Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes.Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities.Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group.Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.
114 Background: Tasisulam, a novel acylsulfonamide antineoplastic agent, promotes apoptosis, exhibits antiangiogenic activities, and demontrates antiproliferative activity against human breast cancer cell lines. In humans, tasisulam is highly albumin bound, with a median half-life of approximately 11 days. Previous phase II studies of tasisulam indicated that an albumin-corrected exposure (AUC alb ) range of 1200 to 6400 h*mcg/mL provided the optimal balance of efficacy and safety. This study investigates the drug’s activity in previously treated patients (pts) with metastatic breast cancer (mBC). Methods: Pts with at least 2 prior therapies for mBC andserum albumin level ≥3.0 g/dL received tasisulam by 2-hour infusion every 28 days, dosed by a lean body weight-based dosing algorithm targeting an AUC alb range of 1200 to 6400 h*mcg/mL. Primary objective was to show at least a 10% response rate (RR) using RECIST 1.0. Secondary objectives included progression-free survival (PFS), overall survival (OS), pharmacokinetics (PK), and safety. Results: Thirty-three pts received at least 1 dose of tasisulam. All were women, with a mean age of 55.4 (±9.7) years. Pts received a median of 2 cycles (ranges 1-8). The majority of pts achieved the target AUC alb range of 1200 to 6400 h*mcg/mL or higher in cycles 1 and 2 (63% and 69%, respectively). The most common tasisulam-related hematologic toxicities were grade 3 anemia (3.0%) and grade 4 neutropenia (6.1%). Common nonhematological adverse events possibly related to tasisulam were fatigue (39.4%), diarrhea (24.2%), and nausea (18.2%). No deaths were considered related to the study drug. The RR (1 CR, 1 PR) was 6.1% (90% CI: 1.1, 17.9), stable disease rate was 24% (n=8; 90% CI: 12.7, 39.5), with a median PFS of 1.81 months (90% CI: 1.64, 2.17) and a median OS of 6.77 months (90% CI: 4.37, 11.63). Conclusions: Tasisulam was reasonably well tolerated, but did not meet its primary objective of overall RR of 10% in this heavily pretreated mBC patient population. PK analysis of the albumin-tailored dosing regimen indicated that the majority of the patients achieved the target AUC alb or higher, suggesting that the modest activity observed was not due to suboptimal dosing.
In an attempt to increase the resection rate of patients with non-small cell lung cancer, two cycles of cyclophosphamide, doxorubicin, and cisplatin chemotherapy and chest irradiation (3000 cGy in 10 fractions, split course) were administered to 42 initially inoperable (T3 or N2M0) patients. Three patients were subsequently determined to be ineligible, two because of small cell histology and one because of M1 disease. Among the 39 eligible patients, 20 (51%) had a regression following the combined-modality therapy. Seventeen of these patients plus two with stable disease had thoracotomy. Complete surgical resection was accomplished in 13 patients (33% of all eligible 39 patients; 68% of all 19 patients who had thoracotomy). There were no statistically significant survival differences between patients not having thoracotomy and those who had thoracotomy (or even those with complete tumor excision). The patients with chemotherapy, chest irradiation, and surgical resection had a low incidence of local in-chest failure (5%), but distant failure was still a major problem.
e18669 Background: A review of the North American Cancer Registries (NAACCR) found that only 66.4% of Stage I, II NSCLC patients received curative surgery. Mapping treatment would reveal the neighborhoods with undertreated patients. Central Texas is ideal for mapping with no competing causes for clustering of cases, no EPA superfund sites and radon is distributed evenly. Aim: Define the location of NSCLC cases by staging, treatment, and survival in the Austin Metro area to guide targeted interventions. Methods: Cancer Registries at Seton and St David’s Hospitals were queried for NSCLC Diagnosed 2004-2014, Age < 80, Address in 5 county metro, excluding resident of chronic care facility, homeless. A total of 2822 patients were identified (Stage I,II = 759, Stage III = 465, Stage IV = 941, and 99 = 657) . Using the registry records each case was coded for initial treatment. The hierarchy for assigning treatment was Chest Surgery, Radiation, Chemotherapy, Metastasectomy. Combined treatment cases were assigned to the higher modality. Results: There was a minor difference from reported curative surgery rate 67% (n = 511) for Stage I, II patients with 11% (n = 82) radiation. Only 16% (n = 119) Stage I, II subjects had no treatment. Forty six percent of Stage III (n = 465) were treated for cure with combined modality therapy, 25% (105) had no treatment. Registrars code 99-unstageable when there is TX, NX, or MX. This group had 46% (n = 304) no treatment patients compared to 35% (n = 329) in stage IV. Overall 30% (n = 857) patients had no treatment, cancer registry entries indicated 48 refused treatment and 70 were considered too fragile to treat. In the entire population, 2% (n = 63) were referred out for initial treatment. Maps comparing treated and untreated patients by stage and follow up days were produced. Conclusions: It is possible to map treatment, stage, and survival. This information should be useful in implementing targeted reduction of the burden of care, screening, and health literacy interventions.
Currently, practically all off-grid power systems supplying electricity access in rural Tanzania are diesel-based. The operator, Tanesco, spend more than US$ 45 million per year purchasing more than 50 million liters of diesel fuel, maintaining a diesel-based generating capacity of about 55 MW in total. The ambitious plans of increasing the level of rural electrification and limited ability to extend the existing power grid, introduces small off-grid power systems (mini-grids) as
a viable option for electricity access in remote rural areas. Despite a certain level of hydropower and biomass resources being evident, the lion’s share of mini-grid candidates will call for other solutions, currently pointing toward diesel, PV or diesel-PV hybrid concepts.
The aim of this thesis has been to assess under which circumstances PV systems can be implemented for cost-competitive and viable power production on mini-grids in rural Tanzania.
The capability of PV systems to provide certain levels of supply security in comparison to more conventional generating technologies depend on meteorological conditions, in addition to establishment of system design and operation criteria. Domestic solar insolation ranges from less than 3.5 kWh/m2day and high seasonal variation in the Kilimanjaro area of the North Eastern Highlands zone, to about 6.0 kWh/m2day and very low seasonal variation in Central Tanzania. Standard deviations in the average annual insolation data has been estimated to less than ±5 % for all conducted measurements, suggesting a high potential for relatively predictable PV power production in most zones.
An LCOE of 0.61 US$/kWh estimated for a base-case PV system under average irradiation conditions is within the willingness to pay for low-consumption electricity (estimated to range from 0.8 US$/kWh to 1.2 US$/kWh). The results also suggest that PV systems are significantly less costly than diesel-based generation, and competitive to diesel-PV hybrids. The technical modularity of PV systems may enable developers to implement stepwise capacity expansion, in order to reduce initial expenditure and provide gradual development of electricity access to rural communities.
While it makes good economic sense to pursue solar energy on mini-grids, there are several meaningful and challenging barriers. The high initial costs of PV systems, combined with income uncertainty in rural areas due to low customer affordability introduce high financial risk, which makes it somewhat difficult to attract private investors. In addition, LCOE estimates obtained for PV systems involve a high degree of configuration dependence and sensitivity to availability
of the solar resource and operational criteria. In particular, the supply security required from a PV system will determine the extent of battery storage capacity needed, which typically represents about 30 % of overall initial costs.
Up-front donor support to developers presenting economically viable operational models and business plans for off-grid electrification projects, may contribute to overcome capital boundaries and promote a broader utilization of solar and other renewable resources on minigrids
in Tanzania.
19603 Background: The ASCO 2006 guidelines specify that regularly scheduled follow-up care of breast cancer survivors should be the standard. Follow up care is a “teachable moment” to train survivors in positive habits. A group visit model at the Cleveland Clinic proved feasible and improved patient satisfaction for other diseases. Our objectives include assessing the feasibility of an adapted group follow-up visit for the care of breast cancer patients and patient satisfaction. Methods: A feasibility study targeting breast cancer patients who completed primary therapy and were scheduled for a routine appointment. We mailed letters inviting patients to a follow-up group visit. Patients were divided into 3 groups, each scheduled for a separate (90–120 minute). During the first half of the visit, participants were divided into three groups; 5-minute physician exam, nurse review of medications and vital signs, and instruction by a social worker. Groups were rotated. During the second half the doctor, nurse, and social worker met with all participants in one room starting with an educational presentation about fatigue and exercise. Each participant was subsequently interviewed by the physician in the presence of their peers. Shared complaints were investigated first. Patients rated their satisfaction with the different parts of the visit on a scale of 1–5. Participants were surveyed pre- and post- education session and asked if they would participate again. Participants were allowed to bring a family member or friend. Results: 29 (29.6 %) out of 98 consented and 22 (22.5%) attended;10 in first visit, 5 in second visit and 7 in last visit. Average age 61±8, ranged from 46–72 years. Most participants were satisfied with all parts of the group visit, except two in the first group were less satisfied with the check in process and moving between rooms. Comparing the pre- vs. post- educational session surveys showed an improved understanding of the importance of fatigue or exercise. 17 (77%) out of 22 participants agreed to participate in another group visit. Conclusion: Group visit format is feasible and provides patient satisfaction. No significant financial relationships to disclose.
e11069 Background: Patients with metastatic breast cancer are treated with multiple lines of therapy. Less is known about the relative benefits from subsequent lines of hormone and chemotherapy and the influence of the molecular subtypes; luminal, HER2, and triple negative. Methods: The tumor registry at Scott & White Memorial Hospital (S&W) was queried for consecutive patients diagnosed with MBC between 2000 and 2009. Of the 409 patients identified, 252 patients met inclusion criteria. Exclusions were partial treatment at S&W (112), unknown ER or HER2 status (26), male sex (5), and palliative care only (14). Treatment regimen and start date was recorded for each line of therapy by review of EMRs. TDC for each line was defined as the treatment start date to the date of the next line of therapy, or the end date of treatment for the final line. Lines of therapy were reported sequentially relative to their order in either hormone or chemotherapy, not in regard to their overall line in systemic treatment. Results: For patients followed to death, median overall survival for luminal (104), HER2 (57), and triple negative (62) was 19.0, 24.1, and 9.3 months respectively. For those who underwent chemotherapy as their final line (162), the median time between last chemotherapy administration and death was 1.5 months. The table reports the median TDC for the first five lines of chemotherapy and first three lines of hormone therapy. Conclusions: All subtypes had continued benefit of chemotherapy on subsequent chemotherapy lines. Overall, HER2 exhibited longer TDCs on chemotherapy. Although biased by case selection, TDC on hormone therapy was superior to chemotherapy for the first three lines of hormone treatment. Our findings support the benefit of successive lines of hormone and chemotherapy for palliation in MBC. [Table: see text]
20663 Background: Proper patient selection in metastatic lung cancer chemotherapy assures palliation. A survey of community oncology practices found 43% of nonsmall cell lung cancer patients receiving chemotherapy in the last 31 days of life. (Oncologist 2006;11:1095). This group does not benefit from chemotherapy. Methods: Ninety-seven consecutive cases with Stage IV lung cancer in 2000 at Scott and White Clinic identified by the American College of Surgeons Tumor registry (ACOS) were retrospectively reviewed. The electronic medical record was queried in regard to chemotherapy use and brain metastasis in each case. Sixteen patients were excluded from analysis: no Pathology-3, transfer to another institution for terminal care-5, single visit for 2nd opinion-4, autopsy diagnosis-1, and not lung cancer- 3 (carcinoid-1, head and neck-1, unknown primary-1). The remaining 81 cases form this analysis. Results: See table. Conclusions: Clinical characteristics can be acquired from ACOS and can easily be integrated with information from the medical record. This method can be used acquire the % of patients receiving chemotherapy in the last 31 days of life and correlate with prognostic determinates. This metric can be used to measure interventions designed to limit futile chemotherapy in metastatic cancer. Group Number of Patients in Group Entire Group % Mean Survival (Days) Survival Range (Days) Patients Treated Last 31 Days Treated Last 31 Days % Group Total Metastatic Lung 81 100% 198 1-1740 11 14% Small Cell 17 21% 131 6-718 5 29% Non Small Cell 64 79% 216 1-1740 6 9% No Chemo 39 48% 68 1-477 NA NA Chemo 42 52% 320 7-1740 11 26% 1 Regimen 31 38% 201 7-821 8 26% >1 Regimen 11 14% 646 112-1740 3 27% Brain Metastasis 27 33% 124 6-604 3 11% Age > 69 44 54% 233 4-1740 3 7% No significant financial relationships to disclose.
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