The National Comprehensive Cancer Network Breast Cancer Guidelines Committee suggests that the omission of adjuvant radiation therapy (RT) after breast-conserving surgery can be a reasonable option among older women with low-risk breast cancer (early-stage, estrogen receptor-positive, and node-negative) if they are treated with endocrine therapy. However, RT usage in this group of women still exceeds 50%. Conversely, older women tend to forego RT (even when necessary) due to cost, inconvenience, and potential adverse responses associated with RT. Understanding health-related quality of life (HRQOL) change with receipt of RT among older women in the modern era is limited due to the under-representation of this population in clinical trials.The proposed study aims to examine the associations of RT with HRQOL trajectories as well as survival outcomes among older women with 5-10 years of follow-up. We will also assess whether prediagnosis comorbidity burden influences receipt of RT and whether the associations between RT and HRQOL trajectory and survival outcomes are modified by the comorbidity burden.We will use a retrospective cohort study design with the population-based Surveillance, Epidemiology, and End-Results database linked to the Medicare Health Outcomes Survey (SEER-MHOS). Older women (≥65 years) who were diagnosed with low-risk breast cancer in 1998-2014, received breast-conserving surgery, and participated in MHOS 1998-2016 are eligible for this analysis. The latent class analysis clustering method will be used to identify each patient's prediagnosis comorbidity burden, and HRQOL will be evaluated using the Short Form 36/Veterans RAND 12-Item Health Survey scales. The inverse-weighted estimates of the probability of treatment will be included to control for treatment selection bias and confounding effects in subsequent analysis. The association of RT with HRQOL trajectory will be evaluated using inverse-weighted multilevel growth mixture models. The inverse-weighted Cox regression model will be used to obtain hazard ratios with 95% CIs for the association of RT with survival outcomes. Differential effects of RT on both outcomes according to comorbidity burden class will also be evaluated.As of October 2020, the study was approved by the institutional review board, and SEER-MHOS data were obtained from the National Cancer Institute. Women with low-risk breast cancer who met inclusion and exclusion criteria have been identified, and prediagnosis comorbidity burden class has been characterized using latent class analysis. Further data analysis will begin in November 2020, and the first manuscript will be submitted in a peer-reviewed journal in February 2021.This research can potentially improve clinical outcomes of older women with low-risk breast cancer by providing them additional information on the HRQOL trajectories when they make RT treatment decisions. It will facilitate informed, shared treatment decision making and cancer care planning to ultimately improve the HRQOL of older women with breast cancer.DERR1-10.2196/18056.
Abstract Purpose of the study: The NCCN guidelines state that adjuvant radiotherapy (RT) can be omitted in older women with estrogen receptor (ER)-positive, node-negative early-stage (i.e., Tis and T1) breast cancer (ESBC). However, there is no specific algorithm to select a subgroup of women who can safely forgo RT. Older women commonly present with multiple comorbid conditions with different levels of functional limitations and health-related quality of life (HRQOL), which challenge the RT-decision process. This study aimed to understand pre-diagnosis comorbidity burdens in this patient group and to examine its relationship with HRQOL and treatment selection in a retrospective cohort study design. Methods: From the SEER-MHOS database, we included 985 older women who were diagnosed at age ≥ 70 years, with ER-positive, node-negative ESBC between 1998 and 2013. SEER provides primary treatments (surgery and radiation), and MHOS provides self-reported comorbidity, functionality, and HRQOL. We used latent class analysis (LCA) to identify clinically distinct comorbidity burden classes. The associations between the comorbidity burdens with HRQOL and treatment selection (lumpectomy only, lumpectomy + RT, mastectomy, mastectomy + RT) were examined using generalized linear models. Results: A mean age at diagnosis was 77 years, 81 % of patients were whites, and 43 % were married. A majority had stage I disease (80 %) with 20 % stage 0. About one fourth (26 %) had ≤ 1 comorbid condition, whereas 28 % had ≥ 4 comorbidities. LCA identified four distinct comorbidity burden classes; healthy (n=577, 58 %), low comorbidity with limited functionality (n=64, 7 %), moderate comorbidity with symptoms (n=247, n=25 %), and high comorbidity with highly limited functionality and symptoms (n=97, 10 %). Classes were distinguished by the presence or absence of comorbid conditions and functional limitations as well as symptoms. Comorbidity burdens were independently associated with HRQOL mental component summary (MCS-12) score (p < .0001) and physical component summary (PCS-12) score (p < .0001) but not with treatment selection (p = 0.096). In stage 0, age (p=0.025) and education level (p=0.024) were the independent predictors of treatment selection while age (p<.0001), education level (p=0.0013), income (p=0.044), and obesity (p=0.026) determined the treatment selection in stage I. Conclusions: Older women with ESBC can be described by four distinct comorbidity burdens that are independent predictors of HRQOL. However, it seems that the comorbidity burdens were not considered in the treatment selection process. Future studies need to address treatment outcomes (such as changes in HRQOL and survival) by comorbidity burdens to better guide treatment decisions. Citation Format: Eunkyung Lee, Jianbin Zhu, Robert Hines, Eunji Nam, Cassie Odahowski. Pre-diagnosis comorbidity class, health-related quality of life, and treatment selection among older women with breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4631.
Neoplastic plexopathy is usually associated with advanced systemic cancer, regional progression of the primary tumor and complication of cancer treatment including radiotherapy. Lumbosacral plexopathy is most commonly found in colorectal cancer and its symptom begins with leg pain, and thereafter numbness and weakness develops. Radiotherapy is generally considered as the 1st line therapy for metastatic plexopathy and it is also a way to relieve pain. We experienced one case of recurrent cervix cancer with lumbosacral nerve root metastasis after radical abdominal hysterectomy without additional radiation therapy and then we report it together with a brief review of literatures.
Abstract Objective The present study investigates the effectiveness of a novel, consumer‐informed, family training for youth suicide prevention. Background Research suggests family members play a key role in reducing suicide risk for their children. However, family members often do not possess the necessary knowledge, confidence, and skills needed to intervene with a suicidal youth. Method Family members ( N = 582) participated in the It's Time to Talk About It: Family Training for Youth Suicide Prevention (ITT‐FT) and completed pretest and posttest measures. Additionally, 158 family members completed a 6‐month follow‐up evaluation. Results Results indicated significant improvements in knowledge, effective attitudes, perceived behavioral control, social norms, and intentions immediately after the training. Knowledge and perceived behavioral control were sustained at follow‐up. Participants identifying as Hispanic/Latinx exhibited greater decreases in stigma related to help‐seeking. Those who had a family history of mental health treatment experienced a greater increase in social norms related to other families seeking help. Conclusion Findings underline the importance of implementing a family‐focused program aimed at improving training outcomes such as knowledge, confidence, and intentions—key constructs associated with behavior change. Implications Improvement in several domains following the training highlight the critical role family members can play in reducing youth suicide risk.
BACKGROUND The National Comprehensive Cancer Network Breast Cancer Guidelines Committee suggests that the omission of adjuvant radiation therapy (RT) after breast-conserving surgery can be a reasonable option among older women with low-risk breast cancer (early-stage, estrogen receptor-positive, and node-negative) if they are treated with endocrine therapy. However, RT usage in this group of women still exceeds 50%. Conversely, older women tend to forego RT (even when necessary) due to cost, inconvenience, and potential adverse responses associated with RT. Understanding health-related quality of life (HRQOL) change with receipt of RT among older women in the modern era is limited due to the under-representation of this population in clinical trials. OBJECTIVE The proposed study aims to examine the associations of RT with HRQOL trajectories as well as survival outcomes among older women with 5-10 years of follow-up. We will also assess whether prediagnosis comorbidity burden influences receipt of RT and whether the associations between RT and HRQOL trajectory and survival outcomes are modified by the comorbidity burden. METHODS We will use a retrospective cohort study design with the population-based Surveillance, Epidemiology, and End-Results database linked to the Medicare Health Outcomes Survey (SEER-MHOS). Older women (≥65 years) who were diagnosed with low-risk breast cancer in 1998-2014, received breast-conserving surgery, and participated in MHOS 1998-2016 are eligible for this analysis. The latent class analysis clustering method will be used to identify each patient’s prediagnosis comorbidity burden, and HRQOL will be evaluated using the Short Form 36/Veterans RAND 12-Item Health Survey scales. The inverse-weighted estimates of the probability of treatment will be included to control for treatment selection bias and confounding effects in subsequent analysis. The association of RT with HRQOL trajectory will be evaluated using inverse-weighted multilevel growth mixture models. The inverse-weighted Cox regression model will be used to obtain hazard ratios with 95% CIs for the association of RT with survival outcomes. Differential effects of RT on both outcomes according to comorbidity burden class will also be evaluated. RESULTS As of October 2020, the study was approved by the institutional review board, and SEER-MHOS data were obtained from the National Cancer Institute. Women with low-risk breast cancer who met inclusion and exclusion criteria have been identified, and prediagnosis comorbidity burden class has been characterized using latent class analysis. Further data analysis will begin in November 2020, and the first manuscript will be submitted in a peer-reviewed journal in February 2021. CONCLUSIONS This research can potentially improve clinical outcomes of older women with low-risk breast cancer by providing them additional information on the HRQOL trajectories when they make RT treatment decisions. It will facilitate informed, shared treatment decision making and cancer care planning to ultimately improve the HRQOL of older women with breast cancer. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18056
Clinical trials in Epithelial Ovarian Cancer (EOC) frequently examine treatment at a particular phase of the patient's disease trajectory. Few major studies have examined the management of patients from diagnosis to death. This international network was developed to compare treatment sequencing and outcomes from six centres across Europe and South Korea.
Methodology
This retrospective cohort study used longitudinal data collected from electronic medical records from 6 European and South Korean treatment centres. A standard protocol & common data model was developed to capture consistent data for patients diagnosed between January 2012 and December 2018, with a minimum of 12 months follow-up. Full treatment data was collected and categorized in programmes of care based on exemplar patient narratives. An extensive data harmonization process was implemented to ensure different country and site medical records were interpreted in a common manner. Overall survival (OS) and time to next treatment (TTNT) were estimated using Kaplan Meier methodology and outcomes stratified by categories of interest. Each site analysed their own EMR data and shared aggregated results for comparison.
Results
Table 1 demonstrates patient characteristics from six sites. In total the overall study cohort includes 2889 patients. Median age for each centre ranged from 53 to 67 years. The majority of patients were FIGO stage III (range 31% to 66%) and high-grade serous morphology (52% to 69.9%) Additional data on treatment pathways and outcomes for each centre will be presented.
Conclusion
Preliminary analysis from this network suggests a consistent profile of adults treated for EOC across most contributing treatment centres in Europe, but with some substantial differences compared to patients treated at centres in South Korea and Romania. The establishment of a common data model between sites across five different countries allows for detailed exploration of the factors influencing differences in patient management and treatment outcomes in ovarian cancer patients.
Disclosures
Sue Cheeseman: I receive consultancy fees from IQVIA Bethany Levick: I am an employee of IQVIA Eunji Nam: I have no conflict of interest to disclose Dongkyu Kim: I have no conflict of interest to disclose Roman Rouzier: I have no conflict of interest to disclose Claire Bonneau: I have no conflict of interest to disclose Paul Kubelac: served on a speaker's bureau for Roche, Bristol-Myers Squibb, AstraZeneca, Novartis. Patriciu Achimas-Cadariu: I have no conflict of interest to disclose Jean-Marc Classe: I have no conflict of interest to disclose François Bocquet: I have no conflict of interest to disclose Sven Becker: I have no conflict of interest to disclose Mariana Guergova-Kuras: I am an employee of IQVIA Geoff Hall: I receive grant support and consultancy fees from IQVIA
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