented all five Rwandan provinces. Twenty-one patients (24%) belonged to the lowest of the four socioeconomic “ubudehe” strata, as defined by the local government, while none were in the highest stratum. Few patients' households owned transportation vehicles with only one owning a private car, 4 (4%) owning a motorbike, and 23 (26%) owning a bicycle. Most patients, 84 (94%) utilized public transport buses for a portion of their travel, while 48 (54%) utilized motorbikes. Median one-way travel time from patients' home to BCCOE was 7 hours (interquartile range: 6-8 hours). The median cost of transportation for each round-trip was RWF12000, approximately $12 USD, which equates to 75% of a Rwandan adult's total monthly consumption. Transportation costs were noted as a significant barrier by 43 patients (46%), and 35 (39%) received financial support from outside their household to pay for transportation. Conclusion Transportation time and cost are significant burdens on patients receiving breast cancer treatment in Rwanda. Studies are needed to evaluate strategies for alleviating these burdens, such as comprehensive transportation financial support and innovative care delivery with telemedicine. Citation Format: Temidayo Fadelu, Cam Nguyen, Nicaise Nsabimana, Evariste Bigirimana, Vestine Mukandayisenga, Hubert Tuyishime, Lawrence Shulman, Timothy Rebbeck. Quantifying Transportation Barriers in Rwandan Patients Seeking Treatment for Breast Cancer [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 67.

Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia.

IntroductionFemale sexual dysfunction (FSD) is a common complication among breast cancer patients following treatment.AimTo assess the prevalence and factors associated with FSD among breast cancer patients in Kelantan.MethodsThis cross-sectional study recruited female patients, aged 18–65, who were married and sexually active with their partner, diagnosed with breast cancer, and had undergone breast surgery. Those with underlying psychiatry disorders, previous pelvic surgery, and husbands with sexual problems were excluded. The questionnaire contained demographic and clinical information, together with the Malay Version of the Breast Impact of Treatment Scale and the Malay Version of Female Sexual Distress Scale-Revised. Their sexual function was evaluated using the Malay Version of the Female Sexual Function Index-6. The data were analyzed with simple and multiple linear regressions.Main Outcome MeasuresThe prevalence and associated factors for FSD in breast cancer patients.ResultsNinety-four eligible patients were recruited for this study. In total, 73.4% (n = 69) of the patients reported having sexual dysfunction. A family history of breast cancer (P = 0.040), duration of marriage (P = 0.046), and frequency of sexual intercourse (P = 0.002) were significant factors associated with FSD in breast cancer patients after surgery.ConclusionThe significant associated factors shown to influence the FSD score include family history of breast cancer, duration of marriage, and frequency of sexual intercourse. About 73.4% of patients have risk of developing FSD after receiving breast cancer treatment.Siang OP, Draman N, Muhamad R, et al. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021;9:100351.

Racial Disparities and Diagnosis-to-Treatment Time Among Patients Diagnosed with Breast Cancer in South Carolina.

Diagnosis-to-treatment interval is an important quality measure that is recognized by the National Accreditation Program for Breast Centers, and the American Society of Breast Surgeons and the National Quality Measures for Breast Care. The aim of this study was to assess factors related to delays in receiving breast cancer treatment. This retrospective cohort study (2002 to 2010) used data from the South Carolina Central Cancer Registry (SCCCR) and Office of Revenue and Fiscal Affairs (RFA) to examine racial differences in diagnosis-to-treatment time (in days), with adjuvant hormone receipt, surgery, chemotherapy, and radiotherapy assessed separately. Chi-square tests, and logistic regression and generalized linear models were used to compare diagnosis-to-treatment days. Black women on average received adjuvant hormone therapy, surgery, chemotherapy, and radiotherapy 25, 8, 7, and 3days later than their White counterparts, respectively. Black women with local stage cancer had later time to surgery (OR: 1.6; CI: 1.2-2.2) compared with White women with local stage cancer. Black women living in rural areas had higher odds (OR: 2.0; CI: 1.1-3.7) of receiving late chemotherapy compared with White women living in rural areas. Unmarried Black women also had greater risk (OR: 2.0; CI: 1.0-4.0) of receiving late radiotherapy compared to married White women. To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.

Ailesel meme kanseri öyküsü olan ve olmayan kadınlarda meme kanseri tanılama davranışları

Amaç: Bu çalışmada ailesel meme kanseri öyküsü olan ve olmayan kadınlarda meme kanseri korkusu, risk algısı, meme kanseri bilgisi ve meme kanseri tanılama davranışları arasındaki ilişkinin incelenmesi amaçlanmıştır.&#x0D; Gereç ve Yöntem: Tanımlayıcı- kesitsel tipte yapılan araştırma, Aralık 2019 – Nisan 2020 tarihleri arasında bir şehir hastanesinin Onkoloji ve Kemoterapi ünitesinde meme kanseri tedavisi gören 308 aile öyküsü olan ve diğer servislerde tedavi gören aile öyküsü olmayan 523 hasta yakını kadın ile yüz yüze görüşme yöntemi ile yapılmıştır. &#x0D; Bulgular: Aile öyküsü olan kadınların olmayan kadınlara göre on yıl içindeki meme kanseri risk algısının 1,938 kat, meme kanseri korku puanının 1,073 kat ve Geniş Kapsamlı Meme Kanseri Bilgi Testi (GKMKBT) tedavi edilebilirlik puanının 3,269 kat arttığı belirlenmiştir.&#x0D; Sonuç: Çalışmada aile öyküsü olan kadınların meme kanseri tanılama davranışlarının (KKMM yapma, KMM yaptırma, 40 yaş üstü kadınlarda mamografi çektirme) aile öyküsü olmayanlara göre anlamlı şekilde arttığı ancak her iki grupta da hala istendik düzeyde olmadığı belirlendi.