scholarly journals Temporal and Atemporal Provider Network Analysis in a Breast Cancer Cohort from an Academic Medical Center (USA)

Informatics ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 34 ◽  
Author(s):  
Bryan Steitz ◽  
Mia Levy
Keyword(s):  
Breast Cancer ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Early Stage ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Breast Cancer Patients ◽  
Analysis Model

Social network analysis (SNA) is a quantitative approach to study relationships between individuals. Current SNA methods use static models of organizations, which simplify network dynamics. To better represent the dynamic nature of clinical care, we developed a temporal social network analysis model to better represent care temporality. We applied our model to appointment data from a single institution for early stage breast cancer patients. Our cohort of 4082 patients were treated by 2190 providers. Providers had 54,695 unique relationships when calculated using our temporal method, compared to 249,075 when calculated using the atemporal method. We found that traditional atemporal approaches to network modeling overestimate the number of provider-provider relationships and underestimate common network measures such as care density within a network. Social network analysis, when modeled accurately, is a powerful tool for organizational research within the healthcare domain.

Application of RSClin to guide treatment recommendations for premenopausal patients with early-stage hormone-positive breast cancer and intermediate risk oncotype recurrence scores.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12511-e12511
Author(s):  
Brittney Shulman Zimmerman ◽  
Shana Berwick ◽  
Alaina J Kessler ◽  
Danielle Seidman ◽  
Sara Malin Hovstadius ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Recurrence Score ◽  
Treatment Recommendations ◽  
Definitive Treatment ◽  
Treatment Recommendation ◽  
Intermediate Risk ◽  
Premenopausal Patients

e12511 Background: The RSClin model, which incorporates the Oncotype Recurrence Score (RS) and clinicopathologic features, was recently developed to further tailor prognosis and prediction of chemotherapy benefit for patients with early-stage hormone positive (HR+) breast cancer (BC) (Sparano et al, 2020). The RSClin calculator is available online to assist treatment planning for situations where chemotherapy benefit is uncertain. Covariates include Oncotype RS, tumor grade, tumor size and patient age. The risk calculator generates a 10-year distant recurrence risk and absolute chemotherapy benefit. This tool may be especially helpful to determine treatment management for premenopausal patients with early-stage HR+ BC with intermediate risk (IR) Oncotype RS (16-25). We retrospectively applied RSClin to this patient population to determine if it would have changed treatment recommendations. Methods: We identified premenopausal women with node-negative early-stage BC with IR RS (16-25) within our large Oncotype database. Using the RSClin model, we selected >5% absolute chemotherapy benefit as a reasonable cutoff to recommend chemotherapy. We compared the treatment recommendation based on RSClin with the treatment previously recommended by breast oncologists at our large academic medical center in New York City. Results: There were 86 patients who met criteria with a median age of 46 years. Of these, 26 patients (30%) were recommended chemotherapy plus endocrine therapy (ET) and 60 (70%) were recommended ET alone. After applying the RSClin model (data available for 83/86 patients), 19 (23%) would have resulted in a change in treatment recommendation and 64 (77%) would have remained unchanged. Overall, 8 (10%) would have withheld chemotherapy when it was previously offered and 11 (13%) would have recommended chemotherapy when it was previously excluded. There were 8 (9%) secondary invasive breast events in this population, with 2 (2%) being ipsilateral, 3 (3%) being contralateral and 3 (3%) metastatic at a median follow up of 46.9 months. Conclusions: The RSClin model would have changed management of premenopausal patients with IR RS in 23% of patients. This model, although not yet prospectively validated, may help individualize therapy for patients with less definitive treatment plans. Using RSClin, we can aim to minimize recurrence rates and avoid unnecessary chemotherapy in selected patients. This model is easy to apply and will have important clinical utility moving forward.

scholarly journals Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Divya A. Parikh ◽  
Rani Chudasama ◽  
Ankit Agarwal ◽  
Alexandar Rand ◽  
Muhammad M. Qureshi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Net ◽  
Primary Language ◽  
Breast Cancer Patients ◽  
Patient Demographics ◽  
Academic Medical ◽  
Race Ethnicity

Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center.Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012.Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37,p=0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48,p=0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06,p<0.0001).Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.

Inferring breast cancer concomitant diagnosis and comorbidities from the Nationwide Inpatient Sample using social network analysis

2014 ◽  
Vol 3 (2) ◽  
pp. 136-142 ◽  
Author(s):  
Radhakrishnan Nagarajan ◽  
Shengfan Zhang ◽  
Fay Cobb Payton ◽  
Suleiman Massarweh
Keyword(s):  
Breast Cancer ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Nationwide Inpatient Sample

Prevalence of self-reported cognitive dysfunction in breast cancer patients.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 131-131
Author(s):  
Heidi Skirbe ◽  
Gabriela Hohn ◽  
Paula Klein ◽  
Mary Ann Juliano ◽  
Jeremy Winell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cognitive Dysfunction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Breast Cancer Patients ◽  
Cognitive Changes ◽  
Convenience Sample ◽  
Cognitive Difficulties ◽  
Emotional Dysfunction

131 Background: In 2011 a series of four time-limited, psycho-educational workshops was conducted by a neuropsychologist at a major urban academic medical center, providing information, coping strategies, and resources to women who had been treated for breast cancer (BrCa) and who then sought cognitive treatment. Based on positive evaluations of these workshops, we assessed the prevalence of self-reported cognitive dysfunction in BrCa patients with the goal of expanding cognitive services to all affected cancer patients. Methods: The study was IRB approved. We surveyed a convenience sample of 50 BrCa patients in a single medical oncology waiting room over several weeks. Subjects completed a 16 item questionnaire assessing potential cognitive problems on a 4 point-scale. Results: Fifty patients completed the survey, of whom 46% were currently employed. Sixty-eight percent of respondents were currently receiving cancer treatment and of those, 61.8% had also received prior treatment. Conclusions: An unexpectedly large proportion of BrCa patients perceived cognitive difficulties that may have been compounded by fatigue and emotional dysfunction. Others may have failed to report cognitive difficulties, unaware of their onset. Quality of life of cancer patients is diminished by cognitive decline. The current data indicate a need for formal assessment and intervention programs that will identify patients with cognitive and emotional dysfunction and remediate the difficulties via workshops and therapy. Formal neuropsychological assessment and treatment resourcestargeting cognitive changes associated with cancer should be expanded to meet documented need. Further research will optimize the scheduling and structure of therapeutic interventions. [Table: see text]

“I had already made up my mind.” The impact of prior experience and health care perceptions on decision making in women with early-stage breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 228-228
Author(s):  
Rebecca England ◽  
Valerie Lawhon ◽  
Audrey S. Wallace ◽  
Stacey A. Ingram ◽  
Courtney Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Medical Center ◽  
Comparative Method ◽  
Academic Medical Center ◽  
Axillary Node ◽  
Additional Treatment ◽  
Early Stage Breast Cancer ◽  
The Impact

228 Background: Shared decision-making (SDM) occurs when informed patients partner with their oncologists to incorporate personal preferences into treatment. Even before engaging with an oncologist about treatment options, patients may have personal experiences or knowledge of other’s experiences with breast cancer that frame their decision-making. This study sought to understand how prior experiences and knowledge drive preferences in early stage breast cancer treatment approaches. Methods: This qualitative study included early stage breast cancer (BC) patients at an academic medical center in the Deep South. Women age ≥18 with an AJCC stage I-III BC diagnosis were invited to complete semi-structured interviews with a trained interviewer. Interviews were audio-recorded, transcribed, and analyzed by two independent coders utilizing a constant comparative method from an a priori conceptual model based on the Ottawa Framework. Major themes and exemplary quotes related to decision-making preferences were extracted. Results: Women (n = 33) interviewed were an average age of 74 (4.2 SD), and 19% of participants were African American. Many women were given the option to omit treatments, such as chemotherapy or radiation therapy, based on hormone receptor status and axillary node involvement. Major themes related to a desire for more treatment were past experiences with family members having cancer or an impression that additional treatment would be more effective. For women that opted out of treatments, prior knowledge of potential physical side effects from friends, family, and other cancer survivors were cited as a major deterrent. Perceptions of low recurrence risk also influenced desire to forgo treatments. Conclusions: Women presenting with early stage BC had varied healthcare experiences, which resulted in preconceived ideas about receiving breast cancer treatments. Consideration of these themes may aid physicians’ ability to address individual concerns to further personalize patient care, thus enhancing the patient-physician partnership. These findings will ultimately assist in improving patient engagement in SDM.

scholarly journals Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as a Stage Determination in Breast Cancer

2020 ◽  
Vol 8 (B) ◽  
pp. 1058-1063
Author(s):  
Sinta Wiranata ◽  
Ida Ayu Widya Anjani ◽  
I Putu Gede Septiawan Saputra ◽  
I Gusti Ayu Stiti Sadvika ◽  
I Putu Yuda Prabawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Cancer Staging ◽  
Neutrophil To Lymphocyte Ratio ◽  
Solid Cancer ◽  
Cancer Stage ◽  
Advanced Stage ◽  
Breast Cancer Patients ◽  
Analysis Model ◽  
Lymphocyte Ratio

BACKGROUND: Breast cancer tends to respond differently to treatments, which are usually determined by clinicopathological characteristics. Several studies evaluated the role of the peripheral blood test as diagnostic and prognostic markers in several types of solid cancer and neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) are two of them which already tested. However, the evidence in breast cancer is still lacking. AIM: Therefore, the study aimed to investigate the value of NLR and PLR as biomarkers concerning breast cancer stage. METHODS: A retrospective study was conducted using breast cancer patients’ medical records from 2014 to 2019 at Sanglah General Hospital. The histopathological records and complete blood counts of the patients were collected and analyzed risk analysis model, receiver operator characteristics analysis, and correlation of NLR and PLR with cancer staging analysis used correlation test. RESULT: One hundred five patients data were used in this study, with 35 subjects had early-stage breast cancer while 70 subjects had an advanced stage. Breast cancer staging with NLR and PLR showed significant associations (p < 0.001). Both NLR and PLR had area under the curve >0.7 (p < 0.001). The cutoff, sensitivity, and specificity values of NLR and PLR were 2.504 (71%; 70%) and 157.1 (73%; 70%). Advanced stage of breast cancer was mostly found in high NLR and PLR value with (OR: 4.231; CI = 1.791-9.995, p < 0.001) and (OR: 3.949; 95% CI = 1.679–9.287; p < 0.001). CONCLUSION: From this preliminary study, pretreatment NLR and PLR values might determine the breast cancer stage. Further research is needed to evaluate the association between grade and patient survival.

Concordance between patient-reported (PR) and physician-documented (PD) comorbidities and symptoms among Stage 4 breast cancer patients (pts).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24089-e24089
Author(s):  
Saumya Umashankar ◽  
Michelle E. Melisko ◽  
Halle Thannickal ◽  
Madeline B. Matthys ◽  
Laura van 't Veer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tumor Biology ◽  
Metastatic Breast ◽  
Cox Proportional Hazards ◽  
Breast Cancer Patients ◽  
Patient Reported

e24089 Background: Comorbidities (Co) and symptoms (Sx) in metastatic breast cancer (MBC) pts impact treatment decisions, eligibility for clinical trials, and influence prognosis and quality of life. The aim of this study was to evaluate the concordance between PR and PD Co and Sx in an electronic medical record to document pts’ health, identify Co or Sx that may be more comprehensively reported by pts vs physicians (phy), and understand if PR, PD, or concordant Co or Sx were more predictive of pt survival. Methods: New pts at UCSF’s Breast Care Center (BCC) are administered an electronic intake survey assessing PR health history, Co and Sx. Chart reviews of the initial clinic visit were conducted for PD Co and Sx. Pt and phy concordance was summarized for 54 Co and 42 Sx. Agreement was quantified using Cohen’s kappa (κ) (poor (κ < 0.2), fair (0.2≤κ < 0.4), moderate (0.4≤κ < 0.6), substantial to high (κ ≥0.6)). Cox-proportional hazards models were used to determine hazard ratios (HR) for survival with PR, PD, and concordant Co and Sx, controlling for factors including age, sites of metastatic disease, tumor biology, etc. Results: Between Nov 2016 and Feb 2020, 168 pts with confirmed MBC seen at the BCC who consented to use of their clinical data for research were included in the analysis (median age, 56 years; median time from MBC diagnosis, 0.46 years). Highest PD Co were obesity, hypertension (HTN) and thyroid disease, while highest PR Co were HTN, depression and arthritis. 23 of 54 Co had a moderate to high level of agreement between physician and pt reports (κ≥0.40). Agreement was high for diabetes, HTN, and low for obesity, anxiety, and gastroesophageal reflux disease (GERD). After controlling for clinical covariates, of these Co, only PR GERD was significantly associated with survival (HR = 1.87, p < 0.05). Only 2 of 42 Sx (shortness of breath and cough) had a moderate to high agreement between PD and PR. PR Sx were the primary drivers for predicting survival (HR > 1, p < 0.05 for PR Sx including vomiting, fatigue, weight loss and others). PD and PR agreement for these sx was poor (κ < 0.2). Conclusions: In this review of data collected as part of routine care at an academic medical center, there was substantial variance in the concordance of Co and Sx reported by pt vs phy. Concordance was higher for Co, with phy documenting a higher number of Co that can be objectively measured by lab values (diabetes, HTN) while pts reported higher rates of Co that were more subjective (anxiety, GERD). Overall, pts reported more Sx than phy. PR Sx were also the highest predictors of survival. Intriguingly, Co such as diabetes and HTN did not predict survival in this metastatic population. This suggests that incorporating PR Sx, either secondary to their cancer or related to their Co, may provide a more informative estimate of a pt’s predicted survival, and assist phy in evaluating trial eligibility and reasonable treatment options.

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