Radiation Therapy Plus Tamoxifen Versus Tamoxifen Alone After Breast-Conserving Surgery in Postmenopausal Women With Stage I Breast Cancer: A Decision Analysis

2003 ◽  
Vol 21 (12) ◽  
pp. 2260-2267 ◽  
Author(s):  
Rinaa S. Punglia ◽  
Karen M. Kuntz ◽  
Jason H. Lee ◽  
Abram Recht
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Breast Conserving Surgery ◽  
Sensitivity Analyses ◽  
Recurrence Free Survival ◽  
Health States ◽  
Free Survival

Purpose: To compare outcomes for hypothetical cohorts of postmenopausal patients with estrogen receptor–positive tumors that are ≤ 2 cm in size, with pathologically uninvolved axillary nodes, treated with radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery. Methods: A Markov model was used to simulate patients’ clinical course and estimate overall survival, recurrence-free survival, time with an intact breast, and death from breast cancer. Probabilities were derived from randomized trials and retrospective studies. Analyses were performed separately by age of diagnosis in 5-year increments from 50 to 80 years. Sensitivity analyses tested the stability of radiation benefit. Results: The modeled recurrence-free survival benefit of giving radiation therapy was 3.35 years for women who were 50 years of age at diagnosis, versus 0.61 years for women who were 80 years of age. In the 50-year-old cohort, radiation therapy resulted in additional 0.60 years survival, compared with 0.04 years among 80-year-olds. A 50-year-old woman who received radiation therapy plus tamoxifen was less likely to die from breast cancer than if she received tamoxifen alone (2.43% v 5.29%; relative-risk reduction, 54%). An 80-year-old woman had a 1.17% chance of dying from breast cancer if she received radiation therapy plus tamoxifen, versus 2.02% with tamoxifen alone (relative-risk reduction, 42%). Sensitivity analyses showed that the magnitude of benefit was strongly influenced by including unequal rates of developing distant disease after breast recurrence between the treatment arms and varying rates of local recurrence. Conclusion: The absolute and relative benefits of radiation therapy and individual patient preferences for different health states should be considered when selecting treatment.

Intervals Longer Than 20 Weeks From Breast-Conserving Surgery to Radiation Therapy Are Associated With Inferior Outcome for Women With Early-Stage Breast Cancer Who Are Not Receiving Chemotherapy

2009 ◽  
Vol 27 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Ivo A. Olivotto ◽  
Mary L. Lesperance ◽  
Pauline T. Truong ◽  
Alan Nichol ◽  
Tanya Berrang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Proportional Hazards ◽  
Reference Group ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Cox Proportional Hazards ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival

PurposeTo determine the interval from breast-conserving surgery (BCS) to radiation therapy (RT) that affects local control or survival.Patients and MethodsThe 10-year Kaplan-Meier (KM) local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and breast cancer–specific survival (BCSS) were computed for 6,428 women who had T1 to 2, N0 to 1, M0 breast cancer that was diagnosed in British Columbia between 1989 and 2003, and who were treated with BCS and RT without chemotherapy. Intervals from BCS to RT were grouped by weeks as follows: ≤ 4 (n = 83), greater than 4 to 8 (n = 2,288; reference group); greater than 8 to 12 (n = 2,606); greater than 12 to 16 (n = 961); greater than 16 to 20 (n = 358); and greater than 20 weeks (n = 132). Cox proportional hazards models and matching were used to control for confounding variables.ResultsThe median follow-up time was 7.5 years. The 10-year KM outcomes were as follows: LRFS, 95.4%; DRFS, 90.5%; and BCSS, 92.5%. Compared with the greater than 4 to 8 weeks group, hazard ratios (HR) were not significantly different for any outcome among patients who were treated up to 20 weeks after BCS. However, LRFS (hazard ratio [HR], 2.00; P = .15), DRFS (HR, 1.86; P = .02) and BCSS (HR, 2.15; P = .009) were inferior for women with BCS-to-RT intervals greater than 20 weeks compared with those greater than 4 to 8 weeks. The matched analysis yielded similar results.ConclusionOutcomes were statistically similar for BCS-to-RT intervals up to 20 weeks, but they were inferior for intervals beyond 20 weeks. Time can be reasonably allowed for the breast to heal and for patients to consider treatment options, but RT should start within 20 weeks of BCS.

scholarly journals Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy

2019 ◽  
Vol 109 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Audrey Y Jung ◽  
Xinting Cai ◽  
Kathrin Thoene ◽  
Nadia Obi ◽  
Stefanie Jaskulski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Survivors ◽  
Postmenopausal Women ◽  
Breast Cancer Survivors ◽  
Breast Cancer Prognosis ◽  
Cancer Prognosis ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Supplement Use

ABSTRACT Background There is a paucity of information on the prevalence of dietary supplement use in breast cancer survivors. Only a few studies have examined the impact of dietary supplements, particularly antioxidants, on breast cancer prognosis and the results are inconclusive. Objective We examined pre- and postdiagnosis use of supplements in postmenopausal breast cancer survivors in Germany and investigated associations between postdiagnosis use of antioxidants and other supplements, and prognosis (total and breast cancer mortality, and recurrence-free survival) both overall and in women who received chemotherapy and radiation therapy. Design Data from 2223 postmenopausal women diagnosed with nonmetastatic breast cancer from the population-based Mamma Carcinoma Risk Factor Investigation (MARIE) study were used. Women were interviewed at recruitment in 2002–2005 and again in 2009 and followed-up until 30 June 2015. Multivariate Cox regression analysis was used to estimate HRs and corresponding 95% CIs. Results Pre- and postdiagnosis supplement use was reported by 36% and 45% of the women, respectively. There were 240 deaths (134 from breast cancer) and 200 breast cancer recurrences after a median follow-up time of 6.0 y after the 2009 re-interview. After adjusting for relevant confounders, concurrent antioxidant use with chemotherapy or radiation therapy among 1940 women was associated with increased risk of total mortality (HR: 1.64; 95% CI: 1.01, 2.66) and worsened recurrence-free survival (HR: 1.84; 95% CI: 1.26, 2.68). Overall postdiagnosis supplement use was not associated with breast cancer prognosis. Conclusions Antioxidant use during chemotherapy or radiation therapy was associated with worsened breast cancer prognosis in postmenopausal women. There was no overall association between postdiagnosis supplement use and breast cancer prognosis. Results from our study align with the current recommendation to possibly avoid the use of antioxidants during chemotherapy or radiation therapy.

Adjuvant Chemotherapy for Breast Cancer: How Presentation of Recurrence Risk Influences Decision-Making

2003 ◽  
Vol 21 (23) ◽  
pp. 4299-4305 ◽  
Author(s):  
Celia Chao ◽  
Jamie L. Studts ◽  
Troy Abell ◽  
Terence Hadley ◽  
Lynne Roetzer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Relative Risk ◽  
Risk Reduction ◽  
Survival Benefit ◽  
Relative Risk Reduction ◽  
Absolute Risk ◽  
Treatment Decision ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
The Impact

Purpose: The purpose of this study was to examine the impact of four methods of communicating survival benefits on chemotherapy decisions. We hypothesized that the four methods of communicating mathematically equivalent risk information would lead to different chemotherapy decisions. Methods: Each participant received two hypothetical scenarios regarding their mother (a postmenopausal woman with an invasive, lymph node-negative, hormone receptor-positive breast cancer) and was asked to decide whether they would encourage their mother to take chemotherapy in addition to surgery and tamoxifen. In the part 1, participants received one of four methods of describing the chemotherapy survival benefit: (1) relative risk reduction, (2) absolute risk reduction, (3) absolute survival benefit, or (4) number needed to treat. In part 2, each participant received all four methods. Following each decision, participants were asked to rate their confidence and confusion regarding their decision. Results: Participants included 203 preclinical medical students. In part 1, participants who received relative risk reduction information were significantly more likely to endorse chemotherapy. In part 2, there were no treatment decision differences when participants received all four methods of communicating survival benefits of chemotherapy. However, receiving all four methods led to significantly higher ratings of confusion. In deciding on endorsing chemotherapy, participants understood the information best when presented with data in the absolute survival benefit format. Conclusion: These results support the hypothesis that the method used to present information about chemotherapy influences treatment decisions. Absolute survival benefit is the most easily understood method of conveying the information regarding benefit of treatment.

Local recurrence‐free survival in women with breast cancer who undergo breast‐conserving surgery

2019 ◽  
Vol 25 (5) ◽  
pp. 1042-1044
Author(s):  
Juliana Rodrigues Tovar ◽  
Eliana Zandonade ◽  
Maria Helena Costa Amorim
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Breast Conserving Surgery ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Local Recurrence Free Survival

scholarly journals Cost-Effectiveness Analysis of a Silver-Coated Endotracheal Tube to Reduce the Incidence of Ventilator-Associated Pneumonia

2009 ◽  
Vol 30 (8) ◽  
pp. 759-763 ◽  
Author(s):  
Andrew F. Shorr ◽  
Marya D. Zilberberg ◽  
Marin Kollef
Keyword(s):  
Relative Risk ◽  
Endotracheal Tube ◽  
Risk Reduction ◽  
Decision Model ◽  
Relative Risk Reduction ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Endotracheal Tubes ◽  
Effectiveness Analysis ◽  
Pivotal Study

Objective.To conduct a cost-effectiveness analysis of the economic outcomes of ventilator-associated pneumonia (VAP) prevention associated with silver-coated endotracheal tubes versus uncoated endotracheal tubes.Design.We used a simple decision model based on a hypothetical 1,000-patient cohort intubated with silver-coated or uncoated endotracheal tubes. The primary end point was marginal hospital savings per case of VAP prevented (savings from using silver-coated endotracheal tubes minus acquisition cost divided by number of VAP cases prevented).Methods.We followed each branch of the decision model to VAP or no VAP and conducted Monte Carlo simulations and sensitivity analyses. Inputs for VAP incidence, relative risk reduction, and hospital costs were derived from publicly available sources. Relative risk reduction was derived from the pivotal study of the silver-coated endotracheal tube.Results.In the base-case analysis, we reduced the pivotal study relative risk in incidence of microbiologically confirmed VAP in patients intubated ≥24 hours from 35.9% to 24%. Thus, 23 of 97 expected cases of VAP could be prevented with silver-coated endotracheal tubes. The savings per case of VAP prevented was $12,840 in the base case, with assumed marginal VAP cost of $16,620 and costs of $90.00 for coated and $2.00 for uncoated endotracheal tubes. Estimates were most sensitive to assumptions regarding VAP cost and relative risk reduction with silver-coated endotracheal tubes. Nonetheless, in multivariate sensitivity analyses, the silver-coated endotracheal tubes yielded persistent savings (95% confidence interval, $9,630-$16,356) per case of VAP prevented. With other base-case inputs held constant, breakeven cost for silver-coated endotracheal tubes was $388.Conclusions.The silver-coated endotracheal tube represents a strategy for preventing VAP that may yield hospital savings.

Lipid Management with Statins in Type 2 Diabetes Mellitus

2005 ◽  
Vol 39 (10) ◽  
pp. 1714-1719 ◽  
Author(s):  
Brian K Irons ◽  
Lisa A Kroon
Keyword(s):  
Cardiovascular Disease ◽  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Data Extraction ◽  
Density Lipoprotein ◽  
Coronary Event ◽  
Lipid Management ◽  
Medline Search ◽  
Patients With Diabetes

OBJECTIVE: To provide an update on lipid management and recent modifications in cholesterol guidelines for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), specifically in patients with diabetes. DATA SOURCES: Studies and guidelines were identified through a MEDLINE search (1996–April 2005). STUDY SELECTION AND DATA EXTRACTION: Studies were selected for review if the primary treatment intervention was a statin, at least 4% of the study population held a diagnosis of diabetes, and diabetes subgroup analysis was available. DATA SYNTHESIS: The Heart Protection Study demonstrated an approximately 25% relative risk reduction of a first coronary event in patients with diabetes, a reduction similar to those without diabetes. In subjects with diabetes, a significant reduction in coronary events was noted regardless of the baseline cholesterol level. The Collaborative Atorvastatin Diabetes Study demonstrated a 37% relative risk reduction in the primary prevention of cardiovascular morbidity in patients with diabetes. CONCLUSIONS: Based on the current literature, a low-density lipoprotein cholesterol (LDL-C) level <100 mg/dL remains an appropriate goal for patients with diabetes in the absence of established cardiovascular disease. For higher-risk patients, such as those with diabetes and a history of cardiovascular disease, a more stringent LDL-C goal of <70 mg/dL is an option according to current clinical trial evidence. At least a 30–40% reduction in the LDL-C level is advisable when initiating statin therapy.

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